Every now and then an opportunity presents itself and you have to seize it. That’s certainly the case with the formation of Sage Squirrel Consulting. Debbie and I have moved on from the Division of Aging, but we both want to continue contributing to the transformation of publicly funded human services and healthcare for older adults and persons with disabilities.
Most of the people who will read this already know that there are tremendous forces at play in the long term services and supports arena: baby boomers have begun turning 65 and longevity has increased for most persons born in the 20th century; the numbers of persons available to provide both paid and unpaid care are decreasing; healthcare costs are exploding, particularly for persons who need or use long term services – and 70% of people over the age of 65 will need some type of long term services and supports. This could range from a family member who helps with groceries all the way to 24 hour care in a nursing facility.
Medicaid has become the largest funder of long term care in all settings – but if all you do is read the headlines, you can see that Medicaid is at the forefront of discussions about the future of healthcare. Plus, Medicaid has a built-in institutional bias, but that bias is becoming increasingly outdated as personal preferences and legal requirements create tremendous pressure to provide needed services in people’s homes or other less restrictive settings. It’s a happy public policy coincidence that doing so, in the aggregate, is less expensive, but making that shift has been very challenging in many places.
For the last four years, we have been both participants and observers in the long term services and supports (LTSS from here on out!) arena. As the former Director and Deputy Director of the Indiana Division of Aging, we have been on the front line of Indiana’s efforts to transform systems to meet these challenges, while observing what was happening in other parts of the country.
Here are our thoughts about what it’s going to take to meet these challenges:
1. Disruption – there is a paradigm shift underway and you can’t ride that out simply doing what you’ve been doing and just trying to do it better. Small tweaks are not going to be sufficient in most cases.
2. Integration – there are silos everywhere you look, but it’s critical to recognize that they are all part of the same system. It won’t be enough to change in one sector without recognizing the implications, laterally as well as upstream and downstream.
3. Operational excellence – it is so easy in highly regulated environments to default to compliance, but compliance is a floor. If you can see those implications across the systems, what are you going to do about it? How do you leverage technology? How do you align the human capital? How will you know if you are driving the outcomes that you need?
4. Compassion and empathy – these systems should be designed around the real human persons that they are intended to serve. People are not a problem to be solved – or an object to be “put” somewhere. They are not seeking to exploit public funds for maximum gain. Many are in crisis and are overwhelmed trying to navigate the complex administrative and eligibility-focused barriers in front of them. We can do better.
5. Collaboration – there is no enemy other than those we create, and there is real positive energy created by bringing together multiple points of view in service to shared objectives. Solutions are more wide-ranging and creative.
Fresh eyes and a sense of humor helps a lot too! We aren’t policy wonks – but we don’t need to be. Most states and communities are getting their policies right, but they don’t always recognize or know how to create the business alignment in support of those policies. That’s where we can help.
A squirrel of ability and the desire to accomplish something can do anything….