Caring For Our Future

Care and support affects a large number of people: eight out of 10 people aged 65 will need some care and support in their later years; some people have impairments from birth or develop them during their working life; some 5 million people care for a friend or relative, some for more than 50 hours a week. The current system does not offer enough support until a crisis point is reached, the quality of care is variable and inconsistent, and the growing and ageing population is only going to increase the pressure. Consequently, two core principles lie at the heart of this White Paper. The first is that individuals, communities and Government should do everything possible to prevent, postpone and minimise people's need for formal care and support. The system should be built around the promotion of people's independence and well-being. The second principle is that people should be in control of their own care and support, with personal budgets and direct payments, backed by clear, comparable information and advice that will allow individuals and their carers to make the choices that are right for them. This paper sets out the principles and approach, with sections covering: strengthening support within communities; housing; better information and advice; assessment, eligibility and portability for people who use care services; carers' support; defining high-quality care; improving quality; keeping people safe; a better local care market; workforce; personalised care and support; integration and joined-up care.

The number of elderly and disabled adults who require assistance with day-to-day activities is expected to double over the next twenty-five years. As a result, direct care workers such as home care aides and certified nursing assistants (CNAs) will become essential to many more families. Yet these workers tend to be low-paid, poorly trained, and receive little respect. Is such a workforce capable of addressing the needs of our aging population? In Who Will Care for Us? economist Paul Osterman assesses the challenges facing the long-term care industry. He presents an innovative policy agenda that reconceives direct care workers’ work roles and would improve both the quality of their jobs and the quality of elder care. Using national surveys, administrative data, and nearly 120 original interviews with workers, employers, advocates, and policymakers, Osterman finds that direct care workers are marginalized and often invisible in the health care system. While doctors and families alike agree that good home care aides and CNAs are crucial to the well-being of their patients, the workers report poverty-level wages, erratic schedules, exclusion from care teams, and frequent incidences of physical injury on the job. Direct care workers are also highly constrained by policies that specify what they are allowed to do on the job, and in some states are even prevented from simple tasks such as administering eye drops. Osterman concludes that broadening the scope of care workers’ duties will simultaneously boost the quality of care for patients and lead to better jobs and higher wages. He proposes integrating home care aides and CNAs into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals. Osterman shows that restructuring direct care workers’ jobs, and providing the appropriate training, could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers. As the Baby Boom generation ages, Who Will Care for Us? demonstrates the importance of restructuring the long-term care industry and establishing a new relationship between direct care workers, patients, and the medical system.

The Future of Aging book presents answers and opportunities to rich and provocative questions related to aging. Each of the books 5 chapters highlights a key aspect of the experience of aging, then explores the challenges and opportunities that an individual or organization might encounter when working with older adults to build a better future. Though each chapter can be read on its own, the book itself represents the richness and complexity of what it means to get older. Together, these chapters reflect a holistic understanding of aging--one in which community, healthcare, technology, identity, and financial well-being are not siloed, but are viewed instead as entangled threads that hold equal importance for building a better future of aging. Chapter 1: Aging and Community The future of health is home. Let's design new communities centered around the home where older adults are empowered to share their skills and participate in activities. This keeps older adults engaged and energized and helps them live happier, healthier lives. Chapter 2: Health Interventions Help older adults embrace the benefits of health care interventions by making them appealing and beneficial - win/win. Let's combat unwelcome physical and psychological changes and negative stereotypes that come with aging by empowering older adults with the vision of what's possible. Chapter 3: Gerontechnology It's not 'What's the matter with you?' it's 'What matters to you?'. Devices, tools and other technological interventions need to be the ultimate in accessibility, customization and simplicity. Insisting older adults be full participants in the design process will exponentially improve uptake and adoption. Older adults see technology in the same way that many young people do -- as a portal to wider worlds, social and otherwise, that are not available in their immediate surroundings. Chapter 4: Economic Contexts Design financial products to be flexible enough to be applied in a variety of circumstances. All people value being recognized for what they have built, supported, or contributed to. Older people benefit from the enhanced social status or more practical outcomes that could come with this recognition. Chapter 5: Identity Challenge the cultural norms and stereotypes that underpin ageism and other forms of discrimination and urge media and other cultural institutions to showcase a realistically diverse range of older adults. Facilitate the participation of older people in workplaces, recreational spaces, schools, and/or other private and public institutions.

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.