Time to ensure infrastructure makes care for older adults a priority

President Biden promised to “build back better” when supporting jobs and economic recovery on the campaign trail. Now, he and members of Congress are promoting policies to recover jobs and the economy by revitalizing America’s crumbling infrastructure. Their vision is not just rebuilding roads, bridges and airports, but also investing in an affordable caregiving infrastructure that enables older Americans and people with disabilities to age in their homes and communities.

Biden’s proposed infrastructure plan makes a groundbreaking $400 billion down-payment towards reimagining how we care for older adults, whose need for coordinated services and supports, such as in-home caregiving and help with transportation, will continue to grow. As Congress considers infrastructure investments, it must incorporate bold, 21st-century approaches that put individuals at the center of the care experience through careful planning and thoughtful policy. 

A recent national survey found that 88 percent of Americans prefer to age in their own home or with family. Recent experience with high rates of death and isolation among residents in nursing homes and other facilities during the pandemic underscored many reasons why.  America needs to adopt a care approach that enhances the autonomy and capabilities of older adults in their communities and homes, rather than defaulting to expensive institutionalization.

Improving how Americans age requires policymakers and health care organizations to broaden their thinking beyond the current medical model to encompass the social drivers of health. Older adults often find it impossible to stay on track with their care plan because they struggle with finances, are unable to access nutritious food or worry about impending home eviction.

The need for change is urgent. The U.S. Census Bureau projects that 77 million adults over age 65 will be alive in 2034, — that’s 30 million more than today. Experience from this past year shows that older adults can safely and effectively receive care at home when services are adapted to meet their needs. For example, policy flexibilities in the Medicare program, from virtual care to meal support and in-home caregiving, confirmed the health system can work with older adults where they are, rather than forcing them into a brick-and-mortar medical facility. 

Person-centered care models deliver real results. Addressing complex mental, social and medical needs improves overall health and well-being and reduces avoidable costs. One example is the Program of All-Inclusive Care for the Elderly, or PACE, which allows older adults to remain at home and in their communities. PACE is projected to save significant dollars nationally through its focus on community-based care.

Federal policymakers can learn from state and local efforts. Those leading the way in providing supportive services for older residents have a clear commitment to a strategic, actionable plan that serves older adults and people with disabilities. States can capitalize on this momentous paradigm shift post-COVID-19 by adopting current federal proposals to account for historic investments in home- and community-based alternatives, and crafting their own roadmap on how to coordinate, deliver and finance services to meet the needs of aging adults.

California, Colorado and Massachusetts are setting the stage by developing robust plans that focus on person-centered care. California’s Master Plan for Aging outlines five bold goals, 23 strategies and more than 100 initiatives to build a “California for All Ages” by 2030. It emphasizes equity, inclusion, and access to services that optimize the quality of older adults’ lives. Amplifying these efforts, the American Rescue Plan committed over $1.4 billion for critical community programs through the Older Americans Act, allowing older adults to receive care at home instead of relying on nursing home care.

Now is the time for federal and state policymakers to ensure an infrastructure that provides modern methods to caring for American adults as they age. Policymakers can clear the path for affordable, meaningful, life-supporting access to care by creating a Master Plan for Aging. 

It starts with placing the person at the center. 

Sarita A. Mohanty, MD, is the president and CEO of The SCAN Foundation, which exists to transform care for older adults through policies and programs that center care and support around an individual’s unique needs and preferences. Mohanty is also a practicing internal medicine physician.