A matter of choice, not chance Challenges in providing health care for the elderly

I participate in a regular game of Bunco with friends from my old neighborhood. For those not familiar with this game, here’s how it’s played:

• People form into tables of four—the person sitting across from you is your partner for that round.
• Each person rolls three dice. The round starts with rolling for ones. If you get a one, you can keep going and you tally up your ones as you go along. If you get three ones, that’s a “Bunco.” If you get three of another number, you get five points, and so does your partner.
• The bell rings, and you move on to “twos.”

This game involves no strategy whatsoever. One’s score is a question of chance (well, okay, careful counting helps). The great benefit of the simplicity of the game is that we get to talk about what is going on in our lives.

Two members of my Bunco group are social workers, steeped in experiences with the “oldest old.” The topic of hoarding, for example, comes up as does that of the challenges of supporting a parent with dementia. Many of the rest of us are trying to figure out how to support aging parents. While it is true that there are some things people can do to prepare for aging—eating right and exercising and saving money—just as in Bunco, a lot also seems to depend on chance.

By 2030, one in five Americans will be 65 or older,¹ and spending on aging, chronic, and long- term care in the US net Medicare expenditure (which doesn’t even cover long-term care) is expected to increase from $512 billion in 2014 to $858 billion in 2024.² Estimates for long-term care spending range from $210 billion to $306 billion, with Medicaid spending on long-term care totaling $123 billion in 2013.^{3, 4}

An upcoming paper from Deloitte’s Center for Health Solutions, The convergence of trends in health care, highlights aging, chronic, and end-of-life care as a significant opportunity area for innovation. Due to new technologies, the demand for value, a growing health economy, and government incentives, the industry is shifting from aging in isolation to community-supported aging.

Online resources to help with these issues seem to be in demand. According to the Deloitte Center for Health Solutions’ 2015 consumer survey, two in five (43 percent) respondents are likely to use online pricing tools that help them compare and possibly negotiate health care prices with providers. Interest varies by age, with, of course, the younger generations, already familiar and comfortable with using online tools for other purposes, showing a greater interest: 47 percent of Millennials, 46 percent of Gen X, 42 percent of Boomers, and 25 percent of seniors say they are likely to use these tools.

Slightly more (46 percent) say they are likely to use online quality rankings, satisfaction ratings, and patient reviews for specific doctors and hospitals. Interest levels vary less than with pricing tools: 47 percent of Millennials, 45 percent of Gen X, 47 percent of Boomers, and 41 percent of seniors are likely to use them.

Resources exist of course. In looking at options for my aunt who lives outside of Philadelphia, for example, I found a treasure trove from the local Area Agency on Aging. But these resources are a far cry from interactive. The Department of Health and Human Services’ Administration on Aging has a good website—longtermcare.gov—which explains what Medicare and Medicaid cover. Various app stores, carry a few apps related to planning for the cost of long-term care. We need more tools to help people of my generation help their parents (and themselves as caregivers) navigate not only the health care system, but that grey area between health care and housing that is long-term care.

I am lucky to have friends to play Bunco with, rolling the dice, talking about supporting our parents. Too bad everyone doesn’t have geriatric social workers as part of their network. Everyone should feel well-prepared—financially and having weighed all the options—and not leave the choice to chance.