Eleven million people over the age of 65 are living alone today. One in five persons are now solo-agers with no adult children to provide the emotional, physical and logistical support needed. More seniors each day do not have family members to care for them. Living alone increases their risk of developing a myriad of long term illnesses. Seniors are also vulnerable to various forms of abuse and financial exploitation.
Older adults are often called “complex” patients—those with significant health and social needs. In a recent survey, funded by the Commonwealth Fund, 58 percent of patients with complex needs did not have a care coordinator helping them navigate the system, and 62 percent experienced stress about their ability to afford housing, utilities, or nutritious meals. Those unmet needs are part of the reason that 47 percent of the patients with complex needs visited the emergency department (ED) multiple times in the previous two years.*
These seniors generally use more health services and receive care from more and different health professionals than do people without chronic conditions. They also frequently rely on such social services as accessible transportation or home-delivered meals provided by community organizations. Given the complexity of their health problems, these seniors are more likely to have chronic, progressive illnesses or experience life-threatening complications. Palliative care and hospice services are often a consideration for these patients, further expanding the range of potential services that must be coordinated to optimize quality of life.
Older adults in the United States with complex needs often encounter a fragmented system that is ill-equipped to help them handle three, four, or even five chronic conditions simultaneously. Instead of a single patient receiving care that’s coordinated, he or she might have a general practitioner treating diabetes, an orthopedic specialist treating foot pain, and yet another health professional—an ear, nose, and throat (ENT) specialist—treating tinnitus. This sort of disorganized, unplanned care is all too common—as well as expensive and ineffective. Such care costs our health care system millions of dollars each year while often forcing patients to make multiple emergency room visits.
Many of the problems in serving patients with complex needs are due to barriers:
- Financing of the U.S health system – the fee for service system
- Lack of comprehensive, integrated systems and use of referrals to specialists
- Lack of professional capacity to treat and manage behavioral and mental health
- Acute complications of chronic ill patients becoming urgent and usurping resources
- Care coordination requires attention to a broader set of services than is typically offered by physicians or hospitals*
*Health Affairs Journal, February 2017. *Agency for Healthcare Research and Quality