The Future of Long-Term Care: Q&A with Frank Spinelli

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Older Americans (those 65 and up) represented 12.4 percent of the population in the year 2000, but the elderly are expected to grow to be 19 percent of the population by 2030.

This dramatic increase explains why providing long-term care to this demographic is such a pressing issue for the healthcare industry (and one that doesn’t get nearly enough attention). It’s also a major facet of healthcare being transformed by technological innovation. Most fascinating is that the social, cultural and functional innovations to long-term care are just as important as medical advances.

Frank Spinelli is vice president of Long-Term Care Solutions for Xerox Government Healthcare Solutions and former Medicaid director and deputy director of the Rhode Island Department of Human Services. His over 30 years of healthcare experience makes him an expert on long-term care.

Tell us a little bit about how you spend your time.

I’m part of the Xerox team that helps state governments with their long-term care and support programs. Providing services to the elderly and people with disabilities is important; it’s one of the most expensive components of a healthcare system. According to a 2012 report from the Scan Foundation, Americans spend over $250 billion dollars a year on long term care and that is not including unpaid family or friend’s caregiving.

You’re a big proponent of focusing on the social and functional aspects of long-term care in addition to the medical components. What sort of steps do you think are needed to move the needle?

First, let’s define the social and functional aspects: The functional aspects of care are the bathing, the dressing, the grooming and the cooking that aides do in independent daily living. It’s also helping with finances so those who need care can pay their bills. These tasks don’t require clinical people; they need people with basic training.

The social aspect of long-term care is one of the biggest issues facing people because of the isolation that they encounter on a daily basis. Those requiring care are either living alone or they’re living with a spouse who’s similarly limited in their ability to care for him or herself.

Amplifying this isolation, there are more than 7 million long-distance caregivers in the U.S.; they’re people in their fifties and sixties taking care of their parents, and they don’t live anywhere near them.

That socialization factor must be addressed by providing networking tools to caregivers so they can share about the burden and depression that sometimes accompanies that role. And those requiring care need to get out, to become part of the community.

So there are lots of medical necessities here, but we also have to leverage what exists in the community and partner that with the healthcare delivery system to provide a more holistic, all-hands-on-deck approach to taking care of people.

That’s a big challenge and requires a culture shift to some degree. Why is it so imperative that we address these issues now?

The demand for service is increasing tremendously. Ten-thousand individuals turn 65 each day, and if you’ve got 10,000 people turning 65 today, with longer life expectancies, 15 years from now we’re going to have 10,000 people a day turning 80. They’re going to need long-term care services.  Compounding this is the fact that the number of Americans who are on disability is skyrocking. That’s huge, not only from a cost perspective, but from a labor perspective. Who are the caregivers going to be?

You have a demand problem, and you’ve got a supply problem. On top of this, costs are going up and inflation is increasing.

I came from a Medicaid background. I was a Medicaid director in Rhode Island, and I’ve been working with Medicaid for more than thirty-five years. What happens is you start competing with other demands on government — like transportation, education. Even in my own programs I had demands between populations — between children and families, between people with developmental disabilities, people with behavioral health issues, people who were aged.

These tensions, these demands are just going to increase.

What kind of role is technology playing in addressing these issues?

Not as big of a role as it should. Some benefits of technology that are really interesting transcend clinical work (e.g., blood pressure monitoring), and they are around environmental monitoring. This is happening with the advent of smart TVs and smartphones.

I mentioned long-distance caregivers. This kind of technology allows them to make sure that the water temperature isn’t too hot, it turns on the air conditioning when a home reaches a certain temperature, it ensures the stove is turned off.

Technology in that area is starting to grow, so we get more home monitoring and more intervention. It helps caregivers and those that need the care.

Another big advent is around medication adherence, reminding people when to take a pill. Xerox is working on a solution along these lines: a tool that can tell you when and if you took medication. It’s a lifesaver, and it’s cost saving.

One of the biggest expenses we have in the behavioral health world is we have to send case managers to people’s houses to make sure that they took medication.  Hopefully five years from now, there will be a little machine that everyone has access to that does this.

That’s really exciting. What else are you working on?

Long-term care has relies heavily on assessment as a basis for determining eligibility and payment for services, as well as for planning needed care. We are really working on the assessment process – trying to do assessments more efficiently and more accurately. We’re working on the social networking piece, on how we can deploy technology in an individual’s settings and connect their circle of support through that platform.

It’s something we can expose to the community as a whole, whether it’s the visiting nurse agency that might have electronic health records or the physician’s office.  We’re connecting stakeholders.

We’re doing a lot of work with electronic health records. For example, working on solutions within nursing facilities where we can improve electronic health records to help them identify where Medicare reimbursements exist.

There’s so much in the works.

Despite all of these innovations, it’s clear that we need to feel real urgency around this issue. What keeps you optimistic?

First, I don’t think this issue gets the attention it needs.

But I think we’re going to be in a position to be successful because technology is starting to be more focused. We’re starting to hear more conversations where people are saying: Let’s address this right now.

The government is starting to look at things differently in terms of regulations in some of their payment policies. This will allow more flexibility and innovation

And I think we’re in a place where in the next ten years we have an opportunity to start to focus and deal with things differently that can make it easier as we get 20 years out when the elderly population has nearly doubled.  I mentioned the importance of community-building.  We’re seeing pockets of this developing throughout the U.S.  There are little five- or six-block areas where neighbors are finding out where individuals are nearby who need services and engaging the community to help them

That really makes me optimistic, because I’m starting to see seeds planted.  We’re creating an infrastructure, which that is what business’ goal is. The government needs to give people and businesses the flexibility to meet individuals’ diverse needs, and I really think that we’re starting down that path.

Frank Spinelli is vice president of Long-Term Care Solutions for Xerox Government Healthcare Solutions. Frank was the former Medicaid director and deputy director of the Rhode Island Department of Human Services. After 30 years of public sector and Medicaid experience, he joined Xerox in December 2008.

(This article was originally published on HealthBiz Decoded, a Xerox-sponsored resource for providers, payers, employers and government agencies.) 

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