Reimagining Senior Care: Why New Thinking is the Only Way Forward

The aging of the US population, the large and growing gap between care demand and healthcare provider supply, and the growing desire to age in place are all intersecting to create a significant crisis. The ability for seniors to receive the quality of care they need, through an experience that aligns with their preferences and expectations, is very much in jeopardy.

The scope of the problem demands new ways of thinking, including new approaches to building up the services, resources, and leadership it will take to provide high-quality, accessible, holistic care to seniors, now and well into the future. Though the challenge is great, the benefits are too important to ignore—including lower cost of care, better health outcomes, and a superior experience that meets older patients where they are throughout their care journey.

The Problem is Urgent and Significant

The senior care landscape presents a dire picture, across every dimension: 

• • Within just a few years, 20% of the US population (about 72 million people) will be over the age of 65. (1)
  • The number of geriatric specialists declined by about 28% in the last two decades (2), while the number of people aged 65+ grew by 60%. Research recommends each geriatrician treat no more than 700 patients, yet the current ratio is about 1 to 10,000. (3)
  • More broadly, the American Association of Medical Colleges projects a shortfall of 124,000 physicians by 2034. (4)
  • Seventy percent of people aged 65+ will need long term care for an average of 3.2 years, and many will require it for more than five years. (5)
  • Only 7.5 million Americans, or about 3.3% of the population, has long-term care insurance. (6)
  • As of 2022, 88% of Americans prefer home care over institutionalization. (6)

Longer life expectancies are now a double-edged sword, as it means there are more seniors living with chronic or age-related health conditions that require ongoing treatment, yet fewer healthcare professionals to care for them. Many prefer to age in place—whether in their current home, at a family member’s home, or in community-based options—and that’s creating unprecedented demand for home health and home care services. The demand for home health aides alone is projected to grow by 22% through 2032. (7)

The resulting financial implications are significant. With the cost of low-acuity home care averaging $30-40 per hour, and home healthcare costs running much higher, it seems that all but the wealthy grapple with how to pay for senior care. Medicare and related supplements often cover part-time skilled nursing care for less than 8 hours each day for up to 21 days for post-episode care, such as care required after surgery. But many seniors need non-episodic, non-medical home care to support activities of daily living on a longer-term basis, and that is rarely covered by traditional insurance. If a senior requires assisted living or skilled nursing care, the costs become exorbitant, with the potential to wipe out hard-earned life savings.

Cohesion and Patient-Centricity are Lacking

As healthcare shifts from hospital settings to alternative sites of care, the home will become an increasingly vital care environment. And as reimbursement models move from fee-for-service to outcomes-based, quality home healthcare and non-medical homecare will become essential to optimizing outcomes by reducing recurrence, reinfection, and readmission rates. But at a time when person-centric and value-based care models are promoting a holistic approach to treating patients, the US healthcare system is woefully unprepared to deliver on that promise for seniors.

The current healthcare system is disjointed and, in some respects, lacks the customer centricity required to treat the whole person throughout their care journey, especially for seniors with complex or chronic conditions. By way of a common scenario, consider what it takes to ensure a senior patient has the comprehensive, holistic care they need and the obstacles that stand in the way of delivering a patient-centric experience.

• • A senior is discharged from a hospital after undergoing hip surgery. The post-surgical treatment protocol will likely take a step-down approach—from 6-8 weeks at an inpatient rehab facility, to full-time home-based care for some period, and eventually part-time home care that could last for months. Yet, no one has mapped out that journey for the patient or their caregivers. Because they lack the information to plan proactively, each transition point becomes an emergency.
  • Along the journey, different providers (including the general practitioner and the rehab specialist) prescribe the patient different medications based on their stage of treatment and recovery. Because the associated technology systems are not often integrated, providers sometimes lack visibility into the patient’s entire clinical profile. Meanwhile, a constrained healthcare system might leave each provider with insufficient time to consider the patient holistically. As a result, one prescribed drug might have contraindications or interactions with another (especially medications for chronic conditions), with the potential to land the patient back to their doctor or the ER.
  • At every stage, the patient is alarmed at the resulting medical bills and their own share of the cost. Given the complexity of health insurance today, it’s not uncommon for seniors to misperceive what’s covered or to be unaware of coverage gaps, especially if they lack Medicare supplemental and long-term care insurance.

This lack of cohesion also creates tremendous pain points for the patient’s caregivers, who are usually family members. The latter often hail from the sandwich generation, struggling to care for both their own children and their aging parents and grappling with the associated physical, emotional, and financial burdens, all while juggling a full-time career. When there is no glue to connect the many disjointed points in the care journey, caregivers and the senior patients who depend on them are unsure where to turn for help.

Meeting the Challenge Demands New Thinking

It’s clear that the healthcare industry needs to weave a more holistic, person-centered care journey that meets seniors where they are, responds to their unique care needs, and improves their health outcomes and quality of life. Such an approach has the potential to benefit everyone involved—including providers, payers, patients, and families—but it will take a new way of thinking around senior care and aging that the healthcare industry has not been known for historically.

This sea change should start with every entity involved gaining a shared understanding of what a seamless, positive patient journey can and should look like for seniors. It will take everyone involved along the continuum of that journey to map seniors’ needs at every stage, which is a marked departure from the current focus on single, discrete, isolated points in time.

Reimagining senior care will also require stepping outside the traditional boundaries and taking a page out of the playbook of the most successful consumer companies—industry leaders that have perfected the art of providing exceptional service throughout the customer journey. Through the right combination of services, technology, partnerships, and leadership, the healthcare industry can overcome long-standing obstacles and rise to the challenge of delivering the quality of care that seniors expect and deserve.

In the second part of this series, we’ll explore in more detail what a customer-centric approach to senior care could look like and propose strategies and solutions that can help the industry turn this concept into reality.

John McFarland is a partner and head of the US Healthcare Practice at Odgers Berndtson, which helps companies across the healthcare ecosystem find the executive talent to achieve their goals.  

Lauren Cody is the co-founder of Mosaic Caregiving Solutions, an online navigation tool and holistic resource to support caregivers of older adults who live with cognitive impairment. After 25+ years serving iconic brands in customer-facing roles in the restaurant and hospitality industry globally, she moved into the aging services space to apply the principles of customer journey mapping and understanding to evolve patient experiences and drive different outcomes.