Despite improvements in health care that have increased the life expectancy of persons throughout the world, aging is still viewed by many Americans with fear and trepidation. Unfortunately, the lack of motivation to make personal health-conscious decisions in early and mid-life may result in inadequate planning for lifelong meaningful activity, social support and living arrangements for later life. Thus, many older adults are not prepared for the natural occurrences of physical decline, loss, and grief.

American Cultural Values

There are several reasons why American cultural values may not prioritize providing health services and support to older adults:

Ageism: Ageism  is the prejudice or discrimination against individuals based on their age. This can result in a negative perception of older adults and a belief that they are not as valuable or important as younger individuals. This can impact the level of resources and attention devoted to addressing the health needs of older adults.

Individualism: American culture tends to emphasize individualism and self-sufficiency, which can lead to a focus on personal responsibility for one’s own health. This can result in a belief that older adults should be responsible for their own health needs, rather than relying on government or community-based resources.

Cost-consciousness: The high cost of healthcare in the United States can result in a focus on cost-consciousness and a belief that resources should be used in a cost-effective manner. This can lead to a perception that older adults are less cost-effective, as they often require more expensive healthcare services, and a lower level of investment in their health and well-being.

Limited public resources: The public resources available to support older adults, such as Medicare and Medicaid, are limited, and there is often limited funding available for additional programs or services. This can result in a lack of resources available to support the health and well-being of older adults.

It’s important to recognize that these cultural values and beliefs can impact the level of support and resources available to older adults. There is a need to address these cultural attitudes and to increase investment in programs and services that support the health and well-being of older adults. This can help to ensure that older adults receive the care and support they need to maintain their health and independence.

Moreover, elder bias can contribute to ageism and age-based discrimination, which can negatively impact the health and well-being of older adults. For example, age-based discrimination can lead to limited access to healthcare services and a lack of resources to support the health and well-being of older adults.

To address these issues, it is important to challenge stereotypes of aging and promote a more nuanced understanding of the health needs and characteristics of older adults. This includes recognizing the diversity of older adults, and the need to tailor care to the unique needs of individual patients. It is also important to address ageism and age-based discrimination through education and advocacy, and to promote policies and practices that support the health and well-being of older adults.

Healthcare Delivery in the US

The current model of health care delivery in the United States has traditionally focused on urgent and emergent conditions, rather than preventive services or support for the management of chronic conditions in older adults. As a result, the health care system may not always meet the needs of older adults with chronic diseases and their families.

However, there has been a growing recognition of the need for a more comprehensive approach to the care of older adults with chronic diseases, which includes a focus on preventive services, self-management support, and care coordination. This approach is often referred to as “chronic care management,” and it emphasizes the need to provide ongoing support and care to older adults with chronic conditions, in order to prevent complications and improve quality of life.

The conditions you mentioned for the care of older adults with chronic disease, including formal interest in self-efficacy, well-oiled outreach and monitoring activities, individual and group coaching in behavior change, and customization of care to fit preferences and family abilities, are all key components of chronic care management.

To effectively implement chronic care management for older adults with chronic conditions, health care delivery systems may need to be redesigned to focus on these elements of care. This may include investments in care coordination, health information technology, patient engagement, and team-based care. It may also require changes to payment and financing models to better support the delivery of comprehensive, coordinated care to older adults with chronic conditions.

However, there is growing recognition of the importance of chronic care management for older adults with chronic diseases, and efforts are underway to redesign health care delivery systems to better meet the needs of this population.

Challenges to Providing Health

There are several challenges to providing health care and a good quality of life for older adults and their families in America, including:

• Cost: The cost of healthcare in the United States is high, and older adults often require more expensive medical procedures, treatments, and medications. This can be a significant financial burden for older adults and their families, especially for those who have limited financial resources or who are not covered by insurance.
• Access to care: Older adults may have difficulty accessing healthcare services, especially in rural areas where there may be a shortage of healthcare providers. This can lead to long wait times for appointments, delayed diagnoses, and limited access to treatments and medications.
• Quality of care: Despite the high cost of healthcare in the United States, the quality of care can be uneven, and there are disparities in access to care based on factors such as race, ethnicity, and income. Older adults may receive care that is not tailored to their specific needs and may not receive care that is of the highest quality.
• Social isolation: Older adults are at risk for social isolation, which can have a negative impact on their physical and mental health. Social isolation can be particularly challenging for older adults who live alone or who have limited access to transportation.
• Family caregiver burden: Family caregivers often play a significant role in the care of older adults, but they can also experience high levels of stress and burnout. Caregivers may struggle with balancing their responsibilities to care for their loved ones with their own needs and responsibilities, and they may require support and resources to ensure their own well-being.
• Limited support services: Older adults and their families may have limited access to support services, such as in-home care, adult daycare, and respite care. This can result in a lack of support for family caregivers and a lack of resources to help older adults maintain their independence and quality of life.

These challenges highlight the need for a comprehensive approach to addressing the health and well-being of older adults and their families in the United States. This may include increased investment in programs and services that support the health and well-being of older adults, as well as efforts to improve access to care and the quality of care received by older adults.

Financing Schemes

Most financing schemes, including Medicare, have traditionally been focused on paying for acute care and procedure-oriented visits or hospitalizations, rather than on the ongoing management of chronic conditions. This has resulted in a financing system that may not adequately support the needs of older adults with chronic diseases and their families.

However, there have been efforts to reform the financing and payment systems in the United States to better support chronic care management for older adults with chronic conditions. These efforts often involve shifting from fee-for-service payment models to value-based payment models, which incentivize providers to focus on outcomes and quality of care, rather than on the volume of services provided.

One example of this is the Medicare Chronic Care Management (CCM) program, which provides payment to primary care providers who coordinate and manage the care of older adults with two or more chronic conditions. The CCM program aims to support the ongoing management of chronic conditions, improve patient outcomes, and reduce health care costs.

Other payment models, such as accountable care organizations (ACOs), also focus on the delivery of coordinated, high-quality care to older adults with chronic conditions. ACOs are groups of health care providers who work together to provide coordinated care to a defined population of patients, and they are incentivized to improve quality and reduce costs.

Overall, there is recognition of the need to reform the financing and payment systems in the United States to better support chronic care management for older adults with chronic conditions. This may involve a shift away from traditional fee-for-service payment models, and towards value-based payment models that incentivize providers to focus on outcomes and quality of care.

The Complexities of Care Coordination

The transitions between different levels of care for older adults can be complex, and that payment systems may not always support effective care coordination and assessment of the true needs of families for safe care in the home. This can result in fragmented care, poor communication between providers, and sub-optimal outcomes for older adults and their families.

To address these issues, efforts are underway to improve care coordination and integration between different levels of care for older adults. This often involves the use of care management and care coordination models, which aim to facilitate communication and collaboration between different providers and settings of care.

One example of this is the use of care transitions programs, which aim to improve the coordination of care for older adults as they move between different levels of care. These programs often involve the use of trained care coordinators or coaches who work with older adults and their families to develop a plan of care, coordinate services, and ensure that there is effective communication between providers.

Another example is the use of health information technology (HIT) to improve care coordination and communication between providers. HIT can facilitate the sharing of information between different providers and settings of care, and can help to ensure that older adults receive appropriate and timely care.

In addition, efforts are underway to develop payment models that incentivize providers to work together and to provide integrated, coordinated care to older adults across different levels of care. These payment models often involve the use of shared savings or bundled payments, which incentivize providers to work together to improve outcomes and reduce costs.

In general, there is recognition of the need to improve care coordination and integration between different levels of care for older adults. This may involve the use of care management and care coordination models, the use of health information technology, and the development of payment models that incentivize providers to work together to provide integrated, coordinated care to older adults.

Emotional Aspects of Illness

Health care providers may sometimes focus primarily on the logical and medical aspects of treating or managing chronic disease conditions, and may overlook the emotional experiences of older adults and their families. This can result in a lack of understanding and empathy for the emotional challenges that older adults and their families may be facing, and can limit the effectiveness of care.

To address this, there has been a growing recognition of the importance of providing patient-centered care that takes into account the whole person, including their emotional, social, and psychological needs. Patient-centered care aims to involve patients and their families in decision-making, and to provide care that is respectful, compassionate, and responsive to their needs and preferences.

One way to promote patient-centered care is through the use of shared decision-making, which involves a collaborative process between patients, their families, and health care providers to make treatment decisions that are consistent with the patient’s values and preferences. Shared decision-making can help to ensure that the emotional needs and preferences of patients and families are taken into account when making treatment decisions.

Another approach is to provide training and support to health care providers to better understand the emotional experiences of older adults and their families, and to provide care that is sensitive to their needs. This may involve training in communication skills, cultural sensitivity, and patient-centered care.

To a large extent, there is recognition of the need to provide patient-centered care that takes into account the whole person, including their emotional, social, and psychological needs. This may involve the use of shared decision-making, training and support for health care providers, and a greater emphasis on empathy and understanding in the delivery of care.