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WELCOME

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All proceeds support the Aging Services Foundation of Boulder County, a local 501c3

nonprofit that helps build and sustain programs, services, and events for older

adults, family caregivers, and professionals.

KEYNOTE

Kathy Greenlee





SPEAKER

Susan Tucker


1

The LTSS Landscape andState Trends Shaping theFuture for LTSS

Susan Tucker, Principal November 7, 2019

Copyright © 2019 Health Management Associates, Inc. All rights reserved. The content of this presentation is PROPRIETARY and CONFIDENTIAL to Health Management Associates, Inc. and only for the information of the intended recipient. Do not use, publish or redistribute without written permission from Health Management Associates, Inc.

2

THIS SESSION WILL COVER: State Trends for Medicaid LTSS

❑ LTSS Landscape and

Populations with Special

Challenges

❑ Integrating Care between

Medicare and Medicaid

❑ Value-based Payment for LTSS

❑ SDOH and LTSS

❑ LTSS Workforce

Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL

LTSS LANDSCAPE ANDPOPULATIONS

WITH SPECIAL CHALLENGES

LTSS EXPENDITURE PRESSURE ON MEDICAID BUDGET

WHAT DOES THE MAP SHOW?The map shows LTSS expenditures as a % of total Medicaid expenditures in FY 2015.

What is the % for the US?LTSS expenditures accounted for 30% ofMedicaid expenditures in FY 2015.

What is the range for the US?Range: 15.9% in AZ to 53% in ND.

Top 5 states, highest %: Wisconsin, Iowa, NewHampshire, Wyoming, and North Dakota.

Key issues to note: States with more of their budget devoted to LTSS may feel the pressure from the demographic changes sooner. Data is purely illustrative of the variation; CMS data itself is not perfect.

Source: HMA, based on CMS data.

Medicaid is the largest payer of long-term services and supports (LTSS), which is defined as “a broad range of supportive services needed by people who have limitations in their capacity for self-care because of a physical, cognitive, or mental disability or condition.”

19


TRENDS IN TOTAL LTSS EXPENDITURES

Medicaid LTSS Expenditure Growth, FY 2011-2016 Medicaid HCBS Expenditure Growth, FY 2011-2016

20


Source: Medicaid Expenditures for Long-Term Services and Supports in FY 2016 IAP Medicaid Innovation Accelerator Program IBM Watson Health May 2018

STATE ACTIONS TO SERVE MORE INDIVIDUALS IN COMMUNITY SETTINGS

21


LTSS POPULATIONS WITH UNIQUE CHALLENGES

People with

both Medicare

and Medicaid

(dual eligibles)

People

with I/DDThe LGBTQ

community

22


MEDICARE – MEDICAID DUALLY ELIGIBLE BENEFICIARIES – NUMBERS AND BENEFITS

Over12 million people nationwide

Historically, dually eligible

beneficiaries account for a

disproportionate share of

spending for both

programs. They represent:

+ 20 percent of the Medicare population and 34 percent of Medicare spending

+ 15 percent of Medicaid beneficiaries and 33 percent of Medicaid spending

Medicare is the

primary payer for their

care, mainly covering

medical services

Medicaid wraps around Medicare

benefits covering any Medicare

premiums and cost-sharing, and for

many dual eligibles, services not

covered by Medicare

Source: CMS State Medicaid Director Letter #18-012, Ten Opportunities to Better Serve Individuals Dually Eligible

23


for Medicaid and Medicare, December 2018.

INTEGRATING CARE BETWEENMEDICARE AND MEDICAID

DUAL ELIGIBLE PLANS & INTEGRATED PLAN PRODUCTS

Health plans are increasingly offering multiple products.

+ Some plans offer an MMP and an MLTSS + D-SNP or a companion plan

+ FAIs/MMPs. Some states are extending their FAIs. MLTSS + MA D-SNPs. Some states are requiring that MLTSS plans operate companion plans. Examples include New Mexico, and Tennessee.

+ FIDE SNPs. Plans in 10 states.

Capitated

Financial Alignment Initiatives (FAIs):

Medicare-Medicaid Plans(MMPs)/”Dual Demo”

D-SNPs

Medicaid MLTSS Plan +

MA D-SNP

FIDE SNPs

MARKET TRENDS FOR THREE INTEGRATED PRODUCTSANTICIPATE GROWTH

25Copyright © 2019 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL

NEW OPPORTUNITIES TO INTEGRATE CARE

Three New Opportunities to Test Innovative Models of Integrated Care for Individuals Dually Eligible for Medicare and Medicaid (SMDL 19-002)

+ Integrating care through two options under the current Financial Alignment Initiative - the capitated financial alignment model and the managed fee-for-service model - and state-specific models that would give states additional flexibility.

Ten Opportunities to Better Serve Individuals Dually Eligible for Medicaid and Medicare (SMDL 18-012)

+ Utilizing new developments in managed care, using Medicare data to inform care coordination and program integrity initiatives, and reducing administrative burden for dually eligible individuals and the providers who serve them


LTSS CONTRACTING MODELS VARY

TRADITIONAL

MCO CONTRACTS

UNDER WAIVERS

TRADITIONAL

MCO PLANS WITH

MLTSS + D-SNPs

TRADITIONAL

MCO CONTRACTS

+ FIDE D-SNPs

Medicaid MCO contracts with state to deliver integrated

acute and MLTSS benefits to enrollees

with and without Medicare

Medicaid MCO delivers MLTSS & wraparound

benefits and companion D-SNP

delivers acute benefits to enrollees with

Medicare and Medicaid

Medicaid MCO delivers wraparound benefits

and FIDE D-SNP delivers acute and MLTSS

benefits to enrollees with Medicare and

Medicaid

Medicaid MCO contracts with state

to deliver MLTSS-only benefits to enrollees

with and without Medicare

Medicare Advantage Plan has 3-way contract with CMS and state to deliver integrated Medicare and

Medicaid benefits including MLTSS to

enrollees with Medicare and Medicaid

MLTSS ONLY

MCO CONTRACTS

MEDICARE

MEDICAID PLANS

(MMP)

PACE ORGANIZATIONS

States may cover PACE enrollees

under expanded Medicaid eligibility

rules to offer yet another managed care benefit with

LTSS for frail elderly


DUALLY ELIGIBLE BENEFICIARIES

Dually eligible beneficiaries are increasinglyenrolling in Medicare Advantage:


Dually Eligible Beneficiaries

Enrolled inManagedCare 2006

Enrolled inManagedCare 2017

All 11% 35%

Partial benefit

18% 44%

Full benefit 10% 32%

Movement toward Managed LTSS (MLTSS) for many state Medicaid programsAs of March 2019

Active MLTSS Program

Intends to Implement

Active capitated Duals Demo (MLTSS for duals in demo)

States to Watch for Potential MLTSS Activity

NOTE:ID began regional implementation of MLTSS for dually eligible individuals not enrolled in its FIDE SNP program - November 2018 in Twin Fall county, with a planned April 2019 expansion to Bonneville, Bingham, and Bannock counites.NE is in the process of adding LTSS to the current MCO contracts. Phase 1 populations (older individuals and individuals with physical disabilities) would begin to be carved in on January 1, 2020, with phase 2 populations (I/DD) to follow on January 1, 2021.NY FIDA demonstration (dual demo) ends December 31, 2019; FIDA/IDD ends December 31, 2020.

DCCA

OR

WA

NV

AZ

AK

NM

UT

ID

MT

WY

CO

TX

OK

KS

NE

SD

ND

MN

WI MI

IA IL

MO

AR

LA

MS AL GA

FL

HI

SC

NC

VA

TN

KY

INOH

PA

WV

NY

NJ

MD

ME

VTNH

MA CT

RI

VALUE BASED PAYMENTAND LTSS

HEIGHTENED FOCUS ON PATIENT TRANSITIONS

Hospitalto Home

Nursing Home to

Community Setting

MCO to MCO

Hospital to

Nursing Home

Nursing Home to

ER

Home toNursingHome

Home to Hospital

ER to Home

From one Community

Based Setting to Another

31

MOVEMENT TO VBP FOR LTSS

+ CMS Medicaid Innovation AcceleratorProgram VBP for HCBS

+ Program for the All-Inclusive Carefor the Elderly (PACE)

+ Shifting LTSS into managed care model and paying MCOs a capitated rate

LTSS quality frameworks

+ National Quality ForumHCBS quality measurement set

+ AHRQ and Truven Health Analytics HCBS Quality Measurement Framework

+ ACO Quality Framework in CMS Shared Savings Program in Medicare

+ HCBS CAHPS Survey

+ National Core Indicators

32

MOVEMENT TO VBP FOR LTSS – STATE EXAMPLE

Value Based Purchasing+ Level 1 - Fee schedule based with bonus or incentives

and/or withhold payable only when outcome/qualityscores meet agreed-upon targets.

+ Level 2 – Fee schedule based, upside-only shared savings– available when outcome/quality scores meet agreed upon targets (may include downside risk)

+ Level 3 – Fee schedule based or capitation with risk sharing (at least 5%for upside and downside risk); and/or global or capitated payments with full risk

• New Mexico Centennial Care2.0 includes aggregate VBP targets

• By contract Period 4 (Jan. 1 –Dec. 31, 2022) 36% in VBP arrangements

Source: New Mexico Medicaid Value Based Purchasing and Nursing Facilities; available at this link

33

https://www.hsd.state.nm.us/uploads/files/About Us/Advisory Committees/MAC Meetings/Value Based Purchasing and New Mexico Medicaid_revised 11_6_18.pdf

FRAMEWORK FOR SOCIAL DETERMINANTS

OF HEALTH IN LTSS

20

SOCIAL DETERMINANTS OF HEALTH AND LTSS

LTSS programs are increasingly recognizing thevalue of addressing SDOH to achieve better outcomes.

1.Social connection (loneliness)

2. Employment needsEmployment services are an optional covered benefit in MLTSS programs

3.Housing and utilities access and security

4.

5.

6.

7.

8.

Food security and nutrition

Exercise needs

Environmental safety

Medical and non-medical transportation

Education

Over one-third of states reported that SDOH data was collected as of FY 2018 or would be collected beginning in FY 2019

SOURCE: Kaiser Family Foundation Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October2018.

SOCIAL DETERMINANTS OF HEALTH AND LTSS

Thirty-seven states reported offering at least some housing-related services in FY 2019 and/or FY 2020

36

SOURCE: Kaiser Family Foundation Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October 2019.

EXAMPLES OF STATE’S ADDRESSING SDOH

ARIZONA+ Arizona Project-Based Rental Assistance

Program (PRA) developed 54 rental units for extremely low-income adults ages 18 to 61 who have at least one intellectual or developmental disability.

+ The state Medicaid agency, found that: (1) state Medicaid agency staff benefit from keeping abreast of forthcoming Housing and Urban Development grants that can support new affordable housing options for LTSS populations; and (2) local housing authorities may require education on the needs of individuals who receive LTSS benefits, including vulnerable subpopulations that cannot afford to pay for room and board

TEXAS+ Texas Medicaid’s agency collaborates

with the state housing agency, the Texas Department of Housing and Community Affairs, and Public Housing Authorities to expand affordable, accessible housing opportunities for individuals with disabilities, including those with SMI and SUD.

+ Texas Department of Housing and Community Affairs administers a Section 811 PRA grant in which private developers of Low Income Housing Tax Credit properties agree to set aside units for individuals with disabilities exiting institutions, young adults exiting foster care, and individuals with mental illness.

37

DIRECT CARE WORKFORCE

INVESTMENTS

OPPORTUNITIES TO ADDRESS DIRECT CARE WORKFORCE CHALLENGES

Collaborating

with educational

institutions on

core training

Training videos

to strengthen

job skills

Scholarship

programs

Mentoring

programs

39

To address LTSS direct care workforce shortages and turnover, more states are reporting wage increases and workforcedevelopment activities

DIRECT CARE WORKFORCE CHALLENGES

SOURCE: Kaiser Family Foundation Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October 2019.

40

41

SPEAKER

Hayley Gleason


State Perspective on Aging and

Long-Term Services and

Supports

Department of Health Care

Policy & Financing

Presented by: Hayley Gleason

43

November 7, 2019

Our Mission

Improving health care access and

outcomes for the people we serve

while demonstrating sound

stewardship of financial

resources

44

Health First Colorado:

Older Adult Members

45

46

Population Aging: Colorado

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

2015 2030 2050

65-74 75-84

78%

173%

282

%

128

%

47

Health First CO Older Adult Members

Long Term Services & Supports (LTSS), 25,762

Health First CO

Members, Non-LTSS,

46,459

SOURCE: Members 65+ Served by the Department as of November 2018.

Expenditures for Older Adults

48SOURCE: Members 65+ Served by the Department, FY2017-2018.

7.7%

92.3

%

Provides in-home and community supports like

transportation, personal care, adult day care, and

assisted living to individuals with physical, intellectual,

and developmental disabilities of all ages

49

Home and Community-Based Services

SOURCE: FY 2016-17. Enrollment from MMIS analysis. Expenditures from FY 2017-18 HCPF Budget Request.

50

Alternative Care Facilities (ACFs)

4,450enrolled

56% are older adults

65 and older

$51,571,332spent

48% for older adults

65 and older

Provides assisted living to individuals with physical,

intellectual, and developmental disabilities of all ages

**These numbers are included in the HCBS Services data on previous slide

Individuals ages 55 and older can live in any setting and

receive all acute and long-term services and supports

through this program because it is a capitated program

including Medicare

51

Program of All-Inclusive Care for the Elderly

SOURCE: FY 2016-17, FY 2017-18 HCPF Budget Request, Average Monthly Paid Enrollment and Cash Based Actuals for PACE

52

Nursing FacilitiesProvide three types of services: skilled nursing or medical care

and related services; rehabilitation needed due to injury,

disability, or illness; and long term care — health-related care

and services not available in the community, needed regularly

due to a mental or physical condition

SOURCE: FY 2016-17. Enrollment from MMIS analysis. Expenditures from FY 2017-18 HCPF Budget Request.

53

LTSS Expenditures for Older Adults

SOURCE: Members 65+ Served by the Department, FY2017-2018.

51.1%

25.7%

14.4%

4.4%

4.4%

54

Average Total Costs for

Older Adults by Setting

SOURCE: HCPF data request, FY 2017-18, Ages 65+, Total Cost per Utilizer per Year by Setting (includes “setting costs” and “other costs”)

Serving Older Coloradans:

Now & Into the Future

Department of Health Care

Policy & Financing

55

56

•Align work focused on older adults within the

Department

•Strengthen aging expertise within the

Department and through external partnerships

•Expand older adult stakeholder outreach and

engagement

•Enhance collaboration with other Departments

and state-level organizations around aging

efforts

•Launch a formal strategic planning process

focused on serving older adults

Health Care

Policy &

Financing

Support Ongoing Work

57

Align Current

Department Initiatives

• Form intra-agency Aging

Strategy Workgroup

• Identify internal initiatives

focused on the older adult

population

• Align efforts and build

collaboration internally

Strengthen Aging Expertise

• Create Older Adult Policy

Advisor Position to lead

aging strategy efforts

• Contract with outside

consultants, vendors to

support internal work

58

Enhance

Stakeholder

Engagement

Expand Older Adult

Stakeholder Network

Develop and Roll-Out

Stakeholder Engagement

Plan with the Roadmap

Enhance Collaboration

59

Align Cross-Department Efforts

around Aging and Older Adults

•Partner with key state leaders

to coordinate efforts (Aging and

Adult Services, CDHS;

Governor’s Office; CDPHE)

•Form ongoing aging work group

•Develop focused, topic-specific

work groups as needed (ex.

Workforce)

Engage with State-Level

Organizations

•Strategic Action Planning Group

on Aging

•Lifelong Colorado

•Colorado Commission on Aging

•Thought Leaders in Aging

•Catalyst for Aging

Launch Formal Strategic

Planning Process

60

Engage Stakeholders

at the State and

Local Levels

•Conducted seven

focus groups

•Conducted ten

regional listening

sessions

Access External

Expertise

•Identify evidence

based programs or

innovative strategies

•Form Expert

Advisory Committee

Create a

Five-Year

Older Adult

Strategic

Roadmap

Promising Strategies

Consider social determinants of health

Expand support for family caregivers

Ensure access to the right services at the right time

Enhancing provider capacity, including strengthening

the direct care workforce

Invest in better end of life planning

61

Strategies to support Colorado’s family caregivers

Governor Polis’ 2020-2021 Budget

• Paid family leave for state employees

• Allow employees to care for a new child, aging partner or

parent

HCPF: Informal Caregiver Supports

62

Family Caregivers

Ensuring access by enhancing provider agency, facility,

and workforce capacity & focusing on quality care

• Nursing Facility Program Capacity

• Program for All Inclusive Care for the Elderly

• Direct Care Workforce Initiative

63

Ensuring Access to High Quality Services

64

Hayley Gleason

Older Adult Policy Advisor

[email protected]

Thank You!

SPEAKER

John Emerson


Convening, Collaborating, and

Catalyzing Efforts to Improve the

Lives of Older Coloradans

“It is therefore the intent of the General Assembly to establish a multi-disciplinary private and public sector stakeholders group to develop a comprehensive Strategic Action Plan on Aging in Colorado through the year 2030. The group shall provide to the Governor and General Assembly comprehensive data on and specific recommendations regarding private and public options for addressing this demographic shift for the state to consider.”

- Legislative Declaration from House Bill 15-1033

C O L O R A D O S T R A T E G I C A C T I O N P L A N N I N G G R O U P O N A G I N G A C T

S T R A T E G I C A C T I O N P L A N N I N G G R O U P O N A G I N G

Jane Barnes – Benefits in Action

Karen Brown – iAging and Aging 2.0

Steve Child – Pitkin County Commissioner

Jim Collins – Mayor Las Animas

Sarah Elliott – Vivage Senior Living

John Emerson – Flying Cloud Health and Aging 2.0

Mindy Gates – Department of Human Services

Hayley Gleason – Department of Health Care Policy and Financing

Christian Itin, Chair – Metropolitan State University of Denver

Gabriel Kaplan – Department of Public Health and Environment

Chris Lee – Visiting Nurse Association

Maureen McDonald, Vice Chair – National Council on Aging

Jean Nofles - AARP

Dave Norman – Northwest Colorado Area Agency on Aging, Retired

Sophie Shulman– Department of Transportation

Karin Stewart – Aging and Adult Services, Jefferson County

Tony Tapia – Latino Age Wave

Jayla Sanchez Warren – Denver Regional Council of Governments Area on Agency on Aging

John Zabawa – Seniors’ Resource Center, Retired

C O L O R A D O ’ S C H A N G I N G 6 5 + D E M O G R A P H I C S

2015 2030

+ 52%

708,200 to 1.2 million

Source: Colorado State Demography Office

C O L O R A D O ’ S C H A N G I N G 8 0 + D E M O G R A P H I C S

2015 2030

+ 63%

164,400 to 315,700

Source: Colorado State Demography Office

O L D E R C O L O R A D A N S A N D T H E L O N G E V I T Y E C O N O M Y

Source: AARP & Oxford Economics

42% of Colorado’s GDP – $135 billion

42% of state and local taxes - $11.3 billion

46% of Colorado’s labor market - 1.6 million jobs

61% of health care consumer spending

51% of entertainment consumer spending

A D U L T S 6 5 + A N D H E A L T H I M P A C T S

35% living with a disability

80% living with chronic condition

68% living with multiple chronic conditions

75% of health care expenses in US

1% of health care expenses spent on public health

Source: National Council on Aging

A C T I O N P L A N H I G H L I G H T S1. Senior Advisor on Aging in Governor’s Office

2. State funding data on top-8 aging-related programs

3. Retirement Security and Colorado Secure Savings Board

4. PERA unfunded liability

5. Financial Security Coalition / Abuse and Fraud Prevention

6. Colorado Work Force Development Council

7. Municipal and County age-friendly planning

2 0 1 9 L E G I S L A T I V E A N D C O N S T I T U T I O N A L F O C U S

• Affordable housing and renter’s Issues - eg. Property Tax/Rent/ Heat Credit

• Increased supports and protections for family caregivers

• Workplace retirement savings and financial security

• Elder abuse, abandonment, and financial fraud

• Age-friendly planning and implementation

• Senior Property Tax Exemption

• Office of Public Guardianship

S A P G A P R I O R I T I E S I N 2 0 1 9

•Health and Wellness

• Increase Outreach and Awareness

•Explore Age-Friendly Public Health Systems

•Continue the Workforce Development and Transportation Committees

•Support Lifelong Colorado

S A P G A M E E T I N G 2 0 1 9 S C H E D U L E

• Full SAPGA Meeting – 2nd Monday of the month (1st Monday in Oct and Nov) at DRCOG 1001 17th Street Denver, CO from noon-3 pm - Aspen Conference Room

• Workforce Development Meeting – 2nd Monday of the month (1st Monday in Oct and Nov) at DRCOG 1001 17th Street Denver, CO from 10:30-11:30 am -Aspen Conference Room

• Transportation Committee Meeting – 4th Monday of the month at CDOT 2829 W. Howard Place Denver, CO – TREX Conference Room

• Engagement and Education Meeting – Quarterly/As-Needed – Email for details

Call-in options are available!

www.colorado.gov/agingstrategy

[email protected]

Innovations DrivingBetter Aging

John Emerson

Founding Partner

November 6, 2019

Technology Marches into Aging Space

Last Century

New Millenia

Listen to me Now!

Fitness and Movement trackingCognitive tracking /Tap controlLanguage translations/ Fall detection /Ear Buds

My Background

“How are you doing?” Talk to doctor w/out phone

“What’s the matter” Ask the Internet first

“Do you need an appointment?” Get the right care, faster

“Let’s stay healthy” Avoid doctors

Care Delivery Trends Impacting Aging

“Leading medical companies are combining personal devices with advanced technology for personalized care management to offer superior patient care and gain larger market share in the US market.”Telehealth Market Outlook and Forecast 2018-2023 (2019)

“It’s not about the technology…. It’s about using the solution to do a job for consumers that makers of incumbent solutions are ignoring—usually in a cheaper, simpler and more accessible way.” (Christensen Institute / HBR/ 2018)

Real Time Impact on Health and Aging

FUTURE OF TRANSPORT:CERNER+UBER=Prescribe transportation from EMR

FUTURE OF CARE DELIVERY:AMAZON: End-end integration symptom checking, telehealth, house calls

FUTURE OF DIABETES COACHING:Pharmacy, digital, coaching and social support

[email protected]

@johannerson

https://www.linkedin.com/in/john-emerson-79480/

mobile: 303-563-9921

https://www.linkedin.com/in/john-emerson-79480/

Q&A

Susan Tucker

Hayley Gleason

John Emerson





SPEAKER

Chrissy Esposito


When Trends CollideHealthy Aging and the Housing Crisis for Older Coloradans

Chrissy Esposito, MPH

Data Visualization and Policy Analyst

Age Well Conference November 2019

Key Takeaways

1. Coloradans are living longer, but income for older adults is being outpaced by the cost of housing.

2. Older Coloradans increasingly find it difficult to find adequate, accessible housing.

3. New data and information is available to help Coloradans advocate for change.

We are Aging Well in Colorado

79

U.S. Life Expectancy

Today

U.S. Life Expectancy

100 Years Ago

39

Source: UN Population Division

But Then There’s the Reality of Paying for Housing in Colorado…

Two Trends Collide: Housing and Aging

Source: State Demography Office

Colorado’s Older Adult Population is Growing

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

Year

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

2027

2029

2031

2033

2035

2037

2039

2041

2043

2045

2047

2049

65 to 79 Population 80+

Housing Has Increasingly Become Unaffordable

Home is Also a Setting of Care

Who are Your People?

Coloradans are Living Longer, But Income for Older Adults is Being

Outpaced by the Cost of Housing.

Affordability

The Case for Affordable, Adequate Housing

Half a million plus older adults could be housing cost burdened by 2030

The Affordability Gap for Older Adults is Growing, 2010-2017

Source: American Community Survey / Zillow

Source: American Community Survey, 2017

More Than One in Four Older Coloradans is Housing Cost Burdened

What It Takes: Monthly Housing Costs

Median monthly income = $2,162

Affordable = $649 per month

$347 in the red

Source: American Community Survey

Median monthly rent = $996

Homeownership Offers Some Protections

Source: American Community Survey

Half of older adult renters are cost burdened

Two in 10 older adult homeownersare cost burdened

Cost Burden Increases as Household Income Decreases

Housing Cost Burden Across Colorado

A Workforce As Housing Burdened As Their Patients

Affordable Housing for Workers is Also Needed

Housing Costs Can Crowd Out Health

53%

70%

Healthy Baseline

Less on Food

Less on Medical Care

Low-income cost-burdened older adults spend …

Source: Joint Center for Housing Studies, Harvard University

Older Coloradans Increasingly Find it Difficult to Find

Adequate, Accessible Housing.

Accessibility

Accessible Homes are Needed as We Age

2 in 3 older adults will develop a disability and need care in their lifetime

1 in 3 older adults will develop a disability and need care today

Accessible Housing: Two Forms

Reality: Few Homes are Truly Accessible

About 1 in 3 homes in Colorado have a zero-step entry

Less than one percent of homes in Colorado are wheelchair accessible

Accessing Places is Getting Harder in Colorado

72% 66%

0%

20%

40%

60%

80%

100%

Ease of Getting to Places in the Community

Just half of rural Coloradans are within 15 minutes of a hospital …

Compared with 87% of urban Coloradans.

2010 2018

Accessibility and Health

Walkable neighborhoods can mean:

• Lower rates of cognitive decline

• Overall better health

• Lower rates of obesity

In-Home Supports

Supportive Housing Services

Indirect Supports

Permanent Supportive Housing (PSH)

Service Coordination

Housing in Colorado

Summarizing the Impact

The Visible The Invisible?

• Displacement and doubling up• Physical and mental health

impacts• Food access• The workforce• Transportation• Access to medical appointments

and community ties

• Rent• Utilities• Property taxes• Repairs• Insurance

New Data and Information is Available to Help Coloradans

Advocate for Change.

The Vision: Make the Case for Housing

Link to Toolkit: coloradohealthinstitute.org/community-toolkit-housing

https://www.coloradohealthinstitute.org/community-toolkit-housing

Spotlight: Boulder

Print and Share: Tell Your Story

Link to Toolkit: coloradohealthinstitute.org/community-toolkit-housing

• Built for everyone, non-experts

• Share with city council, planners, aging partnerships,developers, health systems, etc.

https://www.coloradohealthinstitute.org/community-toolkit-housing

Where Do We Go From Here?

• Senior Residences at Three Springs

• SASH Program in Vermont

NextFifty Initiative: Phase Two

Family, Friends, Neighbors

Photo: http://www.homecareaustralia.com.au

Who Will be Caring for Older Coloradans?

Direct Care Providers

Key Takeaways

1. Coloradans are living longer, but income for older adults is being outpaced by the cost of housing.

2. Older Coloradans increasingly find it difficult to find adequate, accessible housing.

3. New data and information is available to help Coloradans advocate for change.

A Note of Thanks

Chrissy [email protected]

720.382.7098

Sponsor Visits & Beverage Break!




SPEAKER

Claire Cruse


November 2019

The future of aging:

What might aging look like in 2040?

The future of aging: What impact might the expansion of health span have on society?Copyright © 2019 Deloitte Development LLC. All rights reserved.

The future of health will be driven by digital transformation

enabled by radically interoperable data and open,

secure platforms


What is Health?

Health is defined holistically asan overall state of wellbeing

encompassing mental, social, emotional, physical and

spiritual health


“Longevity is here to stay” – Ashton Applewhite

Silver tsunami or permanent sea change?

The middle aging of society

• While longevity has increased in the last century, the years we have gained were not added to the end of life—those “extra” years have been added to the middle of life.

• But still today, the average health span (age 63)—the amount of time that one is healthy in life—stops more than a decade short of the average life span (age 79).

What would happen if we extended health span?

We’ll follow the lives of three individuals:

Larry: Widower, type II diabetic

Chase: Using nudges and technology to manage chronic disease

Dana: Few financial resources, not prioritizing health


A future of health focused on preventing disease can change people’s experiences for the better and create opportunities for today’s life sciences and health care stakeholders

The future of aging could look radically different than experiences people have today

We explored this deeper by discussing four questions with experts in aging services, policy, innovation, and technology:

What will health care “treat” in the

future?

How will the future of health change how people work, retire, and pay for their later years?

How will the future of health change where and how people will live?

How will the future of health change death and dying?

“Social isolation and loneliness are not the same thing. There is overlap, but they are not the same thing. We need a much more thoughtful approach to social isolation and loneliness than what is in place today. You can be lonely in a crowded room.”

—Nonprofit foundation leader


Health care could shift to a greater focus on mental and behavioral health, suicide, loneliness and social isolation

What will health care “treat in the future?”

Vision for 2040:

Data and the consumer will be at the center of the health model; the focus will be on holistic health

Chase

Age in 2040: 40

Health: Living with indolent non-Hodgkin Lymphoma for five years.

Support:

• Embedded sensors in body and environment

• Predictive analytics

• Health advocate assisting with disease monitoring, medication adjustments, and wellness routines to complement disease status

Change is emerging:

Suicide, social isolation, and loneliness epidemics on the rise


Some innovators today are shifting to focus beyond physical health

Early movers to watch

Element3 Health

Socially Determined

Neolth


Attaining this future will likely require action

Bridging the gap: Getting to 2040

Source: Deloitte Analysis

Adopt emerging technology

Forge partnerships

Build new business models

Shift in mindset

“I don’t think people will use the word retirement in 20 years. The fundamental narrative of how we think of our lives—school, work, retirement periods—will be gone. We will have new narratives that will allow older people to work.”

— Longevity market digital publisher


How will the future of health change how people work, retire, and pay for their later years?

Larry

Age in 2040: 70

Health: Type II diabetic, at risk for depression due to recent loss of wife

Support:

• Virtual assistant that detects mood changes

• Health advocate assisting with recommendations to keep him socially engaged (e.g., local clubs, virtual affinity network)

• Paid for mentoring but enjoys intergenerational aspects of work too

Vision for 2040:

Longer health spans could give people the physical and mental stamina to work later in life.

Change is emerging:

Working longer, but out of desire rather than need


Encore.org

emPower

Changes in the concept of work and retirement will likely require new tools to prepare people—and they should focus on the beginning of their careers as much as the end.






Go beyond care

Forge partnerships

Build new business models

Shift in mindset

“If you installed 100 grab bars at $300 apiece and avoided one fall, you would break even because the average fall costs nearly $30,000.”

—Aging in place expert


How will the future of health change where and how people live?

Age in 2050: 80

Health: Type II diabetic, at risk for depression due to recent loss of wife

Support:

• Engagement with social club has led to deep interpersonal relationships

• Move in together to share cleaning and cooking service

LarryVision for 2040:

Pairing smart homes with smart health communities could transform the way older people live.

Change is emerging:

Maintaining choice in aging


Minka

Best Buy

The future of health will shift away from brick-and-mortar locations to meet people in their homes and communities






Close technology gaps

Forge partnerships

Move into the community

Go beyond care

“I’m hopeful that 20 years from now as a culture we are not afraid to talk about death and dying as part of the human experience –that there will be less of a fear of aging.”

—Nonprofit foundation leader


How will the future of health change death and dying?

Vision for 2040:

Concrete plans for end of life supported by data and care teams

Change is emerging:

Open conversations around death and dying

Chase

Age in 2060: 60

Health: His cancer has an accelerated progression at the end stage of the disease that is resistant to treatment

Support:

• End of life planning done years before, now it’s carrying out his wishes

• Enrolling daughter in grief support system


Fabric

Embodied Labs

The future of health may make death more predictable


Death Cafes





Arm health care professionals with new tools

Forge partnerships

Go beyond care


Two critical considerations (questions) for the future

How critical is analogue in the

digital age?

What roles will caregivers play

in the future?

Age in 2040: 60

Health: Declining mobility, at risk for depression

Support:

• Sensors in the grocery section of her local community health hub store detect unhealthy purchases and alert network

• Virtual assistant provides regular check-ins, sends coupons for healthy food options, and alerts established in-person support system to changes in her behavior

Dana


Contacts

Leslie ReadPrincipalDeloitte Consulting LLP+1 617 437 [email protected]

Sarah Thomas, MSManaging directorDeloitte Center for Health SolutionsDeloitte Services LP+1 202 220 [email protected]

Claire CruseHealth policy managerDeloitte Center for Health SolutionsDeloitte Services LP+1 303 305 [email protected]

mailto:[email protected]




The source for health care insights: The Deloitte Center for Health Solutions (DCHS) is the research division of Deloitte LLP’s Life Sciences and Health Care practice. The goal of DCHS is to inform stakeholders across the health care system about emerging trends, challenges, and opportunities. Using primary research and rigorous analysis, and providing unique perspectives, DCHS seeks to be a trusted source for relevant, timely, and reliable insights.

To learn more, please visit: www.deloitte.com/us/centerforhealthsolutions

About the Center for Health Solutions

http://www.deloitte.com/us/centerforhealthsolutions

About Deloitte

Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”), its network of member firms, and their related entities. DTTL and each of its member firms are legally separate and independent entities. DTTL (also referred to as “Deloitte Global”) does not provide services to clients. In the United States, Deloitte refers to one or more of the US member firms of DTTL, their related entities that operate using the “Deloitte” name in the United States and their respective affiliates. Certain services may not be available to attest clients under the rules and regulations of public accounting. Please see www.deloitte.com/about to learn more about our global network of member firms.

Copyright © 2019 Deloitte Development LLC. All rights reserved.

This presentation contains general information only and Deloitte is not, by means of this presentation, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This presentation is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.

Deloitte shall not be responsible for any loss sustained by any person who relies on this presentation.

https://www2.deloitte.com/us/en/legal/about-deloitte.html

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