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Aging services programming: celebrating 20 years of progress

By Sue Matthiesen, managing director of aging services, CARF International

Note: As part of CARF’s 50th year anniversary celebration in 2016, we will be sharing snapshots of the industries in which we offer accreditation services. This is part 1 of that series.

Sue MatthiesenTwenty years ago, when CARF first entered the aging services field, the percentage of the world’s population ages 60 and older was approximately 9.5 percent. Today that share has risen to more than 12 percent and may reach 20 percent by 2050. The rapid growth of this population—due to the combination of declining fertility rates, improvements in life expectancy, and the aging baby boomer generation—has required a fundamental transformation in how health systems deliver care. This transformation, which is evident in the measurable progression in the field toward integrated, person-centered care, has been the most important narrative I have seen throughout my career.

Prior to this transformation, long-term services and supports had traditionally been provided in a fragmented system with few services for those without family support or financial resources. Before the early 1980s, elders and individuals with disabilities who needed long-term services had few choices other than to live in a nursing home or public institution if they did not have family caregivers. Although there had been a steady shift toward increasing humanitarian standards of caring for vulnerable older adults, there were still many limitations. 

As more people began to live longer, and more importantly live well longer, they necessarily desired more variety in care options that could address their individual needs and preferences. Responding to this rising demand, alternative, person-centered program options started to significantly grow in popularity during the 1980s and 1990s. The number of adult day service (ADS) programs in the United States, for example, expanded so quickly that the development of a system of national guidelines and standards became a national priority for the field. This ADS growth prompted two major events in that timeframe. First, the precursor to what is now the National Adult Day Services Association (NADSA) was organized by the National Council on Aging (NCOA). Second, CARF created ADS accreditation standards based on its existing flexible, community-based framework honed in the medical rehabilitation and behavioral health fields. Establishing these tools for ADS helped reflect and legitimize the quality of the fledgling field in the eyes of consumers, payers, and government agencies, and in turn assisted the continued objective to center more on the individual needs of consumers.

By the mid to late 1990s, the assisted living (AL) field in the United States was also expanding at an amazing rate. AL programs popped up in the 1980s to offer assistance to people who needed help with basic daily needs, but desired a non-institutional, home-like setting in which to receive assistance. These new programs made it their mission to offer individualized activities that were focused on dignity and respect for residents. Riding the same wave of consumer interest in quality of life as the ADS field, leaders at provider organizations in the AL field also turned to CARF to help in this objective.

As alternative service offerings like ADS and AL programs became more commonplace and settled into their missions of addressing both quality of care AND quality of life, the original aging service option—the nursing home—was evolving as well. In 2005 I was excited to work with innovative providers, families, government representatives, and association professionals in that field in what we call the long-term care culture change movement. The entire field was shifting away from its historical institutional practices toward person-centered approaches, and CARF represented the perfect partner to help offer guidance in that direction. I have been proud to watch our resulting person-centered long-term care accreditation standards become the industry standard across the world in how to focus on individual resident rights and maintain positive relationships in long-term care settings.

The transformation over the past few decades toward person-centered care in the aging services field means that, today, there is a greater number of options for consumers than ever before. Yet, in addition to the areas already discussed, the industry continues to grow. We have seen the emergence of home and community-based services, integrated post-acute care networks, and stroke specialty programs. Our understanding of dementia, aging with intellectual and developmental disabilities, and other population-specific behavioral health needs continues to increase as delivery of care is fine-tuned. Diverse service delivery models, including continuum of care campuses, are thriving across the globe. It is an exciting time to be involved in the field.

Although the demographic shift in the aging population and progression toward a person-centered philosophy in the aging service field globally are certainly causes for celebration, these trends still present challenges that require tangible, informed responses moving forward. Environments need to be made more age-friendly to foster independence and engagement, workers and staff need better education and training on specific populations being served, and expertise and best-practice experience need to continue to be exchanged among providers so that the high water mark for quality can rise internationally. Therefore, as we at CARF reflect during our anniversary about the progress made over the past 50 years, we look forward to continuing our work with leaders in the aging services field over the next 50 years as well to connecting best-practice ideas and programs and to developing standards that will enhance the lives of persons served.

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Additional reading

(50th Anniversary,Aging Services)

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