It's no secret that the Baby Boomers are coming to the healthcare system. Numerous estimates put the percentage of the US's elderly (over 65) at approximately 20% by 2015 and jumping to 30% by 2030. In addition, life expectancy is increasing and the nation's elderly over age 100 are becoming more numerous every year. Although the numbers of elderly grow, putting a strain on the healthcare system, the nonelderly population is decreasing, resulting in a severe shortage of direct caregivers. Some might say that this sounds like doom and gloom for the future, but I propose that it is an opportunity that we have not experienced in the history of modern healthcare.
Most of us in healthcare were brought up on the ideals of holistic patient care and the seamless healthcare continuum. Those of us who have been in healthcare for 20 and more years realize that, try as we might, we have yet to achieve that ideal. The coming of the Baby Boomers will force us to revisit our early education and strive again for that high standard. As a generation, the Baby Boomers are well educated and informed, technologically savvy, impatient, and demanding. In other words, they will know what healthcare options are available, they'll research what they don't know, they'll decide what they want, and they'll demand that they get it!! It only goes to reason then that the future of healthcare will be patient centered and much more patient directed. To provide the services that will be needed within the demands of future patients and the financial constraints of the reimbursement systems, the current models of care need to change and thus, the opportunity.
Nothing will be the same in the new world of healthcare. The majority of chronic and long-term care will be provided in community settings; the patient's home will become a primary site for healthcare. Instead of patients being discharged from the hospital to home, they will be "admitted" to their homes for care. Through technological advances, continual remote monitoring and assessment will be performed and interventions made at the time of need. Finally, early intervention and prevention of health crises will become the norm and not just something we talk about at a health conference.
How payors reimburse for healthcare services will undergo yet another major metamorphosis. Several demonstration projects and pilots for outcomes-based reimbursement are already underway in the private and government sectors. This model is based on the "purchase" not of services but of health outcomes. Success will be measured by our ability to keep individuals healthy and in the least expensive healthcare setting. Movement from a less intensive setting to a higher level (eg, home to hospital or nursing home) will be penalized while moving patients from intensive settings to lesser levels (eg, hospital to home) will be rewarded.
Healthcare providers will face dual demands to provide more care coordination and disease management and to design a flexible system to meet the individual needs of the ultimate consumer-the Baby Boomer patient. The focus will be on producing acceptable outcomes while preserving health dollars in the middle of a worker shortage and rising production costs.
The challenges for the healthcare industry will be many; technology is expensive, front-line health personnel are going to be scarce, and change is always difficult. Fortunately for the WOC nurse, our history is rooted in caring for the entire family, using a case management model, and making the most of limited resources. Our goal has always been a return to health, prevention of complications and recurrence, and achievement of independence. I believe the future for the specialty is bright. This may seem to be a mad prediction, but I subscribe to what Miguel de Cervantes (1547-1616) wrote, "Too much sanity may be madness. And maddest of all, to see life as it is and not as it should be!!" The challenge to my fellow WOC nurse colleagues is to start seeing life as it should be, not as it has always been.
"Care coordination" is just another way of saying "partnering with others to take advantage of unique skills to achieve the best outcomes possible." The question isn't: "Who's turf is this?" it's "Who can achieve the best overall outcomes?"
The luxury of staying in one setting and having the patient come to us is also soon to end. The new patient will demand our services in the setting of his or her choice and the payors will insist that it be the least expensive setting. Flexibility is the key, and mobility is the solution.
If you are not practicing evidence-based care and documenting valid outcomes, you are almost too late. Anecdotal success will hold no credibility in the healthcare future. No one will be able to afford the financial risk of employing services without proven outcomes. Lest you think this a new concept, I recall having these same discussions early in my WOC career (some 20 years ago!!).
Furthermore, if you are not embracing technology and incorporating electronic communication and remote monitoring in your practice, you will need to run to catch up. The reality is that you are too costly to have at the bedside or home of every patient who will need your services. Success will be defined by being at the bedside or home of the patient who specifically needs your hands-on care when that patient needs you-not when it fits into your schedule. Otherwise, your value will be in the remote assessment, coordination of care, and communication to other members of the healthcare team.
Yet, change is difficult. I truly want to empathize with you as we move into the future together, but I can't. The truth is that we have been talking about this for 20 years. It is time to take control of our role in the future of healthcare. With all its challenges, the future is bright. For those who can see life as it should be, there is no limit to the possibilities. For those who can't move beyond the bedside, the Baby Boomers can use all the direct caregivers they can get!!