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Pioneering MediCaring Communities — The Time Is Now!

This site reflects the commitment of the Program to Improve Eldercare (formerly Center for Elder Care and Advanced Illness) to encourage communities to understand and improve their own care systems for frail older adults and people with disabilities.

Right now, the United States has an opportunity to redesign its service delivery system to ensure that every frail elderly Medicare beneficiary receives comprehensive, cohesive, and person-centered care when they are old, frail and in need of hands-on assistance. We don’t have to create a whole new health care system to do this, or completely overhaul current programs; we just have to prudently and deliberately modify them to better serve our fast-growing population of frail elders who have ongoing medical and long-term care needs.

The good news is that we can start this work at a community level, by assembling willing coalitions of medical and social services providers, advocates and local leaders, to create a special MediCaring Community program for frail elders. The Director, Dr. Joanne Lynn, and the staff of the Program to Improve Eldercare have done a lot of thinking about how to accomplish this, what it takes to get started, and how much it costs.

MediCaring Communities are organized and tailored to meet the needs of frail elders, just like pediatric practices are tailored to meet the needs of infants, children and adolescents. the. The foundation of MediCaring Communities rests on comprehensive assessment and creation of individualized care plans that reflect the older person’s strengths, needs, and goals, as well as a locally-anchored service delivery system that is monitored and managedto ensure that what individuals in the community need most is available.

We need to get ready! In the next decade, we face burgeoning numbers of dependent elderly and diminishing numbers of family caregivers, most of whom have limited resources for their own retirement. At the present time, we have a dysfunctional health services and delivery system that focuses on short-term outcomes from costly and often ineffective medical interventions and fails to provide vitally needed long-term services and supports (LTSS).

Medical advances and healthier living have given us many more years of life, on average. They have transformed the last phase of life into one in which most people will avoid sudden, fatal events and instead experience gradual onset of physical frailty with chronic disease, and a need for significant long term care for extended periods of disability.

Today, the “care system” we have fails to serve the needs and priorities of frail elderly Medicare beneficiaries. Elders are routinely hospitalized and moved to nursing homes because we have not yet developed sufficiently reliable protocols for serving them at home. Many routinely receive inappropriate medications, or have errors in medications, ill-advised tests, and inappropriate treatments. We often inflict avoidable suffering on frail elderly people, drain their savings, and wear out family members upon whom the care system relies for most personal care and coordination of services.

What can we do to ensure that frail elders can live comfortably and meaningfully?

  • First, the MediCaring Communities program requires that the health care system recognize that the needs and priorities of frail elderly call for a specially tailored set of care arrangements.
  • Second, service providers must work with the frail elderly person and family to create and implement person-centered, forward-looking care plans (following comprehensive assessment) that reflect the medical situation and the person’s life circumstances, along with his or her priorities.
  • Third, often inappropriate, undesired, and excessive medical testing and treatment must be replaced by medical care that is guided by a care plan, with prudent testing and treatment, plans concerning hospital use and end of life care, and support of volunteer and paid caregivers.
  • Fourth, the MediCaring Community would supplement the supply of LTSS and would have a management system, or community board, that sets priorities in terms of the well-being of frail elders in a geographic community.
  • Finally, the local system captures some of the savings from more appropriate medical care and invests it in LTSS, and building the community board that would monitor quality and the adequacy of service supply.

The time has come get MediCaring Community programs underway across the country. We can enable financially sound, affordable, and sustainable programs for frail elders and individuals living with advanced disabilities to be built using current programs and current legal authorities. We can build a tailored care system for Medicare beneficiaries that is cohesive, that reflects individual treatment preferences, and is affordable within the constraints of current financing. Working with pioneering partner communities, the Program to Improve Eldercare is prepared to lead the way in making it safe to grow old during the 21st century.

Communities across the country are already working to prepare to launch these reforms. The time is ripe to join together and ask for the necessary flexibility that waivers can provide and that the Centers for Medicare and Medicaid Services has the ability to grant. Allowing a series of pioneering communities to pilot MediCaring programs would do a great deal to help create a far better care system for our elders – one that frail elderly Medicare beneficiaries will welcome, that communities will take pride in building, and that the country can afford.

We invite you to think about whether you can join our effort. If building a better eldercare system is plausible in your community, city, or county, please let us know. Write to us at [email protected]. We can have what we want and need when we are old–but only if we join efforts and build the future together.


1. U.S. Census Bureau. U.S. Census Bureau, Statistical Abstract of the United States: 2003, Table No. HS-16. Expectation of Life at Birth by Race and Sex: 1900 to 2001. Suitland, MD: U.S. Census Bureau; 2003.

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