The dramatically increasing prevalence of elderly persons disabled by conditions associated with aging could motivate reexamination of service delivery and financing for this population, seeking quality, reliability, and efficiency. Research and innovation have established many components of effective reforms, such as patient-directed care planning, encouragement of volunteer networks and family caregiving, mobilizing services to the home, adhering to patient goals and priorities, limiting poly-pharmacy, reducing the risk of falls, and providing adequate support services for people with disabilities. However, none have become widespread and rarely, if ever, are all of the evidence-based improvements available to a particular disabled elder. This essay argues that reform for disabled elders should be anchored in geographic communities, with a new organizational entity having responsibility for measuring performance and implementing improvements. This entity would use data and public input to set priorities, test improvement strategies, and take steps to assure adequate workforce and service supply. In this MediCaring Community, sustaining finances could come from local taxes or capturing the savings in Medicare that arise with optimal comprehensive services. Generating a new structure to monitor and manage eldercare services for a geographic community would be readily accomplished in some communities and would be worth testing.


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pp. 519-529
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