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March 2014 Brief: Volume 21, Number 9

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Iowans Want to Age in Place


by Shawn M. Zierke


By 2030, there will be a dramatic shift in age demographics across the population in the U.S. and in Iowa.[1] Simply put, our nation is aging at a dramatic rate, just as it grew at a dramatic rate between 1946 and 1964 with the birth of the Baby Boomer generation. Currently, Iowa is ranked number one for the highest percentage of population over age 85 in the United States and number four for population over age 50.[2] Iowa is an aging state, and this trend will persist for the foreseeable future. The issue of how best to offer lower-cost health care with better health outcomes in the patient-preferred setting should be at the center of all aging and health-care policy for years to come.


In order for Iowa to meet the needs of its growing aging population and to combat the rising cost of health care in general, understanding of the current health policy landscape and the opportunities to improve care delivery in both a cost-effective and beneficial manner in the patient-preferred setting should be at the center of the majority of policy considerations for the Iowa Legislature and Governor. Policy decisions should be aligned with patient-centered needs. Iowa has an opportunity to lead the way with innovative strategies related to care delivery to rural elderly through more efficient utilization of existing systems — both our health-care and educational systems.


Access to long-term services and supports (LTSS), such as those provided through the less costly and more desired home and community-based services (HCBS) will need to increase. There is a 40-year history of the evolution of both health care and payment policies related to LTSS and HCBS, which is outlined in my Policy Study. In addition, an understanding of the needs unique to Iowa’s Baby Boomer generation is integral to policy formation related to both care delivery and payment models.


It would be better for each of our individual states to work toward crafting comprehensive systems that provide LTSS that also allow older adults to remain in their homes as long as possible — to “age in place,” regardless of their health status or age. According to the Iowa Department on Aging, 93 percent of Iowans age 50 and over desire to “age in place” and receive care in their home.[3]


The nursing home industry has an opportunity to adapt and realign its business model to support the policy goals of lower-cost care with better outcomes in the patient-preferred setting. Typical to Iowa is that nearly every small town has a little care center out at the edge of town. We have all heard the story of the retired farmer and his wife who moved to town because they now have health conditions that make it difficult to remain in their home without assistance. They are moved to the nursing home to receive that care because other HCBS options in their little rural Iowa town are limited.


The nursing-home industry should consider converting a wing of their care facility and turning it into an adult-daycare program or applying to be a Program of All-Inclusive Care for the Elderly (PACE) site as they coordinate care with local primary care providers or regional Medicare accountable care organizations (ACOs) and the statewide Medicaid ACO. They should invest in some small vehicles and additional telemedicine equipment and send their Certified Nursing Assistants (CNAs) and Registered Nurses (RNs) out into the community to provide HCBS and fill these gaps in needed services. They will still be able to bill Medicare and Medicaid and other private insurance as they have been, but the types of services they bill for may change.


Students attending community colleges or universities often come out of their programs without any practical experience in their new field. By requiring just three service-learning credit hours for all students in various curriculum programs, the needs of rural elderly could potentially be met at a tremendous overall social savings. A program that utilizes student labor in coordination with an ACO based in a hospital system could supply the trained and precepted labor force needed to carry this out. Iowa has an opportunity to lead the way in health-care reform and educational innovation by merging these two sectors, allowing for “those in the spring of their lives to serve the needs of those in the autumn of theirs.” Both an increase in better health-care outcomes and a reduction in the “brain drain” problem in Iowa are possible with just such an innovation as is proposed here.


If nothing else, a demonstration project in one area of Iowa could give important feedback on whether or not such a program could be successfully implemented and create a win-win-win situation for the state’s budget, the patients who want to “age in place,” and the students who would gain valuable real-world experience to help them secure paying positions in our expanding health-care sector of the economy. This is a good idea whose time has come. It deserves a try by our politicians and health-care educators and administrators.


Public Interest Institute’s POLICY STUDY, Iowans Want to Age in Place, can be viewed at


[1] US Census Bureau. State Population Profiles. <> accessed 3 March 2013.
[2] US Census Bureau. Resident Population by Age and State. <> accessed 09 September 2013.
[3] AARP Research & Strategic Analysis. “Voices of 50+ Iowa: Dreams and Challenges.” AARP. Report number: <, 2011>.


Shawn M. Zierke is Interim Executive Director of Iowa Counties Public Health Association. Contact her at


Permission to reprint or copy in whole or part is granted, provided a version of this credit line is used:"Reprinted by permission from INSTITUTE BRIEF, a publication of Public Interest Institute." The views expressed in this publication are those of the author and not necessarily those of Public Interest Institute. They are brought to you in the interest of a better-informed citizenry.




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