Aging and disability bridging experiments in the U.S.: Progress and challenges

The United States is ten years into a federally mandated long-term care ‘systems change’ requiring all persons with disabilities be offered the option of community-based services and care (instead of institutional care) when medically feasible. While compliance is mandatory, to facilitate development of model practices and programs and adoption of this ‘cultural change’, the federal government has implemented several policy demonstration programs including Aging & Disability Resource Centers, Money Follows the Person and Community Living (formerly known as Nursing Home Diversion). Each of these demonstrations requires organizational partnering across aging and disability entities. While the type, range, and scope of each demonstration initiative varies, there are several fairly universal challenges and opportunities for bridging across them including building sustainable cross-network collaborations, training professionals for new roles, developing information technology systems to seamlessly transfer information to partner organizations, and generating funding streams beyond the grant demonstration periods. To date government evaluation data suggests progressive success in structurally transforming historically aging-only service systems to be better positioned to help persons with disabilities (younger and older) to find and obtain community-based services. However, the nature of benefits available to persons still varies significantly by differing eligibility criteria for supports, services, and care. Additionally, there is currently limited external evaluation of ‘bridging’ programs permitting only a limited understanding of their effectiveness in meeting care needs of individuals. Finally, there remains a need to evaluate ‘cultural change’ to determine if in fact the new structures created through model programs not only modify systems of service delivery but advance greater understanding and appreciation of experiences of aging and disability among practice professionals and larger aging and disability communities.