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The baby boom generation, by simple numbers alone, will have a dramatic impact on home health services and long-term skilled nursing care.

Mississippi Methodist Senior Services President Steve McAlilly sees tremendous growth in demand for services that will help older adults stay in their homes. The changes, which could create entirely new categories of services, are driven both by consumer demand and economic reality.

"I think it has to happen," McAlilly said. "I don't think our country can afford to provide in-house medical treatment" in nursing homes and hospitals for the baby boomers in the same way it has for previous generations.

McAlilly sees new models of care evolving to answer the needs for older adults. Mississippi Methodist Senior Services was a pioneer with the Green House concept, where the traditional nursing home was broken up into smaller, family-size homes that allow for care and work on a more human scale.

But another new piece is needed to deliver services that allow older adults to remain in their own homes, McAlilly said. One model melds adult day services - which provide the social interaction, stimulation, meals and safe environment - with team-based medical services that stress prevention.

Methodist Senior Services is exploring PACE, or the Program of All-inclusive Care for the Elderly. With PACE, the elderly come for programs and medical care during the day and go home in the evenings.

"The whole goal is to keep them out of the hospital and the nursing home," McAlilly said. "If you do that with early interventions, everyone wins."

These kinds of programs are more cost-effective than nursing homes and hospitals, and elders are happier because they can remain at home.

Developing PACE programs in Mississippi will take significant changes in regulations and medical reimbursement models, McAlilly said.

It should reduce the need for nursing homes, but it won't eliminate it.

"There are always going to be people who need skilled nursing care," McAlilly said.