Talking Heads, Josefina Carbonell, Independent Living Systems, LLC

9 min read

Josefina Carbonell intended to follow her father’s footsteps and become a civil engineer or accountant. Instead, her career path took a different turn as she became actively involved as a United Way volunteer helping elderly Hispanics acclimate to their new lives in the United States.

Her devotion to helping seniors for the past 45 years has led to an extraordinary career in public service and made her a leading voice in the aging community.

In 1972, while still a college student, she co-founded Little Havana Activities and Nutrition Centers (LHANC) of Dade County, Inc., today the largest aging, health and nutrition services program in Florida for older Hispanics. She served as President and CEO of LHANC for the next 29 years, until, in 2001, she was appointed by President George W. Bush as the Assistant Secretary for Aging at the U.S. Department of Health and Human Services (HHS). During her tenure from 2001 to 2008, Carbonell played an instrumental role implementing a prescription drug benefit, known as Medicare Part D, and other programs benefiting seniors and caregivers.

Today, she serves as Senior Vice President of Long-Term Care and Nutrition at Independent Living Systems, based in Miami, Florida. Working in partnership with health plans, providers, hospitals and community-based organizations, ILS provides managed care services aimed at improving health outcomes and reducing costs.

Tax Credit Advisor interviewed Carbonell to learn how ILS’ services can benefit owners and managers of affordable senior housing and what other trends she is seeing in the healthcare marketplace.

Tax Credit Advisor: What in your background inspired you to choose a career path working with America’s aging population? 

Carbonell: I was born in Cuba. When Castro came to power, my family moved to Florida, and we became “native Floridians.” I ended up in the world of public service by happenstance through United Way of Dade County. I volunteered at a kidney dialysis center at Jackson Memorial Hospital working as a translator for Hispanic families. I did not think I could handle it, working with critical patients, their caregivers and family members, but I ended up with a huge elderly patient base. Then in 1972, Miami became a hub for United Way’s relief efforts to assist victims of the earthquake that hit Nicaragua. I worked with an incredible group of volunteers, most of them elderly. Afterwards, we started meeting socially and I went to United Way and said, ‘These people really want a place to interact. Wouldn’t it be nice to create a Hispanic Center?’ We applied for, and received, a grant for $50,000 to create a social program that helped senior Hispanics navigate their new lives in the United States. Little Havana Activities and Nutrition Centers was formed from that seed money and the grand opening was attended by then-Secretary of Health, Education, and Welfare Casper Weinberger. I later interned with Senator Claude Pepper, one of the founding fathers of aging policies in America, who was hugely influential in helping me understand public policy as I grew Little Havana.

TCA: Explain how ILS’ services help family caregivers and seniors who need access to affordable care?  Do you operate nationally or select regions?

Carbonell: ILS operates nationally and in Puerto Rico and Hawaii. The headquarters are in Miami, but we have offices throughout the country. The scope of the work we do is focused on high-risk individuals living with chronic conditions that necessitates social or health intervention to support them. Technology helps us manage the long-term care needs of our members – the elderly, disabled and those with special needs – by creating a support network that assists with coordination of care. This is critical because healthcare has become a fragmented system. We help people navigate their long-term care or disability needs. Technology provides a connection behind the scenes, so that, for example, a doctor can see when a patient needs access to transportation services, or when a patient needs to be rehabilitated that someone coordinates that care, so that people do not fall through the cracks. Technology creates administrative efficiencies, but there are personal applications as well. When I worked at HHS, we funded a project that tested smart phone capabilities. We learned that phones could send alerts as someone approached the front or back door, or could monitor a person’s movements, or if they had fallen or not woken up. The most important use of technology for the work that we do is to provide assistance, supports and tools, so that elderly and disabled persons, and their caregivers, can manage their chronic conditions more independently.

TCA: How can owners and managers of affordable senior housing access this technology so they can provide better healthcare services for their tenants? 

Carbonell: Seniors who are on Medicare or Medicaid are entitled to a range of benefits, but because they do not fully understand them, they leave benefits on the table that go unused. Property managers should understand their tenants and help them access these benefits, identify available healthcare providers and understand their functional limitations, if they have any. And they should know who the case managers are in the community who can coordinate healthcare services. In partnership with our health plan clients, we currently serve about 3.1 million individuals. Property owners and managers can work with us to provide services that those members are authorized to receive. So we can deploy them as needed to your tenants. There may also be investment opportunities, where housing developers share in the risk of creating onsite facilities for doctors and other healthcare professionals. Housing developers and managers do not know how to provide healthcare services, but we do. Matching our capabilities with those of housing owners and managers is where I see opportunities.

TCA: Aside from your services, how can property owners be incentivized to work with caregivers and community organizations to expand healthcare services for tenants?  

Carbonell: I see opportunities for developers who embrace the Aging in Place movement. Many seniors in rural America live 20 to 30 miles away from the nearest medical services. Americans are much healthier today but when chronic conditions set in, individuals who lack access to local supportive services will wind up in nursing homes for the wrong reasons. Building housing near families and near clusters of services is critical, or better yet bringing the services directly to the residents. Home-based care is the wave of the future. People want to remain at home for as long as possible. It is about identifying the services that your tenants need, and are eligible for, and then bringing those services to them. As examples, under my tenure at HHS, we implemented a demonstration program called Money Follows the Person, which helps older adults or persons with disabilities move from institutional settings back into their communities. We also implemented the National Family Caregiver program to provide relief and support to family caregivers in every single community in this country.

TCA: Will repeal of the Affordable Care Act impact access to healthcare services that seniors need? 

Carbonell: As it concerns seniors, disabled, and those with special needs, Medicare and Medicaid will continue to be the core programs of HHS. Medicaid alone is the largest healthcare delivery system in the country and that is where most elderly people are covered. It is estimated by Health Management Associates, a leading independent national research and consulting firm that we work with, that in less than five years, 60 to 70 percent of the population will be covered by public programs, like Medicare and Medicaid. The aging of the U.S. population warrants further intervention to help prevent people from getting sick and identifying chronic conditions as early as possible that can be prevented, taken care of and managed more effectively. Senior healthcare and long-term care services, whether it is a long-term care policy, a long-term care benefit added to Medicare, the creation of tax credits, or some other funding vehicle for elder care, is going to be critical for the United States.

TCA: What trends are you seeing right now in the healthcare marketplace since the election?

Carbonell: There is a lot of anticipation and nervousness, not knowing what to expect. The incoming administration needs to pay attention to the retirement of the Baby Boomers, high healthcare costs and embracing preventive care. The healthcare marketplace is doing its part by reducing rates of re-hospitalization and ensuring that once people are discharged they receive proper care and nutrition. It is about helping educate people about buying healthy food, even though they may be on food stamps. That is the kind of stuff that the healthcare marketplace is looking at. It’s not just about reducing costs, it’s about incentivizing the healthcare and long-term care system to work together in a more integrated fashion, so that people don’t fall through the cracks. Healthy aging and the role that housing plays with the aging of America is a phenomenon that will continue no matter who occupies the White House.

TCA: You spent eight years as Assistant Secretary for Aging at the Department of Health and Human Services. What are you most proud of during your tenure in public service? 

Carbonell: The implementation of a prescription drug coverage benefit under Medicare was extremely exciting. It was not as big as the Affordable Care Act, but it created an additional benefit for 42 million Americans. Another achievement was the rebalancing effort under the Money Follows the Person program, which allows federal benefits to follow a beneficiary no matter where they live. It brought services back into the community so people could access them from home, rather than an institutional setting. We created a nationwide network of Aging and Disability Resource Centers that today serve as single points of entry into the long-term services and supports system for older adults, people with disabilities, caregivers, veterans and families. We also started using science to help us determine how to pay for services and maximize health outcomes. I am most proud of being given the honor to serve my country in an area that I have spent most of my entire adult life.

Darryl Hicks is vice president, communications for the National Reverse Mortgage Lenders Association and a 24-year veteran of associations managed by Dworbell, Inc., the management company of NH&RA.