As if we needed it, this week has provided yet more evidence that the world of both medical and long-term care services for seniors is changing in profound ways. It is complicated and hard to follow, but the bottom line is this: There will be increasingly less government support for the services frail seniors and their families need. And senior services providers and communities must begin to find new ways to work together to make up for those declining government dollars.

Yesterday, Congress disclosed details of  last weekend’s budget agreement–the one that averted a last-minute  government shutdown. The news could have been worse for seniors’ programs, but it still was not good. Some examples: Compared to last year, funding for senior meals programs was frozen, block grants that fund local non-profits were cut by $20 million, low-income energy assistance was cut by $400 million, the community service program for seniors was cut by $375 million, and on and on.

And those cuts were just a down payment. In a period of severe budget constraints and tremendous pressure from the tea party movement, both Congress and President Obama are moving to cut trillions of dollars more from the federal budget. And many of those cuts will hit the frail elderly and their families. Obama’s speech today was evidence of where the debate is going. House Republicans want to cut $800 billion from Medicaid over the next 10 years. Obama vows to fight them, but he’s proposed to cut $100 billion. Republicans want to abolish Medicare and replace it with private insurance and government vouchers. Again Obama says he’ll oppose this, but he’s responded with his own  plan to cut Medicare by $340 billion over 10 years. The way Washington works, a final agreement (reached probably after the 2012 elections) will split the difference on many of these cuts.

Advocates will lobby hard to block these changes, but as hard as they try, they will not succeed in saving today’s funding levels. It simply won’t be possible. So my advice is for providers and communities to think about new ways to deliver services. Work together to build volunteer networks to provide rides and meals to homebound seniors. In my book, Caring for Our Parents, I describe some of these alternatives–senior villages, intentional communities, non-profit caregiver training programs, and many more.

Some senior living providers are beginning to reach into their communities to help organize volunteers. Hospitals and nursing homes are building relationships with local churches and synagogues. There are lots of creative people looking for new models of care.

Of course, volunteers can’t do everything. Nursing facilities as well as home care nurses and aides have to be paid with real money, and finding ways to replace Medicaid funding won’t be easy. Programs like the CLASS Act are a small start in that direction. But there is much that communities can do for those seniors who need help. There isn’t much time, we need to start now to build these alternatives.