Healthcare Reform for Aging - Coursework Example

 Aging with dignity: A call for Medicare reform Introduction: Growing old is not easy. A lot of books have been written to challenge the society to look closer at the need of old people. If it is in our power to do something about it we might as well do it, because it could be for our own future as well. According to study 63 % of people that needs long term care are those 65 and older (Rogers & Komisar, 2003). Under the long-term care needs that have to be met are: medical, social, and personal care. These are intended to meet the needs of somebody that has a chronic ailment that limits his ability to perform daily tasks (NASW, 2008). Unfortunately, only rich people can afford quality long term care because they have the means to buy long term care insurance. Medicare does not cover long term care for elderly and not everybody qualifies for Medicaid. Middle class and upper middle class elderly citizens need first to exhaust1 their finances and be declared “low income elderly” before they can qualify for Medicaid long term care which unfortunately offers only substandard quality care 2(Whitaker, Weismiller, & Clark, 2006a). Many of our elderly came from Depression Era, and they have worked very hard to make a decent life for their families, and they saved for their children and grand children. However, when the need for a long term care arises, they are left with nothing. This is completely unfair. What are the steps taken to address this issue, if there are any attempts at all? There is a need for Medicare reform, in order for human beings to retain their dignity while aging. Older People Requires Special Care: Old people have many occurring needs. As people grow old their physical bodies deteriorate and also their mental state. According to the Department of Health and Human Services, the psychosocial long term geriatric care needs are usually overlooked and minimized resulting to decrease of quality life and increased risk of problems (Department of Health and Human Services [DHHS], 2006). Abuse, neglect, and other forms of elder mistreatment; about 1 to 2 million old adults are affected by mistreatment and in every one case reported another thirteen go unreported according to the study (National Center on Elder Abuse [NCEA], 2005). Depression – always associated with late life mental health condition (AoA, 2004), frequently resulting to suicide (National Institute of Mental Health, 2007). Alcohol, drugs, prescription and over the counter medication abuse – common cause of mental and physical problems occurring with elderly men (American Geriatrics Society [AGS], 2005a). Suicide – have a higher completion rates on older adults than overall population (Centers for Disease Control and Prevention [CDC], 2007). Hoarding – common to old people with dementia (Steketee, Frost, & Kim, 2001); it is a threat to people receiving long term care in home based setting (Yagoda, 2003). These behavioral health problems are usually undetected, untreated, and unreported due to the complexity of the geriatric condition and ageism among health care and long term care providers (AGS, 2005a, 2005b). Poverty also affects one of every ten adults within the age 65 and above. These are also unreasonably affecting older adults who are Alaska native, American Indian, Latino, or Black; also women of all racial and ethnic groups are discriminated which all add to psychosocial pressures of aging. This present additional obstruction on accessing long term care services and supports (U.S. Census Bureau, 2007a, 2007b). Medicare: Medicare is a federal health insurance program that includes 65 years old and above, some people who are disabled, and people with end stage renal disease. It was established in 1965 under the Title VIII of Social Security Act (http://qanda.encyclopedia.com/question/medicare-established-132999.html). Medicare covers many serious medical conditions, conditions from which patients mostly recover. However, Medicare does not cover care that is given at home and nursing homes for people with recurring illnesses, and lengthy treatment (http://www.aging-parents-and-elder-care.com/Pages/Medicare.html). Medicare does not offer long term care support for elderly. In order for an old adult to have long term care support, he must buy his own Supplemental Medicare Insurance (Medigap) from private insurance company (http://www.aging-parents-and-elder-care.com/Pages/Medicare.html). Medicaid: Medicaid is a health insurance program designed for low-income people. People of low-income status are: low-income families with children, aged (65 years old and above), blind and disabled people on Supplemental Security Income, pregnant women, and people who have high medical bills. Medicaid was founded as Title IX of 1965 Amendment to the Social Security Act. Funded and administered through state-federal partnership 3(http://www.longtermcarelink.net/). Medicaid Predicament: Congress is anxious about the rising costs of Medicaid which prompted the 1988 legislation aimed at tightening the financial eligibility. The elderly population who are the recipients of long term care is the most affected group; because this is the fastest growing section for disbursement (http://www.longtermcarelink.net/). “In 1993, legislation directed States to implement a mandatory estate recovery program for recipients over age 55, who are receiving nursing home and community waiver care... and in 1998 Congress mandated that States set up recovery service agencies”4.  The most affected group through these legislations is the elderly. The states are not as anxious about it as the Congress. The states view on this matter is that the elderly people, who are receiving long term care, are truly on the breadline by long-term care cost, and to squeeze these people can only increase the burden of overextended family members. The most recent issue was a lost law suit of West Virginia State; the West Virginia Medicaid refused to implement estate recovery rules which consequently made the Feds to withhold the matching funds. The West Virginia State filed a court case against the Feds for withholding the funds but lost the proceedings. West Virginia State is probably representing the sentiment of many states (http://www.longtermcarelink.net/). The sentiment is that elderly recipients genuinely deserve the support and they should not be punished. Many people are not qualified for Medicaid long term care because they have assets that can be exhausted to cover for long term care, and only when they become too poor can they qualify for Medicaid long term care support (Smith, 2009). Again how can this be fair? People who worked very hard in order to have something to pass on to their children will end up losing it all just to qualify for Medicaid. This calls for a serious Medicare/Medicaid reform. Medicare reform talks are aimed at the 47 million uninsured Americans. An article written by Jane Gross 5 in “The New Old Age: caring and coping” says that the elderly group which is already entitled to Medicare according to age and not to the need is somehow being set aside. Even though Medicare pays for the emergency room visits, hospitalization, and surgery and even for the prescription drugs which are all important; it is short on meeting the very important need of the elderly. What old people need are assistance on basic everyday activities such as bathing, dressing, going to the toilet and walking. To be able to live everyday with dignity is the most important thing. Medicare is totally useless on this issue. It does not pay for any long term care for the elderly or they pay attention to this matter (Gross, 2008). The Long-term Care Dilemma: OBSERVATIONS6 (2009) – “Health Care Reform: thinking long term” by Courtney Burke says that Barak Obama’s administration is facing two great policy challenges that are intertwined with each other. One is to reduce federal deficit and the other is the health care reform. To make it even more difficult, what is eating up the federal funds is the healthcare cost which can be traced to long term care. According to Burke in 2005 alone an estimated $207 billion health care costs were consumed by the long term care. These include the nursing homes, services for people with disabilities, home-based services and hospice care. This figure does not include the 70% of care provided for the elderly by families and friends. The high cost of long term care has a tremendous effect on state governments since they are administering and partially funding Medicaid. The following data will speak for itself – “Medicaid funds close to half of all long-term care; only 25 percent of the enrollees receive Medicaid for long-term care but consume over 70 percent of costs” (Burke, 2009). The expenses consumed by the elderly and the disable are around six times of those for children and adults in Medicaid program. With the aging of the baby boomer generation and the deficit of federal funds in connection to high cost of long term care, discussions should be focused on the health care reform (Burke, 2009). Over the years states have been trying hard to find ways to increase the quality of care for the elderly and at the same time reduce its cost. The following are innovations that could serve as samples for nationwide reform: Home and community-based care programs: provide long term care both for elderly and younger people who are physically challenged in their homes and in their communities instead of living in an institution. There has been a shift from institution to home and community based care over the years through “waiver” programs. The policy requires these systems to be cheaper compared to care given in an institution. Incentives could be offered to the states by the federal government to provide care in home and community settings, while on the other hand states could take on reforms aimed at the effectiveness of such care (Burke, 2009). Green Houses – are new method and model of care delivery for individuals who need specialized care. These are designed to cater a much smaller setting, around 10-12 residents compared to the traditional nursing homes which usually accommodates over a hundred residents. The idea behind their name is a nursing home care architecture which includes sunshine, plants, and outdoor places. Studies have shown that this kind of nursing care gives a greater positive impact on the residents. Residents in smaller groups receive quality care due to the fact that the attention given by staff is focused and more personalized. This is a very good alternative, but the states and providers are finding it difficult to finance the building of Green Houses: federal assistance would help (Burke, 2009). Individual’s choice – individuals are being given by many states power to decide over who is going to provide care. This way they can choose less expensive available options that better suit the need of their loved ones, instead of relying on a home care agency. One consumer-driven program that is doing well is known as cash and counseling. Cash and counseling program is successful in terms of meeting health needs as well as meeting the caregiver satisfaction. Studies have shown that these programs did not increase costs to the Medicaid program. The federal government could continue to support the development of these methods of care delivery (Burke, 2009). Programs of All-Inclusive Care for the Elderly (PACE) – through federal motivations, states have also organized programs to better deal with long-term care through what are known as PACE. Continuous care like adult day care; medical care; home health and personal care, including all required prescription drugs, social services and all necessary care are included in this program (Burke, 2009). There is a solution for everything. Federal government and states can work hand in hand in addressing long-term care. The examples are given to show that the federal government can learn and work together with states for the reform of long-term care. The programs are proven quality and cost effective. This is the time that according to The Nelson A. Rockefeller Institute of Government, the public policy research arm of the State University of New York, to stop experimenting and to start adopting proven methods of health care delivery. Improvement is needed especially that the nation’s long-term challenges are to be met in the next decade (Burke, 2009). Conclusion: Old people deserve to be treated with dignity. Aging is not an easy matter. The prospect of one day living in a nursing home and a long list of medical problems are bad enough already for any individual. None of our old folks deserve to be treated unfairly regardless of color, race, or ethnic background. The idea of losing the assets you have worked for so hard in order that you can avail for a long-term care is devastating. This is the time to seriously address this health care gap. None in the present administration seems to address this issue in a very straight forward manner. The call for health care reform is not aimed at the real issue. Talks are just going round about it, instead of dealing with it boldly. If this problem is not dealt with soon enough, the next decade will be grim for our elderly. References: Administration on Aging (AoA). (2004). Aging Internet information notes: Mental health and aging. Date accessed: November 25, 2009 at www.aoa.gov/prof/notes/Docs/Mental_Health.pdf American Geriatrics Society (AGS). (2005a). Substance abuse. Date accessed: November 25, 2009 at www.healthinaging.org/agingintheknow/ chapters_ch_trial.asp?ch=36#top Centers for Disease Control and Prevention (CDC). (2006). Understanding suicide. Date accessed: November 25, 2009 at www.cdc.gov/ncipc/pubres/ Suicide%20Fact%20Sheet.pdf Courtney, Burke (2009) “Healthcare Reform: thinking long-term”. Date accessed: November 25, 2009 at http://www.rockinst.org/observations/burkec/2009-03-health_care_reform_thinking_long_term.aspx Gross Jane, “The New Old Age: caring and coping”. Date accessed: November 25, 2009 at http://newoldage.blogs.nytimes.com/2008/08/25/long-term-care-obama-vs-mccain/ National Association of Social Workers (NASW), (2008). SOCIAL WORK IN LONG-TERM CARE AND AGING: DECREASED HEALTH CARE COSTS, INCREASED QUALITY OF LIFE Date accessed: November 25, 2009 at http:www.socialworkers.org National Center on Elder Abuse (NCEA). (2005). Fifteen questions & answers about elder abuse. Date accessed:November 25, 2009 at www.ncea.aoa.gov/NCEAroot/ Main_Site/pdf/publication/FINAL%206-06-05%203-18-0512-10-04qa.pdf National Institute for Mental Health (NIMH). Older adults: Depression and suicide facts. Date accessed: November 25, 2009 at www.nimh.nih.gov/health/ publications/older-adults-depression-and-suicide-facts.shtml Rogers, S., & Komisar, H. (2003). Who needs long-term care? (Fact Sheet of the Georgetown University Long-Term Care Financing Project). Date accessed: November 25, 2009 at www.ltc.georgetown.edu/pdfs/whois.pdf Steketee, G., Frost, R. O., & Kim, H. (2001). Hoarding by elderly people. Health & SocialWork, 26, 176-184. U.S. Census Bureau. (2007a). Income, poverty, and health insurance coverage in the United States: 2006. Date accessed: November 25, 2009 at www.census.gov/prod/ 2007pubs/p60-233.pdf U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy. (2006.) The supply and demand of professional social workers providing long-term care services: Report to Congress. Date accessed: November 25, 2009 http://aspe.hhs.gov/daltcp/reports/2006/SWsupply.htm Whitaker, T., Weismiller, T., & Clark, E. (2006a). Assuring the sufficiency of a frontline workforce: A national study of licensed social workers. Washington, DC: National Association of Social Workers. Also available online at http://workforce.socialworkers.org/ studies/nasw_06_execsummary.pdf Yagoda, L. (2003). Hoarding in later life: When things start to pile up. NASW Aging Specialty Practice Section Update. Washington, DC: National Association of Social Workers.750 Other Internet Sources: http://qanda.encyclopedia.com/question/medicare-established-132999.html). http://www.aging-parents-and-elder-care.com/Pages/Medicare.html http://www.longtermcarelink.net/ http://newoldage.blogs.nytimes.com/2008/08/25/long-term-care-obama-vs-mccain/ http://www.aging-parents-and-elder-care.com/Pages/Medicare.html Read More