Medicare

Are we ‘Caring’ for Our elderly?

Jennifer

old-manThe forecast for the global care services market by 2022 is $1,012.02 billion. This is due in part to the consistent increase of the elderly population, more susceptible to chronic medical conditions. Most of this money is coming from insurance by Medicaid or Medicare. Figures for 2012 showed that almost 99% home health agencies, 100% hospice, and 96.5% nursing homes were Medicare certified.

With all this expense though, how satisfied are the elderly – and their loved ones who are often left navigating the system for them – with this care? For Joe Cardona who recently helped his elderly father with getting the right health care for dementia, in Florida, the answer would be very much dissatisfied. He felt like the personal touch was completely amiss: “from the moment you visit a facility or communicate with most healthcare providers, it will become abundantly clear that you and your loved one are nothing more than potential clients, not patients.”

From Cardona’s experiences a lot of these issues are due to the immense bureaucracy that he feels is more challenging in Miami and “particularly thorny and difficult to navigate.” He ultimately concludes from his experience with his now late father, “if a society is measured by how it cares for its most vulnerable, then we are an abject failure.”

Perhaps we need to start looking exactly at how “caring” all this money that is being spent, really ultimately is.

 

Unsettling Silver Tsunami Threatens Baby Boomers

Jennifer

Are Nurses the Solution?

A recent report put out by the Institute of Medicine (IOM) – the research of which was led by Dr. Dan G. Blazer, psychiatric and behavioral science professor at Duke University Medical Center – has found that care providers are simply ill-prepared for an aging population it failed to anticipate.  The amount of people who are now living longer, requiring substantially more healthcare – both physical and mental – has been termed a “silver tsunami.”  In addition, it seems like the mental wellbeing of these individuals is gaining even less attention than the already inadequate physical healthcare.

Almost 20 percent of Americans who are 65-years and up, suffer from a variety of mental health issues.  Substance abuse is also an issue, often to do with a declining mental capacity, or the fact that as people age, they cannot tolerate the same kind of medications prescribed to their younger counterparts.  In addition, since there is such a lack of geriatricians in America (see Dealing with an Aging Population) – only one geriatrician for every 2,500 Americans – it is not surprising this is becoming such a widespread problematic phenomenon, especially since the aging population is likely to increase more than double in the next 20 years.

Medicare and Medicaid to Step Up?

So what’s the solution?  Already there is too much pressure on America’s health care systems to further extend themselves to help the aging population and baby boomers.  Yet still, the IOM’s study findings is pointing the finger.  It is calling for these health care programs to “overhaul payment rules” and prioritize care, counseling and other services the aging population they serve, needs.  Currently, this is not the case at all. Indeed, both Medicare and Medicaid do not cover such treatments.  This exacerbates the problem.

But Blazer is insisting that somehow the problem be solved now, or else, the “older population and their extended families will suffer the consequences.”  At the end of the day, the report has called on policymakers to step up and sort everything out.  It was argued that Congress has to provide extra funding to “evaluate, coordinate and facilitate the efforts of health care workers taking on these enormous challenges.”

NICHE to Help Baby Boomers?

A nurse-led program seeking to improve healthcare quality could possibly provide some relief to this issue.  A study – undertaken at Johns Hopkins University School of Medicine – indicated that the Nurses Improving Care to Healthsystem Elders (NICHE) program “could be an effective model for improving hospital quality and safety for older adults.”

Right now, six systems are being investigated by Medicare Innovations Collaborative to test out potential new programs whose goal it is to improve the care for Medicare patients who suffer multiple chronic conditions.  This study would suggest that Medicare is trying to look at how it can help the elderly population more, at least in hospitals, but that is a start.

So what does NICHE actually do?  It offers a variety of tools that can be used to improve hospital care specifically for the elderly population which is much more prone to picking up infections, etc., while they are being treated in these facilities.  It seeks to increase the availability in hospitals of equipment used specifically for the elderly, as well as other resources needed by nurses for treatment.

One of the main priorities of the program is to improve the knowledge base for nurses while encouraging leadership skills.  Hospitals working with NICHE, appoint a Geriatric Resource Nurse (GRN) who leads other nurses on the unit.  The GRNs are given a specialized-education course on how to nurse adults, along with consistent mentorship and support from a full interdisciplinary team.

The Future of Geriatric Care

While indeed this NICHE program is certainly not a solution to the issue discussed above and still much needs to be done, it is certainly a step in the right direction and is indicative of the fact that Medicare is at least on board vis-à-vis the recognition of eldercare in hospitals.

Healthcare Reform

Jennifer

Accountable Care Organization (ACOs) networks (developed through Obama’s Affordable Care Act) are set to have a huge effect on the health care sector and senior housing.  The ACOs comprise: hospitals, long-term care facilities, doctor’s offices and healthcare providers, which, together, have a responsibility toward the quality and care budget of their patients.  The aim is to ultimately save money on Medicare.

Obama’s Healthcare Reforms

Given that 2012 is election year, a lot of people are talking about how Obama’s healthcare reform plans are going to work in practice.  According to Chief Business Development Officer for Pathway Senior Living, Aaron D’Costa, “the overall impact of healthcare reform will affect the [senior care] industry as a whole.”

ACOs focuses on those individuals who are eligible for both Medicare and Medicaid and how best to meet their needs.  If services are provided in a coordinated setting then this could lead to a reduction in costs across the entire system.

Seniors Save Money with Medicare

Jennifer

Now is the time.  For any senior who is supported by Medicare, now is the time to save money as this is the yearly enrollment period for Medicare prescription drug and Advantage managed care plans.  Given that the new healthcare reform law will be changing certain parts of the Medicare marketplace, it seems like in general, this is going to be beneficial for the elderly population.  There have of course been some criticism of the law since it will be decreasing some of the subsidies to Medicare Advantage, looking at the Advantage and prescription drug markets seniors need not worry.

Review Plan Annually

Everyone – no matter what their particular situation – is advised to review their plan on a yearly basis.  But this is especially important for those on Medicare Part D drug plans since there are often very many changes with the price of drugs; or accessing drugs, throughout the years.  As well, one’s own prescriptions often vary during the year so it’s worth looking into this regularly.

But there is no time like the present vis-à-vis starting the process. Experts in the field are encouraging everyone to make their reviews as soon as possible.  Health reform laws are being put into place earlier than expected and thus one should look to enroll ASAP, with enrollment being available from October 15 to December 7.  Look at your options:  traditional Medicare or Medicare Advantage, and then make your decision.  Just remember to look out for ultimately what is best for YOUR personal needs.

Cost-Effective Senior Health Care Under Threat?

Jennifer
Seniors and Healthcare

Home health care in West Virginia could be seriously under threat if government regulation currently under speculation, is accepted.  Over 50 percent of the region’s Medicare Home Health Agencies could very soon be put in the red which could result in a serious addition to patient health care expenditure for the elderly and frail.

But the good news is that there are some government officials who are fighting the proposal tooth and nail. According to an article in Market Watch, US Representative David McKinley has “publicly express[ed] his concern that changes to the home health prospective payment system (HHPPS) could seriously impact home healthcare in West Virginia, having ‘ruinous consequences for patients dependent on skilled home health services and the providers who serve them.’”

The proposal basically sets out further state aided financial reductions on the basis “that there has been only limited change in patient acuity in past years.”  This would be okay had the general situation not changed within the seniors community.  Apparently, health care providers are noticing that there are substantially more patients requiring care these days, and that they are sicker than in previous years.  Thus, increasing the prices for seniors is going to be very detrimental for that community, and, if they don’t receive the care they need, then the kind of situation that will likely arise will be one of them requiring further care at a higher cost.  Therefore, making these increases in price for seniors now, is probably not a financially-sound plan.  The seniors need to be taken care of properly and live out their years in dignity, but this proposal will probably achieve the opposite outcome.