post from health care student from another university

As a student majoring in health care administration at UW-Milwaukee, I understand how complicated long-term health care can be. Looking at my future career path, medical and health services managers must be prepared to deal with the integration of healthcare delivery systems, technological innovations, an increasingly complex regulatory environment, restructuring of work, and an increased focus on preventive care as the industry continues to rapidly change. Health care administrators are also being looked up to for advice on how to improve the efficiency in healthcare facilities and the quality of the care provided. This puts a lot of pressure on the members in my field to understand the complex healthcare system to recommend the most effective solutions available. Everyone seems to be affected by the regulations put on long-term health care at some point in their lives in some way or another, which is why it is such an important subject to address.

Personally in my family, my grandmother had to go into a nursing home in Brookfield after her second stroke because her boyfriend was no longer able to fully take care of her. Had it not been for medicaid I am not sure how my family would have afforded all of her expenses for the next 3 years. And the service provided was adequate, she was in good hands but I wouldn't say it was exceptional, especially for the price we were still having to pay out-of-pocket. Throughout, my grandmother was never happy there either making it difficult to fully support the staff at the home and their recommendations. She was able to recover enough to live back at her apartment, but now her funds have decreased. Even though my grandma put a good amount aside for retirement during her life, those 3 years cost her most of her savings and I think my family feels that we must be more conservative with her spending.

The CARE system now being proposed does seem to be a step in the right direction. On the other hand, it does seem to be the cycle of life that we must save as much money as possible to end up just spending it all in medical bills down the road. My biggest fear is that as healthcare continues to get more expensive, the money I will save once I start my career and the money out of my paychecks going towards government health programs will not be sufficient enough for even those older than me, and I will then not see a dime of the money I worked to save for my old age. In my opinion, many aspects of long-term healthcare need to be improved and as technology evolves further people will be living longer, and I am not assured right now that there will be enough affordable care for everyone in need.

Post By Patient

Long Term health care seems like a very important aspect of health care that the government often overlooks. To me, it also seems like a huge aspect of long-term health care, is that it provides overwhelming benefits to its patients. This form of health care involves dressing, changing, bathing, and helping out citizens that are not able to do so on their own. It’s also important to realize that this care plan is not simply for senior citizens. If an individual were to be injured or hurt and could not take care of themselves for a long time, long-term health care could definitely be a beneficial option. I think long term health care emphasizes and focuses on the importance of a patients health and comfort, rather then simply a way to treat and dismiss the sick or disabled.

As a patient I can definitely see the two sides of an argument for or against long-term health care. Long-term health care seems to have many pros and cons. Pros to long-term care are obvious. Long-term health care can help provide and pay for a health care that relieves stress and dependence on other family members. It can also assist in choosing nursing homes and providing the quality care a patient deserves. Furthermore, long-term care services can help preserve money and inheritance for family members who would otherwise be paying for their treatment. The cons of long-term care also come in to play when deciding whether a long-term care plan is right for an individual. It seems like long term care plans, have an especially high premium and costs that may be tough for any individual to financially afford. So how does one decide of long-term care should be an important aspect of their health care? Doesn’t general health care provide some long-term coverage for disease or accidents? One question I might have is where long-term health care comes into play for younger individuals that hurt themselves or become ill for a long period of time? Would Medicaid cover this or a long-term care plan? To me it seems like long-term health care should be offered to any individual in the country. Every human being has the right to live and fight for life. It seems like financial burdens should never restrict an individual from being able to live in a place of their choice and at a comfort level satisfactory to the individual patient. I know if I should ever be in a situation where I depend on others for living, I would want the highest quality care possible and I would want to be in a living situation where I was comfortable but not causing a burden for anyone else.

Post by Health Student from another University

I am a student at the University of Wisconsin-Madison and am majoring in Kinesiology. I think the fitness and health and wellness field actually has a unique connection to the idea of long-term health care. As I am learning in classes, some drastic changes in the fitness field are currently underway. The first lady Mrs. Obama just recently started a bill to begin the fight against sedentary lifestyles and the obesity epidemic. My guess is that some individuals who receive long-term care need it because they did not live healthy enough lifestyles. Being a kinesiology major, the current trends and emphasis in the field are in preventative measures and promoting healthy active lifestyles. I’m not sure if this thought process puts me for or against long-term care. I am against it as a fitness major because it kind of seems like a bailout care plan to individuals who did not live a healthy lifestyles and thus are now suffering the consequences. However, I also believe there are many situations where an individual had/has no control over their health and suffered an unfortunate occurrence that leads them to rely on long term care.

Post by a Health Care Professional

Let me introduce myself; I’m a registered nurse of 28 yrs. My professional experience over the years has consisted of home health care, hospital staff nurse, clinic nurse, nursing home care, pediatric care and currently I’m working as a clinic triage nurse in a large pulmonary department. I’ve been asked to share some of my professional insights regarding long-term health care.

Long-term care is and will continue to be a huge health care delivery issue and a huge social and governmental concern.

Availability of quality long-term health care is and will be facing a shortage of professional/licensed/degreed staff and non-professional staff to met the needs of patients receiving care in an in-patient facility and individuals trying to maintain independence in their own residence. The annual income for professional and non-professional health care providers does not attract a high number of newcomers to the field compared to other higher paying jobs. The type of work done by the health care providers is challenging. Many recipients of long-term care require services on a 24-hour basis. This type of work schedule may mean: rotating shifts, weekends, holidays, and on-call availability.

Social and life-styles have changed over the last century. The average life expectancy is longer, extended families live miles away from each other, and medical advancements have allowed patients to sustain life with decreased or changed quality and function. These changes have impacted the long-term care population. In various locations throughout the nation there are specialty hospitals that take on the higher level of 24-hour care often seen in a hospital intensive care unit, called long-term acute care facilities. The specialty hospital that has taken on the responsibilities of providing care for patients on respiratory ventilators, in dwelling catheters, feeding tubes, and with altered levels of consciousness, to name a few of their needs.

Now, on to the expense of health care. This is paramount in the news media and our government. Affordability of health care impacts issues related to long-term care. Many seniors live independently but rely on numerous medications. Most seniors have Medicare as insurance coverage and often will they refuse or decrease the frequency of an essential medication because of the cost. The senior must decide how to budget a fixed income and pay possibly hundreds of dollars per month on co-pay medications. Annually, Medicare changes it’s medication formulary in order to reduce it’s fees paid for medicines, this translates into patients needing to change medications for a certain condition as often as once a year. I’m not sure if I yet understand the Medicare “donut hole” as it relates to long-term medications.

How do we make changes? Honestly, as a long term professional I’m not optimistic. Why and when did insurance companies gain control of deciding about payment for services? Will the insurance company authorize payment for a diagnostic procedure or medication? I’m aware of a Medicare recipient with an immune deficiency that was receiving monthly infusions of gamma globulin to support her health. She changed her Medicare supplemental policy and learned that she is now responsible for 30% of her monthly infusion fee, which is $7000.00. Her decision has been to discontinue the infusion, she cannot afford $2100.00 per month and with her decision her supplemental policy does not have to pay their 70% of the fee. Taking this one situation I ask why does the medication cost so much? How can nationwide health care continue to escalate it’s fees to the extent of having individuals prioritize their health needs? Does health care delivery in the United States of America need improvement? Absolutely. The priority needs to focus on the care, not the cost of the care.

Long-Term Care Reform Proposal #2

Many lawmakers and congressmen are opposed to even confronting long-term care issues.¹ They are making a serious mistake by failing to acknowledge that the chronically ill need a continuum of care that does not come to an end at hospital discharge or when they leave their physician’s office. At the present time, Medicaid is responsible for providing long-term care only to nursing home residents. Furthermore, in 2004, Medicare covered only 13.9% of the cost of care in nonhospital nursing homes². Due to the fact that states are under no legal obligation to provide home care, this assistance is often limited and poorly funded.¹

Congress continues to tackle health care reform, and we believe that any new plan needs to involve a strong long-term care component. Even though many people may be opposed to this idea because our elderly population is still very healthy and independent, there is still an immense need for long-term health care reform. Because of the aging population and the rising cost of health care, states need to search for different ways to increase quality and access while decreasing cost for the older adults and elderly. The primary goals should be higher quality, cost efficiency, and consumer satisfaction.³

Due to the large aging population, the need for long-term care will increase dramatically within the next few decades. For this reason, access to long-term care needs to become more available while remaining cost efficient. Because the elderly population is so large today and their demands are so diverse, we propose that there needs to be a large increase in a variety of institutions in the country. For example, there may be a 65 year old that just needs help getting out of his or her bed in the morning; or there may be a 65 year old with end stage lung cancer that needs to be placed in a hospice care facility. Furthermore, every day we undeniably can see how poor quality increases cost.⁴ For instance, an elderly person does not receive the proper care in his or her nursing home, which leads to skin irritation and a pressure ulcer that eventually sends this person to the hospital. Therefore, each state’s budget needs to take into account the needs of their elderly population and assess this need in order to develop more facilities that provide specific care. An emphasis needs to be placed especially on home health care.

Because our aging population is fairly healthy, many elderly adults want to remain in their home as along as possible to maintain their independence and a high quality of life. The utilization of home health care has declined due to the Balanced Budget Act of 1997, which inflicted restrictions on home health coverage for Medicare beneficiaries.² This act may have controlled costs, but it did not increase quality or access for the elderly. Moreover, home health care is much cheaper than nursing home care.⁵ However, millions of Americans who need long-term care but cannot afford to pay for even home health care, end up spending most of their assets in order to qualify for Medicaid and then move to nursing homes, which are covered by the program. This is incredibly expensive for the government because they pay about 60% of long-term care costs in the United States. Obviously this situation does not benefit anyone because the elderly have to give up their assets in order to obtain health care, which many may not even need to be in a nursing home, and the government ends up spending way more on long-term care.

As a large part of our reform, we propose that both the federal government and each state’s government work with one another in order to incorporate a change in their budget so that both Medicare and Medicaid are distributed better. If the budgets can allow for this type of change, Medicaid and Medicare could allow more money to be put into home health care rather than nursing homes. Consequently, the elderly population would be more apt to paying for home health care because they would receive some money from these programs. Therefore, these changes would decrease cost for both the elderly population and the government, increase access by allowing more people to receive care at home, and increase quality by providing one-on-one care in an individual’s home.

-Kayla Schuster

Sources-

1. Gleckman H. Will Long-Term Care be Included in Health Care Reform? Kaiser Health News. 2009. Available at: http://www.kaiserhealthnews.org/Columns/2009/September/091409Gleckman.aspx. Accessed March 10, 2010.

2. Shi L, Singh D. Delivering Health Care in America: A Systems Approach. Boston: Jones and Bartlett Publishers; 2008.

3. Folkemor D. A Guide to Long-Term Care for Policy Makers: The State of Long-Term Care. National Conference of State Legislators. 2010. Available at: http://www.ncsl.org/Default.aspx?TabId=14491. Accessed March 10, 2010.

4. Smith D. The Role of Long-Term Care in Health Reform. The Heritage Foundation. 2009. Available at: http://www.heritage.org/research/healthcare/tst032509c.cfm. Accessed March 10, 2010.

5. Pickert K. Should Long-Term-Care Insurance Be Part of Health Reform? TIME. 2009. Available at: http://www.time.com/time/politics/article/0,8599,1946431,00.html. Accessed March 10, 2010.

Long-Term Care Reform Proposal #1

Long term care is an important but often overlooked component of health care. Each year, millions of American families are affected by the health care system including long-term care. The main goal of long-term care is to help maximize a person’s independence and functioning at a time when a person is unable to be fully independent.1 Yet, when a person finds themselves in need of long-term care in this country, there is a good chance someone else is making the decisions that affect that person’s activities of daily living such as, the time a person goes to bed and when he or she eats their meals.2 Changes in current health care policies are required in order to maintain a high quality health plan that can reach as many individuals as possible.

Although the United States has not addressed the drastic problems it will soon face in long-term health care, developing a new strategy must become a top priority of the health care reform due to the aging of baby boomers. As the rapidly growing population of people over the age of 75 continues to increase, the need for a stable long-term health care plan is only going to become more pertinent. Unfortunately, many people do not find the need to reform long-term care because their age has allowed them to remain independent thus far.2

Home health care is generally far less expensive then long-term care. The cost of providing for an individual in his or her home requires less medical attention and less medical resources.3 Furthermore, individuals are often more comfortable with home health care because it provides a greater level of privacy. Therefore, for those families with a lower socioeconomic status, home health care may be the best option. However, costs vary greatly depending on where a person lives, the level of care, and the number of hours of services needed per week.4

As a part of our health reform, we propose that the federal government, as well as each individual state work together to implement a change in their budgets and policies to better help guide how Medicare and Medicaid is distributed. By implementing a strategy to re-organize the budget, we hope to increase access and lower costs for long-term health care. Each state needs to adjust their budget accordingly based on an individual state’s elderly population. This plan allows flexibility within states themselves and does not force states into dedicating a set amount of money to long-term health care.

The first step to reorganizing the budget, so that it reflects some positive changes, involves re-structuring Medicaid. If Medicaid put more money into at home care compared to nursing homes, long term care costs would decrease, allowing Medicaid to cover and reach a wider access of people.5 Patient quality would also be projected to increase. Quality could increase as a result of more individuals requesting care at home. Additionally, through home care, families would be present more often and rarely would a patient receive a lack of care due to understaffing. Our goal is to shift costs by providing less funds to people in need of long-term care and increase the funds for those receiving home health care. The costs and revenues saved from this shift as well as the increase access for people to receive home health care would be monumental. The savings built through an investment and emphasis on home health care, would allow a greater spectrum of people to be covered under a new plan. Ultimately this plan gears long-term health care in a direction we think is best. By saving money and cutting costs, this plan hopes to increase the quality of care patients receive while also increasing the number of individuals who have access to quality health care. As many baby boomers have seen through the medical attention given to their parents, the current state of long term health care is inconsistent and does not include the independence and individual care one would receive through home health care.

1. Reed, Charles. "Long-term-care reform must provide consumer choice while saving money." The Seattle Times 20 July 2009. Print.

2. Smith, Dennis. "The Role of Long-Term Care in Health Reform." The Heritage Foundation. 03/25/2009. The Heritage Foundation, Web. 1 March 2010.

3. Planning and Funding Care. Comfort Keepers, 2009. Web. 1 Mar. 2010. .

4. National Clearinghouse for Long-term Care Information. U.S. Department of and Human Services, 30 Dec. 2009. Web. 1 Mar. 2010. .

5. Medicaid: Impact on Long-Term Care. Center for Excellence in Assisted Living, Mar. 2009. Web. 1 Mar. 2010. .

-Natalie Jones

Overview of Long-Term Care

A concerning form of health care is our nation’s long-term care. Long-term care provides medical and non-medical services to those with chronic illness or disability. These services may be community-based assisting with a variety of personal needs such as transportation, meal delivery, and chore assistance. Another form of long-term care provides support to individuals in the comfort of their own homes. Aid with dressing, bathing, cooking, and cleaning may come from family members, volunteers, or licensed health care workers. Moreover, assisted living facilities deliver help with activities of daily living such as eating, bathing, taking medication, and getting to appointments as needed, while nursing home care provides a wide range of attention to individuals that are unable to care for themselves due to physical, emotional, or mental problems. 1

An important aspect of planning for long-term care is deciding how to pay for services. Long-term care is very expensive and generally not covered by Medicare. While some will qualify for Medicaid, most will not. Consequently, the majority of individuals will have to pay for some or all of their long-term care out of personal income and resources. The average cost in the United States in 2009 for a semi-private nursing home room was $198 per day. 2 It is also estimated that providing health care for an older American is three to five times greater than the cost for someone younger than 65. 3 The outrageous cost of long-term health care limits access to those that are able to pay for services.

The number of people 70 and older needing long-term care will increase from 10 million in 2000 to 15 million in 2020 and to 21 million in 2030. As a result, by 2030, the nation’s health care spending is projected to increase by 25%. 3 The current system of long-term care will not be able to handle the explosion of the elderly population. Quality and access to care are sure to decline with the rise of individuals in need of services. The Board on Health Care Services suggests the Health Care Financing Administration and state governments undertake research toward developing an appropriate array of community-based long-term-care services to meet the needs of consumers and assess the quality of the services and outcomes. 4

Poor quality of care has a large impact on the cost of services. According to Dennis Smith, “The journey into the long-term care system often begins with a senior who is on too many prescription drugs becomes disoriented, falls and breaks a hip. A person with a disability who did not get the properly equipped wheelchair is at risk for skin problems that can lead to pressure ulcers and hospitalization.” 5 These situations may be avoidable with a greater emphasis on quality of care.

Younger generations may believe that long-term health care is less important than competing ideas because it does not directly affect them at this time. The truth is long-term health care will be a part of all of our lives at some point in the future, whether it be for our parents or ourselves. In the next 20 years cost, access, and quality are going to be a growing concern in regard to long-term health care. These issues should be addressed now, before we are in over our heads.

Works Cited:
1. "Long-Term Care." Medicare. 03/25/2009. U.S. Department of Health and Human Services, Web. 18 Feb 2010. .

2. "Paying for Long Term Care." National Clearinghouse for Long-Term Care Information. 12/30/2009. U.S. Department of Health and Human Services, Web. 18 Feb 2010. .


3. "The State of Aging and Health in America." National Academy on an Aging Society. 2007. The Merck Company Foundation, Web. 19 Feb 2010. .


4. "Improving the Quality of Long-Term Care." Institute of Medicine. 01/01/2000. Board on Health and Care Services, Web. 18 Feb 2010. .


5. Smith, Dennis. "The Role of Long-Term Care in Health Reform." The Heritage Foundation. 03/25/2009. The Heritage Foundation, Web. 18 Feb 2010. .


- Jade Doro