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.
Awesome story!!! Thanks for sharing!
ReplyDeleteThat story is probably true of a lot of elderly patients. People should not have to put their health aside because they cant afford to keep up with the costs of maintaining it. The condition this patient suffers will only get worse without medication and will most likely lead to a more severe, more expensive condition that we, the well insured, will end up paying for in the long run if the patient cannot. In this case, we all lose. Why not lower the costs of medication or better the coverage so that everyone wins?
ReplyDeleteI think stories like these are not told enough. So many patients forgo care because it's so expensive. Thanks for sharing your story as a health care professional.
ReplyDeleteI like the last comment you made, "the priority needs to focus on the care, not the cost of the care." My question is, how do we go about doing this? As health care providers we can put all of our focus on the quality of care we are providing however the looming cost is still out there.
ReplyDeleteI was a CNA for a couple of years and I agree, the work is not attractive. I will say, the residents of the nursing homes make the job well worth it.
ReplyDeleteWe hear these types of stories all too often. People are constantly forgoing treatment or medications because they cannot afford them. This is not only an issue when it comes to long term care, it is and issue for all of us.
ReplyDeleteThank you for authoring on this blog. I appreciate your thoughts about improving health care and hope you will comment on other postings in this blog or other blogs about health care.
ReplyDeleteI really agree with the other comments--thanks again.