Transcript Excerpts

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Crisis in the health care industry :
the long term care dilemma

Episode #

53

Show

National #2

Airdates

9/99 - 3/00

(see Programming Schedule for specific airtimes)

PROJECT DESCRIPTION

BWN's Spotlights an issue that touches everyone and helps an HMO (SCAN) get national legislation passed. 

Broadcast Excerpts

This topic is one that touches the lives of everyone in America at one time or another. The issue is Heath Care. specifically, Senior Heath Care. We all work hard each day to ensure a certain level of security in our lives. But as we get older, that perception of security seems to fade as we slip into the realm of "the Elderly". Being a senior gets harder each year as living cost increase without the compensatory adjustments in funds dedicated to health care.

In 1984 congress passed the Deficit Reduction Act or DEFRA, in an attempt to provide further health care benefits and community based long term care services, integrated with Medicare. Hence the birth of the Social HMO program. This variance in the Senior HMO program emerged out of a recognition, on the part of Congress, that the supportive care required by the frail elderly and the disabled was not adequately being covered by Medicare or Medicaid, thereby leaving the burden of such care to fall on family members.

The primary purpose of the Social HMO program is to provide and coordinate additional services as an extension of benefits covered by Medicare and Medicaid, thus helping the frail to live safely and independently in their homes whilst avoiding nursing home placement. In 1997 congress directed the Health Care Financing Administration or HCFA to develop and implement a plan to make this program a viable option under Medicare, as a permanent alternative approach to managed care plans. To date this has not been done.

Interestingly the results of the Social HMO program is one that is responsive to the social, chronic and acute care needs and expectations of seniors and their families, without additional spending by Federal and State governments. Imagine the savings to taxpayers, seniors and their families if more seniors could have access to a benefit package that included long-term care at home.

Although Medicaid is an important safety net for seniors with disabilities, its restrictive eligibility criteria cause most seniors to deplete their life savings in a nursing home. Most people who need long term care prefer to remain at home. Unfortunately without private insurance or public program coverage, the high cost of long-term care is unaffordable for most Americans. Statistics show that 1 in 5 seniors can afford to purchase long-term care insurance, leaving millions of seniors with few or no options.

In 1979, HCFA and Congress came up with the idea of Social HMOs as a solution to the Long Term Care issue. Then in 1997, mandated that HCFA, the Health Care Finance Administration, write a plan to make the Social HMO a permanent option under Medicare & Choice. Unfortunately HCFA has had to postpone the implementation of this plan and in the interim, imposed a 36,000 member limit on each of the 4 operations.

The problem is that the membership has grown so quickly that operations like SCAN will soon be turning down eligible seniors for enrollment as they are fast approaching this limit.

In a recent study by the Harvard Medical School's Division on Aging, in Boston, researchers found that the vast majority of individuals living past 100 years of age experienced good health throughout their lives. The "older you get, the healthier you have been", suggest the Harvard researchers. They report that nearly 90% of these very elderly individuals had continued living independently into their 90's. Business World News has learned that significant declines in independence and health were not seen until the last 10 years, according to the investigators at Harvard. During their 90Ăs and past 100 years of age, in a test rating of functional independence, their ability to perform the average tasks of daily living declined from 89% to 35%, whilst the average number of annual hospitalizations doubled.

In closing, it's seemingly obvious that it's about time the issue of Long Term Care is given the attention it deserves. It's about time that all seniors are given the opportunity to retain their sense of dignity in their retirement years. Having paid their dues to society, contributing to the continuing progression of our Nation, is it not our duty to ensure that we provide the best possible environment for our aged?