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? |