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LONG-TERM CARE FOR ELDERLY.
Term Paper ID:25269
Essay Subject:
Examines social, economic, medical, political & ethical aspects of the shift in funding from tax-supported plan (Medicaid) to managed care companies.... More...
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Paper Abstract:
Examines social, economic, medical, political & ethical aspects of the shift in funding from tax-supported plan (Medicaid) to managed care companies.
Paper Introduction:
DELIVERING LONG-TERM CARE FOR THE ELDERLY THROUGH MANAGED CARE
Introduction
Trends in the health care delivery system in the United States are toward a shift in funding of the delivery of long-term Care (LTC) for the elderly from a heavy dependence on tax-supported programs, principally Medicaid, to managed care companies. This trend has become a controversial issue. The issue is considered in this research.
Discussion of the Issue
LTC for the elderly financing in the United States has changed and will change further. These changes will affect the operations of LTC facilities. Funding for long-term care has shifted from an almost total reliance on out-of-pocket spending by fixed-income elderly, to a dependence on tax-supported
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This type of change already isoccurring within the nursing home industry and among some other LTCfacilities. Medical CareResearch and Review, 52(3), 364-388. Rosen, S. L., & Husted, J. E. Long-term care. The issue affects the basic mission ofLTC facilities and the "very definition of institutional care of the frailelderly. A important policy issue is raised by the situation described in thepreceding discussion (Peck, 1996). It is not unrealistic toforecast that a similar fate awaits LTC for the elderly that is funded bymanaged care companies. Residents needing high-tech, skilled, or heavy-dutynursing care bring higher reimbursement than residents needing "custodial"care. M., Fanshel, D., & Lutz, M. As the flow of such patients increases,skilled nursing care is becoming increasingly standard in many nursinghomes. (1997). 69). There is less and less incentive for homes to care for the elderlywho may be very frail and unable to manage on their own in the community,but who are not acutely ill (Collopy, Boyle, & Jennings, 1991). 11). Friedland, R. (199 ). (1994, September-October).Chronic disease and the meaning of old age. If the present pattern ofescalating care continues, it is quite possible that nursing homes will, inthe future, offer very little intermediate and domiciliary care. Health Affairs, 15(2), 17 -184. Medicare could also move toward paying these providerson a prospective basis-"that is, provide a fixed amount to home health-careproviders, regardless of the cost of any single patient's care" (Friedland,1997, p. The average life span in the United States increased from an expected7 years in 196 to 79 years in the 199 s. (Eds.). (1997b). Crist, L. Kane, R. Bureau of the Census. Individuals afflicted with chronic ailments account for approximately1 percent of the American population (Rosen, Fanshel, & Lutz, 1997). New England Journal ofMedicine, 333(18), 1183-1189. Outcomes system implementation forsubacute care. (1996, October). Fiscal Concerns Fiscal constraints have caused the Congress to initiate actionsdesigned to change the Medicare and Medicaid programs as a way to savemoney in the form of federal government expenditures (Ellentuck, 1994). The federalHealth Care Financing Administration has defined LTC for purposes of thefunding of the services. References Aaronson, W. Proposed Health Policy Over the past three years, the managed care industry has rushed in tobecome care providers for both Medicaid and Medicare patients. These changes will affect the operations of LTCfacilities. The agency defines LTC as: "... Ethical decision making innursing. Therefore, persons afflictedwith chronic ailments "require sustained supportive health and socialservices as well as ongoing medical and medically related treatment"(Minahan, 1997a, p. A similar lifeexpectancy increase, however, developed with respect to all age groups inthe American population. In the short run, these limitscould be lowered. in Cf.). Nursing Case management, 2(1), 33-41. Americansociety must decide what is most important: new weapons systems for a fewgenerals and politicians to play with or LTC for the elderly. As theability of the managed care companies to continue to boost profits haswaned, however, an increasing number of managed care companies in 1998 havebegun to drop their Medicaid and Medicare groups. 1996 census test. A. (Ed. If some persons have successfully provided forLTC when they are elderly, requiring them to contribute to a program thatrewards those persons who made no such provisions may be regarded by someas being unjust. B. S. Thus, during any giventime, 15.4 million Americans aged 65 years old or older are receiving LTCof some type. (1997, January-February). Thus, those persons already over 65 years old, onaverage, also may expect to live longer. in Cf.). Effects of market reforms on doctors and theirpatients. Cost containment policies in acute care could in fact transformnursing homes into sub-acute care institutions. A major problem areaconcerns persons over the age of 65 years who require LTC. D. (1995, September).Subacute care, medical benefits, and nursing home behavior. In fact, however, such concerns involve priorities. 39). Evaluation of An Ethical Dilemma Medicare and Medicaid reimbursement rates clearly reflect acute-carepriorities. Bureau of the Census. Such a development would further erode the already thincontinuum of care between hospital care and home care, leaving the healthcare system with few institutions providing assistance in daily livingrather than high-level medical and nursing care" (Collopy, Boyle, &Jennings, 1991, S14). E. health, personalcare, and social services delivered over a sustained period of time topersons who have lost ... (1995, 7 June). Encyclopedia of social work, Vol.2, (27th ed.) Silver Spring, Maryland: National Association of SocialWorkers. (1995)."A trial of annual in-home comprehensive geriatricassessments for elderly people living in community. Medicare: Short-term answers,long-term questions. Minahan, A. (1997). By contrast, however, the ethical principle of justice may not befully served. This pattern ofpopulation change may be expected to continue to 2 3 . Ford, D. Funding for long-term care has shifted from an almost totalreliance on out-of-pocket spending by fixed-income elderly, to a dependenceon tax-supported programs, principally Medicaid. Potential Legal Problems Potential legal problems may arise if the implementation of theproposed policy were to attempt to exclude private insurance and managedcare companies from participation in the delivery of LTC to the elderly.Thus, such companies should be permitted to participate, as long as theyprovide exactly the same service as will be provided by the proposedfederal program and as long as they obligate themselves to cancel noservices as they now are doing with Medicaid and Medicare patients. At any one time, 45 percent of theseelderly individuals require LTC (Minahan, 1997a). (1991, March-April). Sustained supportive services, and ongoingmedical and medically related treatment translates into LTC. Hastings Center Report, 21(2), S1-S15. Nation's Business, 82(2), 78. Beginnings of an integrated deliverysystem. L. Hastings Center Report, 24(5),11-13. Challenge, 4 (1), 3 -45. Therefore, as most of the elderly in the UnitedStates cannot afford the exceptionally high costs of LTC private insurance,a policy is proposed to the effect that LTC for the elderly should befunded through a federal health insurance program that is administeredseparately from either the Medicaid or the Medicare program. Husted, G. With "quicker and sicker" discharges of the elderly fromhospitals, LTC facilities are pressed to provide higher and higher levelsof care, while reimbursement rates favor these levels of care (Aaronson,Zinn, & Rosko, 1995). This situation "serves as an inducement for homes to accept thelarge numbers of high-care patients discharged by hospitals under theconstraints of the DRG system. (1996, June). (1997a). The reason for this situation involves the scarcity of resources,particularly financial resources. 131). (1996, Fall). Allert, G., Sponholz, G., & Baitsch, H. S., & Rosko, M. The health-care levy's impact isdeepened. The "tremendous increase in the number of elderly people over the nextfew decades will be accompanied by an even more dramatic increase in thenumber of old people suffering from chronic diseases and disorders. (Ed. H. The proposed policy described in the preceding section would solve theproblem described above. Collopy, B., Boyle, P., & Jennings, B. Peck, R. The policy proposed also may be seen by some as being fiscallyimprudent. The positive side of managed care isthat such institutions effectively recover the costs of the servicesdelivered. Positions of Parties Involved The Republican majority in the Congress and the managed care industrygenerally favor the trend toward the delivery of LTC for the elderlythrough a managed care regime. The Congress, however, ismoving toward the capping of Medicaid and Medicare expenditures, moves thatlikely will increase the reliance on private-sector insurance to fund LTCfor the elderly (Peck, 1996). The principle of justice requires the fair and equitabletreatment of all persons. Thegrowth rate in the over 65 years old population segment is projected tocontinue to outpace the growth rate for the total population as the "baby-boomer" generation ages. Journal of the AmericanMedical Association, 273(21), 169 -1691. Unlike most hospitals, LTC facilities are paid by Medicaid based onthe cost of providing patient care. Each of these eventualities will reduce the resourcesavailable to LTC facilities. V. There are, however, limits on theamount paid relative to national costs. (1996). (1997, January-February). Kajander, J., & Samuels, M. When for-profit LTC facilities are successful in this typeof marketing effort, the non-profit LTC facilities generally are saddledwith the responsibility for providing health care services to the remainingelderly individuals in society who are least able to fund their own care.The fact that a large proportion of these individuals are not covered byhospitalization or LTC insurance, together with the increasing reluctanceon the part of government to fully fund health care services, places anincreasingly large responsibility on the non-profit institutions (Stuck,1995). One of the potential problems oftencited with respect to the growing role of for-profit LTC facilities in thedelivery of health care services to the elderly in the United States is thetendency for such institutions to target only the most lucrative healthcare business. Chronic ailments and conditions are the primary reasons whyindividuals over the age of 65 years require LTC. Persons aged 65 years old or older account for approximately 13.1percent of the American population. While some countries, such asSweden and Germany, have formulated and implemented effective programs todeal with this problem, others, such as the United States, appear to befloundering in a sea of indecision (Ford, 1996). The total population of the United States increased from somewhat morethan 2 3 million persons in 197 to approximately 262 million persons in1996-an increase of 29.1 percent (calculated from data obtained from Bureauof the Census, 1997, 199 ). (1991). This trend has become a controversialissue. Mosby Co. The expected life span applies toindividuals born in the year for which the statistic is determined-not forthose individuals already in their elderly years. Advocacy organizations for the elderly,such as the American Association of Retired Persons (AARP), and the LTCindustry tend to oppose the trend. 213). St. Considering that 1 percent of the total population, orapproximately 26.2 million persons, are afflicted with chronic ailments,the 15.4 million elderly Americans account for 58.8 percent of thecountry's LTC population. Face of thenation: Statistical Supplement to Encyclopedia of social work, 27th ed.Silver Spring, Maryland: National Association of Social Workers. Journal of Health Care Finance, 23(1), 17-22. Discussion of the Issue LTC for the elderly financing in the United States has changed andwill change further. Census of the United States, 199 .Washington: United States Government Printing Office. Encyclopedia of social work, Vol.1, (27th ed.) Silver Spring, Maryland: National Association of SocialWorkers. Where only 1 percent of the totalpopulation requires LTC, 5 percent of those individuals aged 8 years orolder require LTC (Minahan, 1997b). Most of the 1 percent of the population requiring LTC for chronicailments are elderly (Minahan, 1997b). Future trends in the healthcare economy. While managed care is "hailed by proponents as a means ofconserving health care dollars, many advocates for the elderly and the poorfear that the quality of health care provided to these population groups,and in turn, the quality of life of the majority of the members of thesepopulation groups may deteriorate substantially under a managed careregime" (Aaronson, Zinn, & Rosko, 1995, p. 17 ). Delivering Long-Term Care For the Elderly Through Managed Care Introduction Trends in the health care delivery system in the United States aretoward a shift in funding of the delivery of long-term Care (LTC) for theelderly from a heavy dependence on tax-supported programs, principallyMedicaid, to managed care companies. E., Zinn, J. LTC facilities are being asked to accomplish more with respectto care delivery, while available resources simultaneously are reduced(Crist, 1997). In short,they will be transformed from long-term care homes into long-term carehospitals. This LTCprogram should, as occurs with Social Security, be funded by contributionsfrom all persons during their working years to provide LTC benefits whenthey are elderly and requite such care. Louis: C. Newdirections in nursing home ethics. During that same period, however, the segmentof the population aged 65 years old or older increased by 52.6 percent(calculated from data obtained from Bureau of the Census, 1997, 199 ). This1 percent of the population, however, accounts for approximately 3 percent of the total health care expenditures in the United States (Rosen,Fanshel, & Lutz, 1997). The expected life span forwomen is greater than that for men. The issue is considered in this research. Chronic ailments, incontrast to acute illnesses, cannot be cured. Further, while the 65 and over group is thefastest growing segment of the American population, the 75 and over groupis the fastest growing segment among those persons aged 65 or older(calculated from data obtained from Bureau of the Census, 1997, 199 ).Prior to the 197 s, the 75 and over segment of the population was too smallto merit much attention as a separate population segment. some capacity for self-care. Blumenthal, D. In the delivery of health care services through non-profit or publicsector organizations, it is not always possible to deliver all services, orto deliver specific services at the highest level (Kajander & Samuels,1996). Nursing Homes, 45(9), 53-54. When LTC for the elderly is funded primarilythrough private-sector insurance, LTC facilities increasingly will bereimbursed by managed care organizations. Ellentuck, A. LTC may becontinuous or intermittent. Stuck, A. Providing adequate care for the elderly is agrowing problem in all parts of the world. On the negative side, however, the application of the concepthas the potential to turn a health care institution into an assembly lineactivity, wherein cost accounting will cause the quality of care to suffer. (1994, February). Aleading reform measure for the American health care system generallyenvisions the widespread implementation of the managed care concept (Kane,1995). Ethically, however, this policy would pose adilemma. Washington: UnitedStates Government Printing Office. Minahan, A. Asidefrom infirmity resulting from chronic conditions such as diabetes and heartdisease, the number of people with depression and dementia-especiallyprimary degenerative dementia such as Alzheimer disease, but also vasculardementia and the like-will increase markedly" (Allert, Sponholz, & Baitsch,1994, p. "Long-term care as we know it is finished...." Nursing Homes, 45(6), 67-7 . Publicly-funded LTC facilities may benefit from a managed care"regime; however, patients generally may or may not benefit from changes inphysician behavior induced by the widespread implementation of managedcare" (Blumenthal, 1996, p. On the one hand, the ethical principle of beneficence, as theactions stemming from the policy would do good (Husted & Husted, 1991).Elements of doing what is good include providing treatments andmedications, educating, assisting, supporting competency, kindness, and soforth. It strives to provide care in the leastrestrictive environment" (quoted in Minahan, 1997b, p. Generally, as individuals live beyond the age of 65 years, theyrequire more care and assistance, whether it is health care services orassistance in daily living.
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