Service and Support for Those Who Want to Stay Home

Source: AARP.org

Making the decision to remain at home as one ages, especially if diagnosed with a chronic illness, is becoming difficult. Not only does the “medical system” appear to be better prepared to institutionalize older Americans, but financing practices seem to lean toward placing people in the hospital rather than enabling them to receive care at home.  

AARP conducted a long term care survey in December 2007 and learned that 85 percent of older Virgin Islanders say that it is important to them to remain in their homes as long as possible even if they had to contribute more to the cost of their care. Although they indicated that home care services existed in the community, fifty percent of respondents said they had problems finding appropriate care when needed.

Long-term care statistics indicate that 75 percent of Medicaid’s spending pays for nursing homes and assisted living facilities while only 25 percent goes towards home and community-based care. Clearly, it’s unusual for so little money to pay for home-based care despite the fact that most people say they want it. These statistics indicate a serious lack of choice for those wanting to stay in their homes.

Even more disconcerting for people who want to receive care at home is that the high cost of care eventually becomes the family’s burden. This cost is generally not covered by private health insurance or Medicare and for the most part, these services are commonly provided by unpaid family caregivers or are paid for out-of-pocket. Only after a family spends itself into poverty, can the patient possibly qualify for Medicaid coverage.

Perhaps one reason why the ‘current system’ leans toward the institutional route may be explained by the disjointed care that individuals with chronic illnesses often receive. This approach involves seeing numerous doctors, taking many medications and receiving a wide variety of services with little coordination. Receiving fragmented services this way, may lead to patients risking medical errors, duplicative tests, unnecessary hospitalizations and potentially harmful medication interactions. Experts say that disjointed care drives up out-of-pocket costs because patients often end up spending more time in the hospital or requiring more frequent home health visits. In 2005, it was reported that Medicare spent $12-billion on unnecessary or potentially preventable hospital readmissions. 

The advent of health information technology (HIT) and electronic medical records (EMR) will reduce the disjointed nature of patient care. These new systems will help individuals wanting to receive home care by streamlining the process. HIT will become the medical community’s version of electronic communication where each patient will have an accessible EMR. Under this system, health care providers will need to have their patients’ authorization to access their medical records. Once authorized, providers will be able to monitor all care, tests and medications, completely eliminating the concerns that exist with disjointed care. By reducing medical errors, drug interactions and unnecessary duplicate procedures, home-based services may actually become a viable option for patients.

Research and ask about long term care. We must all prepare not just for aging, but unplanned long term health care needs.

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