The Importance Of Health Care Among Elderly Americans

and skilled nursing facility (SNF) care. Mrs. Zwick spent five inpatient days in the hospital and

Current numbers show substantial growth from the eighties, and estimates suggest that the demand for long term care among the elderly will more than double in the next thirty years. (Feder, Komisar, and Niefeld) This growth will exacerbate concerns about balancing institutional and noninstitutional care, assuring quality of care, and most importantly adopting and sustaining financing mechanisms that equitably and adequately protect the elderly who need long-term care.

As we become older, issues with our health begin to take affect and finding ways to fund for that care is becoming even more difficult. In the article “Some Elders Must Take Drastic Measures to Obtain Long-term Care”, national magazine journalist Mary A. Fischer (2011) states that many Americans must face demeaning and disempowering choices in order to qualify for Medicaid or Medicare—federal funded health insurance programs— such as refusing to pay for a spouses institutionalization, divorce, and spending down assets. The author argues that these choices leave the healthy spouse with decreased funds to plan for their own retirement expense (Fisher, 2011). Working in the health care field for 4 years, along with my family’s own personal experiences I can relate to this article, since I have seen a variety of ways that federal funded health insurances have been unable to meet the expectations and demands of its beneficiaries.

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

Many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status then the care should be provided and is covered by Medicare.In fact, patients often receive an array of treatments that don 't need to be carried out by a skilled nurse but that may, in combination, require skilled supervision.Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will

Medicare part A is hospital coverage for inpatient hospital stays. More specifically, Part A is coverage for critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals. Part A also covers inpatient care in a skilled nursing facility (not supervisory or long-term care), hospice care services and some home health care services. Inpatient care in a Religious Nonmedical Health Care Institution is also covered. In the scenario provided, Mrs. Zwick is admitted to the hospital as an inpatient because she had a stroke. The patient was deemed by the physician to need continued treatment after discharge due to the patient 's condition and was discharged to a skilled nursing facility.

There is also something known as the coverage gap. For some plans, a patient can reach a

“Starting in 2009, Medicare, the US government 's health insurance program for elderly and disabled Americans, will not cover the costs of "preventable" conditions, mistakes and infections resulting from a hospital stay. So for instance, if you are on Medicare and you pick up a hospital acquired infection while you are being treated for something that is covered by Medicare, the extra cost of treating the hospital acquired infection will no longer be paid for by Medicare. Instead, the bill will be picked up by the hospital itself since the rules don 't allow the hospital to charge it to you” (Paddock, 2007).

Benefit provisions vary from one state program to another, but federal guidelines require all states to provide a minimum benefit package, including hospital inpatient and outpatient care, physician care, and many other services. In the area of long-term care, all states are required to pay for nursing home care, and they must also pay for home healthcare for those who are “nursing home eligible” which are those who would need nursing home care if they did not receive home care. And although federal guidelines do not require it, an increasing number of states also pay benefits for home and community-based services. These services may include personal care, home health aide services, rehabilitation, therapies, intermission care, homemaker services, and other services. In addition, a few states pay for long-term care services received in an assisted living residence. Unlike Medicare, with its highly restrictive conditions for payment of nursing home or home care benefits, Medicaid generally meets the need for long-term care (for those who eligible). Medicaid pays benefits for personal and supervisory care even if skilled care is not needed, and the program covers ongoing care needed to cope with a chronic impairment, not just care required for a short time to facilitate recovery from an acute illness or injury. However, there are some important limitations to Medicaid long-term care benefits: (1)

Medicare has been the traditional health care insurance for the elderly. Medicare was never designed to pay for long-term care and custodial services. The limited scope of Medicare coverage is a problem now and will be a greater problem in the

Although nursing homes are here to stay, frequent illness and hospitalization that exist because of a lack of primary prevention in them require unnecessary healthcare costs (Graverholt, Forsetlund, & Jamtvedt, 2014). This problem stems from a downward spiral: As the seven dimensions of health lower from a societal neglect of primary care, susceptibility to illness becomes higher, and the toll illness takes on the patient drives his or her health even further downward. For example, Jim, my uncle, was paralyzed, transferred to a nursing home, and then hospitalized within a week for pneumonia. Immediately after, he was diagnosed with MRSA, transferred to a different nursing home, diagnosed with depression, and hospitalized within three months for a kidney infection. Now he is still in the hospital awaiting another stressful transfer. In the long run, this preventable hassle actually drives up U.S. health care costs by spiking future chronic disease. Patient quality of life also suffers. (U.S. National Diabetes Education Program, n.d.)(Ornish, 2010). Thankfully, etiological risk factors of health deterioration, also defined as causative factors of preventable patient quality of life decline, have been investigated for nursing home residents. Unsurprisingly, the main

Medicare Part A hospital insurance is normally provided for free of charge to individuals, whose ages are 65 and older or have a disability. Each benefit period begins the day Medicare beneficiaries are admitted to the hospital and ends when those individuals have not been hospitalized for a period of 60 consecutive days. When Medicare beneficiaries are first admitted to the hospital, they pay an initial deductible of $1316. From the 61st through the 90th day, they are responsible for a copay amount of $329 per day. After the 90th day, they will pay $658 per day for 60 additional lifetime reserve days or can opt to pay the 100percent of charge and continue to reserve the 60 lifetime days. If there are more than 60 days between a discharge and a following readmission, a new benefit period starts with the same $1316 deductible and coinsurance. Moreover, Medicare beneficiaries may be eligible for skilled nursing facility benefits after being hospitalized for more than 3 days and when the skilled nursing facility admission begins within 30 days of the hospital discharge. In that case, the beneficiaries owe nothing for the first 20 days and are responsible for $144.50 per day from day 21st to day 80th. The beneficiaries are obligated to pay all cost after 100 days. Home health services are covered 100percent by Medicare if beneficiaries are confined at home; however, they have a 20percent

In the event that a nursing home is needed, Medicare will cover a limited number of skilled care for rehabilitation or post hospital stay. Those that need to remain in the nursing home level of care are often forced to pay out of pocket using up any resources they may have had,

The growing concern regarding the financial security of Medicare is one of particular interest to the nearly 72 million baby boomers that become eligible for this government-assisted, and tax-payer bolstered, program over the next two decades. According to the U.S. Census Bureau (2010), there will be a rapid increase in baby-boomers between 2010 and 2030, as the entire baby boomer population move into the 65 years and over category (p.3). Political and financial revisions must be made to ensure the security of Medicare as the numbers of individuals paying into this program are soon to be surpassed by the number of individuals drawing-off this program (U.S. Census Bureau, 2010). The elderly are also at a disadvantage with transportation to health care visits, picking up prescriptions, and rehabilitation services. There needs to be an establishment of access not only to primary care providers, hospitals, and rehabilitation services, but access to other aspects of the health care system for the elderly population.

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.