The Importance Of Strict Eligibility Requirements With Long Term Healthcare

1. Home Healthcare Case: Given what you have learned about the accessibility and financing of home care services, are such services as readily available to other consumers as they were to Joan and Jerry? In this particular case regarding Joan and Jerry, and the availability of home health care services compared to that of others is a quite simple. Lack of knowledge and understanding is of the utmost detrimental in medical terms due to the fact that there are many programs that are available to help those with disabilities or home bound. In this case, perhaps Joan and Jerry 's daughter should have been more involved with the medical needs of both her parents. Especially due to the age of her father who was in desperate attempt to keep his disabled wife comfortable in their home. Home health care services are readily available to covered members of Medicare/Medicaid or other third-party payers. Although in Joan 's later days of life, her medical needs were being attended to by home health care professionals, perhaps her life could have been extended and foreseen medical conditions that could have prevented another stroke. "Being an informal caregiver plays a huge role in providing care and relief to long-term consumers (Pratt, 2010)." If Jerry would have taken advantage of home health care and it 's available services at an earlier stage, then perhaps he would not have to have had a hip replacement by having more rest to take care of himself. "As with other forms of long-term

Germany’s healthcare system is split into two types of coverage which is public and private health insurance. Health insurance companies are not able to deny people coverage due to pre-existing illnesses or to discontinue their treatment because of high costs. The public health care insurance is provided by statute to individuals who are not eligible for private insurance which is people who are salary and make under $50,000 annually. As people age and become ill, they are able to opt out of their insurance and turn to the government’s option. As the economy continues to fluctuate, the population of Germany relies more heavily on the legislative insurance which consists of 85-90% of the population.

The challenge America now faces is the number of people reaching retirement will double in number by 2030, and the U.S. population will increase almost 20 percent ("Our Aging Nation," 2015). The goal is for the elderly to maintain and live with independence and dignity, as well as, provide a wide range of professional health and social service expertise, home care, and residential support and services that will be needed ("Our Aging Nation," 2015). Since the number of caregivers needed for this population will not be able to meet the demands other resolutions are considered necessary.

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.

Our elderly population is living longer than ever before and not all of them are entering into a nursing home. They are choosing to stay in their own home or their caregiver is choosing it for them. Some caregivers are choosing to move their ageing love one in the home with them. Whatever the case may be, there is an increased need for some type of home health as it applies to the elderly population. “Medicare will pay the full cost of professional help only if the physician

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)

In the fiscal year 2010, (O’Shaughnessy, 2012) only about 5.1%, or 3 million people, out of the 57.8 million people age sixty and over, received services funded by the Act. These services included home delivered meals, home care, personal care, or case management services on a regular or intensive basis. About 14%, 8 million people, received other services, such as transportation, congregate meals, or information and assistance on a not so regular basis. A report was made by the Government Accountability Office stating that their findings were that many older people are in need of meals and other supportive services to help remain independent in their own communities, but a large portion of them are not getting the help they are in need of. Some barriers causing this lack of help are lack of funding and lack of knowledge among the older Americans that they may be eligible for benefits and services can be available for them.

The quality of long term care has become a topic for the elderly and their family. Some of the issues are cost, quality, and access of care. The expansion of the elderly population, is expected to affect significantly the provision of long-term care. The impact of care has been considered. Social choice will play in shaping the future of the long-term care system. The Federal Government and the expansion of the Affordable Care Act are part of this social decision. One of the major concerns is the cost of long term care. Most of the U.S. population have the benefits of using Medicare.

After the Great Depression the United States implemented several programs to assist the American people with low income and disabilities (Dingell, 2015). Within these programs included Medicaid and Medicare, which were not set up to serve for the purpose of long-term care for seniors. Today we find that due to the set up of the programs there is a void in the assistance of long term care of seniors in our country (Dingell, 2015).

Seniors who fall under a coverage hole will start getting some help. Some are saying that seniors may lose Medicare benefits they now enjoy, but that is not true. The health reform act will not cut guaranteed benefits; a person will still be able to maintain the coverage they want. Americans on Medicare will receive free preventive care without co- payments or deductibles. Seniors will also receive $250 to help pay for their prescriptions. There will also be alternatives to nursing home placement, such as day-service programs, home-care aides, meal programs, senior centers and transportation services. A public, voluntary long-term care insurance program known as the Community Living Assistance Services and Supports, have enrolled individuals who have substantial daily needs to receive at least $50 a day. This money is to be used to defray the costs of services such as home care, family caregiver support, and adult day-care or residential care.

The solution to this daunting problem was to tax businesses. Payments to current retirees are financed by a payroll on current workers wages’ half directly as a payroll tax and half paid by the employer” (SCHC). “Congress” implemented strategically taking money from financial stable workers and their weather employer to give money to the elderly and physically impaired without hurting the financial stability of those taxed individuals. The government saw an opening for improvement with in their national support and took it for the betterment of the nation. The act also protects the and gives states money to support “unemployment insurance, aid to families with dependent children, maternal and child welfare, public health insurance, and blind services” (SCHC). The act expands on just the elderly receiving government assistance but all groups who can not provide for them selves due to uncontrollable circumstances that where originally caused by the governments neglect and the start of the great depression.

CLASS is the most recent failure at the federal level to create a national program that provides long-term care insurance. The ACA attempted to work around the fact by making CLASS a voluntary and self-sustaining program under difficult political constraints, policymakers tried to walk a narrow line; they aimed to offer a substantial benefit. CLASS would have been unsustainable and would still have left beneficiaries exposed to substantial costs. One positive note, CLASS brought long-term care back onto the federal policy agenda after a 20 years absence, serving as an important reminder that the nation's current to financing long-term care is adequate.

Many dementia patients may eventually be institutionalized. Long term care facilities are very expensive. Patients without long term care insurance or another type of insurance to supplement Medicare may become financially burdened. The Affordable Care Act has enacted several programs to benefit geriatric patients without the financial means to support themselves in a long term care setting or home health care. The following are programs provided by the Medicaid program: Home and Community-Based Services State Plan Option, Community First Choice, State Balancing Incentive Payments Program, Money Follows the Person (MFP),

Rida Elias wrote this case under the supervision of Professor Roderick E. White solely to provide material for class discussion. The