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Big boost is overdue for home health care |
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The Biden Administration wants to put a big new star onto home medical care, proposing to spend $400 billion to boost this vital aspect of Americans’ long-term health treatment. The reasons have been underscored by the coronavirus pandemic: Hospitals are tearing up our health care spending, devouring roughly a trillion dollars annually. Nursing homes are not cheap either, costing those who can afford them roughly $100,000-a-year for a single. These and other long-term facilities also have proven to have major flaws in safeguarding residents and in providing them pleasant and happy places to live. Our nation also is graying rapidly, with huge numbers of older adults wanting to stay in their own homes for as long as possible. Alas, critics say, the nation for too long has lagged in dealing with urgent demographic and practical challenges that affect the lives of tens of millions of us. As the Washington Post reported: “The prominence of the [administration’s] proposed home-care expansion shows how the issue has attracted the attention of a growing number of Democrats and influential groups … It also reflects the growing alarm by some experts about the nation’s inability to absorb the enormous growth in its elderly population — a challenge that threatens to strain an already limited workforce of caregivers; complicate the retirements of millions of people; and force many children, particularly daughters, out of the labor market to care for their parents. White House officials have also stressed they aim to improve the low pay and working conditions for caretakers. “In 2018, the last year for which data are available, the United States spent about $130 billion on long-term care through Medicaid, with about $71 billion of that going to home care, according to the Department of Health and Human Services. Biden’s plan amounts to as much as $50 billion a year for home care in additional spending, close to doubling the existing amount.” Those are heartening sums to advocates who have pressed politicians to deal with the nation’s long-term care crisis. But Republican critics and even those capable of a little fiscal calculation have doubts about the Biden initiative, as the New York Times reported: “Mr. Biden’s proposal, part of his $2 trillion American Jobs Plan, is aimed only at bolstering Medicaid, which pays for somewhat over half the bill for long-term care in the country. And it is targeted only at home care and at community-based care in places like adult day care centers — not at nursing homes, which take just over 40% of Medicaid’s care budget. Still, the money would be consumed very fast. Consider a key goal: increasing the wages of care workers. In 2019, the typical wage of the 3.5 million home health aides and personal care aides was $12.15 an hour. They make less than janitors and telemarketers, less than workers in food processing plants or on farms. Many — typically women of color, often immigrants — live in poverty. The aides are employed by care agencies, which bill Medicaid for their hours at work in beneficiaries’ homes. The agencies consistently report labor shortages, which is perhaps unsurprising given the low pay. Raising wages may be essential to meet the booming demand. The Labor Department estimates that these occupations will require 1.6 million additional workers over 10 years. “It won’t be cheap, though. Bringing aides’ hourly pay to $20 — still short of the country’s median wage — would more than consume the eight-year outlay of $400 billion. That would leave little money for other priorities, like addressing the demand for care — 820,000 people were on states’ waiting lists in 2018, with an average wait of more than three years — or providing more comprehensive services.” In a sign of the increased demand, and potential profitability of home care, Humana, a health care giant, just announced that it will invest almost $6 billion in the business, buying out its partner in an existing venture and increasing its role. Even before the pandemic, experts also were sounding alarms about shortages not only in low-paid health workers but also with doctors and nurses. The medical colleges group in 2020 issued this distressing forecast: “The United States could see an estimated shortage of between 54,100 and 139,000 physicians, including shortfalls in both primary and specialty care, by 2033.” A study published in 2018 in a medical journal had this grim news on registered nurses: “There will be a shortage of 154,018 RNs by 2020 and 510 394 RNs by 2030; the South and West regions will have higher shortage ratios than Northeast and Midwest regions.” The pandemic has only worsened staffing concerns in health care, with a recent Washington Post poll finding that half of those in the business feel burned out. The poll also found that 3 in 10 health workers, including doctors and nurses, are considering quitting the field. As the nation grapples with a housing shortage, which is acute in big cities, there also will be a severe need to assist people in staying in their homes, including with adaptive measures to support them in doing so. Technology also may play a big role in helping homeowners to stay put and healthy. Telemedicine — and not the hollow version done by terse telephone calls — may be combined with appropriate home medical testing and health monitors to ease strains on health workers, potentially maximizing the time of the most highly trained individuals (doctors and specialists) to allow other highly credentialed professionals (physician assistants, registered and practitioner nurses, and medical assistants) to deal with more routine care. Expect to hear lots of new and different ideas about home medical care in the days ahead, as well as lots of howling about its costs. But there doesn’t seem to be any more road to “kick the can down.” Hard decisions and complex actions will need to occur. |
A few dollars can go really far to help home safety |
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Before consumers sink big money into experiments with home medical tests and health monitoring devices, could they get a better return — in both their well-being and their pocketbooks — by putting a bit of this discretionary spending elsewhere? As researchers have discovered, just a few dollars can go a long way to improving the health and safety of millions of us. But many governmental health-related programs do not cover these costs. The New York Times reported this: “A team at the University of California, San Francisco, combed through national data and came up with an estimate, recently published in JAMA Internal Medicine: About 12 million people over 65, living in their own homes, could use equipment to help them safely bathe and use the toilet, two of the activities disabled older people most commonly struggle with. But about five million of them don’t have those items, even though they generally cost less than $50. Looking at Medicare beneficiaries in the National Health and Aging Trends Study in 2015, the researchers identified more than 2,600 people (average age: about 80) who needed such devices, based on measures like holding onto walls as they walked and being unable to rise unassisted from a chair.” While these researchers focused on unmet needs among older adults, online comments on their posted study suggest that others with disability or debilitation could benefit significantly, too, from relatively low-cost items in the home. These include: chairs for use in the shower; grab bars — both near the tub or shower and beside the toilet; and elevated toilets or raised seats for them. Similar, relatively inexpensive accommodation elsewhere in the home could, for example, improve the independence, diet, and well-being of elders or those needing extra support to stay on their own. The kitchen, too, would be safer and more convenient if it had grab rails in it, as well as stable and safe seating to allow an individual to handle cooking chores without long periods of standing. Cabinet doors and drawers might need easier-to-handle knobs and pulls. Families might want to invest in cooking gear and gadgets specially designed for simple and easy handling. Timers and alarms that are easy to see and set would be helpful to remind cooks to turn the stove and other heating elements on or off. The New York Times article on affordable but lacking assistive supports underscored the increasing incidence and rising hazards posed by falls to millions of the aged or less agile. Individuals could spend a few dollars and just a bit of time to safeguard themselves and their homes from this nightmare — decluttering and moving hazards like misplaced furniture or stray electrical cords. Risky spots could get nonslip mats or coatings. Floor coverings that slide, like rugs, can be tacked down. It may be cost effective to consider fixing or installing bannisters on stairs throughout the property, indoors and out. Some folks will benefit from the added support of walkers or canes (notably the so-called quad models, with their broader base for added stability). Those who long have mocked the frequent television ads for devices to aid seniors who “have fallen and can’t get up” can take advantage of new features in smart watches. The premium-priced Apple models, for example, now carry internal systems that can detect if wearers take a serious tumble. The watch, through its link to a smartphone, can connect users to emergency services, if needed. Many homes would work better for their occupants if they installed motion-sensitive, LED nightlights. These have fallen in cost, often are packaged in quantities, and can briefly illuminate stairs, halls, bedrooms, and bathrooms so, for example, partners can attend to nature’s call in the middle of the night without stumbling or waking everyone. Those who are older or more sedentary may want to install timers on lighting in key living areas, so the spaces are brightened up at or before sunset. This can help avert the agitation, restlessness, or confusion often described as sundowner syndrome. Homeowners and renters, of course, can safeguard themselves and their loved ones by installing smoke and carbon monoxide detectors — and by keeping them working with fresh batteries. It doesn’t take a lot of cash. But, based on spiking injuries reported by people homebound during the coronavirus pandemic, a good investment of time might be to find and at least watch online videos giving basic instructions on home improvement projects and use of various hand and power tools. It also could be beneficial to refresh your knowledge about ladders and their safe use and maybe to buy a short, stable model for interior use. |
Recent Health Care Blog Posts |
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Here are some recent posts on our patient safety blog that might interest you:
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HERE’S TO A HEALTHY 2021!
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Sincerely,
Patrick Malone |
