Sunday, August 9, 2009

Is Congress Really Tackling Long Term Care?

The New York Times recently posted an article “Congress Tackles Long Term Care.” Rather than rewrite the entire article, please read it yourself at

Those of us working in long term care or receiving it know this is a crisis in America that must be addressed, especially with the Baby Boomers on the horizon. Barbara Manard, a health economist with the American Association of Housing and Services for the Aging, worked with Mr. Kennedy’s staff to draft the C.L.A.S.S. Act _Community Living Assistance Services and Support) legislation. Although I give them credit for the effort, this only touches the need now and in the future. This is not nearly enough benefits to enable the average disabled senior to stay in their home and receive care.

If everyone has to be vested for 5 years and this program hasn't even been approved, we are talking about a quite a few years down the road. This does not account for the cost of living added to the price of care.

The benefit they’repropsing is $50-$75 a day. Today that would pay for 2-4 hours of home care or about 15-25% of what it would cost for a nursing home room daily. What is Medicaid paying nursing homes daily for care that is usually substandard?

Nursing homes cost between $165-$335 a day, match that against homecare which would provide between 8 and 16 hours a day to allow someone to remain in their home, where they will stay healthier and happier. Not to mention the increased healthcare costs associated with nursing home placement. Nurse’s aides are providing care to minimally 8 patients a day, and as much as 30 or 40 on midnight shift. Just imagine the quality of care with this ratio in a nursing home versus 1:1 or 1:2 care in your own home.

One to one care at home reduces all the healthcare costs of pressure ulcers, infections, and declining mobility that many nursing home residents are suffering from. Nurse’s aides don’t typically have the time to turn bed bound patients every two hours, keep them clean and dry, feed them the sufficient amount of nutrients and provide the fluids they need, to prevent pressure ulcers.

The risk of infection is significantly increased when staff doesn’t use good hand washing technique moving from patient to patient. Nursing homes have new patients coming in all the time with infections and illnesses because insurance companies will not pay hospitals to keep them admitted. Visitors and staff come and go introducing bacteria and viruses to the facility. Patients that are immobile are not all being provided appropriate personal care, and are not exercising their lungs, so they are more prone to urinary tract and respiratory infections.

Without sufficient exercise patients are declining physically, requiring more care. Most elderly patients that have spent even a few days in the hospital are leaving in a weakened condition because they are not getting out of bed, or walking daily. Upon discharge these patients are requiring additional medical and custodial care.

My Dad recently fell and was admitted to the hospital where he stayed for 5 days. Even though I was able to go to the hospital daily and walk the halls with him, he still left in a more weakened condition than he arrived. I have now initiated physical therapy at home so he can regain his strength, balance and mobility. I knew and helped him walk daily to keep his strength up, but how many patients lay in the bed, and are unable to walk alone, yet don’t have anyone to walk with them to keep them mobile. This simple preventative action is not being done and results in higher medical costs.

Homecare reduces hospital, nursing home and other healthcare costs. Seniors will generally eat more at home than the dreaded institutional food in facilities. They are also provided and encouraged more fluids to avoid dehydration, which is another frequent problem in nursing homes. There is less risk of infection in their home environment. If someone is home and bedbound, a caregiver, who is only providing care to one client is able to change their position every 2 hours, and keep them clean and dry, avoiding skin breakdown. Clients that are mobile are able to be kept active, and /or have someone readily available to assist them with prescribed exercises. When seniors can stay in their own home with the assistance of homecare they are happier, also reducing costs.

I can’t offer any statistics on the numbers of seniors who are depressed or have Alzheimer’s and may be exhibiting aggression because they are miserable and socially neglected in nursing homes, but I would venture to guess the numbers would be staggering. One of the most frequent comments I hear from seniors is “I don’t want to go to a nursing home”. Many who go to nursing homes feel they are going there to die and give up. Their motivation to be social, participate in activities, and care for themselves is lessened, and the decline begins.

We are all paying attention to what healthcare reform will be. It isn’t a matter of “if” there will be reform; it is a matter of what kind of reform?

We need to encourage Congress to look at the cost of care rather than price of care. What is the cost of not allowing seniors to have a choice to remain in their homes, and be forced into a facility because they don’t have the finances to pay for homecare? Just think about where you would like to spend your last years of life, and then you’ll realize we must ALL advocate for better long term care benefits.

For more information about homecare in your area go to or email me at

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