With the U.S. Senate on the verge of passing health care legislation by Christmas — issues like Medicare and the public option are taking center stage. But buried in the bill is a provision that would affect home care for America’s aging population.
The Senate health care bill, if passed and signed by President Obama, would cut reimbursements for senior home care by 17 percent — cuts San Diego may not be able to afford with such a rapidly aging population.
San Diego County has more than 330,000 residents aged 65 and older according to St. Paul’s PACE (Program of All-Inclusive Care for the Elderly), a non-profit service provider for seniors with chronic health needs who wish to continue living at home. What’s more, SANDAG estimates that within 20 years, that number will grow up to 125 percent.
At PACE, seniors are fortunate enough not to feel the immediate effect of the cuts as government health care plans are solely responsible for funding the program, said PACE marketing director Amanda Dunkin.
“We cater to the very low income, low functioning seniors,” she said. “Medi-Cal and Medicare are funding our efforts so that the elderly don’t have to struggle to pay for doctors or make co-payments on drugs or hospitalizations.”
While cuts would directly affect PACE programs, Dunkin said she is not too worried as the organization does its share to help out the state.
“The state doesn’t want these people to end up in emergency care,” she said, which she believes is an almost-certainty when dysfunctional seniors are left to care for themselves. “That’s a lot of money.”
The PACE program provides medical care, including drug coverage and doctor visits as well as transportation, for seniors with chronic illnesses who need help but prefer not to move into a nursing home or other institution.
“Most seniors would always rather be at home than in a hospital,” said Sheila Moody, president of Senior Home Care USA in San Diego. Moody’s business, which specializes in providing pre-screened caregivers that work privately with seniors, is non-medical, but does provide live-in positions as well as personal care treatment.
Though she will not have to worry about Medicare reimbursements, Moody said some of her clients, who work with the IHSS (In-Home Supportive Services) will.
“The hours that they can qualify for have really been cut back,” she said. “I think it’s going to be a terrible impact on our community, and it’s going to have a huge hit on home health care agencies.”
At Your Home Familycare, founded by Laurie Edwards-Tate, is a non-medical in-home organization that caters to seniors as well as the disabled and children with disabilities.
“The cuts that are being proposed, my understanding is that it is applicable to Medicare reimbursements and the cuts could be huge. They could be as high as $43 billion to $50 billion,” Edwards-Tate said. “We are also looking at the potential for a wonderful service such as hospice care being reduced by approximately $8 billion over the next decade. The impact, if this type of thing is allowed to happen, would be devastating to Medicare-certified home health care agencies [and] licensed home health agencies which provide medical services in the home.”
Edwards-Tate is a supporter of the CLASS (Community Living Assistance Services and Supports) Act, a bill originally proposed by the late Sen. Edward Kennedy that consists of a long-term care insurance program aimed at helping the disabled and elderly live on their own.
“I do feel that we are in very difficult economic times and we are all suffering because of it,” she said. “But when it comes to cutting care, which either keeps people out of hospitals, which home health does, or out of institutions, which home care models like mine potentially do, it’s counter-productive from a humanity standpoint and counter-productive from a fiscal standpoint.”
As for the bigger ethical questions, Edwards-Tate said she believes individuals at any age have the right to fight for their lives.
“I would hate to see a time in a society where we said that if a person reaches a certain age, they no longer deserve the benefits of what medical science advancements have,” she said.
“Who decides that?” asked Moody. “Who gets to play God? Nobody wants to pull the plug, nobody wants to say, ‘That’s enough.’ But in the end, I guess it all boils down to cost.”
The thing to keep in mind, she warned, is that these issues are not going away.
“It’s important to remember that you’re going to be there. It’s going to affect you one way or another,” she said. “Maybe not right now, but it will.”
End of life health care, San Diego dermatologist Dr. Mitchel Goldman Goldman said, is a huge issue when it comes to spending. Unfortunately, it’s an intensely sensitive subject.
“It raises all these ethical questions,” he said. “When do you stop providing maximal care for people and when don’t you? Is that a good use of funds? The question is whether, in a universal health care system where we’re trying to hold costs down, if decisions like that will be made. If hospitals will spend tens of millions of dollars trying to save people that really have no functional capacity left.”
As the Baby Boomer generation continues to age, that will be an issue San Diegans need to resolve — and quickly.
Jennifer Reed is SDNN’s health and wellness editor. She can be reached at jennifer.reed(at)sdnn.com.