Page images

cannot deal with the red-tape, the "lost claims", the low reimbursements, the appeal process and the general confusion. Many have multiple insurance policies.

I feel that much of the confusion Medicare beneficiaries have could be avoided if they were able to have their questions answered knowledgably by personnel in their physician's offices who have a keen understanding of the Social Security system and Medicare as well as a working knowledge of supplemental insurance plans. I have personally spoken to numerous physician's office personnel who do not understand Assignment of Benefits, do not know current deductible amounts for Part A or the definition of a Benefit Period. These people care very deeply, as I and my staff do, about our senior citizens whose lives they touch each day. Their contact is more frequent and intimate than a visit to a distant SSA office. I encourage physicians to take responsibility for providin continuing education for their professional receptionists and other staff members.

I propose that the Social Security Administration conduct seminars and workshops specifically for medical office personnel regarding updates and revisions in Medicare and other SSA programs.

Medicare was designed to meet the health care needs of the individual. Has it done that?

Better utilization of Home Health Care Services would provide a substantial savings to the Medicare program and help to preserve the dignity of the recipient. The services of

skilled nurses, approved as providers, could show a substantial savings through Community Nursing Centers as proposed by Senators Packwood and Inouye in a bill recently introduced.

Legislation signed into law by President Reagan extending Medicare coverage to Hospice care as of Novenber 1, 1983 will not only save the Federal Government hundreds of millions of dollars in health care costs but allow beneficiaries a compassionate alternative to hospital care. chological needs of the patient and his family will now be dealt with in a humanitarian and cost-effective way.

The psy

I do not believe the Medicare benefits are structured
properly. How can a person relying on Social Security
benefits in 1984, $4,860.00, as his/her only source of in-
come be expected to survive even one average hospital stay
with the Administration's proposed Medicare changes? The
out-of-pocket expenses for an average hospital stay would
amount to more than one-quarter of the total income for
the year.

How can we let this happen to the people who have worked and suffered and fought wars to keep us free?

The fiscal 1984 budget is really just shifting costs to the elderly and disabled. If the deductibles continue to increase as well as the co-insurance amounts and the premiums they will be forced to enroll in the Medicaid program. We cannot honestly expect them to do otherwise if they are to survive.

One of our clients, Mary Husted, an 82 year old childless widow underwent cancer surgery in August of 1981. She re

covered enough to return to her home in the remote area of Hornell, New York. Mary could not manage alone and was forced to rely on others to care for her. But, she had what she wanted, she was home. Home health aids were made available but the expenses were ruled ineligible by Medicare as there is no participating agency supplying the services and billing Medicare in Stuben County. Mary's care did not, therefore, meet all the criteria for benefits. Appeals were filed. Again, denials. Letters to her Conyressman were written with only an oral negative response. All efforts to obtain reinbursement were fruitless.

Mary was forced to draw upon her life savings. She wanted to maintain her independence.

AS she watched her money disappear she tried to do without the home health aids and do more on her own as much as possible. In February of 1982 Mary, alone, fell and fractured her hip. Hospitalized for some time, Mary was eventually allowed to return to her farm home. She again hired home health aids to assist her. She was adamant she would not die poor and again refused the help she needed as long as she could. As her money dwindled, so did her will to live.

Mary was buried two weeks ago.

[ocr errors]

Mr. and Mrs. David B. Gordon had their story published in the September 27, 1982, issue of "Newsweek". Mr. Gordon, a retired police officer, and his wife have a total annual retirement income of $41,100.00, including Social Security, Pension and Dividends and Interest. They have no debt. Mrs. Gordon suffers from Parkinson's disease and its complications and remained at home with her husband and paid

help until a few months ago when she suffered a stroke. She then required more skilled care which her husband, who lovingly gave of himself and often was unable to sleep more than an hour at a stretch, could not provide. The nursing home cost is $105.00 daily or $38,325.00 per year more than their entire net income.

"Other than Medicaid there is practically no insurance that covers extended care in a nursing home. Medicare will pay most nursing home expenses for up to one hundred days, but only under certain conditions---".

"Mr. Gordon must spend all his savings and liquidate all
assets except for $2,600.00 for himself and $2,600.00 for
his wife, enough to bury them, in order for his wife to
be eligible for Medicaid. llis pension will be attached.
If he works, he won't be able to keep his salary."

"The odd part of this arrangement is that by making (them) liquidate (their) savings, the government is depriving (them) of the $1,000.00 a month in bank and dividend interest that could go toward (his) wife's upkeep. If that income could be retained, the nursing home cost to Medicaid would be $600.00

so a month.-------Instead, it will cost the taxpayers, through Medicaid, more than $1,600.00 per month."


Are there any alternatives?


Divorce was suggested as a logical alternative. But why should people who love each other be forced to divorce?

Mrs. Gordon's greatest fear has been that that she might end her life in a charity ward as did her grandmother duriny the Depression. She is in a good nursing home and is well cared for thanks to Mr. Gordon.

Now, what about Mr. Cordon?

Mary and the Gordon's are not isolated cases.

las Medicare been insuring too much or too little? Are nol Medicare recipients currently paying more than their "fair share"?

I thank you for the opportunity to testify and for your kind attention.

« PreviousContinue »