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NEW JERSEY GERONTOLOGICAL SOCIETY
The Medicare program, the federally funded health insurance program for elderly persons 65 and older, which is run by the U. S. Health Care Financing Administration (HCFA) is facing serious fiscal crisis. With increases which average annually 194, health care costs have skyrocketed over the past 5 years. The fiscal solvency of Medicare must be maintained so that access to high quality health care can be assured the fast growing elderly population, This burgeoning growth, particularly in the over 75 population, has caused a resultant shift from acute to chronic conditions. 80% of the 65+ population have one or more chronic conditions with 18% of the non institutionalized elderly so severely impaired as to require assistance in daily living. The U. S. has a health care syster. 'hat has been addressing acute care rather than chronic
Congress must act to redesign the benefits in order to provide long term solutions for Medicare.
liome health care should be a part of the health care delivery system because it provides:
1) A less costly method of providing post-hospital care - older
2) Often a more cost effective method of long term care especially when only 1 or 2 services is needed by the patient which would prevent institutionalization.
3) Assurance of care for those returning home from acute care.
Health funding should be included in considerations for health maintenance and health monitoring programs so that people are encouraged to take responsibility for their own health. The emergency room all to often becomes the substitute for any kind of regulir routine or preventive medical care. What results is the "revolving door syndrome" 3–4 days in the hospital home with no support system in place then back into the hospital after 3-4 distressing days at home. Union County Visiting Nurse and Health Services has provided an eight year demonstration program of health education and monitoring in senior citizen housing. There has been a definite reduction in hospital recitivism and institutionalization as a result of this program.
The number of single older women in the aged population with reduced financial assets is a burden on social and health programs. However, it is unfair to expect this elderly population to assume the major proportion of the skyrocketing rise in health care costs. The reforms must be divided in a fair and equitable way between the caregivers (hospitals and physicians) and the clients. We must not lose sight of the original goal of the program "To provide needed health service of good quality to all Americans 65 or over."
If any of the members of the Gerontological Society of N. J. wish to give testimony or make a statement concerning the proposed changes in Medicare they are urged to do so before April 27, 1983. Congressman Rinaldo is keeping the hearings open up until that time and is anxious to have as much input as possible. The address is:
House Senate Committee on Aging
This statement was compiled by:
Jocelyn B. !Ielm
PRINCETON SENIOR RESOURCE CENTER
I wish to thank Congressman Rinaldo for providing an alternative opportunity for those of us who attended the hearing of the House Select Committee on Aging held in Princeton, New Jersey on March 2nd. Unfortunately, a crowded agenda prevented many of us who provide direct services to the elderly from testifying. I would like to make a few comments concerning the proposed Medicare reform.
For the past 9 years I have served as Director of the Princeton Senior Resource Center which is located in the center of public housing for the elderly. This has afforded me a unique opportunity to see first hand some of the current problems which we must address in our Medicare system. In a population of 74+ we see at least (our housing is 17 years old) 80% of our residents have Chronic disabilities. Their needs are not being met by Medicare because Medicare is an acute care system. Congress must act to redesign the benefits in order to provide long term solutions for Medicare.
Home health care should be a part of the health care deliver system because it provides:
1) A less costly method of providing post-hospital care
2) Often a more cost effective method of long term care
Studies attest to the strong personal preference
Our residents follow the pattern of what is called the "revolving door" syndrome - which is totally cost ineffective in the long run. An example in point - a 72 year old male resident (Mr. B) with no family had been hospitalized for an operation in September and had had several hospitalizations since then. He was not showing much improvement and again was hospitalized in February. After being discharged in February and trying to exist without proper home care he fell ill again and was rushed to the emergency room on Friday March 4th. However, was sent home at noontime. He had no homemaker coming in and our agency was contacted on Saturday AM (when our office is closed) as he was unable to cope by himself. We managed to find someone for Saturday but Sunday he was left on his own and unable to manage and required another trip to the emergency room at noon he was sent home again that same day. Late Monday AM he was back in the hospital for the third time. He has now been in an intensive care facility for two weeks, where he is not expected to recover.
If you dissect this example you can see where Medicare simply does not provide for a satisfactory method of health care for Mr. B's needs.
1) It could not provide home care which would certainly
2) Because of the DRG (Diagnostic Related Group) the hospital is rewarded on a cost basis for emptying the bed as soon as possible in this case before the patient was well enough to function on his own - thus the hospital bed is freed for another patient. New Jersey instituted the DRG only two years ago. Many of us feel that the system has not been proven and that it is too soon to use this as a model for a nationwide system of health care.
3) Because of the medical cost involved Mr. B didn't want
This testimony provided by:
Jocelyn B. Helm, Director
President of the New Jersey
*These statements do not necessarily reflect the position of all the members of the society.
PREPARED STATEMENT OF THE AMERICAN MEDICAL ASSOCIATION
The American Medical Association takes this opportunity to comment
the financing problems of the Social Security System.
The short term financing problems of the old-Age and Survivors (OASI)
and Disability Insurance (DI) Trust Funds and their long-range solvency
problems are not new, representing the second time in less than six years
that the Social Security system finds itself on the verge of bankruptcy.
Included within the Social Security system are the Hospital Insurance
finance Parts A and B, respectively, of the Medicare program.
Medicare program 18 a primary source of medical benefits for the vast
solvency of the Medicare program be maintained in order to assure access
to high quality care for the nation's elderly.
While the Medicare trust
funds do not face the immediate difficulties of the OASI fund, pressures
are projected to begin near the end of the century.
The solvency of the
Medicare' is an "entitlement" program that promises benefits
benefits to all who have worked and contributed to the hospital insurance
Medicare also provides benefits to disabled persons under age 65
and persons who have end stage renal disease and require transplantation
Medicare benefits and administrative costs
are paid from two
funds created under Title XVIII of the Social Security Act, passed in
hospital and other institutional benefits (Part A), is financed mainly among the three social security trust funds.
to 1.35% in 1985 and 1.45 percent in 1986. The wage base is increased
each year by a formula reflecting general wage growth.
revenues and through monthly premiums paid by Part B participants.
general revenue share of Part B funding has grown from 50 percent in 1971
intent of Congress to assure mainstream medical care for the elderly and
problems, the problems of a sluggish economy, and short-term borrowing to
bail-out the OASI trust fund raise the specter of a failure of the Health
of the trust funds is a difficult task, dependent on the assumptions used
and the definition of actuarial soundness that is adopted. According to
the Report of the National Commission on Social Security Reform issued in
depleted by the early part of the 1990's and possibly even by the end of
Public Law 97-123 on December 29, 1981, which allows interfund borrowing
The authority originally