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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.

care.

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
people take much longer than young to recooperate from illness.

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.
Studies attest to the strong personal preference of persons to
remain at home with support of family and friends within
familiar routine.

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
606 House Annex 1
Washington, D.C. 20515

This statement was compiled by:

Jocelyn B. !Ielm
Joann F. Maslin

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
older people take much longer than young to recooperate
from illness.

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

Studies attest to the strong personal preference
of persons to remain at home with support of family and
friends within familiar routine.

care.

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
have decreased the number of days he spent in the hospital
and the number of emergency visits required. 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 recid ivism and institutionalization
as a result of this program. 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.

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
to see a Doctor in the first place, nor was he willing to go
into the hospital; therefore he, like many older people
delayed treatment until he was very ill. Perhaps some
method could be devised where physicians had to except
assigned medicare Payment who fell in an low income bracket.
This is now being done by New Jersey Blue Shield/Blue Cross.

This testimony provided by:

Jocelyn B. Helm, Director
Princeton Senior Resource Center

And:

President of the New Jersey
Gerontological Society*

*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

on

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

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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

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finance Parts A and B, respectively, of the Medicare program.

The

Medicare program 18 a primary source of medical benefits for the vast

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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

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Medicare' is an "entitlement" program that promises benefits

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benefits to all who have worked and contributed to the hospital insurance

fund.

Medicare also provides benefits to disabled persons under age 65

and persons who have end stage renal disease and require transplantation

or dialysis.

Medicare benefits and administrative costs

are paid from two

trust

funds created under Title XVIII of the Social Security Act, passed in

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hospital and other institutional benefits (Part A), is financed mainly among the three social security trust funds.

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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.

The Supplementary

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revenues and through monthly premiums paid by Part B participants.

The

general revenue share of Part B funding has grown from 50 percent in 1971

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intent of Congress to assure mainstream medical care for the elderly and

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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

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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

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depleted by the early part of the 1990's and possibly even by the end of

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Public Law 97-123 on December 29, 1981, which allows interfund borrowing

The authority originally

22-020

0-83--14

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