AN ARENA FOR MY MESSAGE TO CARE FOR ITS EAGUES IN THE FOR MY PART, HE MAYORS AND BMIT TESTIMONY HE FORTITUDE TO 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 19%, 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 care. 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 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 regular 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 clien We must not lose sight of the original goal of the program "To provide needed hea 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. Helm 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 hea of the House Select Committee on Aging held in Princeton, Ne Jersey on March 2nd. Unfortunately, a crowded agenda preven 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 cen of public housing for the elderly. This has afforded me a u opportunity to see first hand some of the current problems w we must address in our Medicare system. In a population of we see at least (our housing is 17 years old) 80% of our res: have Chronic disabilities. Their needs are not being met by because Medicare is an acute care system. Congress must act redesign the benefits in order to provide long term solutions for Medicare. Home health care should be a part of the health care de system because it provides: 1) A less costly method of providing post-hospital car older people take much longer than young to recooperate from illness. 2) Often a more cost effective method of long term car 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 acu care. Studies attest to the strong personal preference of persons to remain at home with support of family and friends within familiar routine. He Our residents follow the pattern of what is called the "revolving door" syndrome - which is totally cost ineffective the long run. An example in point a 72 year old male resid with no family had been hospitalized for an operation in Sept and had had several hospitalizations since then. He was not s much improvement and again was hospitalized in February. Aft being discharged in February and trying to exist without prop home care he fell ill again and was rushed to the emergency r on Friday March 4th. However, was sent home at noontime. no homemaker coming in and our agency was contacted on Saturda (when our office is closed) as he was unable to cope by himsel We managed to find someone for Saturday but Sunday he was lef 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, w 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 c for Mr. B's needs. 1) It could not provide home care which would certainl have decreased the number of days he spent in the hospi and the number of emergency visits required. Union Cou Visiting Nurse and Health Services has provided an eigh year demonstration program of health education and moni in senior citizen housing. There has been a definite reduction in hospital recidivism and institutionalizati as a result of this program. Health funding should be included in considerations for health maintenance and health monitoring programs so that people are encourage 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 as soon as possible in this case before the patient well enough to function on his own thus the hospital is freed for another patient. New Jersey instituted th DRG only two years ago. Many of us feel that the syste has not been proven and that it is too soon to use this a model for a nationwide system of health care. 3) Because of the medical cost involved Mr. B didn't to see a Doctor in the first place, nor was he willing into the hospital; therefore he, like many older peopl Perhaps some delayed treatment until he was very ill. method could be devised where physicians had to except assigned medicare payment who fell in an low income br This is now being done by New Jersey Blue Shield/Blue This testimony provided by: Jocelyn B. Helm, Director Princeton Senior Resource Cente And: President of the New Jersey Gerontological Society* *These statements do not necessarily reflect the position o the members of the society. PREPARED STATEMENT OF THE AMERICAN MEDICAL ASSOCIATI The American Medical Association takes this opportunity to the financing problems of the Social Security System. The short term financing problems of the Old-Age and Surviv and Disability Insurance (DI) Trust Funds and their long-rang problems represent a major problem for this country toda problems are not new, representing the second time in less than that the Social Security system finds itself on the verge of ban Included within the Social Security system are the Hospital Trust Fund and the Supplementary Medical Insurance Trust F finance Parts A and B, respectively, of the Medicare prog Medicare program is a primary source of medical benefits for majority of our population over the age of 65. These citizens, heaviest users of medical care, are heavily dependent on Med: their medical coverage. Therefore it is imperative that th solvency of the Medicare program be maintained in order to assu to high quality care for the nation's elderly. While the Medic funds do not face the immediate difficulties of the OASI fund, The solver Medical As are projected to begin near the end of the century. OAS fund is of great concern to the American however, in this statement we limit our Comments to concerns re the soundness of Medicare trust funds. Medicare is an "entitlement" program that promises benefit who meet Social Security eligibility requirements; it ext benefits to all who have worked and contributed to the hospital Medicare also provides benefits to disabled persons unde and persons who have end stage renal disease and require transp fund. or dialysis. Medicare benefits and administrative costs are paid from t funds created under Title XVIII of the Social Security Act, P 1965. Unlike other Federal health programs, Medicare is not solely by general revenues. The Hospital Insurance Trust Fund, hospital and other institutional benefits (Part A), is financed The edicare program. benefits for the vast se citizens, often the ndent on Medicare for tive that the fiscal order to assure access ile the Medicare trust Le OASI fund, pressures y. n through payroll taxes on employers and employees. The payrol for 1982 was 1.3 percent of wages up to $32,400 per empl contribution rate for the employer is the same. The tax rate to 1.35% in 1985 and 1.45 percent in 1986. The wage base is each year by a formula reflecting general wage growth. The Su Trust Fund, which pays for physicians' Medical Insurance outpatient services is (Part B), financed through Federa revenues and through monthly premiums paid by Part B particip general revenue share of Part B funding has grown from 50 perce to 68 percent in 1981. The Medicare program is intended to provide older Amer financial assistance in covering the costs of hospitaliz physicians' services, and certain other health services. I intent of Congress to assure mainstream medical care for the e not have the aged of the nation shunted into a second-class care. In this regard, Medicare has been a success. Howev problems, the problems of a sluggish economy, and short-term bo bail-out the OASI trust fund raise the specter of a failure of Insurance trust fund to cover its obligations. Ac Because of the critical nature of the benefits that ar present and future Medicare beneficiaries, it is important Medicare funds be soundly financed. Determining the financial of the trust funds is a difficult task, dependent on the assump and the definition of actuarial soundness that is adopted. the Report of the National Commission on Social Security Reform January 1983 the Hospital Insurance Trust Fund is estimat depleted by the early part of the 1990's and possibly even by this decade. The Supplementary Medical Insurance program, financed on a year-by-year basis, faces no projected diffic present. During an earlier crisis facing the OASI fund, Congres Public Law 97-123 on December 29, 1981, which allows interfund among the three social security trust funds. The authority 22-020 0-83--14 |