and cost containment, it is imperative that we have some method of insuring that those patients are getting what they are being charged for. Since 1980, Medicare expenditures for home care have almost trippled from $772 million in 1980 to $2 billion in 1985. Let's make sure that we are really getting all that we are paying for. It is with pleasure that we assist the elderly in meeting some of their expenses, but let's not keep paying the bills without some oversight and some review. Thank you, Mr. Chairman. The CHAIRMAN. Thank you, Mr. Wortley. The Chair recognizes Miss Schneider. STATEMENT OF REPRESENTATIVE CLAUDINE SCHNEIDER Miss SCHNEIDER. Thank you, Mr. Chairman. There is very little question that the home health care market has been growing exponentially. I think that it is significant that we recognize that this is very rapidly becoming an area of high focus and one that provides a very positive alternative. However, some of the current quality assurance provisions that are in effect certainly need to be looked at very closely, and so far as monitoring an ongoing revision of standards, I think that that, too, has to be a high priority. I am happy to be here as a representative of the State of Rhode Island, a State which has fortunately a very good record insofar as maintaining adequate standards for home health care. This, as an alternative to institutionalization has been a high priority for the State, and I am happy to say that at least in our home State it has been working well, and I can only hope to share some of the innovative approaches that my own State has taken with my colleagues on this committee, and I look forward to a detailed investigation as to what the appropriate solutions might be for the nation. Thank you, Mr. Chairman. The CHAIRMAN. Thank you, Miss Schneider. Mr. Schuette. Mr. SCHUETTE. Thank you, Mr. Chairman. I failed to ask your unanimous consent to include in the record today the hearing of the testimony given at the aging hearing at Houghton Lake, MI, which deals in many respects on this vital issue of home health care, if I may. The CHAIRMAN. Is there objection? Without objection, so ordered. [EDITOR'S NOTE.-The referred hearing record titled "Are We Meeting the Health Care Needs of Michigan's Rural Elderly?" held May 12, 1986, in Houghton Lake, MI, committee publication No. 99-581 is available from the Select Committee on Aging upon request.] At this time, I would like to submit for the record the statements of Representatives Marilyn Lloyd and Charles A. Hayes. [The statements of Representatives Lloyd and Hayes follow:] PREPARED STATEMENT OF REPRESENTATIVE MARILYN LLOYD MR. CHAIRMAN, I THINK IT IS IMPORTANT FOR THE COMMITTEE TO FOCUS ATTENTION ON THE AVAILABILITY, AFFORDABILITY AND QUALITY OF HOME HEALTH CARE FOR OUR NATION'S ELDERLY AND/OR DISABLED CITIZENS. IT IS EXPECTED THAT THE NUMBER OF AMERICANS AGE 65 OR OVER WILL MORE THAN DOUBLE BY THE YEAR 2030. WE ARE ALSO EXPERIENCING AN UNPRECEDENTED INCREASE IN THE 85 YEAR AND OLDER POPULATION. WITH ADVANCING AGE, THERE IS A CORRESPONDING INCREASE IN THE INCIDENCE OF FRAILTY AND/OR DISABILITY. AS A RESULT, THERE ARE APPROXIMATELY 5.2 MILLION OLDER PERSONS RESIDING IN THE COMMUNITY WITH DISABILITIES THAT LEAVE THEM IN NEED OF HELP WITH DAY-TO-DAY TASKS. IT IS ESTIMATED THAT 80 PERCENT OF THESE DISABLED ELDERLY RECEIVE CARE FROM FAMILY MEMBERS. THAT MEANS THAT THERE ARE OVER 1 MILLION ELDERLY WHO ARE FORCED TO RELY ON THE COMMUNITY FOR HELP IN MEETING THEIR HOME HEALTH CARE NEEDS. EVEN IN THOSE COMMUNITIES THAT OFFER SERVICES SUCH AS HOMEMAKER ASSISTANCE, ADULT DAY CARE, TRANSPORTATION, HOME-DELIVERED MEALS, ETC., IT HAS BEEN FOUND THAT MANY OLDER ADULTS EITHER DO NOT KNOW WHAT IS AVAILABLE, OR THEY DON'T KNOW HOW TO GO ABOUT ARRANGING FOR THESE SERVICES. AS A RESULT, MANY FRAIL ELDERLY WITH MULTIPLE PROBLEMS LEAVE THEIR HOMES FOR NURSING HOMES, RESIDENTIAL CARE, OR SOME OTHER INSTITUTIONAL SETTING PREMATURELY. IN THE CHATTANOOGA-HAMILTON COUNTY AREA OF TENNESSEE, 28 ORGANIZATIONS HAVE DEVELOPED A CASE MANAGEMENT SERVICE APPROACH TO THE PROBLEM OF IDENTIFYING AND RESPONDING TO THE NEEDS OF OLDER ADULTS WHO ARE HAVING DIFFICULTY IN ACCESSING AVAILABLE SERVICES. AT A TIME WHEN FEDERAL DOLLARS ARE SHRINKING, THE PUBLIC, VOLUNTARY AND PRIVATE ENTERPRISE SECTORS ARE WORKING COOPERATIVELY IN EAST TENNESSEE TO FIND NEW WAYS TO FINANCE SUPPORT SERVICES WHICH ENABLE OLDER ADULTS TO REMAIN INDEPENDENT. LOCAL INITIATIVES OF THIS TYPE ARE AN IMPORTANT PART OF THE EFFORT TO BRIDGE THE GAPS IN OUR HEALTH CARE DELIVERY SYSTEM. THEY COMPLEMENT WHAT WE ON THE AGING COMMITTEE ARE TRYING TO DEVELOP IN THE WAY OF A NATIONAL RESPONSE TO THE OMISSIONS IN FEDERAL AND FEDERALLY-ASSISTED HEALTH CARE PROGRAMS. THEY ALSO DEMONSTRATE THAT PUBLIC AND PRIVATE AGENCIES RECOGNIZE THE NEED FOR A COMPREHENSIVE APPROACH TO PROBLEMS THAT CAN BE POTENTIALLY CATASTROPHIC FOR THE ELDERLY AND THEIR FAMILIES, AND THAT THERE IS A LIMIT TO WHAT CAN BE EXPECTED FROM WASHINGTON DURING THESE TIMES OF BUDGETARY RESTRAINT. I'M SURE THAT TODAY'S WITNESSES WILL PROVIDE ADDITIONAL INSIGHT ON HOW WE AS A NATION CAN BEST RESPOND TO THE HOME HEALTH CARE NEEDS OF AN AGING POPULATION. I THANK THEM FOR THEIR WILLINGNESS TO HELP THE COMMITTEE IN ITS CONTINUING EFFORT TO PROMOTE A QUALITY HOME HEALTH CARE APPROACH AS A COST-EFFECTIVE ALTERNATIVE TO INSTITUTIONALIZATION. PREPARED STATEMENT OF REPRESENTATIVE CHARLES A. HAYES MR. CHAIRMAN, MEMBERS OF THE SELECT COMMITTEE ON AGING, I AM PLEASED TO OFFER THESE REMARKS TO YOU TODAY AS YOU HEAR TESTIMONY ON HOME CARE QUALITY. SEVERAL HUNDRED OF MY CONSTITUENTS IN CHICAGO, ILLINOIS ARE HOME CARE WORKERS AND MEMBERS OF SERVICE EMPLOYEES INTERNATIONAL UNION (SEIU) LOCAL 880. AS A MATTER OF FACT, TO DISCUSS THE ISSUE OF INCREASING THE MEDICAID CEILING ON CLIENT REIMBURSEMENT. THESE CONSTITUENTS WERE IMPRESSED TO LEARN THAT THE HOUSE SELECT COMMITTEE ON AGING IS HIGHLY CONCERNED ABOUT THE QUALITY OF HOME CARE BEING PROVIDED TO THEREFORE I WANTED TO SHARE WITH YOU SOME OF THEIR CLIENTS. CONCERNS. SEIU HAS TAKEN THE POSITION THAT THE $980 PER MONTH CEILING FOR CLIENT REIMBURSEMENT IN ILLINOIS SHOULD BE INCREASED TO $1500 PER MONTH TO ALLOW CLIENTS TO OBTAIN ENOUGH HOURS OF CARE AND TO ALLOW HOME CARE PROVIDERS TO RECEIVE DECENT WAGE AND BENEFIT PACKAGES. SEIU URGES THIS COMMITTEE TO RECOMMEND AN INCREASE IN THE REIMBURSEMENT LEVEL AND TO SUPPORT THE COLLECTIVE BARGAINING RIGHTS OF HOME HEALTH CARE WORKERS. SEIU CONTENDS THAT SOME VENDORS IN ILLINOIS ARE USING MEDICAID FUNDS TO HIRE ANIT-UNION CONSULTANTS (UNION BUSTERS) THEREBY DENYING LOW INCOME PEOPLE THEIR RIGHT TO ORGANIZE. WORKERS AND CLIENTS ARE OBVIOUSLY SHORTCHANGED BY THIS PRACTICE. THE HOUSE SELECT COMMITTEE ON AGING'S SUPPORT FOR AN INCREASE IN THE MEDICAID REIMBURSEMENT CEILING AND A DECENT WAGE AND BENEFIT PACKAGE FOR WORKERS WILL REDUCE TURNOVER OF EXPERIENCED, WELL TRAINED HOME CARE WORKERS. IN TURN, THIS WILL FOSTER BETTER AND MORE CONSISTENT CLIENT CARE. IN ADDITION TO THIS INCREASED CEILING, EFFORTS SHOULD BE MADE TO ENSURE THAT THE USE OF MEDICAID FUNDS ARE NOT USED TO INTERFERE WITH THE COLLECTIVE ORGANIZING OF WORKERS AND CLIENTS. MR. CHAIRMAN, IN CLOSING, I WOULD LIKE TO CONVEY TO YOU MY APPRECIATION FOR ALLOWING ME THIS OPPORTUNITY TO EXPRESS THE CONCERNS OF MY CONSTITUENTS WHO ARE INVOLVED WITH THE DAY-TO-DAY DELIVERY OF HOME CARE SERVICES. WITH YOUR PERMISSION MR. CHAIRMAN, BEFORE THE HEARING RECORD ON THIS ISSUE IS CLOSED, I WOULD LIKE TO REQUEST THAT YOU ALLOW THE INCLUSION OF A MORE EXTENSIVE WRITTEN STATEMENT BY SEIU LOCAL 880. I AM CERTAIN THE MEMBERS OF CHICAGO SEIU LOCAL 880, AND ITS PRESIDENT, MS. IRMA SHERMAN, WOULD CERTAINLY ADD SIGNIFICANTLY TO YOUR UNDERSTANDING OF THIS ISSUE. THANK YOU. |