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Running Head: HEALTH OF AGING

HEALTH OF THE AGING: Reduction in Nursing Home stays Trident University International Kevin S. Varner Topics in Health Care Policy BHM 415 Session Long Project Module Number 1 Coordinator Professor: Dr. Mickey Shachar Core Faculty: Dr. Brad Collins July 25, 2011

HEALTH OF THE AGING: Reduction in Nursing Home stays

When planning for retirement, one area that seldom, if ever, gets attention is future Nursing Home stays. Perhaps it is simply an oversight, or even a feeling that it will never be an issue for the individual. Yet, it is a sad fact that a large portion of Senior Citizens will end up in a Nursing Home at some point after they turn 65, for an unknown length of time. Improvements in technology, progress in medication, better preventative and treatment courses, and other breakthroughs in overall health care may decrease the required length of these stays eventually. However, in the short-term, there are measures that could assist the elderly in decreasing these stays, or avoiding a Nursing Home completely. Two measures have been referred to committee in the Senate that could have an immediate and direct impact on this issue, while measures can be taken in other areas right away to decrease the need for Nursing Home stays. Simple process improvement In 2007 the Commonwealth Fund, a private foundation interested in health system reform, released a paper detailing several steps that could substantially improve savings, and decrease stays in Nursing Homes (Grabowski 2007). Among the reforms mentioned, paying nursing homes based on performance and publicizing performance on nursing home hospitalizations, would show accountability and transparency in the industry. Both would increase, at the very least, a patients ability to choose the best home. Additionally, the report cites a study out of New York from 1999 2004, showing such conditions as Pneumonia (33.25%) , Diabetes (3.92%), and UTIs (17.6%) as some of the most common reasons for Nursing Home hospitalizations (Grabowski 2007). Preventative medicine, patient education and regular patient follow-ups can prevent these issues from becoming dire enough to warrant more than a short visit with their PCM. Investing in these areas of health care

HEALTH OF THE AGING: Reduction in Nursing Home stays

would easily decrease the length of stays in hospital settings, as well as decrease issues causing Nursing Home stays. Health Care Policy Another way to decrease the need for extended hospital stays, or admission to Nursing Homes, is through legislation that could significantly increase the ability of Senior Citizens to remain at home, while still getting the health care they require. Two Bills are currently in the process of review for voting through the Senate Committee on Finance. Senate Bill S.501, titled the Fostering Independence Through Technology Act of 2011, was introduced by Senator John Thune in March of this year (Govtrack.US 2011). After brief discussion it has been referred to committee for review, and if approved, will come up for a vote later this year. In essence, the Bill is designed to begin a pilot project through Health and Human Services (under the Social Security Act) that increases the use of home monitoring and communications technology (Thune 2011). This is designed to decrease costs and increase positive outcomes for patients that choose to remain home for healthcare, rather than living in a Nursing Home. Likewise, Senate Bill S.227, titled Home Health Care Planning Improvement Act of 2011, is designed to improve home health services, and decrease the time spent in Nursing Homes. In essence, this Bill modifies the language of the Social Security Act (42 U.S.C. 1395f(a)) to not only allow physicians to certify home health care services, but also to allow other health care professionals do the same thing. In multiple sections of the legislation phrases are written to be added, inserting health care professionals such as a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant (as the case may be) where before only the term physician was in place (Collins 2011). This could significantly

HEALTH OF THE AGING: Reduction in Nursing Home stays

increase access for home care coverage through the Social Security Act, as well as decrease costs associated with paying for Nursing Home stays, vice staying at home for care. Effectiveness and disadvantages Both the proposed legislation, as well as the process improvement recommendations, would be effective in keeping seniors out of Nursing Homes, and/or decreasing hospital stays. However, there are some disadvantages to all of these. Both Bills are currently in Committee, so may be modified before coming to a vote, then could be modified yet again to allow for passage of the Bill itself. Additionally, S.501 is only a pilot program that would last 5 years before results would be reported to Congress, and only be utilized in areas this type of home technology is most needed; urban and Rural locations (Thune 2011). If it is successful, and is adopted as a new way of doing business, it could be up to a decade before this program would go Nation-wide. Similarly, merely following the recommendations for changing processes will not be a complete fix. The overall system needs to go through massive modifications to focus on preventative care as the primary means of health care services. Stop these conditions from developing into emergencies, decrease costs to seniors to allow for regular health care rather than strictly emergent coverage, and increase home services as the norm rather than pilot programs and short term solutions. Conclusion Retirement planning should not have to include saving for the day you are admitted to a Nursing Home for your health care needs to be met. These modest proposals could have lasting, positive affects if made permanent and implemented as stated.

HEALTH OF THE AGING: Reduction in Nursing Home stays

References Collins, Susan; Conrad, Kent (2011) S.227-Home Health Care Planning Improvement Act of 2011. Senate Bill 227 January 31, 2011. Retrieved from: http://www.opencongress.org/bill/112-s227/text Govtrack.US (2011) S.501: Fostering Independence Through Technology Act of 2011. 112th Congress: 2011-2012. Retrieved from: http://www.govtrack.us/congress/bill.xpd? bill=s112-501 Grabowski, David; OMalley, James; Barhydt, Nancy (2007) The Costs and Potential Savings Associated with Nursing Home Hospitalizations. The Commonwealth Fund, November 6, 2007; Vol 93 Retrieved from: http://www.commonwealthfund.org/Content/Publications/In-theLiterature/2007/Nov/The-Costs-and-Potential-Savings-Associated-with-Nursing-HomeHospitalizations.aspx

Leonard, Kimberly (2011) Telehealth Bill Aims to Expand health IT Access for Home Care Providers. Center for Public Integrity, posted March 23, 2011. Retrieved from: http://www.natlawreview.com/article/telehealth-bill-aims-to-expand-health-it-accesshome-care-providers Thune, John; Klobuchar, Amy (2011) Fostering Independence Through Technology Act of 2011. Senate Bill S.501 March 8, 2011. Retrieved from: http://www.gpo.gov/fdsys/pkg/BILLS-112s501is/pdf/BILLS-112s501is.pdf