Washington lets a health crisis continue

Registered nurse Mary Schlitter, left, speaks to heart patient Maria Marure, with the help of medical interpreter Marina Moreno at Our Lady of the Resurrection Medical Center in Chicago. A study has shown that hospital stays for heart failure fell a remarkable 30 percent in Medicare patients over a decade. Next year, the nations new health law begins punishing hospitals with high readmission rates for heart failure by shrinking Medicare payments.
Registered nurse Mary Schlitter, left, speaks to heart patient Maria Marure, with the help of medical interpreter Marina Moreno at Our Lady of the Resurrection Medical Center in Chicago. A study has shown that hospital stays for heart failure fell a remarkable 30 percent in Medicare patients over a decade. Next year, the nations new health law begins punishing hospitals with high readmission rates for heart failure by shrinking Medicare payments. (M. SPENCER GREEN / Associated Press)
Posted: October 20, 2011

Last week, the Obama administration announced plans to abandon a key part of the health-care reform law, known as the CLASS Act. Although most Americans hadn't heard of the provision, it was meant to fix our broken long-term care system. Abandoning it was a mistake.

A few days ago, I took care of a lively, 86-year-old woman in the emergency room. Let's call her "Mrs. T." Mrs. T lives alone, and she came to the ER hours after a fall. "No one was around to help me up, so I stayed there until my neighbor stopped by," she told me. She was lucky: If her neighbor hadn't stopped by, she might have died there on her own floor.

Mrs. T's story is not unique. Many elderly patients come into the ER after accidental falls. Mrs. T knows she needs help, but she can't afford home-care services. And like most seniors, she does not want to move into a nursing home. But in our current system, that might be her only option.

The CLASS (Community Living Assistance Services and Support) Act was supposed to help patients like Mrs. T get the care they need at home. It was a voluntary insurance program for coverage of community living services and support: making a house wheelchair-accessible, hiring a home caregiver to assist with basic tasks, and the like.

The problem that led to last week's decision was that the program couldn't be made to pay for itself. But that doesn't mean we don't need such a program.

American seniors currently have few long-term care options. They can pay for home care out of pocket, which tends to burn through a lifetime of savings quickly. They can give up their independence and get institutional (and at times dehumanizing) care at a nursing home. Or they can take the significant risks of going it alone, as Mrs. T did.

Home care not only keeps seniors in their homes; it keeps them out of hospitals and nursing homes. Nursing home residents are much more likely to develop depression, lose the ability to get around without assistance, and acquire persistent infections. This creates a vicious cycle of increasing health-care needs and costs.

The federal Program of All-Inclusive Care for the Elderly, or PACE, is a national leader in long-term care done right. More than 80 percent of its funding is spent on home and community programs. The program thereby keeps seniors out of the hospital and in their homes, and it lowers health-care costs. If even part of the money we spend on nursing home care were similarly diverted to home care, the health-care system would be better off, and so would seniors.

The CLASS Act may be dead, but there has never been a greater need for a comprehensive solution to our long-term care crisis. Congress and President Obama should take this opportunity to find one. If enough workers buy in well before they need long-term care, it doesn't have to cost the government money.

Congress and Obama can continue to ignore this problem, but American seniors will continue to suffer at the hands of our long-term care system. Mrs. T is one of them. Having broken her hip, she will likely spend the rest of her life in a nursing home at the government's expense. Until the system is fixed, there will be many more patients like her.


Dr. Kalpana Narayan is a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania. She can be reached at knarayan@mail.med.upenn.edu.

comments powered by Disqus
|
|
|
|
|