Midlands Voices: Proposed health reforms crucial for care of elderly

The writer, of Omaha, is Harris Professor of Geriatric Medicine at the University of Nebraska Medical Center. She is a past president of the American Geriatrics Society.

Many of the older adults for whom my colleagues, students, trainees and I care are concerned about health care reform. A good number are worried that it might change Medicare for the worse. But I’m not.

As a past president and current member of the American Geriatrics Society (AGS) and a professor of geriatrics at the University of Nebraska Medical Center, I’m familiar with the three reform plans that Congress has proposed, including the plan from Senate Finance Committee Chairman Max Baucus.

And I feel confident that proposed reforms — while they aren’t perfect and won’t solve every problem with elder health care — would be good for older Americans.

Rather than undercut Medicare, all three major health care reform proposals include badly needed provisions that would enhance this important government health program. They also would make Medicare more cost-effective, affordable and sustainable, so it would be around for the next generation.

I and fellow members of the AGS — a nonprofit organization of health care professionals who care for older adults and are dedicated to improving their health and quality of life — believe that all Americans, regardless of age, deserve high-quality, cost-effective and affordable care. That’s why we support current efforts to bring about proposed reforms that would make this a reality.

The three major reform plans — the one Sen. Baucus’ committee is now “marking up,” the one approved by a trio of House committees and the Senate Health Education, Labor and Pension Committee plan — differ from one another in many ways. But all would address key problems in elder care.

For starters, all three would help address growing, nationwide shortages of geriatricians (primary care physicians specializing in the care of the elderly) and other geriatrics health care professionals in Nebraska and the rest of the country.

Here in the Cornhusker State, which is currently home to more than 230,000 seniors and will be home to an estimated 376,000 in 2030, we’re already facing serious shortfalls of these professionals. There are just 31 geriatricians statewide. That’s just one geriatrician for every 7,400 Nebraskans age 65 and older.

Growing geriatrics work force shortages are a serious problem because geriatricians and other geriatrics health care providers have advanced training that prepares them to care for even the sickest older patients, including those with multiple chronic health problems such as diabetes, heart disease and dementia. Geriatrics health care professionals typically work in teams, providing comprehensive, coordinated care for such patients.

Research suggests that such care can improve both outcomes and cost-efficiency, saving money. There’s a lot of money at stake: The 20 percent of Medicare beneficiaries with five or more chronic conditions now account for 70 percent of Medicare expenditures.

The Geriatrics Workforce Policy Studies Center at AGS estimates that, by 2030, a staggering 21 million older Americans will have multiple chronic conditions and need the kind of care that geriatricians and other geriatrics professionals are trained to provide. With these professionals in increasingly short supply, it’s time to act!

Provisions in Congress’ proposed reform plans would not only expand training for these professionals but also would enhance training for home health aides and other direct-care workers who care for seniors. And they would better prepare and support the family caregivers who provide 80 percent of all care for older Americans.

In addition, proposed reforms would expand Medicare coverage to include such needed services as care coordination and transitional care — which helps ensure that sick seniors get appropriate care when making what are often difficult and potentially dangerous transitions, say, from home to hospital, or from hospital to nursing home.

Reforms would place greater emphasis on preventive care for seniors and on reducing hospital re-admissions among Medicare patients. And they would address problems with current Medicare payment policies, which have created serious financial disincentives to caring for older adults. Surveys find that these disincentives are a leading contributor to growing shortfalls of geriatrics health care providers.

In short, key provisions in the health reform plans now before Congress would strengthen, not weaken, Medicare. And they would help ensure its future. They would enact important changes for which organizations dedicated to the health and well-being of older Americans have long sought. They deserve our support.

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