Financing of Healthcare

In the office I work for, the majority of the patients will have a co-pay with the remainder covered by their health care plan. With the rising costs of health care there is an increasing strain on the financing of health care.  It is becoming  increasingly more difficult for those without health insurance to meet their health care costs. Our policy makers have been reluctant to combat this issue with meaningful reform such as tort reform.  Regarding insurance there are many patients lacking adequate insurance or have none at all. One way to combat this is with individual mandates as proposed by the current administration. By requiring everyone to purchase health insurance, including the young and healthy, insurance can be provided to those who cannot currently afford insurance. However the constitutionality of individual mandates are in question.  A current concern regarding delivery pertains to the lack of providers in certain areas of expertise such as primary care as well as regional shortages of physicians in rural and impoverished areas. Another concern regarding delivery pertains to changing demographics with inadequate providers in specialties such as urology and geriatrics. 
A solution in this area may be to provide financial incentives for physicians to enter these specialties and serve in these locales. Regarding payments, as the  insurance carriers shift more and more of the costs of health care to the patient it is becoming increasingly more difficult for the patient to meet these costs. Solutions here could include more personal responsibility such as healthy lifestyles, avoidance of obesity, avoidance of alcohol and smoking, and greater physical fitness. This resulting in less need for health care services. Other practical actions include those contemplating a family should not do so if they cannot afford to provide appropriate health care to their children. That is, a greater emphasis and demand for personal responsibility.

Nursing Facility Financing

Recently, I visited a nursing facility in Daytona Beach called Horizon Healthcare Center.  I love to volunteer here, and speak with the lonely residents.  We usually go for walks in the garden or have a quick lunch and spend quality time together.  I spoke with a few residents about their financing situation.  A few residents were uptight about the topic, however many gave me the information I wanted to compare.  I was asking each person (about ten) how they were able to afford their home at the skilled nursing facility.  Many of the residents have Medicaid as their primary source of payment.  Medicare was only 2 of the 10 residents.  The results really threw me for a loop!  I always thought Medicare was used most in nursing homes.  Medicaid to me was for low-income families, and Medicare was for the elderly who lived in nursing homes as their primary housing.
I was asking what was included in the cost, my best answers included, room, board, nursing care, food, therapeutic activity, social services, physical therapy, and speech therapy.  I was in complete shock when I heard all of the above was included.  The rate for Medicaid is set by the state Medicaid agency.
Many of the tenants had a "roommate."  This was the norm here, making it more comfortable for patients to socialize.  However, if you have a private room it will cost you much more than the two bed-room.
If I were ever to put anyone in my family in a nursing home, I would completely choose this place.  It was beautiful with friendly staff, great food, and a wonderful atmosphere for all.  As soon as you walk in you smell the Otis cookies baking in the oven along with a friendly dog who greets you when walking in.  I know nursing homes can be expensive, but it to me is totally worth the money.  It really helps when you feel like you're at home.  Especially when you are sick and cannot take care of yourself.

End of Life Decisions

With the changes in health care today, end of life decisions are increasingly more difficult for patients, families, and physicians.  Physicians must balance patient wishes with realistic expectations.  They also have to take into consideration a patients beliefs.  This can all be accomplished best if the patient and physician have a long term relationship.  It is imperative for physicians making end of life decisions for patients with acute life threatening conditions, to be aware of the patient's quality of life and level of performance prior to being stricken.  Unfortunately, as a nursing student I have observed elderly in-firmed patients being presented to the emergency room where a physician or hospitalist, without prior knowledge of the patient, has to make a decision regarding end of life care or "Do not Resuscitate" (DNR) status.
In years past, patients were more likely to have a long term relationship with their physician and a one on one relationship.  The physician would admit and follow the patient in the hospital and was in the best position to make end of life decisions.
Today patients seem more likely to be treated by a revolving door of physicians and physician extenders.  The special bond between the physician and patient unfortunately is often lost.  When admitted to a hospital with an acute life threatening illness, patients are assigned a hospitalist du jour who very often has to make end of life (DNR) decisions  knowing little about the patient.  Was he/she playing golf three days earlier?  Was he/she singing in the choir?  Was he/she looking forward a granddaughters wedding? Or was the patient living a lonely solitary existence with little happiness and little to look forward to, welcoming end of life?
Sadly, with the de-personalization of healthcare, lack of traditional family physicians, and the use of hospitalists, end of life decisions are not necessarily being made by those best in a position to do so. Therefore, I feel it is important for the elderly to have continuity of care as an outpatient and for this continuity to continue as an inpatient, allowing a physician, familiar with the patient  to have an important role in end of life decisions.  Further, it is incumbent that elderly patients make clear and concise end of life directives when healthy and this must be encouraged by all health care providers.

What does long-term care mean to me?

Long-term care to me is a person requiring individual care for a sustained period of time.  This type of care includes; personal, mental, social, medical/nursing oversight, and also rehabilitation.  When people think of long-term care they immediately visualize a nursing home as the only option.  This is incorrect.  There are multiple facilities that will accommodate you and your loved one.  Nursing facilities, subacute care, assisted living, elderly housing, community based services, home healthcare, adult day-care, and hospice are all examples of long-term care providers.

My favorite program for long-term care individuals is the adult day-care.  This facility provides help for the care-taker, giving them time to themselves without the stress of taking care of their loved one.  My grandmother takes care of my sick grandfather everyday.  I have explained to her on numerous occasions that the stress of being with him and taking care of him everyday is not healthy.  I also have looked into adult day-care's in the area, however she does not want to leave him for any length of time.  I talk to her daily, and their outing of the day is riding up to the mailbox or getting ice cream!  I feel she needs someone to either come to the house or take him to an adult day-care.  His disease is only worsening, making it even harder for her.  This week I am going to get more information on home healthcare services in our area.  Hopefully this will allow her to have time to herself and re-group.