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The Honolulu Advertiser
Posted on: Friday, January 8, 2010

Health care reform ignores needs of elderly


By Dr. Anna Loengard

Home health care is playing an increasingly critical role in today's health care environment, filling in an important gap as people transition from the hospital to recovery at home or helping them stay out of the hospital altogether.

As a geriatrician and palliative medicine specialist, I have personally witnessed numerous incidents of people being discharged from the hospital and left in the hands of family caregivers back at home who have good intentions but are ill-equipped to care for their loved one on their own.

While some have called the recent Senate majority's vote in favor of health care reform "a victory for the American people," it is especially troubling that the combined House and Senate legislation that still needs final approval in a conference committee largely ignores the needs of Hawai'i's growing elderly population.

Over the past 10 years, I have spent most of my time caring for the frailest elderly patients and supporting their stressed caregivers on the Mainland. Limiting services to this population is not what this country or state needs. It is no victory for the elderly when reimbursements for hospice and home care are reduced or eliminated.

The home health care services in danger of being cut are the nursing and physical therapy visits for the frail elderly. Home health care is ordered by the patient's doctor because the patient has declined in some way, and the visits are meant to improve their health and get them back to baseline. Physicians order home health care for many reasons: to monitor vital signs; care for a wound or ulcer; physical therapy after a hospitalization or fall; or even to educate a patient or family to better manage a chronic condition such as diabetes. The ultimate goal is to keep the older person safe and well and out of the hospital.

If the overall goal is to cut health care costs with shorter hospitalizations and reduce readmissions to the hospital within 30 days of discharge, it would seem that decreasing the very services that support these frail patients in the community will not support this goal.

Having nurses and other health care professionals come into the home can be invaluable, as they provide another set of eyes and ears for doctors. In addition to treating the medical issue, these skilled providers may discover things in the home that the patient and family did not think were important or perhaps were too embarrassed to share with the doctor.

The average annual Medicare expenditure per person in Hawai'i is $2,575, while other states spend as much as $4,978 per person. When it comes to home health care, the discrepancy is even greater. In Hawai'i, Medicare pays just $113 per person for home health the lowest in the nation. By contrast, Texas has the highest Medicare home health costs that exceed $1,000 per person.

Hawai'i residents already use this benefit less than any other Americans, and we simply cannot afford to have it cut further.