Countless lives were touched when the tsunami tragically struck
several countries in Asia in December. Many now claim that
thousands of lives could have been saved had there been a better
warning system in place.
In America, we are fortunate to have plenty of warning about the
growing crisis in health care, especially as a potentially
devastating “demographic tsunami” of aging Americans
begins to roll in. This early warning provides an opportunity to
add to the policy debates our unique perspective about the
advantages and cost-effectiveness of home care as we prepare for
the demographic sea-change already under way.
Americans continue to live longer as our oldest citizens
continue to be our fastest-growing population segment. Moreover,
the oldest of the 76-million-strong baby boomer generation (born
between 1946 and 1964) are now poised for their greatest period of
health care utilization. This slow rising tide has far-reaching
implications for government programs like Medicare, Medicaid and
Social Security.
At the same time, federal budgetary constraints will drive
intense fiscal belt-tightening by the Bush administration and 109th
Congress, with a strong focus on curbing health care spending.
These demands, coupled with the high costs associated with health
care, present enormous challenges for the health sector and further
underscore the need for solutions like home- and community-based
health care services.
Growing Focus on Rebalancing
Against the backdrop of budget deficits, Medicaid and Medicare
stand out as targets for policymakers. The threat of shifting costs
to state Medicaid programs has prompted a swift response from
governors. According to a recent report released by the National
Governors Association (NGA) and the National Association of State
Budget Officers (NASBO), Medicaid spending now represents about
one-quarter of state budgets, with an average growth rate of 11
percent per year over the last 25 years.
Rather than allow further cuts in Medicaid spending, however,
governors are uniting in an effort to write their own Medicaid
reform plan for Congress. This will include several
cost-containment strategies already employed by some states,
including rebalancing home and community-based services and
institutional care, placing controls on drug costs, reducing or
freezing provider payments, and reducing or restricting
eligibility.
Other methods for increasing the efficiency of Medicaid have
been discussed, such as enabling beneficiaries to use reverse
mortgages to pay for their long-term care, promoting long-term care
insurance with tax credits and limiting beneficiaries' ability to
transfer or spend down their assets in order to qualify for
Medicaid coverage.
Warnings Provide Opportunity
For both Medicaid and Medicare, at state levels and at the
federal level, we have a golden opportunity to highlight the
benefits of home care — it is patient-preferred, can improve
quality outcomes and is cost-effective. By encouraging support of
the valuable home care solution to the challenges we face now, we
also reinforce a firm foundation for future demands on the nation's
health care system.
Preparing for the Future
As natural disasters remind us in the case of the tsunami,
nothing is worse than being caught unaware, unprepared or
uninformed. This is where the home care industry has an important
story to tell. Local, state and federal representatives need to
know how important home care will be to the baby boomer generation
and beyond, so as stakeholders, we must produce our own rising tide
of concern and advocacy.
Many technologies and hands-on services that are provided by
this industry are unique. Within the health care continuum, home
care will help stem the tide of overwhelming demands the country's
health care system will face during the years to come.
Kay Cox is president and CEO of the American Association for
Homecare, Alexandria, Va. For more information about AAHomecare,
visit www.aahomecare.org, or call 703/836-6263.
