Reform Proposal, A shift towards Cash and Counseling

I am proposing a reform to shift long term care towards more of an individual choice, such as Cash and Counseling.

Cash and Counseling is a program that gives elderly and disabled Medicaid consumers who receive personal assistance services the option of directing their own care. Some examples of the services included would be cooking, bathing, dressing, and housekeeping. Usually, the Medicaid programs are in contract with the home care agencies to provide these services. However, the patient has very little say in who, when, where, or how these very personal needs will be met. The vision of Cash and Counseling includes, “A nation where every state will allow and even promote a participant-directed individualized budget option for Medicaid-funded personal assistant services.” (cashandcounseling.org) Also, Academy Health researchers found a large, statistically significant amount of elderly that proclaimed unmet needs, dissatisfaction with care, and poor quality of health with their current LTC services. Clearly, a change is needed!

All Medicaid consumers should have the right to know their individual choices. A lot of consumers may be unaware that Cash and Counseling even exists. As previously stated, the Medicaid individual would have the personal right to decide who, what, where, and how their personal services would be met. This can include what meals they will be served, who would prepare these meals, or if they would rather purchase cooking equipment to help with the meals they eat. There have been many success stories and individuals have seen a big change. Some of these changes include, patients are more satisfied with the quality of their services, increased access to paid care, had fewer unmet service needs, and experienced an improved quality of life. (cashandcounseling.org) Also, patients who choose to use a family member or friend as their main means of service have benefited from an increase in communication and positive relationship with this person (Kaiser Network).

According to the New York State Health Policy Research Fund, an estimated $207 billion of all health care costs were for long-term care, including nursing homes, services with persons with disabilities, home based services, and hospice care. Also, the high cost of long-term care is important for state governments because they administer and partially fund Medicaid (Courtney Burke). Expenses for the elderly are nearly six times those for children and adults enrolled in Medicaid. It has been proven that Cash and Counseling does not increase states’ Medicaid costs. In terms of cost, I believe it would go down if this service were used more often. Instead of patients paying for services they do not actually need, they could use this for appropriate services. The patients and family can sit down together and discuss what services the patient truly desires. This would benefit cost as well as quality. If the patient themselves is directly requesting the type of care, the quality would greatly increase. According to the Health and Human services committee, almost 75% of the elderly using this program rated their over all quality as, “very satisfied.” The care can be narrowed down to specific services, as opposed to the millions of little services the person was providing before.

In conclusion, Cash and Counseling would greatly benefit the patients and care-givers in both cost and quality. Useless services would no longer be paid for and used. The patient would have a direct say in what services and type of care they would like to receive. This would in turn provide a more efficient service for the elderly.

-Andrea Trojan

http://www.cashandcounseling.org/

http://www.mathematica-mpr.com/_error/index.asp?404;http://www.mathematica-mpr.com/disability/cashcounseling1.asp

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1486

www.state.nj.us/humanservices/dds/.../NGAWinterMtg08NJ_DDS.ppt

http://www.academyhealth.org/files/publications/cashandcounseling.pdf

I am proposing a reform to shift long term care towards a new method called “Green Houses”.

The Green House Project is a model which creates a smaller community for elders, they focus on life and many relationships are formed. Green Houses are different from traditional nursing homes and assisted living facilities. They alter the size of the facility, interior designs, staff members, and the methods for delivering services. The primary purpose is for it to be a place where elders can receive the assistance they need that support the activities of daily living and clinical care. Dr. William Thomas states, “The Green House model is intended to deinstitutionalize long-term care by eliminations large nursing facilities and creating social settings.” The green house vision demonstrates a change in life, work, and relationships.
Green Houses apply to elders qualified to live in skilled nursing homes. Green Houses are licensed as a skilled nursing home and are regulated by each state. It is a home for six to ten elders, which incorporates outdoor and indoor space. Providers need the option of moving Green House nursing homes off of long-term care campuses and across America. Green Houses need to be licensed as a nursing home; service providers may include home health agencies, local health care providers, or an existing nursing home. Departing from traditional nursing homes and moving locations, Green Houses are places where elders can receive the support they need through daily living and clinical care. Green Houses are designed to feel like private homes/apartments in the community. Changes have developed from Green Houses such as introducing plants and animals to structural changes. Changes that occur within Green Houses are deinstitutionalizing elders, moving to a small house setting, changing the structure, and a homelike environment.

For residents, Medicaid, private pay and limited Medicare may cover the elder’s care. But the cost per day depends on the cost structure; Green Houses are licensed as traditional nursing homes are eligible for Medicaid and Medicare reimbursements. There are now more than 100 Green Houses nationally. If Green Houses continued to rise across America the access would definitely increase due to similarities in cost of traditional nursing homes and allow the elders to have a more homelike setting. It’s about quality not quantity in Green Houses. High satisfaction levels have been reported by residents, family, and staff. Also, within Green Houses there has been an increase in daily living activities such as bed mobility, transfer, eating and toileting. There has been a decrease in depression while more meaningful activity increases with relationships and food enjoyment.

Each Green House project is run independently. Green Houses may be developed by individuals and organizations (nonprofit and for-profit) that can provide a high level of services. This proposal plays a large role with the aging population. Dr. Thomas noticed many unexpected deaths in traditional nursing homes and residents did not like what they saw. Dr. Thomas fixed nursing homes by developing Eden Alternative which includes plants, animals, and children into nursing homes. Some people believe that giving grants to Green Houses are not beneficial to elders. But any elder who has had an experience in a Green House would say that the difference is not even comparable. Dr. Thomas interviewed Joe Shapiro in 2005, he said, "I believe that in the nursing home every year, thousands of people die of a broken heart. They die not because their organs fail, but because their grip on life has failed." Along with old age come psychological disorders, evidence shows that Green Houses reduce depression. If depression was decreased there would be an increase in the aging population. Why not help out elders to the best of our ability, while maintaining reasonable cost!

Bailey, Sue. Future Without Nursing Homes? (2004): 6. Web. 25 Mar 2010. .
Breindel, DeSantis. Place to Call Home (2008): n. pag. Web. 25 Mar 2010. .
Halloran, Liz. "Green House Projects Let Elders Age In Homes." (2010): 2. Web. 25 Mar 2010. .
McAilly, Steve. "Green Houses at Traceway Retirement Community: Tupelo, Mississippi - Design Center." (2003): 4. Web. 25 Mar 2010. Simonette, Terry . "THE GREEN HOUSE®." (2008): 24. Web. 25 Mar 2010. .

I am proposing a reform to include holistic health therapies in all long-term facilities.

Holistic health is a philosophy of medical care that views physical and mental aspects of life as closely interconnected and as equally important approaches to treatment. (holisticnetwork.org) It is not allopathic medicine that is used in hospitals and facilities. It consists of focusing on lifestyle, mental well-being and spiritual awareness through health and fitness. Instead of using medicine and regular hospital therapies to help the physical pain or disease of the person, the goal is for a wellness that involves the entire person.

How does holistic health help the patient? It is understood that when symptoms of sickness develop, it is mostly long after the cause of these symptoms actually occurred. The holistic approach focuses on the cause of the symptoms or sickness rather than treating the symptoms and/or syndromes. Some examples of holistic health therapies are chiropractic techniques, massage therapy, reflexology, energy balancing, acupressure, and acupuncture. These are just a few of many different techniques and therapies used in holistic health.

One technique that would be great for elderly or disable in long-term care would be message therapy. Because of the direct contact, massage therapy provides those with Alzheimer's disease a way to relax. In doing so, it reduces the anxiety linked with the disease. Massage also provides stimulation, which helps the residents communicate physically. Pain is very common in many senior’s lives not matter what condition they have, which is why massage therapy is very important. About 80 to 85% of people past the age of 65 will experience pain caused by a health problem. Of these elders, 25 to 50% will admit to having significant pain, and of those living in nursing homes, this percentage increases to 45 to 80%. (massagebysuzanne.com) Massage therapy can help reduce the pain of chronic disease and minor injuries, decrease muscle spasms and stiffness, and increases mobility. However, the only reason massage therapy is important is not only because of the pain. Decreased social contact at this point in their lives makes massage therapy an effective treatment approach for seniors. Basically, massage therapy can be used to help loneliness that the elderly encompass. Just the simple touch of another human being helps the feeling of being lonely decrease.

Another technique that would be useful would be meditation practices. Meditation is used as for pain control as well. It is a way of healing the body, and is used for relaxation and stress relief. It is a simple practice, a skill that can be tremendously beneficial to the body as well as the mind. A guide to meditation is a must when you want to conduct yourself towards enlightenment and inner peace. This is something that may be very important to elderly. Therefore, not only does meditation help their body physically, but it helps their spiritual and mental health as well.

Using these different therapies and techniques would develop a great improvement in residents of long-term facilities. It is a different approach then what is regularly used, and could also be a good way for residents to have fun and socialize. Even if facilities would have a therapy session once a week for the residents it could improve their mental, spiritual, and physical health.

http://www.holisticnetwork.org/about_the_discipline.cfm
http://www.healthynewage.com/
http://www2.kenyon.edu/khistory/holistic/definitions.htm
http://www.massagetherapy.com
http://www.massagebysusanne.com/massage-for-the-elderly.htm
http://www.project-meditation.org

Reform Proposal 1

I am proposing a reform for a shift from nursing home care to home health care, which is much more affordable for patients and long-term care facilities.

One of the major problems with long-term care in our country is all of the costs that go into it. In Wisconsin, it costs an average of $36,594 per year for assisted living and an average of $86,505 per year to live in a nursing home. (aarp.com) The answer is not to reduce costs and lower the wages of these dedicated health care workers, but to try and shift a far greater percentage of people who require long-term care into home and community based settings instead of nursing homes. This way, the quality of care and the quality of life can be drastically improved for those in need of long-term care.

So much money goes into operating nursing homes and many of the residents do not necessarily need to be in these facilities in the first place. I currently work as a Certified Nursing Assistant in a nursing home and at least twenty-five percent of the residents I work with would greatly benefit from home health care. They do not need to rely on caretakers for every moment of the day and are mostly independent. I believe they would also enjoy being able to stay in their own homes instead of a facility.

This reform will allow many people who currently live in nursing homes be evaluated and find out if they can possibly do just as well in the comfort of their own home through home health providers or outpatient visits to rehabilitative or care centers in their community. While the aim is to shift many people to home health care services, some people will still need to be in nursing homes, either for constant care or because they have no family or other support. This way, these changes will not necessarily be detrimental to nursing homes and the services they provide.

Someone might be opposed to this is they think that nursing homes are doing a great job for their residents. While the staff may be dedicated and the facility may be working very hard, it will never be hard enough. Nursing homes are hardly like a “home” at all. They are more like a hospital or some other type of warehouse facility. They are understaffed according to law and in order for care to improve, this law or something about it must change. I think it is important to begin with the shift to home health care to improve the quality of each and every aspect of long-term care.

As mentioned earlier, nursing home care costs $86,505 per year in Wisconsin but having a home health aide in the home for two hours of daily care would cost about $16,060 ($22 per hour) for one year. This would definitely save costs for insurance companies and Medicare as well as those individuals who have to pay out of pocket in the current health plan our country has. By moving from overcrowded nursing homes to home health care and assisted living, access would increase for individuals who are most in need of the services offered by nursing homes. The quality of care would increase for those who are able to move to their own homes and their quality of life would improve.

1. "Long-Term Care: Early Planning Pays Off" MayoClinic.com. 16 Jan. 2010. Web. 28 Feb. 2010.

2. "Medicare.gov - Types of Long-Term Care." Medicare.gov - The Official U.S. Government Site for People with Medicare. 25 Mar. 2009. Web. 28 Feb. 2010.

3. Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America A Systems Approach. 4th ed. Sudbury: Jones and Bartlett, 2008. Print.

4. "What Does Long-term Care Cost In Your State?" AARP Public Policy Institute. 25 Oct. 2006. Web. 28 Feb. 2010.

5. "What is LTC ?" National Clearinghouse for Long Term Care. 22 Oct. 2008. Web. 28 Feb. 2010.