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.
http://www.cashandcounseling.org/
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 do agree with the Cash and Counseling plan, it is a good idea. This plan promotes independence by allowing individuals or their guardians to plan the kind of care the want. As a worker for the developmentally disabled, I am a strong advocate for independence. Even in our young years it is good to have a long term plan so that 1) one know's what is expected and 2)it will be cheaper in long run by not spending money on superfluous services.
ReplyDeleteI definitely agree with more of an individual choice. Being a nursing student, I have witnessed many patients not having a choice as the type of services and care they are given. If the patient were given more of an individual choice, this would allow more of their needs to be met. They could feel as though they have a life again. By deciding the foods they eat, when they eat, the clothes they wear, and other deicsions- they could take on more personal freedom. This may benefit their self esteem and confidence which could be beneficial in long term care.
ReplyDeleteThe idea of individuals such as elderly and the disabled being able to have a voice in the choices made in their everyday care is of great importance. From working with disabled people I have definatley come to realize the importance of individual choice. It can make such a differnce in someone's everyday routine by being able to make decisions for themselves. Making a simple decision between two different shirts or what type of juice to drink for breakfast may not seem like a big deal to a provider but can mean so much to the individual.
ReplyDeleteI believe patients definately deserve to make all of the possible choices they can in a day. People like to have control over their lives and allowing a patient to do something as simple as choosing who will cook for them, bath them etc. can make a world of difference to them. One thing I don't like about the nursing homes I did my clinicals in as a CNA was that there were men taking care of older women. If I was in a care facility I would only chose women to help me out. No offense to men but I would not men to be all up in my buisness if you know what I mean.
ReplyDeleteI have personally witnessed this first hand while being a CNA. I would have to say about 75% of the time while being a CNA, the complaints from the residents had to do with food choices and daily services that were not met. Every person has their own way of going about doing things, and it seems that in settings such as nursing homes often times the residents all seem to blend together. This is exactly what the residents do not need or want. A program such as Cash and Counseling would be extremely beneficial. It will also allow the elderly in their last years of life to enjoy them as they should.
ReplyDeleteIndividuals should definitely have a say as to what services they receive. In my CNA training, it was greatly stressed how we need to allow the individuals a chance for them to voice their opinion and make their own choices whenever possible.
ReplyDeleteHow exactly would this proposal be implemented? Are you suggesting it should be offered and covered through Medicaid?