WASHINGTON — Medicare should create a new benefit to more adequately address long-term care, delegates to the 2005 White House Conference on Aging recommended.
In one of the many implementation plans to improve the health care of aging patients, the delegates to the conference called for the implementation of a “Part E” to the Medicare program, a comprehensive, lifetime, long-term care benefit that would be available to Americans of all ages.
Because Medicare is going bankrupt, and most monies used to pay for long-term care come from Medicaid, “we have to do something to help offset the financial costs associated with a projected increase in these services in the next 10–15 years,” Dr. William Woolery, a delegate from Georgia, said in an interview.
Most nursing home beds are long-term care—paid for either by private funding sources or by Medicaid. A few of the beds, however, qualify as “skilled” facilities and are paid for by Medicare Part A.
“In general, nationwide, there are nonskilled or long-term stay beds for long-stay patients and skilled beds for short-term skilled admissions for things like post-hip fracture recovery or rehabilitation for stroke,” explained Dr. Charles Cefalu, a geriatrician from Louisiana and a member of the American Medical Directors Association, who attended the conference.
Patients have only a small number of options once their coverage for skilled care has been terminated, Dr. Moira Fordyce, a geriatrician and an adjunct clinical professor at Stanford (Calif.) University, said in an interview.
Under the current system, a short-term hospital stay is required before skilled nursing home, home care, or rehabilitation will be paid for by Medicare. Then the Medicare payment is limited to a period of 100 days per condition per lifetime. Such a payment level is “not enough when chronic illnesses over many years are the norm,” she said. Unless skilled care is involved, and the patient is improving, the payment stops.
Personal care is only covered while skilled care is being given. “This means, for example, that someone at home who is coping with chronic illnesses who just needs help in the morning to get out of bed, wash, and have breakfast, then help in getting to bed in the evening would have to pay for this, if he or she has no family to help,” Dr. Fordyce said.
For these reasons, a Part E should also cover home care, in addition to nursing home care; “otherwise it will not be of great value,” she said.
There are many people in nursing homes that could be at home if this type of help were available, she continued. “Home is preferable, and less costly to the patient and society than nursing home care—now costing anything from $40,000 to $60,000 or more each year.”
Creating a Part E to accommodate these types of long-term care patients would require congressional action. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services wouldn't comment specifically on the proposal, only that CMS “would be interested in seeing the final report [from the White House Conference on Aging] based on the final resolutions, and await any actions” on those resolutions.
It's unlikely that the current Congress will be receptive, “but we must start somewhere and keep after them until something is done,” Dr. Fordyce said. “When there are enough vociferous voters, Congress will have to listen.”
Dr. Cefalu wasn't as convinced. “It seems far fetched that Medicare would opt to fund nonskilled nursing home beds that are currently paid for by private or Medicaid services,” considering that the program is overwhelmed with the drug benefit—and that skilled nursing home units and skilled units in acute care hospitals are already trying to cap or rein in skilled nursing home costs with prospective payments, he said.
“It's a pipe dream. Congress is not going to approve it,” he said.
To get resources for a Part E, “we would have to review the alignment of government programs that deliver services to older Americans, look at all programs out there, see where there is duplication, and cut out redundancy,” Dr. Judith Black, a geriatrician and delegate from Pittsburgh said in an interview.
Until that's accomplished, “I don't see how we'll have funding available,” Dr. Black said.