Unbiased Analysis of Today's Healthcare Issues
The increased use of long-term care (LTC) services has been one of the forces increasing health care cost and utilization. Currently, 10.3 million Americans use LTC services. The Kaiser Family Foundation provides a summary of LTC Services and Supports in the U.S. Who uses LTC? One can divide LTC services into those who receive care…
Why are hospitalization rates so high for Medicare beneficiaries living in long-term care facilities (i.e., skilled nursing facilities, nursing facilities, and assisted living facilities)? The first reason is obvious: they are sick. If they weren’t, they wouldn’t need to be living in these facilities in the first place. Hospitalizing sick patients is often necessary. Unnecessary…
Medicare spends a lot of money on beneficiaries living in nursing homes. How expensive are these beneficiaries: Six percent of Medicare beneficiaries spend some time in a long-term care facility, but these same beneficiaries make up 17% of total Medicare cost. Three percent of Medicare beneficiaries spent an entire year in a long-term care facilities.…
Under Medicare Part A, beneficiaries can receive coverage for care provided by skilled nursing facilities (SNFs), also known as nursing homes. Between 2000 and 2007, however, the rate of potentially avoidable re-hospitalizations for five key conditions (congestive heart failure, respiratory infection, urinary tract infection, sepsis, and electrolyte imbalance) increased from 13.7% to 18.5%. One potential explanation…
For Labor Day, I will profile a group of workers who are underappreciated: long-term care workers. These posts are typically filled by certified nurse’s aids (CNAs). Despite the importance of their job, their remuneration is far from generous. In The Politics of Medicaid, Laura Katz Olson reports that CNA hourly wages were only $10.61 in…
Almost 7 out of every 10 of individuals living to age 65 will require some long-term care (LTC) assistance. Of these, over one-third will spend some time in a nursing home. In general, however, the elderly strongly prefer home based LTC if possible. “Mattimore and colleagues (1997) found that 30% of elderly survey respondents would…
In Virginia, there are over one million people age 60 and older and over 90,000 Virginians age 85 and older. These figures will only grow in the upcoming decades. Thus will put increasing strain on public programs and will require service providers to reorient medical care toward providing continued, high-quality long term care services. Long…
Atul Gawande has written yet another excellent article in the New Yorker. This one about end of life care. In the debate surrounding health reform, many politicians hijacked the serious discussion of end-of-life decisions and decisions to use non-invasive medical treatment were termed death panels. But end-of-life decisions merit further investigation. Not only can giving…
A recent paper by Kitchener et al. (HSR 2008) investigates the actions of one nursing home chain to find how they maximized their profits. The authors find that Sun Healthcare Inc. employed three strategies to maximize shareholder value: rapid growth through debt-financed mergers; labor cost constraint through low nurse staffing levels; and a model of…
There is an interesting article a few weeks back in the Wall Street Journal (“Opting Out“) which describes the plight of Amish and Old Order Mennonites who refuse to buy health insurance. Further, since these groups also refuse to participate in Medicaid government assistance will not bail them out either. Nevertheless, these societies do have…