3 search results for ""health affairs""

Affordable Care Act, CMS, Drugs, HHS, Long term care, Medicare, Medicare costs

Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises

“We can send prescriptions to the pharmacy, including [for] narcotics,” says Marie Grosh, a geriatric advanced practice nurse practitioner and the owner of a medical house calls practice in a Cleveland suburb. “We can order lab work, x-rays, ultrasounds, EKGs [electrocardiagrams]; interpret them; and treat patients based on that. But we’re just not allowed to order home care—which is absurd.”

By SUSAN JAFFE  | Health Affairs | June 2019 | Volume 38, Number 8

When Christine Williams began working as a nurse practitioner some forty years ago in Detroit, Michigan, older adults who couldn’t manage on their own and had no family nearby and no doctor willing to make house calls had few options besides  winding up in a nursing home.

Not anymore.

Home check: Nurse practitioner Marie Grosh visits Leroy Zacharias at his home in a Cleveland suburb, He has Parkinson disease, and Grosh says he would be living in a nursing home if he couldn’t get medical care at home. (Photo by Lynn Ischay.)

“The move towards keeping seniors in their homes is a fast-galloping horse here,” says Williams, who settled in Cleveland, Ohio, more than a decade ago. “We don’t have space for them in long-term care [facilities], they don’t want to be in long-term care, and states don’t want to pay for long-term care. And everybody wants to live at home.”

But despite the growing desire for in-home medical care for older adults from nearly all quarters, seniors’ advocates and home health professionals claim that rules set by the Centers for Medicare and Medicaid Services (CMS)  along with  state regulations have created an obstacle course for the very providers best positioned—and sometimes the only option—to offer that care.  [Continued here] …

Drugs, Long term care, Medicare costs

Seeking Dental Care For Older Americans

Since Medicare doesn’t cover most dental care, seniors often go without treatment.

By SUSAN JAFFE  | Health Affairs | December 2016 | Volume 35, Number 12

The last time Evelyn Sell went to the dentist was nearly three years ago, when he told her his staff would no longer be able to lift her out of her wheelchair and into the dentist’s chair. “That really threw me for a loop,” said Sell, 87, a retired preschool teacher who lives in Kingsley Manor, a retirement community in Los Angeles. “I didn’t know what I was going to do about dental care.”

Care at home: During a recent visit to Kingsley Manor, a Los Angeles, California, senior living community, dental hygienist Maria Ladd uses an intraoral camera to take photos of resident Ruth Wilson’s teeth. (Photo: Susanna Castillo)

…Then earlier this year, she found the solution. A flyer in her mail informed her that the management of her assisted living facility had partnered with the Virtual Dental Home project run by Pacific Center for Special Care at the University of the Pacific in San Francisco. Sell could have a dental hygienist come to her home. She was one of the first residents to sign up.

The project is one of several innovative demonstrations that providers and researchers are developing to serve vulnerable uninsured or underinsured patients. Despite their promise, however, these efforts meet only a fraction of the need. A comprehensive solution would likely require federal legislation, but bills to broadly expand Medicare’s dental coverage have languished in Congress. So some advocates for older adults are working on a third front, seeking changes to Medicare coverage policy based on the idea that dental care can be an integral part of the medically necessary care Medicare covers. [Continued here] …

Affordable Care Act, Long term care, Medicare costs

Aging In Rural America

For older Americans, accessing high-quality care can be a challenge. For those in rural communities, it’s even harder.

By SUSAN JAFFE  Health Affairs January 2015 Volume 34, Number 1

Care in rural America: Dr. Robert Wergin goes over medications with Sharon Stutzman at the Milford Family Medical Center in rural Nebraska.

In the southeastern Nebraska town of Milford, population 2,100, Dr. Robert Wergin understands it’s not easy for some of his older patients to get to his office. Some may live on isolated farmsteads several miles out of town, and if they don’t drive, their son or daughter—if nearby—may have to take time off from work to bring them to their appointments because there’s no public transportation. Massive snowstorms are nothing special but still cause a wave of cancellations.

 

In addition to these challenges, rural America’s elderly tend to be poorer, have higher levels of chronic disease, and have a dwindling supply of health care providers, compared to their peers in urban communities, explains Brad Gibbens, deputy director of the University of North Dakota’s Center for Rural Health, in Grand Forks. And their support system is shrinking, as more young adults seeking job opportunities head out to urban areas. “The elderly [rural] population tends to stay put because that’s where they’ve lived all their lives, and there isn’t really an economic beacon that’s pulling them to another area,” he says. [Continued in Health Affairs, and PDF here]…