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Population-Based Health Policy: Elderly

The elderly population in the United States is growing significantly. People who are 80 years and older most likely need long-term care due to severe disabilities.
Demonstration grant for testing experience and functional assessment tools
The TEFT program is created to test quality measurement tools and validate e-health in Medicaid LTSS. The TEFT aims to demonstrate personal health records and create a standard electronic LTSS record. With the help of the grant program, which is approximately $42 million, the Centers for Medicare & Medicaid Services is advocating the use of health information technology in the LTSS system. The TEFT grant program will provide important feedback on how electronic infrastructure as a means of improving health information exchange can be implemented in this component of the Medicaid system. In the US, states that are currently receiving the grant awards include Arizona, Colorado, Connecticut, Georgia, Kentucky, Louisiana, Maryland, and Minnesota.3
 
Costs of Long-Term Care
In 2009, the United States spent $205 billion on long-term care. In 2006, one-year nursing home stay cost an average of $76,000. In 2009, out-of-pocket payments by individuals and their families financed 22% of long-term care in the United States. Medicaid and Medicare pay 34% and 28% of U.S. long-term care expenditure respectively. In 2005, average out-of-pocket costs for healthcare paid by the Medicare beneficiaries estimated to be 20% of family income. One-fifth of these expenses went in nursing homes. Medicare pays for skilled care and not custodial care. Some of the examples of skilled services include changing the dressing on a wound, taking blood pressure, listening to the individuals’ heart and lung to identify heart failure or pneumonia, increasing patients’ awareness about diabetes, hypertension, heart failure, and other ailments, occupational therapy sessions for people with stroke, hip fracture, and other individuals to assist them reach their maximum potential level of functioning, and speech therapy for patients with speech deficits. On the other hand, Medicaid does not cover 24-hour custodial services that include assistance with ADLs and instrumental ADLs. In order to be entitled for Medicaid long-term coverage, families are forced to spend their savings. However, with the help of HCBS 1915(c) waivers, Medicaid recipients receive more care services than before. In 2005, Oregon assigned 71% of its long-term Medicaid dollars to HCBS program, whereas nationally Medicaid spent 35% of its money for this program.1
 
Access to Quality Care
One of the successful long-term care program that enhanced access to quality care is the On Lok program in San Francisco that was implemented in 1971. On Lok, which is a certified Program of All-Inclusive Care for the Elderly (PACE) amalgamates adult day services, in-home care, home-delivered meals, housing assistance, extensive medical care, respite care for caregivers, hospital care, and nursing care into one program. All of the services that are provided by the On Lok program are coordinated by a multidisciplinary team that include physicians, nurses, social workers, occupational therapists, and nutritionists. However, PACE sites care for fewer than 25,000 of the three million vulnerable elderly and disabled population in the United States.1
 
Expanding Program of All-Inclusive Care for the Elderly
The ACA had a significant role in creating few programs, including CFC, state balancing incentive payments programs, MFP, and TEFT to ensure that people can receive long-term services and support. However, the United States has not acquired a social health insurance program for long-term care. Such insurance programs will emphasize access to healthcare services on the basis of individual’s medical needs and essentially redistribute the wealth from the rich to the poor, well to the sick. These programs ensure that all residents, including the elderly, have reasonable access to medically necessary services and enhances long-term viability of the healthcare system. It is essential to expand the PACE to provide solutions to the existing problems of long-term care.
 
References
1. Bodenheimer T, Grumbach K. (2012). Understanding health policy: A clinical approach (6th  ed.). New York: McGraw Hill Medical.
2. U.S. Department of Health and Human Services. (n.d.). Administration for community living. Retrieved from http://www.aoa.gov/aging_statistics/health_care_reform.aspx
3. Medicaid. gov. (n.d.a). Community-based long-term services & supports. Retrieved from http://www.medicaid.gov/AffordableCareAct/Provisions/Community-Based-Long-Term-Services-and-Supports.html
4. Medicaid.Gov. (n.d.b). Money follows the person. Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/balancing/money-follows-the-person.html

 
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