Raising the Eligibilty Age for Medicare and SS?

I just caught wind of this discussion, and I'm afraid this could become a reality.

The CBO just released its "research" that supports raising the Medicare and SS eligibility age:
www.cbo.gov/ftpdocs/125xx/doc12531/01-10-2012-Medicare_SS_EligibilityAgesBrief.pdf

The report indicates that more people will have to work longer--did they realize it's especially hard for those in their 60s to find jobs? (see: www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/Fiscal_Analysis/Long-term-unemployment-addendum-November-2011.pdf) 

The report claimed that about 5% of those using Medicare would be uninsured but that most would get insurance from the private sector (Really--who's underwriting folks in their 60s and offering affordable premiums? The ACA has charged states with creating health insurance exchanges, but those are being challenged and states like Georgia are sitting on their hands waiting for it to be repealed: http://www.ajc.com/news/georgia-politics-elections/waiting-game-may-cost-1291709.html ) or from their spouse's employers (sorry same-sex couples, entrepreneurs, and single/widowed folks).  Here is a quote from the report:

CBO assumed that people who became ineligible for Medicare under the new age limits could purchase health insurance through the exchanges, and, depending on their income, might qualify for federal subsidies. CBO also assumed that people with the lowest income would qualify for Medicaid benefits. Without those changes to the recently enacted health care laws, CBO anticipates many more people would become uninsured if the MEA was raised.

Compare that to Robert Reich's thoughts (found at http://robertreich.org/post/7941066493):

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced.

I really hope the President and Congress take a harder look at their proposals. Perhaps we could save money by allowing them to get health insurance from their spouses or purchasing it in the private market?

Thanks for listening to my rant. I'd love to hear your thoughts.

CNAs: Vital Partners in Caring

Certified Nursing Aides, or CNAs, play vital roles in caring for our elderly and disabled. CNAs, (sometimes called Home Health Aids) provide such services as bathing, dressing, house-keeping, and supervision for those that cannot do those tasks independently.  An estimated 2 million CNAs perform these vital tasks, meeting the daily needs of many Americans.* I can recall numerous times when I felt awed by the work these ladies (89% of CNAs are women) accomplish on a daily basis.  One instance stands out prominently in my mind.  I was at at the bedside of a woman when she took her last breath.  She was living in an assisted living community, and only myself and the CNA were present at her death.  After notifying the nurse and family that the death had occurred, I remember feeling helpless and at a loss as to what to do next.  The CNA didn't, though.  She promptly filled up a small tub with warm, soapy water and began cleansing the deceased woman's body, preparing her for her family to see her.  She washed her whole body, even applied body powder and a new gown, and fixed her hair before her family arrived to say good-bye.  I was amazed by the CNA's swift action and compassion.  I knew that she did not have to do this.  She could have chosen to move on to her next patient, and yet she seemed to not even think twice about what needed to be done.  The family was moved by the peaceful beauty they found when they saw their loved one, and I am forever in awe of the work of CNAs.  

That story is only one of many that I can recall of a CNA going above and beyond for her patients.  I have consistently witnessed CNAs bring patients into their hearts and care for them like family.  It was not unusual to hear of a CNA buying sweets or Cokes for her patients or picking up some fast food for a housebound patient with a craving.  I have known CNAs to go by their patients' houses off the clock just to check in.  These extraordinary efforts are even more amazing when I consider the compensation most CNAs receive. Recently, I stumbled upon PHI PolicyWorks after reading an article in the New York Times.  PHI Policy Works, a non-profit policy group that represents the interest of direct-care workers (CNAs and HHAs) in the US, publishes some interesting statistics on the working condition of CNAs.   The average wage for a CNA ranges from $9-$12/hour. Disappointingly, 28% of CNAs have no health insurance; this is compared to 18% of the total US workforce. The higher uninsured rates among CNAs may be caused by their part-time work status: 48% of CNAs are employed part-time or full-time part of the year.  In the Metro Atlanta area, it seems to be a common and acceptable practice to hire CNAs prn (as needed) and then assign them to 30-40 hours of work a week.  This arrangement gives the employee enough work to get a consistent paycheck and the employer a break from paying for benefits (e.g., health insurance, paid time-off, sick leave, retirement plans, etc.).  It also allows for the employer to not guarantee a certain amount of work or pay.  If the census of a healthcare organization declines, the employer can just assign the prn staff less hours and save money.  That being said, I have no data or stats on this local phenomenon, and I contend that it may be less common than I have experienced.  

Figuring out how to care for our elderly and disabled citizens while keeping it affordable for consumers and profitable for business is no small task.  I am, however, bothered by the apparent inequities in the working conditions of CNAs.  Their work is hard and so necessary, yet their compensation does not reflect this.  Recently, President Obama announced a new rule that will give CNAs working as in-home care workers the same minimum wage and overtime protections afforded to other workers under the Fair Labor Standards Act.  This group of workers has been excluded since 1974.  This new rule is being hotly debated now, and businesses are claiming the potential unintended consequences of higher costs for consumers and job losses for employees make this new rule faulty.  Perhaps it does, but when 46% of CNAs live in households that rely on public benefits, it seems as if there is something faulty with the current system.

Book recommendations:

Barbara Ehrenreich's Nickel and Dimed 
    Barabara Ehrenreich writes about the world of the working poor by going undercover and doing the work they do.  One of her undercover gigs is as a nursing home aide.  This expose reveals the demanding and often undignified world of low-wage work.

Lauren Kessler's Dancing with Rose
    Laruen Kessler also wrote a book after doing some undercover work as an aide at an assisted living community for folks living with dementia.  Her story was supposed to be about the residents/patients, but she revealed just as much about the people caring for them.  I highly recommend this book to anyone that wants to learn more about the world of institutional care.

Click here to learn more about CNA requirements in Georgia.

*PHI Policyworks stated, "In 2008, over 3 million direct-care workers were employed
in the three occupations: Nursing Aides, Orderlies and Attendants (1,470,000);
Home Health Aides (922,000); and Personal Care Aides (817,000)."

The Healthcare Dance

The relationship between healthcare professionals and their patients (patients including both the actual patient and their healthcare proxies) resembles a dance.  And I have begun to realize that neither party always knows whether to follow or lead.  Recently, a woman receiving short-term rehab at a SNF experienced an acute onset of aphasia; she had no prior history of cognitive impairment .  She was alert and oriented but had nonsensical responses to questions and displayed retarded motor movements. This was a new development that came on suddenly.  The nursing home staff examined the resident and called the doctor; the doctor asked the nurses to keep monitoring the resident and call him back with any changes.  The family said, "Well, this should clear up shortly. The doctor has said to just keep watching her."  After 24 hours and no improvement, I pressed the nurses to take a harder look, emphasizing that this is a big change in this resident.  The nurse said, "Well, if the family insists we can encourage the doctor to send her to the hospital for further evaluations."  Did the doctor and SNF staff not realize how big of a change this was for this resident? Did they project cognitive impairment on her that was so common for other SNF residents? Were they waiting for the family to push for more care?  And was the family waiting for the medical staff to push the alarm that something was wrong?  They appeared to be in a dance and not sure who was leading.  My conversation with the nurse led to a longer assessment of the resident and conversation with the family.  The nurse called the doctor and requested that the resident be sent to the hospital. This woman with the acute onset of aphasia had a a cerebrovascular accident, or a stroke.  She spent five days in the hospital and then returned to the SNF with a new rehab plan for speech therapy and a new blood-thinner.  Maybe diagnosing the stroke will make no difference in this woman's outcome, but it made me realize how ambiguous this dance between healthcare professionals and patients can be.  The patient may be assuming and wanting the professionals to be the lead, but the professionals may be waiting for the patient to be in charge, especially in this age of patient-centered care.  Healthcare, and more so in geriatric medicine, is a give and take from both sides.  Good clinicians realize that they are only seeing a snapshot of the patient and that this patient has about seven decades of complicated social and medical history that cannot be captured in the snapshot.  Thus, patients must fill in those gaps, and healthcare professionals must be willing to take the time to ask good questions and complete full assessments.  Patients and healthcare proxies often must advocate for this level of attention and not sit idly by as healthcare professionals do their jobs.