By Lynn Kellogg
Congress has critical budget decisions to make on how to spend reduced dollars. It’s a daunting task without knowing the intricacies of the programs and interests affected.
Big-ticket items dramatically affecting our elder population are in play: the Older Americans Act (OAA), Medicaid and Medicare. Within these structures, key programs exist to save money and create efficiencies in achieving purpose.
This column is intended to help elected officials and the advocating public understand some of these issues.
The Older Americans Act of 1965 created a nationwide planning network by designating entities (mostly private not-for- profit or public), to be Area Agencies on Aging to develop businesses, products and services so persons from all walks of life have the support needed to thrive in advancing years.
Much of today’s supportive business and product infrastructure is a direct result of this work. The ROI is astounding.
The OAA also provides dollars targeted for particularly critical services. Examples are widespread and based on local need, including in-home support and transportation. The most well-known concerns nutrition. OAA remains the primary funder of Meals on Wheels nationwide.
A visionary part of the act, separate from funding discussion, is a call for it to be reauthorized about every five years to see what’s working, what needs to be tweaked or added for maximum impact. This has kept it fresh and efficient. Every reauthorization has passed with strong bi-partisan support.
A bi-partisan reauthorization bill was in play this year when it was delayed with a host of other bills for further consideration. The reauthorization, and separately the budget, needs to move forward.
Medicaid is our state and federally-funded health insurance for the poor. It’s significant for the elder population when someone needs nursing home care. Individuals seeking nursing home care have dealt with health issues for years. They often don’t have much money left. Entering a nursing home impoverishes them and they turn to Medicaid. With an increasingly older population, costs soared.
The solution? A nationwide “waiver” system allowing Medicaid to reimburse for care in the home rather than nursing home. Serving people with high needs in the home costs a fraction of the cost of nursing home care. It’s a true success story.
In Michigan the waiver program is called MI Choice and provides home based care to about 1,000 individuals in Berrien, Cass and Van Buren counties alone. Elected officials need to know it’s very successful and key to lowering per capita costs.
Medicare is historically successful, paying higher percentages of the dollar in actual care versus administrative costs than private insurance, and allowing access to healthcare to all elders. But only Part A of Medicare, hospitalization, is entitlement. Other parts like outpatient care and prescription drugs are premium based.
What happens when people can’t afford them?
People of advanced age with little money are some of the most vulnerable people in the country. They visit emergency rooms in times of distress, often for conditions that could have been managed with proper care. Emergency rooms as a regular source of care is highly expensive and often avoidable.
The solution? Programs like PACE, the Program of All-Inclusive Care for the Elderly, and MIChoice waiver programs provide ongoing care management for the individual. They coordinate Medicare and Medicaid together with tremendous win-win results: a) significant cost savings to the system in avoiding hospital or nursing home care, and b) higher quality of life for the person.
Newer Medicare products such as Special Needs Plans (SNP) are effective models targeting high need, high-cost individuals with specialized plans. Results show lower costs while increasing quality of life.
It’s difficult to know what expertise is still available at the national level to help Congress understand and protect efficiencies in place. It’s critical that those in the field reach out in for dialogue and advocacy.
The local Area Agency on Aging has its annual Legislative Forum from 2-4 p.m.
April 28. Check AreaAgencyonAging.org and click on “Get Involved.” Your voice matters.
Lynn Kellogg is former CEO of Region IV Area Agency on Aging in Southwest Michigan. Questions on age or independence services? Call the Info-Line for Aging & Disability at 800-6542810 or visit areaagencyonaging.org. The Generations column appears each weekend in The Herald-Palladium.