Request for Additional Funding, Essay Example

Date: October XX, 20XX

To: The Senate Committee on Health, Education, Labor and Pensions

Fm: Joseph Smith on behalf of the Medicare Licensed Health Care Workers

Re: Request for additional funding to expand home health care interventions for seniors

Good afternoon, Mr. Chairman and distinguished members of the committee.  I represent the Medicare Certified Home Health Care industry and I would like to offer a proposal for additional funding for home health care services through Medicare and Medicaid.

As you know, seniors represent a significant part of our population and their importance with regard to many issues should be of concern to this committee and the nation as a whole.  Seniors are at risk in medical situations where they should not and there are solutions that would not only be economically viable but also politically expedient, given the growing number of seniors who will be voting.

There are areas in home health care services for the elderly that can use greater funding for expansion and upgrading.  Specifically, I refer to the health service areas of Medicare and Medicaid’s community programs to expand home health interventions for the elderly.  I would propose a home intervention program that would add social workers to the initiative to visit with seniors throughout the country and offer them assistance with health issues and taking their prescribed medications.  This initiative would also offer greater detailed communication and dissemination of health related information between health care providers and the elderly.  By intervening in clients’ homes, we will do a better job of offering medical and mental health-related services of which they may be unaware are available.

Overview of the health policy issue

• There are issues with health care for seniors that may be addressed efficiently and economically in the home.
• There are many seniors citizens that do not take their required medications properly for various reasons.
• A social worker can intervene in the home and offer convincing rationale for helping the elderly maintain their required dosages as long as they understand the health consequences of not taking their medications and the benefits of keeping up their prescribed dosages.
• We will also seek to provide valuable referrals to mental health services for those seniors in disadvantaged or vulnerable positions. An expanded program will foster greater input from our seniors and help them stay healthy while offering better lines of communication and soliciting input from senior clients as to how we may better serve this country through public health programs.

Even though there are a multitude of studies and information on the epidemiology and treatment of alcohol abuse among seniors, little comparable data are available on prescription drug abuse among the elderly. (Simoni-Wastila & Yang, 2006)

Elderly citizens who suffer from depression, social isolation and a history of substance abuse are at an increased risk for the abuse of drugs.  Careful prescribing and regular follow-up interventions allow for successful treatment of pain, anxiety and insomnia in most patients.  Interventions help insure that the elderly are taking the medications they have been prescribed in the proper dosages.  The development and use of accurate screening tools and proper treatment guidelines for prescription drug abuse in seniors may ensure the appropriate use of both established and newer medications. (Culberson, 2008)

Congress can make a big difference for a relatively small investment. We are seeking additional funding for an expansion of home health interventions for senior citizens through the Medicare and Medicaid programs.

Analysis of Beliefs, Morals, Values

What we know:

Low-income seniors frequently suffer from chronic medical conditions and problems with mental health care because of high costs and limited availability of health care.  Older citizens in general, and particularly poorer people, often do not receive the recommended minimum level of care for preventive services and management of chronic diseases.  Proper use of medication is a particular problem among such seniors.

What we can do:

Coordinating efforts among those caring for home intervention patients is essential.  The intervention worker must consider the resources and environment available to the client; and older persons must be included as active partners in their care except when they are too frail, mentally or physically.  The client’s physician must be included in all decisions involving the health and well-being of the elderly patient.

We must expand home interventions for our seniors.  Elderly people can improve their physical well-being and live more independently if they are given access to complex health interventions.  A meta-analysis of over 90,000 senior patients showed that preventive home visits and community based health care after a hospital stay greatly enhanced client’s home living experiences.  The study also showed that home interventions were credited for a 13 percent less chance of being admitted to a nursing home, a 6 percent reduction in hospital admissions and a 10 percent decline in falls. (Beswick, et al, 2008)

Sometimes, elderly patients are not convinced that their prescriptions are helping them or they’ll rationalize the consequences of ignoring them.  We will use the principles of the health belief model in our intervention selection process.  Clients may contact appropriate agencies to volunteer for such programs or they may refer others whom they believe may be in need of these types of interventions.  The health belief model is predicated upon assumptions that a person will take a health-related action if that person believes that a negative health condition can be avoided and the recommended action can be undertaken easily and with confidence. (Culberson & Ziska, 2008)

Policy Strategies

Employing the Health Belief Model:

We will reach out to seniors through community action agencies, doctors, clinics and hospital referrals for patients who meet our criteria for assistance. The health belief model that we will employ is a psychological approach designed to forecast and account for health behaviors by working around the attitudes and beliefs of individuals.  The health belief model was first explained during the 1950s by social psychologists Hochbaum, Kegels and Rosenstock who worked for the U.S. Public Health Services.  The model was developed after a free tuberculosis screening program had failed to produce expected results and the study hoped to figure out the dearth of public participation in health screening and prevention programs.  Since its inception, the model has been used to explore a host of health behaviors, notably those involving the sexual risk activities and the spread of HIV infections. (Culberson & Ziska, 2008)

The model works around four representations of the perceived threats and potential benefits that include perceived susceptibility, perceived threat, perceived benefits and perceived barriers.  These concepts define people’s “readiness to act.”  (Beswick, et al. 2008)

“Cues to action,” is a term that seeks to explain the encouragement required to energize that readiness and produce behavior.  In 1988, Rosenstock, et al. added this concept to better face the challenges of reforming habitual behaviors which are recognized as unhealthy, such as smoking, binge eating and inactivity. (Culberson & Ziska, 2008)

Perceived threat is further divided into perceived susceptibility and perceived severity of a health threat.  Perceived susceptibility is seen as an individual’s subjective beliefs about the risk of contracting an ailment or disease and perceived severity defines the feelings concerning the seriousness of catching a disease or the consequences of leaving one unattended.  This further involves the social worker conducting an evaluation of the medical and clinical consequences and any possible social aftermath.

Other variables in our model include diversity in demographics, social, psychological and structural variables that may affect a person’s perceptions and indirectly affect healthy behavior, and the concept of self-efficacy, or the belief in being able to successfully execute the behavior required to produce desired results. (Beswick, et al. 2008)

Mental Illness in the Elderly:

A common problem among the elderly is untreated depression.  Up to 75% of the elderly who die by suicide had been to a doctor within a month before they killed themselves.  The risk of developing depression increases as other physical problems limit their ability to function independently.  Studies estimate that depression in the elderly can rise from less than 5% of those living in the community to 13.5%, as they require home health care.  In addition, it is estimated that 5 million more have sub-syndromal depression, symptoms that fall short of meeting the full diagnostic criteria for the disorder. Dysthymia or a mild, low-grade but persistent form of anxiety disorder is a type of depression.  Both of these conditions can often escalate into major depression. (NIMH, 2010)

A mixture of social, psychological and biological factors causes Major Depressive Disorder and treatment responses should address all three.  A personalized approach to therapy that addresses the complexity of the disorder should investigate personal, societal, biological, genetic and environmental issues that contribute to the patient’s problems.  (Grohol, 2006)

Recommended therapy options include cognitive behavioral therapy, behavioral therapy, rational emotive therapy to family and group therapy, depending on individual needs and available resources.  (Grohol, 2006)

The drug-taking regiment of the elderly that involves psychoactive prescription drugs is a continuum that ranges from appropriate use for medical reasons through misuse by the patient to persistent abuse and dependence.  Abuse of prescription drugs among the elderly does not usually involve the use of drugs to get a high and the abusers do not usually get them from illegal sources.  More often, unsafe combinations or amounts of medications may happen by seeking prescriptions from multiple physicians (doctor shopping), by obtaining medications from family members or friends, or by stockpiling medications over time. Thus, prescription drug abuse among individuals in later life is qualitatively and quantitatively different than it is for younger adults. (Bartels, et al, 2006)

Expanding Services Through Public Funding:

There is an increasing trend in the application of technology to expand mental health services to people who cannot make it to a clinic or practitioner.  For some seniors who do not have problems with using computers or memory loss, these innovations can save them trips to their mental health care providers.  Advances in technology have been a part of clinical therapy for many years.  Today, psychotherapists use virtual reality models to treat post-traumatic stress disorders.  Mental health facilities have web sites with online screening services for anxiety and depression.  Some clinics offer online appointment scheduling and electronic medial recording systems provide reminders for lab tests and critical values. (Luo, 2005)

Expanded use of “telehealth” – using electronic telecommunications technologies to offer long-distance mental health care and consultation, patient and professional health-related information, public health and health administration – is an expanding resource for in-home mental health caregivers.  Tele-home care and consultations can increase access to mental health care for all patients, but is especially beneficial for individuals with multiple chronic health conditions, those with major illness or disability, underserved urban populations, children, and the elderly.  Public and private insurers do not yet adequately cover or reimburse for telehealth services. (Luo, 2005)

Reimbursement for these services from Medicare or Medicaid must be universal enough to allow evidence-based practices to be implemented, coordinating both actual clinical care and e-health visits while ensuring that services delivered through new technology are supported. Achieving this will require changing policies and coverage in all sectors of the health care business. (Luo, 2005)  Intervention workers can help to insure the system is properly serving the elderly patients by using such programs in conjunction with follow-up visits.

Medical Use Interventions:

Medical use reviews can be performed in the home by the intervention health care worker during a prescription intervention.  Suggested priorities for these interventions should be based on the following criteria: (Quoted from Schaffel, 2005)

• Patients over the age of 75 currently prescribed 4 or more items on a repeat prescription.
• Patients currently prescribed 4 or more items on a repeat prescription.
• Patients over the age of 75 currently prescribed less than 3 items on a repeat prescription.
• Patients prescribed less than 3 items on a repeat prescription.”

Such a review should include advice on all medicines that they are using including prescribed, over the counter, herbal and complementary. The purpose is to develop proper compliance and concordance usage and help the elderly understand their functions and effects.  Intervention workers should work with the pharmacist to ensure appropriate use and effectiveness and refer back to the patient’s doctor when necessary.

Patients should get advice from their pharmacist on the tolerability and side effects of prescription drugs and any problems involved should be brought to the attention of the patient’s doctor.  Social interventions can assist in practical problems relating to the ordering, receiving and using the medication including a possible prescription delivery service or such mundane items as opening safety pill bottles.

Home intervention workers must notify the client’s doctor about any medication which is currently not being taken including meds discontinued by the doctor but never deleted from the prescription or medications the patient has stopped taking due to side effects or patient misunderstanding.

Intervention workers should also notify the patient’s doctor if the client is making infrequent or too frequent prescription requests. Bring to the doctor’s attention any incomplete or unclear directions or any duplication of medications.

Interventions will Save and Improve Lives:

While many suicidal behaviors among the elderly have been effectively curtailed using psychotropic medication, corporate profit can be a powerful motivator.  How much prescription medication is improperly given will never be accurately determined and its quantitative value may never be accurately measured.  The elderly are susceptible to more prescription abuses simply because they consume more medications than the young do.

Recommending exercise to the elderly must be done carefully.  The risk of injury from falling is high among the elderly, but the benefits of regular exercise apply to seniors as well as the young.  Even a modest exercise program and balance training can dramatically reduce the risk of falling and help older patients become more self-reliant.  (Beswick, et al, 2008)

The twentieth century brought rapid technological advancements in medicine and medical sciences and the discovery of new antibiotics and life-sustaining drugs like insulin coupled with better surgical techniques, sanitary procedures and new technologies allowed chronically ill patients to live longer lives.  The new challenges became more involved with sustaining life and developing better chronic care abilities.  This shift in priorities has been largely successful toward an increased life span and a healthier, older population.  Consequently, we should allocate more funding and resources toward preventative efforts and chronic care.  Home interventions for the elderly and disabled would be the most effective treatment option for unhealthy Americans.

Conclusion

In conclusion, this proposal has suggested changes that would improve the liability of public health care for people over age 65 (and selected groups who are younger but have issues similar to their elders).  I propose a home intervention program that would add social workers to visit with seniors throughout the country and offer them assistance with taking their prescribed medications. It has strongly been suggested that this initiative would also offer greater detailed communication and dissemination of health related information between caregivers and the elderly. By intervening in clients’ homes, we will do a better job of offering medical and mental health-related services of which that they may be unaware. Once implemented this home intervention program will make the senior citizens of our nation happier, safer and healthier.

I would ask this committee to propose to the full Senate an increase in Medicare’s budget to accommodate this expansion of services.  As an addendum to the Affordable Care Act, home health interventions can greatly enhance the quality of life for the community and offer preventative care rather than acute care, which will save the program money in the long run.

Thank you for your time and consideration in this matter.

References

Bartels S J, Blow F C, Brockmann L M, Van Citters A D, (2006) “Evidence-based practices for preventing substance abuse and mental health problems in older adults,” Older Americans Substance Abuse and Mental Health Technical Assistance Center, SAMHSA, Washington DC, Pp. 4-25.

Beswick, Andrew D., Rees, Karen, Dieppe, Paul, Ayis, Salma, Gooberman-Hill, Rachel, Horwood, Jeremy and Ebrahim, Shah, (2008) “Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis,” The Lancet, Number 371, Pp. 725-735.

Culberson J.W., and Ziska M. (2008) “Prescription drug misuse/abuse in the elderly,” Geriatrics, Volume 63, Issue 9, Pp. 22-26, 31.

Grohol, John, M., PsyD, (2006) “Depression Treatment,” Psyche Central, March 8, 2006, accessed online on October 28, 2012 at: http://psychcentral.com/disorders/sx22t.htm

Luo, J., (2005) “Technology in Clinical practice: Computer based therapy and radio frequency identification,” Psychiatric Times, October 1, 2005, accessed online on October 24, 2012 at: http://www.psychiatrictimes.com/showArticle.jhtml?articleId=172901320

National Insitute of Mental Health (NIMH) (2010) “Older Adults: Depression and Suicide Facts accessed online on October 28, 2012 at: http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-  fact-sheet/index.shtml

Schaffel, Nicola, (2005) “Bolton PCT guide to interventions,” Prepared on March 2005, accessed online on October 26, 2012 at: http://www.bolton.nhs.uk/clinical/med_manage/documents/Bolton%20Medicines%20use%20review%20and%20prescription%20intervention.pdf

Simoni-Wastila L, and Yang H K, (2006) “Psychoactive drug abuse in older adults,” Am J Geriatric Pharmacother, Volume 4, Issue 4, Pp. 380-394.