I read with great interest "All quiet on the senior front" (May 17, p. 2), which discusses how senior groups are skeptical about the provider campaign to increase federal payments.
Your readers need to know that the Balanced Budget Act of 1997 has wreaked havoc on home healthcare.
I am a member of the senior management team of a midsized home healthcare provider serving a large portion of central Pennsylvania. The organization is freestanding, voluntary, nonprofit and community-based.
Growth in home healthcare over the past five years has been directly related to the increasingly common practice of early hospital discharge and increased availability of technology, which makes delivery of care in the home possible. The value of moving care from the acute or long-term setting to the home is easily understood, from a cost and quality-of-life perspective.
Yet the new payment system for home healthcare has forced more than 25% of providers to go out of business or to discontinue service under Medicare. A recent Congressional Budget Office study revealed a 38% reduction on home-care spending, or a decrease of $47.9 billion, over the five-year period 1998-2002. This will surely reduce the quality of care and the availability of service.
All is not "quiet on the senior front," at least as it relates to access to home health services. A storm is brewing that has already wiped out providers in some areas of the country. For those of us remaining, the going is getting very tough. Many providers have used nearly all their business equity to continue to meet their nonprofit mission.
We've cut our work force by 25% over the past year. Consequently, we spend much of our service time teaching patients and families how to cope with their service needs. Teaching an 82-year-old woman how to care for her husband's colostomy bag is not the direction in which we should be moving, from a national health policy perspective. Forcing that husband into long-term care when the wife can no longer cope is fiscally shortsighted and morally unacceptable.
The current Medicare payment system for home health is a complicated scheme, designed to reduce expenditures for home care and to force providers out of the market. Providers who operated efficiently under the old cost-reimbursed system are at a clear disadvantage.
The frailest and sickest seniors are "quiet" because they have been shuffled off to other settings, like acute and long-term care. Others have been cared for with the business equity that many, like us, have spent years to establish. When that equity is gone and agencies are closed, plenty of seniors will be anything but quiet. Unfortunately, it may be too late.
Donald Wilver Jr.
Chief human resources officer
Sun Home Health Services