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Health care reform and gerontic nursing
FROM
THE
EDITOR
Health Care Reformand Gerontic Nursing H
e a l t h c a r e in t h e U n i t e d S t a t e s has been under s c r u t i n y for years, ever since it was realized M e d i c a r e had a several billion-horsep o w e r e n g i n e a n d no brakes. Unfortunately, we can't quickly construct a runaway offramp at the end of a steep grade while this truck is t h u n d e r i n g downhill. The cost of the federal Medicare program increased from $109 billion in 1990 to $118 billion 1991. T h e Health Care Financing Administration estimated a $204 billion budget in 1992, making it the 12th largest government budget of any kind in the world. 1 Expenditures for health care now consume almost 12% of the gross national product and up to 20% of the income of elders. Total expenditures for home health care during 1990 were $7.9 billion, although that is less than 1% of the total health care budget. 2 Of this, about a third were out-ofpocket expenditures ($2.6 billion). Overall, Medicare paid slightly less than half the health care expenses for poor noninstitutionalized elderly persons. (Health care heads the list of economic considerations in old age. It is the one expense that judicious planning and careful consideration can do little to control.)
To talk about health care when we mean illness care is akin to lumping together prenuptial counseling and divorce counseling. Paramount to these figures is the need to clearly discriminate between health care costs and illness care costs. At present we cannot do that. To talk about health care when we mean illness care is akin to lumping together prenuptial counseling and divorce counseling--they simply are not the same. Health care costs/budgets must be differentiated from illness care costs/budgets.
My purpose in this diatribe is not to point out what everyone already knows, but to suggest that we are using incorrect statistics, terms, and tools to define and solve the health care problems and that we do have the correct ones at our disposal. Most elders have a close family member involved with them, and we have studied these caregivers endlessly. Beyond study, we can strengthen them and promote eider and caregiver health through mobilization and massive replication of the block programs, the good neighbor programs, the mobile nurse programs, the geriatric nurse advice line, nurse practitioner-managed nursing clinics, older womens' clinics, wellness clinics. Each of these models has proved effective but has not proliferated. Many have been instigated by nurses as entrepreneurial ventures. It can be done! N u r s e s are health oriented, and health care is an individual, family, and community proposition to be addressed separately from illness. Alliances, coalitions, efforts at the grass roots--all these have been seen as possible solutions. The opportunities, as well as the legal, moral, and ethical responsibilities, of the gerontic nurse are consequently increasing. The "health care system" itself must be examined carefully to understand how this has expanded, limited, or shifted the professional possibilities of the nurse involved in elder care. The history of the nursing profession has often been that of playing counterpoint to medicine, but in the arena of gerontologic care nurses have always held the lead. There are now several thousand nurses with specialty certification in various aspects of gerontologic nursing. They are represented by several strong nursing org a n i z a t i o n s - - N A D O N A , N C G N P , N G N A , and the Gerontological Nursing Council of the ANA. We are delighted that our first lady, Hillary Rodham Clinton, considers the reformulation of health care delivery a top priority. President Clinton has appointed her to chair the President's Task Force on Health Care Reform. Your ideas regarding health care reform, as it affects the aged, may be sent to the Office of the First Lady, White House Room 100 OEOB, Washington, DC 20500. We gerontie nurses must make our priorities known to her. ( W e m i g h t e x p e c t t h a t her m o t h e r - i n - l a w will do likewise.) 9 Priscilla Ebersole, RN, PhD, FAAN Editor REFERENCES
GERIATR NURS 1993;14:119. Copyright 9 1993 by M o s b y - Y e a r Book, Inc. ISSN 0197-4572/93/$1.00 + .10 3 4 / 1 / 4 5 7 1 8
Ebersole
1. Schwartz R. Heartless Medicare claims denials. Contemporary Long Term Care 1992;I 5(I I):24. 2. US Bureau of the Census. Statistical abstract of the United States 1991 (I 1lth ed.). Washington: US Government Printing Office, 1991.
Geriatric Nursing Volume 14, Number 3
119
THE
EDITOR
Health Care Reformand Gerontic Nursing H
e a l t h c a r e in t h e U n i t e d S t a t e s has been under s c r u t i n y for years, ever since it was realized M e d i c a r e had a several billion-horsep o w e r e n g i n e a n d no brakes. Unfortunately, we can't quickly construct a runaway offramp at the end of a steep grade while this truck is t h u n d e r i n g downhill. The cost of the federal Medicare program increased from $109 billion in 1990 to $118 billion 1991. T h e Health Care Financing Administration estimated a $204 billion budget in 1992, making it the 12th largest government budget of any kind in the world. 1 Expenditures for health care now consume almost 12% of the gross national product and up to 20% of the income of elders. Total expenditures for home health care during 1990 were $7.9 billion, although that is less than 1% of the total health care budget. 2 Of this, about a third were out-ofpocket expenditures ($2.6 billion). Overall, Medicare paid slightly less than half the health care expenses for poor noninstitutionalized elderly persons. (Health care heads the list of economic considerations in old age. It is the one expense that judicious planning and careful consideration can do little to control.)
To talk about health care when we mean illness care is akin to lumping together prenuptial counseling and divorce counseling. Paramount to these figures is the need to clearly discriminate between health care costs and illness care costs. At present we cannot do that. To talk about health care when we mean illness care is akin to lumping together prenuptial counseling and divorce counseling--they simply are not the same. Health care costs/budgets must be differentiated from illness care costs/budgets.
My purpose in this diatribe is not to point out what everyone already knows, but to suggest that we are using incorrect statistics, terms, and tools to define and solve the health care problems and that we do have the correct ones at our disposal. Most elders have a close family member involved with them, and we have studied these caregivers endlessly. Beyond study, we can strengthen them and promote eider and caregiver health through mobilization and massive replication of the block programs, the good neighbor programs, the mobile nurse programs, the geriatric nurse advice line, nurse practitioner-managed nursing clinics, older womens' clinics, wellness clinics. Each of these models has proved effective but has not proliferated. Many have been instigated by nurses as entrepreneurial ventures. It can be done! N u r s e s are health oriented, and health care is an individual, family, and community proposition to be addressed separately from illness. Alliances, coalitions, efforts at the grass roots--all these have been seen as possible solutions. The opportunities, as well as the legal, moral, and ethical responsibilities, of the gerontic nurse are consequently increasing. The "health care system" itself must be examined carefully to understand how this has expanded, limited, or shifted the professional possibilities of the nurse involved in elder care. The history of the nursing profession has often been that of playing counterpoint to medicine, but in the arena of gerontologic care nurses have always held the lead. There are now several thousand nurses with specialty certification in various aspects of gerontologic nursing. They are represented by several strong nursing org a n i z a t i o n s - - N A D O N A , N C G N P , N G N A , and the Gerontological Nursing Council of the ANA. We are delighted that our first lady, Hillary Rodham Clinton, considers the reformulation of health care delivery a top priority. President Clinton has appointed her to chair the President's Task Force on Health Care Reform. Your ideas regarding health care reform, as it affects the aged, may be sent to the Office of the First Lady, White House Room 100 OEOB, Washington, DC 20500. We gerontie nurses must make our priorities known to her. ( W e m i g h t e x p e c t t h a t her m o t h e r - i n - l a w will do likewise.) 9 Priscilla Ebersole, RN, PhD, FAAN Editor REFERENCES
GERIATR NURS 1993;14:119. Copyright 9 1993 by M o s b y - Y e a r Book, Inc. ISSN 0197-4572/93/$1.00 + .10 3 4 / 1 / 4 5 7 1 8
Ebersole
1. Schwartz R. Heartless Medicare claims denials. Contemporary Long Term Care 1992;I 5(I I):24. 2. US Bureau of the Census. Statistical abstract of the United States 1991 (I 1lth ed.). Washington: US Government Printing Office, 1991.
Geriatric Nursing Volume 14, Number 3
119