Health Care and Organ Donation

Are you an organ donor? You should be. While most solid organ and tissue donations occur after the donor has died, some organs and tissues can be donated while the donor is alive. The first successful transplant in the U.S. was made possible by a living donor and took place in 1954. One twin donated a kidney to his identical twin brother. As a result of the growing need for organs for transplantation, living donation has increased as an alternative to deceased donation, and about 6,000 living donations take place each year. Most living donations happen among family members or between close friends. Some living donations take place between people unknown to each other. There is much information available online (such as the HHS) and with other sources about organ donation. According to the Mayo Clinic, enough people to populate a small city — nearly 100,000 — are on the U.S. organ transplant waiting list, waiting for an organ donation. On an average day, about 77 people receive organ transplants. Being an organ donor can make a big difference, and not just to one person. By donating your organs after you die, you can save or improve as many as 50 lives according to the Mayo Clinic.

According to the U.S. Department of Health and Human Services, all people of all ages should consider themselves potential organ and tissue donors. There are few absolute exclusions (HIV positive, active cancer, systemic infection) and no strict upper or lower age limits. Potential donors will be evaluated for suitability when the occasion arises. No one is too old or too young. Both newborns and senior citizens have been organ donors. The condition of your organs is more important than age. Someone 35 years old with a history of alcohol abuse may have a liver that is in worse condition than someone 60 years old who has never consumed alcohol. In addition, people on the waiting list might need to be transplanted with an organ that is less than ideal if there is no other suitable organ available in time to save their lives.

Doctors will examine your organs and determine whether they are suitable for donation if the situation arises. If you are under 18, you will need the permission of a parent or guardian to donate. You may still be able to donate your organs even if you have had an illness or disease. Doctors will evaluate the condition of your organs when the time arises. The transplant team’s decision will be based on a combination of factors, such as the type of illness you have had, your physical condition at the time of your death, and the types of organs and tissues that would be donated.

There are many types of organ donations according to the HHS. The organs of the body that can be transplanted at the current time are kidneys, heart, lungs, liver, pancreas, and the intestines. Kidney/pancreas transplants, heart/lung transplants, and other combined organ transplants also are performed. Organs cannot be stored and must be used within hours of removing them from the donor's body. Most donated organs are from people who have died, but a living individual can donate a kidney, part of the pancreas, part of a lung, part of the liver, or part of the intestine.
Local organ procurement organizations (OPOs) around the country coordinate organ donation. OPOs evaluate potential donors, discuss donation with surviving family members, and arrange for the surgical removal and transport of donated organs. A national computer network, the OPTN (Organ Procurement and Transplantation Network) matches donated organs with recipients throughout the country.

Tissues can also be donated: Corneas, the middle ear, skin, heart valves, bone, veins, cartilage, tendons, and ligaments can be stored in tissue banks and used to restore sight, cover burns, repair hearts, replace veins, and mend damaged connective tissue and cartilage in recipients.

Stem cells can also be donated according to the HHS. Healthy adults between the ages of 18-60 can donate blood stem cells. In order for a blood stem cell transplant to be successful, the patient and the blood stem cell donor must have a closely matched tissue type or human leukocyte antigen (HLA). Since tissue types are inherited, patients are more likely to find a matched donor within their own racial and ethnic group. There are three sources of blood stem cells that healthy volunteers can donate:

1.) Marrow-This soft tissue is found in the interior cavities of bones and is a major site of blood cell production and is removed to obtain stem cells.
2.) Peripheral blood stem cells-The same types of stem cells found in marrow can be pushed out into a donor's bloodstream after the donor receives daily injections of a medication called filgrastim. This medication increases the number of stem cells circulating in the blood and provides a source of donor stem cells that can be collected in a way that is similar to blood donation.
3.) Cord blood stem cells-The umbilical cord that connects a newborn to the mother during pregnancy contains blood and this blood has been shown to contain high levels of blood stem cells. Cord blood can be collected and stored in large freezers for a long period of time and therefore, offers another source of stem cells available for transplanting into patients.

Additionally, you can donate blood. Blood and platelets are formed by the body, go through a life cycle, and are continuously replaced throughout life. This means that you can donate blood and platelets more than once. It is safe to donate blood every 56 days and platelets twice in one week up to 24 times a year. Blood is stored in a blood bank according to type (A, B, AB, or O) and Rh factor (positive or negative). Blood can be used whole, or separated into packed red cells, plasma, and platelets, all of which have different lifesaving uses. It takes only about 10 minutes to collect a unit (one pint) of blood, although the testing and screening process means that you will be at the donation center close to an hour. Platelets are tiny cell fragments that circulate throughout the blood and aid in blood clotting. Platelets can be donated without donating blood. When a specific patient needs platelets, but does not need blood, a matching donor is found and platelets are separated from the rest of the blood which is returned to the donor. The donor's body will replace the missing platelets within a few hours.

The decision to be a living donor must be weighed carefully as to the benefits versus the risks for both the donor and the recipient. Often, the recipient has very little risk because the transplant will be life saving. However, the healthy donor, does face the risk of an unnecessary major surgical procedure and recovery. Living donors may also face other risks. For example, a small percentage of patients have had problems with maintaining life, disability, or medical insurance coverage at the same level and rate. And, there can be financial concerns due to possible delays in returning to work because of unforeseen medical problems. The decision to be a living donor is a very personal one and the potential donor must consider the possibility of health effects that could continue following donation. In most cases, that decision must also take into consideration the life-saving potential for a loved one—the transplant recipient.

The Mayo Clinic also advises that contrary to popular belief, signing a donor card or your driver's license does not guarantee that your organs will be donated. The best way to ensure that your wishes are carried out is to inform your family of your desire to donate. Doing this in writing ensures that your wishes will be considered. Hospitals seek consent of the next of kin before removing organs. If your family members know you wanted to be donor, it makes it easier for them to give their consent. If you have no next of kin or your family will agree to donate your organs, you can assign durable power of attorney to someone who you know will abide by your wishes. An attorney can help prepare this document.

There are many additional facets about donating organs, blood, and tissue. Considerations should be made for either partial or solid organ donation, suitability to donate, follow-up for living donors, donation after brain death, donation after cardiac death, and whole body donation. You should contact local organizations and government agencies about organ donation if you wish to consider this health care option. Other lives have been saved as a result of the generosity of Americans who wish to contribute a part of themselves to the greater good. Organ donation should not be taken lightly, and those who wish to pursue this medical procedure need to consult their family and their physician about the pros and cons of the decision. Whatever your decision, you can feel good about helping others with their health care crisis. Being an organ donor is a generous and worthwhile decision that can be a lifesaver. Understanding organ donation can make you feel better about your choice.

Until next time. Let me know what you think.

Health Care and Increasing Costs

Americans are faced each year with increasing health care costs. Management of these expenses is a major concern when bills come due, and most people think about health care costs on a regular basis. Seniors are primarily concerned about how to pay for prescriptions not covered by Medicare or a Supplemental plan and for costs not paid for by either of these programs including dental and other ancillary services, not to mention catastrophic health events. Families worry about meeting expectations for paying medical bills, especially if their children have major health issues. To prevent significant budget busting, Americans must make sure that they have a handle on regularly managing costs for health care.

AIS Health Business Daily reported this month that people in consumer directed plans use less care including emergency departments and prescriptions. Utilization in these areas is lower as plan members have more control over costs and managing health issues. The report indicated that the good news is that people in CDHPs are not forgoing preventive care. The users on these plans are saving money and more effectively managing their health care expenses.

By several measures according to the National Coalition on Health Care, health care spending continues to rise at the fastest rate in our history. Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of American families. In 2007, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation. Total spending was $2.3 TRILLION in 2007, or $7600 per person. Total health care spending represented 16% of the gross domestic product (GDP). Health care spending in the U.S. is expected to increase at similar levels for the next decade reaching $4.2 TRILLION in 2016, or 20% of GDP.

In 2007, according to the NCHC, employer health insurance premiums increased by 6.1% - two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400. Premiums for employer-based health insurance rose by 6.1 percent in 2007. Small employers saw their premiums, on average, increase 5.5%. Firms with less than 24 workers, experienced an increase of 6.8%. The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,100 in 2007. Workers contributed nearly $3,300, or 10% more than they did in 2006.2 The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712). Workers are now paying $1,400 more in premiums annually for family coverage than they did in 2000.

Since 2000, employment-based health insurance premiums have increased 100%, compared to cumulative inflation of 24% and cumulative wage growth of 21% during the same period as reported by the NCHC. Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits by 2008. And, according to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 2000. The average employee contribution to company-provided health insurance has increased more than 143% since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115% during the same period. The percentage of Americans under age 65 whose family-level, out-of-pocket spending for health care, including health insurance, that exceeds $2,000 a year, rose from 37.3% in 1996 to 43.1% in 2003 - a 16% increase.

So how is all this survey information translated to how Americans are dealing with the increased costs of health care? Here are some ways that people are affected as reported by the NCHC:

1.) National surveys show that the primary reason people are uninsured is the high cost of health insurance coverage. Economists have found that rising health care costs correlate to drops in health insurance coverage.
2.) Nearly one-quarter (23%) of the uninsured reported changing their way of life significantly in order to pay medical bills. In a Wall Street Journal-NBC Survey almost 50% of the American public say the cost of health care is their number one economic concern.
3.) In a USA Today/ABC News survey, 80% of Americans said that they were dissatisfied (60% were very dissatisfied) with high national health care spending.
4.) Rising health care costs is the top personal pocketbook concern for Democratic voters (45%) and Republicans (35%), well ahead of higher taxes or retirement security.
5.) One in four Americans say their family has had a problem paying for medical care during the past year, up 7% points over the past nine years. Nearly 30% say someone in their family has delayed medical care in the past year, a new high based on recent polling. Most say the medical condition was at least somewhat serious.
6.) A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68% of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses. Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
7.) One half of workers in the lowest-compensation jobs and one-half of workers in mid range-compensation jobs either had problems with medical bills in a 12-month period or were paying off accrued debt. One-quarter of workers in higher-compensated positions also reported problems with medical bills or were paying off accrued debt.

The Christian Science Monitor reported some ways to help stem the tide of increased health care expenses. Here are some suggestions by experts, not all politically easy to obtain:
• Provide more information to consumers on what drug works, what procedures are best, which hospitals and physicians have good records. Insurance, for instance, shouldn't cover extra costs if a patient uses a brand-name drug when a cheaper generic does the job.
• Cut off expensive treatment if it extends someone's life only a few days or months.
• Spend more on prevention of disease by encouraging better lifestyles, improved nutrition, and other steps.
• Ban or control the advertising of prescription drugs to consumers, and cap malpractice awards so doctors need not prescribe so many tests and other defensive practices.
• Let HMOs and other healthcare providers return to tighter management of costs.

So we know that Americans are struggling with medical expenses and the ever increasing cost of health care. What needs to happen is for the market place to self-adjust to more acceptable pricing. The way that should take place is for the medical community, employers, insurance companies, and government to work together for more reasonable rates and cost structure. Individuals and families cannot afford continued upward spiraling of costs, and Americans cannot afford government run universal healthcare. The answer is somewhere in between.

Until next time. Let me know what you think.

Health Care and Travel

Medical tourism is becoming a big business. According to the Health Matters Blog on the Wall Street Journal online, in the last few years, the idea of traveling to a foreign country for non-urgent health care at a fraction of the U.S. cost has been gaining popularity among a small slice of the population. 

Faced with sticker shock for domestic care, some Americans do their research and jet off to Mexico for dental work or Singapore for surgery. Many times, it’s for elective procedures that aren’t covered by insurance, such as infertility treatments or cosmetic surgery. Statistics are scant, but interest in medical tourism appears to be growing as more Americans lose their health coverage or struggle to pay their out of pocket costs, and as companies sprout up to match U.S. patients with potential hospitals, doctors or dentists in other nations.

Many employers are now considering this option for their workers. Of course, medical tourism isn’t for everybody, and the sheer complexity involved in making it work leaves many employers cold. The Health Matters Blog also reported that employers desperate to stanch their rapidly rising health insurance costs are taking a closer look at adding a dash of medical tourism to their health-care benefits. 

The National Business Group on Health, a coalition of 300 large employers, released an issue brief this week to help employers do their due diligence and guide them through a maze of legal, financial and medical considerations. To be sure, none of the 35 NBGH employers surveyed in February currently offers a medical tourism benefit, and 57% said they had no intention of evaluating it. But nearly a third of this small sample — 31% — said they were in the process of analyzing the option.

The Blog's author reports that the NBGH encourages employers to examine what kind of legal recourse a patient would have if she suffers malpractice abroad and how to ensure U.S.-mandated patient privacy is maintained. The group also advises validating foreign hospital accreditation with the Joint Commission International and the International Organization for Standardization, as well as pursuing case management and cross-cultural services with experienced medical travel operators. 

Among the basic questions to consider, according to the NBGH: Is the patient able to make the trip without disability? Are there typically minimal post-operative complications? Will the procedure require significant follow-up care? What happens if treatment fails — can the patient receive domestic follow-up care that’s covered by insurance or will he have to return to the foreign destination? These questions and more are worthy of consideration to weigh the costs and risks associated with medical tourism.

It’s no surprise that offshoring for certain surgeries would be financially attractive to employers, despite the rising cost of covering air travel for the patient and, often, a companion as reported in the WSJ Health Matters article. A spinal fusion performed in the U.S. averages $62,000 compared with $7,000 in Thailand and $5,500 in India, according to the issue brief. A knee replacement that goes for $40,000 domestically can be had for $13,000 in Singapore. 

 Heart surgeries represent among the biggest potential savings, but also the biggest risks considering the grueling nature of long-distance international travel for an ailing patient. On costs alone, the case is persuasive: a heart bypass operation totals just $11,000 in Thailand, $18,500 in Singapore and $25,740 in England vs. a tab of $130,000 in the U.S. But these figures may assume best-case scenarios, where everything goes as planned and no costly follow-up care is needed. And it’s hard to believe many patients would sign up for major surgeries that happen so far away from the comforts of home and family.

Another question arises as posed by the Health Matters Blog: given how widely the quality of care varies in this country, shouldn’t more employers explore the possibility of sending U.S. patients to more distant U.S. doctors and hospitals renowned for their successful outcomes in particular specialties? Many large employers have programs like this that help patients find the best care for transplants and, increasingly, cardiac problems at what are called Centers of Excellence, regional hubs that have the best outcomes and often do the largest volume of certain procedures. 

Employers or insurers typically cover the travel and accommodation costs. But these benefits are much harder to find among smaller employers. The market for worldwide medical tourism was $60 billion in 2006, and it’s projected to rise to $100 billion by 2012, according to figures cited in the NBGH survey.

According to MedicalTourism.com, there are a range of possible models for how to go about seeking affordable and high quality health care abroad. Many providers, in Thailand, India, Costa Rica, Singapore, South Africa, Malaysia, and elsewhere, provide direct links to their services via the Internet. Many will help facilitate your travel and accommodation logistics, alongside arranging medical services. 

Take note of the different kinds of providers that are out there --- ranging from major hospitals to smaller clinics and private practices --- as you decide what is the best fit for your medical needs. An alternative to working directly with a provider is to consider going through a company that operate as a full-service broker or concierge service. These companies typically arrange the full spectrum of a medical trip abroad, connecting you to health providers, making logistical arrangements for your medical care and travel, and often providing a single, lump-sum total for the entire package. 

Such brokers, whether based in the U.S. or Europe, or in another country or region, often have established working relationships with a set number of providers covering a range of medical procedures. Early on it is important to consider both the potential advantages (convenience, expertise) and disadvantages (limited choice, possible brokerage fees) of working with a broker as you decide what course of action to take in satisfying your health care needs.

As medical tourism continues to grow in popularity, the costs associated with it will also continue to grow, but not as rapidly as existing health care expenses in the United States. The risks associated with receiving health care outside of the U.S. are greater, but not exponentially greater than similar risks in domestic medical clinics, hospitals and other health care service locations. 

Thousands of patients die every year of staff infections and other complications in American medical facilities as a result of negligence or other issues related to mistakes made by health care professionals. The risk associated with having medical procedures done by highly qualified health care providers anywhere is significantly better when the facility is managed by accredited medical professionals. Medical tourism may or may not be for you. Make sure you do your homework well before embarking on this type of adventure just to save a few thousand dollars. The long term results may be just the ticket.

Until next time. 

Health Care and Childcare

Childcare has become a modern day necessary evil. In the current age of single parents and two-income parents, the need to use facilities designed to oversee, manage, educate, and otherwise babysit children has become big business. There are corporate facilities offered by some employers and small individual "Mom & Pop" locations that provide daily watch care for children. Many of these child care facilities are great options for busy parents. The Day Care offers a safe and secure place for infants, toddlers, and pre-school children.

However, there are some inherent problems associated with leaving children at day care facilities, no matter who operates them. As a parent or guardian, you need to know the pros and cons associated with leaving your kids with caretakers charged with their oversight. Day care operations are big business in America, and there are literally thousands of locations across the country who do a very good job of working with and taking care of children. If you are considering a child care facility, the folks at Daycare.com have some great tips for evaluating child care facilities:

1.) How does your child-care provider greet your child in the morning? Does she seem genuinely happy to see him? Or does she give a curt "Hello" while she busies herself with other things? Studies show that the warmth of the relationship between children and their providers is key to quality care. If children don't feel safe and cared about, they will have difficulties learning and growing.
2.) Is your caregiver tuned in to your child? Pay close attention to how she relates to your little one. Does she squat down and talk to your child eye to eye? The provider who is responsive repeats the sounds your baby makes, or when your three-year-old gets excited about something, the provider asks questions, listens, brings a storybook on the subject, and encourages your child to know that he can learn and enjoy learning. Quality caregivers are responsive and able to read a child's cues, and these characteristics are essential for promoting emotional and intellectual development.
3.) What do you see at the end of the day? Is your child busy at play, engaged in art projects, reading books and interacting with other children? Or does she rush up and cling to you when you arrive? If it is the latter, she may be bored and starved for attention and in need of a new daytime environment.
4.) What is the adult-to-child ratio? Each state has different regulations for how many children a teacher can care for at once. Still, being in compliance with such laws does not necessarily mean that a center is a quality operation. Often, official standards are lower than what child-care experts recommend. A group size of six to eight infants for every two adults, and six to 12 one- and two-year-olds per three adults, is ideal. For preschoolers, look for 14 to 20 children for every two teachers.
5.) What is the teacher turnover? Constant turnover can be disruptive and potentially disturbing for children. If you're hiring a nanny, look for one who does not have a history of job-hopping, or one who can commit to at least a year or more. If you are investigating a child-care center, find out how well it retains workers. Good centers, which pay their workers reasonably well and treat them with respect, should have a turnover rate of less than 25 percent.
6.) Do the teachers have advanced training? Do not dismiss the value of well-trained providers; they understand how children develop and are better able to meet their needs. They also tend to be more intentional. Those who bother to learn how kids grow are more likely to put some thought into furthering your child's development.
7.) Is the environment safe, clean and inviting? At a minimum, providers should follow basic health and safety measures, such as washing hands after changing diapers and keeping a list of emergency numbers so you or a doctor can be quickly contacted if necessary. Check to see that a variety of interesting and age-appropriate activities and toys are within easy reach. Finally, look for more subtle signs that all is well, like displays of children's work on the walls. This simple action shows that the kids' efforts and creations are praised and appreciated, just as they would be in your home.
8.) Do you feel supported as a working parent? The best teachers should seem like part of your extended family. Does she help you to be a better parent? Or do her comments and actions make you worry and feel guilty about leaving your child all day? If she is doing her job well, a provider should help you feel confident in your decision to work or have time alone while your child stays with her.
9.) Would you want to stay there all day? If the answer is no, then look for another arrangement. Your child should not have to tolerate a situation that you would find unpleasant. After all, with the right provider, your child will thrive; and, in turn, so will you.

Leaving a child in the care of another person, especially for a new environment with new people, can be very stressful for both the parent and the child. A child care facility worth its salt will be one where the anxiety of separation will be eased by the knowledge that the child will be well cared for during your absence. Do your homework and make sure that you are satisfied with the references and the quality of the location. Although it may be difficult to leave your child with a "stranger", the provider of these services should be able to satisfy your needs and answer all your questions, leaving no unanswered issues. Day Care can be a positive learning experience for your child.

Make sure that you find one that helps enrich the daily activities in preparation for social skills and early learning. Children need to learn how to interact with others and be prepared to start school when they reach the appropriate age. The best situation for a child is to be in a wonderful, loving and nurturing home environment with attentive parents and lots of stimulation. However, in today's society, it's tough to sustain that when parents work. The next best alternative is to provide a safe location for them to stay during the day. Remember, children are like sponges. They will soak up everything they see and hear. Keep them safe and secure.

Until next time. Let me know what you think.

Health Care and ElderCare

An article just released this month by Benefit News reports that one in four employees currently cares for an older or disabled adult. Of those employees, nearly half (44%) have missed work time to care for a loved one, finds a new national survey of working adults conducted by work-life benefits firm Workplace Options. And, according to the 2008 National Study of Employers released by the Families and Work Institute, 39% of employers today provide access to information about services for elderly family members. Additionally, WPO's poll indicates that 61% of the respondents would utilize a service that assisted with caregiving if it was provided by the employer free of charge.

The Annals of Emergency Medicine just released a study this month that was revised at the end of 2007 an objective to review the rates of emergency room visits by elderly patients. The greatest use noted was by older patients, and they have longer lengths of stay in the ED with a stronger likelihood of hospital admittance. Rates increased 34% over a ten year period that the study was done. Seniors over the age of 65 had a greater increase of ED visits than the rest of the American population. The conclusion is that emergency room crowding will be a trend to be considered as the overall US population ages with over 74 million Baby Boomers now beginning to enter the senior citizen demographic.

Additionally, the federal government lists a variety of resources for eldercare on the HHS website. Each town and city offers a range of supporting services available to older residents 60 years of age or over. Local Information and Assistance Programs and/or Area Agency on Aging can assist older persons and their families in locating the services they need. Some of the services available include:
--Adult Day Care: Adult Day Care Centers offer social, recreational and health-related services to individuals in a protective setting who cannot be left alone during the day because of health care and social need, confusion or disability.
--Caregiver Programs: The National Family Caregiver Support Program provides programs and services for caregivers of older adults and some limited services to grandparents raising grandchildren.
--Case Management: Case managers work with family members and older adults to assess, arrange and evaluate supportive efforts of seniors and their families to remain independent.
--Elder Abuse Prevention Programs: Allegations of abuse, neglect and exploitation of senior citizens are investigated by highly trained protective service specialists. Intervention is provided in instances of substantiated elder abuse, neglect or exploitation.
--Financial Assistance: There are benefit counseling programs that can be accessed through the (I&R/A) specialist at your local area agency on aging to assist older adults with financial assistance.
--Home Health Services: Home health care includes such care activities as changing wound dressings, checking vital signs, cleaning catheters and providing tube feedings.
--Home Repair: Programs that help older people keep the condition of their housing in good repair before problems become major. Volunteers might come to an individual's home and patch a leaky roof, for instance, repair faulty plumbing or insulate drafty walls.
--Home Modification: Programs that provide adaptations and/or renovations to the living environment intended to increase ease of use, safety, security and independence. There are some local, state, Federal and volunteer programs that provide special grants, loans and other assistance for home.
--Information and Referral/Assistance Information Services (I&R/A): Information Specialists are available to provide assistance and linkage to available services and resources.
--Legal Assistance: Legal advice and representation is available to persons aged 60 and over for certain types of legal matters including government program benefits, tenant rights, and consumer problems.
--Nutrition Services: Home Delivered Meals popularly known as "Meals on Wheels," are nutritious meals delivered to the homes of older persons who are homebound. Congregate Meals provide the opportunity for persons aged 60 and over to enjoy a meal and socialize with other seniors in the community.
--Personal Care: Services to assist individuals with functional impairments with bathing, dressing, shopping, walking, housekeeping, supervision, emotional security, eating and assistance with securing health care from appropriate sources.
--Respite Care: Respite is relief or rest, for a specified period of time, from the constant/continued supervision, companionship, therapeutic and/or personal care of a person with a functional impairment.
--Senior Housing Options: The decision to seek care outside an individual’s home is a difficult one. If you are considering such a move for yourself or a family member, please contact your local area agency on aging I&R/A specialist to determine the full range of support options available to you.
--Senior Center Programs: Senior Centers offer a variety of recreational and educational programs, seminars, events and activities for the active and less active older adult.
--Telephone Reassurance: Provides regular contact and safety check by trained volunteers to reassure and support senior citizens and disabled persons who are homebound.
--Transportation: Programs that provide door-to-door transportation for people who may be elderly or disabled, who do not have private transportation and who are unable to utilize public transportation to meet their needs.
--Volunteer Services: There are numerous volunteer programs and opportunities available for older adults such as daily telephone reassurance, friendly visiting and insurance counseling.

Eldercare is a health issue that has received ever increasing attention in the last 5-10 years as the American population is getting older. Information about this issue is available on a variety of websites including Aging Parents and Elder Care.com. Caring for an aging parent, elderly spouse, domestic partner or close friend presents difficult challenges – especially when a crisis hits and you are suddenly faced with the responsibilities of elder care. Perhaps your aging mother has fallen, is hospitalized with a broken hip and needs to go to a rehab facility or nursing home to recover. Caregiving can also begin as a result of a series of unsettling mishaps and warning signs that indicate a need for long term elder care. Perhaps your elderly spouse has wandered off and gotten lost several times. Or a long-time friend has lost a lot of weight and rarely leaves home.
You may be the only person to step in and become the caregiver, or you may be the linchpin of a network of family members and friends willing to help care for your elderly senior. Whatever the situation, you are not sure of the next step, or even the first step.

There are many questions to consider that are mentioned on the site for Aging Parents. If their problems are not correctable, what elder care living arrangements are available for your loved one? What nursing care plans are most appropriate? If they are able to remain in their own home, what kind of elder care services do you arrange? Is assisted living preferred over a nursing home? What challenges does your loved one's condition pose? What is the best way to access community elder care resources? How will you manage it all – and still maintain a life of your own?

Wikipedia states that traditionally elder care has been the responsibility of family members and was provided within the extended family home. Eldercare is the fulfillment of the special needs and requirements that are unique to senior citizens. This broad term encompasses such services as assisted living, adult day care, long term care, nursing homes, hospice care, and in-home care. Increasingly in modern societies, elder care is now being provided by state or charitable institutions. The reasons for this change include decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home. Impaired mobility is a major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb stairs, and to rise from a chair, they become completely disabled. The problem cannot be ignored because people over 65 constitute the fastest growing segment of the U.S. population.

However eldercare is accomplished, the end result is often highly stressful and often expensive. There are many resources available for caregivers. As our population gets older, Americans must consider all available options to decrease health care costs associated with this issue and increase the ability for seniors to benefit from those resources.

Until next time. Let me know what you think.

Health Care and Childhood Obesity

According to an article online with the WashingtonPost.com that was published mid-May, there is an epidemic of obesity that is compromising the lives of millions of American children, with burgeoning problems that reveal how much more vulnerable young bodies are to the toxic effects of fat. Doctors are seeing confirmation of this daily: boys and girls in elementary school suffering from high blood pressure, high cholesterol and painful joint conditions; a soaring incidence of type 2 diabetes, once a rarity in pediatricians' offices; even a spike in child gallstones, also once a singularly adult affliction. Minority youth are most severely affected, because so many are pushing the scales into the most dangerous territory. As reported in the study, with one in three children in this country overweight or worse, the future health and productivity of an entire generation -- and a nation -- could be in jeopardy.

The trouble is a quarter-century of unprecedented growth in girth. Although the rest of the nation is much heavier, too, among those ages 6 to 19 the rate of obesity has not just doubled, as with their parents and grandparents, but has more than tripled. Because studies indicate that many will never overcome their overweight -- up to 80% of obese teens become obese adults -- experts fear an exponential increase in heart disease, strokes, cancer and other health problems as the children move into their 20s and beyond. The evidence as reported in the Washington Post article suggests that these conditions could occur decades sooner and could greatly diminish the quality of their lives. Many could find themselves disabled in what otherwise would be their most productive years. The cumulative effect could be the country's first generation destined to have a shorter life span than its predecessor. A 2005 analysis by a team of scientists forecast a two- to five-year drop in life expectancy unless aggressive action manages to reverse obesity rates. Since then, children have only gotten fatter.

The epidemic is expected to add billions of dollars to the U.S. health-care bill. Treating a child with obesity is three times more costly than treating the average child, according to a study by Thomson Reuters. The research company pegged the country's overall expense of care for overweight youth at $14 billion annually. A substantial portion is for hospital services, since those patients go more frequently to the emergency room and are two to three times more likely to be admitted. Wow!! That is a huge amount of money to handle a problem that should not be happening if Americans would pay attention to their diet. Yet, we have become a land of Fatties!

It's a wonder that the nation doesn't collapse in on itself with all that extra weight. Plus, fat kids make fatter adults. Ultimately, the economic calculations will climb higher. As reported, no one has yet looked ahead 30 years to project this group's long-term disability and lost earnings, but based on research on the current workforce, which has shown tens of millions of workdays missed annually, indirect costs will also be enormous. The article goes on to say that the cycle of obesity and disease seems to begin before birth--women who are overweight are more likely to give birth to bigger babies, who are more likely to become obese. Patterns of eating and activity, often set during early childhood, are influenced by government and education policies, cultural factors and environmental changes. Income and ethnicity are implicated, though these days virtually every community has a problem.

As many as 90% of overweight children have at least one of a half-dozen avoidable risk factors for heart disease. Even with the most modest increase in future adolescent obesity, a recent study said the United States will face more than 100,000 additional cases of coronary heart disease by 2035. The internal damage does not always take medical testing to diagnose. It is visible as a child laboriously climbs a flight of stairs or tries to sit at a classroom desk, much less rise out of it. Additionally, the emotional distress of these ailments, combined with the social stigma of being fat, makes overweight children prone to psychiatric and behavioral troubles. One analysis found that obese youth were seven times more likely to be depressed. Only within this decade, as studies started to corroborate what doctors were seeing firsthand, has child obesity been recognized as a critical public health concern. The news release in the Washington Post is a very telling situation of the current health of today's children.

There are several consequences related to childhood obesity as reported by the Center for Disease Control (CDC). Overweight children and adolescents may experience immediate health consequences and may be at risk for weight-related health problems in adulthood. Some consequences of childhood and adolescent overweight are psychosocial. Obese children and adolescents are targets of early and systematic social discrimination. The psychological stress of social stigmatization can cause low self-esteem which, in turn, can hinder academic and social functioning, and persist into adulthood. Also, overweight children and teens have been found to have risk factors for cardiovascular disease (CVD), including high cholesterol levels, high blood pressure, and abnormal glucose tolerance. Additionally, less common health conditions associated with increased weight include asthma, hepatic steatosis, sleep apnea and Type 2 diabetes.

Roughly 16% of kids are obese according to an article in May, 2008 in the Wall Street Journal. That’s bad, but it’s nothing new. Yet in what passes for good news on the fat front, the proportion of overweight American kids has been holding steady since 1999. The HSC Foundation has reported that national statistics show approximately one in five African American and Latino children are obese. Traditional fitness and weight loss programs have been undermined in low-income minority communities because of a need to focus on basic survival issues. Less recess at school, the lack of safe and well-equipped recreation centers, and few to no grocery stores in some communities have made keeping adequately fit a greater challenge.

What are the contributing factors to this national explosion in obesity among children? The CDC reports that at the individual level, childhood overweight is the result of an imbalance between the calories a child consumes as food and beverages and the calories a child uses to support normal growth and development, metabolism, and physical activity. In other words, overweight results when a child consumes more calories than the child uses. The imbalance between calories consumed and calories used can result from the influences and interactions of a number of factors, including genetic, behavioral, and environmental factors. It is the interactions among these factors – rather than any single factor – that is thought to cause overweight.

The CDC says that a genetic susceptibility may need to exist in conjunction with contributing environmental and behavioral factors (such as a high-calorie food supply and minimal physical activity) to have a significant effect on weight. Genetic factors alone can play a role in specific cases of overweight. However, the rapid rise in the rates of overweight and obesity in the general population in recent years cannot be attributed solely to genetic factors. The genetic characteristics of the human population have not changed in the last three decades, but the prevalence of overweight has tripled among school-aged children during that time. Because the factors that contribute to childhood overweight interact with each other, it is not possible to specify one behavior as the “cause” of overweight. However, certain behaviors can be identified as potentially contributing to an energy imbalance and, consequently, to overweight:

--Energy intake: Evidence is limited on specific foods or dietary patterns that contribute to excessive energy intake in children and teens. However, large portion sizes for food and beverages, eating meals away from home, frequent snacking on energy-dense foods and consuming beverages with added sugar are often hypothesized as contributing to excess energy intake of children and teens.
--Physical activity: Participating in physical activity is important for children and teens as it may have beneficial effects not only on body weight, but also on blood pressure and bone strength; and children may be spending less time engaged in physical activity during school.
--Sedentary behavior: Children spend a considerable amount of time with media. There is more involvement now with computers, TV, and other media.
--Environmental factors: Home, child care, school, and community environments can influence children’s behaviors related to food intake and physical activity.

The authoritative Robert Wood Johnson Foundation argues that childhood obesity is one of the most urgent and serious health threats confronting our nation. The epidemic afflicts and endangers members of every race and ethnic group, as well as all income levels and in every region of the country. Dr. Dean Ornish recently wrote in Newsweek that childhood obesity is almost completely preventable. We don't have to wait for a new drug or technology; we just have to put into practice what we already know. Clearly, genes have changed little, if at all, in the past 40 years. What's changed is our diet and lifestyle. If we caused it, we can reverse it. The Brookings Institute agrees. Given the causes and consequences of childhood obesity, the challenge is to rally the nation’s policymakers, families, schools and healthcare providers to contain and reverse this ominous epidemic.

Until next time. Let me know what you think.

Health Care and the Weather

Have you ever complained about how you are feeling and blame it on the weather? Weather follows your life and makes you cheerful, moody or sick. The weather and health are on our lips more often than we probably realize. We say things like: "The heat is killing me. I can't stand the cold. This wind is driving me crazy". When we are short of a topic for a conversation, we talk about the weather and its myriad ill effects. Instinctively, we know when weather affects us. When you think of weather events that may injure or kill a person, you probably think of extreme events such as the strong winds in tornados; the consequences of floods may come to mind; or you may imagine a person being struck by lightning. The weather can harm you in more subtle ways and affect more people than it does in its violent form.

A conference of broadcast meteorologists in 2003 talked about how weather causes certain health issues. A number of diseases and other health impacts may be affected by climatic conditions and weather. These include:
1.) Heat stroke, dehydration and heat exhaustion, loss of water supplies—Heat waves
2.) Hypothermia, heart attacks—Extreme winter weather
3.) Asthma, cardio-respiratory disease—Air quality degradation
4.) Emerging and spreading infectious diseases—Climate warming and variability
5.) Traumatic injuries and infrastructure damages (e.g., water systems)—Extreme weather
6.) Gastro-intestinal infections (related to water and food quality)—Climate warming, and sea surface temperature variations.

While each one of the above impacts (e.g., heat stroke or emerging infectious diseases) can
occur in the absence of weather and climate changes, it is projected that climate change and
associated alterations in weather patterns may influence the frequency, intensity and geographic
distribution of these health outcomes. Also to be considered are the morbidity and mortality rates associated with weather-related impacts on food quality (especially seafood), and the health impacts of sea level rise and storm surges (e.g., flooding, saltwater intrusion into fresh water supplies).

The State of Pennsylvania has information on their site about how to handle heat related illnesses. People of all ages are sensitive to extremes in temperature. But as you age, your body may become less able to respond to extremely hot or cold temperatures. In addition, taking certain types of medications can affect how your body responds to heat. Be aware of days when extreme heat conditions are predicted by paying attention to your local weather forecast. On hot days, you should:

· Drink plenty of water;
· Avoid long periods in the direct sun or in unventilated rooms;
· Keep air conditioning or fans running;
· Avoid vigorous activity when it is hot and humid;
· Reschedule activities for cooler times of the day;
· Wear light-colored, lightweight, loose-fitting clothing;
· Wear a hat or other head covering when out in the sun;
· Wear appropriate sunscreen protection; and
· Take frequent baths or showers and remain in a cool place.

Heat-related health problems may include the following:

Heat Cramps:
Symptoms: Painful spasms usually in leg and abdominal muscles. Heavy sweating.
First Aid: Firm pressure on cramping muscles or gentle massage to relieve spasm. Give sips of water. If nausea occurs, discontinue.

Heat Exhaustion:
Symptoms: Heavy sweating, weakness, skin may be cold, pale and clammy. Weak pulse. Normal temperature possible. Fainting, vomiting.
First Aid: Get victim to lie down in a cool place. Loosen clothing. Apply cool, wet cloths. Fan or move victim to air-conditioned place. Give sips of water. If nausea occurs, discontinue. If vomiting occurs, seek immediate medical attention.

Heat Stroke (Sun Stroke):
Symptoms: Extremely high body temperature (106+). Hot, dry skin. Rapid, strong pulse. Possible unconsciousness. Victim will likely not sweat.
First Aid: Heat stroke is a severe medical emergency. Dial 911 or emergency medical services or get the victim to a hospital immediately. Delay can be fatal. Move victim to a cooler environment. Try a cool bath or sponging to reduce body temperature. Remove clothing. Use fans and/or air conditioners. DO NOT GIVE FLUIDS.

The Center for Disease Control has information on their site about how to handle health related issues in extreme cold weather. Serious health problems can result from prolonged exposure to the cold. The most common cold-related problems are hypothermia and frostbite.

Hypothermia:
When exposed to cold temperatures, your body begins to lose heat faster than it can be produced. Prolonged exposure to cold will eventually use up your body’s stored energy. The result is hypothermia, or abnormally low body temperature. Body temperature that is too low affects the brain, making the victim unable to think clearly or move well. This makes hypothermia particularly dangerous because a person may not know it is happening and won’t be able to do anything about it. Hypothermia is most likely at very cold temperatures, but it can occur even at cool temperatures (above 40°F) if a person becomes chilled from rain, sweat, or submersion in cold water. Victims of hypothermia are often (1) elderly people with inadequate food, clothing, or heating; (2) babies sleeping in cold bedrooms; (3) people who remain outdoors for long periods—the homeless, hikers, hunters, etc.; and (4) people who drink alcohol or use illicit drugs.

Recognizing Hypothermia:
Warnings signs of hypothermia: Adults: shivering, exhaustion, confusion, fumbling hands,
memory loss, slurred speech, and drowsiness. Infants: bright red, cold skin, very low energy

What to Do:
If you notice any of these signs, take the person’s temperature. If it is below 95°, the situation is an emergency—get medical attention immediately. If medical care is not available, begin warming the person, as follows: Get the victim into a warm room or shelter. If the victim has on any wet clothing, remove it. Warm the center of the body first—chest, neck, head, and groin—using an electric blanket, if available. Or use skin-to-skin contact under loose, dry layers of blankets, clothing, towels, or sheets. Warm beverages can help increase the body temperature, but do not give alcoholic beverages. Do not try to give beverages to an unconscious person.
After body temperature has increased, keep the person dry and wrapped in a warm blanket, including the head and neck. Get medical attention as soon as possible. A person with severe hypothermia may be unconscious and may not seem to have a pulse or to be breathing. In this case, handle the victim gently, and get emergency assistance immediately. Even if the victim appears dead, CPR should be provided. CPR should continue while the victim is being warmed, until the victim responds or medical aid becomes available. In some cases, hypothermia victims who appear to be dead can be successfully resuscitated.

Frostbite:
--Frostbite is an injury to the body that is caused by freezing. Frostbite causes a loss of feeling and color in affected areas. It most often affects the nose, ears, cheeks, chin, fingers, or toes. Frostbite can permanently damage the body, and severe cases can lead to amputation. The risk of frostbite is increased in people with reduced blood circulation and among people who are not dressed properly for extremely cold temperatures.
--Recognizing Frostbite: At the first signs of redness or pain in any skin area, get out of the cold or protect any exposed skin—frostbite may be beginning. Any of the following signs may indicate frostbite: a white or grayish-yellow skin area skin that feels unusually firm or waxy, and numbness. A victim is often unaware of frostbite until someone else points it out because the frozen tissues are numb.
--What to Do: If you detect symptoms of frostbite, seek medical care. Because frostbite and hypothermia both result from exposure, first determine whether the victim also shows signs of hypothermia, as described previously. Hypothermia is a more serious medical condition and requires emergency medical assistance.

If (1) there is frostbite but no sign of hypothermia and (2) immediate medical care is not available, proceed as follows: Get into a warm room as soon as possible. Unless absolutely necessary, do not walk on frostbitten feet or toes—this increases the damage. Immerse the affected area in warm—not hot—water (the temperature should be comfortable to the touch for unaffected parts of the body). Or, warm the affected area using body heat. For example, the heat of an armpit can be used to warm frostbitten fingers. Do not rub the frostbitten area with snow or massage it at all. This can cause more damage. Don’t use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming. Affected areas are numb and can be easily burned.

These procedures are not substitutes for proper medical care. Hypothermia is a medical emergency and frostbite should be evaluated by a health care provider. It is a good idea to take a first aid and emergency resuscitation (CPR) course to prepare for cold-weather health problems. Knowing what to do is an important part of protecting your health and the health of others. Taking preventive action is your best defense against having to deal with extreme cold-weather conditions. By preparing your home and car in advance for winter emergencies, and by observing safety precautions during times of extremely cold weather, you can reduce the risk of weather-related health problems.

Weather can affect your health. Knowing what to do in certain situations is the best prevention for avoiding serious health issues related to both extreme weather conditions and everyday lifestyles. Knowledge is the first step to prevent the ill effects of some weather events. Use common sense. Get educated about how to handle your health when it comes to heat, cold, and any other weather condition.

Until next time. Let me know what you think.

Health Care and the Insurance Bind

According to a recent Kaiser poll taken in April, 2008, over 28% of those surveyed report problems paying for health industry and health care. As health care costs increase, more of those expenses are being shifted to individuals and families in the form of large deductibles or other requirements that patients pay out of pocket for a greater portion of health care costs. The Wall Street Journal reported results from the survey this month. The economy may be a contributing factor, and there may also be a "tipping point" that has been reached for Americans to afford medical care in an ever increasing rise of health care expenditures. Uninsured people surveyed reported at the highest rate of 38% of delaying or going without medical care. However, insured Americans were the biggest increase of those not able to pay for health care, including medical imaging, specialty pharmacy, and surgery.

As reported by MCOL, according to a new report released by the Center for Studying Health System Change, more than 20% of the U.S. population in 2007—one in five people—reported not getting or delaying needed medical care in the previous 12 months, up significantly from 14%—one in seven people—in 2003. Among study findings:
--Access to care deteriorated the most for insured people in poor or fair health—14.2 percent reported going without needed care in 2007, up from 9 percent in 2003.
--Overall, people in poor or fair health with an unmet need increased by 5.1 percentage points between 2003 and 2007 (11.9% vs. 17.0%), compared with an increase of 2.1 percentage points for people in good, very good or excellent health (4.1% vs. 6.2%).
--Uninsured people in poor or fair health reported the greatest problems getting needed care in 2007, with one in four (25%) reporting they went without needed care.
--For people reporting an access problem, cost was the most frequently cited—and a growing—obstacle to care. In 2007, 69 percent of people who went without or delayed needed care cited worries about cost, a 3.8 percentage point increase from 2003.
--Between 2003 and 2007, the frequency with which insured people cited a health plan-related reason for going without or delaying care increased 8.5 percentage points to 39 percent in 2007. Most of the increase was attributable to people reporting more problems getting their health plan to pay for treatment or that their doctor or hospital would not accept their insurance.

There are several ways to manage expenses with health care providers:
1.) Ask for an itemized statement in advance to avoid any surprises.
2.) Work with your insurance company and the medical provider to negotiate better rates.
3.) Seek help from a medical financial counselor to focus on managing health care expenses.
4.) Consult your insurance company to find out if certain procedures and medical providers aere covered under your plan.
5.) Find out what your exposure is for deductibles and co-payments, annual maximums and out-of-pocket expenses, providers located in or out of network, and any other concerns related to your medical needs.
6.) Seek out reputable discount medical plans that offer significant savings.

According to the Dallas Morning News, paying for medical costs can be very stressful and expensive. Although not every situation will not work out in the patient's favor, the medical provider knows that it is in his best interest to negotiate with you to get paid. Be honest with your ability to pay and make any payment that has been promised. Be open and communicative with the health care provider, and be fair and realistic about your options and abilities. Medical debt can drain your bank account, stretch your emotions, and destroy your credit if you cannot meet your obligations for unpaid medical bills.

Financial problems can cause considerable concern and add to the burdens of dealing with illness, especially catastrophic care. People are often embarrassed when they have financial problems and so don't seek the help they need or else they wait until their financial problems are overwhelming before seeking help-which makes them even more difficult to solve. BlueCross BlueShield reports that 50% of adults with incomes of less than $50,000 have experienced problems paying insurance in the past two years. It is common for families to have large expenses, especially if their insurance is limited. If you are worried about paying your medical bills, you are not unusual. However, there are important options for you to know about. Don't wait until you are overwhelmed.

The American Cancer Society (ACS) suggests the following ways to help manage insurance. The following are suggestions to help you and your family better understand your medical coverage:
--Locate all insurance information referring to the current medical problem.
--Read and review carefully any booklets explaining the plan under which you or your family is covered.
--Request written information on benefits if you do not have it.
--Talk with your employee benefits person at your job if you have questions or do not understand any of the terms in the printed materials.
--Make a list of any questions on benefits, deductibles, and coverage.
--Get answers directly from the insurer or managed care group that provides coverage.
--Be sure you understand your tasks in making sure that services are covered.
--Identify one contact person (if possible) in customer service with whom you can discuss claims and request services who will become familiar with your situation. This person may be a case manager.
--Meet with a hospital or clinic financial counselor or person from the patient accounts office to learn about billing procedures.
--Discuss any concerns about your insurance with your team social worker. He or she can help you understand how the system works and where to get help.
--Ask for help from a trusted friend if you feel overwhelmed in dealing with these matters.
--Develop a system for keeping records. For example, you may keep records according to each visit or under each health provider or under each week, whatever makes most sense to you.

The ACS also recommends that records should be kept of the following:
1.) Medical bills from all health care providers.
2.) Claims filed.
3.) Reimbursements (payments from insurance companies) received and explanations of benefits.
4.) Dates, names, and outcomes of contacts made with insurers and others.
5.) Non-reimbursed or outstanding medical and related costs.
6.) Meals and lodging expenses.
7.) Travel (including gas and parking).
8.) Long-distance telephone calls related to medical or other types of care, including psychosocial care.
9.) Admissions, clinic visits, lab work, diagnostic tests, procedures, treatments
drugs given and prescriptions ordered.

Insurance can be difficult to understand and expensive to maintain. Costs can be prohibitive for some health care needs, and many medical costs are unforseen which really wreak havoc on your budget. Even small businesses surveyed show that the cost of health insurance is the Number One issue facing them today as reported this month by the National Federation of Independent Businesses. The National Coalition on Health Care reports that national surveys show that the primary reason people are uninsured is the high cost of health insurance coverage. Economists have found that rising health care costs correlate to drops in health insurance coverage. In a Wall Street Journal-NBC Survey almost 50% of the American public say the cost of health care is their number one economic concern.

Health insurance does not always protect a family from medical bill problems. But insured families—all members have coverage—comprise the majority (68%) of families with medical bill problems. Even with insurance coverage, many families face higher out-of-pocket medical expenses because of rising deductibles, copayments and coinsurance, where patients pay a percentage of the total bill as reported by the Center for Studying Health System Change. The bottom line: Americans must do a better job of managing health care costs.

Until next time. Let me know what you think.

Health Care and Public Assistance

Twelve million people in the U.S., or 25% of the nation's estimated 47 million uninsured, are eligible for public insurance (e.g., Medicaid , SCHIP) but are not enrolled because they are not aware of the programs, don't know how to enroll or don't want to be linked to a publicly financed program, according to the National Institute for Health Care Management Foundation. Most older Americans have health insurance through Medicare. Medicare covers a variety of services, including inpatient hospital care, physician services, hospital outpatient care, home health care, skilled nursing facility care, hospice services, and (beginning in January 2006) prescription drugs. Utilization rates for many services change over time because of changes in physician practice patterns, medical technology, Medicare payment policies, and patient demographics reported at AgingStats.gov.

According to the Federal Interagency Forum on Aging Related Statistics, older Americans use more health care than any other age group. Health care costs are increasing rapidly at the same time the Baby Boom generation is approaching retirement age. Prescription drug costs have increased rapidly in recent years, as more new drugs become available. Lack of prescription drug coverage has created a financial hardship for many older Americans. Medicare coverage of prescription drugs began in January 2006, including a low income subsidy for beneficiaries with low incomes and assets. Most Medicare enrollees have a private insurance supplement, approximately equally split between employer sponsored and Medigap policies. Medicare covers about one-half of the health care costs of Medicare enrollees age 65 and over. Medicare’s payments are focused on acute care services such as hospitals and physicians. Nursing home care, prescription drugs, and dental care have been primarily financed out-of-pocket or by other payers.

The Forum also reported that the number of veterans age 65 and over who receive health care from the Veterans Health Administration (VHA) within the Department of Veterans Affairs has been steadily increasing. This increase may be because VHA fills important gaps in older veterans’ health care needs not currently covered or fully covered by Medicare, such as mental health services, long-term care (nursing home care and community-based care), and specialized services for the disabled. An increasing number of older veterans are turning to VHA for their health care needs despite their potential eligibility for other sources of health care, most notably prescription drug coverage through Medicare. VHA estimates that 94% of its enrollees age 65 and over are covered by Medicare Part A, 74% by Medicare Part B, 51% by Medigap, 13% by Medicaid, 20% by private insurance (excluding Medigap), and 10% by TRICARE for Life. About 4% have no other public or private coverage.

According to Governing.com, twelve years ago, Bill Clinton and the U.S. Congress ended "welfare as we know it." Gone was the idea of an open-ended entitlement for those mired in poverty. In its place came Temporary Assistance for Needy Families and the notion that families could — and should — work their way out of their impoverished straits. The question today is not so much whether TANF works but whether welfare as we now know it still matters. There is considerable evidence that many have. Through the late 1990s, poverty among single-parent families fell by 30 percent. Black-child poverty reached its lowest level in history. A strong economy played a key role in driving down poverty rates during that period. Also, welfare reform, which, besides emphasizing work gave states the flexibility to help clients with things such as child care, transportation, clothing and whatever else a family needed in order to get on its feet.

However, as reported on their site, there's also evidence that the welfare program has become a more punitive system — one geared to pushing people off the rolls rather than helping them become employed and self-sufficient. And the cost of that approach is showing up in increased use of food stamps, Medicaid and other safety net programs. In most states, caseloads have either stabilized or are trending slightly upward. One reason is that the easy cases have been washed out of the system. Those who were essentially work-ready — they just needed a little push and a little extra help — are off the rolls. Now the caseload is made up of those who have more serious and numerous barriers to employment such as mental or emotional problems or illness and physical problems. Many are immigrants who don't speak English. There has always been the threat and use of sanctions. Those clients who don't live up to work requirements could be hit with penalties, which include everything from a gradual ratcheting down of benefits to an immediate and complete cutoff of benefits. Caseworkers are trying very hard to get families to see employment and other options that are available to them.

The Kaiser Foundation reports that every one percentage point rise in the unemployment rate leads to a 1.1 million increase in the uninsured population and a one million increase in Medicaid and SCHIP enrollment, according to a new Kaiser analysis. As the country faces another economic downturn, many states are scrambling to deal with the impact of poor economic conditions on programs, like Medicaid and the State Children’s Health Insurance Program (SCHIP), that are reliant on state funding. To be better able to cope, states are looking for fiscal relief from the federal government as well as obtaining a moratorium on federal regulations that would reduce Medicaid funding for states from the Congress. Like Medicaid, SCHIP is a partnership between federal and state governments.

A definition of the SCHIP program appears on the site of the National Conference of State Legislatures. The State Children's Health Insurance Program (SCHIP) was created by the Balanced Budget Act of 1997, enacted Title XXI of the Social Security Act, and has allocated about $20 billion over 10 years to help states insure low-income children who are ineligible for Medicaid but cannot afford private insurance. States receive an enhanced federal match (greater than the state's Medicaid match) to provide for this coverage. Each state is entitled to a specific allotment of federal funds each year. States are allowed three years to spend their allotments. After three years, Title XXI provides that all remaining funds be reallocated to states that have used up their allotments. President Bush signed an extension of that plan in late 2007 that would cover existing participants.

So how does all this affect the rest of us who are not on public assistance? We pay taxes to support the government's expenditures to cover all those Americans who are on these programs. Taxes are how the system pays for Medicare, SCHIP, the VA, and countless other programs available to Americans. The more people who go on those entitlements, the more our taxes are stretched beyond the limit of use by available money. And taxes continue to increase. Taxes also fund coverage for all public employees, veterans, and the military (e.g. all members of Congress have publicly-funded insurance). That is one of the reasons that universal health care is such a hugely scary deal. Our taxes would go to pay for health care for anyone who didn't have insurance, and the likelihood of the tax rate increasing to pay for it is great. The other option is that the government goes bankrupt because there's not enough money to pay for universal health care.

Public assistance health care is only going to get more expensive as tens of millions of Americans are reaching eligibility for Medicare every year. As the economy gets tough, so does the availability of employer sponsored health care. Clearly, the answer to paying for all the expense involved is going to be a challenge in the months and years ahead.

Until next time. Let me know what you think.