If all’s well that ends well, then it’s not too much of a stretch to think that all’s unwell that ends badly. This is especially relevant when we talk about ensuring the wellness of our seniors — both throughout and at the end of their lives — and in this regard, something’s rotten in the state of health care.
Seniors already face a number of issues in our existing healthcare system, including unplanned hospital readmission, which results in poorer mental and physical health consequences. According to “Our Parents, Ourselves: Health Care for an Aging Population,” a report published this month by the Dartmouth Atlas of Health Care, 16.2 percent of Medicare beneficiaries were readmitted to the hospital within 30 days of discharge in 2008. The figure decreased to 15.5 percent in 2012. The modest dip could be attributed to the implementation of the 2010 Affordable Care Act, which stipulated that the Centers for Medicare and Medicaid financially penalize fee-for-service hospitals demonstrating higher-than-expected rates of readmission.
Still, the fact that one in every seven senior patients finds him/herself returning to the hospital points to many underlying medical and social impediments that elderly patients face. The Dartmouth Atlas pointed out that unplanned readmissions are typically caused by “inadequate discharge planning, poor care coordination between hospital and community clinicians, and/or the lack of effective longitudinal community-based care.” If patients don’t have family members, friends or other forms of social support to remind them to take their medications, drive them to their follow-up appointments, or help them perform their day-to-day activities that may now be more difficult to do, they may end up returning to the hospital through the emergency department.
With the continuous graying of the American population, the magnitude of this challenge will only increase. According to a 2014 report, “An Aging Nation: The Older Population in the United States” published by the U.S. Census Bureau, “In 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012.” To prepare for this inevitability, we need to give more serious thought about mobilizing more resources and personnel to assist the older patient population, which, in time, will affect our family members, friends, and ourselves. This clarion call is already being sounded by public intellectuals like Dr. Atul Gawande, whose most recent book, Being Mortal, described the author’s personal experiences in navigating care for his ailing father, interspersed with heart-wrenching narratives of patients and care providers in elderly care facilities.
Because the problems faced by elderly patients are large and multifactorial, their solutions will have to be equally so. One answer could be to include more aspects of senior care in mandated health care benefits; as of now, most other health insurances — including Medicare — don’t cover long-term care for everyday activities like dressing or bathing. Another answer may be to increase the number of people going into professions that can help coordinate long-term care for senior patients, such as hospital social workers and geriatricians. Unfortunately, these two professions also have the disadvantage of being tough, underappreciated, and underpaid. The annual compensation of medical social work — which typically requires a master’s degree — is $58,662. On the medical side, geriatricians in the United States are internists who have undergone an additional one-year fellowship. While they make $183,523, they also have the dubious distinction of being the only medical specialty in which more training leads to less payment, about $21,856 less compared to that of general internists, according to the the American Geriatrics Society.
Challenges in providing quality long-term health care to elderly patients are problems that virtually all of us will have to face personally as we and our loved ones undergo the inevitable process of aging. We as a society — and as taxpayers — must decide sooner, rather than later, what we are willing to pay to take care of those who are no longer able to take care of themselves.
Contact Yoo Jung Kim at yoojkim ‘at’ stanford.edu.