As you can see, from the graphs below, currently, the numbers of younger, working ,adults outnumber people over the age of 65. Working adults pay payroll taxes that support current Social Security and Medicare recipients. As you view these pyramids, notice how the working age to retirement age mix changes. Do you think we will have a problem supporting this age wave?

Population Pyramid Summary for United States

Watch the shape change before you eyes. If it does not change cut and past this URL into your browser.  http://www.ac.wwu.edu/~stephan/Animation/pyramid.html

III.  Policy Framework:

Currently, the United States does not have a coordinated plan for population aging. Remember the aging phenomenon is new. Your author states that: " often generals prepare for the next war by reliving the last one."

We have no history to guide us nor role models to follow their examples. I've heard it said you can tell the pioneers by the arrows in their backs. Carving out new policy is difficult. No one wants to be wrong and waste public funds. There is little experience to guide us.

For example: Until very recently, Japan has not had a formal aging  policy because of filial responsibility. That means that traditionally, families were responsible for their aging parents.  As their society becomes more Westernized (women entering the work force) social workers and educators from Japan  come to the U. S. to study our system.

Many policy and law makers do not understand the needs of aging people and that complicates the issue. Often their stereotypes and myths about aging get built into their programming and laws. 

This wastes public funds because these programs do not meet the needs of the elderly. There are many other reasons why we must properly frame the policy debate concerning the future of an aging society. 

IV.  Diversity Of The Elderly (differences and variety):

One of the most outstanding characteristics of the elderly population is their differences. They are not a homogeneous group ( not all alike). 

If aging starts at age 65 and the oldest (documented ) person who ever lived was 122 years, then old age, or the elderly years, can potentially span 57 years. age 122 minus 65 equals 57years.

These 57 years represent different generations with different values, beliefs, and very different needs. For example, as you learned, people over age 85 (the fastest growing segment of the elderly) are four times more likely to need services.

There is also a great diversity in their economic well-being

• 25% have incomes of less than $5,000
• 20% have incomes of less than $10,000
• 25% have incomes of more than $30,000

Some elderly are very well off and others are marginal or poor.

Falling below the poverty rate are:

• 23% Hispanic        46% if they are unmarried women
• 36% blacks           63% if unmarried women
• 24% unmarried white women

There is also a relationship between income and health. Lower income populations suffer more chronic health problems. This is because they are less likely to have health insurance and thus preventative  care. They are also more likely to have a lower quality of healthful foods and crowded or inadequate living conditions.

V. Importance Of The Diversity

Society tends to see all older adults as the same with the same needs. Yet  clearly the incomes, and thus the needs, of the very old  are very different from the young more affluent elderly. When we fail to recognize the heterogeneity (differences) of our older population, social problems get distorted or not defined correctly. These misunderstandings can lead to poor policy because stereotypes of the elderly and their needs are created which in turn 
does not create a realistic basis for policy making.

Remember, images and stereotypes affect decision making and can create programs that do not affectively target the elderly thus wasting precious public funds.

Does Education Really Matter?
 
As a board member of a community senior center I was involved in hiring a director for the center. Although not educated in gerontology, the  person the board favored, and hired, had years of decision making experience in the aging field.

For a fund raising activity he sponsored a dance. He hired a band, catered food, set up a bar and held the event at 8 p.m. on Friday night. No one came.

Large sums of money were lost because this director lacked the basic knowledge that the elderly suffer from presbyopia, a condition that does do allow them to see well at night. Because of eyesight, many seniors will not  drive to night time functions.

Refer to Handout:  The Elimination of Premature Disease (also located in week 4)

Did You Know? The Elimination of Premature Disease chart shows the effects of postponing chronic diseases by either improved lifestyle, eliminating it through research or both. For example: according to this chart if we could postpone heart disease from the current average age of  50 to an average age of 65, one might never live long enough to develop the complications associated with this disease. Their natural lifespan would not allow them to develop these complications. In other words, a person would die of old age before the progression of the disease.  
Check out this article: Study Finds Healthy Habits Slash Medicare Costs

VI.  Highlights of Medicare: Health Insurance

1. When one is eligible for Social Security, they are automatically eligible for Medicare, a medical insurance plan for older adults. Because of rising health care costs, the aging of the boomers, and the increase in longevity, Medicare  is one our most vulnerable entitlement programs. The cost of Medicare (to the government) is increasing at 3 times the rate of inflation.
   

The major provisions of the program are funded through a payroll tax. The same tax paid into Social Security. Medicare does not cover the long term costs of nursing homes, home care, or medications.

• If you need skilled nursing, you pay nothing for the 1^st 20 days 
  ( provided you have been hospitalized for a least 3 days and need  rehabilitative services. 
• For the next 80 days you pay $96 per day and no benefits are available after 100 days.
• Solely custodial care is not provided. That means that care must include a need for nursing or rehabilitation services. 

Medicare has two parts. 

• Part "A" is  hospital insurance and does not pay for prescriptions, dentists or eye doctors.The premium is $174.00 per month  
  
• Part "B" is optional and costs an additional $58.70 per month to enrollees. It covers 80% of 
  doctor's visits, some home care, and some rehabilitate care (such as physical therapy and occupational therapy).  

Medicare requires a deductible (the amount the patient must pay before benefits kick in) and out of pocket co payments (the difference between what the plan covers and the cost).

• Hospital Benefits  covered under Part A- Pays when you are Hospitalized. 
  When you are admitted you will have to pay a deductible of $840. ( 2003 figure).
  
• After 60 days your share of costs are $210. per day and after the 90^th  
  day the cost increases to $420 per day.

2. Our Government tried to control these rising costs with something called Diagnostic Related Groups or DRG's.   DRG's consist of a chart outlining  what Medicare will pay for certain  illnesses, including  how many days a person can stay in a hospital for any specific procedure.

This practice resulted in what is called " patient dumping". Patients being discharged too soon and more severely ill were being seen in the community.  Controlling costs at this level also created back-door rationing. Backdoor rationing happens when the level of health care one receives becomes based on the patients economics status or ability to pay.

Older people with limited funds  are dependent on Medicare and thus DRG's, while others who are more affluent can buy private insurance or pay cash.

Medicare also tried to lower costs by using HMO's or Health Maintenance Organizations. But this option created barriers to health care for older adults. HMO's are a packaged basket of health care products. If the service one needs is not in their covered expenses, then coverage is denied. Many procedures older adults want are not covered costs for HMO's (such as multiple home visits).

Many of the non-covered items are products only older people need such as: 

• home care (most cover just a few visits)
• adaptive equipment (walkers, canes, wheelchairs etc.)
• specialized geriatric care
• long-term care/ community or institutionalized

HMO’s that have contracts with Medicare are a network of doctors, hospitals, and other health care providers that agree to give care in return for a set monthly payment from Medicare. Seniors choose to sign their Medicare benefits over to the HMO in return for their care.

Beneficiaries (people who are enrolled in the program) in managed care plans may be restricted as to which doctor and hospitals they can use. However, for many, a managed care plan can reduce  out-of –pocket expenses (it often does not require deductibles and co-payments) and can reduce billing and paper work. Additionally, if one is enrolled in a managed plan they do not need Medi-gap insurance ( explained below). So clearly there are some advantages for low-income beneficiaries. 

Because of multiple complaints of long authorization times, service limitations, and the administration of HMO’s many customers choose to remain in a fee for service system such as straight Medicare. You may later dis-enroll from the HMO plan if you become dissatisfied with their services.

Medicare does not cover :

• prescription drugs
• services outside the U.S.
• routine physical exams
• eye exams
• hearing aids
• dental or foot care chiropractic
• immunizations or
• custodial care.

3.   Medigap Insurance

Traditional "fee-for-service" Medicare coverage (Part A and Part B) provides basic health care coverage. It can not pay all of your medical expenses and it does not pay for most long-term care.

Insurance to fill in the gaps is often called Medi-gap. Medi-gap pays for the deductibles, co-payments and non-covered expenses. 

It is difficult to summarize Medi-gap insurance  since each person can choose a level of coverage desired to suit them. The Health Care Financing Admin. publishes a booklet with information on supplementing Medicare coverage. It’s called Guide To Health Insurance For People With Medicare  and is available from any Social Security office or by writing to:

Medicare Publications, Health Care Financing Admin

7500 Security Blvd.
Baltimore, Maryland 21244-1850
 or visit them on-line 

Guide To Health Insurance For People With Medicare http://www.medicare.gov/Publications/Search/Results.asp?PubID=02110&Type=PubID&Language=English

 

Summary: 
People confuse individual aging with population aging. We have many programs in place for individual aging, such as meals on wheels, home visitors and various in-home assistance. However, population aging is not as well developed. Society is not structured for an aging population.

This is important because as the aging population grows and the working age shrinks, tax dollars to support programs such as Medicare and Social Security will be less. Keeping elders functioning in society can extend their independence and thus decrease the length of time and their reliance on social programs. Perhaps cars that are adapted to older drivers, signs and labels large enough to read, or homes that accommodate an aging body would be a nice place to start. Dedicating more dollars to finding cures for chronic diseases might also delay dependence. 

Because today fewer than 10% of people working in the field of aging are educated in Gerontology, policies and programs put into place do not best utilize the scare resources available. Instead they reflect the stereotypes, and inaccurate assumptions that all elders are alike.

 

Be sure to post questions regarding lecture materials to the discussion board, or visit me during office hours on Yahoo Instant Message sue_ward95945

back to the top    Don't forget to check the assignment page for this week's  assignment.

D. Highlights of Medicare

When one is eligible for Social Security, they are automatically eligible for Medicare, a medical insurance plan for older adults. Because of rising health care costs, the aging of the boomers, and the increase in longevity, Medicare  is one our most vulnerable entitlement programs. The costs of Medicare for the government are increasing at 3 times the rate of inflation.

The major provisions of the program are funded through  payroll tax. The same tax paid into Social Security. As you have seen, Medicare does not cover the long term costs of nursing homes, home care, or medications. 

NOTE Medicare just announced increases for 2005, these numbers are 2004

• If you need skilled nursing, you pay nothing for the 1^st 20 days ( provided you have been hospitalized for a least 3 days and need rehabilitative services only).
  
•  $109.50 per day for days 21 through 100 each benefit period.
• After 100 days there is no coverage under Medicare Solely custodial care is not provided.

 

Medicare has two parts. 

• Part "A" is  hospital insurance and does not pay for prescriptions, dentists, or eye doctors.  
  
• Part "B" is optional and costs an additional $66.00 per month to enrollees. It covers 80% of doctor visits, some home care, and some rehabilitate care (such as physical therapy and occupational therapy). 

• Medicare requires a deductible and out of pocket co-payments:
  
  • Hospital Benefits  covered under Part A- Pays when you are Hospitalized. When you are
    admitted you will have to pay a deductible of $876.00 (2004 figure). 
  • For each benefit period you pay:

    ·         A total of $876 for a hospital stay of 1-60 days.
    

    ·         $219 per day for days 61-90 of a hospital stay.
    

    ·         $438 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).|
    

    ·         All costs for each day beyond 150 days

•  

Our Government tried to control these rising costs with Diagnostic Related Groups or DRG's.   DRG's consist of a chart outlining  what Medicare will pay for certain  illnesses including  how many days a person can stay in a hospital for a specific procedure ( see previous lectures for more details on DRG's). 

This practice resulted in what is called " patient dumping". Patients being discharged too soon,  more severely ill being cared for, in our communities by home care officials.  Controlling costs at this level also created back-door rationing. Backdoor rationing happens because the level of health care one receives becomes based on the patients economics status or ability to pay-- older people with limited funds are dependent on Medicare and thus DRG's, while others who are more affluent can buy private insurance.

Medicare also tried to lower costs by using HMO's or Health Maintenance Organizations. But this option created barriers to health care for older adults. Remember, HMO's are a packaged basket of health care products. If the service one needs is not in their covered expenses, then coverage is denied. Many procedures older adults want are not covered costs for HMO's.

Many of the non-covered items are products only older people need such as: 

• home care (usually there is a small  number of visits covered)
• adaptive equipment
• specialized geriatric care
• long-term care/ community or institutionalized

Recall from previous lectures that HMO’s  have contracts with Medicare. They are a network of doctors, hospital, and other health care providers that agree to give care in return for a set monthly payment from Medicare. Beneficiaries in managed care plans may be restricted as to which doctor and hospitals they can use. However, for many, a managed care plan can reduce  out-of –pocket expenses for deductibles and co-payments, and can reduce billing and paper work. Additionally, if one is enrolled in a managed plan they do not need Medi-gap insurance to cover deductibles and co-payments that Medicare requires ( explained below). So clearly there are some advantages for low-income beneficiaries. 

Because of complaints of long authorization times, service limitations, and the administration of HMO’s, many customers choose to remain in a fee for service system. You may later dis-enroll from the HMO plan if you become dissatisfied with their services. Many HMO's are also pulling out of providing services for Medicare recipients because they claim the reimbursement schedule for services is too low. 

Medicare does not cover :

• prescription drugs
• services outside the U.S.
• routine physical exams
• eye exams
• hearing aids
• dental or foot care chiropractic
• immunizations or
• custodial care.

E. Medi-gap Insurance

Traditional "fee-for-service" Medicare coverage (Part A and Part B) provides basic health care coverage. It can not pay all of your medical expenses and it does not pay for most long-term care.

Insurance to fill in the gaps is often called Medi-gap. Medi-gap pays for the deductibles, co-payments, and non-covered expenses. 

It is difficult to summarize Medi-gap insurance  since each person can choose the level of coverage desired. The Health Care Financing Admin. publishes a booklet with information on supplementing Medicare coverage. It’s called Guide To Health Insurance For People With Medicare (publication #HCFA02110) and is available from any Social Security office or by writing to:

Medicare Publications, Health Care Financing Admin

7500 Security Blvd.

Baltimore, Maryland 21244-1850
 or visit them on-line