After Rx drugs, AARP wants home care

WASHINGTON — Through a new AARP survey, more than 1,100 disabled seniors have made their opinions clear: they want more control over healthcare decisions and they want to be cared for at home. While these preferences are hardly revelatory, the survey titled “Beyond 50 2003: A Report to the Nation on Independent Living and Disability,” confirms what the HME industry has been proclaiming for years: the need for home medical products and services is growing, insurance isn't adequately covering home care patient needs and assistive technology helps people gain independence. The survey — the third in an ongoing series of annual reports from AARP — canvassed disabled people 50 and older. Of the respondents, 68% had limited mobility, 21% had hearing or vision impairments and 18% had cognitive or emotional disabilities. Nearly half of respondents — 46% — told surveyors at Harris Interactive that having more control over decisions about healthcare services would bring a major improvement in the quality of their lives. One of the most striking findings, according to lead survey author Mary Jo Gibson, was that 25% of respondents said they weren't receiving regular assistance, either from family, friends or home care professionals. “Many of these unmet needs were simple, like bathing,” said Gibson, senior policy adviser for AARP's Public Policy Institute. “People are reticent to ask for help.” John Rother, AARP policy and strategy director, added that cost was the main factor for unfulfilled patient needs. “There is a dramatic worsening of the whole medical situation, and even though most patients had some type of insurance, it isn't covering the things they need,” Rother said. Interestingly, one thing survey respondents said they need is assistive technology. Twenty percent said they relied on assistive technology to help them remain independent. Although the 2003 survey didn't cite specific technologies, Gibson pointed out that some needs could be met by making even the modest technology more widely available, such as walkers and wheelchairs. Negative publicity about fraudulent HME suppliers hasn't helped the industry gain support from public and private sector policymakers, but Rother says shifting funds from institutional care to home care is on the AARP lobbying agenda. “Our first priority is securing a decent prescription drug benefit for Medicare beneficiaries,” he said. “But we share the belief that too much money is being directed to nursing homes and not enough to home care. People want to be cared for at home rather than in a nursing home.” The issue of patients wanting more control forms the basis of “consumer-directed care,” a concept endorsed by AARP and the National Family Caregivers Association. Pilot programs are being tried in several states that put Medicaid recipients in charge of their own care. “This program is [a 180-degree] switch from how things are now, where the money goes to the provider,” said Suzanne Mintz, president of the National Family Caregivers Association. “It shows that consumers are much happier, both with their lives and the services they're getting.” Indeed, the Medicaid demonstrations sponsored by the Robert Wood Johnson Foundation are serving as templates for instituting consumer-directed care across the country, Rother said. “The whole approach is about making care more available to people by changing the locus of decision-making from the agency to the client,” she said. HME