Often speaking emotionally from compelling personal family experience, members of the Advisory Board of To Your Good Health, A Health Care Newsletter, at their latest meeting at the Four Points By Sheraton Hyannis Resort unanimously endorsed the Commonwealth's new legislation that allows Medicaid-eligible seniors and the disabled the option of receiving covered care at home instead of the sole previous alternative of entering a nursing home.
At the same time, the Legislature also enacted a law that would, in Representative Cleon Turner's words, "provide a mechanism for certifying qualified home care assistants who would be on a list so people-like my own parents-would be able to call a central clearing agency and determine who is available in their area to come in and help them...and who are qualified to help them."
Mr. Turner called "these two pieces of legislation both economically and socially beneficial."
Lauren Tassinari, an aide to Senator Therese Murray, described the acts as "an absolutely perfect meeting of economics and values."
Diane Kolb, President/CEO of the Visiting Nurse Association of Cape Cod, did qualify that implementation of the new legislation (those devilish details) would be key to its success, but she still was highly in favor of the basic principles.
"Everybody wants to stay at home as long as they can and home care is the most economical," she declared.
Ms. Kolb pointed out that a typical 60-day care period in a skilled nursing facility would cost on average more than twice as much as care at home for a similar period.
Because of this disparity, she said many states already have Medicaid programs where loved ones who need to work to support the family are paid to stay home to serve as caregivers. Taxpayers actually save money from this arrangement.
"Of course, a key element is the amount of care the patient will need," she added.
There is a shortage of home care assistants, Ms. Kolb said, "because they are lower paid and we ask them to do a lot of things...significant things."
But Dr. Kathleen Schatzberg, president of Cape Cod Community College, noted that the school has been "building our capacity" for health-care practitioners.
As the Cape's population of elderly residents increases, a growing number of non-medical home care agencies have been springing up to assist them.
Frank Allosso of Home Instead agreed that this industry probably would expand even more to fill this need as an increased number of the elderly and disabled are being treated at home. "This legislation probably will be a positive thing for our company because it will help keep people at home rather than going to a facility," he said frankly.
Sue Rohrbach, an aide to Senator Rob O'Leary, added that elder services agencies on Cape also have been studying ways to expand their initiatives to assist caregivers who have young children as well as elderly parents at home.
Jim Lyons, retired president of Cape Cod Healthcare, noted that several years ago many independent visiting nurse groups were in serious financial trouble and actually were rescued (in terms of patients they covered) by becoming part of the merged Cape Cod Healthcare family under the VNA of Cape Cod umbrella.
The new legislation should increase the VNA's census, which, in turn, would make feasible increased reliance on technology to cover the expanded load. This is a major consideration due to the Cape's unique extended configuration.
The technology does exist.
Dr. Schatzberg said Four C's has submitted an application for a large Department of Labor grant on the use of information technology and patient care to ease this burden on the VNA. (She added that there are "several hundred" applications for the 75 grants of $600,000 each...so don't hold your breath.)
Under the more advanced technology, patients can be hooked up to a device that monitors all of their vital signs. ("It does everything but cook breakfast for you," Ms. Kolb interjected.) These data are fed directly to a central office, which is alerted in real time-bells, whistles, beeps?-to significant changes that might require the instant dispatch of a VNA nurse...or ambulance.
According to Dr. William McDermott, former executive director of the Massachusetts Medical Association, this type of technology also could assist Nurse Practitioners and Physician Assistants in their role of filling the gaps left by our current shortage of primary care physicians. These practitioners technically must work under the supervision of a fully qualified doctor. But often they are physically alone and really act as a gate-keeper, treating minor problems and referring more serious cases up the ladder. In these cases, technology could speed communication and minimize misunderstandings.