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PRODUCTION SUPPORT FOR THIS EPISODE OF "InFOCUS" IS
EPISODE OF "InFOCUS" IS PROVIDED BY...
>> WE'VE ALL HEARD STORIES ABOUT SENIORS LOSING THEIR ENTIRE LIFE
SENIORS LOSING THEIR ENTIRE LIFE SAVINGS AND EVEN THEIR HOMES TO
SAVINGS AND EVEN THEIR HOMES TO PAY FOR CARE LATE IN LIFE.
PAY FOR CARE LATE IN LIFE. LONG TERM CARE FACILITIES CAN
LONG TERM CARE FACILITIES CAN COST UPWARDS OF $200 A DAY.
COST UPWARDS OF $200 A DAY. THERE SEEMS TO BE AGREEMENT THAT
THERE SEEMS TO BE AGREEMENT THAT PEOPLE WOULD RATHER STAY IN
PEOPLE WOULD RATHER STAY IN THEIR HOMES AND LIVE
THEIR HOMES AND LIVE INDEPENDENTLY AS LONG AS
INDEPENDENTLY AS LONG AS POSSIBLE.
POSSIBLE. BUT ASSISTANCE IS DIFFICULT TO
BUT ASSISTANCE IS DIFFICULT TO COME BY AND PEOPLE CAN SPEND
COME BY AND PEOPLE CAN SPEND MONTHS ON WAITING LISTS.
MONTHS ON WAITING LISTS. WE'LL LOOK AT THE COST AND
WE'LL LOOK AT THE COST AND BENEFITS LONG-TERM CARE CAN
BENEFITS LONG-TERM CARE CAN BRING TO THE ELDERLY AND THEIR
BRING TO THE ELDERLY AND THEIR FAMILIES ON THIS EPISODE OF
FAMILIES ON THIS EPISODE OF "INFOCUS."
>> THANKS FOR JOINING US. I'M SARAH WITTMEYER.
I'M SARAH WITTMEYER. THE FASTEST GROWING POPULATION
THE FASTEST GROWING POPULATION IS INDIANA ARE PEOPLE 85 AND
IS INDIANA ARE PEOPLE 85 AND OHLER.
OHLER. MORE THAN 115,000 HOOSIERS FIT
MORE THAN 115,000 HOOSIERS FIT INTO THAT AGE BRACKET AS WTIU'S
INTO THAT AGE BRACKET AS WTIU'S GRETCHEN FRAZEE REPORTS THE COST
GRETCHEN FRAZEE REPORTS THE COST OF AGING CAN BE HIGH AND GETTING
OF AGING CAN BE HIGH AND GETTING LOVED ONES THE CARE THEY NEED
LOVED ONES THE CARE THEY NEED AND WANT CAN SOMETIMES BE
AND WANT CAN SOMETIMES BE DIFFICULT.
DIFFICULT. >> AS MORE PEOPLE AGE, THERE'S
>> AS MORE PEOPLE AGE, THERE'S MORE OF A DEMAND FOR SERVICES.
MORE OF A DEMAND FOR SERVICES. HOW TO PAY FOR CARE BECOMES A
HOW TO PAY FOR CARE BECOMES A COMPLICATED QUESTION.
COMPLICATED QUESTION. THERE'S LONG-TERM HEALTH
THERE'S LONG-TERM HEALTH INSURANCE, MEDICARE, MEDICAID,
INSURANCE, MEDICARE, MEDICAID, SELF-PAY.
SELF-PAY. IN INDIANA THE STATE OFFERS
IN INDIANA THE STATE OFFERS ASSISTANCE TO ELIGIBLE SENIORS
ASSISTANCE TO ELIGIBLE SENIORS IN THE FORM OF A PROGRAM CALLED
IN THE FORM OF A PROGRAM CALLED CHOICE.
CHOICE. THE ACRONYM STAND FOR INDIANA'S
THE ACRONYM STAND FOR INDIANA'S COMMUNITY AND HOME OPTIONS TO
COMMUNITY AND HOME OPTIONS TO INSTITUTIONAL CARE FOR THE
INSTITUTIONAL CARE FOR THE ELDERLY AND DISABLED.
ELDERLY AND DISABLED. THE PROGRAM PROVIDES INHOME
THE PROGRAM PROVIDES INHOME SERVICES.
SERVICES. BUT THE WAITING LIST IS ABOUT
BUT THE WAITING LIST IS ABOUT 5,000.
5,000. >> IF PEOPLE ARE ON A WAITING
>> IF PEOPLE ARE ON A WAITING LIST TO GET THOSE SERVICES, TO
LIST TO GET THOSE SERVICES, TO GET THOSE CHOICE DOLLARS, HOW
GET THOSE CHOICE DOLLARS, HOW MANY OF THEM ACTUALLY ARE GOING
MANY OF THEM ACTUALLY ARE GOING TO STILL BE HERE AND LIVE TO SEE
TO STILL BE HERE AND LIVE TO SEE GETTING ONTO THE LIST?
GETTING ONTO THE LIST? >> CORA LUCAS PROVIDES HELP WITH
>> CORA LUCAS PROVIDES HELP WITH BASIC NEEDS TO SENIORS IN
BASIC NEEDS TO SENIORS IN JACKSON COUNTY.
JACKSON COUNTY. SHE PARTICIPATED IN A RALLY AT
SHE PARTICIPATED IN A RALLY AT THE STATE HOUSE WITH DOZENS OF
THE STATE HOUSE WITH DOZENS OF SENIORS WHO WANTS TO SEE THE
SENIORS WHO WANTS TO SEE THE LEGISLATURE ALLOCATE MORE MONEY
LEGISLATURE ALLOCATE MORE MONEY FOR COMMUNITY BASED SERVICES.
FOR COMMUNITY BASED SERVICES. >> FUNDING HAS TO CONTINUE AND
>> FUNDING HAS TO CONTINUE AND WITH THE GROWING POPULATION OF
WITH THE GROWING POPULATION OF THE BABY-BOOMERS WE'RE GOING TO
THE BABY-BOOMERS WE'RE GOING TO NEED INCREASED FUNDING, AND
NEED INCREASED FUNDING, AND BUDGETS ARE BEING CUT OR NOT
BUDGETS ARE BEING CUT OR NOT INCREASED FOR THE DEMAND, HOW
INCREASED FOR THE DEMAND, HOW ARE WE GOING TO MEET THE NEED.
ARE WE GOING TO MEET THE NEED. >> THE SOLUTION IS SOMETIMES TO
>> THE SOLUTION IS SOMETIMES TO ABANDON THE WAITING LIST AND
ABANDON THE WAITING LIST AND SOMETIMES ENTER A NURSING HOME.
SOMETIMES ENTER A NURSING HOME. THERE ARE A NUMBER OF PEOPLE WHO
THERE ARE A NUMBER OF PEOPLE WHO COULD REMAIN IN THE COMMUNITY IF
COULD REMAIN IN THE COMMUNITY IF THEY GOT FOUR HOURS OF CARE IN
THEY GOT FOUR HOURS OF CARE IN THE MORNING AND A COUPLE HOURS
THE MORNING AND A COUPLE HOURS IN THE EVENING.
IN THE EVENING. >> MEDICAID IS REQUIRED TO PAY
>> MEDICAID IS REQUIRED TO PAY FOR LONG-TERM CARE.
FOR LONG-TERM CARE. BUT IUPUY PROFESSOR KATHLEEN
BUT IUPUY PROFESSOR KATHLEEN UNROE SAYS EVEN THAT GETS
UNROE SAYS EVEN THAT GETS COMPLICATED.
COMPLICATED. IF SERVICES DON'T KICK IN UNTIL
IF SERVICES DON'T KICK IN UNTIL ASSETS ARE DEPLETED.
ASSETS ARE DEPLETED. >> TO PAY THE DAILY COST OF A
>> TO PAY THE DAILY COST OF A NURSING HOME WILL EAT THROUGH
NURSING HOME WILL EAT THROUGH SOMEONE'S SAVINGS PRETTY
SOMEONE'S SAVINGS PRETTY QUICKLY.
QUICKLY. IF THEY DON'T HAVE OTHER
IF THEY DON'T HAVE OTHER INSURANCE COVERAGE, TO TAKE CARE
INSURANCE COVERAGE, TO TAKE CARE OF IT, OR TO HELP OUT WITH THAT,
OF IT, OR TO HELP OUT WITH THAT, OR LONG-TERM CARE INSURANCE
OR LONG-TERM CARE INSURANCE COVERAGE, WHICH MOST PEOPLE DO
COVERAGE, WHICH MOST PEOPLE DO NOT HAVE, OR THEY DON'T HAVE
NOT HAVE, OR THEY DON'T HAVE FAMILY THAT CAN PAY THAT BILL,
FAMILY THAT CAN PAY THAT BILL, THEN THEY -- THEIR SAVINGS WILL
THEN THEY -- THEIR SAVINGS WILL BE SPENT DOWN PRETTY QUICKLY.
BE SPENT DOWN PRETTY QUICKLY. SOMEONE SPENDS DOWN TO
SOMEONE SPENDS DOWN TO ELIGIBILITY TO MEDICAID.
ELIGIBILITY TO MEDICAID. >> NURSING HOME COSTS CAN RANGE
>> NURSING HOME COSTS CAN RANGE FROM $5,000 TO $12,000 A MONTH,
FROM $5,000 TO $12,000 A MONTH, DEPENDING ON THE AMOUNT OF
DEPENDING ON THE AMOUNT OF SERVICE NEEDED.
SERVICE NEEDED. WAYS AND MEANS CHAIRMAN
WAYS AND MEANS CHAIRMAN REPRESENTATIVE TIM BROWN SAYS
REPRESENTATIVE TIM BROWN SAYS THE SOLUTION TO PROVIDING
THE SOLUTION TO PROVIDING SENIORS TO QUALITY CARE IS LIKE
SENIORS TO QUALITY CARE IS LIKE A THREE-LEGGED STOOL.
A THREE-LEGGED STOOL. >> YOU HAVE TO HAVE THE
>> YOU HAVE TO HAVE THE LONG-TERM CARE INSURANCE.
LONG-TERM CARE INSURANCE. YOU HAVE TO HAVE MAYBE SOME
YOU HAVE TO HAVE MAYBE SOME SCREENING ELIGIBILITY GUIDELINES
SCREENING ELIGIBILITY GUIDELINES AS YOU GO FORWARD.
AS YOU GO FORWARD. AND THEN YOU HAVE TO HAVE FAMILY
AND THEN YOU HAVE TO HAVE FAMILY AND YOUR OWN SELF-PAY AS A PART
AND YOUR OWN SELF-PAY AS A PART OF THAT.
OF THAT. >> IF ANY LEG OF THE STOOL IS
>> IF ANY LEG OF THE STOOL IS BROAKSEN THE WHOLE THING IS AT
BROAKSEN THE WHOLE THING IS AT WRIST K OF COLLAPSING.
WRIST K OF COLLAPSING. >> AS THEY PREPARE AND SAVE
>> AS THEY PREPARE AND SAVE THEIR WHOLE ENTIRE LIVES, IT
THEIR WHOLE ENTIRE LIVES, IT SHOULD BE FOR WHAT YOU NEED.
SHOULD BE FOR WHAT YOU NEED. IT *** NECESSARILY BE THAT
IT *** NECESSARILY BE THAT I'M SAVING TO PASS SOMETHING ON
I'M SAVING TO PASS SOMETHING ON TO MY FAMILY.
TO MY FAMILY. IT SHOULD BE FOR THE CARE THAT I
IT SHOULD BE FOR THE CARE THAT I NEED AND THEREFORE NOT GIVE AWAY
NEED AND THEREFORE NOT GIVE AWAY ASSETS JUST BECAUSE I HAVE THE
ASSETS JUST BECAUSE I HAVE THE ASSETS TO GIVE AWAY.
ASSETS TO GIVE AWAY. >> CARUTHERSVILLE RESIDENT JAMES
>> CARUTHERSVILLE RESIDENT JAMES DALEY CONSIDERED CONSIDERS
DALEY CONSIDERED CONSIDERS HIMSELF LUCKY.
HIMSELF LUCKY. HE HAS LONG-TERM HEALTH CARE
HE HAS LONG-TERM HEALTH CARE INSURANCE THAT CAN HELP COVER
INSURANCE THAT CAN HELP COVER HIS EXPENSES IF HE NEEDS TO BE
HIS EXPENSES IF HE NEEDS TO BE PLACED IN A FACILITY AND HAS
PLACED IN A FACILITY AND HAS THREE DAUGHTERS.
THREE DAUGHTERS. >> I SAY WHENEVER THINGS GO
>> I SAY WHENEVER THINGS GO WRONG, PUT ME IN THERE BUT LET
WRONG, PUT ME IN THERE BUT LET ME STAY OUT, IF I CAN DO THINGS
ME STAY OUT, IF I CAN DO THINGS MYSELF AS LONG AS I CAN AND
MYSELF AS LONG AS I CAN AND REASONABLE AND KNOWLEDGEABLE
REASONABLE AND KNOWLEDGEABLE ABOUT WHAT'S BEST FOR ME.
ABOUT WHAT'S BEST FOR ME. LET ME STAY HOME IF I CAN.
LET ME STAY HOME IF I CAN. >> WE'RE JOINED IN STUDIO
>> WE'RE JOINED IN STUDIO TONIGHT BY GINGER FITZPATRICK,
TONIGHT BY GINGER FITZPATRICK, THE HEALTH FACILITY
THE HEALTH FACILITY ADMINISTRATOR FOR AMERICAN
ADMINISTRATOR FOR AMERICAN SENIOR COMMUNITIES, SHARON
SENIOR COMMUNITIES, SHARON SPENCER, COLUMBUS REGIONAL
SPENCER, COLUMBUS REGIONAL HEALTH'S CLINICAL CASE MANAGER,
HEALTH'S CLINICAL CASE MANAGER, AND ASIF NAZIR, AN ASSISTANT
AND ASIF NAZIR, AN ASSISTANT PROFESSOR AND AT THE IU SCHOOL
PROFESSOR AND AT THE IU SCHOOL OF MEDICINE AND MEDICAL DIRECTOR
OF MEDICINE AND MEDICAL DIRECTOR FOR WESTPARK REHABILITATION
FOR WESTPARK REHABILITATION FACILITY.
FACILITY. THANKS TO YOU ALL FOR BEING
THANKS TO YOU ALL FOR BEING HERE.
HERE. I WANTED TO GET THE CONVERSATION
I WANTED TO GET THE CONVERSATION GOING BY JUST TALKING ABOUT HOW
GOING BY JUST TALKING ABOUT HOW THE ROLE OF NURSING HOMES HAS
THE ROLE OF NURSING HOMES HAS CHANGED, SAY, OVER THE PAST
CHANGED, SAY, OVER THE PAST COUPLE OF DECADES.
COUPLE OF DECADES. DO YOU WANT TO GET US STARTED?
DO YOU WANT TO GET US STARTED? >> SURE.
>> SURE. WELL, I'VE BEEN DOING THIS OVER
WELL, I'VE BEEN DOING THIS OVER 30 YEARS.
30 YEARS. I HAVE BEEN PRIVILEGED TO WATCH
I HAVE BEEN PRIVILEGED TO WATCH AND BE A PART OF HOW THE CHANGE
AND BE A PART OF HOW THE CHANGE HAS HAPPENED.
HAS HAPPENED. I WOULD TELL YOU THAT THE ROLE
I WOULD TELL YOU THAT THE ROLE OF NURSING HOMES HAS EXPANDED
OF NURSING HOMES HAS EXPANDED SIGNIFICANTLY FROM BEING A FOCUS
SIGNIFICANTLY FROM BEING A FOCUS AND A HOME FOR PEOPLE WHO WERE
AND A HOME FOR PEOPLE WHO WERE DISABLED AND HAD NO OTHER
DISABLED AND HAD NO OTHER OPTIONS IN LIFE TO BEING VERY
OPTIONS IN LIFE TO BEING VERY FOCUSED ON REHABILITATION.
FOCUSED ON REHABILITATION. NURSING HOMES TODAY CAN PROVIDE
NURSING HOMES TODAY CAN PROVIDE AND DO PROVIDE LOTS OF AVENUES
AND DO PROVIDE LOTS OF AVENUES AND VENUES FOR RESIDENTS TO COME
AND VENUES FOR RESIDENTS TO COME IN, REHABILITATE AND GO HOME.
IN, REHABILITATE AND GO HOME. THEY ARE AS BIG A SUPPORTER OF
THEY ARE AS BIG A SUPPORTER OF THAT AS ANY OTHER PROGRAM OUT
THAT AS ANY OTHER PROGRAM OUT THERE.
THERE. THAT'S PRIMARILY HOW I'VE SEEN
THAT'S PRIMARILY HOW I'VE SEEN THEM CHANGE, TO FOCUS THAT
THEM CHANGE, TO FOCUS THAT DIRECTION, TO HELP PEOPLE BE
DIRECTION, TO HELP PEOPLE BE INDEPENDENT AND RETURN TO THEIR
INDEPENDENT AND RETURN TO THEIR HOMES.
HOMES. OFTEN WE HAVE PEOPLE WHO WILL
OFTEN WE HAVE PEOPLE WHO WILL COME TO US FOR REHAB MAYBE TWO
COME TO US FOR REHAB MAYBE TWO OR THREE TIMES BEFORE THEY'RE
OR THREE TIMES BEFORE THEY'RE EVER AT A POINT WHERE THEY NEED
EVER AT A POINT WHERE THEY NEED TO STAY FOR LONG-TERM CARE.
TO STAY FOR LONG-TERM CARE. SO THAT'S A VERY GOOD EVENT OF
SO THAT'S A VERY GOOD EVENT OF THE PROCESS THAT'S HAPPENED
THE PROCESS THAT'S HAPPENED THROUGH THE YEARS.
THROUGH THE YEARS. >> I THINK THAT RUNS COUNTER TO
>> I THINK THAT RUNS COUNTER TO WHAT A LOT OF PEOPLE THINK,
WHAT A LOT OF PEOPLE THINK, THOUGH.
THOUGH. >> DEFINITELY.
>> DEFINITELY. >> NURSING HOMES ARE FOR LONG
>> NURSING HOMES ARE FOR LONG TERM.
TERM. >> LONG TERM WHERE YOU GO TO
>> LONG TERM WHERE YOU GO TO DIE.
DIE. ONCE I GET IN THERE I'M NEVER
ONCE I GET IN THERE I'M NEVER GOING TO GET OUT.
GOING TO GET OUT. I PLACE PEOPLE IN FACILITIES
I PLACE PEOPLE IN FACILITIES ALMOST ON A DAILY BASIS WITH THE
ALMOST ON A DAILY BASIS WITH THE PRIMARY FOCUS OF SHORT-TERM, GET
PRIMARY FOCUS OF SHORT-TERM, GET YOU STRONGER, GET YOU BACK HOME,
YOU STRONGER, GET YOU BACK HOME, GIVE THE FAMILY A CHANCE TO COME
GIVE THE FAMILY A CHANCE TO COME UP WITH A PLAN ON HOW TO KEEP
UP WITH A PLAN ON HOW TO KEEP YOU HOME.
YOU HOME. >> YES.
>> YES. I AGREE.
I AGREE. I THINK THESE CONCEPTS HAVE
I THINK THESE CONCEPTS HAVE CHANGED SIGNIFICANTLY OVER THE
CHANGED SIGNIFICANTLY OVER THE LAST TWO, THREE DECADES.
LAST TWO, THREE DECADES. NURSING HOMES, IF YOU LOOK AT
NURSING HOMES, IF YOU LOOK AT THEIR HISTORY, SHOW US OVER THE
THEIR HISTORY, SHOW US OVER THE YEARS NURSING HOMES HAVE BEEN
YEARS NURSING HOMES HAVE BEEN VERY -- HAVE OFTEN MORPHED TO
VERY -- HAVE OFTEN MORPHED TO MEET THE NEEDS OF THE SOCIETY,
MEET THE NEEDS OF THE SOCIETY, AND THIS IS WHAT WE'RE SEEING,
AND THIS IS WHAT WE'RE SEEING, NURSING HOMES AGAIN, IF YOU
NURSING HOMES AGAIN, IF YOU WILL, HAVE RISEN TO THE OCCASION
WILL, HAVE RISEN TO THE OCCASION TO HELP OUR FRAIL ELDERS WHO ARE
TO HELP OUR FRAIL ELDERS WHO ARE NOT READY TO GO HOME FROM THE
NOT READY TO GO HOME FROM THE HOSPITAL AND PROVIDE ACUTE CARE
HOSPITAL AND PROVIDE ACUTE CARE FOR THEM.
FOR THEM. BECAUSE WITHOUT THOSE SERVICES,
BECAUSE WITHOUT THOSE SERVICES, WE SEE THAT -- THERE'S NOBODY AT
WE SEE THAT -- THERE'S NOBODY AT HOME TO PROVIDE THAT CARE.
HOME TO PROVIDE THAT CARE. SO I THINK NURSING HOMES HAVE
SO I THINK NURSING HOMES HAVE DONE WELL IN TERMS OF PROVIDING
DONE WELL IN TERMS OF PROVIDING THOSE RESOURCES.
THOSE RESOURCES. BUT WHAT NURSING HOMES IN TERMS
BUT WHAT NURSING HOMES IN TERMS OF THE RESOURCES THEY HAVE, THAT
OF THE RESOURCES THEY HAVE, THAT IS A QUESTION.
IS A QUESTION. SOMETIMES NOT ALL THE NURSING
SOMETIMES NOT ALL THE NURSING HOMES ARE READY TO PROVIDE THESE
HOMES ARE READY TO PROVIDE THESE KIND OF TWO-PRONGED CARE.
KIND OF TWO-PRONGED CARE. ON ONE END THEY HAVE TO PROVIDE
ON ONE END THEY HAVE TO PROVIDE CARE TO THE LONG-STAY RESIDENTS
CARE TO THE LONG-STAY RESIDENTS WHO ARE THERE FOR THE RESIDENTS
WHO ARE THERE FOR THE RESIDENTS WHO ARE GOING TO BE THERE
WHO ARE GOING TO BE THERE BECAUSE THAT'S THEIR HOME.
BECAUSE THAT'S THEIR HOME. BUT, ON THE OTHER HAND, THEY
BUT, ON THE OTHER HAND, THEY HAVE TO PROVIDE THIS TOTAL SHIFT
HAVE TO PROVIDE THIS TOTAL SHIFT IN PHILOSOPHY KIND OF CARE WHICH
IN PHILOSOPHY KIND OF CARE WHICH IS VERY ACUTE IN NATURE, PRETTY
IS VERY ACUTE IN NATURE, PRETTY MUCH SIMILAR TO WHAT OUR
MUCH SIMILAR TO WHAT OUR HOSPITAL USED TO PROVIDE A FEW
HOSPITAL USED TO PROVIDE A FEW YEARS BACK.
YEARS BACK. I DON'T THINK A LOT OF PEOPLE
I DON'T THINK A LOT OF PEOPLE REALIZE THAT -- HOW
REALIZE THAT -- HOW SIGNIFICANTLY NURSING HOMES HAVE
SIGNIFICANTLY NURSING HOMES HAVE CHANGED AS A REQUIREMENT OF THE
CHANGED AS A REQUIREMENT OF THE SOCIETY FOR THAT.
SOCIETY FOR THAT. >> I AGREE, DOCTOR.
>> I AGREE, DOCTOR. I BELIEVE THAT OUR REHAB UNITS
I BELIEVE THAT OUR REHAB UNITS AND LONG-TERM CARE FACILITIES
AND LONG-TERM CARE FACILITIES TODAY, AND I HAVE PRETTY
TODAY, AND I HAVE PRETTY EXTENSIVE BACKGROUND IN THAT,
EXTENSIVE BACKGROUND IN THAT, ARE VERY MUCH WHAT THE RE HAD
ARE VERY MUCH WHAT THE RE HAD BEEN UNITS WERE IN THE HOSPITAL
BEEN UNITS WERE IN THE HOSPITAL A NUMBER OF YEARS AGO.
A NUMBER OF YEARS AGO. WHERE THE HOSPITALS HAVE MOVED
WHERE THE HOSPITALS HAVE MOVED AWAY FROM THAT, MORE TO
AWAY FROM THAT, MORE TO DIAGNOSTICS AND LAYING OUT A
DIAGNOSTICS AND LAYING OUT A TREATMENT PLAN, THAT PEOPLE COME
TREATMENT PLAN, THAT PEOPLE COME TO LONG-TERM CARE.
TO LONG-TERM CARE. WE'RE NOT JUST TALKING
WE'RE NOT JUST TALKING GERIATRICS.
GERIATRICS. WE'VE HAD OUR FAIR SHARE OF HIP,
WE'VE HAD OUR FAIR SHARE OF HIP, KNEE REPLACEMENTS, PEOPLE
KNEE REPLACEMENTS, PEOPLE YOUNGER THAN I AM, AND HAVE COME
YOUNGER THAN I AM, AND HAVE COME IN TO REHAB FOR PERIODS OF TIME,
IN TO REHAB FOR PERIODS OF TIME, 20 DAYS, FOUR WEEKS, DEPENDING
20 DAYS, FOUR WEEKS, DEPENDING ON WHAT THEY HAVE -- WHEN THEY
ON WHAT THEY HAVE -- WHEN THEY LEAVE US THEN THEY HAVE A BETTER
LEAVE US THEN THEY HAVE A BETTER OPPORTUNITY BEING SUCCESSFUL AT
OPPORTUNITY BEING SUCCESSFUL AT HOME.
HOME. THE RE SI RECIDIVISM RATE BACK E
THE RE SI RECIDIVISM RATE BACK E HOSPITAL READMISSION IS MUCH
HOSPITAL READMISSION IS MUCH LOWER.
LOWER. THAT'S A TREMENDOUS SAVINGS TO
THAT'S A TREMENDOUS SAVINGS TO THE HEALTHCARE DOLLAR.
THE HEALTHCARE DOLLAR. >> AND I WOULD LIKE TO SPECIFY
>> AND I WOULD LIKE TO SPECIFY ON THAT, ON -- OVERALL I WOULD
ON THAT, ON -- OVERALL I WOULD SAY THEY HAVE BEEN HELP.
SAY THEY HAVE BEEN HELP. BUT NURSING HOMES, ESPECIALLY
BUT NURSING HOMES, ESPECIALLY FOR HEART FAILURE, COPD,
FOR HEART FAILURE, COPD, UNFORTUNATELY PATIENTS WHO COME
UNFORTUNATELY PATIENTS WHO COME TO REHAB MAY NOT DO AS WELL.
TO REHAB MAY NOT DO AS WELL. WE HAVE ROOM FOR IMPROVEMENT
WE HAVE ROOM FOR IMPROVEMENT THERE.
THERE. JUST GOING BACK TO THE TREND
JUST GOING BACK TO THE TREND THAT NURSING HOMES EVOLVED OVER
THAT NURSING HOMES EVOLVED OVER THE LAST FEW DECADES, I WOULD
THE LAST FEW DECADES, I WOULD SAY ONE THING THEY HAVE DONE IS
SAY ONE THING THEY HAVE DONE IS PUT A LOT OF PRESSURE ON NURSING
PUT A LOT OF PRESSURE ON NURSING HOMES TO PROVIDE HIGH VOLUME
HOMES TO PROVIDE HIGH VOLUME CARE TO THE REHAB PATIENTS WHICH
CARE TO THE REHAB PATIENTS WHICH IS QUITE INTENSIVE, WHICH MAY
IS QUITE INTENSIVE, WHICH MAY HAVE LED TO SOME LESS FOCUS ON
HAVE LED TO SOME LESS FOCUS ON RESIDENTS WHO ARE THERE FOR
RESIDENTS WHO ARE THERE FOR LONG-TERM STAY.
LONG-TERM STAY. THE NURSING HOMES HAVE BEEN
THE NURSING HOMES HAVE BEEN ASKED TO PROVIDE TWO DIFFERENT
ASKED TO PROVIDE TWO DIFFERENT KIND OF CARE WHICH ARE THE TWO
KIND OF CARE WHICH ARE THE TWO EXTREMES, I WOULD SAY, RIGHT.
EXTREMES, I WOULD SAY, RIGHT. ON ONE SIDE THERE'S A FAILED
ON ONE SIDE THERE'S A FAILED RESIDENT WHO IS 89 YEARS OLD,
RESIDENT WHO IS 89 YEARS OLD, DEMENTIA, WHERE A FAMILY WANTS
DEMENTIA, WHERE A FAMILY WANTS TO JUST PROVIDE COMFORT, CARE,
TO JUST PROVIDE COMFORT, CARE, SUPPORTIVE CARE.
SUPPORTIVE CARE. WHILE ON THE SAME FLOOR, ON THE
WHILE ON THE SAME FLOOR, ON THE OTHER END OF THE NURSING HOME
OTHER END OF THE NURSING HOME BUILDING, YOU MAY HAVE SOMEBODY
BUILDING, YOU MAY HAVE SOMEBODY WHO IS 69 YEARS OLD, VERY
WHO IS 69 YEARS OLD, VERY ROBUST, RECENTLY HAD HEART
ROBUST, RECENTLY HAD HEART DISEASE AND IS IN THE NURSING
DISEASE AND IS IN THE NURSING HOME JUST TO RECOVER FROM THEIR
HOME JUST TO RECOVER FROM THEIR EPISODE.
EPISODE. I THINK THAT HAS LED TO SOME NEW
I THINK THAT HAS LED TO SOME NEW ISSUES THAT NURSING HOMES HAD TO
ISSUES THAT NURSING HOMES HAD TO FACE.
FACE. ALSO DEFINITELY HAS LED TO
ALSO DEFINITELY HAS LED TO HIGHER COSTS FOR NURSING HOMES.
HIGHER COSTS FOR NURSING HOMES. >> ABSOLUTELY.
>> ABSOLUTELY. >> I WANT TO ASK, THIS SHIFT IN
>> I WANT TO ASK, THIS SHIFT IN WHO WE'RE SERVING MORE IN
WHO WE'RE SERVING MORE IN NURSING HOMES NOW, HOW HAS THIS
NURSING HOMES NOW, HOW HAS THIS CONTRIBUTED JUST TO THE QUALITY
CONTRIBUTED JUST TO THE QUALITY OF CARE PEOPLE ARE GETTING IN
OF CARE PEOPLE ARE GETTING IN NURSING HOMES?
NURSING HOMES? THE 2011 SURVEY BY AARP SHOWED
THE 2011 SURVEY BY AARP SHOWED IPPED RANKED 47th OUT OF 50
IPPED RANKED 47th OUT OF 50 STATES IN -- FOR A NUMBER OF
STATES IN -- FOR A NUMBER OF CRITERIA, BUT OVERALL BASED ON
CRITERIA, BUT OVERALL BASED ON QUALITY AND ACCESS TO CARE THAT
QUALITY AND ACCESS TO CARE THAT THAT SO ARE WE NOT SHIFTING OVER
THAT SO ARE WE NOT SHIFTING OVER TO SERVING THIS NEW GROUP WELL?
TO SERVING THIS NEW GROUP WELL? >> I THINK ONE THING WE HAVE TO
>> I THINK ONE THING WE HAVE TO DO IS ALSO TO KNOW OUR SCORING
DO IS ALSO TO KNOW OUR SCORING SYSTEMS.
SYSTEMS. AS I WOULD SAY, THESE SCORING
AS I WOULD SAY, THESE SCORING SYSTEMS ARE BASED ON MINIMUM
SYSTEMS ARE BASED ON MINIMUM DATA SET MEASURES.
DATA SET MEASURES. MINIMUM DATA SET IS A SET OF
MINIMUM DATA SET IS A SET OF INDICATORS ON RESIDENTS THAT HAS
INDICATORS ON RESIDENTS THAT HAS MORE THAN 400 ITEMS.
MORE THAN 400 ITEMS. THIS WAS REALLY PRODUCED IN
THIS WAS REALLY PRODUCED IN 1990s BASED ON THE OMNIBUS
1990s BASED ON THE OMNIBUS RECONSIDERATION ACT.
RECONSIDERATION ACT. WHICH STATED PATIENT CARE SHOULD
WHICH STATED PATIENT CARE SHOULD BE GAUGED.
BE GAUGED. THAT WORKED WELL FOR THE
THAT WORKED WELL FOR THE POPULATION IN THE 1990s.
POPULATION IN THE 1990s. BUT ARE THOSE SCORECARDS STILL
BUT ARE THOSE SCORECARDS STILL VALID FOR A POPULATION WHICH A
VALID FOR A POPULATION WHICH A NURSING HOME IS CARING FOR WHICH
NURSING HOME IS CARING FOR WHICH COULD BE A POPULATION WE
COULD BE A POPULATION WE CONSIDER AS ACUTE CARE
CONSIDER AS ACUTE CARE POPULATION FROM 10 TO 15 YEARS
POPULATION FROM 10 TO 15 YEARS AGO?
AGO? I THINK ALL OF OUR ASSESSMENT
I THINK ALL OF OUR ASSESSMENT BASED JUST ON SCORING CARD
BASED JUST ON SCORING CARD SYSTEMS AT THAT TIME WOULD NOT
SYSTEMS AT THAT TIME WOULD NOT BE THE RIGHT THING TO DO BUT, OF
BE THE RIGHT THING TO DO BUT, OF COURSE, SCORECARDS DO HAVE A
COURSE, SCORECARDS DO HAVE A ROLE TO PLAY TO SOME EXTENT.
ROLE TO PLAY TO SOME EXTENT. I AGREE THAT INDIANA HAS SOME
I AGREE THAT INDIANA HAS SOME ROOM FOR IMPROVEMENT WHEN YOU
ROOM FOR IMPROVEMENT WHEN YOU LOOK AT THE SCORECARD MEASURES
LOOK AT THE SCORECARD MEASURES OVERALL.
OVERALL. >> I WOULD AGREE WITH YOU,
>> I WOULD AGREE WITH YOU, DOCTOR.
DOCTOR. AGAIN, IT IS SLANTED BY THE
AGAIN, IT IS SLANTED BY THE ACUITY OF MANY OF THE TARGETS
ACUITY OF MANY OF THE TARGETS THAT ARE LOOKED AT IN THAT DATA.
THAT ARE LOOKED AT IN THAT DATA. WHEN THE ACUITY IS INCREDIBLY
WHEN THE ACUITY IS INCREDIBLY HIGH, IT DOES SKEW THAT DATA TO
HIGH, IT DOES SKEW THAT DATA TO NOT BE NECESSARILY WHAT IT TRULY
NOT BE NECESSARILY WHAT IT TRULY IS.
IS. >> REALLY THE IF HE HAD RUL
>> REALLY THE IF HE HAD RUL GOVERNMENT IS TRYING TO WORK ON
GOVERNMENT IS TRYING TO WORK ON THAT BECAUSE THE NEW SCORECARDS,
THAT BECAUSE THE NEW SCORECARDS, WHICH AS 5 STAR RATING, WHICH
WHICH AS 5 STAR RATING, WHICH EVERY NURSING HOME IN THIS
EVERY NURSING HOME IN THIS COUNTRY IS RATED, WHICH IS A
COUNTRY IS RATED, WHICH IS A PART OF THE MEDICARE PROGRAM, IS
PART OF THE MEDICARE PROGRAM, IS RATED ON THE NURSING HOME
RATED ON THE NURSING HOME COMPARE WEB SITE AND YOU CAN
COMPARE WEB SITE AND YOU CAN GOOGLE IT AND FIND IT ON THE TOP
GOOGLE IT AND FIND IT ON THE TOP AND NURSING HOME CARE AND PUT
AND NURSING HOME CARE AND PUT YOUR ZIP CODE.
YOUR ZIP CODE. SO THERE ARE -- THE FEDERAL
SO THERE ARE -- THE FEDERAL GOVERNMENT IS CHANGING THE
GOVERNMENT IS CHANGING THE SCORECARD TO MAKE IT MORE
SCORECARD TO MAKE IT MORE CONDUCIVE TO THE FACT THAT A LOT
CONDUCIVE TO THE FACT THAT A LOT OF NURSING HOME PATIENTS ARE A
OF NURSING HOME PATIENTS ARE A DIFFERENT POPULATION THAN THEY
DIFFERENT POPULATION THAN THEY USED TO BE 20 YEARS AGO.
USED TO BE 20 YEARS AGO. SO HAS BEEN SOME ADJUSTMENT.
SO HAS BEEN SOME ADJUSTMENT. >> IT'S RARE WE PLACE A PATIENT
>> IT'S RARE WE PLACE A PATIENT THESE DAYS WITH THE IDEA OF THEM
THESE DAYS WITH THE IDEA OF THEM GOING THERE TO LIVE.
GOING THERE TO LIVE. >> CORRECT.
>> CORRECT. >> IT HAPPENS MAYBE ONE OUT OF
>> IT HAPPENS MAYBE ONE OUT OF 15 PATIENTS THAT I HAPPEN TO
15 PATIENTS THAT I HAPPEN TO PLACE.
PLACE. SO THE MINDSET OF SOMEONE -- FOR
SO THE MINDSET OF SOMEONE -- FOR SOME OF THE FAMILIES, WHEN THEY
SOME OF THE FAMILIES, WHEN THEY ARE LOOKING AT THE CARE THAT
ARE LOOKING AT THE CARE THAT THEIR LOVED ONE IS RECEIVING, IT
THEIR LOVED ONE IS RECEIVING, IT MAY NOT BE AT THE SAME POINT
MAY NOT BE AT THE SAME POINT WHEN THEY'RE DOING THEIR
WHEN THEY'RE DOING THEIR SURVEYS.
SURVEYS. >> EXACTLY.
>> EXACTLY. I WILL JUST EXTEND THAT VERY
I WILL JUST EXTEND THAT VERY GOOD ARGUMENT.
GOOD ARGUMENT. WHEN WE TALK TO FAMILIES ABOUT
WHEN WE TALK TO FAMILIES ABOUT CHOOSING A NURSING HOME 30 YEARS
CHOOSING A NURSING HOME 30 YEARS AGO, IT USED TO BE YOU'RE
AGO, IT USED TO BE YOU'RE SELECTING A HOME BASICALLY.
SELECTING A HOME BASICALLY. THINGS LIKE CLOSENESS TO
THINGS LIKE CLOSENESS TO RELATIVE'S HOMES, HOW FAWF IS
RELATIVE'S HOMES, HOW FAWF IS THE PASTOR, HOW FAR IS YOUR
THE PASTOR, HOW FAR IS YOUR FAVORITE HAIRDRESSER.
FAVORITE HAIRDRESSER. NOW PATIENTS ENTER THE NURSING
NOW PATIENTS ENTER THE NURSING HOME THROUGH A DIFFERENT ROUTE.
HOME THROUGH A DIFFERENT ROUTE. THEY'RE COMING FOR A SHORTENED
THEY'RE COMING FOR A SHORTENED REHAB PURPOSE AND IT'S IMPORTANT
REHAB PURPOSE AND IT'S IMPORTANT FOR US TO INFORM THEM THAT THE
FOR US TO INFORM THEM THAT THE PURPOSE OF WHAT -- WHAT THEIR
PURPOSE OF WHAT -- WHAT THEIR PURPOSE OF A NURSING HOME STAY
PURPOSE OF A NURSING HOME STAY IS.
IS. IF IT'S GOING TO BE FOR
IF IT'S GOING TO BE FOR LONG-TERM PURPOSES, THEN THOSE
LONG-TERM PURPOSES, THEN THOSE FACTORS ARE IMPORTANT BUT IF
FACTORS ARE IMPORTANT BUT IF IT'S NOR SHORT-TERM PURPOSES,
IT'S NOR SHORT-TERM PURPOSES, THEY NEED TO DO THEIR HOMEWORK
THEY NEED TO DO THEIR HOMEWORK AND FIND OUT WHICH FACILITY WILL
AND FIND OUT WHICH FACILITY WILL BE ABLE TO PROVIDE THE REAL
BE ABLE TO PROVIDE THE REAL ACUTE CARE.
ACUTE CARE. THE NEED WOULD BE HEART FAILURE
THE NEED WOULD BE HEART FAILURE CARE, IT COULD BE WOUND CARE.
CARE, IT COULD BE WOUND CARE. I THINK WE HAVE OUR JOBS CUT OUT
I THINK WE HAVE OUR JOBS CUT OUT FOR US TO EDUCATE RESIDENTS AND
FOR US TO EDUCATE RESIDENTS AND FAMILIES THAT NURSING HOMES ARE
FAMILIES THAT NURSING HOMES ARE CHANGING AND PROVIDE DIFFERENT
CHANGING AND PROVIDE DIFFERENT SERVICES THAN BEFORE.
SERVICES THAN BEFORE. >> I WANT TO TOUCH ON SOMETHING
>> I WANT TO TOUCH ON SOMETHING ONE EVERY YOUR COLLEAGUES SAID
ONE EVERY YOUR COLLEAGUES SAID IN THE STORY AT THE BEGINNING OF
IN THE STORY AT THE BEGINNING OF THE SHOW WHERE SHE SAID WE HAVE
THE SHOW WHERE SHE SAID WE HAVE A LOT OF PEOPLE WHO ARE IN
A LOT OF PEOPLE WHO ARE IN NURSING HOMES WHO WOULDN'T HAVE
NURSING HOMES WHO WOULDN'T HAVE TO BE IF THEY COULD GET SERVICES
TO BE IF THEY COULD GET SERVICES AT HOME.
AT HOME. THE FIGURE I SAW WAS SOMETHING
THE FIGURE I SAW WAS SOMETHING LIKE 4,000 OR 4200 PEOPLE,
LIKE 4,000 OR 4200 PEOPLE, PERHAPS.
PERHAPS. IS THERE A SHORTAGE OF THAT KIND
IS THERE A SHORTAGE OF THAT KIND OF CARE IN INDIANA?
OF CARE IN INDIANA? ARE WE SEEING PEOPLE -- ARE YOU
ARE WE SEEING PEOPLE -- ARE YOU SENDING PEOPLE TO NURSING HOMES
SENDING PEOPLE TO NURSING HOMES PERHAPS RECOMMENDING THAT?
PERHAPS RECOMMENDING THAT? >> I AM DOING THAT, BECAUSE OF
>> I AM DOING THAT, BECAUSE OF THE FACT THAT I CANNOT GET
THE FACT THAT I CANNOT GET SERVICES FOR THEM THAT'S
SERVICES FOR THEM THAT'S AFFORDABLE.
AFFORDABLE. MANY PEOPLE DO NOT PLAN FOR THE
MANY PEOPLE DO NOT PLAN FOR THE FUTURE.
FUTURE. THEY CANNOT AFFORD TO PAY FOR
THEY CANNOT AFFORD TO PAY FOR 24-HOUR CARE IN THE HOME.
24-HOUR CARE IN THE HOME. NOR CAN THEIR FAMILY.
NOR CAN THEIR FAMILY. TO ASK FOR ANY ASSISTANCE
TO ASK FOR ANY ASSISTANCE THROUGH THE AREA AGENCIES IS
THROUGH THE AREA AGENCIES IS GOING TO TAKE ANYWHERE FROM SIX
GOING TO TAKE ANYWHERE FROM SIX MONTHS TO TWO TO THREE YEARS,
MONTHS TO TWO TO THREE YEARS, DEPENDING ON WHICH PROGRAM
DEPENDING ON WHICH PROGRAM THEY'RE LOOKING FOR.
THEY'RE LOOKING FOR. MANY PEOPLE ARE GOING TO FAIL
MANY PEOPLE ARE GOING TO FAIL BEFORE THAT'S AVAILABLE.
BEFORE THAT'S AVAILABLE. SO IF WE ARE -- IF WE'RE
SO IF WE ARE -- IF WE'RE VALUATING THEM, WE DETERMINE
VALUATING THEM, WE DETERMINE THAT THERE IS NOT GOING TO BE A
THAT THERE IS NOT GOING TO BE A RESOURCE FOR THEM AT HOME AND
RESOURCE FOR THEM AT HOME AND THE SAFEST PLACE FOR THEM FOR
THE SAFEST PLACE FOR THEM FOR THAT PERIOD OF TIME WOULD BE IN
THAT PERIOD OF TIME WOULD BE IN THE NURSING HOME, AND THAT'S
THE NURSING HOME, AND THAT'S WHAT WE'RE GOING TO RECOMMEND.
WHAT WE'RE GOING TO RECOMMEND. >> AND THE IMPORTANT THING TO
>> AND THE IMPORTANT THING TO SEE HERE IS THAT, I KNOW WE'RE
SEE HERE IS THAT, I KNOW WE'RE DOING THIS, BUT IF YOU REALLY
DOING THIS, BUT IF YOU REALLY COMPARE THE COST FOR A NURSING
COMPARE THE COST FOR A NURSING HOME STAY FOR A MONTH, YOU CAN
HOME STAY FOR A MONTH, YOU CAN BE SPENDING UP TO SIX OR $7,000
BE SPENDING UP TO SIX OR $7,000 A MONTH BUT IF YOU CAN PROVIDE
A MONTH BUT IF YOU CAN PROVIDE RESOURCES FOR THE RESIDENTS TO
RESOURCES FOR THE RESIDENTS TO STAY AT HOME WITH SOME PAID
STAY AT HOME WITH SOME PAID SERVICES AVAILABLE TO THEM, IT
SERVICES AVAILABLE TO THEM, IT WOULD BE A LOT LESS THAN THAT.
WOULD BE A LOT LESS THAN THAT. ACTUALLY, A LOT OF STATES HAVE
ACTUALLY, A LOT OF STATES HAVE TRIED THOSE PROGRAMS, AND WE
TRIED THOSE PROGRAMS, AND WE HAVE SOME PROGRAMS WHICH WE HAVE
HAVE SOME PROGRAMS WHICH WE HAVE A BIG WAIT TIME, BUT I WOULD
A BIG WAIT TIME, BUT I WOULD DEFINITELY LIKE TO MENTION A
DEFINITELY LIKE TO MENTION A PROGRAM CALLED THE PACE PROGRAM
PROGRAM CALLED THE PACE PROGRAM WHICH A LOT OF STATES HAVE
WHICH A LOT OF STATES HAVE INSTITUTED THAT -- WITH EXTRA
INSTITUTED THAT -- WITH EXTRA HELP THEY ARE ABLE TO KEEP THEIR
HELP THEY ARE ABLE TO KEEP THEIR PATIENTS IN HOMES, NOT IN
PATIENTS IN HOMES, NOT IN NURSING HOMES.
NURSING HOMES. I THINK THERE IS SOME -- A LOT
I THINK THERE IS SOME -- A LOT OF RESIDENT COULD BENEFIT FROM
OF RESIDENT COULD BENEFIT FROM BE INNING IN THE COMMUNITY.
BE INNING IN THE COMMUNITY. >> ABSOLUTELY.
>> ABSOLUTELY. WE ALL AGREE.
WE ALL AGREE. I THINK WHEN YOU LOOK AT THE
I THINK WHEN YOU LOOK AT THE NURSING HOME AND LOOK AT THE
NURSING HOME AND LOOK AT THE COST OF HOME CARE AND YOU LOOK
COST OF HOME CARE AND YOU LOOK AT THE NURSING HOME, IF YOU'RE
AT THE NURSING HOME, IF YOU'RE AT NURSING HOME AND SAY YOUR
AT NURSING HOME AND SAY YOUR COST FOR A MONTH IS $6,000,
COST FOR A MONTH IS $6,000, YOU'RE LOOKING AT LESS THAN $10
YOU'RE LOOKING AT LESS THAN $10 AN HOUR.
AN HOUR. AND TO ACQUIRE THAT KIND OF CARE
AND TO ACQUIRE THAT KIND OF CARE SERVICES, FINANCIAL SUPPORT
SERVICES, FINANCIAL SUPPORT OUTSIDE OF THE NURSING HOME, IF
OUTSIDE OF THE NURSING HOME, IF YOU HAVE A FAMILY MEMBER WHO YOU
YOU HAVE A FAMILY MEMBER WHO YOU ARE LIVING WITH OR LIVING IN AN
ARE LIVING WITH OR LIVING IN AN ENVIRONMENT WHERE YOU HAVE
ENVIRONMENT WHERE YOU HAVE PEOPLE TO TAKE CARE OF BASIC
PEOPLE TO TAKE CARE OF BASIC THINGS, THOSE OTHER SERVICES
THINGS, THOSE OTHER SERVICES CERTAINLY COULD SUPPORT THEM.
CERTAINLY COULD SUPPORT THEM. ONE OF THE PROBLEMS IS THAT THEY
ONE OF THE PROBLEMS IS THAT THEY DON'T HAVE THAT AND THERE IS
DON'T HAVE THAT AND THERE IS A -- IF THERE IS A FIRE IF THE
A -- IF THERE IS A FIRE IF THE HOME AND THEY'RE NOT ABLE TO GET
HOME AND THEY'RE NOT ABLE TO GET OUT OR IF THEY'RE DECLINING,
OUT OR IF THEY'RE DECLINING, THEN THOSE ARE THE PEOPLE THAT
THEN THOSE ARE THE PEOPLE THAT BECOME --
BECOME -- >> ABSOLUTELY.
>> ABSOLUTELY. THERE'S A GROUP OF PEOPLE WHO
THERE'S A GROUP OF PEOPLE WHO WOULD PROBABLY -- WITH COG ANIF
WOULD PROBABLY -- WITH COG ANIF IMPAIRMENT OR WOULD NOT SURVIVE
IMPAIRMENT OR WOULD NOT SURVIVE OR DO WELL OUTSIDE THE
OR DO WELL OUTSIDE THE ENVIRONMENT.
ENVIRONMENT. BUT THERE IS A GROUP OF PEOPLE
BUT THERE IS A GROUP OF PEOPLE WHO WOULD BENEFIT IN TERMS OF
WHO WOULD BENEFIT IN TERMS OF BIG ONE IS LIFE QUALITY.
BIG ONE IS LIFE QUALITY. OF COURSE, NO MATTER WHAT KIND
OF COURSE, NO MATTER WHAT KIND OF A NURSING HOME ENVIRONMENT
OF A NURSING HOME ENVIRONMENT YOU CAN CREATE FOR OUR OLDER
YOU CAN CREATE FOR OUR OLDER SENIORS, THEY WOULD STILL RATHER
SENIORS, THEY WOULD STILL RATHER BE AT HOME, AND WHY NOT?
BE AT HOME, AND WHY NOT? SO LIFE QUALITY ISSUE WOULD ALSO
SO LIFE QUALITY ISSUE WOULD ALSO BE SERVED WELL IF YOU CAN
BE SERVED WELL IF YOU CAN CLOSELY LOOK AT THIS ISSUE.
CLOSELY LOOK AT THIS ISSUE. >> LET'S TALK ABOUT THE COST,
>> LET'S TALK ABOUT THE COST, THOUGH.
THOUGH. HOW MUCH THIS IS COSTING SOCIETY
HOW MUCH THIS IS COSTING SOCIETY IN GENERAL.
IN GENERAL. CORRECT ME IF I'M WRONG, BUT THE
CORRECT ME IF I'M WRONG, BUT THE FIGURE I'VE SEEN IS LIKE 80% OF
FIGURE I'VE SEEN IS LIKE 80% OF ALL MEDICAID DOLLARS ARE SPENT
ALL MEDICAID DOLLARS ARE SPENT IN NURSING HOMES.
IN NURSING HOMES. SO WHAT SHOULD INDIVIDUALS BE
SO WHAT SHOULD INDIVIDUALS BE DOING DIFFERENTLY TO PREPARE FOR
DOING DIFFERENTLY TO PREPARE FOR THE COST?
THE COST? MAYBE THEY CAN'T AFFORD THIS
MAYBE THEY CAN'T AFFORD THIS IN-HOME CARE.
IN-HOME CARE. >> WE WERE CHATTING ABOUT THAT
>> WE WERE CHATTING ABOUT THAT BEFORE WE STARTED THIS.
BEFORE WE STARTED THIS. PEOPLE IN OUR SOCIETY WANT TO
PEOPLE IN OUR SOCIETY WANT TO VERY MUCH LEAVE RESOURCES TO
VERY MUCH LEAVE RESOURCES TO THEIR FAMILIES.
THEIR FAMILIES. WE HAVE TO TAKE A DIFFERENT
WE HAVE TO TAKE A DIFFERENT MINDSET AT SOME POINT IN TIME
MINDSET AT SOME POINT IN TIME THAT, RESOURCES WE HAVE ATTAINED
THAT, RESOURCES WE HAVE ATTAINED NEED TO BE UTILIZE TO DO KEEP US
NEED TO BE UTILIZE TO DO KEEP US IN AN ENVIRONMENT AND TAKE CARE
IN AN ENVIRONMENT AND TAKE CARE OF US THE WAY WE WANT TO BE
OF US THE WAY WE WANT TO BE TAKEN CARE OF, NOT TO PUT THAT
TAKEN CARE OF, NOT TO PUT THAT BURDEN BACK ON THE GOVERNMENT TO
BURDEN BACK ON THE GOVERNMENT TO DO THAT.
DO THAT. WE HAVE TO TAKE THAT
WE HAVE TO TAKE THAT RESPONSIBILITY BACK.
RESPONSIBILITY BACK. WE'RE A DIFFERENT SOCIETY.
WE'RE A DIFFERENT SOCIETY. 50 YEARS AGO, GRANDMA AND
50 YEARS AGO, GRANDMA AND GRANDPA CAME TO LIVE WITH YOU,
GRANDPA CAME TO LIVE WITH YOU, THEY STAYED WITH YOU AND ONLY AT
THEY STAYED WITH YOU AND ONLY AT THE VERY END WHEN YOU COULD NOT
THE VERY END WHEN YOU COULD NOT PROVIDE THE CARE THEY NEEDED
PROVIDE THE CARE THEY NEEDED WERE THEY PLACED INTO A
WERE THEY PLACED INTO A LONG-TERM CARE FACILITY.
LONG-TERM CARE FACILITY. BUT SOCIETY HAS CHANGED.
BUT SOCIETY HAS CHANGED. FAMILIES WORK.
FAMILIES WORK. THEY HAVE CHILDREN.
THEY HAVE CHILDREN. THEY'RE INVOLVED.
THEY'RE INVOLVED. IT'S A TOTALLY DIFFERENT THING.
IT'S A TOTALLY DIFFERENT THING. PEOPLE ARE NOT AS RECEPTIVE OR
PEOPLE ARE NOT AS RECEPTIVE OR ABLE TO.
ABLE TO. >> THE OTHER PART OF THAT IS
>> THE OTHER PART OF THAT IS THERE ARE FEWER FAMILIES THAT
THERE ARE FEWER FAMILIES THAT ARE STAYING IN THE SAME AREA.
ARE STAYING IN THE SAME AREA. MOST OF THE CHILDREN HAVE MOVED
MOST OF THE CHILDREN HAVE MOVED TO ANOTHER AREA OF THE COUNTRY.
TO ANOTHER AREA OF THE COUNTRY. EACH IF THEY'RE IN THE SAME
EACH IF THEY'RE IN THE SAME STATE, THEY MAY BE TWO HOURS
STATE, THEY MAY BE TWO HOURS AWAY.
AWAY. SO BEING ABLE TO PROVIDE THAT
SO BEING ABLE TO PROVIDE THAT DAY-TO-DAY-CARE IS NOT
DAY-TO-DAY-CARE IS NOT AVAILABLE.
AVAILABLE. >> I WOULD LIKE TO ADD THAT, IT
>> I WOULD LIKE TO ADD THAT, IT IS A MINDSET CULTURE WHICH NEEDS
IS A MINDSET CULTURE WHICH NEEDS TO BE CHANGED.
TO BE CHANGED. WE NEED AS A SOCIETY NEED TO
WE NEED AS A SOCIETY NEED TO TAKE A MORE BREAUX ACTIVE ROLE.
TAKE A MORE BREAUX ACTIVE ROLE. IT IS SUCH AN IMPORTANT PART OF
IT IS SUCH AN IMPORTANT PART OF OUR FUTURE PLANNING WHICH HAS TO
OUR FUTURE PLANNING WHICH HAS TO BE DONE.
BE DONE. LIKE ADVANCED CARE PLANNING.
LIKE ADVANCED CARE PLANNING. DISEASE MANAGEMENT.
DISEASE MANAGEMENT. I THINK THERE'S A LOT MORE ROOM
I THINK THERE'S A LOT MORE ROOM FOR EDUCATION AND THIS IS A ROLE
FOR EDUCATION AND THIS IS A ROLE WHICH PRIMARY CARE PHYSICIANS
WHICH PRIMARY CARE PHYSICIANS CAN PLAY IN THE CLINICS FOR YOUR
CAN PLAY IN THE CLINICS FOR YOUR PATIENTS WHEN THEY'RE YOUNGER
PATIENTS WHEN THEY'RE YOUNGER FOR PREVENTATIVE MEASURES.
FOR PREVENTATIVE MEASURES. OTHER THAN THE MINDSET, THERE'S
OTHER THAN THE MINDSET, THERE'S OTHER THINGS PEOPLE CAN DO,
OTHER THINGS PEOPLE CAN DO, WHICH I'M SEEING NOW THE
WHICH I'M SEEING NOW THE BABY-BOOMERS ARE PAYING MORE
BABY-BOOMERS ARE PAYING MORE ATTENTION TO IS HAVING SOMETHING
ATTENTION TO IS HAVING SOMETHING LIKE LONG-TERM CARE INSURANCE SO
LIKE LONG-TERM CARE INSURANCE SO INVESTING INTO WHEN YOU'RE
INVESTING INTO WHEN YOU'RE HEALTHY.
HEALTHY. ONCE YOU HAVE AN ACUTE CRISIS
ONCE YOU HAVE AN ACUTE CRISIS IT'S GOING TO BE HARD.
IT'S GOING TO BE HARD. >> YOU'VE -- YOU'RE NOT GOING TO
>> YOU'VE -- YOU'RE NOT GOING TO BE ABLE TO GET ANY LONG-TERM
BE ABLE TO GET ANY LONG-TERM CARE.
CARE. >> I'M JUST SEEING IT'S BEEN A
>> I'M JUST SEEING IT'S BEEN A RISE IN NUMBER OF PEOPLES USING
RISE IN NUMBER OF PEOPLES USING PRIVATE INSURANCE FOR LONG-TERM
PRIVATE INSURANCE FOR LONG-TERM CARE.
CARE. I THINK THE NUMBER IS ALMOST 5%
I THINK THE NUMBER IS ALMOST 5% NOW AS OPPOSED TO LIKE 3% A
NOW AS OPPOSED TO LIKE 3% A COUPLE DECADES AGO.
COUPLE DECADES AGO. I THINK WE HAVE TO EDUCATE OUR
I THINK WE HAVE TO EDUCATE OUR PATIENTS WHEN THEY'RE YOUNGER,
PATIENTS WHEN THEY'RE YOUNGER, WHEN THEY'RE HEALTHIER, TO THINK
WHEN THEY'RE HEALTHIER, TO THINK ABOUT IN VER INVESTING.
ABOUT IN VER INVESTING. WHEN YOU'RE YOUNGER, THINGS ARE
WHEN YOU'RE YOUNGER, THINGS ARE GOING WELL, ONE DOES NOT THINK
GOING WELL, ONE DOES NOT THINK ABOUT THESE ISSUES.
ABOUT THESE ISSUES. I THINK IT DEPENDS UPON THE
I THINK IT DEPENDS UPON THE HEALTH EDUCATORS AND PHYSICIANS
HEALTH EDUCATORS AND PHYSICIANS AND PRIMARY CARE DOCTORS TO
AND PRIMARY CARE DOCTORS TO BRING THESE COMPLEX DISCUSSIONS
BRING THESE COMPLEX DISCUSSIONS INTO THE EXAM ROOM.
INTO THE EXAM ROOM. >> INDIANA RANKS POORLY IN TERMS
>> INDIANA RANKS POORLY IN TERMS OF THE NUMBER OF PEOPLE WHO HAVE
OF THE NUMBER OF PEOPLE WHO HAVE LONG-TERM CARE INSURANCE.
LONG-TERM CARE INSURANCE. IS IT A LACK OF EDUCATION OR
IS IT A LACK OF EDUCATION OR JUST COST PROHIBITIVE?
JUST COST PROHIBITIVE? >> FOR MANY YEARS IT WASN'T
>> FOR MANY YEARS IT WASN'T PROMOTED.
PROMOTED. AND --
AND -- >> IT WAS OFF THE RADAR.
>> IT WAS OFF THE RADAR. >> IT WASN'T TALKED ABOUT.
>> IT WASN'T TALKED ABOUT. >> MORE ON THE EAST COAST.
>> MORE ON THE EAST COAST. IN THE MIDWEST IT WAS NOT.
IN THE MIDWEST IT WAS NOT. I CAN REMEMBER GOING TO
I CAN REMEMBER GOING TO SYMPOSIUMS 30 YEARS AGO AND IT T
SYMPOSIUMS 30 YEARS AGO AND IT T WASN'T IN THIS MARKET.
WASN'T IN THIS MARKET. IT'S NOT BEEN ON THE RADAR.
IT'S NOT BEEN ON THE RADAR. I THINK THAT'S VERY CLEAR.
I THINK THAT'S VERY CLEAR. ANOTHER POINT I THINK, AT LEAST
ANOTHER POINT I THINK, AT LEAST I WOULD LIKE TO BRING FORWARD
I WOULD LIKE TO BRING FORWARD FORD DISCUSSION, IS I THINK THAT
FORD DISCUSSION, IS I THINK THAT OFTEN OUR SENIORS, IF THEY WORK
OFTEN OUR SENIORS, IF THEY WORK WITH THEIR PHYSICIANS AND THEY
WITH THEIR PHYSICIANS AND THEY UNDERSTAND WHAT THEIR
UNDERSTAND WHAT THEIR CIRCUMSTANCES ARE, WILL WANT TO
CIRCUMSTANCES ARE, WILL WANT TO CHOOSE WHAT THEY WANT IN TERMS
CHOOSE WHAT THEY WANT IN TERMS OF EXTENDED CARE.
OF EXTENDED CARE. THE FAMILIES ARE NOT ALWAYS
THE FAMILIES ARE NOT ALWAYS COOPERATIVE WITH -- THE CHILDREN
COOPERATIVE WITH -- THE CHILDREN WILL WANT YOU TO PURSUE THINGS
WILL WANT YOU TO PURSUE THINGS THAT PERHAPS THE PARENTS DID NOT
THAT PERHAPS THE PARENTS DID NOT WANT.
WANT. I THINK CLARIFYING THAT AND MORE
I THINK CLARIFYING THAT AND MORE OF AN ACTIVE ROLE WITH THE
OF AN ACTIVE ROLE WITH THE ATTENDING PHYSICIANS IS
ATTENDING PHYSICIANS IS CRITICAL.
CRITICAL. >> ABSOLUTELY.
>> ABSOLUTELY. >> YOU WANT TO DO WHAT THE
>> YOU WANT TO DO WHAT THE SENIOR WANTS.
SENIOR WANTS. >> IT JUST FALLS UNDER THE BIG
>> IT JUST FALLS UNDER THE BIG UMBRELLA OF GOALS OF CARE
UMBRELLA OF GOALS OF CARE PLANNING.
PLANNING. I MEAN, AS PHYSICIANS AND THE
I MEAN, AS PHYSICIANS AND THE MEDICAL COMMUNITY, WE CAN DO A
MEDICAL COMMUNITY, WE CAN DO A LOT FOR OUR PATIENTS.
LOT FOR OUR PATIENTS. THERE ARE MANY OPTIONS WE CAN
THERE ARE MANY OPTIONS WE CAN PURSUE BUT IS IT WHAT THE SENIOR
PURSUE BUT IS IT WHAT THE SENIOR WANTS?
WANTS? AND REALLY GETTING THE BIG
AND REALLY GETTING THE BIG EXTENDED FAMILY ON THE SAME PAGE
EXTENDED FAMILY ON THE SAME PAGE SO WHEN THINGS GO HAYWIRE OR THE
SO WHEN THINGS GO HAYWIRE OR THE CRISIS COMES EVERYBODY KNOWS
CRISIS COMES EVERYBODY KNOWS WHAT MOM WANTED AND CAN RESPECT
WHAT MOM WANTED AND CAN RESPECT THAT.
THAT. I AGREE, THIS FALLS UNDER
I AGREE, THIS FALLS UNDER ADVANCED CARE PLANNING.
ADVANCED CARE PLANNING. DO YOU WANT TO BE RESUSCITATED?
DO YOU WANT TO BE RESUSCITATED? DO YOU WANT TO BE ON 50
DO YOU WANT TO BE ON 50 MEDICATIONS?
MEDICATIONS? OR DO YOU WANT TO BE ON TUBE
OR DO YOU WANT TO BE ON TUBE FEEDINGS?
FEEDINGS? AND WHERE DO YOU WANT TO LIVE
AND WHERE DO YOU WANT TO LIVE WHEN YOU'RE OLDER AND YOU --
WHEN YOU'RE OLDER AND YOU -- CONCEPTUALLY FALLS IN THE REALM
CONCEPTUALLY FALLS IN THE REALM OF THE SAME DISCUSSION.
OF THE SAME DISCUSSION. >> SHARON, WHEN YOU ARE HAVING
>> SHARON, WHEN YOU ARE HAVING CONVERSATION WITH FAMILIES OF
CONVERSATION WITH FAMILIES OF LOVED ONES, HOW MUCH DOES COST
LOVED ONES, HOW MUCH DOES COST FIGURE INTO THOSE DISCUSSIONS?
FIGURE INTO THOSE DISCUSSIONS? >> IT IS A HUGE FACTOR.
>> IT IS A HUGE FACTOR. WHEN YOU APPROACH A FAMILY AND D
WHEN YOU APPROACH A FAMILY AND D TALK TO THEM ABOUT WHAT THEIR
TALK TO THEM ABOUT WHAT THEIR LOVED ONE IS GOING TO NEED, WHAT
LOVED ONE IS GOING TO NEED, WHAT MIGHT BE PAID FOR BY MEDICARE,
MIGHT BE PAID FOR BY MEDICARE, IF THEY HAVE MEDICARE, WHAT
IF THEY HAVE MEDICARE, WHAT MIGHT NOT BE, WHAT MIGHT BE
MIGHT NOT BE, WHAT MIGHT BE THEIR OUT OF POCKET COST, WHEN
THEIR OUT OF POCKET COST, WHEN THEY START HEARING THOSE
THEY START HEARING THOSE FIGURES, YOU JUST SEE THEM
FIGURES, YOU JUST SEE THEM COMPLETELY SHUT DOWN.
COMPLETELY SHUT DOWN. OR THEY LOOK AT YOU AND SAY,
OR THEY LOOK AT YOU AND SAY, THERE'S NO WAY.
THERE'S NO WAY. WE CAN'T DO THIS.
WE CAN'T DO THIS. >> EVERYBODY HAS COME TO THE --
>> EVERYBODY HAS COME TO THE -- PEOPLE DO GET SHOCKED BECAUSE
PEOPLE DO GET SHOCKED BECAUSE THEY REALIZE WE LIVE -- WE LIVE
THEY REALIZE WE LIVE -- WE LIVE IN THE UNITED STATES OF AMERICA.
IN THE UNITED STATES OF AMERICA. WE PROBABLY WILL BE ENTITLED TO
WE PROBABLY WILL BE ENTITLED TO ALL THE HEALTHCARE EVENTUALLY
ALL THE HEALTHCARE EVENTUALLY BUT THEY'RE NOT AWARE THAT THERE
BUT THEY'RE NOT AWARE THAT THERE ARE CERTAIN AREAS OF HEALTHCARE
ARE CERTAIN AREAS OF HEALTHCARE WHERE THEY HAVE TO CONTRIBUTE
WHERE THEY HAVE TO CONTRIBUTE AND THIS IS ONE BIG AREA.
AND THIS IS ONE BIG AREA. I WOULD JUST LIKE -- ONE OTHER
I WOULD JUST LIKE -- ONE OTHER THOUGHT ON THAT, TALKING ABOUT
THOUGHT ON THAT, TALKING ABOUT INSURANCE COVERAGE, I DON'T KNOW
INSURANCE COVERAGE, I DON'T KNOW IF YOU HAVE SEEN THAT, WHAT I'M
IF YOU HAVE SEEN THAT, WHAT I'M SEEING AS A PHYSICIAN WORKING IN
SEEING AS A PHYSICIAN WORKING IN SKILLED NURSING FACILITIES, A
SKILLED NURSING FACILITIES, A LOT OF PATIENTS ARE COMING IN
LOT OF PATIENTS ARE COMING IN WHO HAVE GOTTEN THEMSELVES INTO
WHO HAVE GOTTEN THEMSELVES INTO AN ADVANTAGE TYPE OF COVERAGE,
AN ADVANTAGE TYPE OF COVERAGE, GIVEN AWARE THEIR MEDICARE AND
GIVEN AWARE THEIR MEDICARE AND HAVE TAKEN ADVANTAGE COVERAGE
HAVE TAKEN ADVANTAGE COVERAGE WHICH MAKES THEM PAY HUNDREDS OF
WHICH MAKES THEM PAY HUNDREDS OF DOLLARS A DAY COPAY SO THAT
DOLLARS A DAY COPAY SO THAT THEIR SKILLED NURSING CARE
THEIR SKILLED NURSING CARE BECOMES EXPENSIVE.
BECOMES EXPENSIVE. I HAVE SEEN THAT ISSUE EMERGE
I HAVE SEEN THAT ISSUE EMERGE MORE AND MORE.
MORE AND MORE. HAVE YOU SEEN THAT?
HAVE YOU SEEN THAT? >> I ACTUALLY HAVE JUST GOTTEN
>> I ACTUALLY HAVE JUST GOTTEN THROUGH A SITUATION WITH A
THROUGH A SITUATION WITH A PATIENT WHERE WE WOUND UP
PATIENT WHERE WE WOUND UP KEEPING HER IN THE HOSPITAL FOR
KEEPING HER IN THE HOSPITAL FOR ALMOST TWO WEEKS TRYING TO WORK
ALMOST TWO WEEKS TRYING TO WORK THIS OUT BECAUSE NOT ONLY IS IT
THIS OUT BECAUSE NOT ONLY IS IT THAT THEY HAVE TO PAY LARGE
THAT THEY HAVE TO PAY LARGE AMOUNTS OF MONEY OUT OF POCKET,
AMOUNTS OF MONEY OUT OF POCKET, BUT THEY -- THE PRECERTIFICATION
BUT THEY -- THE PRECERTIFICATION PROCESS IS VERY, VERY CLOUDY.
PROCESS IS VERY, VERY CLOUDY. SOME INSURANCES REQUIRE A
SOME INSURANCES REQUIRE A PRECERTIFICATION THAT MAY TAKE
PRECERTIFICATION THAT MAY TAKE FRAIZ HOURS BEFORE YOU GET AN
FRAIZ HOURS BEFORE YOU GET AN ANSWER.
ANSWER. OTHERS WILL SAY THERE'S NO
OTHERS WILL SAY THERE'S NO PRECERTIFICATION.
PRECERTIFICATION. IT'S ALL OVER THE MAP WITH THAT.
IT'S ALL OVER THE MAP WITH THAT. >> THE REASON I BRING IT UP IS
>> THE REASON I BRING IT UP IS THAT IT'S LIKE, IF YOU WANT TO
THAT IT'S LIKE, IF YOU WANT TO CHOOSE AN INSURANCE WHICH IS
CHOOSE AN INSURANCE WHICH IS GOING TO WORK FOR YOU BUT YOU
GOING TO WORK FOR YOU BUT YOU WANT TO MAKE SURE THAT IT'S
WANT TO MAKE SURE THAT IT'S GOING TO ALSO BE PROVIDING
GOING TO ALSO BE PROVIDING LONG-TERM CARE.
LONG-TERM CARE. WHAT I REALIZED FOR MY OWN
WHAT I REALIZED FOR MY OWN PATIENTS IS THEY ACCEPTED THIS
PATIENTS IS THEY ACCEPTED THIS OFFER BECAUSE THEY WERE GOING TO
OFFER BECAUSE THEY WERE GOING TO GET FREE HEARING AIDS.
GET FREE HEARING AIDS. THEY DIDN'T REALIZE THEY WERE
THEY DIDN'T REALIZE THEY WERE GIVING UP RIGHTS TO LONG-TERM
GIVING UP RIGHTS TO LONG-TERM CARE.
CARE. >> THE OTHER PART OF IT IS THAT
>> THE OTHER PART OF IT IS THAT THEY HAVE DIFFICULTY PAYING FOR
THEY HAVE DIFFICULTY PAYING FOR MEDICATIONS ON A WEEK-TO-WEEK
MEDICATIONS ON A WEEK-TO-WEEK BASIS, AND THEY CAN GET THEIR
BASIS, AND THEY CAN GET THEIR MEDICATIONS WITH A LIMITED
MEDICATIONS WITH A LIMITED COPAY.
COPAY. BUT IF THEY DO WIND UP NEEDING
BUT IF THEY DO WIND UP NEEDING LONG-TERM CARE, THEN THEY'RE
LONG-TERM CARE, THEN THEY'RE PAYING AT MINIMUM $50 A DAY
PAYING AT MINIMUM $50 A DAY COPAY.
COPAY. >> WHICH WOULD ADD UP.
>> WHICH WOULD ADD UP. >> ADDS UP QUICKLY.
>> ADDS UP QUICKLY. THEY DO THAT FOR APPROXIMATELY
THEY DO THAT FOR APPROXIMATELY 10 TO 20 DAYS.
10 TO 20 DAYS. THEN IT JUMPS TO $150 A DAY.
THEN IT JUMPS TO $150 A DAY. THAT CAN GO ON FOR FROM DAY 21
THAT CAN GO ON FOR FROM DAY 21 TO DAY 60.
TO DAY 60. >> ONE OF THE CHALLENGES BEYOND
>> ONE OF THE CHALLENGES BEYOND THAT, THEN, ONCE THEY'RE IN THE
THAT, THEN, ONCE THEY'RE IN THE ECF IS THE CHALLENGE OF THEIR
ECF IS THE CHALLENGE OF THEIR INSURANCE AND HOW THEY WILL
INSURANCE AND HOW THEY WILL EVALUATE THEIR PROGRESS.
EVALUATE THEIR PROGRESS. AND THEY TAKE A MUCH MORE
AND THEY TAKE A MUCH MORE AGGRESSIVE ROLE IN DISCONTINUING
AGGRESSIVE ROLE IN DISCONTINUING THEM FROM COVERAGE BECAUSE
THEM FROM COVERAGE BECAUSE THAT'S PART OF THE SHARED COST
THAT'S PART OF THE SHARED COST WITH THAT INSURANCE COMPANY.
WITH THAT INSURANCE COMPANY. SO IF THEY DON'T PROGRESS AT A
SO IF THEY DON'T PROGRESS AT A CERTAIN POINT, OR SAY THEY COME
CERTAIN POINT, OR SAY THEY COME IN IN THE MIDDLE AND THEIR
IN IN THE MIDDLE AND THEIR PROGRESS DECREASES, THEY WILL
PROGRESS DECREASES, THEY WILL IMMEDIATELY DISCONTINUE THEM
IMMEDIATELY DISCONTINUE THEM FROM COVERAGE.
FROM COVERAGE. SO THE LOSSES OF THEIR MEDICARE
SO THE LOSSES OF THEIR MEDICARE HAS CATASTROPHIC CONSEQUENCES ON
HAS CATASTROPHIC CONSEQUENCES ON THEM THEY DON'T UNDERSTAND
THEM THEY DON'T UNDERSTAND BECAUSE THEY SEE IT -- THEY SEE
BECAUSE THEY SEE IT -- THEY SEE THEY SAVE $75 A MONTH BY GOING
THEY SAVE $75 A MONTH BY GOING TO THESE PROGRAMS.
TO THESE PROGRAMS. >> MANY CASES IT'S NOT JUST THE
>> MANY CASES IT'S NOT JUST THE ACTUAL PERSON WHO NEEDS THE
ACTUAL PERSON WHO NEEDS THE SERVICES WE'RE TALKING ABOUT
SERVICES WE'RE TALKING ABOUT OPINION THIS HAS IMPLICATIONS ON
OPINION THIS HAS IMPLICATIONS ON IF THEY HAVE A SPOUSE -- I MEAN,
IF THEY HAVE A SPOUSE -- I MEAN, I'VE HEARD CASES WHERE PEOPLE
I'VE HEARD CASES WHERE PEOPLE HAVE PERHAPS LOST THEIR HOUSE,
HAVE PERHAPS LOST THEIR HOUSE, BUT I THINK THERE ARE
BUT I THINK THERE ARE PROTECTIONS NOW WITH THAT,
PROTECTIONS NOW WITH THAT, RIGHT?
RIGHT? AM I CORRECT?
AM I CORRECT? >> MEDICAID HAS A SYSTEM THAT
>> MEDICAID HAS A SYSTEM THAT THE PERSON IS NOT DEPOT ZESTED
THE PERSON IS NOT DEPOT ZESTED IN INDIANA.
IN INDIANA. >> THIS IS IS SOMETHING THAT CAN
>> THIS IS IS SOMETHING THAT CAN TAKE ALL OF SOMEONE'S ASSETS.
TAKE ALL OF SOMEONE'S ASSETS. >> AND THE IMPORTANT THING TO
>> AND THE IMPORTANT THING TO REMEMBER, THE FIVE-YEAR RULE,
REMEMBER, THE FIVE-YEAR RULE, BEFORE YOU SET UP YOUR MEDICAID,
BEFORE YOU SET UP YOUR MEDICAID, YOU CAN GIFT YOUR HOUSE OR
YOU CAN GIFT YOUR HOUSE OR ASSETS TO SOMEBODY BUT IT CANNOT
ASSETS TO SOMEBODY BUT IT CANNOT BE WITHIN FIVE YEARS OF APPLYING
BE WITHIN FIVE YEARS OF APPLYING FOR MEDICAID BECAUSE THEN YOU'RE
FOR MEDICAID BECAUSE THEN YOU'RE NOT ALLOWED TO GET MEDICAID, IF
NOT ALLOWED TO GET MEDICAID, IF YOU GIFTED AWAY SOME PART OF
YOU GIFTED AWAY SOME PART OF YOUR ASSETS.
YOUR ASSETS. >> THAT'S IF YOU HAVE TIME TO
>> THAT'S IF YOU HAVE TIME TO PREPARE.
PREPARE. IF YOU HAVE SOMETHING SUDDENLY
IF YOU HAVE SOMETHING SUDDENLY PREPARE --
PREPARE -- >> YOU HAVE TO BE --
>> YOU HAVE TO BE -- >> MORE AND MORE PEOPLE DO THAT.
>> MORE AND MORE PEOPLE DO THAT. THERE'S A REAL MOVE.
THERE'S A REAL MOVE. IN FACT, THERE ARE SPECIALTY
IN FACT, THERE ARE SPECIALTY ATTORNEYS THAT SPECIALIZE IN
ATTORNEYS THAT SPECIALIZE IN THAT AND THEY'RE OUT THERE AND
THAT AND THEY'RE OUT THERE AND HELP PEOPLE GET THAT DONE, MORE
HELP PEOPLE GET THAT DONE, MORE AND MORE PEOPLE, IF YOU WATCH
AND MORE PEOPLE, IF YOU WATCH TELEVISION YOU'LL SEE THEM
TELEVISION YOU'LL SEE THEM ADVERTISE.
ADVERTISE. MORE AND MORE PEOPLE ARE LOOKING
MORE AND MORE PEOPLE ARE LOOKING AT THAT AND TAKING THAT APPROACH
AT THAT AND TAKING THAT APPROACH TO PLAN THEIR ESTATES, WHERE,
TO PLAN THEIR ESTATES, WHERE, THEN, THE BURDEN LATER WOULD
THEN, THE BURDEN LATER WOULD FALL UPON THE STATE RATHER THAN
FALL UPON THE STATE RATHER THAN THEM UTILIZING THEIR OWN
THEM UTILIZING THEIR OWN RESOURCES TO TAKE CARE OF
RESOURCES TO TAKE CARE OF THEMSELVES.
THEMSELVES. THAT PRESENTS A PROBLEM, THEN,
THAT PRESENTS A PROBLEM, THEN, FOR OUR SOCIETY AS A RULE.
FOR OUR SOCIETY AS A RULE. I MEAN, I'M NOT SAYING IT'S
I MEAN, I'M NOT SAYING IT'S RIGHT OR WRONG.
RIGHT OR WRONG. IT JUST IS A REALITY.
IT JUST IS A REALITY. BUT IT HAPPENS.
BUT IT HAPPENS. >> BUT I WAS GOING TO ADD, THERE
>> BUT I WAS GOING TO ADD, THERE IS LIGHT AT THE END OF THE
IS LIGHT AT THE END OF THE TUNNEL.
TUNNEL. WE ARE SEEING SOME BENEFITS OF
WE ARE SEEING SOME BENEFITS OF THE ACUTE -- THE ACCOUNTABLE
THE ACUTE -- THE ACCOUNTABLE CARE ORGANIZATION.
CARE ORGANIZATION. THERE IS GOING TO BE A WHOLE
THERE IS GOING TO BE A WHOLE DEBATE ABOUT THE PROS AND CONS,
DEBATE ABOUT THE PROS AND CONS, BUT ONE BENEFIT WHICH I'VE SEEN
BUT ONE BENEFIT WHICH I'VE SEEN AS A PHYSICIAN IS THAT HOSPITALS
AS A PHYSICIAN IS THAT HOSPITALS AND NURSING HOMES IN GENERAL ARE
AND NURSING HOMES IN GENERAL ARE FOCUSING MORE ON QUALITY.
FOCUSING MORE ON QUALITY. THERE IS MORE ACCOUNTABILITY FOR
THERE IS MORE ACCOUNTABILITY FOR PHYSICIANS, MORE ACCOUNTABILITY
PHYSICIANS, MORE ACCOUNTABILITY FOR SYSTEMS AND I'VE SEEN NOW
FOR SYSTEMS AND I'VE SEEN NOW THAT THE HOSPITAL ADMINISTRATORS
THAT THE HOSPITAL ADMINISTRATORS ARE BUILDING IN MORE SYSTEMS TO
ARE BUILDING IN MORE SYSTEMS TO MAKE SURE THEY TAKE CARE OF THE
MAKE SURE THEY TAKE CARE OF THE WHOLE EPISODE OF CARE, NOT JUST
WHOLE EPISODE OF CARE, NOT JUST THE PATIENT FOR 30 DAYS OR 10
THE PATIENT FOR 30 DAYS OR 10 DAYS WHILE THE PATIENT IS IN THE
DAYS WHILE THE PATIENT IS IN THE HOSPITAL.
HOSPITAL. THEY'RE MAKING SURE THE PATIENT
THEY'RE MAKING SURE THE PATIENT IS DOING WELL NOT JUST IN THE
IS DOING WELL NOT JUST IN THE HOSPITAL BUT ALSO IN THE NURSING
HOSPITAL BUT ALSO IN THE NURSING HOME AND BY THE TIME THEY GET
HOME AND BY THE TIME THEY GET HOME THEY HAVE RESOURCES.
HOME THEY HAVE RESOURCES. >> UNFORTUNATELY WE ARE OUT OF
>> UNFORTUNATELY WE ARE OUT OF TIME.
TIME. I APOLOGIZE WE COULDN'T GET TO
I APOLOGIZE WE COULDN'T GET TO MORE BUT WE'LL HAVE A LOT MORE
MORE BUT WE'LL HAVE A LOT MORE ON OUR WEB SITE.
ON OUR WEB SITE. THANKS FOR JOINING US FOR THIS
THANKS FOR JOINING US FOR THIS EDITION
EDITION I'M SARA WITTMEYER.
I'M SARA WITTMEYER. THE FASTEST GROWING POPULATION
THE FASTEST GROWING POPULATION IN INDIANA IS PEOPLE WHO ARE 85
IN INDIANA IS PEOPLE WHO ARE 85 AND OLDER.
AND OLDER. MORE THAN 115,000 HOOSIERS
MORE THAN 115,000 HOOSIERS MY THANKS TO OUR PANEL OF
MY THANKS TO OUR PANEL OF EXPERTS FOR JOINING US. SEND
EXPERTS FOR JOINING US. SEND US YOUR QUESTIONS FOR NEXT MONTH
US YOUR QUESTIONS FOR NEXT MONTH AT INFOCUS@INDIANA.EDU.
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SEE THE FULL VIDEO OF THIS SHOW BY VISITING OUR WEBSITE-
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INDIANAPUBLICMEDIA.ORG/INFOCUS. THANKS ALSO TO ALL OF YOU ALL
THANKS ALSO TO ALL OF YOU ALL FOR WATCHING AND LISTENING.
FOR WATCHING AND LISTENING. HAVE A GREAT NIGHT.