HOME IS WHERE THE HEART IS,
BUT WITHOUT THE MONEY
Journal of Healing – Nov. 12, 2003
By Mary Koch

Irony dripped from a full-page advertisement that appeared in major newspapers across the country last week. The ad, paid for by the federal Department of Health and Human Services, trumpeted: "We care about the quality of home health care." Well, home health care may be where the government’s heart is, but it isn’t where it puts its bucks.

As part of the government’s "Home Health Quality Initiative," the ad was designed to help consumers make the right choice – as if we had one. It compared how various home health agencies rank in terms of helping patients get better. (You can learn more on the Internet at www.medicare.gov.)

The thing is, at least in Washington state, there’s precious little competition for Medicare home health patients. We in the boondocks feel fortunate that we have even one agency, and it’s a community-based, non-profit organization.

Okanogan Regional Home Health and Hospice helped me see my husband through the very scary early years at home following his stroke. It came as no surprise to me that our local agency ranked higher than average. But what if it hadn’t? It would have been them or nobody and frankly, we never would have made it without them.

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THE AD THAT was supposed to help consumers with their non-existent choices instead conclusively demonstrated something else about home health: A majority of patients treated by home health nurses, therapists and aides do something extraordinary. They get better. They can get out of bed by themselves, get to the toilet, bathe themselves and get dressed. Those are the kinds of basic skills that allow people to stay out of nursing homes. Not only that, fewer than one in four home health patients ends up back in the hospital or emergency room – a very expensive if not disconcerting place to be.

It’s pretty clear that home health is worth its weight in benefits. Yet there’s a discrepancy between Medicare funding of home health care and glitzier, high-tech treatments such as orthopedic or cardiac surgery. Health analysts say Medicare’s payment system emphasizes procedures while largely ignoring the actual costs of providing care.

The squeeze on home health and other vulnerable health care areas continues to grow as the Congressional carousel, pressured by the AARP lobby, pursues the golden ring of a Medicare prescription benefit. Making it easier for senior citizens to buy ever more drugs over the next 10 years is likely to cost $400 billion. That, combined with the not-so-distant thunder of Baby Boomers stampeding toward retirement could turn Medicare into a budgetary black hole.

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SENIORS CHAMPING for a drug benefit need to be asking themselves what they’re willing to give up in exchange.

According to news reports, Congressional negotiators only recently dropped a plan to require co-payments from home health recipients. Still on the table, however, is a provision that will deny annual update payments to home health agencies, which will be left to absorb inflation and cost-of-living raises for employees.

Just recently (as of Sept. 1) new limits were placed on therapy benefits for some home health patients – as well as other therapy out-patients.

In our profit-driven system, health care goes where the money is. The New York Times recently reported there’s a building boom in very expensive, specialty hospitals across the United States. Example: The Heart Center of Indiana, a 60-bed hospital that cost $60 million. The math on that one is not difficult.