America’s Health Care System Is Failing Our Seniors - Honolulu Civil Beat

About the Author

Kathleen Kozak

Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.

Medicare plans are too complex, and the problem will only worsen unless we act now.

“My parents have no expectation that their kids would take care of them,” said Henrika from Finland.

“In Germany, we have places where the older people go that provide care and are paid for by the government through our taxes,” said Stephan, as his countrymate shook his head in agreement.

“In Canada, care for my parents is subsidized by the government just like our healthcare system,” Holly shared.

Just a few weeks ago I was in Boston, participating in the Global Healthcare Leaders Program at Harvard Medical School and we were listening to Prof. David Grabowski, a U.S. policy expert in the long-term care situation in our country.

Currently, if someone is poor enough that they qualify for Medicaid, then long-term care coverage is available. However, the income limits are fairly strict. Prior assets have to be spent first, including retirement accounts, down to a level below $2,000.

However, Medicare does not cover long-term care, only post-hospital care — and that’s only for a maximum of 90 days per episode. Even having long-term care insurance may not protect most seniors from having serious cost issues for any assistance they may need.

Medicare advantage plans are required to follow the minimum standards of Medicare, and may offer more options for assistance but do not cover long-term care either.

So what are seniors to do?

When It Hits Home

As I physician, I see these problems regularly in my office. Families needing to provide care for loved ones, either by bringing meals, or doing their shopping, housework, or in some cases, having their loved ones move into their family home.

Others may have resources to live in a different care location. This can take place in a nursing home, or an assisted living facility, both of which are often prohibitively expensive.

Some families may hire care aides, people to come into the home to help and sometimes just make meals and cook, while making sure that patients are taking their own medication regularly. Still this is a financial cost that many seniors are unable to afford.

This all hit home the hardest when it came to my own father. After a prolonged hospital stay, followed by acute rehabilitation, and then a nursing home, he is now home alone, in the house I grew up in on the East Coast.

William Kozak with his daughter, Kathleen. (Courtesy Kathleen Kozak.)

Coming to visit and trying to organize home-care aides has been a nightmare. Shortages with staffing, untrained people — it’s almost impossible to find a caregiver to come consistently for even just a few hours a day.

Medication management has humbled me. Here’s my well-educated father taking whatever multicolored pills are presented to him, not knowing what they are for or which ones need to be taken with food. He has to get refills from multiple doctors, and his new medications are not the same that he was on before, so the requests require a long explanation to each doctor’s office staff.

He’s overwhelmed, and frankly, so am I.

Expecting seniors to handle this type of complexity on their own is one of the true failures of our healthcare system.

Simple tasks at home like doing the dishes is impossible for someone who is using a walker and has bad balance. Doing the laundry? Not happening. Not to mention the usual general cleaning.

Our care system today fails our seniors on a regular basis, turning kids into caregivers, making it necessary to hire strangers to help with personal needs like bathing and showers, and hoping that our elderly loved ones don’t have a catastrophic fall or even worse, die languishing on the floor because no one was there to help them get up.

We have a socialized version of care for everyone over 65 already. The federal government runs Medicare insurance, and has also partnered with the private commercial sector to provide Medicare Advantage plans. This year, the enrollment in these Part C plans is almost 50%. The experiment to see if there can be a private/public partnership has succeeded in many ways.

Our care system today fails our seniors on a regular basis.

The next step is to consider how to create a system of home-care options for seniors that are covered by, or at least partially subsidized by insurance. This would provide the social safety net that we need to make sure that everyone over a certain age has a secure place to live, care if they need it, and if necessary, coverage for nursing home care long-term.

To do less is to ignore the very population that Medicare was created for: those who are elderly, living on fixed incomes. Not just the indigent who qualify for Medicaid, but for all seniors who have needs.

No one would choose to live in a nursing home if they could live on their own. It’s highly doubtful that there will be a sudden rush by seniors to be admitted to long-term facilities.

But coverage for adult day care, for senior home care aides, for transportation to senior centers, these services are investments that can be made for all seniors that will ensure their ability to live independently as long as possible, but also avoid financial ruin when they cannot.

A subsidized program would provide more resources that will support novel types of care locations. Daycare for children happens either at a facility or even in people’s homes if they are certified.

Creating a nationwide certification program where daycare for seniors could take place in private homes, especially those that may already have seniors living there under adult residential care, might expand the opportunities for care to be delivered in ways it has not been to date.

The expense for such a program could come from the savings that happen when one senior is not admitted to the hospital due to neglect at home — or doesn’t fall down and break a hip, resulting in an expensive surgery, because they have someone helping with their needs.

Our tax dollars help to pay for Medicare services after someone has a need. But we can improve on the quality of life of our seniors before they have a major injury or land in the hospital. Just by paying for the very care needs that are often missed which results in disaster.

For now I will continue to try to provide whatever help I can for my own father, much like a few years ago when my mother was still alive.

But every day I leave my medical practice to take care of my family is a day I am not able to work taking care of anyone else’s. That’s one less doctor available when there is already a shortage of us in Hawaii.

The answers are not easy. We will all reach an age where this might be necessary someday, and if we don’t look to fix the senior care crisis now, then it’s only going to get worse. That’s a risk none of us should take.

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About the Author

Kathleen Kozak

Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.

Latest Comments (0)

Medicare is a bureaucratic mess. Every week, I get spam calls, confusing literature from medicare in the mail, and every second tv commercial pushes drug companies trying to scare people into changing their plans. Even my smartest friends are confused. It is ridiculous. On the positive side, shingles shots are covered and medicare can now negotiate with the drug companies and co-pays have caps that have been slightly adjusted. I still actually pay almost as much as I did with private insurance. USA pays the most of any country for health care with some of the worst results. In Canada, people don't even think about this. Opponents (Insurance & drug companies) say that patients have to wait for care & it's not the best but that is not true. Optional cosmetic and things like that are not covered. I really looked forward to my Medicare but it needs cleaning up to be less confusing & supported by the politicians 100%. The opportunists should be ousted & scary chatter tamped down. Nursing homes are too expensive but necessary.

Concernedtaxpayer · 7 months ago

Sadly the rest of the developed nations are able to provide much more than U.S. in healthcare for all ages. They can. We can't. But we are exceptional? Medicare providers have had a few cuts to their reimbursement over the years which has meant many providers will not take Medicare patients at all. Currently one more pay cut is in the works. If we want to cover our aging population with minimal healthcare coverage we must stop cutting Medicare reimbursement to the medical profession.

Valerie · 7 months ago

The new trend is for physicians to create clubs for health care services; my 82 year old Mom was just dropped by her longtime primary care provider; she could stay with this Dr, but it would now require an annual $3000.00 fee to remain as a patient.Well needless to say my Mom like many other seniors lives on a fixed income, it would take 2 months of SS checks to cover this annual payment.

koti · 7 months ago

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