When you went out to shovel snow last winter, you never anticipated the consequences: a heart attack and admission to the hospital. Nor did you expect to undergo a cardiac catheterization which would reveal coronary arteries blocked with cholesterol plaques requiring bypass surgery. Nor that the surgery would require splitting your breastbone with a saw to reach the affected arteries and a lengthy incision along your leg to harvest the blood vessels which would serve as the grafts needed to bypass the blockages.
But that was only the beginning. Soon you would learn that the hospital would be discharging you within three days of your surgery, your chest still sore, and weak as a kitten. You were anxious to go home but your wife was relieved to learn that you would be going to a rehab facility for at least a week. But when your insurance company decided that your time was up, you were still moving pretty slowly and your leg ached from the surgery. Your wife was a mess, worried about how she was going to be able to take care of you and manage to keep her job as well. So where to turn?
Here is where home health steps in. They provide assistance in adjusting to the new medical regimen that you have been given; provide physical therapy at home to help you until you are able to participate in an outpatient cardiac rehab; and, if you live alone, provide some home care services as well. However, no surprise, they are now going to be subjected to the same restrictions placed on hospitals and nursing homes. They operate on a very thin financial margin and they are now going to be subjected to the same penalties for early returns to the hospital. This despite the fact that physicians today rarely, if ever, see their patients at home.
To make matters worse, they are having restrictions placed on them regarding who can and who cannot utilize those services (ie: what is “medically necessary”). It must be noted that not all insurance companies are doing this. Some recognize that this may be the least expensive alternative to keep folks from returning to the hospital. But guidelines for its approval assume that one size fits all. That what’s appropriate for a fifty-five year old married individual is the same as that for a ninety year old individual living alone.
Hospitals, nursing homes and home health agencies are now, in many cases, trying to collaborate to keep the costs of care down while still preventing serious complications from developing in their patients served. But no matter how you slice it, they are trying to provide care with ever decreasing funds. And consequently, many home health agencies are experiencing financial crises and several are being forced to shutter their operations.
This leaves the remaining agencies servicing an ever-expanding geographic area. In practical terms, this means that your help is coming from further away, and in inclement weather, (snow storms and the like), services may frequently be delayed or unavailable.
Without these services, what other options exist? Are you left to your own devices? Well, without transportation you pretty much are. However if you can avail yourself of some means of transport, there are outpatient physical therapy services available. But again you will find yourself limited in how much you might be able to benefit. If you are slow in progressing, not meeting treatment objectives fast enough, you may find your benefits terminated. And even if you are progressing, each session has a co-pay and these can accumulate rapidly, resulting you having to terminate your benefits due to cost considerations.
So while options exist for care beyond the nursing home, their availability is shrinking and the the amount of money involved often limits that availability still further. But unfortunately, while hospitals, nursing homes, and physician services make up a large portion of the costs of care, there are other drivers of health care spending.
Next time we will explore the current trends in medical testing and treatments. And why it seems that your doctor doesn’t want to perform the tests for you that you expect from watching TV and reading the most recent issue of your health care quarterly.