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Medicare could Save $26 Billion per Year by Delaying Onset of Disability

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Duke Health News 919-660-1306

DURHAM, N.C. - Grandma's bypass surgery should keep her heart ticking for another five years, but her chronic arthritis is threatening to put her in a nursing home by the year's end if she can't manage to feed, dress and bathe herself.

Desperate as her situation sounds, Dr. Laurence Branch said it is typical of the crisis facing older Americans, who are living longer and healthier but not necessarily without assistance from family members or nursing care.

While scientific advances have cut the death rate from cancer and heart disease, the medical establishment has fallen behind on fixing the chronic conditions - osteoporosis, arthritis, blindness and dementia -- that land most seniors in dependent care and nursing homes, the Duke gerontologist said.

And according to a new study, that lapse is costing taxpayers $26 billion a year, money that could be reclaimed by delaying disability for just a single year per senior citizen who becomes disabled or needs home care, Branch said.

He said that keeping grandma out of that nursing home will prevent both the huge financial burden as well as the emotional and social toll that dependence extracts from the patient and his children.

"There's half a billion dollars per week being spent on caring for newly disabled seniors and nursing care residents that could be spent on prevention and wellness programs to keep them independent," Branch said.

"If we spend just one week of these costs on research to prevent or delay this loss of independence, we would nearly double the total annual research budget of the National Institute on Aging."

The massive numbers Branch reels off are the product of a year-long review he and others conducted on Medicare records of disability, nursing home admissions, and health care costs for seniors - all at the behest of the non-profit Alliance for Aging Research. Now that the numbers are available, the alliance said it hopes the nation's key lawmakers and medical associations will take notice.

In a June 10 presentation to the Senate Special Committee on Aging, Branch -- on behalf of his colleagues Jack Guralnick, Lisa Alecxih and Joshua Weiner -- quantified the bottom line for lawmakers and presented a list of ways to reduce disability and divert health care dollars toward preventing and treating disabling conditions.

The four experts in geriatrics, health policy, demography and economics were charged with the task of assessing the medical, social and economic toll that disability puts on the nation and the Medicare budget in particular. Among the figures they compiled:

The annual Medicare price tag of caring for a person who enters a nursing home is seven times more than a person who remains living at home. That's independent of the cost of the nursing home itself.

A senior who requires help with daily living tasks at home costs Medicare nearly $13,000 more per year than an independent senior.

According to the panel, it is not acute illnesses like cancer or heart disease that are landing seniors in nursing homes, but rather chronic conditions that restrict their ability to bathe, dress, eat, use the bathroom and get out of bed that cause them to be dependent. In fact, four common causes for losing independence - visual and mental difficulties, mobility impairment and incontinence - are not life-threatening at all, but simply restrict a person's ability to perform essential functions of daily living.

"Our medical establishment is so disease-oriented that we forget to focus on the end-product of disease, which often is disability among older people," Branch said. "Of how much benefit is extending a life when the person ends up immobile and isolated from family and friends?"

As an example, Branch describes a typical patient who has a fairly routine heart condition with a manageable case of diabetes. On top of the medical conditions, the patient is overweight and sedentary and as a result has trouble getting around.

"Her medical conditions may not be clinically significant, but she is still on a trajectory to becoming immobile and requiring dependent care," Branch said. "And most physicians are not trained in geriatrics, so they generally do not recognize and head off the warning signs of disability."

Branch notes that something as simple as asking your patient about potential hazards in the house, such as tubs without rails or slippery area rugs, could prevent a major fall that results in a broken hip -- one of the most common reasons for nursing home care.

Likewise, treating incontinence could reduce social isolation that leads to depression, a psychiatric condition that nonetheless boosts the risk of dying from a variety of physical causes.

Recommendations

If the nation were comprised of fewer senior citizens, such health care issues would naturally take a back seat to other pressing issues, Branch said. But given the vast and ever-growing population of seniors, there is a need to study, understand and intervene in age-related conditions, he

Already, seniors over the age of 85 make up the fastest growing segment of the population in the United States. In 30 years, the number of people over age 65 is expected to surpass the number of people under age 18.

In view of these numbers, the panel's report, titled "Independence for Older Americans: An Investment for Our Nation's Future," calls for immediate action. The panel, comprised of experts in health policy, demography, economics and geriatrics, recommends in its report that:

The National Institutes of Health sponsor more research on diseases that cause disability among seniors, with NIH setting the tone nationally by making age-related disability research a priority;

Medicare be reformed in a comprehensive way, including the development of measures that would quantify the impact of disabling conditions and illnesses on the elderly;

Research funding should focus on identifying strategies to improve access to health care and reduce unnecessary health care expenditures. Breakthroughs in science must be implemented into daily clinical practice much sooner than the six to 10 years it now takes;

Research should focus on preventive measures and on postponing the impact of conditions that hasten dependancy. Prevention must begin before old age -- even in childhood - to have optimal effect;

Better and more reliable data on conditions that affect older Americans must be collected, analyzed and made part of regular health care. Research must establish specific recommendations for prevention that reduce the cost of elder care.

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