Health Care Choices are in Patients’ Hands

NEWPORT CITY – Andy Carter, President and CEO of Visiting Nurses Associations of America (VNAA), was in town this week to meet with officials from area associations. Carter’s visit included a trip to some of the most rural areas of Essex County with representatives from Orleans/Northern Essex VNA and Hospice (ONEVNA). They also had a round table discussion at the ONEVNA office Tuesday morning. Carter tries to visit VNAA members all over the country to get a firsthand look at the challenges they face, what the patients are like, what their worries are and how they are planning for the future. There is a common concern that federal efforts to cut spending on healthcare will damage access. “It seems more acute here because the financial challenges of covering these vast distances between patients are huge,” said Carter. Home healthcare providers are trying to work with hospital partners and physician groups to provide healthcare differently, more efficiently, more safely and with better results. “That sense of innovation and planning for the future is coming in both urban and rural settings,” he said.Carter spoke about the flat fee, home healthcare organizations receive for taking care of a patient on Medicare. The fee, said Carter, is adjustable depending on the type of care the patient needs and where the person lives. Thanks to the healthcare reform law, there is a three percent additional bump in the payment. However, that increase is not enough, but it was the best VNAA could get.Rep. Bob Lewis of Derby, who sits on the ONEVNA board, expressed concerns about what will happen when the baby boomers start to leave the workforce. Lewis is also concerned about the large number of people depending on government assistance.“This is an issue,” said Lewis. “This is going to hit us square in the face in the very near future.”Carter, who agreed, said if Pres. Obama's healthcare reform gets struck down by the U.S. Supreme Court, the Medicare trust fund would be there until 2014, when it runs out of money. If it doesn’t get struck down, the fund will be there for a couple more decades.“We have more people demanding services and a shrinking workforce to support them,” said Carter. He also said the baby boomers are famous for being demanding consumers. “They will demand in ways other generations have not. They will want healthcare their way and that will include in their home.”“It’s a big load for younger people today to finance the healthcare of older adults,” Carter said during a break. Americans need to have a conversation about their expectations for getting old. “We cannot turn ourselves over to the last decade of our life being completely overwhelmed with healthcare services. People don’t want it in the end, but the system sort of now pushes them into consuming healthcare services.”Policy makers can do their part, but Americans need to be honest with their loved ones, say what they're willing to do and decide they want getting old to be successful, meaningful and comfortable. They need to carefully think about how much cure and treatment they want. Carter said the patient is the one who should ultimately make the decision regarding his or her care.In some cases, patients can visit with their healthcare providers, who use modern technology and the Internet. However, that is not available where there is no broadband access. Polls show that most Americans want to receive as much care as they can in their homes, Carter said.“The fact is, if you are wealthy, it’s relatively easy to have healthcare where you want it,” Carter said. “If you are of more limited means, the choices that are available to you are far less.”Home care workers can save money if individuals can stay out of hospitals, if they take care of their chronic conditions, and if they contact VNA and hospice staff instead of 911 when they have a problem. Most people would rather receive treatment in their own home. The reason some homecare providers feel stress is not because people don’t believe in them, but because they are more concerned about abuse of the system that takes place in some parts of the country, Carter said.