The cost of quality health care is a major concern to everyone, particularly to the present Administration in Washington. The rapidly escalating costs of Medicare are of grave concern to the Federal budget managers. We are in an era of cost accountability when we must be able to document the cost effectiveness of our services as professionals. This is not always an easy task to accomplish. We must have clear, measurable objectives for our nursing care plans and documentation of the degree to which these objectives have been achieved, regardless of where the care is delivered-hospital, nursing home, community, or in the client's own home. At the same time we must be constantly searching for and trying out new and innovative methods of delivering nursing care and other health services needed by our older citizens. Right here I want to clarify the difference between medical care and health care. For too long medical care has dominated the health care delivery system and it is like the tail wagging the dog. Health care,particularly for the elderly, includes all of the social and psychological services as well as a total team approach to meeting the variety of needs that arise out of illness and disability. The Reagan administration has stated several times that they intend to expand home care as well as Day Health Care in an effort to prevent costly institutionalization. Home care has been an accepted treatment modality for many years and research has shown that most older persons prefer to remain in their own homes as long as this is possible. Day Health Care is a relatively new innovation and again we must be clear in our definitions. Most Senior centers are not Day Care centers. Day Health Care must be licensed by the appropriate body in the state where it is conducted and includes professional staffing to meet the needs of the physically and/or mentally disabled client. All nurses should be familiar with the facilities available in their own communities. I strongly recommend that nurses get out and visit such facilities. Nurses must assume more responsibility in acting as advocates for the disabled elderly, who are usually unable to speak out on their own behalf. The families who are providing care at home need a great deal of help and support. They can be organized into very effective advocacy groups. It is essential that local Boards of Directors and Advisory groups have nurse representation. They are usually delighted when knowledgeable nurses volunteer for such assignments. You can't sit back and wait to be asked.
There has been more and more written recently about individuals assuming more responsibility for their own health. This again is an area where nurses can be very effective. Most older persons are very eager for knowledge about their health and we need a great deal more emphasis upon "wellness" as well as illness. In a small survey which I conducted for the local Area Agency on Aging about health needs of older persons, I had the opportunity to interview, individually and in groups, over 500 older persons. The unanimous complaint that they eagerly voiced was in regard to the lack of information that they were able to obtain from their physicians. From this experience, I concluded that they badly needed classes in assertiveness as well as general health information. I have completed four classes for Seniors in the past year and a half and one television series of eight sessions. I will be starting another television series this coming April. The TV programs are called "Talk Back" and, besides having a studio audience that can ask questions, the viewers can also call in and ask questions. It is a live show so we have two persons screening the phone-in calls. It has certainly been a learning experience for me and seems to be most gratifying to the viewers, as we are always overwhelmed with calls. I have frequent guest experts with me on the programs. We focus primarily on normal aging and life styles which promote health, as well as covering the more common chronic diseases and conditions of older persons. The TV programs are funded through a special grant from The Fund for the Improvement of Post-secondary Education (FIPSE) in Washington. The grant is to our local PBS Station and is locally sponsored by a savings and loan bank. A booklet is prepared ahead of time with supplementary information on the series and is purchased by the viewers. There are also other classes offered within the grant.
Even though Medicare and other third party payers are footing a large portion of the costs of health care, it is very important that we teach people how to cut down on the costs by using services more wisely and carefully. Most important of all is helping them maintain their health, and preventing costly and distressing illness and hospitalization. We must remember that we are all paying the bills for Medicare and I want to be sure that there will be enough money left in the fund when I need it. I hope that more nurses can become experts in being cost-conscious and cost-effective. The day of accountability is right here with us. Nurses must become more active in monitoring the health programs in their own communities and also in assuring that the present administration does not impose any unfair budget cuts upon the helpless and silent elderly.