The following question was asked of a random group of Journal of Gerontological Nursing readers:
My hope for managed core (capitateci systems) for the aged Is:
That they will look at each person and evaluate needs and not ration health care by age and /or disease. I would also wish that a person's autonomy be respected even if the person decided that no health care be provided given his options.
Clarice H. Lube!, RN, BSN, PHN,
Senior Health Project
County of Riverside
Health Services Agency
Department of Public Health
Palm Springs, California
That it will provide a broad range of services which will include health promotion, comprehensive medical care and follow-up care which will enhance [elders'] quality of life. The system could be cost effective if managed efficiently and focus on prevention and health maintenance, as well as implementing medical care services without delay.
Mary Lou Giacchi, RN, C, MS
Staff Development Coordinator
Southern Ocean Nursing and
Manahawk'm, New Jersey
There is the realization that many of the elderly have one or more chronic illnesses and that the gerontological advanced practice nurse is prepared to address the health care concerns and should be given a prominent voice, place and financial support to do so.
Barbara M. Vassallo, RN, MSN,
Nursing Division, Graduate
Gwynedd Valley, Pennsylvania
A standardized protoXi. col developed by a broad spectrum of gerontological health care providers for all elderly patients, whereby decisions related to appropriate treatment are based on prudent medical and nursing judgment and guided by ethicists not economists.
Marie Morgan, RN, CNS, C
Clinical Nurse Specialist
Ancora Psychiatric Hospital
Hammonton, New Jersey
Question submitted by Gerì Richards Hall, PhD(c), ARNP, CS, Department of Nursing, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Dr. Hall responds:
We read, almost daily, about impending cuts to Medicare and the potential for managed care for the elderly. Most examples provided describe "heroic" expensive procedures such as transplants on the oldest old, and use of medical specialists for simple conditions instead of using less expensive primary providers who will treat conditions in a less costly "more reasonable" manner. While few would argue with this logic, changes should be generated from more typical senior health care scenario.
Instead, I am witnessing a reluctance to diagnose, treat, and provide ongoing care to senior citizens based on comparing the costs of a diagnostic procedure or treatment to the aggregate percentage of likelihood of change. A common example is omitting diagnostic tests for dementing illness because of a 95% certainty that an aged adult with memory loss will not have a treatable cause, yet diagnosing and treating a reversible dementia saves the average family $22,000 to $40,000 per year.
My fear is either a lack of change or medicallydirected change using immediate costs as the basis for decision-making without consideration of long-term impact to the patient and family. Gerontological nurses know and understand these costs.
My hope for managed care systems for the aged is that they are based on models of maximizing functional competence, rather than disease states or activities of daily living. A new system must encompass the acute and long-term care continuums; recognize the impact and cost of cognitive impairment - reimbursing accordingly; and utilize interdisciplinary models of care and a broad spectrum of social and health providers (including senior consumers) to promote preventive and restorative measures that enhance quality of life. My hope for services for the aged are that while they are increasingly research-based and that research is not used to limit access to diagnostic and treatment services without consideration of long-term costs, impact on society) and most important, quality of life.
The only way these hopes will be realized is if gerontological nurses develop a strong advocacy voice for care of the aged, as we understand the issues of long-term costs. We must prepare to be articulate, knowledgeable, and strident in participating for planning these changes.