MORE THAN the unstable economy, the damaged environment or the turbulent world political scene, the most serious crisis facing Americans today is in health care.
The system (really a non-system) is in a state of crisis, crippled by spiraling costs -- and it is about to be overwhelmed by a tidal wave of older Americans in need of long-term care.
A major solution to the crisis is right under our noses -- and has been for over 100 years. More people can be -- and want to be -- treated in the comfort of their own homes.
Home health care is a significant and beneficial solution to many health-care problems, but it is too little used and understood. It is a godsend to patients and families, and it represents substantial savings for health-care insurers.
Yet, Medicare pays for only limited amounts of skilled care and home health care. Medicaid generally pays only for nursing home care and requires that the patient be a pauper before eligibility can be established. Most private insurance provides limited, if any, coverage for long-term care in the home or in a nursing home. New, specialized long-term policies are expensive and have severe limitations.
The first step to solving the long-term care crisis is to educate people about the availability and cost-effectiveness of home care, and to work for expanded care for the frail elderly.
If health insurers are to consider offering better home care coverage, they need to know more about home health care -- its cost savings and emotional and social benefits.
Home care is not only the most humane way to deliver care, and the one most preferred by the patient, but it is often the most cost-effective. A study by Aetna, for example, shows significant savings when home care is provided for certain health problems that are traditionally treated in hospitals.
For instance, the average annual cost of treating a patient dependent on a respirator in a hospital is $270,000, compared with $21,000 at home. And while the average daily cost for each bed in a Maryland hospital was $673 (in fiscal year 1990), it was $93.39 in a nursing home last year and only $54.19 in a patient's own home.
Home health care not only eases the obvious financial burdens of long-term or chronic illness; it reduces psychological and emotional stress by allowing the patient to remain in a familiar and comfortable setting. The following true story is an example:
In September 1988, 28-year-old Randy B. almost lost his life. Beaten and robbed, Randy suffered a severe skull fracture that rendered the left side of his brain 75 percent dead and left Randy with scant hope for survival.
Randy returned home in 1989 following 111 days at the University of Maryland's Shock-Trauma Unit and six months in a Pennsylvania rehabilitation hospital.
Randy's severe limitations require nursing care once a month to change his stomach tube; a home health aide five times a week; and regular speech, occupational and physical therapy. All of it can be done in Randy's home. With long-term assistance from an array of home health services, he is making remarkable progress.
For the sake of future Randys, the time has come for the federal government and legislators at every level to recognize the need for a policy of long-term care. That policy should include care at home.
Ann H. Jackson is director of community affairs for the Visiting Nurse Association, an organization founded in 1895 that provides an array of home health services, a home hospice program and private duty care in greater Baltimore.