Vulnerable Elders: The VNAA vs Medpac

Just today, Medpac---the Medicare Payment Advisory Commission---issued a report to Congress recommending reinstatement of co-payments for elderly Medicare recipients receiving home health services. Medpac, an independent Congressional commission, is comprised of various professionals with expertise in health care delivery and financing, with two of the current members being nurses.

The Visiting Nurse Association of America (VNAA), has categorically denounced the recommendations, maintaining that "most home health patients are elderly, female, and living on fixed incomes." The VNAA further predicts that many patients without a Medicaid supplement will undoubtedly eschew home care services due to the additional $150 co-payment being recommended by Medpac, leaving them further vulnerable to unnecessary hospitalization and avoidable complications which could be prevented by timely and affordable home care services.

Based on information obtained from the VNAA and the Medicare and Medicaid Supplement for 2010, home health patients are overwhelmingly elderly, with 34.7% between the ages of 75 and 84, and 29.1% over the age of 85. Furthermore, 63% of these patients are female, the majority on fixed incomes. The co-payments in question were eliminated by Congress in 1972 in order to foster increased usage of home care services, which are astronomically more cost effective than care in hospitals and long term care facilities.

While both agencies obviously wish to facilitate the delivery of cost-effective high quality care for needy and vulnerable patients, re-imposing potentially prohibitive co-payments on predominantly elderly clients living at home on fixed incomes is not necessarily the most judicious choice for fixing the economic woes of the American health care system. Changes are certainly needed---many of them drastic---but I support the VNAA in its opposition to Medpac's proposed reinstatement of the home care co-payments.

As a nurse with 15 years of experience focused on home care, I have seen first-hand how elderly clients on fixed incomes must frequently make difficult choices, such as choosing between food and heating oil. Adding the differential of extra medical co-payments for elderly patients wishing to remain at home rather than become institutionalized is, in my opinion, a misguided recommendation that should be set aside in pursuit of more effective (and less draconian) economic measures.