The government spends a fortune on health care for impoverished older Americans, especially for people who are known as "dual eligibles," meaning they qualify for both Medicare and Medicaid. There are about 2.6 million dual eligibles with measurable physical limitations when it comes to dressing, bathing, walking, preparing meals and more.
According to a 2010 study for the U.S. Department of Health and Human Services, about 300 million Americans in 2006 ran up roughly $1 trillion in health care spending. People with functional limitations accounted for 14 percent of the population, and nearly $475 billion was spent on their health needs, which accounts for more than 45 percent of the nation's total health care bill. The average annual tab for their care was $11,284 per person in 2006.
In 2006, those 2.6 million dual eligibles ages 65 and older led to $37 billion in health care spending, or an average of nearly $14,200 each, according to the study, "Individuals Living in the Community with Chronic Conditions and Functional Limitations: A Closer Look," conducted by health care consulting firm The Lewin Group.
With the numbers of seniors ages 65 and older growing by an average of 10,000 people a day during the next 15 years, the frighteningly large proportions of dual eligibles could have a detrimental impact on the government.
There are no silver bullets in addressing these challenges. But there is a blessedly common-sense research effort underway in Baltimore that could act as a blueprint for improving the quality of life for millions of older Americans, while saving money for taxpayers in the process.
Many, if not most, low-income older Americans live in substandard housing, and they receive little preventive medical care. Even if they have exactly the right set of medications to deal with their health challenges, the odds are high that they make mistakes in following their drug regimens, and have no one to consult with when there are complications. Doctors and nurses will tell you errors are the norm, not the exception, when it comes to older patients being treated for multiple chronic illnesses and conditions.
Ultimately, a large percentage of these people will wind up moving into a nursing home and effectively become a very costly and long-term guest at the government's expense, as their illnesses may progress and require expensive care.
What if, instead, that same government could come into a person's home and provide a range of preventive health care services? What if this home-based intervention also included home improvements that allowed frail seniors to be more safe and secure in their homes?
And what if these services also saved the government a bundle of money in the long run, by either greatly delaying a person's entrance into a nursing home or preventing it altogether? In the process, of course, it would also be nice if these money-saving efforts greatly improved the person's quality of life. And how about if they even helped the person live longer?
Good deal, right?
Things are rarely so simple. But the Baltimore test program – called Community Aging in Place, Advancing Better Living for Elders, or CAPABLE – may generate the kind of hard data that would prompt government regulators to approve such services for all eligible older Americans. If this happened, it would represent a game changer for the nation's seniors and the way we approach health care.
In the program, occupational therapists visited clients in their homes and helped them deal with functional difficulties and safety issues. This included installing safety and access features like handrails.
A previous version developed in Philadelphia, called ABLE, worked well but health researchers at Johns Hopkins University in Baltimore wanted to expand it in two ways: adding nursing assistance and providing home repairs in addition to the senior-friendly tools and add-ons. Researchers did a small-scale test a few years ago, and then sought government funding for a larger trial that would generate the kind of actionable data needed to convince authorities to approve a larger program.
[Read: How to Raise Money for Medical Bills.]
Sarah Szanton, program director and an associate professor at the Johns Hopkins School of Nursing, says two larger tests began last year and will ultimately include 800 participants. One test is funded by the National Institutes of Health and the other by the Center on Medicaid and Medicare Innovations, which has stepped up community-based health care programs as part of the Affordable Care Act.
Szanton says she thinks the programs will greatly improve the quality of life for participants. The ABLE program did that even without nursing and home repairs, she says, and helped people live longer.
Despite these positive outcomes, the core financial question of the tests is whether the money spent on each participant – roughly $4,000 for nursing and home repair work – can save the government enough money in the long run for the program to pay for itself.
Szanton says it is too early to say. Researchers need to know more about the long-term health effects of the program, and the numbers game in measuring money not spent can be very tricky. But when looking at possible savings to Medicare and Medicaid due to the healthier population of test subjects, she says CAPABLE looks promising.