LTC Insurance

For my LTC "Wild Card Blog", I decided to type long term care on google and see what the results would be. To my surprise, after scrolling down the literally millions of results from my query, I kept stumbling on article upon article on LTC insurance.

I personally thought that I would read about the horrors of LTC, about abused customers, enraged family members and the dangers of unkept facilities. Instead, I came across long guides on how to select the proper insurance from AARP, essays from the NY Times on how to avoid overpaying for insurance and trim the "fat" from costly insurance programs, and stories about elderly patients that after years of paying premiums in a timely matter are denied simple care that costs pennies on the dollar.

What is LTC insurance (LTC-i)?

LTC-i is a safety net to avoid the unprecedented costs of the long term care needed in our later years, this type of insurance started in the early 70's and was initially popular with wealthy individuals who were aware on the steep incline of medical services in the United States. Premiums floated around $7,000 a year, and they did not include services such as home modification (adding rails to bath tubs, replacing door knobs to door handles) or extended hospice stay. A standard medium range LTC insurance costs about $1,600 and it offers many services not covered by MediCare, such as home help with ADL's, Adult Day Care, and home nursing.

Still, many Baby-boomers are reluctant to buy LTC-i, they are afraid that like their parents, many services will not be covered and their money will go to waste. Although we cannot for see what the future standards of care will be, organizations like AARP and other elderly advocacy groups have fought to regulate LTC-i practices.

In short, aging gracefully is turning more into an art than a right. As consumers we need to inform ourselves and take care of our elderly population as new and more advanced systems of healthcare are being developed, and although these systems will help us live longer healthier lives, we need to have the resources to finance them. LTC-i is one of the many ways to finance our care. Although not perfect, and for many still a luxury, LTC-i is a necessary evil to those privileged enough to know about the importance of a plan for our golden years.

Finally, I will give you a couple of suggestions AARP recommends to look for in LTC-i:

Coverage: A coverage that is appropriate for your style of living is the most important part of your policy. Coverage can include a home nurse, hospice stay, alternative care, adult day care etc. The costs that exceed your coverage, or that are not covered are the responsibility of the patient.

Daily or Monthly Benefits: Benefits are usually payed in either of the formats and the insurance company divide the amount it pays to the Health Facility according to daily or monthly use. Once again if care exceeds any of the time frames the patient pays the balance.

Benefit Period: This is the span that your coverage will last. Your can choose to cover for a predetermined amount of time or for the entirety of your life.

Waiting Period: This is the period before your insurance kicks in. It can last from a couple of months to no waiting period. The shorter the waiting period, the more pricey the insurance policy will be. During the waiting period, the patient is responsible for payment.

Inflation Protection: This is simply to assure you that you will pay for future treatment at current prices.

Non-Forfeiture of Benefit: This can add a lot of cost to your policy, but it protects patients from cancellation of benefits from lack of pay.

(Source AARP)

Citation:

Long Term Care Insurance. (2007). Retrieved January 23, 2009 from AARP, AARP.org: http://www.aarp.org/​money/​financial_planning/​sessionfive/​longterm_care_insurance.html.

What does Long Time Care mean to me...

Long Term Care to me is a health system designed to provide care to an individual for an extended period of time. For many skilled nursing or skilled health care has to be available for extensive periods in order for full recovery; from accident victims to palliative care. Nursing Homes, Rehabilitation Services and Hospice care immediately pop into mind.  Another aspect of Long Term Care (LTC) is the stigma that LTC carries, nursing home abuse, overworked nurses and disgruntled employees dealing with overcrowded facilities. Seldom do we think of the millions of patients that learn how to walk for a second time, or the  elderly that have no family to provide basic care or even the care (physical and spiritual) that both patients and families receive from hospice workers. 

What I know about LTC is that sooner or later someone we care for (or even us) will need to use the services of a long term care facility. For that reason we need to improve the service being provided, we need to streamline the delivery of care and we need to change the way we think about these necessary health care facilities. This semester I hope to learn more about the history, development and role these organizations have in our health care system. I also hope to learn where these organizations should be heading, that way when I am part of the United States Health System, I am able to better serve my patients.  

End of Life

I thought it was appropriate to talk about End of Life for the last blog in this Health Care Ethics class. There are many issues that we could talk about, from abortion to death with dignity. Surely in the news you have read about doctors who in the name of beneficence perform "mercy killings", patients in Oregon have the ability -after jumping through many loopholes- of requesting to end their life.

Where does the Hippocratic Oath fit? Should it be revised? Is it all encompassing? As I discuss this with my family and friends, I have heard many different arguments both in favor and against this topic. The only thing that pretty much everyone agrees on is that in the end, it should be the patient who decides. And even when the patient does not have a voice, the health care surrogate should try to represent the interests of the individual to the best of their knowledge.

Finally I want to talk about the importance of a living will. A living will is a document that lists your wishes in case you are not able to make a decision about your life. To put bluntly, it is a legal document that will serve as a your decision, in case you do not want to be resuscitated or if you do not want to be hooked up to life support if you are brain dead. It can be very detailed, and you can specify treatment that you do not want performed on you and it could also include specific instructions about organ donation. It is free and once again, to be respected by any court. I bring this up, because its important to take the burden away from your family. No one wants to be responsible for the decision of taking some one off life support, and by having this document you can take the burden away from your spouse or your parents. This holiday season, talk to your family, ask them how they feel about a tough situation like the one Terry Schiavo was in. Tell them how you feel, and you might be surprised by their res ponce. Take responsibility of your life, and if the unthinkable happens, don't leave them with that responsibility.

Florida Living Will

What role...

What role should spiritual care take in the Hospital setting?

Many hospitals are sponsored by religious institutions, the Methodist church, the Mormon church and the catholic church stand behind some of the most prestigious hospitals in the nation. Here in Orlando Florida hospital is the only hospital in the central Florida area to perform transplants and yes they are backed by a religious entity. And even though the care they provide is rooted on scientific research, what role should their spiritual care take in the Health Aid setting?

As I read article after article on how faith can be used as part of mental health, I am convinced that spiritual care can be an asset, even hospitals that are not sponsored by a religious denomination usually employ chaplains or people specialized in faith based relations. But, what are the boundaries of Faith Based Care?

In a journal entitled "Ethical Boundaries of Spiritual Care" the author outlines a couple of suggestions on what the boundaries should be, and all of them focus on the same principle, respecting the patient. This is my interpretation of those suggestions:

1.- In order to provide care, the provider should have an understanding of the patient beliefs.

Simply put, we cannot override the wishes of an autonomous person, we are responsible for educating ourselves, listen to what the patient has to say, and learn from their beliefs -even if we don't agree.

2.- Respect means following the patient wishes.

We can learn, listen and understand but if we don't follow patient wishes, we are infringing on their rights.

3.- Providers should not prescribe spiritual practices, nor urge patients to relinquish their beliefs.

We cannot undermine a patients belief system. If providers start to suggest practices, rituals or other forms of spiritual care, it will end up degrading the respect that medical care deserves. This in turn could damage the personal and professional integrity of the provider.

4.- Health Care Providers who care for the spiritual needs of patients should understand their own spirituality.

One cannot help in this very touchy subject if one is confused about our own belief system.

Ultimately, as said before, spiritual healing is an important part of wellness. But every provider should be aware of the fine line that spiritual care can pose.

Link to Journal:
Ethical Boundaries of Spiritual Care

Is Informed Consent Essential to Health Care Ethics?

Last month as an assignment, I was asked to debate the virtues and reasons of why Informed Consent is still essential to Health Care Ethics. I took the assignment and was very happy with the topic because I do believe that it is essential. Then after the debate was over, I started to think about the opposite side and how hard it would be to be in the "con" side of that statement.

Even though I agree that Informed Consent is essential to Health Care Ethics, I decided to look for options to Informed Consent and ask different health professionals about their thoughts. 

This are my results:

The Nurse: 

As a pediatric Nurse Mike O, believed that the only thing that could take over informed consent was the eduction of the Health Care Workers. With moral issues issues on the rise, he believed that by educating providers in advanced issues such as abortion and religious beliefs and the understanding and empathy, the informed consent walls that are put up could be avoided. 

The Physician:

Dr. K, a third year resident was surprised by the question, and told me that the only option to informed consent would be a modified informed consent. She believed that the consent could come from peer review, and that the every decision could be made with the help of a more experienced physician. This is already done in the case of Nurse Practitioners and Physician Assistants, but the input of the patient is always required.

The Administrator:

Carl T. is part of the business team, and he deals with billing. As you might know, a procedure can only be billed if the patient consents (explicitly or implicitly) to it. He believes that if we didn't have informed consent his job would be easier, but as expensive as our health system is provider induced demand would skyrocket. The solution, to have universal Health Care. That way, costs would not be a factor in what the physician would prescribe. Money would not be an option.

As you can see, all of the Health Care professionals had ideas, but none of them were perfect. Informed Consent, even with it's imperfections is the only (for now) way that we can curb the absolute power otherwise given to the people that care for us.  

Balancing Beneficence and Nonmaleficence

Beneficence is the principle of doing good, demonstrating kindness, showing compassion and helping others. In other words beneficence requires one to do good. For example resuscitating a person who is drowning,  encouraging a person to quit smoking.

Nonmaleficence is the principle of not doing harm, it is not concerned with improving life, but it is centered on the idea that by not inflicting harm on others, and as a result improving the lives of others. For example stopping a medicine that is showing harm to the patient, or even not telling the truth to a patient for fear of causing emotional pain. 

There are times when the balancing of the two are essential to Health Care Ethics. For example, one might not want to tell a patient about a condition because it would cause emotional pain, but by telling the person the person will be aware of the situation and seek help. Or one might want to help a person by prescribing a medication that has severe side effects, but if we measure the benefits we might find that treatment is harming the patient more than the disease. 

Neither option is universal by itself, and a balance of the two should be tried to reach in complete harmony. While neither of them is perfect; with good judgement and understanding of the two the health care provider can provide the best health care as possible. The most important factor is that we cannot rely on paternalistic views when making our decisions, we value self-determination and that should be accounted when making the decision. And because of Self-Determination, informed consent is completely essential. With it, and with the consensus of the patient, a health care worker can make the best decision in the care of said patient. 

Ethical Issues in Managed Care

Managed care in a nutshell sounds like an excellent idea. Paying Doctors for the managed health of the insurers. That means that instead of paying the doctor every time the patient uses their service, they get payed a fixed rate and are encouraged to keep their clients healthy. 

We know that the path to fix our health care system begins with prevention; and managed care focus on that, but it has it's shortcomings. Managed Care relies on gatekeepers and protocols that might limit the selection of physicians your insurance covers; and the latest issue is the limitations imposed on experimental treatment. 

In case study I read a physician "Dr. Stanley" the medical director at Springdale Health Systems, a regional managed care organization was in charge of authorizing or denying the coverage for an 8 year old with terminal cancer. His parents found out of an experimental procedure that could possibly treat their sons cancer. 

Should a physician be responsible for the decisions in the continuing health of a patient? The Hippocratic oath states that a physician should "leave this operation to be performed by practitioners, specialist in this art". Should we interpret this as "a physician should always look for the physician who will treat".

Health Care Management argues that experimental procedures are expensive and most of the time are not successful. But what happens if out of fifty procedures one is successful? 

Where is the beneficence on this case? Where is the greater good? Is the greater good in long term savings of resources and health care money by denying a procedure that has a very slim possibility of being successful; or is the greater good to save the life of one individual even though  resources will be scarce and treatment might not be successful.