Elder Care and New Ways to Stimulate the Economy

The U.S. will see a massive increase in the numbers of both young -old (ages 60 to 74) and old-old (ages 75 or more)  adults over the next decade. Despite the evidence which shows that more, expensive hospital care just increases costs, not patient health or satisfaction of care, there has been a massive increase in new hospital construction in response to the aging population. Studies have shown that Medicare spending in the last two years of life can vary up to 5-fold depending on where you go for treatment (http://www.nytimes.com/2008/04/07/health/policy/07care.html?scp=1&sq=researchers%20find%20huge%20variations%20in%20end%20of%20life%20treatment&st=cse). For example,  Medicare spending costs is $93, 842 per patient at the UCLA Medical Center and $53, 432 at the Mayo Clinic. According to the study’s director, Dr. John Wennberg of Dartmouth Medical School, “Contrary to popular assumption, its the volume of services, not the price per service, that accounts for most of the variation in Medicare spending”. At an institution such as the Mayo Clinic, patient care is coordinated by teams of salaried primary care physicians and nurses which has been shown to keep costs down.

The Institute of Medicine recommended that we should retool the healthcare system in response to the aging population by increasing the number of primary care physicians trained to care for the elderly (gerontologists) (JAMA 299:2611, 2008). To meet the demand they recommend an estimated 36,000 board-certified geriatricians; however, in 2007 only 253 of 468 first year geriatric training fellowships were filled. Why? Because Geriatric Medicine like all of Primary Care Medicine pays little compared to the higher profile specialty and sub-specialtiy fields.

The report also calls for more public, private and community organizations to help prepare family members and friends of elders to assist with home care and feel part of the long term care team. Currently, 70% of elders requiring long term care are cared for by family or friends. These unpaid, unprepared caregivers deliver 8.4 billion hours of home care with an economic value of $89 billion! 

How about using the economic stimulus package to beef up long term care for the aging population? $89 billion economic value!! Lets use some of the stimulus to build affordable, government-subsidized long term care facilities. Currently, nursing homes are only for the rich-costs can run upwards of $60,000 a year. This is a tremendous growth industry that can provide numerous employment opportunities. Caring for our loved ones at home is an economic “downer”. These caregivers are under a lot of strain which results in high absenteeism from work, more chronic disease, and depression all leading to less productivity and less revenue.

There is a lot of evidence which shows that primary care has more bang for the buck for delivering quality healthcare than specialist care. We don’t have to do anymore studies to come up with ways to attrack young doctors into primary care. Pay them more or offer them free education. We’ve been talking about how our current fee for service pay system focuses on number of procedures rather than quality care. Let’s change it! Primary care doctors should be paid handsomely for keeping patients healthy. This would drive healthcare costs down. I don’t think anyone would ague that Mayo’s costs are lower because they provide poor healthcare!

In today’s NY Times, Martin Fackler described some of the mistakes made by Japan when they initiated their stimulus package to recover from their economic downturn of the 1990’s http://community.nytimes.com/article/comments/2009/02/06/world/asia/06japan.html). They spent 180% of their $5.5 trillion dollar economy on mostly infrastructure projects! In the end many economists concluded that spending did little more than sink Japan into more debt leaving an enormous tax burden on future generations. I am not saying we scuttle our stimulus. What I am saying is that we should use the experience of the Japanese economic stimulus and generate a plan that will stimulate our economy. A nonprofit policy group in Japan found that you get the most bang for the buck by investing in care for the elderly and social programs. Financing for schools and education deliver even more stimulus! Yes, I  firmly agree that we must do something about our aging infrastructure. Levees must be rebuilt, schools must be modernized, bridges and roads must be repaired; however, let’s not use stimulus money to build bridges and highways to nowhere.

We can put stimulate our economy and reduce our healthcare costs by spending money on elder long term care. Senior citizens do as well or better when they avoid hospitalizations in the end of life and the economy would prosper by reducing costs and expanding a whole new industry.


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