What is right/wrong with this (Aging in Place) Picture

I started reading this USA Today article about states enrolling their long term care clients in private plans to save money. Intriguing. They finally get the cost savings that come from good monitoring and management at home? Clients live in the home of their choice. One client who is sprung form a nursing home is quoted ” I never thought I would get out.” Though the story is not about aging, Aging in Place is implied when the coming boomer hordes are mentioned.

The article describe lifts installed to get clients into their homes and into and out of bed. The article explains that aids are brought in to help with bathing and other chores. Care coordination is a significant element. In one state the waiting lists for home and community based services are slashed when managed care takes over.  The article explains the nursing home industry concern about cutting into their territory. I am thinking we are on the right track.

Is the managed care bureaucracy that much more efficient? How is the money saved?

Wait. Things aren’t that good. The new private clients are medicaid recipients. Some are also on medicare. Two different administrative units. Left hand doesn’t know what right hand is doing. Client is hospitalized by a medicare paid physician, but medicaid funded managed care program is not informed. Did I use the word coordination?

Wait once more. It gets worse.  The lead to the story is a young woman suffering from the continued effects of a devastating motorcycle accident. Her mother is now caring for her at home. The move home saves the insurer $18,000/year. It all works because her mother, a former nurse, retired to care for her. Mom curtailed her working career to provide her daughter a better life, saving the insurance company a small portion of what mom was earning. That is not sense! This is freakenomics!

The closing has more truth. The care coordinator “has arranged for home care aides to occasionally work additional hours so Holly’s mother can get some rest.”. Is the story about balancing medicaid spending on the backs of families?

I have often said we need to support family and informal caregivers to take advantage of the value they provide. No one doubts that care at home is better and mom, husband and daughter in law are better caregivers. The National Alliance for Caregiving has demonstrated the value. But this is economic shenanigans. There are lots of analogs. Mountain top removal mining without considering the cost of the streams destroyed. Farming and non-point sources destroying ecosystems and fisheries. Manufacturing production that does not account for the cost of air pollution or employee health. There are countless examples of old school economics where the costs of resources, waste and destruction are ignored. Do we have to learn this all over again as we move to health care at home? We need real, whole cost accounting as we innovate.