May 22, 1974
Page 16018
NRTA-AARP STATEMENT SUPPORTS S. 2695, HOME HEALTH SERVICES ACT
Mr. MUSKIE. Mr. President, the American Association of Retired Persons and the National Retired Teachers Association recently presented a statement to the Subcommittee on Health of the Senate Committee on Labor and Public Welfare which not only strongly supports S. 2695 but persuasively argues that there is an imbalance in our utilization of health services.
In reviewing the performance of Medicare, the associations state:
There is a clear indication that the use of in-hospital services rose with the introduction of the program and continues to increase. The program has responded reasonably well in treating acute ailments. However, there has been very little use of the post-hospital alternatives – extended care facilities and home health services. In short, insurance coverage is heavily skewed among the different services, causing an imbalance in benefit coverage and an unbalanced and generally expensive pattern of utilization.
I heartily concur with this statement, for the Subcommittee on Health of the Elderly, of which I am chairman, has received a wealth of evidence that home health services and other alternatives are not adequately covered by medicare. As a result, the elderly may be treated inappropriately in acute care hospitals simply because the reimbursement mechanism favors such treatment.
Aged persons often have chronic and disabling ailments which require different types of services from those provided to the acutely ill. Yet the lack of alternatives forces them into the acute care system.
The lack of coverage by medicare is a major reason why our home health resources are so underdeveloped and in short supply almost everywhere. On the other hand, we have developed an oversupply of hospital beds in many areas. This imbalance in resources needs to be closely examined as the Congress considers national health insurance legislation.
S. 2695 would be a first step in correcting this imbalance and 26 Senators have joined in cosponsoring this legislation which is a part of the home health legislative package introduced by Senator FRANK CHURCH, chairman of the Committee on Aging, and myself.
Mr. President, I request unanimous consent that the statement by the associations be printed in the RECORD.
There being no objection, the statement was ordered to be printed in the RECORD, as follows:
STATEMENT OF CYRIL F. BRICKFIELD, LEGISLATIVE COUNSEL
On behalf of the American Association of Retired Persons and the National Retired Teachers Association, with a combined membership of more than six million older Americans, I would like to express our strong support of legislation introduced by Senator Church to stimulate the expansion of home health agencies and services (S. 2695).
Before turning our attention to this important legislation, Mr. Chairman, I would appreciate your indulgence in a brief discussion of our Associations' position on home health care.
Earlier this year, our twenty-member Legislative Council – a volunteer panel of experts which formulates our Associations' legislative policy – adopted the following policy statement:
The cost of institutional care requires the upgrading of home health services to provide a viable alternative in the health care of older Americans.
Working from this policy directive, my staff, in conjunction with program components of our Associations, developed three key objectives for Congressional action:
1. An expansion and clarification of the eligibility for home health care under Title XVIII and Title XIX (Social Security Act) to make home health care a realistic alternative to institutional care. Such redefinition should include vital homemaking services, necessary transportation costs and inhalation therapy as reimbursable items. Existing eligibility restraints should be eliminated.
2. We urge the elimination of the three-day prior hospital stay requirement for home health care benefits under Part A of Medicare.
3. We urge a federal grant and loan program to assist and encourage the development of home health agencies.
Legislation containing the first two objectives has been introduced and referred to another committee for consideration. I speak of S. 2690, introduced by Senator Muskie and Senator Church, which has been referred to the Senate Finance Committee and S. 3154 (the Comprehensive Medicare Reform Act of 1974), introduced by Senator Ribicoff, which has also been referred to the Senate Finance Committee.
Reviewing the performance of Medicare, there is clear indication that the use of in-hospital services rose with the introduction of the program and continues to increase. The program has responded reasonably well in treating acute ailments. However, there has been very little use of the post-hospital alternatives – extended care facilities and home health services. In short, insurance coverage is heavily skewed among the different medical services, causing an imbalance in benefit coverage and an unbalanced and generally expensive pattern of utilization.
Our Associations are concerned that the elderly are not utilizing the kind of health services they probably need to the extent necessary, with the possible exception of acute inpatient hospital care. Despite increased social visibility and increased levels of public funding in their behalf, there is ample evidence to indicate that the aged, and particularly the chronically ill and disabled, have not been particularly successful in securing appropriate health services.
The importance of our failure to service the aged chronically ill and disabled has broad implications when one realizes that 40 percent of persons 65 years and over suffer some limitation of activities because of chronic conditions. Recognizing that the oldest part of the older population is growing faster – that segment of the population which has a significantly higher impairment of functions due to chronic illness – our need for direct action to stimulate health programs to meet the needs of this growing population becomes apparent.
With this as a means of introduction, let us turn our attention to our third legislative objective – the provision of aid to home health agencies – which is encompassed in S. 2695, the Home Health Services Act now before this Committee.
The demand for medical services is greater today than ever before, and the capacity of our nation's medical care system is being severely strained by these demands. There is a major need to refocus our health strategies to improve efficiency and insure optimum utilization of our scarce medical resources. Although we view no one approach as the panacea, neither should one course of action be discouraged. In this light, we believe that home health services may well be one of the more promising approaches to help resolve the complex problems hampering the efficient delivery of health care in our nation.
As the Senate Special Committee on Aging report on Home Health Services in the United States points out:
"The availability of comprehensive home health services in the United States could substantially affect the appropriate utilization of all health care resources. Such comprehensive services are not available at the present time. The potential of broad community-based home health programs capable of serving large population groups with varying and fluctuating needs has barely been demonstrated. Hospital-based programs are also in short supply and are not being developed in proportion to need. Focused upon short-term concentrated care, they do not have available in the community those services which can be extended to meet longrange need. Home health services, where they do exist are under-financed, limited in their capacity to cover the population in need and frequently lacking in essential components which might make them an effective resource."
We view the Home Health Services Act as a viable incentive to stimulate home health care. Now, no mechanism exists for home health agencies to expand or for new ones to be established in communities without services. Home health agencies do not have sufficient funds to finance the expansion of services since their reimbursement barely covers operating costs. S. 2695 offers a plan of action to assist public and nonprofit home health agencies in extending their services to those in need as well as a structured grant program to initiate new home health agencies where none exist. Equally important, S. 2695 authorizes a much needed program for training home health personnel.
A review of home health services leads to the conclusion that they do not constitute a valid resource for the population which could make appropriate use of them. They are in short supply; they do not offer the comprehensive range of services required; they are limited in their capacity to provide for any significant volume of the population in need; and they have no geographic coverage. Where they do exist, the services are fragmented and are decreasing rather than expanding.
Our Associations believe that home health services are an essential component of any system of comprehensive health care. The Home Health Services Act (S. 2695) is an important program to make these services available, and we urge immediate passage of this legislation.