More on Complex Health Needs for Seniors


In previous articles, I have talked about the “medically complex senior” as a phenomenon that is increasingly recognized in today’s health care world.  You can see these articles in the following search results.

One of the basic components of the concept is chronic disease, and quite often multiple chronic diseases, that the senior must deal with.  This is an issue both for the caregivers, clinical or not, but it is also a huge financial issue for our health care system, overall.

beckershospitalreview.com recently published a review of a number of what they call “healthcare niches.”  One of those is chronic disease.  Among other things, they point out that,

… a huge amount of healthcare dollars are spent on chronic diseases, including asthma, diabetes, and chronic obstructive pulmonary disease.

Within this context, beckershospitalreview.com quotes the Cleveland Clinic that,

… personal health behaviors are a major cause of the unsustainable medical costs and chronic illnesses that are overwhelming [the U.S.] healthcare system.  Almost three-fourths of all medical costs are for four chronic conditions: cardiovascular disease, obesity, diabetes and cancer.

The summary by beckershospitalreview.com goes on to say that,

Sixty to 90 percent of these ailments are preventable and approximately 96 percent of all Medicare dollars are used for people with chronic illnesses.

So, what is obvious is that the medically complex senior, quite probably suffering from multiple chronic diseases (at Support For Home Health Care, we have provided care from folks suffering from lung cancer and diabetes; from COPD and congestive heart failure; from diabetes and heart disease …), is a very large segment of our patient population.

What is not always as obvious is that their needs – and the treatments required – go well beyond the purely clinical approach.  The Agency for Healthcare Research and Quality, of the U.S. Department of Health & Human Resources, published a white paper titled, “Coordinating Care for Adults with Complex Care Needs in the Patient-Centered Home: Challenges and Solutions”.

Yes, the study is actually longer than the title. 🙂  The bottom line for the study is that,

Patients who have complex health needs require both medical and social services and support from a wide variety of providers and caregivers, and the patient-centered medical home (PCMH) offers a promising model for providing comprehensive, coordinated care.  Smaller practices, however, face particular challenges in coordinating care for these patients.

This is one of the most critical points about caring for the medically complex senior.  It is not just about good clinical care.  It is about the services of “a wide variety of providers and caregivers,” including support for Activities of Daily Living (ADLs and Instrumental ADLs).

A Band-Aid on Health Care

If Medicare reform and health care reform, more broadly, is going to be successful, the broad approach of the patient-centered medical home, inclusive of non-clinical caregiving, is going to be a critical component.  Additionally, the temptations of clinical thinkers to shrink back into the traditional mold will need to be resisted.  Health care is both clinical and non-clinical, if it is to be successful.  Anything else is just a Band-Aid.

Best wishes.  Bert

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