Aging Baby Boomers Come Up for Air

• By Jason Hensel, Jill Hanson
• Sep 01, 2002

America's health care system faces a compounding challenge: It must control costs and maximize outcomes as a staggering percentage of its population grows old.

Determining the best critical pathways and plans for the delivery of appropriate patient care may always involve controversy. Reimbursement and regulatory pressures will continually raise questions about the government's abilities to meet escalating costs and rampant demand. In this chaotic environment, home care consistently emerges as a solution.

The baby boom, represented by those born between 1946 and 1964, comprises the largest segment of the U.S. population, and it is aging. As boomers age, it is inevitable that health care utilization in our country will skyrocket.

Like many other countries, the U.S. 50+ population is increasing as a percentage of the total population. At the onset of the millennium, about 28 percent-or 76 million-of Americans were age 50. By 2020, 40 million more people will enter that category which will then comprise 36 percent of the total U.S. population. This equates to someone turning age 50 every eight seconds during the next 20 years.

The pressures this places on the health care system-the costs and care required-is profound.

In this chaotic environment, home care consistently emerges as a solution.

Meanwhile, the percentage of insured among America's aging is on the decline. According to the American Association of Retired Persons (AARP), the percentage of uninsured between 50 years and 64 years of age rose from 11 percent to 14 percent between 1988-2000.

There are, however, some positive trends in the aging boomer crowd. All signs point to the fact that they don't intend to run off to a nursing home or sit in a rocking chair anytime soon. In fact, they plan to spend as many of their so-called retired years still busy at work. And, with the healthier lifestyle choices that have become increasingly popular among baby boomers and Americans today, coupled with a more aggressive approach to disease prevention, disease management, patient care and education, this group is well-equipped to ward off some of the afflictions which traditionally hit Americans in very high incidence rates.

Home Care: The Prudent Solution

Most people, particularly baby boomers, would prefer to recover or be cared for in the comfort of their own homes. Research continually shows that recovery is enhanced and expedited when a patient has the chance to heal at home.

Several studies have determined the following conclusions about home care:

• Shortens inpatient hospital stays in certain situations.
• Reduces overall cost of care without sacrificing outcomes.
• Improves outcomes including mortality.
• Proves satisfying and rewarding to the patient and caregiver.
• Improves patient independence and reduces the risks of potential placement in a health care institution such as a nursing home, long-term health care center or assisted living facility.
• It can be among the most cost-effective strategy for achieving improvement when compared with inpatient rehabilitation, nursing home-based care and hospital-discharge without the introduction of formal home care services.
• Achieves highly favorable results when a goal-oriented program is developed and followed through.
• Produces favorable results over brief periods of time when targeted to specific interventions.

Today, with technological advances continually entering the health care field along with the reimbursement pressures that face the industry, home care has become the most welcome, rational and resourceful solution. The ability to provide various types of care to patients in their own homes has been embraced by patient, payer and physician alike. Patients get the opportunity to be cared for in their homes; payers are able to control escalating health care costs; and physicians can work closely with health care providers to monitor patient progress and successes.

The integration of home health care into a plan of care can relieve pressures on our health care system and actually aid those baby boomers faced with unfortunate disease occurrences. In fact, as these baby boomers age, more technologies will become available, making the prospect for home care even more viable.

One particular area of home health care on the rise is the delivery of home respiratory therapy services. The home respiratory care market currently represents approximately $4 billion of the total health care pie, with growth in the services sector estimated at approximately thirteen percent annually over the past five years.

Today, many respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma and pneumonia are manageable in the home if appropriate plans of care have been established. The key component to the delivery of a successful home care program is the establishment of an appropriate and realistic plan of care, which incorporates an extensive disease management approach.

Coming Up for Air

As baby boomers mature, their health care utilization will begin to tax our health care system, posing a threat to Medicare and Medicaid reimbursement and raising further question about our government's abilities to support these demands.

The Institute For the Future, Menlo Park, Calif., made several conclusions when asked to predict what the U.S. health care system would resemble in the next decade. These include:

• Between now and 2010, the country will need significantly more nurses and more nurse practitioners in nursing homes, clinics and community health settings.
• The drop in hospital beds, which began in the 1990s, will continue as more care will take place in the home.
• Real-time, on-line analysis of clinical outcomes will dominate care choices.
• Use of medical devices, drugs, minimally invasive surgery and gene-mapping will accelerate.
• Case managers will assume a larger role, and they will incorporate more psychosocial aspects into care.
• Providers will make more of an effort to achieve best practices with the aid of pathways and protocols, ensuring continuity of care across all delivery sites.
• Patients will be more empowered in their self-care.

It is believed that skyrocketing incidence rates of lung disease among aging baby boomers will have a devastating effect on already strained health care budgets in the United States as well as other nations.

COPD continues to rank relatively high in prevalence rates among aging Americans. COPD is a disease of the airways with slow progression, which exhibits continuing loss of lung function. COPD includes chronic bronchitis, chronic obstructive bronchitis, emphysema, or a mixture of these diseases. Symptoms of COPD vary from chronic cough and phlegm production to acute shortness of breath. In certain people, the chronic coughing and phlegm are the initial signals that there is a risk for the onset of airflow obstruction and the development of shortness of breath symptoms which serve as disease indicators. In others, it is the shortness of breath that may be among the first signs of COPD.

The National Heart, Lung and Blood Institute estimates there are about 16 million American adults with COPD. This number encompasses approximately 14 million who have chronic bronchitis and two million who have emphysema. Many more Americans may have COPD but are unaware of it because the disease has not yet shown symptoms. According to the World Health Organization, COPD was the fourth leading cause of death worldwide in 2000. It ranks fourth in the U.S. and is expected to rank third by 2020.

The most significant risk factor for COPD is cigarette smoking. Other types of tobacco such as pipe and cigar also pose risk factors. Occupational dusts and chemicals are also known to cause COPD while air pollution can also be a considerable irritant to lung diseases. The most important step toward preventing COPD, and inhibiting its progression, is the elimination of smoking. Presently, there is no identified cure for COPD. Treatment for COPD is usually designed to alleviate symptoms and enhance quality of life.

In the United States. during 2000, the direct and indirect costs of COPD were estimated to be at about $30.4 billion. Direct costs (which include those associated with hospitals, physician and other professional care, home care, nursing home care and medications) represented $14.7 billion and indirect costs (lost earnings due to illness and lost future earnings resulting from death) accounted for $15.7 billion.

Other prevalent respiratory diseases include emphysema and asthma, once thought to primarily afflict children but is now of grave concern to people of all ages.

Since COPD is becoming increasingly prevalent among the 50+, the American Association for Respiratory Care (AARC) is lending its foresight and expertise to the respiratory industry to help address this dramatic up rise. The AARC has begun to encourage and prepare respiratory therapists and providers to assume greater roles in the case management of COPD and asthma patients. This includes arming industry professionals with the appropriate tools and skills necessary to manage these diseases. The recent AARC initiatives include the hosting of a series of workshops that aid in patient assessment of various respiratory diseases such as COPD as well as an asthma disease management program.

The Control Factor: Disease Management

As the baby boomers age, they will certainly become more prone to a variety of respiratory diseases, however, more importantly, they also will be taking a more proactive role in the establishment and implementation of their own plans of care.

The ability to decrease the rising costs of health care for patients with chronic illnesses through the implementation of disease management programs continues to gain broad acceptance among the medical community. This process has led to the emergence of full-scale disease management programs that require involvement on the part of the patient, payer and physician.

Disease management programs are finally receiving the recognition they deserve and are proving the benefits they can reap. These programs have gained broad acceptance and in certain instances, are being integrated into the reimbursement equation. And, home health care is becoming more accepted as a key element to an effective disease management program.

Historically, care plans were outlined and ordered by physicians without the establishment of any criteria for these directives. Physicians would simply determine the path of care and prescribe it to patients. Not many questions were asked and the plan of care was dictated by the power of the doctor's pen.

Today, there are standards of care criterion, which are based on objective data. Patients must meet certain criteria for specific plans of care in order to receive appropriate reimbursement.

Cost containment pressures remain rampant in today's health care landscape and cost cutting measures are driving the changes we are seeing in the delivery of care. Patients are now entering the hospital sicker yet being forced to leave sooner.

The homecare solution provides a favorable environment for those respiratory care providers who can meet the needs of patients in their own home and help them with their own administering of care and education. The primary goal of home respiratory therapy services providers is to supplement the patient's needs in the home setting. Those needs are now higher because patients are facing earlier hospital discharges and are being sent home to recuperate.

Respiratory Care Providers to the Rescue

With homecare becoming a more apparent solution for many, various providers are racing to aid patients upon their discharge from the hospital. Respiratory care providers in particular can play a vital role in the home treatment and management of respiratory disease by focusing on certain objectives, such as:

• Aiding in the diagnosis process and determining progression of lung disease afflictions.
• Helping avoid repeated hospital visits through the establishment of plans of care and disease management programs.
• Working closely with physicians and payors to create plans of care that guide patients while controlling costs. The plans of care they help facilitate incorporate several key components:

Patient Education

Respiratory care providers often become very involved in a range of education programs designed to increase public awareness. These include preventative programs focused on educating the healthy about the ramifications of lung disease. It can also include the sponsoring of health fairs where simple tests such as an oximetry are being performed to measure oxygen in the blood and detect potential cardio-respiratory disease.

Patient Involvement

Patient involvement is another education function that can be spearheaded by the respiratory care provider. Respiratory care providers place great emphasis on involving patients in their own care practices. They play an important role in helping patients learn how to manage their disease and how to comply with their plans of care. Frequently, respiratory care providers are primary supporters of programs such as asthma camps or local respiratory support groups or clubs which serve as a platform for joining patients together, allowing them to establish camaraderie among others faced with similar conditions.

Patient and Caregiver roles

It is important to allow patients to become an integral part of the plan of care and the decision making process. At the time of hospital discharge, the respiratory care provider can meet with the patient and offer extensive demonstrations on equipment usage and provide trouble-shooting tips. They also take time to explain why certain medications were prescribed and elaborate on possible side affects. This approach can make patients aware and alleviate uncertainties they may be experiencing from the prescribed plan of care.

Patient Assessment and Follow up

Respiratory care providers continue the patient involvement process after the patient is sent home. They aggressively conduct phone assessments and make in-home visits to review patient compliance and progress. This close observation helps to ensure progress and avoid the likelihood of readmission to the hospital and occurrence of higher utilization costs.

Patient monitoring

Respiratory care providers serve as a liaison for patients and physicians in the care process. During the follow up process, respiratory care providers can determine patient status through their assessments. By coordinating data collection and evaluations, they can provide early detection in any changes to the plan of care, make necessary alterations and provide the physician with early relevant feedback.

Patient Progress and Outcomes

It is the close relationship forged between the three parties - patient, payor and physician - that contributes to achieving the best possible patient outcomes. Most importantly, respiratory care providers remain committed to securing positive patient outcomes and empowering patients as they attempt to manage their disease in their own homes, with the support of family members. Since patients are involved in devising the plan of care, they are more in control.

These initiatives allow respiratory care providers to help stabilize lung conditions in the home setting and enable them to be prominent contributors to patients' plans of care. By aligning with physicians and working closely with payors, respiratory care providers are offering a stronger support system to lung disease patients spanning all ages and conditions.

The Great Boom Ahead

Pursuing care in the home, as baby boomers mature, will be extremely significant to controlling overall health care expenditures over the next 20+ years. Already, home care is becoming the solution of choice for managing health care costs and fostering recovery processes.

Physicians and payers are placing more value on the role respiratory care providers play in patient care and the development of appropriate disease management programs. And with advances in technology and close attention to patient progress, their capabilities will continue to grow.

There is no doubt that baby boomers will contribute to escalating health care utilization. However, there is also no doubt that the provision of respiratory care services in the home, when administered by committed, qualified and educated providers, will ease the ailing system.

Since fees for providing care in the home are significantly less than those associated with the delivery of acute care, home care will continue to play an integral role in our health care system in the 21st century. There will be few better ways to address the unparalleled increase in the number of people at risk for costly age-related chronic diseases and health conditions.

This article originally appeared in the September 2002 issue of HME Business.