group plans and about 1 million are covered under mass-enrollment programs. The remaining aged (about 2.5 million) covered by insurance companies have individual policies. The following table (source Blue Cross Association) shows the proportion of the hospital bill presently covered by hospital insurance for the two categories (1) Patients under 65 and (2) patients over 65: A second method for the financing of the health care of the aged is that of public programs. Most noteworthy are state public assistance programs, established under the Social Security Act and financed in part from federal grants-in-aid. Public Assistance is primarily an income-maintenance program for those needy individuals who meet the requirements of a means test. Recent amendments have increased the extent to which the federal government will share in state and local expenditures for health care of individual recipients. The programs for providing medical care for the needy 65 years of age and older under Public Assistance are administered by the respective states and benefits may vary accordingly. The Kerr-Mills Amendment of 1960 to the Social Security Act adds a new category - medical assistance for the aged. This Amendment provides vendor medical payments.for the medically indigent and makes liberalized federal grants to state programs under old-age assistance. Implementation of Kerr-Mills rests with the respective states. If a state decides to participate in the medical assistance program for the medically indigent aged, it must provide both institutional and non-institutional services. Beyond the basic requirement, the state is free to determine benefits. Hence, the benefits, under state implementation now effect, vary considerably. The range of possibility is great when a state chooses to participate. It may cover all of these services: inpatient hospital services; skilled nursing home services; physicians' services; outpatient hospital services; home health services; private duty nursing services; physical therapy and related services; dental services; laboratory and x-ray services; prescribed drugs, eye glasses, dentures, and prosthetics; diagnostic, screening, and preventive services; and any other medical care or remedial care recognized under state law. The purpose of this program is to provide benefits to those aged whose income is insufficient to meet medical expenses plus other personal requirements. Provisions for eligibility may vary from state to state. It is estimated that perhaps eight million of the nation's approximately 17 million individuals 65 years or older would be eligible for M. A.A., if the average program of presently participating states was entire to all the states. Such a program, if extended, would cost about $800 million per annum, including federal, state and local costs. Other programs are being proposed to add to, or replace, some of the present programs for health care for the aged. For example, there is the King-Anderson bill in the federal Congress which has the support of the present Administration. It is the subject of intense idealogical debate and proposes to use the Social Security mechanism for the raising of tax funds to support it. The provisions of this proposed legislation would offer the following benefits for individuals 65 and over under the Social Security and railroad retirement systems: (1). Inpatient hospital services up to 90 days in a benefit period, subject to a deductible amount (paid by the patient) of $10 a day for up to nine days, with a minimum of $20. (2). Skilled nursing home services, after transfer from a hospital, for up to 180 days. (3). Outpatient hospital diagnostic services as required, subject to a $20 deductible amount in any one diagnostic study. (4). Home health services up to 240 visits in one calendar year, including part-time or intermittent nursing care, therapy, medical social services and part-time homemaker services. In addition, the Blue Cross Association has developed a set of benefits for what is called a National Blue Cross Open Enrollment Program. Those eligible for this contract would be all persons age 65 and over who are presently enrolled, as well as those not now covered by Blue Cross. The objective of this proposal is to realize a national Blue Cross plan for the aged with adequate coverage. This is a voluntary, non-profit proposal. Those with adequate funds could purchase their own policies and those with incomes below a certain level could participate through government assistance in event that the government would choose to use this program. The proposed benefits are: (1). 70 days of care in any acute general hospital in accommodations having three or more beds (including room and board, general nursing service, drugs, dressings, and the customary services provided by hospitals). (2). Emergency accident care within 72 hours in the outpatient department for surgical procedures and benefits for x-ray and radiation therapy. (4). Visiting home nursing services up to 70 visits per year. (5). Also, care in chronic and rehabilitation hospitals. VI. SERVICES FOR THE AGED AND CHRONICALLY ILL The question of the kind and extent of services that should be provided arises are considered. in rather pertinent form as the health needs of the aged and the chronically ill The Commission on Chronic Illness states that the variety of services and facilities useful to the long-term patients illustrates the complexity of their needs. The Commission specifies that at some time in the course of the long-term illness, regardless of whether at home, or in a general or special hospital, or in special institution, that the patient will require several of these As this list indicates, the long-term patient needs, in addition to definitive medical care, those services that will restore his morale and will serve to keep him intellectually and emotionally in the stream of life. Social work, occupational therapy, physical therapy, rehabilitative services and counselling services are of prime importance in the care of the chronically ill. The psychological adjustment that is required of the long-term patient is one that must be constantly kept in mind and facilitated. His self-image is gravely menaced, and others in actuality tend to view him as inferior. The psychological and spiritual phase of his problem must be adequately met. Edna Nicholson, in her book "Planning New Institutional Facilities for LongTerm Care", points out that in addition to medical services and nursing services that rehabilitation, physical therapy, occupational and recreational therapy, religious activities and social service are of vital importance. The following is a brief rationale for these services: (1). Rehabilitation Every institution should provide for each patient the services necessary to restore him to his best possible capacity for normal living and to maintain this capacity. Rehabilitation means more than mere custodial care and should be an integral part of every long-term patient's treatment if such treatment is indicated. The use of a psychiatrist, a physical therapist, an occupational therapist, and the provision for vocational counselling and training are necessary aspects of rehabilitation. Even the recovery of a partial or a very limited independence must be considered as worthwhile. :). Physical Therapy This service is important both in rehabilitation of the patient and in relieving discomfort. It should be available in all institutions for the aged or chronically ill to improve the physical function of the patient |