Three Things That Could Keep You From Getting Quality Care

Trends in Health CareContributors: Florence Carlson, Sara Hamm, Abet Vego, James Standish

For many older Americans, it’s not until they’re faced with a health crisis that they think about finding quality long-term care they can afford. In fact, while 72% of adult children think their parents should be making long-term health plans, only 41% say their parents are actually doing so.1

Quality Care Preventers

If your assumption is that insurance, Medicare, or even your long-term care insurance policy will take care of everything if you have a health crisis, you might want to factor in three things that can keep you from getting the kind of quality care you deserve. And then plan accordingly.

  1. Finding Quality Care in a Crisis

    When Florence Carlson, a resident of Abbey Delray, talks about this issue, she gets people thinking with these questions. “What if suddenly, due to illness, skilled nursing care is required? Where do you go? Who chooses for you? How does one afford the high cost of nursing home care?” She adds, “When you’re no longer in control, having to make quick decisions is extremely challenging.”

    Sara Hamm, senior vice-president of Successful Aging & Health Services for Lifespace, says that getting an appointment with your busy primary care doctor may be difficult in a crisis. “If unable to secure a timely physician’s appointment, many aging adults resort to urgent care clinics or emergency rooms for medical care and treatment.”

    Abet Vego, director of Home Services at Beacon Hill, adds, “The choice of a hospital, clinic, or long-term facility is mostly dictated by the insurance policy. Patients may be admitted in a place that’s far from home or their family, or that may not suit their needs.”

    Vego also says that it’s not uncommon for unprepared seniors to be in a panic mode when a health emergency occurs. This stress can add to their health condition, especially if there are financial concerns, and make it harder to recover.

    Hamm notes something that can get overlooked when you’re facing a health crisis is ensuring appropriate discharge planning, follow-up care and securing where you’ll go after you’re discharged. “Winging it may compromise your health and well-being,” she says, “and may result in unplanned hospital readmissions or negative health consequences.”

  2. Coordinating Care

    What happens when you need more than one care provider? Or you have to move from the hospital to rehab or a long-term care center? How do you ensure that everyone involved knows your situation and can meet your needs?

    “If a resident comes to a health center and needs a transfer due to the provider’s inability to meet the resident’s needs, finding the right center can be a geographical and financial nightmare,” says James Standish, administrator at Beacon Hill.

    Hamm says, “A lack of coordination of care often results in unexpected emergency room visits and hospital readmissions.” Research indicates that aging adults receive approximately eight minutes of discharge education before they leave the acute care hospital setting. “Many of these patients have multiple health issues and take a large number of prescription medications,” says Hamm. “It’s estimated that 30% of rehospitalizations among seniors are the result of medication errors. If discharge orders and follow-up instructions are unclear or incorrect, medication errors may occur and a lack of timely follow-up may result, which often leads to rehospitalization within 30 days of discharge.”

  3. Long-Term Health Care Costs

    The costs of health care keep rising, and many seniors underestimate how much care will cost. In fact, 60% can’t estimate health care costs in retirement.2

    According to the latest Fidelity Investments Retirement Health Care Cost Estimate, the average couple can expect to spend an estimated $245,000 on health care throughout retirement.3

    “Many seniors believe that because they have Medicare, all health care costs are covered. This is completely untrue,” says Hamm. “Medicare Part A covers inpatient skilled nursing and rehabilitation services in a health care center. Medicare won’t cover 100% of services. It only covers a maximum of 100 days, and very few patients receive 100 days of Medicare coverage due to the technical requirements. In addition, most secondary insurance policies do not cover long-term care or home health services. You need to have additional funding sources.”

    When faced with large out-of-pocket expenses they can’t afford, some seniors have chosen to go home and/or forego the necessary level of care – which can cause even more health problems. Some have had to rely on family members to care for them or to pay for their care. And in worst-case scenarios, some have had to sell their homes and assets.

What Can You Do?

What advice does Florence have for peers who don’t have a contingency plan in place yet?

“Many seniors have opted to move to a continuing care community while they are well enough to enjoy the many benefits and activities of independent living,” she says. “Then, if needed, they are in a position to transition into assisted living or skilled nursing care. Your care plan, which would include all necessary providers and medications, is supervised by doctors and nurses.”

Hamm notes, “We don’t plan vacations without researching a variety of hotels, resorts and accommodations.” With something as important as long-term care, or even post-discharge care following hospitalization, it’s important that you research your options now so that you have a plan of action to get quality health care in case you ever need it.

1. Fidelity Investments® Family & Finance Study 2016
2. Nationwide 2016 Health Care Costs in Retirement Survey
3. Fidelity Investments® Family & Finance Study 2016