VOLUME 8, ISSUE 4

 

The Magazine for the Respiratory Care Professional eae Om as lces

AARTimes presents the proceedings of the
Surgeon General’s Regional Workshop on Home Care

 
Home Care Savings Potential
Draws National Attention

Al Kemp Addresses Community-Oriented Home Care

The disabled comprise the fastest growing segment of our population, and the
most vulnerable within these groupings are the children and the elderly. Here inthe St. Louis area, asis
the case in the rest of the country, we find probably the fastest growing segmentof our population by age
category — those over 65. This is the top region of the country as far as the proportion of
percentage of elderly over 65.

Medical, surgical and technical advances have saved the lives of children andadults who would have
died in past years. Children and adults with multiple disabilities now live longer and have more
productive lives. The ramifications for health care needs of these disabled children and adults depen-
dent upon technology for daily living are far reaching and complex. Pioneering efforts of
doctors and nurses, allied health professionals, state agency officials, insurance, hospital adminis-
trators, social workers and parents’ advocacy groups have made it possible for ventilator-dependent
children to live in the community with significant savings. Yet now, this growing population needs
regional coordinating organizations to maintain and refine current Strategies providing
community-based health care to guide and support parent groups and to educate the professional and

private sector about the dynamics of community-oriented home care. For these reasons, we are
gathered here today.®

Sam Giordano Says Communication Vital To Home Care Success

This country’s method of providing health care is undergoing a great deal of
scrutiny and revision. The problem is in achieving a balance between cost efficient medica! care and
quality care. One possible and popular solution to the problem is the “unbundling” of medical
services. Simply stated, this means that efforts should be made to effect an appropriate match of
health care resources to patient needs. This results in a more cost effective way of rendering care
with assurances that the patient will receive necessary medical care.

A key element in the unbundling process is home care. The Surgeon General,
C. Everett Koop, MD, recognized that a significant benefit could be derived if certain patients not re-
quiring hospitalization could be supported in their home environments. Pursuant to that goal, Dr. Koop
convened a workshop on the plight of the ventilator-dependent child in late 1982. Several important
recommendations were generated at the workshop. Not the least of those was to hold future
workshops to identify problems and barriers confronting the home care patient, and to establish a
network of that first follow-up workshop. Held Dec. 13, 1983, in St. Louis, MO, health care providers
and ventilator-dependent patients from across the country convened to share their stories and to
develop an understanding of the problems with home care under our present health system. lam sure
that after reviewing this issue, you will find that there is a great deal of support for the home care
patient, however, that aid is lacking central coordination and consistency.

It is our hope to continue to present the latest information on ideas, problems and methods,
for indeed the first step in establishing an adequate structure to support home care must be
communication — two-way communication. This issue satisfies only a part of that request. | invite you
to satisfy the second part: please give us the benefit of your thinking. Please share with us ideas that
may not be presented in this issue, and certainly send us comments on the subjects as they are

presented here. This exchange will eventually result in an efficient and effective home care support
network throughout this country. @

PaGaL PREM OLA TN Ce mel ast YET Tela mVA I] Department of Health and Human Services
AS

am Giordana, RRT, is executive director of the American Association for Respiratory Therapy.

 
 

 

WhatlIsA Waiver?

Many of the articles in this special report on the Surgec>
General's Workshop refer to the waivers available to ven=:.2:c"-
dependent patients. if you are unfamiliar with the waiver o7ccess.
it is important to note that there are different kinds of wa... 275

In 1981, as part of the Budget Reconciliation Act, Congress gave
the states greater flexibility to establish home and communtv-
based long term delivery systems for Medicaid individuais 4 risk
of institutionalization. These waivers, known as Section 2176
waivers are quite different intheir scopes, with some states targeting
solely on the aged and physically disabled population, while oiners
focus on the developmentally disabled. Each state requests its
own range of services, and some do include respiratory therapy
home care.

There is a second kind of waiver permitted under the 2176
program. The “model waivers” permit a state to target a specific
group of no more than 50 blind or disabled individuals for Medicaid
eligibility and community-based long term care services who, jf
without the waiver, would be eligible for Medicaid benefits only
if institutionalized.

Further, there are the Katie Beckett waivers, established
by Section 134 of PL 97-248. These waivers give the states
the option of extending coverage to disabled children living
at home or in the community provided that the cost of the
care does not exceed the cost of institutional care.
Interestingly, and this is the basis of part of the AART'S

 

 

 

arguments, only one state, Idaho, has chosen the ob Qn

Section 134 Katie Beckett waiver option. Ge Sen, Very, e

Avery important fact to note about the waiver Pap teray, Ce C25 Cen,

system is that it is exactly that — 2 system which ie, § Cooé th? t &P 1p

waives existing rules. It becomes the exception IPecay , Nora. Pn Xen ; 1995
rather than the rule. The AART firmly believes that te ve ne 2o, 6° e An, %

respiratory care for ventilator dependent Wig Cw 4 vo 2 Chy, ery VAL,

individuals ought to be the rule rather than nonin th diggPe an Mon ea or a

the exception. Scio} lits wy “F Witp, aie etuy