In recent months, much attention has been focused on the baby boomers and their impact on healthcare. A report released on July 10 by the Institute of Medicine (IOM; the health arm of the National Academy of Sciences) presented some disturbing findings regarding care for mental health and substance abuse issues for seniors.
The committee that formulated the report noted that millions of baby boomers are likely to face difficulties getting diagnoses and treatment for these problems unless there is a major effort to significantly boost the number of health professionals and other service providers able to supply this care as the population ages. The report noted that the magnitude of the problem is so great that no single approach or isolated changes in a few federal agencies or programs will address it.
The report notes the need for a redesign of Medicare and Medicaid payment rules to guarantee coverage of counseling, care management, and other types of services crucial for treating mental health conditions and substance use problems so that clinicians are willing to provide this care. It added that organizations that accredit health and social service professional schools and license providers should ensure that all who care for seniors, including primary care physicians, nurses, physicians’ assistants, and social workers, are able to recognize signs and symptoms of geriatric mental health conditions, neglect, and substance misuse and abuse and provide at least basic care.
The committee recommended that the top leaders of the US Department of Health and Human Services should promote national attention to building a work force of sufficient size that is trained in geriatric mental health and substance abuse care. They should ensure that all the department’s relevant agencies are devoting sufficient attention and resources to these conditions. The committee conservatively estimated that between 5.6 million and 8 million older Americans (14-20% of the nation’s overall senior population) have one or more mental health conditions or problems stemming from substance misuse or abuse. Depressive disorders and dementia-related behavioral and psychiatric symptoms are the most prevalent. Rates of accidental and intentional misuse of prescription medications are increasing. The rate of illicit drug use among older individuals is low; however, studies indicate that it will likely increase as the baby boomers age.
The report stresses that inattention to older adults’ mental health conditions and substance misuse is associated with higher costs and poorer health outcomes. For example, older individuals with untreated depression are less likely to properly take medications for diabetes, high blood pressure, and heart disease; furthermore, they are more likely to require repeated costly hospital stays.
The report stressed that training in geriatric care for these problems is necessary. It explained that age alters the way an individual’s body metabolizes alcohol and medications, increasing the general risk for overdoses; these changes also can worsen or cause alcoholism and addiction. Older adults are also more likely to have physical conditions and impairments in thinking and ability to function that can complicate the detection and treatment of mental health problems and substance misuse or abuse. For example, cognitive impairments can affect an older person’s ability to comply with medication directions.
The report noted that Medicare and Medicaid payment policies deter effective and efficient care for substance abuse and mental health conditions by limiting which personnel can be reimbursed and which types of services are covered, the committee found. Effective care includes helping patients self-manage their conditions and monitoring to prevent relapses, services that can be provided by a range of trained providers and in a variety of care settings. The report recommended that the Centers for Medicare and Medicaid Services should evaluate alternative payment methods that would better reflect and fund effective services and coordinated team-based care for mental health and substance abuse.
Take home message:
This report describes another problem facing baby boomers. One situation that could further impact healthcare to seniors––as well as the general population¬¬––is the threat by a large number of physicians to quit practice if Obamacare is not repealed. Although repeal is by no means a certainty, if the provision persists it is likely to undergo modification. In addition, some of the physicians who are threatening to quit may not actually do so if Obamacere perseveres. However, some physicians will carry out their threat; thus, further impacting US healthcare.
Reference: Institute of Medicine