With all the emphasis on caring for our elderly parents, Boomers are apt to lose sight of the fact that we are the “elderly” some twenty years from now and that the groundswell of Medicare recipients will begin entering the system in 2010. Politicians are focused on paying the bill – who is designing the care?

Are we going up or down?

Here are some major issues:

Access

Pain Management

Medicare Rules

Access and Care:

• Doctors are reluctant to accept Medicare patients because the Medicare reimbursement for service is so low. Even now, our parents are finding it hard to find doctors who will take them as new patients when they move to a different area to be near family. What is going to happen when the onslaught of Boomers hit this country's medical offices?

• Hospital care is focused on survival with only secondary concern for the quality of the life saved.

• Rehab/nursing home facilities are short staffed. There is a shortage of over 400,000 nurses. Certified Nursing Assistants (CNA) and Licensed Practical Nurses (LPN) do most of the patient care and there aren't enough of them, either. Some are well trained; some are not.

• There is a lack of access to "alternative" medicine. Boomers have used massage therapists, chiropractors, herbal remedies and various body treatments for decades. These are not available in most care facilities.

• Call bells don’t always get answered in a timely fashion. When the staff is engaged in giving out the complicated regimen of medications, there isn't time to get a person to the bathroom or make someone comfortable. Water pitchers are empty because there isn't anyone coming around regularly to fill them.

• Meal trays are left for patients to tackle on their own, unless someone cannot use utensils. Even if a person can feed him/herself, this takes energy and sometimes that energy/interest just isn't there, particularly if the food doesn't look too appetizing. For short term care patients, food can be merely an annoyance; for long term care patients, food becomes depressing.

• Patients in wheelchairs are lined up at the nurse’s station so that they can be watched, but there is nothing for them to do.

• Patients have their bodily needs met, but have few outlets for conversation or activity.

Pain Management:

• Advance Medical Directives/Living Wills are interpreted very narrowly and if they are written for a terminal illness are not considered when in the hospital for something else.

Medicare Rules:

• Medicare regulations determine length of stay, choice of tests and what a patient can do and not do in order to receive benefits i.e. patients must be "homebound" in order to receive in-home care and there are severe limitations on leaving home. Doctors have little say in the matter.

And Then, There's Funding:

• Medicare has just experienced its second “funding alert” which indicates that there is not sufficient projected revenue to cover the expected cost from 2008 into the future (see Trustees Report at (www.cms.hhs.gov or a Summary at www.ssa.gov/OACT/TRSUM/trsummary.html).

• Medicare pays doctors a miniscule amount of the fee that would cover their investment in education, office staff and insurance.

• Fewer people are choosing to become physicians because of the high cost of med school and the low return on the investment. Accordingly, specialties such as Neurology are facing a dearth of students in the pipeline. Dermatology, on the other hand, has more than its share because plastic surgery is not covered by insurance and doctors can charge a more realistic rate.

• Nursing homes rely on their "private pay" patients to make ends meet. The facilities lose money on every Medicare/Medicaid patient they take. When the Boomers start crowding the care facilities and our savings can no longer pay the bills, we will become the Medicaid patients. What is going to be the quality of our care?

But it's Not About the Money!

Even if politicians could find the money, we don't want the care the money could buy. It's like buying loose leaf notebooks, when what we really need are digital planners.