Lawmakers continue to debate the politically-charged issue of prescription drug coverage for seniors. The U.S. House of Representatives, on a near party-line vote of 221-208, approved a GOP-backed $350 billion Medicare reform package on June 28. House Democrats strongly oppose the Republican prescription drug plan contained in the bill and introduced their own 10-year drug benefit plan estimated to cost between $800 billion and $1 trillion. However, the GOP leadership blocked Democrats from offering their proposal on the House floor.

At press time, the Senate was expected to consider a drug plan in mid-July, though it was unclear which proposal they would take up. Bob Graham (D-FL), Ted Kennedy (D-MA), and Zell Miller (D-GA) introduced legislation (S. 2625) in June that is generally favored by Senate Democrats; the group of senators dubbed the "Tripartisan Group," including Republican Charles Grassley (R-IA), Democrat John Breaux (D-LA), and Independent James Jeffords (I-VT), unveiled their own plan in July. Right now, the prospects for final passage of a prescription drug benefit are uncertain as both parties jockey for political advantage in an election year.

Senate Aging Committee Releases Long-Term Care Findings
Following 13 hearings on long-term care, the Senate Special Committee on Aging released findings on June 20 summarizing the recommendations of the many government officials and outside experts who have testified before the committee on the nation’s long-term care crisis. The new report calls this country’s current financing policies “unsustainable” in coming decades, particularly in light of the additional strain the health care system will experience once 77 million baby boomers hit retirement age. Without reform, changing demographics will force nearly 75 percent of all federal revenue to be spent on Social Security, Medicare, and Medicaid by 2030, the report said.  

To address the problem, governors and other witnesses testifying before the committee argued that money could be saved if Medicare and Medicaid dollars were combined in order to avoid duplication or delay in services, a common occurrence in those considered “dual eligible.” Other savings could result by using Medicaid and Medicare funding to pay for preventive care, with a goal of delaying institutionalization, the report noted. Governors have also creatively used the Medicaid waiver process to increase home and community-based services for the elderly and disabled.

In addition to financial concerns, the report highlights other issues important in meeting the needs of aging baby boomers, including addressing workforce shortages. In particular, the report states:  “The number of health care professionals with specific geriatric training is not keeping pace with the changing demographics.” Moreover, while all 125 of the nation’s medical schools have a pediatrics department, only three medical schools have a geriatrics department, the report said, noting that many experts have recommended an increase in the number of specialized physicians, nurses, and other health care professionals trained in geriatrics. “However, we are currently a long way from having an established cadre of trained practitioners: At the current time, Medicare supports almost 100,000 medical residency/fellowship positions but only about 300 are in geriatric medicine.”

The report, Aging Committee: Hearing Finding Summary, is available on the committee’s website at: http://aging.senate.gov/events/ltc.pdf.
 
AGS Member Testifies on Elder Justice
AGS member Carmel Dyer, MD, testified before the Senate Finance Committee June 18, at a hearing on “Elder Justice: Protecting Seniors from Abuse and Neglect.”  Dr. Dyer appeared before the committee on behalf of the Texas Elder Abuse and Mistreatment (TEAM) Institute in Houston. Established in 1997 as a collaborative project between the Baylor College of Medicine Geriatrics Program at the Harris County Hospital District and the adult protective services Division of the Texas Department of Protective and Regulatory Services, TEAM seeks to improve the lives of abused and neglected elders through clinical care, research, and education.  

At the hearing, Senator John Breaux (D-LA) urged fellow senators to support his comprehensive legislative proposal to address elder abuse, released last month and developed with input from AGS. The Senator’s plan would establish dual Offices of Elder Justice at the U.S. Departments of Justice and Health and Human Services, require FBI background checks for those employed by long-term care providers, and provide incentives to increase and maintain staff in long-term care facilities. It would also provide grants and programs for cross-training in geriatrics and forensic pathology and loan forgiveness for educational debt incurred by geriatricians.

Using examples of patients she has treated who are victims of elder abuse, along with photographs of their injuries, Dr. Dyer graphically illustrated for the committee the compelling need for the remedies provided in Senator Breaux’s proposal. She emphasized the importance of the interdisciplinary nature of the TEAM Institute model—of which geriatric medicine is the cornerstone—in preventing and responding to cases of elder abuse. “Big gaps in the knowledge of this serious public health problem still exist,” Dr. Dyer told the committee. “Health care professionals and others do not have all the information they need to accurately detect, effectively intervene and/or prevent elder abuse.”  An increased focus on geriatric research and efforts to increase the numbers of geriatricians are needed to help prevent elder victimization, she said.          

Senate Committee Approves Bill on Alzheimer’s Disease
In June 26, the Senate Health, Education, Labor, and Pensions Committee approved legislation that would authorize $1.5 billion for the National Institute on Aging for research on Alzheimer’s disease. The bill will also take steps to assist those living with Alzheimer’s disease and their family members. S. 2059, introduced by Senators Ted Kennedy (D-MA) and Barbara Mikulski (D-MD) in March calls for the following:

• Authorizing the Alzheimer’s Disease Prevention Initiative
• Establishing an Alzheimer’s Disease Cooperative Study Group
• Establishing a program for caregiver research
• Reauthorizing the Alzheimer’s Demonstration Grant Program

Rep. Ed Markey (D-MA) introduced the House version of the legislation on April 25.

HHS Announces New Partnership with Ombudsmen on Nursing Home Quality Data
Health and Human Services (HHS) Secretary Tommy Thompson announced re?- cently that long-term care ombudsmen will begin helping consumers use new comparative quality information about nursing homes released by the agency as part of its Nursing Home Quality Initiative. “This new partnership will help families take advantage of our new quality information about nursing homes as they make critical decisions about choosing a nursing home,” Thompson said. HHS’ Administration on Aging’s (AoA) long-term care ombudsman program involves 1000 paid staff and 8000 volunteers who are trained to handle complaints about nursing homes. Under the partnership, ombudsmen will work with the Quality Improvement Organizations (QIOs) of the Centers for Medicare and Medicaid Services (CMS) to respond more effectively to consumer inquiries and educate consumers about the new quality measures. Ombudsmen will also share information with the QIOs on quality issues in nursing homes that require improvements in services.

In April, HHS released new quality data on Medicare- and Medicaid-certified nursing homes in Colorado, Florida, Maryland, Ohio, Rhode Island, and Washington, and expects to expand the initiative nationally later this year. Information on AoA’s Long-Term Care Ombudsman Program is available at http://www.ltcombudsman.org; for information on HHS’ Nursing Home Quality Initiative go to www.medicare.gov.