Professor Kaufman
Assignment 2
Long Term Care, The Elderly, and HMO's
Submitted by Michael Handsman
The elderly have difficult choices when it comes to health care. This document will help seniors obtain information about Alternatives to traditional Medicare, (Medicare Managed Care HMO's), and nursing homes throughout New Jersey.
Nursing Home Medicine The Annals of Long Term Care is a periodical, which presents up to date information on the Nursing Home Industry, which is valuable to consumers and providers. Their website is www.mmhc.com
The home page at this site has the table of contents of articles that are featured in the most recent publication. You may click on any of the articles to obtain full text. You may also pull up the table of contents for any of the past publications from 1997 to the present. If you are interested in a specific topic, you may enter the topic and you will get a listing of pertinent articles and the degree to which the articles match your search.
There were several articles relevant to the topic that I selected.
Future Directions for Managed Care in Nursing Homes, Robert Kane, Annals of Long Term Care; 1998 7(2): 52-55.
This article discusses the potential of Managed Care in Nursing Homes. The author suggested that managed care may lead to quicker discharges from hospitals to nursing homes, and management of problems in the nursing home rather than transfer back to hospitals. He notes the potential for integrated care through the use of computer driven information systems.
Comparison of OBRA Surveys of Long Term Care Facilities in Two States, Debra M. Phillips, Annals of Long Term Care, 1999; 7 (7): 258-262.
This article examined trends in Nursing Home surveys in Illinois and Missouri. Nursing Directors were asked to assess the value of the most recent survey: informative, beneficial, reasonable, antagonistic, and fair. Differences were observed between for profit and not for profit nursing homes. Twice as many for profit homes were fined, and Illinois homes were three times as likely to be fined.
Rating **** Full text articles
are readily available. You do not have to subscribe or give any personal
information to access the articles. This web site has current information
available that is very specific to the long-term care industry. It is geared
to providers rather than consumers.
The New Jersey Department of Health and Senior Services has a Web Site which has extensive information on a variety of topics, such as New Jersey HMO's and Nursing Home Ratings. This information may be accessed at http://www.state.nj.us/health/hmo
At this site, you are able to review the HMO Report Card booklet. This booklet has a listing of the eleven different HMO's that are available to New Jersey residents.
Results of an HMO Customer Satisfaction Survey are available. HMO's are rated on a variety of factors such as:
-Ease of finding a personal doctor
-Ease of getting a referral to specialists
-Prenatal care and preventive services
-The amount of time that there physician spends with them
-Reasonableness of paperwork
and payment
Rating **** Very good information
about the different aspects of care provided through the current HMO alternatives
throughout New Jersey. The information located at this website would be
very helpful for choosing an HMO; however, most people do not put much
time and effort into objectively evaluating their choice of HMO's.
You may also look at Medicare HMO membership by County at http://www.naic.org/nj/hmo
You are able to see the percent of the 65 and older population that have HMO's versus traditional Medicare. This figure varies significantly by county. For example, 31% of Burlington County Seniors are in HMO's versus only 10% of seniors in Warren County.
Rating *** Strictly for the number
crunchers.
Another important website link provided by the New Jersey Department of Health and Senior Services is located at http://www.state.nj.us/health/ltc/hcfa
At this site you are able to look up the annual survey and inspection results for any nursing home in New Jersey. This is a good starting place for information on nursing homes. There is a listing for each nursing home, which provides address, phone number, number of beds, specialized care and other features.
There is also specific information regarding the department of health survey results, including the dates of the last survey, the number and types of deficiencies cited and the scope and severity of deficiencies.
You may also pull up the scores
for all facilities in a particular county to facilitate comparison of local
homes.
Rating **** This is a beginning
point for consumers. This is not a substitute for personalized tours of
facilities or word of mouth recommendations from community members. Certain
facilities are offering virtual tours on the Internet. You still need to
visit facilities to get a feel for the environment of care and the attitude
of the staff.
The Federal Government through the Health Care Financing Information has a website at http://www.medicare.gov/
This site also has comparative information about the various Medicare HMO options by region. This site offers information regarding quality and cost. This is very important since cost of services is a major part of choice. This site offers cost information on each plan regarding physical exams, vision services, dental and prescriptions.
Under quality information, information is available regarding the manner in which each plan handles certain medical conditions such as Mammography, Beta-Blockers after Heart Attack, and eye exams for members with diabetes.
At this site you may also download
the handbook entitled Medicare and You, 2000. This explains basic Medicare
benefits and the Medicare HMO option.
Rating***** This site has a wealth
of information regarding Medicare and HMO's.
| Note: The information below may contain additional relevant materials and documents. Some of the information may be duplicate. The evaluations depend on both the student doing the review and the information contained at the time of the review. Sites are subject to change! |