The impact of aging on healthcare
The number of aging baby boomers and retirees is on the rise. Is our healthcare system ready?

by Dana E. Blozis

Since the 2000 U.S. census was conducted, government agencies and officials and healthcare providers have attempted to estimate population growth over the next 25 years, particularly in adults over age 60, a rapidly growing segment of the population. According to estimates from the Washington State Office of Management and Budget, the population over age 60 in Whatcom, Skagit, San Juan and Island counties will more than double between 2000 and 2025. With such dramatic growth in that age group, we must ask ourselves, “Are we ready to support a significantly older population?” More importantly, is our healthcare system ready? Area healthcare experts say no.
“The aging population is a huge issue in terms of providing healthcare services,” Sue Sharpe, co-director of the Whatcom Alliance for Healthcare Access (WAHA), said.
A greater percentage of healthcare services are needed for the aging population versus the growing population. In terms of hospital care services alone, people over age 65 incur five times more healthcare services than someone under age 65, according to Sharpe.
“There is going to be a tremendous demand for healthcare services for the aging population,” Sharpe said.

The current state of healthcare
To better understand this population’s future needs, let’s examine the current healthcare system in northwest Washington.

Medicare woes
Throughout the state of Washington, the number of primary care physicians willing to see Medicare patients (ages 65 and over) has dramatically declined in recent years, because of adverse changes in federally regulated Medicare reimbursement rates. Prior to 2003, Washington state ranked 41st in the nation in “per beneficiary” reimbursement costs. Following the Medicare Modernization Act of 2003, however, the state’s reimbursements dropped to 45th, reducing healthcare provider reimbursements below the cost of providing care. This means that healthcare providers are absorbing any costs associated with the care that exceed the rate of reimbursement. As a result, there is a gap between the need for primary care providers for Medicare patients and patient access to care.
“The dynamic that’s occurring across Washington state is that primary practice physicians are electing to close their doors to new Medicare patients,” Matt Groenig, director of St. Joseph Medical Group. “Medicare reimbursements can’t even begin to cover the overhead that private practice physicians throughout our state need to be financially viable.”
Richard Dietz of the Northwest Regional Council and Area Agency of Aging agreed that the Medicare reimbursement rates set by the federal government are based on a flawed formula that controls overall Medicare spending without considering overhead costs associated with providing healthcare.
“Medicare rates nationwide are low and problematic and slated for additional cuts,” Dietz said.
To close the gap between available care and needed care, local healthcare providers say we need to revamp the Medicare system.
“The way Medicare is administered and funded is going to need to be changed,” WAHA’s Sharpe said. “It’s a very difficult political issue.”
“We have to find a way to keep Medicare and Medicaid sustainable in terms of reimbursement rates,” Dietz said.
Victoria Doerper, executive director of the Northwest Regional Council, agreed, “We need reimbursements that will encourage healthcare providers to care for geriatric issues or to provide primary care.”

Lack of education and training in geriatric care
Another challenging issue in providing adequate care to adults over age 60 is the lack of education and training for healthcare providers who care for older adults and those with special needs. While our healthcare system is full of general practitioners, pediatricians and primary care physicians, the number of geriatricians, who specialize in caring for older adults, is insufficient to meet our population’s needs.
“Their health issues are very different,” Doerper said.
Shelly Zylstra, planning director for the Northwest Regional Council, explained that geriatric care deals with the last 30 years of life. This age range often includes multiple chronic illnesses and other complex issues that require special training. Of particular concern is the growing mix of behavioral health issues that many don’t recognize affect older adults. For example, domestic violence and substance abuse are often viewed as teen or adult issues when, in fact, they also impact seniors.
“One of the issues of getting older is that one experiences more loss than at any other time of life,” Doerper explained. “Loss is a huge issue for people getting older – loss of people, loss of function, loss of opportunity.”

Medication issues
Older adults are often prescribed various medications to treat chronic illnesses and conditions. With skyrocketing prescription costs, however, healthcare providers cannot always ensure that patients will have their prescriptions filled, nor can they ensure that medications are taken properly. Failure to follow medication directions can further exacerbate health conditions, creating additional issues.
“Medications help us live longer, but that creates problems if patients aren’t taking their meds,” said Cindy Hamming, director of the Senior Behavioral Health Center at United General Hospital in Sedro-Woolley. “We are living longer but not necessarily healthier.”

Inadequate infrastructure, facilities and transportation
Other areas of concern for older adults include outdated infrastructure, insufficient healthcare facilities and transportation issues, each further limiting access to care. From an infrastructure perspective, governments and other businesses and organizations need to include the special needs of older adults in their planning. This includes not only compliance with the Americans with Disabilities Act in buildings but also in terms of items like navigable sidewalks and crosswalks.
Maureen Kane with Senior Information and Assistance said that she believes many of senior healthcare facilities are currently acceptable from a numbers viewpoint, but that will change.
“Right now we’re OK,” she said, “But looking at the numbers, we won’t be.”
Matt Groenig said that St. Joseph’s Center for Senior Health is reaching a maximum threshold for the number of providers. Also, from the hospital’s view, more than 400 beds will be needed in the future based on population estimates for the entire community’s needs.
Skagit Valley Hospital in Mt. Vernon is currently undergoing a major expansion to meet the needs of its community as well, which includes a new cancer center, surgical department, a second cardiac catheterization lab, and expanded emergency and trauma care and critical care.
“We have to look at the needs of the entire community,” Skagit Valley Hospital CEO Gregg Davidson said. “One of the very important variables on estimating future needs is the age of the community, so that has a strong influence on the projects and on the site of the facility you are building.”
In addition to primary care and hospital services, United General’s Hamming is concerned about the lack of resources to support “geri-psych” patients over age 55, many of whom are diagnosed with diseases like Alzheimer’s and dementia and who can’t care for themselves.
Hamming, whose 10-bed facility provides acute, in-patient, geri-psych care, said their facility receives patients from all over the state because of the lack of needed in-patient services in many of the rural communities.
“The need for our services in an aging population is great,” Hamming said. “We maintain a high census all the time.”
Hamming believes the problem stems from funding cuts to outpatient programs that provide needed healthcare and behavioral health services before patients reach the acute stage, requiring hospitalization.
“As outpatient dollars are cut, treating patients in an acute, in-patient setting remains the only option,” Hamming explained. “At the local level, we don’t have the ability to treat all of the patients.”
In addition, transportation to access care is insufficient for many older adults. For those who don’t have friends, family or caregivers available to transport them, they must rely on public transportation or postpone visits until assistance is available.
“How do you move a senior through not just the Center for Senior Health but through the community?” Groenig asked, referring to the need for additional lab work, x-rays and prescriptions.

Closing the gaps: Medicare or MediFair?
In order to close the gaps between access to and available healthcare services, it is important that both government officials and the general public understand the impact of the growing percentage of older adults.
“If the impact was clear at this moment, things would change rapidly,” Dietz said.
To that end, healthcare providers and legislators throughout the area are working on solutions. Here is a sample of potential solutions to effect a more sensitive, adaptable healthcare system for our elders.
One of the most critical actions taken to improve the Medicare reimbursement system is the MediFair Act of 2005 (S. 411), reintroduced by U.S. Senator Patty Murray in February 2005. According to a summary provided by the Congressional Research Service, the MediFair Act seeks to amend title XVIII (Medicare) of the Social Security Act to establish a system for making adjustments to the amount of payments made for items and services provided under the original fee-for-service program under Medicare parts A (hospital services) and B (supplementary medical insurance.) The amendment would require the Medicare Payment Advisory Commission, known as MEDPAC, to develop recommendations on policies and practices that encourage healthy outcomes and quality care and the efficient use of Medicare payments. The MediFair Act has been referred to the Senate Committee on Finance for further discussion.
In a press release issued by Sen. Murray’s office on February 16, 2005, Murray said, “Currently, our state is being penalized because we have a tradition of low-cost, efficient healthcare and healthy seniors. Medicare should reward that.
“The MediFair act will ensure that seniors aren’t punished when they choose to live in Washington state. It will encourage more doctors to accept Medicare patients and will ensure that retirees and patients about to retire can still find a doctor of their choosing.”
The House and Senate companion bills will be co-sponsored by other local legislators including Senator Maria Cantwell and Representative Rick Larsen.
In addition to this Medicare legislation, Whatcom County healthcare experts, including Dietz, have formed a Medicare study group to specifically address what is happening in Whatcom County.
“From a community perspective, a number of individual agencies are coming together to strategize solutions,” Doerper explained.

Information, training and education
At the patient level, the Senior Information and Assistance agency is trying to educate the aging population along with caregivers in issues like how to handle doctor’s visits, home health safety, behavioral health, medication management and housing. Kane suggested that a national Nurse Helpline, ideally funded by Medicare and Medicaid, could assist seniors and their caregivers with questions on noncritical matters. Coupled with better education and training of geriatric issues for healthcare providers, these solutions would make better use of healthcare resources.

Improved access to care
Healthcare providers throughout the area are improving access to healthcare services in a number of ways. From extending hours to assist with transportation and caregiver issues to medical record sharing within the Community Health Record program, providers are reaching out to patients to close the gaps where resources are sufficient to do so. WAHA, in particular, is one such agency that focuses on improving access to care, not only for older patients but for those in the community who are currently underserved. One project in which WAHA was involved was the recent opening of the Ferndale Family Medical Center, improving access to care in northern Whatcom County. Others include partnering with community coalition groups to provide a systematic approach to providing health and dental care to seniors.
Another key initiative to improving patients’ access to care can be found in Skagit County where Skagit Valley Hospital management is getting involved in the recruitment of both primary care and specialty physicians.
“We are investing more effort and resources into our community,” Davidson explained.
This includes not only the active recruitment and retention of physicians and other healthcare providers but also having open discussions with medical staff about opportunities for expansion. Where possible under state and federal law, Skagit Valley Hospital is financially supporting these efforts as well as helping to recruit medical staff.
“Our focus is on community need and access to services,” Davidson said. “As we expand the hospital, we will need not only more hospital staff and more hospital nurses, but we’re going to need more physicians to care for those patients or we’re not going to be able to fill the additional capacity. They are a vital part of the healthcare community in providing services in the clinics and primary care facilities but also in the hospital.”
“We need to create a system that gets care to the right people at the right time without obstacles,” Davidson said.
To do so, he said, care needs to be affordable so that older adults are not faced with choosing between paying for healthcare services, including medication, and other basic needs.
“Patients should get the care they need and deserve,” Davidson said.
Hamming believes that funding is the key issue to improving access to care and supplying adequate resources like outpatient services and sufficient beds in in-patient facilities.
“Funding is the bottom line for everything,” Hamming said.
Zylstra, on the other hand, believes that a holistic approach is the only thing that can overhaul our current healthcare system, particularly as it pertains to healthcare for older adults.
“Healthcare doesn’t exist in a vacuum,” she said. “We should not to try to fix the parts of the whole. We have to look at it from a holistic approach. Charge each section of the government to develop a way to deal with this age wave.”
Regardless of the programs or services that healthcare providers and legislators work toward improving, one idea remains constant: There is much work to be done.
“We have a lot of work to do to deal with where we are now and to prepare for the future,” Sharpe said. “We have to identify better ways to care for patients and better ways to allocate the resources we have.”