50+ Lifestyles

Your Advocacy Connection

We Solve Long Term Care Problems

By Jamie Long
The Passionate Patient Advocate
GolderCare Solutions, Unlimited, LLC

I’ve been at it one way or another in this industry for over 40 years now. Of those, these last couple have been among the roughest and scariest times I’ve experienced both professionally and personally. Lately, I’ve become an unwilling witness to the collapse of our healthcare system – both acute care and long-term care.

Physically, I occasionally enjoy riding roller coasters. Metaphorically, however, I don’t appreciate being forced to live on one – either personally or professionally. But it feels as though I am.

Personally, first. Your Choice?

Well, you can take it or you can leave it. Is that good enough for you? I am over 65. I am on Medicare. More specifically, I am on Traditional Medicare. That means I have Parts A and B, but not C.

(For the last 20 years or so, Medicare recipients must choose between (1) Traditional Medicare coverage, that is, having Medicare Parts A and B while excluding Part C, or (2) Medicare Advantage coverage, that is, having Medicare Part C while excluding both Part A and Part B. You can’t have both types of coverage – or all three parts – together.)

I chose – and continue to choose – Traditional Medicare coverage. I feel secure, knowing it gives me maximum access to healthcare services.

For the last 10 years or so, I’ve experienced a mild level of discomfort in the wake of the ACO (“Accountable Care Organization”) provider model making its way into Traditional Medicare delivery. The ostensible purpose of the ACO model is to dis-incentivize the provision of unnecessary or excessive medical services in an effort to keep overall costs of the healthcare system down. I didn’t feel all that threatened by the ACO model as it had not yet progressed to the level of healthcare rationing. The ACO may have been held financially responsible for the cost of my healthcare, but it was still unable to dictate what care I could receive or where. I still had access to the full range of healthcare services, and the choice as to which to utilize was still mine.

The free choice of Traditional Medicare recipients like me is currently under attack and in grave danger from something called the “Direct Contracting Model.” This next step beyond the ACO provider model isn’t merely a provider model, it’s a new third-party payer model. In a nutshell, it would task private insurance companies not only with facilitating the payment of benefits under Traditional Medicare, but with the ultimate determination of what those benefits are and should be (within guidelines). Limited networks and limited services are the hallmark of private insurance coverage. This represents a scale-back of Traditional Medicare coverage and benefits in an attempt to save the government money. The worst part about this new model is that it would allow the assignment of Traditional Medicare beneficiaries into these private insurance coverage without our choice or even our knowledge.

Professionally, next. No Room at the Inn.

The recent COVID blizzard together with the collapse and evacuation of Galesburg Cottage Hospital has triggered the worst long-term care placement crisis I’ve experienced in my 40 plus years of this type of advocacy. Many attempted long-term care placements have been well-nigh impossible for the last couple of months. Layering this on top of governmental policy and business trends to pare back nursing home placements, we are witnessing what I consider to be an ongoing collapse of that part of the long-term care industry.

The good news, you ask?
Well, it’s honing our patient advocacy skills.

Jamie Long is the Chief Patient Advocate for GolderCare Solutions and can be contacted at 309-764-2273.