Home Care Savitlgs Potential Draws National Ahtition Al Kemp Addresses Community-Oriented Home Care The disabled comprise the fastest growing segment of our population, and the most vulnerable within these groupings are the children and the elderly. Here in theSt. Louisarea,as is the case in the rest ofthecountry,wefindprobablythefastestgrowingsegmentof our population by age category - those over 65. This is the top region of the country as far as the proportion of percentage of elderly over 65. Medical, surgical and technical advances have saved the lives of children andadultswhowould have died in past years. Children and adults with multiple disabilities now live longer and have more productive lives. The ramifications for health care needs of these disabled children and adultsdepen- dent upon technology for daily living are far reaching and complex. Pioneering efforts of doctors and nurses, allied health professionals, state agency officials, insurance, hospital adminis- trators, social workers and parents' advocacy groups have made it possible for ventilator-dependent children to live in the community with significant savings. Yet now, this grow'ing population needs regional coordinating organizations to maintain and refine current strategies providing community-based health care to guide and support parent groups and to educate the professional and private sector about the dynamics of community-oriented home care. For these reasons, we are gathered here today.0 Sam Giordano Says Communication Vital To Home Care Success This country's method of providing health care is undergoing a great deal of scrutiny and revision. The problem is in achieving a balance between cost efficient medical care and quality care. One possible and popular solution to the problem is the "unbundling" of medical services. Simply stated, this means that efforts should be made to effect an appropriate match of health care resources to patient needs. This results in a more cost effective way of rendering care with assurances that the patient will receive necessary medical care. A key element in the unbundling process is home care. The Surgeon General, C. Everett Koop, MD, recognized that a significant benefit could be derived if certain patients not re- quiring hospitalization could be supported in their home environments. Pursuant to that goal, Dr. Koop convened a workshop on the plight of the ventilator-dependent child in late 1982. Several important recommendations were generated at the workshop. Not the least of those was to hold future workshops to identify problems and barriers confronting the home care patient, and to establish a network of that first follow-up workshop. Held Dec. 13, 1983, in St. Louis, MO, health care providers and ventilator-dependent patients from across the country convened to share their stories and to develop an understanding of the problems with home care under our present health system. I am sure that after reviewing this issue, you will find that there is a great deal of support for the home care patient, however, that aid is lacking central coordination and consistency. It is our hope to continue to present the latest information on ideas, problems and methods, for indeed the first step in establishing an adequate structure to support home care must be Communication -two-way communication. This issue satisfies only a part of that request. I invite you to satisfy the second part: please give us the benefit of your thinking. Please share with us ideas that may not be presented in this issue, and certainly send us comments on the subjects as they are presented here. This exchange will eventually result in an efficient and effective home care support network throughout this country. 0 /`i/hat Is A waiver? ~~~~ of the articles in this specral report On the Surgec' ieneral's workshop refer t0 the waivers available t0 ven:: aTc-- , endent patients, lf you are unfamiliar with the waiver Z-ccess- 1: important to note that there are different kinds Of wa `*e's l,, jgSj, as part of the Budget Reconciliation Act, Congress ga\e he StateS greater flexibility to establish home and cOmmun:T"- ,ased tong term delivery systems for Medicaid individuals at risk rf institutionaIizatiOn. These waivers, known as Section 2176 Maivers arequitedifferentintheirscopes.withsOmestates:argetlng ecus on the developmenta\\Y disabled. Each State reguesIs its ,olely on the aged and physically disabled POPUlatiOn, wnlle Otners 1wr-r range of services, and some do include respiratory theraP\ P' 3r el vu if `~,",~~~~a second kind of waiver permitted under the 2175 "model waivers" permit a state to target a specific `~~pa~~~oh~ore than 50 blind or disabled individuals for Medlcaid i lithout the waiver would be eligible for Medicaid benefits Only igibility and community-based long term care services who, i institutionalized. Further, there are the Katie Beckettw ly Section I 34 of PL 97-248. These wai he Option of extending coverage todisa-.- t home or in the community provided that the c are does not exceed the cost of institutional car nterestingly, and this is the basis Of part of the 1 4 hnsen the rrguments, only one state, Idaho, has cl .-- - / Section 134 Katie Seckett waiver oPtion, A very important fact to note about the wa'ver ;ystem is that it is exactly that - - -;=I ",.. .-- I ,,&es existing rules. It becomes the ex--, ather than the rule. The AART firmly believes that / lespiratory care for ventilator dependent aivers. established x ' + ,,,. vers give the states bled children living ost of the $RT's individuals ought to be the rule rather tm.-.. thr -,,on+inn