Leadership and Management in Health Care Term Paper

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Leadership & Management, Health Care

Leadership & Management in Health Care

President Clinton's Secretary of Health and Human Services, Donna Shalala, used to tell a story about her mother, who was 86 at the time but still a full-time attorney representing several clients who lived in nursing homes. She would tell Shalala, "Donna, I don't care whether they are good nursing homes or bad nursing homes, you have to watch them like a hawk" (Cited in White House, 1998, quoted by Hovey 2000, 43). Clinton's presidency was very aware of health care issues, even if it was unable to solve them. Shalala's remarks were delivered at a press conference regarding nursing home regulation; arguably, under the current administration, issues of health care for the aged have gotten more problematical rather than less.

Background

Despite relatively little action regarding health care for the aged by the federal government, there is little doubt that the news media has crated heightened awareness of the "graying" of American, and "has focused attention on the distinctive needs of individuals who are disabled, chronically ill, or functionally impaired. By no means are all of these people elderly" (Kahl & Clark 1986, 17+). Kahl and Clark noted that the aging of the population was expected to put pressure on the demands for hospital care, and that hospital use was significantly greater for the aged than for those under age 65 and that, in fact, the aged are hospitalized more often and stay in the hospital longer than those who are under 65. Indeed, the rapidly growing population that was age 85 and above used twice as many hospital days as those between 65 and 74. (Kahl & Clark 1986, 17+).

Kahl and Clark wrote almost two decades ago. Their predictions, which were made for only the ten years after their research, have held true even into this millennium. Without serious restructuring, legislators worry, the U.S. health care system -- particularly the need for long-term care, will "bust the bank." In 2000, it was noted that 35% of Medicaid's $160 billion budget went to long-term care. "That percentage is almost certain to increase as the roughly 77 million baby boomers age and medical science keeps people with chronic diseases and disabilities alive longer" (Fox-Grage & Shaw 2000, 30). Worse yet, predict Fox-Grage and Shaw, more than fifty percent of the U.S. population will need some sort of long-term care; that care costs about $51,000 a year in 2000 terms (2000, 30). Adding to the future woes caused by the aging baby boom, even current residents of long-term care facilities cannot be expected to vacate and save some funding for the future:

Just under half of the 13.5 million Americans who need long-term care are under the age of 65 and are expected to live longer than their counterparts did a generation ago. People 85 and older -- half of whom need help with basic daily living tasks like dressing and bathing -- now number about 4 million and represent the fastest growing segment of the population.

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By 2050, their numbers are expected to swell to perhaps 27 million. (Fox-Grage & Shaw 2000, 30).

It is possible that the number of those who need help with care is higher than Fox-Grage and Shaw note; in 1986, Kahl and Clark gave as 4.1 million the number of those who would need nursing home care by 1996. (1986, 17+)

Nor is aging the end of the problem. There is also the problem of multiple health problems in the very aged, along with the technological advances that make performing multiple and complicated surgeries on the aged less risky; however, that may also lead to need for long-term care. This trend, according to Kahl and Clark, was likely to wipe out any gains that were realized as hospital stays decreased in average length (1986, 17+).

In 1986, health sector output had outstripped economic growth in general, contributing a 5.6% annual gain in real output, compared to a 3.3% increase in real GNP (now called GDP) between 1960 and 1984 (Kahl & Clark 1986, 17+). Apparently, however, the growth in the aged population, along with the trend toward performing more procedures noted above, means that as of 2000, the cost of health care for the aged posed a larger dilemma than Social Security and Medicare. (Fox-Grage & Shaw 2000, 30)

Any discussion of health care for the aged means one sort of long-term care or the other. Here are the facts contributing to the need for leadership in that sector:

Nearly 13.5 million people needed long-term care in 1996. That number is expected to rise dramatically by 2020.

The Census Bureau estimates that the elderly population will more than double by 2050 to 80 million as the baby boomer generation grows older. But not just the elderly need long-term care services; roughly 6 million or 44% of people needing long-term care are under the age of 65.

Medicaid spends roughly $60 billion on long-term care, and the Congressional Budget Office expects it to rise to more than $75 billion by 2020.

Private long-term care insurance expenditures are expected to rise to little more than half of Medicaid expenditures -- $36.2 billion.

National spending for long-term care in 1997 was $115 billion; nursing home care accounted for 72% of the bill.

About 35% of total Medicaid spending paid for long-term care services.

Institutional care-nursing homes and intermediate care facilities for the mentally retarded -- accounted for 75% of total Medicaid long-term care spending......

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