Medicaid Managed Care - U.S. Senate Special Committee on Aging

35
MS. CHRISENSEN. Thank you, Kathy.
Nancy.
STATEMENT OF NANCY LEONARD, MSW, LCSW CARE MAN-
AGER, CONNECTICUT COMMUNITY CARE, INC., ON BEHALF
OF THE ALZHEIMER'S DISEASE AND RELATED DISORDERS
ASSOCIATION, WASHINGTON, DC
Ms. LEONARD. Good morning. I represent the frail elderly, particularly
those diagnosed with Alzheimer's disease. I would like to
go over some facts and figures in regard to frail older adults and
those in particular affected with Alzheimer's disease. I will "walk"
you through a real ease to demonstrate some "best practice" issues
and some of the obstacles those of us "in the trenches" experience
on a daily basis.
These facts and figures provide a snapshot of long-term care issues.
One in five Americans over the age of 50 may need long-term
care in the next year, according to the Journal of the National Association
for Home <strong>Care</strong>. Most of those needing long-term care receive
their care at home; only 4.2 percent of people over 65 are in
nursing homes. Only 20 percent of those 80 and older are in nursing
homes.
Expenditures for nursing homes still consume a major share of
long-term care spending. In FY 95, Federal and State governments
spent over $49 billion in <strong>Medicaid</strong> dollars, of which $40 billion went
to nursing home care, and only $9.5 billion was spent on home and
community-based care. <strong>Medicaid</strong> is the major source of public funding
for long-term care services.
Allow me to focus on one disease entity particular to our older
citizens, which is Alzheimer's disease. Four million people in the
United States have Alzheimer's disease. Fourteen million people in
the United States will have Alzheimer's disease by the middle of
the 21st century. The disease process may begin in the brain as
much as 20 years before the symptoms of Alzheimer's appear.
The total annual cost of caring for victims of Alzheimer's disease
in the United States is estimated to be $100 billion. This makes
Alzheimer's the third most costly disease after heart disease and
cancer.
I would like to illustrate the points that Susan, through her fax,
asked us to bring forth by discussing my client, Mrs. M.
Mrs. M. is a retired teacher living alone on her teacher's pension.
She lives at home, with a diagnosis of cancer of the bowel, with a
colostomy, diabetes, and dementia. She takes a total of six medications
twice daily. Because of her dementia, she cannot be left alone.
Mrs. M. is disoriented to person, time and place. She demonstrates
impaired judgment by leaving pots on the stove for long
periods of time until they burn. She demonstrates behavior problems
such as suspiciousness, wandering, sleep disturbances and
hallucinations. She requires assistance with bathing and cueing for
dressing.
She is unable to perform any of her household management such
as cooking, cleaning, and money management. She is unaware of
her own health status, and she cannot manage her medications appropriately.