Updated 10/17/08

The next president of the United States must address the challenge of trimming Medicare and Medicaid costs. The vast baby boom generation has just begun to require services. Young and old citizens alike are succumbing to chronic diseases that can require years of expensive treatments. Many enter the system years ahead of schedule because of partial or total disability.

As a person living with and caring for someone with chronic illnesses, I want to share the following strategies that could greatly reduce the costs associated with these and related programs.

Redistribute a large portion of the funds now set aside for nursing home care into agencies that provide home care, day care, and respite services. The current regulations are absurd. Many caregivers provide full-time care for their loved ones because they can’t afford to send them to nursing homes or because most nursing homes have such bad reputations. The stress of attending to someone around the clock can lead to disability, premature death, or an illness that requires both the caregiver and patient to be admitted to a nursing home, in spite of the caregiver’s heroic efforts.

In addition to the in-home medical care and health education now provided, caregivers need help with bathing their patients two to three times a week and cleaning their homes once a week. Sitters and overnight respite care should be available as necessary. If based on individual family circumstances and guided by practical regulations, these services could help to reduce the number and length of nursing home admissions and create new jobs.

Require certification of non-medical home care agencies and training for their personnel. The pay is often so low that many of the workers don’t take their jobs seriously. Requiring certification and training would justify higher fees and wages and attract more responsible individuals into these positions.

Simplify paperwork for medical professionals. The amount of required documentation increases the cost of medical care and frustrates providers. The number of providers who will accept new Medicare patients in my city shrinks almost every month.

Reimburse non-traditional services provided by practitioners of functional medicine (FM). Unlike mainstream or allopathic medicine, functional or systems medicine addresses the causes of disease. FM practitioners focus on prevention as well as treatment of chronic diseases.

Give enough in food stamps to cover the cost of nutritious meals. Malnutrition leads to disease. Most people I know who are on food stamps run out of food long before the end of each month. A friend of mine, who is disabled, receives $10 a month. That won’t buy enough food to keep a cat healthy.

Ask recipients and providers how to improve these programs. Participants understand the weaknesses and strengths of the system.

For more on elder care issues, read my next three posts, “Elder Law Can Interfere with Good Care,” “Never Assume Anyone Thinks Like You,” and “Blog Offers Thanks for Spotlight on Elder Abuse.”

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Jacqueline L. Jones is author of Unmasking a Diagnosis: How to get Help for a Confusing Chronic Illness Without Filing for Bankruptcy. The book is available through Lulu.com and soon will be available through Amazon.com and other online book retailers.