Assessing the ability of these individuals to perform basic tasks in their daily lives can also have much significance (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Many older Americans are able to feed and clothe themselves without apparent problems, but others are not as fortunate (Marshall, Warren, Hand, Xie, & Stumbo, 2002). If they are unable to do these things correctly without help, their nutritional status will often suffer (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Patients who are older should be assessed for their ability to do these simple tasks, and also for their ability to perform slightly more complex tasks such as fixing their own meals, cleaning their house, and balancing their checkbook (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Sometimes cognitive impairment will lead to a lack of nutrition, and when this is the case, it often shows up in forgetfulness and an inability to perform even simple tasks that require some thought (Marshall, Warren, Hand, Xie, & Stumbo, 2002).
Older Americans can be protected from much of this pain and suffering that they sometimes face in later years, but intervention is necessary. Those that evaluate older Americans must pay attention to whether these individuals are losing weight without any apparent effort, whether they seem depressed, whether they have a support system of friends and family, and many other factors. They should pay attention to the medications that these individuals take, especially those that can cause a loss of appetite, and to the oral health of these patients, as this has been seen to be a cause of malnutrition when teeth are decayed and painful or when dentures do not fit properly. As the baby boomers age, there will be a rapid increase in older Americans, and this will place a burden on society in some respects.
However, many of these people will continue in good health in their later years. The average life expectancy for both men and women in this country continues to rise, and this is encouraging news, but it also means that there will be more older Americans, and those that live with chronic ailments and other problems will need care and support from family, friends, and the medical community. Something as simple as a visit from someone in the neighborhood around lunchtime can have an effect on an older America that is having difficulties with loneliness and depression, and there are other simple ways to help these people as well. For those that need more complex answers to their problems, the medical community must be aware of the problems that these individuals face and the idea that malnutrition among older Americans is a serious problem that must be addressed.
In the medical community, however, many doctors and others are not ordering the tests and medications that their elderly patients need because the insurance that their patients have does not cover what they actually should have done or offered to them. Now that nutritional status and information has been discussed, information regarding Medicare and its drug coverage must be discussed so that the reader can see how vulnerable elderly people are where their insurance and medical care is concerned.
Prescription drug coverage is one of the major concerns when discussing Medicare reform. Seniors that have Medicare do not have any coverage for prescription drugs, and because of this they have to pay a large amount of money out of pocket. It is good that Medicare pays for doctor visits and other issues that the elderly people must deal with, but most people who are in the grips of old age are on medication, and when this medication is something that they cannot afford, they often either do without it or do without some basic necessity of life in order to afford the medication.
The prescription drug plan that Medicare is proposing is good, but it is not enough. It still requires premiums that are too high, and it requires a $275 deductible per year, with Medicare then paying 50% of the cost of the drugs up to $4,500 per year. After that, Medicare would pay the rest. However, the $275 deductible and the 50% co-pay are still too much for many seniors to afford (Miller, 2003).
Some congressmen want to know why seniors are being treated so badly. One member of Congress figured out that Congress people are paid approximately 20% of their medical costs, and their insurance company pays 80%. For seniors, this new prescription to plan would mean that Medicare will be paying approximately 20% of the seniors' medication bill, and the seniors will be left to pay 80%. This particular congressman wants to know why Congress is treated so much better than the elderly individuals in this country, and calls the Medicare prescription drug reform program nothing but a fraud (Zweifel, 2003).
Another thing that the Medicare plan will do is stop the government from negotiating with drug companies to attempt to get low rates for seniors. This has been done in the past, and the Department of Veterans Affairs has successfully negotiated in the past to get a 40% reduction in medication costs for senior veterans. Medicare, however, will not be able to do the same, and this will end up costing seniors more (Zweifel, 2003).
It is clear, however, that something must be done about the Medicare system. At the current rate, Medicare will begin running out of money in 2016, and it will go completely bankrupt by the year 2030 (Kaveny & Keenan, 1995). This is why Medicare reform must begin now. However, many believe that the Medicare reform that is being proposed to take effect in 2006 is not what is really needed. The argument has been made by many of those in the Senate and in Congress that the prescription drug plan that so many seniors need is just a desert that is being dangled in the face of government to get them to swallow a very bitter package of other Medicare reform ideas that will not actually help seniors at all (Lakely, 2003).
The prescription drug benefit, while many believe it is not helpful to those that need it most, will actually help some seniors. There are approximately 15 million elderly individuals in this country that live at or near the government poverty line. Those individuals will pay no premiums, and they will pay between one and five dollars per prescription. This appears to be the only group of seniors that will actually be helped by the drug coverage plan, but in the past, Medicare has had no prescription drug coverage at all, and therefore the plan does have some benefits for some individuals. The concern for many is that it does not have enough benefits for enough individuals in the long run (Wilson, Garrett, and Angle, 2003).
There was clearly much concern in the House and Senate when they voted on the Medicare reform bill, as it passed with a 55 to 44 margin in the Senate and was hotly debated on for quite some time before the House chose to pass it. The problem with much of the Medicare reform is that surveys conducted showed that 75% of the people asked thought that the law should be passed, however 62% admitted that they really knew little to nothing about the details of the plan (United, 2003).
Another change that the proposed reforms would make to the Medicare system would allow for different grades of Medicare. Just as traditional insurance and HMOs can be utilized more specifically or more thoroughly by those that wish to pay more, Medicare would be designed the same way. Many do not want to see Medicare tampered with, but President Bush insists that the differently tiered Medicare system would be more beneficial. Those that wished to pay more, and those that could afford to pay more, would have better coverage and more options that those that were on the very basic Medicare. However, all tiers of Medicare would house some type of prescription drug coverage, which is more than they have now (Gambrell, 2003).
One of the main concerns about Medicare reform is that individuals that are not as sickly and do not want to pay Medicare premiums will go out on their own and find cheaper private insurance. This will leave Medicare to take care of an older and sicker population. In time, this will take its toll on the money that the Medicare system has. President Bush has asked for 400 million dollars over the next 10 years to continue Medicare reform, but it is possible that even this may not be enough to stave off the rising costs of the larger and sicker populations of individuals in the Medicare system (Meckler, 2003).