Aging population stresses many health care services

Henry Ruiz, Fermin Velasquez and Dallas Larreau (front to back) exercise on the NuStep elliptical machine at Penrose’s medically supervised gym.

In an uncertain health care environment, industry experts are sure about one forecast: An aging population will impact services, providers and payers like never before.

But exactly how much it will stress the industry — and in what ways — is still unknown, those same experts say. Health care groups already are struggling to create better access to care, and an aging population is bound to exacerbate the problem.

Some doubt comes from uncertain federal budgets, unknown Medicare reimbursement levels and the new ground covered in the Patient Protection and Affordable Care Act. But the Baby Boomers, just now eligible for Medicare, will bring their own particular stamp to health care, as they have in other consumer areas.

They’re healthier, more active, more fit — and that means health care providers will have to ramp up services like orthopedics and wellness programs. Boomers are used to being catered to — and as their health care needs increase, so will their demand for services that meet those needs.

“We know they’ll change health care,” said Dr. Sara Qualls, professor of psychology and director of the Gerontology Center at the University of Colorado Colorado Springs. “We’re still wondering how they’ll change it. We know Boomers are different — their service utilization patterns have been different. We don’t know what they’re going to demand, however.”

Qualls said that the current crop of Boomers, those just turning 65 and joining the Medicare rolls, have used mental health services more often than other generations.

“And that’s the kind of pressure they’re going to put on the delivery system,” she said. “We know they access services more often, but we don’t know how they’ll change delivery systems.”

Hospital services

Hospitals aren’t waiting to be swamped by the aging population — instead, they are trying new services and new ways of delivering health care to meet future needs. For instance, Penrose-St. Francis Health Services is ramping up its orthopedics department in response to the growing need for hip and knee replacement surgery. It’s also growing its cardiovascular department to deal with heart conditions and bypass surgeries.

Penrose-St. Francis CEO Margaret Sabin says the hospital system is growing its wellness and prevention services to keep the aging population healthier — and at home — longer. Under Sabin’s direction, Penrose also is reaching out to neighborhood organizations, encouraging individuals to change the habits of a lifetime to stay healthier.

Like Qualls, Sabin is interested in brain health as well as physical health.

“One issue that aging has is the health of the brain,” Sabin said. “So we’re expanding more into integrating behavioral health with physical health care. Exercise, for instance. We know that exercise is good for the body, and now it turns out, it’s good for the brain as well.”

Penrose has a Silver Sneakers program to aid the aging population in starting to exercise, and it boasts the only medically supervised gym in Colorado.

People who go to the gym can get their heart rate checked before, during and after exercise. Their blood pressure and hydration levels also are monitored, she says.

“Even folks in their 90s can benefit,” she said. “There’s a social aspect to brain health as well as a fitness one that’s very important as we age.”

But Penrose isn’t merely treating health care and prevention differently. It’s also working with Pikes Peak Hospice on another way Boomers will change health care: They’ll want to address death on their own terms as well.

So Penrose has a floor for hospice patients, those who can’t be at home with hospice care.

“A lot of money goes into the end-of-life care,” Sabin said. “In fact, it’s about two-thirds of health care dollars go into the last two weeks of life. We’re looking at changing the delivery system in order to keep people healthier longer. We think that will save money even as the population ages and needs more care.”

Hospitals will respond by offering more services outside their walls, says Steven Summer, executive director of the Colorado Hospital Association. More services will be “ambulatory,” he adds.

“We’re already doing some of that,” he said. “Things like portable oxygen, portable IVs, insulin injections. They aren’t inpatient services, and in the past, hospitals stayed away from those types of services. But now, we’re moving toward offering services past our front doors.”

Workforce needs

But all the additional services and delivery changes mean an even bigger need for health care workers — everyone from home health nurses to doctors and mental health professionals.

In an area already facing shortages — Colorado needs more doctors, nurses and psychiatrists — the demand for health care professionals will only grow more acute as the population ages.

“We know we don’t have the numbers to meet the current need, let alone future stress that Boomers will put on the workforce,” said Qualls. “But there’s some good news: People aren’t leaving the workforce at 65. They’re planning to wind down employment in a different way, so it could stress the system less.”

It’s fiscally feasible to meet the demand for new workforce services and new health care delivery — but it won’t be easy.

“It’s where the population is, so it’s where the workforce will be as well,” she said. “But if there’s anxiety about reimbursement for Medicare, which is the primary funding source for health care — there’s no price mechanism to keep costs from escalating.”

Even more troubling — there isn’t a current pipeline for geriatric specialists, she said. Most medical schools don’t offer a specialty in geriatrics.

“It’s a specialty problem,” she said. “Hospitals and health care agencies are forced to grow their own from people who have an affinity for working with older adults and also have a solid background in health care. A broad toolkit is needed because Boomers are going to need a skill set that covers the complexities of aging.”

Short-term outlook

Hospitals are being hamstrung in their attempts for long-term planning for an aging population, Summer said. Congress, he says, is at fault.

“We’re hanging over this fiscal cliff,” he said, “and its threats to Medicare. Even as the population is aging, Congress is considering additional cuts — ones that aren’t offset by increasing people who have insurance.”

Summer said the industry was braced for Medicare cuts under the ACA, because those cuts would be offset by having more people insured. But the cuts under sequestration could equal $400 million in Colorado alone.

“Since 35 percent of patients in hospitals are on Medicare, that’s a problem,” he said. “We have about 72,000 hospital employees who are depending on Medicare funding.”

Health care groups are preparing for changes that go into effect in 2014, however. The way payments are made — changes from pay-for-service to outcome-based — means the way doctors and hospitals interact with patients will change as well, particularly for Baby Boomers.

“We’re actually getting paid to keep people out of the hospital now,” Summer said. “So, if someone falls and breaks a hip, the hospital will do a home survey to make sure they aren’t going to fall and be right back in the hospital.

“The goal now is to reach out to patients, to keep people well and keep costs down. As the country gets older, that personal touch is going to be more important.”