your life. In fact, accumulated knowledge and experience make the later decades more congenial to new accomplishments. Join an art group or a woodworking or calligraphy class.
• Be happy. Maintain your sense of humor. Make each day an opportunity for optimism for yourself and others. A positive mind creates expectations that something good is about to happen and opens doors to new options for success. Learn a new joke every day.
• Be independent. Don’t depend on others for your well-being. A well-developed sense of who you are is the crucial link to a long and meaningful existence. We all need to maintain dignity, autonomy, and independence in our daily lives. Find a place to live where you have access to shopping, the library, your place of worship, and other necessary amenities.
• Be kind to yourself. Make time in your day to meditate, pray, or have quiet moments.
• Be motivated, and see challenges as opportunities for change. Difficulties in your life can be overcome if you regard them as opportunities. Do something to change your situation or emotional mindset. Join the senior’s activity center near you.
• Be necessary and responsible. Live outside yourself. Volunteer your services. See each day as a chance to help someone or something. Associate with other active, involved individuals. Sharpen your sense of duty to preserve your environment, the earth that nurtures everyone. Do some gardening today.
• Be positive. Be willing to see different sides to a situation, and pursue a course of action and thinking that allows for positive changes, or acceptance of what is. Invite that old friend over for tea and mend the rift between you.
It is essential that you maintain balance in your life. Be aware that to be healthy, you need to pay attention to all parts of yourself. Successful aging means your body, mind, and spirit are used to capacity.
2
The Health Care System
The health care system in North America is a complicated array of systems and services, and for many people, it is shrouded in mystery. This chapter follows the story of Mrs. Martino, whose encounters with the health system are quite typical for many elders. Research shows that family help is usually the first line of defense, and formal care provided by the health system is accepted only as the last resort. This chapter helps you understand the kinds of services available to elders and their families — before a crisis forces you to make a quick decision.
The health care systems in the United States and Canada are very different, so not all of the information in this chapter may apply to you. However, the basic concepts of the care needed for elders are the same wherever you live. Your doctor, regional health board, or local state department of social and health services can help you determine how to receive the best possible care for your needs.
The Health Care System in the United States
Because health care in the United States is not government subsidized, many people carry private health insurance (usually through their employers or unions). If you do not have private health insurance and you have no assets, you are covered under Medicaid. Medicaid is a federally supported, state-operated public assistance program that pays for health services for people with low incomes, including elderly or disabled persons who qualify. Medicaid pays for long-term nursing facility care; some limited home health services and may pay for some assisted living services depending on the state. Medicaid pays for the care of half of the clients in us skilled nursing facilities.
Medicare is the largest insurer in the United States and insures more than 40 million people. It is a federal health insurance program for people —
• age 65 and older,
• of any age with permanent kidney failure, and
• under 65 with certain disabilities.
Medicare provides primarily skilled medical care and medical insurance under the following schemes:
• Medicare Part A is hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care, and some home health care. Most people get Medicare Part A automatically when they retire as part of their social security benefits.
• Medicare Part B is medical insurance that helps pay for doctor’s services, outpatient hospital care, and some other medical services that Part A does not cover (like home health care). You must pay a monthly premium to receive benefits under Part B. The cost in 2003 was $58.70 per month.
Medicare Supplemental Insurance (often called Medigap) is private health insurance that pays Medicare deductibles and coinsurances and may cover services not covered by Medicare. Most Medigap plans will help pay for skilled nursing care, but only when that care is not covered by Medicare.
Health maintenance organizations (HMOS), pre-provider organizations, provider sponsored organizations, and private fee-for-service organizations all contribute to Medicare-managed care plans. A professional or group of professionals from any of these organizations paid by Medicare oversees and provides medical services for the people they insure, including hospital care, home care, and long-term care. Since Medicare is a co-payment plan and rates differ depending on the services, the people they insure need to partially pay for these services. Bear in mind though, that the physicians in these organizations are the gatekeepers. To save the organization money, they can control the number of tests ordered and the type of treatment recommended. (Note: Medicare is for people 65 and older.)
Social health maintenance organizations (S/HMO) provide the full range of Medicare benefits offered by standard hmos, plus additional services. These may include care coordination, prescription drug benefits, chronic care benefits covering short-term nursing home care, a full range of home and community based services such as a homemaker, personal care services, adult day care, respite care, and medical transportation. Other services may include eyeglasses, hearing aids, and dental benefits. Membership offers other health benefits that are not provided through Medicare alone or most other health plans for elders. There are currently four s/hmos participating in Medicare: Portland, Oregon; Long Beach, California; Brooklyn, New York; and Las Vegas, Nevada.
The Health Care System in Canada
In Canada, basic health care is universal and free. This means that in each province everyone is entitled to see a physician and to have access to hospital care at no cost to the individual. The Canada Health Act’s principle of portability means that care should be the same in each province. However, the Health Act refers to acute care hospitals, illness, and disease treatment by physicians — nothing else. While some provinces have chosen to include other aspects of health, such as home care, it is not consistent across the country. Some provinces include home care as a universal right, and others do not include it. Another gray area is long-term care. Some provinces include nursing home facilities as universal, others are pay as you go, and still others pay for different levels of nursing homes depending on your income.
Because of cutbacks to the Canadian health care system, many people also carry private health insurance to supplement their provincial benefits.
The Health Care System: Mrs. Martino’s Story
Mrs.
