Health Equity and Access to LTC Pharmacy Services
Despite gains during the pandemic, wide gaps remain in access to health care and long-term care and services for seniors with long-term care (LTC) needs living at home or in the community. These vulnerable Americans have much greater health care needs, suffer much greater cognitive impairment, and take far more prescription drugs than their community-dwelling peers who do not need LTC. The enhanced services LTC pharmacies offer could help bridge the service gap that could keep these vulnerable people where they want to be – in their homes, but short-sighted payment policies, especially Medicare payment policies, make it difficult for seniors to get those services at home.
Unfortunately, current operational and policy barriers limit access to LTC pharmacies in the home and other community settings like low-income senior housing and other living environments where such Medicare beneficiaries come from traditionally underserved communities often live. The lack of access to LTC pharmacy services in the home and community must be addressed to improve outcomes and quality of life, and to reduce health inequalities.
Four million Medicare beneficiaries need LTC. They need assistance to perform daily activities like bathing, eating, or dressing without assistance. Three-quarters of these folks – three million people – live at home, while only one million live in LTC facilities like nursing homes and assisted living communities.
Many of these three million Medicare beneficiaries living at home are members of traditionally underserved communities. In fact, community-dwelling Medicare beneficiaries with LTC needs are twice as likely to be Black or Latinx as facility-dwelling Medicare beneficiaries with LTC needs or community-dwelling Medicare beneficiaries without LTC needs.
Recent research by ATI Advisory and the Senior Care Pharmacy Coalition found that existing policy is biased toward institutional care, leaving the increasing number of older Americans who choose to live at home without the support they deserve. The impact of these barriers to equitable medication support cannot be overstated.
Like their peers residing in facilities, Medicare beneficiaries with LTC needs living at home require more medication and care management than their peers who do not need LTC. Medicare beneficiaries living at home with LTC needs average fourteen prescriptions, far more than the average eight prescriptions for community dwelling beneficiaries who do not need LTC, and even more than the twelve-prescription average of those living in LTC facilities.
Chronic health conditions, such as diabetes, heart disease, lung disease, depression, and mental illness, are more prevalent among Medicare beneficiaries with LTC needs. Because of these substantial chronic care needs, Medicare beneficiaries with LTC needs use health care much more frequently. Consequently, those living in the community with LTC needs are more likely than those without LTC needs to have expensive medical events such as hospitalizations or emergency department visits, thus generating higher health care costs than Medicare beneficiaries who do not need LTC, whether they live in LTC facilities or in the community.
Research increasingly demonstrates that key LTC pharmacy services for community-dwelling beneficiaries improve patient outcomes, reduce health care costs, and keep people in their homes longer. Congress and the Centers for Medicare & Medicaid Services (CMS) must adopt new policies and remove barriers to allow LTC pharmacy services to expand beyond facilities into homes and communities where they can help patients in need.
Home delivery alone is not the answer. LTC pharmacies offer care coordination across medical, non-medical, and pharmacy services, as well as pharmacy-related consultant services designed to reduce excessive or unnecessary medications, increase adherence, and prevent adverse drug reactions. LTC pharmacies also offer educational services to patients, family caregivers, and other natural/informal supports, and deliver medication based on the needs of the individual. Increasing access to LTC pharmacy services designed to meet the complex needs of individuals with cognitive and functional frailty and chronic health conditions could improve quality of life for those eligible by providing essential services.
Limited community access to LTC pharmacy services has implications for achieving health equity in LTC. The confluence of needs for long-term care and chronic health care services among Medicare beneficiaries who need LTC should be central to policy making. Congress and CMS should craft integrated policies that address chronic health care and LTC needs for individuals living in the community, and medication management should be central to such efforts. Policy makers should embrace the services LTC pharmacies provide, since these services are crucial to effectively manage the chronic LTC patient population living at home. Not only would greater community access to LTC services improve outcomes and reduce costs, it would provide more equitable access to LTC and services in the community and help to keep more people in their where they want to be – in their own homes.
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