GOVERNMENTMedicare's mindfield: Problems in treating the elderly's mental healthPhysicians struggle with obstacles to care for older patients. Today's problems will only intensify as the baby boomers enter the program.By Geri Aston, amednews staff. July 1, 2002. When an 83-year-old patient -- convinced that her neighbors were killing animals and babies -- barricaded herself in her home, Kenneth Sakauye, MD, decided she needed inpatient hospital care to treat her paranoid disorder. But her Medicare health plan made a different call. It wouldn't authorize coverage for a hospital stay, ruling instead that the patient belonged in a nursing home because she also had mild dementia. "We couldn't discharge her because she was a danger to herself," said Dr. Sakauye, professor of clinical psychiatry at Louisiana State University Medical School in New Orleans. The patient was ultimately treated in the hospital even though the plan denied coverage. Dr. Sakauye is appealing the plan's ruling and trying to get reimbursement. His experience is just one example of the myriad obstacles to mental health care services for Medicare beneficiaries. Physicians cite traditional Medicare's unequal coverage policies, the lack of outpatient drug coverage, a persistent stigma associated with mental illness, and health system weaknesses as other barriers. Doctors warn that the problem will hit crisis level if no action is taken. Why? Demographics. The first wave of 76 million baby boomers will reach Medicare eligibility in 2010. By that year, there will be 40 million people older than 65 in the United States, and more than 20% of them will experience mental health problems, according to the American Assn. for Geriatric Psychiatry. "If it stays the way it is now, the future is pretty bleak," Dr. Sakauye said.
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Copyright 2002 American Medical Association. All rights reserved.
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