1. Marrelli, Tina MSN, MA, RN

Article Content

As the presidential election heats up, there are a number of factors converging on the home care and hospice industries. Unfortunately, they might not bode well for our professions, organizations, and most importantly, the patients and families we serve. First, the budget numbers for the next fiscal year are staggering and include some significant cuts to home healthcare and hospice. Next, the Administration on Aging (AOA) just released the "Profile of Older Americans: 2007." With one glance at the numbers below, it is easy to see that more is needed to care for this population in the lowest-cost healthcare setting-not less. Some of the highlights include:

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* The older population (65+) numbered 37.3 million in 2006, an increase of 3.4 million or 10% since 1996.


* The number of Americans aged 45-64 (who will reach 65 over the next two decades) increased by 39% during this decade.


* About 1 in every 8 Americans (or 12.4% of the population) is an older adult.


* Persons reaching age 65 have an average life expectancy of an additional 18.7 years (20.0 years for females and 17.1 years for males).


* Older women outnumber older men at 21.6 million older women to 15.7 million older men.


* Older men were much more likely to be married than older women--72% of men versus 42% of women. Forty-three percent of older women in 2006 were widows.


* About 30% (10.7 million) of noninstitutionalized older persons live alone (7.8 million women; 2.9 million men).


* Almost half of older women (48%) age 75+ live alone.


* About 450,000 grandparents aged 65 or older had the primary responsibility for their grandchildren who lived with them.


* The population aged 65 and older will increase from 35 million in 2000 to 40 million in 2010 (a 15% increase), and then to 55 million in 2020 (a 36% increase for that decade).


* The 85+ population is projected to increase from 4.2 million in 2000 to 6.1 million in 2010 (a 40% increase), and then to 7.3 million in 2020 (a 44% increase for that decade).


* The median income of older persons in 2006 was $23,500 for males and $13,603 for females.


* Major sources of income for older people in 2005 were: Social Security (reported by 89% of older persons), income from assets (reported by 55%), private pensions (reported by 29%), government employee pensions (reported by 14%), and earnings (reported by 24%).


* About 3.4 million elderly persons (9.4%) were below the poverty level in 2006, which is a statistically significant decrease from the poverty rate in 2005 (10.1%).


* About 11% (3.7 million) of older Medicare enrollees received personal care from a paid or unpaid source in 1999 (Administration on Aging, 2007).



These numbers validate what we see in home healthcare and hospice: that patients and families are aging, that we care for more women who are older and live alone with few resources, that many Medicare enrollees have pieced together some kind of caregiving network (be it paid, unpaid, safe, etc.), that many of our older adult patients are surviving solely on Social Security and that we see many more grandparents (and some great grandparents) caring for their grandchildren and/or assisting with the care of their great grandchildren.


The January 24th issue of the New England Journal of Medicine published a thought-provoking article entitled "The Amazing Noncollapsing U.S. Health Care System--Is Reform Finally at Hand?" This article suggests that "Perhaps pondering this question can yield insights into the system as the 2008 elections approach. The diagnosis of imminent collapse rests on three symptoms. First, without affordable universal coverage, the system leaves 47 million Americans uninsured. Second, health care costs are extraordinarily high: The United States spends about 16% of its annual gross domestic product (GDP), or $6,400 per capita, on health care[horizontal ellipsis]Third, the U.S. system is in fact a nonsystem, an incoherent pastiche that has long repulsed reforms sought by private and public stakeholders" (Brown, 2008).


Together we can be a voice for those who cannot speak for themselves--our patients who are literally voiceless and homebound--who are not "seen" and unfortunately not "heard" by decision makers and others. We must work together to be the voice. Accurate data with costs savings can always help support better decisions. To that end, this issue of HHN brings readers information that can help organizations and clinicians improve outcomes and deliver evidence-based care.


"Fall Risk Reduction in Home Health and Hospice" by Carol A. Schlismann provides information that has important implications for safety. The "Interdisciplinary Team Perspective" column offers "Pressure Ulcers and the Home Health Aide: Evaluation of an Educational Program," an article that speaks to the role of these important team members, aides, in observing and reporting patient changes related to skin care. Lisa A. Gorksi's article explains the newly revised home health nursing standards in "Implementing Home Health Standards in Clinical Practice: An Overview of the Updated Standards." Other articles include "Morbid Obesity: Issues and Challenges in Home Health, "A Practical Approach to Hiring Your Next Business Consultant" and "Management of Diabetes at End of Life." We hope you find this issue of HHN helpful, and as always, we look forward to your feedback. If you or a colleague would like to contribute an article, please e-mail me at


Tina Marrelli, MSN, MA, RN




Administration on Aging, U.S. Department of Health and Human Services. (2007). A profile of older Americans: 2007.[Context Link]


Brown, L.D. (2008). The amazing noncollapsing U.S. health care system-is reform finally at hand? The New England Journal of Medicine, 358, 325-327. [Context Link]