Health Care Without Medicare

Joseph A. Jackson, Health Care Without Medicare. (Solarian Press, Lenox, MA: 2000). Amazon.com price: $29.95 (click on book to find).

Built on an early 20th century medical model, our health care system is superb at treating acute problems but woefully inadequate when it comes to assisting those with chronic, long-term illnesses. Patients who allow federal programs like Medicare and Medicaid to dictate their course of treatment very quickly find themselves shunted off to nursing homes.

It need not be that way. Most patients would prefer to live independently in the community--and in many cases they can. What they lack is the knowledge to manage the complexities of long-term care planning, which requires not just medical know-how but expertise in elder law, financial services, insurance, social services, and counseling as well.

Enter the independent care manager, an individual who is highly skilled in at least one of these areas and is well enough versed in the others to offer sound advice and refer to a specialist when necessary. Health Care Without Medicare is an indispensable practice manual for this newly emerging army of foot soldiers fighting to help the chronically ill and disabled stave off long-term institutionalization.

The core of Health Care Without Medicare is a primer on the essential knowledge base that all care managers must possess. Readers will find chapters on the health care system as it is presently structured, the many forms depression can take, housing options, the medical problems of the chronically ill, estate planning, and how to complete a continuing-care needs assessment.

Author Joseph A. Jackson, who heads a care management company in western New England, uses the concept of Community LifeCare Planning (CLCP) to describe the multidisciplinary approach that care managers must follow if they are to help their clients achieve the goals of preserving independence and assets. CLCP involves mobilizing all of the resources available to the elderly individual, including health insurance; personal income and assets; community resources; family, friends and neighbors; and, most importantly, the client's own abilities.

No matter their specialty, everyone in the care management field should find something of use here. Nurse practitioners, for example, will likely skim the chapter on 'Medicine for Care Managers' but carefully study 'Estate Planning for Care Managers.' Elder law practitioners will doubtless do the reverse. The author makes clear that CLCP requires a team approach; no one can be an expert in every planning area. 'The care managers' greatest skill,' Jackson writes, 'may not be in providing the services themselves, but in connecting clients with the specialists who are best able to help.'

For those wishing to explore a particular area in greater depth, each chapter ends with a list of further resources. The useful appendices include Community LifeCare Planning forms, three case examples of care plan option reports and a sample estate planning/financial planning alliance.

Today's simplistic definition of health care is 'medical treatment only.' We can wait for the system to change, Jackson implies, or we can make creative use of what is currently at hand to help the elderly and others with chronic illnesses live independently and with dignity. Health Care Without Medicare is a pioneering guide for professionals taking the latter course.