Too Remote For Care?

Future Consequences

With fuel prices unlikely to return to previous levels in the foreseeable future, some health care organizations are already looking at the possible long-term effects.

"Since there's already a nursing shortage, which is very serious, it's going to make it even harder to do some distance traveling for home care," said Lauren R. MacArthur, a registered nurse in Waterbury, Conn., who does some in-home care. "You're not only taking care of the patient, you're taking care of the family at the same time."

MacArthur is currently taking some time off to watch her grandchildren and alleviate fuel costs for her children.

"I'm relieving a cost that can now go into the gas tank," she said.

But MacArthur sees some benefit in the rising fuel costs. "This just might force peoples of all nations to conserve, which, in turn, will reduce pollution and other harmful practices," she said. But she worries about some of the short-term consequences.

Steven Lieberman, the president of Lieberman Consulting and formerly the assistant director for health and human resources at the CBO, said there are a number of possible solutions to the problem, but they will likely mean a drop in services or a rise in costs.

Home care services could have less-trained people provide the services that currently come from nurses, he said. But money will have to come from somewhere in order to continue the services currently available.

"Generally, providers aren't going to deliver services if their costs systematically exceed their revenues."

And that source of extra money will have to be taxes.

"Primarily, working Americans would pay more," he said.

While having homebound patients live in communal housing might alleviate the transportation problem, Lieberman doesn't see that happening.

"Historically, Medicare has taken the view that Medicare rates should generally be adequate to provide access to services throughout the country."

Based on her area, and the independence of people in her community, Leibrand agrees.

"The population we have here would never go to an alternative site," she said.

End in Sight?

With no long-term solutions imminent, some see the problem getting worse in the near future.

"How do we manage that group of people with fewer and fewer nurses and the economic challenges that we have?" said Halamandaris.

He sees some of the problems being alleviated by personal responsibility.

"Seniors who are well-bodied need to get busy and care for their colleagues that are less well-off," he said.

But he doesn't think that will be enough to counter the aging of the baby boomers.

"We haven't seen the problem at all, but it's going to hit like a tidal wave … all you have to do is play out the demographics."

He also sees the Boomers having a higher disability rate, and therefore needing more services.

"Baby Boomers worked hard to stay young forever; all that activity has a lot of good points, but it also puts a lot of stress on the body."

For more information, visit the National Association for Home Care and Hospice at

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