CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Reimbursement Issues in the Treatment of Older Adults

The barriers to care experienced by many individuals who need intervention or treatment for problems related to their alcohol use have been of great concern to the alcohol treatment field. A further concern has been the observation that only a small minority of those who need treatment receive it.² Reasons include lack of identification and referral of those who need treatment, lack of treatment options, and financial barriers to care. All of these barriers may affect older adults. Currently, however, the financial barriers are changing the fastest, and some of the shifts in reimbursement are alarming.

Private third-party insurers are funded through premiums paid by purchasers, with premiums adjusted based on claims made by any subscriber group. Generally, except for self-insured plans, coverage minimums and premiums are regulated by States through their insurance departments. Medicare is generally thought of as a public third-party payer for health care services. The benefits provided are authorized through legislation.

The current trend, however, is for States to turn their Medicare programs over to managed care companies. Since its inception in 1965, Medicare has generally covered 12 days of inpatient alcohol treatment. However, most managed care companies eliminate coverage for as much inpatient treatment as possible and often cut services for alcohol treatment altogether to keep costs down.

These cuts in coverage are contrary to all that is known about treating older adults with alcohol problems. Coverage of 12 days of inpatient treatment is extremely important for older adults because they are likely to have a greater number of physical and cognitive problems than younger adults. For example, older adults often have more prolonged and severe alcohol withdrawal than younger adults.⁵⁴

In addition, participation in group treatment is more difficult for older adults in the early stages of treatment. They are also more likely to need more intensive outpatient care after an inpatient stay than younger adults.

Medicare reimbursement for alcohol prevention and early intervention efforts in primary care settings would make sense. Research indicates that early intervention programs are effective with a large proportion of older at-risk and problem drinkers. Such initiatives will save the medical community money by preventing more costly complications of heavier alcohol intake.

With ongoing changes in the delivery of alcohol treatment services from inpatient to outpatient settings and the shifting reimbursement structure from fee-for-service Medicare to managed Medicare, coverage of effective treatment is increasingly uncertain. The changes in treatment venue and fee structures underscore the importance of conducting multidimensional outcome assessments in the context of quality management.

Convincing research is important in the effort to ensure that older adults who need intervention and treatment for alcohol problems receive appropriate treatment and followup. Ongoing evaluation of patient outcomes can help safeguard the health of at-risk older adults. It would also foster the development of innovative treatment approaches to meet the needs of this vulnerable population.