The Medicare Project
From the project, we learned that end-stage renal disease (ESRD) is a medical condition where an individual’s kidneys are irreversibly damaged, and the kidney ceases to function. It is the last stage of chronic kidney disease. It was discovered that as social workers, we must understand the organizations and the insurance cover for Medicare to ensure that we teach the old age and those that lack adequate information. We learned to engage the community in talks regarding their healthcare needs. This made me realize that I can be a good community advocate. We observed that we could effectively implement successful community projects.
For the community, we noted the knowledge gap about insurance covers and various services offered by the Department of Health. We need to encourage individuals eligible for the cover to utilize it for improved quality of life and increased survival chances. We realized that some people do not understand that even when one has ESRD Medicare but is not illegible for the age and disability cover, after attaining 65 years, they should take the cover to ensure optimal cover for their health needs. Still, they are not eligible due to age. They should people with the disease require dialysis or kidney transplant for survival.
We learned that Medicare is a federal healthcare program covering people older than sixty-five, individuals with ESRD that require dialysis for survival, and indeed young people with incapacitating disabilities (Neuman & Jacobson, 2018). The healthcare program has three parts, namely parts A, B, and C. In the group project, we realized that part A covers inpatient care, nursing homes, hospice care, and home care facilities. Part B covers physician care and visits, outpatient services, preventive services, and medical supplies, while part C covers drugs and prescriptions (Butler, 2020). We realized that for one to be eligible for the program, they must be equal to or older than sixty-five years with the ESRD and have enough history of work probability and retirement to qualify for social security retirement or social security disability insurance (SSDI).
We also noted that one could get the benefits through their parent or their spouse’s work history. To be enrolled, they should visit the Social security service and the dialysis center to send documentation of the patient’s treatment requirements if one has the age or disability cover before developing ESRD. Medicare cover starts on the first day of the four months of the dialysis plan (Centers for Medicare & Medicaid Services (CMS), 2018). Medicare covers most ESRD bills such as inpatient hospital dialysis, kidney transplants, home dialysis, medication related to the condition, outpatient dialysis from an inpatient certified hospital, and medical advice.
There are two choices for the coordination of benefits. If one had Medicare first before becoming eligible by age and any group health coverage, they pay for the first 3d days and then the after the Medicare covers them. If one enrolls in ESRD Medicare before registering for the usual Medicare cover, they also undergo a coordination period of 30 days. Medicare ESRD members get advantages such as joining special needs groups so long as the group serves the people with special needs. One can join if one fits the particular category group; however, there are no special groups in Hawaii (Charles, 2021). The department of health partners with Medicare and offers health coverage for the aged, people with disabilities, and ESRD. Through the health insurance office, we understood that the department gives a guideline on establishing an ESRD facility. Such facilities have to go through the public hearing process.
The department also offers the Medicare enrollment forms and ensures that the facilities do not exploit the beneficiaries. The aging executive office is under the Department of Health (Oh, 2017). It is a lead agency in the coordination of the aging systems and Hawaii’s support services as per its authorization in state and federal laws. It is in charge of various programs such as the Senior Medicare Patrol (SMP) in Hawaii, the Hawaii State Health insurance assistance program (SHIP), the long-term care ombudsman program (LTCOP), and the healthy aging partnership (State of Hawaii Department of Health [SHDH], 2021). They all deal with insurance issues for the aged and people with disabilities.
The federal government funds the health insurance program and ensures to assist the Medicare beneficiaries, their caregivers, and their families. In the project’s implementation, we learned the department is under the Executive Office of the aging. It also serves the soon-to-be retirees. It has certified counselors who help with the Medicare Advantage and other programs that suit the individual beneficiaries’ needs. The wing also refers to an individual for community services (SHDH, 2021). We learned that it is at this point that the social workers should help the beneficiaries access the community resources and enable them to make informed Medicare choices.
What Inspired Us
We were inspired by our growing ability to apply practical skills and public health skills in realizing the advocacy and evaluation of the social health determinants in Medicare beneficiaries’ classes (Koprowska, 2020). Also, the collaboration with the EOA gave most of us a sense of fulfillment and gave us the courage to approach ESRD Medicare beneficiaries with confidence. The hands-on community engagement was also a source of inspiration. We gained an understanding of the role of SHIP counselors in the program.
Accomplishment and Community Impacts
We enhanced my teamwork and communication skills during the interaction with the counselors and online video learning and class presentation. We understood the Medicare enrollment and coverage as well as the choices of the beneficiaries. We also improved the community participation and advocacy skills in the project implementation. Through the partnership with the EOA were realized the broad roles of social workers such as counseling on the Medicare choices, community engagement, and mobilization of the community resources.
Before the enrollment in this course, most of us had no background knowledge of Medicare, the legibility, coverage, and the role of the EOA in the ESRD Medicare. We learned how the coordination period works as well as the people legible for the cover. We acquired communication, time management, and the ability to be a team player in community engagement. We are grateful for the growth and realization of the importance of human relationships, integrity, social justice, competence, and service in dealing with the cover classes’ partners and beneficiaries (Koprowska, 2020). We cannot take my interaction with the SHIP counselor and the organizations mentioned above for granted. They have empowered us beyond the social determination of the health needs as a social worker to partnerships, advocacy, and mobilization of community resources.
Furthermore, we were empowered to link the vulnerable communities and groups to the organization to help with their needs. Studies have mentioned the unique role of a social worker in improving people’s lives, maintaining professional relationships, and acting as a guide and advocate in the care (Lee, 2020). We are proud to have undergone the program. It has empowered and extensively brought insight into social work’s broad nature and reminded me not to be narrow-minded. Through group discussions and explanations in the video sessions, we understood the earlier perceived complex concepts into simple ones. We also learned how to share responsibilities which simplifies complex tasks. For instance, in the presentation delivery, we would discuss and prepare the demonstration as a group and then choose one person to represent the rest of us in the arrangement.
Lastly, we take pride in the group members and the instructor for the project implementation’s vast encouragement and teamwork. We made the community understand the importance of information in making decisions regarding their health care needs. We impacted integrity, openness, and positive health-seeking behaviors. The community understands the need for an insurance cover and how good working history is a determinant of the ESRD Medicare cover. This encouraged the community to work so that the family members and the spouse could benefit from the cover.
Areas of Improvements, Unexpected Experiences, and Barriers
In the project’s implementation, most of us were introverted and lacked effective communication. However, the partnership grew our communication skills. We interacted with the SHIP counselors, sensitized the community about the insurance covers, and made choices regarding their Medicare cover. We effectively communicated among ourselves and our groupmates and cultivated professional relationships with the partnering organizations. A good number of us improve my time management skills.
The Course has instilled discipline in me. Before the Course, we had poor time management. Due to the seriousness that the organizations had with timekeeping, we would like to maintain discipline even in our other daily activities. We will use this skill even in other courses that we will undertake in the Course of my social worker career. As far as the Course is concerned, there are no gaps that were noted, especially in the delivery of the course content and the implementation of the community program.
We were surprised by how the SHIP counselors were willing to walk with us throughout the Course and their willingness to teach us. The teaching team was incredible, unlike most of the instructors. They had a sense of humor as well and cultivated a close and professional relationship with us.
This was above our expectations, and we live forever be obliged to thank the course instructor and the organizations.
The teaching team created a conducive environment for wellness, learning, and awesome activities, even at the community level. They had excellent learning instructions and effective communication. They always kept us engaged through the online platforms, and We enjoyed the implementation of the community-level project since they fostered community participation and involvement. Also, we surprise at how the EOA officials appreciated us and their willingness to interact with us. Some of them have high-end titles, but their humility captured our attention.
We experienced some challenges in balancing the demands of different classes throughout the semester. However, the teaching team was supportive and willing to provide a conducive environment for us to adapt quickly. They were also concerned with our lessons. When we later learned to plan our times and most of us overcame the challenge. It also taught us the necessity of sacrifice for those things that we are usually passionate about. At times such barrier occurs due to a lack of good coping skills; we developed them to make our experience incredible.
How the Course Changed our Thinking and Future Persuasion
The Course has changed our thinking on different paths regarding our careers. Each has improved their knowledge regarding SHIP and Medicare coverage. We saw the broad nature of social workers. Before the Course, we thought that social workers’ responsibility included investigations of the various health determinants and helping in the wavering of the hospital bills to the needy (Powers et al., 2020). However, we understand our role in informing the community on the Medicare coverage to cater to their health needs.
We resolved to look out for the resources such as financial assistance programs, job training programs, and self-help groups as a way of creating opportunities for those wishing to have a good work history. We also want to join the advocacy groups to advocate for equality and fight against abuse and fraud by some of the Medicare facilities (Butler, 2020). We wish to mobilize community resources in the future and train the community to turn challenges into opportunities. We will also volunteer in the Hawaii program to render services to the community and practice the skills and knowledge acquired throughout the Course.
When we offer to teach the community about Medicare and how they can utilize the programs offered at the Departed of Health and the EOA, they will be empowered. We will promote a culture of hard work and encourage integrity among the healthcare facilities offering treatments for ESRD.
Why the Course Should be Taken next Year to the Graduates and Undergraduates
The Course should be offered to the undergraduates. However, we are indeed grateful and lucky to have been selected as the pilot students in this program. We have experienced vast learning opportunities. The remarkable interactions, counselors, volunteers, and different organizations have made our semester outstanding and exceptional. The system will benefit both the graduate and the undergraduates because it will change their views about social work and ensure adequate information regarding the SHIP and Medicare coverage.
It will also offer volunteering activities for the graduate as well as offer numerous career options. The Course will enhance their interactive, time planning, and communication skills. It will improve their knowledge of the various roles of the social worker on the beneficiaries of Medicaid. It will also enhance their standards of practice as well as professionalism. It will also renew their commitment to social justice.
There is a myriad of opportunities in studying this course, especially for the undergraduate who have not undergone so many steps in their career. They can choose from being an advocate social worker to volunteering in the SHIP program (Nedelkoska & Quintini, 2018). They can also train as counselors in the SHIP program. For the graduates, it is an inspirational and empowering course. It promotes active community participation in Medicare information and choices. We also encourage social workers who have already qualified and are practicing to undergo this excellent and productive program.
Butler S. M. (2020). Medicare advantage for all, perhaps? JAMA, 324(13), 1275–1276. Web.
Centers for Medicare & Medicaid Services (2018). Medicare program; end-stage renal disease prospective payment system, payment for renal dialysis services furnished to individuals with acute kidney injury, end-stage renal disease quality incentive program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and fee schedule amounts, and technical amendments to correct existing regulations related to the CBP for certain DMEPOS. Final rule. Federal Register, 83(220), 56922-57073. Web.
Charles, N. S. (2021) Barriers and facilitators to supportive care for ESRD dialysis patients—a social worker’s role. Kidney.org. Web.
State of Hawaii Department of Health. (2021). Executive office on aging. Web.
Koprowska, J. (2020). Communication and interpersonal skills in social work. Sage.
Lee, Y. J. (2020). Social Work in Action: The Cognitive Health of Older Adults in Hawai ‘i: Implications for Social Work. Hawai’i Journal of Health & Social Welfare, 79(4), 127. Web.
Nedelkoska, L., & Quintini, G. (2018). Automation, skills use and training. OECD Social, Employment and Migration Working Paper No. 1815199X. Web.
Neuman, P., & Jacobson, G. A. (2018). Medicare advantage checkup. The New England Journal of Medicine, 379(22), 2163–2172. Web.
Oh, J. (2017). Analysis of hospital readmission patterns in medicare fee-for-service and medicare advantage beneficiaries. Professional Case Management, 22(1), 10-20. Web.
Powers, B. W., Yan, J., Zhu, J., Linn, K. A., Jain, S. H., Kowalski, J., & Navathe, A. S. (2020). The beneficial effects of medicare advantage special needs plans for patients with end-stage renal disease. Health Affairs, 39(9). Web.