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In the past two weeks I have visited two college campuses---one in Brooklyn and one in Wisconsin.' Large numbers of students turned out to hear about the new reform law and wanted to know what it meant for them.'
Reading the Modern Love essay in the New York Times Style section has become a favorite Sunday pastime. A widely diverse set of stories explore the paths that love and relationships have taken over the years. Funny, sad, deeply personal and evocative. I find myself connecting with the writers and their subjects in unexpected ways. This week's essay, Sweetest at the End, shared the story of a beloved and accomplished husband's decline and then death from an atrophy of the frontal brain lobe.
Today is National Healthcare Decisions Day (NHDD)a day devoted to recognizing the importance of expressing your choices about your health care through advance directives, by creating a living will and designating a medical power of attorney.
Greetings from the National Alliance for Caregiving! Last week I participated in a very interesting panel on Preventing Alzheimer's and Cognitive Decline. It was a pleasure for me to meet and confer with expert academics and clinicians on' this emerging field of research.
Obama administration officials and the president himself have been on the road selling the benefits of health reform.' The other day in Maryland the president was touting the $250 rebate sent this week to some three million Medicare beneficiaries whose prescription drug expenses have reached the infamous donut hole where there is no coverage.
Lifestyle May Not Prevent Alzheimer's trumpets a headline in Time magazine. The article goes on to describe a carefully conducted review of decades of evidence examining the hypothesis that exercise, social relationships, diet or vitamins can ward off Alzheimer's disease. The study concludes that there is not sufficient evidence to be able to recommend that the public take any of these actions to prevent or delay the disease.
Do consumers buy health insurance like they buy canned peas? Or should they? That's the big question market place advocates have been trying to answer now for more than a decade. The government and others have thrown gobs of money at this vexing problem trying to figure out the best combination of stars, bars and other symbols that will catch the shopper's eye.
When the Centers for Medicare and Medicaid Services (CMS) took the rare step this spring of kicking Fox Insurance out of the Medicare Part D drug benefit program, it pretty much went unnoticed. CMS went after Fox, admittedly small fry in the pool of insurers, and said they couldn't sell any more stand-alone prescription drug plans to seniors These plans are the kind that people buy to complement Medigap policies that don't offer any drug coverage.
The decision by Metropolitan Life to stop selling long-term care (LTC) insurance once again calls into question the viability of that product as a way to pay for nursing home, assisted living and home care needed by the growing number of elders. MetLife was a solid company'big and reputable, with a knack for selling policies to workers whose employers offered the coverage as an extra benefit. It was a name that people trusted in an industry characterized by many small sellers, some of whom became insolvent.
Oh, those clever insurance agents, always on the prowl for new customers. This time they are using the current period of open enrollment for Medicare to snag customers for other insurance products'products that consumers may not need or want.
As Medicare's open enrollment season draws to a close, it's a good bet that seniors are still sifting through all those brochures and flyers that have come in the mail the last several weeks. My husband received 22. Here's a simple rule to make the sifting go a little faster.
An inside look at the cost of health care: a physician confused by the transparency of Medicare reimbursements and a patient in San Francisco unable to afford treatment for an enlarged prostate.
Heather Rubesch first remembers talking with her mom, Linda, about end-of-life care as a teenager. "When I was 14, I had an aunt who passed because she did not receive a kidney transplant. As a family, we had that conversation-if something happened to one of us, organ donation was what we wanted to do," said Rubesch, 37, a business and marketing writer from Kansas City, Mo. Decades later, when Heather got the call from the hospital, informing her of her mother's terminal condition, she was shocked to discover she was expected to make immediate decisions about her mother's end-of-life care.
Someone I know who is just over 65 received an unlikely solicitation'from The Scooter Store located in New Braunfels, Texas, on Independence Drive no less. The outside of the envelope promised a free personal mobility assessment. This person is totally mobile and hardly needs a scooter.
I can't deny it I miss the mother I once had. Even at age 80, she was vibrant, loving, and independent. And she was strong. For nearly 20 years she provided care to my father, who before his death struggled with normal-pressure hydrocephalus and macular degeneration. What an incredible woman!
For those of you who haven't yet heard, I have recently been diagnosed with Stage IV inflammatory breast cancer. This rare form of breast cancer is known for its rapid spread. True to form, it has metastasized to my spine. This means my time is limited. As a nurse, I knew it from the moment I saw a reddened spot on my breast and recognized it for what it was.
As Jerome Rafferty, diagnosed with a progressive form of dementia and an incurable, antibiotic-resistant infection, became more ill, his wife, Renata Rafferty, used hospice services at home initially to assist her in caring for him.
Three a.m. can be a lonely time for caregivers. But when Renata Rafferty's husband Jerome struggled to breathe late one night, she knew she wasn't completely alone. Though it was the middle of the night when Renata called, the on-call nurse at their hospice responded immediately: arranging medical equipment and a nurse to check on Jerome. Now, months after Jerome's death, Renata says hospice 'is not the place you go to die, it's the place you go to celebrate and finish your life, in an environment where that is the sole and only focus.'
Bob Stewart, who will turn 99 this May, began taking supplements in 2000, when he was in his late 80s. The retired podiatrist is also a strong believer in keeping active. He takes exercise classes at least three times a week and participates in numerous community activities, including a local men's chorus.
This is the first in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future.
Even before I officially signed up for Medicare, sellers of Medicare Advantage plans, prescription drug benefits and Medigap policies began stuffing my mailbox with marketing brochures and lead cards'the kind that ask for your name and address and tell you that a salesperson will call if you return the card. Since the first of the year, I have received five lead cards asking for personal information, four solicitations for Medicare Advantage plans, two for stand-alone drug plans and three for Medigap insurance.
The first step after reading my collection of Medicare Advantage, prescription drug, and Medigap sales brochures was to find a way to fill in core Medicare coverage gaps'the deductibles for hospital stays and doctor care and the coinsurance for physician visits, lab tests, and hospital outpatient treatment that could really leave me with an unwelcome bill. I would have to pay 20 percent of those bills if I didn't have supplemental coverage.
If I were to choose a Medigap policy to supplement my basic Medicare coverage, I would still have to buy a separate plan for prescription drugs, since Medigap sellers can't include drug benefits in those policies.
Ah, those Medicare Advantage (MA) plans! The government can't seem to decide if it loves or hates them. On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. So it seemed like I was being encouraged to select an MA plan.
Shortly after I was diagnosed with inflammatory breast cancer a scan showed a hot spot on my lower spine. Was it the spread of cancer? My oncologist scheduled a bone biopsy at my hospital, Maimonides Medical Center, in order for us to find out.
Even though I have written about Medicare for many years, it wasn't until I actually went through the process of selecting an option to cover Medicare's gaps that I realized seniors have an extraordinarily difficult, if not impossible, task. You can't make a perfect decision because so much depends on your future medical needs and no one can predict those with certainty.
I once thought that when I signed up for Medicare, I would never again have to worry about paying for health care. But I will. Medicare's future shape and substance is uncertain.
Two new studies have found there are numerous benefits when people discuss their end-of-life preferences with their clinicians and caregivers.
Because cancer is primarily a disease of aging, we shouldn't be thinking pink for Breast Cancer Awareness month'we should be thinking silver.
Does long-term care insurance have a future? In this roundup, Nancy Folbre, Don Taylor, and Trudy Lieberman offer their forecasts and perspectives on its costs.
Delirium and dementia are not synonymous, though in elderly hospitalized patients, delirium is often overlooked or dismissed as such. Here, Nora O'Brien-Suric and Susan Seliger discuss their parents' hospital experiences with delirium, which new research shows, has dangerous implications.
Did you know that every nursing home resident in the US must be asked every quarter whether she wants to go home, regardless of her health or mental status? And if she says yes, there is a local agency that must spring into action to make that happen.
On a chilly New York day, a sales agent for UnitedHealthcare stood on a noisy street corner in Spanish Harlem pushing Medicare Advantage (MA) plans. He was engaging in table marketing a way to snag new customers, converts from other MA plans, he hoped.
If you or a family member is on Medicare, you would assume that if they are in the hospital their care would be covered under Medicare's Part A hospital benefit. Right? Well, not always.
I remember when my father-in-law passed away nine years ago. A nervous young doctor had the uncomfortable task of telling him that nothing more could be done about his leukemia and it was perhaps time for hospice.
Self-efficacy is a very important concept in health care. It is nearly the same thing as self-confidence, or a belief that you can do something, like monitor mood, change eating habits and start being more physically active. It turns out that self-efficacy is linked to hospital utilization (low confidence = increased ER visits and days in hospital), to blood sugar control (low confidence = worse blood sugar control) and to changes in behavior.
Whenever I am in an interaction, I know these three ideas can help shape the encounter. How is the person doing with these three tasks? What can I do to help? Are they confident in these three tasks?
Virginia was particularly concerned that she would not get medical treatment after she turns 75. She had heard at that age, 'they send you a letter. They are going to start sending you literature on death.'
People have a right to receive in plain language a summary of what doctors bill, what insurers pay and how much they themselves must pay.
Recently, New York Magazine published an agonizing first person cover story by Michael Wolff, 'A Life Worth Ending,' about the terrible choices and harsh reality of illness at the end of his mother's life. The summary slug for the piece says it all: 'The era of medical miracles has created a new phase of aging, as far from living as it is from dying. A son's plea to let his mother go.'
It is easy to understand why the medical machine the clinicians, the tests and assorted medical procedures is poised to provide constant often heroic interventions to save and prolong life.
Last week's essay, Shifting to Palliative Care: Help Us Change our Pace
, provoked the following commentary from my friend and colleague, James Cooper -- to which I responded.
Along with the invention of smart phones, an entire medical mobile application (app) industry has cropped up, promising patients enhanced connectivity, health data collection, and overall care quality at lower costs...For all the hype about robo-grannies, aging in place technologies, and how high tech solutions will reduce healthcare costs, the reality is that these hopes are unlikely to be achieved with the baby boomer generation.
I am a physician. The hardest thing I've ever had to do was to end my mother's life. She was diagnosed with breast cancer at the age of 47. After a seven-year battle that involved multiple surgeries and countless rounds of chemotherapy, she decided that she had fought long enough.
Gail Hunt is president and CEO of the National Alliance for Caregiving and serves on the Board of Commissioners for the Center for Aging Service Technology, the Governing Board of the Patient-Centered Outcomes Research Institute (PCORI), and the CFAH Board of Trustees. This is the third in a series of interviews between CFAH President and Founder Jessie Gruman and patient and consumer group leaders about their experiences with and attitudes toward comparative effectiveness research.
Who cares for our ill, our aged, our vulnerable? Is it physicians, nurses, social workers, aides? Or is it perhaps another member of the health care team? The largest portion of health care is delivered by families.
Even though open enrollment closes this week for some 47 million seniors who can change their Medicare coverage arrangements for next year, the federal government is extending the deadline for certain people. Who are the lucky ones?
We believe that CER can be a valuable strategy to improve health care'?¦We are concerned, however, that older adults have often been excluded from clinical trials of drugs, medical devices and procedures.
We need to do better if we want people to have high-quality care that is provided in a way that is safe and makes the best use of scarce health care resources. CER that is relevant, timely and rigorous is fundamental to achieving these objectives.
If we want our end-of-life wishes to be properly carried out, we have to prepare in advance and our clinicians must also be prepared to help us realize them.
It turns out Japan has much to teach us about improving health…In many ways, Japan scores much higher than the U.S. when it comes to the health of its population.
My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we'd gathered to discuss: When was it time to let Mom die?
How many friends/family members/social workers does it take to change the mind of a frail person? Even if the frail person was/is one of the leading geriatric social workers in the country?
I find myself relieved that I don’t have to figure out how to document (or not document?) concerns [in patient records]...Wondering what they are? Ok, I will tell you, but shhh...don’t tell my elderly patients that I may be considering these topics as I care for them.
A few days ago, Empire Blue Cross Blue Shield sent me one of those Medigap sales brochures that seniors usually expect during the fall open enrollment season.
Not long ago, I was chatting with a friend about my mom, whose life had revolved around work since my dad died 17 years ago. I was worried that my mother might be lonely, but worse, I didn't know how I would care for her at such a distance if she got sick.
Last week, both my husband and I came away from a conversation with my doctor positive that we understood my new weight-gain plan. Funny thing: Each of us recalled a different plan.
This week in health news: Using shame to promote weight loss doesn’t work | Black nursing homes face challenges | Hispanic and Black children not getting the right asthma meds | Electronic health records not widespread
The key to improving the health outcomes of our older patients (and the overall quality of our healthcare system) is through re-investment in dialogue between patients and clinicians and a strengthening of trust within the patient-clinician relationship.
Life is full of surprises, but statisticians tell us that most Americans who make it to age 65 can expect to live to almost 85, and about 1 in 4 will live past 90. Unfortunately, because palliative care is a relatively new specialty, it is often misunderstood by patients, families and even some physicians.
This week in health news: For teens, fighting is bad for the brain | Skeptical elderly turn to home remedies | Bedwetting treatments offer help | Green light for eating and drinking during labor
"You don't get a manual when you become a family caregiver," says Constance Adampoulos. CFAH's latest feature offers advice, practical tips and links to expert online resources to help people manage caregiving's challenges...
It's a scene that plays out daily in exam rooms across the country. The aging patient, accompanied by a caregiver, is seeing his or her physician and a discussion starts regarding the patient's memory.
I know a young woman who serves as the primary caregiver for her mother. Watching her put everything on hold to take the helm is both inspiring and heartbreaking. With her stamp of approval, here are ten tips for anyone out there trying to support a caregiver.
During my recent visit to Canada, I had a chance to meet obesity expert and medical director of Canada's Bariatric Medicine Institute, Dr. Yoni Freedhoff. What he had to say was somewhat surprising...
Perhaps like many of my age, I am not captivated by a number of much-touted technological innovations, increasing choices I don’t desire and fulfilling needs I didn’t realize I had. My nervous reaction to Personal Health System Technology is that of the distancing of patients from doctors, adding still another barrier between doctors and patients, and in the seductive name of their medical welfare.
It isn't breaking news that exercising and eating a healthy diet can help improve your overall health and fitness, but that doesn't make it any easier for most of us to follow suit. These resources from CFAH's 'Be a Prepared Patient' can help...
It is challenging, in the years following a cancer diagnosis, to assemble health care that protects us from the lingering effects of the disease and its treatment and that alerts us to a recurrence or new cancer. I hope these reflections will help those who've been diagnosed with cancer live as long and as well as they can...
Let's stop telling the public that exercising and eating blueberries are guarantees for avoiding frailty and disability. Let's start talking about how to maintain our quality of life as we age and inevitably encounter health problems.
After half a lifetime of following the Medicare program, on October 1, 2013, I became a Medicare beneficiary. I'm part of the leading edge of baby boomers joining the program, ten thousand a day. Here are some reflections upon joining...
In the eighth and final part of our series, we explain who the various people are in your doctor's office, from nurse practitioners to lab technicians. Knowing their different roles can make your visit go more smoothly...
Getting and being sick changes everything in your life, and that includes how you manage your health. For people focused on so-called patient engagement, health empowerment, and social networking in health, the elephant in the room is that most people simply don't self-track health via digital means...
I am all for transparency when it comes to health care. So when Medicare announced a few weeks ago that it would begin to tell the public how much doctors are paid to treat Medicare patients, my first thought was "hooray." Still, I keep returning to the question: What will the data do for the average person?...
A couple weeks ago, the Medicare Rights Center, a well-known New York-based advocacy group, released a report card showing that seniors on Medicare are struggling to pay for their health care. This finding brings up an important question: Why aren't seniors using the variety of state and federal programs that have been set up to help people in this situation?
Seniors are starting to realize that fewer doctors and hospitals may be available to them if they select a Medicare Advantage plan. Restricting these choices – in theory – is a way to control the price of health care. There's just one problem: Consumers still want to choose their doctors or stick with the ones they've got...
The Obama administration and Affordable Care Act supporters have not bothered to explain how the law includes cross-subsidization, missing an opportunity to talk about the "we" aspects of the law. As one 58-year-old woman put it: "The chances of me having a child at this age is zero. Why do I have to pay an additional $5,000 a year for coverage that I will never, ever need?" Here's how it works...
The stories told by people with Alzheimer's can teach us a lot about their lives. They also help us find important topics to discuss when we visit, which can make our visits far more pleasant and meaningful to the person we're seeing...
I recently had breakfast with an aging cousin, Walter, who has become infirm in his senior years. I knew he had several doctors and took medicine. It wasn't until breakfast time, however, that I realized how many medicines Walter took – and I was bowled over...
My husband has been in the hospital 14 times over the past 24 years. What I've learned is that my role as advocate is just as important to his recovery as the roles of doctors and the nurses. You may not have a medical degree, but you have intelligence and instincts...
"I walked in a person, and out a cancer patient," my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine – the side on the exam table or gurney, as opposed to the one standing over it. In time, it became clear we were running out of money...
If there is a population in which we have the biggest opportunity to see improvements in both cost and quality of care outcomes, it is older Americans. The debate on how best to deliver effective primary care has gone on a long time, sometimes frustratingly so, but it has almost never included a crucial constituency: older adults. The John A. Hartford Foundation is pleased to help change that...
I don't know if it's growing older, or New England winters, or the meds I take, or watching Homeland and Downton Abbey in the same week – but my memory isn't as crisp as it used to be. My partner, Richard, has become part of my cerebral cortex...
One in every five older Americans takes medications that work against each other. And some interactions between prescription drugs and supplements can pose dangerous health risks. So what must we do to make sure that we benefit from the drugs we take?
Bewildered, panicked and disheartened, I watched my mother's eyes dart back and forth as she read the pharmacy's prescription cash price list, knowing she could not possibly afford her monthly medicines. We drove home, not saying a word, but I knew she was deeply distraught. When we arrived, she began cutting each tiny elliptical or rounded tablet into halves and quarters...
Recently, a friend commented that she was not sure whether or not to agree to a DNR order for her 90-year-old mother. Complicating her decision was the knowledge that her mother had chosen a DNR status when she was cognitively intact, but then reversed her decision at the time of acute illness, believing that DNR meant she would not receive vigorous medical treatment. This is incorrect, and physicians are confused as well...
Media-fueled flip-flops and research breakthroughs on lifestyle and health behaviors are wearing down my usual patience with the provisional nature of science. Even simple dietary recommendations like lower fat/salt recommendations have become complicated as old truisms are overturned by new evidence. So I'm asking: To whom should I turn for meaningful guidance about modifying my risk for illness and boosting my health?
To those of us who have had a loved one succumb to cancer, who had to negotiate the frightening choice between the rock and the hard place, always holding out hope for another round of chemo...we know that reining in health care costs will mean more than just raising co-pays and lowering drug costs and funding more effective interventions. It will also mean quashing hope. And learning to tell ourselves the truth...
We've watched it many times on television or in a movie: The patient lies in the intensive care unit, gravely ill, with the family at the bedside. The doctor walks into the room and asks, "What do you want us to do?" and opens up a huge can of worms that is, in fact, ethically incorrect. The first priority that a physician has is to their patient...
That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles, even if much of the public remains unaware…
I am writing this post while seated comfortably in a motorized leather recliner with a window view and lots of other perks. What a legacy we would leave Saskatchewan citizens if we could figure out how to extend this first-class patient care to all patients and their families wrestling with chronic disease...
Just a few years ago it seemed that advocates for health care transparency had scored a big victory. The Centers for Medicare and Medicaid Services (CMS) announced that they would rate nursing homes by awarding five stars to the best and fewer stars to lower-quality facilities. It turns out, though, that five-star nursing homes may not be delivering five-star quality...
My 77-year-old parents were recently impacted by a medical error. The good news is that the story ends happily. The bad news is that it could have been averted simply by checking the date on lab tests...
American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers...
I recently spoke with a gentleman with a significant illness whose main goal is to stay home. He decided to utilize our skilled home health services and home medical equipment. Over time, he transitioned into our palliative care program and currently is in our hospice program. Here is information on what these services are and who may benefit from them...
I have just done something I said I would never do: shop for a Medicare Advantage plan to cover my gaps in Medicare. The usual flyers and brochures from sellers of Medicare Advantage plans began to arrive in the mail with their enticing sales pitches, and one nearly fooled me. Short of having a Medicare representative on the phone, you're stuck in an information swamp. No wonder studies show that beneficiaries are not eager to shop around even if they can get a new policy with a smaller monthly premium...