Can Medicare Reform Save Money and Improve Quality?

Medicare, which will celebrate its 50th anniversary next year, needs to be fixed. But if backers of reform frame that change primarily as a way to reduce federal spending, they are doomed to fail.

The other day, former Republican senator Judd Gregg wrote a guest column in The Hill newspaper about a gathering of policy wonks at Dartmouth College aimed at reforming the health care program for seniors. Gregg, co-chair of Fix the Debt, a nonpartisan group that wants to slow the flow of federal red ink, tried to thread the needle. The Dartmouth group, he wrote, was looking “both to improve the delivery of Medicare to seniors and to reduce its unsustainable cost path, which is a large driver of the nation’s debt.”

Should We Take Zeke Emanuel’s Advice And Be Ready To Die At 75?

In a recent article in The Atlantic, entitled “Why I Hope to Die at 75,” Ezekiel Emmanuel makes the following provocative argument: I am not interested in living beyond age 75 since I am likely to suffer from functional limitations and will no longer be able to contribute much to society. I will not accept curative medical treatment, only comfort care. Put me on the ice floe and push me out to sea.

Like much of what Emanuel has written over the years, the piece is challenging and (not accidently) incendiary. It is about half right, but in some important ways, very wrong.

Reimagining End Of Life Care

Imagine being able to receive fully integrated medical, social, and spiritual care in your own home. Nursing care is available 24/7. Home health aides provide basic personal assistance. Care is person-centered and focused on the specific needs of each patient. And for people with incurable chronic conditions, it focuses on managing symptoms, including pain, thus vastly improving their quality of life.

Such a model exists. There is just one catch: You need to be dying to get it. Not dying in the sense that you really want it. Dying in the sense of, well, dying. The model is hospice. Done well, it is close to the ideal system of care. Medicare even pays for it. But it doesn’t want too many people to use it.

What’s Behind the Criticism of Hospice? Is It Fair?

Hospice is facing unprecedented public criticism. In recent months, The Washington Post has published at least four highly critical articles, alleging widespread instances of poor care and fraud. In June, The Huffington Post published a long investigative piece largely targeting the practices of the for-profit hospice operator  Vitas Healthcare Corp.

What’s this about? How did a movement aimed at comforting the dying become a target for widespread allegations of fraud and patient abuse? Is the criticism legitimate? Here are a few thoughts:

Hospice has grown from a social movement to an industry. Largely thanks to Medicare reimbursement, hospice is big business.

Will the White House Conference on Aging Accomplish Anything?

The Obama Administration has announced its preliminary plans for the next White House Conference on Aging, which would be held next year.

It would be the first such conference in a decade and could be quite valuable, given the rapid aging of the U.S. population and vast changes in the medical and long-term care environment since the last session. 2015 also has powerful symbolic meaning since it will be the 50th anniversary of Medicare, Medicaid, and the Older Americans Act.

But the conference risks being a bust—even more disappointing than the 2005 version, which accomplished little of substance.

Looking Beyond Medicare’s Nursing Home Ratings: What You Really Should Know Before Picking a Facility

This week, The New York Times published an investigative report by Katie Thomas on Medicare’s five-star rating system for nursing homes.  Among its findings: Medicare’s Nursing Home Compare tool relies largely on self-reported data by the facilities themselves and is thus unreliable.

On one hand, this is a bit odd, since Medicare’s website explicitly describes these very shortcomings.  On the other hand, the article (which will get a lot of attention because it is The New York Times) may encourage consumers to look beyond Medicare’s rating system. And that would be a good thing.

Preventing Malnutrition Among Older Adults

When we think about the health of frail older adults, severe, high-profile illnesses such as dementia, heart disease, cancer, and debilitating arthritis come to mind. But for many seniors, small things can turn a manageable chronic condition into an acute medical crisis.

One is malnutrition.  Spend a little time in a hospital emergency department and you’ll be shocked at how many frail elderly patients arrive malnourished. A new study reports that one of every six older adults living at home reaches a hospital ER weakened by malnutrition and as many as 6 in 10 are at least at risk for the condition.

Six Questions to Ask Before You Move Into a Senior Living Community: A Resident Tells the Inside Story

What should you know before you move into an independent living senior community? To find out, I asked a long-time resident.  But not just any resident.

Len Bachman has been living in an upscale 313-unit independent senior community in Chevy Chase, Maryland for about a decade. In some ways, he’s very typical of his neighbors. Now an active 89, he moved in not long after his wife died and soon after he suffered a serious leg injury that required a couple of months of rehab and home care.

A New Way to Save for Long-Term Care Costs in Old Age, But How Many Will Buy?

Earlier this month, with absolutely no fanfare, the Treasury Department announced what could be a major change in the way we save for retirement. It will now permit people to shift a portion of their 401(k)s or IRAs into a deferred annuity that provides a guaranteed stream of income once you reach old age.

The idea has the potential to fix several flaws in today’s defined contribution retirement plans and it could make it easier for many older Americans to pay for long-term care. But it raises two huge questions: Will consumers understand these complex products, and will insurance companies bother to sell them to a mass market?

We Are A Long Way From An Alzheimer’s Cure

Two take-aways from the recently concluded Alzheimer’s Association International Conference in Copenhagen: First, after years of research, we still know remarkably little about what causes dementia or how to prevent or delay it. Second, the dementia establishment, including the Alzheimer’s Association and the White House’s National Plan to Address Alzheimer’s Disease, is so focused on a cure that it pays too little attention to the immediate needs of those who already have dementia and those caring for them.

The conference was filled with academic papers based on small, preliminary studies. Researchers are testing every possible variable in older people’s lives to determine if it could be the key to dementia. And the results were all over the place.