The New World of Assisted Living

Assisted living facilities (ALFs) may be going the way of cable TV.  Still around, but with a limited future.

Their residents are changing. Even as their needs become more complicated, they are demanding less institutional-like care.  At the same time, assisted living will have to find its place in a world where medical and social care are becoming better coordinated and providers will be expected to organize themselves in very different ways than today.

Assisted living was once a creative alternative to nursing homes. Soon, something new will replace ALFs. The details remain uncertain, but we can begin to see what this new model of residential care will look like.

What Does Genworth’s Bad News Mean for the Future of Long-Term Care Insurance?

Last week, Genworth Financial, the dominant player in the traditional long-term care insurance market, acknowledged it is continuing to struggle to keep the product afloat. The firm announced it increased its reserves against future insurance claims by $531 million and said it is reviewing outstanding policies to determine whether it will have to take an additional charge before the end of the year. Its stock price plummeted by more than one-third (though it has rebounded a bit since) and the firm is facing enormous pressure from Wall Street to stop selling LTC policies.

What the GOP’s Congressional Victory Means for Senior Services

Republican control of Congress means that senior service programs—most of which have been frozen for years—will face growing budget pressures. At the same time, the GOP also may try to give states more flexibility in the way they provide Medicaid and other benefits to the elderly and disabled. And while the GOP leadership will be under pressure from Tea Party conservatives to trim Social Security and Medicare benefits, it is less likely a Republican Congress will try to do so without bipartisan support.

How Medicare Advantage Plans Can Improve Care and Save Money

Medicare Advantage plans, the managed care programs that currently insure nearly one-third of all Americans over 65, are supposed to achieve two goals: Improving health outcomes by organizing care of older Americans and reducing costs. Those two goals can sometimes conflict, but a new study provides something of a roadmap for how plans can do both.

Nursing Homes Use Too Many Antibiotics, and Residents Are Dying

Infections are all-too-common in nursing homes. And all-too-often facilities treat these conditions with large doses of antibiotics. Now the Obama Administration has announced a major initiative aimed at dramatically reducing the use of these drugs. And the effort has the potential to fundamentally change the way nursing homes operate—and the way residents receive care.

Today, antibiotic use is routine in nursing facilities. The Centers for Disease Control estimates that two-thirds of all residents will be given at least one course of antibiotics this year, and that 25 percent to 75 percent of those prescriptions will be inappropriate. But as a result of the heavy use of antibiotics, 27,000 nursing home residents will suffer from a drug-resistant infection. And many will die.

Don’t Panic About Ebola: Get a Flu Shot and Wash Your Hands

If you are 65 or older and living in America, your chances of getting Ebola are vanishingly small. You are far more likely to contract—and die from—everyday infectious diseases such as flu, a variety of stomach viruses, or common bacteria such as C. difficile (c. dif.) and methicillin-resistant Staphylococcus aureus (MRSA).

These common infectious diseases are responsible for one-third of all deaths among older adults in the U.S. while Ebola has been responsible for none.

Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought

Nearly 18 million older adults, or nearly half of everyone 65 and older, report that they need some assistance with routine daily activities. That’s significantly more than generally believed and suggests that the burden on families and the overall care system may be much greater than previously thought.

According to a new study by Vicki Freedman of the University of Michigan and my Urban Institute colleague Brenda Spillman, about 11 million of those 18 million seniors were getting help in some form—usually from a family member or friend and less frequently from a paid aide. Their study was published in the September, 2014 issue of the Milbank Quarterly (behind a pay wall).

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.