What Obama’s Final Budget Would Mean for Seniors

In his newly-unveiled 2017 budget, President Obama has proposed little or no increase in federal funding for key senior services programs, higher consumer out-of-pocket costs for brand-name drugs and home health services under Medicare, higher Medicare premiums for upper-income seniors, and reductions in federal subsidies to Medicare Advantage managed care plans. The budget also includes many other changes in the health delivery system aimed at increasing the use of managed care though bundled payment arrangements and accountable care organizations.

A Bipartisan Plan To Pay For Long-Term Care

Four former top government officials—two Democrats and two Republicans—have proposed a new plan aimed at improving the nation’s system for financing long-term care. Their package of ideas is detailed but relatively modest. However, by agreeing to a consensus plan, the officials have taken a major step in raising the profile of the critical issue of long-term care financing.

The group recommends changes in two key areas: making private long-term care insurance more attractive to middle-income buyers and improving Medicaid benefits for long-term supports and services for lower-income individuals. The former officials also say they’ll consider more ambitious ideas in a second stage of their initiative.

Medicare Wants to Pay Doctors and Hospitals for Performance, But Can It Really Be Measured?

Prodded by Congress, Medicare will tie more of its compensation for doctors and hospitals to the quality of their care. And who, you might ask, could be against such pay for performance–besides incompetent providers trying to preserve their reimbursements?  Doesn’t it make sense to pay docs and hospitals for improving the health of their patients rather than for the volume of tests, therapies, and other services they provide?

Don’t Get Trapped By The Myth Of The “Good Death”

Dying is trendy.

I got an email the other morning about “celebrity deaths.”  After the recent demise of David Bowie, Glenn Frey, and “Grizzly Adams,” it seems that everyone is doing it—dying, that is.

Apparently, people have been live tweeting the deaths of loved ones at least since 2013. Rock star docs such as Atul Gawande have created their own mini-industry writing about end of life care. There is “The Tibetan Book of Living and Dying” and “The Pagan Book of Dying” and “The Art of Dying.” A reality show can’t be far behind. No doubt, dying is a thing. And Boomers being Boomers, we want to do it our way. And do it better than anyone else. Kind of like workouts at the gym.

Hawaii Is About To Debate A Public Long-Term Care Insurance Program


The state of Hawaii is about to have a fascinating debate over whether to create a first-in-the-nation universal long-term care insurance program. The benefit would be modest—about $70-per-day for a year– but it would be available to all long-term residents of the state and be funded through a broad-based tax.

The measure will be introduced by Senate Commerce, Consumer Protection and Health committee chair Roz Baker, according to a report in the American Prospect magazine. Hawaii has been working on this issue since the 1990s—not surprisingly since the state has a rapidly growing population of those 75 and older and has a cultural traditional of caring for older adults.

Feds to Hospitals: Improve Your Discharge Planning, or We’ll Make You

Discharge planning is often a broken link in the chain of care for hospital patients. Older adults and others with complex care needs nearly always need follow-up after they are discharged. They’ll almost certainly have to take new medications. They may need bandages changed after surgery, or physical therapy after a stroke. Unfortunately, they and their families rarely get the information they need to manage once they get home.

That may be changing in important ways. Both states and the federal government are taking steps to require hospitals to improve their discharge plans and better communicate them to patients and their families.

Congress OK’s Big Boost In Alzheimer’s Research But Offers Little To Help Those Who Already Have The Disease

Just before leaving town for the year, Congress passed a budget that increased funding for Alzheimer’s research by 60 percent, but, as usual, provided little new money for programs that help those who have the disease, other frail elders, or their caregivers. Over the past six years, funding for most of these much-needed programs has not even kept up with inflation, much less matched  increases in the population of older adults.

Listen to the Cry of a Family Caregiver

I recently received a letter from a caregiver in California, expressing her frustration at the lack of support for family members who sacrifice so much to help loved ones. This is a lightly edited version of what she wrote:

I read your story on the difficulties of caring for a family member with dementia and think you really have the problem in focus: Although Alzheimer’s Disease research gets funding, the funding is NOT for the caregiver–save for tip sheets, training programs, support groups, and the advice to care for yourself first. There is no direct support or financial aid to help pay the bills.

How Can Frail Seniors Who Live At Home Get Better Care?

We all want to live at home as we age. But while we may not want to admit it, getting the support we need can be much tougher at home than in a nursing home or assisted living facility.

For all their problems, nursing homes or residential care facilities can be an efficient way to deliver care to many people who live in one building or on one campus. Aides can visit multiple residents by walking down the hall. A community bus can provide transportation. Social supports and activities are readily at hand. Meals are available in the dining room.

Women Will Face High Long-Term Care Risks As They Age

It is no secret that long-term care is among the greatest financial risks we will face as we age. But if you are a woman, your chances of needing significant levels of personal care after age 65 are especially high. So are the dangers of not planning for costs that will average more than $180,000 for a woman turning 65 today.

On average, according to my Urban Institute colleague Melissa Favreault and Judith Dey of the Department of Health & Human Services, about half of all Americans will need a high level of long-term supports and services at some time before they die. In other words, the chances that you’ll need extensive paid assistance in old age are about 50/50. But if you are a woman, they are nearly 6 in 10. Take a look at this chart: