“If This Is An Emergency, Go To The Emergency Department”

Want to know what’s wrong with the health care system for older adults in the US? It can be summed up in that 10-word response on a physician’s voice mail.

One evening last month, I got a panicked call from a friend: She came home from work and discovered that her widowed mother, who has been living with her for the past year, had—for the first time—an episode of bowel incontinence. Her mom, who was distressed and almost certainly embarrassed,  wanted to go to the emergency department of the local hospital. What should her daughter do?

What the Medicare “Doc Fix” Means for Seniors: Six Things To Know

The House yesterday easily approved some of the biggest changes to Medicare since Congress created the drug benefit a decade ago.  While the measure still must be approved by the Senate and signed by President Obama (who supports it), it represents a significant shift in the way many seniors get—and pay for—their health care.

The measure, known in Washington-speak as the “doc fix,” is primarily aimed at repairing the way Medicare reimburses physicians for the services they provide. But it is a complicated proposal that would do much more than that. It would raise Medicare premiums for high-income seniors, limit some benefits under Medicare Supplement (Medigap) insurance, continue funding some information services programs for older people, and begin a process aimed at changing the way doctors are paid by focusing more on quality care and health outcomes instead of simply paying by the procedure.

What the Battle Over Home Health Care Worker Pay Is Really About

Should the aides who provide home care for frail elders and younger people with disabilities receive a living wage and decent benefits? If they do, how can families, who often are unable to afford care today, be expected to pay those higher wages and benefits? Should the market be allowed to set these prices, or should government intervene through minimum wage and mandatory overtime laws? Should cash-strapped Medicaid programs be required to pay more for these services? And which home care workers should be eligible for pay raises and Medicaid reimbursement?

The Death With Dignity Debate Misses The Point

Ever since the death of Brittany Maynard–the 30-year old with terminal brain cancer who ended her own life last November– the issue of physician-assisted suicide has received an enormous amount of attention.  Now it is back in the headlines as many states consider laws permitting the practice. It is an important and passionate debate, but for the vast majority of people, it misses the point.

For most of us, the critical question is how we will live with chronic conditions, not just how we will die. We make a terrible mistake if we focus only on the last days of life when so many of us will live for years with chronic– perhaps even terminal– but manageable diseases.

How We Spend Our Health Care Dollars As We Age

We spend more on our health care as we age. No news there. But you may be surprised to learn that all health spending is not created equal. For most of us, as long as we can stay out of the hospital or a nursing home, our costs are relatively modest–and steady–even as we grow older.

But that can change if we have a severe, acute medical episode that lands us in a hospital bed or a skilled nursing facility, or if our functional or cognitive limitations get so severe that we need home health care or even must move to a nursing home. While we use those services infrequently, we are more likely to do so as we age. Because they are extremely expensive and often not paid for by Medicare, our out-of-pocket costs for those services can go through the roof.

The Myth of the Demanding Patient

Ask a physician why he prescribes unnecessary tests or treatments, and he’s likely to say he’s responding to demands from his patients (or trying to avoid a lawsuit). But a new study in the journal  JAMA Oncology finds that perception may be wildly wrong.

The study, by Keerthi Gogineni, Katherine L. Shuman, Derek Chinn, Nicole B. Gabler, and Ezekiel  Emanuel found that patients asked for a specific test or treatment in less than 10 percent of visits, and that nearly 9 in 10 of those requests were medically appropriate. In short, patients demanded what their physicians considered inappropriate care only about 1 percent of the time.

Consumers are Buying Less Long-Term Care Insurance Coverage

It is no secret that fewer consumers are buying long-term care insurance—annual sales are only about one-third of what they were a decade ago. But it turns out that those who are still buying are purchasing less coverage than ever, even though long-term care costs are rising.

When industry leader Genworth Financial Inc., which sold about one-third all traditional LTC insurance in 2013, released its quarterly financial statement last week, Wall Street focused its attention on the extra reserves the firm had to set aside to cover higher-than expected future claims. But deep in its presentation to analysts, Genworth also described an important trend: Remaining buyers are scaling back the protection they do purchase.

How Much Money Would An Alzheimer’s Treatment Really Save?

The Alzheimer’s Association predicts that finding a drug treatment for memory loss could save families and the government $935 billion over 10 years. But its report tells only part of the story and ignores key costs, including costs of the therapy itself.

The group could have included an estimated price of those therapies in its report but chose not to, citing the uncertainties of any forecast. However, by excluding any estimate at all—or even a range of projected costs—it leaves out critical information and may inflate potential savings by tens of billions of dollars. In addition, it may also overstate the number of people who would benefit from an Alzheimer’s treatment.

Is Obama’s Budget the Beginning of the End for Nursing Home-Based Medicaid?

President Obama’s 2016 budget would make important changes in the way personal care is delivered to older Americans and younger people with disabilities. The biggest: A plan that could be a major step towards ending Medicaid’s long-standing bias in favor of nursing homes. At the same time, the fiscal plan would modestly boost funding for some senior services programs.

While seniors will welcome the new funding, initiatives aimed at broadening access to home and community based could be much more far-reaching. Most consumers and many governors want to accelerate the shift of Medicaid long-term care services out of nursing facilities and into homes and communities.

Caring for Our Parents: If Kathy Can’t Do It, How Can You?

Like millions of others, Kathy Kenyon is trying as best she can to care for her parents—both of whom have some dementia. The health care system won’t let her.

In a presentation to the prestigious Institute of Medicine a couple of weeks ago, Kathy described in painful detail what is it like to try to navigate the disorganized maze we call health care.

Kathy has enormous advantages over most caregivers. She was general counsel of a major health system so she understands the medical business and is an experienced advocate. She is comfortable with the medical and legal jargon that baffles many caregivers. Her husband is one of the nation’s most knowledgeable long-term care policy analysts. She has a supportive family. And her parents have the financial resources to pay for quality care.