Americans Want Docs to Talk About End-of-Life.

The public overwhelmingly thinks doctors should have end-of-life conversations with older patients. It even thinks Medicare ought to pay for those talks. It just doesn’t want to have them, at least not yet.

Those are results of a new Kaiser Family Foundation poll, which found that 89 percent of respondents felt physicians should discuss end-of-life choices with them. But only 17 percent of all those surveyed, and about one-in-four older adults, said they have talked about death and dying with their doctors. The better news: About one-in-three people who have a debilitating disease have had “the conversation” (to borrow the title of Angelo Volandes book).

When $500,000 in Social Security and Medicare Benefits Isn’t Enough

A typical American turning 65 this year is in line to receive about $500,000 in lifetime Social Security and Medicare benefits. That’s more than $1 million for older couples. But many still won’t have enough money to pay for out-of-pocket medical care and long-term supports and services.

While the wealthiest seniors will have the resources to pay these hefty out-of-pocket costs, most older adults won’t come close. As with the overall population, there is an enormous gap between the incomes and assets of the best off and everyone else.

Easy and Inexpensive Ways for Older Adults to Prevent Falls

Falls are the leading cause of injury-related death among people 65 and older. One-third of older adults will fall, many will be hospitalized, and some will die. You’ve probably heard the common story: A frail senior is doing relatively well until she falls. She breaks a hip, everything seems to go downhill, and she dies.

But many falls are preventable. Two articles, one in the Journal of the American Medical Assn. and a one from the Harvard Medical School, provide some terrific, low-cost, low-tech ways to avoid dangerous falls. I’ve supplemented their advice with ideas from other sources. They all are based on two simple sets of solutions: changing behavior in small but important ways and changing your home environment.

How Can We Keep Nursing Home Residents Out of Hospitals?

One-third of nursing homes residents are admitted to the hospital at least once each year, and half of those admissions could be avoided. Preventing them could protect hundreds of thousands of older adults from potential harm and save Medicare billions of dollars.

The problem is neither new nor surprising. But it is tough to fix. Last week, the federal Centers for Medicare and Medicaid Services (CMS) announced a second stage of what it calls an Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.

Home Care Workers Are Going To Be Paid More, But Where Will the Money Come From?

Many home health aides and other direct care workers are going to get raises. An important court decision on Friday, an aggressive lobbying campaign by unions, more generous state minimum wage laws, and—perhaps most important of all—growing demand for paid home care by consumers—will inevitably drive up wages for these aides.

The question is: How will older adults, younger people with disabilities, their families, and government pay for this extra compensation?

When It Comes To Long-Term Care Insurance, Americans Don’t Get It

A newly-released survey shows just how conflicted Americans are about long-term care insurance. And how unrealistic they are about how much long-term care costs and how much insurance they can buy for what they are willing to spend.

The survey, completed in 2014 by the consulting firm RTI International and the survey research firm GfK Research for the US Department of Health and Human Services, found that consumers prize two attributes above all others when they think about long-term care insurance: They want lifetime coverage and low premiums. Their willingness to buy any LTC insurance declines dramatically as premiums rise and the benefit period shrinks.

Like A 1965 Ford Mustang, Medicare Needs a Redesign

Medicare is the 1965 Ford Mustang of healthcare. It was cutting-edge back in the day. But, like that half-century old car, Medicare no longer runs very well and needs a remake.

The real issue is not its finances, which is what most of Medicare’s 50th anniversary commentary is about. It’s about redesigning how it delivers care, which is what really matters to older Americans.

Don’t underestimate Medicare’s importance. In 1965, for the first time, it made health care available to millions of seniors who otherwise had no access to much beyond primary care. And it is no coincidence that life expectancy at age 65 has increased by a staggering five years, or by more than a third, between 1960 and 2013. We can’t lose sight of that.

We Need to do a Better Job Caring for 40 Million Family Caregivers

Family caregivers are invisible.

Those children, spouses, or other relatives who provide personal assistance to loved ones with physical or cognitive limitations are often taken for granted or even ignored. But without them, our system of long-term supports and services would collapse. Frail elders and younger people with disabilities would get sicker. Hospitalizations would increase. Medicare and Medicaid costs would explode.

There are at least 40 million family members caring for adults in the US. According to a new study by the AARP Public Policy Institute, they provided 37 billion hours of assistance in 2013, or an average of 18 hours a week. And AARP figures the economic value of that care was $470 billion. To put it another way: that’s roughly what it would cost to replace that family assistance with paid services.

A New Way To Get Hospice Services Without Giving Up Aggressive Treatment

A new Medicare pilot program will make it easier for patients to access some hospice benefits without giving up standard medical treatment for a terminal disease. It is an important step towards building a health system that fully integrates social, spiritual, and palliative care such as pain management with health care. But it doesn’t get all the way there.

Today, fewer than half of all Medicare recipients ever enroll in hospice, and those that do often wait until just a few days before they die. While we are still trying to understand why, one reason may be that people feel they are being forced to give up medical treatment in exchange for hospice services. This pilot could begin to change that.

What Are the Chances You’ll Need Long-Term Care And How Much Will It Cost?

What are the odds you’ll need assistance to help with personal activities such as bathing or dressing before you die? For those about to turn 65, it’s about 50/50, according to an important new study. On average, you can expect to need this high level of care for about two years. But one-in-five Americans will need such assistance for less than one year while about one in seven will need extensive help with daily living for five years or more.