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.

Obama’s Family Leave Proposals Largely Ignore Caregivers of Frail Seniors and Disabled Adults

Note to President Obama: Families don’t just care for young children. They also care for aging parents, spouses, and adults with disabilities.

In his State of the Union address last night and in an announcement last week, Obama proposed a number of steps aimed at helping working parents care for sick kids. Among his ideas: requiring employers to offer up to seven days of paid sick leave each year, expanding access to paid family and medical leave, providing up to six weeks of paid family leave to federal workers, and allowing federal agencies to advance up to six weeks of paid sick leave.

Hospice Is Becoming a Chain Business

Large multi-agency, multi-state hospices are fast become the primary source of end-of-life care in the U.S.

According to a new study, chains cared for nearly half of all hospice patients in 2011, a dramatic increase from a decade before when small organizations (mostly non-profits) provided three-quarters of all care. And my own review of their financial reports suggests the biggest chains have grown even more since 2011.

The Coming Congressional War Over Social Security Disability

A technical rule change engineered by House Republicans on the first day of the new Congress may signal the beginning of a major battle over the future of the Social Security Disability program—and, more broadly, other federal programs for people with disabilities.

The immediate issue is the fate of the SSDI trust fund, which is expected to become exhausted in 2016. If new funding is not found, SSDI benefits will be cut by about 20 percent for 9 million workers, 2 million of their children, and about 160,000 spouses.

A Provocative New Way To Think About Dementia

Just about everything you think you know about Alzheimer’s disease and other dementias is wrong. And because the conventional wisdom is so off-track, so are the ways we—both family members and professionals– respond to those with dementia.

That’s Dr. G. Allen Power’s provocative message. He wants us to stop thinking that people with dementia are victims of a terrible debilitating disease that destroys their memory and perception. Instead, Power argues, dementia is “a shift in the way a person experiences the world.”