Drugs, Dementia and Nursing Homes

The overuse of antipsychotic drugs “is one of the most common and longstanding, but preventable practices causing serious harm to nursing home residents today,” Toby Edelman of the Center for Medicare Advocacy told the Senate Aging Committee last week.

She said these drugs are often used off-label (that is: for purposes other than the ones for which the FDA approved them) and that overuse both costs Medicare hundreds of millions of dollars and harms patients.  

Last year, an investigation by the federal Department of Health & Human Services inspector general found that 14 percent of nursing home residents were prescribed anti-psychotics but 8 in 10 were off-label, and, thus, not for treatment of mental illness.

Sen. Corker: Long-Term Care is “Heading for a National Crisis”

Senator Bob Corker (R-Tenn) warned today that long-term care financing is “a major train wreck” and “heading for a national crisis.” Corker, the senior Republican on the Senate Aging Committee, said he was very worried about the viability of private long-term care insurance and added , “there is no doubt there is a public sector role” in the future of financing long-term care supports and services.

At a time when the issue has fallen victim to partisan demagoguery (Exhibit A: the CLASS Act)  Corker’s remarks, at a Senate Aging Committee hearing on long-term care,  suggested an opening to build a consensus on future financing and delivery reforms. 

Make Long-Term Care Insurance Part of Health Care

Why not make insurance for long-term care services and supports part of health care coverage?

It is a radical idea that turns the current model—which often treats long-term care insurance as an element of retirement planning—entirely on its head. 

The concept isn’t new. John Rother, who ran public policy for AARP for many years, talked about integrating long-term services and chronic care long ago. And real people with chronic disease see no difference between medical and personal care. But nobody could ever figure out how to make the insurance work.

What You Need to Know if Mom Needs Surgery

Increasingly, surgeons are beginning to change the way they perform operations on elderly patients. They are coming to realize that almost everything is different about surgery on older people:  The patient’s goals, the likelihood of complications, and the entire process of treatment from pre-op through surgery itself to recovery.

As a result, doctors are learning that they not only need to adjust the way they perform surgery, but the health system needs to do all it can to be sure older patients are as healthy as possible before these procedures. Surgeons are also coming to understanding that while some procedures are absolutely appropriate for even very elderly patients, others are not.