Older adults with chronic illness often need a combination of medical treatment and social and spiritual supports. Together, they can make people healthier and happier, and less likely to suffer acute episodes that result in preventable hospitalizations. The medical treatment comes from doctors, hospitals, and health systems while the spiritual support comes from faith communities. And, in many cases, so [...]
There is no doubt that the widespread over-use of opiods has become a serious public health problem in the US. But I worry that older adults with palliative care needs may become unintended casualties of efforts to reduce the use and accessibility of these powerful drugs. The opiod problem is real. Nearly 30,000 Americans died from use of these drugs [...]
A typical 65-year-old couple will need to save nearly $400,000 to pay for out-of-pocket medical care and long-term care in old age, according to new estimates by the Fidelity Benefits Consulting. That is $60,000 more than a typical couple’s entire savings at retirement, including equity in their home. Fidelity estimated an older couple will need to put away an average [...]
In recent years, it has become conventional wisdom that physicians avoid the end-of-life mistakes that many of the rest of us make. The story: They die at home rather than in hospital intensive care units. And they rely on comfort care such as hospice or palliative care rather than often-futile high tech medicine. That conventional wisdom, it turns out, is [...]
Last year, Congress changed the way Medicare pays physicians, It scrapped a system that paid docs based largely on the number of procedures and tests they do, and instructed federal Medicare officials to come up with a design that rewards quality and value. Medicare has already moved in this direction for hospitals and health systems, and the new law was [...]
Public opinion surveys show that most Americans incorrectly think Medicare pays for long-term supports and services (LTSS). It does not. But should it? Should Congress add a long-term care benefit to the program’s current package of insurance for hospital care, doctor visits, and drugs? Three highly respected health researchers, Karen Davis, Amber Willink, and Cathy Schoen, think it should. In [...]
We’ve all seen those best- places-to-retire lists. Inevitably, they are based on low taxes, good weather, or lots of activities. But how about this metric: Where will you get the best care if you are old and frail? Hint: Oregon is good. Rural Louisiana is not. The Dartmouth Institute for Health Policy and Clinical Practice, which has access to an [...]
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 [...]
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 [...]
Older adults are getting too much medical treatment. No, I am not suggesting we ration treatment for seniors or empower the mythical death panels. Rather, the health system should replace aggressive but ultimately useless medical interventions with more care. This means rethinking the way we care for older adults with chronic disease. We should organize care around the goal of improving their quality of life rather than on [...]