No issue generates more anger and confusion among Medicare recipients than observation status—that hospital stay that really isn’t a hospital stay. Over the holidays, I got an earful from three people who had been treated at a hospital by hospital staff yet not admitted to the hospital. A typical case goes like this: A person comes to a hospital emergency [...]
Increasingly, older Americans are likely to die at home, and not in a hospital. And more seniors are using hospice care as they near end of life. However, stubbornly large numbers of Medicare beneficiaries still land in intensive care units or find themselves shuttled from home to hospital and back again in their last months of life. A fascinating and [...]
Older adults are among the biggest victims of our often disorganized, uncoordinated, and impersonal system of medical care. Backwards financial incentives encourage useless tests and dangerous hospital admissions and discourage important social support, personal assistance, and preventive care. The result is that Medicare pays hundreds of billions of dollars for treatment that not only fails to improve the quality of [...]
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 [...]
Dying is trendy. I got an email the other morning about “celebrity deaths.” After the recent demise of David Bowie, Glenn Frey, and “Grizzly Adams,” it seems that everyone is doing it—dying, that is. Apparently, people have been live tweeting the deaths of loved ones at least since 2013. Rock star docs such as Atul Gawande have created their own [...]
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 [...]
In a recent essay in The Washington Post, geriatrician and author Jerald Winakur described the recent hospital experience of his 91-year-old mother. You won’t be surprised to learn it was a nightmare: Poor pain management, overworked staff, insufficient training, little communication among physicians and no communication between his mom and the waves of medical professionals who treated her each day. [...]
Of all the complex rules that plague fee-for-service Medicare, few are harder to understand and potentially more important for seniors than observation status. By now, many older adults have heard the phrase. But they are still not clear what it means. A new study by AARP sheds some light on the consequences for seniors of hospital observation stays. But they [...]
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 [...]
When we think about the health of frail older adults, severe, high-profile illnesses such as dementia, heart disease, cancer, and debilitating arthritis come to mind. But for many seniors, small things can turn a manageable chronic condition into an acute medical crisis. One is malnutrition. Spend a little time in a hospital emergency department and you’ll be shocked at how [...]