Friday, January 21, 2022

Webinar Elder Justice Decision-Making Capacity Symposium

Register now for this important virtual symposium from DOJ's Elder Justice Initiative, scheduled for April 19th through April 21, from 1-5 eastern.  Here's a description about the Symposium.

Every day the lives of older adults are profoundly and negatively impacted in both the criminal and civil justice systems based on mistaken assumptions and inadequate assessments of their capacity to make decisions for themselves. In order to raise greater awareness of these issues and improve how elder justice professionals approach these issues, the Department of Justice will be hosting the Elder Justice Decision-Making Capacity Symposium, a three-day virtual conference on April 19-21.

The Symposium will highlight what we know today about the aging brain and its impact on decision-making, and discuss the protocols and tools available to assess decision-making capacity. The Symposium will then focus on the myriad of ways that perceptions of an older adult’s decision-making capacity can have profound implications on their treatment in criminal and civil proceedings. These may include elder abuse or fraud prosecutions not being pursued; unnecessary or inappropriate guardianships being imposed; and civil legal remedies being denied to older victims of elder abuse, neglect and financial exploitation.

By shedding light on the latest science as well as best clinical, legal and judicial practices, the Symposium aims to increase access to justice while promoting the autonomy of older adults.


Free Symposium provided by the Elder Justice Initiative, U.S. Department of Justice.

Click here to register.

January 21, 2022 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, Web/Tech | Permalink | Comments (0)

Thursday, January 20, 2022

Tech Use Among Older Adults Increased

Pew Research Center periodically releases reports about older adults using tech, with the latest one released last week. Share of those 65 and older who are tech users has grown in the past decade explains although tech use is higher among younger folks, "on several fronts, adoption of key technologies by those in the oldest age group has grown markedly since about a decade ago, and the gap between the oldest and youngest adults has narrowed, according to new analysis of a Center survey conducted in 2021."  Here's some data collected about specific technologies:  about 65% of older adults (65+) have smart phones, about 1/3 less than younger people.  There's a bigger gap between the age groups as far as social media uses. The gap on internet access is narrowing, although those 65+ are connected at about 75% of the rate of younger folks, but this gap narrows for the near old. However, the data on frequency of internet usage shows a significant gap based on age,  with less than 10% of the 65+ group indicating they were on the internet constantly.

I was a bit surprised at the numbers, thinking with social isolation, the participation by older adults would have been higher.  There is some good info in this report, so check it out.

January 20, 2022 in Consumer Information, Current Affairs, Other, Statistics, Web/Tech | Permalink | Comments (0)

Wednesday, January 19, 2022

Register Now: EJI Webinar: Trauma Informed Counseling for Older Adults – 1/27/22

DOJ's Elder Justice Initiative announced an upcoming webinar on Trauma Informed Counseling. Here's info about the webinar

Many older adults have been exposed to trauma in their lifetime. They may have been exposed to violence, discrimination, natural disasters or have survived a past crime.

The accumulation of past trauma experiences can exacerbate symptoms related to a current trauma.

In this webinar, attendees will learn:

- the importance of referring older survivors of crime to counseling services,

- the factors that increase an older adult's risk for future victimization,

- how counseling services can help a survivor and aid in your professional role,

- and what types of counseling resources are available to older adults.

Issues pertaining to cultural sensitivity and ethical dilemmas will be explored.



Speaker:

Sheri Gibson, PhD

To register, click here.

January 19, 2022 in Consumer Information, Crimes, Current Affairs, Other | Permalink | Comments (0)

Friday, January 14, 2022

Roundup of Articles Part 2

Thursday, January 13, 2022

Roundup of Articles

I've been off the grid for a while, so I have a backlog of articles for the blog.  I think they are interesting, even though they may be dated by a couple of months. So I'm going to list some of them here and if the topic interests you, click on the link to read the article.  There are so many, I'm not going to summarize or discuss them.

Lowe’s sees sales growth by helping baby boomers stay in their homes.

Costs and considerations for home health care of aging loved ones in Florida. (48 minute podcast plus accompanying article)

End-of-life conversations may be helpful to patients and families

From my friend Professor Naomi Cahn: Contextualizing Menopause in the Law.

The data that shows Boomers are to blame for the labor shortage

‘Greatest Generation’ runs counter to its wholesome image in survey on race, sex and combat during World War II

Private Equity Is Gobbling Up Hospice Chains And Getting Involved In The Business Of Dying

Three key numbers that explain America's labor shortage (discussing early retirement).

I have more for tomorrow's post and then I'll be "caught up" with the news!

January 13, 2022 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Discrimination, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Wednesday, January 12, 2022

Will Medicare Part B Premiums Drop in 2022?

Last fall I had blogged about the significant increase in the Medicare Part B premiums for 2022. Part of the increase was due to the cost of the new Alzheimer's drug.  There have been developments since the Part B premium was announced.  Here are a couple. First, the AP reported on January 10, 2022 that Medicare told to reassess premium hike for Alzheimer's drug.

" U.S. health secretary Xavier Becerra on Monday ordered Medicare to reassess a big premium increase facing millions of enrollees this year, attributed in large part to a pricey new Alzheimer’s drug with questionable benefits.  [This] came days after drugmaker Biogen slashed the price  [about in half]."  Based on that cut, the Secretary determined that a review of the 2022 premium was appropriate. This is no guarantee that the Part B premium will be reduced, but the article notes that beneficiaries will [not] see [an] immediate change to their costs, but Monday’s move could open the way for a reduction later in the year. The Department of Health and Human Services says it is reaching out to the Social Security Administration, which collects the premium, to examine options."

Second, Kaiser Health News  included summaries of stories from several news outlets regarding the decision by CMS regarding coverage of the new Alzheimer's drug  Medicare To Limit Coverage Of Contentious And Costly Alzheimer’s Drug.  For example, the AP story, Medicare limits coverage of $28,000-a-year Alzheimer’s drug, "The initial determination from the Centers for Medicare and Medicaid Services means that for Medicare to pay, patients taking Biogen’s Aduhelm medication will have to be part of clinical trials to assess the drug’s effectiveness in slowing the progression of early-stage dementia as well as its safety. Medicare’s national coverage determination would become final by April 11, following a public comment period and further evaluation by the agency."  The drug manufacturer disagrees with the decision.

So what will be the impact of the price drop, the reassessment and the coverage decision?  Stay tuned.

January 12, 2022 in Cognitive Impairment, Consumer Information, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Saturday, January 8, 2022

Sad News: The Passing of Civil Rights Advocate Lani Guinier, Reportedly of Complications of Alzheimer's

I read the news late on Friday of the passing of Lani Guinier and it was especially sad to learn that family members reported her death, at just 71, was due to "complications of Alzheimer's disease."  That report made me realize that I hadn't heard from her on the important civil rights issues of the last few years -- and this history probably explains why.  Nonetheless, her teaching, her writing, her advocacy in court and in the field on behalf of civil rights, on voting rights, on student empowerment (often on behalf of women in law school classrooms, urging them them to speak out) will continue to impact the nation.  In her 2002 book, The Miner's Canary -- sitting nearby on my shelf --  cowritten with Gerald Torres, the conclusion resonates with equal strength in 2022:   

We credit the civil rights movement and the liberal legal model to the extent that each created a space for progressive politics and reduced racism as conventionally defined.  This tolerance model has made alliance possible that were once unthinkable.  But the civil rights movement too often seems to measure progress by looking backward; we want to shift the focus to where we are going, not how far we have come.  In the past, conventional ideas of race were deliberately tied to issues of social policy in order to make programs of general concern sound like special pleading.  Our response is to reclaim race in order to "complete" democracy."  

With grateful feelings, and remembering her as a role model for so many, we will miss her.  

January 8, 2022 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues | Permalink | Comments (0)

Wednesday, December 22, 2021

Budgeting for Medicare Increases?

Yesterday the New York Times ran what I consider to be an important article about Medicare costs to beneficiaries. How to Cope With Medicare’s Rising Costs focuses on how beneficiaries can plan for the rising costs of Medicare.  There was a lot of excitement over the 2022 SSA COLA increase, rightfully so, but that excitement would quickly evaporate when CMS announced the 2022 Medicare increases, especially the Part B premium, which is going up 14.55%.   Initially it was announced in part that the increase was due to the anticipated cost of the newly approved Alzheimer's drug. However, this week, the article notes, the manufacturer dropped the price of the drug. But will there be a commensurate drop in the Part B premium?

The Part B premium is not the only increase in out of pocket costs. The article discusses the deductible as well as the Part D costs and how those increases, especially for drugs, affect beneficiaries' ability to access health care and take their meds.  Remember that one provision of the Build Back Better is to allow CMS to negotiate some drug prices and cap Part D out-of-pocket costs, as well as that for insulin.

The article contains a section on how to budget for these increases. In addition to including plan choices, the article offers several more suggestions, such as a health savings account, delaying Social Security, and annually reviewing plan choices during each fall's open enrollment.

 

December 22, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Does Technology Combat Social Isolation

With this latest COVID surge right in time for the holidays, folks may be debating about traveling vs. staying home.  As we learned during the first lockdown, isolation can have a particularly devastating impact on many, and especially on older adults. 

A bit ago, the Washington Post published an article,  How technology can help seniors beat loneliness and isolation, which examines social platforms that provide connections, entertainment, and more. The article reviews some of these platforms. One featured, Papa, is provided through Medicare, Medicaid and some employer health plans and provides in-person connections.  Other platforms provide these connections as well, and there is an opportunity for younger generations-not just family-to connect with older folks.  Then, of course, are the platforms that connect virtually for virtual communications, some that emphasize intergenerational connections and match folks based on a common interest.  Then the more "high tech" platforms are those that provide virtual reality, with the article noting that "[t]he immersive, 3-D experience is more compelling than FaceTime or Zoom. “It’s like the difference between a phone call and a video call...."

December 22, 2021 in Consumer Information, Current Affairs, Other, Web/Tech | Permalink | Comments (0)

Tuesday, December 21, 2021

SNF Staffing Standards-New Report

Yesterday I blogged about California's consideration of tying Medicaid funding for SNFs to certain quality of care benchmarks. Today I wanted to let you know about a new report released by the National Consumer Voice for Quality Long-Term Care. State Nursing Home Staffing Standards SUMMARY REPORT opens noting that

"Chronic understaffing has been a serious problem in nursing homes for decades and has been exacerbated by the COVID-19 pandemic. While there are numerous factors contributing to this problem, one major cause is the lack of adequate minimum staffing standards at both the state and federal levels. Minimum standards ensure that staffing will not fall to a level that would be harmful to residents. Local, state, and national advocates have pushed for minimum staffing standards for years. Knowledge of the range of state staffing requirements can be very useful in these efforts. To that end, the focus of this summary report is to present staffing requirements from each state and analyze how they compare to each other and to levels recommended by research conducted for the federal government. This information can also be helpful to policymakers, researchers, and the media.

The report discusses the connection between staffing and quality care, the research on minimum staffing standards, laws and regs at both state and federal levels, an analysis of state staffing standards, recent developments, and concludes with this

Twenty years after the CMS study found that at least 4.1 hprd of direct care nursing staff time are needed just to prevent poor outcomes, state staffing requirements, with a few exceptions, are nowhere near that recommended level. Only the District of Columbia requires this overall level of staffing, and only six states mandate the presence of a registered nurse 24 hours a day regardless of facility size. Despite what is known about the relationship between staffing levels and quality care, staffing standards in almost every state remain severely low. Residents have waited decades for adequate staffing around the clock. Every day that passes without sufficient staffing jeopardizes their health, safety and welfare. Ongoing and robust advocacy is needed at both the federal and state levels to provide residents with the care to which they are entitled and that they deserve.

The full report is available here, a summary here, Appendix A (guide to state staffing standards) here, and Appendix B (state staffing standards comparison) here.

December 21, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Statutes/Regulations | Permalink | Comments (1)

Monday, December 20, 2021

California Reconsidering Criteria for SNF Medicaid Funding

Well, as I write this, it looks at though the world is heading for another COVID surge.  Thus, this recent article from Kaiser Health News is particularly timely. After ‘Truly Appalling’ Death Toll in Nursing Homes, California Rethinks Their Funding opens with this sobering statistic: about 1 of every 8 of those California residents who died due to COVID resided in SNFs which translates to roughly 9,400, with an added  56,275 SNF residents with confirmed COVID who survived it.  As a response, the article notes, that the Governor's office is looking into a proposal that ties SNF funding to performance, with "those that meet new quality standards would get a larger share of state funding than those that don’t."

There will be several hurdles, and the industry is gearing up to oppose it while families of those who died are prepared to support it.  For example, the CEO of  California Association of Health Facilities, doesn't think the facilities should bear the blame, since "residents naturally at higher risk than the rest of the public, [and] facilities were forced to accept hospital transfer patients who had not been tested for the virus, they couldn’t get adequate supplies of personal protective equipment, and they suffered as staff members got covid in the community and then brought it into work."  The counter-point from various studies notes that SNFs "with fewer nursing staff members experienced significantly higher covid infection and death rates. That devastating outcome is bolstering a two-decades-long argument by patient advocates that nursing homes must hire more workers."

Staffing is not the only issue, and the article explores others, including the profits made by the various chains.  California is not alone in considering actions to improve quality of care.  I'm sure there will future blogs on this topic.

December 20, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, State Statutes/Regulations | Permalink

Friday, December 17, 2021

Using Dark Web to Steal Older Americans' Identities

The U.S. Attorney's Office for the Northern District of Georgia released a press release that Two Georgia men sentenced for using Dark Web to steal identities of elderly victims. According to the press release, here's how the scam worked. "[T]he charges, and other information presented in court: [two perpetrators] purchased personal identifiable information (PII) from dark net markets and used the information to open credit accounts using the victims’ information. They then forwarded the phone lines, mailing addresses, and the emails of their victims to their control. This allowed [the perpetrators] to impersonate victims with creditors and prevented victims from learning about the fraud."

One defendant "was sentenced to three years, ten months in prison for access device fraud, to be followed by two consecutive years imprisonment for aggravated identity theft.  He was also sentenced to serve three years of supervised release and ordered to pay restitution in the amount of $108,397.55.  [He] was convicted on these charges on May 14, 2021, after he pleaded guilty."  The other defendant "was sentenced to one year, six months in prison for access device fraud, to be followed by two consecutive years imprisonment for aggravated identity theft.  He was also sentenced to serve three years of supervised release and ordered to pay restitution in the amount of $66,097.55.  [He]was convicted on these charges on September 9, 2021, after he pleaded guilty."

Thanks to my friend and colleague Professor Bowman for sending me the link to the press release.

 

December 17, 2021 in Consumer Information, Crimes, Current Affairs, Federal Cases, Federal Statutes/Regulations | Permalink | Comments (0)

Thursday, December 16, 2021

California Aid-in-Dying Statute Revisions

You may have already read about this, but just in case....  Kaiser Health News has reported about changes to California's aid-in-dying law.   New California Law Eases Aid-in-Dying Process explains that "in October, Gov. Gavin Newsom signed a revised version of the law, extending it to January 2031 and loosening some restrictions in the 2015 version that proponents say have become barriers to dying people who wish to avail themselves of the law." This change becomes effective in 2022. 

With the original law, as an example, "patients who want to die must make two oral requests for the medications at least 15 days apart. They also must request the drugs in writing, and two doctors must agree the patients are legally eligible. After receiving the medications, patients must confirm their intention to die by signing a form 48 hours before ingesting them."

Now, with the changes, "the revised law reduces the 15-day waiting period to just two days and eliminates the final attestation [and] requires health care facilities to post their aid-in-dying policies online. Doctors who decline to prescribe the drugs — whether on principle or because they don’t feel qualified — are obliged to document the patient’s request and transfer the record to any other doctor the patient designates."

The article offers poignant examples, provides statistics, and discusses the approach of insurance companies for coverage of the prescription ("[M]ore than 60% of those who take the drugs are on Medicare, which does not cover them. Effective life-ending drug combinations are available for as little as $400.")

December 16, 2021 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, December 15, 2021

Loss of Dignity As Ageism

My friend Professor Naomi Cahn, sent this essay published in the Washington Post that really resonated with me.  Opinion: Please do not put a party hat on my head — and other indignities of old age. When I look at birthday cards that note a person is infirm because of age, or party decorations with an over the hill theme, I shake my head.  I'm glad I'm not alone in this.  The author offers that  she is "83 and have no idea if I’ll ever reach that three-digit number. But I’m warning my children and friends that if they dare to top my noggin with [a child's birthday party hat]  I will use every bit of strength to rise from my chair, grab a cane if there’s one handy and whack them all in the head."  She writes about the helpful folks who assume she needs assistance instead of asking first. Here's her approach

Whenever I get the chance, I announce my age. I do this because it’s a disservice to us older folks if we hide it. To me, that’s saying we’re ashamed to have lived so long. We’re covering up an important fact, as if we’re descendants of a long line of serial killers.

One way I’m protesting against the popular image of an old person is to be a showoff. On my 80th birthday, to celebrate my achievement of finally learning how to swim (the crawl, with flippers), I got a tattoo on my right biceps. I’d gotten my first on my left — my kids’ names and images reflecting them — for my 60th. But the newest has not shut me up.
Her approach to aging is quite positive and she offers good advice at the end of her essay:

If you’re a woman of my vintage, I ask this of you: Do not dye your hair. Do not get cosmetic surgery. Do not lie about your age. Be proud of the years you’ve lived, the talents you’ve contributed to your world and the importance of your being a witness to decades of history.

And maybe, get a tattoo.

So don't buy decorations or cards that imply an age number correlates with infirmities and remember that ageism is a real and harmful thing. 

December 15, 2021 in Consumer Information, Current Affairs, Discrimination, Other | Permalink | Comments (0)

Tuesday, December 14, 2021

NY Times Investigation Into CMS Appeals Process for SNFs

The New York Times published the results of an investigation into SNF deficiencies in How Nursing Homes’ Worst Offenses Are Hidden From the Public opens with 3 examples of errors and notes "[s]tate inspectors determined that all three homes had endangered residents and violated federal regulations. Yet the federal government didn’t report the incidents to the public or factor them into its influential ratings system. The homes kept their glowing grades."

Describing the results of the investigation, the article notes

that at least 2,700 similarly dangerous incidents were also not factored into the rating system run by the federal Centers for Medicare and Medicaid Services, or C.M.S., which is designed to give people reliable information to evaluate the safety and quality of thousands of nursing homes.

Many of the incidents were uncovered by state inspectors and verified by their supervisors, but quashed during a secretive appeals process, according to a review of thousands of pages of inspection reports and nursing home appeals, which The Times obtained via public-records requests. Others were omitted from the C.M.S. ratings website because of what regulators describe as a technical glitch.

Knowing the importance of the results of the inspections, the article offers that "[o]n-the-ground inspections are the most important factor in determining how many stars homes receive in Medicare’s rating system. The reports that inspectors produce give the public an unvarnished view inside facilities that house many of the country’s most vulnerable citizens."  

Despite the importance of such info, the system isn't transparent.  "On the rare occasions when inspectors issue severe citations, nursing homes can fight them through an appeals process that operates almost entirely in secret. If nursing homes don’t get the desired outcome via the informal review, they can appeal to a special federal court inside the executive branch. That process, too, is hidden from the public." Even though CMS may prevail, the results don't always end up on the compare website.  Why not?  "Jonathan Blum, the chief operating officer for C.M.S., said that citations are omitted during state-level appeals to be fair to nursing homes that are disputing inspectors’ findings. He acknowledged that even after appeals are exhausted, some citations still don’t appear on Care Compare. He said C.M.S. is 'working to correct this issue.'"

The article offers an excellent overview of the inspection requirements and process, as well as pointing out some of the limitations of the process.

This is a really important report and I plan to make it required reading for my students. You need to read it also!

Thanks to my friend and colleague, Professor Bauer, for sending me the link to the article.

December 14, 2021 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations | Permalink | Comments (0)

Monday, December 13, 2021

Who Has Been Most Affected by COVID-19?

The New York Times reports that even through people in the US aged 65 and older are the "most" vaccinated of all age groups, they still comprise "three-quarters of the nation's coronavirus death toll."  Of course, the impact has not been "just" in terms of the greater risk of serious illness and death.  I think it is pretty clear there has been an age-related leveraging of fear and isolation with each news story that reports another surge in outbreaks.  

One in 100 older Americans has died from the virus. For people younger than 65, that ratio is closer to 1 in 1,400.

 

The heightened risk for older people has dominated life for many, partly as friends and family try to protect them. “You get kind of forgotten,’’ said Pat Hayashi, 65, of San Francisco. “In the pandemic, the isolation and the loneliness got worse. We lost our freedom and we lost our services.” 

 

....

In both sharp and subtle ways, the pandemic has amplified an existing divide between older and younger Americans.

COVID-19 is now "the third leading cause of death among Americans 65 and older, after heart disease and cancer.  It is responsible for about 13 percent of all deaths in that age group since the beginning of 2020, more than diabetes, accidents, Alzheimer's disease or dementia." 

For more, including the difficult choices some older adults have encountered, only to find that all their efforts failed to keep them safe, read the full NYT article, "As U.S. Nears 800,000 Virus Deaths, 1 in Every 100 Older Americans Has Perished." 

 

December 13, 2021 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (1)

Tuesday, December 7, 2021

What Do We Mean by Care? Heather McGhee Interviews Ai-Jen Poo

The New York Times is a host for The Ezra Klein Show, a podcast (and short written commentary) with episodes that generally appear on Tuesdays and Fridays each week. Ezra Klein is on paternity leave right now, and in his absence, Heather McGhee, author of The Sum of Us, interviewed Ai-jen Poo, MacArthur grant winner and author of The Age of Dignity: Preparing for the Elder Boom in a Changing America.  The discussion is timely.

Interestingly, the title assigned by the NYT to this podcast is "Every 8 Seconds, an American Turns 65.  How Do We Care for Everyone?"  

Use of that statistic seems to be intended to shock, or at least, to cause a nervous, worried reaction.  Yet the "8 Second" rate is also used for new births in the U.S.  At the outset of the interesting interview, Heather asks Ai-jen for a definition of "care."  Ai-jen responds in her usual fashion -- thoughtfully and carefully -- and says, in essence, "Care is the most fundamental form of support we offer others.  We both offer and rely on care; care is essential." She adds, however, that for most families, private care is unaffordable, whether the need is for child care, disabled family member care, or elder care.

I wonder why it is that we so often ask whether "we can afford" the care of older adults?  That implies the public form of "we." Yes, too often the response (if not the answer)  is "no," but I tend to think that one of the reasons for that fact is that we continue to think that we, as individuals, have some "right" to stay in our homes no matter how long we live, and no matter how much this becomes impossible to manage.  Is it just "too" hard as individuals to plan for alternatives? I think the answer is "yes," but if we aren't going to plan as individuals, it seems likely that the costs will always be treated as unaffordable by "the public."

December 7, 2021 in Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (0)

How Does Your Hospital's Average Wait Time Compare?

Following my post urging new approaches to "waiting room" protocols, I received several direct replies. I think I've touched a nerve.  First, the fact that the replies were sent directly to my email address probably reflects a little "wait time" problem for the Typepad Blog Platform itself. More than one reader commented on the difficulty of logging in to submit their own responses to a Blog post.  My apologies!  

But, I'm always happy to read commentary, no matter the means of communication.  Some people wrote to report innovations in their own communities.  Among the most interesting have been people who reported "pop-up clinics," especially on the outskirts of larger cities or even more rural areas.  These clinics are a direct response to COVID-19 pressures on hospitals -- and they make a lot of sense.  Other suggestions have included the option of "beepers" being provided to waiting patients so that they have the option of moving outside the crowded waiting room without fear of losing their spot.  If restaurants can do this, why can't hospitals!  

I also heard from two friends who are physicians.  Both reported their own frustrations.  They can end up facing patients and family members who are worn out or angry by the time they reach the person who can diagnose and offer treatment.  One doctor speculated on the trend of ordering diagnostic tests such as CT scans before the doctor's first communication with the patient, echoing some patients' suspicion that the tests increase the cost of the visit, and the question is necessity.  

A newspaper that serves a nearby Pennsylvania county (York) also carried a story over the weekend reporting on average wait times at various regional hospitals -- and one large, high volume hospital was reporting waits of almost 5 hours.  Could ERs publish this kind of information at the door, so that families understand that challenges ahead, and can consider options before checking in?  Heck, Departments of Motor Vehicles routinely post waiting times!

And it turns out that a Medicare.gov Care Compare website, in addition to offering comparative information on nursing homes, also offers information about other health care providers including hospital emergency rooms.  Evaluative items related to "quality" include reports on "timely & effective care, complications & deaths, unplanned hospital visits, psychiatric units services, and payment & value of care."  Under  the first category, when I searched a local hospital's data, I learned that Medicare considered this hospital to have a "medium" volume of patients, but the average ER wait time of 207 minutes was similar to much larger volume hospitals.  I don't think anyone is likely to access this website while headed to the emergency room, but perhaps the information does facilitate better advance planning before an emergency to identify nearby options for the future.

 

December 7, 2021 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Saturday, December 4, 2021

It is Time to Rethink "Waiting Rooms"

Today I read an interesting Washington Post article about a judge in a northern New Mexico town who has been willing to rethink criminal justice for drug-related offenses.  The approach this judge is taking goes beyond the "drug court model, once widely viewed as a progressive alternative to jail." As described in The Judge Who Keeps People Out of Jail Judge Jason Lidyard meets directly with participants in his program, outside the court house, to discuss progress one-on-one:  

He does not expect his clients to abstain from using -- in fact, he assumes the contrary. 'I don't care if you're high, so long as you show up here,' he tells one.  And informed by childhood memories of his own father's addiction, he categorically refuses to use jail as a sanction. 'Only two things will get you kicked out,' he explains. If you don't show up, or if you commit new crimes.

My own work doesn't focus on criminal justice.  But I am ever more intrigued by the willingness of some prosecutors, jurists and court systems to rethink solutions to different forms of problematic behaviors.

This article also intrigued me because I had recently spent an evening in an emergency room of a small town hospital. An older friend -- in her 90s -- had been waiting since early afternoon for diagnosis of symptoms of light-headedness, "waves" of confusion, and sudden inability to walk normally.  Her symptoms were serious.  After more than an hour at an urgent care facility, transfer by ambulance and 3 hours in the hospital's ER, some tests had been conducted.  But when I arrived the results were not available and she had yet to see a doctor.  Friends and then her daughter (driving several hours from her home in a large city) had been taking turns sitting with her and hoping to get some recommendation about how best to handle these worrisome symptoms. 

Over the last few years, as I suspect is also true for many of our readers,  I've done this same sort of "camping out" in ERs in multiple hospitals with aging friends and family members.

But that evening was startling in the intensity of what I was observing.  Every chair in this relatively new hospital was taken, and even more patients were sitting in wheelchairs.  There was only one person at the "intake desk" and it is an understatement to say that person was suffering from front-line burn out.  Rather, she was in full flame.  

At least a third of the patients I was seeing were "older."  Some of them had no family members with them.  One woman, with no family and clearly deeply affected by some form of dementia, was wrapped in a blanket, no shoes, and, I realized, no clothes on under the blanket. She was wandering, and moaning, very unstable on legs that appeared distorted by cellulitis.  Another patient was holding one of his legs in the air with his own hands, as he was in such pain that he couldn't stand to have his foot touch anything -- and no wonder, as I could see a large, weeping hole in the center of the foot.  I was moving in and out of that ER for about 4 hours.  Many of the patients that were sitting with agonized expressions on their faces when I first arrived at 6 p.m. were still in the same location when I left for the final time just after 11 p.m.  There were no hospital rooms available.  Period.  

My friend could not take the chance of going home to wait for the tests results, and it was clear that if she did so, no one would be available to talk with her by phone who could give an informed diagnosis and discuss options.

COVID-19 and certainly the recent variants, have exposed and intensified what has long been a problem for hospitals: the process of emergency admissions.  My father, years ago, summarized the problem accurately even while he was in the early stages of dementia.  "I would rather die on the steps than spend one more night in that place" -- referring to the ER.

But it isn't just emergency rooms at hospitals.  I've had to abandon waiting rooms in doctors' office, dentist offices, even the pharmacy, because whomever I was bringing in for help was panicking when they felt trapped in chairs that they were afraid to even touch. Post-Covid-personnel shortages at all levels of care are clearly making the problem of access to health care very problematic. But I suspect the problem pre-existed the pandemic.  (Inadequate, un-separated seating in airport lounges and transport buses? I'm thinking of you too!)

Solutions?  I'm not sure.  But certainly some creative minds could tackle this.  I know some care-sites ask patients, if possible, to wait in their cars to be called in for the actual appointment.  But that doesn't work for many older persons, especially in hot or cold weather, or where it is a very long walk to get to a bathroom.  

I do know that one source of help I stumbled across in one state was using the non-emergency number for the 911 responders in the area.  In that state, I discovered calling that number resulted in a "first available" non-emergency response by a team of trained professionals who could do high level assessments, and who could help prioritize any needed transport to the ER.  But that doesn't' seem to be a uniformly available alternative in all states.

There is a saying, sometimes attributed to Winston Churchill (probably incorrectly) reminding us to "never let a good crisis go to waste."  Let's use the current crisis to rethink ways to more effectively access health care assessments.  Certainly that would be better for patients, but also for the front-line responders.  

December 4, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (1)

Friday, December 3, 2021

Are Luxury Senior Homes Worth the Price?

The New York Times recently published an article about the market for and appeal of luxury senior homes, in Growing Old in High Style. The article features several high-end senior housing complexes.

There are

several luxury assisted-living homes that have sprung up in the last few years, especially in places like New York City with its many affluent retirees with upmarket tastes and cosmopolitan demands. .... These upscale retirement homes cater to the affluent end of the “the silver tsunami” — the coming wave of aging baby boomers who are still socially and culturally active, and who have become accustomed to a certain quality of life.

The vibe at these places is less dreary nursing home and more five-star wellness resort. 

The article notes the high cost of this type of housing, especially compared to ALFs.  One expert described these high-end housing options as "promoting “the idea of affinity rather than exclusivity” — that is, to live among like-minded people. And in cities like New York, the high cost of living and urban setting means that there is a large pool of highly educated, financially successful and culturally curious retirees who are seeking similar company."  The article discusses amenities, describing the services provided as giving the feel of luxury rather than an institution.

December 3, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (0)