Here is an article that appeared in the NY Times regarding the dangers for patients with Parkinson’s who do not get their medications on time, or who get other medications that worsen the Parkinson’s and cause delirium. http://newoldage.blogs.nytimes.com/2013/04/17/hospital-dangers-for-patients-with-parkinsons/ .
The article points out that people with Parkinson’s are hospitalized much more frequently than others their age, and their stays last longer. A common reason: “These patients aren’t getting their meds on time, and they’re not getting the right meds.” Some need to take their dopamine-replacing drugs as often as every two hours, a schedule at odds with standard hospital regimens.
Besides going to the hospital, any change in the routine of a person with Parkinson’s can cause delirium and psychotic episodes.
My client, who I will call Caroline, was living in her own apartment with 24/7 aides. She attended an adult day care program several times a week. Caroline was very attuned to when she needed her medications. Even when she went out of the house, she carried a few pills in an envelope that was marked with the name of the medications, the dosage and the time to take them. Even without being prompted, she was aware when the Parkinson’s medication was due, because she would feel pain or trembling in her legs.
Caroline had been experiencing some unusual anxiety at night. We called the Neurologist for help. He recommended increasing the Seroquel, an anti-psychotic medication. It helped some, but Caroline was still resisting help from her aides, so the family decided she might do better in an assisted living facility.
The Assisted Living Facility offered medication management, as well as companions to take the resident to and from meals. They assured us that they were very familiar with Parkinson’s Disease and could handle her medications. Almost immediately after admission, Caroline was diagnosed with a Urinary Tract Infection. Here is a blog post that describes what a UTI can do to a person with Parkinson’s much better than I can. “I have learned that UTI’s are very common in advanced Parkinson’s patients. Because all the muscles of the body are implicated in this nasty disease, it is very difficult for sufferers to completely empty their bladders, always leaving behind some urine. This creates a perfect breeding ground for bacteria.” Here’s the link to the blog. http://day2dayparkinsons.blogspot.com/2010/09/saturday-night-fever.html
Once Caroline’s UTI was cleared, everything seemed to go back to normal and she was getting used to her new home. However, when I called to see how she was, she kept complaining that she wasn’t getting her meds on time. I spent a few days with her and it did seem that the meds were not being given on a regular basis and I asked about it at the nurses station. It seems that the house psychiatrist had changed the times of some of the meds because Caroline was complaining about being tired. They had changed the time of her Parkinson’s medication to fit their schedule, waking her at 5 Am to allow for the five doses a day she needed. We had given her from Stalevo every four hours from 8 AM to 10 PM. In addition, they changed the Seroquel dose from bedtime to lunch hour.
A few weeks later, I was told that Caroline was wandering around the building and not able to function at an independent level. When I arrived at the facility, she couldn’t even put on her clothes. She was so distracted, that she wasn’t aware of where she was. On the advice of a colleague at Zucker Hillside Hospital, I immediately took her the emergency room.
The Zucker Hillside Hospital is North Shore-LIJ’s nationally recognized behavioral health center known for its pioneering clinical, teaching and research programs. The Geriatric Psychiatry Inpatient Service is staffed by a multidisciplinary behavioral health team with special gerontological expertise. Patient populations include elders with late-life depression, psychotic disorders, Alzheimer’s disease or a related dementing condition with concomitant serious behavioral disturbances such as agitation, aggression, paranoia, and mood abnormalities, and medical/neurological illnesses with psychiatric symptom expression. The team at Zucker Hillside determined that Caroline was having an extreme reaction to the medications. Several weeks later, they are still working to normalize her. The psychiatrist explained that most assisted living memory programs are not appropriate for patients with Parkinson’s induced psychosis. More on where people with dementia’s that are not Alzheimer’s related can best be cared for coming in our next post. In the meantime, here is a free kit that can help you prepare for a visit to the hospital or even just to keep around the house so that others can see what they must know to help the person with Parkinson’s.
The Aware in Care kit can be requested at www.awareincare.org or by calling 1-800-4PD-INFO (473-4636).
Did you know that three out of four people with Parkinson’s disease do not receive their medications on time when staying in the hospital? People with Parkinson’s visit hospitals more often, and, combined with the great importance of the timing and dosing of Parkinson’s medications, face greater risks in the hospital.
This is why the National Parkinson Foundation (NPF) has launched the Aware in Care program, which aims to help people with Parkinson’s disease get the best care possible during a hospital stay.
To protect, prepare and empower people with Parkinson’s before, during and after a hospital visit, NPF has developed a free Aware in Care kit with tools and information to share with hospital staff during a planned or emergency hospital stay.
The kit is large enough to fit your Parkinson’s medications to take with you on your next trip to the hospital.
The kit includes:
Hospital Action Plan Read about how to prepare for your next hospital visit—whether it is planned or an emergency.
Parkinson’s Disease ID Bracelet Wear your bracelet at all times in case you are in an emergency situation and cannot communicate.
Medical Alert Card Fill in your card with emergency contact information and place in your wallet.
Medication Form Complete this form and keep copies in your kit for use at the hospital.
Parkinson’s Disease Fact Sheet Share the facts about Parkinson’s with hospital staff and ask that a copy be placed in your chart.
I Have Parkinson’s Reminder Slips Share vital information about Parkinson’s disease with every member of your care team in the hospital.
Thank You Card Present this card to a staff member who provides high quality care.
Magnet Use this magnet to display a copy of your Medication Form in your hospital.
I often act as health care proxy and power of attorney for my clients. I always make it clear that I am a Patient Advocate, not a family member. Yet, every time I speak to someone at the hospital or any care setting at all, the people constantly refer to ‘My Mom.’
Do they think they are reaching me at some level, where I will turn off my business sense and burst out in tears of thankfulness for their sensitivity. Surely they say this to everyone, like when the home health aide says “I treat everyone like my grandmother?”
I have several clients who are in their early seventies. They seem more like friends to me, since we are all baby boomers. They are nothing like my mother, who went to high school during WWII and lived through the depression. Their hair has less grey in it than mine! Yet, people still refer to them as ’Your Mom’ when we are talking about their care.
Some of my clients have their own children, who have hired me because they want a professional to help them to navigate the complex and fragmented health care system. Some of the people have hired me themselves, because they are used to delegating to professionals or because they have hit a wall with the long-term care bureaucracy. They need someone to take care of business, not another child.
My mother was an executive secretary to a Supreme Court Judge. She also ran political campaigns and was the go to person when something happened in the neighborhood. She knew the bankers, the lawyers and the chiefs of whatever you needed. After she passed, many of her neighbors told me that they would miss her counsel more than anything. Even when I had to invoke her health care proxy, I didn’t think of myself as being the decision maker. I was simply carrying out her wishes. I wasn’t the ‘child’, I was the person who she had placed her faith in to convey her preferences.
As professionals, we often talk about the importance of preplanning. As we move into a time when long-term care will be ‘Managed’ along the lines of our health insurance plans, I ask you to consider the terminology that will be used to refer to the person receiving the care. Will it be the ‘user’, ‘the consumer’, or ‘your Mom’? I hope it will be the ‘individual’ with all the rights and choices that come along with the title.
2013 will bring many changes to GetHealthHelp. As we stand on the fiscal cliff and cower under the debt ceiling, it is hard to be flippant about what the New Year holds. The usual New Year’s resolutions, like eating healthier or to start an exercise program, don’t seem to take on any urgency when we see our nation’s leaders and our role models kicking the can down the road. Being the eternal optimist, here are a few resolutions that I plan to keep and some that I will probably need some help with. My best wishes to all for a healthy and happy New Year.
2- Make the GetHealthHelp website easier to navigate.
3- Make the GetHealthHelp website more interactive.
4- Make the GetHealthHelp website more fun.
May you find everything you envision.
Many adult children who are paying for in-home caregivers are facing the reality that their parents will outlive their savings. By the time they are calling me, it usually goes something like this, “My Dad is running out of money, I need to place him in an assisted living facility,” or “My Mom has spent everything, now she needs to get on Medicaid.” The children have decided on the ‘Tactics’ without considering what the ‘Strategy’ is for reaching their parent’s life expectations or taken into account the ‘Goals’ and associated realities of their parent’s situation.
Miriam-Webster defines strategy as a careful plan or method for achieving a particular goal, usually over a long period of time.
Sari Klinghoffer, Director of Sales, WPI Communications Inc. wrote “A strategy looks at the big picture and uses various tactics in its execution.” The big picture is to gain their customers trust. In the past she used direct mail. Presently they have added blogging and social media. So, while the ‘Tactics’ may have changed with the times, the ‘Strategy’ and ‘Goals’ have remained the same.
This may be said of our Elders also because the things that really mattered to them continue to do so, but the tactics must change in response to the new financial situation.
Instead of using business terms like strategy and tactics, we use words like ‘Life Expectations & Planning’. Life Expectations is often thought of in terms of years. But, instead we should think of what we ‘expect’ from life. An example of a lifetime expectation strategy would be to find contentment or peace, or you may want to find excitement and fun. We call it ‘Giving a Voice to Your Health Concerns.”
My client Virginia, who has stage 4 Alzheimer’s Disease told me that she likes to have change in her life. She was outspending her income and had drawn down all of her assets. The family thought she was ready for a nursing home. Her strategy is to keep life interesting. The tactic we employed to reach her strategy was moving to a different assisted living facility, one that had more activities for Alzheimer’s patients and where the costs were within her income level.
Sandra, a client, saved her money from years of teaching to purchase her dream apartment, even though the monthly bills were eating into her investment accounts. She never expected to find herself confined to a wheelchair. Always fiercely independent, Sandra hired private aides to tend to her needs. After depleting her savings, she told me that she’d rather live in her apartment without food than move to a nursing home. With the help of her accountant and attorney, we are getting Medicaid coverage and enrolling in a Long Term Managed Care Plan. Her strategy is to stay at home, her tactics are to apply for Medicaid Long Term Care coverage.
You can apply this concept to any situation. First determine your strategy, your mission, your goal. Then find the resources to provide you with the tactics to execute your strategy. A Patient Advocate can help you to think things through to identify your strategy and to prioritize which tactics will work best for you.
Call us for a free phone consultation, Caryn Isaacs, Paient Advocate GetHealthHelp.com 347-965-9222. E-mail firstname.lastname@example.org
Sari Klinghoffer, Director of Sales
WPI Communications, Inc.
Your Source for Newsletter Marketing
55 Morris Avenue
Springfield, New Jersey 07081
Tel: 973-467-8700 | 800-323-4995 Ext. 1028
Fax: 973-467-0368 | 800-677-9742
Sandy strikes another blow on seniors and caregivers. Many home health aides lost their homes and cars in Sandy. Some families, who are juggling work and caring for their parents just can’t get to the store and run over to their parents home, while negotiating with plumbers and electricians at their own storm ravaged place. The effects of Sandy just keeping coming, like the wave that rammed through the area over a month ago.
Last week, I went to meet a couple who required 24/7 care. Dad has Alzheimer’s and is in a wheelchair. Mom had two car accidents in as many days over the past weekend. First, she had a run in with a tractor-trailer who was in town for Sandy and wasn’t familiar with the roads. Then, she rammed into a cement divider because the street lights were out and she couldn’t see. To top it off, one of the usual aides for the couple couldn’t make it in to work because of damage to his home and car. Senior Helpers Caring in Home Companions came to the rescue. Laura Giunta, Director of Business Development said, “Senior Helpers provides companion care in homes and facilities throughout Long Island. Services include Cooking, Housekeeping, safety monitoring, errands, plant and pet care, transportation, socialization and integration. As a certified Senior Advisor, I assist families in getting to the next step regarding the care and safety of their loved ones.” The agency arranged for one of the aides to drive Mom to the police station to get the report, then to take her to the Jewish Center where she teaches Hebrew. Both the day and evening home care workers were well acquainted with the family dynamics between the couple and their adult children, who were also busy rebuilding their Sandy affected homes. Kam, the aide who took on the extra shifts also lost his car in the storm. He was forced to travel two hours each way by bus to be there in time to coordinate getting Dad in and out of bed, which takes two people. He said the agency supports him in making sure he has the resources to know what to do in any emergency.
Laura and I share another client in Nassau County. This couple, Dad with Dementia and Mom suffering with chronic back pain and a history of falling, decided to go to Florida instead of sitting around their gutted neighborhood. Also, their usual companion had been told by her doctor to stop work because she was pregnant and shouldn’t be in such a stressful environment. Mom had fallen in her home earlier in the week, so she reluctantly agreed to have a replacement aide come in for a few hours each day. The day before they were to get on the plane, the couple decided to go to the store for a few things. About 5 PM I had a call from their daughter. Mom twisted her arm while opening the ice cream freezer and fell on her head. She was bleeding all over the place..and luckily conscious….and Dad was in the car! A customer, who was also a nurse, called their daughter and she called me. I told her to call Melanie from Senior Helpers. The agency had a companion drive over to the market to pick up Dad, take him home for dinner and get him settled. He was pretty upset and disoriented until she offered him ice cream. The police drove the car home. Mom was in the hospital for 7 hours. They scanned her head, neck, arm and then finally super glued her head gash. Senior Helpers had a special aide pick her up, get her into bed and stay over night. The aide also went to the store to get those needed items the next day and got the couple on their way. They landed in one piece in Florida and are thankful that Senior Helpers was there for them.
Many of my clients are facing similar issues when their aides cannot make it to work or are resigning their posts. Going through the hiring process to replace a long time private aide can be traumatic for the patient as well as the family. This is one of the reasons I prefer to use a reliable agency who can make sure there is always someone available. You can reach Laura at
Phone: 631-383-4341 516-750-0035
Weeks after Sandy ran a river through living rooms and took our cars with it, we are still hearing stories of people living without electricity, heat, hot water or word about when things will be back to normal. Yet, my clients have been through worse. Even as they are the ones who really need help, they offer encouragement and a positive attitude to the younger folks who are frozen in fear that they can’t get gas for their cars.
Just before the storm, I met with Anne and her husband Harold who live in Brighton Beach. Harold requires help to get from his bed to his wheelchair. Anne is a cancer survivor, but still supervises Harold’s home health aides, wound care and medications. They get picked up by Access-a-Ride everyday so that Harold can receive Hyperbaric Oxygen Therapy. After the storm, their apartment had no power, no heat and no hot water. The blocks surrounding their home were all evacuated, but their elevator wasn’t working, so there was no way for then to reach the Access-a-Ride. For the first few days, the Visiting Nurses couldn’t get to their neighborhood because the trains weren’t working. The local stores were all closed including the Duane Reade which had a sign on it telling people to go to their other store, many miles away. Then the National Guard came door to door and when they saw Harold, they sent for the EMT and took him to the hospital, but not the local one in Coney Island because that is evacuated also. Now Anne is traveling by taxi to visit him, but needs to get home each day for their cat. There is light, but no heat or hot water. Even with all this, she tells me first about the wonderful lunch her sons took her to in Manhattan yesterday. She also hopes to go to the Met for a show that a friend recommended, as long as Harold is safe in the hospital.
Sandra was getting rehab at the Glengariff Health Center. She was anxious to get home to her apartment in Battery Park City. Then came Sandy. A few days later, when their phones came back on, Sandra told me that she was happy to be there, safe, warm and fed. The only thing she needed was dental floss. She told me not to worry, that she could wait until I could get there next.
My friend and mentor Martha and her husband Matthew, both in their 80′s live in Freeport. Last year, Irene flooded their basement, while they were out in Mattituck at their summer place. They came back to a black mold and had to have the whole level demolished, including irreplaceable designer details and a lifetime of photos and everything else one saves for the memories. Now, Sandy came along and took the furnace, the water heater, the washer and dryer, along with the boxes of dry cleaned clothes that had been returned by their insurance company after Irene. Their son just moved to Florida from Long Beach. He considers himself lucky even though the antiques he left at the house in Freeport are a complete loss.
I had an appointment to take a client for a tour of the beautiful New Nautilus Hotel in Long Beach on the Wednesday after the storm. Needless to say, we couldn’t get there. We don’t even know when they can open, as the reports for Long Beach and the Rockaways are not good. Here is an excerpt from a Daily News article, which was the only way I knew what was happening to another client, who has been living in the Long Island Living Center.
Morris Sorid, aged 102 and a Holocaust and cancer survivor, also made it through Hurricane Sandy in one piece. He was living in an assisted living facility in Atlantic Beach, just over the Atlantic Beach Bridge from Far Rockaway, Queens, and was evacuated as part of a “mass emergency exodus” as the storm approached. He is currently residing in the basement library of the New Hempstead retirement home in Kew Gardens, Queens.
He says, “I was nearly destroyed six or seven times in my life. To tell you the truth the hurricane doesn’t excite me too much.”
He has the utmost confidence in his caretaker, too – Archie Catacutan, a 26-year-old nurse. Of him, Sorid says, “I depend on him, so I have nothing to be afraid of.”
During the storm it was stressful, but Sorid was more concerned about his fellow roomies and even offered up his bed by the wall to a man who looked like he was going to fall off his bed.
Sorid survived the Nazi invasion of Pruzany, Poland (this is now Belarus) with his wife by hiding in a bunker for 18 days after hearing about the trains heading to the death camps. After they left the bunker, they lived in the forest, eventually escaping and emigrating to Brooklyn in 1948. They had left their daughter with grandparents, but learned later that she, along with the rest of their family, perished in Auschwitz. Sorid and his wife went on to have two sons, and he published his memoir, “One More Miracle,” at age 95.
“Sandy has been horrific, impacting so many, and taking so much. Sandy has caused loss of life, loss of necessities and loss of possessions. Sandy has taken so much, and for those of us not directly impacted, we thank God, maybe say a prayer and think of how we can help. For those directly affected, those who need to rebuild, we need them to know that their community is with them, that they are not alone, that there is a shoulder to cry on. That while possessions may be gone memories are not, while necessities have been taken, it is ok and honorable to accept help, accept a smile, accept a listening ear. It is ok feel beat up but not beaten, to feel weary but not defeated, to feel sad, as you hold your loved ones close and begin to reevaluate what you appreciate. While Sandy, this horrific event took so much, it did not take away those characteristics that make us who we are and makes you, you, allowing you to be who you are. Try to take steps every day, even little steps that can help you rebuild, feel empowered and know we all know how horrific Sandy’s aftermath is. “said Lori Metz, LCSW, CCM, when I asked her for a few words of encouragement. Learn more about Lori at http://therapists.psychologytoday.com/rms/prof_detail.php?profid=71121&sid=1262182052.4014_32358&state=New+York&lastname=Metz
When signing your health care advanced directives, make sure you discuss your preferences with the person you name your health care proxy. I have a questionnaire for the person you are thinking of naming as your health proxy. It can help you both to decide if they will be prepared and likely to honor your wishes. Many times, when the questions are posed, both people realize that they have conflicting views, and it may be better to choose someone other than your closest relative. A recent example is a woman who had a debilitating condition that was likely to become life threatening in the near future. She did not want to have unusual measures employed if only to keep her alive when there was no hope of her living her life outside of a nursing home bed. When we used the questionnaire, it became clear that her brother, whom she had named as the health proxy, did not believe in removing life support under any circumstances. Once this was brought to light, the woman asked her niece, who is an attorney if she would be able to do it, and she agreed. Imagine having to fight your own family when you are so sick.
In the case of SungEun Grace Lee, I think the courts considered that the young woman was still able to make her own decisions and so the health proxy was over-ridden by her own wishes.
Mixed Message From Obama Advisers on Medicare: E-mails show outside advisers were previously open to private plans.
by Meghan McCarthy
Updated: September 11, 2012 | 7:31 p.m.
September 10, 2012 | 11:11 a.m. Reprint from the National Journal
President Obama has seized on Republican proposals to overhaul Medicare as a top campaign issue, saying that the GOP plan to add a private insurance option would end seniors’ guarantee of government health care. But behind the election-season politics, influential experts who have advised Obama on health care are open to a future for Medicare that includes competition among private insurance plans.
The drumbeat against privatizing Medicare was loud and clear at last week’s Democratic National Convention and over the weekend as Obama campaigned in Florida and made Medicare .a top issue. Obama has warned that the plan from GOP nominees Mitt Romney and Paul Ryan would cost seniors $6,400 more a year for their health care.
It may not be what voters hear on the campaign trail from Obama and his surrogates, but converting Medicare from a government program that covers all of seniors’ health needs into subsidies that seniors use to buy private health insurance is the future—not the apocalyptic event Democrats would have voters believe.
One private e-mail exchange illuminates this point well. In e-mail exchanges with the staff of the White House-appointed fiscal commission that were obtained by National Journal, David Cutler and Jonathan Gruber, who have both advised Obama, gave qualified support to a Medicare voucher plan offered by Ryan and former Clinton budget director Alice Rivlin in talks to reduce the deficit.
Cutler and Gruber are both hot shots of the health economics world. Cutler is a professor at Harvard, Gruber at MIT. Both advised Obama on health care in the 2008 campaign, and both had major roles in helping develop Democrats’ 2010 health care law. When they offer counsel, the White House is listening.
Staff from the National Commission on Fiscal Responsibility and Reform — which was led by former White House chief of staff Erskine Bowles and former Sen. Alan Simpson — asked Cutler and Gruber in November 2010 for their thoughts on the Ryan-Rivlin plan, which did not keep traditional Medicare as an option for seniors. Both experts offered suggestions to make it more palatable to commission Democrats. Neither balked at the plan, which is arguably more conservative than the Medicare plan offered by GOP presidential nominee Mitt Romney.
“How about this … removing the special status of [traditional] Medicare,” Cutler wrote. He then suggested giving an executive board created by the Democrats’ health care law the option of “moving the Medicare population into the exchanges.”
“That would be the same as the voucher,” Cutler concluded.
In other words, Cutler wasn’t just recommending that the Democrats incorporate vouchers into Medicare, something the Obama campaign is squarely against now. He was also proposing that the federal government move seniors into insurance exchanges through a much-criticized executive-branch Medicare board. That is a proposition you won’t hear in talking points from either Cutler or the Obama campaign.
Cutler now says he was only proposing an idea for Medicare if insurance exchanges are “shown to work well for the non-elderly population,” by getting people into good plans and lowering costs.
“If you show me evidence that something works, I am in favor of doing more of it,” Cutler said in an e-mail to National Journal. But that caveat was not included in his 2010 e-mails with fiscal-commission staff.
Gruber also said he approved of the Ryan-Rivlin plan in 2010 e-mails to fiscal-commission staff, as long as the insurance market reforms of the Democrats’ health care law are kept in place.
“So overall I like this proposal for Medicare – SO LONG as it is built on top of health reform,” Gruber wrote in 2010. “Without broader health reform, I don’t think it works.”
Gruber now says that economists don’t know enough yet to move the majority of Medicare enrollees into private-insurance plans. As part of the effort to expand coverage to the uninsured, President Obama’s health care law would establish insurance exchanges for people younger than 65 to buy private health care. Gruber said that this is a better way of testing out new approaches, adding that it would be “stupid” to experiment first on the older and sicker Medicare population.
“We are getting better, but we are not quite there yet,” Gruber said in an interview. “But premium support is ultimately where we need to be.”
The complicated politics of Medicare and private competition are also at play in some of the Obama administration’s own policies. As National Journal reported on Saturday, Obama’s Health and Human Services Department is giving states leeway and funds for pilot programs that would move some of the poorest and most vulnerable Medicare patients into managed-care programs.
Regarding the broader future of Medicare, Gruber agreed that any plan shifting the majority of the program’s beneficiaries out of the government-run Medicare program and onto private plans would “end Medicare as we know it,” a phrase Obama and his surrogates have often repeated on the trail.
“It does. I don’t think it’s a lie,” Gruber said. “In theory, [premium support] is not wrong. In practice it’s not ready yet.”
There are three key problems that still must be worked out, Gruber said. First, policymakers have to figure out how to keep insurance companies from cherry-picking healthy people and essentially forcing the sickest patients on to traditional Medicare, which would drain the program of money. Second, policymakers must find a way to make sure insurance companies design benefits so they are easy-to-understand for beneficiaries, and don’t trick seniors into buying more expensive plans that aren’t suitable for them. Third, they have to figure out just how quickly government checks for seniors to buy coverage could grow.
Still, Gruber said he could see Medicare becoming a premium-support-style plan within a five-year timetable, after the Affordable Care Act’s health insurance exchanges start enrolling an estimated 30 million people into insurance plans in 2014.
“In the first few years of the insurance exchanges we will learn a lot,” Gruber said.
Of course, anything five years away would require action in the upcoming presidential term, whether it belongs to Obama or Romney. It is unclear if Obama would be willing to approach any premium-support-style plan for Medicare — even if it meets the caveats his external advisers have now laid out. The Obama campaign did not return repeated requests for comment.
The Cutler and Gruber e-mails must be considered in the context of the challenge of securing support for long-term deficit-reduction measures. In any serious effort to rein in deficits, health care costs, mainly through Medicare, are the albatross that neither party can get off its neck. The Democrats’ health care law contains dozens of pilot programs and billions of dollars to test new ways to reduce health care costs by restructuring how hospitals and doctors are paid. But it isn’t enough to change the deficit outlook now. So it makes sense to test every theory you can.
Meanwhile, Cutler continues to warn that the Romney-Ryan Medicare plan would be catastrophic for seniors.
“Mitt Romney — like his counterparts on the campaign trail and Paul Ryan — would end Medicare as we know it, turning it into a voucher program,” Cutler wrote in March memo for the Obama campaign.
“Some Republican plans, including Romney’s, offer traditional Medicare as an option for seniors. But whether the plans force new retirees out of traditional Medicare immediately or steadily raise its cost over time, the result in the same.”
That public statement does not jibe with Cutler’s 2010 private e-mail, which proposed having the executive-branch Medicare board simply move seniors into exchanges to buy their own coverage, where traditional Medicare would not be an option. Cutler says he criticized the Romney-Ryan plan because the way they are designed will “bleed out traditional Medicare.”
“Nowhere in the campaign memo do I say that private plans are a bad idea for Medicare,” Cutler said in an e-mail to National Journal. “Indeed, my recent JAMA paper explicitly says that such plans could be more efficient than traditional Medicare — though the case is not completely clear.”
But Cutler’s JAMA article ultimately concludes that premium support plans “may offer” a solution for Medicare, if the Democrats’ health care law fails to slow health care costs.
He attributes the differences in his 2010 e-mail and what he says now for the campaign and in public articles to “trying to explain health care economics to people who are not economists or health care specialists.”
“I agree, people should read my articles and books. But if they don’t, I need to communicate in pieces,” Cutler wrote.
I reodered my vistaprint rack cards which have increased my business by leaps and bounds. For some reason the back came out crazy. I called them and they gave me a full credit and are sending the corrected cards ASAP. Thank you VistaPrint for making me look great.
On most of these occasions, my role is to help the family make the decision to accept hospice for their loved one because they have waited so long, hoping the patient was going to get well and go home. But recently, I found a large gap between what the system has to offer in between independent living and the nursing home. A lot has to do with licensing and advertising.
In this case, the client was suffering from moderate dementia, she used a walker but had no other medical complications. Her heart was healthy and she didn’t have diabetes or COPD. She was living in a private residence for seniors, but not a licensed assisted living according to state law and therefore not covered by Medicaid. However, everyone assumed that because the residence offered room and board and everyone there used either a walker or a wheelchair, that this was an Assisted Living Facility. In fact, they were advertised on many web sites under the heading Assisted Living Facility. I don’t think this was the fault of the residence. There is simply no distinction on these websites between those that qualify for Medicaid and those that are private. It is up to the family to shop around.
The cost of the stay at most private residences is about $5000 a month, including assistance from a licensed home care agency that provided help with bathing, dressing and medication. Sometimes the bill can be as much as $7000 including Cable TV and other utility bills and personal services such as hair cuts and toe nail clipping. If the patient does not have diabetes, toe nail clipping is not covered under Medicare.
I was called in to help with the Medicaid application, pending the move from the independent residence to the nursing home. The financial paperwork had been with the nursing home for months. Since the nursing home accepted that I would be able to help the patient qualify for Medicaid, we were asked to speak to the admissions nurse to get a move in date. That’s when we found out that the patient did not medically qualify for admission to the nursing home, as she was able to perform most physical activities of daily living with a minimum of supervision. Even though she was not mentally able to live on her own, dementia is not considered a reason to confine a patient to a nursing home level of care. We realized that it would even be cruel to condemn the woman to a life of laying in bed or sitting in a wheelchair, just because her memory wasn’t what it used to be.
Now, here is where the gap in the system showed itself. No one could point me to where the client could find the level of care she needed that would be covered by Medicaid. The nursing home staff suggested someone might be able to take her into their home. Since the woman did not have any family, I was pointed to unlicensed homeowners who will take a persons social security check in exchange for room and board. I couldn’t accept that in all good conscience, so I pulled out my trusty SUN-B Directory. There I found Fred Altman, who I remembered is like a real estate agent for senior residences. He said there was only one place in about a 50 mile radius that would be appropriate.
As it turns out, the facility is licensed as an Adult Home and so can accept Medicaid, when the resident is in need of a higher level of assistance with activities of daily living, but not ready for a nursing home. The kicker here is that since the facility is set up to treat people requiring this higher level of care, many services that this client needs are included in the basic rent. Medication Management, assistance with bathing and dressing, making sure the resident gets to meals and activities are all covered. For this client, it meant that she would not even need to qualify for Medicaid as she had sufficient income to pay for her monthly expenses.
This was a very good ending to a story that could have gone another way. The person could have been made homeless without the intervention of the people at the original Senior Residence, who called the alarm early enough for something to be done. The woman could have been pushed into an inappropriate setting if the Nursing Home hadn’t been ethical about her qualifications. Or the Adult Home could have been full, as I am sure they will be soon, as more and more people live longer, but just need a little help.
by Caryn Isaacs, Patient Advocate http://gethealthhelp.com
Resources: Senior Umbrella Network of Brooklyn http://sunb.org ;
Fred Altman, http://www.ElderCareAdviceInc.com;