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In the U.S. and around the globe, longevity on a mass scale is posing new challenges for health care systems.
Managing clinical trials is a complex endeavor and an uncharted territory for many new clinical investigators.
Many primary care physicians do not believe that they can make a reasonable living caring for Medicare beneficiaries.
Two out of every five adults are the family caregiver of a loved one – that is tens of millions of family caregivers across the country.
How does it feel knowing the clinical decisions our physicians make effect their pocketbook? MIPS, or the Merit-based Incentive Payment System, is now the law of the land.
Family caregiving is today’s issue just as childcare was in the 1980’s. More than 25 million Americans are working at a job and caregiving at home—that’s nearly one out of five workers.
As our nation’s baby boomer population grows, the concept of “aging in place” is moving front and center.
Every year, one in three older adults will fall and more than two million will be treated in emergency departments for fall-related injuries.
Care coordination is one of the most popular solutions to saving Medicare. But, while it may be a useful tool, it has limitations.
Assistant Secretary Greenlee Calls for Stronger Advocacy, Solutions, and “Community-Based Technology
On April 26, Assistant Secretary for Aging Kathy Greenlee addressed the National Association of Area Agencies on Aging (n4a) at its spring policy conference.
On Tuesday, April 19, 2016 the Older Americans Act (OAA) was reauthorized for three years – an important bipartisan accomplishment.
In a poignant video released in 2014, Person-Centered Matters, Lon Pinkowitz shared his personal perspective as a caregiver to his father living with dementia.
Advancements in medicine allow people with chronic and complex conditions to live longer than ever before. But longer life for people who are sick may bring challenges, such as pain, stress, and other symptoms that accompany serious illness.
Over the past few years, I have enjoyed teaching first- and second-year medical students about the art of interviewing patients. While it’s certainly good to give back, it has also been an eye-opening experience.
In the last month, three separate bipartisan groups—the Bipartisan Policy Center, LeadingAge, and the Long-Term Care Financing Collaborative—released recommendations about how to help working Americans better prepare for their future long-term care needs and associated costs.
Most American families and even health policy experts have never heard of the Aging Network (AN), a loosely organized, community-embedded aggregation of service organizations that provide elders with vital services such as housing repairs, food, and transportation.
California is among a dozen states participating in the national demonstration to improve care for people with serious chronic illnesses and functional limitations who qualify for both Medicaid and Medicare.
The litany of catastrophes that occur in our poorly organized medical care system—preventable, avoidable suffering—is overwhelming. So far, though, no one is listening.
Working in a big emergency room as part of a team that tries to intercept unnecessary hospital admissions of frail elderly people, I seem to find there are fewer elderly people who call an ambulance themselves and are brought to the emergency room, than elderly people who turn up because somebody else thinks they should be there.
When I took my medical ethics course in medical school many years ago, I learned about the concept of patient autonomy, which is basically the right to make one’s own decisions.
The White House held its sixth Conference on Aging, and what a difference a decade makes.
Nurses Jennifer Meindel and Chad Ditlevson stand in front of monitors in a small room at the Mayo Clinic reading vital signs and occasionally calling up video images of patients lying in beds. All of the 40-some patients cycling across the screens are in intensive care in the Mayo Clinic Health System. But none of them are actually at Mayo.
The Voices for Better Health project at Community Catalyst, a Boston-based national consumer health advocacy organization, has released a new video highlighting an important strategy to improve the health and well-being of vulnerable older adults
Very, very dysfunctional. You need evidence? Try these two tales.
Basically my wife Robin’s mum Liz and dad Nigel became quite frail over the last several years, at roughly the same time, with all sorts of health, psychological, and general care problems.
The Institutes of Medicine (IOM) and National Research Council (NRC) recently released a summary for the fall 2014 workshop on the future of home health care, featuring speakers from Altarum Institute
In December, California entered another two-year legislative cycle, with almost 40 new lawmakers arriving in Sacramento ready to tackle pressing issues facing our state.
A member of my family was a target for criminal fraud a while back. She’s my oldest sibling at 67. She received a telemarketing call announcing her winnings of a free cruise!
The Centers for Medicare and Medicaid Services (CMS) has quietly put out two evaluations of the readmissions work– and both documents are remarkable for their failure to evaluate the programs fairly or to provide insights as to what works in what circumstances.
Such outrage about awful healthcare! Too many mistakes, too many adverse drug reactions, hospitals making people sick, accidents in the operating room, arrogant doctors, costs going through the roof. What’s the matter? Everyone wants answe
Good news! We will, most of us, live to a ripe old age!
Patients with serious illnesses need medical treatments to survive. But they are increasingly taking advantage of the specialty known as palliative care, which offers day-to-day relief from symptoms as well as stress and lifestyle management.
The Medicare Readmission Reduction Program (MRRP) encourages hospitals to reduce readmissions within 30 days of discharge by imposing substantial financial penalties on hospitals with more readmissions than would be expected if the same patients were discharged from an average hospital.
Several years ago, one of my delightful and independent 93-year-old patients had chest pain while in my office.
Dr. Joanne Lynn of the Altarum Institute will take part in a workshop hosted by the Institute of Medicine (IOM) and National Research Council titled “The Future of Home Health Care” to discuss the current state of home health in the nation’s health care delivery system in order to improve the understanding of the role that home health care will play in the future.
Every September, advocates come together during Hunger Action Month around the shared goal of ending hunger in America.
As a physician, I’ve witnessed firsthand the plight of so many families whose lives are thrown into turmoil as an older parent or grandparent takes a fall, suffers an injury, and experiences a sudden health decline.
Age-related issues, including family caregiving, must become integral to the domestic policy agenda. Until now, they have received lip service.
"Bob" is 87. He is a proud and accomplished man who was born in the 1920s in small-town Saskatchewan with birth injury to his arms and legs.
In early July, Sen. Bob Casey (D-PA) will introduce a novel policy proposal that could be life changing for the millions of Americans who quietly worry and wonder who they can call on for help and steady companionship when a loved one becomes ill, disabled, or very old.
Last month at the annual meeting of the American Geriatrics Society, I heard an interesting presentation on the value of reducing a certain class of medications with potential side effects in people with dementia.
May is Older Americans Month, and this year’s theme is Safe Today. Healthy Tomorrow.
Medicare 2014 has achieved the main goal of Medicare 1965: Access to medical treatment for older Americans. That, and advances in medicine, public health, and technology, have led to long lives and better health. Nevertheless, the system designed for the priorities of 1965 does not match the needs of 2014, and beyond.
We’ve watched it many times on television or in a movie: The patient lies in the intensive care unit, gravely ill, with the family at the bedside.
If you were in a car crash today or become so sick you could not speak for yourself, would anyone in your family know what you’d want the hospital to do?
Getting on in a medical career, especially caring for elderly people whose priorities don’t tend to be technically-based or even specific, I sometimes suspect that my value to people if any is sort of symbolic.
Family caregivers make long-term services and supports work, and yet the risks and challenges to their own health and well-being are often unseen or disregarded.
A recent visit to a very sick friend (let’s call her Ellen) coincided with the weekly visit from her hospice nurse. Having worked for many years on projects to improve care for the end of life—including hospice programs, which are good but not perfect—I was happy to see ideas that we had promoted actually in place.
For all of us, the start of the new year brings an opportunity for reflection and the chance to chart a bold path forward.
Clearly, any effort to reduce the ever-widening income gap is one step forward.
During the development of the Patient Protection and Affordable Care Act (ACA), there was a proposal to pay doctors to discuss end-of-life issues with their patients
It’s difficult coming to terms with the inevitable loss of a loved one, but conversations aimed at preparing friends and family members can alleviate the stress, grief, and confusion that accompanies death and dying
National Family Caregiver Month: Center for Elder Care and Advanced Illness Work to Make Life Better
November is National Family Caregiver Month, in which the nation turns, however briefly, to honor and reflect on the role of family caregivers in delivering essential care to millions of adults.
On one level, discussion at the Altarum Institute’s Sept. 26th Policy Roundtable described familiar ground – a dysfunctional health care system that is blind to the needs of vulnerable older Americans. But on another level, the answers and solutions offered were clear and bold.
People suffering from a serious illness shouldn’t have to worry about having their health care preferences honored; however, too often patients’ wishes are compromised because of a variety of factors, including an absence of planning and education.
My 83-year-old mother recently fell and broke her pelvis. She lives on the Big Island of Hawaii, which is about an hour’s flight from Honolulu and very rural. I knew of Mom’s fall by a call from the ambulance company, part of an automatic alert service purchased for my mother, whose children all live an ocean away. She was whisked to the hospital, where it was discovered that her fracture was “nondisplaced,” and that was the beginning of the frustrating, illogical, lunatic odyssey that is all too typical of how we care for the elderly in the United States.
Planning for the likely eventuality of our own physical aging is something we tend not to want to think about.
My 55-year-old brother-in-law, Vince, had arrived at Howard County General Hospital’s intensive care unit late Saturday night. Sunday morning, the police called us: Vince was in critical condition, and we needed to come to the hospital. This is the story of how the journey of my brother-in-law's death led to organ donation and hope for many others.
A couple of months ago Gertrude woke up with a pain in her right groin. I was pretty sure it was a pulled hip-flexor muscle from a forgotten awkward turning-over in bed, and for a while she was fine with some Tylenol. But then it got worse.
It is no secret that Americans are aging, but what is too often lost in this fact is that most people will need help as they grow older. Unfortunately, America does not have a strategy to deal with this growing demand.
A recent article featured on The New Old Age blog, “Walking Away from Medicare,” describes one geriatrician’s decision to switch gears.
The Commission on Long-Term Care held its first meeting Thursday on Capitol Hill with some members acknowledging that their late start adds to their challenges in offering Congress recommendations on how to finance the expensive services for seniors and disabled Americans
The mood in the Senate hearing room where an “Older Americans Summit” was being held on the eve of Memorial Day weekend was both hopeful and defiant as Edwin Walker, Deputy Assistant Secretary for Aging of the Administration for Community Living, stood to speak to a packed gathering of advocates, seniors, and lawmakers.
Our challenge is to get out of the 1972 mindset and create a system of care for the present and beyond that offers a range of financial options to protect individuals and families from having to spend all of their assets to pay for long-term care needs.
The Area Agency on Aging 1-B (AAA 1-B), seeks to meet care transitions needs for elders in two of their counties, Oakland and Macomb, with an innovative multilayer strategy.
Two recent studies demonstrate the tension between efforts to bring the benefits of hospice to patients and their families earlier in the course of a final illness and the requirement that hospice patients die on regulators’ schedules and without expensive drugs or procedures that affect the bottom line.
Pope Benedict's abdication prompts us to consider figuring out how each of us can make this aging journey is an essential task for us all.
Quality Improvement Project Shows Major Improvements in Hospital Use for Medicare Beneficiaries in Communities
The Journal of the American Medical Association (JAMA) has published a report describing how communities nationwide applied quality improvement (QI) methods to reduce readmissions.
Beyond the usual talk about a more coordinated and accountable health care system, we must provide new tools to help individuals responsibly plan for their needs as they grow older.
Dr. Joanne Lynn describes the poor treatment pathway for her mother with a crushed vertebra.
Many of the issues that emerge in the chasm between a hospital discharge and full reentry at home are things that are beyond the hospital walls.
We need to rally to demand changes—and fast—if we are to have a medical and social system that can help us to live well and meaningfully in late old age, without bankrupting our families and our society.
There must be a physician who knows and understands the diseases the patient has and how they interact, all the medications he has been prescribed, which ones he actually takes, and, most important, the patient himself—his usual state of health and his routines.
Continuity of care, being followed by the same doctor over time, something we took for granted 50 years ago, is critical now, especially for frail, elderly patients with complex medical problems accumulated over a lifetime.
The Atlantic Philanthropies—in partnership with the John A. Hartford Foundation—funded the Practice Change Fellows Program.
The Aging Population: An Altarum Health Policy Roundtable Gives Voice to the Challenges of Elder Care
Altarum Institute held a roundtable, Speak Up! Influential Women Give Voice to the Challenges of Elder Care that featured five prominent women authors, social commentators and caregivers, to discuss challenges in elder care.
During the roundtable discussion, “The Last Word: Influential Women Discuss What Matters When Loved Ones Face Aging,” the presenters discussed their experiences in caring for aging loved ones and patients.
Supporting healthy food and exercise would do more to improve health than high-cost medications or surgeries. Can we usefully apply the same perspective to the care needed for frail and disabled elders?
Models most likely to meaningfully improve quality of life and the efficiency of health care delivery are those that both coordinate care among providers and actively engage people in planning and decision-making.
More than 40 percent of medication errors arise during care transitions when various possible medication lists are not brought together in a process called reconciliation.
Knowing the details of your diagnosis and likely course, and how your care should happen at every step along the way, is critical.
The SCAN Foundation has launched a guide titled, “10 Things You Should Know About Aging with Dignity and Independence.”
As a result of our health system, we will experience fear: constant anxiety over unreliability and gaps; high cost from waste and mismatching of needs with services; and widespread dishonesty.
When I hear people talk about integrated health systems, or ACOs, or medical homes, or bundling or any of those innovations, I don’t hear a lot of explicit talk about palliative care, or end-of-life care.
The announcement that the Community Living Services and Supports (CLASS) Act will not be implemented drew a call for Congressional hearings to account for dollars spent on CLASS preparation since the March 2010 Affordable Care Act (ACA) made the measure law.
Patient Activation is a popular topic in recent health policy discussions, and is yet another area where we find health disparity.
A recent study confirms elderly and minority customers get higher-cost hospital care than other more affluent white customers and are more often exposed to harmful, even deadly outcomes.
In a complex system, we are often so grateful for the few carefully done and reported research endeavors that funders and researchers easily fall into the trap of insisting upon slavish replication.
So many fundamental activities crucial to our daily lives can be measured with certainty and confidence, but not so in health care—and certainly not when it comes to aging and long-term services and supports.
A paradigm shift that combines personal responsibility for long-term care needs with government support is needed to achieve a sustainable, efficient continuum of care.
A column by New York Times columnist David Brooks, read in combination with a recent report from the Office of the Inspector General (OIG) make painfully clear how urgently America must rethink the way it approaches the end of life.
The cornerstone of a more effective and efficient system of care is to engage people in making decisions about their life and health in a way that upholds their dignity, independence, and right to self determination.
Sadly, Glenn Campbell has been diagnosed with Alzheimer’ disease. Mr. Campbell’s decision to put a face on this awful disease by continuing to tour is a mark of real courage and heart.
Before passage of the Patient Protection and Affordable Care Act (ACA), the limited set of federal and state options for community-based care hampered the extent to which this vision could be realized.
Mary Naylor, Ph.D., R.N. and team have developed and refined a Transitional Care Model at the University of Pennsylvania.
There was the constant expectation that my family could step in as caregivers, that we could somehow manage the machinery and technology intended to keep my grandmother comfortable through her final days.
A major challenge of the current system of care for adults with functional limitations is the inability of middle-income individuals to protect themselves against the financial risk of needing and accessing available supports and services to help them remain in their homes and communities.
America is waging its war against heart disease with stockpiles of statins. More than one of every six adults—nearly 40 million people—now takes these cholesterol-lowering drugs.
The Obama administration often touts the health-law provision that will close a gap in Medicare prescription drug coverage. But officials rarely cite one that might cause sticker shock among some seniors.
Some research has established that medications can be cut in nursing home patients with good outcomes. But in the community, where there is often no single doctor keeping track of all the patients’ medicines, it can be challenging.
While the mix of morality and money can be extremely difficult, it’s vital for policymakers, clinicians, and patients to come together to improve the ways in which patients with a terminal illness get treated.
Transitions are one of the weak points in the U.S. health care system. Poor coordination and inadequate communication around transitions is particularly pronounced in the care of frail elderly people with multiple chronic diseases.
A little-known provision of the health reform law has the potential to transform long-term care services and delivery.
As the nation ages, health care must evolve to focus around three critical factors: adopting person- and family-centered engagement, improving the health of the older population, and improving cost efficiency.
Health care reform offers significant opportunities not only to improve the quality of end-of-life care, but to apply the principles of good end-of-life care to improving our health care system.
As if just talking about dying weren’t hard enough for most of us, now comes the disinformation campaign about end-of-life care discussions waged by opponents of health care reform.