Tag Archives: medicare

We are all members of the Caring Majority

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I spent part of this week in Minneapolis, attending Caring Across Generation’s Field Gathering. Family and paid caregivers, along with caregiver advocates from all over the country came together to discuss strategies on how to improve the lives of caregivers and the quality of care for those at every stage of life who needs assistance.

It was inspiring to be in a room full of people who are determined to fight for something so important that has been ignored by many government officials and society for too long. Whether it’s protecting Medicaid funding, pushing for paid family leave on a state and federal level or expanding quality care options and respite opportunities for family caregivers, there are a lot of issues to address.

Some states, like Hawaii, Maine, Minnesota and Washington, to name just a few, are making inroads at the local and state level. Hawaii passed the Kupuna Caregivers Act this summer, which pays family caregivers who work $70 per day to cover the cost of caregiving. Take Action Minnesota is working with cities on securing paid sick leave, and the Maine People’s Alliance is moving forward with its support of a Universal Family Care bill and Universal Home Care ballot initiative. The more programs that are established at the local and state level that are proven to be successful, the more we can move the needle to encourage other states to implement similar programs, and eventually, gain support at the federal level.

Long-term care is one of the core issues that Caring Across Generations is working to address. Many people don’t realize that it’s Medicaid, not Medicare, that picks up the costly expenses of long-term care for our elders once personal finances are exhausted. In addition to protecting this funding, we need to work on making it easier for people to age at home. This will help reduce the cost of care.

These issues should be bipartisan, but sadly, as Americans, we’ve made values like caring for our most vulnerable populations a point of contention. But the Caring Majority is growing. We are all part of it, even if some people don’t realize it yet. Once illness touches your family, you learn very quickly how important good care is, and that it is essential. Everyone alive right now was cared for as a baby, and will likely be cared for again as they grow older. We all have a responsibility to alleviate the financial, physical and emotional burdens of caregiving.

If you are interested in learning more about Caring Across Generations, check out their website or visit them on Facebook and Twitter. If you are interested in sharing your caregiving story or attending next year’s gathering, reach out to me in the comments section below.

 

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Hospital visits for dementia patients often tied to insurance type

There is much talk here in the U.S. as the new health care exchanges that the Obama administration has developed to lower health insurance costs open on October 1st. But I found an article this week that has some surprising results in another part of the health insurance world that impacts dementia patients.

Presbyterian Hospital, the last place I saw Dad alive.

Presbyterian Hospital, the last place I saw Dad alive.

A study conducted by NYU researchers found that dementia patients with managed care insurance were sent to the hospital less often to treat end-of-life health issues that would not improve their quality of life. Managed care organizations receive a lump sum payment for each patient, so they have an incentive to keep costs low by not encouraging unnecessary medical care. However, those with traditional Medicare which pays a fee for each service rendered were sent to the hospital more often. The difference in hospitalizations by insurance type was significant: only 4 percent for those with managed care vs. 16 percent for those with Medicare.

Managed care incentives to keep costs low can backfire on patients, sometimes limiting coverage of services that are not medically necessary but would improve quality of life. But in this instance, the focus on the financial aspect of healthcare actually benefits advanced stage dementia patients. My father was in and out of hospitals the last year of his life because his inpatient stays were completely covered by Medicare. But they did not improve his quality of life; in fact the sudden change of environment may have left him more mentally confused. The elderly are also at high risk for serious, even deadly hospital-acquired infections every time they spend time in an inpatient facility.

It’s one of those rare examples where shrewd and calculating financial decisions actually translates to compassionate action.

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Medicare broadens coverage of therapy for dementia patients

I was pleased to learn that Medicare is no longer requiring the “demonstrable improvements” mandate when it comes to covering the charges for a variety of therapy treatments for those with dementia. Most of us who have cared for a loved one with dementia know that physical therapy, speech therapy and occupational therapy can often improve quality of life. While this improvement was often not at the level Medicare required for reimbursement, it offered benefits that the indifferent eye of bureaucracy could not see.

While I have witnessed firsthand the challenges of successful rehab with a dementia patient, I think there are specific therapy programs that could brighten a dementia patient’s mood and help them better communicate their fears and frustrations. Dad somehow learned to walk again, despite being in the mid-stages of Alzheimer’s. I think it takes specially-trained therapists who know the best ways to reach dementia patients.

I hope more dementia patients can take advantage of therapy programs without their families having to worry about the financial consequences.

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Dad’s fate decided by bureaucracy

Medicare and the rest of the government regulations that impact elderly care in this country didn’t give my father dementia, but they certainly played a major role in deciding how the end of his life played out. My Demented Mom posted a good blog entry about how U.S. senators are finally investigating the misuse of antipsychotics in the elderly that are in institutionalized care. It’s about time. I’ve written about the subject multiple times, about how Dad resembled a zombie and how indifferent the ER staff were about possible drug interactions. Sadly, most who have dealt with dementia in their families have these stories to tell.

I’m still reading this book I’ve written about before, a collection of end-of-life essays. I just finished one that really struck home hard, about a sweet lady named Margaret who had a stroke and went through rehab as approved by Medicare. Unfortunately, she just couldn’t make progress during the short rehabilitation period, though she did try. But after her rehab allotment time was up, Medicare forbid any further treatments, because she was not a good candidate for improvement. So she never was able to return home, and instead declined rapidly in the nursing home, despite her loving family trying to visit her as much as they could. (Like my family, they didn’t have the funds to hire 24-7 care for her at home.) What had once been a delightful, talented woman who loved to paint became the typical defeated nursing home patient, parked in a wheelchair with head drooping, alive in physical form only.

And one could argue that bureaucratic rules led to her early demise. Government regulations stole her dignity, and ultimately, her life.

I feel the same way about my father. He also had rehab a couple of times, for the allotted days that were covered by Medicare. But if he had been approved for a longer period of time, maybe he could have gained enough physical strength back to return home, where Mom could have set up home care. Instead, time was up, Dad couldn’t navigate stairs, and away he was whisked to a facility over an hour’s drive from my mom.

Now, I’m the practical sort and I know that programs have to have funding limits. I’m not a fan of tax increases. And yes, families shouldn’t be given false hope by their loved ones undergoing treatments that are futile. I don’t have the solutions, but at least the conversation is beginning.

But the elderly deserve to be treated better at the end of their lives. So many of them fought for freedom, worked hard to support their families, sacrificed in ways we will never know … we can’t continue to discard them like a broken-down car, a heap of junk pushed off to the side of the road that we try to avert our eyes from as we hurry on with our busy lives.

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