Life Lessons to Hold Off Alzheimer’s Disease

Read our guest blog in Advance in Long term Care Management. We look at some life lessons that can help slow, maybe even prevent the onslaught of Alzheimer's disease.

Legislation to expand access to long-term care insurance introduced.

Legislation to expand access to long-term care insurance and strengthen consumer protections of these insurance products has been introduced in the House. The Long-Term Care Affordability and Security Act of 2009 would permit long-term care insurance to be included in employer-sponsored cafeteria plans and flexible spending accounts, enabling people to pay long-term care insurance premiums using pre-tax dollars.

The Long-Term Care Affordability and Security Act of 2009 is endorsed by the American Association of Retired Persons (AARP), the American Health Insurance Plans (AHIP) and the American Council of Life Insurers (ACLI).

I am a proponent of long term care insurance. In fact my wife has carried it from before I met her. She bought it in her 30’s and it was offered by her employer at the time, a very progressive company indeed.

All this is great of course but just because you allow people to buy using pre-tax dollars in no way means that they will buy long-term care insurance. Our culture denies aging and its consequences. As we say everyday in this blog, prepare now so you will not face a crisis in the future. So in short, don’t just support this legislation do something after it is passed. Individuals don’t have many options for affording long term care. This is one way to prepare for it without losing all that you own.

susan Boyle, Stereotypes and Ageism

Great article in the NYT about how people make judgments and rationalize them. We process information so quick that we size things up in nanoseconds. Interestingly the article notes this about ageism:

AGE plays a role in forging stereotypes, too, with older people traditionally seen as “harmless and useless,” Professor Fiske said. In fact, she said, research has shown that racial and ethnic stereotypes are easier to change over time than gender and age stereotypes, which are “particularly sticky.”

We have a long way to go folks to break the stereotype of what it means to grow old and be productive.

Intergenerational Programs in Nursing Homes Good for the Young and Old

The Isabella Geriatric Center in New York city has an innovative program, really a culture of connecting the generations. Their Project N.O.I.S.E.E. (Naturally Occurring Interactions in a Shared Environment Everyday) is an intergenerational program that grew out of a partnership formed between their on-site childcare center and their Therapeutic Recreation Department.

Under the supervision of the Therapeutic Recreation Department, the children are afforded close contact with the residents. The innovative idea of bringing children and residents together, both for scheduled programs and spontaneously, has ultimately become part of the natural rhythm of the day.

Children bring noise—laughter, screams and giggles—and their physical presence completely changes the atmosphere, injecting enthusiasm, energy and youthful excitement.

The objectives of the program are:

• To facilitate daily natural interactions between residents of the nursing home and the children.

• To utilize the entire Isabella campus as the children's classroom.

• To provide therapeutic recreation for residents in the form of daily intergenerational activity. Residents can actively participate or passively observe.

• To stimulate the spontaneous feelings of nurturing and loving that older adults (despite disabilities) often feel-when the environment is conducive to such attention and caring.

• To create for children the non-threatening experience of being with individuals who are elderly and/or impaired, which will serve as a foundation for sensitized interaction with people, over the course of their lives.

Intergenerational activities are important to both the development of children and the quality of life of the nursing home residents. At the same time, residents are teaching the children about respect, understanding and celebrating other cultures.

Going a step further, using the format of a children's board game, 43 offices, public areas, dining rooms, recreation rooms, etc. throughout the campus were renamed. The recreation suite was referred to as "Marshmallow Sky," the 9th floor dining room was Chocolate Chip Jungle, the finance department was Caramel Swamp, and the beauty parlor was Mashed Potato Mountain, to name just a few. As the locations were renamed, the children ventured throughout the campus to share their enthusiasm with the residents, staff and visitors.

Rather than have story hour in the childcare center, the teachers and children would bring their books and magic carpets to Raisin Rain Forest (the physical therapy gym) or have their snacks at Yum Yum Hill (the staff cafeteria).

Project NOISEE consists of five puzzle pieces-structured activities, scheduled programs, spontaneous playtime, special themed events and senior sharing sessions.

Following the therapeutic recreation assessment, the therapeutic recreation specialist ascertains which residents would be willing and would benefit from Senior Sharing Sessions-an opportunity for the resident to share his or her special skill with the children. There are several residents who "work" in the childcare center several hours during the week.

With residents and children increasingly sharing their environment and interacting with one another, acceptance and affection have blossomed.

It is clear that children who participate in an intergenerational program have more positive feelings towards older adults. At the same time, residents have something to look forward to and contribute to; activity is increased while loneliness and depression are decreased. Just as important, staff throughout Isabella say they feel uplifted by the children's presence and the parents believe that being brought into more frequent contact with older people and individuals with special needs has had a positive and important impact on their children.

This program need not be limited to those in day care.

The Harvard School of Public Health-Met Life Foundation Initiative on Retirement and Civil Engagement had this to say about such ventures:

"Community based initiatives that bridge the generations should receive special attention. The programs build community by integrating the old with the young, transmitting knowledge and experience to future generations and reinforcing the value of people of all ages. Studies have found that young people in such programs show measurable improvements in school attendance, attitudes toward school and the future, and attitudes toward elders. Adult volunteers report substantial benefits to themselves: the satisfaction of sharing their experience, feeling useful. And giving back to the community."

We have launched a test pilot intergenerational program with high school students. Our “Senior to Senior” program connects high school seniors and senior citizens through an exercise where the students interview older adults about their life, capture it in word and video and then virally share it.

Obviously the older adults love this because they want to share their story. What has been amazing to watch is how the preconceived notions of older people among some of the students (older folks are scary, dirty, etc) change immediately once they complete this exercise.

What has been frustrating is not being able to convince more schools to come on board.

Regardless, intergenerational programs are the future. Those in need of nursing home care for themselves or a loved one should look to facilities that are breaking the mold and offering the type of program Isabella and others offer.

Poor Staff Communication Negatively Impacts Patient Care

A study, conducted by Zogby International and commissioned by Cisco, sheds new light on the heavy toll that poor staff communication takes on patient care. More than 250 practicing nurses were surveyed online.

The primary issue identified in the survey of nurses centered on the opportunity to improve communications among care team members. As much two hours per shift were reported wasted just chasing other people for answers. About 60 percent of nurses estimate they work up to 10 hours of overtime each week due to time wasted or lost trying to communicate with other staff.

When asked to what extent communication lapses impact patient safety, 92 percent of nurses surveyed noted a "medium to very high" impact. When asked to rate the potential impact of improved communication on the patient experience, 74 percent of nurses surveyed noted a "high impact."

Don’t misunderstand. Cisco conducted this survey so that it could connect it to a solution they offer that being their portfolio of technologies designed to improve communication among mobile clinicians.

Nonetheless the study makes a significant point. Poor staff communication affects patient care negatively. The disconnects are huge. Perhaps hospitals can take a lesson from the Cleveland Clinic where clinicians and other care providers (pastoral care and soon ancillary services) round together. That kind of holistic approach to patient care is bound to improve communication.

Hospital Deception - A Chilling Tale

This blog is worth a read and shows just how diligent you need to be in tracking your health care. This is a chilling account of how one hospital deposed a witness then falsified her testimony. Luckily this hospital deception was uncovered as she kept a copy of her original signed affidavit.

Doctors Fleeing Medicare So Shop Around Before You Become Eligible

Following up from yesterday’s post comes news that doctor’s are fleeing Medicare. According to the New York Times, some physicians including internists and many specialists are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage.

Why: reimbursement rates are too low and paperwork too much of a hassle.

Doctors who opt out can charge whatever they want to patients but neither they nor their patients can try to seek reimbursement from Medicare. Doctors who remain in the system fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

So you the consumer really need to shop around and do so before you become Medicare eligible. Easier said than done because as the population ages, there are fewer people opting for medical careers especially careers in primary care.

Talk to your doctor. Even if not accepting new Medicare patients he/she may allow existing patients to stay. The Times also mentions an option for patients to sign a private contract that stipulates the patient will be responsible for paying the doctor’s fees and that lists exactly what those fees are and what they cover. Some doctors may be willing to negotiate and tailor prices to what patients can afford.

www.medicare.gov provides a list of Medicare enrolled doctors. Other sources are state medical societies and local hospitals. But that’s no guarantee they will see new patients. A new trend emerging is the use of retail health clinics as primary care providers. Most accept Medicare. Another, more expensive option is concierge medicine. In the most popular kind, doctors accept Medicare and other insurance, but charge patients an annual retainer of $1,600 to $1,800 to get in the door and receive services not covered by Medicare, like annual physicals.

The other form of concierge medicine — doctors who have opted out of Medicare — is more expensive with fees ranging as high as $15,000 a year and cover office visits, access to the doctor when care is needed, referrals to specialists and thorough annual physicals.

So as we always advise. Become educated on these issues before they affect you or a loved one and start making preparations sooner than later for health care in your advancing years.

Medicare Advantage at a Disadvantage?

Facing five percent cuts and a watchful eye from the Obama administration, Medicare Advantage programs are starting to cry poor saying it could result in premium increases for beneficiaries.

The Obama administration and Democrats have criticized the Republican-backed Medicare Advantage programs because they cost 14% more on average to care for than Medicare fee-for-service beneficiaries.

Medicare Advantage counters that it, unlike traditional Medicare, actually coordinates care for beneficiaries, which is especially important for seniors with multiple chronic illnesses. Having helped launch a company that offers Medicare Advantage programs I can attest that care coordination is prominent. It is not just the right thing to do. You see the government pays Medicare Advantage programs so much per enrollee per month. You keep them well you keep more of the payment.

Medicare Advantage's first mover advantage in the beginning was that you had prescription drug coverage as part of the benefit. Now that is available to all Medicare beneficiaries.

My mom is an enrollee in a Medicare Advantage program and she was just hospitalized out of state for a fall she took. Let me tell you that there was little coordination of care and she had to and still does have to go through hoops for everything she needs.

There is truth somewhere in the middle. But the only people who can make a judgment as to whether Medicare fee for service or Medicare Advantage has the advantage are those that experience the care. So my mom will decide when she switches plans….AGAIN!