Physically and Socially Active Adults Less Chance of Being Disabled in Elder Years

Older adults who remain as physically and socially active as possible have a better chance of not becoming disabled in their elderly years. That's the conclusion of Rush University researchers in Chicago. 

Investigators studied 954 older adults with a mean age of 82 who were not classified as disabled at the beginning of the study. The scientists measured social activity by having participants report how often they did activities such as going out to eat, attending sports events, playing bingo, taking weekend trips, doing volunteer work and more. They then assessed patients regarding disabilities by asking them about daily task performance, and whether they were able to do the following without help: bathe, prepare meals, get dressed, walk across a room unassisted, do housework, go up and down stairs and other daily activities.

Results found that seniors with a high level of activity were twice as likely to remain independent and disability-free for longer periods of time. "Social activity has long been recognized as an essential component of healthy aging, but now we have strong evidence that it is also related to better everyday functioning and less disability in old age," said lead researcher Bryan James, Ph.D. 

Speaks for itself doesn't it?

Source: McKnights Long-Term Care

British Caregiver Survey Tool Can Help U.S.

A new manual to provide health and social workers with a tool to measure the quality of life of adult, unpaid caregivers has been launched by The Princess Royal Trust for Carers, in association with the University of Nottingham in the U.K.

It is a simple 40-item questionnaire that measures a carer’s quality of life in eight domains: support for caring; caring choice; caring stress; money matters; personal growth; sense of value; ability to care; and carer satisfaction. The questionnaire can be used on a one-off basis for the purpose of an assessment, or as a pre or post intervention tool to measure change and the impact of support. 

Find the survey here. 

Dr Moira Fraser, Director of Policy of The Princess Royal Trust for Carers, said: “We hope the questionnaire will be widely used to help us measure what works in providing support for carers and also help us see trends at a national level.”

Osteoarthritis and Obesity Can Shave 3.5 Years of Healthy Life

Harvard Medical School conducted a study that showed that close to 40% of elderly Americans are obese or have osteoarthritis of the knee, or both, which, on average, eliminates 3.5 years of a positive quality of life.

Researchers found that about 33% are obese and do not have osteoarthritis—and can lose almost 2.5 healthy, pain-free life-years. People with osteoarthritis who are not obese (3.3%) are expected to lose 1.9 years of good health. About 3.3% of seniors who are obese and have knee osteoarthritis are projected to experience 3.5 fewer years of pain-free, good health.

Researchers noted that telling people to lose weight didn't work until you couched it around lifespan. In other words, your lifespan will be 3.5 years longer if you were not obese and had osteoarthritis.

In my keynote, The Meaning of Life, I talk about eight traits that people who live long, quality lives have and for each trait there is a corresponding number of years added to their life. This is the glass half full model!

Iowa Eliminates 10 Nursing Home Inspectors

Iowa Gov. Terry Branstad (R) has cut 10 of the state's 38 nursing home inspecting positions. That leaves just 28 people to inspect 442 nursing homes!

Iowa's financial challenges were the reason for the reduction. Officials said other staffers in the Inspections and Appeals department could be trained to fill in the gaps left by the inspectors.

While campaigning for governor, Branstad said state inspectors often fine Iowa nursing homes unfairly. These comments drew accusations that Branstad was a pawn of the nursing home industry.

Politics aside, the only ones hurt by this are nursing home residents and their families. This is an impossibly few number of inspectors who will spend even less time checking up on how facilities treat your mom and dad.

Nurse Dissatisfaction in Nursing Homes

Researchers at the Penn School of Nursing released information that shows 27 percent of nursing home nurses and 24 percent of hospital nurses reported being dissatisfied with their jobs.  Just 13 percent of nurses in other healthcare environments reported such feelings.

95,000 nurses in 614 U.S. hospitals and other healthcare settings were surveyed. Those who provide direct care to patients experience higher rates of burnout than nurses in other healthcare sectors. Makes sense doesn't it. In fact these same nurses then go into less acute environments after the burnout.

Staffing levels and emotionally depleting work were cited as reasons. Nursing home nurses (37%) had the highest rate of burnout.

These same nurses also are less satisfied with their own employer-provided healthcare and retirement benefits than nurses who work in other healthcare settings.

There is a lot of talk about patient experience out there but that experience can only be good if we in turn offer exceptional experiences for healthcare staff, empower them but also provide the needed emotional support so that they can thrive in their jobs and not take all that stress home. 

Video Games Good for Elderly

Studies show that video games that encourage physical activity also help with depression, sense of place and relevancy. At the Gerontological Society of America's Annual Scientific Meeting in New Orleans late last year, Patricia Kahlbaugh, Ph.D., an associate professor of psychology at Southern Connecticut State University presented a study that showed that even just a few sessions with the Wii led to improved balance, coordination and strength, and could help prevent falls among elders.

Further research by Kahlbaugh has shown that these games are also proving to help with depression, sense of place and relevancy. They may even help bridge generational divides.

By recreating the experience of sports they once enjoyed, researchers say that also brings back the same feelings and emotions they experienced back then.

The University of California, San Diego School of Medicine conducted a study on seniors with depression. More than one-third of participants who played Wii games reported a 50 percent or greater reduction of depressive symptoms.

Said Kahlbaugh quoting her father, "The trick of getting older successfully is finding out how to stay relevant."

Exactly. Having purpose and relevance as you age is one of the eight points I cover in The Meaning of Life keynote I give to people. People with purpose live longer.

Source: Aylin Zafar, The Atlantic

Osteoarthritis Poses Disability Risk

At the annual meeting of the American Academy of Orthopaedic Surgeons in February, researchers reported that the risk for disability from osteoarthritis of the knee is just as harmful as the risk for disability from cardiovascular disease. 

Osteoarthritis researcher Fred Nelson, M.D. said that osteoarthritis of the knee is one of the top five leading causes of disability in elderly men and women. 

He points out that current treatments do not address the cause of the disease, just the symptoms.

"The feedback of nerve signaling can have a direct effect on the cartilage cell itself,” Dr. Nelson says. “Knowledge of the back and forth messaging between the tissue components may lead to better interventions for pain. But we can't know that until we start looking at the knee with a broader view."

So lesson for today - as you explore conventional treatments for arthritis, whether knee replacements, physical therapy, question your physician in terms of underlying causes for this and any other conditions you may have. After all, this would not be the first time that the symptoms and not the underlying cause were treated.

My Senior Care New Resource for Caregivers

I came across a new resource called My Senior Care. It is a resource for caregivers that has two things going for it. 

First, they have assembled and advisory panel of aging services experts who you can write to with your questions about all aspects of caregiving.

Second they have a list of housing, home care and hospice organizations that they have personally vetted to assure that they are legitimate businesses. Providers must demonstrate proof of licensing and liability insurance to be listed.  

Those organizations in turn have an opportunity to contribute to their listing.  The search tool allows users to search by the specific type of care they require and the payment methods supported.  Users can also read user reviews of each provider and call toll-free numbers to schedule a free consultation.

They also feature 500+ articles reviewed by industry experts, message boards, and user and expert authored blog. 

MySeniorCare’s mission is to support families and their aging loved ones during a highly stressful time as they search for information, resources and providers of senior care. The service is completely free for families and providers and it also used by professionals in finding care for the people with whom they work. Even the National Institute on Aging has given this site their nod of approval.

Check out My Senior Care.

Pain in the.....Negative Thinking, Pain and Healing

Should doctors consider the affect of negative thinking from patients? British and German researchers would think so. They concluded that pessimism could override the effectiveness of powerful treatments.

They strapped a heat-beaming device onto the legs of 22 healthy volunteers, zapping it until people rated their pain at nearly 70 on a scale of 1 to 100. Then the researchers hooked up an IV to give them the powerful morphine-like painkiller remifentanil.

When the researchers induced the burn and turned on the drug, the volunteers said their pain improved a fair amount. The researchers next told the volunteers they were about to inject the painkiller even though they'd never turned it off. Those pain ratings dropped even more – the expectation of relief doubled the drug's painkilling benefit. Then researchers said (lying) they were stopping the drug and that pain would probably increase. Sure enough, the volunteers' pain levels soared back up. Mind over matter.

Learning how anxiety influences pain is crucial to understanding this nocebo effect - how you get the pain you expect, said co-author and Oxford neuroscientist Irene Tracey. Part of this stems from having a positive doctor-patient relationship as well.  Managing patients' expectations and spelling out exactly what will happen can go a long way in building patient confidence in healing.

So perhaps researchers are suggesting that positive patients seek out positive physicians. After all there are so many curmudgeons out there. Get someone who will be positive but frank in his or her relationship with you.

Longevity Project Busts Aging Myths

Thanks to the findings in a surprising new book, The Longevity Project, you can learn why some people make it to a very old age and others don’t. 

Howard S. Friedman, Ph.D., and Leslie R. Martin, Ph.D., have spent the past 20 years following subjects from childhood to adulthood to discover why some thrived well into old age and others did not. In the end, they discovered that many of the mantras we hear are good for us in lots of ways but don’t necessarily ensure a longer life. Check out some of these myths,

Myth #1 – Marriage Guarantees a Longer Life - (They conclude yes - for men.)

Myth #2 – Taking It Easy Adds Years to Your Life - (Ambition, perseverance, impulse control, high motivation led to a resilient work life and more years.)

Myth #3 – You Can Worry Yourself to Death - (Prudent, well organized, detail oriented, in other words worriers lived longer.)

Myth #4 – More Degrees Mean More Years- (In terms of having the smarts to live healthier yes but productivity and persistence win out over education.)

Myth #5 – Friendly Outgoing People Thrive - (Highly sociable people engage in the dangers of the moment and give into crowd; optimistic people did not tend to live any longer either.)

Myth #6 – Jocks Outlive Nerds - (Jocks who retire and become sedentary lose all advantage.)
 

Adapted from Parade Magazine. Take their longevity quiz here.

National Kidney Foundation Conducting Online Survey

The National Kidney Foundation is conducting an online survey to understand the needs of patients with certain serious kidney ailments and their caregivers. The survey is being conducted by Harris Interactive, a market research firm known for The Harris Poll.  The caregivers they want to survey are family caregivers (parents, siblings, friends, and other family members) or paid home caregivers (nurses or aides) of these patients.

If you choose to participate, you will first be asked a few qualifying questions.  If you qualify and complete the 30 minute online survey, you will receive $25. The National Kidney Foundation is grateful for your participation in this important survey that will improve services to patients and caregivers.

Contact Jasmin Smith.

MRI's Could Detect Early Onset Stroke When Patient Can't

Magnetic resonance imaging, or MRIs, might be able to help physicians figure out if clot-busting drugs will help patients who present with unclear-onset or “wake-up strokes,” a new study finds.

Researchers in South Korea used MRIs to screen 430 patients who were either uncertain of when their stroke symptoms began or who woke up while a stroke was in progress. This is an important factor as clot-busting drugs are most effective at preventing disability if administered within four-and-a-half hours of the onset of symptoms.

"Wake-up, or unclear-onset, strokes account for a quarter of all ischemic strokes but have been automatically excluded from clot-busting techniques because the onset time cannot be known,” said lead study author Dong-Wha Kang, M.D., from the Ulsan College of Medicine in Seoul, South Korea. “Our study shows that such patients could also be treated safely and effectively."

Source:McKnights

Of Tennis Balls, Walkers and Alternatives

Certainly you have noticed people with walkers who use tennis balls for braking and stability. Turns out there's a better way.



NOVA, a supplier of independent living products has created a web site to educate people on the dangers of using tennis balls on the bottom of walkers. And they have ted it to a contest. NOVA will reward one person that kicks the tennis ball habit with $1000 and a mobility makeover.

“I’ve got nothing against tennis balls – on the court or at the dog park!” says NOVA CEO, Sue Chen. "Tennis balls on walkers are unsafe, unsanitary and unattractive. They pick up and track germs, they make the walker unstable, they actually add to the wear and tear on the walker, and they are a disrespect to the person using the walker.” OK tell me how you really feel!

Of course they have a better way. They created a product called Walker Skis, small grey, plastic pieces that resemble very short skis and fit on the legs of most walkers. 

The contest runs through July 31. Participants submit photos or video getting the tennis balls off of their walkers and are entered to win $1,000 and a mobility makeover. 

I have to admit to being mystified about tennis balls on walkers. This new product seems cumbersome but who knows. If anyone has used these new walker gadgets please comment on this blog.

Seniors May Benefit from Moving into a Community

Atria Senior Living and the International Longevity Center (ILC-USA) recently published the results of a six-month survey looking at satisfaction of seniors living in independent and assisted living communities.

The study suggests that seniors in congregate living situations can experience greater subjective well-being in this type of setting.

Keep in mind this was a small study of 28 people already living in an Atria community. Some might suggest this as being self-serving. After all, isn’t the purpose to conclude that there are valuable reasons not to live at home and seek community living? Nonetheless….

Six items were tested to gauge well-being and life satisfaction among participants.

• Satisfaction with Life
• Positive Effect
• Negative Effect
• Mastery of Environment
• Purpose in Life
• Positive Relationships

The authors contend that there is no accepted industry standard in place for evaluating the key elements for ensuring a safe and emotionally healthy transition to senior living communities.

Residents who participated in the study exhibited significant improvements between the first and second administrations of the study on four of the six measures, indicating a favorable assimilation into their senior living community.

Khristine Rogers, Vice President of Active Aging with Atria Senior Living says “Our ultimate goal is to continually create better and more seamless transitions into senior living communities, not just for the residents we serve, but for the aging population at large.

Here is the survey.

 

Clinical Trials Ignore Seniors

According to researchers, more than half of clinical trials in the United States exclude the elderly from their studies, even though 34% of personal medical expenditures come from this group of people.

In a review of clinical trials, researchers from the University of Michigan found more than 50% of trials did not include senior citizens or people with age-related illnesses. The remaining studies also excluded frail participants and those with cognitive problems.

"These findings are concerning because it means that doctors cannot be confident that clinical trial results apply to their older patients," says Donna Zulman, M.D., the study's lead author and a Veterans Affairs scholar with the RWJF Clinical Scholars program at the University of Michigan Health System. "Health care providers and patients need better evidence about treatment strategies that improve the health and quality of life of seniors" she told Medical News Today. 

"Our findings suggest a need for policy change by government agencies like the Food and Drug Administration and the National Institutes of Health to increase the representation of typical older adults in clinical trials." 

Who knew? Wouldn't it seem obvious that our seniors need to be part of these? Or does it go along with other studies that have suggested that physicians do not treat seniors with the same aggressiveness as younger patients. In other words, they are implying that the senior has less life to live so we will focus elsewhere. It is pervasive and we need to advocate for those most vulnerable.

NFL to Pay LTC Premiums

The NFL has agreed to pay long-term care insurance premiums for retired players, according to a league announcement. The agreement was signed with Transamerica Life Insurance Company and will cover the premium for those who are eligible retirees.

The NFL claims that an average of 120 former players die each year each year and many pass due to the lack of long-term health care.

No doubt that the whole concussion issue spurred some of this on. And I say good for the players. But it also plays to the continued disparity between the haves and have nots. Because let's face it. Few if any employees would be so generous. So what about us?

My personal belief is that the CLASS Act is not the answer. It is a voluntary benefit and still costs a substantial amount out of pocket. So while the NFL players can rest easy knowing that their long-term care costs are covered, many of the rest of us will be blind-sided by the heavy blow of the financial burden that we neither anticipated or planned for - a real knockout punch.

Read my about.com blog related to this.

More Providers Obligated to Tell Patients About Quality Organizations

The Centers for Medicare and Medicaid Services has proposed a new rule that would require an expanded class of providers and suppliers of Medicare services to alert beneficiaries to the existence of quality improvement organizations (QIOs). Previously, only hospitals and select others had been obligated to do so.

Under the new rule, nursing homes, therapy providers, outpatient centers and many others would have to give written information to beneficiaries about how to contact state quality improvement organizations in the event of poor quality of care. 

CMS contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands to serve as that state/jurisdiction's Quality Improvement Organization (QIO) contractor. QIOs are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.   

CMS is accepting comments on the proposal until April 3 and said it “will respond to comments in a final rule to be issued in the coming months.”

From a consumers standpoint it would not hurt to know who these quality agencies are. Check them out here.

Etanercept Found to be Helpful Post Stroke

The drug etanercept holds hope for treating brain inflammation that comes after a stroke, researchers have found. The effect can be realized years after a stroke.

The drug works by neutralizing a cytokine (small cell-signaling protein molecules that are used extensively in intercellular communication) that initiates and amplifies inflammation.

When etanercept was administered to three stroke patients, all demonstrated improvement in areas such as motor function, gait, hand function, sensory deficits, spatial perception, speech and cognition within 10 minutes.

While strokes are emergencies, nonetheless, be aware of this new drug and ask your physician about it especially if you have heightened stroke risk factors.

90 Percent of Nursing Homes Employ People Convicted of a Crime

The U.S. Department of Health and Human Services (HHS) Office of the Inspector General issued a report that concludes that more than 90 percent of nursing homes employ one or more people who have been convicted of at least one crime. Five percent of all nursing home employees working in 92 percent of facilities have at least one criminal conviction.

To qualify this, most often, criminal convictions were for crimes against property (e.g., burglary, shoplifting, and writing bad checks) and occurred prior to employment. For 16 percent of employees with convictions, the most recent offense occurred after they had started work in a nursing home.

The report also noted that most States required, and/or nursing facilities reported conducting, some type of background check.

HHS recommended that CMS develop background check procedures and develop lists of convictions that disqualify individuals from employment, as well as defining whether any of those conviction types can be assumed to be mitigated because of the passage of time and which convictions should never be considered mitigated or rehabilitated.

Senator Herb Kohl, Democrat of Wisconsin, who has investigated nursing homes as chairman of the Aging Committee, told the New York Times"The current system of background checks is haphazard, inconsistent and full of gaping holes in many states. Predators can easily evade detection during the hiring process, securing jobs that allow them to assault, abuse and steal from defenseless elders."

In my about.com blog I have written about the federal program here. It is full of issues.

I think the bigger issue for the industry is a PR one.

And for consumers, the lesson is clear. When investigating a home for your loved one, whether nursing homes or assisted living, make sure to ask about the use of background checks. But don't settle for an answer on that they perform them. Ask how they perform them. And use this study to ask questions about whether the home you are looking at was impacted by this study.

Caregiver Help for Those Caring for Veterans

The Department of Veterans Affairs (VA) has opened a toll-free National Caregiver Support Line that will serve as a primary resource/referral center to assist caregivers, Veterans and others seeking caregiver information can call the line, which is staffed by VA employees who are licensed clinical social workers.

The Support Line will provide information on VA/ community caregiver support resources and referrals to dedicated Caregiver Support Coordinators located in every VA Medical Center; emotional support for the caregiver will be an integral component of this service. The National Caregiver Support Line is also available to respond to inquiries about the caregiver benefits associated with Public Law 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010.

The National Caregiver Support Line is open Monday through Friday 8:00 a.m. to 11:00 p.m. and Saturday 10:30 a.m. to 6:00 p.m. Eastern Time.  The National Caregiver Support Line Toll-Free number is 1-855-260-3274.

Also see VA’s updated caregiver website.

Family Caregiver Survey Explores Use of Technology

United Healthcare in connection with the National Alliance for Caregiving recently conducted a survey to examine family caregivers’ receptivity to technology. The study assessed how helpful 12 technologies would be in supporting caregivers or helping them provide care.

The 1,000 family caregivers surveyed have expectations for the technology including:

• being able to save time
• making caregiving easier logistically
• making the care recipient feel safer
• increasing feelings of being effective
• reducing stress.  

Technologies that help caregivers deliver, monitor, track, or coordinate their loved one’s medical care is key. Though there is a belief that the technology would be expensive.
Other limiting beliefs included:

• the technology does not solve or address a pressing caregiving issue  
• the care recipient would resist accepting the technology 
• the technology would diminish the care recipient’s sense of independence or pride
•  the technology would lessen the care recipient’s privacy
• the technology would take too much time or effort to learn or use 
•  the technology would decrease the care recipient’s level of social interaction

The three top technologies that caregivers desire are: 

1. Personal health record to track of care recipient’s personal health records, including patient history, symptoms, medications, tests, etc.
2. Caregiving coordination system for doctor appointments and other caregiving needs. Caregivers can use the system to request a volunteer on certain days and times, and family members and friends can use it to sign up to help. Think about something we blogged about called Lotsa Helping Hands. 
3. Medication support system that reminds the care recipient and dispenses pills on schedule.

Three other technologies appear to have moderate potential:

• A symptom monitor and transmitter that electronically sends information such as blood sugar or blood pressure readings to a doctor or care manager.
• An interactive system for physical, mental and leisure activities, a TV‐based device, like a Wii Fit, that would allow the caregiver to create a schedule of gentle physical activities and mental games for the care recipient.
• A video phone system with video capability or an Internet‐connected computer with webcam that allows caregivers to check in and see the care recipient when they can’t physically be together.

Having less potential are:

• caregiver training simulations
• caregiving decision‐support too
• passive movement monitoring systems, being able to track and detect if someone has fallen for example, without the person needing to push an emergency response button
• caregiving coaching software
• caregiving mentor matching service

Younger caregivers, no surprise, are more likely to adopt technology and perceive fewer barriers.

What technologies do you employ now as a caregiver?

What technologies would you like to see?

Long-Term Care Funding: Here's Looking to You!

The Commonwealth Foundation conducted a study in Penn. looking at long-term care funding and came to some interesting conclusions. Pennsylvania taxpayers pay $6.6 billion per year to fund long-term Medicaid spending, 40% of the state's Medicaid spending. It is unsustainable so they are looking at several options.

• Rebalance Medicaid
  In other words, provide more home care at a perceived lower cost. But Commonwealth contends that research shows that home care does not result in overall savings.  Providing more home care delays, but does not replace, institutional care, and actually costs more in the long run they contend.
  
  That leads me to believe that aging-in-place in unattainable for many. If I am reading through the lines correctly, it would seem that they are saying that most people at one time or another will need care in a nursing home.
  
• Reduce Enrollees
  
  The only way to achieve the balance and assure quality care is available and being paid for in skilled nursing homes is to reduce the number of people on Medicaid says the Fund. They cite four things.
  
  
  1. Asset Spend Down
     
     By reaching aging Pennsylvanians while they are still young, healthy, and affluent and teaching them to plan responsibly for long-term care, the state could save  $120 million per year by preventing only 20% of its dual eligibles from ending up dependent on the program in the future. A dual eligible is someone who is on both Medicare and Medicaid.
     
     Lesson - plan for your long-term care needs because eligibility for Medicaid in the future may make it hard for many to avail.
      
  2. Estate Recoveries
     
     If Pennsylvania Medicaid recovered funds from estates, the commonwealth could recover an additional $213 million per year. States can come after estates to recoup Medicaid dollars it spent on a person's care.
     
     Lesson - this is money in the bank if states decide to pursue. So consult an accountant and elder attorney to learn more about asset protection.
     
     
  3. Home Equity Conversion
     
     In short, reverse mortgages as a cure. Pennsylvania may have 135,000 households that could receive an estimated $62,800 each or $8.5 billion in total from reverse mortgages to help pay for their own long-term care, and stay off Medicaid.
     
     Lesson - a reverse mortgage could be worth investigating especially now when you have the freedom to do so and not later when you may be forced to look at it as an option to help you survive retirement.
     
     
  4. Private Long-Term Care Insurance
     
     If there were tougher income and asset limits for Medicaid eligibility, the Commonwealth contends that more citizens would buy long-term care insurance.
     
     Lesson - read this as states are going to look to make eligibility more stringent and that puts more of the burden on you to finance your long-term care.
     

So in short as we try to say every day, you need to plan for your long-term care needs. And you can start by trying to minimize the likelihood that you will need long-term care. From looking at how to age-in-place, to keeping yourself in shape and healthy, to financially preparing, there are things you can do to make aging enjoyable not something that can turn into a crisis at the drop of a hat (does anyone wear hats!?).

Medicare Standards Too Stringent Courts Rule

Federal courts in Pennsylvania and Vermont have ruled that Medicare standards are too stringent when it comes to deciding if a patient is eligible for skilled nursing home care or home health.

The Federal District Court in Pittsburgh disagreed with Medicare's decision to terminate coverage of an 81-year-old woman who required skilled nursing care, physical therapy and occupational therapy in a nursing home after a hip replacement. After five weeks of treatment, Medicare ended her coverage claiming that she had not improved and wasn't likely to. In the Vermont case, Medicare terminated coverage of a 66-year-old woman who was getting home health services after suffering from two strokes. The federal court there ruled that Medicare improperly denied the woman coverage. Her lawyers argued, successfully, that home therapy was needed to keep her condition from deteriorating, The New York Times reported.

Following these two rulings, 17 House Democrats wrote President Obama a letter asking for more relaxed standards.

Working in healthcare, I am used to insurer scrutiny of care, length of stay, etc. but this one caught me by surprise as I am not used to hearing about Medicare clamping down in this way. Sure they have standards and protocols but it seems in these instances they were jumping to care conclusions when maybe it was not their place to do so.

In any case, lesson is to not be caught surprised by what your insurer will or will not cover. Verify. And if after the fact you are not satisfied enlist the services of a patient advocate to health. No one will fight for your healthcare except you.