Tagged Aging

State Highlights: Minn. Gov. Blasts Medica For $120M Funds Transfer; In Mass., Closing Arguments In Murder Trial Related To Compounding Pharmacy Meningitis Outbreak

Media outlets report on news from Minnesota, Massachusetts, Texas, New Hampshire, Kansas, Arizona, Pennsylvania, Ohio, Georgia and Ohio.

The Associated Press: Closing Arguments Set In Deadly Meningitis Outbreak Trial
Attorneys are preparing to make their closing arguments in the case of a Massachusetts pharmacist charged with second-degree murder in a deadly meningitis outbreak. Closing arguments in Glenn Chin’s trial are expected Friday in Boston’s federal courthouse. Chin faces second-degree murder, mail fraud and other charges under federal racketeering law. (Richer, 10/20)

Dallas Morning News: Two Texas ERs Got Bad Reviews Online. Now They Want Google To Help Them Find Out Who Did It 
Two North Texas free-standing emergency room operators want tech giant Google to give up the identities of nearly two dozen reviewers who rated them poorly online. Highland Park Emergency Center on Lemmon Avenue and Preston Hollow Emergency Room on Walnut Hill Lane filed a joint petition Tuesday in Dallas County District Court. The 30-page pre-suit deposition lists the screen names used by 22 individuals, who the facilities claim never were treated in their emergency centers. (Rice, 10/19)

Kansas City Star: Fungus Destroyed Inmate’s Brain While Kansas Prison Contractor Did Nothing, Suit Says
Marques Davis was in the infirmary at Hutchinson Correctional Facility on Dec. 27, 2016, back with the same symptoms he’d been complaining of for months, including numbness and weakness in his legs. But on that day there was something new. “It feels like something is eating my brain,” Davis told Corizon Health employees who staff the prison infirmary. According to a lawsuit filed in federal court Monday, something was infecting his brain: a fungus that slowly killed the 27-year-old over the next four months, as he pleaded for help. (Marso, 10/17)

Arizona Republic: Arizona Heat Takes An Extra Toll On People With Mental Illness
Out of all the people who died of heat-associated causes in Maricopa County in 2016, around 15 percent had a history of mental illness, according to an Arizona Republic analysis of autopsy reports. …Some medications, including certain types of antidepressants and antipsychotics, block the body’s ability to regulate its temperature, said Dr. David Eisenman, a professor of medicine at the University of California, Los Angeles. (Altavena, 10/19)

The Philadelphia Inquirer/Philly.com: Major Sanctions At Darby Nursing Home After Neglect Found
The Pennsylvania Department of Health revoked the regular license of St. Francis Center for Rehabilitation & Healthcare last month and installed a temporary manager at the Darby nursing home after an August inspection found that a patient had developed “wounds that went down to the bone with exposed tendon.” The 273-bed facility, one of five sold in 2014 by the Archdiocese of Philadelphia to Center Management Group of New York, appealed the decision and remains open under a temporary manager installed by the health department. The revocation was the first in Pennsylvania since at least the beginning of 2014. (Brubaker, 10/20)

Des Moines Register: Quadriplegic Spent Hours In Dirty Diaper After Services Cut
Throughout last summer, 25-year-old quadriplegic Louis Facenda Jr. spent as much as half of each day in a dirty diaper after his caregiver services provided through Iowa’s Medicaid program were dramatically cut. …The cuts ended payments for at least 16 visits each week for an in-home care program that helped the family dress, feed and change the diapers of Facenda Jr. two to three times each day. (Clayworth, 10/19)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Amid For-Profit Surge, Rural Hospice Has Offered Free Care for 40 Years

PORT ANGELES, Wash. — Rose Crumb can’t even count the number of people she’s helped die.

The former nurse, 91, who retired in her mid-80s, considers the question and then shakes her head, her blue eyes sharp above oval spectacles.

“Oh, hundreds,” estimates Crumb, the woman who almost single-handedly brought hospice care to this remote Pacific Northwest city nearly 40 years ago.

But the actual number of deaths she has witnessed is likely far higher — and Crumb’s impact far greater — than even she will admit, say those affiliated with the Volunteer Hospice of Clallam County.

“[Rose] let people know hospice is not all about dying,” said Bette Wood, who manages patient care for VHOCC. “Hospice is about how to live each and every day.”

In a nation where Medicare pays nearly $16 billion a year for hospice care, and nearly two-thirds of providers are for-profit businesses, the tiny Washington state agency is an outlier.

Since 1978, the hospice founded by Crumb — a mother of 10 and devoted Catholic — has offered free end-of-life care to residents of Port Angeles and the surrounding area. She was the first in the region to care for dying AIDS patients in the early days of the epidemic. Her husband, “Red” Crumb, who died in 1984 of leukemia, was an early patient.

“He died the most perfect death,” Rose Crumb told visitors on a recent afternoon. “He spent time alone with each of our kids. That meant so much to him.”

At the same time, Crumb and her successors have refused to accept federal funding or private insurance, relying instead on a mostly volunteer staff and community donations to keep the hospice going.

Since 1978, the Volunteer Hospice of Clallam County has offered free end-of-life care to residents of Port Angeles, Wash. (Dan DeLong for KHN)

That’s rare, said Jon Radulovic, a spokesman for the National Hospice and Palliative Care Organization, NHPCO, an industry trade group. Most of the nation’s 4,000-plus hospices receive Medicare payments for their services. He estimates there are only a few volunteer hospices like Crumb’s in the U.S.

There was pressure in the early years to “take the money,” as Crumb put it. But she had little use for the regulations that accompanied federal Medicare reimbursement starting in 1982.

“It was our experience that we could operate on a much smaller budget and we could be more flexible in providing services,” Crumb wrote in a 2007 newsletter.

Today, the hospice relies on 10 paid staff, 160 volunteers and an annual budget of less than $400,000 to provide end-of-life care for 300 patients each year, according to federal records.

Patients don’t have to meet Medicare’s criteria of having six months or less to live to be enrolled, though most do. They can keep their own doctors instead of turning over care to a hospice physician. If families need medical equipment, the hospice supplies it for free.

“I don’t know how I would have made it without them,” said Eve Farrell, 82, whose husband, Daniel, had cardiopulmonary obstructive disorder, or COPD. He died in January at age 80 after four months of hospice care at the couple’s Port Angeles home.

Eve Farrell holds a portrait of her husband, Daniel, in her Port Angeles, Wash., home. Daniel died on Jan. 15, 2017, of complications of COPD — chronic obstructive pulmonary disease. (Dan DeLong for KHN)

Staffers helped her husband shower when she couldn’t lift him, offered advice about medication and gave her breaks from relentless caregiving.

“We felt like Dan was the only patient they had,” Eve Farrell said.

Crumb was drawn to hospice care in the 1970s, after the book “On Death and Dying” by Dr. Elisabeth Kübler-Ross galvanized conversations in the U.S. about how to treat the terminally ill. Years earlier, when Crumb’s father was diagnosed with lymphoma, she helped him die at home.

“It was the most meaningful experience in my nursing career,” she said.

In April 1977, when Crumb attended a convention that included a program on hospice, she was hooked.

“Everything clicked,” she recalled. “I thought ‘Yes!’”

Organizers had little money and less support, Crumb said. The local medical community was skeptical about hospice, which started in the U.S. in Connecticut in 1974.

“Some of the doctors called us ‘the death squad,’” Crumb said. Crumb’s refusal to take federal funds put her at odds with the for-profit hospice industry, which lobbied state lawmakers in 1992 to eliminate an exemption that allowed volunteer hospices to remain unlicensed.

Bette Wood is patient care manager at the Volunteer Hospice of Clallam County. “[Rose] let people know hospice is not all about dying,” Wood says about Crumb. “Hospice is about how to live each and every day.” (Dan DeLong for KHN)

Crumb had to enlist the services of her eighth child, Patrick Crumb, then a corporate lawyer, to fight back.

“In my view, they were clearly misrepresenting the current status of the law,” recalled Patrick Crumb, 55, who is now president of the AT&T Sports Network. “I told them, ‘If you do what you’re threatening to do, I’m going to sue you and I’m going to win.”

Lawmakers eventually agreed to create an exemption to state law that allows volunteer hospices to remain unlicensed and unregulated. Crumb’s hospice remains the only agency in state history to use it.

In 2002, the volunteer hospice faced a for-profit rival, Assured Home Health and Hospice, now owned by the LHC Group based in Lafayette, La. Documents show that Assured officials predicted they’d serve 70 percent of the local hospice market within two years.

But competition was fierce, recalled Dr. Tom Kummet, medical director at the Olympic Medical Cancer Center, who referred dying patients to hospice care.

“It was a bit of an awkward time,” he said.  “Assured hospice wanted to be a successful business. And Volunteer Hospice was going to negatively impact their chances of being a successful business.”

“We don’t have oversight from the government, but we have minute oversight from the community,” says Astrid Raffinpeyloz, volunteer services manager and community outreach committee co-chair of the Volunteer Hospice of Clallam County. (Dan DeLong for KHN)

Fifteen years later, Assured still struggles, said Leslie Emerick, director of public policy and outreach for the Washington State Hospice and Palliative Care Organization.

“They tread lightly up there because of Rose,” Emerick said.  “Rose is a beloved person in that community.”

Officials with LHC declined to discuss competition in the Port Angeles market or to say how many patients Assured has enrolled.

“We value the care that Volunteer Hospice provides for our community,” Candace Hammer Chaney, a local Assured manager and community liaison, said in a statement.

Emerick and other hospice industry officials said volunteer hospices don’t offer the range of services required of those who receive federal funding. And, Emerick added, there’s little oversight.

“They don’t have a reputation of negligence or complaints as far as I’m aware, but there’s always the possibility of that when they’re unlicensed or unregulated,” she said.

But Astrid Raffinpeyloz, VHOCC’s volunteer services manager, said the hospice wouldn’t have lasted long in a small town if there were problems.

“We don’t have oversight from the government, but we have minute oversight from the community,” said Raffinpeyloz.

Mike Clapshaw poses with a picture of himself and his wife, Deborah, in his Port Angeles, Wash., home. (Dan DeLong for KHN)

For Mike Clapshaw, 71, there was no question about who would care for his wife, Deborah, when her cancer came back for the third time, leading to her death in December 2014. She was 60. For the last four months of her life, VHOCC staff eased her pain — and his.

“It was always, ‘What can I do to help?’” he said.

Helping was always the point, said Rose Crumb, whether the pain at the end of life was physical, emotional — or both.

“Some people just need someone to listen to them,” she said.

Crumb, at nearly 92, now suffers from osteoporosis, congestive heart failure and other ailments that plagued her patients in earlier years. But she’s not worried about her final days.

“I’m all signed up for hospice,” she said.  “I have everything written down.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Categories: Aging, Public Health

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Some Tips To Help Decide Whether Popular Medicare Advantage Plans Are Right For You

These private insurance plan take the place of traditional Medicare and vary in coverage and cost.

CNBC: Here’s How To Snag The Best Medicare Advantage Plan
Medicare open enrollment is underway, which means you have until Dec. 7 to sign up for an Advantage Plan or to make changes to the one you already have. If you’re uncertain whether one of these plans is right for you, it’s important to first understand your options. … In simple terms, these plans provide coverage from an insurance company and take the place of original Medicare, comprised of Part A (in-patient coverage) and Part B (outpatient care). While regulated by the government, Advantage Plans are administered by insurers and can vary in terms of coverage and cost. (O’Brien, 10/18)

Kaiser Health News: Medicare Vs. Medicare Advantage: How To Choose
As health insurers struggle with shifting government policies and considerable uncertainty, one market remains remarkably stable: Medicare Advantage plans. That’s good news for seniors as they select coverage for the year ahead during Medicare’s annual open enrollment period (this year running from Oct. 15 to Dec. 7). … Despite Medicare Advantage plans’ increasing popularity, several features — notably, the costs that older adults face in these plans and the extent to which members’ choice of doctors and hospitals is restricted — remain poorly understood. (Graham, 10/19)

And in news on Medicare payment models —

Modern Healthcare: ACOs For Specialty Providers Could Be Key To Medicare Savings
Providers saw promising savings from accountable care organization models over the last year, and recent data has shown the value-based programs could find more success in a relatively untapped area: specialty medicine. The CMS last week quietly released data showing that three ACO programs saved providers millions of dollars. Last year, the Comprehensive End-Stage Renal Disease Care Model saved $75 million, according to the agency. That’s more than the $68 million saved by Pioneer ACOs, and the $48 million saved by NextGen ACOs in the same period. Pioneer and NextGen ACOs mainly focused on better coordinating the primary care needs for Medicare patients. (Dickson, 10/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Calif. Gov. Signs Key Health Bills; New York Issues Updated, Emergency Guidance For Home Health Care Employers

Outlets report on news from California, New York, Oregon, Texas, Georgia, Connecticut, Puerto Rico, West Virginia, Ohio, Illinois and Florida.

California Healthline: Governor Inks Support For Some Key Health Bills, Nixes Others
Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning. Facing a Sunday deadline to approve or reject measures passed by the legislature this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves. (Bartolone and Ibarra, 10/16)

Modern Healthcare: New York Issues Emergency Regs On How It Pays Home Care Workers For 24-Hour Shifts
The state Department of Labor has issued an emergency update to its minimum-wage regulations that reinforces its longstanding guidance to home health care employers to pay workers for just 13 hours of a 24-hour shift. The policy, known as the ’13-hour rule,’ helps control state spending on home care, which accounts for about 11% of the Medicaid budget. But it conflicts with three New York appellate court decisions issued in April and September that threw the home care industry into a panic. The rulings said home health aides who don’t live full time with their elderly or disabled clients should be paid for every hour of a 24-hour shift. (Lewis, 10/16)

The Oregonian: Oregon Voters Will Decide Whether To Overturn $340 Million In Health Care Taxes 
An effort to overturn part of Oregon’s $550 million health care tax plan qualified for the ballot on Monday, which means voters will decide whether to keep the taxes in a Jan. 23 special election. State lawmakers passed the taxes earlier this year to raise money so they could balance the state’s Medicaid budget and stabilize the individual insurance market. Oregon’s health agency faced a budget gap due to reasons including the long-planned ramp down of federal support for states that expanded Medicaid under the Affordable Care Act. (Borrud, 10/16)

The New York Times: On Health, De Blasio Focuses On Crises And Inequality
Four years ago, Bill de Blasio, then the city’s public advocate and a mere mayoral hopeful, took part in a rally in Midtown Manhattan to protest the imminent closing of Long Island College Hospital. Surrounded by dozens of singing and cheering hospital workers, he chanted “No Hospital, No Peace,” and helped block the entrance to the offices of the chancellor of the State University of New York. The police arrested Mr. de Blasio and charged him with disorderly conduct. (Santora, 10/16)

The Washington Post: A 2-Year-Old’s Kidney Transplant Was Put On Hold — After His Donor Father’s Probation Violation
A father in Georgia who had prepared to donate a kidney to his 2-year-old son said last week that he is being forced to wait after a recent stint in county jail. Anthony Dickerson’s son, A.J., was born without kidneys, and Dickerson, who is a perfect match, was ready to donate one of his, he told NBC affiliate WXIA in Atlanta. He was arrested days before the planned transplant but released from Gwinnett County Jail this month to undergo surgery. Now, he said, the transplant center at Emory University Hospital has put it on hold — in a case that one expert called befuddling. (Bever, 10/16)

The CT Mirror: Malloy Counters With ‘Lean, No-Frills, No-Nonsense’ Budget
In a bid to end Connecticut’s budget stalemate and persuade legislators to abandon a legally questionable deferral of contributions to the state’s underfunded pension system, Gov. Dannel P. Malloy unveiled his fourth budget proposal for the new biennium Monday. It asks lawmakers to reduce tax increases by accepting deeper cuts to town aid, education and social services. (Phaneuf, Pazniokas and Rabe Thomas, 10/16)

Georgia Health News: An Alarming Trend: Premature Births Go Up In Georgia
Georgia’s preterm birth rate rose in 2016 after years of decrease, a disturbing trend that is mirrored by national data, state officials said Monday. Preterm birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. It’s also called premature birth. (Miller, 10/16)

The Washington Post: Puerto Rican Families Draw Water From Superfund Site
Every 10 minutes or so, a truck or a van pulled up to the exposed spigot of an overgrown well, known as Maguayo #4, that sits not far from a bustling expressway and around the corner from a Krispy Kreme doughnut shop. Fencing around the area had been torn open, and a red and white “Peligro” sign, warning of danger, lay hidden beneath debris and dense vegetation. One after another, people attached a hose to draw water for bathing, washing dishes and, in some cases, drinking. They filled buckets, jugs, soda bottles. (Hernandez and Dennis, 10/16)

Kaiser Health News: On Back Roads Of Appalachia’s Coal Country, Mental Health Services Are As Rare As Jobs
Every other month, Tanya Nelson travels 32 miles from the heart of Appalachia’s coal country for an appointment with the nearest psychiatrist for therapy and to renew prescriptions. But the commute, which should take less than an hour through the winding mountain roads of southern West Virginia, consumes her entire day. Nelson, 29, needs treatment for bipolar disorder, depression and anxiety. But she does not drive, so she must use a van service to keep her appointments. It makes numerous stops along the highway, picking up other travelers, and usually doesn’t return to her home in New Richmond, W.Va., until day’s end. (Connor, 10/17)

Cleveland Plain Dealer: BioEnterprise To Oversee Struggling Global Center For Health Innovation
BioEnterprise, which promotes and nutures healthcare companies and bioscience technologies, will oversee marketing, promotion and tenants at the struggling Global Center for Health Innovation. The nonprofit company was retained Monday by the Cuyahoga County Convention Facilities Development Corp., the nonprofit organization that oversees the Huntington Convention Center and Global Center. (Farkas, 10/16)

Reuters: U.S. Nursing Home Chain Faces Landlord Showdown Over Default
The fate of one of the largest U.S. nursing home operators, HCR ManorCare, will reach a critical court deadline on Thursday in a battle over months of unpaid rent, a growing problem in an industry where eviction would put thousands of elderly out on the street. Many nursing home chains spun off their properties to real estate companies over the last decade to unlock value. Now those landlords need to deal with operators behind on their rent without harming thousands of elderly residents. (Rucinski, 10/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Calif. Gov. Signs Key Health Bills; New York Issues Updated, Emergency Guidance For Home Health Care Employers

Outlets report on news from California, New York, Oregon, Texas, Georgia, Connecticut, Puerto Rico, West Virginia, Ohio, Illinois and Florida.

California Healthline: Governor Inks Support For Some Key Health Bills, Nixes Others
Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning. Facing a Sunday deadline to approve or reject measures passed by the legislature this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves. (Bartolone and Ibarra, 10/16)

Modern Healthcare: New York Issues Emergency Regs On How It Pays Home Care Workers For 24-Hour Shifts
The state Department of Labor has issued an emergency update to its minimum-wage regulations that reinforces its longstanding guidance to home health care employers to pay workers for just 13 hours of a 24-hour shift. The policy, known as the ’13-hour rule,’ helps control state spending on home care, which accounts for about 11% of the Medicaid budget. But it conflicts with three New York appellate court decisions issued in April and September that threw the home care industry into a panic. The rulings said home health aides who don’t live full time with their elderly or disabled clients should be paid for every hour of a 24-hour shift. (Lewis, 10/16)

The Oregonian: Oregon Voters Will Decide Whether To Overturn $340 Million In Health Care Taxes 
An effort to overturn part of Oregon’s $550 million health care tax plan qualified for the ballot on Monday, which means voters will decide whether to keep the taxes in a Jan. 23 special election. State lawmakers passed the taxes earlier this year to raise money so they could balance the state’s Medicaid budget and stabilize the individual insurance market. Oregon’s health agency faced a budget gap due to reasons including the long-planned ramp down of federal support for states that expanded Medicaid under the Affordable Care Act. (Borrud, 10/16)

The New York Times: On Health, De Blasio Focuses On Crises And Inequality
Four years ago, Bill de Blasio, then the city’s public advocate and a mere mayoral hopeful, took part in a rally in Midtown Manhattan to protest the imminent closing of Long Island College Hospital. Surrounded by dozens of singing and cheering hospital workers, he chanted “No Hospital, No Peace,” and helped block the entrance to the offices of the chancellor of the State University of New York. The police arrested Mr. de Blasio and charged him with disorderly conduct. (Santora, 10/16)

The Washington Post: A 2-Year-Old’s Kidney Transplant Was Put On Hold — After His Donor Father’s Probation Violation
A father in Georgia who had prepared to donate a kidney to his 2-year-old son said last week that he is being forced to wait after a recent stint in county jail. Anthony Dickerson’s son, A.J., was born without kidneys, and Dickerson, who is a perfect match, was ready to donate one of his, he told NBC affiliate WXIA in Atlanta. He was arrested days before the planned transplant but released from Gwinnett County Jail this month to undergo surgery. Now, he said, the transplant center at Emory University Hospital has put it on hold — in a case that one expert called befuddling. (Bever, 10/16)

The CT Mirror: Malloy Counters With ‘Lean, No-Frills, No-Nonsense’ Budget
In a bid to end Connecticut’s budget stalemate and persuade legislators to abandon a legally questionable deferral of contributions to the state’s underfunded pension system, Gov. Dannel P. Malloy unveiled his fourth budget proposal for the new biennium Monday. It asks lawmakers to reduce tax increases by accepting deeper cuts to town aid, education and social services. (Phaneuf, Pazniokas and Rabe Thomas, 10/16)

Georgia Health News: An Alarming Trend: Premature Births Go Up In Georgia
Georgia’s preterm birth rate rose in 2016 after years of decrease, a disturbing trend that is mirrored by national data, state officials said Monday. Preterm birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. It’s also called premature birth. (Miller, 10/16)

The Washington Post: Puerto Rican Families Draw Water From Superfund Site
Every 10 minutes or so, a truck or a van pulled up to the exposed spigot of an overgrown well, known as Maguayo #4, that sits not far from a bustling expressway and around the corner from a Krispy Kreme doughnut shop. Fencing around the area had been torn open, and a red and white “Peligro” sign, warning of danger, lay hidden beneath debris and dense vegetation. One after another, people attached a hose to draw water for bathing, washing dishes and, in some cases, drinking. They filled buckets, jugs, soda bottles. (Hernandez and Dennis, 10/16)

Kaiser Health News: On Back Roads Of Appalachia’s Coal Country, Mental Health Services Are As Rare As Jobs
Every other month, Tanya Nelson travels 32 miles from the heart of Appalachia’s coal country for an appointment with the nearest psychiatrist for therapy and to renew prescriptions. But the commute, which should take less than an hour through the winding mountain roads of southern West Virginia, consumes her entire day. Nelson, 29, needs treatment for bipolar disorder, depression and anxiety. But she does not drive, so she must use a van service to keep her appointments. It makes numerous stops along the highway, picking up other travelers, and usually doesn’t return to her home in New Richmond, W.Va., until day’s end. (Connor, 10/17)

Cleveland Plain Dealer: BioEnterprise To Oversee Struggling Global Center For Health Innovation
BioEnterprise, which promotes and nutures healthcare companies and bioscience technologies, will oversee marketing, promotion and tenants at the struggling Global Center for Health Innovation. The nonprofit company was retained Monday by the Cuyahoga County Convention Facilities Development Corp., the nonprofit organization that oversees the Huntington Convention Center and Global Center. (Farkas, 10/16)

Reuters: U.S. Nursing Home Chain Faces Landlord Showdown Over Default
The fate of one of the largest U.S. nursing home operators, HCR ManorCare, will reach a critical court deadline on Thursday in a battle over months of unpaid rent, a growing problem in an industry where eviction would put thousands of elderly out on the street. Many nursing home chains spun off their properties to real estate companies over the last decade to unlock value. Now those landlords need to deal with operators behind on their rent without harming thousands of elderly residents. (Rucinski, 10/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

A Few Pointers To Help Save Money And Avoid The Strain Of Medicare Enrollment

Older or disabled Americans with Medicare coverage have probably noticed an uptick in mail solicitations from health insurance companies, which can mean only one thing: It’s time for the annual Medicare open enrollment.

Most beneficiaries have from Oct. 15 through Dec. 7 to decide which of dozens of private plans offer the best drug coverage for 2018 or whether it’s better to leave traditional Medicare and get a drug and medical combo policy called Medicare Advantage.

Some tips for the novice and reminders for those who have been here before can make the process a little easier.

Pay Attention To The Mail

If you are already enrolled in a Medicare Advantage or drug plan, carefully read the “annual notice of change” or “evidence of benefits” letter from the insurer. It is not another sales pitch or more insurance mumbo-jumbo. That required letter highlights the cost and benefit changes in store for next year. Ask the insurer for another copy if you can’t find it.

“Some people just tend to get that mail and throw it all in the trash, but it’s really important that they read it,” said Francine Chuchanis, director of entitlement rights at Direction Home Akron Canton Area Agency on Aging & Disabilities, an Ohio group that assists older adults and people with disabilities.

Choosing Between Traditional Medicare and Medicare Advantage 

The open enrollment period is your opportunity to switch plans, including moving between the government-run traditional Medicare program and Medicare Advantage.

Medicare Advantage plans are offered by private insurers, which receive payments from the federal government to help cover the costs of beneficiaries. They restrict members to their network of doctors and hospitals and a list or formulary of covered drugs. With some rare exceptions, you cannot leave the plans midyear — even if the plans drop drugs from the formulary or your hospitals, physician specialists or medical equipment suppliers leave the plan.

But unlike traditional Medicare, Medicare Advantage plans often cover dental, hearing and vision care, and they cap your out-of-pocket expenses. Once you reach that limit, the insurer pays for covered services, and you pay nothing. But details of these plans — such as the caps on member spending, the premium prices and service areas — can change from year to year.

On the other hand, with traditional Medicare, patients can go to any provider who participates in the program, and most providers do. Because there is no limit on the share of medical expenses beneficiaries pay, most purchase “Medigap” supplemental policies or have other insurance to lower those costs.

Check Your Plan’s Network 

If you choose Medicare Advantage, contact your doctors, hospital and other providers directly to find out if they are in the plan’s network. Be sure to give the office the plan’s full name, not just the name of the insurance company since insurers offer multiple plans that may have similar names, said Gina Upchurch, executive director of Senior PharmAssist in Durham, N.C. If you have the plan’s code numbers, she said, those can help the doctor’s office check.

Confirm Where Your Drugs Are Available 

When choosing a drug plan, also known as Medicare Part D, the total costs are most important. Consider factors beyond the premiums. You may pay different amounts when the plan first begins each year than when you’re in the coverage gap called the doughnut hole and after you get out of that hole. Find out whether the lowest price is available at your favorite pharmacy or if you must travel elsewhere to get that price. Most plans offer their lowest prices only at their preferred, in-network pharmacies.

Also, ask what other restrictions apply. For example, do you need prior authorization or have to try another drug first before you can get the one your doctor prescribed? Also, will the price vary depending on the frequency or the quantity of your prescription?

“You can save thousands of dollars just by switching pharmacies,” said Christina Dimas-Kahn, director of the San Mateo County office of the California Department of Aging’s Health Insurance Counseling and Advocacy Program. That’s because drug plan prices can depend on whether a drugstore is a preferred pharmacy within the plan’s network. She helped a senior reduce his drug bill last year from $119,000 to $18,000 after changing pharmacies.

Do You Qualify For A Subsidy?

Low-income people can qualify for the “extra help” subsidy that pays for the premiums of certain drug plans and other costs. They may also be eligible for assistance to reduce their share of medical costs in traditional Medicare. Premiums and subsidy amounts can change each year, so if you already have the subsidy confirm that it is enough to cover the plan’s premium next year. Otherwise, you can be billed for the difference.

Check The Calendar 

There’s a lot to consider and only seven weeks to do it. And remember, this enrollment period is different from the Affordable Care Act’s marketplace enrollment, which begins Nov. 1 and lasts through Dec. 15.

Federal officials have granted seniors who live in areas affected by this year’s hurricane damage — Alabama, Florida, Georgia, Louisiana, Mississippi, South Carolina, Texas, Puerto Rico and the U.S. Virgin Islands — or depend on caregivers in those areas until the end of December to make their choices.

Getting Help 

Individual assistance is free from the federally funded Senior Health Insurance Information Program (www.shiptacenter.org), the Medicare Rights Center (800-333-4114 and its website Medicare Interactive (www.medicareinteractive.org) as well as from Medicare’s plan finder website and helpline (www.medicare.gov, 800-633-4227) .

Still, studies have shown that most Medicare beneficiaries don’t switch plans.

“They are likely to stay with whatever plan they’re in because they are afraid to make a change,” said Bonnie Burns, a consultant for California Health Advocates.

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation and its coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Insurance, Medicare

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Viewpoints: Heavy Drinking As A Public Health Crisis; Steps The Federal Gov’t Should Take To Curb Opioid Crisis

A selection of opinions on health care from around the country.

RealClear Health: Treat Heavy Drinking Like The Public Health Epidemic It Is
Excessive alcohol consumption is very common in America, but quality treatment is scarce. It’s time we transform our current treatment system into a modern one that can sufficiently respond one of the largest public health problems we face. At a time when government leaders show little interest in increasing commitments to health treatments, doing so requires that business leaders step in. (Mark Willenbring, 10/16)

JAMA: Ten Steps The Federal Government Should Take Now To Reverse The Opioid Addiction Epidemic
The United States is in the midst of the worst drug addiction epidemic in its history. Prescriptions for and deaths from opioids both quadrupled between 1995 and 2010. … There are no simple solutions to ending this epidemic. Effective programs need to address 2 separate priorities: (1) prevention of addiction among people not currently addicted, and (2) treatment and risk reduction to prevent overdose and death among the millions of individuals in the United States now addicted. In this Viewpoint, we suggest 10 steps that could accelerate progress; national declarations, state-specific emergency declarations, or both could potentially facilitate implementation of these steps. (Andrew Kolodny and Thomas R. Frieden, 10/13)

RealClear Health: Mixing Agenda And Science: A Formula For Public Misconception
October is Breast Cancer awareness month—a time to remember friends and loved ones that have passed and promote cutting-edge research and early screenings that will prevent future deaths. However, many are pushing an alternative agenda. Activist researchers and a variety of media sources are focusing on the recently conjured connection between consuming the slightest amount of alcohol and breast cancer. (Sarah Longwell, 10/16)

Richmond Times-Dispatch: People In Mental Health Crisis Should Have Viable Alternative To Police Transport, Report Concludes
A state study released this month calls for the agency overseeing public mental health services in Virginia to establish a statewide alternative system of transportation, which could serve adult patients who are mobile and not considered by a magistrate to be a flight risk or pose a danger to themselves or others. About 40 percent of people mandated to receive care under the terms of a temporary detention order met those conditions during a pilot program conducted in five Southwest Virginia counties between Jan. 1, 2016, and March 13, 2017. (Burnell Evans, 10/13)

Miami Herald: Never Again Will A Lack Of A Generator Kill Nursing Home Residents In Florida
In September, elected officials, long-term care center administrators, advocates, and influencers stood together before a standing-room only crowd at a town hall meeting in North Miami Beach City Hall to take a solemn vow. We pledged that we would never allow our senior citizens to be subjected to catastrophic conditions like the ones that occurred when the Rehabilitation Center at Hollywood Hills lost power during Hurricane Irma’s passage. (U.S. Rep. Frederica Wilson, 10/14)

Arizona Republic: VA Failings To Treat Vets Continue To Outrage
Now we’re once again confronted with a revelation that the VA has been covering up the abuses of many of its own health-care practitioners who have badly served patients. A USA TODAY investigation found that the VA has not only failed to report many of its poorly performing medical providers to state licensing boards, it has stood by quietly as they have taken up new practices beyond the VA system. (10/15)

Hackensack (N.J.) Record/New Jersey.com: ‘Dangerous’ Doctors Have No Place Within The VA
When someone signs up to serve in the U.S. military, that person goes in with eyes open knowing they might be sent to a foreign field, unfriendly waters, or dangerous skies. These are our bravest citizens, and they go through extensive training. Still, once deployed they are never absolutely certain what challenge, obstacle or life-and-death circumstance awaits. That should never be the case when it comes to veterans and their health care. (10/11)

The New York Times: How To Win Against Big Soda
The soda industry won big in Chicago this week when county commissioners voted to scrap the 1-cent-per-ounce tax on sugary drinks that had been in place for just two months. This is a stark turn for the effort to tax these drinks, which has been making headway as voters and City Councils in at least a half-dozen other cities, including San Francisco and Philadelphia, in recent years approved measures in favor of soda levies. The sudden about-face in Chicago, after a battle in which both sides spent millions on TV and radio ads, offers an important lesson for advocates of these taxes, ourselves included, as the industry we call Big Soda takes aim at other communities: We can’t forget the grass roots. (10/15)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Fires Prey On Frail Residents Living On Their Own

They were asleep when the fire reached their home. Charles Rippey, 100, and his wife, Sara, 98, had been married 75 years. They died together, after a caregiver struggled to save them but couldn’t get them out in time.

A 27-year-old woman had spina bifida and used a wheelchair. In the hours after the fires broke out, her relatives frantically sought information about her whereabouts. When a fire inspector visited her home, he found her body.

Wildfires continue to spread through Northern California counties, already taking the lives of at least 31 people. Hundreds more are missing. Local officials and advocates fear that many among them are seniors or disabled people unable to flee, as many residents have, on a moment’s notice.

Others have been saved only by luck and quick-thinking neighbors.

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In Mendocino County’s Redwood Valley community, retired firefighter RedHawk Palleson came across a disoriented elderly woman wandering in his neighborhood and an older couple in their bathrobes as flames chased them down the street, the Santa Rosa Press Democrat reported. He drove them to safety in his truck.

The deaths and close calls illustrate the particular vulnerability of frail people living on their own during a fast-moving disaster. “The fires have raised a lot of questions about how we respond and provide safety to vulnerable people in an imminent crisis,” said Marty Omoto, executive director of the California Disability Community Action Network. “We have to ask ourselves how we respond when there’s no warning.”

Omoto said he is still trying to reach friends and colleagues living with disabilities in the region. “We’re operating on hope,” he said.

In both Sonoma and Napa conties, where the wildfires have been the most severe, about 18 percent of residents are age 65 or older, higher than the statewide percentage of 13.6 percent, according to U.S. Census data. About 6 to 8 percent of those counties’ residents have disabilities.

This week, people posted poignant queries on social media hoping to find loved ones still missing. “Has anyone seen the woman on the right?” Elizabeth Northrup wrote on Facebook, providing a picture of an older woman. “Her name is Norma Lou Peoples. She uses a red walker.”

Nursing homes aren’t fail-safe, as was tragically illustrated by the eight deaths in a sweltering Florida nursing home left without air conditioning after Hurricane Irma. But they, along with assisted living facilities and homes for the disabled, do have disaster and evacuation plans. In-home caregivers rarely get training on how to help their clients in an emergency, Omoto said, and in a disaster they may have their own families to care for. And of course some frail people don’t receive in-home care.

Marianne McBride, president and CEO of Sonoma County’s Council on Aging, said Wednesday that she and her staff were still trying to track down the agency’s social services clients, including up to 1,200 who regularly receive “meals on wheels.”

It was a challenge. Over the weekend, cellphones either didn’t work or worked only sporadically as the fire destroyed 73 cellphone towers. Internet and electricity were down in some areas. But by Monday, the agency had reached 600 seniors, McBride said.

McBride, whose brother lost his home in the fires, said seniors or disabled people should consider keeping their landlines rather than relying only on cellphones. She also said social service providers should keep paper copies of client locations as a backup when internet and electrical services fail.

McBride also recommended that family members get acquainted with the neighbors of their elderly relatives and provide them with their contact information in case of emergency. Neighbors have to look out for each other, she said.

“There’s not a service agency that can take care of all the aging individuals that we have in the community,” McBride said, choking back tears. “What the fires bring out is that the only way we’re going to successfully age is if we do so in community, and the community feels it has a responsibility to look out for neighbors and get them the resources they need.”

As developmentally disabled people increasingly live independently, they too need support both during and after disasters.

Vicki Smith, a deputy director at the California State Council on Developmental Disabilities, said the public agency in the past year has trained more than 1,100 developmentally disabled people in disaster preparedness with simplified materials, including how to assemble an inexpensive emergency backpack. She estimated that there are more than 10,000 developmentally disabled people living in Sonoma and Napa counties.

Disaster experts say the general preparedness recommendations for everyone are even more important for people with limited mobility. For instance, keep the car gassed up and put a change of clothes and an emergency kit in the trunk. And sign up for your community’s alert system (although there were some complaints from Northern California residents that they never received these alerts).

Nancy McPherson, state director for AARP California, urged people to learn ahead of time the routes to buildings likely to be used as shelters during an emergency, such as a local high school.

McPherson said the AARP has partnered with the Federal Emergency Management Agency in the past, but this year’s severe hurricanes and fires have sparked a new effort to make emergency preparedness for seniors “more robust,” she said.

Some communities have tried to develop registries of elderly and disabled people who might need rescue in emergencies, but such registries are difficult to keep current, McPherson said.

“There’s been a lot of thinking about this, but plans get put on a shelf and we tend to forget that they are there,” McPherson said.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: Aging, Public Health

Tags: ,

Fires Prey On Frail Residents Living On Their Own

They were asleep when the fire reached their home. Charles Rippey, 100, and his wife, Sara, 98, had been married 75 years. They died together, after a caregiver struggled to save them but couldn’t get them out in time.

A 27-year-old woman had spina bifida and used a wheelchair. In the hours after the fires broke out, her relatives frantically sought information about her whereabouts. When a fire inspector visited her home, he found her body.

Wildfires continue to spread through Northern California counties, already taking the lives of at least 31 people. Hundreds more are missing. Local officials and advocates fear that many among them are seniors or disabled people unable to flee, as many residents have, on a moment’s notice.

Others have been saved only by luck and quick-thinking neighbors.

Use Our Content

In Mendocino County’s Redwood Valley community, retired firefighter RedHawk Palleson came across a disoriented elderly woman wandering in his neighborhood and an older couple in their bathrobes as flames chased them down the street, the Santa Rosa Press Democrat reported. He drove them to safety in his truck.

The deaths and close calls illustrate the particular vulnerability of frail people living on their own during a fast-moving disaster. “The fires have raised a lot of questions about how we respond and provide safety to vulnerable people in an imminent crisis,” said Marty Omoto, executive director of the California Disability Community Action Network. “We have to ask ourselves how we respond when there’s no warning.”

Omoto said he is still trying to reach friends and colleagues living with disabilities in the region. “We’re operating on hope,” he said.

In both Sonoma and Napa conties, where the wildfires have been the most severe, about 18 percent of residents are age 65 or older, higher than the statewide percentage of 13.6 percent, according to U.S. Census data. About 6 to 8 percent of those counties’ residents have disabilities.

This week, people posted poignant queries on social media hoping to find loved ones still missing. “Has anyone seen the woman on the right?” Elizabeth Northrup wrote on Facebook, providing a picture of an older woman. “Her name is Norma Lou Peoples. She uses a red walker.”

Nursing homes aren’t fail-safe, as was tragically illustrated by the eight deaths in a sweltering Florida nursing home left without air conditioning after Hurricane Irma. But they, along with assisted living facilities and homes for the disabled, do have disaster and evacuation plans. In-home caregivers rarely get training on how to help their clients in an emergency, Omoto said, and in a disaster they may have their own families to care for. And of course some frail people don’t receive in-home care.

Marianne McBride, president and CEO of Sonoma County’s Council on Aging, said Wednesday that she and her staff were still trying to track down the agency’s social services clients, including up to 1,200 who regularly receive “meals on wheels.”

It was a challenge. Over the weekend, cellphones either didn’t work or worked only sporadically as the fire destroyed 73 cellphone towers. Internet and electricity were down in some areas. But by Monday, the agency had reached 600 seniors, McBride said.

McBride, whose brother lost his home in the fires, said seniors or disabled people should consider keeping their landlines rather than relying only on cellphones. She also said social service providers should keep paper copies of client locations as a backup when internet and electrical services fail.

McBride also recommended that family members get acquainted with the neighbors of their elderly relatives and provide them with their contact information in case of emergency. Neighbors have to look out for each other, she said.

“There’s not a service agency that can take care of all the aging individuals that we have in the community,” McBride said, choking back tears. “What the fires bring out is that the only way we’re going to successfully age is if we do so in community, and the community feels it has a responsibility to look out for neighbors and get them the resources they need.”

As developmentally disabled people increasingly live independently, they too need support both during and after disasters.

Vicki Smith, a deputy director at the California State Council on Developmental Disabilities, said the public agency in the past year has trained more than 1,100 developmentally disabled people in disaster preparedness with simplified materials, including how to assemble an inexpensive emergency backpack. She estimated that there are more than 10,000 developmentally disabled people living in Sonoma and Napa counties.

Disaster experts say the general preparedness recommendations for everyone are even more important for people with limited mobility. For instance, keep the car gassed up and put a change of clothes and an emergency kit in the trunk. And sign up for your community’s alert system (although there were some complaints from Northern California residents that they never received these alerts).

Nancy McPherson, state director for AARP California, urged people to learn ahead of time the routes to buildings likely to be used as shelters during an emergency, such as a local high school.

McPherson said the AARP has partnered with the Federal Emergency Management Agency in the past, but this year’s severe hurricanes and fires have sparked a new effort to make emergency preparedness for seniors “more robust,” she said.

Some communities have tried to develop registries of elderly and disabled people who might need rescue in emergencies, but such registries are difficult to keep current, McPherson said.

“There’s been a lot of thinking about this, but plans get put on a shelf and we tend to forget that they are there,” McPherson said.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: Aging, Public Health

Tags: ,

Medicare Cuts Off Payments To Florida Nursing Home Where Residents Died After The Hurricane

Fourteen residents died after the facility lost air conditioning. Florida’s two senators have called for a congressional investigation. The nursing home had previously announced it would close permanently.

Miami Herald: Feds To Cut Medicare For Hollywood Hills Nursing Home After Residents Died
Federal regulators on Thursday said they are cutting off Medicare, a crucial financial lifeline, to the Hollywood Hills nursing home where residents died from sweltering heat after Hurricane Irma knocked out power to the facility’s air conditioning and forced an emergency evacuation in September. The Centers for Medicare and Medicaid Services, or CMS, also imposed a penalty of $20,965 a day for the three days that the Rehabilitation Center at Hollywood Hills lost power to its air conditioning unit, from Sept. 10 — when Irma made landfall in Florida — to Sept. 13, when the facility was evacuated as its residents wilted. (Chang, 10/12)

Sun Sentinel: Rubio Joins Nelson In Call For Senate Probe Of Hollywood Nursing Home Deaths
U.S. Sen. Marco Rubio said Thursday the Senate committee with jurisdiction over Medicare and Medicaid should investigate what led to the deaths of 14 residents of a Hollywood nursing home in the aftermath of Hurricane Irma. U.S. Sen. Bill Nelson asked the Senate Finance Committee two weeks ago to investigate what happened at the Rehabilitation Center at Hollywood Hills. (Man, 10/12)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Medicare Cuts Off Payments To Florida Nursing Home Where Residents Died After The Hurricane

Fourteen residents died after the facility lost air conditioning. Florida’s two senators have called for a congressional investigation. The nursing home had previously announced it would close permanently.

Miami Herald: Feds To Cut Medicare For Hollywood Hills Nursing Home After Residents Died
Federal regulators on Thursday said they are cutting off Medicare, a crucial financial lifeline, to the Hollywood Hills nursing home where residents died from sweltering heat after Hurricane Irma knocked out power to the facility’s air conditioning and forced an emergency evacuation in September. The Centers for Medicare and Medicaid Services, or CMS, also imposed a penalty of $20,965 a day for the three days that the Rehabilitation Center at Hollywood Hills lost power to its air conditioning unit, from Sept. 10 — when Irma made landfall in Florida — to Sept. 13, when the facility was evacuated as its residents wilted. (Chang, 10/12)

Sun Sentinel: Rubio Joins Nelson In Call For Senate Probe Of Hollywood Nursing Home Deaths
U.S. Sen. Marco Rubio said Thursday the Senate committee with jurisdiction over Medicare and Medicaid should investigate what led to the deaths of 14 residents of a Hollywood nursing home in the aftermath of Hurricane Irma. U.S. Sen. Bill Nelson asked the Senate Finance Committee two weeks ago to investigate what happened at the Rehabilitation Center at Hollywood Hills. (Man, 10/12)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Social Security Giveth, Medical Costs Taketh Away

Retirees spent on average more than a third of their Social Security benefits on out-of-pocket medical costs in 2014, according to a recent study. Even after factoring in other sources of income, medical spending still took a substantial 18 percent bite out of seniors’ total retirement income, the study found.

In dollar terms, the typical retiree spent $4,274 per year on medical costs, not including long-term care. Insurance premiums accounted for about two-thirds of that total, according to the study, published this month by the Center for Retirement Research at Boston College.

“The premiums are huge,” said Melissa McInerney, an associate professor of economics at Tufts University and a study co-author, describing their importance in overall spending by retirees.

Michelle AndrewsInsuring Your Health

McInerney said she was surprised at the findings, however, when the team did incorporate spending on long-term care and found little difference in spending between seniors who needed those services and those who didn’t. Survey respondents who said they or their spouse lived in a long-term care facility or received home health care services spent 19.2 percent of their total income on medical care, versus 17.8 percent for those who didn’t need long-term care.

For the study, researchers analyzed 2002-2014 data from the Health and Retirement Study, a national survey conducted every two years of 20,000 people over age 50. The sample was limited to people at least 65 years old and were receiving both Social Security and Medicare benefits. It included those who also had Medicaid, Medicare Advantage or private group retiree health insurance.

Overall, the average retiree’s out-of-pocket medical spending declined 9 percent over the years studied from just under $4,700 in 2004 (in 2014 dollars) to $4,274 in 2014. That’s likely due in part to the introduction of Medicare Part D prescription drug coverage in 2006 and the gradual closing of the drug coverage gap known as the “doughnut hole” that began in 2010 under the Affordable Care Act, the study found.

However, medical costs for Medicare beneficiaries are expected to outpace the increase in Social Security benefits after 2018, and retirees will have to put a growing percentage of their Social Security income toward medical care, according to study authors, citing projections by Medicare and Social Security trustees and the Congressional Budget Office.

“The main takeaway from the study is that right now, even for retirees who live in the community and aren’t using long-term care, medical out-of-pocket spending is high and is a big share of their income,” said McInerney. “And we might expect that to grow if spending rises at end of this decade.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Cost and Quality, Medicare, Navigating Aging

Tags:

Social Security Giveth, Medical Costs Taketh Away

Retirees spent on average more than a third of their Social Security benefits on out-of-pocket medical costs in 2014, according to a recent study. Even after factoring in other sources of income, medical spending still took a substantial 18 percent bite out of seniors’ total retirement income, the study found.

In dollar terms, the typical retiree spent $4,274 per year on medical costs, not including long-term care. Insurance premiums accounted for about two-thirds of that total, according to the study, published this month by the Center for Retirement Research at Boston College.

“The premiums are huge,” said Melissa McInerney, an associate professor of economics at Tufts University and a study co-author, describing their importance in overall spending by retirees.

Michelle AndrewsInsuring Your Health

McInerney said she was surprised at the findings, however, when the team did incorporate spending on long-term care and found little difference in spending between seniors who needed those services and those who didn’t. Survey respondents who said they or their spouse lived in a long-term care facility or received home health care services spent 19.2 percent of their total income on medical care, versus 17.8 percent for those who didn’t need long-term care.

For the study, researchers analyzed 2002-2014 data from the Health and Retirement Study, a national survey conducted every two years of 20,000 people over age 50. The sample was limited to people at least 65 years old and were receiving both Social Security and Medicare benefits. It included those who also had Medicaid, Medicare Advantage or private group retiree health insurance.

Overall, the average retiree’s out-of-pocket medical spending declined 9 percent over the years studied from just under $4,700 in 2004 (in 2014 dollars) to $4,274 in 2014. That’s likely due in part to the introduction of Medicare Part D prescription drug coverage in 2006 and the gradual closing of the drug coverage gap known as the “doughnut hole” that began in 2010 under the Affordable Care Act, the study found.

However, medical costs for Medicare beneficiaries are expected to outpace the increase in Social Security benefits after 2018, and retirees will have to put a growing percentage of their Social Security income toward medical care, according to study authors, citing projections by Medicare and Social Security trustees and the Congressional Budget Office.

“The main takeaway from the study is that right now, even for retirees who live in the community and aren’t using long-term care, medical out-of-pocket spending is high and is a big share of their income,” said McInerney. “And we might expect that to grow if spending rises at end of this decade.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Cost and Quality, Medicare, Navigating Aging

Tags:

State Highlights: In Minn., Nurses File Complaint About Allina Staffing; Mich. Gov.’s Testimony On Legionnaire’s Disease Outbreak Draws Scrutiny

Media outlets report on news from Minnesota, Michigan, Tennessee, California, Massachusetts, Ohio, Georgia and Oregon.

The Star Tribune: Nurses File Complaint Over Allina Staffing
The union representing Allina Health hospital nurses filed a complaint Wednesday — one year to the day after ending a 37-day strike — over the continued assigning of patients to supervisory charge nurses. Allina leaders haven’t lived up to a key provision in the contract that ended the strike, said Emily Sippola, a nurse at United Hospital in St. Paul: a commitment to meet and discuss how to prevent charge nurses from being overworked by being assigned patients. (Olson, 10/11)

The Washington Post: Michigan Governor Sticking To Story About Legionnaires’
Michigan Gov. Rick Snyder is sticking by his congressional testimony about when he learned about a fatal outbreak of Legionnaires’ disease during the Flint water crisis, despite a senior aide’s new disclosure that he informed the Republican governor weeks earlier. Some Democrats in Congress are pouncing on the conflict and urging the U.S. House Oversight and Government Reform Committee to investigate. (White, 10/11)

Nashville Tennessean: Nashville’s Emergency Rooms Prep For Mass Shootings, Stock ‘Go Bags,’ Tourniquets And Revise Plans
The frequency of mass shootings has changed how Nashville’s top trauma medicine experts think about whether it could happen here: It’s no longer a theoretical scenario of “if.” It’s when. And with each event — the Pulse Nightclub shooting in 2016, the Las Vegas shooting, the 2011 massacre that killed 77 in Norway, the 2015 attack at the Bataclan in Paris, to name just a few — the trauma teams review what happened and modify their plans. (Fletcher, 10/11)

Detroit Free Press: Beaumont, U-M-Dearborn Collaborate On A New Autism Center In Dearborn
The newly expanded 33,000-square-foot center is a collaboration between the Beaumont Center for Exceptional Families and the University of Michigan-Dearborn’s Early Childhood Education Center, and includes a preschool program where children with autism can be included with typically developing children and experience what it’s like to be in a mainstreamed classroom before they start kindergarten. The demand for a center like this is huge. About 50,000 people in Michigan are on the autism spectrum. It is the fastest-growing developmental disability in the U.S., according to the Centers for Disease Control and Prevention, now affecting as many as 1 in every 68 children. (Shamus, 10/11)

Sacramento Bee: Smoke From Northern California Wildfires Blankets Sacramento With Unhealthy Smoke
Sacramento Valley and foothills residents awoke Wednesday to the heavy smell of smoke, hazy brown skies and ashes on car windshields – the result of nearly two dozen Northern California wildfires, including the Atlas Fire, which exploded overnight in the hills west of Fairfield. …Air meters throughout the region registered unhealthy levels of particulate matter from Vacaville and Davis in the west valley to higher foothill elevations in Grass Valley and Colfax early Wednesday. (Bizjak, Anderson and Glover, 10/11)

California Healthline: Giving Birth Is Hard Enough. Try It In The Middle Of A Wildfire.
Days before there was any sign of fire, Nicole and Ben Veum of Santa Rosa, Calif., had been waiting and waiting for their baby to arrive. Nicole’s due date came and went. Her doctor called her into the hospital — Sutter Santa Rosa Regional Hospital — to induce labor. That was Friday. “So we were very excited at that point,” she said. “And then, day after day after day with not a whole lot of progress.” (Dembosky, 10/11)

Columbus Dispatch: Local Vietnam Veterans Share Struggles With Late-Onset PTSD
About 8 percent of people who serve in the military go on to develop PTSD, said Heather Axtell, who oversees trauma recovery in the behavioral-health service at the Department of Veterans Affairs’ Chalmers P. Wylie Ambulatory Care Center on the Northeast Side. That means that about 700,000 veterans of the Vietnam War, which ended more than 40 years ago, have struggled with the disorder. (Viviano, 10/12)

Georgia Health News: Parents, Advocates Sue State, Claim Inequities In GNETS Schools
Parents of children with disabilities and advocacy groups filed a lawsuit in federal court Wednesday alleging the state of Georgia has discriminated against students placed in “unequal and separate’’ schools for kids with behavioral disorders and problems. The Georgia Network for Educational and Therapeutic Support (GNETS) schools are “segregated programs,’’ housed in separate buildings or in separate wings of regular schools, the lawsuit says. (Miller, 10/11)

Atlanta Journal-Constitution: Georgia Disabled Students Segregated In Inferior Schools, Suit Alleges
Georgia uses its unique network of psychoeducational schools as a “dumping ground” for unwanted students with disabilities, a new class-action lawsuit claims. The suit, filed Wednesday by several advocacy groups on behalf of three parents, accuses state officials of violating federal law and the U.S. Constitution by placing disabled children in segregated schools and classrooms operated by the Georgia Network for Educational and Therapeutic Support, or GNETS. (Judd, 10/11)

Cincinnati Enquirer: What’s Top Concern For Cincinnati Parents? Their Kids’ Mental Health
In a first-of-its-kind survey this year by Beech Acres Parenting Center, nearly half of Greater Cincinnati parents, 44 percent, said “understanding kids’ mental health issues” is “very or extremely concerning” to them. More than half of respondents, or 55 percent, were “very or extremely interested” in getting training or guidance to address childhood mental-health issues. (Saker, 10/11)

Kaiser Health News: Dementia Patient At Center Of Spoon-Feeding Controversy Dies
An Oregon woman with Alzheimer’s disease, whose husband claimed she was kept alive with spoon-feeding against her written wishes, has died. Nora Harris, 64, died early Wednesday at the Fern Gardens senior care center in Medford, Ore. Her husband, Bill Harris, said the death marks the end of an eight-year battle with the progressive, debilitating disease, which included an unsuccessful court fight to withdraw all food and liquid. (Aleccia, 10/12)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: In Minn., Nurses File Complain About Allina Staffing; MIch. Gov.’s Testimony On Legionnaire’s Disease Outbreak Draws Scrutiny

Media outlets report on news from Minnesota, Michigan, Tennessee, California, Massachusetts, Ohio, Georgia and Oregon.

The Star Tribune: Nurses File Complaint Over Allina Staffing
The union representing Allina Health hospital nurses filed a complaint Wednesday — one year to the day after ending a 37-day strike — over the continued assigning of patients to supervisory charge nurses. Allina leaders haven’t lived up to a key provision in the contract that ended the strike, said Emily Sippola, a nurse at United Hospital in St. Paul: a commitment to meet and discuss how to prevent charge nurses from being overworked by being assigned patients. (Olson, 10/11)

The Washington Post: Michigan Governor Sticking To Story About Legionnaires’
Michigan Gov. Rick Snyder is sticking by his congressional testimony about when he learned about a fatal outbreak of Legionnaires’ disease during the Flint water crisis, despite a senior aide’s new disclosure that he informed the Republican governor weeks earlier. Some Democrats in Congress are pouncing on the conflict and urging the U.S. House Oversight and Government Reform Committee to investigate. (White, 10/11)

Nashville Tennessean: Nashville’s Emergency Rooms Prep For Mass Shootings, Stock ‘Go Bags,’ Tourniquets And Revise Plans
The frequency of mass shootings has changed how Nashville’s top trauma medicine experts think about whether it could happen here: It’s no longer a theoretical scenario of “if.” It’s when. And with each event — the Pulse Nightclub shooting in 2016, the Las Vegas shooting, the 2011 massacre that killed 77 in Norway, the 2015 attack at the Bataclan in Paris, to name just a few — the trauma teams review what happened and modify their plans. (Fletcher, 10/11)

Detroit Free Press: Beaumont, U-M-Dearborn Collaborate On A New Autism Center In Dearborn
The newly expanded 33,000-square-foot center is a collaboration between the Beaumont Center for Exceptional Families and the University of Michigan-Dearborn’s Early Childhood Education Center, and includes a preschool program where children with autism can be included with typically developing children and experience what it’s like to be in a mainstreamed classroom before they start kindergarten. The demand for a center like this is huge. About 50,000 people in Michigan are on the autism spectrum. It is the fastest-growing developmental disability in the U.S., according to the Centers for Disease Control and Prevention, now affecting as many as 1 in every 68 children. (Shamus, 10/11)

Sacramento Bee: Smoke From Northern California Wildfires Blankets Sacramento With Unhealthy Smoke
Sacramento Valley and foothills residents awoke Wednesday to the heavy smell of smoke, hazy brown skies and ashes on car windshields – the result of nearly two dozen Northern California wildfires, including the Atlas Fire, which exploded overnight in the hills west of Fairfield. …Air meters throughout the region registered unhealthy levels of particulate matter from Vacaville and Davis in the west valley to higher foothill elevations in Grass Valley and Colfax early Wednesday. (Bizjak, Anderson and Glover, 10/11)

California Healthline: Giving Birth Is Hard Enough. Try It In The Middle Of A Wildfire.
Days before there was any sign of fire, Nicole and Ben Veum of Santa Rosa, Calif., had been waiting and waiting for their baby to arrive. Nicole’s due date came and went. Her doctor called her into the hospital — Sutter Santa Rosa Regional Hospital — to induce labor. That was Friday. “So we were very excited at that point,” she said. “And then, day after day after day with not a whole lot of progress.” (Dembosky, 10/11)

Columbus Dispatch: Local Vietnam Veterans Share Struggles With Late-Onset PTSD
About 8 percent of people who serve in the military go on to develop PTSD, said Heather Axtell, who oversees trauma recovery in the behavioral-health service at the Department of Veterans Affairs’ Chalmers P. Wylie Ambulatory Care Center on the Northeast Side. That means that about 700,000 veterans of the Vietnam War, which ended more than 40 years ago, have struggled with the disorder. (Viviano, 10/12)

Georgia Health News: Parents, Advocates Sue State, Claim Inequities In GNETS Schools
Parents of children with disabilities and advocacy groups filed a lawsuit in federal court Wednesday alleging the state of Georgia has discriminated against students placed in “unequal and separate’’ schools for kids with behavioral disorders and problems. The Georgia Network for Educational and Therapeutic Support (GNETS) schools are “segregated programs,’’ housed in separate buildings or in separate wings of regular schools, the lawsuit says. (Miller, 10/11)

Atlanta Journal-Constitution: Georgia Disabled Students Segregated In Inferior Schools, Suit Alleges
Georgia uses its unique network of psychoeducational schools as a “dumping ground” for unwanted students with disabilities, a new class-action lawsuit claims. The suit, filed Wednesday by several advocacy groups on behalf of three parents, accuses state officials of violating federal law and the U.S. Constitution by placing disabled children in segregated schools and classrooms operated by the Georgia Network for Educational and Therapeutic Support, or GNETS. (Judd, 10/11)

Cincinnati Enquirer: What’s Top Concern For Cincinnati Parents? Their Kids’ Mental Health
In a first-of-its-kind survey this year by Beech Acres Parenting Center, nearly half of Greater Cincinnati parents, 44 percent, said “understanding kids’ mental health issues” is “very or extremely concerning” to them. More than half of respondents, or 55 percent, were “very or extremely interested” in getting training or guidance to address childhood mental-health issues. (Saker, 10/11)

Kaiser Health News: Dementia Patient At Center Of Spoon-Feeding Controversy Dies
An Oregon woman with Alzheimer’s disease, whose husband claimed she was kept alive with spoon-feeding against her written wishes, has died. Nora Harris, 64, died early Wednesday at the Fern Gardens senior care center in Medford, Ore. Her husband, Bill Harris, said the death marks the end of an eight-year battle with the progressive, debilitating disease, which included an unsuccessful court fight to withdraw all food and liquid. (Aleccia, 10/12)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Medicare Advantage Plans’ Star Ratings Shows Little Change In Quality Over Past Year

Although the number of these plans earning four stars or better have fallen slightly, more beneficiaries are signing up for the higher performing plans.

Modern Healthcare: Medicare Advantage Star Ratings Show Insurers’ Performance Hasn’t Improved 
The CMS’ release of its Medicare star ratings reveals that performance among insurers overall in Medicare Advantage remains largely unchanged year-over-year. … The CMS said about 44% of the 384 active Medicare Advantage contracts in 2018 that also have Part D prescription drug coverage earned 4 stars or higher for their overall rating. This is a drop from 2017 when about 49% of the 363 active Medicare Advantage plans earned 4 stars or higher. Although the overall number of 4-star or high plans dropped slightly, more beneficiaries will be covered by the highest performing Medicare Advantage plans in 2018, the CMS said. Nearly 73% of Medicare Advantage enrollees are in contracts with 4 or more stars, compared to about 69% of enrollees in such plans last year. (Castellucci, 10/11)

The Philadelphia Inquirer: Ten Questions To Ask During Medicare Open Enrollment
It’s time for one of the more confusing rituals of the retirement years: Medicare open enrollment. If you like your current plan, it might be tempting to leave things alone for another year, but experts say that’s not a good idea. Insurers tweak Medicare Advantage plans all the time, and depending on your needs, these changes can cost you money or leave you unable to see your favorite doctors. Even in traditional Medicare, it’s a good idea to reevaluate your drug plan because insurers may change which drugs they cover or the co-pays they charge. (Burling, 10/12)

CNBC: If You Miss This Medicare Deadline, It Could Hurt Your Health
It’s likely you’ve started hearing chatter about Medicare’s open enrollment period, which begins Sunday and runs through early December. If you’re like many older Americans, the question is whether you need to do anything. Put simply, it depends. (O’Brien, 10/10)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Dementia Patient At Center of Spoon-Feeding Controversy Dies

An Oregon woman with Alzheimer’s disease, whose husband claimed she was kept alive with spoon-feeding against her written wishes, has died.

Nora Harris, 64, died early Wednesday at the Fern Gardens senior care center in Medford, Ore. Her husband, Bill Harris, said the death marks the end of an eight-year battle with the progressive, debilitating disease, which included an unsuccessful court fight to withdraw all food and liquid.

“It is a blessing and a relief,” he said.

Nora Harris, a librarian and scholar who was diagnosed with early-onset Alzheimer’s disease at age 56, had drafted an advance directive that called for no measures to prolong her life, including artificial nutrition and hydration.

Her husband contended that the document covered oral assisted feeding, too. He went to court last year to force staff at the center to stop spoon-feeding Nora, saying the practice violated his wife’s wishes and her advance directive.

“Nora never wanted to live like this,” said Bill, 76, a retired tech worker.

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However, a local judge denied his request, siding with the state’s long-term care ombudsman who said state rules to prevent abuse required the center to offer residents three meals each day and provide help eating, if needed. That practice continued in recent weeks, even as Nora’s kidneys failed and she became bed-bound.

“I had to struggle with everybody all the way through to the end to try and respect her wishes,” Bill said.

The controversy turned Nora Harris into a central character in an ongoing debate over advance directives and dementia. At issue is whether patients with Alzheimer’s and other progressive diseases can stipulate in advance that they want oral food and liquid stopped at a certain point, hastening death through dehydration.

It’s a controversial form of what’s known as VSED — voluntarily stopping eating and drinking — a small but growing practice among some terminally ill patients who want to end their lives. In those cases, people who still have mental capacity can refuse food and water, usually resulting in death within two weeks.

“The right to VSED is reasonably well-established, but it’s when a person isn’t competent that’s the issue,” said Paul T. Menzel, a retired bioethicist at Pacific Lutheran University in Tacoma, Wash., who has written extensively on the topic.

Unlike medical aid-in-dying, VSED doesn’t require a law or a doctor’s approval. But the question of whether it’s possible for people who can no longer actively consent to the procedure remains ethically and legally unclear. That’s especially true for patients who open their mouths to accept food and fluids, as Nora Harris did until her last days.

“VSED is a unique exit option,” said Thaddeus Mason Pope, director of the Health Law Institute at Hamline University in St. Paul, Minn., and an expert on end-of-life law. “This is probably the least discussed option. We don’t have statutes, we don’t have regulations, we don’t have a court case.”

Advocates for VSED contend that, with proper medical support, it can result in a peaceful death that allows patients control over their own fate. Critics say the practice amounts to torture and that it will lead to starvation of elderly, disabled and mentally ill people.

Advance directives that tell caregivers to continue or withdraw artificial nutrition and hydration provided through feeding tubes or IV lines are common. Most don’t mention assisted oral feeding, however.

Nearly two dozen states have laws that address assisted feeding, including many that specifically prohibit withdrawing oral food and fluids. Other states address only artificial feeding or are unclear or silent on the issue.

Just one state — Idaho — appears to sanction withdrawal of assisted feeding by a health care proxy “in accordance with a valid directive,” according to a July analysis compiled by Charles Sabatino of the American Bar Association.

But Idaho state law also prohibits any form of assisted suicide and requires “comfort care” for patients if artificial nutrition and hydration is withdrawn. It’s not clear whether a request to halt assisted feeding would be honored, said Robert Aldridge, a Boise lawyer who has worked for years to shape Idaho’s Medical Consent and Natural Death Act.

“Assisted feeding is a somewhat limited situation if the patient is not competent,” Aldridge said in an email.

With more than 5.5 million people living with dementia in the U.S., questions about stopping assisted feeding are becoming more common, said Judith Schwarz, clinical director for End of Life Choices New York, which advocates for medical aid-in-dying.

“Increasingly, this is going to be an issue,” she said. “The people I talk to are much more afraid of Alzheimer’s than they are of cancer. They are afraid of being stuck for years in a nursing home in a diaper.”

The doctor overseeing Nora Harris’ case, Dr. Karen Kahn, called the situation “one gigantic gray zone.”

On one hand, research shows that “feeding somebody with end-stage dementia will not prolong their life,” said Kahn. On the other hand, if a patient accepts food and swallows it, “it should be incumbent on them to feed her,” she added.

Bill Harris said he sat for three hours on Tuesday afternoon watching as Nora took tortured breaths. She died at 1:32 a.m., he said.

“What the court case did a year ago in July was they condemned her to the full gamut of the disease,” he said.

He said he’ll continue to push for changes to state law to allow people with dementia to stipulate in advance if they don’t want assisted feeding.

“From my perspective, the way the laws are written now, they do not respect people with dementia,” he said.

When Nora Harris was diagnosed with Alzheimer’s in 2009, she made arrangements to donate her brain and spinal cord tissue to the University of California-San Francisco, medical school for research.

“She didn’t want anyone else to go through what she did,” Bill Harris said.

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation and its coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging

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In Oregon, End-of-Life Wishes Are Just A Click Away

Just four hours earlier, Sallie Cutler had been sharing Mother’s Day lunch with her mom, Alyce Cheatham.

Then, that same evening, Cheatham, 96, landed in a Portland, Ore., emergency room, lethargic, unable to speak and paralyzed on her right side by a massive stroke.

Cutler now admits her first impulse was to demand action.

“It’s, like, do something; make her better,” said Cutler. “As a child, you can’t just say let her die.”

But Cheatham’s medical records contained a different demand. When the doctor on duty at Oregon Health and Science University clicked once in the chart header, it was immediately clear: Cheatham wanted no efforts to prolong her life.

“He said, ‘The good news is, your mom had a POLST form, so you don’t really have any decisions to make,’” recalled Cutler, 63, of Sherwood, Ore.

“I was so relieved. I cannot tell you how relieved I was. She had made all the decisions for me ahead of time.”

POLST forms, formally known as Physician Orders for Life Sustaining Treatment, have become a staple in care for the fragile or seriously ill. They document in detail what kind of medical treatments patients want — or don’t want — at the end of life. Nearly every state in the U.S. has a program; dozens are established or developing.

But in Oregon, where the documents were developed in the early 1990s, organizers have taken a step to ensure that final medical wishes are honored.

Officials at OHSU have partnered with a California technology firm, Vynca, to allow health care providers to electronically find any of the 172,000 active forms in Oregon’s POLST registry with a single click, no matter where they were filed.

Since the link went live June 1, OHSU providers have clicked nearly 14,000 times, said Dana Zive, the registry’s director.

“It’s not just in the ER setting,” Zive said. “It’s actually any health professional, in any setting.”

Previously, OHSU providers had access to the 16,000 POLST forms filled out by patients within the hospital system, but not those submitted elsewhere. The hospital, which tops the state list in the annual U.S. News & World report rankings, reports more than 1 million visits from nearly 300,000 patients each year.

Now, during any of those visits, the information is easy to see at the top of the patient’s medical record, said Dr. Susan Tolle, director of the OHSU Center for Ethics in Health Care and a co-founder of the state’s POLST program.

“POLST forms only work if health care professionals can find these orders quickly, especially in an emergency,” she said.

Expanding OHSU’s electronic capability is the first step toward universal, instant access to the forms by health systems across the state. Samaritan Health Services, a nonprofit network of hospitals and clinics in Portland and the surrounding area, plans to add the feature later this year. And Oregon officials are negotiating with additional vendors to expand accessibility, Tolle said.

The state’s Oregon Health Authority pays about $380,000 a year to run the POLST registry. The cost of the electronic expansion is paid by the hospitals, however. Neither hospital officials nor Vynca representatives would reveal the price tag, saying it was proprietary information.

Research suggests that POLST forms guide end-of-life care, whether patients die at home or in a health care facility. A 2014 study of deaths among Oregon POLST users found that 6.4 percent of patients who specified comfort-only measures died in a hospital, compared with 44.2 percent of those who chose full treatment — and 34.2 of people with no POLST form on file.

A recent analysis found that seriously ill patients in Oregon are more likely to have their end-of-life wishes honored than those in nearby Washington state — or the rest of the U.S.

Still, it’s been difficult to ensure immediate access to POLST forms and other advance care planning documents in emergency settings, said Dr. Ryan Van Wert, a critical care physician and chief medical officer for Vynca.

“The problem is, if you come into an ER in distress and you’re unable to speak for yourself, the default is we do everything,” he said.

So, sick or frail patients who don’t want CPR or intensive care might receive aggressive treatments against their will, simply because medical personnel couldn’t find the forms.

Oregon is the first state with one-click access to POLST registry forms. New York, which uses forms called Medical Orders for Life Sustaining Treatment, or MOLST, has a different system, a web-based application that allows completion of and access to forms at sites statewide.

Amy Vandenbroucke, executive director of the nonprofit National POLST Paradigm, said individual states are still figuring out what works.

“We’re still very much in an innovation stage,” she said. “Right now, we don’t have any guidance to say what is the best way to do it.”

For Alyce Cheatham, however, OHSU’s easy access to her POLST form ensured her wishes were followed. After the stroke last May, she returned to her Portland retirement home, where she died a week later.

“She didn’t want any kind of life support at all,” Cutler, her daughter, recalled. “She didn’t want to be on any feeding tubes at all.”

Being able to determine her care was important to Cheatham, an independent, forceful woman who was active in many Portland civic groups and projects, including development of the POLST program. Over the years, she contributed more than $500,000 to the center that developed it, records show.

“She was very excited about the POLST form,” Cutler said. “There’s a symmetry to it. It’s good that it worked so well.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Categories: Aging, Health Industry, Public Health

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Dementia Patients Hold On to Love Through Shared Stories

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Credit Paul Rogers

Can you keep the love light shining after your partner’s brain has begun to dim? Just ask Denise Tompkins of Naperville, Ill., married 36 years to John, now 69, who has Alzheimer’s disease.

The Tompkinses participated in an unusual eight-week storytelling workshop at Northwestern University that is helping to keep the spark of love alive in couples coping with the challenges of encroaching dementia.

Every week participants are given a specific assignment to write a brief story about events in their lives that they then share with others in the group. The program culminates with a moving, often funny, 20-minute written story read alternately by the partners in each couple in front of an audience.

Each couple’s story serves as a reminder of both the good and challenging times they have shared, experiences both poignant and humorous that reveal inner strength, resilience and love and appreciation for one another that can be easily forgotten when confronted by a frightening, progressive neurological disease like Alzheimer’s.

“It’s been an amazing experience for us,” Mrs. Tompkins said of the program. “Creating our story revealed such a richness in our life together and is helping us keep that front and center going forward.”

She added that the program provides “an opportunity to process what you’re going through and your relationship to each other. It helped me digest all the wonderful things about John and how well we relate as a couple, things that don’t go away with Alzheimer’s disease. John is so much more than his disease.”

Ditto for Robyn and Ben Ferguson of Chicago, married 42 years in 2012 when they learned that Ben, a psychologist, had Alzheimer’s disease. “The diagnosis was crushing,” said his wife, who is also a psychologist. “Telling people in the program about it helped us recognize the impact on our lives and relationship and really face that. It made things feel not quite so bad.”

The Fergusons have publicly presented their 20-minute story together 19 times so far, helping to enlighten medical students and those training in social work and pastoral care, as well as researchers and members of the general public. “It reinforces our relationship as a couple, rather than caregiver and patient, even though he is 85 percent dependent on me for the activities of daily living.”

Dr. Ben Ferguson, now 69, said, “I feel we’re giving people information that could be very valuable in their future. It’s helpful to them to see us smile, have a good time and give a good report – as well as a bad report – about what goes on with this disease. It’s helpful for people to hear it from someone who has it, and it’s helped us avoid getting so morose.”

As for their presentations, which they now give almost monthly, his wife said, “They help us stay positive and give us a sense of purpose. We both feel a real need to do advocacy work, and this is the best thing we can do right now. We know there’s a sell-by date on this – we won’t be able to do it forever. But we don’t think about that now. Now we’re focused on helping people understand that your life doesn’t stop with the diagnosis. We want people to hear that you go on with your life, even though you may need a lot of help.”

Another workshop participant, Sheila Nicholes, 76, of Chicago, said of her husband, Luther, who has vascular dementia, that the storytelling “brings him back to being funny again. Writing our story together gave us a way to talk about these things, to think about where we were then and where we are now.”

Noting that dementia is “a very hush-hush illness in our black community,” Ms. Nicholes said she hoped that telling their story would help others speak more openly about it and learn to “just roll with the flow.”

The storytelling workshop, which started in January of 2014, was the brainchild of Lauren Dowden, then an intern in social work at Northwestern’s Cognitive, Neurological and Alzheimer’s Disease Center. She quickly learned from family members in a support group that “their concerns were not being addressed about dealing with loss, not just of memory, jobs and independence, but also what they shared as a couple.”

During the group sessions, Ms. Dowden said, “there’s so much laughter in the room, so much joy and love of life as well as poignancy and tears. As they move forward, as the disease progresses, they can be reminded of who they are, their strength and resilience, what has made their relationship strong, what they loved about the person, as opposed to just being patient and caregiver.”

As the program moves week to week, Ms. Dowden said, “there’s more touching, affection, looking at one another and laughing. There are delightful moments of connection when one member of a couple reveals something the other didn’t know.”

The weekly story assignments require that the couple collaborates, “and they learn how to work together in new ways, how to make adjustments, because they’ll have to make thousands and thousands of adjustments throughout the course of the disease.”

In executing the workshop assignments, Dr. Ferguson said she would ask her husband questions, he would answer and she would write down what he said. “The workshop was really transformative,” she said. “It gave us hope for our future together in dealing with this disease.”

Ms. Dowden said the feedback from those in the audience for the 20-minute joint stories has been heartening. She explained, “Students learn about the biology of neurodegenerative conditions. These stories enable them to see the human side of the disease, what it’s like to live with it, and may help them develop programs that help these families live better. In addition to the stigma, there’s a tendency to write off people with dementia.”

Ms. Dowden said she is currently refining the workshop curriculum so that it can be used as a model for other institutions to replicate. She is also expanding it to include mother-daughter and sibling pairs.

She realizes, of course, that a storytelling workshop may not be suitable for every couple. “It’s not good if there’s a lot of behavioral issues, a lot of conflict, and no insight,” she said. “But for those it does fit, it’s an opportunity to tap into the core of relationships, to still grow and learn and be delighted by one another.”

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Breast-Fed Babies May Have Longer Telomeres, Tied to Longevity

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Credit Roberto Schmidt/Agence France-Presse — Getty Images

Breast-fed babies have healthier immune systems, score higher on I.Q. tests and may be less prone to obesity than other babies.

Now new research reveals another possible difference in breast-fed babies: They may have longer telomeres.

Telomeres are stretches of DNA that cap the ends of chromosomes and protect the genes from damage. They’re often compared to the plastic tips at the end of shoelaces that prevent laces from unraveling. Telomeres shorten as cells divide and as people age, and shorter telomeres in adulthood are associated with chronic diseases like diabetes. Some studies have linked longer telomeres to longevity.

The new study, published in The American Journal of Clinical Nutrition, is a hopeful one, its authors say, because it suggests telomere length in early life may be malleable. The researchers, who have been following a group of children since birth, measured the telomeres of 4- and 5-year-olds, and discovered that children who consumed only breast milk for the first four to six weeks of life had significantly longer telomeres than those who were given formula, juices, teas or sugar water.

Drinking fruit juice every day during the toddler years and a lot of soda at age 4 was also associated with short telomeres.

Socioeconomic differences among mothers can muddy findings about breast-feeding because the practice is more common among more educated mothers. However, this group of children was fairly homogeneous. All of them were born in San Francisco to low-income Latina mothers, most of whom qualified for a government food program.

“This adds to the burgeoning evidence that when we make it easier for mothers to breast-feed, we make mothers and babies healthier,” said Dr. Alison M. Stuebe, an expert on breast-feeding who is the medical director of lactation services at UNC Health Care in Chapel Hill, N.C., and was not involved in the study. “The more we learn about breast milk, the more it’s clear it is pretty awesome and does a lot of cool stuff.”

The study did not establish whether or not breast-feeding enhanced telomere length. It may be that babies born with longer telomeres are more likely to succeed at breast-feeding. A major drawback of the research was that telomere length was only measured at one point in time, when the children were 4 or 5 years old. There was no data on telomere length at birth or during the first few months of life.

“We don’t have a baseline to see if these kids were different when they came out,” Dr. Stuebe said. “It could be that really healthy babies can latch on and feed well, and they already had longer telomeres. It could be successful breast-feeding is a sign of a more robust kid.”

The researchers were following children who were part of the Hispanic Eating and Nutrition study, a group of 201 babies born in San Francisco to Latina mothers recruited in 2006 and 2007 while they were still pregnant. The goal of the research was to see how early life experiences, eating habits and environment influence growth and the development of cardiac and metabolic diseases as children grow.

Researchers measured the babies’ weight and height when the children were born. At four to six weeks of age, they gathered detailed information about feeding practices, including whether the baby had breast milk and for how long, and whether other milk substitutes were used, such as formula, sugar-sweetened beverages, juices, flavored milks and waters. Information was also gathered about the mothers.

Children were considered to have been exclusively breast-fed at 4 to 6 weeks of age if they received nothing but breast milk, as well as medicine or vitamins.

When the children were 4 and 5 years old, researchers took blood spot samples that could be used to measure the telomeres in leukocytes, which are white blood cells, from 121 children. They found that children who were being exclusively breast-fed at 4 to 6 weeks of age had telomeres that were about 5 percent longer, or approximately 350 base pairs longer, than children who were not.

The new findings may help explain the trove of benefits that accrue from breast-feeding, said Janet M. Wojcicki, an associate professor of pediatrics and epidemiology at the University of California, San Francisco, and the paper’s lead author.

“What’s remarkable about breast-feeding is its ability to improve health across organ systems,” Dr. Wojcicki said. “Telomere biology is so central to the processes of aging, human health and disease, and may be the link to how breast-feeding impacts human health on so many levels.”

There are several possible explanations for the correlation between breast-feeding and longer telomeres. Breast milk contains anti-inflammatory compounds, which may confer a protective effect on telomeres. It’s also possible that parents who exclusively breast-feed their babies are more scrupulous about a healthy diet generally.

Yet another possibility is that breast-feeding is a proxy for the quality of mother-child attachment and bonding, said Dr. Pathik D. Wadhwa, who was not involved in the research but studies early-life determinants of health at the University of California, Irvine School of Medicine. “We know from studies looking at telomere length changes in babies who came from orphanages that the quality of the attachment and interaction, and more generally the quality of care that babies receive, plays a role in the rate of change in telomere length,” he said.

When children are exposed to adversity, neglect or violence at an early age, “psychological stress creates a biochemical environment of elevated free radicals, inflammation and stress hormones that can be harmful to telomeres,” said Elissa Epel, one of the authors of the study who is a professor at the University of California, San Francisco, and director of the Aging, Metabolism and Emotions Lab.

“The idea that breast-feeding may be protective for telomeres is heartening because we don’t know much about what’s going to help protect them in children, besides avoiding toxic stress. And boy, do we want to know,” Dr. Epel said.

Although genes can’t be changed, Dr. Epel said, “This is part of the genome that appears to be at least partly under personal control.”

Meet the Super Flasher: Some Menopausal Women Suffer Years of Hot Flashes

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Credit Kim Murton

What kind of hot flasher are you?

The hot flash — that sudden feeling of warmth that can leave a woman flushed and drenched in sweat — has long been considered the defining symptom of menopause. But new research shows that the timing and duration of hot flashes can vary significantly from woman to woman, and that women appear to fall evenly into four hot-flash categories.

Some women, called “early onset” hot flashers, begin to experience hot flashes long before menopause. Symptoms can begin five to 10 years before a woman’s last period, but the symptoms stop with the end of the menstrual cycle.

Then there are women who don’t experience their first hot flash until after menopause, the “late onset” hot flasher. And some women fall into a group the researchers called the “lucky few.” Some of these women never experience a single hot flash, whereas others briefly suffer only a few flashes when they stop menstruating.

And then there are the “super flashers.” This unlucky group includes one in four midlife women. The super flasher begins to experience hot flashes relatively early in life, similar to the early onset group. But her unpleasant symptoms continue well past menopause, like those in the late onset group. Her symptoms can last 20 years or more.

The findings come from the Study of Women’s Health Across the Nation, or SWAN, a 22-year-old study that has been tracking the physical, biological and psychological health of 3,302 women from a variety of racial and ethnic backgrounds. The study is being conducted at seven research centers around the country and is paid for by the National Institutes of Health.

“It explodes our typical myth around hot flashes, that they just last for a few years and everyone follows the same pattern,” said Rebecca Thurston, the senior author and a professor of psychiatry and epidemiologist at the University of Pittsburgh. “We may be able to better help women once we know in what category they are more likely to fall.”

That includes women like Lynn Moran, a 70-year-old retired financial planning assistant who lives near Pittsburgh and falls into the “super flasher” category. She remembers having her first hot flash around the age of 47. While the symptoms were subtle at first, soon the hot flashes became more bothersome. “It was enough to wake me up out of a sound sleep,” she said. “I wasn’t sleeping well because they were coming all night long and during the day. I was just miserable.”

Ms. Moran began hormone therapy, which helped but did not eliminate the symptoms. But when medical studies began to show health risks associated with the treatment, her doctor advised her to stop using hormones. She waited another 18 months until she retired, then stopped taking hormones in 2005.

The hot flashes “came back with a vengeance” and haven’t stopped since.

“I still have them. I still laugh about them,” she said, noting that she may experience several hot flashes a day. “I’ll be trying to get ready to go somewhere, curling my hair and have to redo everything and dry my hair again because I’ll be drenched. My makeup will literally run down my face. Here I am, 70 years old, complaining of hot flashes.”

Dr. Thurston notes that understanding variations on hot flashes is important to understanding women’s health in midlife. A 2012 study, published in the journal Obstetrics and Gynecology, suggested that the timing and duration of hot flashes may be an indicator of a woman’s cardiovascular health. The study found that frequent hot flashes were associated with higher cholesterol markers, particularly in thin women.

The latest findings from the SWAN study identified some patterns around the four subsets of women who experienced varying degrees of hot flashes. Women were distributed about equally among the groups, meaning 75 percent of women experienced some degree of hot flashes, while only 25 percent escaped the symptom.

Women in the early onset group were more likely to be white and obese. Women in the late onset group tended to be smokers. The lucky few women who had no hot flashes or only a few were more often Asian women and women in better health. The super flashers were more likely to be African-American, to be in poorer health and to consume alcohol. But the researchers cautioned that while they identified some statistical trends in each group, it’s important to note that each subset of hot flashers included a variety of women representing all races, ethnicities, body weights and health categories. No one factor appeared to determine a woman’s risk for any hot flash category.

For instance, while African-American women were three times as likely to be in the super flashers group, they represented only 40 percent of that group. The remaining 60 percent were white women, some Asian women and other groups.

Dr. Thurston said it is important that doctors understand that 75 percent of women have hot flashes in midlife and that they persist in at least one in four..

“It flies in the face of the traditional wisdom that women have these symptoms for three to five years around the final menstrual period,” she said. “We now know that is patently wrong.”

Talking to Younger Men About Growing Old

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For Robert Goldfarb, 85, resisting the decline of old age goes beyond the treadmill.

For Robert Goldfarb, 85, resisting the decline of old age goes beyond the treadmill.Credit

An electronic display on the treadmill in my local gym reminds me I’m not only running on the machine, but out of time. Its graph comparing changes in the runner’s heart rate to that of peers goes no further than age 70. I’m 85, and find it ominous that the machine presumes that anyone that old shouldn’t be on the thing.

Reminders that I’m now officially one of the old-old appear with greater frequency. Some are subtle, like the treadmill display; others are more jarring, like my daughter’s approaching 60th birthday. Most reminders are well-meaning: a young woman offering her seat on a bus, an airport employee hurrying over with a wheelchair, happily telling me I won’t have to walk to the gate or stand in line. I graciously decline their kindness, struggling not to protest, “But, I’m a competitive runner!” That I feel robust doesn’t matter; the man I see and the man they see are two very different people.

I recently read something the philosopher Montaigne wrote over 400 years ago: “The shorter my possession of life, the deeper and fuller I must make it.” His words inspired me to seek a path through old age without surrendering to it or ignoring its reality.

I began by fighting memory lapses. Rather than substituting “whatever” for an elusive word, I now strain to recall that word, even if means asking others to bear with me for a bit. I avoid phrases that suggest the end of things, like “downsizing” or “I no longer do that.” I subscribe to internet memory games. To recapture the excitement I felt in long-ago classrooms, I began rereading books I read in college.

I also decided to reach out to men my age to learn how they navigate through growing old. Like most of the men I began speaking with, I’m a product of the 1950s and its pressure to conform, to avoid risk, to shun anything that marked one as “different.” Many young people then were warned by parents that signing petitions bearing words like “protest” or “progressive” would get them rejected for a job or fired when they grew up. Men in my platoon didn’t embrace when we parted after serving in the Korean War. Closer than brothers, we settled for a handshake, knowing that’s what men did.

Almost immediately, I found conversations with men my age awkward. Attempts I made to discuss aging were met with jokes about the alternative. With few exceptions, those I spoke with regarded feelings as something to be endured, not discussed. It quickly became clear I was free to contemplate growing old, but not with them.

My wife suggested I meet with younger acquaintances to learn if they would talk with me about aging. I did, and found that men just 10 years younger spoke openly about changes in their minds and bodies. No one joked or changed the subject when one of them confided, “My father had Alzheimer’s, and I’m beginning to forget the same things he did,” or, “My firm’s managing partner said I was slowing younger associates and had to retire.”

It puzzled me that they felt so much freer to discuss feelings than men born just a decade earlier. Could it be because they were shaped by the ’60s, rather than the ’50s? Growing up, they protested what we accepted, challenged authority we obeyed, celebrated their individuality while we hoped to be one of the men in a gray flannel suit. They were the “me” generation, defined by Woodstock and rock ‘n’ roll, while my generation found comfort in Eisenhower’s paternal leadership and listening to soothing ballads like George Shearing’s “I’ll Remember April” and Margaret Whiting’s “Moonlight in Vermont.” Separated by a sliver of time, the two decades seem an eternity apart.

As I seek to reinvent myself, questioning what I do out of habit and what I’m not doing that could be liberating, it’s the voices of these younger men that I hear as I run on the treadmill today. That and the voice of Frank Sinatra from the ’50s, crooning a line from “September Song” that captures what I’ve been feeling: “But the days grow short when you reach September.” It’s realizing that I’ve reached November that presses me forward, ignoring the treadmill’s display, hoping I can lead a deeper and fuller life before I run out of time.

Robert W. Goldfarb is a management consultant and author of “What’s Stopping Me From Getting Ahead?”

Downward Facing Dog and High Heels

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Tao Porchon-Lynch teaches a yoga class in Scarsdale, N.Y. “I haven’t finished learning,” says Ms. Porchon-Lynch, who is 97. “My students are my teachers.”

Tao Porchon-Lynch teaches a yoga class in Scarsdale, N.Y. “I haven’t finished learning,” says Ms. Porchon-Lynch, who is 97. “My students are my teachers.”Credit Gregg Vigliotti for The New York Times

Tao Porchon-Lynch, 97, breezed into her regular Wednesday evening yoga class in a brightly colored outfit: stretch pants, sleeveless top, flowing scarf and three-inch heels.

She put down a mat, folded her long, limber legs into a lotus position, and began teaching her zillionth session. Softly, she guided the 15 or so students through stretching and strengthening moves, and meditative breathing.

The group, at the JCC of Mid-Westchester in Scarsdale, ranged from rank beginners to 20-year veterans of Ms. Porchon-Lynch’s classes, which she has been teaching for decades. She walked the room, adjusting poses, as her students shifted from dog to cobra to camel.

Ms. Porchon-Lynch herself moved through the poses with no apparent effort. At one point, she suspended herself above the floor, supported by her arms.

“Feel your whole body singing out, and hold,” she instructed.

“The ladder of life will take you to your inner self,” said Ms. Porchon-Lynch, who said that before the class, she had knocked out two hours of ballroom dancing.

“I did the bolero, tango, mambo, samba, cha-cha and, of course, swing dancing,” she said.

After the class, she slipped back into her heels — modest height, by Tao standards. Six-inch stilettos are more her speed because the lift helps the flow of energy from the inner feet up through the body, she said.

Back at her apartment in White Plains, she pointed to a photo of herself being dipped dramatically by a dance partner in a competition.

“He was 70 years younger than me,” she crowed. When Ms. Porchon-Lynch was in her 80s she began competitive ballroom dancing and competing widely, even appearing on “America’s Got Talent.”

“I’m very silly. I haven’t grown up yet,” she said. Then she sat and described her “I was there” life story, a march through history that rivaled a Hollywood film.

She said she was raised by an uncle and aunt in Pondicherry, India, after her mother died giving birth to her on a ship in the English Channel in 1918 toward the end of World War I.

At age 8, she began practicing yoga when few women did, and she traveled widely as a child with her uncle, a rail line designer.

Her father, she said, came from a French family that owned vineyards in the South of France, and she moved there as World War II approached. She and an aunt hid refugees from the Nazis as part of the French Resistance.

In London, she entertained troops as a cabaret dancer, and after the war she began modeling and acting in Paris, she said.

She spoke of English lessons with Noël Coward, and hobnobbing with the likes of Marlene Dietrich and Ernest Hemingway.

She said she had acted in Indian films and around 1950 was signed by Metro-Goldwyn-Mayer and had bit roles in big films such as “Show Boat” and “The Last Time I Saw Paris.”

She had stories about marching with Mohandas K. Gandhi and, years later, with the Rev. Dr. Martin Luther King Jr. and attending demonstrations with Charles de Gaulle.

Ms. Porchon-Lynch said she had studied yoga over the years with prominent teachers such as Sri Aurobindo, Indra Devi and B. K. S. Iyengar and taught yoga to many actors in Hollywood.

Even after three hip replacement surgeries, she still drives her Smart car daily and travels widely to teach yoga.

“I haven’t finished learning,” she said. “My students are my teachers.”

Ms. Porchon-Lynch, a longtime widow with no children, attributed her longevity to keeping her vortexes of energy flowing with “the fire of life,” and waking up each morning with the positive attitude that each day will be your best.

“Whatever you put in your mind materializes,” she said. “Within yourself, there’s an energy, but unless you use it, it dissipates. And that’s when you get old.”

Five hours of sleep a night is plenty, she said.

“There is so much to do and think about,” said Ms. Porchon-Lynch, a lifelong vegetarian and a wine enthusiast who still enjoys imbibing.

At the JCC class, she took her students through sun salutation movements and told them, “Remember, the sun salutation means that the dawn is breaking over the whole universe.”

Finally, she talked them through a wind-down period of relaxing meditation.

“Bring your consciousness back down to the physical plane,” she said. “May the light of the union of all things join our mind, our body and our spirit.”

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After Cataract Surgery, Hoping to Toss the Glasses

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How the World Looks With Cataracts

This video shows what it is like to see the world when you have cataracts.

By CLINIC COMPARE on Publish Date May 4, 2016.

Two years ago, Anne Collins of Arlington, Va., who has been wearing glasses since fifth grade, noticed she had trouble reading the overhead street signs while driving. Cataracts, the clouding of the natural lenses that occur with age, were taking their toll.

She decided it was time for cataract surgery.

Mrs. Collins, now 61, chose to have her lenses replaced with two different intraocular lenses – one for seeing far and the other for seeing near — in a procedure known as monovision cataract surgery.

“I thought it was a miracle,” Mrs. Collins said after the surgery was completed. “It was like I was back in second grade and didn’t have any problems with my eyes.” Still, her vision isn’t perfect. Mrs. Collins still needs glasses to read the newspaper, but she can see her cellphone just fine.

By age 80, more than half of all Americans either have a cataract or will have had cataract surgery, according to the National Eye Institute. The average age for the surgery is the early 70s.

Cataracts typically develop in both eyes, and each eye is done as a separate procedure, usually one to eight weeks apart. Patients most commonly have their clouded lenses replaced with artificial monofocal lenses that enable them to see things far away. Most will still need glasses for reading and other close-up tasks.

With monovision surgery, the patient’s dominant eye receives a replacement lens for distance vision. In a subsequent operation, the less dominant eye receives a lens for close vision. Once surgery on both eyes is completed, the brain adjusts the input from each eye and patients typically can see both far and near. Some people can stop wearing glasses altogether, although many, like Mrs. Collins, still need them for certain tasks.

But monovison takes some getting used to. The ideal candidates may be people who already have tried a monovision approach with contact lenses for 15 or 20 years, before they even have developed cataracts, said Dr. Alan Sugar, a professor of ophthalmology at the University of Michigan. “People who have worn contact lenses in their 40s, with one contact for near vision and one for distance, are good candidates,” he said.

Others may be able to give monovision a trial run. The cataract surgeon replaces the first eye with a lens that corrects for distance vision and then, if the cataract in the second eye hasn’t progressed too far, can let the patient use a contact lens for near vision in the second eye, Dr. Sugar said. If the patient is comfortable with the trial monovision, the surgeon can then implant a lens for near vision in the second eye.

Experts caution that monovision surgery is not for everyone. “Many patients get misled by asking how their friends like monovision,” said Dr. David F. Chang, a clinical professor of ophthalmology at the University of California, San Francisco, and past president of the American Society of Cataract and Refractive Surgery. “Some individuals hate what another individual loves.”

After any cataract surgery, including monovision surgery, patients may also experience what doctors call “dysphotopsia,” or visual disturbances like seeing glare, halos, streaks or shadows. Moderate to severe problems occur in less than 5 percent of patients, said Dr. Tal Raviv, an associate clinical professor of ophthalmology at the New York Eye & Ear Infirmary of Mount Sinai Icahn School of Medicine. Symptoms often improve during the first three months after surgery without treatment, he said, though in a small number of cases one or both lenses may need to be replaced.

In addition, some patients who get monovision surgery will need a separate pair of glasses that focus both eyes for distance vision for driving at night. “Night driving is more difficult if both eyes are not optimally focused at distance,” Dr. Chang said.

Another option in cataract surgery for those hoping to get rid of the glasses altogether is the use of multifocal lenses, which focus each eye for both near and far viewing, something like the progressive lenses in eyeglasses. In one study of around 200 patients who had either multifocal or monovision cataract surgery, just over 70 percent of the multifocal group could forgo glasses altogether, compared to just over 25 percent of the monovision group.

But patients who undergo multifocal surgery are more likely to have side effects like glare and halos, according to Dr. Mark Wilkins, the lead author of the study and a consultant ophthalmologist and head of clinical services at Moorfields Eye Hospital in London. In his study, six of 94 patients in the multifocal group had to have second surgeries to get replacement lenses, versus none in the monovision group.

Typically, Medicare covers regular cataract surgery and implantation of standard monofocal lenses but does not pay for multifocal lenses, so insurance reimbursements may be limited.

The key to deciding which type of cataract surgery is right for you is to understand your eyes and goals. “Talk about the pros and cons” of each type of cataract surgery, Dr. Wilkins said. “There’s no other way really.”

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Aging in Place

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Credit Paul Rogers

When I asked the other three members of my walking group, all of whom are in their mid to upper 70s, whether they had any concerns about future living arrangements, they each said they had none despite the fact that, like me, they live in multistory private homes without elevators and, in two cases, without bathrooms on every floor.

My Los Angeles son asked recently what I might do if I could no longer live in my house, and I flippantly replied, “I’m coming to live with you.” The advantages: I’d be surrounded by a loving and supportive family, and the warm weather is a benefit for someone like me who becomes increasingly intolerant of the cold with each passing year. The disadvantages: I’d lose a familiar community and a host of friends, and his house, unlike mine, is on a steep hill with no nearby stores; if I could no longer drive, I’d have to be chauffeured everywhere.

Probably my biggest deterrent would be relinquishing my independence and the incredible number of “treasures” I’ve amassed over the last half century. The junk would be easy, but parting with the works of art and mementos would be like cutting out my heart.

I suspect that most people are reluctant to think about changing where and how they live as long as they are managing well at the moment. Lisa Selin Davis reports in AARP magazine that “almost 90 percent of Americans 65 or older plan to stay in their homes as they age.” Yet for many, the design of their homes and communities does not suit older adults who lack the mobility, agility and swiftness of the young.

For those who wish to age in place, the authors of “70Candles: Women Thriving in Their 8th Decade,” Jane Giddan and Ellen Cole, list such often-needed home attributes as an absence of stairs, wide doorways to accommodate a walker or wheelchair, slip-resistant floors, lever-style door knobs, remotely controlled lighting, walk-in showers, railings, ramps and lifts. Add to these a 24-hour help system, mobile phone, surveillance cameras and GPS locaters that enable family members to monitor the well-being of their elders.

In many communities, volunteer organizations, like Good Neighbors of Park Slope in Brooklyn and Staying in Place in Woodstock, N.Y., help older residents remain in their homes and live easier and more fulfilling lives.

While many young adults chose to live and bring up children in the suburbs, a growing number of empty-nested retirees are now moving to city centers where they can access public transportation, shop on foot for food and household needs, and enjoy cultural offerings and friendly gatherings without depending unduly on others.

One reason my friends and I are unwilling to even consider leaving our Brooklyn community is our ability to walk to supermarkets, banks, food co-ops, hardware stores, worship and recreational facilities, and get virtually everywhere in the city with low-cost and usually highly efficient public transportation. No driving necessary.

We also wallow in the joys of near-daily walks in a big, beautiful urban park, remarking each time about some lovely vista — the moon, sunrise, visible planets, new plantings and resident wildlife.

Throughout the country, communities are being retrofitted to accommodate the tsunami of elders expected to live there as baby boomers age. Changes like altering traffic signals and street crossings to give pedestrians more time to cross enhance safety for people whose mobility is compromised. New York City, for example, has created Aging Improvement Districts, so far in East Harlem, the Upper West Side and Bedford-Stuyvesant, to help older people “live as independently and engaged in the city as possible,” Ms. Giddan and Ms. Cole wrote. In East Harlem, for example, merchants have made signs easier to read and provided folding chairs for seniors who wish to rest before and after shopping.

In Philadelphia, a nonprofit organization, Friends in the City, calls itself a “community without walls” designed to bring members closer to the city’s resources and to one another. It offers seniors a daily variety of programs to suit many cultural and recreational interests.

Also evolving is the concept of home sharing, in which several older people who did not necessarily know one another get together to buy a home in which to live and share responsibilities for shopping, cooking, cleaning and home repair. For example, in Oregon, Let’s Share Housing, and in Vermont, Home Share Now, have online services that connect people with similar needs, Ms. Giddan and Ms. Cole report. There’s also an online matching service — Roommates4Boomers.com — for women 50 and over looking for compatible living mates.

Of course, there are still many older adults, widows and widowers in particular, who for financial or personal reasons move in with a grown child’s family, sometimes in an attached apartment or separate floor. Host families may gain a built-in babysitter, and children can develop a more intimate relationship with grandma or grandpa.

For those with adequate finances, there is no shortage of for-profit retirement communities that help older people remain independent by providing supportive services and a host of amenities and activities. Some have extensive recreational and exercise facilities, as well as book and craft clubs, discussion groups and volunteer opportunities. Some take residents to theatrical productions and museums and on trips to nearby attractions.

I confess that retirement communities that house only older adults are not my style. I can’t imagine living in a place where I don’t see and interact with children on a daily basis. I find that nothing cheers me more than a smile or comment from a toddler. I guess I take after my father, who used to flirt with every child he noticed in a car near his. But I realize that, just as some people are averse to dogs, not everyone enjoys the companionship of a high-energy child.

For older people likely to require help with the activities of daily living, there are many assisted living facilities where residents can get more or less help, including aid with medications, feeding and ambulation, according to their changing needs.

And should I ever have to leave my home, Ms. Giddan and Ms. Cole point out that there is a new and growing cadre of professional organizers and moving managers to “help people sort through accumulated belongings, distribute and disperse what won’t be needed in the new setting, and assist with all stages of packing, moving and then unpacking, and staging the new home.”

This is the second of two columns about adjustments to aging. Read the first part: “Thriving at Age 70 and Beyond.”

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