As if just talking about dying weren’t hard enough for most of us, now comes the disinformation campaign about end-of-life care discussions waged by opponents of health care reform.
Healthcare Topic: Aging
Tuesday, November 11, 2009
Health care reform offers significant opportunities not only to improve the quality of end-of-life care, but to apply the principles of good end-of-life care to improving our health care system.
Tuesday, May 5, 2010
A little-known provision of the health reform law has the potential to transform long-term care services and delivery. The Community Living Assistance Services and Supports Act establishes the nation’s first voluntary insurance program to purchase long-term care services and supports from the community.
Tuesday, June 6, 2010
Transitions are one of the weak points in the U.S. health care system. Poor coordination and inadequate communication around transitions is particularly pronounced in the care of frail elderly people with multiple chronic diseases—or maybe an acute illness or injury on top of a whole big bunch of chronic diseases.
Tuesday, September 9, 2010
Terminal illness is one of the most difficult issues in medicine and health policy. Terminal illness forces us to address end of life care, death, quality of life, and the limits of modern medicine. Terminal illness is also hugely expensive.
Thursday, September 9, 2010
Medicaid currently pays for half of all long-term care in the United States at a cost of more than $100 billion a year to taxpayers. As a result, state and federal budgets are collapsing under the weight of these skyrocketing expenditures
Tuesday, December 12, 2010
Some research has established that medications can be cut in nursing home patients with good outcomes. But in the community, where there is often no single doctor keeping track of all the patients’ medicines, it can be challenging.
Thursday, February 2, 2011
The Obama administration often touts the health-law provision that over the next decade will close the unpopular “doughnut hole”—a gap in Medicare prescription drug coverage. But officials rarely cite another provision, one that might cause sticker shock among some seniors.
Tuesday, March 3, 2011
Some health experts are now worrying that our infatuation with statins may be spiraling out of control. Not only do many doctors question whether statins should ever be used to prevent heart disease, but some are dubious that these medications have ever been the miracle drugs they are advertised to be.
Thursday, April 4, 2011
Palliative care is the thorough assessment and treatment of symptoms, attention to the whole person and support for the entire journey we each will face at the end of life. We know palliative care helps. Let's make it standard care.
Tuesday, June 6, 2011
What if a high-risk, chronically ill elderly patient that was admitted to the hospital had an advanced practice nurse (APN) caring for him (or her) from the get-go? And that nurse enhanced health care team communication and prevented functional decline?
Wednesday, June 6, 2011
For most seniors, the “right place” is what they consider to be their homes and communities. Before passage of the Patient Protection and Affordable Care Act (ACA), the limited set of federal and state options for community-based care hampered the extent to which this vision could be realized.
Thursday, July 7, 2011
Glen Campbell’s decision to put a face on Alzheimer's by continuing to tour is a mark of real courage and heart. Not many celebrities let us come so close.
Thursday, August 8, 2011
The cornerstone of a more effective and efficient system of care is to engage people in making decisions about their life and health in a way that upholds their dignity, independence, and right to self determination. Unfortunately, when it comes to serving older Americans who face advanced illness, this concept is contrary to the way most health care is actually delivered.
Friday, September 9, 2011
While hospice provides a good model of care for the cancer patients it was originally designed to serve, it does not deliver efficiently or comprehensively what the majority of us will need.
Thursday, October 10, 2011
So many fundamental activities crucial to our daily lives can be measured with certainty and confidence, but not so in health care—and certainly not when it comes to aging and long-term services and supports.
Thursday, October 10, 2011
Carefully done research on small numbers in a few settings will not be enough to guide practical implementation of process redesign.
Tuesday, November 11, 2011
The Obama Administration abandoned the Community Living Services and Supports (CLASS) Act last month. This public long-term care insurance program was slated to be the country’s first attempt at dealing with an aging Boomer population that is in denial about what it costs to grow old in America.
Tuesday, November 11, 2011
In many cases the health care system has determined that certain people are incapable of understanding their health issues and making their own decisions.
Thursday, November 11, 2011
In many cases the health care system has determined that certain people are incapable of understanding their health issues and making their own decisions.
Tuesday, November 11, 2011
Let’s not capitalize on or mourn the loss of CLASS for too long. We have work to do – and we do not have the luxury of time before forging ahead.
Tuesday, December 12, 2011
Dealing with the hard stuff – the very sick, the complex, the dying – is the essence of quality health care in an aging society.
Tuesday, January 1, 2012
Our health care system ably treats sudden threats to life, prevents many illnesses and cures much of what ails us. But it cannot reliably and efficiently support us when we face serious chronic illness and disability—a predictable part of the end of life. As a result, instead of living meaningfully and comfortably, we will experience fear: constant anxiety over unreliability and gaps between silos of service; high cost from waste and mismatching of needs with services; and widespread dishonesty, sugarcoating what we face.
Tuesday, January 1, 2012
Although not an easy discussion, it is vital that we know the preferences and choices of loved ones (and they know ours) regarding the kind of support you and those you love expect long before a crisis occurs.
Thursday, March 3, 2012
A few days into my 68-year old father’s hospitalization for sepsis, his doctors determined the strain of bacteria that plagued him: streptococcus. My sister was there when they came in with this part of the diagnosis; she has a doctorate in engineering with a focus on the human heart (that engineering marvel), and she likes details.
“What strain?” she asked the doctor. “A, B, or C?”
His reply: “What does it matter to you?”
Thursday, March 3, 2012
According to the Institute of Medicine’s Preventing Medication Errors report, the average hospitalized patient encounters at least one medication error per day. One in five errors harms the patient. More than 40 percent of medication errors arise during care transitions (admissions, transfers, and discharges from one setting to another) when various possible medication lists are not brought together in a process called reconciliation.
Tuesday, April 4, 2012
The goal of a more effective and efficient system of care is straightforward—better care at lower costs. The path to that goal has proven far more elusive. To meet these aims, we must focus on those who really need the system to perform better—people with advanced illness and functional limitation. We must speak with them on their terms and build plans of care that appreciate them as people, not just as patients.
Tuesday, May 5, 2012
Readers of this blog are familiar with—and mostly supportive of—these two claims: (1) that social and environmental factors are stronger than health care services in shaping the population’s health, but (2) those factors are weaker than health care services in securing funding and public attention. Most of us are convinced that sending more funds and public support toward healthy food and exercise would do more to improve health than sending those funds toward high-cost medications or surgeries,
Thursday, May 5, 2012
Your 80-year-old mother, who can’t recognize you due to severe Alzheimer’s dementia, has developed pneumonia after being hospitalized with a broken hip. Her doctor has told you that she might pull through and that the medical team needs your input on how and where she will live after this episode: at home, or at a nursing home, and with what help—family, home care agency, and/or hospice. You realize that you don’t know what her wishes are—and that she can no longer express them.
Thursday, July 7, 2012
The Supreme Court’s recent ruling in favor of requiring all American citizens to have health insurance coverage has eliminated much uncertainty over who will have access to health care, but it has not prepared us for a crisis over the availability and cost of health care that is just about to hit. In fact, some would argue that this crisis is already upon us. FACT: Every day, 10,000 Boomers turn 65, a trend that will continue for the next 18 years—and most of them will live to a ripe old age.