Like everyone else I’ve been glued to my computer, newspapers, and the radio, keeping track of the catastrophic and heartbreaking events that occurred in Newtown, Connecticut. As a parent and an educator, I’ve alternated between tears and anger, prayer and frustration, trying to understand how someone could murder little children and their teachers, and imagining the thought of losing my own child. I’ve been awed by the bravery of the educators at Sandy Hook.
Yet, as I listen to the media, I’m appalled by the reports and conversations equating — intentionally or not — mental illness with violent behavior. You see, my family can imagine losing a son and brother to mental illness, because we experienced it for 24 years. Violence against others was never part of the equation, and it’s not for most people who live with brain diseases. Read the December 17, 2012 New York Times Health section article, In Gun Debate, a Misguided Focus on Mental Illness by Richard A. Friedman, M.D.
From the time my brother, Jeff, was 18 until he took his own life at age 42, he suffered from bipolar brain disease. He was erratic, often upset, and frequently angry with us — his family members. He wanted so much to be like the rest of us, his friends and family, and to get on with his life. Despite all of his problems, however, he was not violent toward people. His most erratic behavior occurred when he overturned a grocery cart in a parking lot next to our car — an attempt to demonstrate how angry he was with my father, who was trying to reason to him.
Adult children who help aging parents should check out the Washington Post article At End of Life, Medicare Beneficiaries Spend Thousands Out-of-Pocket. Reporter Sarah Kliff explains that a recent study, Out of Pocket Spending in the Last Five Years of Life (abstract), published in the Journal of General Internal Medicine, examined the amount of money that aging Medicare recipients spend on health care during the last five years of life. The abstract leads to the first two pages of the study, freely available.
According to the Post article, “The average Medicare beneficiary spent $38,688 out-of-pocket during the last five years of life.” This is in addition to the portion that Medicare covers. The Post article also features two excellent charts.
Researchers studied people who died between 2002 and 2008 using data from the Health and Retirement Study (HRS), based at the University of Michigan. HRS is a large nationally representative study funded launched in 1992 and funded by the National Institute on Aging.
One out of five hospitalized Medicare patients needs to return to the hospital a second time within 30 days of their first discharge.
A second hospital admission, shortly after the first, is a no-win situation for everyone concerned about an elder parent. Patients are often sicker, they are unnecessarily exposed to other hospital bacteria, and families of the patient have more worries and parent monitoring. Moreover, Medicare spends a lot more money — 17 billion dollars — on these readmissions.
A blog post at The Agency for Healthcare Research and Quality (AHRQ) website, explains a lot more about preventing Medicare patient hospital readmissions. Written by the agency’s director, Carolyn Clancy, M.D., the post provides links to research, successful hospital readmission prevention programs, and patient guides. Dr. Clancy’s columns are also available at the AARP website.
These tips for adult children and their families look like common sense suggestions. Often however, when family members seek an assisted living community for an elder parent, they need to make decisions quickly without much time to read all of the fine print and ask the less obvious questions. Sometimes time constraints can put common sense at the bottom of the list.
Check out item number eight in the Smart Money list, “We pay people to put you here.” A family needs to know a lot about the placement service itself before considering its recommendations for an assisted living community.
Our family was most fortunate to discover Chesterbrook Residences in Northern, Virginia, where my husband’s mother lived for nearly two years. Their policies were transparent and clear.
In case you missed this news on December 7, 2011, you may want to learn more about the new Virginia health care directive registry. It’s a free service. This article, Virginia Announces Free Online Health Care Registry, appeared on Richmond’s NBC News 12 site and explains more.
The Virginia Department of Health, working in a public-private partnership with Microsoft and UNIVAL (a health information technology company), now provide the registry as a communication tool to help people save and archive their end-of-life wishes and ensure that these wishes are honored by family members and/or caregivers. Personal preferences are saved in an easy-to-access web location so that loved ones can honor a person’s last wishes when necessary. Registered users will receive an identification care and pin number which can be given to family members.
Individuals can put the following information into the registry.
National Public Radio’s On Point program with host Tom Ashbrook comes out of WBUR in Boston. The December 6, 2011 program featured Dr. Donald Berwick sharing his thoughts, ideas, and vast knowledge about improving health care — and Dr. Berwick was only a few days past taking leave as head of the Center for Medicare and Medicaid Services (CMS). On the talk show Berwick was articulate, thoughtful, and easy to understand. Moreover, he was unruffled by people who called in to disagree.
Just about everyone who cares about health care quality, solid medicare services for aging parents, and appropriate access to health care for people with lower incomes knows the shameful congressional saga of Dr. Berwick’s rejection.
However, by the end of OnPoint I decided that Dr. Berwick, now that he’s had seventeen months to head CMS, may be a highly visible advocate outside of the government. In fact, the people in the Senate who submitted statement after statement railing about Berwick, quoting his writing out of context, and in general being hateful, may soon wish he were still in the government, quietly going about his daily business with all of the communication constraints of a senior level government official..
They may have unwittingly created a health care rock star.
The Bucksbaum Foundation has donated $42 million to the University of Chicago to create an institute that concentrates on clinical excellence with a focus on partnering with patients. What a common-sense, and timely idea. Disclosure: I have a graduate degree from U of C.
As university president, Robert J. Zimmer comments in the press release:
This generous gift offers the opportunity to bring a new level of rigor to the study of the doctor-patient relationship and clinical judgment. The Bucksbaum Institute for Clinical Excellence provides an important complement to the biological research and clinical strengths of this institution.
The main focus? Developing the environment for better communication thereby ensuring better patient care (and better outcomes when it comes to recovery). Adult children who are helping older senior parents through medical care often find that communication gaps occur frequently and are complicated by information overload and reticence of older patients to ask questions.
According to the announcement on the website: Read more »
Stop by the KevinMD blog and read Government Austerity with Medicare Reform as a Top Priority. The blog post, by medical student Nathanael Heckman, addresses the issue of medicare reform and life expectancy.
Raising the age for eligibility is inequitable, because the rich live longer and the poorer Americans need the care that Medicare provides. Heckman provides a nifty and attention-grabbing graph that depicts the differences in life expectancy for men, age 65 who are at the top half and the bottom half of wage earners .
Click on the above link of the thumbnail of the graph to visit the KevinMD blog and read the entire post.