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When Medicare Pays the Bills…

One of the “fixes” that gets talked about when it comes to medical care is to focus more of it in the home rather than in care facilities. That sounds good until you realize that Medicare will only pay for in-home care if a patient is “homebound.” This means confined to the building in which he/she resides. This rules out a trip to son or daughter's house for lunch. A trip to the hair dresser is OK, but not to the pizza place down the street afterwards. A doctor’s visit is OK, but the time limit is three hours.

Medicare runs the lives of the people it serves. If Boomers want a different future, then we need to begin to change the rules.

How long does it take your toe nails to grow? If you can’t bend your knees to reach down to clip your own, you could wait 61 days to go to the podiatrist ( and only if you’re a diabetic with complications).

Thick toenails, sight or weight problems that impede your being able to see your feet or diseases that put you at risk of infection don’t get you covered, nor does pain while walking. What is termed “routine” foot care is not covered.

So, “go get a pedicure”? Besides the cost, a pedicure isn't always a safe option because of the dangers of infection from a cut cuticle or unsanitary soaking chairs. “Get a family member to do it”? This is an option if you’re not living alone or not embarrassed to ask someone to take care of such a personal task. Medicare rules need to change.

Home Care is Like a Marriage

Living with another person is a choice that usually takes enormous thought and preparation. When the other person is a caregiver - or many caregivers - the choice is made by others. Adjusting to a spouse is hard enough; adjusting to a Licensed Practical Nurse (LPN) or other medical aide who may have different personality strengths, food, music or entertainment preferences is even more so. This adjustment takes place at a time when the ability to change is hardest and one's stamina and patience are weakest. The best alternative are innovative devices that allow a person to remain at home and still accomplish daily tasks. The MIT Age Lab and Intel's Home Health Systems Research Lab are examples of efforts to meet this need.

News Links:

  • Being Heard About Life's End
     “Slow medicine,” which encourages less aggressive care at the end of life, is increasingly available in nursing homes.

  • How much medical care to receive is an issue that will grab the attention of most of us. If the body is breaking down, surgery, more tests and more discomfort may be the last thing we want. The quality of life is as important as its length. Carol Mithers shares her experiences when her 93 year old father-in-law suffered a “small stroke.” See “For the Dying, Less Can be More” in the Los Angeles Times: For the Dying, Less Can Be More

  • On the other hand age shouldn't necessarily be a signal to throw in the towel either. Ending the expensive hospital stays and opting for what has been called “slow medicine,” is an attractive option for those who have to pay for them. It can be a slippery slope between stopping aggressive treatment for those who have little hope of achieving independence and assuming that older people don’t want to live any longer. See Slow Medicine: How Do We Keep Personal Choice from Becoming Impersonal Policy?

  • And then there are the people who don't even get the chance to talk. Doctors can be reluctant to initiate conversations about the seriousness of an illness. Read CNN's report at Death Talk or a more complete article at Study Touts Honesty to Dying Patients.
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  • Technology Adapts to Boomers recounts the ways that devices such as hearing aids are being retooled and marketed as "cool" products for Boomers. Joseph F. Coughlin of MIT's Age Lab is convinced that it is Boomers who will be setting the styles of the future, not the younger set. Cell phones with large numbers, bicycle seats that accommodate the "middle age spread," and the now re-visioned "personal communication assistant" formerly known as a hearing aid are being marketed to style conscious Boomers.

  • The Older Dominion Partnership is a non profit effort by Richmond, Virginia businesses, foundations, academics and state government to create strategies to meet Boomer needs. This is part of what is called "age wave preparedness" and municipalities all over the country are gearing up to address the financial, healthcare, social  and informational needs of the Boomer demographic. "Age-friendly" may be next big selling point for real estate developers. There is extensive research about nationwide initiatives on the web site.

  • Boomers have reinvented many aspects of society. We have become our own telephone operators, stock traders, cashiers, bankers, travel agents, teachers and gas attendants. How will we change health care? Find the right model and the money will be found as well. This is, after all, the generation that pioneered spending $2 for bottled water and $3 for a cup of coffee. We Need to Come Up With a New Plan for Health Care.

  • The quality of health care is a concern to many. AARP conducted a survey of Virginia residents that primarily focused on the problem of medical errors. The AARP Report: Strategies to Improve Health Care contains a number of predictable results. 99% agree that having "enough nurses to provide good patient care" is "a good idea" and that hospitals should be required "to have in place quality control systems designed to reduce medical errors." Other responses, however, are more notable: 89% want "doctors, nurses, pharmacists and other medical professionals to periodically demonstrate that they are good at communicating with their patients."

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