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Do you believe everything you hear or read?

13 Aug

Can you believe that 80% of readers/viewers in the U.S. were well versed on Tom Cruise’s divorce but had no idea of the impact that the Affordable Care Act would have in their lives? And among the 20% that had read about the Act, most were uninformed about its implications. I know that many times information we receive is biased and censored forcing me to be skeptical of the source and to always read the other side of the story. While my views are biased in regards to the Affordable Care Act, given the fact that I have lived in a country, Australia, that had universal healthcare and I believe in it, some of the arguments we are hearing are predicated on lies. The Affordable Care Act, in its entirety, is a HUGE victory for seniors, strengthening Medicare, improving community long-term care, providing additional transparency protections against abuse and neglect and lowering costs of medications, among others.

However, what we are hearing during this election year is that the Act that was formulated and approved by Congress, now called Obamacare, will kill 800,000 jobs, is bad for the economy and worse it is a federal takeover. Recently, Congress spent $50 million of our taxpayer’s money drafting a bill to roll back the Act. But let us examine these statements to get to the bottom of the arguments.

According to the Congressional Budget Office 800,000 workers will now retire because they will have healthcare insurance. I assume that those jobs will then be open to others who are seeking employment. So in a sense, it is not a loss of jobs but perhaps the creation of new job opportunities. Let’s face the fact that we cannot afford to continue with the spiraling healthcare costs. In the last three months my husband has had four MRIs, each costing around $4,000 each. He is in perfect health but doctors insist that to be sure nothing has changed he must have another one. Reigning in the growth of healthcare costs is one of the priorities of the Act. Moving dollars away from expensive fee for service Medicare is good for the economy. Experts have concluded that after 10 years of the Act our healthcare system will cost half a trillion dollars less than today. The last argument that this is a federal takeover is a complete undiluted lie. Would you say that delivering 30 million new customers to private insurance companies is a federal takeover? Liberals in fact agree that the Act should have created a more robust public option but that did not pass muster with the strong lobbying arm of the private insurance companies. Seven other states, including Massachusetts, have in the past passed laws offering coverage to all. All but one has failed because the law did not mandate that everyone must be covered. Only Massachusetts mandated that and was the only one that became succesful.

My advice to you is that you must seek the truth, always consider the source of information and use common sense to make your own conclusions. Be skeptical of all you read and hear.


Changing Lifestyles is our Business

1 Aug

At the beginning we just wanted to provide a dignified life to our low-income seniors. We had seen what isolation and neglect was doing to seniors living in public housing. Most of them had given up on life and were just waiting for the day that they would leave their sorrowful living conditions. Our first impulse was to provide them with a clean, comfortable apartment and the services that would allow them to keep living with decency. After we experienced how their lives changed by having good meals, a little help in getting out of bed and bathing, the opportunity to be with others and having the right medication at the right time, we realized that there was much more we could do. What about if we improve their life expectancy, help them avoid hospitalization, prevent them from falling down, make them more alert so they can enjoy this stage of life.

At first most were reluctant to engage in any kind of physical activity. After all, most had never done much exercise in the past and exercising was not an acceptable behavior from elderly individuals. Changing their mind-set was sometimes a struggle, a change of routine from one of complete inertia to one where they have to exert themselves. So we started with a very small group of “willing victims” that were willing to perform stretching exercises. We used music and dancing to entice them. Some were embarrassed at the beginning but later it became their morning routine. Little by little others, watching from afar, joined the group. After all, it seemed that those willing to go along were having fun and socializing with those next to them. The group grew from a handful to over fifty and from that moment they were not willing to live without the exercises. We became more innovative with our program, offering dancing classes, yoga, music classes, fitness programs, personal trainers, aquatic courses and gardening.

The clients were having fun but that was not all. Those who regularly engaged in these activities saw great improvements in cognitive and physical health, fewer trips to the emergency room, less need for medication, 50% less daily bathroom trips, a decrease in back and muscle pain and dramatic decrease in nursing home care. They also experienced less anxiety and agitation, using their energy in a positive way. Another side effect was an increase in socialization with the staff and the residents.

The beneficial results of exercising have been well-recognized, not only for aging individuals but for people of all ages. Recent reports on wellness programs collaborate what we found happening among our clients, improved health, less hospitalization, increased alertness and feeling of wellness and increased socialization among clients.

The moral of the story: if you give seniors a chance to change their lifestyles, after some reluctance they will experience, on their own, a sense of wellness and optimism. But this is not all, by changing lifestyles and improving health, everyone wins. Healthcare costs go down, costs to families are reduced and turnover at the facility goes down.

The Untouchables – Alzheimer’s Clients

10 Jul

I am alarmed to hear of the number of Alzheimer’s clients that are projected in the next decade and thereafter. Even more alarmed when I see the complete disregard our current long term care system has for those afflicted with the disease. It is almost like we want to keep this as a secret, which does not help very much when advocating for change.

In 1995 the State of Florida was putting together the assisted living waiver and establishing who would have priority for this new funding. My thought immediately was – those who are suffering with Alzheimer’s in the hope that it would incentivize assisted living providers to take care of them. The provision was added to the waiver eligibility requirements but it did not move those private providers to open their doors. One of their reasons was that it costs more to care for an Alzheimer’s client as they require more staff to avoid elopement. Florida is one of a dozen states that pays a fixed rate for the care of an individual in an assisted living facility no matter how much service they require. This leads to a lot of what we call “cherry picking” and who in their right mind will pick the Alzheimer’s clients.

But cost is not the only reason. In a study conducted in 1996 it was found that half of the states had admission and discharge criteria that prevented the admission and retention of people with cognitive impairments (Alzheimer’s). Later studies continued to reveal a reluctance of assisted living providers to admit/retain residents with the type of behavioral symptoms brought about by the disease. The Alzheimer’s Association supports the ability of residents to age in place, however, the fact remains that the few that do offer dementia specific units to Alzheimer’s clients do so at the detriment of the residents. There are cases of residents being neglected and ostracized and care needs are very high. This is a reason why most of the nursing home residents are in fact Alzheimer’s clients; individuals who do not need medical attention but basic supervision. However, they end up there because no one else would take them. According to a 2006 study, over 40% of discharges from assisted living facilities to nursing homes were because of cognitive impairments.

How dementia friendly are those brave assisted living facilities that cater to Alzheimer’s clients? Universally all dementia units use methods of exit control and clients are served in separate areas of the buildings – not to be seen or heard. At the first facility we opened here in Miami we welcomed Alzheimer’s clients and half of the population was in fact afflicted with the disease. Morally opposed to any type of segregation, our dementia clients were interspersed through the eight (8) floor facility. They ate their meals with everyone else and partook of the activities with the rest of the community. There were complaints from those who were able and fit, particularly during dinner hours. But, the complaints did not persist when they were asked if they too would like to be locked up if ever afflicted with the disease. After one year of this experiment, Florida International University performed an evaluation of our program and found, to everyone’s surprise, that our clients’ cognitive health had drastically improved because they were allowed to be part of the entire community. What a novel idea!


Elders Do Better at Home

19 Jun

 What accounts for reducing healthcare costs, faster recovery of seriously ill clients and improved physical and cognitive heatlh? You will never guess – bringing services to where these clients live.

The private assisted living industry is now fully engaged in servicing elderly clients in their homes. Most major assisted living chains are now caring for clients by dispatching caregivers to their homes at a cost of $240/day. Most have seen a growth of 20% in this line of service. The impetus to engage in this line of service may have come as a result of the stagnation that private facilities have been experiencing for the last five years; or, perhaps it may have been the result of several studies revealing that 89% of elders wish to remain at home as long as possible. Hospitals are finding out that seriously ill elders do better when medical services are provided in their homes.

John Hopkins University School of Medicine began the home-hospital movement back in 1996 as a pilot program. Research has proven that elders with potentially deadly diseases like congestive heart failure and cellulites can be safely treated at home with astonishing results. Not only was the care as safe and as satisfactory as hospital care, but recovery was faster and the cost much lower, 60% less.

There is no doubt that the trend in the future will be to provide as many services as possible to elders in their homes. A great idea!


The Challenges of Global Aging

23 May

America is a relatively young country as far as the percentage of individuals 65 years and older in the U.S. today. About 12% of the population in the U.S. is 65 years and older. However, that percentage is projected to increase to 20% within the next decade. Compare those numbers with that of other countries like Japan with the highest percentage of seniors currently at 21.5% of the population. Global aging affects all aspects of our society: work, health care, retirement, services and housing, among others. One of the major challenges is what we call the dependency ratio which means that for every person age 65 years and older there will be fewer than two persons in the workforce and available to care for the older generation. Exceptions are those countries with high birth rates (Mexico, Iceland and Turkey) or in countries like Australia, Canada and New Zealand with high immigration. However, in most countries the dependency ratio will sharply increase from 2020 to 2050. It is becoming more important that we create new ways to care for this aging population that is cost effective and dignified. The U.S. has the highest per capita health care expenditure in the world with a per capita cost per individual of $6,714. Japan, on the other hand, has the lowest health expenditure with a per capita expenditure of $2,581, half of that of the U.S. Most of the expenditure in Japan is paid by the government.

During the Ashoka Summit held this month we were able to discuss with other Fellows challenges facing their countries. Masue Katayama, a Fellow from Japan, has worked for the past twenty years in providing services to the older population in Japan. She came to learn how our firm has been able to change how we care for this older population. We believe that the global financial crisis is pushing us to make due with less and to learn how to use government funding more efficiently. Our firm has a proven track record of being able to service three times as many seniors with the funding the government spends on one. Japan, along with many European countries, has older people and lower health care spending than the U.S. They do this by fixing prices and manipulating prices to keep costs down. Every two years the price of each treatment, test and medication is examined to see if excess profits are leading to overuse and if so the price is cut. This is not done in the U.S. because those who profit from high prices are so powerful. This rationing and price cutting impacts the ability to control chronic illnesses at an early stage. Instead of rationing, Japan should look at ways to improve people’s lives by systematically changing lifestyles through better diets, exercise, medication management and supervision. This is something that Japan and other European countries can learn from the U.S.

Masue and I sat down to establish a collaborative effort that will enable us to learn from each other. She visited one of our affordable assisted living facilities and was impressed with the home atmosphere and the improvement in the physical and cognitive health of our residents. We agreed to formalize this collaboration by her sending a group of her operators to the U.S. for a month to live and learn at one of our facilities. Mia will do the same as we know that there are lessons to be learned from Japan as they tackle the common challenges of global aging.