The debate about the effectiveness and safety of vaccines rages on. Opinions vary wildly about their usefulness for children and the nation as a whole. Recent outbreaks of measles have brought the issue front and center in the media, but not many people are talking about the effect on the elderly population. So what do vaccines do for seniors? Are they beneficial for those with an aging and weakening immune system, or do they open people up to more illness than they protect against? Here’s a few facts to consider when debating whether you or someone you care for should be vaccinated:
It’s hard to imagine children growing up in nursing homes, never mind dying there. But right now there are over 6000 kids living in medical facilities for the elderly, according to federal data. These are sick children, in need of high levels of medical care to survive each day; nursing homes are not the best place for them, but they are better than every other option their parents have. Nursing homes for the elderly are specifically designed to handle complex and time consuming medical needs, but they are not intended to meet needs specific to children.
It can also be hard to find a nursing home willing to take a child, and sometimes kids end up far from home and family. Zach moved into a nursing home at ten years old because his needs were too intense for most child care programs, and his mother had to keep her job for the insurance that paid his medical care – not to mention provided food and a place to live. The state would not pay for at home care and the only place that would take him was 200 miles away in another state. His mother made the trip every 2-3 weeks to visit and meanwhile tried every way she could think of to bring him closer to home. When Zach turned 21, after eleven years in a home for the elderly, he was no longer eligible for the children’s program that had supported him, and his care deteriorated. He spent most of his time in bed and got sicker. His mother’s primary fear was not so much that he would die, but that he would be alone when it happened. A program that would allow him to receive care at home became available, but Zach had lived out of state for so long that he was not eligible. He would have to live in an in-state facility while waiting on a list, thousands of people long, to get into the program. At 25 he died in the nursing home waiting for his chance.
Bylon was six years old when she had a stroke. She received care at home until her mother got sick and was hospitalized. Bylon had to move into a nursing home and not too long after that, her mother died in the hospital. On the day of the funeral, aides got her dressed and ready to travel, but the van to pick her up never came and she missed her mother’s funeral. She wanted out of the nursing home badly, but there was no one to take care of her. At 23, Bylon got into a program that would pay for an accessible apartment and aides, but there was a waiting list. She was excited to live her own life, for the first time since she was six. She aspired to finish high school and go to college. A year later, Bylon died in the nursing home.
Nursing homes are designed to take care of the elderly. Typically, patients are tended to for medical and basic personal needs and left to themselves the rest of the day. Activity programming is geared toward the interests of people over 60, not under 10. There is no friendship, no social time, no education, and not many visitors. There is no childhood in a nursing home. However, there is life. When there is no other alternative, placement in a nursing home saves kids’ lives; having a place to turn in desperation is a godsend. Most parents are fortunate enough not to have to consider sending their child away to live in such an environment, and because the problem only affects a small percentage of the population, better solutions (like youth nursing homes) are not well funded. Where else are desperate families to turn? Until there is a better solution, children will continue to be sent away from the familiarity and relative comfort of home to live in a facility amongst the sick and dying.
Antipsychotic drugs are a dangerous treatment for dementia patients – they increase risks for heart failure, infections, and death. And they do absolutely nothing to improve dementia. Yet in 2011 nearly 88% of Medicare claims for antipsychotic drugs given in nursing homes were to treat dementia patients. Why?
The reason is disturbing and appalling. Doctors in nursing homes prescribe antipsychotic drugs to dementia patients to make them easier to handle. It is much simpler for nursing home staff to monitor and care for a person who is drugged into a stupor. They don’t get confused or agitated, wander away, or resist treatment. They simply sit without complaining. It is called chemical restraint, and it is against the law.
After the 2011 study, the government decided to crack down and stop this dangerous behavior. But the solution has no teeth. Take the example of Texas, whose nursing homes have the highest rate of antipsychotic drug use in the US. An independent analysis of Medicare claims and payments has shown that Texas nursing homes are actually less likely to be censured for their misuse of drugs than most other states. In fact, only 2% of infractions were rated at a level that incurred a fine when state inspectors made their visits. CMS’s approach is one of collaboration with states. The Chief Medical Officer said, “There are many near misses…where medication might be given that’s not needed and doesn’t cause permanent harm. We view that as a learning opportunity.” An alternative view: it is illegal and harmful to patients.
But Medicare keeps paying for it. In one six-month period, they paid $116 million, and they keep doing it. CMS would rather partner with states to reduce claims over time than put a halt to this unconscionable behavior right now. It’s not hard to imagine what would happen if Medicare started denying the claims. It is, however, very hard to imagine why they continue to approve them. My insurance company won’t pay for medicines that they believe I don’t need – since when does Medicare?
It’s hard to imagine a person who is poor enough to qualify for Medicaid passing their medical debt down onto their children, but it happens. One woman whose mother had recently passed was handling the sale of her mother’s home. Her mother had been ill for the last few years of her life and rather than go to an expensive nursing home, she had aides come by to help her out. There were doctors’ bills and prescriptions, all covered by Medicaid once she qualified. After the mother’s death, the woman received a bill for over $85,000 that Medicaid said she had to pay for her mother’s care. It came as a shock, but it is completely legal.
States are actually required to try and recoup cost of care from the estates of people who die having received Medicaid after turning 55. In order to qualify for Medicaid, a person must have very little in the way of assets. However, it is allowable to own a home and still receive benefits. But after death, the state will send a bill for the cost of care; this can mean assets from the sale of a house go to the state.
This regulation has actually been around since Medicaid began, but was used very little because it only affected people over 65 (now it’s 55), few of whom qualified for Medicaid in the first place. But with recent expansions to Medicaid, more people are falling into this category and should be aware of the possibility.
While states are required to make an attempt to recoup their costs, the effort they must put into it is not established. Some only go so far as to send a bill. Ten states so far have indicated that they will be following up on claims and seeking retribution. Others are holding off due to the costs involved in pursuing reimbursement and the fact that a good portion of the money they get back goes straight to the federal government anyway.
This practice has already begun to discourage people from signing up for Medicare, which puts a lot of people in a tough spot. Anyone will attest to the exorbitant cost of medical care these days. Trying to get by without Medicaid lands people in serious debt, and creditors will not wait until you pass away to collect their due. Medical bills are the number one reason individuals file bankruptcy in the US. Overall, Medicaid is still the right choice for people in need, but it is important to be aware of the potential cost to your heirs. There is a small chance it will cost your kids a little inheritance, but it will improve your healthcare options and financial stability while you are still alive.
The short answer…Yes. Until recently the federal government refused payment for such treatments claiming they were controversial and unproven. Now the ban has been lifted so the decision comes down to regional judgment. Some areas have jumped to allow it, while others are playing wait-and-see. Nine states have even gone as far as to declare that insurance companies covering mental illness cannot decline transgender operations as treatment; New York is the most recent to join in, pending a public comment period of 45 days.
So what does the public think? Be it proven treatment or not, gender related issues are a hot button topic and not everyone is happy that their tax dollars will be paying the bills. As you might imagine, public opinion runs the gamut. Here are a few remarks that are representative of the greater range of opinions:
“If it bothered them that much then they should have saved up money while they were younger and paid for the surgery themselves. Obviously it wasn’t that important to them or they would have done that. Our government is 17 trillion dollars in debt. We don’t need to add to that debt by paying for elective cosmetic surgery. It’s ludicrous.”
“…providing trans gender people the gender reassignment surgery (below the waist) and providing them with the drugs needed for the transition is acceptable BUT the other services like permanent hair removal, breast and buttocks augmentation, and all facial cosmetic surgery should not be paid for by any health insurance company or medicaid. Why, because the insurance companies do not provide these services for others who want or need it; providing these services for a select few individuals while excluding all the others is unfair, biased and sexist…”
“Medicare, in my jurisdiction, doesn’t cover anxiety or depression. Why would they (me) pay for a surgery to make someone (you?) happy? How about a face lift too…enlighten me as to why tax payer money should pay for this and not other procedures that are pertinent to a patient’s health?”
“Do you think the same thing about things like hip and knee replacements or corneal implants? Where do you draw the line on what conditions should be treated and what should not.”
“My wife suffers from depression because her breasts are smaller than what she would like them to be. So will medicare cover her boob job so she’ll have more confidence in herself?”
“It’s a biological condition that’s formed in the womb when sex traits start to develop.”
“Please somebody tell me this is a joke. We have veterans DYING waiting for appointments and this administration wants to spend taxpayer money on ELECTIVE SURGERY?”
“No. Just NO.”
Public forums slant rather heavily toward the outraged and sarcastic, but there are voices of agreement as well. Whether or not the law passes the public comment period in New York, more insurers – Medicare and Medicaid included – are covering sex change surgery and hormone therapy as treatment for a mental disorder. So, as it turns out, even the long answer is: Yes, you can get a sex change on Medicare.
In Washington State an 83 year old dementia patient was raped, and it was caught on film. The family of the victim had suspected abuse and so they set up a hidden camera. The result was a video of the facility’s owner sexually attacking the elderly woman. Authorities arrested the man, shut down the facilities he owned and ran, and sent all remaining patients to the hospital to be checked for signs of abuse. This instance was handled with swift action, but sadly this is the exception to the rule.
A study was done in Chicago nursing homes and found that over a two-and-a-half year period authorities investigated 86 cases involving sexual assault of a resident. Of those cases, only one led to an arrest. Eighty-five people were reported as victims of sexual assault and found no justice. The study found that the vast majority of these crimes were perpetrated by another resident who forced his way into a woman’s room or abused her while staff was not nearby. Incidentally, the one case that was actually prosecuted was one in which a staff member was accused. Outside of nursing homes, Chicago police make approximately one arrest for every three reports of sexual assault filed. There is a huge disconnect between typical arrest patterns and those in nursing homes.
The study dug a little deeper into the locations where assaults were reported. Instances of rape were found to be reported from only 30 of the 119 communities in Chicago, and these particular locations were twice as likely to have residents who were felons or mentally ill. They also have substandard staffing as compared to those where rapes were not reported. A picture is painted of predators roaming around unchecked, terrorizing the elderly, the sick, and the helpless.
In one instance, a 28 year old man confessed to beating and raping a schizophrenic elderly woman in the facility where he lived. The woman corroborated the story at the time, but was not as cooperative later in the investigation. Despite the confession and physical evidence to back it up, no arrest was made.
Another case involves a dementia patient in hospice care. A call reporting sexual abuse was made to the nursing station of the facility in which she lived. The head nurse did nothing for one whole day. The victim was bathed, her clothes were laundered, and her room was cleaned – in other words, the evidence was removed. The alleged perpetrator was allowed to continue caregiving duties in the area where the victim lived. After a full day, the patient was sent to the hospital for a routine physical, not for a suspicion of assault. It was only when the hospital declined (she was not due for her exam) did the story come out. Even then, the nurse only called authorities after the hospital threatened to do so themselves.
Cases like these are fraught with problems for law enforcement. Victims are often mentally ill, afraid for their safety (as they live with the rapist), or unwilling to cooperate. However, it is appalling and unacceptable to allow this type of behavior to go unchecked, especially in cases where the supposed caregivers are turning a blind eye to the problem. Instances where staff members impede the investigation should be treated extremely harshly. Losing a job or a license is not enough; there ought to be criminal culpability for helping a predator to escape.
Retirement isn’t just card games and gardening anymore. The flower children of the ‘60s are now filling up assisted living communities and they are definitely making love, not war. According to the National Survey of Sexual Health Behavior, over half of men and forty percent of women above 60 are sexually active. Put all those consenting adults together into an apartment complex 24/7, and it becomes more like a college frat house than a nursing home!
The abundance of sex is not the problem by itself, but the spread of disease is a concern. Senior citizens are charging ahead with astonishing growth in STDs, and the trend isn’t going soft. Numbers reported from the CDC show that over a four year period chlamydia infections among the senior population grew by more than 30% and syphilis cases rocketed upwards by 52%. HIV has been on the rise as well. The generation now in retirement received far less sex education than those coming up behind. Aside from warnings about ladies in foreign ports, there was no talk of safe sex for this group. Studies show that across all age groups, condoms are used about 40% of the time, but in the senior population they are only used in 6% of sexual encounters. Medicare does offer free screenings for STDs, but that seems akin to a morning-after pill, and only about five percent of qualified people use them anyway.
So why the sudden rise in…figures, shall we say? The most obvious answer would be the assortment of pills for male performance that were not as widespread in previous generations. Overall health and mobility are improved, as well. More senior men are physically able to have sex, and post-menopausal women with no fear of pregnancy are abundant. Besides, sex is fun! Just because you don’t think of grandma as a minx between the sheets, doesn’t mean she hasn’t learned a thing or two in her time.
There seems to be an untapped market for condom education and sales here. A vending machine in every retirement community? Or maybe housekeeping could leave something besides a mint on the pillow when they clean apartments? Whatever your personal opinion on the matter, Bingo is out – sex is fast becoming the favorite activity of retirement communities!
The Department of Health and Human Services recently published a study finding that about 22% of Medicare patients who go into a skilled nursing facility are actually harmed while they are there. Over half of these incidents were deemed preventable in the study, meaning more than ten percent of the people who go into nursing homes get sicker when they should have gotten better. Another 11% of residents experienced temporary harm, but their overall condition did not worsen because of it. That probably doesn’t make them feel better about it.
The HHS study found that more than half of the instances where a patient was harmed could likely have been prevented with better quality of care. Reasons found for these events are things like lack of monitoring, substandard treatment or, worse yet, necessary treatment not being provided at all. And sometimes the reason is simply a lack of skill in the person administering care – nurses hired and trained to provide healthcare are not very good at it. We’ve all known of someone who isn’t good at their job yet, inexplicably, stays on staff. But did you ever think it would be the person responsible for your life? Incompetencies like these resulted in the death of 1.5% of all Medicaid patients in a skilled nursing facility.
Aside from the horrible outcome of sick and dying people, these types of events lead to longer stays in SNFs, more readmissions to hospitals, and more time and money spent on care. The study estimates that $136 million was spent in August of 2011 on hospital readmissions from these likely preventable incidents. And yes, that is in just one month!
Instead of suggesting measures to improve training and programs, HHS’s recommendations were to enforce much the same oversights and reporting that hospitals face. While the threat of losing money can be a great incentive, a system that is already woefully under-financed might need a bit more to make the kinds of gains that patients need. Further, changing the payout system to force SNFs and hospitals to share one purse (another reform) sounds like elementary school justice rather than positive change. If you can’t share it, nobody gets any! Wouldn’t it benefit everyone to put a bit of that misspent money into improving nursing home care?
End of life care is as tender, emotional, and difficult as it comes. There are so many different factors that lead people to hospice, but the common thread is the search for comfort for both dying patients and the families accompanying them on the journey. Hospice workers take on patients knowing that hope is essentially gone and all that is left is to ease pain and provide support until the end.
Yet hospice is not always the end. In fact, about 20% of hospice patients are discharged alive each year. Of these, about a third chose to leave the program, which means that nearly 13% of patients relying on hospice services are expelled from the program. It sounds like this means terminal patients are recovering, but sadly around 40% of these people die within six months of being released. If you’re not doing the math, that’s 5% of people who qualified for hospice dying without services. Fifty-five thousand people, every year.
Hospice is supposed to be a comfort – pain management, grief counselling, an easing of suffering and the fear of death. It seems worse than cruel to offer help to these desperate people and then yank it away, leaving them to find their own way again. And it is happening more and more often. Between 2002 and 2012 the number of people discharged from hospice rose by fifty percent. I’m sure the reason will come as no surprise: budget cuts. Many patients have their care covered through Medicare or Medicaid. In the year 2000, Medicare spent $2.9 billion on hospice; in 2009 the bill rose to $12 billion. And now the budget is shrinking. CMS has had to get tougher about approving payments. Payments that can be held up for months (or more) while being reviewed put small hospice centers under a financial strain. Rather than risk bankruptcy from delayed or denied claims, they are getting stricter about who receives care.
Hospice is intended for patients who have less than six months to live. If their prognosis improves while under hospice care, it is legal (or in CMS’s case, required) to discharge them. Whether it is ethical is another question, actually one of some debate. The difference between true recovery and a temporary plateau is hard to determine, especially over just a few weeks. Even though people can be readmitted if their condition worsens, the trust is gone. Hospice care cannot be a yo-yo, jerking people up and down, leaving them uncertain what each week will bring. This is not comfort and support, but torture at the worst time in families’ lives. Yet, where will the money come from to pay for services? Doing the ethical thing can put for-profit hospice centers out of business, and then all of their patients suffer. Where is the line?
It is a terrible thing to have to judge how fast a person should die.
Living to be 100 used to be practically unheard of, but more and more people are making the trek thanks to better medical care and healthier lifestyles. Dissecting the choices these centenarians made has led to some interesting pointers for how to live to 100.
Some things won’t surprise you. Healthy eating and regular exercise are at the top of the list. A Mediterranean diet is the best for a long, healthy life. Foods like olive oil, fish, and vegetables are ideal for keeping your heart healthy and reducing the risk of certain cancers, Parkinson’s disease, and Alzheimer’s. One small change that may make a big difference is to eat a handful of nuts every day. This can reduce your chance of death by twenty percent. Beans and berries, especially blueberries, are the best source of antioxidants (which help reduce the effects of aging on cells). Rather than taking vitamins, get your nutrition from healthy foods. Add balance training to your exercise routine to reduce your risk of a fall, which is a serious danger for those of advanced age. Also, exercise your mind with mentally challenging activities to improve your chances of avoiding dementia. Likewise, social engagement and some type of religious affiliation will keep your mind healthier.
Living longer means making healthy lifestyle choices, but it also means avoiding certain risks. Obviously, avoid cigarettes and excesses like overeating or too much couch time. But did you know overtime can keep you short of your 100th birthday? So can traffic (think air pollution and frustration). People who leave work on time and take regular vacations tend to live longer. Keeping stress and anger levels down plays an important role in long term health.
It turns out that well-rested, optimistic, happy people actually live longer. Yes, into every life a little stress must fall, but don’t let it become an ongoing state. If you want to live to 100 (and enjoy it), here are a few more tips gleaned from those who have already made the journey:
∞ Be female. Of the 105,000 centenarians in the US, 80% are female. Sorry, guys!
∞ Have money. At least enough to be comfortable, take care of your health, and go on vacation now and then.
∞ Sleep. At minimum, 7 hours a night is recommended.
∞ Do it. Getting intimate around twice a week increases your life expectancy. But play it safe, diseases will shorten it.
∞ Get up. Keep TV time under 2 hours a day, especially as you age. After retirement, television keeps many people on the couch longer than is healthy.
∞ Pat a dog. Pets reduce stress and pet owners tend to live longer than those who aren’t.
∞ Laugh. As it turns out, it really is good medicine.
Sadly, there is no perfect formula to having a healthy, happy 100th birthday. But, as Theodore Roosevelt said, “Old age is like everything else. To make a success of it, you’ve got to start young.”