Monthly Archives: April, 2017

“For Some, Pre-Hospice Care Can Be A Good Alternative To Hospitals” – NPR

pre-hospiceAt Gerald Chinchar’s home in San Diego, Calif., Nurse Sheri Juan (right) checks his arm for edema that might be a sign that his congestive heart failure is getting worse. – Heidi de Marco/Kaiser Health News

“Gerald Chinchar, a Navy veteran who loves TV Westerns, isn’t quite at the end of his life, but the end is probably not far away. The 77-year-old’s medications fill a dresser drawer, and congestive heart failure puts him at high risk of emergency room visits and long hospital stays. He fell twice last year, shattering his hip and femur, and now gets around his San Diego home in a wheelchair.

“Above all, Chinchar hopes to avoid another long stint in the hospital. He still likes to go watch his grandchildren’s sporting events and play blackjack at the casino.

“‘If they told me I had six months to live, or [could instead] go to the hospital and last two years, I’d say leave me home,’ he said. ‘That ain’t no trade for me.’

“Most aging people would choose to stay home in their last years of life. But for many, it doesn’t work out:” Click here to continue reading this NPR article.

“PA House Republican Budget Squeezes Medicaid” – Pennsylvania Health Law Project newsletter

“The Pennsylvania House of Representatives has passed a Fiscal Year 2017-18 general fund budget that could have significant implications for the state’s Medicaid program. House Bill 218 (HB 218) was approved along strict party lines and referred to the Senate Appropriations Committee on April 4. At $31.5 billion, the House Republican budget proposal is considerably more austere than the $32.3 billion budget proposed by Governor Wolf in February, and would reduce overall state spending by just under one percent compared to the current fiscal year.

“Among other funding reductions, and without specifying how such savings would be achieved, House Bill 218 contained the following Medicaid appropriations:

  • MA – Capitation: $178 million less than the Governor’s Budget
  • MA – Fee-for-Services: $2.6 million less than the Governor’s Budget
  • MA – Long Term Care: $25 million less than the Governor’s Budget
  • Behavioral Health Services: $4 million less than the Governor’s Budget
  • Home & Community Based Services: $2.2 million less than the Governor’s Budget
  • Services to Persons with Disabilities: $2.1 million less than the Governor’s Budget

“Without further explanation, House Majority Leader Dave Reed, R-Indiana, told reporters that implementing managed care ‘lock-in’ – by which Medicaid recipients could change insurance plans only once per year – would achieve $100 million in Medicaid savings. Whether the remaining Medicaid savings would require cuts to reimbursement rates, waiting lists for HCBS waiver programs, or still-to-be-announced policy changes is not yet known.

“HB 218 did include the funding for the consolidation of four Departments—Aging, Drug and Alcohol Programs, Health, and Human Services. Over the last month, Legislative Committees have been holding hearings regarding consolidating the Departments and forming one Department of Health and Human Services (HHS). Separate legislation would be needed before the departments could consolidate, and lawmakers have expressed concerned about the lack of details available thus far about plans to bring the agencies together as of July 1st-the proposed start date for this action. Legislative committees held two hearings in Harrisburg on this issue with another hearing scheduled in Pittsburgh on May 1, 2017. More information about the hearings held thus far can be found here. Governor Wolf has released a website that details draft HHS unification legislation and organizational charts. The website also includes a way for the public to provide feedback.

“Both chambers of the General Assembly and Governor Wolf are now expected to  continue budget negotiations, with a final agreement expected before the next fiscal year begins on July 1st.”

Friday Wrap-Up, April 28, 2017 | a message from the Secretary of Aging

Each week the Office of the Secretary of Pennsylvania’s Department of Aging releases a Friday newsletter with information relevant to activities, issues and events for older Pennsylvanians and persons with disabilities across the Commonwealth.

Click here to download the April 28 newsletter.


“The patients we do not see” – The Conversation

patients we do not see“An empty wheelchair – or is there a person there we do not see? From”

“In medicine, we speak of ‘seeing patients’ when we are rounding in the hospital or caring for those who come to our clinics. But what about those people who may be sick but do not seek care? What is our responsibility to the patients we do not see?

“This question takes on greater urgency in the current political climate, as patients face the threat of losing health insurance. Renewed efforts to repeal and replace the Affordable Care Act leave millions wondering whether they will be covered.

“For me, as a physician practicing in the safety net, abstract numbers evoke the very real stories of my uninsured patients. One of my patients, whom I’ll call Elsa, had not seen a doctor since immigrating to the United States 15 years ago. That abruptly changed one morning: She awoke to find the room spinning around her and, terrifyingly, she could not articulate the words to explain to her husband what was going on. She was having a stroke.

“There are many reasons that patients like Elsa may not seek care – until they have no choice.”

Continue reading this article at The Conversation.

HealthChoices and Community HealthChoices Information

understanding community healthchoicesClick on the graphic to download the infographic as a .pdf file. 

The Wolf Administration issued a document entitled Understanding Community HealthChoices vs HealthChoices to explain the similarities and differences between the two programs.

Community HealthChoices (CHC) is a new initiative that will increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. HealthChoices is Pennsylvania’s mandatory managed care program for 2.2 million Medical Assistance participants.

CHC was developed to: (1) enhance access to and improve coordination of medical care and; (2) create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life. Long-Term Services and Supports help eligible individuals to perform daily activities in their homes such as bathing, dressing, preparing meals, and administering medications.

The document describes eligibility, timelines for implementation, and the CHC managed care organizations that will operate in each zone beginning in January, 2018.

“Views and Experiences with End-of-Life Medical Care in Japan, Italy, the United States, and Brazil: A Cross-Country Survey” – Kaiser Family Foundation

“In 2014, Americans ages 65 and older made up 15 percent of the total U.S. population; by 2060, that share is projected to grow to 24 percent. A majority of Americans (57 percent) believe the growing number of older people in the U.S. is a problem for the country, including a third (36 percent) who see it as a major problem. Older Americans themselves are more likely to see the aging of the population as a problem; six in ten (62 percent) of those ages 65 and over see it as a problem, including half (48 percent) who believe it is a major problem.”

end of life conversations

“In partnership with The Economist, the Kaiser Family Foundation conducted a cross-country survey of adults in the United States, Italy, Japan, and Brazil about people’s views and experiences related to aging and end-of-life medical care. These four countries are each at different stages of population aging, and have different cultural and institutional considerations when it comes to preparing and providing care for those near the end of life.

“This report gives an overview of the survey results for the U.S. A summary report comparing themes across the four countries and highlighting specific findings in Japan, Italy, and Brazil is available here.

Army OneSource offers FREE online behavioral health continuing education courses

caring for those who serve

Military Families face some unique challenges. In today’s Military culture, many Service members experience multiple deployments. This can leave them with health concerns, such as Posttraumatic Stress Disorder (PTSD), domestic violence issues and suicidal tendencies. Now more than ever, Military Families need our support.

Army OneSource can help. FREE online behavioral health continuing education courses are available (through August 26, 2017) to help inform health care providers, physicians and first responders about Military culture and the traumas of war. We want to help those who, in the course of their work, come into contact with a Service member, Family member or Veteran.

If you treat Service members, strengthen your knowledge – Take advantage of this FREE resource. Register and complete a continuing education course today. 

register now

Log in to the Army OneSource Member Sign-In Page and click “My Courses” to complete this important and timely training today.

To register for courses:

  • After logging in, select “Bring Them the Rest of the Way Home,” from the navigational toolbar.
  • Click “Army OneSource Online Training” and select “Add to Cart.”
  • Select “Checkout,” then update your contact information when asked, and click “Submit Order.”
  • Once you submit your order, you’ll be able to see the continuing education under “My Courses” and begin the online course.

Behavioral Health Continuing Education Courses help service providers better understand Military culture and the traumas of war. Thank you for your interest in caring for those who serve.



“Ageism In Healthcare And The Danger Of Senior Profiling” – Get Better Health

by Dr. Val Jones. “Val Jones, MD is the President and CEO of Better Health, PLLC, a health education company devoted to providing scientifically accurate health information to consumers. Most recently she was the Senior Medical Director of Revolution Health, a consumer health portal with over 120 million page views per month in its network. Prior to her work with Revolution Health, Dr. Jones served as the founding editor of Clinical Nutrition & Obesity, a peer-reviewed e-section of the online Medscape medical journal. Dr. Jones is also a consultant for Elsevier Science, ensuring the medical accuracy of First Consult, a decision support tool for physicians.”

“Hospitalized patients are often different than their usual selves. As we age, we become more vulnerable to medication side effects, infections and delirium.”

“We’ve all heard the saying, ‘age is just a number.’ Nowhere is that more important than in the hospital setting. Over the years I’ve become more and more aware of ageism in healthcare – a bias against full treatment options for older patients. Assumptions about lower capabilities, cognitive status and sedentary lifestyle are all too common. There is a kind of “senior profiling” that occurs among hospital staff, and this regularly leads to inappropriate medical care.

“Take for example, the elderly woman who was leading an active life in retirement. She was the chairman of the board at a prestigious company, was an avid Pilates participant, and the caregiver for her disabled son. A new physician at her practice recommended a higher dose of diuretic (which she dutifully accepted), and several days later she became delirious from dehydration. She was admitted to the local hospital where it was presumed, due to her age, that she had advanced dementia. Hospice care was recommended at discharge. All she needed was IV fluids.

“I recently cared for an attorney in her 70’s who had a slow growing brain tumor that was causing speech difficulties. She too, was written off as having dementia … ”

Read this article in its entirety, click here.



HHS Unification – a website explaining the particulars.

Earlier today, the Governor’s Office launched its website for all stakeholders to learn more about Governor Wolf’s initiative to create a unified Pennsylvania Department of Health and Human Services (HHS).  On this site, you can review the draft legislation, dive deep into the HHS draft organizational charts, and hear from the prime sponsors in the House and Senate. The website also includes a way for all stakeholders to provide feedback.

HHS Unification Website

“Using Our Pink Friend (POLST) Appropriately: Please Help!” – GeriPal

NOTE: This article is about the Physician’s Order for Life Sustaining Treatment Form – commonly referred to as the P.O.L.S.T. form. In Pennyslvania, the same form is modified a bit to the Pennsylvania Order for Life Sustaining Treatment.


POLST Paradigm Forms are different in each state — the order of the sections or the options within a section may be different — but they cover the same information.”

“The National POLST Paradigm Task Force (NPPTF) has just released their updated ‘Appropriate POLST Paradigm Form Use Policy,’ which can be accessed at So I’ll just start by disclosing that I am very fond of POLST (Physician Orders For Life Saving Treatment).”

Now on to the article at GeriPal: “Using Our Pink Friend (POLST) Appropriately: Please Help!”