“Northwestern Medicine may have found the one hospital market where investment in long-term care hasn’t paid off: affluent north suburban Lake Forest.
“Northwestern-owned Lake Forest Hospital recently applied to permanently shutter its long-term care unit, Westmoreland Nursing Center, citing increased operating costs, failure to adequately fill 84 beds and flood damage from mid-July.
“In its application to the Illinois Health Facilities & Services Review Board, which decides on health care projects to prevent duplicating services, Lake Forest Hospital noted that it originally planned to close the long-term care facility by the end of the year, but that heavy rain damaged the nursing home and forced early transfer of patients. The board received the hospital’s application to discontinue 660 N. Westmoreland Road on July 28.
“Although the number of people age 65 and up has swelled in recent years to the fastest growing population in the U.S. … “
“Every summer around this time, pediatricians’ offices are flooded with children getting the vaccines they need to start another year of school.
“Doctors base their advice on which shots patients should get when on the Centers for Disease Control and Prevention’s vaccine recommendations. The guidelines are presented in two schedules, one for children, the other for adults, both divided into subgroups based on developmental biology and social behaviors common at different ages. Unfortunately, there’s a major problem with the guidelines. And it’s representative of a larger failing in our health care system.
“There are 17 subgroupings for children from birth through age 18. That makes sense because, of course, a 6-month-old has had little time to develop immunity, weighs far less than an 8-year-old and is exposed to fewer people than a teenager. There are five subgroups for adults. But all Americans 65 and older — including the two fastest-growing segments of our population, the 80- to 90-year-olds and those over 100 — are lumped in a single group, as if bodies and behaviors don’t change over the last half-century of life.
“You don’t need to be a doctor to see that this is absurd.”
Read this New York Times opinion column in its entirety, click here.
“As more and more seniors need care, their budgets will be strained. As a result, they may rely on Medicaid.”
“Efforts to repeal and replace Obamacare have been suspended for the time being, and many Americans are breathing a sigh of relief. But Obamacare is far from safe, and the same is true for one of the key programs – Medicaid – that the law used to expand health care coverage for millions of Americans.
“While many people may think of Medicaid as a government program that helps only the nation’s poor, that is not accurate. Medicaid helps pay for – and is indeed part of estate planning strategies for – nursing home care and other forms of long-term care. Since all Americans live in communities with elderly people, will grow old themselves or have aging parents, long-term care and how to pay for it is a matter that affects us all, even if we do not realize it.”
Medicaid and seniors
Enter Medicaid. While many may think Medicaid primarily covers poor people, about 28 percent of its overall budget is spent on long-term care.
That money is vital to seniors and to the nursing homes they live in. In 2014, Medicaid paid for 62 percent of nursing home residents. Increasingly, it covers assisted living and in-home care, which many elderly people prefer.
Continue reading this article at The Conversation, click here.
Quality Insights shares Practice Change Package | a resource for those who prescribe, dispense and monitor patients with chronic pain
Quality Insights’ Special Innovation Opioid Project Team, in collaboration with the West Virginia University (WVU) Health Sciences Center School of Medicine and the WV Geriatric Education Center, has developed a Practice Change Package entitled Opioid Misuse and Diversion: The Big Picture; A Guide for Practice Change, to serve as resource to those who prescribe, dispense and monitor patients with chronic pain.
This guideline is:
- designed to improve patient outcomes, such as pain reduction and improved function
- based on emerging evidence, including observational studies and randomized clinical trials
- voluntary- not a prescriptive standard
- designed to improve communication between clinicians and patients about the risks and benefits of opioid therapy use when managing chronic pain
“The goal was to make sure hospitals didn’t send patients home too soon, without a plan for following up or without enough support at home to recover completely. – Science Photo Library / Getty Images”
Commentary by Kumar Dharmarajan and Harlan M. Krumholz
“Too often, people return home from the hospital only to find themselves heading back soon after. Sometimes the need arises because, despite the best care, it is difficult to slow the progression of disease. But other times, it’s because we in the health care system fail to communicate, coordinate and orchestrate the care that people need to successfully make the transition from hospital to home.
“Historically, U.S. hospitals have had little incentive to keep patients healthy following discharge. Hospital discharge indicated success, and we paid little mind to what happened on the other side. Meanwhile, 1 in 5 patients returned to the hospital within 30 days of discharge, and the health system largely felt it had no responsibility for that. Hospitals were paid each time a patient was readmitted.
“Over time, it became clear that the risk for readmission could be reduced with improved quality of care. For this to happen, hospitals would have to institute programs that would take into account the challenges of managing the recovery period. They would also have to be sure people were strong enough to leave the hospital – and had the support they needed after discharge. And mistakes that were all too common, like sending people home with the wrong medication list, would need to be addressed.”
Read this NPR article in its entirety – click here.
Yesterday, “Veterans Affairs Secretary David J. Shulkin … removed the two top officials at the Manchester VA Medical Center and ordered a ‘top-to-bottom’ review of New Hampshire’s only hospital for veterans.
“Shulkin’s action came within hours after The Boston Globe published a Spotlight Team report detailing what several doctors and other medical staffers allege is dangerously substandard care given at the facility.”
“Portrait of a four-star veterans’ hospital: Care gets ‘worse and worse’ – The Boston Globe SPOTLIGHT REPORT
The U.S. Department of Veterans Affairs annually rates its facilities; the 2016 End of Year Hospital Star Rating lists its healthcare facilities. Lebanon Veterans Affairs Medical Center received a four-star rating as did the Manchester, NH hospital.
“One-fifth of all Americans have a disability, but less than 1 percent of doctors do. That’s slowly starting to change—to the benefit of medicine and patients.”
Photo illustration by Slate. Images via rashadashurov, oculo/iStock.
“When Dr. Bliss Temple was in training, she remembers being in an elevator wearing her white coat and her stethoscope when a patient who was using a wheelchair got in. Temple is paraplegic; she also uses a wheelchair.
“We checked out each other’s chairs, and then he looked at me and said, ‘Oh! You’ve joined the enemy.’
“More than 56 million Americans have a disability of some kind—nearly a fifth of the country. Yet a vanishingly small percentage of doctors have a disability of any kind—estimates vary and data is scant, but the consensus suggests that the number is somewhere around 1 percent.”
See how the Better Care Reconciliation Act (BCRA) impacts you | interactive map “compares county-level projections of premiums and tax credits for marketplace enrollees”
This Kaiser Family Foundation article contains an iteractive “map (which) compares county-level projections of premiums and tax credits for marketplace enrollees under the Affordable Care Act (ACA) in 2020 with estimates for the Better Care Reconciliation Act (BCRA) as unveiled June 22 by Senate Republicans. Our maps comparing premiums and tax credits under the ACA and the American Health Care Act (AHCA) passed through the House are here.
“This map includes premium and tax credit estimates by county for current ACA marketplace enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $60,000, $75,000, $100,000, or 351% of the federal poverty level (which is just above the cutoff for tax credits under the BCRA). The map includes estimates for premiums, tax credits, and premiums after tax credits for bronze and silver plans in each county in 2020.
Most current Healthcare.gov enrollees have lower incomes:
- About 66% of enrollees have incomes at or below 250% of poverty (approximately $31,250 for a single individual in 2020), with the bulk (44% of all enrollees) having incomes at or below 150% of poverty (approximately $18,750 in 2020).
- About 36% of enrollees are under age 35, 37% are age 35 to 54, and 27% are 55 or older.”