Posted on 03 October 2010. Tags: alzheimer's, Aromas, big sur, California, caregiver, caregiving, carmel, carmel highlands, carmel valley, Dementia, elder, elder care, gilroy, hollister, Hospice, king city, live-in, marina, memory walk, monterey, Moss Landing, pacific grove, pebble beach, private duty, prunedale, salinas, sand city, seaside, senior, senior care The upcoming mid-term elections have both Republicans and Democrats targeting an important voter segment: senior citizens. I hope you all go to the polls! The Wall Street Journal ran an article 9/29 talked about the growing battle over a number of issues, including Health Care and Social Security. With inflation at a stand still causing the elderly to get by without cost of living increases necessary to cover rising health care and other day-to-day costs, these are hot issues.
According to the article, Republicans are focused on telling elderly voters that the Democratic health care overhaul will cripple Medicare by cutting $50 bil. from the program, while Democrats are telling older voters that the Republicans wan to gut Social Security, with some calling for a partial phase out of this money into private investment accounts.
This is a terrible idea in my opinion. At my last job I watched a man who was almost 70 and just getting ready to retire sitting at his computer crying as the market crash wiped out much of his 401K plan which he had planned to tap to have a peaceful and happy retirement. This was a few years ago but I just saw him last week–still sitting at his desk and unable to retire.
One problem these lawmakers may not have considered is the growing number of seniors with dementia and Alzheimer’s disease. My company, Family in Home Caregiving of Monterey, services these people with private duty caregivers which drive all over the peninsula to meet whatever needs they have. From Salinas to Gilroy to Monterey, our caregivers sometimes take the place of family, and we form a special bond with them. A frequent problem is getting them to take their medications. Many are forgetful or just don’t care. We don’t delve into their financial situations, however, I have spoken to many other people in the industry and there are a lot of seniors slipping into dementia and Alzheimer’s which unfortunately haven’t prepared for this situation with a living trust or someone who can take over their affairs. What would happen to these people if their social security were invested in the stock market and we had another prolonged economic downturn? It’s unlikely they would be able to make the proper financial decisions in order to protect their assets. My company motto is to allow seniors to remain independent and live in their own homes as long as possible. One sad story I recently witnessed was a caregiver looking for a job because the person she was caring for was being foreclosed on and they had to move in with a relative. I hope politicians don’t enable this to happen by throwing what should be a safe annuity payment, social security, into the volatile stock market. In the 2008 presidential election, voters 65 and older were 16% of the vote. 30% of voter were over 60 in the 2006 mid-term elections–I hope to see more seniors at the polls in these important elections. Posted on 03 October 2010. Tags: alzheimer's, Aromas, big sur, California, caregiver, caregiving, carmel, carmel highlands, carmel valley, Dementia, elder, elder care, gilroy, hollister, Hospice, king city, live-in, marina, memory walk, monterey, Moss Landing, pacific grove, pebble beach, private duty, prunedale, salinas, sand city, seaside, senior, senior care There was a disturbing story in the New York Times today about patients in nursing homes having to go out to pain clinics to get medication because of a policy many live-in facilities have which will not allow them to dispense certain medications without a written or faxed prescription from the Doctor on file.
The Drug Enforcement Administration (DEA) is now scrutinizing this practice, which can result in seniors being in pain for days before the proper paperwork arrives. The practice is an unfortunate consequence of the DEA cracking down on abuse of prescription narcotics, which some people get filled and then sell on the black market. Some unscrupulous Doctors have even been involved in this practice.
The DEA has also examined some nursing homes which allegedly dispensed narcotics without a written order from a Doctor, resulting in the current situation where some of the elderly living in assisted living facilities are left to suffer in pain, particularly on weekends when it’s difficult to get in touch with their primary care physician. Even on a good day Doctors are busy–according to the medical directors association, a doctor at a nursing home typically writes 169 prescriptions per month for a controlled substance. And many assisted living facilities don’t have a Doctor on staff causing further delays.
I’ve written on my blog many times about the unintended negative consequences of the new health care reform laws, which is costing seniors time and money. And many of them simply don’t have an abundance of either. I founded my company, Family inHome Caregiving of Monterey to help seniors from of all walks of life stay in their own homes and remain independent. I have Clients all over the county from Pacific Grove to Castroville and Salinas, and up to Moss Landing and Aromas. They are thankful that there is someone to help.
For many of them, we stop by and make sure they take their meds, get a hot meal, and get out and about and socialize with others which improves their mental faculties. They are the lucky ones who have friends and family looking after them, or have had the foresight to put money away and establish a trust or buy long-term health care insurance so they can be taken care of properly.
Unfortunately, there are millions of others which are shut away in nursing home and have no one looking after their best interests. As the NYT article pointed out, this often results in pain and suffering. It’s bad enough being left on your own with no friends and family, I hope the DEA can resolve this issue quickly.
Posted on 03 October 2010. Tags: alzheimer's, Aromas, big sur, California, caregiver, caregiving, carmel, carmel highlands, carmel valley, Dementia, elder, elder care, gilroy, hollister, Hospice, king city, live-in, marina, memory walk, monterey, Moss Landing, pacific grove, pebble beach, private duty, prunedale, salinas, sand city, seaside, senior, senior care New theories and possible solutions to treating Alzheimer’s Disease and dementia appear in the press on a weekly basis. The latest report in the Monterey Herald this week called attention to a recently published study with a new theory by Alison Goate of Washington University in St. Louis, MO in the PLoS Genetics journal. For a full copy of the study, click on this link.
Much of the research on Alzheimerse revolves around beta-amyloid plaque, although success has been mixed–I wrote in my blog about Eli Lilly’s pulling a promising new drug (Semagacestat) from the market in August after finding that those on the drug fared worse than those given a placebo.
The more recent report focused on protein tangles that clog brain cells. This could determine how quickly a person develops symptoms of Alzheimer’s Disease. This, paired with a second protein called tau, might signal how aggressive the onset of the disease becomes. The research report found that patients with mild Alzheimer’s and high levels of tau harbored a genetic alteration that predicted that they would worsen faster. The race is on now to figure out how to lower tau levels in patients which could be developing Alzheimer’s Disease, because this could slow down its onset. The new study posits that both proteins, tau and amyloid, play a role in how quickly people develop Alzheimer’s. Many harbor the disease for years, even decades, without showing symptoms. The study from Goate showed that there was up to a seven-fold difference in how quickly people deteriorated if they had a gene which caused them to produce abnormal tau. Genetic testing may one day be able to uncover signs that people are going to develop Alzheimer’s and many other terrible diseases. Although the research is promising, unfortunately it’s just the first-step in what is likely to be a long research project to explore this line of thought. Goate told a reporter that tau is just likely to be one of many genetic markers to be discovered that impacts Alzheimer’s Disease. That’s one reason I am a major supporter of the Alzheimer Association’s annual Memory Walk, their largest fundraiser of the year. This great organization is the largest private funding group for Alzheimer’s Research and the Family inHome Caregiving team has raised over $20,000 for this noble cause. To track our progress or find out more about the event (10:00 a.m. at the Custom House in Monterey on Saturday, October 16) click on this link. As always, thanks for your support.
Physical Therapists Offer Home Safety Tips To Avoid Falls
As the nation observed the third annual Falls Prevention Awareness Day on September 23, the American Physical Therapy Association urged older adults to take a moment to complete a room-by-room checklist to identify and repair possible fall hazards in their homes and begin an exercise plan to reduce chances of falling and risk of injury. "It’s critical that seniors remain active in and outside their homes to help reduce their risk of falling," says APTA spokesperson Patrice Winter, PT, MPT.
"However, hazards in the home are one of the leading causes of falls in older adults. Removing throw rugs, rerouting electrical cords, and installing handrails are simple ways in which one can make a home safer. Furthermore, an older adult’s risk of falling can be decreased through an individualized exercise program, designed by a physical therapist, to improve his or her strength, mobility, and balance."
According to the Centers for Disease Control and Prevention, more than one third of adults ages 65 and older fall each year in the United States. Falls are the leading cause of deaths due to injuries and the most common cause of nonfatal injuries and hospital admissions for trauma for the aging population. In addition to addressing home safety and exercise, older adults should ask all health care providers to review their medicines — both prescription and over-the counter — to reduce side effects and interactions. They should also have their eyes checked by an eye doctor at least once a year.
Family inHome Caregiving Blog
by Richard Kuehn on 04/13/14
Most pension plans have recovered nicely
after the recent stock market boom, however, some analysts are worried because there
will be a 52% increase in regulatory costs which will be phased in by 2016. Estimates are that there will be a whopping
$150 billion surge in liabilities because retirees are living longer. Morgan Stanley told the Wall
Street Journal that the new fees will add $20 billion in costs to their $2
trillion in pension obligations. And
that's just for one company! There are
more than 60 million Americans who are covered by defined benefit plans
currently, but this is likely to significantly decline over time. These new fees will only serve to increase
the number of companies that stop offering traditional pension plans to
employees because they are getting too expensive to offer.
by Richard Kuehn on 04/13/14
Many people get way too much salt in their
diet via snack and processed foods such as canned vegetables. There is a new
source of danger out there according to a recently published study in the
British Medical Journal. Anything that
you take regularly which fizzles in a glass or dissolves in your mouth is
likely to be packed with sodium. Those
who take these tonics have a 16% increased risk of heart attack, stroke and
vascular death compared with those who got sodium-free versions of the same
thing. This is likely due to the fact
that having excess sodium in your system increases your blood pressure, which
can cause other health problems. Make
sure you check the labels of anything dissolvable that you are taking.
by Richard Kuehn on 04/11/14
There has been quite a bit of press activity
regarding the recently released report from the inspector general for the Department
of Health and Human Services showing Medicare payments by doctor in 2012, and
now local newspapers are starting to pick through the data and single out
highly paid physicians. The front page
story of the Monterey
Herald yesterday focused on two local oncologists (a father and daughter
team) who were paid $2.6 million by Medicare in 2012. They were the two highest paid in Monterey
County and in a group of 54 doctors who received more than $300,000. One of the oncologists at the top of the list
said the high payments were due to chemotherapy drugs which were then billed to
patients and he said there was almost no profit margin on them, describing it
as a complete wash. After practicing on
the Peninsula for 40 years, he said Medicare reimbursement rates had been
pushed too low and praised Sam Farr for his efforts in getting reimbursement
rates raised, which I wrote about on my blog a
few days ago. It's too bad that
Medicare can't release reports regarding how much doctors are paid for services
rather than goods like pharmaceuticals.
It does seem like the margin on the pharmaceuticals would be quite slim.
by Richard Kuehn on 04/11/14
I wrote yesterday on my blog about the
Medicare study of 2012 data showing that the top one third of the highest paid
doctors were ophthalmologists. Today, a New
York Times article found various explanations for this. First, "There are just these pockets of
profitability within the system," Dr. Lisa Bielamowicz, executive director
and chief medical officer for research at the Advisory Board Company, referring
to the fact that there are a handful of doctors who can do a high volume of
very expensive procedures. Since it is
such a limited field, quite a bit of business goes to these doctors who do have
very lucrative practices. Other
ophthalmologists interviewed, however said the results of the study were misleading
because many give patients with macular degeneration multiple injections of a
very expensive drug on which they make very little margin. Medicare reimbursed doctors $1 billion in
2012 for the most expensive macular degeneration drug called Lucentis. It costs about $2,000 per injection and needs
to be given to the patient once per month.
One doctor who received $9.5 million in Medicare reimbursements in 2012
said it was largely due to Lucentis injections, on which he makes a profit
margin of just 3%. One doctor
interviewed said he performed 6,000 injections of Lucentis in 2012 at a cost of
about $12 million. There is certain to
be a big public debate about this in the coming weeks.
by Richard Kuehn on 04/09/14
I wrote on my blog yesterday about a Novartis
drug for congestive heart failure got two thumbs down from the Food & Drug
Administration (FDA), however, it did get good news on another drug
which is being developed to treat a rare form of lung cancer. The drug, which is called ceritinib is used
to treat ALK-positive lung cancer and has been found to be 20x more effective
as the current drug on the market, which is called Xalkori. Both drugs essentially turn off this ALK gene
which is causing the cancer. Xalkori has
only been on the market since 2011 and, although it's been effective, most
patients become resistant to the drug within 12 months and then relapse. The hope is that multiple drugs will be found
done to treat this disease, and patients can then be rotated between drugs so
they don't gain resistance.
by Richard Kuehn on 04/09/14
As promised, the inspector general for the Department
of Health and Human Services released 2012 data showing Medicare payments by
doctor and, as expected, there were a few outliers which are expected to cause
quite a bit of public outrage. One ophthalmologist
was paid $20.8 million and he had already been in the news last year after it
was discovered that a Senator had been using the doctor's personal jet to make
trips to the Dominican Republic. The top
1% of the 825,000 medical providers which were paid by Medicare in 2012
accounted for 14% of the $77 billion in billings. Medicare paid 344 physicians and other health
care providers more than $3 million each.
The 1,000 highest paid Medicare doctors received a total of $3.05
billion. Strangely, one-third of the top
earners were ophthalmologists and 10% were oncologists. The inspector general has promised to look
into this. This is an interesting moment
in time. This data has been available
for decades but the American Medical Association (AMA) got an injunction to
prohibit the release of the data in 1979.
However, in 2011 the Wall Street Journal's parent-company, Dow Jones,
fought to have the injunction lifted. It
won last year, and so this data will be made public going forward and will call
attention to potential fraud. The state
with the most top earners was Florida, which has been a hotbed for Medicare
fraud. This was followed by California,
New Jersey, Texas and New York.
Hopefully this data will be used to single out doctors who may be
by Richard Kuehn on 04/09/14
I see a lot of elder abuse in my line of work
and, sadly, it's often done by a family member or someone else that the senior
deeply trusts. In one of the more
disgusting cases I have read about recently, a police officer in the east bay was
arrested after it was discovered that he used his status as a police
officer to enter the apartments of seniors as well as an occupational medical
facility and steal their prescription pain killers. As if that weren't bad enough, the man was in
the K-9 unit so he had a large German Shepard with him which he may have used
to scare the senior citizens. Thankfully,
he is being held on $480,000 bail.
by Richard Kuehn on 04/08/14
A wonderful new tool has been
used which will reduce the need for some biopsies. Dubbed
"liquid biopsies", blood tests can now test for traces of cancer
cells or fragments of tumor DNA which are in the blood in just trace
amounts. A study which was published in
The New England Journal of Medicine showed that in some cases a liquid biopsy
could detect the worsening of breast cancer a full five months before it could
be seen on a CT scan. Some in the
medical community believe that these blood tests could one day be used to
screen healthy people for a myriad of different cancers, not just focusing on a
single problem such as a PSA test does.
Rather, it could be like running a DNA on your whole system to look for
abnormalities. There are still many
skeptics of this, but hopefully it will be proven to be a useful tool as many
biopsies can be very invasive.
by Richard Kuehn on 04/08/14
Novartis AG suffered a huge set-back when a
Food & Drug Administration advisory committee unanimously voted against
approving their new drug called Serelaxin (brand name Reasanz). The company believed it was going to be a
blockbuster drug, providing treatment for millions of patients with acute heart
failure. Currently most drugs on the
market for this aren't very impactful.
Last June, the FDA had put the drug in an expedited category called
"breakthrough therapies" and many believed it would gain
approval. Novartis said it would
continue to push for approval and that there is sufficiently compelling
scientifically and medically relevant to satisfy regulatory requirements.
by Richard Kuehn on 04/08/14
Physicians are under a full out
attack by a number of attorneys which are pushing a California referendum which
would throw out the $250,000 cap on malpractice suits that has been in place
since 1975. They hope the referendum
will gain momentum because it's paired with a popular idea that hospital
doctors should undergo routine drug and alcohol testing. "My view is that you can talk about
everything else, but the underlying reason (for the ballot measure) is the
$250,000 cap. It is going to increase health
care costs by several billion dollars and that will have direct adverse
consequences," Duane Dauner, chief executive of the California Hospital
Association, told the Wall Street Journal.
There will be plenty of lobbying on both sides of this issue. The medical industry in California had $31
million in campaign funds ready to fight the effort at the end of last year and
will be looking to raise more. The
California Medical Association, Planned Parenthood, pharmacists, hospitals and
insurance groups are all against it as well.