New World of Health Care

Article taken from The Senior Spirit newsletter

Although the good old days of seeing a family doctor are disappearing, health care is evolving so quickly that it could cause vertigo. Health clinics in local retail malls are increasing, and emergency centers are moving in next to grocery stores and hair salons. Meanwhile, hospitals are creating emergency rooms just for seniors.
A more significant change is the new emphasis on preventive medicine. Partly spurred by rising health care costs and the Affordable Care Act, new incentives encourage health care providers to focus more on prevention. Plus, in this age of electronic communication, your primary care physician can treat you at home, even if she doesn’t make house calls.

Concierge Medicine
Those who want more personal care from their physicians can use a “concierge” service. For an annual or monthly fee, ranging on average from $1,200 to $5,000 per year paid out-of-pocket, your physician is available at any time and can coordinate your health care. Doctors who practice in expensive areas tend to charge the highest fees; a high fee may also mean that they limit their practice to fewer patients to give each patient extra attention to discuss their health and any concerns and care needs. Concierge medicine is appealing to those who want a strong relationship with their doctor and who don’t want to wait to schedule an appointment or talk to their physician.

New Health Care System
One big change to the traditional health care system is the Accountable Care Organization (ACO), a network of doctors and hospitals that shares responsibility for providing coordinated care to patients with the goal of limiting unnecessary spending. At the center of each patient’s care is a primary care physician who coordinates the patient’s care with other providers.
In traditional medical care, hospitals and health care providers receive payment based on each service, visit or procedure provided, known as fee-for-service. Under the new system, the ACO is designed to pay doctors and hospitals based on how successfully they treat patients and keep them out of the hospital. ACOs must meet benchmarks for health care quality, focusing on prevention and managing patients’ chronic diseases while lowering costs with fewer hospital admissions, redundant tests and unnecessary treatments.
Medicare, the nation’s largest health insurer, has designated “Pioneer Accountable Care Organizations” and tracked their performance on 33 quality and performance measures, from patient satisfaction to hospital readmission rates to how reliably people with asthma, for example, get the care they need.
Last summer, the Centers for Medicare & Medicaid Services announced positive and promising results from the first performance year of the Pioneer ACO Model. Pioneer ACOs earned $76 million by providing coordinated, quality care and saved nearly $33 million to the Medicare Trust Funds.

Neighborhood Medicine
Another new development in health care provides easy access for consumers. Retail clinics—medical clinics located in pharmacies, grocery stores and “big box” stores, such as Target—are rapidly increasing across the country. They provide care for the more every day aches, pains and common conditions—such as bronchitis and vaccinations—typically delivered by a nurse practitioner. While you’ve long been able to get a flu shot or get treated for a sore throat, many established retail clinics, such as Walgreens’ Healthcare Clinic, have expanded into diagnosing and treating chronic illnesses.
With longer hours and no appointment needed, retail clinics fill a gap between your regular physician and costly emergency room care, are often more conveniently located and accept the same insurance that your regular health care provider would.
Free-standing emergency centers are the newest addition to convenient health care options and are located in the same shopping centers as the retail medical clinics. Both accept insurance. These free-standing centers offer emergency care and promise a faster in-and-out time than hospital emergency departments (EDs). In Washington State, emergency centers treat, diagnose and discharge patients within about 90 minutes, as opposed to the state’s average hospital ED wait of four hours. Costs are comparable to those of traditional EDs—at least for the patient. However, emergency centers are also generating complaints, because many people confuse them with urgent care centers, which are a form of retail medical centers for those requiring immediate care, but not serious enough to require an ED visit. Neighborhood EDs charge more than urgent care centers, because by law they must be equipped for emergencies, with special equipment and certified personnel. Some people who are treated for minor ailments, such as an allergic reaction, at a free-standing emergency center are shocked to later see huge bills. And insurance companies aren’t happy either, fighting large bills in court.

Medicine by Electronic Means
Although telemedicine has been around for a while, especially for rural clients far from medical centers, it’s becoming more widely used. For example, patients with chronic illnesses can be monitored at home, with their medical data sent to the health care provider, who can often prevent a trip to the hospital. Homebound patients can have their blood glucose or heart ECG monitored and data sent to a home health agency or a remote diagnostic testing facility for interpretation.
With telemedicine, various applications and services, including two-way video, smart phones and wireless tools, electronically communicate medical information between physical sites. For example, a primary care physician and specialist can together determine a diagnosis using interactive video or the transmission of diagnostic images, vital signs and/or video clips along with patient data.
Even mental health therapists can practice using telemedicine. Carolinas Medical Center in Charlotte, N.C., recently introduced a system-wide telepsychiatry program, which provides a mental-health evaluation without moving the patient to a psychiatric facility.

Senior Emergency Rooms
With a growing senior population, hospitals are taking steps to cater to the medical needs and sensibilities of aging baby boomers and their parents, with emergency rooms specifically designed for the elderly. They feature nonskid floors, rails along the walls, reclining chairs for patients and thicker mattresses to reduce bedsores, natural lighting throughout common areas, reduced chaos and noise, and staff specifically trained in geriatric emergency medicine.
Hospitals noticed that emergency rooms were not meeting the needs of the elderly. Older patients’ conditions are often more complicated because these patients may be taking many medications, have more than one condition, and are sometimes unable to clearly express what is wrong.
Hospitals also have strong financial incentives to focus on the elderly. People age 65 and older account for 15 percent to 20 percent of emergency room visits, hospital officials say, and that number is expected to grow as the population ages. At Mount Sinai Hospital in New York, volunteers interact with older patients to help keep them alert. An artificial skylight, which turns dark at night, is intended to combat “sundowning”—agitation and confusion at the end of the day. An iPad allows patients to have a two-way video conversation with a nurse, or touch the screen to ask for lunch, pain medication or music.

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Death and Dying..Have that Conversation!

Yesterday at a senior forum I attended there was a discussion on communication and what you want to happen when you reach your end of life times. The one absolute certainty in life (taxes aside) is if you are alive today, you will die sometime in the future. Unfortunately our society seems to be in denial about death and just does not want to discuss end of life with family. It is critical that you have discussions with your elder loved ones while they are still able to make sound legal decisions. The fastest growing segment of our population is 80 and older and the current statistic is 1 out of 2 people over 85 will have some form of dementia and will no longer be able to make legal decisions on their own.

A woman in the audience made the point that you not only need to have the discussion, but it needs to be in writing. Her story was she was the caregiver for her mother and she knew what her mother wanted in her final days. When her mother was hospitalized and facing her final days she was following her mother’s wishes not to seek treatment to extend her life but to just keep her comfortable. Her siblings, who were not involved in mom’s care accused her of “killing” their mom by not taking aggressive measures to keep her alive.

Seeing loved ones dying is difficult and we want to keep them with us as long as possible. How we want to spent our end of life times is very personal and everyone should have a written plan that is given to our family giving them permission to follow your wishes.

So how can this be done? There is a document available on-line called “The Five Wishes” That in plain language allows you to state in your own words the following:

• Who you want to make health care decision for you when you can’t make them
• The kind of medical treatment you want or don’t want
• How comfortable you want to be
• How you want people to treat you
• What you want your loved ones to know

The Five Wishes document is legal in 42 States and is available at:
There is a small cost, $5.00 for a copy, but it will be the best money you will spend to let family and doctors know exactly how you want your end of life to be.

Fortunately for the woman sharing her story, she and her mom had that conversation and because it was in writing, when the siblings saw their mom’s signature on the document they no longer interfered and mom passed peacefully. Go and have that conversation with your loved ones.

Starting this conversation may not be easy, especially if there is resistance. To help those who are planning on or have tried and met resistance, please share your experience on breaking through the first step.
….Steve Kramer

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Joining the Journey

I attended a great presentation today on how to reduce hospitalization in persons with dementia. There were about 80 participants that asked very good questions. Most in attendance either had a spouse or close friend who were in varies stages of dementia. The one question that struck me was from a gentleman whose wife was in the mid-late stage of Alzheimer’s and he wanted to know how to get her to understand she had Alzheimer’s and what that meant.
The speaker handled this very well by saying no matter how much you want to get your wife to understand, she will not be able to because the disease has robbed her the ability to reason. She went on to say that the one thing you can do is to join her where she is at. If you continue to try to reason with an individual who is no longer capable of understanding often the result is frustration for the caregiver and acting out behaviors by the person with Alzheimer’s. They act out because they are confused and frustrated themselves and because of the disease cannot express it in a constructive manner.
I always tell the families of our clients that they need to join their loved one in their “reality”. If they say the white wall is purple, then it is purple to you also. If dad says he needs to leave to go to work so he won’t be late, go along with it and when the opportunity presents itself, distract him with another task such as “ok dad but first we need to make your lunch”. Often he will forget all about work. Now this takes energy on your part, but far less than being in a constant battle when you try to convince him he is retired and no longer works.
What are your experiences in caring for an elder loved one with dementia? How have you joined their journey?

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Adapting to Growing Older-one mans perspective

Taken from the website


“I’m just dealing with the struggles of getting older.”
“What are those?”
“Oh, you know. It’s not as easy to run. Not as easy to do the things I used to do.”
“What’s something that improves with age?”
“You have more experience, I guess. And less pressure.”
“Less pressure?”
“Yeah. When you’re younger, you’re always so concerned about where you’re headed— whether you’re getting ahead, or falling behind, things like that. When you’re older, for better or worse, you’re pretty much already there. And you learn to adjust.”

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Living to 100 and Beyond

Characteristics of Centenarians
A study by the Boston University School of Medicine found that centenarians varied widely in years of education (zero years to post-graduate), socioeconomic status (very poor to very rich), religion, ethnicity and patterns of diet (strictly vegetarian to extremely rich in saturated fats), they found a number of characteristics in common:
• Few centenarians are obese. In the case of men, they are nearly always lean.
• Substantial smoking history is rare.
• Centenarians may be better able to handle stress than the majority of people.
• Not all centenarians show signs of dementia, and some had healthy-appearing brains.
• A woman who naturally has a child after the age of 40 has a four times greater chance of living to 100 compared to women who do not. A late pregnancy may be an indicator that the woman’s reproductive system is aging slowly and that the rest of her body is as well.
• At least 50 percent of centenarians have first-degree relatives and/or grandparents who also achieve extremely old age, and many have exceptionally old siblings. Male siblings of centenarians have a 17 times greater chance than other men born around the same time of reaching age 100, and female siblings have an 8.5 times greater chance than other females born around the same time of achieving age 100.
• Many of the children of centenarians (age range of 65 to 82) appear to be following in their parents’ footsteps with marked delays in cardiovascular disease, diabetes and overall mortality.
• Some families demonstrate exceptional longevity that cannot be due to chance and must be due to familial factors.
• The offspring of centenarians, compared to population norms, score low in neuroticism and high in extraversion.

The Role of Genes Versus Environment
Scientists have long debated the role of nature versus nurture: Studies of identical twins reared apart, for example, have shown 70–80 percent environmental influence and 20-30 percent genes. However, the New England Centenarian Study discovered that exceptional longevity (living over the age of 100) runs strongly in families. Other study results strongly suggest that the genetic component of exceptional longevity gets larger and larger with increasing age and is especially high for those age 106 years and older. The New England study was particularly interested in how centenarians are able to markedly delay, or in some cases escape, Alzheimer’s disease.
Researchers performed detailed and annual neuropsychological examinations on centenarians in the Boston area. The study concluded that most people have the genetic makeup to live into their mid- to late 80s in good health, and like centenarians, compress the time they are sick toward the end of their lives. Much of their ability to do so depends upon healthy behaviors, including not smoking, strength-training exercise and a diet conducive to being lean. Other studies have found that a sense of humor, playing music and a strong social system contribute to living over 100.

Recent Scientific Breakthroughs Science is making discoveries that could keep people living even longer than 100-plus. In March, Science magazine announced that a team led by an Australian researcher found that targeting a single anti-aging enzyme in the body has the potential to prevent age-related diseases and extend lifespan. This means that a whole new class of anti-aging drugs could ultimately prevent cancer, Alzheimer’s disease and Type 2 diabetes.
“The target enzyme, SIRT1, is switched on naturally by calorie restriction and exercise, but it can also be enhanced through activators. The most common naturally-occurring activator is resveratrol, which is found in small quantities in red wine, but synthetic activators with much stronger activity are already being developed.”
In May, a team of 70 scientists from the United States, China, Australia and Japan reported that it sequenced and annotated the genome of the lotus plant, which is believed to have a genetic system that repairs genetic defects and may hold secrets about aging successfully (“Research may help scientists learn anti-aging secrets of sacred lotus,”
“The lotus genome is an ancient one, and we now know its ABCs,” says Jane Shen-Miller, one of the researchers and a senior scientist with UCLA’s Center for the Study of Evolution and the Origin of Life. “Molecular biologists can now more easily study how its genes are turned on and off during times of stress and why this plant’s seeds can live for 1,300 years. This is a step toward learning what anti-aging secrets the sacred lotus plant may offer.”
Longevity research seems to be increasingly aimed not at getting people to live longer but, if they are going to live longer, to stay healthy. In the New England study, nonagenarians (subjects in their 90s), centenarians (ages 100–104), semi-supercentenarians (ages 105–109) and supercentenarians (ages 110+) had progressively shorter periods of their lives spent with age-related diseases. These findings support the hypothesis, known as the compression of morbidity, that as one approaches the limits of lifespan, diseases (morbidity) must be delayed (or escaped) toward the end of these longest lived, and that there truly is a limit to human life span and that this limit is around 110–125 years.
Despite this finding, the field of increasing our lifespan, known as life extension science, is a large one and appears to be growing.

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How to Have a Good Retirement on a Budget

Article is from the Senior Spirit newsletter.

The concept of a golden retirement is a relatively new idea. It was not until the late 19th and early 20th centuries that workers started getting pensions and lived long enough to enjoy their later years. Before that, people worked until they died.
More recently, we’ve created the ideal vision of retirement: usually a couple living near a beach (probably Florida) where they spend their days swimming, fishing, golfing and eating out with friends. Even though this ideal is unrealistic for most people, retirement can be pleasant if you watch your budget.

Creating a Budget: While figures vary, the general rule of thumb is to plan for a retirement that lasts 20 years, depending, of course, on what age you retire. This can be a long time to stretch your savings. The rule of thumb is that you’ll need about 70–80 percent of your pre-retirement income to live on in retirement, but that depends on your lifestyle and your health.

In creating a budget, experts recommend deciding how much money you need to live comfortably, taking inflation and taxes into consideration. If you are using financial planning software, you may be able to create an estimate of how much your money will depreciate over the next few decades. Even a small percentage of inflation (under 4 percent) will cause you to lose almost half of your buying power over 25 years.
Whether you’re thinking about retiring or have already retired, it’s good to make a budget, figure out what you need and what you don’t. First determine your income, remembering to use all your sources, including a long-term care policy or a reverse mortgage.
Experts recommend being realistic about investments and how much they will increase over time. Because the stock market is not performing as reliably as it once did, the old rule of withdrawing 4 percent a year from your nest egg is far from viable these days for most people. Economists have lowered their long-term projections for the stock market since its downturn. For example, baby boomers’ net household assets, 401(k)s, pensions, homes and other investments, minus their total debt, have lost 18 percent of their value since 2007, according to the Employee Benefit Research Institute.

Controlling Spending: Most retirees can’t control their amount of income, whether Social Security or rate of return on investments or pensions, but they can control spending. To give yourself a realistic view of how much money you need every month and what can be cut, experts recommend looking at your past expenses, usually your bank account and credit card statements for the past last 6 to 12 months. The next step is to list all your fixed or required monthly obligations, breaking them down into three parts:
• Essentials: This includes expenses that cover food, clothing, housing, transportation and health care.
• Non-essential monthly obligations: These include payments for cable TV, cell phone, gym memberships and subscriptions.
• Required non-monthly expenses: Items such as property taxes, insurance premiums, auto registration and home warranties may come up once a year. These expenses should be calculated on a monthly basis and included in your retirement budget.
Next, list all your flexible or optional expenses, such as traveling, hobbies, eating out and so forth. Even if you’ve retired already, you might want to think about your dream retirement, all the things you could do if you had the means. Then, consider how you could reallocate money from current spending.
The last step is to calculate your fixed versus flexible expenses and then total the two. Divide your fixed expenses by your total expenses. This shows you how much of your retirement income is going toward fixed expenses.
Several budget worksheets are available on the Internet to help you keep track of your expenses.

Getting Rid of Unnecessary Expenses.
Financial advisors recommend several ways to save money by removing superfluous expenses.
Insurance: Retirees can save thousands of dollars a year by getting rid of unnecessary insurance policies. You should sit down with your advisor to review your insurance portfolio to determine if there might be ways to reduce your premiums or perhaps eliminate coverage that is no longer needed.
If you’re no longer working, you probably don’t need disability insurance.
Downsizing: If you don’t need the big house, maybe the one you raised your family in, moving to a smaller house or simpler apartment can reduce your expenses considerably. Downsizing can shrink costs for utilities such as heating and air conditioning, as well as for maintenance on roofs, furnaces, yard work and so forth. A smaller home usually means less expensive property taxes. Even moving to a less expensive location can save money.

Debt: More than half of retirees had outstanding debts upon retirement, according to a study by the CESI Debt Solutions. Interest payments can cost thousands of dollars a year, money that you could spend on traveling or eating out. Because debt payments will eat into your relatively fixed nest egg, financial advisors recommend getting rid of as much debt as you can.
Many financial advisors recommend a strategy of paying as much as possible on the highest interest-rate debts first and minimum payments on all other debts until all are paid off.

Investment fees: Financial advisors recommend assessing whether retirees are paying too much in the form of expense ratios, transactional fees and trading and account costs for their investments. Some seniors can cut these fees substantially without altering their portfolios or making significant allocation changes. Managing such costs can save thousands of dollars a year, according to one estimate. One advisor recommends keeping fees as close to 1 percent of the total portfolio as possible.

Phones: Getting rid of either your landline or cell phone can save hundreds of dollars annually. Although most seniors might opt for getting rid of their cell phones, because of concerns about reception, one advisor recommends disconnecting the landline. You can use a cell phone anywhere, and a signal booster can improve reception.

Household appliances: Retirees can save money on their utility bills by replacing older, inefficient appliances and other energy-wasting items, as well as by improving their home’s insulation. Many utility companies offer free or discounted home energy audits to help homeowners and renters assess their power usage. One expert estimates that homeowners can save as much as $500 a year in energy costs after making recommended changes. Further, many states and utility companies now offer rebates for purchasing more energy-efficient appliances, such as refrigerators and air-conditioners.

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How good is your memory?

Wanted-1,000,000 people to participate in a memory study. Matthew Huentelman from T-GEN, a non-profit research facility in Phoenix, Arizona, is doing a worldwide study on how thinking and memory change as we age. Matt is looking for a range of ages, from 18-80 with a variety of backgrounds and cognitive abilities. The goal is to help find a cure for Alzheimer’s and other brain disorders.
Participation is easy and only takes 10 minutes, go to and take the memory test and be a part of the solution for Alzheimer’s.

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