Yesterday, I attended the funeral of one of my weight-lifting friends, who had suddenly died of heart failure while sitting at the breakfast table.  This gentleman, only a year older than I, was a PhD Physical Therapist, and the go-to person on our team for any strains or injuries we thought we had incurred during a training session.  He was also a loving husband and father who cared for his wife and their children during both of his wife’s bouts with cancer.

But like the cobbler’s children who have no shoes, my friend never bothered to get checked out himself – in fact, it had been more than six years since he visited the doctor.  My friend had put on some weight over the years, and he enjoyed an occasional cocktail – did he stay away from the doctor because he didn’t want to be scolded for these lifestyle choices?  Was he afraid to get a definitive answer about something he suspected?  Or, as a partner in a busy practice with multiple family obligations, was it just something that continually moved to the bottom of a long to-do list?  Unfortunately, we will never know.

What we do know is that the choice to stay away from the doctor not only affected my friend, but also his family, his business partners, his patients and all of us who care about him. 

As part of the Affordable Care Act, both Medicare and private health insurers are required to provide many preventative services, including an annual physical and screening mammograms and colonoscopies, at no cost to the patient.  The purpose of this law is to give you the opportunity to learn whether you have a potentially dangerous health condition when it can still be effectively treated.  It can also prevent a much deeper pain for those who can’t imagine going forward without you.

Despite recent advancements in coverage for preventative care, Medicare still does not not cover dental care that is primarily related to the health of your teeth. For example, Medicare will not cover routine checkups, cleanings or pay for fillings or dentures, even if Medicare has paid to have a teeth pulled (extracted) as preparation for a medical procedure. Read the rest of this entry »

A VA study indicates that the use of nasal insulin spray can improve memory, thinking skills and functional ability for people with Mild Cognitive Impairment (MCI) and Alzheimer’s Disease.

Researchers in previous studies had found that low insulin levels in the brain might be a contributor to Alzheimer’s.  The nasal spray quickly delivered the insulin directly to the brain, with no apparent side effects.

104 adults participated in the study, with some receiving the insulin and others receiving a saline placebo.  The results were sufficiently encouraging to support broader trials to study the use of this therapy to either prevent Alzheimer’s or slow its progression.

The Study was conducted by a team at the Geriatric Research, Education and Clinical Center at the VA Puget Sound Health care Center, and led by that National Institute on Aging, which is part of the National Institutes of Health (NIH).  Results were reported in the Archives of Neurology, published on September 12, 2011.

A recent study in the highly respected New England Journal of Medicine (http://www.nejm.org)  reports that a significnt number of patients with Alzheimer’s disease or other terminal conditions are moved from their care facilities to the hospital for tests or treatment that do not make medical sense.  It appears that some percentage of these moves are motivated by the fact that Medicare will pay a premium to the nursing home when it takes the patient back after a period of hospitalization. 

In addition to enduring the trauma of the move, these patients are more likely to have a feeding tube inserted or to develop a pressure wound (bedsore) than those patients who remain in their care facility. And many of the conditions for which these individuals are moved could be treated just as well in the nursing home. 

Many of us who are involved in caring for the elderly, either in our families or through our professions, react by thinking “they needed a study to tell us that?”  Unfortunately, for all the focus in The Patient Protection and Affordable care Act on reducing hospital readmissions, there is minimal attention to preventing unnecessary first admissions. 

As with most medical decisions at the end of life, the best prevention is to have your medical directives in place, and to make sure the agent in your health care power of attorney  understands that you do not wish to endure unnecessary hospitalizations at the end of your life.  The ability to honor our loved one’s wishes can be the best gift we can give them at this sacred time of life.

Two posts in today’s weekly bulletin for members of  the National Academy of Elder Law Attorneys highlight the ways in which our institutions need to continue to evolve to keep pace with changes in our society.  (www.naela.org)

According to figures from the most recent U.S. Census, the number of couples over 65 who are living together has tripled over the past decade.  This may be partly due to financial reasons, as both parties want to keep the maximum amount of Social Security income that they can, and may want to avoid co-mingling their funds.  But it also reflects changes in attitude, as the number of people who believe that living together outside of marriage is sinful is steadily declining.  As more and more baby boomers – many of whom lived together before their marriages – reach this age, these numbers are likely to continue to grow.

The second post talks about increased enforcement of government guidelines to protect hospital patients’ rights to choose their own visitors.  Without these regulations, adult children could exclude their parent’s live-in companion, or other relatives could exclude a same-sex partner.  However, according to the standards that all hospitals must follow in order to be eligible for Medicare and Medicaid reimbursement,  hospitals much explain to their patients that they have the right to choose who may visit them, whether it is a family member, a domestic partner of either gender, or any other visitor, and they can also withdraw their permission for visitation at any time. Earlier this week, The Centers for Medicare and Medicaid sent a letter to the state agencies that audit compliance with their rules highlighting these new procedures.  More information on the CMS guidance.