Health Care--Baby Boomers--American Recovery Reinvestment Act--COBRA--Medicare

As a baby boomer with an aging parent, health care, Medicare, and the American Recovery Reinvestment Act are all important to me in many ways.

My mother, now 94, has full Medicare coverage (she worked for 45 years and earned it)--both parts A and B.  She also has the AARP Medicare Supplement Insurance and Aetna as her Medicare D (pharmacy-plan) provider.  She's paying premiums for all of these insurance coverages and, after paying her doctors her 2009 deductible of $135, most of her medical bills are paid for.  The pharmacy bills are different.  Aetna offered a good plan--I've had to change providers every year since they started the Medicare D program).  Mom has been averaging about $165 out of pocket per month since January for her medicines.  We've switched all we can to generics.  Coming up soon (perhaps this month) she will go into the "hole in the donut" of the plan.  The initial coverage will have been used up and she will have to pay for her medicines until she reaches a "catastrophic level" of out of pocket expenses.  When I looked into this last December, this may amount to as much as $450 more per month for September, October, November, and December.
As a baby boomer, I can expect higher costs for health care as I age.

I can certainly see that we do need better systems in place to provide quality healthcare to everyone--without anyone being "ripped-off" in the process (by scamming people, doctors, medical facilities, etc.).  I have also experienced some of the health care providers submitting bills to Medicare, then billing my mother for the same fee.   I have to stay on top of things to make sure that legitimate bills are paid by the appropriate organization or insurance and to remember not to write a check for every bill I receive in the mail from a healthcare provider.

There is much emotion and drama being reported in the media about people and their concerns for health care.  My local congressman wants to have a telephone "town meeting" to talk about health care this evening. It's important!!  (See my post about CCRCs last week.)  Canada, the United Kingdom, and Australia have forms of "socialized medicine" that include both public and private doctors.  Various ideas have been proposed in the USA as to what kind of coverage is needed.  Many Senators are advocating the health care package provided to Senators and members of the House of Representatives as the model for everyone.  I don't know what their coverage provides.

I have Aetna's EPO plan with a dental supplement.  I had a marginally effective vision plan and, since I have my eyes examined at Sam's Club and Costco and get my glasses there when I need new ones, the Sam's Club and Costco prices are not so high that I absolutely need a vision plan.  I do need annual check-ups from an internal medicine physician, a dentist (twice a year), and an eye doctor.  These are to keep me in good shape and to make sure I don't have major problems not being tended to in a timely manner.

Individually and for families, getting and affording good health care is essential.  Not having it can cause permanent damage to health, family cohesion, and even death.

Keep working, Congress, to get all of us the best possible health care coverage from now on.  (I'm worried about the ongoing viability of Medicare and Social Security as we baby boomers continue to age and there are fewer workers to contribute to these funds.  Having a workable alternative that will be good for the next generations is important, too.)

Walking the Talk--Preventive Medicine and Vaccinations

I believe that it is important to "walk my talk" (to put into practice what I advocate).  (See my blog post about "What if everything were perfect, just the way it is?").

My health care plan would only pay for the normal seasonal flu shot for 2009-2010 if my doctor administered the shot.  My doctor's office is not planning to get the vaccine until late in September, 2009.

The Centers for Disease Control (CDC) have released the seasonal flu vaccine and pharmacies are already stocked.  Guidelines from the CDC advise administering the flu shots as soon as the supplies become available.

I went to my local Dominick's (Safeway) pharmacy and the pharmacist administered the flu shot.  Because insurance wouldn't cover the flu shot administered by a pharmacist, I paid $28 for the shot--well worth it to get it while I'm well and before flu season starts.  The vaccine should "stay in my system" for one year--through this year's flu season.

In October or November, if all goes well, the H1N1 (Swine Flu) vaccine will be available and distributed.  I plan to be in line for that vaccination as soon as I can qualify for it.

I had a Shingles vaccination last year.  I had chicken pox as a child and my cousin--at the age of 60--contracted shingles.  The one-time vaccination is supposed to protect me from shingles for the rest of my life.

My 10-year pneumonia vaccination expires this year and I'll be getting another one of those as well.  When I had an annual physical with my doctor earlier this month, he advised me that I'm nearing the end of protection of my tetanus vaccination.  I'll be OK for another two or three years as long as I don't have a "dirty" wound.  If I have one they'll give a booster shot.

Preventive medicine--which, for me, includes vaccinations--is important.  As with an automobile, it's better to catch or prevent problems rather than trying to fix them.  Part of my preventive medicine routine is to have an annual physical and to have an annual eye exam--both of which I had in August.  I also go to specialists as needed.

In 2008 I almost waited too long to have my appendix out--it hurt in my back rather than in my right side.  I was fooled by the placement and, when the emergency room took a CT-Scan, it showed that my appendix had "flipped over" somehow and was at my back rather than at my side.  I had felt pain a month before I went to the emergency room and then it passed.  It turns out that my appendix was already dead and was about to burst.  (It didn't.)  The surgeon saw me about 7:00AM (I had come to the emergency room at 5:00AM) and said that he was going to "warm up" by removing a gall bladder, then I was second on his "dance" (surgery) card.  He did a laparoscopic appendectomy and I was out of the hospital within 36 hours of going to the emergency room.

I do water aerobics almost daily and the day before I had my appendix removed I had done 400 sit-ups in the water (thank heaven they were in the water).  I usually am in the water between 5:00 and 7:00AM and the next day, rather than going to the wellness center on the hospital grounds, I drove myself to the emergency room.

I'm pretty healthy and plan to stay that way.  How about you?

Aging, Quality of Care, Quality of Life--Healthcare Oversight of Continuous Care Retirement Communities

Healthcare for the aging--a worry for baby boomers with aging parents and for young adults with aging baby boomers for parents--and a huge and growing worry for Medicare.

Hospitals, Rehabilitation Facilities, Nursing Homes, and Continuous Care Retirement Communities (CCRCs) are all part of the health care system for the aging in the USA.

Much of my day today has been invested in reviewing information available on the World Wide Web comparing nursing homes, and hospitals.  Medicare has made some additions to its http://www.medicare.gov website where you can choose to compare hospitals and nursing homes. The government data for nursing homes associated with CCRCs appears to be inadequate--sometimes focused on only Medicare-related services rather than including the entire range of service provided by the CCRC to include skilled nursing care.

Continuous care retirement communities (CCRCs) today include independent living units, assisted living units, memory care units, and skilled nursing care units. So far the government surveys do not focus on the overall community.  Instead they focus on sub-elements of one unit.  For example, they may look at the Medicare wing (19 beds) of a Skilled Nursing Facility (with 70 beds).

CRCC Oversight

CCRCs are accredited today by the  Continuing Care Accreditation Commission (CCAC) which is wholly owned by the Commission for Accreditation of Rehabilitation Facilities (CARF).  In many states, this is wholly voluntary and there is no mandate for accreditation by any organization. In the accreditation process, the service provider pays the Commission to conduct an in depth survey of the facility and what it offers.  The Commission treats  service providers in much the same way a university treats its students.  Providers pay for the surveys as students pay tuition to the university for a course.  Service providers may or not pass the standards to be accredited just as students may not pass the standards set for course or degree completion by the university.

The CCAC was acquired by the CARF in 2003 and is the nation's only accrediting body for CCRCs and other types of continuums of care referred to by the commissions as "aging services networks."  (You can see more detail on the CCAC website listed above.)    


This accreditation is at least a step in the right direction of allowing the public to make more informed decisions about healthcare.  CCRCs are not inexpensive and a major concern about any such place is ongoing quality of care and quality of life.  That's not easy to measure, especially on surveys where not enough residents may be willing or able to complete the survey.  At the same time, even if they had a mandate, governmental oversight agencies may not look at (or even for) a clear picture of the quality of care and quality of life afforded at a CCRC.


We are still in a "buyer beware" situation.  The information available over the world wide web (Internet) is at least helpful in making more informed decisions.  The information needed may not be readily available, however, and may require some depth of research (and time investment) to uncover information crucial to making the informed decisions.

CCRC Decision-making


One thing that CCRCs seem to be doing--in the footsteps of lots of other organizations--is trying to consider themselves as either unique (one of a kind) or too similar (much like) another organization. The CCRC my mother lives in has decided to move to 12-hour shifts for its employees dealing with residents in assisted living and the skilled nursing facility.


In my personal experience of working 12-hour shifts, it is not a healthy option for anyone involved.   While on duty at the Pentagon many years ago, my group decided to go on 12-hour shifts.  We would start either at Noon or at Midnight and work that shift for several days (four, I think). This meannt that we would work from Midnight to Noon for four days, have two days off, then work from Noon to Midnight for four days and have three days off.  While we had time off, I remember sleeping the first two days after the Midnight to Noon shift and not being able to sleep for awhile when we switched to the Noon to Midnight shift.  (There were military reasons for the starting times, by the way.)  Nursing homes and hospitals usually like a 7AM to 7PM shift and a 7PM to 7AM shift.


At the end of a twelve-hour shift, and even more so at the end of several days of that shift, we were not at our best.  The constant switch of our internal clocks really messed people up--we react to lightness and darkness and it takes time to recover.  A 34-year-old major working with me had a stroke and died after we were on the new schedule for a few months.  He left a wife and two children.  No one functioned at his or her best and decisions made when we were not at our best could (in an emergency situation) not have been the best ones to take.  (We didn't have that problem during the time I am referring to.)


Many hospitals and now CCRCs are advocating the 12-hour day shift schedule, talking about how much time-off people will have in the course of 14 days and the continuity of care patients or residents will receive by seeing the same people on the same shifts.  The CCRCs say that it has been successful in hospitals so they want to implement it.  In my experience, what this shift schedule does is insure continuity of worse care for the people being cared for and continuity of a feeling of jet-lag and frustration on the part of the care-givers.  It is good for schedulers and may help in financing plans.  In hospitals I have seen diminished quality of care from caregivers toward the end of their 12-hour days.  CCRC's usually do not have the same intensity of responsibility seen by nursing staff in hospitals and they have their own concerns at the CCRC.


At the end of my day I am aware that I have touched the "tip of the iceberg" and have lots more to learn about ensuring the quality of care and quality of life offered by CCRCs to my family.  It's also something I have to think about in my own future as well.