FRIDAY, JULY 15, 2016
A special supplement to the AUSTIN DAILY HERALD
Jerry Rosenblad of Humana Health Insurance leads a seminar Thursday at the Mower County Senior Center about getting the most out of your doctor’s visit. Photos by Eric Johnson/photodesk@austindailyherald.com
Quarterbacking your healthcare
Program helps people maximize doctor visits By Brita Moore
newsroom@austindailyherald.com
Self-care is crucial as people age. While it’s often easy to assume doctors will know how to take care of patients best, but without knowing their patients’ own concerns, he or she will not be able to provide you the best care. That’s some of the advice offered by Jerry Rosenblad of the Humana health insurance company during a presentation at the Mower County Senior Center Thursday. He addressed how seniors can get the most out of their doctor visits. “Your primary doctor is like the quarterback of your healthcare,” Rosenblad said. “It’s important to trust and get along with them.” Rosenblad’s talk was part of Humana’s initiative to give back to communities. He is an agent for southeastern Minnesota and focuses on products for people on Medicare. To help your doctor take care of you, Rosenblad suggested in the presentation to spend some time preparing for the visit. He encouraged to bring a list of all medications you’re taking, including over-the-counter medica-
tions, and any allergies you’re aware of. Keep your routine screenings up-todate and track the results, so you don’t miss any problem areas. Rosenblad also recommended discussing your family medical history, so your doctor is aware of any potential risks you may face as you age. Secondly, it’s important to keep track of health questions. Write them down if needed, then ask them. That way, the doctor will know what he or she needs to look into. If taking medications, ask questions about those as well, especially about risks and side effects. After the visit, don’t hesitate to call that doctor if more questions come up. “That’s what they’re there for,” Rosenblad said. Lastly, always follow the doctor’s instructions. Whether that means simply drinking more water or finishing all of your prescription medication, be sure to do so. If he or she recommends a follow-up visit, keep the appointment. With these tips in mind, you will be able to help your doctor help you, and you’ll take better care of yourself too.
A group of people listen to Jerry Roseblad of Humana Health Insurance as he gives a seminar on getting the most out of a doctor’s visit Thursday at the Mower County Senior Center.
Senior Living Women more likely than men to face poverty during retirement 2-SL
JULY 15, 2016
Associated Press
CHICAGO — During their working years, women tend to earn less than men, and when they retire, they’re more likely to live in poverty. These are women who raised children and cared for sick and elderly family members, often taking what savings and income they do have and spending it on things besides their own retirement security. The National Institute on Retirement Security, a nonprofit research center, reports that women are 80 percent more likely than men to be impoverished at age 65 and older. Women age 75 to 79 are three times more likely. While experts cite a pay gap as a major cause for retirement insecurity, other factors play a role, from single parenthood and divorce to the fact that women typically live longer than men. For Marsha Hall, 60, the process of trying to save for retirement has been nearly impossible. “I’ve had jobs that included a 401(k) and I was able to put some money aside, every month,” she says. “But then I would get laid off and have to cash out the 401(k) to have money to live on.” Born and raised in Detroit, Hall is divorced and doesn’t have any children. She works part time as a file clerk. She and her siblings pitch in to care for their 75-year old mother. Hall says she tries not to think about what her situation will be like at that age. “My bills are current, I have food,” she says, “but I’m still living paycheck to paycheck, if it wasn’t for Section 8 (a housing subsidy), I don’t know where I’d be living.” Joan Entmacher, vice president for family economic security at the National Women’s Law Center, says “the solution to the retirement (funding) crisis
AUSTIN DAILY HERALD
starts with the earnings and wage gap.” That gap narrowed between the 1970s and 1990s, but stopped shrinking in 2001. Women earn about 76 cents to 79 cents on the dollar, compared with men. Women are more likely to report that Social Security is the biggest source of income — 50 percent to 38 percent for men, according to a recent poll by The Associated Press-NORC Center for Public Affairs Research. Women are 14 percentage points less likely to say they will receive a pension. Entmacher says women are more likely to take on caregiving responsibilities, which increases the likelihood they will end up working part-time jobs, often for lower wages, and without benefits such as pensions, sick leave and health care. “The bulk of stay-at-home moms are not these high income, well-educated women that you read about,” she says. Over a 40-year career, the pay gap between men and women adds up to an average of $430,480, accordion to the Census Bureau. For minorities and women of color, the number is much higher. “If we are talking about a 65-year-old black woman, she was born before desegregation,” says Karen Lincoln, a professor at the University of Southern California and director of a center for geriatric social work. “This has a huge impact on things like the quality of education they receive, the employment opportunities available to them, and their ability to accumulate wealth,” Lincoln says. Lincoln points to additional census data showing African-American women are paid 64 percent that of white men, compared with 54 percent for Hispanic and Latina women. In addition to making less, women are much more likely to be single parents, putting ad-
ditional economic strains on them. In 2013, almost 83 percent of custodial parents were mothers, according to the census. Starting with the Johnson administration’s “War on Poverty” in 1964, and the creation of safety-net programs such as Medicare and Medicaid, poverty rates among both men and women have been falling steadily. In 1966 the percentage of women over 65 living below the federal poverty line stood at 32 percent, compared with 12.1 percent in 2014. For men over 65, the numbers are 23.5 percent and 7.4 percent, respectively. Yet some analysts say the poverty rate is a poor gauge to assess the quality of life for aging seniors. “The poverty rate is a deceptive number, it doesn’t reflect the money they (men and women) need to actually exist,” says Jennifer Brown, manager of research at the National Institute on Retirement Security. Brown says that increasing life spans mean a woman in the United States today will live five years longer than the average man, and about four years longer than her grandmother. “Those increases in longevity come with huge increases in medical costs,” Brown says. “Especially if you’re taking about things like long-term care or treatment for mental disabilities such as dementia and Alzheimer’s.” Medicare does not cover long-term care. To get some subsidized coverage, seniors would need to spend down their assets to qualify for Medicaid or have a longterm care insurance policy. In 2016, the census poverty threshold for a single person is $11,880. According to UCLA’s Elder Index, a measure of the cost for housing, food, transport and health care, for a 65-year-old renter, the base cost pay for these needs is $24,024 and growing.
Senior Living
A special supplement to the AUSTIN DAILY HERALD
FRIDAY, JULY 15, 2016
3-SL
Is there a doctor?
Medical workforce shortage already affects region By Trey Mewes The Mankato Free Press
M A N K AT O — S t eve Gottwalt likes to surprise lawmakers with what he calls a remarkable statistic. As the executive director of the Minnesota Rural Health Association, Gottwalt knows the difficulties behind getting quality medical care in Greater Minnesota. That’s why, when speaking with state legislators, he tells them about the kind of access people have to their doctor. “If you’re in Minneapolis, you have almost 1 M.D., or medical doctor, for every 300 people,” he says. “When you go to rural, and deep rural Minnesota, that’s as many as 2,000 people.” Physicians have been in demand across the state for decades, but a looming boom in retirees has industry experts calling on lawmakers and medical companies alike to create more solutions and improve access to medical care before it becomes a problem. Yet for many south-central Minnesotans, it’s already difficult to access medical care. Parts of Blue Earth, Waseca, Faribault, Freeborn and Brown counties are considered to be medically underserved either geographically — meaning there’s a ratio of one doctor to 3,500 patients or more — or because there aren’t enough doctors to treat low-income populations, according to the Minnesota Department of Health. There are far worse shortages in specialized medical fields. Blue Earth, Wa t o n w a n , F a i r b a u l t and Martin County don’t have enough dentists to meet low-income patient demand. And only southeastern Minnesota and the Twin Cities metropolitan area have enough mental health professionals to meet patient needs. Those needs will only
“If you’re in Minneapolis, you have almost 1 M.D., or medical doctor, for every 300 people. When you go to rural, and deep rural Minnesota, that’s as many as 2,000 people.”
— Steve Gottwalt, Executive director of the Minnesota Rural Health Association grow during the next decade. “We’re facing a real need right now,” said Dr. John McCabe, director of the University of Minnesota’s Mankato Family Medicine Residency Program. Greater Minnesota’s population is aging at a faster rate than urban Minnesota — meaning there are more older people aging in rural parts of the state. And more doctors will be needed as baby boomers age out of the workforce — a trend demographers are calling the “silver tsunami” of retirees across the U.S., which typically need more medical care than younger people. “It lays out, demographically, a pretty tough situation going forward where we expect labor supply to continue to be a challenge,” said Susan Brower, Minnesota’s state demographer.
What the shortage means
The U.S. will need about 90,000 more doctors by 2025 to meet incoming medical demands, according to the Association of American Medical Colleges. That shortage particularly affects rural areas, which have older people who live far ther away from medical facilities compared to their urban counterparts. It’s not a new phenomenon, but it will have harsh consequences for Minnesota, as more than half of the state’s population still live in rural areas. “It’s really the areas that have been losing the younger generations for some time,” Brower said. The Mankato area is faring better than most when it comes to medical access. With two hospital systems
and several area colleges, Mankato-area residents are statistically in a good position to have ongoing access to medical care. That’s not enough to solve access issues, however. Transportation is a large part of the state’s medical access issues. And area organizations keep busy driving patients to their medical appointments. “The majority of our rides tend to be medical,” said Carol Clark, transportation manager for VINE Faith in Action. “That’s our primary rides that we do.” The Mankato-based interfaith volunteer organization transported people in Blue Earth, Nicollet and Le Sueur counties to medical centers 2,033 times in 2015. Of that, 1,135 rides were for senior citizens. In addition, south-central Minnesota faces the same sort of underemployment issues hurting rural regions across the U.S. That’s what makes initiatives like the Minnesota Valley Action Council’s Wheel Get There program so popular. The Mankato of fice’s transportation prog ram sells donated cars for $400 to $700 dollars to buyers living in poverty. D a n Jo n e s, M VAC ’s transportation manager, gets 6,000 calls each year for a car. MVAC usually receives about 150 donat-
access to health care while training more people to perform more tasks within their respective roles. Ray Christensen, associate dean of the University of Minnesota — Duluth Medical School, believes primary care physicians, or general practitioners, will have a larger role to play in medical care. While many medical students choose specialized Future care fields to pursue their caOver the next two de- reers, there’s an increascades, more than 600,000 ing need for primary care people are expected to doctors in family medireach age 65 or older, ac- cine, pediatrics and geri—Distributed by Tribune cording to the U.S. Census atrics across the U.S. Content Agency. Bureau and the Minnesota State Demographic Center. Minnesota’s population as of 2014 is 5.4 million. At the same time, Minnesota’s medical care field — doctors, nurses, personal care assistants, hygienists, etc. — is expected to grow by tens of thousands of jobs by the year 2024. “As employers have a hard time filling out jobs, what we hope is they’re not going to stop creating jobs,” Brower said. In essence, the positions will only appear if there are candidates willing to take on those roles. Solving that issue will require a lot more than just warm bodies in doctor jackets or nurse uniforms, however. It’s going to take a concerted effort to improve ed cars a year, 200 at most. It takes two days at most to sell a car, and in some cases takes less than two hours. Most people tell MVAC they need the car so they can get to the doctor. “There’s a huge, huge need,” Jones said. “A significant number of my calls come from people who are on disability.”
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Though hospitals rush to recruit doctors nowadays, Christensen believes there could be a point where demand for specialists decrease because there could be too many of them filling roles that better suit a general practitioner. “As of now, there’s still a lot of places you can specialize,” he said. “In the long run ... I’m not sure how sustainable that’s going to be.” Yet the incoming senior boom means there’s little time for medical companies and policy makers to put solutions into place. “They need to be educated on that and respond accordingly,” Gottwalt said. “The time is getting short.”
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Senior Living
FRIDAY, JULY 15, 2016
A special supplement to the AUSTIN DAILY HERALD
Few young doctors are training to care for America’s elderly By Kara Lofton
West Virginia Public Broadcasting, Kaiser Health News
A t E d g e wo o d S u m m i t retirement community in Charleston, West Virginia, 93-year-old Mary Mullens is waxing eloquent about her geriatrician, Dr. Todd Goldberg. “He’s sure got a lot to do,” she said, “and does it so well.” West Virginia has the third oldest population in the nation, right behind M a i ne and F lorida. B ut Goldberg is one of only 36 geriatricians in the state. “With the growing elderly population across America and West Virginia, obviously we need healthcare providers,” Goldberg said. That includes geriatricians — physicians who specialize in the treatment of adults age 65 and older — as well as nurses, physical therapists and psychologists who know how to care for this population. “The current workforce is inadequately trained and inadequately prepared to
deal with what’s been called the silver tsunami — a tidal wave of elderly people — increasing in the population in West Virginia, across America and across the world really,” Goldberg said. The deficit of properly trained physicians is expected to get worse. By 2030, one in five Americans will be eligible for Medicare, the government health insurance for those 65 and older. Goldberg also teaches at the Charleston division of West Virginia University and runs one of the state’s four geriatric fellowship programs for medical residents. Geriatric fellowships are required for any physician wanting to enter the field. For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four geriatric fellowship programs in West Virginia in the past three years. “This is not just our local program, or in West Virgin-
ia,” said Goldberg. “This is a national problem.” The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled. With that kind of competition, Goldberg laments, why would a resident apply to a West Virginia School, when they could get into a program like Yale or Harvard? Adding to the problem, the average medical student graduates with $183,000 in debt, and every year of added education pushes that debt higher. Dr. Shirley Neitch, head of the geriatrics department at Marshall University Medical School in Huntington, W.Va., says students express interest in geriatrics almost every year. But, “they fear their debt,” she said, “and they think that they need to get into something without the fellowship year where they can start getting paid for their work.” This trend troubles many people, including Todd P l u m l e y, wh o s e m o t h e r,
Gladys, has dementia and lives in West Virginia. “It’s kind of scary that [older patients] don’t have the care that they really need to help them through these times, and help them prolong their life and give them a better life,” Plumley said. There are no geriatricians in the family’s hometown of Hamlin, so Plumley drives his mother almost 45 minutes to another town, Huntington, to see one. He says seeing this specialist has helped stabilize his mother’s symptoms. “Right now, if we didn’t have the knowledge and resource,” he said, “I believe my mother would have progressed a lot further along, quicker.” Plumley is in his 50s. He worries that if he needs the care of a geriatrician as he gets older, driving even 45 minutes may not be an option. This story is part of a partnership that includes West Virginia Public Broadcasting, NPR and Kaiser Health News.
Study: Younger seniors amass more end-of-life care than the oldest By Rachel Bluth Kaiser Health News
Americans in their 80s and 90s are not the ones amassing the largest medical bills to hold off death, according to a new analysis that challenges a widely held belief about the costs of end-of-life care. Yo u n g e r s e n i o r s — those with potentially longer expectancies — are. Medicare claims data for 2014 for beneficiaries who died the same year shows that average Medicare spending per person peaked at age 73 — at $43,353, the Kaiser Family Foundation repor ted Thursday. That compared with $33,381 per person for 85-yearolds and among 90-yearolds, $27,779 per person. (KHN is an editorially independent program of the foundation.) “This is a patter n we
“This is a pattern we weren’t really expecting to see.” — Juliette Cubanski Associated director of the program on Medical care policy weren’ t really expecting to see,” said Juliette Cubanski, the associate director of the program on Medicare policy for the Kaiser Family Foundation. Kaiser researchers said their findings suggest that providers, patients and their families may favor more costly, lifesaving care for younger seniors, and turn to hospice care when patients are older. “It kind of goes against the notion that doctors are throwing everything including the kitchen sink at people at the end of life regardless of how
old they are,” Cubanski said. Medicare covered eight of 10 people in the U.S. who died in 2014, establishing it as the largest insurer of medical care provided at the end of life, according to the Kaiser report. Medicare spent an average of $34,529 on each of them, and most of that money (51 percent) went to inpatient hospital expense. The rest was spent mostly on skilled nursing facilities, home health care and hospice (23 percent) or physicians (13 percent) or medication, 6 percent. Overall, the larg-
est portion, 31 percent, of per capita spending for all beneficiaries goes to inpatient hospital expenses. The Kaiser team said spending on people who die in a given year represents a small and declining share of traditional Medicare spending —18.6 percent in 2000 but 13.5 percent in 2014. Overall, the aging baby boomer population is leading to a decrease in the growth of spending on patients’ last years of life. More beneficiaries are younger and healthier, and they are living longer, so their last years of life are cheaper. Kaiser’s analysis cov-
e re d o n ly t r a d i t i o n a l Medicare beneficiaries during the calendar year in which they died and did not include spending in the full 12 months before their deaths. The report also did not include spending on beneficiaries in Medicare
Advantage because data was unavailable. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
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