Mature Lifestyles - October 2017

MATURE

Lifestyles October 2017

a special publication by

2 - Mature Lifestyles - October, 2017 - TheIntelligencer.com

Older residents more vulnerable during disasters ATLANTA (AP) — Like clockwork, stories of suffering by the oldest residents in the line of hurricanes, floods, tornadoes and other natural disasters seem to follow.

Regulations dictate nursing homes and other facilities must have preparation plans in place, but the realities of how older Americans cope with a storm go beyond any piece of paper. The issue burst to the forefront again Wednesday with news of eight deaths at the Rehabilitation Center at Hollywood Hills in Florida, where workers say Hurricane Irma caused the air conditioning to fail, and they struggled to keep residents cool with fans, cold towels and ice.

A look at the issues at play in keeping the oldest safe in the line of disaster: RISKS RISE FOR MOST VULNERABLE RESIDENTS Time and again, natural disasters have claimed residents of nursing homes and other senior communities. The risks rise in a state like Florida, which has the highest proportion of people 65 and older of any state, one in five of its residents.

Hurricane Andrew caused a diaspora of nursing home residents, and family members frantically searched to locate their elderly relatives. Hurricane Katrina was followed by harrowing tales from St. Rita’s nursing home, where dozens died. And Hurricane Harvey washed through La Vita Bella

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assisted living facility, and brought a viral photo of elderly women sitting in deep floodwaters while they awaited rescue.

PLANS IN PLACE, BUT NOT ALWAYS THOROUGH The Centers for Medicare and Medicaid Services, which regulates nursing homes, gives the Rehabilitation Center at Hollywood Hills a below-average rating, two stars on its fivestar scale. But the most recent state inspection reports showed no deficiencies in the area of emergency plans.

Both federal and state laws require emergency plans for nursing homes and training for staff. A 2012 report from the inspector general of the U.S. Department of Health and Human Services found the vast majority of nursing homes comply with that requirement, but that serious gaps persisted.

The plans often included unreliable transportation contracts and little collaboration with local emergency managers, the audit found.

Nursing homes in Florida are required by state and federal law to file an emergency plan that includes evacuation plans for residents. County officials released documents showing the Hollywood facility was in compliance with that regulation and that it held a hurricane drill with its staff in October.

The California Department of Public Health, which regulates all long term care facilities, requires nursing homes have an alternate source of power for their medical equipment and oxygen supply. It also requires an emergency plan that insures the self-sufficiency of the facility for at least 72 hours. The state’s regulations say that during the first three days after a widespread disaster, nursing homes must provide essential medications and oxygen for those who need them, enough food and water for residents and for the staff required to care for them and supplies needed to maintain hygiene in the premises.

Lisa Baker, a professor at the University of Alabama at Birmingham who teaches a class on disaster preparedness and co-authored the book “Vulnerable Populations and Disasters,” said each new catastrophe brings lessons of how to improve planning and response. But she said when factors are constantly changing, it’s impossible to have a plan that addresses every variable.

“I don’t know that there is a perfect way,” she said.

“You’re preparing for something that you really don’t know how it’s going to play out.”

DANGEROUS EVEN OUTSIDE STORM’S PATH Even though threats can be grave to seniors staying in facilities in the path of a storm, evacuations also can be deadly. When tornadoes ripped across Alabama in 2011, they flattened an assisted-living center, tore through a brand-new senior housing complex and ripped apart a nursing home, where four dozen residents massed in hallways, praying as trees crashed down and a cloud of dust rained upon them.

TheIntelligencer.com - October, 2017 - Mature Lifestyles - 3

Family faces a rare dementia gene

By JUDITH GRAHAM Kaiser Health News

MARBLEMOUNT, Wash. — John Janda knows he takes after his mother.

At 68, the graying building contractor is sentimental, just as she was. He smiles indulgently as he shows off photos of his 9-month-old grandson; he tears up at the memory of losing his dad in a construction accident more than 40 years ago.

“I’m emotional,” he said, eyes glistening. “I know I got that from her. They call that ‘a kind heart.’ That’s one of the best blessings there ever was.”

Along with the blessings, however, Janda inherited what many would call a curse: a genetic mutation that causes a devastating brain disorder known as frontotemporal dementia, or FTD. His mother, Lucille Janda, had the mutation and the disease, a relentless illness that ravaged her personality starting in her late 40s and eventually robbed her of the ability to think, speak and walk.

John Janda has the same mutation, doctors say. But unlike his mother, who died in 2014 at age 93, Janda has shown no sign of the disorder, more than 15 years after symptoms typically appear.

“I can’t tell you that I feel anything,” said Janda, a lifelong builder who operates a woodshop, metal shop, sawmill and lumber kiln on his remote property about 100 miles northeast of Seattle. “I could go on my job and do anything I did 25 years ago. The knowledge is still there.

I’m still gaining information all the time.”

That makes him a medical mystery, a puzzle to scientists who can’t say why Janda has so far been spared his mother’s fate.

“The overwhelming majority of the people who have this mutation develop the disease, but there are a few who don’t,” Dr. Thomas Bird, a University of Washington professor of neurology and medical genetics. “We would love to know why. What a terrific clue that would be to treatment of the disease.”

Bird was part of the team who first identified the mutation in the MAPT gene, one of three now linked to FTD. He has been studying the Jandas and other affected families for more than 35 years. Last year, he published a paper in the American Journal of Medical Genetics detailing the family’s experience.

“John’s an outlier. He’s going to be 69 years old this summer and he’s doing great,” Bird said.

FTD, also known as frontotemporal degeneration, is a progressive, irreversible disorder that accounts for between 10 and 20 percent of all dementia cases. An estimated 55,000 people in the U.S. are affected by the disease, though experts say it’s vastly underdiagnosed. High-profile suf-

ferers include former congressman Maurice Hinchey, 78, whose family recently announced his diagnosis.

It strikes people earlier than other types of dementia, usually in their 50s or 60s, and begins with gradual declines in behavior, judgment and language that eventually lead to profound disability. There is no treatment and no cure.

In the beginning, people with FTD lose social skills. They might tell a neighbor her dress is ugly or get into arguments with people at work. As the disease progresses, the behaviors escalate. Bird recalls one FTD patient who would crawl on the floor of a department store, collecting spare change. Others develop obsessive or repetitive behaviors or become physically or sexually aggressive.

“We’re talking about a disease that steals the essence of who you are as a human being,” said Susan Dickinson, executive director for the Association for Frontotemporal Degeneration. “It’s hard to comprehend exactly what this disease steals from people.”

When Janda was growing up, no one knew what to call the condition that has so far affected 18 people in four generations of the family, from Washington to Wisconsin.

“Uncle Ernie went bad, Aunt Verna went bad,” recalled Janda, who is one of eight siblings. “There was four or five who went bad.”

In Janda’s mother’s case, family members began noticing that she was acting strangely starting in her mid-40s.

“Mom would make comments or go off on a tangent that wasn’t part of the conversation,” Janda recalled. “My dad could notice it, but no one talked too much about it.”

Then his father, James Janda, died suddenly at age 56 in a 1976 construction accident, devastating his adult children — and exacerbating his wife’s illness.

She became distant and withdrawn, more temperamental and easily confused.

“She couldn’t focus on an issue, but she could remember little things, old songs, things like that,” said Janda, who used to sing “Hello, Dolly!” to his mom to make her smile.

“She could remember some people. It got worse as she got older. She could remember me way, way into it.”

By her late 50s, Lucille Janda could no longer cook or drive. She went to live with another son, Tony Janda, and his wife, Candace. The couple cared for her at home for the next three decades.

“It’s a lot of work, but you won’t ever forget it,” said Tony Janda, 59.

Lucille Janda’s sister was referred to Bird in the late 1980s by a Seattle neurologist. The scientist later located three far-flung cousins with the disease, all men, who were in the same chronic care veterans hospital in Wisconsin.

“I saw them, I examined them, I was able to get blood samples,” Bird said. “I made arrangements to have brain autopsies done when they died.”

4 - Mature Lifestyles - October, 2017 - TheIntelligencer.com

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6 - Mature Lifestyles - October, 2017 - TheIntelligencer.com

Health safety net providers fear dwindling savings

By Glenn Howat Star Tribune (Minneapolis)

MINNEAPOLIS — A drug discount program that helps safety net providers save millions could be significantly weakened under new regulations proposed by the Trump administration.

Apart from looking at higher drug costs, hospitals and clinics say the biggest hit will come to programs and services for low-income or vulnerable patients.

That’s because the safety net providers are required to use the savings earned from discounted drug purchases to invest in programs, such as extending clinic hours, giving free or discounted medications to the uninsured or providing mental health treatment.

Little known outside health care circles, the so-called 340B program requires drugmakers to discount sales of medications to providers that serve a high percentage of low-income or uninsured patients. The prices are set according to a federal formula and vary by drug, but the discounts range from 20 to 50 percent, according to some studies.

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“This is an opportunity for facilities to stretch their scarce dollars,” said Charles Cooper, 340B program director for Minneapolis-based Fairview Health Services. “It is a way to be able to provide services that they feel are needed for their unique settings and populations.”

One study found that in 2013, qualifying providers spent $7 billion on medications under the program, which yielded savings of $3.8 billion.

Only drugs used or dispensed in outpatient or emergency room settings are eligible for the discounts.

In July, the federal Centers for Medicare and Medicaid Services, which runs the two large health care programs for the elderly and the poor, proposed a new rule that would, in essence, erase the savings that come with the discount.

Under the rule, the Medicare program would impose a nearly 30 percent decrease in the reimbursements it pays providers for outpatient drugs they purchase using 340B, making the insurance payments closer to the price providers paid for the drug.

Federal officials said the change would help Medicare beneficiaries because it would lower the 20 percent co-pay that they make under the Medicare Part B program.

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New treatments, few doctors for Parkinson’s disease

By MICHAEL OKUN University of Florida

(THE CONVERSATION) For many, hearing the word “Parkinson’s” conjures an image of tremors. But Parkinson’s disease, brought about by loss of nerve and other brain cells, is actually an incredibly complex movement disorder that can cause symptoms as wide-ranging as smell loss, thinking issues, depression and swallowing problems. More than 1.5 million people in the U.S. have the illness, and millions more loved ones and caregivers are affected by it, too.

Thanks to medical advances and better treatments, both patients and physicians understand that Parkinson’s is a livable disease, and that people with this condition can be happy, healthy and successful.

And yet, there is a critical shortage of doctors trained specifically in how to treat Parkinson’s disease. Only 40 to 50 new Parkinson’s specialists – neurologists with fellowship training in the disease – go into practice each year across this country. And according to national doctor fellowship match data, this number has been relatively flat for the last five years. This shortage could worsen as the 70 million baby boomers age, as Parkinson’s typically afflicts older people; the average age of diagnosis is in the early 60’s.

Recently I wrote an article which provides an update on current treatments of Parkinson’s disease for the Journal of the American Medical Association. A key takeaway of my new article is that there are many treatments for Parkinson’s, and some patients are going to live for 10, 20, 30, even 40 years with the disease.

Also, as national medical director of the National Parkinson Foundation, I have come to realize that there is a gap between how physicians manage Parkinson’s in clinics nationwide and what we actually know from evidence and from experience in treating this disease for many years. In particular, many generalists remain unaware of treatments beyond the standard use of medications that have been used since the 1970s, and there is a lack of appreciation for the importance of the timing of medication dosages.

Updating approaches to Parkinson’s We know from the scientific literature that patients who see even a general neurologist have lower rates of morbidity, mortality and nursing home placement. But given that the majority of Parkinson’s patients are under the care of general practitioners, internists and family medicine doctors, how do we help all of those who are affected by Parkinson’s?

Based on studies that show that people are living longer with Parkinson’s, one of the first messages we need to impart is that life is most certainly not over.

A second important message is that new medications can and do make a difference.

These findings underscore the necessity of having doctors trained in Parkinson’s.

For example, there is a myth that when you diagnose Parkinson’s, you prescribe a medicine called carbidopa-levodopa (also called Sinemet) three times a day, and that’s all.

But Parkinson’s is an incredibly complex disease with more than 20 motor and nonmotor features. The idea that dopamine, the main active ingredient in carbidopa-levodopa, is the only drug and the only treatment and there’s nothing more you can do – that’s a myth. This is something we must make sure to emphasize and educate doctors in training and those seeing these patients in practice.

Timing may not be everything, but it is important In my JAMA article, I tried to lay a framework for the different phases a Parkinson’s patient may go through and the many types of treatments that are available today.

We now know, for example, that in the early phase of Parkinson’s, specific exercises can be just as important, if not more important in some patients, than medications.

Understanding the options and windows of opportunity can be the difference between success and failure.

We also now know that the timing of medications is critical and in many cases needs to be exactly aligned to particular hours of the day. In addition, some patients see benefits by changing drug dose, adjusting medication intervals and possibly the addition of one of many other drugs.

There are windows of opportunity for some patients where great benefit may result from surgical therapy. These include deep brain stimulation or the use of an externally worn pump that infuses a gel formation of a dopamine medication directly into the small intestine, which is a newer therapy approved by the FDA two years ago. But the physician must be aware of what those windows are, and who are the patients likely to experience benefit.

In other words, we must tailor the treatment to the patient.

What’s more, in Parkinson’s disease there is the possibility of an array of nonmovement-related symptoms, such as speech problems, hallucinations and depression.

These nonmotor symptoms are commonly more disabling than the motor symptoms such as tremor or stiffness.

Today, experts are involving social workers and counselors and also commonly using antidepressant and cognitive enhancers in their care.

As a field, we need to better understand that Parkinson’s patients have many choices of therapies and this is a compelling reason why special Parkinsons’ doctors are needed.

When treated appropriately, we really can make this a livable condition. We need to educate more general practitioners and general neurologists on the basics of tailoring care for Parkinson’s disease, and we need to dedicate more money to training more Parkinson-specific neurologists.

8 - Mature Lifestyles - October, 2017 - TheIntelligencer.com

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10 - Mature Lifestyles - October, 2017 - TheIntelligencer.com

Is America ready for aging cancer patients?

By KEITH BELLIZZI University of Connecticut

(THE CONVERSATION) In the next few decades, the number of adults living with cancer is expected to triple in size.

Age is the single greatest risk factor for cancer. By 2030, according to the Centers for Disease Control and Prevention, the population of Americans over the age of 65 will double.

The good news is that early detection, innovative treatments and supportive care have turned many cancers into chronic illnesses, one disease among other chronic health conditions that older adults may experience. But these coexisting health conditions are likely to complicate the treatment and management of older adults’ cancer.

Our current understanding of appropriate care for older adults with cancer and their unique needs is limited. As an expert in cancer survivorship and aging, I see several specific areas that warrant our attention.

Generational differences Cancer in older adults is complex. For the elderly, cancer is often one of several coexisting health conditions that they may be managing, such as heart disease, arthritis or diabetes. Eighty percent of older adults with cancer report two or more additional health conditions. One in four cancer survivors between 65 and 74 years old have more than five concurrent health conditions.

Older adults with multiple chronic conditions are more likely to have poorly coordinated care, adverse interactions between medications and worse health outcomes. They also tend to use more health care services and, on average, take six or more prescription medications.

In older adults, the late health effects of cancer can be different or exacerbated by age. For example, cancer-related fatigue, reductions in cognitive function and chemotherapy-induced peripheral neuropathy can pose unique issues.

The interplay between these treatment-related effects and common age-related issues presents challenges for care of older adults with cancer.

The psychological and social experience of cancer can also differ markedly for young and older adults. Roles, responsibilities and support systems change as people age.

Many young adults with cancer are dealing with competing demands of work or family. Having fewer demands as an older adult might make the disease more manageable in some respects.

But a decrease in social networks and support – such as retirement or living farther away from family – may have negative effects. Many older adults will minimize their distress, so not to burden their families and caregivers. This leads to underdiagnosis of treatable distress.

These effects can be exacerbated by health care providers

with competing priorities, short office visits and no organizational support for psychosocial distress screening.

Health care providers In 2008, the National Academy of Medicine warned of a looming shortage of geriatric oncologists and nurses, as well as a lack of interest among medical professionals in geriatric oncology.

The number of oncology office visits required by older adults with cancer is projected to surpass the available oncologic workforce by 2020. What’s more, older adults may see up to 12 different health care specialists in a given year.

Who should coordinate this care? Oncologists are experts in the diagnosis and treatment of cancer, but many older adults have competing health concerns that require more than just an oncologist. Geriatricians are trained in managing multiple health conditions and optimizing functional performance in older adults, but may be less familiar with managing cancer.

We need to make a concerted effort to foster collaborative care partnerships between geriatricians and oncology – including geriatric nurses in both fields, as they are on the front lines interacting with older cancer patients. A team of health professionals could jointly share responsibility for managing the health of older adults with cancer, exchanging patient data and information between the team.

Research shows that this type of collaborative model leads to better cancer follow-up care, health outcomes and effective management of coexisting health conditions.

Focus on the family Cancer is a disease that reverberates across the family system, leaving no one untouched. In fact, research suggests that caregivers and family members often report higher levels of distress than does the individual with cancer.

With more and more cancer care delivered on an outpatient basis, coupled with the changing nature of cancer as a chronic disease, there is a growing burden on family to help a loved one manage their disease. Moreover, many older family members may themselves be dealing with a chronic illness and other life stressors, adding to the burden.

Research suggests that providing psychological and educational support for cancer caregivers and family members may improve not only the health of patients, but the health of caregivers.

What’s next?

Planning for the health care needs of our aging cancer survivors represents a significant public health challenge.

What we know about caring for cancer survivors is largely based on the experiences of adult survivors of child-onset cancer and proactive groups of middle-aged breast cancer survivors. There is an urgent need for additional research on the needs and care of the burgeoning geriatric population.

TheIntelligencer.com - October, 2017 - Mature Lifestyles - 11

Shedding new light on hospice care

By JUDITH GRAHAM Kaiser Health News

A few weeks ago, Kathy Brandt’s 86-year-old mother was hospitalized in Florida after a fall. After rushing to her side, Brandt asked for a consult with a palliative care nurse.

“I wanted someone to make sure my mother was on the right medications,” Brandt said.

For all her expertise — Brandt advises end-of-life organizations across the country — she was taken aback when the nurse suggested hospice care for her mother, who has advanced chronic obstructive pulmonary disease, kidney disease and a rapid, irregular heartbeat.

“I was like — really?” Brandt remembered saying, struggling with shock.

It’s a common reaction. Although hospices now serve more than 1.4 million people a year, this specialized type of care, meant for people with six months or less to live, continues to evoke resistance, fear and misunderstanding.

“The biggest misperception about hospice is that it’s ‘brink-of-death care,’” said Patricia Mehnert, a longtime hospice nurse and interim chief executive officer of TRU Community Care, the first hospice in Colorado.

In fact, hospice care often makes a considerable difference for those with months to live. “When someone is further out from death, we can really focus on enhancing their quality of life,” said Rachel Behrendt, senior vice president of Hospice of the Valley, which serves the Phoenix metropolitan area.

New research confirms that hospice patients report better pain control, more satisfaction with their care and fewer deaths in the hospital or intensive care units than other people with similarly short life expectancies.

What should seniors and their families, the largest users of hospice care, expect? It’s fairly well understood that patients forgo curative therapies in favor of comfort care when they enter hospice. Here are additional features: FOUR LEVELS OF CARE Hospice providers are required to offer routine care in patients’ homes (this includes seniors who reside in assisted living or nursing homes); continuous care at home for people with out-of-control symptoms such as pain or breathing problems; inpatient respite for families that need a break from caring for a loved one; and general inpatient care for medical crises that can’t be handled in any other setting.

With continuous care, a nurse must be on-site in the home for at least eight hours a day, helping to bring symptoms under control. Usually, this will happen in one to three days. Respite care has a maximum limit of five days.

Some hospices have their own general inpatient facilities

and “it’s a common misconception that patients are sent to inpatient hospice to die,” said Jean Cohn, clinical manager at Montgomery Hospice’s inpatient facility, Casey House.

“In fact, we’re frequently fine-tuning patients’ regimens in inpatient hospice and sending them back home.”

INTERMITTENT CARE AT HOME Routine care at home is by far the most common service, accounting for about 94 percent of hospice care, according to the latest report from the National Hospice and Palliative Care Organization.

While services vary depending on a patient’s needs, home care typically involves at least one weekly visit from a nurse and a couple of visits from aides for up to 90 minutes. Also, a volunteer may visit, if a patient and family so choose, and social workers and chaplains are available to address practical and spiritual concerns.

Hospices will provide all medications needed to address the underlying illness that is expected to cause the patient’s death, as well as medical equipment such as hospital beds, commodes, wheelchairs, walkers and oxygen. Typically, there is no charge for such gear, although a copay of up to $5 per prescription is allowed.

What families and patients often don’t realize: Hospice staff will not be in the home every day, around the clock.

“Many people think that hospice will be there all the time, but it doesn’t work that way,” Brandt said. “The family is still the front line for providing day-to-day care.”

In assisted living, patients or their families may have to hire nursing assistants or companions to provide supplemental care, since hands-on help is limited. In nursing homes, aides may visit less often, since more hands-on help is available on-site.

SELF-REFERRALS ARE ALLOWED Anyone can ask for a consultation with a hospice. “We get many self-referrals, as well as referrals from family and friends,” said Behrendt of Hospice of the Valley. Usually, a nurse will go out and do a preliminary assessment to determine if a person would qualify for hospice services.

To be admitted, two physicians — the patient’s primary care physician and the hospice physician — need to certify that the person’s life expectancy is six months or less, based on the anticipated trajectory of the patient’s underlying illness. And recertification will be required at regular intervals.

YOU CHOOSE YOUR PHYSICIAN You have a right to keep your primary care physician or you can choose to have a hospice physician be in charge of your medical care.

At JourneyCare, the largest hospice in Illinois, “we prefer that the patient keeps their primary care physician because that physician knows them best,” said Dr. Mark Grzeskowiak, vice president of medical services.

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Abuse can lead to depression in older patients

By BARBARA SADICK Kaiser Health News

Abuse often leads to depression and medical problems in older patients — even death within a year of an abusive incident.

Yet, those subjected to emotional, physical or financial abuse too often remain silent. Identifying victims and intervening poses challenges for doctors and nurses.

Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/ Weill Cornell Medical Center ER. The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.

The VEPT program — initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation — includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern.

These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.

“We work at making awareness of elder abuse part of the culture in our emergency room by training the entire staff in how to recognize it,” said Rosen.

It’s easy for the ER staff to alert the VEPT team and begin an investigation, he said.

A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness.

Additional testing is ordered if the doctor suspects abuse.

“Unlike with child abuse victims, where there is a standard protocol in place for screening, there is no equivalent for the elderly, but we have designed and are evaluating one,” said Rosen.

The team looks for specific injuries.

For example, radiographic images show old and

new fractures, which suggest a pattern of multiple traumatic events.

Specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break when an older adult holds his arm in front of his face to protect himself.

When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity.

The team offers resources but can do little more if the patient isn’t interested.

They would have to allow the patient to return to the potentially unsafe situation.

Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found.

Unlike with children and Child Protective Services, Adult Protective Services won’t become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.

During the first three months of the program, more than 35 elders showed signs of abuse, and a large percentage of them were later confirmed to be victims.

Changes in housing or living situations were made for several of them.

“It’s difficult to identify and measure appropriate outcomes for elder abuse victims, because each patient may have different care goals,” said Rosen.

“But we are working on making a case that detection of elder abuse and intervention in the ER will improve the patients’ lives. We also hope to show that it will save money, because when an elder is in a safe place, expensive, frequent trips to the ER may no longer be needed.”

The team’s ultimate goal is to optimize acute care for these vulnerable victims and ensure their safety.

They plan to work at continually tweaking VEPT to improve the program and to connect to emergency medical, law enforcement and criminal justice services.

Eventually, they hope to help other emergency departments set up similar programs.

(Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.)

TheIntelligencer.com - October, 2017 - Mature Lifestyles - 15

Rising Medicare Part B will sting some seniors

By JUDITH GRAHAM Kaiser Health News

Millions of seniors will soon be notified that Medicare premiums for physicians’ services are rising and likely to consume most of the cost-of-living adjustment they’ll receive next year from Social Security.

Higher 2018 premiums for Medicare Part B will hit older adults who’ve been shielded from significant cost increases for several years, including large numbers of low-income individuals who struggle to make ends meet.

“In effect, this means that increases in Social Security benefits will be minimal, for a third year, for many people, putting them in a bind,” said Mary Johnson, Social Security and Medicare policy consultant at the Senior Citizens League. In a new study, her organization estimates that seniors have lost one-third of their buying power since 2000 as Social Security cost-of-living adjustments have flattened and health care and housing costs have soared.

Another, much smaller group of high-income older adults will also face higher Medicare Part B premiums next year because of changes enacted in 2015 federal legislation.

Here’s a look at what’s going on and who’s affected: The Basics Medicare Part B is insurance that covers physicians’ services, outpatient care in hospitals and other settings, durable medical equipment such as wheelchairs or oxygen machines, laboratory tests, and some home health care services, among other items. Coverage is optional, but 91 percent of Medicare enrollees — including millions of people with serious disabilities — sign up for the program.

(Those who don’t sign up are responsible for charges for these services on their own.)

Premiums, which change annually, represent about 25 percent of Medicare Part B’s expected per-beneficiary program spending. The government pays the remainder.

In fiscal 2017, federal spending for Medicare Part B came to $193 billion. From 2017 to 2024, Part B premiums are projected to rise an average 5.4 percent each year, faster than other parts of Medicare.

‘Hold Harmless’ Provisions To protect seniors living on fixed incomes, a “hold harmless” provision in federal law prohibits Medicare from raising Part B premiums if doing so would end up reducing an individual’s Social Security benefits.

This provision applies to about 70 percent of people enrolled in Part B. Included are seniors who’ve been enrolled in Medicare for most of the past year and whose Part B premiums are automatically deducted from their Social Security checks.

Excluded are seniors who are newly enrolled in Medicare or those dually enrolled in Medicaid or enrolled in Medicare

Savings Programs. (Under this circumstance, Medicaid, a joint federal-state program, pays Part B premiums.) Also excluded are older adults with high incomes who pay more for Part B because of Income-Related Monthly Adjustments (see more on this below).

Recent Experience Since there was no cost-of-living adjustment for Social Security in 2016, Part B monthly premiums didn’t go up that year for seniors covered by hold harmless provisions.

Instead, premiums for this group remained flat at $104.90 — where they’ve been for the previous three years.

Last year, Social Security gave recipients a tiny 0.3 percent cost-of-living increase. As a result, average 2017 Part B month premiums rose slightly, to $109, for seniors in the hold harmless group. The 2017 monthly premium average, paid by those who weren’t in this group and who therefore pay full freight, was $134.

Current Situation Social Security is due to announce cost-of-living adjustments for 2018 in mid-October. Based on the best information available, it appears to be considering an adjustment of about 2.2 percent, according to Juliette Cubanski, associate director of the program on Medicare policy at the Kaiser Family Foundation. (Kaiser Health News is another, independent program of the Kaiser Family Foundation.)

Apply a 2.2 percent adjustment to the average $1,360 monthly check received by Social Security recipients and they’d get an extra $29.92 in monthly payments.

For their part, the board of trustees of Medicare have indicated that Part B monthly premiums are likely to remain stable at about $134 a month next year. (Actual premium amounts should be disclosed by the Centers for Medicare & Medicaid Services within the next four to six weeks.)

Medicare has the right to impose that charge, so long as the amount that seniors receive from Social Security isn’t reduced in the process. So, the program is expected to ask older adults who paid $109 this year to pay $134 for Part B coverage next year — an increase of $25 a month.

Subtract that extra $25 charge for Part B premiums from seniors’ average $29.92 monthly Social Security increase and all that be left would be an extra $4.92 each month for expenses such as food, housing, medication and transportation.

“Many seniors are going to be disappointed,” said Lisa Swirsky, a policy adviser at the National Committee to Preserve Social Security and Medicare.

Higher Income Brackets Under the principle that those who have more can afford to pay more, Part B premium surcharges for higher-income Medicare beneficiaries have been in place since 2007.

16 - Mature Lifestyles - October, 2017 - TheIntelligencer.com

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