When I read news articles about caring for elderly parents at a distance, I sometimes shake my head. There's a tendency to put the best spin on the experience: As long as you contact the right people, get the right information and treat the ups and downs as just part of life's challenges, you'll be fine. You can do this! I find myself wondering when the author last talked to a caregiver ...

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As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home. We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about ...

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Consider this scenario. You are getting older, and are concerned about the costs of nursing homes and long term care.  So, you decide to get expensive long term care insurance to protect your family from these costs.  The policy will pay some of the cost of long term care if you develop cognitive or physical disability.  All you have to do is keep making payments on the policy until you have ...

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A 92-year-old woman with a history of stroke comes to an emergency department and is found to have fractures of her cervical spine. Neurosurgery sees her but doesn't think she needs surgery. The emergency department physician tries to admit her to the hospital as she has a new functional disability due to the fall but the hospitalist refuses as the patient doesn’t meet criteria for inpatient admission. And there she sits ...

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Home visits are hard, there is no doubt about it. I felt like I had been driving for hours.  The thirty minute travel time showing on my GPS was woefully understated due to the arctic temperatures and colossal snowfall.  My jacket and clothes felt caked with dried salt rubbed off from the car or somehow accumulated from the ether.  I pulled the key out of the ignition and braced for the ...

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In most states, doctors are mandated to ask their patients if they feel physically “safe at home.” With an aging population, perhaps another question should be added: are you financially safe? Two examples suggest the problem. “Trudy” had always managed her financial matters, even complex transactions. Aging, however, had made her short-term memory a bit more problematic and her focus diminished by TIAs. Even though her daughter shared responsibility on some of ...

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Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever (subjectively hot to the touch), shortness of breath, and a cough producing yellow sputum.  Her daughter asks if she can be treated with antibiotics "to make her feel better."  The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also ...

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When it comes to the health care of a frail older person, families really need a good personal health record (PHR) system. So I am once again preparing to take a look at what’s available, in hopes of finding something that I can more confidently recommend to the families I work with. (To see what medical info I urge families to track, see this Geriatrics for Caregivers post.) I have -- ...

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I guess it shouldn't have been a surprise. Her house was exactly as I expected it to be.  The door couldn't have been more fitting; red wood with a green holiday wreath attached perfectly in the center.  The carpet was so white that I almost took off my shoes on the front porch before entering through the threshold.  The room was warm.  The ambient temperature was accentuated by a plethora of ...

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If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications. Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A trust fund is projected to have insufficient funds to cover ...

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