On October 1st Medicare started to penalize hospitals for patients who are readmitted into the hospital within 30 days of discharge for the same diagnosis. This is initially designed to curb the percentage of Medicare patients who are routinely readmitted for three primary conditions; heart failure (24.7%), heart attack (19.7%) and pneumonia (18.5%). The healthcare industry is tracking all diagnosis readmissions, and bracing for other diagnosis to be added to the penalty list.
There’s no doubt serious issues will arise within this new accountable care environment, one being that some hospitals are choosing not to officially “admit” Medicare patients, instead classifying them as “under observation”. Unfortunately, to the patient there is no clear indication they are just under observation, and many older adults have found themselves with large bills for post-acute rehabilitation stays because since they were never officially admitted to the hospital they are not eligible to receive Medicare reimbursement for rehab services. Be aware and ask for clarification of the satus of any hospital stay.
On the positive side, this is quite simply the biggest boost to the business case for prevention and wellness promotion that I’ve seen in the 20+ years I’ve been in the field of older adult wellness. For the past 5 years I’ve been advocating for senior living to take a leading role in changing the way people view and experience aging. And this is a golden invitation for senior living to become the champions of recovery, re-claiming vitality after a health crisis, and reframing possibilities – regardless of challenges. All the pieces and parts are there – it’s just a matter of claiming that “space” in the healthcare continuum.
I'm happy to report that the fight against ageism got both a boost and a spotlight last week! I recently co-wrote a chapter titled, Media Portrayal of Ageing, for a book published by the Global Council on Ageing. The book, Global Ageing, Peril or Promise?, was launched at the Global Economic Summit in Davos, Switzerland on January 26th, and Margaret Chan, Director-General of the World Health Organization called it a "must read".
See below (News & Updates) to download a pdf of the whole book or download the chapter Media Portrayal of Ageing. The chapter explores how ageism got a foothold in society and how media and marketing images reinforce negative stereotypes that influence health beliefs and behaviors. It also offers some practical solutions for confronting and re-scripting the negative story of aging.
The "X" Factor
Age has less to do with who a person is and what they're capable of than almost any other single factor, yet it often becomes a direct or indirect barrier to an individual reaching his or her personal potential.
For example, consider that young people with disabilities receive resources, opportunities and social support to overcome disabilities and excel in spite of them. Yet adults who are challenged with a disability later in life are often simply given tools to cope with disabilities. There's a profound difference between a mindset of coping with, versus overcoming, challenges – one that directly impacts expectations, interactions and outcomes.
The successes of the disability movement come from their mindset of looking at possibilities rather than disabilities. As individuals and as a society, we can work for the same kind of positive change in expectations and opportunities for older adults challenged by functional limitations.
"I believe the health care crisis is not going to be solved by government programs," Kay continues, "but instead by individuals inspired into action for their own well-being, and by companies worldwide who mobilize resources to reach out to their customers with healthy lifestyle strategies."
A recent article in the New York Times describes research by Dr. Levine (Mayo Clinic) identifying sitting as a “lethal” activity. Most people know that a sedentary lifestyle can lead to all kinds of health problems, but what I found interesting is that even the twice weekly aerobic classes doesn’t offset sedentary time as much as we would all like to believe.
Sitting, as it turns out, is an independent pathology. As Dr. Levine puts it, “being sedentary for nine hours a day at the office is bad for your health whether you go home and watch television afterward or hit the gym. It’s bad whether you are obese or thin”.
Marc Hamilton, an inactivity researcher at Pennington Biomedical Research Center adds that electrical activity in the muscles while seated goes “as silent as those of a dead horse” (of course that really hit home with me) causing a cascade of harmful metabolic effects including drops in insulin effectiveness, the ability to break down lipids and triglycerides, and levels of HDL (good cholesterol). Hamilton even studied young, fit and thin voluteers and recorded a 40 percent reduction in insulin uptake after only 24 hours of being sedentary.
Certainly exercising after a day of sitting is hugely better than sitting more when you get home; but this study calls for changes throughout the workday as well. Dr. Levine calls for consciously creating minor movements each day. Really DO get up every hour and move about, take the stairs, stand up when you talk on the phone or when you’re reading a document. Look for and then take advantage of opportunities to ingrain movement into every hour of the day — and then hit the gym or go for a walk or just keep MOVING when you’re at home.
For the full article go to http://www.nytimes.com/2011/04/17/magazine/mag-17sitting-t.html
I recently started reading about something called the nocebo effect (meaning will-do-harm). I'd heard of it's kind cousin, the placebo effect (do-no-harm), in relation to drug trials. Brain scans show that beliefs and expectations "I believe these pills will help" can cause biological changes like reducing heart rate and blood pressure, improving immune function, and changing gastric secretions. That's why researches use two study groups; one group gets the real drug and one group gets a placebo. Negative expectations and beliefs can have an equally powerful effect. It's been proven that patients will feel more pain, take longer to heal, and even believe they are incapable of healing, due to negative expectations. That's the nocebo effect.
When you realize how powerful beliefs and expectations are, then you start to understand why the negative aging myth can be so detrimental to well-being. It can undermine aging expectations and manipulate what a person believes is possible and probable. What if we all believed that living well through the full lifespan was a probability rather than just a possibility?