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.
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."
I recently finished the 2nd edition of my book Exercise Programming for Older Adults, originally published in 1995. The new title is Exercise and Wellness for Older Adults, 2nd edition (2010). The new book retains the same format by offering background and research into adult wellness, and lots of practical programming strategies. It provides chair exercise, low-impact aerobics, water aerobics, arthritis exercise, and a new section on strength and power training exercises. It also makes a significant shift from primarily "exercise-based" to a whole-person wellness approach incorporating all six dimensions of wellness- physical, social, emotional, intellectual, spiritual, and vocational. A new section focuses specifically on challenges and opportunities unique to wellness programming in seninor living settings.
There is one major difference between the 2010 and 1995 editions - my fundamental change from an age-based approach to a function-based approach. Over the past 15 years it became very clear to me that age is just a number that has less to do with who a person is and what they're capable of than almost any other factor you could name. The old book made statements like, "older adults need _____, or older adults want _____". I'm embarrassed by these generalizations now and have made a studied attempt to eliminate generalizations based on age and any other ageist thinking. I added a new chapter on the psycho-social aspects of aging and wellness to help readers make that same shift. I really hope this new book will be the practical guide you need to create and improve your exercise and wellness programs for mature adults. Follow the Products tab at www.kayvannorman.com for more information.