Not Enough Geriatricians?
May 25, 2016
Geriatrics is one of the few medical specialties in the United States that is contracting even as the need is growing.
An article in the New York Times says it ranks at the bottom of the list of specialities that internal medicine residents seek to pursue.
These specialists are needed more than ever as life expectancy increases. Yet residency slots go unfilled.
One reason there are so few going into the specialty, according to the story, is that young doctors believe they can’t cure old people’s problems, so why try?
It is also one of the lowest paying specialties. Reimbursement rates by Medicare make it difficult for doctors to thrive financially. And nearly all elderly patients are on Medicare.
Some doctors who have geriatrics training don’t advertise it, as they don’t want too many Medicare patients.
There are primary care physicians who say the specialty is unnecessary as the ailments seen in the elderly are also common in middle-age patients. But others say that is just not true.
The story says, however, that some in the field believe geriatrics will soon receive the recognition it deserves. New payment models may see to that.
Is Alzheimer’s Catching?
May 18, 2016
Some disturbing news from a Swiss medical journal suggests that Alzheimer’s may be transmissible during some medical treatments.
An article on nature.com says that autopsies done on the brains of seven people who died of the rare brain-wasting Creutzfeldt-Jacob disease found that five of the brains showed some of the signs associated with Alzheimer’s.
All of the people had received surgical grafts of dura mater — the membrane that covers the brain and spinal cord — from human cadavers that were contaminated with the protein that causes C-J disease.
The researchers suggested that the transplanted dura matter may have been contaminated with small seeds of amyloid protein, which some believe may be a trigger for Alzheimer’s, along with the prion protein that gave the recipients C-J disease.
The study does not imply that Alzheimer’s could ever be transmitted through normal contact with caretakers or family members.
A Prescription For Confusion
May 11, 2016
Taking medications at the correct time is a special problem for the elderly.
They take quite a few more drugs than younger people do, many take seven or more a day.
Still, studies show that the more times a day you have to take a medication, the lower the chances of adhering to the proper schedule, according to a story in the New York Times.
When patients can’t stick to the plan, the consequences can be severe.
There are several reasons why the elderly often can’t comply with the proper medication plan.
Perhaps they can’t afford the pills once they get into the Medicare Part D “donut hole.”
Or they may not even fill their prescription to begin with because it is not included in their plan’s formulary.
In some cases they don’t take them on purpose because they don’t like the side effects.
But many times it is because the schedules for taking each drug may vary and it gets confusing.
The article suggests a universal medication schedule. This means labels on pill bottles would set out four standard times — morning, noon, evening and bedtime — for taking drugs.
A study showed that patients who got such patient-centered labels made significantly fewer errors in taking their prescriptions. California actually has called for this type of labeling, though it is not required.
The story also suggests pills should be consistent in appearance. Generics, for example, can often have a different shape or color than the brand name drugs.
The story says there is a free program available through Medicare called Medication Therapy Management that will review prescriptions, doses, costs and other questions for older people who take multiple medications.
Half of Prince Estate to go to Government
May 4, 2016
Since music superstar Prince did not have a will, it appears more than half of his $300 million estate will go to the government.
Both the federal and Minnesota governments have estate taxes. The top federal rate is 40 percent. In addition, Minnesota takes 16 percent over the first $1.6 million.
If Prince had been married, his estate would have gone to his spouse tax free.
As a single man, he might have taken advantage of some tax reducing strategies, but the government was still going to take a large share, the Daily Signal notes in a story.
Don’t Allow Divorce Derail Retirement Plans
April 27, 2016
The divorce of a long-married couple can be especially tough when it comes to retirement and estate plans.
Assets, particularly retirement accounts, can require the complete revision of in-place estate plans, according to a story on estateplanning.com.
It says it is key to work toward the fair division of assets so neither runs out of money later in life. It also says to update estate plans.
- Know what belongs to who. There is separate property and marital property.
- Think about setting up trusts. These can make sure that a second spouse cannot disinherit children from a first marriage, for example.
- Update the beneficiary forms on IRAs and other retirement accounts.
- Keep good records. Make sure not to overlook any assets you may have but may have forgotten about.
Estate Planning for your Pets
April 20, 2016
What will happen to your pets when you die?
Usually, they will end up in a shelter where, if not adopted, they too will die.
But one method pet owners can prevent that is to include your pets in your estate plan, says a story in the Union Leader.
Taking in and finding new homes for pets left after their owner’s death is something that certain special shelters do — granted there is a plan and funds are set aside
It takes planning though. Besides the plan, the pet owner should have a card in their wallet or in some easily seen place saying how many pets are owned and where they are, and it should include numbers for the vet, a pet-sitter and a trusted friend who has been spoken to about caring for the pets in case something happens.
If you can leave a trust, talk to a lawyer who has experience in this area.
Angie’s List on Estate Planning
April 13, 2016
A survey by AARP showed that about 40 percent of Baby Boomers don’t have a will. That number increases to 71 percent for all Americans over age 34.
Top excuses are procrastination, lack of incentives and cost.
However, a story on fox40.com that quotes Angie Hicks of Angie’s List says ignoring your own mortality can really cost your loved ones.
“While no one looks forward to planning their estate or funeral, it’s something we should all do because it an be considered a gift to your family because you are reducing stress that would be on them at that time,” she said.
The piece says an estate planning attorney can offer advice and file the necessary papers to make sure your assets go where you want them. An attorney quoted in the story strongly recommends that parents establish a trust that allocates inheritance at certain ages to kids don’t get too much too soon.
A trust is also critical if you have a disabled child, the attorney noted.
Hicks said you should expect to pay a minimum of $1,500 for the most basic estate plan.
Robotic Helpers In Your Future
April 6, 2016
As folks live longer, the ranks of the old and frail are growing by leaps and bounds. A big concern is over who will care for them.
An article in the New York Times says drones may be the answer.
It points out that a University of Illinois robotics designer has received a $1.5 million federal grant to explore the idea of designing small autonomous drones to perform simple household chores, like retrieving a bottle of medicine from another room.
The robotics expert, Naira Hovakimyan, said such drones will become everyday fixtures within a decade or two.
Other ideas include intelligent walkers, smart pendants that track falls, sensors that monitor health status, aides to help with balance and even robotic companions.
Medicare Paying for End of Life Talks
March 30, 2016
Medicare patients are being urged to discuss advance care planning with their doctors more frequently due to new changes in billing codes.
Starting this year, Medicare will allow payments to doctors for counseling their patients about end of life planning at different times. In the past, it would allow payments only on the first visit as a Medicare patient.
This is part of the Obama administration’s plan to help patients make more informed decisions, says a story on centredaily.com.
Now, Medicare will pay doctors to have this discussion on an annual basis.
Studies have shown fewer than half of all seniors have written down their wishes for end of life treatment.
Daily Living Activities Make Up Long-Term Care
March 23, 2016
Most long-term care focuses on helping people with basic personal needs rather than providing medical care.
Needs for long-term care are calculated by looking at whether a person needs help with six basic activities that most people do every day without help, says a story on elderlawanswers.com.
These are bathing, dressing, eating, moving from bed to a wheelchair and back, toileting and continence (the ability to control one’s bladder.) These are called Activities of Daily Living.
Other activities are important to independent living but not necessarily needed on a daily basis. These include things like using a telephone, managing medications, fixing meals, housekeeping, shopping for food and caring for pets. These are called instrumental Activities of Daily Living.
These items are scored by long-term care providers when determining whether help is needed, if the person is eligible for long-term care insurance or whether the person qualifies for Medicaid.