Quality of Life

Research & Thoughts

The Tampa Bay Times reports use of a Yacker Tracker at Tampa Bays two veterans hospitals.  A Yacker Track “is a testing device that measure the decibel level on inpatient wards. Placed at nursing stations and looking like a red light signal, the device flashes red when the noise exceeds levels set by the hospital.”

VA hospital officials, it is reported, understand that noise can delay recovery and healing. Look for signs in the hospital that state “Quite please Patients healing.”

The Wall Street Journal, today, states on its editorial page the definite and imperative need for Medicare reform in one sentence. “The brutal math is that Medicare spending has been growing about three percentage points faster every year than the overall economy for the last quarter-century and is now the main driver of the financial crisis.”  Legislative leadership is shifting to a stipend approach.  This may cap the Federal Government’s financial exposure.  With a stipend one often finds not enough payment to cover the choice you prefer. 

How will Health Care marketplace respond to this change of focus? How will consumer directed care be better served?

These questions and many others will reframe the debate about health care entitlements.  It is probably time to reframe the debate, the boomers are not their parents elders.  Choices and alternatives to traditional long term care approaches are desired by the boomers.  Life style and personal preferences are key to the boomers making these choices.  As the role of the patient changes into a health care consumer the market place and pricing for care will respond.  The Boomer who desires to create a supportive care environment that does not financial exhaust may find satisfaction with the flexibility that a market driven choice could provide.

Keep you eyes on the ball, the politics of Medicare is an interesting game.

The medicaid transition program is one of Florida responses to the US Supreme Court case named Olmstead.  The Olmstead case brought ADA rights to those in nursing homes paid for by Medicaid. I find it important to recall the Haddad case from the Jacksonville US District Court.  In the Haddad case an adult who was disabled living at home, refused to wait 60 days of residing in a nursing home. She argued that she would lose her supportive care network that had been established for years if she relocated.  The federal court found her pleas had merit and ordered the state to provide the transition program.  Currently Florida Citizens are forced to wait for care in the community. The Rosenrkanz law firm seeks to be creative during the 60 day wait for Transiton.

This headline ran over a Wall Street Journal article about rationing of health care in Canada.  It offers a sad outlook if the US Health Care System follows the Canadian “Too Old for Hip Surgery” model.  Preventive care will be the focus of the future.  Quality of Life depends on having a supportive and conscientious environment within which to age.  Recognizing the risks in the American system, scholars and policymakers have begun to differentiate between the fundamental causes of healthcare disparities – access, education, poverty – and patient level disparities.  Scholars Peter Franks, MD and Kevin Fiscella, MD use the term “downstream reforms” in an effort to describe the disparities that occur at the patient level.  In the January 2008 edition of The Journal of Internal General Medicine, they highlight downstream reforms that are important to improving the health care for the chronically ill. 
These Doctors argue that disparities can be addressed by examining both the provider-patient interaction and the manner in which clinical decisions are made.  Much of their discussion centers on what individual doctors and patients can do to change their own biases and actions.  The Baby Boomers are moving to individualize health care where personal preferences, desires and comfort are often just as important as clinical factors.
Until widespread reforms are made that affect physician and clinical decision-making, elders and their families will need to implement their own downstream reforms through self-education and advocacy to improve care and prevent disparities.  The Rosenrkanz law firm may be able to help build a supportive care environment that does not financially exhaust the family.

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