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Tag: Chronic conditions

  • Caring for multiple chronic conditions need not be so complicated

    Caring for multiple chronic conditions need not be so complicated

    Managing multiple chronic conditions can be as complicated as living with them. If you have multiple chronic conditions—conditions that are long-lasting and require medical attention—talk to your doctor about simplifying your treatment regimen.

    About one in four Americans suffer from multiple chronic conditions, including obesity, diabetes, heart disease, high blood pressure, arthritis and high cholesterol.  And, having multiple chronic conditions generally means having multiple doctors, multiple medical appointments, multiple tests, multiple medications and multiple medical directives with which to comply.

    Edie Grossfield reports for Next Avenue that the “burden of treatment” for people with multiple chronic conditions can be so great as to reduce the likelihood they will comply with their treatment regimens. It’s overwhelming. There’s a solution.

    A new model of care, Patient Priorities Care, engages you in a discussion with your physician about your health care wishes and goals. What’s most important to you? Living a longer life, engaging with others, pain relief, mobility? Once that’s established, you can get a personalized treatment plan that is less of a burden on you.

    Rather than ask patients an open-ended question like what are your treatment goals, Patient Priorities Care asks patients specifically what they want to be able to do on a daily basis. What gives you the greatest joy? What’s most important to you today?

    To date, Patient Priorities Care has been tested on 350 people, and it appears to be an effective model. Patients report that it lightens their burden of treatment. They don’t have to deal with treatment regimens they’d prefer not to deal with or that they believe don’t work.

    To be sure, patients often must accept trade-offs to benefit from Patients Priorities Care. For example, they might limit their medication intake in order to experience fewer side effects or get fewer lab tests. In the process they might end up living a little less long but a lot happier.

    Patients involved in the study felt less burdened by their treatment because they received less “unwanted care,” including medications, diagnostic testing, procedures and self-management tasks that patients either didn’t believe helped them or thought was just too much.

    The Patient Priorities Care model recognizes that we are all different. What works for some in the way of treatment will not likely work for all. Our bodies, our living situations, our relationships, our financial resources, our moods and more play a role in what works for us. The goal is to support us in the ways that best work for each of us.

    Will the Patient Priorities Care model catch on? It’s hard to know. It means that doctors have to give their patients more time. And, time is limited. But, patients can and should initiate the conversation about their priorities with their doctors. The first couple of visits will likely be a bit longer, but after that they should return to their normal length.

    If you speak to your doctor about streamlining your care regimen, keep in mind that Medicare requires doctors to follow disease treatment guidelines. However, those guidelines generally don’t apply to patients over 75 or 80. For other patients, physicians need only document the benefits of a different regimen for a patient.

    Here’s more from Just Care:

  • How to support a loved one diagnosed with a serious health condition

    How to support a loved one diagnosed with a serious health condition

    Sachin H. Jain writes for Forbes about the importance of understanding how difficult a grave diagnosis can be for a patient. Many people do not want to accept the fact that they have a serious condition, let alone a life-threatening illness. If your loved ones are diagnosed with a serious condition, try to appreciate why they might be in denial and help them manage their emotions.

    Jain explains that being told that you have a serious health condition is a lot like hearing that someone you love has died. People feel grief and often struggle to accept reality. Denial can be a way for people to protect themselves. It is a coping mechanism which permits people to move forward with their lives. Otherwise, it’s easy to feel burdened and at a standstill.

    For sure, accepting a diagnosis of a serious health condition also can be helpful. Acceptance can lead people to change their behaviors or seek medical treatment. Often acceptance follows denial.

    For family members and caregivers who want only the best for their loved ones, it can be hard to see them in denial about a serious illness. You want your loved ones to modify their behaviors in order to extend their lives. But, that may not happen immediately. It’s therefore best for you to be patient and not judge your loved ones for failing to act as you would want them to.

    As a general rule, you and other caregivers should accompany the people you love when they visit the doctor. It can help them manage their sadness and fear. If the sadness and fear is recognized and discussed, rather than suppressed, behavioral modifications and other treatments are generally easier to follow.

    Do not focus on a loved one’s denial of a condition or non-compliance with treatment recommendations. Recognize how hard it is to face a serious health condition and how such a diagnosis can be scary and cause sadness.

    Here’s more from Just Care:

  • Ten tips for checking your blood pressure at home

    Ten tips for checking your blood pressure at home

    Doctors are increasingly recommending that patients check their blood pressure at home to diagnose high blood pressure (hypertension) and make treatment decisions. Seeing the pattern of your blood pressure at home allows a doctor to make a more informed decision about treatment than a single test at the doctor’s office.

    To ensure appropriate treatment, it’s important that you take appropriate steps when you monitor your blood pressure. Mistakes in your technique at home could misdirect the doctor to prescribe you too much, too little, or the wrong type of medication.

    If you’ve been advised to monitor your blood pressure at home, follow these ten tips to ensure your data is accurate:

    At your doctor’s visit:

    1. Learn your numbers. Ask your doctor what your target blood pressure is. Targets can differ by as much as 20 points, depending on age and medical condition. Ask your doctor how often to check, and what results require an urgent call to the office, or a visit to the emergency room.
    2. Bring your machine to the doctor at least once. The office can check your machine against office measurements. Make sure that your cuff size is correct: a cuff that’s too small will overestimate your pressure and a cuff too large will underestimate it.
    3. Relax. It’s common for your blood pressure at the office to be higher than your results at home. This is called “white coat hypertension,” and is probably a result of the mild anxiety you may feel at the doctor’s office. That’s why doctors often recommend patients check their blood pressure at home. Doctors sometimes recommend further testing with another method, if available, for patients with white coat hypertension; this method is called ambulatory blood pressure monitoring.

    At home:

    1. Plan in advance. No smoking, caffeine or exertion 30 minutes before. Empty your bladder. Rest for 5-10 minutes before you start.
    2. Know the correct body position.
      • Sit upright with your back supported and your feet on the floor. Don’t cross your legs or rest them on an ottoman.
      • Rest your arm at the level of your heart (for example, on pillows, books, or on a table). If your arm is too low—for example, lying in your lap–your results could overestimate your pressure.
    3. Consistently measure either the right or left arm.
    4. Stay still and quiet while the machine runs.
    5. Repeat the cycle once.
    6. If you get a high number, don’t panic. Expect some normal variations between days. Remember things like emotion, stress, exertion, or pain temporarily raise blood pressure, and this is not necessarily the same as poorly controlled blood pressure. Your blood pressure will typically be a little higher in the morning than the evening. Use your doctor’s guidelines to know what your action plan should be for high numbers.
    7. Check your blood pressure regularly, if your doctor has recommended home monitoring.  Checking it only when you are feeling bad can be misleading. But, do not become overly obsessed with checking if your blood pressure is alright. Two to three times a week is usually sufficient, unless your doctor recommends otherwise. Light headedness may indicate your blood pressure is too low, so do check in that instance. Low blood pressure is a frequent problem for older patients leading to falls or other problems, so it is important to note when this happens. Record your numbers in a log with the date and time, and bring the log to your next doctor’s appointment.

    This post was originally published on May 15, 2015

    Here’s more from Just Care:

  • People with serious health needs more likely to disenroll from Medicare Advantage plans

    People with serious health needs more likely to disenroll from Medicare Advantage plans

    A new study by David Meyers, Brown University School of Public Health, et al., of people enrolled in Medicare Advantage plans, published in JAMA Internal Medicine, shows that people with high health care needs disenroll from these commercial Medicare health plans into traditional Medicare at higher rates than people in better health. Their findings suggest that commercial health plans, overall, are not in business to meet the needs of people with complex conditions.

    Medicare Advantage plans have financial incentives to attract healthy members and steer less healthy members out of their plans. The federal government pays these plans a fixed rate per member. The less care each member receives, the more money the health plan gets to keep.

    The study’s authors find that rates of disenrollment from Medicare Advantage plans increase after people experience a serious health condition. The Government Accountability Office also has studied this issue and found that a high proportion of people disenroll from Medicare Advantage plans when they have serious health care needs.

    We have little clue how poorly the people with complex conditions who remain in their Medicare Advantage plans fare. Some evidence is concerning. In May 2018, Just Care reported on another study showing that enrollees in Medicare Advantage plans are more likely to end up in poorer quality skilled nursing facilities than people in traditional Medicare. More recently, a judge in Northern California found that UnitedHealth illegally denied necessary care to tens of thousands of enrollees with mental health needs.

    Poor treatment by commercial health plans of people with costly conditions is one reason why proponents of Medicare for All support improving and expanding Medicare to everyone. Medicare for all would fill gaps in traditional Medicare coverage, eliminating premiums, deductibles and coinsurance and adding vision, hearing, dental and long-term care. Medicare for All would also end commercial health insurance, including Medicare Advantage plans, which drive up costs and differ dramatically from traditional Medicare.

    The study’s authors looked at data of 13.9 million people enrolled in Medicare Advantage plans over a two-year period. They found a disenrollment rate of 4.6 percent for people with high needs as compared to a disenrollment rate of 3.3 percent for people without high needs. They infer from the data that Medicare Advantage plans are less likely to meet the preferences of people with complex conditions than people with fewer health care needs.

    The authors’ findings confirm what we already know. People with complex conditions are often hard-pressed to see the doctors they want to see and get the care they need when enrolled in a commercial Medicare Advantage plan.

    Of course, not all Medicare Advantage plans are alike. The study’s authors suggest that the ones with low star ratings are likely less well-equipped to meet the needs of people with costly conditions. But, the Medicare Advantage plans with five-star ratings could be ones that are engaged in wrongful delays and denials of care; the five-star ratings do not say enough about a plan’s performance to rely upon.

    The authors do not disclose the names of the Medicare Advantage plans with the disproportional disenrollment among enrollees needing costly care. Generally, Medicare Advantage plans only allow researchers to use their data on the condition that the researchers not call out particular health plans; in some cases, the researchers do not know which data belongs to which health plans. Keeping this information confidential is a particular disservice to the public.

    The authors categorized people as having a high health need if they have two or more “complex chronic conditions such as heart failure, chronic obstructive pulmonary disorder, and depression” or “six or more chronic conditions.”  They also looked at dual-eligibles–people with Medicare and Medicaid.

    Dual-eligibles with costly health needs disenrolled from Medicare Advantage plans to traditional Medicare at higher rates than others. But, the authors did not explore whether this is because others may not be able to buy the supplemental coverage they need to fill coverage gaps if they switch to traditional Medicare. The ability to buy supplemental coverage is not guaranteed in many states, except when people initially enroll in Medicare at 65.

    If you support Medicare for All, please tell your members of Congress. Please sign this petition.

    Here’s more from Just Care:

  • Six ways to help speed your recovery after surgery

    Six ways to help speed your recovery after surgery

    Healing after surgery always takes time.  But, there are things you can do or not do to help speed your recovery after surgery. And, yes the most basic five are ones that will not comes as a surprise. Keep in mind that it’s always best to have a buddy at the hospital with you before, during and after surgery if at all possible. For more on that and how to prepare for your hospital stay, click here.

    1. Don’t smoke. Smoking is not only bad for your lungs, it’s bad for your entire body.  Smoking hurts your vascular system, which can slow down the speed at which your wounds heal and can lead to infection. If you smoke, keep in mind that Medicare covers smoking cessation programs.  To learn more about Medicare coverage to help with smoking cessation as well as for other preventive services, click here.
    2. Eat well. A poor diet can slow down recovery. If you are malnourished, you will likely have a weaker immune system and your body will be less prepared to recover from surgery. Malnutrition is considered a risk factor for illness and mortality after surgery.  Medicare sometimes covers nutrition counseling.
    3. Keep your weight down to a healthy level. People who are overweight are less fit for surgery, often because they have heart disease, high blood pressure and breathing issues as well. Obesity can slow down the wound healing process. Medicare covers obesity counseling programs.
    4. Take care of your health condition. If you have a chronic condition, such as diabetes or hypertension, make sure you are getting good treatment to manage your condition. A managed chronic condition will help you recover faster from surgery. For example, good blood sugar control speeds up healing and reduces the risk of infection.
    5. Make sure you understand and follow directions for your care after surgery. You should receive a written discharge plan before you leave the hospital. And follow these steps before leaving the hospital.
    6. Make sure you understand what medications you should be taking (or not taking) after your surgery. For example, your surgeon or primary care provider may recommend changes to your usual blood thinner (such as aspirin) or diabetes medication after surgery.

    Here are two other things you might want to know:

    1. Some evidence suggests that chewing sugarless gum after surgery can help your digestive system to get back to normal, especially if you have a bowel surgery. There is no apparent downside.
    2. Very little evidence supports the notion that carbohydrate supplements prior to surgery speeds the recovery process.

    This post was originally published on September 17, 2015.

    Here’s more from Just Care:

  • Improve your health with a buddy

    Improve your health with a buddy

    We live in an “every man for himself” society at a time when we would fare better recognizing the benefits of being “all in it together.” Social solidarity has a lot to say for itself when it comes to our health and financial security. At the policy level, there’s no better testament to the value of social solidarity than Medicare and Social Security. And, at the personal level, there’s mounting evidence that we improve our health when we have buddies, including casual acquaintances.

    The data suggest that having health care buddies improves your health and extends your life. Buddies can provide mental, physical, emotional, social and psychological support that many older adults, particularly those living alone, are lacking. People with few or no social relationships are as likely to experience an early death as people who smoke. And, they are more likely to die prematurely than people who do not exercise or who are overweight.

    SFGate reports on a study in Health Psychology which shows the value of having casual buddies, people you may not know well but whom you see every now and then at church, at the gym, the grocery store or coffee shop. Over four years, researchers looked at people’s lung function–which is a good predictor of health and longevity. They found that people who had more people in their social networks fared better. It may be because people with more relationships tend to take better care of themselves and be more positive in their outlooks.

    It’s also great for your health to have one or more close buddies who can be your partner when you need medical care. Close family members and friends can help you navigate your health care options and coordinate your care. People with multiple chronic conditions–about three out of four older adults–especially benefit from a health care buddy to help coordinate their care. Your health care buddy can be anyone you trust to help ensure your health care needs are met.

    No matter how old you are, if you have a chronic condition, it’s important to bring someone with you to your doctor’s appointment. You may be seeing an array of doctors and other health care providers each year, are likely on multiple medications and getting a lot of instructions about how to care for yourself. Your health care buddy serves as a second pair of eyes and ears, takes notes on what you need to do, and asks questions that you might not feel comfortable asking or might forget to ask. It’s wise to have a written record of what your doctor recommends. It’s difficult to keep track of all the things you need to do. A buddy can help keep you on track.

    Similarly, it’s important to have a buddy to go with you to the hospital, even if your buddy is not a family member. Your buddy can make sure you are well cared for, both while you’re in hospital and when you leave the hospital. A buddy also can help prevent or reduce the chance of medical mistakes and delirium when you’re moving from one care facility to another.

    Your buddy can ensure you get any new prescriptions filled and that you understand how to care for yourself after you leave. Ideally, your buddy can help you with any questions or concerns you have and, if necessary, speak to your doctor on your behalf.

    When it comes to your health and quality of life, buddies matter. Do your best not to go it alone. If you don’t have a buddy, consider making it your mission to find one. You might offer to be a buddy for a friend or neighbor and have that friend or neighbor be your buddy.

    Here’s more from Just Care:

  • If you’re often tired during the day, you could have sleep apnea

    If you’re often tired during the day, you could have sleep apnea

    Many people suffer from sleep apnea, particularly older adults.  Sleep apnea is a pausing of breath or shallow breathing while you sleep.  But, because it occurs during sleep, it often goes undiagnosed and untreated. Indeed, it is estimated that up to 80 percent of people with sleep apnea have not been diagnosed for it.

    Most people with sleep apnea have obstructive sleep apnea. During sleep the airway collapses or is blocked. When air squeezes through the blockage it can cause you to snore loudly. People who are overweight are more likely to have it. A small number of people have central sleep apnea. With this condition, the part of your brain that controls your breathing will not send the proper signals and you will not breathe for short periods.

    The National Institutes of Health explains that sleep apnea has one of two causes: a person’s physical structure or medical conditions.  A wide variety of medical conditions  could cause sleep apnea, including obesity, large tonsils, endocrine disorders, neuromuscular disorders, heart or kidney failure, certain genetic syndromes, and premature birth.

    Sleep apnea symptoms include snoring, stopping breathing, or gasping during your sleep. If sleep apnea is severe, you might experience 30 or more long interruptions in breathing an hour. Or, interruptions can be few and only last for a few seconds. But, these interruptions in your breathing can pull you out of your deep sleep into a light sleep. You then end up with a bad night’s sleep and may feel tired during the day. You might also wake up with a headache.

    Healthy changes in your lifestyle could decrease your risk of developing sleep apnea. Smoking, drinking alcohol and unhealthy eating patterns that lead to obesity all could increase your risk of sleep apnea.

    Sleep apnea, when untreated, is associated with heart disease and heart deaths, as well as high blood pressure or hypertension. It can increase your risk of asthma, atrial fibrillation and pancreatic, renal and skin cancers. Sleep apnea is more prevalent among people with diabetes, coronary artery disease and congestive heart failure.

    Your doctor cannot diagnose sleep apnea through a blood test. It is typically diagnosed through a polysomnogram. Once diagnosed, you can usually treat sleep apnea through changes to diet and lifestyle, devices that help you breathe, mouthpieces and surgery.

    The NIH has a short video to help you better understand what happens to people with sleep apnea.  And, here are seven tips from the National Institutes of Health for getting a good night’s sleep.

    Here’s more from Just Care:

  • Two in five older adults needing long term care do not get it

    Two in five older adults needing long term care do not get it

    As they age, most older adults living in their communities rely primarily on family and other unpaid caregivers to help them cook and do laundry as well as to help them with bathing and dressing, according to a new report from the Commonwealth Fund. If their income is low, Medicaid may cover the cost of paid caregivers to provide these long-term care services and supports. But, two in five older adults needing long-term care do not get it. 

    The federal government needs to fund long-term services and supports (LTSS) to ensure that all older adults and people with disabilities get needed care. Medicare does not cover LTSS. Today, significantly fewer than half of people with Medicare needing LTSS (43 percent) receive unpaid assistance from family, friends and community service programs. Because paid services are costly, only 15 percent of people with Medicare receive paid services; a lot of those people get those services through Medicaid. 

    Two out of five people with Medicare needing LTSS today (42 percent) do not receive any LTSS, paid or unpaid. While people with Medicare and Medicaid are the most likely to receive paid LTSS, one in three people with both Medicare and Medicaid reported not getting any help. Whether they get help depends in significant part on their eligibility for LTSS in the state they live in, along with the waiting lists for services.  And, most of them rely heavily on unpaid support, regardless of whether they get paid support.

    About 5o percent of people with Medicare who have three or more chronic conditions and substantial medical needs rely on unpaid care exclusively. And, one in five (20 percent) of these people receive no assistance with their personal care at all.

    Because the population is aging, an increasing number of older Americans will need LTSS. The federal government covers about two-thirds of LTSS costs through Medicaid today, but more funding is needed for personal care services and to keep people out of nursing homes.

    If the federal government covered LTSS, it would be in addition to the unpaid care people receive. It would not replace it. The Commonwealth Fund report found that people with Medicare receive the same amount of unpaid care whether they receive paid care or not.

    Here’s more from Just Care:

  • Eat less, live longer

    Eat less, live longer

    Over the last 30 years, the risk of chronic conditions in people 55-64 has declined. Researchers now believe that we can improve quality of life and live longer, if we eat less.

    While studies have not been done on humans, studies on rats, mice and monkeys show that reducing their daily calorie intake by 30 percent–while ensuring good nutrition–improves their health and extends their lives.

    According to the BBC, even in Ancient Greece, eating less was considered best for one’s health. Plain and simple, slim Greeks lived longer than obese Greeks.

    Two major studies on calorie intake of rhesus monkeys show that a 30 percent lower calorie intake means longer life and better health. Their risk of cancer and heart disease was cut in half.  And, none of them developed diabetes. Moreover, almost four in ten (37 percent) monkeys who did not reduce calorie intake died of age-related causes in 20 years; fewer than one in eight (13 percent) monkeys with reduced calorie intake died in 20 years.

    And, while we are not rhesus monkeys, our DNA is 93 percent identical. We also age in a similar way, with skin and muscles that typically sag, and hair that generally thins and goes grey. Like people, rhesus monkeys are also prone to diabetes, heart disease and cancer as they age.

    Stat reports that a professor at USC, Valter Longo, is selling diet boxes based on the theory that fasting and eating less will improve our health and extends our lives, as it has been shown to do in mice and other lab animals. Longo suggests that fasting allows us to turn off cells that are otherwise active if we’re always eating. In the process, fasting strengthens the cells so they can burn more fat.

    Here’s more from Just Care:

  • Heart health and cardiovascular care

    Heart health and cardiovascular care

    Heart health can mean the difference between a good quality of life as we age and one with serious disabilities. Heart disease is the number one killer in the United States, and people with heart disease may have no symptoms. “Cardiovascular” or heart care can be critical.

    The risk of many forms of heart disease, heart attacks, and stroke increases with age. And, like it or not, we are growing older. Heart disease is also associated with factors that are within our control: high blood pressure, high cholesterol, high blood sugar and cigarette smoking.

    We can dramatically reduce our risk for most forms of heart disease and stroke by controlling these risk factors with a healthy diet, regular exercise, and smoking cessation. (Medicare covers nutritional counseling, weight counseling, and smoking cessation counseling.)

    The National Institutes of Health recommends that you stay aware of blood pressure, blood cholesterol, and blood sugar levels to keep them within a healthy range. More than one in three adults have high blood pressure, which increases your risk of heart disease.

    Have a doctor check your blood pressure each year. Medicare covers the full cost of an annual blood pressure screening during your Welcome to Medicare visit and each year after that during your Annual Wellness visit. Your medical screening should include:

    1. Discussion about aspirin use: Men and women between the ages of 55 and 79 should generally take an aspirin a day. And, daily aspirin is often recommended for men beginning at 45, ten years before women.
    2. Blood pressure screening: Recommended for all adults.
    3. Behavioral counseling: A healthy diet is highly recommended.

    To identify conditions that could lead to heart attack or stroke and lower your risk of cardiovascular disease, Medicare also covers three important cardiovascular screening blood tests every five years, if ordered by a doctor:

    • cholesterol
    • lipid
    • triglyceride levels

    You can benefit from coverage with no out-of-pocket costs. If you have:

    • Traditional Medicare: See a doctor who takes assignment, who accepts Medicare’s rate as payment in full.
    • Medicare Advantage, private Medicare plan: See an in-network provider.

    For some people with serious heart conditions, Medicare also covers cardiac rehabilitation programs.

    Here’s more from Just Care: