Tag Archives: ambulance

Saving Medicare billions: Trying too hard can get in the way

Ambulance parked in front of my bedroom window waiting to pick up a neighbor

Today is Sunday, February 26, 2012.  I took the photograph above last week. My apartment is within an eight-story building housing 90 low-income elderly and disabled individuals, an ambulance parks outside my window at least once a week. Sometimes my neighbors and I return. Sometimes, not. The cost for Medicare, Medicaid, and other services to go on the gurney ride to the hospital and beyond is many times higher than the cost of preventing and treating.

The following article appeared in the October, 2011 issue of  HME News and it still reflects an ongoing concern. Following the article, I will provide a memorial note on one of the residents who did not return.

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The money saved as a consequence of concentrating on what is right will astonish the body politic

” I have saved up enough pills to kill myself,” a neighbor told me, “if I ever have to go to Centre Crest.”

I live in an independent housing apartment building in downtown State College, Pa. The nearly 100 residents of Addison Court are disabled or elderly. Most of us are poor–the more affluent are on Social Security or Social Security Disability and Medicare.
At least once a week, the ambulance stops by my window and a resident goes off to the hospital. The lucky return. The not-so-lucky move on to Centre Crest, the default public nursing home about 11 miles away, where assisted living means expensive round-the-clock care, diaper changes, attachment to machines that keep the biological aspects of life going, medical personnel who make sure medications are taken correctly, and a world view that echoes Dante’s inscription over Hell: “Abandon hope, ye who enter here.”
Last year, Pennsylvania’s Department of Aging estimated it costs Medicare $40,000 extra each year for a resident to move from an independent living to an assistive living facility. The loss of dignity to the individual is incalculable.
The French philosopher Jean Paul Sartre observed that when one tries especially hard to listen, often the trying gets in the way of hearing. Medicare is trying too hard to do the wrong thing. Medicare‘s purpose is not to save money, but to provide health care in a way that concentrates on improving the quality of life. Recent evidence on the brain’s adaptive capacity provides hope that not only can individuals resume physical capacity from the devastation of a variety of afflictions that affect us at Addison Court, but also we can regain our talents to improve this society, not simply take from it.
“The Brain that Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science,” by Columbia University’s Norman Doidge, M.D., points to the brain’s ability to recover from strokes and other disorders with rehabilitation and concern.
“Traditional rehabilitation,” Doidge writes, “typically ended after a few weeks when a patient stopped improving, or ‘plateaued.’ And doctors lost the motivation to continue.  But…these learning plateaus were temporary…Though there was no apparent progress in the consolidation stage, biological changes were happening internally, as new skills became more automatic and refined.”
The Obama administration’s penny-wise-and-pound-foolish cutbacks on availability to durable medical equipment, rehabilitation services, and home health care are forcing residents of independent living facilities into the Centre Crests of this country. For example, the narrow focus is apparent in Medicare‘s frequent citations of the Congressional Budget Office‘s competitive bidding estimates of relatively insignificant savings for Medicare Part B ignoring the astronomical costs that will result to Part A when disabled individuals like me can no longer pick up the phone and call my local medical equipment provider. Instead, I must wait for a competitive bidding winner (several have unsavory reputations and some are based out-of-state) to provide a battery. Delays could easily force me into Centre Crest as a result of falls, problems getting to the bathroom, etc. Delays would rob me of the ability to work as an adviser on virtual reality models for construction of future aging in place housing–construction which will result in significant Medicare savings.
Medicare is discouraging the necessary alliance between rehabilitation therapists and medical suppliers. This alliance will help restore the ability of my fellow residents to function and contribute to society.
“Individuals with disabilities remain one of our nation’s greatest untapped resources,” said Rep Jim Langevin, D-R.I., the only quadriplegic in Congress. To release the untapped resources of the elderly and disabled, Medicare must stop thinking about saving money and start thinking about improving health. The money saved as a consequence of concentrating on what is right will astonish the body politic. Providers of durable medical equipment require the support of consumers like me. Providers and rehabilitation therapists have been slow to recognize that in unity there is strength. Together they must spread the word that when an individual becomes old or disabled, science is rapidly increasing the ability to regain talent and good health.
–Joel Solkoff is the author of “Learning to Live Again, My Triumph over Cancer” and is adjunct research assistant at Penn State’s Department of Architectural Engineering.
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Memorial Note: Tonight, November 14, 2011, Jack Seidner aged 93, my neighbor and friend at Addison Court, State College. PA, died while talking to his son who had called from Israel. He died at Centre Crest, an assistive care facility in Bellefonte, PA, 11 miles from Addison Court.
Jack was a veteran of World War II and was a monthly calendar boy on the Jewish War Veterans calendar last year  He will be buried beside his wife in Harrisburg at a private funeral.
Jack was a wonderful man. He was basically an intellectual although he hid it as much as possible. When I wrote a story about home medical oxygen, oxygen which he received to stay alive, he refused to be photographed saying, “I have been studied enough.”
His sense of humor was ever-present, sometimes to the point of reciting bawdy limericks to the residents of Addison Court. I will miss him. He died at Centre Crest. The article below, originally published in HME News on September 27, 2011, is dedicated to his memory. In these days of turmoil at Penn State University, the need to care for the real needs of this community should be apparent.

Saving Medicare billions: Trying too hard can get in the way

Memorial Note: November 13, 2011, Jack Seidner aged 93, my neighbor and friend at Addison Court, State College. PA, died while talking to his son who had called from Israel. He died at Centre Crest, an assistive care facility in Bellefonte, PA, 11 miles from Addison Court.
Jack was a veteran of World War II and was a monthly calendar boy on the Jewish War Veterans calendar last year  He will be buried beside his wife in Harrisburg at a private funeral.

 

Jack was a wonderful man. He was basically an intellectual although he hid it as much as possible. When I wrote a story about home medical oxygen, oxygen which he received to stay alive, he refused to be photographed saying, “I have been studied enough.”
His sense of humor was ever-present, sometimes to the point of reciting bawdy limericks to the residents of Addison Court. I will miss him. He died at Centre Crest. The article below, originally published in HME News on September 27, 2011, is dedicated to his memory. In these days of turmoil at Penn State University, the need to care for the real needs of this community should be apparent.+++
Saving Medicare billions: 
Trying too hard can get in the way 
The money saved as a consequence of concentrating on what is right will astonish the body politic
“I have saved up enough pills to kill myself,” a neighbor told me, “if I ever have to go to Centre Crest.”

I live in an independent housing apartment building in downtown State College, Pa. The nearly 100 residents of Addison Court are disabled or elderly. Most of us are poor–the more affluent are on Social Security or Social Security Disability and Medicare.

At least once a week, the ambulance stops by my window and a resident goes off to the hospital. The lucky return. The not-so-lucky move on to Centre Crest, the default public nursing home about 11 miles away, where assisted living means expensive round-the-clock care, diaper changes, attachment to machines that keep the biological aspects of life going, medical personnel who make sure medications are taken correctly, and a world view that echoes Dante’s inscription over Hell: “Abandon hope, ye who enter here.”

Last year, Pennsylvania’s Department of Aging estimated it costs Medicare $40,000 extra each year for a resident to move from an independent living to an assistive living facility. The loss of dignity to the individual is incalculable.

The French philosopher Jean Paul Sartre observed that when one tries especially hard to listen, often the trying gets in the way of hearing. Medicare is trying too hard to do the wrong thing. Medicare‘s purpose is not to save money, but to provide health care in a way that concentrates on improving the quality of life. Recent evidence on the brain’s adaptive capacity provides hope that not only can individuals resume physical capacity from the devastation of a variety of afflictions that affect us at Addison Court, but also we can regain our talents to improve this society, not simply take from it.

“The Brain that Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science,” by Columbia University’s Norman Doidge, M.D., points to the brain’s ability to recover from strokes and other disorders with rehabilitation and concern.

“Traditional rehabilitation,” Doidge writes, “typically ended after a few weeks when a patient stopped improving, or ‘plateaued.’ And doctors lost the motivation to continue.  But…these learning plateaus were temporary…Though there was no apparent progress in the consolidation stage, biological changes were happening internally, as new skills became more automatic and refined.”

The Obama administration’s penny-wise-and-pound-foolish cutbacks on availability to durable medical equipment, rehabilitation services, and home health care are forcing residents of independent living facilities into the Centre Crests of this country. For example, the narrow focus is apparent in Medicare‘s frequent citations of the Congressional Budget Office’s competitive bidding estimates of relatively insignificant savings for Medicare Part B ignoring the astronomical costs that will result to Part A when disabled individuals like me can no longer pick up the phone and call my local medical equipment provider. Instead, I must wait for a competitive bidding winner (several have unsavory reputations and some are based out-of-state) to provide a battery. Delays could easily force me into Centre Crest as a result of falls, problems getting to the bathroom, etc. Delays would rob me of the ability to work as an adviser on virtual reality models for construction of future aging in place housing–construction which will result in significant Medicare savings.

Medicare is discouraging the necessary alliance between rehabilitation therapists and medical suppliers. This alliance will help restore the ability of my fellow residents to function and contribute to society.

“Individuals with disabilities remain one of our nation’s greatest untapped resources,” said Rep Jim Langevin, D-R.I., the only quadriplegic in Congress. To release the untapped resources of the elderly and disabled, Medicare must stop thinking about saving money and start thinking about improving health. The money saved as a consequence of concentrating on what is right will astonish the body politic. Providers of durable medical equipment require the support of consumers like me. Providers and rehabilitation therapists have been slow to recognize that in unity there is strength. Together they must spread the word that when an individual becomes old or disabled, science is rapidly increasing the ability to regain talent and good health.
Joel Solkoff is the author of “Learning to Live Again, My Triumph over Cancer” and is adjunct research assistant at Penn State’s Department of Architectural Engineering.

When I was treated for cancer 36 years ago, I wrote the following account:

[Note: I was diagnosed and treated for cancer in 1976 when I was 28 years old. This is how I described the experience when I was in the midst of my first round of radiation treatment.]
                                                                                                              
 A New Lease on Life by Joel Solkoff, November 26, 1976
I am 28 years old and I have cancer. Anger comes before anything else. There are times that the anger becomes overwhelming, turns to frustrated rage, because there is no one to be angry at. I can curse God which I’ve done many times, but it is unsatisfying because God doesn’t shout back. Crying helps.
I started weeping in the hospital. An intern; frightened by the emotion, asked me to stop, She said I was upsetting the other patients. I told her to get lost, and when I was done weeping I found her and shouted at the top of my lungs, “You’re what’s wrong with doctors. You have no feelings!” It felt good to shout at someone.  
My form of cancer was first described in 1832 by Dr. Thomas Hodgkin—after whom it is named—and its cause is still a mystery. It is a disease of the lymphatic system, clogging the body’s ability to purify the blood and thus to fight off infection.  
The cancerous tumors, which are enlarged lymph nodes, may also take over nearby vital organs, such as the liver and lungs. Because the tumors are part of a system that circulates throughout the body, surgical removal generally does not remove the disease. A microscopic piece of tumor may remain in the body, or whatever caused the gland to grow abnormally large may already be elsewhere. Such problems made Hodgkin’s disease extremely difficult to treat and meant that, until quite recently, it was described as “universally fatal.”  
In my lifetime, advances in treatment have been so successful that it appears unlikely that the disease will affect my lifespan or that I will feel its effects. Many techniques are so new that we patients haven’t lived long enough to establish whether we’ve been “cured.” The other day, as the technician adjusts my body under the linear accelerator, she said, “If I had to pick a disease to have, I’d pick yours.”  
During the months of incapacitation, I have slowly begun to appreciate that I am fortunate to be living in these times.   The process began when a lump under arm right arm did not go away. The lump did not hurt; it wasn’t even uncomfortable, but seeing a doctor seemed sensible. My appointment was on a Friday afternoon, and when the internist grabbed the phone, told me to run three blocks to the nearby surgeon, and then reassured me “not to worry,” I was frightened. Removing the lump, under a local anesthetic, hurt less than I had feared. After an assortment of pathologists had looked at sections of the lump under a microscope and after one misdiagnosis (Hodgkin’s disease is a difficult cancer to identify), my internist’s suspicions were confirmed.
Then came tests. To treat the disease it was first necessary to know where it was located.  I was injected with isotopes So that my liver would show up on a television screen. Marrow was taken from the hip bone. There were blood tests and X-rays. My feet were slit open so an opaque fluid could run through the lymphatic system.
Finally, there was abdominal surgery. Its purpose was exploratory, but the pain afterwards was overwhelming. Screaming for more relief than the drugs could give, I was oblivious to the long-term beneficial result. I had always thought that pain was either avoidable or imaginary.
As soon as I recovered from surgery, the internist prescribed the treatment–radiation. The radiology lab is in a basement, and most of us walk in off the street as outpatients. When patients come in for the first time, their names are placed on a blackboard, with the name of the disease and of the doctor. Etiquette forbids the placing of numbered odds, but most patients do not share my apparent good fortune.
I go into the room where X-rays are sent through my body every day for 12 weeks. The process takes a few minutes and is painless. The rays kill all cells the area at which the machine is focused. Because cancer cells multiply more rapidly than normal cells, the rays do more lasting damage to the cancer cells. However, since cells are killed indiscriminately, treatments make me feel weak and weepy.

I have trouble swallowing. The hair on the back of my neck has fallen out –temporarily. I have severe skin burn. My stomach feels queasy and I spend a lot of energy fighting the urge to vomit. Slowly, I have come to understand that life has been given to me for a second time.

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Joel Solkoff is author of the forthcoming book “You Reap What You Sow: How the Government Regulates Agriculture.”