doctor patient relationship, when you;re old and blue, no one to tell your troubles too, Your Doctor and You -- Fourth in a Series

OLD, SICK AND ALONE

“Old age is not for sissies.”

Betty Davis

You’re over 75. Your friends are dying off. You’re divorced or widowed. You live alone. You’re one of 150 million Americans with one or more chronic diseases – arthritis, depression, hypertension, diabetes, coronary artery disease, heart failure, emphysema, Alzheimer’s.

You're frightened and confused about the new Medicare drug plan. Will you fall in the dreaded “Donut Hole,” or won’t you?

Your kids have moved and live in a distant warm weather state, most likely Florida, California, Texas, or a Southeastern state with a moderate climate. People are questioning your ability to drive, your last vestige of independence (“Older Drivers Fight to Stay on the Road,” Wall Street Journal, March 25, 2006).

You do not know quite what to do with the time you have left.

Should You or Shouldn’t You

Should you try to stay in your current home? That would be best. You want to maintain your dignity and independence. But it isn’t easy. It’s the simple things that are hard to do – cooking, shopping, and doing the laundry. Sometimes you need help dressing, bathing, and even doing ordinary toiletry. Where can you turn for help for these seemingly simple chores?

Should you sell the big house? Should you move into a condo? Should you consider an assisted living facility? Should you move closer to your children for family support? Should you get rid of your assets so you can qualify for Medicaid-assisted nursing homes?

These are scenarios and questions you face everyday. Doctors qualified to address problems of the elderly may not be available. A huge shortage of geriatricians exists in this country. The government is concerned. Chronic disease and long term care is costing a lot of money. Twenty percent of patients with chronic disease generate 80 percent of all health costs (in the management and economic worlds, this is known as Pareto’s Law – 20 percent of problems cause 80 percent of results).

Patients with Five or More Chronic Diseases

The Centers for Medicare and Medicare Services, says patients with five or more chronic conditions accounts for 23 percent of its beneficiaries but 68 percent of spending. These patients see an average of 13 different doctors each year and fill 50 prescriptions. By 2020, 25 percent of Americans will be living with multiple chronic conditions, and costs for managing them will reach $1.07 trillion (Source: Center for Medicare and Medicaid Services)

Medical Records, Medical Homes, and Home Monitoring

Some health plans are offering financial incentives to primary care doctors to invest in electronic medical records to improve care for patients with multiple ailments. With these records, doctors can coordinate care among multiple doctors and nurses.

The American College of Physicians, representing internists, the American Association of Family Practice, and the Academy of Pediatrics are asking to be paid more to establish a “medical home” in their offices.

The Centers of Medicare and Medicaid (CMS) have launched a pilot program covering 100,000 beneficiaries. CMS will pay eight companies, including Healthways, Aetna, CIGNA, and Health Dialogue to coordinate care.

Electronic Monitoring of Home-Bound Patients

One rapidly evolving trend is remote electronic monitoring of home-bound patients with small bedside video and audio units though. Through these units, chronically ill patients can initiate conversations with nurses and doctors and signal distress. Doctors and nurses, in turn, can see you, talk to you, listen to your heart and lungs through a remote stethoscope, and monitor your vital signs, your weight, and even your blood oxygen.

Next Episode of Your Doctor and You. Old, Sick and Alone. Fending for Yourself.