By Kerry Young CQ HealthBeat Associate Editor
November 12, 2013 -- The frail elderly too often are treated with expensive drugs and medical treatments while they lack the basic services that would do more to keep them healthier, an elder care expert recently said.
Doctors pay too little attention to the community support services that their patients may need, viewing these as something that someone else in the community knows about and will take care of, Joanne Lynn, director of the Center for Elder Care and Advanced Illness at the nonprofit Altarum Institute in Washington, said at a recent press conference sponsored by the Journal of the American Medical Association (JAMA). Yet, she said, services such as the Supplemental Nutrition Assistance Program and Meals on Wheels aid many of the frail elderly, who often suffer from multiple medical conditions that can be made worse by inadequate nutrition,
“There’s no bigger threat that has happened in the past year to the well being of the elderly than the cuts in SNAP and food support,” Lynn said, adding that an estimated 12 million meals were lost due to the budget sequester. “Where are the doctors rallying to yell about their patient not having enough food?”
JAMA included a Viewpoint article by Lynn in its Nov. 13 issue, dedicated to examining critical issues in the United States health care system. The aging of the baby boomers is making the question of better coordination of care for the frail elderly more urgent, as there will be fewer family members available to fill in any gaps in the health system, she said. The ratio of working people to dependent and disabled older adults, which was five-to-one in 2011, will drop to three-to-one in 2029, Lynn said in her paper.
In her talk last week at the National Press Club, Lynn said she was optimistic that more community services could be put in place and expanded to aid frail elderly people.
“This is one we could solve if we could actually do it right, if we could only forge the will to do it,” she said.
That will take a re-examination of how health dollars are directed. Now, doctors can fairly freely order treatments, including cancer drugs that may at best only buy patients a few months of added life for a cost of about $50,000. But they can’t line up substitute caregivers when one falls ill or make sure rugs are secured in homes to prevent falls, she said. Providing more of these services could save money, with people avoiding trips to the hospital and staying out of nursing homes longer. Thus, there are savings to be found elsewhere in the health system that could support providing more support services within the community, Lynn said.
Lynn cited the example of her then 90-year-old mother’s treatment after damaging a vertebrae to support for her argument against misplaced priorities. This injury triggered about $10,000 worth of care, but would have cost Medicare about $30,000 if Lynn had not persuaded her mother to ignore her doctor’s suggestion that she undergo a costly treatment. Lynn knew of two studies that showed that the recommended treatment wouldn’t benefit her mother, yet the services that would have helped her more, such as a home-care nurse to get her mobilized and manage her pain drugs, “was completely unavailable,” Lynn said. She said that these kinds of scenarios are repeated all too often in the United States’ health system, driving up costs.
“It’s the banal over expenditure that’s driving us into economic ruin,” Lynn said. “It’s the ordinary stuff. It’s not the dramatic thing that makes the front pages of the newspaper.”