Reading the letters to the editor section of the newspaper is appealing to me. If published in a well-respected periodical, such letters can provide even more insight into an issue than the original article, as they often represent various viewpoints. So, it was with interest that I read the letters in response to the October 16, 2011 New York Times article How Medicare Fails the Elderly. The article’s premise was that costly and sometimes inappropriate, even harmful, procedures and treatments can be willingly paid for by Medicare while denying funding for what people really need.
No question these are thorny issues. They raise complex and challenging ethical concerns and often surface conflicting, emotionally laden, and/or confusing family beliefs and values. I found that the letters to the editor in response to this article echoed the philosophy of many an Alzheimer’s advocate, including the need to:
- Identify a trusted health care advocate who can be designated as a health care power of attorney; and
- Maintain a record (preferably electronic) of an individual’s health status, including medications, surgeries, treatments, etc. (we would go a step further and ensure that a person’s cognitive abilities are also identified and, of course, updated).
The health care system is confusing enough for anyone faced with medical treatment decisions, but especially so when you are given inadequate information. One letter expressed the need for the medical community to be totally honest with their patients. We need information about the likely outcome, the recovery period, the cost and the long-term effects of treatments. And, we simply have to have dialogue about palliative and end-of-life care. Not mentioned in any of the letters, but equally important, is the recognition that cognitive decline impacts an individual’s decision making ability and without proper planning, disasters can result.
Another letter mentioned the importance and value of long-term care insurance. Isn’t it too bad that a feature of the Patient Protection and Affordable Care Act (signed into law by President Obama in 2010) – the Community Living Assistance Services and Supports Program — is now dead on arrival? Unfortunately, the federal administration determined that the cost structure was not supportable. Where does that leave us? At a time when many of the insurance companies are now actually getting out of the business of writing long-term care insurance, we appear to have no plan at all to deal with the looming expenses many baby boomer Americans will face.
On a more positive note, the Council of State Governments (CSG), a nonpartisan non-profit organization serving the state governments held their annual conference in Bellevue, Washington last week and conducted a Health Policy Academy on “Aging and Alzheimer’s Disease: Emerging Issues and Policy Solutions.”
It was an informative and interesting program, with speakers from the Centers for Disease Control and Prevention, the AARP Public Policy Institute, the University of Washington, plus two men with early stage Alzheimer’s disease who spoke eloquently and with emotion and humor about their personal experiences. I was thrilled to be able to present information about California’s Alzheimer’s Disease State Plan, which was followed by an equally informative discussion about Alzheimer’s outreach in North Dakota. Two very different states with different populations and needs, but we can certainly learn from each other.
The fact that the meeting was so well attended by state legislators and policy makers convinces me that Alzhiemer’s disease is getting on people’s radar. Yeah! Thanks go to the Alzheimer’s Association for working over the past few years with the CSG to make this Health Policy Academy a reality!