- California’s Aid in Dying Act
- Iconic Boomers Shape Their Last Days
- Doctors’ Quality Measurement
- Housing, Mortgages and Economics
- Millennials’ Healthcare Influenced by GenX, Boomers
- Caregiving Economics on the Cusp of Change
California’s Aid in Dying Act
People with a diagnosis of 6 months or less to live can request a prescription for lethal medications from their doctors. California’s law prohibits the practice from being referred to as euthanasia, mercy killing, assisted suicide or homicide. California expects very low utilization of the Act. Medi-Cal will cover the treatment.
California’s end of life option means is “another step towards overthrowing a system in which doctors — even religious leaders – tell people how to live and die” writes Matt Perry in California Health Report. The End of Life Option Act is the ultimate example of patient-centered healthcare. It returns the power of health decisions — even at the time of death — to the person who matters most. Like many progressive movements launched in the Golden State, as goes California so goes the rest of the country. California is the 5th state with aid in dying legislation.
Iconic Boomers Shape Their Last Days
Muhammad Ali detailed his funeral wishes in “The Book” — a 2 inch thick document signed in 2010, but under revision until Ali’s death in an Arizona hospital last week. David Bowie also meticulously planned the last year of his life, knowing death was near.
This demographic shift, heralded in Time Magazine in 2013, means Baby boomers are “not going to allow their last chapter in life to be an extended period of loss, fear, pain, and suffering.”
I see an empty chair
Someone was sitting there
I’ve got a feeling it was me
And I see a glass of wine
I’m pretty sure it’s mine.
— Kris Kristofferson, An Outlaw at 80, discusses his life with N. Strauss in Rolling Stone this week.
Quality Measurement News
We don’t eat in restaurants with an F grade. Why doesn’t that apply to doctors? D. Newman and Amanda Frost Reimagine the Consumer Role in Improving Value for the Health Affairs blog. Measuring quality will remove low-quality healthcare providers. Aggregating the metrics into simple star ratings that signal quality about an entire health plan (as required by 2017) changes people’s buying decisions.
This week, UCSD halted their program to publish quality reviews. Oops! They forgot to tell patients filling out the surveys that their reviews would be public. Once it’s straightened out, UCSD will join about 25 healthcare providers that display publicly what patients think about their doctors. The idea is that patient experiences may be almost as important in improving and maintaining health as a correct diagnosis and treatment.
VIP Syndrome caused Boomer celebrities to get worse medical care, writes Carla Johnson in Time.com. Doctors have lost their bearings treating Michael Jackson, Joan Rivers and perhaps Prince.
Doctor’s don’t get their medical wishes either. While doctors desire to have less intervention than their patients, it doesn’t work out that way. The freight train of medical intervention runs over many patients, even doctors. Why? It’s easy to order up tests and procedures.. But “if a patient needs less-skilled home care — such as help with feeding and bathing — it’s much harder to write a prescription,” writes Carolyn Johnson on Wonkblog for WPost.com.
In older patients, it’s harder to detect abuse of prescription drugs, reports NYTimes.com. People can become addicted in 10 days, yet few doctors screen for addiction. And, addiction can be mistaken for the symptoms of aging, caregivers can be enablers, and those with financial freedom can easily find physicians to write scripts for opioids.
Housing, Mortgages and Economics
Homeowners 55+ control 2/3 of the nation’s home equity — $8 trillion. The decisions of Baby Boomers will direct the housing market in the next 10 years, writes Freddie Mac Chief Economist Sean Becketti in a blog post on Wednesday. Most don’t want to move but prefer to age in place, tightening the housing market for millennials.
Like it or not, many elders people need reverse mortgages. Many traditional finance companies left the reverse mortgage business years ago, because they didn’t need the bad publicity of evicting grandparents from their homes after they couldn’t pay ongoing property taxes, maintenance and insurance. NYTimes.com’s Ron Lieber writes “Love Them or Loathe Them, Reverse Mortages are Here to Stay.” Bank of America is returning to the market. Look for calls for elders to reverse mortgage their homes to pay for long term care.
The World Bank downgraded its global growth forecast for 2015, saying the global economy is fragile and weak. Developed countries are contending with aging workforces and lackluster productivity growth.
Millennials’ Healthcare Influenced by GenX, Boomers
More Millennials have healthcare, thanks to A.C.A., but still still find it scary-expensive and complicated. A new survey shows that nearly 1/2 of Millennials have a diagnosed health condition, led by depression, weight issues, and anxiety.
Millennials are most concerned about the cost of healthcare. Many struggle to pay for insurance beyond $200 per month. Millennial’s #1 and #2 priorities are taking care of their health and getting and keeping a job. Affordable health insurance comes in at #7.
GenX and Boomer moms and step-moms are the #1 source of healthcare information for millennials. Some healthcare plans have already reached out with campaigns encouraging mothers to talk to their adult a children about healthcare. This cross-generational marketing mimics elder care — where GenX and Boomer women are decision-influencers.
Millennials bring their expectations and experiences from other parts of their life — for convenient, on-demand services — to healthcare. Yet healthcare is playing catch-up behind millennials’ experience in most every other industry — banking, food, transportation. New apps that make it convenient to make appointments, check wait-times, will be expected in more doctors’ offices. As more millennials become parents and caregivers, their desires shift how providers are measured in pediatrics and geriatrics.
Caregiving Economics On Cusp of Change
We know the trendline: demand for caregivers is increasing. But real wages for “direct care workers” have fallen over the last 10 years, to $10.85 per hour. Everyone wants to pay the lowest possible price — public policymakers, insurers, employers, and consumers. Low investment in training and high turnover of workers are acceptable to consumers and insurers. Wage increases are most vehemently opposed by disability advocates.
Increasing demand for caregivers will shift today’s business models and P&Ls. The American Society of Aging reports that the high-demand future requires competitive wages and benefits, and other elements of improved job quality: stable and predictable hours, higher training standards, and better supervision. We are entering a fundamentally different labor market for direct care workers that will break existing business models.