ConfusedAs the Social Worker in the Out-patient clinics at UTMB I both look forward to and dread this time of the year.  Medicare Open Enrollment is a confusing and overwhelming time for seniors and their families.  Last year I assisted more than 120 patients review their Medicare enrollments.   I look forward to this time because our patients are able to get out of plans that do not work for them anymore.  I dread it because there are many uninformed people giving seniors advice that is not correct and sometimes the senior is stuck with the wrong plan until next year.

On October 15th Medicare Open Enrollment begins.  Any enrollment changes for 2014 must be completed by Midnight December 7th.  There is a lot of press regarding aspects of the Affordable Healthcare Act currently going into effect.  These aspects impact persons who do not have medical insurance up to age 65. Most seniors age 65 and older have Medicare.

Medicare recipients need to review their options during the Open Enrollment as new companies and plans are available depending on living location.  New drug plans are being offered.  For the next ten (10) weeks there will be numerous commercials regarding the “best” plans being marketed.  This can be a very confusing time and the number of options overwhelming.

Seniors can go on-line at and use a program to identify options available and estimated costs.  Medicare does not pay 100% of costs and many recipients have opted for Medicare Advantage Plans which cover the uncovered parts but still have co-pays.  When considering an Advantage Plan seniors need to verify that their doctors and medical care facilities are in the Plan’s network.  Out-of-Network co-pays and deductibles can be expensive.

At a minimum, seniors need to check that the drug plan they have is still the best one.  The drug plans change drugs in their formulary.  Medications are added and dropped, Tier levels change, and quantity limits or pre-approval requirements are changed.  The plan a spouse is in may not be the best one for the partner.  I helped a couple who were in the same plan and after review the wife was in the plan that best met her needs but the husband was able to save more than $500 over the year in a different plan.  Be aware of deductibles and monthly premiums, some seniors have difficulty affording the deductible the first of the year.

Participants not comfortable using a computer can call Medicare (1-800-Medicare) and receive assistance by phone.  When calling, seniors need to call in October or November as hold times in December may be very long. When they call  they need to have their Medicare card and prescriptions ready as the helper will need more than just the name of the drug.  Social Security offers assistance with cost of premiums and medications for low income seniors. Applications for this can be found  on-line or by contacting the local Social Security office.

These suggestions can help your patients to have less costly and more positive healthcare experiences.

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room:

Our Guest Blogger is Adele Herzfeld, LMSW. She is the social worker in the UTMB Geriatric

Adele Herzfeld

Adele Herzfeld

Ambulatory Clinics.  She obtained her MSW at Stephen F Austin State University and has worked seniors in long-term care, home health, hospice and out-patient settings.  Ms. Herzfeld coordinates and assists with an educational seminar for Caregivers of persons with memory loss.  She is also an Alzheimer’s Association trained co-facilitator for the caregiver support group held at Libbie’s Place in Galveston.  Ms. Herzfeld participates in several community organizations that focus on the needs of seniors in the community.


Hospice is a great idea. Developed in England over 50 years ago and a part of Medicare for the last 30 years, it has become an accepted part of end-of-life care. At first hospice was offered through non-profit services and mostly at home. Now a great deal of hospice care is offered by for profit corporations and in long term care facilities. The for-profit hospice services appear to have been “gaming the Medicare system” to maximize profits. The development of for profit businesses that exist to exploit aspects of Medicare and other insurance has a long history; remember in-patient youth psychiatric facilities in the 80’s and early 90’s? (Baughman, 1998; Gale Group, 2011)

Kenen (2011) discusses how the Department of Health and Human Services is seeking to cut back Medicare payments for hospice services. Hospice has grown into big business. Kenen states, “According to a June 2011 MedPAC report, the number of people getting Medicare hospice care doubled from 2000 to 2009, to more than 1 million, or about 40 percent of deaths. Total payments quadrupled, from less than $3 billion in 2000 to $12 billion in 2009. … Now, about half of hospices are for profit. Some are small, locally owned businesses, but much of the recent growth has been in big, publicly traded national chains, one of which is owned by the company once known as Roto-Rooter.”

Several strategies for reducing the costs have been suggested. Kenen says, “In 2009, MedPAC recommended that Congress scrap the standard payment rate, now about $151 per day, and replace it with a ‘U’ shaped scale. Hospices would get paid more at the beginning and at the end, when they typically provide the most hands-on care. In between, the daily rate would drop. Any hospice with a very high rate of long-stay patients would face additional regulatory scrutiny. A second approach, included in a recent MedPAC blueprint for offsetting Medicare doctor fees, would be to pay hospices a lower rate for nursing home care — 6 percent less, or about $3 billion in reductions over 10 years.”

Frankly these suggestions are rearranging the deck chairs on the Titanic. Health care policy in the US is rife with micro-management of services and costs that simply rearranges the status quo.

Why not rethink the whole thing? Go back to the beginning. Hospice was developed to meet a need in end-of-life care to back off from intensive interventions and to allow the dying person to approach death in a mindful and pain free manner. Was not the intent that hospice as a model for end-of-life care should become the regular and customary way any health care system helps dying people? In other words, get rid of hospice as an entity and simply make these well proved methods regular practice. All dying people would receive palliative care appropriate to their needs and their  care providers would know how this was done and arrange for it.

By eliminating  hospice as a specialized service and by stopping specific payments for providing it, we eliminate those niche for profit businesses that exploit Medicare. Hospice becomes not a “special activity” but a routine part of a person’s life. Seems simpler somehow. What’s wrong with this idea?


Baughman, Fred A. The Fraud of ADHD – Psychiatric History Repeating Itself. February 13, 1998.

The Gale Group, Inc. Psychiatric Hospitals: Industry Report. 2011.

Kenen, Joanne. Medicare eyes hospice savings. October 17, 2011.

Is Aging a Disease? 

By Rodger Marion

We are born and after awhile we die. We all die. All that varies is the time span between birth and death. No one actually dies from old age. We die from various accidents or pathologies. Then, what are the benefits of increasing the lifespan?

David Gems, in the referenced article below, defines some useful terms to begin our discussion. If we do not die from old age, what do we call it. Gems says, “… biologists use the term ‘senescence’ for the increasing frailty and risk of disease and death that come with aging.” And he calls increasing the lifespan “decelerated aging” and he’s all for it. So am I, in general, but the deeper questions might be: is senescence a disease and why is living longer a good thing?

On the disease question, Gems says, “Consequently, populations accumulate mutations that exert harmful effects in late life, and the sum of these effects is aging. Here evolutionary biology delivers a grim message about the human condition: Aging is essentially a multifactor genetic disease. It differs from other genetic diseases only in that we all inherit it. This universality does not mean that aging is not a disease. Instead, it is a special sort of disease.

Well all that sounds like dancing around the issue but it appears that as we get older things change and our odds go up that we develop something terminal.

OK, so what about the prospect of putting off the inevitable for awhile? Gems says, “It is possible to slow aging in laboratory animals. In fact, it is easy.” He goes on to explain how the life span of nematode worms can be extended tenfold through a simple gene alteration. This logic probably extends to humans as well, but Gems says, “One theory attributes [aging] to an accumulation of molecular damage. Another points to excess biosynthesis … Yet the truth remains unclear.”

So there is a genetic solution in there someplace. Further, Gems encourages a holistic approach to wellness and treatment. He says, “One scientist studies heart disease, another Alzheimer’s disease, another macular degeneration and so on. Yet such ailments are symptoms of a larger underlying syndrome: aging. It is for this reason that there is a law of diminishing returns when it comes to treating diseases of aging. The battle with aging is akin to that between Heracles, the hero of Greek mythology, and the multiheaded Hydra. Each time Heracles hacked off a head, two more would sprout in its place.”

He concludes, “Yet in the long run a more powerful way to protect against age-related disease would be to intervene in the aging process itself. This would provide protection against the full spectrum of age-related illnesses. Returning to our classical illustration, to really defeat the  diseases of late life we need to strike at the heart of the Hydra of senescence: the aging process itself.”

Back to why live longer? Gems ponders the issue but I concluded he was inconclusive. I want to leave the question open for you all to explore. So, here is your assignment: What’s your take on the value of decelerated aging?


Gems, David. Aging: To Treat, or Not to Treat? American Scientist, July-August 2011.

Image from American Scientist: