Frequent Use of Technology Slows Cognitive Decline: Empowering Seniors to Thrive in a Digital Age

A recent Newsweek article boldly declared: "[o]lder adults who frequently use digital technology may experience slower rates of cognitive decline." The article continues, "sweeping new analysis challenges previous research that has suggested digital technology could reduce cognitive function as we age and instead suggests that use of technology may be linked to lower rates of cognitive decline in older adults."  

Far from being a hurdle, technology equips seniors with tools to improve health, safety, security, dining, and social connections, fostering independence and vitality. Below, we'll explore practical ways seniors can leverage technology in these areas, including passive fall detection and alert systems alongside active solutions, inspired by the study’s call for balanced tech adoption.

Health: Proactive Wellness with Digital Tools

Technology empowers seniors to monitor and manage their health effectively. Wearable devices like Fitbit or Apple Watch track heart rate, sleep, and activity, alerting users to potential concerns. Apps like MyFitnessPal support nutrition tracking, while telehealth platforms like Teladoc offer virtual doctor consultations, minimizing travel. 

Medication management apps, such as Medisafe, send timely reminders for prescriptions. Seniors can begin with one tool, like a wearable, and consult their healthcare provider to align it with their needs, ensuring a proactive approach to wellness.  Seniors can also share their technology experiences, and results, with others, helping foster a sense of community. 

Personal Safety: Enhanced Protection with Passive and Active Systems

Smart technology bolsters personal safety for seniors living independently. 

Passive Fall Detection:  Systems, integrated into devices like Apple Watch or specialized sensors from companies like SafelyYou, automatically detect falls and alert emergency contacts or services without requiring user action—ideal for those at risk of falls, or proactice seniors wanting a robust sense of safety.

Passive Alert Systems:  Embedded in smart home hubs and security systems, these applications monitor daily routines and notify caregivers if unusual patterns (e.g., prolonged inactivity) are detected. These systems work without the necessity of a user pushing a button, or remembering to wear a device or operate it properly. Working autonomously and "in the background," they offer comfort and saferty to both the healthy and well-oriented and the impaired or disabled.  

Active systems: Life Alert, Medical Alert, Lifeline, and others, allow seniors to press a button  to summon help instantly, or in the cases of voice activated home applications like Alexa, Siri, and Google Home, summon help verbally. 

Additional tools, such as motion-sensor lights and smart doorbells with cameras (e.g., Ring), reduce fall risks and enhance home safety. Seniors can start with a single device, like a smart speaker or fall detection wearable, and gradually build a comprehensive safety net.

Personal Security: Safeguarding a Senior 

Security systems and cameras are pivotal in supporting seniors who wish to age in place, offering safety, independence, and peace of mind for both the seniors and their families. These technologies enable adult children to remotely monitor their parents’ well-being and home security without being intrusive, leveraging advancements in smart home systems, AI, and connectivity.  These offer family members opportunities to support an independent senior, conveniently and capably. .  

Remote Monitoring for Safety and Well-Being: Modern security systems and cameras allow adult children, and grandchildren to check on their parents from anywhere—home, work, or on the go—using smartphones, tablets, or computers. This is facilitated by cloud-based platforms and mobile apps that provide real-time access to camera feeds and system alerts.

• Non-Intrusive Observation: Cameras with two-way audio and motion detection (e.g., Ring, ADT, Vivent, Arlo, Google Nest) can be placed in common areas like living rooms or kitchens, allowing children to "drop in" virtually without disrupting their parents’ routines. For example, children can view live feeds to ensure their parent is active or safe without needing to call or visit. Systems like Amazon’s Echo Show or Google Nest Hub also enable video calls where seniors can accept or decline, preserving their autonomy and privacy.

• Health and Activity Monitoring: Some security systems integrate with wearable devices or smart sensors (e.g., FallCall or GrandCare) to detect falls or unusual inactivity. If a senior hasn’t moved past a motion sensor in a set period, an alert can notify children to check in. This is discreet, as it doesn’t require constant video surveillance.

• Privacy Considerations: To avoid intrusion, cameras can be set to record only when motion is detected or during specific times. Privacy-focused systems allow seniors to disable cameras or set “do not disturb” modes. Clear communication about where cameras are placed and their purpose ensures seniors feel respected.

• Convenience and Accessibility for Remote Monitoring:  The design of modern security systems prioritizes ease of use for both seniors and their children, ensuring monitoring is seamless and non-disruptive.

• Mobile Apps for Remote Access: Systems like Vivent, ADT, Blink, Wyze, or Eufy offer user-friendly apps that let children check camera feeds, review recorded footage, or receive alerts from anywhere with an internet connection. For example, a child at work can quickly open the  app to confirm their parent answered the door safely or check if a package was delivered.

• Customizable Alerts: Families can set up notifications for specific events, such as motion in the backyard at night or a front door left ajar. This reduces unnecessary interruptions while ensuring critical events are flagged. For instance, SimpliSafe allows users to prioritize alerts (e.g., “urgent” for a door alarm, “informational” for a delivery).

• Voice-Activated Systems: For seniors, voice assistants like Amazon Alexa or Google Assistant can control cameras or locks hands-free, reducing the need to interact with complex apps, devices, or keypads.  With many, a smartphone or doorbell can be linked to voice or facial recognitions so that  a senior can verbally open a door.  Children can also use these platforms to drop in via voice or video, making check-ins feel like a casual conversation.

Security Alarms and Fraud Prevention: Security systems are critical for protecting seniors from external threats, such as break-ins or fraudsters, while also monitoring home safety issues like doors left open. These systems provide real-time alerts to both seniors and their children.

• Doorbell Cameras for Fraud Protection: Video doorbells (e.g., Ring, Nest Doorbell) allow seniors to see and communicate with visitors without opening the door. Adult children can receive notifications when someone rings the bell and view the feed to identify potential scammers or unrecognized visitors. For instance, if a fraudster poses as a utility worker, children can intervene by calling their parent or contacting authorities. AI features in some doorbells can detect suspicious behavior, like loitering, and send alerts.

• Door and Window Sensors: Smart security systems (e.g., Vivent, SimpliSafe, ADT) include sensors that automatically lock doors, notify users if a door or window is left open, or is tampered with. This is particularly useful for seniors with memory issues who might forget to lock doors or secure windows. Children can receive these alerts via an app and remind their parent or take action remotely, such as locking a smart door lock

• Integration with Smart Locks: Smart locks (e.g., those with security systems, or stand-alone products from August, Schlage) allow family members to lock or unlock doors remotely if their parent is unable to do so or if a caregiver needs access. This ensures security without requiring the senior to manage physical keys.

Additional Benefits of Technology for Aging in Place: Beyond monitoring and security, these systems enhance seniors’ independence and quality of life:

• Emergency Response Integration: Many security systems connect to 24/7 monitoring services that can dispatch emergency responders if a fall or intrusion is detected. Children are notified simultaneously, ensuring rapid response even if they’re far away.

• Smart Home Integration:: Cameras and security systems often pair with other smart devices, like smart lights or thermostats, to create a safer environment. For example, motion-activated lights can prevent falls at night, and children can adjust settings remotely if needed.

• Data-Driven Insights: Advanced systems use AI to analyze patterns, such as a senior’s daily routine, and flag anomalies (e.g., no activity in the kitchen by noon). This helps children intervene proactively without constant monitoring.

Challenges and Solutions: While security and safety systems are powerful tools, there are challenges to consider:

• Technology Adoption: Some seniors may resist or struggle with new technology. The solution is to choose, at least initially user-friendly systems with simple interfaces (e.g., Ring’s plug-and-play cameras) and provide training or involve tech-savvy grandchildren to assist.  Don;t forget to encourage seniors that using tech may help them retain cognitive capability! 

• Privacy Concerns: Seniors may feel "watched" or "dependent."  Use cameras with clear indicators (e.g., lights when active), limit their placement to non-private areas, and involve seniors in setup and deployment decisions.

• Cost: Systems can be expensive, with cameras costing $50–$200 each and monitoring services adding monthly fees. Opt for affordable options like Wyze or Blink, which offer robust features without subscriptions, or prioritize key devices like a video doorbell and door sensors. Another strategy is to spend the money for a high-end system from a good security system provider (ADT, Vivent), take advantage of discounts, and terminate monthly monitoring as soon as possible. Having their tech supoport later may be worth the investment. 

Real-World Examples:

• Home Security: A senior’s Ring Doorbell detects a stranger at the door. The adult child, at work, receives an alert, views the feed, and uses two-way audio to deter the visitor, protecting their parent from a potential scam.

• Arlo Cameras with Motion Detepreventing a security riskction: Motion sensors in an Arlo system notice no activity for several hours, sending a notice to all users. A child checks the camera feed, and sees their parent on the floor, calling emergency services while heading to the home.

• Apple Watch Passive Fall Detection: A senior falls walking to the bathroom in the middle of the night.  The watch detects the fall, and notifies an emergency contact and local emergency services.  After the child rushes across town, she arrives to find that EMT has treated the parent and preparing for a trip to the local hospital yo make sure no injuries are severe.

• Life 360 Collision Detection: A senior is involved in a single car accident travelling from an event in the late evening. Life 360 detects the collision and notifies the family group and emergency services. 

• Door Sensors: A senior forgets to close the back door. The child gets an alert after 15 minutes, checks the parent's safety on a camera, and calls the parent to remind the senior to close the door, preventing a security risk  The child can lock the door remotely via a smart lock.

Security systems and cameras empower seniors to age in place by enhancing safety and enabling discreet, convenient monitoring by their children. Video doorbells, door sensors, and smart cameras provide real-time insights into home security and potential threats like fraudsters, while motion detectors and fall alerts ensure well-being. By prioritizing user-friendly, privacy-respecting technology, families can balance independence for seniors with peace of mind for themselves, all manageable from any location. For optimal use, families should select systems that align with the senior’s comfort level and involve them in the setup process to foster trust and autonomy.

Financial Security: Safeguarding Privacy and Finances

Cybersecurity is vital as seniors embrace technology. Password managers like LastPass securely store credentials, while apps like LifeLock monitor for identity theft. Seniors should activate two-factor authentication on banking and email accounts and explore free cybersecurity workshops through libraries or AARP to navigate the digital world confidently. These tools ensure personal and financial security without overwhelming users.

Food and Dining: Simplifying Nutrition and Social Engagement 

Technology streamlines meal planning and dining. Grocery delivery services like Instacart,  Amazon Fresh, or Uber Eats Delivery, bring ingredients to the door, while meal kit services like Blue Apron provide pre-portioned recipes tailored to dietary preferences. Apps like Yummly generate recipes based on available ingredients, and smart kitchen devices, such as Instant Pots, simplify cooking. Seniors can discover local dining deals via apps like OpenTable or join virtual cooking classes to make meal prep a social experience, fostering both nutrition and enjoyment.

 Avoiding Isolation: Fostering Connections Digitally

Social isolation is a pressing concern for seniors and their families, but technology can help bridge the gap. Video call platforms like Zoom or FaceTime connect seniors with loved ones, while social media like Facebook builds community ties. Online groups on platforms like Meetup offer virtual book clubs or hobby classes, and apps like SilverSneakers combine fitness with social interaction through virtual classes. Seniors can start with a weekly video call or join one online group, gradually expanding their digital social network to stay engaged and connected.

Getting Started: A Balanced Approach

To avoid cognitive overload, as cautioned in the Newsweek study, seniors should adopt technology incrementally. Begin with one tool—perhaps a passive fall detection device, an active alert system, or a video call app—and master it before adding others. YouTube tutorials or local senior center classes offer beginner-friendly guidance. Setting screen time limits and balancing tech use with offline activities, like reading or walking, maintains well-being. Family members can assist by setting up devices or teaching basic functions, ensuring seniors feel confident and supported. Tech-savvy grandkids can help teach grandparents and demonstrate technology and apps, fostering engagement, respect, and nurturing family bonds.  

  

Conclusion

Technology is a powerful ally for seniors, enhancing health, safety, security, dining, and social connections. From passive fall detection and alert systems to active Life Alert solutions, smart home tools, and virtual communities, seniors can live more independently and joyfully. The Newsweek study emphasizes mindful adoption, and by starting small and balancing digital and offline life, seniors can unlock technology’s full potential. Whether monitoring health, securing the home, or connecting with friends, technology empowers seniors to thrive in the digital era and age in place.

*For more on the study, visit [Newsweek’s article](https://www.newsweek.com/technology-reduced-digital-dementia-study-2058511).

American Heart Association Updates Recommendations for Age-appropriate Heart Disease Care

As bodies age, heart muscles and arteries can change in ways that increase the risk for heart disease. According to the American Heart Association (AHA), age should be considered in the diagnosis and treatment of heart disease. To that end, the AHA  published a scientific statement in Circulation updating its age-appropriate heart disease care recommendations.

Acute coronary syndrome (ACS) is a group of conditions in which blood flow to the heart is reduced, including angina and heart attacks, or myocardial infarctions.  According to the AHA,  “ACS is more likely to occur without chest pain in older adults, presenting with symptoms such as shortness of breath, fainting or sudden confusion.”

“Management of Acute Coronary Syndrome (ACS) in the Older Adult Population,” highlights normal aging and age-related changes in the heart and blood vessels, and acknowledges that older adults often have multiple medical conditions and medications complicating diagnosis and treatment.  

For example, large arteries and the heart muscle become stiffer with age, and the heart may work harder but pump blood less efficiently. Many normal changes increase the risk of blood clots.

“Age-related changes in metabolism, weight and muscle mass may necessitate different choices in anti-clotting medications to lower bleeding risk,” according to a press release. Kidney function also declines with age. 

One of the issues the authors highlight is that clinical practice guidelines are based on clinical trial research, but older adults are often not included in trials because their health care needs are more complex when compared to younger patients. 

According to said Abdulla A. Damluji, chair of the scientific statement writing committee and an associate professor of medicine at Johns Hopkins School of Medicine in Baltimore, “[o]lder patients have more pronounced anatomical changes and more severe functional impairment, and they are more likely to have additional health conditions not related to heart disease." “These include frailty, other chronic disorders (treated with multiple medications), physical dysfunction, cognitive decline and/or urinary incontinence – and these are not regularly studied in the context of ACS.” 

The authors emphasize the need to look beyond the clinical outcomes for older adults, like bleeding, stroke, and heart attack, and to also focus on quality of life and the ability to live independently and/or return to their previous lifestyle or living environment. 

CDC Reports that LTC the Overwhelming Source of Legionnaires' in Healthcare Facilities

Legionnaires' disease tends to be more common and deadly within post-acute care facilities than others — and providers need to do more to reduce the risk to residents.

Researchers with the Centers for Disease Control and Prevention recently conducted a study finding that 76% of Legionnaires' cases reported in 2015 could be traced to healthcare facilities. Of those cases, 80% were linked back to long-term care facilities, followed by 18% at hospitals and 2% to both.

Eighty-eight percent of Legionnaires' cases that year were reported in patients older than 60, the CDC said. About 25% of patients in healthcare facilities who contract legionnaires' die from it. That's two-and-a-half times the rate of all who contract the disease, which comes from inhaling water containing Legionella bacteria.

According to an article in McKnight's:

“Legionnaires' disease in healthcare facilities is widespread, deadly and preventable," CDC Acting Director Anne Schuchat, M.D. said during a press conference. “People can inhale the bacteria from small water droplets from showers, water therapy spas, baths, cooling towers, decorative fountains and medical equipment, like respiratory therapy equipment.”

The report comes three days after the Centers for Medicare and Medicaid Services issued a memo to surveyors explaining that healthcare providers soon will be expected to have policies in place to reduce the risk of Legionnaires'.

Marc Siegel, M.D., told providers to monitor patients with pneumonia for Legionnaires', and to keep their facilities sterile, according to MedlinePlus.

“This is all about improper maintenance, improper sanitation and improper sterilization, and a vastly underreported problem,” Siegel reportedly said.

Legionnaires' disease is a severe, often lethal, form of pneumonia.  Like many diseases, it presents greater risk to populations likely to reside in skilled nursing facilities, such as:

• People 50 years or older;
• Current or former smokers;
• People with a chronic lung disease (like chronic obstructive pulmonary disease or emphysema);
• People with weak immune systems or who take drugs that weaken the immune system (like after a transplant operation or chemotherapy);
• People with cancer;
• People with underlying illnesses such as diabetes, kidney failure, or liver failure.

The fatality rate of Legionnaires' disease has ranged from 5% to 30% during various outbreaks, but "Hospital-acquired" Legionnaires' has a fatality rate of 28%.  

Facial Injuries in Nursing Homes Underappreciated and Contribute Significantly to Healthcare Costs

A recent study illustrates yet another reason that consumers should plan to "Age in Place," and avoid unnecessary and avoidable institutional care.  The incidence of facial injuries suffered by nursing home residents may be underappreciated and therefore missing from coordinated efforts to prevent the injuries resulting in “substantial amount of costs” to the U.S. healthcare system, the  recent study suggests.

A research team from Wayne State University in Michigan conducted the first-ever population-based analysis of facial trauma in the skilled nursing setting, with the goal of shedding light on the “significant clinical issue.”  “Because [facial trauma] has been largely neglected in the literature, characterization of facial injury patterns among the elderly population, including the extent to which this affects our health care system, may be exceedingly invaluable,” the study's authors wrote.

Analysis of data from the National Electronic Injury Surveillance System found that nearly 110,000 nursing home residents required emergency department care for facial trauma between 2011 and 2015. While residents in their 60s had relatively equal facial injury rates, the number of injuries increased with age for female residents.

The most common facial injury among nursing home residents were lacerations and other soft-tissue injuries, such as contusions or hematomas. The study estimated that nearly 3,000 facial fractures occurred in skilled nursing residents each year.

The analysis discovered that 22.7% of facial fractures occurred as a resident was transferring in and out of bed, suggesting an area of targeted interventions from providers, healthcare researchers and policymakers.

Results of the study were published last Thursday in JAMA Otolaryngology - Head & Neck Surgery.

Can Aging be Stopped and/or Reversed?

An intriguing article, "Purging the body of 'retired' cells could reverse ageing," published in the Guardian, reconsiders the question: "Can aging be stopped and or reversed?  The articles suggest that recent scientific advances suggest that purging retired cells from the body can reverse the ravages of old age.  New research raises the prospects of new life-extending treatments, and preventative therapies resulting from sweeping away dormant cells, :senescent cells" that  fail to divide genetically due to age, but create mischievous and malicious health impacts as they persis and build-up in an aging body.

The article reads as follows: 

When mice were treated with a substance designed to sweep away cells that have entered a dormant state due to DNA damage their fur regrew, kidney function improved and they were able to run twice as far as untreated elderly animals.

The team are now assessing whether the mice also live longer and are planning a series of safety studies in humans with the ultimate goal of testing whether getting rid of so-called senescent cells could help reverse a range of age-related disorders.

The discovery adds to a wave of new findings hinting at the possibility of a future in which doctors can treat ageing itself, rather than trying to combat the host of diseases that come along with it.

Such a scenario is now supported by science, according to Peter de Keizer, the 36-year-old scientist who led the latest work at Erasmus University Medical Center in the Netherlands. “Maybe when you get to 65 you’ll go every five years for your anti-senescence shot in the clinic. You’ll go for your rejuvenation shot,” he said. “That I can envision when we reach that age.”

Go here to read the rest of the article.  

Considerations in Crafting Health Care Proxies or Durable Powers of Attorney for Health Care

The most important document in your estate plan is the document appointing a health care proxy.  In Ohio and in Missouri this document is called a Durable Powers of Attorney for Health Care.  A health care proxy is a legal document that appoints another person to make health care decisions for you if and when you are unable. This person is usually called a proxy, agent, or attorney-in-fact.

The reason your health care proxy is the most important document in your estate plan, is that it protects you during your life at a time when you are most vulnerable- when you are ill, incapacitated, and/ or incompetent.  It helps to ensure that timely health care decisions can be made in emergent situations, and  it also helps to ensure that you always receive the health care you prefer. In health care decision-making, timeliness, quality, and preferences, are all important objectives best attained by a proper health care proxy.

Typically, you do not have to be terminally ill for a health care proxy to go into effect.  Nonetheless, a health care proxy can, if you so choose, enforce your end-of-life decisions.  Your living will, or advanced declarations, make your wishes known to your health care professionals.  In the event that they decline or refuse to act on your behalf, your health care proxy can protect your decisions.

If you do not appoint a health care proxy and cannot make health care decisions, state law determines who can make decisions on your behalf. Most states have laws that let close family members and others (surrogates) act on your behalf if you haven’t appointed a health care agent, but you may not want these people to make decisions for you.  Moreover, there may be delay resulting from identifying and verifying the relationship of these surrogates.  Finally, there may be limitations on what decisions these surrogates can make on your behalf.  

When choosing a health care agent, it’s important to appoint someone:

• Who you trust;
• Who you are confident will implement your decisions rather than substituting their decisions for your own;
• Who knows you, and therefore well understands your medical preferences;
• Who will be assertive in making decisions;
• Who will honor your wishes;
• Who will be able to resist pressure from family, friends, and/or health care professionals and institutions to ignore or alter your decisions;
• Who will be capable of communicating effectively with health care professionals;
• Who can be reached in the event of an emergency.

Because you should always appoint multiple successive agents, it is not necessary that the person you choose be the person that lives nearer your hospital, but you might resist appointing a person in active military service who is often unavailable for long periods of time.  Additionally, because familiarity with the health care system and medical terminology and procedures might make for more efficient communication and decision-making, you might consider more favorably those with medical background or experience.

Regardless, once you have appointed an agent, you must follow through with the appointment by communicating your choices with your agent.  At a minimum, that should mean providing the agent a copy of your health care proxy, and living will.  You should inform them of the identity of your primary care physician. In addition, you should discuss with your health care agent:

• Personal attitudes towards health, illness, dying, and death;
• Religious beliefs;
• Feelings about doctors and other caregivers;
• Feelings about institutional care and alternatives to institutional care;  
• Feelings about palliative care versus life-sustaining treatments like technologically supplied food and and hydration;
• Treatment preference if you are permanently unconscious or unconscious for a long time and not expected to recover.

You might consider a system like LegalVault® to effectively communicate, store, and make available your health care decisions and information to your agents and health care professionals.

A health care proxy generally only confers upon your agent the authority to make medical decisions for you. Decisions about things such as health insurance may be considered a financial, and not a medical decision,  depending on state law. It’s generally best to consult with a lawyer to appoint a general power of attorney for financial and non-medical decisions.

You do not need an attorney to write a health care proxy. You can use a standardized form and tailor it to your needs, but you may want to consult legal counsel to ensure that it meets all of your state’s legal requirements. Many attorneys, like myself, will either provide a statutory form, or will prepare a health care proxy at no or minimal expense.  

There is a Shortage of Health Care Professionals Capable of Serving the Elderly Population

There is a troubling shortage of health care professionals specializing in treating and caring for the elderly, according to an article published in Kaiser Health News. This shortage includes geriatricians, physicians who specialize in the treatment of adults age 65 and older, as well as nurses, physical therapists and psychologists who know how to care for this population.

The American Geriatrics Society estimates that the nation will need approximately 30,000 geriatricians by 2030 to serve the 30 percent of older Americans with the most complicated medical problems, according to an article in Health News from NPR. There are, however, only about 7,000 geriatricians currently practicing. To meet the projected need, the society estimates medical schools would have to train at least 1,500 geriatricians annually between now and 2030, or five times as many as last year.

Dr. Todd Goldberg, a geriatrician, recently told Kara Lofton, of West Virginia Public Broadcasting:

“With the growing elderly population across America and West Virginia, obviously we need healthcare providers...The current workforce is inadequately trained and inadequately prepared to deal with what’s been called the silver tsunami — a tidal wave of elderly people — increasing in the population in West Virginia, across America and across the world really.” 

The deficit of properly trained physicians is only expected to get worse. By 2030, one in five Americans will be eligible for Medicare, the government health insurance for those 65 and older.

Dr. Goldberg teaches at the Charleston division of West Virginia University and runs one of the state’s four geriatric fellowship programs for medical residents. Geriatric fellowships are required for any physician wanting to enter the field.

For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four geriatric fellowship programs in West Virginia in the past three years.

“This is not just our local program, or in West Virginia,” said Goldberg. “This is a national problem.”

The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled. 

Parents May Be Refused Details of Adult Child's Medical Care

Michelle Andrews, from Kaiser Health News, has penned an excellent article explaining why many adult children should execute health care powers of attorney and a HIPAA release in favor of a parent or parents.  The article, entitled, "Parents May Be Refused Details of Adult Child's Medical Care," was recently reported by Health News from NPR:

When Sean Meyers was in a car accident on a November evening three years ago, he was flown by air ambulance to the emergency department at Inova Fairfax Hospital, in Northern Virginia. With his arm broken in four places, a busted knee and severe bruising to his upper body, Meyers, 29, was admitted to the hospital. Though he was badly hurt, his injuries didn't seem life threatening.

When his car went off the road, Meyers had been on his way to visit his parents, who live nearby in Sterling. They rushed to the hospital that night to wait for news and to be available if Sean or the hospital staff needed anything. But beyond the barest details, no one from the hospital talked with them about their son's condition or care, not that night nor during the next 10 days while he was hospitalized.

"All the time he was there, the hospital staff was very curt with us," says Sam Meyers, Sean's dad. "We couldn't understand why we were being ignored."

After leaving the hospital, Sean moved into his parents' spare bedroom temporarily to continue his recovery. About a week later, he was in their kitchen one evening with his girlfriend when suddenly he collapsed. He was rushed to the nearest hospital, where he died. An autopsy revealed that he had several blood clots as well as an enlarged heart.

For Sean's parents, the results were particularly wrenching because there's a history of blood clots on his mother's side of the family. How much did the hospital staff know?

"It might have saved his life if they'd talked to us," Sam Meyers says. 

 A spokeswoman for Inova Fairfax says, "We cannot comment on specific patients or cases." But she noted that information about a patient's care can be shared in a number of circumstances.

These days when people think about patient privacy problems, it's usually because someone's medical record has been breached and information has been released without his consent. But issues can also arise when patient information isn't shared with family and friends, either because medical staff decides to withhold it or patients themselves choose to restrict who can receive information about their care.

The federal Health Insurance Portability and Accountability Act of 1996 — HIPAA — established rules to protect the privacy of patients' health information while setting standards for hospitals, doctors, insurers and others sharing health care information.

Stepped-up enforcement in recent years and increased penalties for improper disclosure of patient information under HIPAA may lead hospitals and others to err on the side of caution, says Jane Hyatt Thorpe, an associate professor at George Washington University's department of health policy and an expert on patient privacy.

"For a provider who's uncertain about what information a provider may or may not be able to share, the easiest and safest route is to say no," Thorpe says.

Go here to read the remainder of the article.

Nursing Home Residents Twice as Likely to Suffer Fractures

A Canadian survey has revealed that older adults living in long-term care facilities are more than twice as likely as their peers living at home to suffer a fracture.  New guidelines endorsed by the Scientific Advisory Council of Osteoporosis Canada provide guidelines designed to reduce the risk.  The guidelines are similar to those those made by the Society for Post-Acute and Long-Term Care Medicine in the U.S., and those for residential care facilities in Australia.

Go here to read the original article in The Hospitalist.

The Trouble With Advance Directives

Where are your advance directives?  Are they up-to date?

A recent article in the New York Times highlights two major problems with advance directives: 1) the existence of these legal documents is often not known about by medical professionals or loved ones (and even if it is, the physical location of these might not be known) and 2) these documents can be rather ambiguous with vague or outdated language.

The author of the piece tells a troubling tale of an older gentleman suffering from dementia who had created an advance directive years earlier where he stated that while he wanted to remain comfortable, he did not want any “heroic” measures to save his life. Years after his advance directive was filed, the gentleman was hospitalized for a nosebleed and was later put on a ventilator and given a feeding tube for survival. These drastic measures seem to contradict the patient’s wishes, so why on earth were these treatments administered?

The answer is simple – his advance directive was buried away in his medical chart and none of his early doctors had noticed it, and his son who was calling the shots knew nothing of his fathers’ wishes.

This is an all too common scenario in emergency rooms where the goal of healthcare professionals is to keep patients alive and, without the proper paperwork, doctors are required by standing orders to take all necessary medical steps to sustain life.

As an attorney, I stress the value of advance directives.  But, I know all too well that they are only useful when they are accessible before medical treatment commences.  My firm is one of a growing number of firms that are providing an effective tool, LegalVault®, to help clients solve this problem.

LegalVault® is a great tool which allows you to securely store your advance directives and estate planning documents. Here’s how it works:

• The client executes an up-to-date General Power of Attorney for Health Care, and Advanced Directive/Living Will;
• Each document is electronically scanned, and an electronic image of each document is made (which is far superior to a copy);
• Each  client is given a secured LegalVault® account;
• Our firm uploads the image of the  documents to the client's LegalVault® account;
• LegalVault® sends out an Emergency Access Wallet Card which contains instructions for healthcare providers on accessing healthcare-related documents online or via a 24/7 fax back service;
• Once an account has been created, the LegalVault® physician notification system sends a notice to the primary care provider informing him or her of this invaluable service and the storage of advance directives, ensuring that these important planning documents never fall to the back of a medical chart where they go unnoticed for weeks; 
• Clients control what information is available to health care providers, and can quickly update the account with up-to-date documents or information (such as medications or allergies) from their home computer or smart phone;
• With the client's permission, images of other estate planning documents (Wills, Trusts, Powers of Attorney, etc.) are uploaded to the client's LegalVault® account; 
• Clients can log in to their accounts to share other non-healthcare-related documents with our firm, or even upload copies of family keepsakes (photos, home videos, letters to children, family trees) to ensure these are safely secured and passed down to younger generations;
• Clients can keep or maintain important legal and financial records such as insurance policies, annuities, savings bonds, stock certificates, leases, contracts, and other instruments, potentially lost, stolen, discarded, or destroyed by third parties at a time of death or disability;
•  Clients can alert authorities of significant needs or concerns, such as "disabled child at home," "pets at home," or the like;
• A separate vault, inaccessible to our firm, accessible only to the client, and an executor, successor trustee, or personal representative, can store passwords to online accounts;
• Upon renewal of the LegalVault® account (every 3,5, or 7 years) updated documents are executed, ensuring that the documents are never out-of-date.

There is no limit to the storage space available for estate planning documents, pictures, letters, financial documents, and the like.  The cost of such a service is probably less than you might imagine. Contact us if you want to add this valuable service to your estate and/or financial plan. 

Autism Patients Share Common Pattern Of Brain Inflammation

From Sarah Klein, Senior Editor, Health and Fitness, for the Huffington Post;

While science has yet to pinpoint the exact cause of autism, a new study reveals that the brains of people with the disorder share a common pattern of inflammation from an overactive immune response. 

Johns Hopkins and University of Alabama at Birmingham researchers analyzed data from autopsied brains of 72 people, 32 of whom had autism. In the brains of people with autism, they found genes for inflammation permanently activated in certain cells. The study, published in the online journal Nature Communications on Dec. 10, is the largest so far of gene expression in autism. 

"There are many different ways of getting autism, but we found that they all have the same downstream effect," Dan Arking, Ph.D., an associate professor in the McKusick-Nathans Institute for Genetic Medicine at the Johns Hopkins University School of Medicine said in a statement. "What we don't know is whether this immune response is making things better in the short term and worse in the long term." 

Inflammation is not likely a root cause of autism, but a consequence of a gene mutation, Arking stressed. To better understand inflammation's effects, researchers will want to find out whether treating it makes autism symptoms any better, he said.

Go here to read the rest of the article.  

Hospitals Referring to Fewer SNF's

According to Jeff Terkowitz, senior manager with Avalere, between 2009 and 2012 – the most recent year for which CMS has released comprehensive Medicare data – there was an increase in the average number of SNFs that received a volume of patient referrals from hospitals. However, that trend may be slowing; the .3% increase in average number of SNFs to which hospitals discharged patients in 2012 came after increases of .7% and .9% per year from 2009-2011.

In 2009, short-term acute care hospitals discharged patients who were admitted on average to just over 37 different SNFs following the hospital stay.  In 2010 and 2011, that number grew, with hospital patients going to just under 38 and just under 39 SNFs, respectively.  By 2012, that number reached 39.14, a slight increase from 2011.

Hospitals, therefore, are still sending patients to many different SNFs, indicating, according to Terkowitz, that referral networks may not be well established.  But, he suspects that even though the total number of SNFs is still going up, there is a higher concentration of patient volume at a smaller number of facilities. He notes, for example, that between 2009 and 2012, there was a slight increase in concentration during which time the average hospital went from having just over nine SNF partners who received 10 or more patients to having 9.54 partners receiving that higher volume. 

He warns that the environment is rapidly changing, though; "there are many examples of hospitals moving towards tighter, more coordinated post-acute care networks." 

Medicare Home Health Care Benefits

One common objective of estate and financial plans is the avoidance of institutionalization. Most folks prefer home care, or "aging in place" rather than institutional care.  Aside from the obvious perceived benefits in the control and quality of care for the individual, home care prevents separation of spouses and families.  Home health care can also reduce the risk of, and/or the need for guardianship.  If, however, seniors are are going to avoid institutional care, seniors, and their families, caregivers, and planning professionals should understand the rights to home care under Medicare.  It is a far too common misconception that Medicare will not pay for home care. 

Medicare does indeed have a home health benefit, under which patients typically receive four to ten hours a week of skilled care and home health aide services. Depending on your need, Medicare will pay for skilled nursing and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week (up to a total of 35 hours in unusual cases).

Medicare will help pay for your home care if all four of the following are true:

1.  You are considered homebound. Medicare considers you homebound if you meet the following criteria:  

• You need the help of another person or special equipment (walker, wheelchair, crutches, etc.) to leave your home or your doctor believes that leaving your home would be harmful to your health; and

• It is difficult for you to leave your home and you typically cannot do so.

2.  You need skilled care. This includes skilled nursing care, but only on an intermittent basis.  "Intermittent means you need care for as little as once every 60 days to as much as once a day for three weeks (this period can be longer if you need more care but your need for more care must be predictable and finite). This can also mean you need skilled therapy services.  Skilled therapy services can be physical, speech or occupational therapy (If you only need occupational therapy, however, you will not qualify for the Medicare home health benefit. But, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. When your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you still need it);

3.  Your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care.  That means your doctor will need to complete CMS Form 485.   Another format of the form can be found here.  The certification must also say that a plan of care has been made for you, and that a doctor regularly reviews it. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare. 

• As part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you related to the main reason you need home care within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are homebound and qualify for intermittent skilled care.

• The face-to-face encounter can also be done through telehealth. In certain areas, Medicare will cover examinations done for you in specific places (doctors offices, hospitals, health clinics, skilled nursing facilities) through the use of telecommunications (such as video conferencing). 

The plan of care, which details the care you will receive and the frequency of services, covers no more than 60 days. However, so long as you continue to qualify for the Medicare home health benefit at the end of the plan of care, Medicare will recognize a new plan of care approved by your doctor.

4.  You receive your care from a Medicare-certified home health agency (HHA).

Your doctor will decide whether you qualify as homebound when he or she prepares your plan of care for the home health benefit. Whether or not you qualify depends on your doctor’s evaluation and knowledge of your condition over an extended period of time, not on a daily or weekly basis.  

Leaving home for medical treatment, religious services. or to attend a licensed or accredited adult day care center does not put your homebound status at risk. Leaving home for short periods of time or for special non-medical events, such as a family reunion, funeral or graduation, will also not keep you from being considered homebound. Taking an occasional trip to the barber or beauty parlor is also allowed.

If you qualify for the home health benefit, Medicare covers the following types of care:

• Skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).

• Medicare pays in full for skilled nursing care, which includes services and care that can only be performed safely and effectively by a licensed nurse. Injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are examples of skilled nursing care that Medicare may cover.

• Medicare pays in full for a home health aide if you require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If you ONLY require personal care, you do NOT qualify for the Medicare home care benefit.

• Skilled therapy services. Physical, speech and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury. Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength to a body area. Speech-language pathology services include exercises to regain and strengthen speech and language skills. Occupational therapy* helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes. Medicare should pay for therapy services to maintain your condition and prevent you from getting worse as long as these services require the skill or supervision of a licensed therapist, regardless of your potential to improve.

• Medical social services. Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.

• Medical supplies. Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for your care.

• Durable medical equipment. Medicare pays 80 percent of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20 percent coinsurance (plus up to 15 percent more if your home health agency does not accept "assignment"—accept the Medicare-approved amount for a service as payment in full).

One common misconception is that Medicare will not cover the cost of chronic home care.  If you are homebound and qualify, your coverage is based on a need for skilled care.  Medicare should cover your home care from a Medicare-certified home health agency regardless of whether your condition is temporary or chronic. Although beneficiaries often hear otherwise, Medicare covers skilled nursing and therapy services intended to help you maintain your ability to function or to prevent or slow you from getting worse. Medicare should not deny home health care because your condition is chronic or stable or because the care will only maintain, not improve your ability to function.

It can be hard to find a home health agency willing to provide Medicare-covered services to individuals with chronic care needs, however.  If you have Original Medicare you can call 800-Medicare for a list of home health agencies in your area. If you are in a Medicare Advantage plan (private health plan) you should check with your plan to find out which home health agencies are in the plans network.

Medicare’s home health care benefit is nonetheless limited. Medicare does not cover many home care services. Medicare home health care does not, for example cover:

• 24-hour a day care at home;

• Prescription drugs (To get Medicare drug coverage, you need to enroll in a Medicare Part D plan. You can choose a stand-alone Medicare private drug plan (PDP), or a Medicare Advantage plan with Part D coverage (MA-DP);

• Meals delivered to your home;

• Homemaker or custodial care services (i.e. cooking, shopping, and laundry, unless custodial care is part of the skilled nursing and/or skilled therapy services you receive from a home health aide or other personal care attendant.

The Medicare hospice benefit may pay for some of these items and services for people at the end of life.  It is wise for people who anticipate the use of hospice to consider involving hospice in your planning once there exists a diagnosis of a chronic, critical, or terminal condition.

As long as you are homebound and need skilled care, there is no prior hospital stay requirement for Medicare Part B coverage of home health care. There is no deductible or coinsurance for Part B covered home health care.

If you have been in the hospital as an inpatient for three days, or have been in a skilled nursing facility after a hospital stay, Medicare Part A covers your first 100 days of home health care. Medicare Part B covers the additional days. Regardless of whether your care is covered under Medicare Part A or Part B, Medicare pays the full cost.

Medicare Advantage plans must follow Original Medicare’s rules for providing you home care, but they can impose different costs and restrictions. You may need to choose an HHA that contracts with your Medicare Advantage plan (private health plan) to get care. You may also have to get your plan's prior approval or a referral before receiving home health care. Although Original Medicare does not charge a co-payment, some Medicare Advantage plans do.

If no HHA in your plan's network will take you as a patient, call your plan. Your plan must provide you with home health care if your doctor says it is medically necessary. 

If no network HHA will take you, but a non-network one will, your plan must pay for your care that you receive from the non-network HHA. If you cannot find an HHA in your area that is able to take you as a patient, talk with your doctor and your plan about other options that are available to you.  For more information regarding Medicare Advantage in Ohio, go here.  Call your State Health Insurance Assistance Program (SHIP) for more assistance. You can call 800-Medicare to find the number of your local SHIP.  In Ohio, the number is 1-800‐686‐1578

If you have questions about billing issues for home health care you should contact 800-MEDICARE.

For more information regarding Medicare and your rights, visit The Medicare Rights Center a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.