Get A Free Claim Evaluation

Does Medicare Fail the Elderly?

October 17th, 2011

In The New York Times, reporter Jane Gross wrote a fascinating opinion piece about Medicare. She calls it the “dirty little secret of health care in America”:  That while we assume that Medicare provides universal health care coverage for the elderly, what Medicare actually covers isn’t what recipients want or actually need.

With all the advances in medicine, much of the medical care provided to the elderly today are dangerous, pointless, and expensive. As Jane Gross writes:

Of course, some may actually want everything medical science has to offer. But overwhelmingly, I’ve concluded in a decade of studying America’s elderly, it is fee-for-service doctors and Big Pharma who stand to gain the most, and adult children, with too much emotion and too little information, driving those decisions.

Researchers have discovered that some “standard” treatments are both useless and harmful. For example, feeding tubes cause infections, nausea, vomiting, and agitation…but rarely prolong life. Frail elderly patients who have abdominal surgery, gall bladder surgery, or joint replacements, experience  complications…and often require placement in nursing homes.

Medicare pays for all those hazardous treatments. However, Medicare does not typically pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet. Ms. Gross continues her story:

In the case of my mother, who died at 88 in 2003, room and board in various assisted living communities, at $2,000 to $3,500 a month for seven years, was not paid for by Medicare. Yet neurosurgery, which I later learned was not expected to be effective in her case, was fully reimbursed, along with two weeks of in-patient care. Her stay of two years at a nursing home, at $14,000 a month (yes, $14,000) was also not paid for by Medicare. Nor were the additional home health aides she needed because of staffing issues. Or the electric wheelchair after strokes had paralyzed all but the finger that operated the joy stick. Or the gizmo with voice commands so she could tell the staff what she needed after her speech was gone.

She paid for the room. My brother and I paid for the private aides and bought her the chair and the “talking board.” What would her life have been like without the skilled care she required and the ability to get around her floor and communicate her needs? I shudder to think. But none of this was Medicare’s responsibility.

Yet Medicare would pay for “heroic” care for a woman who was dying of old age, not a disease that could be treated: Diagnostic tests. All manner of surgery. Expensive medications. Trips to the emergency room or the hospital — had she not refused all of them, in the last year of her life. So, in less than a decade, by my low-ball estimate, my mother spent $500,000 of her own money and uncalculated sums from her two children before winding up what she considered, with shame, “a welfare queen.”

Did you catch that last bit? Half a million dollars?

If you think that’s not in your parents’ future (or your own future), consider that 70 percent of the elderly will need extended care before they die. It would be enormously helpful if Medicare would pay for the care that older patients actually need.

That’s the dirty little secret. That while we count on Medicare to help us keep up with medical care in our golden years, what it actually does is pay for mostly pointless procedures. The actual care falls to families, until all resources are drained, relationships are strained, and adult children lose their retirement savings.

This article scared me. This is one secret that’s not good for anyone.

To read the full article in The New York Times, click here:  How Medicare Fails the Elderly