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Improving Health Care for Older Americans - Wall Street Journal

I heartily agree with Elizabeth Goldberg on “How To Improve Health Outcomes for Older Americans” (op-ed, Feb. 10). Almost all of the suggested ways to address the eldercare crisis, and the recommended steps toward a solution, involve domains that are covered by medical and geriatric social workers. We are uniquely trained to pick up on the clues of an elder in crisis, to understand the complex circumstances and issues involved and, with our knowledge of community resources, to intervene in a way that supports the senior’s dignity as well as their safety. Too often hospitals insist that already overworked nurses can make discharge plans, or doctors without the opportunity to see the whole picture can write prescriptions as grandma is wheeled out the door.

Catching the dementia, the lack of support system, the physical deterioration early, creating a workable plan to help the situation and following up to ensure implementation occurs—this is the heartbeat of a medical social worker. Use us!

Joanie R. Faddol Gruber, MSW, LISW

Cincinnati

Photo: Getty Images/iStockphoto

Accountable Care Organizations (ACOs) have been created with the blessing of Medicare to address those concerns posed by Dr. Goldberg. Screening for dementia? As part of the annual wellness visit, a visit done once a year for the Medicare patient to bring his or her preventive measures up-to-date, the patient is, indeed, screened for early dementia, which is addressed if present. Same day visits? Good ACOs, and good physicians, provide room in their schedules for same-day sick visits, instead of telling patients to go to the emergency room. Well-run ACOs, and Medicare for that matter, have learned that the only way to save money in health care is to keep people healthy and out of the hospital. The cost to the system of an office visit, and to the patient, is always much less than a visit to the emergency room.

A three-day hospital stay to qualify for transfer to rehab? Medicare is working to eliminate that requirement for well-run ACOs. Many hospitals remain stuck in their previous model of putting fannies in beds and making tons of money as a result. That is why Medicare moved to the value-based system, and those providers who can adapt will survive.

Paul D. Sovran, M.D., FACP

Central Florida ACO

Trinity, Fla.

Dr. Goldberg’s suggestions are all practical and sound but Hipaa laws and fear of lawsuits prevent doctors from leveling with patients’ families. I met with my father’s primary-care provider, as I knew my father was starting to fail cognitively, but his doctor wouldn’t involve me in a treatment plan because my ailing, now slightly paranoid, father wouldn’t sign any papers, including medical release forms and IRS tax forms. We need to deal with this reality.

Kathleen Penak

Grapevine, Texas

Unfortunately, many of the issues are out of individual physician’s control. The answers are complex and involve the evolution of societal norms and participation by patients, families. physicians and payers alike. Doctors alone cannot make a lasting difference and, by themselves, haven’t driven policy in decades.

Mark T. Stephan, M.D., FACR

Lafayette, La.

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