Category: Culture

What’s new with old drivers?

published date
February 25th, 2020 by
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Where’s my Uber?

A front page story in the Boston Globe (No longer in the driver’s seat; for elders, giving up the keys comes with a cost: giving up their freedom) is one that could have been written any time over the past 30 years or so. In fact, the same story has been written many times, which makes me wonder why the Globe bothered publishing it again now.

It’s a 29-paragraph article, and only in paragraphs 26 and 27 do we see any reference to ride share apps. Even then, it’s done dismissively:

These days, technology offers car-less seniors more options, freeing those who can pay for rides from depending on neighbors. Unlike past generations, seniors relinquishing licenses are a mouse click away from delivery or ride-sharing services.

But in remote settings, ride-sharing services can be harder to access, and family and friends often pick up the slack.

That really misses the point. The line about “those who can pay for rides” implies that Uber and Lyft are luxury services. Actually, for people who don’t drive that many miles –which is the population we’re talking about– taking a ride share service as needed will be a lot cheaper than owning a car, paying for insurance, maintenance, parking, etc. So almost by definition,  ride share services are affordable to seniors who would otherwise be driving.

Uber and Lyft are all over the place (there are not that many “remote settings” in the Boston area). But sure, I guess that affects some people.

I’ve been impressed that even non-tech savvy people, like my 80+ year old relative are able to summon Uber and Lyft successfully.

Cars themselves are getting easier and safer for the elderly to drive. Fully autonomous vehicles are still a few years in the future, but plenty of modern cars have features like adaptive cruise control, automatic emergency braking, pedestrian detection, lane keeping assistance, and rear cross traffic warning that help older drivers compensate for declines in physical and mental capacity.

Those get no mention in the article.

It’s also worth pointing out that elderly drivers are not that big of a threat to the public. They drive fewer miles, wear seatbelts, and are generally mellow behind the wheel. Inevitably, some die. Part of the reason is that older people are more frail, and more likely to die in an accident that a younger person would survive.

By healthcare business consultant David E. Williams, president of Health Business Group.

 

 

The United Provinces of Canada (at least on healthcare)

published date
July 1st, 2019 by
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Happy and Healthy?

Happy Canada Day!

We usually think of Canada as a divided nation, with the province of Quebec perennially at odds with the rest of the county and threatening to secede. I was in Montreal over the weekend and it’s fair to say there wasn’t much evidence of enthusiasm for the upcoming Canada Day (the rough equivalent of our 4th of July).

And yet, at least when it comes to healthcare policy, Quebec is very much at peace with the rest of the country.  From the Montreal Gazette (Quebecers united with Canadians on health, divided on language, hockey):

When it comes to stoking national pride, Canadians and Quebecers are united in their appreciation for universal health care and the Canadian passport. They also see eye-to-eye on the importance of the monarchy, Air Canada and Tim Hortons as national symbols, in that they don’t find them particularly important.

A national survey asked the question, “How important are each of the following as a source of personal or collective pride in Canada?”

Universal healthcare scored highest. Seventy three percent of Canadians and 70 percent of those from Quebec ranked it as very important. Anglophones and Francophones responded the same way.

We usually think of the United States of America, but when it comes to healthcare that is certainly not the case. If anything, Americans might be united against the idea of a Canadian-style system.

Kind of odd, then that the people living under that regime are so proud of it.


By healthcare business consultant David E. Williams, president of Health Business Group.

#CareTalk – Riding Amazon’s coattails

published date
February 28th, 2018 by

Amazon is teaming up with JP Morgan Chase and Berkshire Hathaway to create a new healthcare business to serve the companies’ employees. But all we hear about is Amazon’s role, while the other two are barely mentioned. Are they just along for the ride?

In this episode of #CareTalk, CareCentrix CEO John Driscoll and I tackle this question along with other meaty topics including big data, the CDC, Apple and Medicaid.

Enjoy the show -and don’t miss the lightning round!

Overview:

(0:20) How will the partnership between Amazon, JPMorgan Chase and Berkshire Hathaway impact healthcare?

(3:45) Are JPMorgan Chase and Berkshire Hathaway just “along for the ride” with Amazon?

(5:06) Who is looking out for the Medicare beneficiaries?

(8:01) The Economist published a statement that data will drive a revolution healthcare. Is The Economist right?

(10:42) Can we take any solace in the innovations happening on the state level?

(13:06) Was it the right move to force out CDC Director, Brenda Fitzgerald?

(14:20) What should be made of Trump’s description of the opioid crisis as an “emergency”?

(14:51) Will we be downloading Apple’s new Health app?

(15:37) Our thoughts on Indiana’s Medicaid program.

Listen to #CareTalk on iTunes: https://apple.co/2FxbeoX

Listen to #CareTalk on Google Play: http://bit.ly/2EuWHLd

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By healthcare business consultant David E. Williams, president of Health Business Group.

Hospice: Another sad sector of the opioid crisis

published date
August 30th, 2017 by
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Help yourself?

A person addicted to drugs might do anything to get their hands on the next dose. Whether that means ‘borrowing’ painkillers from a relative who had their wisdom teeth extracted, breaking into cars to grab small bills and coins, or stealing their mother’s jewelry –all things I’ve seen myself– there are no real limits. So I was saddened but not surprised to read Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds, which highlights the trouble dying patients face in keeping hold of their painkillers.

The Kaiser Health News examples are only anecdotal, but the combination of high quantities of opioids and homebound patients unable to fend for themselves is an ideal setting for diversion. The problem is two-fold: theft of drugs while the patient is alive, and diversion once the patient passes away. Since many patients die within days or weeks of beginning hospice, the second problem is a major one.

The examples offered in the article are heartbreaking:

  • In Mobile, Ala., a hospice nurse found a man at home in tears, holding his abdomen, complaining of pain at the top of a 10-point scale. The patient was dying of cancer, and his neighbors were stealing his opioid painkillers, day after day.

  • In Monroe, Mich., parents kept “losing” medications for a child dying at home of brain cancer, including a bottle of the painkiller methadone.

  • In Clinton, Mo., a woman at home on hospice began vomiting from anxiety from a tense family conflict: Her son had to physically fight off her daughter, who was stealing her medications. Her son implored the hospice to move his mom to a nursing home to escape the situation.

Some hospices are trying to do something about the problem, but it’s not easy. After all, their primary goal is to ease the pain of dying patients. It’s not really their job to keep track of and control everyone else. Some of the ideas being tried include:

  • Screening families for a history of drug addiction
  • Limiting the amount of meds delivered at any one time
  • Drafting agreements with families about consequences for drugs that disappear
  • Encouraging the destruction and disposal of drugs after the patient dies

None of these approaches is likely to succeed on its own. The country will have to address the broader opioid crisis in order to bring this part of it under control. However, there are a couple additional steps that could be taken now:

  • A few states let hospice employees destroy drugs once a patient dies. That should be expanded nationwide and made mandatory. There is no conflict here with the patient’s needs
  • Some patients, who would otherwise be eligible for home hospice, should be moved to facilities such as nursing homes, where controls can be tighter. (Much as I hate to argue against home care this needs to be part of the discussion)

By healthcare business consultant David E. Williams, president of Health Business Group.