Term
| Elders have a _______ rate of disability and disease, and more consistent medical coverage of service |
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Definition
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Term
| Our elders are the highest users of what four things |
|
Definition
| physician services, hospitals, prescription drugs and long term care. |
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Term
| However, a significant portion of the cost of these services still comes |
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Definition
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Term
| We need to know the ______ and _______ of elder health care as professionals. |
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Definition
|
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Term
| Sufficient ________ and ____ __ _____ are the vital to health in later years |
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Definition
| income, access to medical care |
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Term
| When did social security begin |
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Definition
|
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Term
|
Definition
working adults show payslip,
Financed by taxes on salaries of working adults |
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Term
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Definition
|
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Term
| Some just have SS, some also have |
|
Definition
| pensions, assets and earnings |
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Term
| When was supplemental security income established? |
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Definition
|
|
Term
| Supplemental security income was established to |
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Definition
| to assist aged, blind and disabled |
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Term
|
Definition
| participation in the workforce |
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Term
| In 2004, SSI helped 7 million people, -___% were elders |
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Definition
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|
Term
| The longer a person works, the |
|
Definition
| higher benefit upon retirement |
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Term
| SSI comes in if social security benefits are insufficient to cover |
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Definition
|
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Term
|
Definition
| fed govt through general taxes with contributions and managed by the states. |
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Term
| Four other sources of income |
|
Definition
| personal assests, pensions, continued working, IRA |
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Term
| 2004 more than ___% of elders were still working. |
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Definition
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Term
| IRA have ________ over the years. |
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Definition
|
|
Term
| Are IRA guaranteed to grow? |
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Definition
| Not guaranteed to grow and may lose money |
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Term
| Elders average about ___ doctor visits per year, _____ that of younger adults |
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Definition
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|
Term
| The hospital admissions rate is ______ times that of younger adults |
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Definition
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|
Term
| Elders are _____ as likely to be prescribed medicine from a physician |
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Definition
|
|
Term
| Elders spend ____ times more from their own pockets than those under 65 |
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Definition
|
|
Term
| For elders there is an ________ in hospital admits and their stay is longer and an ________ in medical procedures for this population. |
|
Definition
|
|
Term
| Medical care is financed by what six things |
|
Definition
Medicare
Medicaid (MediCal in California)
US Department of Veteran Affairs
Indian Health Service
Private insurance
Out of elders’ pockets |
|
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Term
| Some of the ________ was paid by the state and federal medical insurance programs, some by private insurance and some out of pocket |
|
Definition
|
|
Term
| Medicare has what two types? |
|
Definition
|
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Term
|
Definition
|
|
Term
Part A is hospital insurance
Supported by |
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Definition
|
|
Term
| Most elders don’t pay __ _____ ______(have to have contributed to SS for 10 years) |
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Definition
|
|
Term
| Medicare Part A has ____ _____ _____ prescribed by doctor |
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Definition
|
|
Term
Medicare Part A 1st two months of hospital stay = ____
After that, _____ per day |
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Definition
|
|
Term
| Medicare Part A 1st ___ days in skilled nursing place = Free (only after at least 3 days in hospital) |
|
Definition
|
|
Term
| medicare part A Days 21-100 in the hospital = $___/day then on your own |
|
Definition
|
|
Term
| Medicare Part A Provides a variety of hospice care for |
|
Definition
|
|
Term
| Medicare was signed into law by President _______ _______in ______. |
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Definition
|
|
Term
| Medicare is paid majority by |
|
Definition
| taxes but also premiums, ductibles, copays and co-insurance. |
|
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Term
|
Definition
|
|
Term
| Less than ____% are enrolled in Part C of Medicare and is not always offered in areas |
|
Definition
|
|
Term
| Part C of Medicare gives choices for . |
|
Definition
|
|
Term
| Medicare DOES NOT PAY for long-term |
|
Definition
| care insurance, vision, hearing, or dental = need other income/insurance for that |
|
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Term
|
Definition
|
|
Term
| Most elders monthly premium = $____/month for Medicare part B |
|
Definition
|
|
Term
| Elders who got paid more during working life pay |
|
Definition
|
|
Term
| save Medicare about $___ billion in the next 5 yrs |
|
Definition
|
|
Term
| ___ of elders = Medicaid can pay the premium (low-income) |
|
Definition
|
|
Term
| Deductible for Medicare Part B = $ |
|
Definition
|
|
Term
| Medicare-approved lab services = |
|
Definition
|
|
Term
| Doctor services = ___% of allowed amount of medicare part B |
|
Definition
|
|
Term
|
Definition
| private managed care plan |
|
|
Term
|
Definition
| A + B (and sometimes D) in one plan (covers Medicare prem. and deduc.) |
|
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Term
|
Definition
| is prescription drug coverage |
|
|
Term
| Who is eligible for part d? |
|
Definition
| anyone eligible for A, B, or C |
|
|
Term
| Part D is not through _____, but is through ________ |
|
Definition
|
|
Term
| Premium penalty for part D if you don’t sign up at |
|
Definition
|
|
Term
|
Definition
Almost any elder can qualify
No exclusions for preexisting conditions
Little worry about exhausting coverage |
|
|
Term
|
Definition
Complex/confusing
Still expensive
Doesn’t cover everything or fully reimburse (covers half the costs)
No cap on out-of-pocket expenses
Huge cost to all Americans |
|
|
Term
| Original Medicare plans include |
|
Definition
| Fee-for-service plan (pays copays/deduc.) |
|
|
Term
| ___ of elders are on the original medicare plans |
|
Definition
|
|
Term
| Under original Medicare elders can go to any |
|
Definition
| doctor, hospital or pharmacy, as many times as needed |
|
|
Term
| Under original Medicare, Elders can go to any doctor, hospital or pharmacy, as many times as needed |
|
Definition
| which may lead to uncoordinated treatments |
|
|
Term
| Under orignal medicare The government pays the most for the |
|
Definition
| sickest patients (they take the risk) |
|
|
Term
| Original medicare ________ and ______ throughout the country (more stable) |
|
Definition
|
|
Term
| Medicare Advantage plan is also known as |
|
Definition
|
|
Term
What percent of elders
use these plans |
|
Definition
|
|
Term
| Two types of plans under the Medicare Advantage Plan |
|
Definition
| Managed care plans (HMO or PPO) |
|
|
Term
| Under the Medicare Advantage Plan Doctor/plan manages |
|
Definition
|
|
Term
| what plan Less choice of doctors, not standardized, increased benefits (want to attract healthy), and lower out-of-pocket costs |
|
Definition
|
|
Term
| Under the medicare advantage plan They want to enroll the healthiest elders because |
|
Definition
| payment is for each individual (capitation) |
|
|
Term
| Payment is for each individual regardless of |
|
Definition
| how much or how few services are used. |
|
|
Term
| Enroll healthiest elders and it may ________ the chance of preventative services but also may ______ chances of some services |
|
Definition
|
|
Term
| Preferred Provider Organizations is a contract with |
|
Definition
|
|
Term
|
Definition
| doc fixed ratio amt/month, less per visit |
|
|
Term
| PPO can see out-of-network for a ____ cost |
|
Definition
|
|
Term
| Health Maintenance organizations Pays docs a |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Under HMOs patients are responsible for |
|
Definition
|
|
Term
|
Definition
| patient choices for increased benefits, decreased costs |
|
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Term
|
Definition
|
|
Term
| PPOs and HMOs, enrollee agrees to set |
|
Definition
|
|
Term
| PPOs and HMOs, elders don’t usually need a supplemental policy since |
|
Definition
| advantage plan should cover |
|
|
Term
| Medicare reimbursement rates are |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ______ insurance to help cover the things Medicare doesn’t |
|
Definition
|
|
Term
| SHI The greater the benefit, the |
|
Definition
|
|
Term
| Medigap is regulated and categorized |
|
Definition
| “A” through “N” for easy comparison |
|
|
Term
| Medigap insurance should be bought near the ___th birthday as companies cannot turn you down during this time |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| the poor, blind, disabled of all ages |
|
|
Term
|
Definition
| hospitals, doctors, medications, home services, and nursing home |
|
|
Term
| In 2004, Medicaid ____ of expenditures = long-term care |
|
Definition
|
|
Term
| Eligibility for Medicaid is based on |
|
Definition
| monthly income and total assets, and determined by each state (“asset shifting”) |
|
|
Term
| ___% of Medicare elders use Medicaid too (dual-eligibility)…Medicaid pays for part or all of expenses |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Long term care (Medicaid) |
|
Definition
| some facilities may not accept or have only a few because of low money reimbursement |
|
|
Term
|
Definition
| New laws state that assets have to be shifted three yrs before nursing home admittance, and 5 yrs. Before for trusts (a way that elderly can “pass on” assets and still be covered by Medicaid) |
|
|
Term
| US department of veteran affairs is financed by |
|
Definition
|
|
Term
| Largest central service system in the U.S. |
|
Definition
| US department of veteran affairs |
|
|
Term
| Qualification factors for US department of veteran affairs (4) |
|
Definition
veterans w/ service-connected disabilities
-recipients of veterans pension
-veterans 65+ (considered disabled)
-declared medically needy veterans |
|
|
Term
| US department of veteran affairs |
|
Definition
| physician services, hospitalization, home health, long-term care (to beneficiaries too) |
|
|
Term
| In 2009, __ million veterans were 65 and older |
|
Definition
|
|
Term
|
Definition
| centrally directed hospital and medical service system in the United States. |
|
|
Term
| The Indian Health Service in an agency in |
|
Definition
| the Department of Health and Human Services (federally funded) |
|
|
Term
|
Definition
| Community-based care to American Indian and Alaskan Natives |
|
|
Term
| There are not enough resources to help with (Indian Health Service) |
|
Definition
| long-term care or rehabilitation |
|
|
Term
| American Indians have higher rates of disability but receive __ services of general elder population |
|
Definition
|
|
Term
| Federal funding is about ___% that of the rest of the population |
|
Definition
|
|
Term
| Indians are Less than __% but consume a much higher proportion of it’s funds. |
|
Definition
|
|
Term
| In 2006, elders spent an average of $4,241 (___% of the average income) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Medical providers/supplies: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| The US faces _________ numbers of elders each year – elders are high users of medical services |
|
Definition
|
|
Term
| Profits from prescription drugs are |
|
Definition
|
|
Term
| _____ and _____ drive up the costs |
|
Definition
|
|
Term
| Hospital administration costs are |
|
Definition
|
|
Term
| __________ expenses are the highest single item in the national health bill |
|
Definition
|
|
Term
| the biggest cause of bankruptcies in the United States |
|
Definition
|
|
Term
| Medicare reserves are projected to be depleted by |
|
Definition
|
|
Term
| Studies indicate that for-profit hospitals are |
|
Definition
| costlier and less efficient |
|
|
Term
| For profit hospitals have |
|
Definition
| Higher death rates and higher payments for care |
|
|
Term
| For-profit hospitals tend to spend more on ________ and less on |
|
Definition
| administration, direct patient care. |
|
|
Term
| For profit hospitals are ____ likely to have an ER and ____ likely to provide charity care |
|
Definition
|
|
Term
| For profit hospitals have _____ staffing levels and _____ patient care outcomes. |
|
Definition
|
|
Term
| Inequity in treatments include |
|
Definition
| gender, race/ethnicity, age |
|
|
Term
| Women/men? = more chronic illnesses and disability |
|
Definition
|
|
Term
Poorer outcomes due to more advanced age
men/women? |
|
Definition
|
|
Term
| 5 Key dimensions of ageism that result in poor care of older individuals |
|
Definition
Health care professionals lack geriatric training
Elders are less likely to get preventive care
Elders are less likely to be screened for or diagnosed with life-threatening diseases
Elders are more likely to receive inappropriate or incomplete treatment
Elders are underrepresented in clinical trials |
|
|
Term
|
Definition
| when medical treatment or environment make the person sick |
|
|
Term
| Iatrongenic illness is common in |
|
Definition
| hospitals/nursing homes when infections are passed around |
|
|
Term
| Iatrongenic illness can be from |
|
Definition
| errors, neglect, drug interaction |
|
|
Term
| Iatrongenic illness results in |
|
Definition
| longer hospital stays, poor health, depression, deterioration, death |
|
|
Term
| Going to the doctor can be very difficult for some elders because of |
|
Definition
|
|
Term
| Medicare ______ the reimbursement rate for house calls |
|
Definition
|
|
Term
| Medical House Call Program is a model for |
|
Definition
| serving home-bound elders |
|
|
Term
| ___% of visits are in doctor offices or hospital |
|
Definition
|
|
Term
| Three benefits of house calls |
|
Definition
| elder better, seeing the environment, medicine cabinet |
|
|
Term
| By 2030, elders will comprise ____ of the patient load of many doctors |
|
Definition
|
|
Term
| Majority of elders cared for by doctors and specialists that are without |
|
Definition
|
|
Term
| Medicare helps ___ billion a year for medical residencies in the United States |
|
Definition
|
|
Term
| We need to increase _______ ______in medical school |
|
Definition
|
|
Term
| Doctors treat patients based on |
|
Definition
| education, experience, intuition, and doctor/patient relationship |
|
|
Term
| _______-based medicine is more popular than _________-based medicine |
|
Definition
|
|
Term
| What agency tries to standardize medical practices |
|
Definition
| Agency for Healthcare and Research Quality |
|
|
Term
| Standards don’t exist for the ________ of diseases. |
|
Definition
|
|
Term
|
Definition
| trial and error information based on previous experiences. |
|
|
Term
|
Definition
| combines clinical judgment with the outcome of studies that are peer reviewed, published, well designed and placebo controlled |
|
|
Term
| Three parts of communication from the doctor patient relationship |
|
Definition
Slow down V
Include a family member
Interpret “doctor-speak |
|
|
Term
|
Definition
| the ability to seek-out, process and understand basic information and services needed to make good decisions about health |
|
|
Term
| ____% of American elders have low health literacy leading to poor compliance |
|
Definition
|
|
Term
| Poor health literacy is more common in those who |
|
Definition
|
|
Term
| solutions to low health literacy |
|
Definition
| use interpreters, go to the doctor with a friend, health professionals need to watch their use of language and assure understanding |
|
|
Term
| ________ education for Baby Boomer generation but also _________ elder immigrant population |
|
Definition
|
|
Term
| When an elder sees many specialists, this may cause |
|
Definition
| overlap or unnecessary services |
|
|
Term
| Medical services and community services are often not |
|
Definition
|
|
Term
| Solutions for comprehensive care |
|
Definition
Primary care provider or case manager can coordinate services (remember Jeannette?)
Managed care may help
Interdisciplinary team approach |
|
|
Term
| Managed care may help if elders can use one |
|
Definition
|
|
Term
| four Medicare demonstration projects |
|
Definition
Testing for improvements in Medicare
Usually targets elders with specific illnesses
Heart Partners
Senior Risk Management Program |
|
|
Term
| Three disease management program |
|
Definition
Many came from Medicare demonstration projects
Additional education, tools for monitoring and information on managing
Don’t seem to save money |
|
|
Term
|
Definition
| have congestive heart failure. It offers education, nurse review of daily weights and symptom checklists, prescription drugs by mail and communicates with personal physician. Helps to decrease hospitalization by improving care provided at home. |
|
|
Term
|
Definition
| is a screening for preventable illnesses and conditions and provides tailored information, behavior change recommendations and tools for risk factor reduction |
|
|
Term
| Ambulatory surgical centers |
|
Definition
Operating room facilities
Usually less expensive than hospitals
Many focus on one type of procedure
Mostly found in urban areas |
|
|
Term
| Innovative Use of Personnel |
|
Definition
Using mid-level practitioners to help see many patients
May become experts in specific areas
Less trained than doctors
Hospitalists |
|
|
Term
|
Definition
| are for low risk patients. Mostly cataract surgery, cosmetic procedures, colonoscopies, dental surgery, orthopedic surgery. |
|
|
Term
| Innovative use of personnel |
|
Definition
is to match the level of personnel skill to the level of care needed. So not going to a specialist for a sprained ankle.
Mid-level practitioners such as nurse practitioners, nurse midwife, nurse anesthetists, clinical nurse specialists and physician assistants.
Hospitalists are physician specialists who work only in the hospitals or primary care physicians. |
|
|
Term
|
Definition
The Health Insurance Portability and Privacy Act (HIPPA) protects patient privacy
Patient information cannot be shared without permission and signed consents |
|
|
Term
| Electronic Medical Records |
|
Definition
There are no comprehensive medical records that follow you from doctor to doctor
Government and private initiatives are trying to create a unified electronic system, but it is difficult. |
|
|
Term
|
Definition
is patients communicating with doctors through email
Can be convenient, cheap, private and anonymous
Without a physical exam or lab tests or verification of credentials, patients must beware |
|
|
Term
|
Definition
refers to connecting with doctors through the telephone, fax, and/or audio-video links
Improves access in rural areas |
|
|
Term
| Currently __ states permit Medicaid reimbursements for cyber medicine. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Many elders have used some sort of -_-------- medicine including supplements
It is important to share this information with your doctor |
|
Definition
|
|
Term
|
Definition
| refers to the practice of traditional or conventional Western medicine. The term allopathic medicine is most often used to contrast conventional medicine with alternative/complementary medicine, or homeopathy. |
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|
