Staying At Home As You Age

Dan Weinrieb  0:03  
Homes today in our country, less than 6% of them are actually equipped to support aging in place. But we also know that people over the age of 65 If you ask them the question 9 out of 10 people are gonna say I want to stay in my home. I do not want to go to a facility.

Terry Wilcox  0:20  
This week on a Patients Rising Podcast, a wonderful Christmas gift for many is staying in their homes as they get older. But a lot of times, unfortunately, that isn't possible. Today, we're speaking with Dan Weinrieb with Jukebox Health to discuss the current challenges to aging in place, and what he thinks could help. Welcome to the Patients Rising Podcast. I'm your host, Terry Wilcox, CEO of Patients Rising. I'm joined by my co host, who treated his recent bout of COVID with mega doses of blueberries and peaches. He's Bob Goldberg, co founder of the Center for Medicine in the Public Interest. So Bob, why fruit?

Bob Goldberg  0:59  
Well, fruit is the elixir of life Terry. So, you know, I know that a lot of people will say, Bob, this is amazing. Do you have any other fruit related tips or any tips to you know help us live longer, because of course this show is about aging in place. So you ready? 

Terry Wilcox  1:18  
I'm ready.

Bob Goldberg  1:18  
For my tips? Number one: don't run for a bus. There'll always be another. Never ever eat or touch fried food. And stay out of small cars, Ferraris no good. And then of course eat fruit, nectarine, even a rotten plum is good, trust me.

Terry Wilcox  1:39  
Okay! Those are pretty good tips.

Bob Goldberg  1:42  
They're not bad.

Terry Wilcox  1:44  
I'm from Texas, the fried food one might be a little bit hard.

Bob Goldberg  1:47  
Yeah. So listen, as we know that just because you're getting older, doesn't mean you have to move to a home or an assisted living facility as you and I both know. And actually according to A.A.R.P. or AARP, as they now call themselves, 77% of adults over 50 would prefer to age in place.

Terry Wilcox  2:11  
Now Bob, that makes a lot of sense to me. And it makes a lot of sense to Dan Weinrieb who we heard from at the top of the show. He is the head of strategic partnerships at Jukebox Health. Now Weinrieb says for anywhere near this number of people to remain in their homes, we need to start working on it much earlier in life.

Dan Weinrieb  2:31  
It's an interesting phrase "aging in place," right? If you look at the programs today that are being deployed to homes for kind of like this aging at home or health at home, those are interventions for people that are further along in their disease state, right? They have more complex chronic conditions, they might even be homebound, right? It's kind of living out your last days in the comfort of your own home. Where I think we struggle from a policy perspective and even from a human perspective, is there's a lot that can be done up front to support that kind of aging in place, which in my mind is really like living well in your environment. 

Bob Goldberg  3:15  
Not only do the numbers show that people want to stay in their homes, they show that it's beneficial to do so.

Dan Weinrieb  3:22  
Well, I think the research definitely supports and shows that people that are able to stay in their environment and not be in a facility setting are far better off from a quality of life perspective. And also from a slowing down that trajectory of needing institutional care or costing more or having more events, right? The research that's out there clearly demonstrates that being able to stay at home is better overall.

Terry Wilcox  3:53  
Well, since the public wants this, and it seems to help keep people healthy. Our system must be designed to make this a reality, right?

Dan Weinrieb  4:02  
I can't pinpoint a scenario where it's working, which is sad. Falls are the number one cause of death and injury and people over the age of 65. That number equates to, you know, hundreds of millions of dollars in avoidable healthcare spend and also forgot the spend, it's just improving quality of life, right? It's treating people with dignity and respect and giving them the opportunity to live out their days where they want to. We don't do a good job of that here.

Bob Goldberg  4:36  
So Terry, it makes sense. Of course, we're not doing it. Medicare does provide some home healthcare and some supportive care to keep people in place. But it's not enough in the sense that you could be doing a lot more with Medicare to reduce that except that Medicaid is a separately funded program. And Medicare at this point gets no economic benefit from keeping people out of nursing homes.

Terry Wilcox  5:11  
Well, you know, I know for a fact that I mean, my dad would have loved to have aged in place. Now, it wasn't possible. But he was a prime candidate for somebody who the minute you took him out of his home, everything went haywire, because he just wasn't happy. But it's to really start to think about it while you still have your faculties and your physical health. And really start to think about like, Jonathan, and I actually think about it, we hope that we don't have to worry about it anytime soon. And I don't think we will. But you know, that we live in an old colonial house, it's got, you know, basically three levels, right stairs to our bedroom, all kinds of things that you have to think about. So, what about you, Bob, what do you what do you think about? And what about your dad? How's he doing it?

Bob Goldberg  6:01  
Well you know, my father is really still self sufficient, if not for the arthritis in his knee. I mean, he would be a lot more active, I think the thing for him is, he doesn't want to spend money on having someone come in to sort of work with his stability and balance and other things. Medicare doesn't cover for it, you know, you need to get prior offer for occupational therapy, and even that, and that's really for rehabilitation. So I agree 100%, that something that would be proactive. And here we are, again, talking about proactive, to save money would make a heck of a lot of sense. Weinrieb knows that the issues are, you know, they're known, everyone knows what they are. But taking action to fix the problems is where our system falls short.

Dan Weinrieb  6:56  
Identification, we do a decent job of that there's no shortage of data, population, health analytics, all of that stuff, risk analytics, all of it. We know, right? We know that chronic conditions are correlated to an increased risk of falls, certain chronic conditions, all of that information is out there. It's the solution part. And I think that historically, what, from a policy perspective, you know, 2019 health plans, and CMS gave health plans the green light to start offering more social care benefits, right social needs benefits, especially Medicare Advantage. And I think that health plans were excited to be able to do that. But I also think that we're looking at it from a lens of acquisition member acquisition and member retention. Marketing and sales of course growth is hugely important to the sustainability and financial health of any organization, at the same time, those benefits, nobody was really monitoring whether or not they were having an impact on health outcomes and quality, right? and care, and alignment with value, and alignment with community providers. It was shiny objects that attract, you know, members and retain members and gain market share.

Terry Wilcox  8:13  
Weinrib also says that we need to reframe how we think about our aging population. Take a listen.

Dan Weinrieb  8:21  
One thing that I always see in the industry today is we're fostering an environment or we're fostering a mindset of dependence, right? Personal care hours, caregiving services, right? Those are things that are probably the most utilized services for people over the age of 65. Right, whether they're dual eligible or managed Medicaid, or even Medicare Advantage, personal care services. A lot of times we see that addressing a home modification, right or making home modifications, will reduce the need to have personal care hours, right and allow that person to be more independent. And these are simple, simple fixes that just give people their dignity back. Right, they can groom themselves, they can go to the bathroom on their own, right, they don't need to have someone come in and help them bathe.

Bob Goldberg  9:12  
And Terry, from a benefits perspective, Dan says that they need to offer help that actually empowers, which actually helps.

Dan Weinrieb  9:12  
You need to offer benefits and programs that are going to help move the needle, keep people safe or reduce falls, right? So that's first and foremost. Take a look at what you're offering today. You're not going to be able to offer benefits that are shiny objects anymore, that are not tied to some sort of return on the cost of care and quality of life metrics, right? So that's first and foremost, the second: improve the programs that you have in place today, especially on the Manage Medicaid side and the dual eligible side. The states are making these social care services available. They're really difficult to navigate. They're really difficult to operationalize from a plan perspective. So make those programs more effective.

Terry Wilcox  10:13  
Yeah, I mean, I think Bob, this is really ripe for like, a public, you know, service campaign to Gen Xers and spry baby boomers on the younger side, right?

Bob Goldberg  10:25  
Yeah, look, and it's consistent with everything that we've talked about this year and last year is that there are entrepreneurial initiatives and companies that have identified the problem well ahead of what the government is already doing to solve some of these concerns and address these issues. They over 90 population is the fastest growing segment of the population in the country. This needs to be a priority, Terry. 

Terry Wilcox  10:59  
There's all sorts of things now. Thank goodness in our society that will allow you to age in place like Uber, like DoorDash, like all of these things that can deliver stuff. You know, if you live alone, and you're not feeling that, well, someone can deliver you dinner, even if there's not a visiting angel available.

Bob Goldberg  11:16  
Yeah, and I think increasingly, even if you're not in the peak of condition, it is still the way to go. I mean, I'd rather I think this is going to grow because most of us, as we get older are going to say why, you know, why waste the money? Why have Medicaid, take all your money, and use it for nursing home that is outdated. So when we mentioned dual eligibles, which means people that are eligible for Medicare, and for Medicaid. In next week, our show will be focused on that topic. So for now we have a link to Jukebox Health's website in the show notes, where you can learn more about how this great company supports aging in place.

Terry Wilcox  12:10  
This episode of the Patients Rising Podcast is brought to you by the Patient Helpline. This is an absolutely free service. It is a wonderful way to get all the questions you have about things like medical transportation, health insurance, caregiving, all of them answered by our navigators. You can call you can email and we will handle it. Our navigators have handled countless issues for patients and caregivers just like you. If you or someone you know has a healthcare question, challenge or an issue. We are standing by and ready to help to get in touch, leave us a voicemail, or send us an email using the link in the show notes.

Bob Goldberg  12:51  
Now, before we go today, Terry, we have talked before about these prescription drug affordability boards and several states. I think there's seven. And today we bring more news about one of them. And this is from Colorado. Stamps reporting that Vertex Pharmaceuticals is celebrating because the Colorado prescription drug affordability board voted unanimously not to place the company's best selling cystic fibrosis medication on a list of drugs for which payments will be set. Now keep in mind, the drug carries a wholesale price of about $310,000 before any rebates or discounts were value based purchasing agreements.

Terry Wilcox  13:38  
Well first of all, I'm not shocked I'm going to just start with I'm not shocked that the Affordability Review Board, despite Patients for Affordable Drugs, best efforts, did not vote to place Vertex's cystic fibrosis medication on the list. Nobody likes to talk about it. And full disclosure, we don't get any money from Vertex just so everybody knows. It's a fantastic drug. It's an absolutely fantastic drug. We know many patients who are who are on it, and they're staying out of the hospital. And I think if you can do the math of staying out of the hospital, you'll realize that this medication is worth it. Plus they have a fantastic patient assistance program. 

Bob Goldberg  14:23  
The other thing I would say Terry is if patients for affordable drugs had their way, then there would be patients for no drugs because the latest product from Vertex is now a gene therapy for sickle cell anemia. Which is a which is a cure. All right. So if you want 21st century medicines, you've got to pay 21st century prices, but we can find a way to pay for these things. 

Terry Wilcox  14:55  
Well, you know, look, the thing is, at the end of the day, people We'll need to stop grandstanding about drug prices being too high and start really getting in there and thinking about solutions to 21st century medicine, not 20th century medicine, 21st century medicine, and how we're going to pay for it, because that's the conversation. We have a serious problem, we have to figure out how to pay for cures and treatments that are going to be transformative. 

Bob Goldberg  15:28  
That's right. So that's all for today, Terry, but we have another episode right here next week. So make sure to follow the patient's rising podcast on your favorite podcast player, so you can be notified as soon as a new episode is live. Plus, stick with us in 2024 because we have a lot of great resources coming your way.

Terry Wilcox  15:51  
To everyone listening, I hope this holiday season has been wonderful and restful for you and all your loved ones. Until next week for Dr. Bob and everyone here at Patients Rising, I'm Terry Wilcox, stay healthy.