Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 4. Major Life Changes by Many Seniors Complicate Care Delivery


On top of all the other challenges, caring for frail elders is complicated by the fact that many are experiencing major life changes, including functional declines, a loss of independence, major illnesses, and the death of a spouse. For example, one elderly focus group participant spoke of these life changes and how they can make it harder for people to accept care recommendations:

My husband worked all his life, and now that he’s no longer working, he looks like he’s falling apart. Everything is wrong with him. He needs a hip replacement. He won’t do it. He’s a diabetic. He has several problems.

In other cases, focus group participants spoke of wanting to ensure that they had tried every means to save the life of a dying spouse or parent. This desire often led to conflicts with the MCOs about the types of care and referrals that should be provided to people with end- stage illnesses. One man spoke passionately about how he had wanted to obtain additional specialist referrals for his wife who had recently died, even though he now recognized that no efforts would have saved her. This man’s experience suggests that MCOs may want to pay special attention to end-of-life care delivery. Seniors and their providers face many very difficult decisions at such a time, and MCO decision-making processes that seem acceptable at other times of life seem harsh when seniors and their families face death. Referral to counseling services or even special care to review and discuss treatment options may be useful in helping seniors and their families face this time of life and judge the value of alternative courses of treatment. Not only would such attention and discussions help seniors make critical end-of-life decisions, they might improve relationships between families and the MCOs. Nevertheless, efforts of this type may be difficult to fund in the current system because, as one focus-group physician mentioned, “Unfortunately, there is no CPT billing code for compassion.”

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