Americans want a long life and most of us will get to live into our 80's and beyond, but we have not squarely faced the challenges of living well in the last years of long lives. This book lays out a thoroughly pragmatic way to organize service delivery and financing so that Americans could count on living comfortably and meaningfully through the period of disability and illness that most will experience in the last years of life - all at a cost that families and taxpayers can sustain. MediCaring Communities offers to customize care around the priorities of elders and their families and to manage the local care system so it is reliable and efficient.Three out of four of us will need long-term care. The period of needing someone's help every day now lasts more than two years, on average. Most of us will not have saved enough to get through this part of life without financial help from family or government - indeed, we'll spend almost half of our total lifetime healthcare expenditures in this last part of life, mostly on personal care that is not covered by Medicare. We have not yet required housing to be modified for living with disabilities or secured a ready supply of home-delivered food, and we certainly have not required medical care to focus on the patient and family priorities in order to enable the last years to be meaningful and comfortable. Family caregiving will be a crisis as families become smaller, more dispersed, older, and facing inadequate retirement income for the younger generation. MediCaring Communities improve care by building care plans around the health needs and living situation of the elderly person and family, and especially from respecting their choices about priorities. The improvements in service delivery arise from integrating supportive services at home with customized medical care and installing local monitoring and management. The improvements in finance arise from harvesting savings from the current overuse of medical tests and treatments in this part of life. These come together in MediCaring Communities.Strong evidence supports each component, but the real strength is in the combination, where savings support critical community-based services, communities build the necessary environment, and elders and their families craft their course with the help of interdisciplinary teams. This book lays it out, using expansion of PACE (The Program of All-Inclusive Care of the Elderly) as the test case. The book provides a strong and complete guide to serious reform, and just in time for the aging of the Boomers which will escalate the needs dramatically during the 2030's. Now is the time to act.Advance Praise for MediCaring Communities"For decades, Joanne Lynn's has been the clearest, strongest, most soulful voice in America for modernizing the ways in which we care for frail elders. This essential book is her masterpiece. It offers a magisterial, evidence-based vision of that new care, and an entirely plausible pathway for reaching it. Facing a tsunami of aging, our nation simply cannot afford to ignore this counsel."-Donald M. Berwick, MD, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, and former Administrator, Centers for Medicare & Medicaid Services."MediCaring Communities integrates good geriatrics and long-term services and supports, and building upon an expanded PACE program can be a tangible start. We should try this!"-Jennie Chin Hansen, Lead in Developing PACE; Past President, AARP; and Past CEO of On Lok Senior Health Services and the American Geriatrics Society.

This book provides a comprehensive and systematic state-of-the science review of major primary care delivery models, how they address specific needs of older adults, and available evidence for their efficacy. Written by experts in the field, this book explores the patient-centered medical home model (PCMH) in depth and dives into the complexities of the “medical neighborhood”. It describes and analyzes primary care specifically directed toward special, complex populations, such as the Health Home for safety net patients with mental health needs, and intensive primary care for older adults. It reviews an array of primary care models related to dual eligible patients including the GRACE primary care consultation model and PACE models. It describes primary care with Advanced Practice Nurses and Physician Assistants and explores in-depth the massive effort within the VA to develop the Patient Activated Care Team (PACT), a VA form of the PCMH that also has several offshoots that address complex older veterans and veterans with severe mental illness. Finally, it illuminates rarely discussed primary care that occurs within the home and within long-term care. Throughout the entire book, experts navigate the workforce, care quality, and financing challenges of primary care for older adults. Primary Care for Older Adults is a valuable resource for clinicians, researchers, patients, caregivers and their advocates, and policy makers who have an interest in designing, promoting, and implementing high quality primary care for older adults.

The desire to help our elders navigate health issues is clear and universal—how to assure proper care and a good ending is not. Combining adroit storytelling skills with expert advice, The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare brings the reader into all-too-familiar scenarios facing our aging parents and offers answers to questions we may not know to ask until it’s too late. Author and biologist Marcy Houle shares her personal journey of caring for her father, a surgeon, who developed Alzheimer’s, and later her mother, who succumbed to other medical conditions. Like many children of aging parents, Marcy often felt powerless traveling this sad trajectory—watching them fall through the cracks of a fragmented and confusing healthcare system, where professionals often wrote off their symptoms as “just old age.” Not having the understanding of the changes that come with aging, she was led to believe there was nothing she could do to help. The tragic secret? According to coauthor and geriatrics physician Elizabeth Eckstrom, these symptoms frequently are not “just old age.” Rather, the problem is that the current healthcare delivery model for older people is ill-equipped to provide the comprehensive, person-centered care seniors need. Today, thousands of aging people face unnecessary suffering, hospitalizations, nursing home stays, and even death due to complications that could have been prevented or treated. Even more troubling, many healthcare professionals have had little or no training in the care of older adults. The Gift of Caring reveals these pitfalls and provides families with tools they can use to avoid them. Interspersed with every few chapters of Marcy’s riveting story, Dr. Eckstrom shares professional medical insights, compiled from the latest research, into what Marcy could have done to safeguard her parents. She shows us how to navigate the system, how we can become our loved one’s best advocate, and what we need to know to achieve healthy aging and meaningful, compassionate final years. Honest, at times humorous, and ultimately uplifting, The Gift of Caring sheds new light on aging from twin perspectives: a story of a daughter desperately seeking help for the parents she loves, and a geriatrician who gives us the knowledge we need to insist upon a better way.

This book explores the meaning of quality of life in care for older persons and introduces the reader to their main concerns when receiving care. Based on qualitative research, it pays particular attention to the needs and requirements of older people, considering their individual family situations, social circumstances, values and lifestyles. Person-centred care is a way of providing nursing care that puts older people and their families at the core of all decisions, seeing each person as an individual, and working together to develop appropriate solutions. Following an introduction to the concept of quality of life in old age, the book reviews essential findings from worldwide research into the experiences of older people with regard to nursing care and the impact of these experiences on their quality of life. It investigates health promotion, care provided in nursing homes and assisted living facilities, and palliative care. Each chapter includes a brief introduction to the respective field of nursing care and the problems it has to deal with, concluding with a discussion of their implications for nursing practice in the respective field of care. In closing, the evidence from qualitative research is discussed in relation to current gerontological theories.

From Ira Byock, prominent palliative care physician and expert in end of life decisions, a lesson in Dying Well. Nobody should have to die in pain. Nobody should have to die alone. This is Ira Byock's dream, and he is dedicating his life to making it come true. Dying Well brings us to the homes and bedsides of families with whom Dr. Byock has worked, telling stories of love and reconciliation in the face of tragedy, pain, medical drama, and conflict. Through the true stories of patients, he shows us that a lot of important emotional work can be accomplished in the final months, weeks, and even days of life. It is a companion for families, showing them how to deal with doctors, how to talk to loved ones—and how to make the end of life as meaningful and enriching as the beginning. Ira Byock is also the author of The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life.

Just a few generations ago, serious illness, like hazardous weather, arrived with little warning, and people either lived through it or died. In this important, convincing, and long-overdue call for health care reform, Joanne Lynn demonstrates that our current health system, like our concepts of health and disease, developed at a time when life was mostly short, serious illnesses and disabilities were common at every age, and dying was quick. Today, most Americans live a long life, with the disabilities and discomforts of progressive chronic illness appearing only during the final chapters of their life stories. Sick to Death and Not Going to Take It Anymore! maintains that health care and community services are not set up to meet the needs of the large number of people who face a prolonged period of progressive illness and disability before death. Lynn offers what she calls an "owner's manual for the health care system," which lays out facts, concepts, strategies, and action plans for genuine reform and gives the reader new ways to interpret information creatively, imagine innovative possibilities, and take steps to implement them.

Includes: "Poetic elements in Sanskrit literature " explains the extensive use of verse in Indian texts. "Introduction to Metrics " gives a clear overview of Sanskrit prosody. "A Treasury of Common Meters" includes fully-worked examples of verses drawn from many sources. "Figures of Speech" explains similies, metaphors, and other poetic uses of language. "Figures of Sound" explains techniques that affect sound, such as rhyme and alliteration. A metrical analysis of the Hathapradipika, the best-known work on Hatha Yoga, is included. An Introduction to the Hathapradipika by Anthony Biduck summarizes key spiritual and philosophical ideas of Hatha Yoga.

The United States is in the midst of a major demographic shift. In the coming decades, people aged 65 and over will make up an increasingly large percentage of the population: The ratio of people aged 65+ to people aged 20-64 will rise by 80%. This shift is happening for two reasons: people are living longer, and many couples are choosing to have fewer children and to have those children somewhat later in life. The resulting demographic shift will present the nation with economic challenges, both to absorb the costs and to leverage the benefits of an aging population. Aging and the Macroeconomy: Long-Term Implications of an Older Population presents the fundamental factors driving the aging of the U.S. population, as well as its societal implications and likely long-term macroeconomic effects in a global context. The report finds that, while population aging does not pose an insurmountable challenge to the nation, it is imperative that sensible policies are implemented soon to allow companies and households to respond. It offers four practical approaches for preparing resources to support the future consumption of households and for adapting to the new economic landscape.