America’s Hospice Crisis

Hospice in Crisis – Joanne Kenen

It might seem odd to talk about “innovations in dying,” but in recent decades the hospice movement has become an important new pathway for the most difficult phase of life. As American health care has become ever more high-tech and expensive, the hospice model of home-based care for terminally ill patients has enabled millions of Americans to die peacefully in their own houses, without painful medical procedures—often greatly reducing stress on both the families and the health care system.

Now, however, the hospice model is coming under stress of its own. Some of that’s because the industry has changed, with a lot more for-profit hospice agencies and investor-owned chains, which are coming under scrutiny from regulators. But much of the stress comes from shifts in how we die, how we live—and with whom. These are big demographic changes that make the original conception of hospice harder to carry out as it was once intended.

“We need to address this very quickly,” said Joan Teno of the University of Washington, a prominent geriatrician who both practices and researches end of life care. “The tsunami of frail elderly people with complex multiple illnesses is coming.”

In theory, hospice would be an ideal system to deal with this tsunami. From the time it was developed in Britain in the 1960s and ‘70s, it represented a pushback against the over-medicalization of death, emphasizing comfort care and emotional support over disruptive medical interventions. It put great emphasis on family; hospice care is often delivered by close relatives rather than medical staffers. And it was originally designed with cancer in mind, at a time when cancer killed quickly.

Families have changed since hospice took root in the U.S. health system. They tend to be smaller, and live farther apart. More women work–making it harder for them to take on traditional roles as full-time caregivers. And millions of old, frail Americans—divorced, widowed, or never married—now live alone without family nearby, or without family at all. The most isolated are sometimes called “the unbefriended.”

“We have different illnesses, and different social situations than the traditional hospice user,” said David Stevenson, an expert on aging at Vanderbilt Medical School.

No matter how good and caring the hospice team—nurses, aides, social workers and, as desired, chaplains—much of the work falls to the family. For those with less support—it can be monumentally difficult. But no less important.

“There are people who would literally rather die than leave home. And they are really left without a good option,” said Dr. Drew Rosielle of the University of Minnesota, who, like his fellow palliative care physicians, works hard to keep his patients safe at home as long as possible. “The patients who genuinely don’t have loved ones who can essentially move in with them—most of those people do not die at home.”

They end up getting care they don’t want, in a place they don’t want to be in—and it costs more. “The ER, a hospital bed or a nursing home. That is our long-term care system for people who don’t have a support system.” said Edo Banach, the new president and CEO of the National Hospice and Palliative Care Organization, who took the job knowing it’s time for some fresh thinking about hospice—and the rest of American health care.

Even strong advocates of hospice know that it’s time for changes to match the complex medical needs of today’s patients and the demographic realities of the country—as well as trends arising from long-term use of hospice in existing institutions like nursing homes. But in the near future, there aren’t a whole lot of fabulous solutions, at least not ones that don’t cost a lot of money.

This is where Washington might come in. But a comprehensive national long-term care program is so challenging economically and politically that hardly anyone in the capital even bothers talking about it.

IN SOME WAYS, hospice is a throwback to how we died before the surge of medical machinery and ICUs, and it can seem jarring that the movement would take root in contemporary America at all. When patients elect hospice, they must usually give up on curing or containing their disease—a difficult decision to make in a system that dangles the promise of a medical fix just within reach. In practice, people often turn to hospice for only a handful of days, at the very end, after using up a lot of expensive high-tech care that may have drawn out death more than it extended life.

Once they do elect hospice, a whole different philosophy of care begins. It’s more than easing physical pain and managing symptoms, though there’s that. It’s built around team-based care, both physical and emotional, and it’s intended to support the family as well as the patient.

But dying people can require companionship around the clock—and the paid hospice team isn’t there 24/7, not even close. Families—or home aides when a family can afford to hire them—fill the gap. The care is complex and intensive, not in the sense of “intensive care,” but hands-on intense.

Family support is so crucial that some hospices won’t even try to arrange home care for someone on their own; the last big survey of hospices, conducted a decade ago, found that more than one in 10 hospices refused to take on a patient without a family caregiver.

Patients who are mostly on their own may do OK for a while, but decline is inevitable. They may not be able to prepare their meals, feed themselves, get out of bed—or manage their meds. They may experience acute pain, disorientation, shortness of breath. And when that happens, instead of calling the hospice nurse, the instinct is to call 911.

Even if the hospice patient who is rushed to the hospital ends up back home, all those transitions likely made things worse. Care gets disrupted, protocols get changed, mistakes get made—and costs rise—with each handoff. “It impacts the quality of care,” said Teno, the geriatrician, who has studied care transitions extensively and who has been a medical director in nursing homes and hospice. “It’s crying out for someone to fix it.”

If the Medicare agency and Congress aren’t diving into reinvention of hospice, doctors and policy experts have some ideas of their own—though not always with clear-cut ways to pay for them. By and large, they are still in the “floating ideas” stage, not agenda items for Congress or the Medicare agency.

Some physicians interviewed suggested tiered payments, which would replace the one size fits all daily rates. In other words, they could pay more for a patient with a particularly complex condition, or for a patient who can’t stitch together the necessary social support system. Another idea is to create more flexibility on how Medicare defines “continuous care”—a higher level of care for which the hospice gets a higher rate. Right now “continuous care” means an eight-hour block of hospice-provided care. Some doctors think paying for smaller blocks, like four hours, might be more practical.

we [sh]ould move toward a system where families can be supported, not exhausted. Where patients can get the holistic approach pioneered by hospice, without “giving up” on more aggressive treatment. Where patients who understand their choices can get off the conveyor belt of high-tech medicine, and find whatever balance of curative and palliative care is right for them. For both those who are surrounded by family, and the “unbefriended,” it could become a little less hard to die at home.


Seniors & Technology: Never Too Old

Smartphones, iPads and the Internet … Oh My!

Seniors and TechIf you think smartphones, ipads, social media and the world of apps are for today’s youth only, think again! The technology boom has mostly occurred over the course of older adults’ lifetimes, and many seniors have dipped their toes in the water, becoming rather tech savvy. In fact, for many seniors, technology has had a positive impact, improving their overall quality of life by helping them to be engaged, learning new things and remaining socially connected.

While America is graying, a recent Pew Research Center study found that seniors are moving towards more digitally connected lives. According to the study published just this past May, roughly two-thirds of those ages 65 and older go online, and a record number now own smartphones, with smartphone adoption among seniors quadrupling in the last five years. Older adults, like the population as a whole, have seen a steady rise in the use of tablets, e-readers, the internet and social media.

Surfing Grandparents
The Pew study found that roughly three-quarters of internet-using seniors go online on a daily basis. Among older adults who own smartphones, this figure is even higher and going on the internet occurs several times a day or more. For the population of older adults who use Facebook, many log in on a daily basis.

Digital technology has transformed the way people communicate, get their news, shop, find friendship and even love — and many are liking it! The fact is, today’s technology can keep seniors engaged, connected, mentally active, and physically safe.

Enhancing Lives Through Technology
We’ve come a long way from the VCR and the rotary phone. Technology has changed the face of aging and many seniors are reaping the benefits. Here are some examples of tech benefits that are keeping older adults engaged:

Social ConnectionEmail, video chatting and social media can keep seniors in touch with long-distance loved ones including children, grandchildren and friends.

Exercise and RecreationGames and activities help promote physical fitness and brain fitnesslearn a new language, play a game of tennis or golf on the Wii Fit, listen to music, read, view photos or play a game of Scrabble or Solitaire.

SafetySeniors living alone or in assisted living can get help a personal emergency system and the push of a button, giving families peace of mind for emergency situations.

Adapting to the Digital World
It is not always easy for seniors to use and adopt new technologies, and physical challenges might make it difficult to use or manipulate a particular device. Sometimes a little help with set-up and some guidance or training from a grandchild, family member or friend, can be the answer to a happy digital life.

Stein Assisted Living also has integrated technology into residents’ routines to help seniors stay connected, mentally active and physically safe. For more information, talk to a staff member or contact Jackie Kott, Director of Recreation, (732) 568-1155 or email her at

The Oscar and Ella Wilf Campus for Senior Living is comprised of Stein Assisted Living, Jaffa Gate Memory Care Neighborhood, Stein Hospice, Wilentz Senior Residence, Wilf Transport, and The Foundation at the Wilf Campus. For more information, contact us at (732) 568-1155, or visit us at

Blog on Eye Health

Easy on the Eyes

As people age it is not uncommon to experience vision changes. Even if you enjoy good vision now or did when you were younger, taking care of your eyes is vital to your overall health and wellbeing. While it is normal to encounter some visual changes, such as difficulty adjusting to glare or trouble distinguishing shades of color, vision loss is not a normal part of aging.


According to the American Academy of Ophthalmology, some of the more common changes in vision you may notice with age include:

  • Your eyes take longer to adjust and focus, especially between light and dark.
  • Driving may be more difficult, especially at night or in the rain.
  • Distinguishing an image from its background, especially when subtle gradations of tone are involved, may become more difficult.


Taking Control of Eye Health
You may be surprised to learn that the health of your eyes is related to many different factors, some of which are in our control. Check out this list and see where you might be able to make some lifestyle changes:


Nutrition – As part of an eye-healthy diet, choose foods rich in antioxidants, like vitamins A and C, such as leafy green vegetables and fish.

Smoking – Avoid smoking which exposes the eyes to an increased risk of a variety of conditions that affect eye health.

Sunlight – When outdoors on a sunny day, wear sunglasses and a hat with a brim to block harmful ultraviolet (UV) rays.

Systemic Health Problems – Keep your eye doctor informed about any health conditions, such as high blood pressure or diabetes, that can affect eye health.

Exercise – Regular exercise, including walking, yoga, tai chi and stretching, stimulate good blood circulation and oxygen intake which our eyes need.

Sleep – Getting enough sleep is important because it is then that our eyes enjoy continuous lubrication and clear out irritants such as dust, allergens or smoke that may have accumulated during the day.

At the Computer – Try to reduce the impact of computer eyestrain by keeping your computer screen at a healthy distance from your eyes (20-24 inches), adjusting light to minimize glare and taking a break every 15 minutes to focus on a distant object.


Set Your Sights on Eye Health and Safety

Having regular check-ups with an eye care professional can help you continue to maintain an active lifestyle well into the golden years without ever experiencing vision loss. It’s important to have a complete eye exam every year or two after age 65 to check for age-related eye diseases such as glaucoma, cataracts, age-related macular degeneration, diabetic retinopathy and other eye conditions such as low vision.


Eye injuries are also a risk in older adults, with about half of all eye injuries occurring in or around the home. If you should experience an eye injury, get immediate medical attention. But to prevent an injury, take some simple steps to reduce the risk of falls, which become more likely as we age due to changes in vision and balance:

  • Make sure that rugs and shower/bath/tub mats are slip-proof.
  • Secure railings so that they are not loose.
  • Cushion sharp corners and edges of furnishings and home fixtures.


Eyesight is a precious treasure throughout life. Safeguard your vision so that you will be seeing into the future for years to come.


The Oscar and Ella Wilf Campus for Senior Living is comprised of Stein Assisted Living, Jaffa Gate Memory Care Neighborhood, Stein Hospice, Wilentz Senior Residence, Wilf Transport, and The Foundation at the Wilf Campus. For more information, contact us at (732) 568-1155, or visit us at




Social Security: Careful Calculations

Social Security – To Claim or Not to Claim… That is the Question

Social security

Social Security provides a financial safety net to individuals as they reach retirement but the pros and cons of when to actually tap into the benefits are complicated. Choosing the age at which you draw benefits is a decision you should make with care.

Some people start collecting Social Security as soon as they are eligible at age 62, while others may wait until as late as age 70, preferring to see their benefits grow. Then there are those who are in between, drawing on Social Security when they reach full retirement age, which is 66 or 67 for people born after 1942. How do you make a smart decision?

No One-Size-Fits-All

According to the Social Security Administration, you’ll get the same amount of total benefits whether you collect early, at full retirement age or at age 70 – assuming you live to the average life expectancy for your age. The longer you live past that age, the more you’ll benefit from delaying your payments. Conversely, if you’re in poor health, you might be better off taking benefits early.

The earlier you claim Social Security benefits, the smaller your monthly payment will be. So, while you can claim at the age of 62, the amount you’ll receive will be less by a percentage than if you wait until your full retirement age (determined by the year you were born), at which point the Social Security Administration will pay out 100% of your benefits. If you wait to claim Social Security until after you reach full retirement age and up until the age of 70, the Social Security Administration will reward you with retirement credits which translate into an increased monthly payment.

“At first blush, the extra amount that can be received by waiting to claim until 70 appears to make waiting the smartest decision,” explains The Motley Fool website,, a website dedicated to helping to empower individual investors. “However, it’s important to remember that the amount that is paid out in benefits over a lifetime is calculated to be the same, regardless of what age you claim.” So while you might get bigger checks by waiting, you also will collect fewer checks in your lifetime.

A Careful Calculation
Social Security benefits are determined by a complex formula. Knowing when to claim Social Security benefits is an integral part of retirement planning. If you want to explore the different scenarios of when to take Social Security, you can estimate your projected payment by using the online Social Security calculator, You can also view your projected payment by creating an account on the Social Security Administration’s website,

If you don’t feel comfortable with calculators or have more complex issues, consider finding a financial planner or financial advisor you can trust to help you weigh your options and make decisions. It’s important to evaluate which strategy is right for you and will provide the most financial security in your golden years. The right strategy depends upon many factors including health status, how long you intend to work, retirement goals, family longevity and other personal matters.

The Oscar and Ella Wilf Campus for Senior Living is comprised of Stein Assisted Living, Jaffa Gate Memory Care Neighborhood, Stein Hospice, Wilentz Senior Residence, Wilf Transport, and The Foundation at the Wilf Campus. For more information, contact us at (732) 568-1155, or visit us at

Dating Is Anybody’s Game – Love After 60

Dating After 60Dating After 60

If you think dating isn’t for the senior set, think again! Relationships and intimacy are an important part of life at any age and often contribute to happiness, health and well-being. As we enter our senior years we may find ourselves unattached and lonely due to the loss of a loved one. But our population is living longer, staying fitter and healthier into the golden years, and that means there are more seniors looking for companionship.

With so many people unattached later in life, it’s only natural to think about dipping your toes into the dating pool. Keep in mind that your ideas about an ideal partner may have changed over time and you may now have different needs, desires and expectations. Start by defining the kind of relationship you want – such as friendship, intimacy, love, companionship, a committed relationship or marriage –  and then rediscover the art of meeting new people!

Looking for Love in All the Right Places
It’s nice when family and friends introduce you to people, but for those who don’t want to go that route or don’t have that option, here are some other ways to meet senior singles:

  • Local Neighborhood Activities – Just like in the old days, neighborhoods are still prime spots to meet not only potential partners but also friends. Libraries, local groups or neighborhood gathering places provide a casual place to share hobbies and interests.
  • Senior Centers/Community Centers Pick up a calendar from your local community center and check out any events or outings. This is a great way to meet others with similar interests right in your neighborhood.
  • Senior Living Communities – Many people find companionship in senior living communities. Whether it’s a 55 and older community, independent living or assisted living, being in close proximity to others and sharing meals and activities together may result in companionship, friendship or even love.
  • The Internet and Online Dating – There’s one notable way in which the dating scene has changed since most seniors were last dating — the Internet. Online dating is not for everyone but if you like using a computer or a mobile phone it’s one more tool in the toolbox. There are several sites that are built specifically for older adults, among them or and

Be Realistic
While some things in the dating world have changed, some have stayed the same. Common sense still counts and it’s important to be yourself. There is no hurry, so take your time before entering the dating world again. Here are a few tips:

  • Stay flexible – know what appeals to you in a partner or friend, but try not to be too rigid. Sometimes the person you think won’t be a match will surprise you!
  • Age is secondary — once you get into your senior years, the actual number of your age becomes less and less significant. Your health and what you do at your age are far more important.
  • See beyond the surface — older adults are wise enough to know that looks have little to do with whether someone is going to be a kind, loving and caring companion. Being attractive is more a function of your personality.
  • Try a dinner date – more than any other activity, dinner is where older adults feel the isolation of being alone most strongly. Sharing a meal can be an important first step in gauging compatability.
  • Think companionship – Whether it’s a dinner date, traveling, playing bridge, engaging in a favorite activity or just relaxing together, many seniors are really look for a companion and nothing more.

Adults over 60 have experienced a lot and already have some ideas about what works in their lives. Let the maturity of your years guide you to be clearer about what you want in a relationship.

The Oscar and Ella Wilf Campus for Senior Living is comprised of Stein Assisted Living, Jaffa Gate Memory Care Neighborhood, Stein Hospice, Wilentz Senior Residence, Wilf Transport, and The Foundation at the Wilf Campus. For more information, contact us at (732) 568-1155, or visit us at