Tuesday, June 25, 2019

Live a Long, Healthy Life - Try These Tips!

As we reach the last few years of our life, our ideal medical reports should read: "healthy, healthy, healthy, healthy, dead."  This statement was made by the instructor of a brain health class I recently attended.  The point she wanted to make was that we all should strive to live lives which are as healthy as possible, right up to the time we die at a very old age.  If these are our goals, how can we increase our odds of making that happen?  What can we personally do to live as long and as healthy a life as possible?

See Your Doctor and Dentist

It may seem obvious, but too many people believe they are better off avoiding doctors. As a result, they are unaware of what is actually going on inside their bodies and may miss the opportunity to avoid easily treated ailments.  Everyone needs to make sure they are engaged in the medical system and do the following:

Maintain a healthy blood pressure
Monitor their A1C or their blood sugar level
Get a colonoscopy
Women should get regular mammograms
Get flu and pneumonia shots
Get professional teeth cleanings
Be checked for other health conditions such as Hepatitis C, skin cancer, prostate cancer, C-reactive protein, and any other tests your doctor recommends.

Practice Self Examinations

While seeing your doctor and dentist regularly is important, your medical providers will not be with you all the time.  Everyone should examine their own bodies regularly and be aware of any changes.  In particular, you will want to check for:

Yellow eyes, which indicate liver problems
Drooping eyelids, which could indicate Bell's palsy or a stroke
Changes in moles
Changes in the color of your urine or bowel movements
Any other changes to your skin, breasts, teeth or mouth.

Sleep a Reasonable Amount Each Night

Get a regular amount of sleep each night, but not too much.  Ideally, you should sleep between 7 and 9 hours a night.  If you have trouble getting a restful night's sleep, check with your doctor and participate in a sleep study, if possible.  Work with your doctor to determine what could be causing your sleep problems ... sleep apnea, too much caffeine, medications you are taking, etc.  Our bodies need sleep to stay healthy and there have also been studies indicating that restful sleep may help remove toxins from the brain and reduce our dementia risk.

Exercise in a Variety of Ways

Any exercise you get is better than nothing at all.  However, the more you move in a variety of ways, the healthier you are likely to be and the longer you will probably live.  Your exercise plans should ideally include:

Aerobics such as walking, swimming, bicycling and dancing
Strength training such as weight lifting or Pilates
Flexibility through stretching or yoga classes
Balance exercises
Back exercises, which could help prevent chronic back pain

Eat a Healthy Diet

Following the Mediterranean Diet, the MIND Diet or the DASH diet, which are all very similar, are great ways to eat whole, healthy food which you will enjoy, while also maintaining good health.  You may also be interested in "The MIND Diet Plan and Cookbook" which, along with the other suggestions in this article, is a great way to keep your brain functioning at optimal levels. 

Below are a few things to include in your healthy diet:

Fish and poultry
Nuts and beans
25 grams of fiber a day
8 to 10 servings of fruit and vegetables daily
Healthy oils like olive oil

Reduce your consumption of the following foods:

Sugar and artificial sweeteners
Refined flour
Fried foods
Red meat and butter

Avoid other Dangers to Your Health and Life

No matter how much you exercise or how well you eat, an accident or excess stress can undo all your good intentions.  As a result, there are a few more dangers which you should avoid or minimize in your life.  While some of the items on the list below may seem unrelated to living a long, healthy life, research has shown that these can be problem areas which many people, especially senior citizens, need to address.  

Quit smoking
Drink only small amounts of alcohol
Stay off stepladders and stools
Learn how to deal with stress in healthier ways
Get help with your financial problems
Don't use your phone while driving
Avoid left turns while driving
Cut back on night driving
Ride in the back third of airplanes
Wear a life jacket whenever you are in a boat
Wash your hands and avoid sick people, when possible
Be suspicious of unexpected phone calls, emails or visitors
Avoid dangerous situations by shopping during the day and parking near the entrance to businesses.  The elderly are frequently the victims of crimes, so it is wise to be cautious.

Enjoy Your Life

Finally, living a long happy life is not only about avoiding illness and dangers.  It also means finding a way for your life to include joy and meaning.  Here are some ways to make that happen:

Volunteer doing something which is meaningful to you
Socialize frequently and make new friends
Spend time with family and grandchildren
Get a hobby which engrosses you
Take classes which interest you and chat with the other students
Attend religious services

All of the above activities will bring meaning and happiness to your life and give you reasons to want to live a long life!

If you are interested in learning more about common medical problems, financial planning, Social Security, Medicare, where to retire in the US and abroad and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles in this blog.

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Photo credit:  morguefile.com

Tuesday, June 18, 2019

Dementia and Alzheimers Disease - Shocking Research from UCI - MIND

As of 2019, it has been more than 15 years since any new medications have been developed to treat patients with dementia, including Alzheimer's Disease. According to experts, none of the drugs currently available can stop the development of dementia or slow it down.  None of the drugs can reverse dementia or prevent it.  In other words, as of today, there are no successful medical treatments for dementia, despite the "pseudo-scientific" reports you may have read in the newspaper or products you have seen advertised on TV.  Patients are often given medications to help them stay more alert, sleep better, or deal with depression, but these medications do not restore their memory.

These are just a few of the shocking facts reported by Dr. Joshua Grill from the University of California - Irvine MIND program, where their exclusive focus is on memory impairment and neurological disorders. UCI - MIND is one of thirty research centers around the United States which have been given the task of studying dementia and Alzheimer's Disease by the Centers for Disease Control.

How Big is the Problem of Dementia in the U.S.?

By early 2019, there were an estimated 5.8 million Americans living with Alzheimer's Disease, the most common form of dementia.  Nearly two-thirds of them are women.  This may be partly because Alzheimer's Disease and other forms of dementia are closely linked to aging, and women tend to live longer than men.  However, there are other factors which affect your risk, in addition to aging.  Hispanics are 1.5 times as likely as Caucasians  to develop Alzheimer's Disease.  African-Americans are twice as likely as Caucasians.  However, regardless of your background, no one can feel as though they are safe from dementia.

People of every race and demographic face the risk of developing dementia.  In California, where I live, 11 percent of senior citizens currently have Alzheimer's Disease and one out of eight people over the age of 55 will eventually develop it.  People who live to be 90 have about a 40% chance of being diagnosed with some type of dementia. People who live to be 85 have a 20% chance of having dementia. Even as early as age 80, there is a 10% chance you will be diagnosed with dementia. Unfortunately, the older you are, the greater your risk. 

What are Common Causes of Dementia?

As you see in the graphic from UCI - MIND at the top of this article, dementia is an umbrella term which covers a number of causes of memory loss and cognitive impairment.  In a few cases, such as when the dementia is accidentally caused by certain prescription medications, the brain function can sometimes be restored when the medications are adjusted.

In most cases of dementia, the underlying pathology is progressive and irreversible.  The most common cause of dementia is Alzheimer's Disease, and the word Alzheimer's is sometimes used almost interchangeably with the term dementia.  However, other common causes of dementia are just as debilitating.  They include Frontotemporal Lobar Degeneration (the most common cause of dementia in those under the age of 60), Parkinson's Disease related dementia, dementia with Lewy Bodies, vascular dementia (common in people with heart disease) and Creutzfeld Jacob Disease.

It is possible to have more than one type of dementia develop simultaneously.  For example, someone with Alzheimer's Disease or Parkinson's Disease could also develop vascular dementia because of their history of heart disease.  In addition, the patient's medications, a stroke, or a former brain injury could make the symptoms even worse.

Dementia is Financially Devastating for Families

In 2019, Alzheimer's Disease cost the U.S. $290 billion.  By 2050, it is estimated that Alzheimer's will cost the U.S. $1.1 trillion.  This does not include the value of the estimated $18.5 billion in unpaid care given by the family members of these patients.

Many families eventually have to either institutionalize the loved one or pay someone to come into their home and care for them.  This is because patients often reach the point where they need 24 hour a day care, and have to be protected from risky behaviors such as trying to cook, or wandering off.  The lifetime cost of dementia care can amount to an estimated $350,174 per individual living with dementia (in 2018 dollars).

One way to deal with the high cost of future memory care for you and your spouse is to purchase long-term care insurance, preferably while both of you are in your 50s or 60s and decades away from needing the care.  Although Medicare does not cover the cost of any type of long-term care, in some cases the cost may be covered by Medicaid.  It would be smart to explore the financial requirements necessary to qualify for Medicaid in your state.  Another option is to save enough money, if possible, to cover the cost of putting a loved one in a memory care facility. Even some types of life insurance could help defray the cost.  Having a plan can make the situation a little easier when the time comes.

What is it Like to Live with Someone who has Dementia?

It can be frustrating and exhausting to live with someone who is developing dementia.  Behavior changes are often noticeable even before the memory loss. They may have difficulty doing things which used to be easy for them, such as cooking, driving or handling money. They may experience mood swings, ranging from apathy to depression or anxiety.  They may virtually stop talking, or they could become hostile and argumentative, even violent in extreme cases.  They could become childlike and excessively dependent on you.  They may cry easily.  At times, they may behave inappropriately.  You may eventually be required to take care of their basic hygiene and do virtually everything for them. They may ask you the same questions over and over again.

No one is going to have all of the above-mentioned behavior changes, but regardless of what differences you observe, it will be obvious that what was once a loving relationship could eventually turned into a nurse-patient relationship.

The confusing aspect of these behavior changes is that they often build slowly and most people will not recognize them as early symptoms of dementia.  Your spouse may be able to perform routine tasks and engage in conversations with you for years after the behavior changes start, but they could have more difficulty getting along with the neighbors or relatives.  They might become a prime example of a "grumpy old man or woman."  They may become a bit more reclusive.  Their memory may seem fairly normal, other than annoying you by forgetting what you told them yesterday.  You may feel as though they have changed and are not as much fun as they once were, but it could be years before you recognize that these were the early stages of their developing dementia.

Real Life Examples of Dementia

A friend of mine, whose husband has dementia caused by Parkinson's Disease, initially took her husband to adult day care one day a week, so she could grocery shop and run other errands.  She is now taking him to adult day care three days a week.  The amount of care he requires continues to increase, and someday the community resources my friend relies on may not be enough.  Eventually, he may need around-the-clock care, if he reaches the point when she cannot care for him by herself during the hours when he is not in day care.  Around-the-clock care or a memory facility will put a severe financial strain on her.  His dementia developed fairly rapidly, over just a couple of years after his retirement.

My own mother died of Alzheimer's Disease, which was probably complicated by vascular dementia. My father cared for her for a decade after her initial diagnosis, since her dementia developed slowly.  He enrolled her in several trial drug studies, but they did not seem to help.  In the three years prior to her death, my mother was cared for in my sister's home, where she had the full attention of my father, my sister and my brother-in-law.  Even then, she managed to slip away a few times and it was only because of watchful neighbors that she was found before she wandered too far.  Once, when my sister and brother-in-law were at the store, my father went into the bathroom and could not find my mother when he came out.  She had slipped out of the house barefoot and wearing only a light nightgown in the middle of winter.  A neighbor who lived several houses away found my mother knocking at her door and the neighbor called my sister.  If my mother had been outside much longer, the results could have been fatal.

My mother also fell down the stairs a couple of times and had to be hospitalized for broken bones, even though my sister had a chair lift installed in her home.  However, my mother was not able to use it by herself and she would sometimes try to walk up and down the stairs when no one was watching.  These falls may have also had a subtle effect on her dementia progression.

You are Not Helpless - You can Reduce Your Risk of Dementia

This may seem like a lot of negative information, but there is also some some encouraging news.

First, a small amount of memory loss, diagnosed as mild cognitive decline, may never progress beyond that point.  Just because you forget what you had for breakfast this morning does not mean you are on your way to total dementia. Do not panic every time you misplace your keys.

In addition, researchers around the world are continuing to work on a wide variety of medications which they hope will slow down some of the various causes of dementia. Obviously, different approaches will be needed for the wide variety of health issues involved, but scientists are relentless in their research.

Meanwhile, even though there are currently no medications which can stop or cure dementia, there are a few personal actions you can take to lower your risk of getting it in the first place.  Below are two lists of the things you should be doing if you want to reduce your risk of dementia.  These lists are based on actual research by scientists at UCI - MIND and other memory research facilities.  Currently, these actions are more effective than any medication on the market!

Cut Your Risk Factors for Developing Dementia

Stop smoking - If you smoke, stop!

Moderate your alcohol consumption - Women should not consume more than one five-ounce drink of alcohol in a day; men should not drink more than two five-ounce drinks in a day.  You can lower your dementia risk even more if you only consume alcohol occasionally, not every day.

Avoid being overweight - Control your weight, particularly in middle age.  Maintaining a healthy weight is good for the brain.

Reduce your risk of cardiovascular disease and stroke - Control your blood pressure and cholesterol. Anything which is good for the heart is also good for the brain.

Avoid head trauma - People with a history of concussions may be especially vulnerable to memory loss. In addition, losing your balance and falling late in life can also cause dementia.  Make sure your home is safe and use a walker or cane if your doctor recommends one. Many senior citizens benefit by taking a balance class.

Improve your sleep quality - Take the time to get a good, solid seven to eight hours of regular sleep every night.  Your brain needs plenty of deep sleep in order to regenerate.  It is believed that some of the toxins which build up in the brain during the day are cleaned out during sleep.

More Actions Which Lower Your Dementia Risk

Eat a Healthy Diet - The Mediterranean diet, with its emphasis on fruits, vegetables, whole grains, and small amounts of fish and poultry is a good diet for the brain.  If you want to try an eating plan which is especially designed to benefit the brain the most, you may be interested in "The MIND Diet Plan and Cookbook."  Eating properly is one of the best steps you can take to protect your brain.

Daily exercise - Physical exercise causes fresh blood to flood through the brain, giving it the oxygen it needs to function well.  A brisk daily walk can help keep the blood moving.  Several walks a day will be even more effective. Avoid being sedentary. 

Take care of your overall health - Our brain is unlikely to do well as we age if we do not take care of the rest of our body.  See your doctor at least annually for a full physical. Follow their personalized instructions.  If you are taking several medications, make sure you are taking the correct dosage.  Go to the dentist, as well.  There is a definite connection between poor dental hygiene and both heart problems and memory problems.  Manage diabetes and any other chronic illnesses you may have.  Uncontrolled blood sugar can cause a variety of health problems.

Be a lifelong learner - Never, ever stop learning new things.  Take a class; learn a new language; take up a hobby; go back to school; read a book; become more proficient on the computer; play chess or bridge; work puzzles.  Continue to challenge your brain right up to the end of your life.

Manage your stress - Whether it means a walk in the woods, yoga, meditation, prayer, or simply spending time alone working on a hobby you love, anything you do to handle your stress will keep your brain relaxed, too.  When you are stressed, the blood vessels in your brain (and the rest of your body) constrict, and less blood and oxygen get where they are needed.  Relaxation helps our blood to flow better, and helps clear toxins from the brain.

Socialize - Although a little time alone is good for you, as with so many things, it can become unhealthy when taken to extremes.  It is very important to also spend time socializing with other people.  When you have a simple conversation, it keeps your brain in shape because you are constantly responding to what the other person is saying.  If you "zone out," you are not fully participating in the conversation.  You have to become engaged and interested in the conversation if you want to get the most out of it.  Practice having interesting conversations with people you enjoy.  Listen to what they say and respond appropriately.  This is great for your brain.  In addition, socializing with friends can help lower our stress levels.  Get out there and enjoy other people!

You Can Participate in a Dementia Study

If you are interested in joining a dementia study, there is a good chance that one is being conducted near you.  I have signed up to participate in the studies going on at UCI - Irvine, and will continue to report here on this blog about what I learn.  Several of my friends are participating, too.

To see which cities have a research center near you, check the attached map.

You can learn more about the trials going on at the various research centers throughout the nation and get more information, as well as their contact information, by checking out this website:


You may also want to sign up for the newsletters from one or more of the research centers.  This is a great way to stay current on cutting edge dementia research. 

To learn more about dementia, other common health problems as we age, Medicare, Social Security, financial planning, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit: Photos of UCI-MIND slides taken by author

Tuesday, June 11, 2019

Wine Region of New Zealand - A Baby Boomer Dream Trip to Canterbury

This week we have a very special guest post about New Zealand's Canterbury wine region, including information on the wineries you may wish to visit, as well as popular restaurants in the city of Christchurch.  The post was written especially for this blog by experienced kiwi tour guides at MoaTrek, a company which operates small group tours in New Zealand. 

The country of New Zealand is on the bucket list for many American retirees who have always dreamed of traveling south of the equator.  The New Zealand authors who wrote this post even provided several photos of tourists enjoying the food and wine in their unique part of the world, including the top photo with Lake Wanaka in the background.  

Since this blog has never had an article about this region, we are sure our readers will enjoy the article below.  Perhaps it will spur a few of you to explore New Zealand personally! Below is their post:


MoaTrek Wine Bucket List – Canterbury
If you love food, wine and unique travel experiences, New Zealand is probably already on your bucket list. You can get many big-name brands of New Zealand wine at your local restaurant or supermarket in a number of countries, but the most memorable experiences are created by visiting the remote but accessible corners of New Zealand’s wine regions, where you personally meet winemakers, drink the world's best wine, and eat meals to match. 
This New Zealand wineries guide for travelers has been written by experienced tour guides at MoaTrek, which has been running small group tours around New Zealand since the 1970s and, over that time, figured out where the best wines and wineries are. This article is a guide for overseas travelers planning a trip to New Zealand’s Canterbury wine regions, suggests the best wineries to visit, and recommends the best wines to try on your trip.

New Zealand is one of a group of ‘new world’ wine growing countries changing the global wine landscape - and while our viticulture history doesn’t go back as far as the traditional wine growing areas of Europe and the Middle East, it hasn’t taken long for New Zealand wines to gain a fantastic international reputation. As the youngest country on earth, our wine making history is relatively short; the first grapes were introduced by missionary Samuel Marsden in 1819, who remarked “New Zealand promises to be very favourable to the vine”.
The first larger scale wineries were established by Croatian immigrants around Auckland at the end of the 19th century, but it wasn’t until the 1970s and 1980s that the industry really started to develop. 
With warm summers, cold winters and good soil, Canterbury has a reputation for excellent and elegant Pinot Noirs, Chardonnays and aromatic wines, renowned for their rich flavour.  The Canterbury GI is very large, covering a 44,500 square kilometre (17,200 sq mi) region of New Zealand. (GI stands for the "Geographical Indications - Wine and Spirits - Registration Act" and
provides an international safeguard for New Zealand's geographic names in the wine sectors).
However, almost all of the region's vineyards are concentrated in a relatively small area around the city of Christchurch, prompting the establishment of two sub GIs within it, North Canterbury and the Waipara Valley. These are not the only wine producing areas you may wish to visit, with excellent wineries near Cheviot, Hanmer Springs and on the road to Akaroa producing well-regarded Pinot Noir; but the area around Christchurch is the area we will focus on in this article. 
The North Canterbury Wine Region is the top half of the larger Canterbury GI north of the Rakaia River in a small cluster of vineyards concentrated in 168 hectares (420 acres). The area plants Pinot Noir, Sauvignon Blanc, Riesling, Pinot Gris, and Chardonnay varieties.  Notable producers include French Peak (formerly French Farm), Melton Estate and Lone Goat, which is notable for producing well-reviewed Riesling from the vineyards originally owned by Giesen Estate and New Zealand's only Ehrenfelser wine. 
The main wine growing area of Canterbury is the Waipara Valley, north of Christchurch, and one of New Zealand’s newer wine regions, which began production in the late 1970s with Pegasus Bay.   The valley floor provides a warm micro-climate ideal for viticulture, with a rain shadow from the Southern Alps, low coastal limestone ridges and moderate, cool ocean winds to the east. 
Master of Wine Liam Stevenson has described Waipara as possibly the ‘most exciting place to grow Pinot Noir’, and it makes up the bulk of Canterbury's plantings (although there are also white wine varietals grown there).

Award winners from this region include Greystone Wines Pinot Noir, which has won the Decanter International Trophy and the Air New Zealand Trophy, and Black Estate, awarded the Trophy for Best Pinot Noir at the International Wine & Spirits Competition in 2010. 

Down-to-earth, warm and embracing, New Zealanders are known for their friendly hospitality... the perfect way to sample the top drops while relaxing in beautiful sunny settings and enjoying gourmet spreads.

How to Get to the Canterbury Wine Region of New Zealand

As the gateway to the South Island, many travelers will spend a night or two in Christchurch and take the opportunity to visit surrounding areas. Popular day tour destinations are Hanmer Springs, Kaikoura and Akaroa, which all have wineries on route to visit. You can drive yourself or take day tours from Christchurch. 

For real wine connoisseurs the Waipara Valley is on the way to both Kaikoura and Hanmer Springs. For those traveling South after crossing the Cook Strait by ferry, a stop-over in Kaikoura will be the perfect place to stay before visiting the Waipara Valley on the way South the following day. 

Canterbury wineries to visit:    
Pegasus Bay Winery, north of Christchurch
Terrace Edge Vineyard and Olive Grove in Waipara
Waiau River Estate in Hanmer Springs 

One Canterbury wine you have to try:
Mount Brown Estates North Canterbury Pinot Gris 2017

What to Eat in New Zealand

Being an island nation, New Zealand is big on fish and seafood. Our coastline is teeming with fish; local favourites include snapper, hapuka and the delicately-flavoured John Dory – best served lightly crumbed with lemon. One could say that fish and chips on the beach is a kiwi weekend institution! 

Scallops and mussels are restaurant staples, and delicious Bluff Oysters come into season during the New Zealand autumn. The rich waters off Kaikoura – an hour north of Christchurch – are famous for crayfish. In the Maori language, ‘kai’ means food and ‘koura’ means crayfish - and unsurprisingly, the local bounty you’ll find here is some of the best available in the world. (See the attached photo of koura, or crayfish.) One of the best ways to enjoy this delicacy is from one of the local ‘crayfish caravans’. These caravans are dotted along the coastline, selling freshly caught crayfish prepared with garlic butter and lemon. Devouring one of these beauties while sitting on the rocks looking out to sea has got to be one of the most quintessentially kiwi dining experiences you can have and certainly tops off a day of marine life encounters in this famous town.

Our Favourite Restaurants in Christchurch
Smack bang in the middle of the breadbasket of the nation and as the largest city in the South Island, Christchurch has always punched above its weight in the restaurant game. A lot of our guests finish their New Zealand trip in Christchurch, so a celebration dinner is called for!

Best overall - Cook'n with Gas - One of the most talked about restaurants in Christchurch. This award-winning bistro serves excellent modern New Zealand cuisine in a chilled out 1860s villa.

Best value - Shirley's Kitchen - Popular with university students, this Malaysian spot offers fantastic and affordable food. Try the Kampua, a mouthwatering dish that features noodles, BBQ pork and crispy onions.

Best takeaway - Burgerfuel - This iconic burger joint has locations all over New Zealand and the burgers are top quality - made with fresh, local ingredients such as 100% pure New Zealand grass fed beef and batch brewed tomato relish.

New Zealand has many other famous wine regions you may be interested in visiting like the Marlborough, Hawkes Bay and Central Otago. Check them all out here: 

* * * * * * *

THANK YOU to the kiwi tour guides from MoaTrek for this fun information about what to eat and drink during a tour of the Canterbury wine region in New Zealand.  I hope some of my Baby Boomer readers decide to plan an adventure there.

For more information, you may also be interested in "The Rough Guide to New Zealand."

If you are interested in reading more about what to do after you retire, where to retire, financial planning, Social Security, Medicare, common medical issues after retirement and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credits:  New Zealand kiwi tour guides from MoaTrek 

Tuesday, June 4, 2019

Medicare Inpatient and Outpatient Hospital Stays - What are the Differences?

If you are on Medicare and are rushed to the hospital, you may be told by emergency room staff that they are admitting you to the hospital as an outpatient, or for observation.  If you are sick enough to be kept overnight in the hospital, you probably are not paying full attention to what is going on.  Your only concern is being treated for your condition and feeling confident you are getting the best possible care.  However, whether or not you are admitted as an inpatient or an outpatient does make a difference for your future care and could have a significant financial impact on you.  Here are a few things you and your family need to know.

Why You Might Be an Outpatient Rather than an Inpatient

What if you are rushed to the hospital with chest pain, but the tests performed by the emergency room doctor do not indicate you have had a heart attack?  Rather than sending you home, they may decide to keep you overnight for observation.  You may stay in a special observation unit or you could be in a regular hospital room.  You will spend the night, or even several nights, in the hospital, and will probably need to sign some paperwork, but you are listed as an outpatient, under care for observation. Other than that, your treatment will be the same as if you had been admitted as an inpatient, but the decision could affect both you and your hospital in other ways.

Why Does the Hospital Admit Patients as Outpatients?

The simple reason why this happens is because Medicare has rules governing who can be admitted as an inpatient, and these rules have become stricter because outpatient care is cheaper for Medicare.

In 2011, Medicare spent $690 million for outpatient care.  By 2016, that amount increased to $3.1 billion and has continued to rise since then.  Simultaneously, the cost of reimbursements for inpatient care has decreased.  Hospitals do not like these Medicare rules because they get paid about one-third less to care for an outpatient than they do an inpatient.  In most cases, the patients receive the same care, but the hospitals are paid less to provide that care.

Hospitals face stiff penalties from Medicare if they do not follow the strict guidelines for admission as an inpatient.  If the hospital is audited and Medicare determines they admitted people as inpatients when they should have been admitted as outpatients, the hospital has to return the full amount of the Medicare reimbursement they received.  In fact, in 2016, outside audits forced hospitals to return over $400 million to Medicare for incorrect Part A (hospitalization) charges.

More Procedures are Becoming Outpatient Procedures

Approximately twelve years ago, a neighbor of mine had knee replacement surgery. She spent three nights in the hospital and a week in a rehabilitation center.  Since she was an inpatient during the three night hospital stay, Medicare Part A covered her hospital expenses, as well as the additional week in the rehab center.  This was helpful to her recovery, since she lives alone and would not have been able to care for herself for the first week after her surgery.

In 2018, the rule changed.  Total knee replacements are now considered outpatient procedures.  Even though nothing has changed about the procedure or the required after-care, Medicare now reimburses hospitals less money and patients who cannot afford to pay out-of-pocket for a stay in a rehabilitation facility must find someone who will take care of them.

Even in situations when the hospital does have some discretion about whether the patient should be admitted as an inpatient or outpatient, many of them are hesitant to admit people as inpatients.  This is because Medicare penalizes hospitals when they admit someone as an inpatient and the patient is readmitted within 30 days.  If the patient is only in the hospital under observation, the penalties for re-admittance do not apply.

Hospital Admittance as an Outpatient can Hurt You Financially

At first, you may assume that it really does not make a difference to you whether you are admitted as an inpatient or an outpatient, as long as you receive the same care.  However, being an outpatient can hurt you financially.

If you are admitted to a hospital as an inpatient, you are covered under Medicare Part A.  If you are admitted as an outpatient under observation, you are covered under Medicare Part B.  Under Part B, you may be liable for up to 20 percent of the cost of your hospital stay, unless your Medicare Supplement (Medigap) or your Medicare Advantage plan covers this extra cost.

After you are released from the hospital, the financial pain may continue. If you need to go to a skilled nursing facility or rehabilitation facility after your discharge from the hospital, Medicare will not pay for any of the cost of the rehab if you were in the hospital as an outpatient or if you were an inpatient for less than three days.

On the other hand, if you were admitted to the hospital as an inpatient and spent at least three nights there, Medicare will pay fully for the first 20 days of skilled nursing care and partially for an additional 80 daysThe cost of skilled nursing can be substantial, so this is an important consideration for patients.

The rules regarding inpatient vs. outpatient hospital stays have saved Medicare millions of dollars in reimbursements to skilled nursing facilities.  In fact, it resulted in a decrease of 15 percent in skilled nursing days covered by Medicare between 2009 and 2016.  However, it also forced patients to either pay out-of-pocket for skilled nursing or do without it.

What Can Patients do to Protect Themselves?

Patients and their families need to understand the difference between an inpatient and outpatient hospital admittance.  If they believe they should be in the hospital as an inpatient, particularly if they expect to need skilled nursing care after they are released, they should appeal any decision to only list them as outpatients. Patients also need to set aside funds to cover the cost of skilled nursing whenever it is unlikely Medicare will pay for it.

In addition, you should ask in advance whether or not your Medicare Supplement or Medicare Advantage plan will cover any of the cost of skilled nursing care when you purchase your policy.  If not, you may want to set aside money for these types of events.

You may also want to check with Medicare.gov periodically, so you stay up-to-date on changes.

For more information on a variety of Medicare topics and issues, including ways the Medicare program could be strengthened, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional helpful articles on Medicare, Social Security, where to retire in the US and overseas, financial planning, common medical problems and more.

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