Judith Graham | (TNS) KFF Health News

Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice.

Pain shot through her left knee and ankle. After summoning her husband on her phone, with difficulty she made it back to the house.

And then began the runaround that so many people face when they interact with America’s uncoordinated health care system.

Gilliam’s orthopedic surgeon, who managed previous difficulties with her left knee, saw her that afternoon but told her “I don’t do ankles.”

He referred her to an ankle specialist who ordered a new set of X-rays and an MRI. For convenience’s sake, Gilliam asked to get the scans at a hospital near her home in Sudbury, Massachusetts. But the hospital didn’t have the doctor’s order when she called for an appointment. It came through only after several more calls.

Coordinating the care she needs to recover, including physical therapy, became a part-time job for Gilliam. (Therapists work on only one body part per session, so she has needed separate visits for her knee and for her ankle several times a week.)

“The burden of arranging everything I need — it’s huge,” Gilliam told me. “It leaves you with such a sense of mental and physical exhaustion.”

The toll the American health care system extracts is, in some respects, the price of extraordinary progress in medicine. But it’s also evidence of the poor fit between older adults’ capacities and the health care system’s demands.

“The good news is we know so much more and can do so much more for people with various conditions,” said Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with health care. “The bad news is the system has gotten overwhelmingly complex.”

That complexity is compounded by the proliferation of guidelines for separate medical conditions, financial incentives that reward more medical care, and specialization among clinicians, said Ishani Ganguli, an associate professor of medicine at Harvard Medical School.

“It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,” she said. If someone has multiple medical problems — say, heart disease, diabetes, and glaucoma — interactions with the health care system multiply.

Ganguli is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities. (The data is from 2019, before the covid pandemic disrupted care patterns. If any services were received, that counted as a day of health care contact.)

That study found that slightly more than 1 in 10 seniors, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care — at least 50 days a year.

“Some of this may be very beneficial and valuable for people, and some of it may be less essential,” Ganguli said. “We don’t talk enough about what we’re asking older adults to do and whether that’s realistic.”

Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, has for many years raised an alarm about the “treatment burden” that patients experience. In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills, monitoring health at home, and following recommendations such as dietary changes.

Four years ago — in a paper titled “Is My Patient Overwhelmed?” — Montori and several colleagues found that 40% of patients with chronic conditions such as asthma, diabetes, and neurological disorders “considered their treatment burden unsustainable.”

When this happens, people stop following medical advice and report having a poorer quality of life, the researchers found. Especially vulnerable are older adults with multiple medical conditions and low levels of education who are economically insecure and socially isolated.

Older patients’ difficulties are compounded by medical practices’ increased use of digital phone systems and electronic patient portals — both frustrating for many seniors to navigate — and the time pressures afflicting physicians. “It’s harder and harder for patients to gain access to clinicians who can problem-solve with them and answer questions,” Montori said.

Meanwhile, clinicians rarely ask patients about their capacity to perform the work they’re being asked to do. “We often have little sense of the complexity of our patients’ lives and even less insight into how the treatments we provide (to reach goal-directed guidelines) fit within the web of our patients’ daily experiences,” several physicians wrote in a 2022 paper on reducing treatment burden.

Consider what Jean Hartnett, 53, of Omaha, Nebraska, and her eight siblings went through after their 88-year-old mother had a stroke in February 2021 while shopping at Walmart.

At the time, the older woman was looking after Hartnett’s father, who had kidney disease and needed help with daily activities such as showering and going to the bathroom.

During the year after the stroke, both of Hartnett’s parents — fiercely independent farmers who lived in Hubbard, Nebraska — suffered setbacks, and medical crises became common. When a physician changed her mom’s or dad’s plan of care, new medications, supplies, and medical equipment had to be procured, and new rounds of occupational, physical, and speech therapy arranged.

Neither parent could be left alone if the other needed medical attention.

“It wasn’t unusual for me to be bringing one parent home from the hospital or doctor’s visit and passing the ambulance or a family member on the highway taking the other one in,” Hartnett explained. “An incredible amount of coordination needed to happen.”

Hartnett moved in with her parents during the last six weeks of her father’s life, after doctors decided he was too weak to undertake dialysis. He passed away in March 2022. Her mother died months later in July.

So, what can older adults and family caregivers do to ease the burdens of health care?

To start, be candid with your doctor if you think a treatment plan isn’t feasible and explain why you feel that way, said Elizabeth Rogers, an assistant professor of internal medicine at the University of Minnesota Medical School.

“Be sure to discuss your health priorities and trade-offs: what you might gain and what you might lose by forgoing certain tests or treatments,” she said. Ask which interventions are most important in terms of keeping you healthy, and which might be expendable.

Doctors can adjust your treatment plan, discontinue medications that aren’t yielding significant benefits, and arrange virtual visits if you can manage the technological requirements. (Many older adults can’t.)

Ask if a social worker or a patient navigator can help you arrange multiple appointments and tests on the same day to minimize the burden of going to and from medical centers. These professionals can also help you connect with community resources, such as transportation services, that might be of help. (Most medical centers have staff of this kind, but physician practices do not.)

If you don’t understand how to do what your doctor wants you to do, ask questions: What will this involve on my part? How much time will this take? What kind of resources will I need to do this? And ask for written materials, such as self-management plans for asthma or diabetes, that can help you understand what’s expected.

“I would ask a clinician, ‘If I chose this treatment option, what does that mean not only for my cancer or heart disease, but also for the time I’ll spend getting care?’” said Ganguli of Harvard. “If they don’t have an answer, ask if they can come up with an estimate.”

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(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Patrick Blennerhassett | (TNS) Las Vegas Review-Journal

LAS VEGAS — Bruce Hiatt is hoping the integration of artificial intelligence will help take his real estate company to the next level, and in turn, could require fewer in-person agents in the process.

Hiatt, a Las Vegas-based broker who is also the owner of Luxury Realty Group, is currently beta testing an AI conversational avatar that speaks with potential homebuyers and learns from those interactions. Hiatt said they are scheduled to launch the technology in 22 U.S. cities and three in Canada as part of the rollout at the start of June. The goal is to have about 24 agents in each city.

The idea behind using AI is to aid in the homebuying search via software that can learn potential homebuyers’ names along with preferences of what they are looking for in a home. Hiatt is partnering with India-based chatbox builder Kore.ai on the technology. The company received $150 million in a new funding round, including an investment from chipmaker Nvidia.

“Unlike ChatGPT, our AI website will have a fully conversational AI avatar. The avatar’s name is Luxora and she will engage conversationally with you as you ask questions about Las Vegas real estate,” Hiatt said. “She can also handle very complex, compound search requests you say to her. For example, ‘show me Summerlin homes in the Summerlin Ridges with four bedrooms, an office, 3.5 bathrooms, a four-car garage, a kitchen with a Wolf stove and ceiling height in the great room 25 feet or higher.’”

Hiatt acknowledged there is obvious pushback from employees regarding the integration of AI as many fear the technology could cost them their jobs.

“People assume all AI is like that,” he said. “And we may not be able to speak for how it will effect other industries, but as far as real estate agents go, the AI is more of an advisor, it will never be a licensed agent, there’s always that legal need for a licensed agent… there’s still a certain need for humans to do the work too, maybe just in a different way.”

Jonathan Catalano, a real estate agent with ERA Brokers Consolidated in Las Vegas, said he uses AI technology to help him write marketing materials and descriptions for homes he is listing. He said he is not worried about AI actually replacing the need for agents.

“I look at it from the standpoint that this technology is here and as a Realtor I need to embrace it and use it to my benefit,” he said. “So I didn’t shy away from it when I think a lot of people get afraid of it, I mean it’s so complex and powerful and generally people don’t like change so they’ll kind of steer clear of AI, but I’ve been using it every day in my business.”

Aya Shata, an assistant professor at UNLV’s Journalism and Media Studies, who has been studying AI’s integration into the media landscape and overall workforce and the ethical issues arising around the technology, said there is always a initial fear factor built into public sentiment when something new comes around.

“I feel like it’s actually changing and for the better, and what I mean is that you always fear what you don’t know, but when you actually start to use AI, you realize it’s not really that perfect, and it can’t replace humans for so many reasons, it can’t replace jobs but it is definitely going to change how we do our jobs.”

Shata did acknowledge that some major corporations and companies, mostly within the online and technology industries, have publicly stated that they have been able to cut jobs and replace those positions with AI.

“It is true that AI may take a few jobs, but not all of the jobs or most of the jobs,” she said. “There are certainly jobs it can actually replace, but the point is that it will also offer a lot of new jobs as well. If you go back to when social media first came around and everyone was concerned, especially in television and radio and traditional forms of communication, it has not really been replaced but it’s been adapting. And with social media we now have lots of social media jobs like social media managers, social media directors and entire social media marketing agency companies, all of this just to manage social media.”

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