September 12, 2010

A GUIDE TO SENIOR LIFESTYLES

THE DISPATCH • www.cdispatch.com2 SUNDAY, SEPTEMBER 12, 2010 TIME OF YOUR LIFE

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About the cover: Dr. Roy Ruby went to work for Mississippi State University in 1964. He stayed at MSU for 40 years, including 17 1/2 years as vice-president for student affairs and three years as dean of the College of Education. Ruby later served as interim president of the university and is now working on an oral history of the changes on the campus during his time there. He is currently serving as interim vice-president of student services at MUW.

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Ladies & Gentlemen Serving Ladies & Gentlemen

BY JASON BROWNEjbrowne@cdispatch.com

The Simpsons arethe type of non-tra-ditional students

everyone hopes to be oneday. Clyde and ElizabethSimpson, both 73, attendclasses at MississippiUniversity for Women forthe sake of personalgrowth.

“When you retire youmake a decision,” saysClyde Simpson. “You cansit in front of the televi-sion and wait to die, oryou can do somethinginteresting and exciting.That’s why I take coursesthat stimulate me, to stayabreast of what’s going

on in the world.”John Dillon, 52, is the

type of non-traditionalstudent you don’t want tobe. Out of work since theTupelo-based BlockCorp., which bought theAmerican Trouser plantin Columbus, went out ofbusiness in 2008, Dillonwasn’t ready for retire-ment. So he signed up forthe information systemstechnology program atEast MississippiCommunity College in

Submitted photo

John Dillon, 52, a student and technical support employee at East Mississippi Community College in Mayhew,assists Courtney Pilkinton, a freshman Medical Technology student from Columbus.

MORE INFOn MUW CENTER FORACADEMIC EXCELLENCE:662-329-7138n EMCC WORKFORCETRAINING: 662-243-2682

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Back to school

THE DISPATCH • www.cdispatch.com SUNDAY, SEPTEMBER 12, 2010 3TIME OF YOUR LIFE

Chronic Kidney Disease (CKD) is the diagnosis of chronic renal failure resulting in the loss of kidney function. It is now estimated that one out of every ten Americans has some form of CKD. If a patient is referred to a Nephrologist, in addition to regular visits to your primary care physician, it may be possible to slow the progression of CKD. Some patients’ disease will progress to a point where the patient will need dialysis or a transplant.There are two leading causes of kidney failure, diabetes and hypertension (high blood pressure). Control of these two conditions can prevent or delay the onset of kidney failure.Some of the most common symptoms of kidney disease include but are not limited to:• Change in the frequency of urination • Loss of appetite, nausea or vomiting • Muscle cramps • Elevated blood pressure • Swelling or loss of sensation in feet & hands • Blood or protein in the urineIf a patient is diagnosed with CKD, it is unlikely it will ever be cured but early detection is important in preventing progression. If you have been diagnosed with kidney disease, the following are ways to man-age it:• See your Nephrologist regularly. Scheduled appointments are made in accordance with

your disease progression. Drs. LeBrun, Dunn, and Mock will work closely with your primary care physician in management of other medical conditions.• Manage blood pressure either through diet and exercise, or by taking prescribed medications. Regularly check blood pressure by having it monitored by the primary care physician. • If you are a diabetic, it is very important to manage blood sugar levels.• Implement a low saturated fat, low cholesterol, and low salt diet. Some patients will need to implement a low protein, low sugar, and low potassium diet as well. Dialysis and TransplantsEnd-Stage Renal Disease (ESRD) is the diagnoses of a patient with total or nearly total and permanent kidney failure. Patients with ESRD must undergo dialysis or have a kidney transplant to survive. If the patient decides to start dialysis, Dr. Dunn, Dr. LeBrun and Dr. Mock are experienced in dialysis and are able to explain the options including hemodialysis and peritoneal dialysis. If the patient is healthy enough and is able to locate a donor, Drs. Dunn, LeBrun and Mock work closely with area Transplant Surgeons to coordinate successful transplants and medical management for the transplant patient.

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DISPATCH STAFF REPORT

Dr. Roy Ruby of Starkville is aman of few words but manyaccomplishments. Now a

sought-after public speaker, Roywent to work for Mississippi StateUniversity in 1964.

He worked for MSU for 40 years,including 17 1/2 years as vice-presi-dent for student affairs and threeyears as dean of the College ofEducation. He later served as inter-im president of the university.

Since retiring in 2004, Roy hasbeen enjoying the benefits of retire-ment: freedom to “do what you wantto do,” (within the law, he jokinglyadds) and “you do get a discountevery now and then.”

But it’s not all play for Ruby nowthat he’s retired. He’s stayed closelyinvolved with Mississippi State andis currently working with the col-lege’s Mitchell Memorial Library onan oral history of the institution.

Ruby believes the most signifi-cant change at the school in thetime he spent there was MSUbecoming a truly co-educationalcampus.

“It took a very strong universityand gave it a much better environ-ment and strengthened it,” Rubysaid. “You think about it, now it’s

almost 50-50, and just think about allof the students you’d be missing if itwasn’t a co-educational environ-ment.

“The old days are good to thinkabout but you wouldn’t want to goback,” he added.

Of his own old days in college,Ruby joked, “Well, I didn’t reallyknow anything then,” when askedwhat he knows now that he didn’tknow in college.

Roy always believed he wouldhave to work for what he wanted; henever expected anything to be givento him.

“Let me tell you something Iknow now; I know how verydependent you are on other people.Every success I have ever had isdue more to other people. I’veworked for other people that helpedme be successful; I’ve worked withother people that helped me be suc-cessful; people have worked for methat were so good that I was givencredit for the work they were doing.

“So I guess if there is any lessonI’ve learned in life it’s that you areso very dependent on other peopleto truly succeed.”

Ruby is well known for his partic-ipation in the Rotary Club, wherehe’s been known to break out a joke

or two. “We have what’s called the‘Rotary Minute’ which is then fol-lowed by an ‘Absolutely Nothing todo with Rotary Minute’ when I tell ajoke or a story we think is funny,”Ruby said.

Ruby and his wife of 48 years,Patricia, like to take day trips intheir free time to see the sights orshop for antiques. He admits that issomething they do together, notnecessarily something hewould do alone. They alsolike to eat out and enjoy localrestaurants. Among theirother joys are attending MSUathletic events, which PatriciaRandall Ruby now enjoys justas much as her husband.Over the years, it has becomea family passion, and theirchildren — Robert Ruby, asupervisory special agentwith the FBI, and Mary RubySpencer, the mother of Royand Patricia’s two grandchil-dren, ages 9 and 15 — arejust as much “fanatics” as heand his wife.

Roy Ruby’s love for allthings MSU are obviouswhen he sincerely says,“MSU has done more for me than Iever did for MSU.”

METRO CREATIVE GRAPHICS

Today’s seniorsmight cringe at theescalating costs of

necessities such as pre-scription medication andeven higher utility bills,and understandably so.However, savvy seniorscan save by taking advan-tage of a host of discountsexclusive to the thoseover the age of 65.

n Travel perks. Manyseniors love to travel, andcan even do so at heavilydiscounted prices. Largerhotel chains often offerseniors discounts as highas 10 percent.Unfortunately, many U.S.domestic airlines, facinghigher fuel prices anddwindling business duethe global economicdownturn, ceased offer-ing senior discounts in2009. However, certainairlines, includingSouthwest Airlines, stilloffer discounted rates toseniors. These discountscan be as much as 10 per-cent. It’s also common forcar rental agencies tooffer senior discounts.

n Transportation.Many communities pro-vide heavily discounted, ifnot free, rates to seniorsfor public transportation.

Consult with your localgovernment to determineif you qualify for seniordiscounts.

n Food. Grocerystores commonly offerdiscounts to older cus-tomers, and many timesyou don’t even need to bea senior citizen to qualify.In general, chains offersenior discounts, includ-ing special days for sen-iors to shop, to anyoneover the age of 55.Restaurants are alsoknown to offer senior dis-counts, and often thesediscounts extend beyond“early bird special” dis-counts of yesteryear.While early bird specialsstill exist, many chainrestaurants offer dis-counted prices to seniorsregardless of time of day.In many cases, these dis-counts aren’t listed on themenu, but it never hurts,and typically saves, to ask.

n Arts and culture.Seniors looking to spenda day or night on thetown and take in someculture can typically do soat a discounted rate.Museums and NationalParks typically offer dis-counted admission to sen-iors, as do movie theatersand even some concerthalls.

EducationContinued from Page 2

Mayhew to update his skills.“I didn’t have a very high

opinion of the notion that youhave to have a (college) degreeuntil after I was laid off,” saidDillon.

Fortunately, all three stu-dents are in their element attheir respective schools.

The Simpsons are both stu-dents and instructors in MUW’sLife Enrichment Program, aseries of classes not tied to adegree which aim simply toimprove the student’s quality oflife. Last semester, Clyde tookclasses in criminal justice andthe history of Lowndes Countywhile teaching an introductionto computers course.

“It’s a question of gettingtogether with people in an intel-

lectual environment and dis-cussing problems and issues insociety,” he said. “We try toevolve not only on local gossipbut also the affairs of theworld.”

The LEP program, in itsthird semester, has grown from25 students to more than 100.For $35 per semester studentscan take as many classes asthey please. Courses areoffered from 9 a.m. to 7 p.m.Monday through Thursday.

But there’s more than oneroute for non-traditional stu-dents at MUW. Persons aged 65and older who wish to takestandard courses for collegecredit are admitted free ofcharge.

MUW Admissions Director

Cassie Derden says seniorsneed only call the Center forAcademic Excellence to applyfor the scholarship. Studentstaking advantage of the scholar-ship do not pay tuition but areresponsible for all class materi-als such as books. Those stu-dents are free to take any classprovided a slot is available.

Much of Dillon’s costs aredeferred as well, but not due tohis age. Because he was laid offhe was eligible for fundsthrough the Trade AdjustmentAssistance program.

Dillon may not have thoughttwice about going back toschool while he was employed,but he’s found his element atEMCC.

“I am having such a blast. I

have tried to fully immersemyself in the college experi-ence,” said the Air Force veter-an.

He immersed himself to thepoint that a picture of Dillon infull lion makeup and costumeduring Spirit Week wound up inthe yearbook.

Academically, he says hisfirst math course in 35 yearswas a bit challenging, but hishard work has landed him intwo honors societies and a part-time job in information technol-ogy at EMCC. Dillon will gradu-ate in May with his associate’sdegree and the ability toachieve up to eight professionalcertifications with additionalclasses.

In addition to the shock of

how much fun community col-lege can be, Dillon says he’salso surprised how many stu-dents his age attend classes atEMCC.

“There’s quite a growingpopulation on campus of non-traditional students. It’s fun tosee each other as we’re goingthrough the hallway and, even ifwe don’t know one another,there’s an automatic acknowl-edgment between us for goingthrough the same sorts ofthings,” he said.

Some senior citizens also optfor the community collegeroute. EMCC officials reportbetween 25-30 seniors enrolledin classes.

Kelly Tippett/Dispatch Staff

Retired Mississippi State University administrator Dr. Roy Ruby dictates a history of the changes and happeningson MSU campus during his 40 years of service.

Longtime MSU administrator:Retirement has its perks

Variety of commondiscounts availableto senior citizens

DID YOU KNOWDid you know that more and more online dating sites areaccommodating the growing number of seniors who wantto meet a special someone whether for romance or friend-ship? These sites are relatively inexpensive and present awide array of eligible people. Web-savvy seniors are findingdating sites convenient for meeting people. What’s more,there are a number of dating sites that are catering specif-ically to the senior market. This makes dating even easier.As with anything, it’s wise to be cautious when meetingpeople online. It’s easy to falsify information through theInternet, and photos posted on dating sites may not beindicative of how a person looks today.

BY RYAN POErpoe@cdispatch.com

When JohnMcPherson begangoing to the

Columbus YMCA, he justwanted to touch his toes.

Now, the 72-year-old isproud to say he lost 20pounds in a year by exercis-ing and taking senior citi-zens classes.

“I feel better than I havethe last 20 years,” saidMcPherson, who goes tothe gym four or five days aweek. “I don’t feel 72.”

Both the YMCA andFitness Factor in Columbushave several classes tai-lored specifically to meet

seniors’ needs.At the YMCA, seniors

have stretch class, a SilverSneakers class and wateraerobic classes to choosefrom. The rate is $3 per dayfor non-members, or $40 amonth for new memberswith a one-time fee of $25.

The Fitness Factor alsooffers senior classes, butfor $20 per month for threeclasses each week.

Many seniors, likeMcPherson, have discov-ered the benefits of regularexercise, said YMCAWellness Director MelissaParsons.

The stretch classes atthe YMCA became so pop-ular, they had to createanother class, she said.

“It keeps you fromfalling apart,” added 83-year-old member Ruth Lee.“If you don’t keep moving,you’ll deteriorate real fast.”

Clarence LeBlanc, 78,said he had never realizedthe benefits of stretchinguntil he took the class.

“Can you imaginestretching your eye mus-cles? That’s some of theexercises we do,” saidLeBlanc, who works parttime at the front desk.

But exercise isn’t theonly reason seniors attendthe classes, said the 18-yearYMCA and U.S. Air Forceveteran.

“That’s one of the thingsI like about exercising — itgets your mind off the badstuff,” he said.

Bad stuff like brokenhips and aching bones,added 65-year-old JudyMackenzie, who began tak-ing water aerobic classesafter her hips werereplaced in 2003.

Now, thanks in part tothe classes, she can walk

and move around.“I might look like 65, but

I don’t feel like it,” she said.“(Exercise) kind of savedmy life.”

Exercise is important foreveryone, but especially forseniors, said MississippiUniversity for WomenWellness CoordinatorMarion McEwen.

“The main thing aboutseniors is that exercisingevery day can preventdementia and keep themhealthy,” said McEwen,who is also an instructor atFitness Factor.

Fear is what keeps manyseniors from joining class-es, she continued. But whatthey should really fear isnot going.

“It’s never too late tostart and you can alwaysimprove,” she said.

Her class at FitnessFactor focuses on improv-ing strength, balance, flexi-bility and endurance — allkey to keeping peoplehealthy as they grow older,McEwen said.

“It is a well-roundedclass because we try to hitall of those components,”she said.

But for some seniors,exercise is only part of thefun.

“They love it because it’sa social time as well,”McEwen said.

The classes allow peopleto make new friends andmeet with old ones,Mackenzie said. When shewas in the hospital, classmembers even broughtpresents.

“When you quit work-ing, it’s your (class) friendsyou see every three or fourtimes a week,” she said.

“It’s always nice to havepeople to talk to,”McPherson said. “I’vemade lots of friends aroundhere.”

THE DISPATCH • www.cdispatch.com4 SUNDAY, SEPTEMBER 12, 2010 TIME OF YOUR LIFE

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Seniors discover the benefits of exerciseYMCA REGULAR: ‘I feel better than I have the last 20 years.’

METRO CREATIVE GRAPHICS

Exercise is importantfor all people,including the elder-

ly. Yet, seniors who havelimited mobility or areconfined to a wheelchairmay think they couldn'tpossibly exercise.However there are manythings such individualscan do to stay in shape --all while sitting down.

Doctors recommend atleast 30 minutes of dailyexercise for most people.Exercise is beneficial forseniors because it keepsmuscles from atrophying,improves mental alert-ness, strengthens bones,and leads to a healthiermetabolism, among otherthings.

For seniors who thinkthey won't be able to han-dle traditional exercise,chair exercises or modi-fied pilates can be effec-tive, even for those withtrouble walking or stand-ing for extended periodsof time.

To get started, all oneneeds is some loose-fit-ting clothing and a chair.Begin by doing somestretching movements ofthe neck, arms and legs.Rotate the head left andright and in circles tostretch the neck and backmuscles. Lift arms overthe head and slowly dropdown to the sides of thebody to stretch arms andback muscles. Lift andlower the legs a few timesto warm them up.

To begin exercises,start slowly and graduallybuild up repetitions.Exercises to try includeboxing or punching into

the air, arm circles, andarm curls. For the legs,work the back and frontof the legs. Kick the legsout in front of the bodyseveral times. Hold legsparallel to the floor (asmuch as possible) and doleg crosses. Put feet flaton the floor and lift up theheels. Keep feet on thefloor and push down towork the buttocks and thetop of the thighs.

If swimming is possi-ble, or even simply enter-ing a pool, water providesgentle resistance andcould be a good way towork the body in a grad-ual manner. Buoyancyfrom the water will beeasy on joints and thistype of exercise is verylow-impact.

Those looking tochange things up fromday to day can thinkabout doing yoga in achair or even tai chi exer-cises. Deep breathing andmeditation after workoutscan be part of a cool downand stress-relief program.

Individuals who havemastered these exercisesand have been told by adoctor that it is OK to dosomething a bit morestrenuous may want toadd very light weights tothe equation for moreresistance. Two or fivepound weights are allthat's needed to give mus-cles even more of a work-out.

Remember to alwaysconsult a doctor beforebeginning any type ofexercise regimen, be itwith a personal trainer oron your own. The doctorcan discuss which type ofexercises may be safe.

Exercises for seniorswith limited mobility

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BY MELISSA A. PARSONSFrank P. Phillips YMCA Fitness Director

For the past 13 years,I’ve worked with agreat friend at the

YMCA who just so happensto be a senior citizen. Fromtime to time, ClarenceLeBlanc would ask me whatstretches would be good forvarious tight muscles. Overthe course of a couple ofyears, I would give him ministretch lessons behind thefront desk. Along the way hewould say, “Melissa, the Yshould have a stretch classfor seniors;” I agreed withhim and thus the SeniorStretch class was born.

Since commencing onJan. 9, 2008, the class hasseen many seniors passthrough its doors. Somecome for a short while, someebb and flow and then thereare those, like Ruth Lee, an84-year-old participant, whofrom the very beginning hasfaithfully come to everyclass.

The class entails a full

regimen of flexibility, balanceand core exercises that pro-mote a stronger more flexi-ble frame. The benefitsprove to be very beneficial asparticipants experience anoverall sense of well beingand a renewed ability to dothings long unable.

I hold close to the notionthat when I’m a senior, Iwant to be able to get to thefloor, touch my toes and easi-ly look over my shoulder toreverse my car. My approachis progressive so participantsmove gradually into a fullrange of motion, or not if,movements are modified.

I incorporate some Yogaposes, like the upper half ofthe Eagle Pose. Initiallysome participants have diffi-culty in performing it, butafter time they are able tocomplete the stretch in itsentirety. I brag on their suc-cess to my ‘younger’ fitnessclasses in hopes of encourag-ing them that it’s possible tobecome more flexible. If theseniors can do it, so canthey!

The exercises are per-formed while standing, sit-ting in a chair, and on thefloor. Participants who can-not get to the floor just stayin the chair and perform

modified exercises. Myfather, the late Richard P.Walters Sr., who in his 50sbecame a Personal Trainer,always stated, “You’re nevertoo old to start working out,but you’re always too youngto quit.”

The YMCA seeks to helpseniors who think exercise isnot for them become activeolder adults. We invite you tocheck out not only theSenior Stretch class but themany senior programs the Yhas to offer.

The senior stretch classmeets Mondays from 9:45-10:30 a.m. and Wednesdaysfrom 10-11 a.m. This class isfree to members and open tothe public for a nominal feeof $3.00. For more informa-tion about the class, callMelissa Parsons at 662-328-7696.

HOW TO GOWhat: Senior Stretch class Where: Frank P. PhillipsYMCA, 602 Second Ave. N. inColumbusWhen: Mondays from 9:45-10:30 a.m. and Wednesdaysfrom 10 -11 a.m.Cost: This class is free tomembers and open to the pub-lic for a nominal fee of $3.For more information about theclass, please call MelissaParsons at 662-328-7696.

Stretch those musclesSENIOR STRETCH:YMCA class offersarea seniors some flexibility

METRO CREATIVE GRAPHICS

Ask anyone whatthey envisiondoing most in their

retirement, and chancesare travel will be at thetop of their list. For thosewho have already retired,traveling is a luxurymany no doubt look for-ward to.

Seniors about to taketo the road, however,should consider the fol-lowing tips:

n Pack medications inyour carry-on. Medicineshould be packed in your

carry-on whenever travel-ing to prevent losing vitalmedications should yourchecked bags be lost dur-ing your travels.

n Consult with yourphysician and create alist of past and currentconditions and any med-ications. In the event youlose any of your medica-tion or fall ill during yourtravels, a list of all cur-rent and past conditionsand medications can helpthe physician who will betreating you better under-stand you and your med-

ical history. n Figure out time

zones and a medicationschedule ahead of time.When traveling to differ-ent time zones, it can bedifficult to adhere to amedication schedule.

n Be sure your vacci-nations are up to date.Certain countries man-date your vaccinationsare up to date before youcan enter the country,and some require vacci-nations be administeredas early as six weeksbefore your visit.

Medical travel tips for senior citizens

BY KRISTIN MAMRACKkmamrack@cdispatch.com

A successful retire-ment depends onplanning, prepara-

tion and protection, saylocal financial advisers.

“Planning ahead is thebiggest thing, having agood plan,” said WesleyPlatt of Financial Works.“Personally, I like tobreak it into five-yearincrements and havekind of a dream list ofgoals I want to accom-plish, with a time frameattached to those goals.Then, I set a strategy ofhow I want to accom-plish them.

“The preparation partis having a sound finan-cial adviser that can helplead this process andkeep check on the pro-gression toward thosegoals,” he continued.“The preparation phasealso needs to includeyour employer, physicianand particularly a planfor insurance. A lot ofpeople say they want toretire, but they haven’tlooked into health insur-ance.”

“The main thing peo-ple don’t think about thatthey should think aboutis long-term care,”agreed Denise Good ofState Farm Insurance.“Because that is whatprotects all of yourassets that you built. Along-term care policypays for your care andprotects your assets, ver-sus using them up todepletion.

“People need insur-ance to cover their long-term care needs,” shecontinued. “People usedto call it a nursing-home

policy. If you need assis-tance with the activitiesof daily living and youhave to go into (anassisted-living) facility,the average cost is about$5,000 (a month) andwho can do that? That’sthe first step in planningfor your retirementyears.”

“There are severalquestions we would needto ask (for successfulfinancial planning),” saidMitch Griffin, a financialplanner with AxaAdvisors. “How manyassets do you have? Do

you need income off it(and) what are yourfuture plans? There are alot of questions thatneed to be answered.

“Hire somebody that’sbeen in the business forseveral years,” he addedof finding a financialplanner.

“And I tell clientsannuities are kind of agood thing for retirees,because they do haveguarantees that pay, nomatter what happens inthe market.

“They do provide aguaranteed income forthe client, for the rest ofhis life.

“But, No. 1, sit downwith a financial plannerand come up with agame plan. Stick to thegame plan. Don’t varyfrom the game plan, justbecause the market maybe down 100 points.”

“The No. 1 tip is toeducate yourself,” saidJohn D. Acker, a finan-cial planner with StateFarm, advising retireesto avoid financial advis-ers who only want to“push product.”

“Seek guidance fromsomeone like myself oranother financial profes-sional.”

Traditionally, Ackersaw clients retire with apension guaranteeingthem a “check for life,”but situations now aredifferent.

“That reality is chang-

ing,” he said. “We’re get-ting into a world of401(k) plans and wherepeople walk away withlump sums of money andthat can be a very diffi-cult thing to manage.The biggest problem isseniors with a lot ofunrealistic expectationsand they withdraw toomuch money too fast.Typically, you want tohave a 4- to 5-percentwithdrawal rate.”

“When we move intoretirement years, that’s atime we can’t afford tomake mistakes and wehave to be protected,particularly our income,”said Platt. “There needsto be a guaranteedincome that I know, nomatter what happens tothe stock market orcredit market, I have alevel of income I cancount on.”

THE DISPATCH • www.cdispatch.com6 SUNDAY, SEPTEMBER 12, 2010 TIME OF YOUR LIFE

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© The Dispatch

THE THREE P’S OF RETIREMENT

Photo illustration by Kelly Tippett/Dispatch Staff

Mitch Griffin looks over a retirement portfolio with a client in his office at AxaAdvisors.

Planning, preparation and protection

“The preparation part is having a soundfinancial adviser that can help lead thisprocess and keep check on the progres-sion toward those goals.”

Wesley Platt of Financial Works

BY SUSAN JAFFESpecial to The Washington Post

After Ann Callan, 85,fell and broke four ribs,she spent six days at HolyCross Hospital in SilverSpring, Md. Doctors andnurses examined her dailyand gave her medicationsand oxygen to help herbreathe. But when shewas discharged in earlyJanuary, her family got asurprise: Medicare wouldnot pay for her follow-upnursing home care,because she did not havethe prerequisite threedays of inpatient care.

“Where was she?” asksher husband, Paul Callan,85, a retired U.S. Armycolonel. “I was with her allthe time. I knew she was apatient there.”

But Holy Cross hadadmitted her only forobservation. Observationservices include short-term treatment and teststo help doctors decide ifthe patient should beadmitted for inpatienttreatment. Medicare’sguidance says it shouldtake no more than 24 to 48hours to make this deter-mination.

Yet some hospitalskeep patients under obser-vation for days, and thatdecision can have severeconsequences. Medicareconsiders observationservices outpatient care,which requires beneficiar-ies to cover a bigger shareof drug costs and otherexpenses than they wouldwhen receiving inpatientcare. And unless patientsspend at least three con-secutive days as an inpa-tient, Medicare will notcover follow-up nursinghome expenses after dis-charge.

Legal actionThe Callans owe

$10,597.60 to RenaissanceGardens, the Silver Springnursing home where AnnCallan spent three weeks.

“I’m going to fightthis,” Paul Callan says. “Idon’t care how long ittakes, because I don’tthink it’s right.”

The Callans have sinceretained an attorney topursue the matter, andhospital officials wouldnot discuss details of thecase “in anticipation ofpossible legal action,” aspokeswoman said.However, Karen Jerome, aphysician who is an advis-er on care management atHoly Cross, said in a state-ment that the hospital hasa policy of informingpatients when they are inobservation care and thatpatients receive a thor-ough review to determinetheir status.

While patients general-ly stay in observation sta-tus for no longer than 48hours, she said, it is thepatient’s condition andneed for medical care thatdoctors have to considermost, not the clock.Sometimes the patientdoes not meet criteria forinpatient care after 48hours but hasn’t improvedenough to go home. Whenthat happens, the hospitalwill keep the patient untilhe or she has “a safe dis-charge plan.”

Claims from hospitalsfor observation care havegrown steadily and so hasthe length of that care,says Jonathan Blum,deputy administrator atthe Centers for Medicareand Medicaid Services(CMS), the federal agencythat runs Medicare. Themost recent data showclaims for observationcare rose from 828,000 in2006 to more than 1.1 mil-lion in 2009. At the sametime, claims for observa-tion care lasting morethan 48 hours tripled to83,183.

Claims growingIn a report to Congress

in March, the MedicarePayment AdvisoryCommission said theincrease may be explainedby hospitals’ heightenedworries of more-aggres-

sive Medicare audits ofadmissions andMedicare’s decision in2008 to expand criteriathat allow patients to beplaced in observation sta-tus. Yet the number ofpeople admitted to inpa-tient status remained sta-ble, the report said.

The trend is emergingas hospitals cope withincreasing constraintsfrom Medicare, which isunder pressure to controlcosts while serving morebeneficiaries. In additionto more stringent criteriafor inpatient admissions,hospitals face more pres-sure to end over-treat-ment, fraud and waste.

In this environment,doctors have to make diffi-cult judgments about theirelderly patients, saysSteven Meyerson, medicaldirector for care manage-ment at Baptist Hospital ofMiami.

“Under a set of ratherarbitrary definitions,which are very vague anddifficult to understand andapply, we have to decidewho’s an inpatient andwho’s an outpatient whensometimes the distinctioncan be two or three pointsin their sodium level orthe amount of IV fluidsthey are receiving,” hetold CMS officials at aninformation-gathering ses-sion Aug. 24.

If the distinction isn’talways clear to doctors,it’s even more elusive forpatients.

Toby Edelman, a seniorpolicy attorney at theCenter for MedicareAdvocacy in the District ofColumbia, has receiveddozens of complaints fromseniors who assumed theywould have the fuller cov-erage provided to inpa-tients.

“People have no way ofknowing they have notbeen admitted to the hos-pital,” says Edelman.“They go upstairs to a bed,they get a band on theirwrist, nurses and doctorscome to see them, theyget treatment and tests,they fill out a meal chart— and they assume thatthey have been admittedto the hospital.”

Medical conditionsSetting a patient’s sta-

tus is complicated. Morethan 3,700 U.S. hospitalsuse a tool created byMcKesson HealthServices to guide the deci-sion. It provides criteriafor medical conditions andtreatment based on scien-tific evidence to identify“over 95 percent of all rea-sons for admission to anylevel of care,” RoseHiggins, McKesson’s vicepresident for care man-agement, said in a state-ment. Higgins said thathospitals can tell patientsthe criteria used to assesstheir status, but the com-pany’s recent filing withthe Securities andExchange Commissiondescribes the decision-making tool, calledInterQual, as a tradesecret.

Many patients are nottold by hospital officialsthat they haven’t beenadmitted. (Medicare doesnot require such notifica-tion.) And the designationcan change during a per-son’s hospital stay.Sometimes a physicianwho hasn’t seen thepatient will determine thatthe case does not meritinpatient status; Medicarerequires that patientswhose status is downgrad-ed must be informed.

Ed Timmins, 88, hasbeen in a nursing home inSpringfield, Va., since hewas discharged fromInova Fairfax Hospitalafter falling in a restaurantparking lot in June. TheDefense Departmentretiree was an observationpatient during his fourdays at the hospital, wherehe was treated forextreme back pain andreceived an MRI andother treatment.

But without the three-day inpatient stay,

Medicare will not coverhis nursing home bill,which reached $23,864through the end ofAugust.

On his first day in thehospital, Timmins, whohas Alzheimer’s diseaseand was taking powerfulpainkillers, received anotice saying he wasbeing “placed into an out-patient status forOutpatient Observation orExtended Recovery. Youare still considered an‘outpatient’ but are beingcared for on a nursing unitfor further evaluation of

your symptoms by yourphysician. Within 24hours, your physicianshould make a decision toeither ... Admit you forinpatient treatment orDischarge you for contin-ued outpatient follow-upcare.”

“For him to be treatedat an Inova hospital forfour days and then be con-sidered an outpatient isludicrous,” says hisdaughter, Lynn Hollway.She was in his room — onthe phone updating hermother — when hereceived the notice but

assumed they could dealwith the issue once hiscondition stabilized.

Status is importantHospital officials say

status decisions are oftennot in their hands.“Medicare rules requireus to make sure that apatient meets what’scalled medical necessityto be in an inpatient sta-tus,” says Linda Sallee,vice president for casemanagement for the InovaHealth System. A hospitalspokeswoman said Inovaphysicians would not dis-cuss details of Timmins’care.

Even if patients knowthey are observationpatients, there is little theycan do to change their sta-tus. Medicare has coveredtheir care on an outpatientbasis, so they have not

been refused benefits.“There’s no official

appeal,” says Edelman.“Medicare has not deniedcoverage. You’re in noman’s land.”

Hospitals officials saythey pay a price if theygive inpatient status to aMedicare patient whoshould only be underobservation. When thathappens, the hospital isovercharging Medicareand can be required torefund some of the moneythe government paid.

During a three-yearpilot project in six states,Medicare auditors, whoreceived commissionsbased on overchargesthey uncovered, forcedhospitals and other health-care providers to return$1 billion in improper pay-ments. The program isbeing expanded to every

THE DISPATCH • www.cdispatch.com SUNDAY, SEPTEMBER 12, 2010 7TIME OF YOUR LIFE

‘Observation’ status limits Medicare benefits

See MEDICARE, 8

TO LEARN MOREIf you have questions about your hospitalization or nursing homecoverage, you can:n Call Medicare at 800-633-4227. n Obtain a Medicare pamphlet about observation care atwww.medicare.gov/publications/pubs/pdf/11435.pdf. n Find information prepared by the Center for MedicareAdvocacy at www.medicareadvocacy.org/InfoByTopic/ObservationStatus/ObservationMain.htm.

THE DISPATCH • www.cdispatch.com8 SUNDAY, SEPTEMBER 12, 2010 TIME OF YOUR LIFE

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MedicareContinued from Page 7

state this year.Pressure to increase the

use of observation statusmay also come from thenew federal health law,which includes penaltiesfor hospitals that haveunusually high rates of pre-ventable readmissions.Because observationpatients have not officiallybeen admitted, they would-n’t count as readmissions ifthey need to return.

No chance for changes?The stepped-up audits

and the new law’s financialincentives are intended tocontrol skyrocketingMedicare costs and toreward better care. Thatcould be jeopardized by anincrease in costly inpa-

tients. Easing the standardfor inpatient status wouldalso raise the agency’snursing home spending.

“We’ve asked them tochange it,” says Sallee. “ButI would be very surprised ifthey did, because it wouldcost a lot of money.”

Blum says that manyfactors are involved in theincreasing use of observa-tion care. “It’s not clear tous whether or not thistrend is due to financialincentives,” he says.“There could be lots ofother things going on.”

For example, he says,doctors may be “doing theright thing” by keeping vul-nerable seniors in the hospi-tal for observation if theylack a support system athome.

Medicare officials areweighing changes to theadmissions policy and sentletters to hospital associa-tions in July soliciting sug-gestions. Among theoptions are requiring hos-pitals to notify patients thattheir stay is consideredobservation, setting a stricttime limit for observationcare and changing how theagency pays hospitals forsuch care, Blum says.

For some, changes maynot come soon enough.

“This system is imprac-ticable and just locks uppatients in the hospital,”Meyerson told CMS offi-cials last month. “They arenot well enough to leaveand not sick enough toadmit. So what do you dowith them?”

Get involved … with your child’s life.

BY SUSAN JAFFESpecial to The Washington Post

Q. How do I know what my hospital sta-tus is?

A. Ask your doctor or other hos-pital officials if you are in the hospi-tal for observation or as a regularinpatient. If you are an observationpatient, ask why. Even if you areadmitted as an inpatient, the hospi-tal can switch you to observationstatus; in that case, the hospital isrequired to notify you.

If you do not have three consec-utive days of hospitalization as aninpatient — excluding the day ofdischarge — Medicare will notcover a subsequent stay in a nurs-ing home. For those who do quali-fy, Medicare pays for up to 100 daysof rehabilitation or skilled nursingcare.

Q. How long can the hospital keep me forobservation?

A. Medicare expects patients toremain in observation status for nomore than 24 to 48 hours. But there

are no rules limiting the time; somepatients spend several days inobservation.

Q. What can I do if the hospital won’tchange my observation status to inpa-tient?

A. “You cannot directly appealthe hospital’s determination thatyou are or were an observationpatient,” says Ellen Griffith, aMedicare spokeswoman.

If you think you should be con-sidered an inpatient, ask your per-sonal physician to call the hospitaland request a change in status,although your doctor cannot man-date this. If that is not successful,there are other steps you can take.

Q. If the nursing home or hospital saysMedicare won’t cover my nursing homestay, what can I do?

A. Ask the nursing home to billMedicare when you enter the facili-ty, Griffith says. Medicare will denythe claim if you do not have therequired three inpatient days. Thenext step is to appeal that decision

to the Medicare billing contractor,which will probably also deny yourrequest. You can then appeal thatdecision.

If the nursing home won’t billMedicare, the Center for MedicareAdvocacy, a public interest lawfirm, recommends that you com-plete a “Notice of Exclusions fromMedicare Benefits: Skilled NursingFacility” form. Ask the nursinghome to submit it to Medicare toget a decision about coverage. Thenursing home will not bill you whileyou wait for a response.

You can also question yourMedicare Summary Notice, whichis the explanation of benefits, saysthe advocacy center’s TobyEdelman. It probably will show lim-ited coverage — for rehabilitationservices — instead of a full nursinghome benefit. You can appeal to theMedicare billing contractor for fullnursing home coverage, which gen-erally is denied. To appeal thatdenial, follow the instructions in theMedicare Summary Notice.

Ask doctor to help on coverage

BY CAROLYN BUTLERSpecial to The Washington Post

As we come to the tailend of a perfectly healthy,happy, snot-free summerand head back to school— with all those germs —Mom has decided to goon the offensive. My mis-sion? To build up ourimmunity and preventcolds, viruses and infec-tions as much as possible.

That can be a tallorder, says GerardMullin, a Johns HopkinsHospital internist andgastroenterologist. “Thechange of seasons weak-ens your immune systemby draining your body’sneuroendocrine systemand stressing it with thechanges in day and night

and coldness andwarmth, all of whichmakes you more suscepti-ble to catching a cold orflu.”

He notes that beingforced back into crowdedplaces such as class-rooms doesn’t help mat-ters, nor do changes tobedtime and wake-up rou-tines. “Going back toschool and a stricterschedule, and not beingable to hang out, sleeplate and get up at 10: It’s anew rhythm and a differ-ent world for kids,” heexplains. “Just like for therest of us, not gettingenough rest ... plus deal-ing with the elements, thechanging weather andstressors like school orwork.”

Boosting the family’simmune system