Posted in the Senior Care Topics Series by Everbrook Senior Living

Seniors reading or watching the news are informed that Medicare, through its parent agency, Centers for Medicare and Medicaid, CMS, is now covering some essential non-medical services such as in-home care, transportation, and soon phone consultations with the doctor. In brief, Medicare following passage of the CHRONIC Care Act of 2017 and through reinterpretation of its own rules, has empowered only Medicare Advantage Plans, “MA”, to offer a broader array of supplemental benefits including vision/hearing screens to name a few and now non-skilled home-health to beneficiaries who demonstrate a medical need for such services. A supplemental benefit under Medicare is defined as: 

• A service or benefit not covered by traditional Medicare 
• A service or benefit that is primarily health-related, and
• A service or benefit in which the MA plan incurs a non-zero direct-medical cost.

Although seen universally as a positive step toward the continuing trend to reform coverage rules so medical providers can be paid to treat longer term chronic illness, in reality, seniors in need of home-health aides to support disabilities or who hope to talk to their doctor over the phone instead of having to travel their office will likely have to wait several years to receive those benefits in manners which make real improvements to their quality of health and life. Yet, for seniors with complex chronic illness which includes many senior living residents, MA plans appear to be the best option to get the most comprehensive coverage including essential supplemental benefits not available in traditional Medicare like in-home care or telehealth benefits, although with some uncertainties to work through. Medicare Part D amendments and other payment models being tried at CMS are not discussed here.

Nutritional fads come and go. But one fad which seems to have elevated to a gold-standard of credibility has been the so-called "Mediterranean Diet". The Mediterranean diet recommends eating lots of plant-based foods mainly fruits, vegetables, and legumes and foods infused with monounsaturated fat such as olive oil. This popular diet acquired high acclaim in the US as a nutritional best-practice in preventing heart disease after a five-year study by a group of Spanish nutrition scientists caused the New England Journal of Medicine, NEJM, to publish its conclusions suggesting that the Mediterranean diet can decrease risk of heart attack and strokes. The study concluded: prolonged exposure to the Mediterranean diet produced a substantial reduction in risk of major heart disease among high-risk people.

Recently, a statistical sleuth named John Carlisle exposed many flaws in the study namely its claim to have assigned people randomly to the study and other anomalies. Carlisle’s analysis refuted the study’s findings thus discrediting it, causing the NEJM in the summer of 2018, to retract the original publication. This turn of events has re-ignited the debate on what is optimal diet for seniors in later life and whether nutrition can have a positive impact on the health and wellness of very old adults? Ironically, much the Mediterranean diet compares agreeably to nutritional best-practice recommendations of public health organizations and other accredited bodies but without all the feigned notoriety. Yet, to deliver nutritional best-practices in later stages of life requires that special accommodation be made to address health-status changes.