Aging Archives - �Թϲ��

More Medications, More Risks. If You’re Worried, Start a Deprescribing Discussion.

Blake Farmer, Nashville Public Radio and Cara Anthony — Tue, 20 Oct 2026 09:00:00 +0000

(Maria Fabrizio for WPLN and �Թϲ��)

For nearly three years, Jonathan Bledsoe of Reading, Pennsylvania, took one prescription to stabilize his mood and one to keep his cholesterol in check, among a handful of other medications.

“You wouldn’t think you would have to be your own advocate and look out for yourself as far as managing your medications,” the Marine veteran said. “But when you wake up one morning and what you pee comes out the color of fresh brewed coffee, there’s an issue.”

He took his concerning symptoms back to his multiple doctors and learned the interaction between his medications was starting to damage his liver. After he changed medications, his liver and kidney function returned to normal.

Adverse drug interactions are becoming a bigger health concern as more people take multiple medications, said Amanda Mixon, a hospitalist and associate professor of bioinformatics at Vanderbilt University.

The percentage of Americans over 65 taking five or more medications, known as polypharmacy, nearly doubled from 2000 to 2020, according to a study published in . Now, more than a third of older adults are taking five or more medications a day.

Mixon said she sees older patients with an average of 16 medications, often from multiple prescribers and pharmacies.

“As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases,” Mixon said. “As these medications get added sort of progressively, that can accumulate over time, and then people are having more side effects.”

The QTip:

If you’re taking medications and supplements, keep your own up-to-date list and have it with you.

If you’re concerned about your medications, here’s what to know:

There’s No ‘Unicorn Pharmacist’

Sometimes, a medication intended to treat one issue leads to many more, known as a “prescribing cascade”: A prescription for the initial symptom causes a side effect, then that side effect needs to be treated. Eventually, the combination of meds may cause other issues that require yet another medication.

For instance, Mixon said, heart failure patients take a water pill to reduce fluid retention. As a result, the constant need to urinate can lead to incontinence, which is treated by another medication.

“We do an amazing job of treating. We are great at diagnosing, and medicines have an amazing role in increasing our longevity as humans,” said pharmacist . He’s the CEO of the North Carolina-based consulting company GeriatRx, which focuses on helping patients get off unnecessary medications. “It’s not the intent of our providers to overtreat. It’s just what we’ve been trained to do.”

When multiple prescribers are involved, they may not be aware of the patient’s other medications, he said, especially if the health providers are affiliated with different health systems that have separate patient records.

“Do not assume that someone is checking all of these things in the background. There isn’t this magical unicorn pharmacist just making sure everything is safe. Yes, even at the local pharmacy,” Canterbury said. “So make sure, if you notice something is off, that you advocate for yourself.”

A Shift Toward ‘Deprescribing’

“Deprescribing,” the process of intentionally tapering off medications, in the past decade, alongside the corresponding rise of polypharmacy and the associated health risks.

The science on how to taper patients safely is newer and still not widely taught in medical schools, Canterbury said.

He said patients who are worried about taking multiple medications — especially people experiencing a new symptom or an unexpected side effect — should start a conversation about deprescribing with their specialists or primary care providers.

“I promise you, they don’t bite,” he said. “Because you’ll be surprised that the more you bring up stopping a medication, the more willing they are to actually have that dialogue and help you get off of it if you don’t need it.”

The goal isn’t kicking as many meds as possible, Canterbury said — it’s patient safety. With age, bodies metabolize medications differently, he said, increasing the likelihood of harmful side effects like constipation, diarrhea, falls, and memory loss.

Keep a Medication List

Many pharmacists and doctors agree on the value of keeping an updated medication list, including the vitamins and supplements you’re taking. While there are QR code bracelets and medication tracking apps, sometimes the easiest strategy is an old-fashioned piece of paper.

“Everyone needs a medication list in their pocket,” said pharmacist Jen Hammons, director of rural health advancement at the Appalachian College of Pharmacy in Virginia. “If you can’t commit it to memory, you need to have a list.”

People and Policy

Health and Human Services Secretary Robert F. Kennedy Jr. has championed weaning Americans off psychiatric medications that he says are overused, a stance that has polarized the medical community. This year, the Centers for Medicare & Medicaid Services that clarifies how physicians and pharmacists can be paid for their work reviewing medications and helping patients taper off when appropriate. Previously, physicians reported uncertainty over whether they could get paid for deprescribing, which can be a time-intensive process.

Katherine Ruppelt and Emily Siner at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable healthcare system. It’s a collaboration between Nashville Public Radio and �Թϲ��.

�Թϲ�� is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

This article first appeared on �Թϲ�� and is republished here under a .

Readers Are Pleading To Make American Healthcare Greater

Mon, 19 Oct 2026 09:00:00 +0000

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Not-So-Great Healthcare

Why doesn’t world-class medicine produce world-class health?

Hayat Norimine’s reporting gets at something that has bothered me for a long time about American healthcare (Priced Out: “As Health Insurance Costs Soar, Healthcare Workers Also Feel the Pinch,” Sept. 22).

We are very proud of U.S. medicine, and we should be. We are at the forefront of new treatments, our clinician workforce is unmatched, and we deploy technologies that seemed impossible just a few years ago. Yet we are in the middle of the pack compared with other countries, in terms of healthy lifespan and many markers of quality care.

At the same time, the cost of accessing care has become outrageously high. When clinicians stop getting health insurance for themselves and their families, you know something is deeply broken.

What good is our health system if most people cannot afford to use it?

One family in Norimine’s story went without insurance when their premiums climbed. Another person kept her coverage but waited weeks to see a doctor because of a $10,000 deductible. These are different problems, but both expose the distance between the care we can provide and the care people can actually access.

Insurance is supposed to help people get the care they need to stay healthy, not just when they are at death’s door. Yet the way insurance is designed can discourage someone from seeing a clinician early, filling a prescription, or following up before a problem gets worse. A clinician may say, “This is what you should do next,” while a person’s coverage gives them a reason to wait or decline.

That tension is not an accident. It is how the system was built. Doctors design care. Insurers design coverage. The two are put together in separate rooms by different teams, measured on different things, then handed to the same person as if they were one plan. No physician would design a $10,000 deductible; it just blocks people from investing in prevention and getting care early. But no physician was in the room when that threshold was set.

Making coverage affordable is essential. So is asking what that coverage enables people to do. If better health is the goal, the people responsible for a person’s health need a hand in shaping what their coverage pays for and when. Design coverage and care together, and it gets easier for people to get the care we know works while avoiding waste.

— Clay Johnston; Austin, Texas

On Dementia, Violence, and Sedation

Reading “Drugs Are Widely Used To Sedate Dementia Patients. Her Sons Wanted To Keep Her Off Them” (Sept. 30) inspired me to share my own experience.

My husband died of dementia about two years ago at age 86. It was not an easy journey. Dementia made him agitated for the same reason it does to others: People with dementia cannot tolerate being told “no.”

So when I had to tell him to stop driving, he became violent. I was told by an eldercare specialist that if my husband remained at home, he might kill me. So it was off to a memory care center, a really good and really expensive one. And he became violent and agitated there because he couldn’t come home, which was what he wanted, and which I could not safely handle. I was also aware that if he couldn’t make it at the memory care center, there was virtually no other place that would take him.

So did I say yes to medication? I did indeed. Even with the antipsychotic, my husband would become out of control. He often tried to “abscond,” as they say in memory-care speak. I also paid through the nose for one-on-one care, which kept him sort of safe. But one night, he fell in the bathroom and broke his hip. A hip replacement was suggested. He was suffering, he had absolutely no quality of life, and I turned the offer down. He was transferred to palliative care and died peacefully about five days later.

There is no solution to this problem that I can see other than medical aid in dying, which he probably would have refused. Me — I will not refuse. My current terror is that I might do this to my remaining family.

— Nora Staffanell; Monroe, New York

The issue is appropriate treatment, not simply drug avoidance.

Jordan Rau’s report rightly highlights the danger of using sedating medications simply to make people with dementia easier to manage. But inappropriate chemical restraint should not be confused with medically appropriate treatment of serious neuropsychiatric symptoms.

Psychosis, agitation, and aggression are distinct. Before prescribing medication, clinicians should identify the target symptom and look for reversible contributors such as pain, infection, medication effects, constipation, sleep disruption, sensory impairment, fear, environmental overstimulation, or the way personal care is being delivered.

Nonpharmacological, person-centered interventions should generally come first. The American Psychiatric Association recommends antipsychotics, outside of emergencies, only when agitation or psychosis is severe, dangerous, or causes substantial distress and after nonpharmacologic approaches have been assessed. When used, treatment should begin at a low dose and aim for the minimum effective dose.

However, nonpharmacological measures do not always suffice. In 2026, the APA reaffirmed that antipsychotics can benefit some older adults with behavioral and psychological symptoms of dementia when used judiciously within a comprehensive treatment plan. Brexpiprazole, for example, received FDA approval in 2023 for agitation associated with Alzheimer’s dementia.

These drugs carry real risks, including increased mortality, sedation, orthostasis, extrapyramidal symptoms, cerebrovascular events, and falls. But untreated severe agitation or aggression also carries risks: distress, injury, emergency transfers, hospitalization, caregiver breakdown, and loss of placement.

The responsible question is therefore not whether antipsychotics are dangerous, but whether, for a particular patient and target symptom, likely benefits outweigh risks after reversible causes and nonpharmacological measures have been addressed.

Good dementia care means neither reflexive prescribing nor reflexive withholding. It means careful diagnosis, person-centered care, informed risk-benefit discussion, lowest effective dosing, close monitoring, and periodic attempts to reduce or discontinue medication when appropriate.

— James Ellison; Philadelphia

Decoding ER Bills

Autumn Daniels was billed $410 for an emergency room visit in which no clinician evaluated her (Bill of the Month: “She Left After Waiting Hours in the Emergency Room. The ER Billed Her Anyway,” Sept. 29). She received registration, vital signs, and a single question, then sat in the waiting room for four hours and left.

Carle Health billed CPT code 99281, an evaluation and management service. The American Medical Association’s CPT guidelines, quoted in your article, state that triage alone is not an evaluation and management service and cannot be reported with that code. Carle’s own email confirms the problem by defining “care” to include registration and nursing assessment. That’s triage under another name.

Billing for a service that was not performed is the most important reason insurers deny hospital claims, and it’s what physicians are trained to recognize as fraud. Daniels’ insurer denied the claim under “against medical advice,” a label that cannot apply to a patient no clinician ever saw. The right response is a written refusal to pay, addressed to the hospital, stating that the billed service was never rendered.

I spent 20 years in clinical medicine and over a decade as a health insurance medical director reviewing exactly this question. Daniels should owe nothing.

— Virgie Bright Ellington; New Rochelle, New York

This article goes much deeper than simply exploring lack of treatment in the emergency room. It’s about callous treatment, which is unacceptable on many levels. The ER provided poor care and wasn’t busy, but because the unseen patient was only feeling unwell and not bleeding from every orifice, she wasn’t taken seriously as a priority, so she left. Yet despite not being seen by a doctor, a miscellaneous bill — over $400 — was submitted for payment.

What is pain anyway — feeling uncomfortable? Pain is people dying from triggers in the body. Therefore, treating people like a business by these corporate hospitals is extremely concerning. A person feeling ill, receiving no treatment after four hours of waiting, then leaving the ER with a chronic headache — which could be anything from a brain injury, an upcoming stroke, or a hemorrhage — should not be charged. And certainly a miscellaneous code should not have been applied for the pleasure of pain, waiting, and the five minutes it took to take her temperature.

No, the insurance company should not pay, and it should also let the hospital know that it will be booted from the network for false claims — spending less-than-adequate time with a patient and then submitting bills.

Laws need to be mandated, and advocates must demand optimum care, with healthcare providers abiding by the Hippocratic oath.

People are not stick figures to be treated carelessly and then charged fully. Every time a baseless claim is submitted by the hospital to the insurance company, there’s a trickle-down effect, and rates go up.

It’s akin to being charged for walking on the sidewalk outside a grocery store, checking the fruit stands, getting help from the outside clerk, and then being charged by the store — despite not making a purchase.

Bad service serves no one and will backfire on the provider in the end. How many times do we have to check management at the door for not understanding that very concept? Far too often. We need to show that medical disregard and abuse are not tolerated. It’s essential to pursue change at the federal and state level. Why? Because, ultimately, hospitals are taking advantage of people. They’ve forgotten why they exist.

— Tiff Gadison; Sacramento, California

Living Under the Government’s Thumb

It’s not a good feeling to know that the government has the upper hand and pulls the strings (Health Hub: “Sticker Shock at the Doctor’s Office Could Motivate Midterm Voters,” Sept. 18). Here it is, 2026, and this single mother still struggles — but even more so with talks of cuts and funding to programs I and so many others depend on.

I was interviewed back in November 2018 about an absurd medical bill I received and was expected to pay, even though I have Medicare and Medicaid. Jay Hancock wrote my story, which aired on All Things Considered (Bill of the Month: “Chronically Ill, Traumatically Billed: The $123,000 Medicine for MS,” Nov. 28, 2018). It also appeared on CBS Mornings with Gayle King.

Things definitely haven’t gotten any better for me. I worry about not only my health insurance and my medication but the fact I am on permanent disability. The state of the nation under the current administration is pretty frightening. My Social Security/SSI is my only means of getting by. I receive EBT (electronic benefits transfer for food assistance), and I have a family to feed. I live in government-subsidized housing, based on my income. So pretty much my whole life is controlled by the actions of folks who probably have zero clue how it is to live on a fixed income and with a chronic health condition, one in which stress exacerbates the symptoms, as well as being a single parent.

Don’t even mention being able to afford the price of gas; my car will sit more than go now. I have to pick and choose when to run errands, usually on a day I already have a scheduled appointment. That not only causes me lots of anxiety, but the fatigue is relentless! This is a very stressful, unnerving way to live.

— Shereese Hickson; Niles, Ohio

Uniting for Good

I’m writing on behalf of students with the American Lung Cancer Screening Initiative (ALCSI). Our team recently came across Noam N. Levey’s Common Ground article “‘Cancer Doesn’t Care’: Citizen Lobbyists Unite To Push Past Washington’s Ugly Politics” (Oct. 21, 2025), and its message about cancer bringing people together across political divides strongly resonated with our team.

I wanted to share a recent development in California that reflects a similar idea. A lung cancer screening awareness bill that began as an idea from a small group of California college students was signed into law by Gov. Gavin Newsom on Sept. 28, after receiving support from legislators of both parties.

As students passionate about lung cancer screening awareness, our team began exploring legislative action to improve screening rates. In March 2025, we developed the initial proposal that ultimately became California SB 1124 and continued advocating for the bill throughout the legislative process until it was signed into law.

Lung cancer is the leading cause of cancer-related death in the United States. Screening can catch the disease at an earlier, more treatable stage, but many people eligible for lung cancer screening don’t know they qualify or that screening is available to them. SB 1124 addresses that gap by requiring tobacco retailers across California to post signage about lung cancer screening at the point of sale, reaching people where they already are rather than relying on them to seek out the information. Considering that California has historically been one of the states with the lowest lung cancer screening rates, this action is crucial.

The bill was introduced by Sen. Bob Archuleta (D–Pico Rivera). Through grassroots outreach, students involved with this bill initiative helped build a coalition of support from organizations across California and the country, including the California Academy of Family Physicians, the American College of Surgeons, and the NAACP California Hawai‘i State Conference, among dozens of others.

Our experience really echoed what stood out to us in Levey’s article: that cancer can bring together people who may disagree on plenty of other issues. We also hope our experience shows that young people can have a meaningful voice in that process and contribute to bringing people together around a shared public health goal.

— Elaine Dong; Los Angeles

This article first appeared on �Թϲ�� and is republished here under a .

Aging Life Care Managers Can Be a ‘Godsend’ for Families

Paula Span — Wed, 14 Oct 2026 09:00:00 +0000

Kristin Martinelli began her workday at 7:30 a.m. on a recent Monday, completing an online Medicaid recertification form for a client in a nursing home in Austin, Texas.

Next, she drove to meet an 85-year-old and her daughter, who had come in from out of town. The older woman had “pretty advanced dementia” and was scheduled to move into the secure memory care unit of a senior living facility that day, said Martinelli, who works as an aging life care manager with Mir Care Consultants in Central Texas. The three of them had a 9 a.m. meeting with the primary care doctor who would complete the paperwork for the move.

At the meeting, Martinelli explained the situation, and the doctor said he’d fill in the patient’s forms that afternoon. But later in the day, she got a call from a colleague saying that the doctor wouldn’t be able to complete the forms that day after all. That created a scramble because the woman wasn’t safe alone in her house. Martinelli ended up calling a home care agency she trusted. “I begged them to provide me with a caregiver in the next four hours,” she said.

If a combination of appointments, bureaucracy, vigilance, and worry about a vulnerable older person — often interspersed with medical emergencies — sounds familiar, it might help to know about a service its providers ruefully call the best-kept secret in eldercare.

Independent certified professionals like Martinelli used to be known as geriatric care managers. That’s what I called the people who make the 125-mile move from his apartment to a continuing care community near me, and later helped my disabled sister transition from her home to an assisted living facility.

I also used words like “godsend” and “indispensable.” After the moves, the care managers kept tabs on both my father and sister monthly and eased my fears that something urgent might strike the moment I left on a vacation or a work trip.

About a decade ago, these experts rebranded themselves as aging life care managers. It usually takes a couple of years to become one. Most enter the profession as nurses or social workers; some are physical or occupational therapists or gerontologists. They must attain a required combination of before they can take the certification exam.

The Aging Life Care Association, the nonprofit that represents these professionals, was founded in the 1980s and has grown to more than 2,000 members, but care managers still have a persistent public awareness problem.

“When we talk to someone, they say, ‘I wish I could have called you six months ago, but I didn’t know you existed,’” said Susy Elder Murphy, who owns Aging Well Eldercare, a large practice serving Washington, D.C., and its Maryland suburbs.

The caller is typically an adult child, the Aging Life Care Association has reported. Martinelli described a common scenario: “Mom is in the hospital, or the children went to visit and hadn’t realized she was so sick. They’re in a crisis.”

Enter the aging life care manager. What distinguishes her (it is usually a woman) from people with confusingly similar names — senior care advisers, patient advocates, care navigators — is her independence.

Aging life care managers work for the client and the family paying them, not for hospitals or insurance companies. Moreover, the association’s specifically prohibits “accepting or giving referral fees, fee splitting, kickbacks or other similar arrangements in exchange for client referrals.”

Contrast that with companies that promise free advice on senior living, like A Place for Mom. Care facilities pay A Place for Mom fees for steering new residents their way, as the organization . Advisers for companies that receive fees may be unlikely to recommend places that don’t pay, or to recommend home care, unless the company also contracts with local agencies.

“They’re really marketers, salespeople,” Julie Wagner, chief executive of the Aging Life Care Association, said about the referral companies. Some companies are about these financial incentives.

“If you want to buy a car and you go to the Ford dealer, they will not say, ‘I really see you in a Subaru,’” Murphy said. “You should be talking to someone who’s objective, neutral, and experienced.”

Care managers don’t come cheap. Wagner said association members’ hourly rates range from $150 to $350, with big geographic variations. In Texas, Mir’s standard rate is $185 an hour, billed in 15-minute increments. In Washington, Murphy’s practice charges $210 an hour. Sometimes families share the cost, as my sister and I did. And in some cities, social service agencies provide these specialists on a sliding scale.

Aging life care managers serve as coordinators, not hands-on caregivers, and the range of services they provide is quite broad.

They can, for example: Arrange and oversee a move to or within a senior living facility. Deal with insurers, including Medicare and Medicaid. Drive a client to the dentist. Recommend not only local residential communities and home care agencies but elder law lawyers, medical specialists, therapists, , and hospice organizations. Visit weekly or monthly to see that everything is going smoothly. Alert family members if it isn’t.

“A part of our job is mediating between family members, acting as a sounding board,” Martinelli said.

In fact, care managers like Murphy find their clients often seem more willing to listen to them than to their adult children — even if the advice is the same. “Your mom didn’t change our diapers or teach us to talk,” she said. “It’s a different relationship.”

In a of clients and families commissioned by the Aging Life Care Association, “the responses were overwhelmingly positive,” said Jullie Gray, a co-author of the study who teaches at the University of Washington School of Social Work.

The nearly 200 respondents did not constitute a representative national sample, Gray said. But 93% said the benefits of hiring an aging life care manager outweighed the costs, and 99% said they would recommend such a manager to someone else. The survey’s findings were presented at the 2025 meeting of the Gerontological Society of America.

Jeffrey Bernstein, an engineer in Middleton, Massachusetts, has for years relied on Aging Well Eldercare for help with his parents, two older siblings, and an aunt, all in Maryland. Like many people who eventually learn about care managers, “I had no idea such a person existed,” he said, until his wife read about them in a magazine.

Bernstein, 65, was unable to relocate to care for his family directly. But with care managers, “when something came up, they were there, they stepped up,” he said. “More importantly, they knew what to do when I wouldn’t have. It was tremendously helpful for my peace of mind.”

The same was true with Martinelli’s 85-year-old client in Austin. She spent the night with temporary caregivers and moved into her new home in the memory care unit that Tuesday, after her doctor finally produced the necessary documentation. “She went in just before noon,” Martinelli reported. “She had lunch.”

How was the new resident adjusting? “It’s been OK,” Martinelli said, sounding relieved. “So far, so good.”

The New Old Age is produced through a partnership with .

This article first appeared on �Թϲ�� and is republished here under a .

Doctors Should Keep an Eye on Your Mix of Medication. If They Don’t, You Should.

Paula Span — Mon, 05 Oct 2026 09:00:00 +0000

Medications can snowball as we age. Pill organizers pile up. Prescriptions that are no longer necessary can mix with other drugs to create concerning side effects.

“Once you get to six or seven prescription medications, you get a nearly 100% chance of some sort of side effect or intolerance,” said physician , director of geriatrics at MedStar Washington Hospital Center.

Paula Span writes “The New Old Age” column for The New York Times and �Թϲ��. She joined WAMU’s Health Hub on Sept. 30 to talk about common medications — from aspirin to benzodiazepines — that some older patients are overusing.

Span shared tips for keeping loved ones safe and said it’s important for patients and caregivers to be proactive.

“Doctors prescribe medicine based on the evidence available at the time. But science doesn’t stop,” Span said. “Your doctor might not be up on the latest research. And patients get into a routine. They may not question if they still need the drugs they’ve been taking.”

Experts and pharmacists say: Check with your doctor to make sure the meds you’re taking are still right for you.

The New Old Age

3 Common Drugs Older Adults Might Be Overusing

Not all older people need benzodiazepines, antibiotics, or daily aspirin — and taking them can carry increased risks.

By Paula Span Sept. 17, 2026

This article first appeared on �Թϲ�� and is republished here under a .

Drugs Are Widely Used To Sedate Dementia Patients. Her Sons Wanted To Keep Her Off Them.

Jordan Rau — Wed, 30 Sep 2026 09:00:00 +0000

In December 2024, Marjorie Tingley’s adult sons received an urgent email from the dementia care unit at Vista Grande Villa, a Michigan senior living community. They were told that their 85-year-old mother was a major safety threat.

On at least 10 days in the previous month, Tingley had hit, kicked, or elbowed aides when they were trying to help her change her briefs, get dressed, bathe, or go to the bathroom, according to Vista Grande behavior logs. Vista Grande wanted permission to sedate her.

Into the new year, Tingley’s sons and Vista Grande fiercely wrangled over one of the most contentious topics in long-term care: the use of antipsychotic medications to pacify agitated people with dementia. The medications come with risks: The Food and Drug Administration requires pharmaceutical companies to warn that these potent drugs increase the chance of death in older people with Alzheimer’s and similar diseases.

More than have a diagnosis of dementia. Despite a 14-year campaign by the federal government to reduce the use of psychotropics, 1 in 4 Medicare beneficiaries with dementia are potentially inappropriately prescribed antipsychotics and other brain-altering medications that can cause delirium, falls, and hospitalizations, a estimated.

While some families and guardians agree that the benefits of these drugs outweigh the risks, those with misgivings confront a wrenching choice: consent to drugging loved ones or risk eviction from a long-term care facility.

As the Tingleys alternately acquiesced to and resisted Vista Grande’s insistence on medication, administrators started calling 911 after altercations, according to ambulance and police dispatch records. Tingley was repeatedly taken to the emergency room for assessment, hospital records show.

After four trips, Vista Grande gave Tingley a 30-day eviction notice, and it sent her to the hospital four more times while the family was arranging a new placement, medical records show.

“I want her out of here,” a flustered administrator told an ambulance crew, one entry shows.

Marjorie Tingley was taken to an emergency room eight times after a series of incidents in which she exhibited aggressive behavior at her memory care facility, according to medical and facility records. A pending lawsuit by her family alleges Vista Grande Villa, the senior living center in Michigan, initiated the ER trips in retaliation for disagreements with the family about Tingley’s care. Vista Grande and its director have denied the allegations. (David Tingley)

Tingley died at another facility in January 2025. The cause was plaque buildup in her brain, a , a degenerative brain disease and the most common type of dementia.

“They just wanted to have her drugged up,” David Tingley, one of her five sons, said about Vista Grande in an interview. “It’s a lot easier to take care of someone who’s just out of it.”

Her sons’ lawsuit against Vista Grande and its director at the time accused them of negligence, causing emotional distress, and wrongful eviction. The suit also asserted Vista Grande initiated the ER trips in retaliation for the family’s disagreements about Tingley’s care. Vista Grande and its director have denied the allegations. Their attorneys and the director did not respond to requests for comment.

In a legal filing, Vista Grande called the drugs recommended to the Tingleys “routine medication” and said it sent their mother to the hospital “because of her family’s refusal to allow Ms. Tingley to be treated on site.”

A Michigan Circuit Court judge has dismissed the negligence claim on legal grounds. A trial is scheduled for early next year on the remainder of the lawsuit if mediation fails.

Earlier this year, Vista Grande, which was a nonprofit, became a wholly owned subsidiary of Otterbein SeniorLife, which renamed it Otterbein Jackson SeniorLife Community. Otterbein is not named in the lawsuit, and representatives did not respond to requests for comment.

Dangers of Aggression

Diseases that cause dementia damage the parts of the brain that regulate impulse control and perception. Impaired people can become aggressive because of fear — especially when they no longer recognize their caregivers — or because they have no other way to communicate that they are in pain, are hungry, or have some other need.

Altercations between agitated people with dementia and other residents or workers charged with caring for them are in long-term care facilities and private homes. �Թϲ�� previously found that federal inspectors have cited nursing homes more often for resident-to-resident abuse than for any other type of abuse, neglect, or exploitation.

Those dangers are particularly true in the more than that specialize in dementia care, usually in locked buildings or units populated by people with cognitive damage. These memory care facilities promise specially trained staff and meaningful activities for residents and usually charge more than standard assisted living.

The long-term care industry’s reliance on tranquilizing medications has been a concern of Congress for half a century. A stated that “an ugly pattern of prescription drug misuse, with harsh consequences to patients, exists in many nursing homes of the United States.”

A National Campaign

In 2012, the Centers for Medicare & Medicaid Services launched its to target overprescribing. It has shown some success with reducing the use of antipsychotics, which the FDA has approved primarily for people with schizophrenia. Excluding those patients, antipsychotics were given to nursing home residents in 2025. An inspector general identified “alarming instances of inappropriate use of antipsychotic drugs.”

Nationally, nearly in assisted living facilities have Alzheimer’s or other diseases and conditions that cause dementia. Unlike nursing homes, assisted living facilities don’t provide skilled medical care around the clock, but they help people with fundamental activities like bathing and eating. States regulate them, not the federal government.

A study published in 2023 in JAMDA, the journal of the society representing post-acute and long-term care medicine, found that, on average, assisted living residents with dementia for 13% of the time they lived there. Other researchers through 2017 concluded the federal campaign “did not appear to affect antipsychotic prescribing” in these residents.

Lauren Gerlach, a geriatric psychiatrist and an associate professor at the University of Michigan Medical School, said there is evidence that aggressive behaviors are better addressed by non-medication interventions, like looking for underlying medical issues or heading off situations that typically upset the person. But, she said, “for some patients, these behaviors are so severe that medications will be required.”

A Steady Decline

The details of Marjorie Tingley’s time at Vista Grande — as alleged in documents filed in the lawsuit; records provided by the Tingleys and their lawyer, Ron Marienfeld; and interviews and emails with the family — provide an unusually intimate look into what can happen when families and caregivers clash over brain-altering drugs.

A Detroit native, Tingley was a volunteer reading teacher in the Jackson, Michigan, public school system and worked in the general office. Later, she was a certified financial planner. Her sons said she was successful but made less money than she might have, because she didn’t direct investments to get the highest commissions. Instead, she did what she thought was best for clients.

“She was just so honest,” David Tingley said.

She was an active member of the Catholic Church. Her husband, Eugene, died in 2010.

Vista Grande Villa gave Marjorie Tingley an eviction notice after her sons resisted requests to sedate their mother with medications, medical records show. She died less than two weeks after moving to a new facility. (David Tingley)

Around 2018, her sons noticed she was becoming forgetful, not taking her regular medications or recognizing aides they had hired. David and his brother Mark, who shared power of attorney, said in an interview that their mother’s memory deteriorated further after a head injury in a 2019 car collision.

They hired caregivers to help at her home in Jackson, but by 2021, they decided she needed to be in a facility, choosing the assisted living unit at the nonprofit Vista Grande.

In 2023, Vista Grande told them that their mother’s dementia had progressed and that she needed to go into the memory care unit or leave. Vista Grande’s memory care marketing materials said its “dedicated team creates an individual program of support for each resident” and “provides for the precise services you need.”

David said they reluctantly agreed to the move but thought the quality of care was better in general assisted living, even though memory care cost more. Vista Grande charged Tingley $9,150 a month for memory care, her lease shows.

‘These Pills Have Side Effects’

Vista Grande first contacted the Tingleys in early December 2024 about behavioral incidents. According to facility records, Marjorie Tingley pushed an aide trying to help her use the bathroom and the aide almost fell. She yelled and kicked at staff trying to put on her shoes and socks. She wandered into another resident’s room and took a walker.

The facility requested permission to medicate Tingley, but her sons said they first wanted her checked for a urinary tract infection, which they said had caused her agitation in the past. “These pills have side effects,” Mark said. “I thought, ‘Personally, I don’t want her to have that.’”

Vista Grande collected the sample but didn’t ensure it was tested by a lab for more than a week, by which time the test had to be redone, according to facility and medical records.

In mid-December, Vista Grande sent Tingley to Henry Ford Jackson Hospital for a mental health evaluation, at which psychiatrists could decide whether she required involuntary hospitalization. Doctors did not find that necessary, but they confirmed a urinary tract infection and she was given antibiotics. Vista Grande declared she could not return unless the family agreed to sedating medication, according to hospital records.

In a court filing, Vista Grande said Tingley had become a “danger to herself and others.” Mark recalled feeling at the time that: “It’s like they’re holding her ransom unless I say she can have that pill.”

Medication Begins

The specific medications were prescribed either by hospital doctors or a nurse practitioner working for a medical group that serviced residents of Vista Grande and other long-term care facilities, medical records show. David said Vista Grande had encouraged the family to replace their mother’s longtime physician with that medical group. The lawsuit did not name the nurse, the medical group, or the hospital as defendants. Henry Ford Health declined to comment.

The brothers allowed Vista Grande to give their mother the drug Ativan, the brand name , as needed. Ativan is not an antipsychotic but a benzodiazepine that the FDA for people with anxiety. The label says it can , unsteadiness, and weakness and is supposed to be used “with caution” in patients with breathing problems — like Tingley, who had sleep apnea. It can cause “paradoxical” reactions such as agitation and rage.

After a week, Vista Grande workers gave “mixed reports” about whether the Ativan was calming Tingley, according to her medical records. Employees said she still would yell and was “very agitated.”

The family said they authorized Vista Grande to replace Ativan with a low dose of Zyprexa, the brand name for the , which the FDA has approved to treat schizophrenia and bipolar disorder. The FDA requires Zyprexa to carry a stating that it is not approved for the treatment of patients with dementia-related psychosis and places them at greater risk of death.

Nonetheless, Zyprexa has a long history of being prescribed that way. Eli Lilly, the drug’s manufacturer, pleaded guilty in 2009 to allegations that it improperly promoted the use of Zyprexa for dementia with long-term care providers and primary care physicians. The company a criminal fine and civil settlement totaling $1.4 billion.

The black box warning on Zyprexa alarmed the sons, and their online research made them worried that Zyprexa could damage their mother’s heart, since she had . While the family approved the prescription, they authorized only 2.5 milligrams of Zyprexa a day, half the starter dose recommended by Eli Lilly.

‘She Could Barely Function’

On both New Year’s Eve and New Year’s Day, Vista Grande sent Tingley to the emergency room. On Jan. 2, Vista Grande gave the family the 30-day eviction notice. “We have determined we are unable to meet the level of care and expectations required for your mother’s well-being,” it said in the letter.

While the family started looking for another facility, Vista Grande sent Tingley to the ER four more times.

Vista Grande Villa gave Marjorie Tingley an eviction notice after her sons resisted requests to sedate their mother with medications, medical records show. Tingley’s family said she was being excessively sedated. “She could barely function,” her son David says. (David Tingley)

A psychiatrist consulting with the hospital endorsed doubling the Zyprexa to the starter dose recommended by Eli Lilly, and the Tingleys consented, according to medical records.

For five days, there were no incidents at Vista Grande, according to her medical records. But the family alleged in court filings that Tingley was being excessively sedated. They instructed that the Zyprexa be cut back to its initial level, according to her medical records.

“She could barely function,” David said in the interview.

The sons said they were especially disturbed to learn she was being given both Ativan and Zyprexa after they had approved Zyprexa as a replacement drug.

Reports from emergency room crews and the hospital made the sons doubt their mother was as aggressive as Vista Grande described, they said. Those records show that throughout the ER trips, Henry Ford employees and ambulance workers generally found Tingley cooperative and polite.

A nurse said Tingley allowed her to braid her hair and blew her kisses when she left. “Just the sweetest patient and very loving,” another ER worker wrote in the medical records. A physician noted the discrepancy from what Vista Grande was reporting, writing in her record: “Her behavior on what I am witnessing is completely contrary to what they are indicating.”

In a legal filing, Vista Grande attributed Tingley’s calm to medication and the “familial love and attention” her sons gave her at the emergency room.

“The next time Ms. Tingley decompensated, the cycle predictably resumed,” Vista Grande said in the filing.

Vista Grande reported that aggressive behaviors resumed and continued sending Tingley to the hospital. On the last trip, Jennifer Wheeler, then-director of Vista Grande’s memory care unit, told ambulance workers that Marjorie would not be accepted back, according to EMS notes. “She is a danger to other residents and a danger to my staff,” Wheeler said.

Tingley stayed in the hospital until she was moved to another memory care facility in Jackson. on Jan. 26, 2025, less than two weeks later.

Her sons asserted in their lawsuit that the frequent trips back and forth to the hospital hastened their mother’s demise.

“They weren’t really caring about my mom,” Mark said. “If they were, they would know that all this back-and-forth to the hospital was no good for her.”

This article first appeared on �Թϲ�� and is republished here under a .

These 100 Nursing Homes Face Perilous Flood Risk. Minnesota Shows What Can Happen.

Wed, 30 Sep 2026 09:00:00 +0000

NEW RICHLAND, Minn. — Floodwater seeped through the nursing home’s front door just before sunrise.

Inside the New Richland Care Center, staff members rushed to move 36 residents out of the building on Sept. 19 while they still could. They pushed elderly residents in wheelchairs through 4-inch-deep water to buses waiting in the parking lot, said nursing home administrator Robert Johannsen.

Inches turned to feet as the last three residents were wheeled out on hospital beds, lifted “as high as they can go” to escape the rising water, Johannsen said. Firefighters and volunteers from a high school football team pushed the beds to safety across the street, he said.

“It’s pretty devastating,” Johannsen said of the now-shuttered nursing home. “There was at least 2½ feet of water flowing down the hallways.”

The small-town, government-run nursing home is about 100 yards from a drainage ditch in southern Minnesota. It has flooded three times in 16 years, including during the September storm that was large but far from historic, according to the National Weather Service.

New Richland is one of 100 U.S. nursing homes that face some of the nation’s worst flood risk — where at least 2 feet of water during a big storm could endanger residents — according to a �Թϲ�� analysis of peer-reviewed flood hazard mapping provided by Fathom, a United Kingdom-based company considered a leader in flood simulation.

The �Թϲ�� analysis builds upon a 2025 investigation that used Fathom’s mapping to identify at least 170 U.S. hospitals at risk of significant flooding. Fathom’s estimates are generally seen as more modern than official flood maps released by the Federal Emergency Management Agency, which are often out of date and don’t account for the changing climate.

“Every community across the United States carries some level of flood risk,” said Oliver Wing, the chief scientific officer at Fathom. “There is this idea that unless you can either see the ocean or the Mississippi from your front room, then you’re not at risk of flooding — when the reality is that anywhere rain can fall, it can flood.”

The U.S. has nearly 15,000 nursing homes housing more than 1.2 million people. In floods and other disasters, the residents are especially vulnerable because many are medically frail, cognitively impaired, or immobile. Some require daily care that can’t be reliably provided during a disaster, yet they are also so fragile that relocation could send them to the emergency room.

Additionally, many nursing homes were built near coastlines or waterways in the 1970s, before widespread concern about climate change, to keep residents cool and content, said David Dosa, the head of geriatrics at the UMass Chan Medical School.

“It’s a lot more comfortable than being in an urban jungle,” Dosa said. “Obviously, now you’re in places that are a little more at risk.”

Dosa has studied nursing home evacuations since Hurricane Katrina flooded the New Orleans area in 2005. Dozens of people were killed in facilities that tried to ride out the storm and flooded after the levees broke.

After Katrina, the nursing home industry pivoted toward evacuations, although some of those decisions also led to deaths, Dosa said.

In preparation for the next three Gulf hurricanes, more than 270 nursing home evacuations were recorded, according to a Dosa co-wrote in 2011. Within the 30 days that followed each storm, the regions hit saw a cumulative total of 277 more nursing home resident deaths than expected, suggesting a “significant increase in mortality and morbidity associated with evacuation,” according to the study.

“It’s Russian roulette. You’re damned if you do. You are damned if you don’t,” Dosa said of evacuations. “Older adults and disasters don’t mix.”

A similar found a 16% greater chance of ER visits among residents of Florida assisted living facilities who were evacuated before Hurricane Irma in 2017. People in assisted living facilities generally need less care than those in nursing homes.

“Assisted living residents are quite frail in their own right,” said Cassandra Hua, an assistant professor at UMass Lowell, who led that study. “But nursing home residents are usually at higher risk. So anything you see in assisted living might be multiplied in a nursing home setting.”

Even a few inches of flooding can interrupt nursing home care and force an evacuation. For each of the 100 nursing homes identified by the �Թϲ�� analysis, Fathom’s data predicted a 100-year flood event could bring at least 2 feet of water to the buildings.

Aerial footage shows lingering floodwater in New Richland, Minnesota. The white-roofed New Richland Care Center can be seen along the upper-left edge of the ponding water. (WCCO/CBS Minnesota)

A 100-year flood is an intense weather event with a 1% chance of occurring in any given year, but it can happen more often. Climate scientists largely agree that extreme weather is worsening as the planet warms, which allows the atmosphere to hold more moisture and causes sea levels to rise.

And storms are drenching regions once considered at lower risk for flooding, where essential facilities and entire communities might be less prepared, said Drew Gronewold, a University of Michigan climate scientist. In other regions, storms are now less frequent but becoming “off-the-charts” powerful, he said.

“Storm tracks are changing their trajectory,” Gronewold said. “These types of, in air quotes, ‘unanticipated events’ are going to be part of our future.”

Some of the nursing homes �Թϲ�� has identified as at risk have flooded in the past five years, including facilities in Florida, Kentucky, Texas, and Washington.

Five of the facilities flooded in 2012 as Superstorm Sandy clobbered New York, according to a report from the , while a sixth, the elevated Seagate Rehabilitation and Nursing Center, narrowly . In Indiana, more than 150 people from the five-story Munster Med Inn during Hurricane Ike in 2008. Members of the National Guard carried some residents down flights of stairs in the dark.

Rescuers from the Indiana National Guard and the Munster Fire Department evacuate a resident of the Munster Med Inn in Indiana, in the wake of Hurricane Ike in 2008. More than 150 residents were evacuated, according to a U.S. Army news release. (Michael B. Krieg/Indiana National Guard)

Then there is the New Richland Care Center. Local media reports show it was evacuated due to flooding in 2010 and 2016, then partially surrounded by floodwater in 2023, before the Sept. 19 evacuation.

Storms dropped 4 to 8 inches of rain on much of southeastern Minnesota the day before, setting off widespread flooding, said National Weather Service meteorologist Brennan Dettmann. The rainfall was heavy for September but would not have been out of place in July, he said.

It was too much for New Richland. Storm runoff from nearby farms pooled in a low-lying baseball diamond at the edge of town before swamping nearby streets. Johannsen, the nursing home administrator, said maintenance workers who were trying to fix sewer drains called him in the middle of the night to warn about flooding in the park across the street.

“They said, ‘You need to come in. The water is rising,’” Johannsen said. “At that point, I think the water was a good 30 feet away from the building. I wasn’t really concerned.”

The New Richland Care Center in southeastern Minnesota flooded on Sept. 19, forcing the evacuation of 36 residents. Some residents were pushed on hospital beds through feet of floodwater to escape the facility, administrator Robert Johannsen says. (WCCO/CBS Minnesota)

Wing, the Fathom scientist, said the danger should have been obvious. Although Minnesota’s natural landscape once would have absorbed heavy rains, the farmland around New Richland funnels runoff into creeks and ditches that lead to a low-lying bowl near the nursing home. It’s almost as if the location is designed to flood, Wing said.

“The choice has been made that we don’t want water in our crop fields. We want it in the nursing homes of vulnerable people,” Wing said. “That’s the choice that has been made, politically, in that part of Minnesota.”

Inside the ruined nursing home, receding floodwaters left behind knee-high watermarks, mud-smeared floors, and a lingering smell that Johannsen said reminded him of growing up on a farm. Water destroyed treasured photo albums left behind in a low cabinet, he said.

Johannsen said the nursing home — which, with 85 employees, is one of the largest employers in town — will be closed for five months to a year for repairs. He said all its residents were moved into a school gymnasium and have been resettled across about nine area nursing homes.

“It was an awful experience that I hope nobody ever has to go through. Because these people lost homes,” Johannsen said. “My staff is losing their jobs. And I don’t know what to do.”

New Richland Care Center administrator Robert Johannsen (left) examines the damaged nursing home in the wake of a Sept. 19 flood that forced the evacuation of 36 residents. Johannsen says the facility will be closed for months for repairs. (WCCO/CBS Minnesota)

Methodology

For this analysis, we used data from Fathom, a United Kingdom-based company that specializes in flood-risk modeling worldwide. To assess the United States’ vulnerability, Fathom uses sophisticated computer simulations and detailed terrain data covering the country. It accounts for environmental factors such as climate change, soil conditions, and many rivers and creeks not mapped by other sources. Fathom’s modeling has been peer-reviewed and used by insurance companies, the World Bank Group, the Nature Conservancy, and government agencies in Florida, Texas, and elsewhere. The Iowa Flood Center has validated Fathom’s U.S. data.

Through a data use agreement, Fathom shared U.S. mapping data that predicts areas with at least a 1% chance of flooding in any given year. Fathom’s data estimates the effects of coastal, fluvial, and pluvial flooding and accounts for dams, reservoirs, and other structures that defend against floods.

To identify at-risk nursing homes, we used a Centers for Medicare & Medicaid Services database to map more than 14,000 nursing homes. With GPS coordinates as the center point, we created a circle with a 100-yard radius around each nursing home, which in most cases captured the building and nearby grounds. We then mapped Fathom’s flood-risk data to see where it overlapped with these circles. We started by looking for nursing homes where at least 20% of the circle’s area had a predicted flood depth of at least 1 foot. That gave us an initial list of more than 750 nursing homes.

Then we visually inspected those facilities using mapping software and Google Maps to confirm that floodwaters were predicted to reach or surround the buildings. We trimmed our list to the 100 nursing homes where the most flooding was predicted, with additional weight given to deeper water.

Our analysis does not account for how flooding beyond a nursing home’s footprint could still affect employees or patients. And it does not assess what steps facilities may have already taken to prepare for severe weather events.

Fathom provided guidance and feedback as we developed our analysis.

This article first appeared on �Թϲ�� and is republished here under a .

Nursing Home Beds Are Becoming More Scarce

Paula Span — Wed, 23 Sep 2026 09:00:00 +0000

The San Vicente de Paúl Nursing Home in the South Bronx hasn’t admitted a patient since December 2024. ArchCare, which operates the facility, has reduced its capacity from 120 available beds to 53 and plans to shrink it further.

Another ArchCare nursing home, on Staten Island, has shut down a full floor. North of the city, in Dutchess County, its Ferncliff Nursing Home has contracted from 309 available beds to 196.

The eight nursing homes owned by ArchCare, a nonprofit that provides eldercare through the Archdiocese of New York, have 269 fewer usable beds than they did 18 months ago, a nearly 12% decline, creating waiting lists for patients seeking long-term care.

Across New York state, 24 nursing homes have closed since 2020, resulting in a loss of more than 3,000 licensed beds, according to LeadingAge New York, which represents nonprofit senior living organizations.

That mirrors . In 2015, the Centers for Medicare & Medicaid Services certified 15,648 nursing facilities. A decade later, that number had fallen by more than 900.

With the oldest baby boomers turning 80 this year, an age when the need for long-term care climbs sharply, researchers are sounding alarms. Will there be enough nursing home beds for a rapidly graying nation?

“We’re seeing a serious problem and it’s heading in the wrong direction,” said David Grabowski, a health policy researcher at Harvard Medical School. He is an author of a study in JAMA Internal Medicine that in national nursing home capacity from 2019 to 2024. “As you look at the demographics, this is only going to get worse, maybe a lot worse,” he said, especially given looming Trump administration policies on immigration and Medicaid financing.

The reasons for the shrinkage?

ArchCare blames inadequate state reimbursement for Medicaid, a perennial industry complaint. The primary payer for nursing home care, Medicaid provides less than the daily cost of care, said Clif Porter, chief executive of the American Health Care Association, an industry trade group.

“Before the pandemic and inflation, the losses were sustainable,” said Jason Hutchens, ArchCare’s chief operating officer. More recently, he said, “we were running at an unsustainable loss — we had no choice.”

Nursing homes, , try to compensate by attracting short-stay patients covered by Medicare, which pays higher rates than Medicaid. When they can’t, “unless you’re extremely rapacious or extremely efficient, you’re not going to make it,” said Vincent Mor, a health services researcher at the Brown University School of Public Health who is an author of an article, published in the New England Journal of Medicine, about reduced capacity. “The numbers don’t add up.”

Staff shortages, which have plagued nursing homes for decades, have also caused contractions and closures. Nursing home aides work stressful, low-paying jobs with historically high turnover rates. Their median hourly wage last year was $20.67, according to , a research and advocacy group for direct care workers. Although pay has risen over the past decade, about 40% of nursing home aides rely on some form of public assistance, such as Medicaid or the Supplemental Nutrition Assistance Program, PHI reported.

The number of nursing home aides has rebounded from the covid pandemic, according to PHI, but fewer are working than in 2015. And while hiring and retention have improved, Porter said, “there’s still a significant gap between demand, especially future demand, and where the workforce currently is.”

National occupancy rates, which fell sharply during the pandemic, have returned to a more typical 80%.

That figure can be misleading; it doesn’t mean 1 bed in 5 sit empty, awaiting a patient. Occupancy counts state-licensed beds, but the more meaningful number is operating beds — how many are actually available depending on a facility’s staffing and other factors.

That number is usually lower and, in many cases, sinking. The American Health Care Association reported in 2024 that almost half of nursing homes were and 57% had waiting lists for new residents.

It’s possible, of course, that they also face financial losses because of lower demand. “Nursing homes close because people don’t want to go to nursing homes,” said Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care, an advocacy group. “The quality is so low that people avoid them like the plague.”

Last year, Medicare inspectors found at least one quality violation serious enough to harm or jeopardize residents in 27% of nursing homes, according to an analysis by KFF, a health information nonprofit.

In recent decades alternatives emerged that diverted patients from nursing homes. About a million older adults currently live in assisted living facilities. And among Medicaid recipients, the ongoing policy shift called “rebalancing” has enabled more people to receive services at home () rather than in nursing homes.

In 1988, only 10% of Medicaid expenditures for long-term services went to home- or community-based services; the rest paid for institutional care. By 2020, more than 60% of expenditures funded home and community care, said Priya Chidambaram, a KFF senior policy manager specializing in Medicaid, citing a staff analysis.

How big a problem these trends pose depends partly on geography. The decline in the number of nursing homes in rural locations — about 10% from 2015 to 2025 — than the national drop of about 6%.

“It’s more difficult to staff a rural nursing home,” Chidambaram said. “Labor pools are smaller, and it’s hard to get people to take lower-paid or part-time jobs if they have to travel long distances.”

Bed shortages are also creating bottlenecks at hospitals. Where nursing home capacity declined, Grabowski’s team found, patients stayed in hospitals longer because they couldn’t locate posthospital care. They often had to travel farther to find facilities. “It gums up the entire system,” Grabowski said.

On two fronts, Trump administration policies could make matters worse, experts said. Revoking legal status for certain immigrant groups .

So far, “we’re not seeing significant impact across the country,” Porter said. But the effects are being felt in specific locations, including Florida, New York, and Massachusetts, he confirmed. With further revocations and deportations, “a lot fewer older adults are going to have caregivers,” Grabowski said.

The administration’s more than $900 billion in cuts to Medicaid over a decade are also expected to exact a toll. As states grapple with reduced funding, analysts expect home and community services to take a greater initial hit than institutional care. But that could increase pressure on nursing homes if patients who lose home care turn to institutions instead.

Less of these services “means more nursing home entry,” Grabowski said.

As policy ideas circulate — with calls for better data tracking, special visas for immigrant health workers, and targeted grants for nursing homes serving high-cost populations — researchers, advocates, and families are waiting to see what unfolds.

“So much of this is speculative,” Chidambaram said. “We don’t know what states will decide. We don’t know how the market will react. We’re in new territory here.”

The New Old Age is produced through a partnership with .

This article first appeared on �Թϲ�� and is republished here under a .

3 Common Drugs Older Adults Might Be Overusing

Paula Span — Thu, 17 Sep 2026 09:00:00 +0000

The scenario often unfolds like this: Medical researchers investigate a frequently used drug and report that it’s less effective for older patients than previously thought, or that its risks outweigh its benefits in older adults. More studies follow, confirming those findings.

After a few years, medical associations revise their guidelines, warning that the drug in question should be avoided or at least prescribed more selectively. It might be added to the Beers Criteria, an influential list of potentially inappropriate medications for older patients, published by the American Geriatrics Society.

If the drug’s role is preventive, the U.S. Preventive Services Task Force, an independent expert panel, may weigh in with cautions. The FDA may issue “black box” warnings about concerning side effects.

After a few more years, researchers look at broad national data to see whether use of this drug declined. Often, the answer is: Yes, but not enough. Sometimes, though, use didn’t decline much at all or actually increased.

“Medications are like barnacles,” said Michael Steinman, a geriatrician at the University of California-San Francisco and co-director of the . “They’re easy to start, but they can be hard to stop.”

This medical inertia partly reflects the time lag involved in disseminating findings. “Clinicians have a million things they need to know and attend to, and information may take a while to get to them,” Steinman said.

But it also reflects the way “clinicians and patients get used to treating conditions in certain ways,” he said. “They become ingrained habits.” Finding alternative approaches is challenging, so “it’s easy to go with what you know.”

Recent studies of three medications or classes of drugs widely used among older Americans illustrate the problem.

The Drawbacks of Benzodiazepines

Scientists began about benzodiazepines more than 20 years ago. Prescribed for insomnia and anxiety, “they offer prompt relief,” said Mark Olfson, a psychiatrist and epidemiologist at Columbia University.

? Benzodiazepines (including Valium, Xanax, and Ativan) and the related “Z” drugs (Ambien, Lunesta) “may impair balance, coordination, and cognition that can translate into falls and fractures and motor vehicle accidents,” Olfson said. In patients also taking opioids for pain, benzodiazepines can cause overdoses.

Moreover, “once you’ve taken them for a period of time, you develop a dependence,” Olfson added. “When you come off them, you may develop withdrawal symptoms.”

So what’s happened to , who are more sensitive to these effects? In a , published in the Annals of Internal Medicine, Olfson and his team reported progress. Among people 65 and older, the rate of patients filling prescriptions for benzos dropped to 11.5% in 2024, from about 14% in 2015.

But that decline has stalled since 2020, perhaps related to the covid-19 pandemic. Moreover, prescribed use actually rose among those over 75, from 12% in 2020 to about 13% four years later. Dispensing through pharmacies in long-term care facilities more than doubled. And about a third of users were taking the drug for longer than six months, increasing the likelihood of dependence. “It’s worrisome,” Olfson said.

But he cautioned that patients shouldn’t stop benzodiazepines suddenly or on their own, which can provoke withdrawal. “It requires supervised tapering” with a medical professional, he said. “It takes many weeks.”

Overprescribing Antibiotics

For years, the standard treatment for diverticulitis, the inflammation or infection of small pouches that form in the colon, was antibiotics, primarily fluoroquinolones (like Cipro and Levaquin) or amoxicillin-clavulanate (Augmentin).

“It was unquestioned,” said Jesse Sutton, a pharmacist and researcher at the Minneapolis Veterans Affairs healthcare system. “Antibiotics are safe and effective, great, lifesaving drugs, so the mindset was: When in doubt, use them.”

But in 2015, the against routinely prescribing antibiotics for “uncomplicated” diverticulitis, which represents a great majority of cases. Other .

Clinical trials had shown that, for this condition, antibiotics on mortality, the need for surgery, complications, or recurrences. “They hadn’t improved anything,” Sutton said.

And as with any drug, “, unintended consequences,” he said. “Side effects from antibiotics account for a ” for symptoms like nausea, vomiting, and diarrhea. Antibiotics heighten the risk of the virulent C. difficile infection, too.

Plus, “the more you use antibiotics, the less they work in the future,” Sutton said. The World Health Organization has “a major global health threat.”

So Sutton and his colleagues, studying treatment in 70,000 visits to 120 VA facilities, expected to see antibiotic use for uncomplicated diverticulitis decline over 10 years.

Instead, they in the Annals of Internal Medicine that antibiotic prescriptions remained nearly universal at 97% of visits, guidelines or no guidelines. The patients would most likely have done as well with a few days of Tylenol and a clear liquid diet.

for other conditions of later life, too, including the kind of that cause no troublesome symptoms and upper respiratory infections that are typically viral, not bacterial.

In such cases, when a doctor prescribes an antibiotic, “I’d encourage patients to say, ‘Please explain the rationale for doing this,’” Sutton said. “If they don’t, it’s OK to press pause.”

When Aspirin Isn’t the Answer

Aspirin is different. Because it’s cheap and sold over the counter, anybody can start taking it on their own — and , thinking it will help prevent cardiac problems.

For people who’ve already had a heart attack, stroke, or cardiac intervention like a stent or bypass surgery, daily low-dose aspirin for “secondary prevention” does lower the odds of another event, studies have demonstrated.

But for “primary prevention” in people who haven’t had one, the guidelines changed in 2019, when the American College of Cardiology and the American Heart Association for this purpose in those 70 or older. The , warning against aspirin for primary prevention starting at age 60.

Large clinical trials had shown scant benefit for aspirin as a primary prevention measure, but there were harms, notably gastrointestinal bleeding. “As we age, the risks of bleeding go up,” said Timothy Anderson, an internist at the University of Pittsburgh who co-directs its Prescribing Wisely Lab. More rarely, but more seriously, aspirin can cause bleeding in the brain.

In a published last year, Anderson and his co-author found the message was getting through: Aspirin use for primary prevention, as reported in the National Health and Nutrition Examination Survey, had dropped substantially from 2011 to 2023. But more than a third of those 70 or older were still taking it.

Some caveats: A subgroup of older adults with high risk factors for cardiovascular disease may benefit from aspirin for primary prevention. And, confusingly, some evidence suggests that older patients already taking aspirin face a higher risk of cardiovascular disease .

“Step 1 is a conversation with your primary care physician” about aspirin, Anderson said. “‘Is this still right for me as I get older?’”

Older patients taking aspirin, , “are interested in reducing their risk of heart attack and stroke,” he said. “They’re trying to be proactive and healthy.” But with blood pressure medications and statins for cholesterol, “we have better strategies than aspirin for that.”

The New Old Age is produced through a partnership with .

This article first appeared on �Թϲ�� and is republished here under a .

Readers Wrestle With Healthcare Inequalities and Want a Word With Congress

Fri, 11 Sep 2026 09:00:00 +0000

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Imbalance of Power — And Healthcare

Why can members of Congress remain on full taxpayer-funded salaries during prolonged medical absences while millions of working Americans cannot afford to get sick? (Kennedy, Oz Contend Fraud Crackdown, Not Skyrocketing Prices, Led Millions To Leave Obamacare, Aug. 3.) Sen. Mitch McConnell’s current extended medical absence brings that disparity into sharp focus. He has missed dozens of Senate votes while continuing to receive his $174,000 taxpayer-funded salary.

Meanwhile, I have a friend who works two jobs and still cannot afford her mortgage and utilities without a roommate. She does not even have basic medical insurance. She earns too much to qualify for government assistance but not enough to comfortably afford insurance along with the basic cost of living. What happens if she gets seriously ill?

She doesn’t have the luxury of taking months off to recover while her income continues. She could lose her income, her home, and everything she has worked for simply because she got sick. Yet she is one of the taxpayers providing that financial security to members of Congress.

McConnell’s situation is particularly striking because of his long legislative history of opposing or limiting federal family and medical leave protections.

If continuing someone’s income while they recover from a serious illness is reasonable and humane when that person is a member of Congress, why isn’t it reasonable and humane for the Americans paying their salaries?

Americans should not face financial ruin because they get sick while their elected representatives enjoy protections unavailable to the people they serve.

— Ruth Bower; Salem, Oregon

Hospice Saga Hits Home

I could really have used the information in the article “My Husband Was Kicked Out of Hospice for Dying Too Slowly” (Aug. 14) before it happened to me. I was notified on a Monday morning by my husband’s residential hospice agency that I needed to find a new place for him ASAP, and “here’s a list of places.” I asked what it would cost for him to stay a day or two — saying I would pay it myself, just tell me how much. They didn’t. So I got on the phone, and it was a hectic and horrifying day calling around for a new place.

My husband had been home twice between hospital stays, had fallen both times, requiring me to call 911, and then he was rehospitalized. I’m 64, and there was no way I could lift my 300-pound husband if he fell again. Even a half-dozen firefighters had trouble.

I spent most of his final day calling hospice agencies, and a representative from one even showed up to visit (uninvited and unexpected). It was scary how little oversight or medical professionalism there was. His life ended about 7 p.m. that evening. We had already stopped his pacemaker a few days before.

I will never forget or forgive that I wasted my last day with him because he was not dying quickly enough for the hospice. He never saw a doctor once he enrolled in hospice. There are great nurses in hospice — I’ve met a few — but there are a lot of places for which this is just an easy revenue stream, and they seem to be in it just for the money.

— Debbie Bond; Corpus Christi, Texas

On Improving the Hospice Experience

Thank you for publishing the article on hospice. As a hospice clinician and leader who has been providing hospice education for over 20 years, I, too, continue to see the need for increased awareness around hospice in our communities. This story is similar to many I have recently collected from families who are searching online, using AI tools that fall short of accuracy, and expressing they are overwhelmed.

As the article states, they were given a list of hospices to pick from; that is common and can be a major cause of panic for families. The article provides nice tips on choosing a hospice, but there is so much more to it. Picking a hospice that aligns with your values is a good first step, but we cannot overlook the idea that people and families need help walking this journey, help with exploring their care goals and wishes.

I recently took on a mission to enhance and make hospice education more accessible. In doing so, I launched an app, , focused on helping people and families learn about hospice before they need it; what hospice is and how it works, when they are ready; and what to understand and expect, all the way to the end. Two important articles were posted this year: a recent one entitled “,” by Kurt Merkelz, and a about how the Centers for Medicare & Medicaid Services could save $1.5 billion annually if hospice were elected just five days sooner.

The data supports that people and families are looking for reliable sources of education. However, the hospice industry as a whole has focused on providing that information once someone is admitted, which is too late.

Educational leaders in our communities need to work together to enhance end-of-life knowledge. Our mission is to give them a tool to make a meaningful impact.

— Jason Kimbrel; Columbus, Ohio

Common Ground: The Height of Folly?

Whoever is investigating common ground between the major political parties (�Թϲ��’ series “Common Ground”) clearly isn’t interviewing or polling Republican members of Congress — although there are probably a few Democrats in Congress who’ve gone along with making cuts to Medicaid and the Supplemental Nutrition Assistance Program, who don’t want to tax the rich more to keep the Social Security trust funds solvent, and who would never, ever vote for national healthcare systems similar to any of those in Western Europe or the Scandinavian nations.

I’ve yet to read that any members of Congress have seriously analyzed how nations with “universal” healthcare coverage manage such a system, and how much it would cost to implement in the United States. That demonstrates that neither party is truly committed to finding a better way to provide healthcare for all of us.

Too many GOP members of Congress have, for many years, tried to privatize Medicare (with some success), cater to healthcare insurers, and in every way demonstrate that they do not share what’s supposedly a general concern: improving the healthcare system in the U.S. and improving access for anyone not superwealthy to good quality healthcare. They should not only be making it more affordable, but making pre-med training and obtaining a doctor or nurse practitioner degree far, far, far more affordable than good programs for obtaining those degrees currently are.

We also need to pay registered nurses better than what they are being paid now, and support the National Science Foundation, the Centers for Disease Control and Prevention, the National Institutes of Health, et al., so that the U.S. continues to conduct medical research and fund the FDA so it can actually regulate the drug industry. We need an affordable drug system, too. Again, too many people in the U.S. can’t afford drugs that are affordable in other nations.

There’s no way the GOP in Congress will fix this. Republican presidents, from Ronald Reagan to the present, could’ve done so and did not. That the GOP has managed to propagandize so many people on vaccines, and toleration of increasingly expensive and poor-quality healthcare (and less access), just goes to show how many in the U.S. seem willing to effectively sabotage their lives — and the lives of their children.

— Susan Hogg; Newport, Oregon

Monopolies Hurt Healthcare Providers, Too

I am a recently retired health executive. I just read the article “Same Knee Surgery, Twice the Price: Hospital Monopolies Push Up Healthcare Costs” (Aug. 10). I loved the article. Very well written. Based on my experience, it is completely accurate. Well done.

However, you omitted a critical factor. During my approximately 40-year healthcare career, I saw the competitive landscape among health insurance companies shrink incredibly. One cannot discuss “merger mania” among hospitals and other medical institutions without acknowledging the negative impact that consolidation of health insurance carriers has had on the industry.

While the article made great points, it failed to articulate the effect insurance carrier consolidation has on healthcare providers’ bottom lines and their ability to negotiate reasonable fees. Your readers deserve to hear a balanced story.

— Quinten Davis; Randallstown, Maryland

Healthcare Students Clutching at Straws

Benjamin Pinckney’s story about the new federal student loan caps upending his dream of becoming a physician assistant is one that many students and prospective students unfortunately know all too well (“He Dreamed of Becoming a Physician Assistant. New Loan Rules May Thwart Him,” June 30). I’m a nurse practitioner and educator myself, and federal student loans were instrumental in my own educational journey. I might not be where I am today without them.

There are many bright, aspiring individuals seeking to become nurses to serve our nation’s growing patient needs. Yet the new federal loan caps have the healthcare workforce clutching at straws, as many students question their ability to pursue higher education. While the goal of lowering the cost of education is worthwhile, the rule risks forcing nursing students to choose between drowning in private, high-interest loans and abandoning their educational goals entirely. Either way, it will weaken our healthcare workforce at a time when the United States is expected to face worsening shortages of advanced practice providers and nursing faculty.

Just consider a few key data points: Demand for advanced practice nurses is much faster than the 3% average growth for all occupations. by 2030, far outpacing the projected number of new nurse graduates. And across the nation currently sit vacant, with about 81% of open positions requiring advanced degrees.

Fewer students can afford nursing education. Combined with fewer opportunities for clinical educators to pursue the advanced training needed to prepare future professionals, that equals a reduced ability of the nation’s healthcare system to meet Americans’ demand for high-quality care.

For now, the healthcare workforce is relieved that the rule has been paused in the courts. Looking ahead, we must actively work not only to control graduate education costs but also expand educational opportunities by championing legislation that designates advanced nursing degrees as professional degrees. Students who wish to become nurse educators and advanced practice registered nurses should be able to secure the federal financial aid they need, which is why legislation like the , the , and the are all so important.

I urge Congress to listen to stories like Pinckney’s and to the countless aspiring nurses across the nation who want to pursue careers that will strengthen our healthcare system but are being held back by loan policies that stand between qualified students and the workforce our country urgently needs.

— Lorie Hacker; Bargersville, Indiana

Rural Healthcare Needs AI That Earns Its Place

Rural patients’ skepticism of artificial intelligence raises an important point (“Patients Wary of Governments, Companies Pushing AI as a Rural Healthcare Solution,” Aug. 11). At this point, there’s not a “should” around AI adoption. It’s more about whether the technology can demonstrate enough value to earn the trust of patients and clinicians.

AI can and will help rural health systems facing staffing shortages, financial pressure, and limited technology resources. But the most meaningful opportunities may initially be behind the scenes. Reducing documentation burden, streamlining referrals, improving scheduling, and automating repetitive administrative work can give clinicians something rural communities urgently need: more time to care for patients.

That’s very different from asking patients to replace a trusted relationship with an AI avatar or chatbot.

Healthcare leaders should resist measuring success by how many AI tools they deploy or how many people use them. Rural AI investments should be judged by outcomes. Did clinicians save time? Did patients get appointments sooner? Did the technology reduce costs, improve efficiency, improve access, or produce better clinical results?

Because many AI tools have been developed using data and infrastructure from large health systems, rural organizations also need rigorous evaluation, strong governance, and reliable data before scaling them.

Patient skepticism is not an obstacle to innovation. It reminds us that technology earns trust through results. If AI gives rural clinicians more capacity to deliver human care — and health systems can prove it does — it can become part of the solution without pretending to be the solution itself.

— Jason Griffin; Missouri City, Texas

This article first appeared on �Թϲ�� and is republished here under a .

When a Friend Becomes a Caregiver

Paula Span — Thu, 10 Sep 2026 09:00:00 +0000

For several years, Nicole Straight and Patricia Wood, who lived across the street from each other in Sausalito, California, were more neighbors than friends, exchanging sociable greetings and occasionally having coffee.

Then, last October, Wood took a fall, broke her neck, and spent three months in rehabilitation. When she returned to the house she shares with her niece, she couldn’t walk without assistance. “I still don’t dare go up and down stairs unless someone is with me,” said Wood, 93.

That has redefined their neighborly relationship. Straight, 53, a retired chef, now visits weekly, bringing lattes and cookies, and often leftovers from dinners she has made. Her husband installed a grab bar in Wood’s bathroom, put up shelves, and changed her light bulbs and smoke detector batteries. The texts fly back and forth.

Straight calls to say I’m going to the grocery store. Do you need anything? Wood, who no longer drives, provides a shopping list.

“She is a gift from heaven,” said Wood, a retired insurance executive. “We talk and talk. Sometimes we shed a few tears, but mostly we laugh. I never thought I’d have a new best friend at this time of my life.”

Eldercare, typically considered a family obligation, is evolving to adapt to demographic shifts that make reliance on spouses and children less assured.

“The number of older adults who have never married or are divorced has been increasing, so we have more people aging alone,” said Deborah Carr, a sociologist at Boston University who has investigated these trends.

“The proportion who are childless, by choice or not, is also growing,” she added, and families with children have fewer of them than in past generations.

Geographic distances or also fuel the need for other kinds of caregivers — roles that friends or neighbors can fill.

How commonly do friends step into caregiving gaps? A recently published study in JAMA Network Open, led by researchers at the University of Michigan, looked into , usually in supplementary roles.

They used data from the National Health and Aging Trends Study, in which more than 2,600 older people with health limitations (average age: 79) identified friends and family members who provided help. Family members were most likely to care for aging relatives, but about 14% of participants identified friends (including neighbors) in that role. That represents 2.4 million caregiving friends nationally, the authors estimated.

Last year, a by AARP and the National Alliance for Caregiving put the proportion of caregivers supporting nonrelatives at 11%.

“Friends are among the auxiliary caregivers who have not been acknowledged,” said Karen Fingerman, a gerontologist at the University of Texas-Austin and co-author of a the study. “We neglect the sacrifices they make.”

The study, believed to be the first nationwide look at caregiving friends, found they functioned differently from relatives. They’re unlikely to live with the person they’re helping, for example, and rarely serve as the sole caregiver.

“They provide fewer care hours,” said Yee To Ng, a gerontologist and lead author of the study, which found that friends supplied 18 hours of help a month on average, compared with about 67 hours from family.

They assist in different ways, too. “Friends are more likely to provide transportation,” Ng said. Two-thirds of caregiving friends drive their friends around; shopping, helping people go outside, preparing meals, and accompanying patients to medical appointments round out the top five tasks.

Sometimes they do more. Czes Ferrino, 82, is widowed and lives alone in Westerly, Rhode Island. She has no disabling health problems, but when her car died recently, her next-door neighbor went with her to several Subaru dealers to find a used replacement. “He walked me through it like a son would for a mother or grandmother,” Ferrino said.

On the other hand, “there are some tasks friends might not be well equipped to provide or be comfortable with,” Ng said. Personal care, like bathing and dressing, remains largely the province of family members.

“Those can infringe on people’s self-esteem,” Ng said. “With family, we accept that when you’re really ill, they step up with intimate activities. It’s embarrassing to have your friends help you use the toilet.”

The researchers also found that respondents who named friends as caregivers were younger than those with only relatives in that role, and more apt to have college degrees. People with higher education levels have larger social networks, Fingerman said.

Those assisted by friends were also, unsurprisingly, less likely to be married and more apt to live alone — like Ann Greenwater, 84, who lives in a mobile home park in rural Humboldt County, California.

She managed independently until a few years ago, when severe back pain rendered her bedridden for nearly three months. Although she’s up and about now and can handle housekeeping, cooking, and personal care, “I’ve never really fully recovered,” Greenwater said.

She is single, with no family beyond a distant nephew she barely knows, and has stopped driving. But a cadre of friends she knows from a nearby Zen Buddhist center stepped in.

Milli Quam, 86, does her laundry and drops it off, sometimes picking up prescriptions en route. A 73-year-old helped Greenwater with her computer and, along with several others, takes her grocery shopping or shops for her. Members of a local volunteer organization drive her to medical appointments.

“I love Ann, and I’m happy there’s something concrete I can do,” Quam said. “I hope I can keep doing it for a long time.”

Friends have some advantages as caregivers. “Our friends are our own age and understand what we’re going through,” Carr said. “They may have more empathy and sometimes real knowledge they’ve acquired.” When family caregivers are on the job, friends’ efforts can reduce their burden.

But nonrelatives may also prove less stable as a source of help. Neighbors move. Strains can develop if the person needing care becomes too demanding or feels guilty about accepting help, challenging the egalitarian expectations for friendships. These in those with physical limitations, a study led by Carr found.

Nor is there much policy support for these caregiving relationships. The federal Family and Medical Leave Act, for instance, “with rare exceptions does not provide job-protected leave from work to care for a friend with a serious health condition,” Laura Lawless, a labor and employment lawyer with Squire Patton Boggs, said in an email.

“For family, ‘through thick and thin’ is the expectation,” Carr said. “There’s huge stigma to being estranged from your family, but it’s kind of normal for some friendships to just fall away.”

In Sausalito, Wood tells Straight that “she’s not allowed to move until I die.” She’s joking, sort of.

Greenwater’s friends in Humboldt County, to her gratitude, have not fallen away either. But they are aging along with her; at 86, Quam pointed out, she may stop driving before long, too.

“I’m wondering what will happen when these friends aren’t able to come to me,” Greenwater said. “I guess we’ll deal with it when it comes.”

The New Old Age is produced through a partnership with .

This article first appeared on �Թϲ�� and is republished here under a .

Aging Archives - �Թϲ�����

More Medications, More Risks. If You’re Worried, Start a Deprescribing Discussion.

Readers Are Pleading To Make American Healthcare Greater

Aging Life Care Managers Can Be a ‘Godsend’ for Families

Doctors Should Keep an Eye on Your Mix of Medication. If They Don’t, You Should.

3 Common Drugs Older Adults Might Be Overusing

Drugs Are Widely Used To Sedate Dementia Patients. Her Sons Wanted To Keep Her Off Them.

These 100 Nursing Homes Face Perilous Flood Risk. Minnesota Shows What Can Happen.

Nursing Home Beds Are Becoming More Scarce

3 Common Drugs Older Adults Might Be Overusing

Readers Wrestle With Healthcare Inequalities and Want a Word With Congress

When a Friend Becomes a Caregiver

Aging Archives - �Թϲ��