Young diabetes coalition coordinator forms partnerships to uncover and fight the disease in five Eastern Kentucky counties

By Mallory Powell
University of Kentucky

Growing up in Hazard, Brittany Martin was familiar with diabetes. Many of her older relatives had been diagnosed with the chronic condition, and her younger family members were starting to develop it as well. In a state with one of the highest rates of diabetes — 11.3 percent of adults had a diagnosis in 2014 —Martin’s family wasn’t out of the ordinary, but she found the status quo unacceptable.

Since she graduated from the University of Kentucky in 2014 with a dual degree in biology and sociology, Martin’s family history and her interest in health have converged in her current role as coordinator of the Big Sandy Diabetes Coalition, where she serves as an AmeriCorps Vista volunteer.

Brittany Martin administers a diabetes screening. (UK photo)

The coalition, based at Big Sandy Health Care in Prestonsburg, aims to improve detection, prevention and treatment of diabetes through screening and connection with local resources; it serves Floyd, Johnson, Magoffin, Martin and Pike counties, the Big Sandy Area Development District.

Diabetes is especially prevalent in the region, with 13 percent of adults diagnosed with it. In Pike County, the rate is at least 16 percent.

The rates are based on surveys that ask people if they have been diagnosed with the disease. An estimated 138,000 Kentuckians are thought to be living with undiagnosed diabetes.

As diabetes coalition coordinator, Martin juggles many responsibilities, from hosting community screenings to planning board meetings and writing a regular newsletter. It didn’t take her long to observe that irregular screenings, a lack of follow-up, and shortage of robust data inhibited diabetes prevention and care at both individual and community levels.

“We decided we wanted to set up more systematic screenings, instead of opportunistic screenings, and eventually set up a diabetes registry and keep track of participants,” Martin said.

She is now leading a project to determine whether regular community screenings and targeted follow-up can help to identify undiagnosed cases, measurably improve health, and reduce the emotional and economic burden of diabetes through connection with local resources.

"Brittany’s important work, receptivity to our input, and unparalleled enthusiasm have made her a stellar CLIK participant," said Nancy Schoenberg, co-director of community engagement and research for the CCTS. "She is an ambassador for UK, the CCTS and CLIK, sharing her expertise and her commitment to the health of residents of the commonwealth."

Martin, a registered phlebotomist, has personally screened 586 people since she began working with the coalition in August 2015. At each initial screening, she gathers baseline data and provides diabetes education. She then follows up with people who are diabetic or pre-diabetic to connect them with local resources and encourage them to come back for screening in six months.

Much of Martin's work has been supported by grants and training from the University of Kentucky Center for Clinical and Translational Science, which facilitates interdisciplinary and community-engaged health research with a focus on Appalachia. A CCTS community engagement grant provided funding for a pilot study of diabetes screening at a senior living center in Pike County.

Martin, 25, has since received further funding and research training through the CCTS Community Leadership Institute of Kentucky, which aims to enhance the capacity of local leaders to address health challenges.

Through CLIK, Martin received training on evidence-based interventions, data mining for research, and data collection and analysis — essential skills to assess the impact of a project. Equipped with this additional expertise, she is now researching the effectiveness of her diabetes screening system in Martin County.

The opportunity to work in several Appalachian counties, especially Kentucky's two easternmost, has enlightened even a native of the region about its diverse needs and challenges.

“People speak of Appalachia as a whole, but Martin County has so much less than Pike County,” she said. “Martin County doesn’t have a hospital. They have such a lack of access to care. They have one grocery store. It was very hard for me to find the resources to give them.”

Depending on the month, Martin hosts up to 10 community screenings across the five counties served by Big Sandy Health Care.

The results alarm her. “It’s actually kind of scary. Roughly 24 percent of people are pre-diabetic and 25 percent are diabetic. That’s roughly half of my sample in the red zone,” she said.

Martin sees particular challenges for individuals who face multiple health issues and dire socioeconomic circumstances. “Sometimes we’ll go do screenings in the homeless shelter. Imagine being homeless and diabetic. Sometimes people are also recovering from addiction. Really, can you imagine being homeless and diabetic and recovering from an addiction?”

At some of the community screenings, people have been surprised to learn that they’re diabetic or at immediate risk. In a screening at Big Sandy Community and Technical College, she said, many students “learned that they had pre-diabetes, and they were in their early 20s. It was scary for them. One person was diabetic and didn’t know it. At all ages we’ve screened, there’s been at least one person who’s said ‘Oh my god, I didn’t know, I didn’t know the signs.’”

However, the data she has gathered encourages her about the potential impact of systematic community screening with targeted follow-up.

Her initial screening study in Pike County found that 50 percent of people who received follow-up information and returned for their six-month screening had lower A1C levels, the essential measurement for a diagnosis of diabetes.

Martin's demonstrated success has also yielded nearly $20,000 in outside funding to pay for community screenings and upcoming educational classes. The Anthem, Aetna and Passport health plans have provided a total of $11,000 in sponsorships for screenings. It costs about $7 to screen one person.

Martin also recently received a $9,000 grant from Marshall University in West Virginia to support diabetes education classes in Big Sandy communities, with “gentle yoga” exercises for their clients in order to increase movement and activity, especially for individuals who are wheelchair-bound or have trouble exercising.

“There are a lot of positive health effects of gentle yoga,” she said. “We work with the aging population, and as they age we want to keep them moving. Safe, slow movements, even if someone is wheelchair-bound, can help keep away chronic effects of things like diabetes.”

Martin is developing yet another partnership to integrate retinopathy eye screenings at some community-outreach events. Over the course of nearly 600 diabetes screenings, Martin observed the a great need for eye care, and engaged both UK and the new Kentucky College of Optometry at the University of Pikeville to provide retinopathy screenings at some of her events.

When Martin isn’t busy with her full-time (and mostly unpaid) work as the diabetes coalition coordinator, she works at least 30 hours a week as a waitress. She is also studying for the Medical College Admission Test and the Optometry Admission Test, with plans to apply to medical and/or optometry school at Pikeville. Her ultimate goal is to become a practicing physician in a rural community.

She has a demanding portfolio of responsibilities, and says she sleeps about five hours a night but doesn’t tire of her work: “I’m right where I’m supposed to be.”

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Ky. leads nation in cancers that are caused by a virus for which there is a vaccination, but most kids don't get the vaccinations

By Melissa Patrick
Kentucky Health News

Kentucky has the highest overall rate of cancers associated with the human papillomavirus, and among females is tied for highest with West Virginia, while at the same time falling in the bottom 10 states for vaccinations that can keep the virus from causing cancers, according to a federal Centers for Disease Control and Prevention report.

"Kentucky faces many challenges when it comes to encouraging parents, adolescents and providers to understand the importance of the HPV vaccine," Dr. Ardis Hoven, infectious-disease specialist for the  state Department for Public Health, said in an e-mail to Kentucky Health News.

Speakers at a recent HPV conference in Lexington placed most of the blame for the poor uptick of HPV vaccinations on physicians, because many of them still don't strongly recommend it. They cited a study showing that a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether children get vaccinated.

The speakers offered several reasons for the lack of such recommendations: The vaccination isn't required by law, many physicians don't realize its importance, some falsely believe that it takes too much time to explain, and the vaccine treats diseases that pediatricians don't deal with. They also noted that the vaccine's greatest obstacle is that it is associated with a sexually transmitted disease.

“In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer,” Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center in Columbus, told HealthDay News. “Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe,”

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through any skin-to-skin contact.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls, though it can be given through age 26 for females and age 21 for males. It is recommended at an early age because adolescents have the best immune response to the vaccine, are more likely to keep coming in for annual visits and most are not yet sexually active and therefore not likely to have been exposed to the virus.

HPV infections cause more than 90 percent of anal and cervical cancers and 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.

The CDC report found that there were almost 39,000 annual cases of HPV-related cancers in the country between 2008-12, a 16 percent increase from the previous five year period. Most of these cases were oral cancers in men and cervical cancers in women, 12.638 and 11,771 respectively.

The data showed that almost 80 percent of the cancers were caused by two strains of the virus that are covered by all of the commercially available vaccines and 10 percent were caused by five other HPV strains that are covered by the newer nine-valent vaccine.

In Kentucky, only 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 were vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.

Hoven said that Kentucky is working to improve its HPV vaccination rates. She noted such efforts as its HPV initiative team, which has created a comprehensive statewide plan to prevent and control HPV infections; a statewide media campaign last summer to encourage parents to get their children vaccinated; ongoing outreach to universities and colleges about the need to immunize students; and a current survey of knowledge among teens and adults about the importance of HPV vaccinations.

The state health department "has taken up the challenge of improving vaccination rates in the state, and will continue this effort going forward," Hoven said.

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Kentucky's 40% surcharge for smokers on Obamacare plans probably scared some away, hasn't encouraged them to quit

Allowing insurers to charge smokers extra for Obamacare health insurance appears to have discouraged them from getting it, "undercutting a major goal of the law," Carolyn Y. Johnson reports for The Washington Post. "The surcharges, of up to 50 percent over nonsmokers' premiums, also showed no sign of encouraging people to quit." That's according to a study at the Yale School of Public Health, published in Health Affairs.

"To explain how the surcharge works, Friedman and colleagues provided this example: Take the case of a 49-year-old with an income at 150 percent of the poverty level. If that person were a nonsmoker, he would pay only $60 per month for a particular health plan, because the tax credit would pay the rest," Johnson writes. "But the premium surcharges that smokers face are not eligible for tax credits. So a smoker would — based on an analysis of 43 states that allowed surcharges in 2014 — pay a median $70 surcharge on top of that premium, doubling their out-of-pocket costs of insurance."

26.5 percent of Kentuckians smoke, second only to West Virginia.

Kentucky was one of those states, allowing surcharges of up to 40 percent. It has the nation's second-highest smoking rate, 26.5 percent.

The researchers found that in 2014, the number of U.S. smokers with insurance rose to 76 percent, from 70 percent in 2013, but "estimated that if the surcharges did not exist, that number would have risen to 80 percent," Johnson reports. "The effects were especially noticeable for smokers under 40 years old. In 2014, 65 percent of the smokers in the sample had health insurance, but 75 percent would have enrolled if the surcharges were eliminated, the researchers estimated."

Scaring away younger smokers backfired. "Younger smokers tend to have health-care costs similar to other young nonsmokers, so their participation in the marketplaces helps balance the risk and makes insurance work," Johnson notes. "Second, stopping smoking when people are younger can have big, long-term health benefits for individuals and in helping to prevent costly chronic conditions."

A spokeswoman for the Centers for Medicare and Medicaid Services noted that before the health-reform law, insurance companies could refuse to cover smokers. And the law required insurance plans to pay for smoking-cessation programs and medications.

The authors of the study said states could reduce or eliminate the surcharges, or (and this would be harder to administer) eliminate them for people who enroll in smoking-cessation programs. "A separate concern that Friedman raised was that the rules could lead people to lie about whether they smoke, to avoid the surcharge," Johnson reports. "If that also led to patients lying to their doctors, it could have real public-health consequences."

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Obamacare's 2017 California Rates to Increase an Average of 13% With the Biggest Players Going Up 17.2% and 19.9%

After last year's 4% rate increase, California's Obamacare insurance exchange rates appear to be catching up to the rest of the country.

The two biggest carriers are raising rates by much more than the average 13.2% increase. Blue Shield said its average increase was 19.9% and Anthem said it would increase rates an average of 17.2%

According to the LA Times, Covered California officials blamed

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UnitedHealth's Optum Division Settles Case Alleging it Enrolled Non-Terminally Ill Patients in Hospice, Thus Risking Their Deaths Due to Treatable Illnesses

Fraudulant hospice enrollment is a uniquely dangerous practice, yet the latest cases of it have, as usual, attracted little attention.

Background

As we have discussed before, hospice care was initially designed to provide more humane treatment of the terminally ill, particularly patients with advanced cancer.  The idea was that rather than subjecting such patients to futile, but often painful or dangerous treatment, they would receive humane, palliative care.  Hospice care initally was provided in the US by small, local non-profit organizations.  But since Medicare pays for hospice care fairly well, for-profit corporations soon got into the act.  As we have discussed previously, some hospices, often but not always for-profit, began to admit patients who were not terminally ill.

The danger is that hospice care specifically excludes potentially curative care, such as antibiotics for infection or surgery for appendicitis.  So if a patient who is not terminal is in hospice and that patient develops severe bacterial pneumonia, that patient may not get antibiotics and thus may die of a potentially curable disease. 

We have been writing about this dangerous aspect of modern hospice care since 2011 (look here).  In various posts here we have detailed particular cases of non-terminal patients admitted to hospice who later died, seemingly of the neglect of treatable illness mandated by the concept of hospice care.  There have also been cases in which patients with chronic pain, but no terminal illness, may have died from hospice's overly aggressive use of narcotics .  For example, in a 2014 Wasthington Post story,

Clinard 'Bud' Coffey, 77, a retired corrections officer, did the crossword in The Charlotte Observer after breakfast every morning, pursued his hobby of drawing cartoons, talked seven or eight times a day to his son Jeff and, just two weeks before his death, told a pal that he still felt 'like a teenager.'

He did, however, have some chronic back pain, and in late March he was enrolled in hospice care 'essentially for pain management,' his doctor said. Over a two week period, he received rising doses of morphine and other powerful drugs, grew sleepy and disoriented, and stopped breathing, dying peacefully at home, according to his family and medical records they provided.

The Latest UnitedHealth/ Optum Case

The latest case of allegations of fraudulant hospice enrollment involved a very big, very profitable corporation.  As reported in detail only in the Minneapolis Star-Tribune,

A division at Minnetonka-based UnitedHealth Group is paying $18 million to settle allegations that it submitted false claims to Medicare for hospice patients who were not terminally ill.

The payment announced this week resolves a whistleblower lawsuit against Optum Palliative and Hospice Care that alleged the company tried to boost the number of patients for whom it could bill the federal Medicare program, without regard to whether they were eligible for and needed hospice services.

UnitedHealth Group's Optum subsidiary is a fairly big player in the commercial hospice world,

Optum/Evercare provides hospice care in 12 U.S. markets, including Arizona and Colorado. It does not operate in Minnesota.

The Strib provides a bit more detail about what seems to have happened.

The government alleged that false claims in the case were submitted to Medicare from Jan. 1, 2007, through Dec. 31, 2013. The lawsuit argued that Optum discouraged doctors from recommending that ineligible patients be discharged from hospice, and failed to ensure that nurses accurately and completely documented patients’ conditions.

The allegations were first raised by former employees in whistleblower lawsuits, which let private parties sue on behalf of the government and share in any recovery. The share to be awarded in the Optum case has not yet been determined, the Justice Department said in a news release.

As is now tediously typical in legal settlements involving large health care organizations, the government allowed the case to settle without any determination of guilt or innocence, and of course, without any individual who may have profited from the alleged bad behavior having to suffer any negative consequences.

'We are pleased to resolve this issue and are proud of our long record of providing high-quality, compassionate hospice care consistent with the needs of patients and supported by their doctors and family members,' Optum said in a statement. 'We believe Evercare Hospice acted properly and did not engage in wrongdoing.'

Also,

'The claims resolved by the settlement are allegations only, and there has been no determination of liability,' the Justice Department said in a news release.

As is also usual in these cases, the monetary value of the settlement, while it might appear large to a middle-class lay-person, is tiny compared to the revenue of UnitedHealth. For example, according to Google Finance, the corporation's 2015 total revenue exceeded $157 billion.

All that would be bad enough if the case only involved financial fraud.  Again, as noted above, it is possible that some patients without terminal disease who were enrolled in UnitedHealth's Optum hospice could have died of treatable conditions.  Yet this possiblility was not addressed by the limited press coverage of this case, or even by the US Department of Justice's news release about the settlement. 

Other Recent Cases

In 2016, there have been nearly anechoic media reports of cases of smaller hospices at least alleged to have deliberately enrolled non-terminal cases.  Perhaps because these organizations involved were not "too big to jail," some of these cases involved findings of guilt.

Home Care Hospice

In February, 2016, according to the Philadelphia Business Journal,

Nearly three years after fraud charges against a Philadelphia nurse first surfaced, a jury found 68-year-old Patricia McGill guilty for her role in scamming Medicare out of $9.32 million.

McGill was the director of professional services for Home Care Hospice for roughly three years beginning in 2005. During that time, she authorized and supervised the admission of patients for hospice services that they did not need or were not eligible for, according to court records.

This was not the first finding of guilt in this case involving a small, local for-profit hospice.

Alex Pugman and Matthew Kolodesh, the owners of the defunct Home Care Hospice – at one time located along Grant Avenue in Northeast Philly – were previously convicted for their part in the crime. Kolodesh, of Bucks County, was sentenced to 14 years in prison after being found guilty on more than 30 separate counts.

Note that the sentences were severe, but as far as I could tell, not based on the possible danger to patients without terminal illness created by their admission to hospice.

Horizon Hospice Subsidiairy of  JourneyCare

As reported by the Pittsburgh Post-Gazette in March, 2016,

The former top executive at Horizons Hospice in Monroeville is set to enter a guilty plea Friday in connection with charges of scheming to send patients to the center who weren’t terminal so she could bill Medicare and Medicaid.

She was not the first person to be found guilty in this case.

One of the key witnesses was expected to be Oliver Herndon of Peters, the medical director at Horizons from 2008 to 2012.

Herndon was sentenced in July to 33 months in prison after pleading guilty to certifying patients for hospice care who weren’t terminal and keeping them there longer so Horizons could continue billing the government.

Again, the possible danger to the fraudulantly enrolled patients was not discussed in the media accounts. Note that Horizons Hospice is a subsidiary of JourneyCare, which appears to be a non-profit organization.

Multiple Michigan Hospices

As reported in April, 2016, by the Washington Free Beacon,

Five individuals who have donated to Democratic politicians pleaded guilty to a scheme that drained Medicare out of $33 million dollars.

Two physicians and three owners of hospice and home care companies based out of Detroit, Mich., were charged on June 18, 2015 as part of the largest Medicare fraud case in history for submitting fraudulent claims for home health care and hospice services that were either not provided or deemed medically unnecessary.

The elaborate operation revolved around Muhammad Tariq, Shahid Tahir, and Manawar Javed—the owners of the home health care and hospice companies—paying kickbacks and bribes to physicians for referrals to their companies that included A Plus Hospice and Palliative Care, At Home Hospice, and At Home Network Inc.

While the reporting of this case focused on the apparent political leanings of the individuals involved, it also ignored any danger to non-terminal patients.


Discussion

The problem of fraudulant enrollment of non-terminal patients in hospice continues, despite our efforts over five years to make the problem more public.  The latest case involved a very big, very wealthy for-profit health care corporation which has had its share of troubles in the past.  Yet the latest case is as anechoic as earlier ones, including smaller cases this year.

These enrollments may be motivated by the desire for more money, but they put patients at risk.  Nonetheless, such abuses by hospices get little press coverage, seemingly are ignored by health care regulators and law enforcement, and are almost completely anechoic in the health care, medical and health policy literature.

If a measure of society is how it cares for the most vulnerable patients, the US laissez faire approach to for-profit hospices suggests a society in decline.

To repeat what I wrote the last time for-profit hospices were (barely) in the news for enrolling the wrong patients,...

 In my humble opinion, we should return control of direct patient care, especially of the most vulnerable patients, to health care professionals and if necessary small non-profit community organizations.  We ought to give strong consideration to banning corporate hospices, and banning all forms of the corporate practice of medicine and corporate health care "delivery."

Given how many insiders make so much money from the current version of laissez faire capitalism in health care, however, I would expect strong resistance should such apparently "radical," but actually conservative proposals actually get any mainstream attention.

But in an election season now often dominated by ridiculous hyperbole and outlandish statements, maybe such vitally (literally) important issues should start getting some attention.     

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Kentucky College of Optometry about to open in Pikeville

Artist's rendering of Kentucky College of Optometry, Pikeville

The University of Pikeville says it is about to open the nation's largest optometric college in terms of floor space, the Kentucky College of Optometry.

"Dr. Andrew Buzzelli, vice president for optometric education and the college’s founding dean, said that, at 130,000 square feet, KYCO is the largest optometry college in the country," Josh Little reports for the Appalachian News-Express in Pikeville. "The cost to build the college is $55 million, plus $9 million for equipment."

Students at the college will perform optometric services for local residents, under the supervision of doctors of optometry. "Pikeville Medical Center will still continue to be the main provider in the area, but they only have two providers, so the care is in here," Buzzelli said. "In the other schools around the country, care is all around the city, that’s not true here. ... This will be for our specialty clinics, such as laser surgery." He said The college will offer electrophysiological tests, which now require residents to travel to Lexington or Huntington, W.Va.

The university is already home to the School of Osteopathic Medicine.

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Hearing loss can lead to cognitive decline or even dementia, but is often unaffordable, and financial aid for it is shrinking

By Trudy Lieberman
Rural Health News Service

Nearly two-thirds of adults over age 70 have hearing loss that doctors consider “clinically meaningful.” In plain English that means as people age, they are likely to become hard of hearing. Many of those people, however, don’t get the help they need, often because they simply cannot afford it.

“The prevalence of hearing loss almost doubles with each age decade of life,” says Dr. Frank Lin, an otolaryngologist at Johns Hopkins University, but for older people, he adds, “there are multiple barriers that prevent individuals from getting their hearing loss addressed.”

Lin spoke about the subject to a group of journalists in a recent phone conference sponsored by a Washington, D.C., advocacy group the National Committee to Preserve Social Security and Medicare. He is a co-author of a June report issued by the National Academies of Sciences, Engineering, and Medicine that recommends better access and support for treating hearing loss.

Lin told the group that although hearing loss is a normal part of the aging process, “hearing care is inaccessible” to many seniors. He said studies over the last five years have shown that such loss “can increase the risk of cognitive decline.”

Using data from a longitudinal study (one that tracks data from the same people repeatedly over many years or decades) that began in 1958, Lin and his colleagues at Johns Hopkins found that those with hearing loss had a higher probability of developing dementia. The more severe the loss, the more likely the dementia.

Photo from howmanyarethere.net

That isn’t the only problem. Hearing loss is also associated with a greater risk for falls and other accidents because a person can’t hear traffic or a smoke alarm in their home. Furthermore, those with hearing loss often feel isolated and shun normal social contacts because they can’t hear others speak. That’s a blow to productive aging, the goal promoted by the late Dr. Robert Butler, a well-known gerontologist who fought against ageism.

So why, then, is hearing care so inaccessible? Cost may be the major barrier. Nearly all expenses for hearing care must be paid out-of-pocket, and for many seniors on fixed incomes, that’s sometimes hard to do. Lin told me the average cost of two hearing aids is $4,700 and rarely covered by insurance.

Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids. It does cover diagnostic hearing and balance exams, but only if your doctor orders those tests to see if you need medical treatment. In that case, if a person has traditional Medicare and a Medicare supplement policy, often called a Medigap, he or she has to pay 20 percent of the approved amount for the exam. Some Medicare Advantage plans may include hearings tests as part of the extra benefits they offer.

The National Committee and other advocacy groups are campaigning to add a hearing benefit to Medicare’s benefit package. Their campaign is bucking a trend in Washington to cut Medicare benefits by raising the age of eligibility, making richer seniors pay more, and requiring those with traditional Medigaps to have more skin in the game.

Politicians have already begun redesigning Medigap policies to make seniors pay more out of pocket for their care. Beginning in 2020, for example, insurers will not be allowed to sell Medigap policies that cover the deductibles for Medicare Part B that pays for physicians’ services, lab tests and hospital out patient care. The theory behind this shift is that seniors will pay more and the government less, thus helping to save Medicare money.

I asked Dan Adcock, the National Committee’s policy director, about the chances of adding benefits to treat hearing loss, or for that matter vision and dental care, when the focus has been on cutting benefits of all kinds. He said one major source of funds to pay for hearing aids could come from lowering the price of what Medicare pays for drugs. The 2003 legislation that gave seniors a drug benefit also prohibited the government from negotiating prices for the drugs it buys. Drug makers strongly oppose such negotiations.

Adcock said he remains hopeful. If better hearing means a decrease in dementia, falls and accidents, fewer people would need treatment for those conditions. The savings could potentially “pay” for the hearing aids, he said.

For now, though, seniors and their families are on their own. The National Academies offer an "Action Guide for Individuals and Families" that suggests actions people can take to prevent hearing loss, and strategies for families to cope with it when it occurs. It’s available at www.nas.edu/hearing.

What experiences have you or a family member had with hearing loss and obtaining treatment? Write to Trudy at trudy.lieberman@gmail.com.

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