He said, “No more surgeries.”
Mike Salmon was 73 years old and had been in intensive care for three months. He also suffered from sepsis and an escalating delirium. After another potentially deadly aortic rupture and an ambulance ride, doctors gathered around Mike Salmon’s hospital bed told him that the solution involved two major and risky surgeries.
They predicted that if Mike didn’t do anything, the sepsis or aneurysm would kill him. When will it happen? One doctor replied, “Weeks.” Mike said, “I am amazed I have made it to this point.” We were abruptly shifted to hospice care, the end-of-the line of American medicine.
Patients who are expected to die in six months or less can be cared for by hospice agencies. The hospice agencies do not provide drugs or curative treatments. They aim to make patients more comfortable at home as their illness comes to an end. Most of the care is provided by families, with 85% of them expressing satisfaction. This includes supplies of medical equipment and drugs, as well as visits from nurses and aides.
In the past fiscal year, more than 1.9 millions Americans were enrolled as hospice patients. More than 80% of these patients were on hospice for at least four weeks before they passed away. About 6% of hospice patients leave each year because their doctor determines that they no longer have a high likelihood of dying within the next 6 months.
Mike was one of the select few who joined this group in May. Mike’s experience both inside and outside the hospice system taught him surprising things about managing care. Uncovering the process of being removed from hospice was a revelation for us. It can provide a much-needed respite to families, but it can also be very damaging for those with chronic illness.
What we’ve learned from our time on hospice and after.
Before you decide, check before choosing
“Choose one.” I was given a list by a hospital nurse of hospices in my area. Mike would be able to go home sooner if we signed up. The suddenness of Mike’s illness had me stunned. I pointed at the first name in the alphabetical listing, thinking they would be the same.
Big mistake. Medicare has basic standards that it pays hospice agencies, but many are poorly staffed and run. Amy Tucci of Hospice Foundation of America noted that certain agencies offer extra services, such as aide support and therapy.
Problems with the organisation I chose began immediately. The staff were frequently late. Mike’s medical records were filled out with inaccurate information and they didn’t correct it when alerted. Medicare gives you the option to change or quit agencies. I therefore asked my neighbors for their recommendations. Kristina N. Newport, Chief Medical Officer of the American Academy of Hospice and Palliative Medicine said that was a great start. However, she also suggested I check the ratings of Medicare Care Compare and National Hospice Locator. These sites could have shown me our first agency’s poor ratings. Newport suggested that patients and caregivers call the top-rated agencies in their locality to determine which ones provide services they need. This could include staff who are fluent in the native language of the patient, offer spiritual care aligned with his or her beliefs or station themselves nearby so that an ambulance can be dispatched quickly if there is an emergency.
Local, well-established non-profits that were recommended by neighbors handled the transfer smoothly. The staff were punctual, kind, and accurate. After we changed, we got the chef’s kiss: The nurse of the company I originally chose called me to express her concern about the care we provided for your mother.
Some people get better on hospice
Some people’s health actually improves under hospice care. Research is still examining the reasons for this. According to studies, hospice patients who have lung cancer or congestive cardiac failure live, on average about one month longer than their counterparts in standard medicine.
Terry Bertholet teaches elder law and hospice at the University of Connecticut. She said that many patients are better off leaving hospital settings where there is a risk of infection or overtreatment. Mike was able to walk and get up without having to wait hours for a nurse overworked to unplug monitors. He also got to eat real food. The hospice nurse also gave him sleeping pills to aid him in getting through the night. Soon, he began to gain weight and strength.
Not dying fast enough can cause you to fail out of hospice
Medicare, as well as many other insurance companies, only pay hospice care for those patients who are certified by physicians to be likely to die in the next six months (not at the time of their enrollment). Hospice staff therefore regularly assess patients. Medicare conducts audits of agencies in order to detect fraud. It also demands reimbursement of money spent on patients whose auditors determine are not terminal. Both good and bad hospices worry about the bottom line and Medicare fraud audits. Patients who are a threat to the financial stability of their organization may be pressured by hospices to leave, even if they can take away important medical care. Bertholet stated that Medicare is more concerned about fraud and abuse than about patients not receiving enough care.
Hospice physicians may discharge patients if they improve or stabilize, especially for diagnosis with an uncertain outcome.
Mike was lucky that his aneurysms and sepsis did not develop. In early May his injuries had healed and his health had returned. He was able to return to his favorite activities, including gardening, bridge and baking his latticed blueberry-cinnamon pie. We appreciated Mike’s nurse visits, and we were happy to have the drugs and supplies delivered. However, Mike was no longer in need of care. So we decided that he should be discharged.
Discharges for patients with more incapacitating illnesses can be “nightmares,” according to Krista Harrison a Hospice researcher at University of California San Francisco. Discharges are often quick. Medicare mandates that patients be given at least two days notice.
Harrison’s in-law was diagnosed with a similar neurodegenerative disorder to Parkinson’s and discharged from the hospital because of his declining health. The family had to scramble to pay for and replace hospice equipment, such as an oxygen tank and a bed, while also finding and hiring aides who could replace the hospice assistants. She said that “just getting his medications reestablished was a huge deal.” She said that her father-in law died just six weeks after being discharged.
Make sure you do your research to get the best care
By knowing your rights and risks, you can get hospice care when you are in need.
Be sure of your diagnosis. Most cancer patients will not be discharged. Patients with Parkinson’s, dementia and heart disease often reach a plateau. Harrison from UCSF said that patients with dementia, heart disease and Parkinson’s are more likely to leave the hospital.
Select a hospice that has a high rating. According to research, for-profit hospices are more likely than non-profit hospices to discharge their patients. Medicare’s Care Compare website will let you know which one is which.
Keep records. Harrison from UCSF said that caregivers who document, for example, a growing patient’s need for assistance with eating can be a great asset to hospice staff in approving continuing care or building a stronger case.
Inform your doctor. Bertholet said that doctors “do not have the financial interests” of hospices and may be able to help you contest a discharge.
Appeal quickly. Information on how to appeal a discharge must be provided by hospice agencies. You must appeal the discharge (online or over the phone) before noon the day prior to the termination date. This may only give you a couple of hours if the notice was at least two days.
Reenroll. Reenrollment is possible at any point. You may be accepted by another hospice immediately. Tucci, from the Hospice Foundation, suggested that you wait until your patient’s condition deteriorates before re-enrolling in the hospice agency where you were previously enrolled.
Our plan is to go with the last option. Mike and I enjoy these bonus days. Mike says he is comforted by the knowledge that he will receive good care whenever his fate decides to catch up with him. He said, “They will try to improve what little time I still have.”

Utah’s health professionals and pediatricians urge measles vaccines, as the school year begins and new cases continue to be reported each week.
Dr. T.W. Jones, who is a pediatric specialist in disease, has had the opportunity to interact with families and children hospitalized for measles. He said that he saw a disease that was eradicated as a child now cause serious illness.
It isn’t just the sniffles or a common cold. Even a mild case of the measles can be traumatic. Families miss work and kids miss school. It costs hundreds of dollars. “When it’s bad, it really is bad,” said he.
In a Tuesday press conference, he spoke with doctors and other health officials. He said that just as firefighters know that smoldering fire cinders will reignite a fire, doctors also know one or two cases of measles can spread to many others if conditions are met.
As a specialist in pediatric diseases, he expressed concern.
Vaccinations
Jones stated that today, there are more immunocompromised children than at the time of introduction of measles vaccination. This includes organ recipients and kids who receive new medication for illnesses which may have not had an effective treatment back then. Jones said that these children were “profoundly susceptible” to the measles and could even be at risk of death.
Utah Department of Health and Human Services Statistics show that only a handful of cases have been reported in the past few weeks. However, data collected from wastewater samples suggests there may be many more cases not yet diagnosed.
Leisha Norlen, state epidemiologist at the Department of Health, said that the department was “very concerned” with what would happen to measles once school started and when the temperatures cooled. Now is the best time for children to be protected.
Nolen stated that of the 700 Utahns infected with measles, a third were admitted to hospital and 8% had been treated at the ER. Nolen encouraged parents to take steps to protect themselves and their children.
She said, “Now is the perfect time to ensure that your children are protected from measles by getting them vaccinated.” We don’t want parents to take a chance with their children; we want them to be as safe as possible.
Dr. Jordan Roberts is a family doctor who encourages patients to consult him instead of searching the Internet for vaccine information. He and his colleagues said they had done research, and that there was no need to lie about the fact the vaccine is more beneficial than harmful.
Roberts stated that the only motivation for his team was to maintain public health and keep people healthy.
He stated that doctors have been working hard to restore trust in the wake of COVID-19 and that they deserve this trust.
Roberts promised: “I will promise that we’ll give you a response based on truth, not politics.”
Get Immunized
Lee Cherie Booth is the immunization supervisor at Salt Lake County Health Department. She says that immunizations “are easier and more affordable than most people believe.” They are also available in local health departments and pharmacies, which often stay open over the weekend. She added that they can be obtained at doctors’ offices or at pediatrician and doctor’s offices.
The Utah Statewide Immunization System, your doctor or local health department can provide you with your immunization record.
She said that no one would be denied vaccines by the health department of the county because they could not pay. There are also programs for children who have low incomes or lack insurance.
Booth stated that “costs shouldn’t be an obstacle to anyone… Most, if they don’t all, insurance plans cover vaccinations for free or at no charge.

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According to a new, massive study, the age of a sibling can affect health later in life.
Researchers from Columbia University and the University of Chicago analyzed medical data collected from 10,000,000 U.S. sibling siblings for two decades. They found that there may be a link between birth order and specific health risks.
Researchers examined 569 categories of disease across families, and found 150 that had a significant relationship with the birth order.
LONGER LIFE, BAD HEALTH? Scientists Discover a Troublesome Trend Across Generations
The first-born child showed an increased likelihood of receiving neurodevelopmental or psychiatric diagnosis, such as autism, ADHD and Tourette’s syndrome, and immune-allergic disorders like food allergies.
Statistics show that second-borns are more likely to suffer from migraines, shingles and substance abuse disorders. They also have a higher risk of gastrointestinal problems like gastritis.
While discussing the results on Fox & Friends, Dr. Marc Siegel (senior medical analyst at Fox News) noted the importance of such a large-scale research.
The doctor stated, “I like this study as it raises more questions than answers. But I do think I know some of the answers.”
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Siegel’s own theory about parenting behavior was offered in response to the increased prevalence of ADHD with first-borns.
My theory is that they are getting more stimulation. He said that the parents hover over their children, like helicopters. “They don’t even know what to do,” he added.
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Siegel, in addressing the disparity between allergic conditions and the early exposure to the environment, said, “I believe it is because the immune system of the firstborn has not seen the environmental before.” If it is not properly set, then you will get an allergic reaction.
Siegel also discussed biological and psychological aspects when evaluating the differences between sibling.
I think that the womb is different after the first pregnancy, so the second baby will have a used womb. He said that the womb is more prepared for it because it has already been used.
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Siegel, in a response to the increased rate of substance abuse disorders among children born second, suggested that emotional factors may also be at play. “It could all come down to the same thing: I want attention. I’m looking for attention. “I want to do something that will make you laugh.
The study has some limitations, even though it highlights trends across a wide population.
These findings show correlations, not direct causality, which means that the trends aren’t always due to physiological changes, early microbe exposures, or social dynamics.
The data also relies heavily on the commercial health insurance claims which may reflect different diagnoses, differences in healthcare seeking behavior, and parental attention, rather than just true biological functions.
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These associations are also complicated by factors such as age differences between parents and siblings. Researchers concluded that birth order is a risk indicator at the population level, rather than an accurate health predictor.
Nature Health published the research.

County health officials report that West Nile Virus has been detected in 35 percent of mosquitoes screened this week at the Salt Lake City Mosquito Abatement District. This represents a risk “significantly greater than normal” for the virus.
Salt Lake County Health Department officials announced on Wednesday that a second case of West Nile virus was also reported. On July 30, the county reported its first case of West Nile virus of the year.
West Nile Virus, the virus most commonly spread by mosquitoes and which has a wide range of effects on humans.
According to the Centers for Disease Control and Prevention, some people will not show symptoms. However, they can develop headaches, body aches, and fever within two to fourteen days. The severe cases may result in high temperatures, stiff necks, confusion, muscle convulsions or even death.
Salt Lake County Health Department advises people to:

It’s not just about being active, but choosing the best activity for your health. The best way to combat the effects of ageing is to do resistance training. This includes bodyweight exercises, free weights, and resistance bands. It helps you to build muscle that will support your daily activities, as well as prevent osteopenia, osteoporosis, and fractures. Even if it has been a while since you lifted weights, now is the perfect time to begin.
Abby Bales founder of Reform Physical Therapy, PT DPT CSCS says: “Weight lifting is the fountain for youth.” Weight training helps increase bone density and prevent fractures. The muscle mass it builds is also helpful in regulating our blood sugar levels and metabolism. Weight training can improve coordination and balance, reducing the likelihood and severity of falling.
According to a study in Frontiers in Neuroscience published in 2023, resistance training can also help prevent neurological diseases like Alzheimer’s disease and dementia. This makes it an excellent tool for healthy aging. Lifting weights is your best option to maintain energy and resilience as you age.
Start with easy, small steps. For example, incorporating light weights or resistance bands into your workout routine can help build confidence. Try our four-week Strong After 50 plan for some extra guidance.
It’s important to remember that building a routine for strength training doesn’t need to be difficult. Just be consistent. Bales says, “Start slowly, increase your intensity gradually and stay with it.” Bales recommends beginning with just two to three sessions a week. To keep your workouts balanced, alternate between core, upper and lower body exercises.
Be patient. Bales says that results usually appear in 6 to 8 weeks. It’s important to show up every day and have fun. Your future self will be grateful.
Try our Strong After 50 Workout plan for more.
Advice from Real Women Lifters
Want some motivation to start? The challenges of weight lifting in later life are many, but they’re worth it. These women who have previously spoken with WH about their strength-training journeys in later life will inspire you.
Marilynn Larkin advises not to be held back by fear or insecurity. She told WH that she would “feel your fear and then get through it”. After a cancer diagnosis she began lifting weights to overcome her fear and accept all her body could do. Weight lifting is about accepting your body as is and allowing it to achieve its potential.
Ginny McColl suggests starting small and challenging goals, celebrating every milestone, no matter how big or small. Focus on the progress rather than perfection. She told WH that “little by little these small changes lead to big ones” after she became the oldest woman on American Ninja Warrior to successfully complete an obstacle and break a Guinness World Record. Instead of negative thoughts and negativity creeping in like “I can’t”, I concentrate on becoming stronger physically and mentally. “It works.”
Michelle Alber advises not to wait. She reversed osteoporosis after 18 months training focusing on progressive overload. She told WH that there is no ‘right time’ to begin or a perfect time’ to start anything. Was it difficult to change your lifestyle at 65 years old? Yes! “But it is about taking charge of your own life and choosing the ‘hard.’
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