I was ecstatic to host my special guest for the inaugural podcast episode of “Staging Later”! Dr. Sherita Hill Golden is a physician-endocrinologist and the Hugh P. McCormick Family Professor of Endocrinology and Metabolism at Johns Hopkins. Her research spans clinical quality improvement, health equity, and preventive care. She is the Principal Investigator on the DPP/DPPOS long-term clinical research study, a prolific peer-reviewed author, and the founder and CEO of Golden Touch & Associates Consulting and Speaking, LLC. She is also a primary caregiver for her mother - a role that has fundamentally reshaped how she understands the American healthcare system, not as a physician, but as a family member navigating it from the other side. (Since this is the inaugural episode, no professional edits here. Just a good conversation and hey - no sponsor ads!) Conversation Highlights Medicare Coverage Gaps * Observation vs. Acute Admission:Medicare’sthree-night inpatient ruledetermines subacute rehab eligibility — observation-status patients on the same unit as acute patients are billed differently and can be denied rehab coverage entirely. * CNA/personal care is not covered by Medicare — only skilled nursing (wound care, tube feeding, ostomy management) qualifies; Activities of Daily Living (ADL) assistance (bathing, dressing, transfers) is entirely out-of-pocket. Long-Term Care (LTC) Insurance Realities * Policies vary and many carriers have and/or are exiting the business. In Dr. Golden’s parents’ LTC policy, a $10,000 deductible applies before any coverage kicks in. * Many insurers are exiting the long-term care insurance market due to longevity and chronic disease costs; policyholders risk buyout offers or loss of coverage. Home Care & Transition Risks * Discharge timing is abrupt— Medicare/Medicare Advantage decisions leave families scrambling to coordinate home health on the same day, and that discharge date is often unpredictable. * Muscle loss is rapid — even 2 days in a hospital bed significantly increases fall risk in elderly patients. * Gaining admission to a subacute facility resembles "applying to college" — availability, willingness to accept complex patients, and quality vary widely. Caregiver Physical Risk * Transfer devices (Hoyer lift, sit-to-stand, gait belts) are not intuitive— not all CNAs are trained, and family members frequently step in without proper technique. * Caregiver injury is a systemic risk — if the caregiver is incapacitated, the care recipient loses their primary support. Legal & Documentation Essentials * Elder care law is a distinct legal specialty — an elder care attorney helped restructure the Golden family’s estate plan, including healthcare and financial Powers of Attorney. * MOLST (Medical Orders for Life-Sustaining Treatment): Maryland’s form detailing DNR, intubation preferences, dialysis, feeding, and time-limited interventions — equivalent forms exist in most states. Electronic Health Record (EHR) Caregiver Access * Access processes vary significantly by practice— some require in-person medical records visits, others use self-service portal delegation (Epic in this case), and at least one practice verified nothing over the phone and took verification orally (!) Resources: * Caregiving.org * Mydirectives.com * https://marylandmolst.org This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit deanneprimozic.substack.com
