For more information about the author, click to view their website: VITAS Healthcare
By Dr. Valerie Hart Quezada, Team Physician/Geriatrician, VITAS Healthcare
If we believe in stereotypes, older adults are all the same. Yet this fast-growing population is very complex and diverse. They defy a simple description because chronological age is not the same as physiologic age.
Both Sylvester Stallone and Arnold Schwarzenegger are in their late seventies while living robust, active and independent lives. Contrast this with a frail individual of the same age living in a nursing home with balance and mobility issues who relies on support for daily living activities.
Because we age in different ways, it’s important to know as much as possible about the patient we are treating and cultivate skills to match care to their health, functional status, priorities, and life expectancy. It is not enough to know age and comorbidities only.

The baby boomer population is living longer yet doing so with chronic illnesses. Often, health professionals are not well prepared to care for patients with multiple chronic conditions and have a harder time understanding disease trajectories. The “silver tsunami” of 73 million individuals in the US will require the mindfulness and holistic care of clinicians.
The normal aging process produces an increase in hearing and vision issues, frailty, sleep disturbances, urinary tract infections (UTIs), potential falls, gait and balance issues, and osteoporosis.
How the body manages these changes will depend more on physiologic age than chronological age.
When aging, cellular and molecular damage contribute to a decrease in physiologic reserve, or the body’s ability to withstand stress and recover from illness. The loss of muscle mass, increase in cortisol, and changes in hormones and blood pressure can affect homeostasis. With decreased physiologic reserve, small “insults” can result in significant decline. A new medication can lead to acute renal failure. Contracting pneumonia can turn into respiratory failure. A minor illness or even dehydration can produce delirium.
Suppose an 85-year-old who is robust, independent, and perhaps still driving gets a UTI. They may experience a dip in functionality but can likely recover quickly. Another 85-year-old who is weaker and frail may also acquire a UTI—and may not be able to recover to baseline.
Developed by the Institute for Healthcare Improvement, the “4M’s” help healthcare professionals gauge the status of their patients. They are:
A fifth “M” can be multimorbidity if the patient is experiencing several chronic conditions.

Remember that most older adults do not want to become a burden to loved ones. When they express this to us, it is a good place to start the conversation. This is an ongoing discussion because it can change for the patient over time, as their serious illness progresses. Here is a sampling of questions:
Once assessed, acting on these responses can help us align the care plan with what matters most to the older adult. If opting for hospice and palliative care, the patient receives wholistic care that includes medical, psychosocial, and spiritual support. Sharing information about the Medicare Hospice Benefit, which covers 100% of hospice services under Medicare Part A, can ease the patient’s mind about financing this type of end-of-life care.
Older adults are experts on aging, and it helps to show them sincerity and empathy. Because they sometimes experience ageism from their community, the healthcare system, or even their own family, they may not receive the care they need.
Breakdowns in care may happen when healthcare professionals assume all older adults are the same or focus only on the “medical” instead of the whole person. The cognitive/emotional, familial/social, environmental, and financial domains are interconnected. Taking this whole-hearted approach will help healthcare professionals provide care that enhances their quality of life.
Do you have a patient with serious illness or multiple morbidities? Could it be time to have a goals of care conversation? For assistance with this conversation or questions about hospice-eligibility, contact VITAS.
VERY IMPORTANT: Regarding Medicare it is illegal for an insurance agent to call, text, e-mail, knock on your door, hang anything on your door or vehicle or approach you without your consent. If they do ask for their National Producer Number NPN, and you will hear a click and removed from their list. If they dont hang up, get their number and report them to Medicare. There is so much fraud where people are being switched to plans that they never approved or they were miss led. Shop local, do background checks before you give anyone your personal information. You can google them, google reviews, check their Facebook, etc. Make sure that if you are working with someone you can call them personally if you have any questions or concerns. Medicare Annual Enrollment is October 15-December 7th for January 1st, 2027, effective. What can be changed at this time is Medicare Part D Drug Plans and Medicare Part C (Advantage Plans). You should have received your Notification of Change from your current insurance plan. This outlines the current year to the new year changes, as an example if your specialist provider costs $20 now it might say $35 in 2027 (no correlation just an example). Medicare Part C / Advantage Plans, most carriers have raised out of pocket limits and copays along with decreased extra value benefits for 2027. Annually Medicare Advantage Plans make changes. They must all include the same features as Original Medicare but not at the same cost share. They can have a premium, Medical and or Prescription deductible, copays and coinsurance can change. Extra Value such as Vision, Dental, Over the Counter, Part B Give Back, transportation, etc. can all change or be eliminated. Medicare sets the annual in-network out of pocket maximum; in 2026 it is $9,250 for in-network and $13,900 out-of-network services combined (2027 this will increase). However, individual insurance plans may set lower limits. The old saying if it is not broken do not fix it DOES NOT apply to Annual Enrollment. Every year I see many people that have not checked/compared their current plan to what is new. I have saved so many people hundreds and in many cases thousands of dollars. You should be working with a broker that represents many insurance companies. Make sure you check them out, especially if you are going to allow someone in your house. I recommend meeting in their office. For me we represent most insurance carriers in our area and carrying all their literature with me is almost impossible. We use three large screens so that our clients can clearly see and compare the differences between the plans. The minimum information always needed is all your doctors, medications: names, milligrams, and dosage. We load your current plan and then compare it to all the other companies in your area. What companies have all your doctors, the price for your medication normally makes a significant difference. Then the Extra Value is what is most important to you. We do NOT CHARGE for your review and if warranted to change your insurance plan. Ethics is most important and if you are on the best plan we will tell you, plus you can see for yourself. If your plan was CANCELLED/DROPPED for 2027, you have a guaranteed issue into a Medigap/Medicare Supplement. This is huge and very important, know your options!Medicare Seminars they are good for general information. A one-to-one appointment where you can dive into your doctors and medication is best, plus you can then compare other companies in one place. Medicare Part D most insurance carriers have taken away insurance agents ability to help you with your Part D Only drug plans this does not apply to most Advantage plans, standalone drug plans as well as Advantage Plans, you wont have to pay more than $2,400 in out-of-pocket drug costs, which include deductibles, co-pays, coinsurance. It is especially important to check your plans formulary as medication must be in formulary to be capped. 2027 RX deductible will be capped at $715.00. As a reminder the cost of the plan is not as important as the cost plus your medications, that is what you look at, the total cost. It is important to know what the medication is used for to determine if it is covered by the plan. Example Wycovy may be covered but to be covered it must be used for certain heart conditions or diabetes, Medicare does not cover weight lose medications at this time. As a reminder if you choose NOT to ENROLL in a Part D drug plan and in later years you want one you will have to wait for Annual Enrollment and then you will assed a penalty for every month you did not have a drug plan, that penalty will last for the REST OF YOUR LIFE! When you turn 65 you are eligible for Medicare, once you have worked 40 quarters roughly 10 years there is no cost for Medicare Part A. Part A covers Hospitals, Skilled Nursing, Home Health & Hospice. Medicare Part B you can choose to take at 65, or you can hold off if you are still working and have credible coverage. If you do not have group health insurance that is considered qualified, and then you want Medicare you would have a late enrollment penalty for each month you did not have Part B & Part D, and that penalty will last for the rest of your life. Part B covers doctors, imaging, blood work, ambulance, durable medical equipment, etc. Part D is a Medicare Drug Plan and covers medications. During your initial enrollment period it is especially important to understand your options! Medicare Supplements/Medigap Plans are NOT guaranteed issues; you may need to medically qualify. You can purchase a Medigap Plan during your 1st 6 months on Medicare Part B without medical underwriting. There are a lot of things you need to know. Again, work with an agent you can trust! Especially important: when you move you need to know your options. Can you keep the same plan? Do you need to make a change and what does that look like? Logical Insurance Solutions is a SWFL Insurance Broker that works with most of the insurance carriers in your area, we are happy to help you through the maze. We offer Free Medicare Seminars, Personal Appointments & Virtual appointments. Please e-mail [email protected] to register or call 239-362-0855 for dates. Medicares website is www.Medicare.gov. www.Logicalinsurance.com 239-362-0855 [email protected] Ulla-Undine Merritt (Dee) National Producer Number (NPN) 8853366
One of the most important decisions families can make as their loved one's age is when to begin exploring senior living options. Too often, the conversation doesnt happen until a crisis occursa fall, hospitalization, medication concern, caregiver burnout, or sudden change in care needs.At that point, families may feel overwhelmed and pressured to make a major decision quickly. Instead of choosing what truly feels right, they may simply choose what is immediately available.Senior Living Should Be a ChoiceNot a CrisisPlanning ahead gives seniors and their families something incredibly valuable: time.Time to tour communities.Time to ask questions.Time to compare services and costs.Time to meet the team.Time to understand care options.And most importantly, time for the senior to have a voice in the decision.When the decision is made proactively, seniors can participate in choosing where they want to live, what lifestyle appeals to them, and what is important to their daily happiness and independence.Why Families Choose Springwood CourtAt Springwood Court Assisted Living, we believe the transition to senior living should feel like a new beginningnot a response to an emergency.Our goal is to provide a warm, welcoming environment where residents can receive support while continuing to enjoy the things that make life meaningful.With a tenured, experienced team, 24/7 staff presence, engaging activities, chef-prepared meals, housekeeping, outings, and a strong focus on personalized care, Springwood Court strives to create a community where residents feel known, valued, and at home.Our philosophy is simple:The building may be brick and mortar, but the people are what make it a home to thrive! That is why we encourage families to visit us before there is a crisis. Come through the doors. Meet our team. Talk with residents. Ask questions. Learn about our services and how we can support changing needs.Planning Ahead Protects ChoiceExploring senior living early does not mean someone has to move immediately.Sometimes the best first step is simply taking a tour and beginning a conversation. A senior may decide they arent ready todaybut now the family knows their options and has a relationship with a community they trust.That preparation can make an enormous difference when circumstances eventually change.Dont Wait Until There Is No ChoiceA crisis can take away options. Planning creates them.At Springwood Court, we want families to feel comfortable starting the conversation earlywhen there is time to make thoughtful decisions, involve their loved one, and find the right fit.Start the conversation. Take the tour. Ask the questions. Know your options.Because senior living should be about choosing where you want to livenot simply finding somewhere to go when you have nowhere else to turn.Springwood Court Assisted LivingFeel the Difference.The Residents Are Not Our Business. They Are Our Why.
When it comes to choosing a senior living community, finding the right balance of personalized care, wellness, engaging experiences, and comfort is essential. At The Watermark at Marco Island, residents can enjoy a thoughtfully designed lifestyle in a beautiful setting while receiving support tailored to the way they want to live.A Place to Call Home on Marco IslandLocated at 1170 San Marco Road in Marco Island, Florida, The Watermark at Marco Island offers assisted living and memory care in a welcoming residential environment.The community is designed to provide more than just a place to live. Here, personalized care is complemented by opportunities for wellness, enriching daily experiences, social connection, and chef-prepared dining.For seniors and their families, that means having support available while maintaining independence and enjoying the lifestyle that makes each day meaningful.Personalized Care Designed Around YouEvery resident has unique needs, interests, routines, and preferences. The Watermark at Marco Island takes a personalized approach to care, creating support around the individual rather than expecting residents to fit into a one-size-fits-all model.Whether a senior needs assistance with daily activities or specialized support associated with memory care, the goal is to help residents feel comfortable, confident, and engaged in their surroundings.This thoughtful approach allows families to have greater peace of mind while their loved ones enjoy a community designed around their well-being.Wellness and Enriching ExperiencesLife at The Watermark at Marco Island extends beyond care. The community incorporates holistic wellness and enriching daily experiences designed to encourage residents to remain active, connected, and engaged.Common areas provide opportunities to socialize with friends, participate in activities, enjoy hobbies, or simply relax in a comfortable environment. From a game of pool to sharing a meal or spending time with neighbors, residents have opportunities to make each day their own.The emphasis is on supporting the whole personmind, body, and spirit.Dining Made From ScratchGood food is an important part of a fulfilling lifestyle, and dining at The Watermark at Marco Island is designed to be an enjoyable part of each day.Residents can experience chef-prepared meals made from scratch, offering the opportunity to enjoy delicious food while dining in a social and welcoming environment.Meals can be more than simply meeting nutritional needsthey can provide residents with another opportunity to connect, celebrate, and enjoy the pleasures of everyday life.Comfortable ResidencesThe Watermark at Marco Island offers thoughtfully designed residences intended to provide comfort, privacy, and a sense of home.Bright interiors, comfortable furnishings, and inviting living spaces create an environment where residents can settle in and feel at ease. Families can visit and spend quality time with their loved ones in a setting that feels warm and welcoming.The community's design also provides convenient access to shared spaces where residents can socialize and participate in daily activities.See Your Day HereChoosing senior living is a significant decision, and seeing a community in person can make all the difference. A personal visit allows seniors and their families to experience the environment, explore the residences, learn about available care, and get a better understanding of everyday life at the community.The Watermark at Marco Island invites prospective residents and their families to step inside, tour the residences, and picture what their day could look like here.To schedule a personal visit, call 239-999-4601.The Watermark at Marco Island1170 San Marco RoadMarco Island, FL 34145WatermarkMarcoIsland.com
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more.Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N Tamiami Trail, Suite 102, Naples 34103Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more.Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N Tamiami Trail, Suite 102, Naples 34103Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more. Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N. Tamiami Trail, Suite 102, Naples 34103 Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support