Spruce CBD Oil Brand Review

Spruce CBD Oil Brand Review

Spruce CBD is a family-owned company that has been overshadowing the CBD market in only two years of existence. The company prides itself on quality, high potency CBD that delivers results and peace of mind with sustainably sourced products. With middle-of-the-road prices and attentive customer service, Spruce is a top contender for CBD oils.

Our Rating:

Buy Spruce

Pros

  • High Potency options
  • Sustainably sourced, lab grade, organic, vegan, and gluten free
  • A family-owned business with quality customer service

Cons

  • Only one flavor option, only available in one size
  • No international shipping
  • No lower potency options

Our Verdict

Serious CBD users should take note of Spruce CBD for its effective results, high potency, organic ingredients, and lab-grade products. The company strives for no-frills, just quality. Its commitment to simple, honest products shines through unflavored and peppermint CBD oils for humans and dogs. Anyone in the USA can purchase Spruce CBD oils with free shipping, and it won’t break the bank.

CBD Oil Tincture

Best for Everyday Use

Spruce’s CBD oil tincture is one of the most popular CBD products on the market right now. With the options of 2,400 mg and 750 mg in potency, you can find a dosage that works best for your tolerance and needs. Spruce also offers peace of mind that you’re using a high-quality product since the oils are organic, vegan, gluten-free, and third-party lab tested.

The two different dosages make Spruce’s CBD oil an excellent choice for everyday use, and the simplistic product line mirrors their goal for efficiency. The price of their oil is about average for the market, plus you get free shipping on all US orders. The materials, potency, and quality of Spruce’s CBD oil tincture make it a great option.

About Spruce CBD

Spruce CBD began in 2018 and continues to be a family-run business. Founder, Tony Spencer, created Spruce in North Carolina as a means of providing high-quality CBD oils and topical products. While noticing customers’ big desire for CBD options, yet inconsistency in quality, Spencer sought out to sell lab-grade, organically sourced CBD products that were also effective.

In addition to oils, Spruce also sells its popular 750 mg CBD oil tincture for dogs, made special to appeal to our canine friends. CannaHealth even recognized Spruce as providing one of the best CBD oil tinctures for 2019.

Price Options

$39 for 750mg $269 for 2,400mg Max Potency

Bottle Size

30mL

Strength/Potency Options

25 mg and 80 mg per serving

Suggested Dosage

1 full dropper twice per day

Top Features

Vegan, gluten-free, organic, full-spectrum, and third-party lab tested

Customer Service and Reviews

An overwhelming majority of customers agree that Spruce’s CBD oils are useful and worth the purchase compared to other competitors. Many customers have commented that they receive their orders promptly (2-4 business days), and the free shipping option is a great incentive. Spruce also ships to all 50 US states. There is also a fair return policy, as you can return items for a full refund within 30 days. Your first return can also include an open and used product, but future standard delivery returns must be unopened and in its original packaging. It’s a slight inconvenience that the customer has to pay for the return shipping, but customers are typically satisfied with the products. Spruce responds directly to customer reviews, and those who were dissatisfied were met with an effort to solve their issue through refunds or exchanges. The company even responds to positive reviews, and multiple reviews sharing heartfelt or life-changing stories had responses from Spruce that shared that the company sent free products to these customers as a thank you.

“I work night shifts 10 days at a time, and for 6 months I hadn’t been able to sleep more than 4-5 hours at a time — and the sleep was only light sleep. I’d been feeling wired and frazzled this whole time, and even though I started wearing blue light blockers and stopped getting headaches, I could still only sleep 4-5 hours at a time. I tried melatonin and zzzquil etc. Not a single thing helped me sleep any better — though the melatonin did make me groggier. Since I’ve started taking the Spruce CBD before bed, I’m sleeping 6-7 hours easy. It’s like someone flipped a switch. Now I’m actually thriving on night shift and no longer concerned for my sanity. Literally life changing! Thanks, Spruce!!”

Nicholas

“I’ve tried a whole range of CBD products from different brands…and different forms…and the problem with other CBD brands that I’ve tried so far is that I often times don’t feel the effects. I’m happy to report that Spruce CBD is on a whole new level. Spruce’s lab grade oil is quite strong and helps relieve a lot of stress & anxiety that I get during my workdays.

Bernard

“I’ve purchased my 3rd bottle because I’m convinced I’ve finally found the best CBD on the market. I have a calm cool energy during the day and I have been sleeping better than I’ve slept in years! I noticed the change quickly …I highly recommend Spruce, it’s a top tier product! Wouldn’t mind if they made it better tasting, but the taste isn’t nearly horrible enough for me to stop using the product.”

Stefanie

Cost

The cost of Spruce’s CBD oils is middle-of-the-road compared to other brands. Since they only offer two choices with high potency, the $89 and $269 price points are rather fair for the quality. Many other companies price their full-spectrum 750mg CBD oils around the same as Spruce or higher. The company also offers a Subscribe and Save option that discounts 15% off the regular price, and the free shipping reduces costs as well.

Quality

Spruce offers lab-grade CBD with third-party lab testing. The company shares its lab results online for all of its CBD products, so customers know they’re buying a pure, third-party tested product. Their lab results show that their CBD oils are free of pesticides, contain no heavy metals, and no biotoxins. Product labels are also transparent about the correct dosage and amount of CBD contained in each bottle. With Spruce’s high potency CBD and its emphasis on effective results, they don’t offer a flavor for their 2,400 mg CBD oil as it would make it less potent. The 750 mg CBD oil is a natural peppermint flavor. Most customers shared that the flavor is easy to ingest, but it may be inconvenient to purchase the high potency to receive an unflavored option. The packaging is also aesthetically modern and whimsical. Spruce’s CBD is sourced from two family-owned farms in Kentucky and North Carolina, both sustainably sourced.

FAQs

Does Spruce CBD offer coupons or discounts?

Spruce offers a Subscribe and Save option to save 15% off orders, and they also offer free shipping. Further discounts have been provided by customer service to extend a resolution to any issues with products or complaints.

Can I buy Spruce CBD near me?

Spruce CBD products can only be purchased with online retailers. No matter where you are, Spruce will ship free within the US, and you should get your product within 2-4 business days.

Using CBD Oil

CBD oil is becoming increasingly popular for its effectiveness in temporarily treating several medical symptoms. Many CBD users share that it has helped with relieving migraines, chronic pain, insomnia, anxiety, and inflammation. Many are finding CBD a useful and natural alternative to other medicines. With a variety of uses, CBD oils can be taken on its own and mixed with other liquids. As CBD becomes more regulated, it will be more transparent as to the quality and benefits of using CBD.

Conclusion

With so many CBD brands and products on the market these days, it can be challenging to narrow down a quality CBD oil that’s right for you. Spruce CBD oils are effective, sustainably sourced, and backed by an overwhelming amount of positive reviews. If you’re having a difficult time finding a CBD oil that works, it may be time to believe the hype and try Spruce.


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Top 10 CBD Oils for Seniors

Which CBD Oil Works Best?

The CBD oil that works best for you should meet your needs for symptom relief, price point, and minimal side effects. Since this is different for everyone, you may need to do your own research and try a couple different oils before you find the one you like best.

However, if you’re like us, you probably don’t want to break the bank testing out a variety of products. That’s why we’ve already done it for you. Below, we’ve picked the top 10 CBD oils on the market today and evaluated them for a range of different uses. Whether you’re looking for an unflavored oil, broad spectrum, or high potency, we’ve got you covered.

Keep in mind that CBD could be a great option toward holistic health and wellness, though there’s still much research to be done. Use our guide to help get started with CBD.

Our Favorite CBD Oil

Spruce 2,400mg Lab Grade CBD Oil

$39 – $269

Buy Spruce

Jump to a section:

Our Top Picks

Product Reviews

Additional Information

Top CBD Oils for 2019

Best High Strength
spruce cbd

Spruce

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Jump To Review

Best Low Dosage
charlotte's web

Charlotte’s Web

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Jump To Review

Best Based on Reviews
medterra tincture

MedTerra

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Best Broad Spectrum
onyx and rose

Onyx & Rose

Buy Onyx & Rose
Jump To Review

Best Full Spectrum
CBDistillery

CBDistillery

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Best Flavored
cbd fx tinctures

CBDFx

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Jump To Review

Best Unflavored
vertias farms

Veritas Farms

Buy Veritas Farms
Jump To Review

Best on a Budget
pluscbd oil

PlusCBD Oil

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Jump To Review

Best Variety
cbdMD

cbdMD

Buy cbdMD
Jump To Review

Best Ingredients
fab cbd

Fab CBD

Buy Fab CBD
Jump To Review

Top 10 CBD Oils for Seniors

There are many CBD oils out there these days, so we’ve narrowed it down to 10 great options to kick start your entry into the CBD world. We compared CBD oils based on how they utilized, price, dosage, size, and top features. We also considered the diet’s it may be best suited for and unique qualities. By collecting customer reviews and research, we’ve got you covered on the best CBD products available.

Best Potency

Spruce

Buy Spruce

Price:
  • $39 – $269
Dosage:
  • 2,400 mg / 80 mg per dropper
Size:
  • 30 mL

Top Features:
  • Family owned business
  • Unique moonshine extraction method
  • Organic
  • Vegan and gluten-free
  • Offer an “extra strength” potency

Spruce offers lab-grade CBD in the form of oils and cream. They offer a competitive price with 2,400 mg of oil at $269, and 750mg oil tinctures for both humans and dogs at $89. They also offer a subscribe and save option for all products that will give you a 15% discount and free shipping. Spruce offers one of the best options in dosage and price comparison, and customers agree that it’s hard to beat their potency.

Best for Beginners

Charlotte’s Web

Buy Charlotte’s Web

Price:
  • $74.99 – $188.99
Dosage:
  • 17 mg per 1 ml dropper
Size:
  • 30 ml or 100 ml (1 fl oz or 3.38 fl oz)

Top Features:
  • Extra beneficial compounds
  • Free shipping
  • 30-day satisfaction guarantee
  • Lemon, Mint Chocolate, Olive Oil, and Orange Blossom flavors
  • Online quiz to find the right product for you

Charlotte’s Web provides excellent packaging and multiple forms of CBD, making it an excellent option for beginners to try out. Their 17mg CBD oil is accessible based on various flavor options, beneficial compounds (essential fatty acids, phytocannabinoids, terpenes, flavonoids), and is US Hemp Authority Certified. Dosage ranges from 7 mg to 60 mg, and bottle sizes are 30ml or 100ml, so there are options to customize your CBD routine.

Best by Reviews

MedTerra

Buy MedTerra

Price:
  • $34.99 – $132.99
Dosage:
  • 50 mg, 1000 mg or 3000 mg per bottle
Size:
  • 1 fl oz

Top Features:
  • US Hemp Authority Certified
  • Ship to all 50 states and internationally
  • 30-day money-back guarantee
  • Non-GMO and organic
  • 10% discount when you subscribe

MedTerra offers CBD tinctures that combine 99% CBD and MCT oil in one-ounce bottles. They offer 500 mg, 1000 mg, and 3000 mg per dropper, and the tinctures have measurement markers to allow for accuracy and flexibility in servings. The average customer reviews for MedTerra are the best based on price, effectiveness, and speediness in delivery.

Best Broad Spectrum

Onyx & Rose

Buy Onyx & Rose

Price:
  • $99
Dosage:
  • 1,000 mg
Size:
  • 2 fl oz

Top Features:
  • Broad-spectrum in orange and mint flavors
  • Subscribe and save option
  • 90-day return policy
  • Non-GMO, organic, gluten-free, vegan, and cruelty-free
  • 10% discount when you subscribe

Onyx & Rose offers broad-spectrum CBD oil that is both aesthetically pleasing and agreeably effective, making it the best broad-spectrum option right now. The 1,000 mg of oil comes in mint or orange flavor, is organically grown, contains MCT oil, is gluten-free, vegan, non-GMO, and cruelty-free. You can get yourself a bottle for $99, and the box and bottle are also recyclable.

Best Full Spectrum

CBDistillery

Buy CBDistillery

Price:
  • $60-$70
Dosage:
  • 1000 mg per bottle/ 33 mg per serving
Size:
  • 1 fl oz

Top Features:
  • Full-spectrum with
  • Third-party lab tested
  • US Hemp Authority Certified
  • Non GMO with natural farming methods
  • Includes Omega 3 fatty acids, B complex vitamins, and 20 amino acids

CBDistillery’s Full spectrum CBD oil tincture is the best full spectrum on the market based on price and high quality. At $60, you can get their 1000 mg tincture that contains MCT and aerial part CBD hemp extract. CBDistillery products are also third-party lab tested, US Hemp Authority-certified, non-GMO, and use natural farming practices.

Best Flavored

CBDFx

Buy CBDFx

Price:
  • $59.99 – $119.99
Dosage:
  • 500 mg, 1,000 mg or 1,500 mg per bottle
Size:
  • 30 ml (1 fl oz)

Top Features:
  • Full-Spectrum
  • Third-party lab tested with test results on the website
  • Blueberry Pineapple Lemon flavor
  • Organic
  • 15% off first order with a subscription

CBDFx offers a delicious blueberry pineapple lemon flavor, making it the best flavor option in CDB. This 30mL tincture is a full-spectrum CBD with MCT oil that comes in 500mg, 1000 mg, and 1500 mg dosages. The CBD is made in third party labs and is organic.

Best with No Flavor

Veritas Farms

Buy Veritas Farms

Price:
  • $29.99 – $199.99
Dosage:
  • 250 mg, 500 mg, 1,000 mg, 1,500 mg, or 2,000 mg per bottle
Size:
  • 1 fl oz

Top Features:
  • Full-Spectrum with <.3 thc="">
  • Third-party lab tested
  • Unflavored, Citrus, Peppermint, Watermelon, and Strawberry flavors
  • Organic
  • 5 different strengths

Veritas Farms offers a great Full-Spectrum CBD tincture with multiple flavors but has the best-unflavored option out there. With 33.3 mg per dropper, you can get this CBD oil in 5 strengths (250 mg, 500 mg, 1000 mg, 1500 mg, and 2000 mg) and five flavors (Unflavored, Citrus, Peppermint, Watermelon, and Strawberry). A larger size tincture in 100 mL is also available. All ingredients are organic, and they use third-party lab testing.

Best Low-Cost

PlusCBD Oil

Buy PlusCBD Oil

Price:
  • $22.95 – $67.95
Dosage:
  • 100 mg or 500 mg per bottle / 11 mg-33mg per serving
Size:
  • 1 fl oz or 2 fl oz

Top Features:
  • Full-Spectrum
  • Non-GMO and gluten-free
  • US Hemp Authority Certified
  • Vegan
  • Unflavored and Peppermint flavors

PlusCBD Oil’s raw formula is the best low-cost CBD oil option on the market right now. Starting at just $22.95, you can get dropper in multiple varieties to suit your needs. A one-ounce bottle with 100 mg of CBD or 2 ounces with 500 mg of CBD is available, and you can choose between unflavored or peppermint. The full-spectrum CBD is non-GMO, gluten-free, vegan, and US Hemp Authority Certified.

Best for Multiple Options

cbdMD

Buy cbdMD

Price:
  • $29.99 – $39.99
Dosage:
  • 10 mg – 250 mg per mL
Size:
  • 1 or 2 fl oz bottles

Top Features:
  • Broad-Spectrum
  • Non-GMO and vegan
  • Natural, Berry, Orange, and Mint flavors
  • Third-party lab tested
  • Free shipping and 30-day money-back guarantee

cbdMD offers CBD oil tinctures in many varieties based on potency and flavors. 30mL bottles have 300 mg, 750 mg, 1500 mg, 7500 mg, 3000 mg, and 5000 mg potency options. 60mL bottles have the options of 1000 mg or 1500 mg potency options. All bottles have many flavor options, including natural, berry, orange, and mint. Starting at $29.99, cbdMD is best if you’re looking for multiple options.

Best Ingredients

Fab CBD

Buy Fab CBD

Price:
  • $39-$99
Dosage:
  • 5 mg – 20 mg per mL
Size:
  • 1 fl oz

Top Features:
  • Full-Spectrum
  • Third-party lab tested
  • Citrus, Mint, Natural, Berry, and Vanilla flavors
  • Organic and non-GMO
  • Terpenes added

Fab CBD offers oil drops with multiple flavors and sizes, as well as the best ingredients. These high-concentration CBD oils are full-spectrum cannabinoid blends. Citrus, Mint, Natural, Berry, and Vanilla flavors are available in 300 mg, 600 mg, or 1200 mg in potency. Fab CBD products are organically grown, non-GMO, contain terpenes, and are made to order.

What is CBD Oil?

CBD oil or Cannabidiol is a natural molecule of cannabis, which comes from the hemp plant. It’s become popular in the media over the last couple of years, but it was discovered before THC in 1940. The chemist, Roger Adams, of Harvard University was the first person to extract CBD successfully, and scientists started to see the benefits of CBD in the 1960s.

Scientists Dr. Walter S. Loewe and Dr. Raphael Mechoulam took further steps to conduct a test to prove CBD doesn’t alter your mental state. They also identified the three-dimensional structure of the molecule.

By utilizing CBD from hemp rather than a marijuana plant, the oil doesn’t contain any THC, and you won’t experience a “high.” By extracting from the hemp plant instead of cannabis, this also means that CBD and hemp plants are legal across the country.

CBD oil is extracted either using the CO2, Ethanol, or olive oil methods. The CO2 process is the most common and provides high-quality extraction. It’s performed by heating CO2 and diffusing it throughout the hemp plant to pull the oil. Extraction then leads to the many methods of bottling and consumption, such as tinctures, vape juice, gummies, massage oils, and pet treats.

You can ingest the oil by mixing it with other drinks and liquids or just put a few drops on your tongue. Gummies are also extremely popular, and many people feed their pets CBD infused treats to help with anxiety and illnesses. Topical oils and lotions containing CBD may also alleviate sore muscles and joint pain. Users enjoy CBD oil as it may relieve pain, anxiety, inflammation, nausea, and seizures.

Why Should Seniors Use CBD?

Seniors can benefit from CBD if you’re looking for a natural, plant-based product instead of pharmaceuticals. CBD may temporarily ease symptoms that are caused by digestive problems, muscle pains, and other common medical issues. Users report that CBD oil causes very minimal side effects, is non-toxic, non-addictive, and there are currently no reported deaths or overdoses linked to CBD. CBD oil may be an excellent alternative to some medications as it is cost-effective and eco-friendly.

How to Start Using CBD

While the FDA hasn’t created regulatory guidelines just yet, doctors are commonly suggesting CBD as an option for the relief of temporary symptoms. Patients may consider their current health and prescriptions they’re already taking, and ask your doctor if CBD may negatively interact with current medications. CBD is known to increase the effects of some medicines and natural blood thinners, so your doctor may be able to share insight into this and even suggest precise doses that won’t harm your body.

Determining what dose of CBD oil to take is based on many factors, including the chemistry of your body and BMI. You should always consult your doctor first since they can more accurately decide how much of the product you should take, and it may be smart to start at a lower dose and slowly increase your daily use. Before beginning to use CBD, you should also consider the quality of a CBD product based on organic growing techniques, extraction method, mg per dose, full-spectrum offerings, flavors, and reviews reporting effectiveness.

What are the Potential Benefits of CBD?

The benefits of CBD are becoming increasingly transparent as it’s gaining popularity. For many, it may temporarily relieve insomnia and muscle pain, and seniors are finding it useful for alleviating chronic pains and some medical problems. As a natural source, CBD is starting to replace some pharmaceuticals and is also being progressively researched.

Potential Benefits of CBD:

  • May reduce inflammation
  • May relieve pain
  • May alleviate migraines
  • May relieve sciatic nerve pain
  • May improve sleep
  • May reduce anxiety and depression
  • May help with appetite and weight loss
  • May improve memory
  • May alleviate symptoms related to cancer
  • May reduce acne
  • May help treat epilepsy

Common FAQs

Is CBD safe for seniors?

CBD may have many benefits for seniors, but it’s essential to consult with your doctor before giving CBD a try. Your current prescriptions and medications may react with CBD products, so your doctor can recommend replacing CBD with some medications or advise on the correct dosage for your specific needs.

Does CBD oil have side effects?

Side effects of CBD are rare but could include dry mouth, nausea, diarrhea, and changes in appetite. If you’re taking other medications, CBD can affect the way the liver breaks down those medications causing an adverse reaction. CBD has also been linked to temporarily lowering blood pressure.

Can I buy CBD oil online?
CBD oil has increasingly become more available online, with numerous retailers across the world shipping CBD right to your doorstep. It helps to do your research and compare products based on potency, flavors, price, size, extraction, broad vs. full-spectrum, how you consume the CBD, dietary restrictions, and other factors. There are many CBD options for you to try out as you begin your journey.

CBD in the News

CBD is undoubtedly gaining traction, and ingestible forms are projected to grow up to 375% in the next year, according to the Food Institute Blog. As CBD beverages, gummies, and baked goods become more popular, and the market could grow into a $2.75 billion industry in 2020. Companies noticing this increase are also becoming aware of the pressure of getting FDA approval. Nonetheless, CBD is growing, and this could lead to new types of products and lower prices as well.

Business Insider shares that Dollar General will start carrying CBD products in 2020 in Tennessee and Kentucky, all priced at $20 and below. While CBD is still unregulated in the US, the FDA stated that the CBD could be questionable and advises that customers should be cautious about buying CBD at mass retailers. The low cost may intrigue consumers, but could it also be a warning sign?

Seniors are increasingly looking towards CBD for treating aches and pains, but it can be challenging to find safe products while the market isn’t regulated. Forbes discussed that it’s now becoming a trend to make your own CBD products as a means of having more control of the quality and for cost-savings. A company called Ardent is leading the way for DIY CBD customers to have research at their fingertips, and their “Nova” product lets you make an activated form of CBD right at home.

Conclusion

CBD oil has made great strides in the year 2019, and cannabidiol products will increasingly be a popular remedy for medical symptoms. It’s important to remember that CBD still needs more thorough research while it exists in a non-regulated industry, and your doctor can best advise on how CBD can work for you. Seniors should definitely take note of the risks, but CBD could be a viable option if you’re looking for natural relief for pains, anxiety, and restlessness. Luckily, there’s plenty of resources out there now if you’re looking to kick start your journey into the CBD trend.

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Making Sense of Nutrition Advice for Seniors

Nutrition can be especially confusing for seniors, but of course these days nutrition is confusing for everyone. Every month a new study comes out that revises our understanding of what, and how much, we should eat. And even when experts agree on nutrition advice, it can be next to impossible to understand how to apply that advice to senior nutrition.

The confusion isn’t just about what seniors eat: it’s also about what they don’t. Because aging affects all systems in the body, seniors frequently have additional challenges to face when it comes to eating properly. Illness, disability, and isolation can prevent seniors from getting the food they need to maintain a healthy lifestyle, and even some of the more common effects of aging, such as the loss of taste and smell and the loss of appetite, can make seniors less interested in taking in calories and nutrients.

Unfortunately, nutrition is just as important for seniors as it is for younger people: undernourished seniors can have problems fighting infection, experience cognitive issues, and suffer from the sort of muscle weakness that can put them at risk for catastrophic falls.

Fortunately there are ways to address all these issues, and, armed with those strategies, and with a full understanding of how standard nutrition advice can be modified to suit seniors’ unique needs, there’s no reason why age should prevent an otherwise healthy senior from getting all the nutrition they need—or, if they’re fighting illness or injury, getting the nutrition they need to heal.

Senior Nutrition: The Big Challenges

people passing food around the table

people passing food around the table

Still, there’s no escaping the fact that age can make it harder for some people to eat and drink as much as they should. And as a result, malnourishment can be a significant issue among the elderly, exacerbating problems and dangers that are already present. For example, a 1995 study found that 43% of senior patients who were admitted to an intensive care unit were malnourished.

Where do these challenges come from? Here’s a quick look at some of the issues that can prevent seniors from getting all the food they need.

%

Of Senior Patients Who Were Admitted To An Intensive Care Unit Were Malnourished.

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Social Factors

In this article we’ll be focusing mostly on the problems that individual seniors can face, but if you’re a senior, or have a senior in your life, it’s important to keep some broader concerns in mind. For example, many seniors find themselves less interested in eating because they live alone—an effect that can be especially profound for people who have recently lost loved ones.

Many seniors also have problems keeping up their nutrition because, living on a fixed income, they have trouble affording food. In fact, a survey conducted by the AARP Foundation of people 50 and older found that many—even many whose income was double the federal poverty line—had found themselves needing to cut down on what they’d spent on food in the previous year. If you’re a senior wrestling with either of these issues, you might find it hard to admit that you’re having problems.

Still, understand that a lack of interest in mealtimes can lead to health issues, just as they will for younger people. If you have a senior in your life, be sure to check in: ask specifically if they’re skipping meals out of loneliness or cutting down on their food budget. There are services that can help provide companionship, even if you can’t, and of course there are services like food pantries and Meals on Wheels that exist primarily in order to help seniors in need.

Lack of Appetite

Now to consider physical barriers to good nutrition. The first sounds simple: lack of appetite. To a certain extent, the loss of appetite among seniors is understandable, and possibly benign: aging tends to cause loss of muscle mass; the loss of muscle mass means seniors need fewer calories, and this naturally causes older people to be less hungry. The problem, however, is that it’s difficult to maintain healthy levels of vital nutrients—vitamins, minerals, and essentials like protein—as your intake of all foods decline.

Other factors in loss of appetite are less benign, however. As we get older, we start producing less of the hormones that trigger hunger in our bodies, meaning that we can even start to get fewer calories than we need to maintain ordinary activities. Older people are also likely to be taking medications that suppress appetite or even cause nausea. What’s more, GI issues and other infirmities can also cause seniors to lose their appetite.

Loss of Sense of Smell and Taste

Another related effect of aging is our tendency to lose our senses of smell and taste. Younger people don’t have to wait until they get to the table to appreciate the smell of cooking food: older people, however, may not appreciate kitchen aromas, and even when they’re eating, they may not enjoy the taste or smell of their food as much as they used to. Unfortunately, too, some medications can dull the sense of taste, and so again they may contribute to seniors’ disinterest in food.

Gastrointestinal Issues

Quite apart from actual GI illnesses or the side effects of illnesses elsewhere in the body, our GI system tends to run into problems simply because we’re getting older. As we age, our intestines become less efficient at absorbing nutrients. Digestion slows, too, and as our stomachs take longer to empty, they cause problems like reflux and heartburn, and can make gas issues more likely. What’s more, as appetite decreases for other reasons, so does our intake of the fiber essential for good gut health, leading to a vicious cycle in which poor nutrition leads to digestive issues that then lead to poor nutrition.

Related to gut problems are problems elsewhere in our GI system, particularly with chewing. As we get older, we lose muscle mass everywhere, even in our jaws, and this can make both chewing and swallowing more difficult. What’s more, age can lead to dental issues, and this, too, can interfere with seniors’ ability to chew—and, by extension, cause problems in their digestive system.

Disabilities and Mental Health

More than 38% of people over 65 had at least one disability as of the last census, according to the U.S. Census Bureau. And physical disabilities can also take a toll on nutrition: They can prevent seniors from being able to shop for food or prepare their own meals, and can, in some cases, even prevent them from feeding themselves. And cognitive issues like dementia can also get in the way of seniors’ ability to make their own meals, even when other functions aren’t affected. Finally, many seniors struggle with depression, and depression often leads to a lack of appetite.

Some Basic Nutrition Strategies

natural supplements in a spoon with veggies in the background

natural supplements in a spoon with veggies in the background

With all these hurdles in the way of good nutrition, what can seniors—and the people who care for them—do? The short answer, though it involves a lot of details that we’ll get to later, is simply to get in the habit of eating regular, nutritious meals. But there are some things to stay mindful of even if you’re fully on board with more healthy eating.

What about Supplements?

Remember one of the fundamental issues in senior nutrition: that even when a lack of appetite comes from needing fewer calories, taking in less food can prevent seniors from getting the vitamins, minerals, and other essential nutrients that they still need—and may need more of now that they’re older. In such a situation, many doctors will recommend that seniors take dietary supplements. These supplements don’t have to come in pill form either: liquid meal replacements like Ensure can also help seniors get the nutrients they need—and also provide some badly-needed calories.

It should be noted, however, that not all researchers agree on the importance of supplements. A 2014 review by the U.S. Preventive Services Task Force, for example, recommended against daily multivitamins for adults who had no serious health problems. And even seniors may be able to avoid using supplements as long as they’re continuing to eat healthy, so you might be better off spending your money on actual food. Finally, it’s important to note another caveat about supplements: they are also implicated in choking incidents among seniors.

But that’s the cost-benefit analysis for otherwise healthy people. For seniors having real problems getting enough nutrition from the food they eat, taking supplements can be a useful, and healthful, strategy. And there are particular supplements that seniors may need more than younger people.

  • Since seniors are less likely to get sun exposure, they may need help getting vitamin D, for example, even though vitamin D is now known to help with chronic pain and help prevent heart disease.
  • Senior digestive systems also have difficulty absorbing vitamin B12, and so supplements might be necessary, especially since a deficiency in B12 is linked to dementia.
  • Many older women supplement with calcium, since loss of bone mass is known to be a problem faced by women, but men, too, have to deal with this issue, especially as they get older.
  • Finally, while the body has no trouble absorbing Omega-3 fatty acids, your brain cells, the chief beneficiary of Omega-3 in your body, tend to have a hard time taking on this essential nutrient as you get older. As a result, the amounts you take in in food might not be enough to support this nutrient’s benefits for mood and memory. For that reason, an Omega-3 supplement may be essential.

There’sone last nutrient that you may want to supplement for: protein. It’s such an obvious need that you may not think about it as a nutrient, but it’s essential to maintain muscle mass (which in turn helps with a variety of important functions from simple activity to immune system strength). And if appetite is reducing the intake of food, there’s a good chance that a senior won’t be getting enough protein. Mixing protein powders into shakes or using meal replacement drinks will help you stay healthy.

There’sone last nutrient that you may want to supplement for: protein. It’s such an obvious need that you may not think about it as a nutrient, but it’s essential to maintain muscle mass (which in turn helps with a variety of important functions from simple activity to immune system strength). And if appetite is reducing the intake of food, there’s a good chance that a senior won’t be getting enough protein. Mixing protein powders into shakes or using meal replacement drinks will help you stay healthy.

Hydration

One secret weapon in keeping seniors well-nourished is easily accessed, fairly palatable, and mostly free. And that’s water. The problem is, however, that, once again, age interferes with our body’s ability to get as much water as it needs. For one thing, older bodies retain less water than younger bodies do, sometimes as much as 5-10% less. To make things worse, older people are less likely to feel thirsty, even when they’re on the verge of being dehydrated. What’s more, drinking water can lead to some unpleasant effects: a single glass can make a senior feel full, cause bloating or gas, and can cause significant problems for those dealing with incontinence.

Despite all these issues, good hydration is essential. After all, being dehydrated can cause serious problems in its own right. For example, dehydration may make people as much as twice as likely to die from a stroke. Not having enough water can also cause unpleasant health issues such as headaches, fever-like symptoms, dizziness, and a lack of energy—as well as problems with memory and focus. Finally, dehydration can lead to a loss of appetite and other unpleasant GI problems like heartburn and constipation.

The good news, however, is that staying hydrated doesn’t necessarily mean constantly refilling of your water glass. Not everyone needs the proverbial “eight glasses of water” anyway, and people can maintain hydration using beverages they enjoy, including fruit juices, coffee, and tea. What’s more, juices, milk, soft drinks, and other beverages may also contain calories, enabling a senior to meet two nutrition needs at a time.

Tackling GI Problems

As mentioned above, a variety of digestive issues can contribute to poor nutrition for seniors, but there are things you can do to make gut problems much less of a hurdle.

Just Eat Better:

The simplest way to improve GI health is to eat a more balanced and healthy diet in general. The more nutrition you bring in, the better off all parts of your body will be, including your digestive system. There’s obviously a chicken-and-egg element to this approach, but if you can replace some unhealthy food with healthier food, or begin to eat more high-fiber foods, for example, you may be able to make it easier to stay well-nourished.

Remove Irritants:

We all have certain foods that we love that also cause us digestive problems. For younger folks, that might not lead to any larger issues, but in older people, who might have trouble staying well-nourished at the best of times, missing a meal because of an upset stomach could be a much bigger deal. If you can, try to eliminate from your diet anything that might cause you problems: find alternatives, and, if that’s not possible, reduce your intake.

Eat Softer Foods:

If you’re experiencing problems chewing or swallowing, there are a number of steps you can take to make it easier to take in calories. Instead of cereal for breakfast, you can make smoothies. Instead of raw fruits and vegetables, you can cook them so they’re easier on your teeth and throat. You can keep drinking water through the meal in order to ensure that your food has enough moisture to be easy to chew. You can also elect to go with softer food in general, such as bananas, or cooked cereals. There’s no reason to be ashamed of taking such measures: even younger people can have dental problems, and better nutrition may eventually make chewing and swallowing easier.

Rethinking Diet

Again, just eating a variety of appetizing foods is often enough for seniors to get enough nutrition. But given the challenges some seniors face, it can help enormously to take a different approach to meals and to food in general. That’s because much of the standard advice about what’s healthy and preferable in terms of the food you eat doesn’t apply as much when you’re not eating enough. Here are some ways to think about food that may make it easier to get the nutrition you need as a senior:

Is a weight-reduction mindset still appropriate?

As we get older, it’s always possible that the effects of our diet over the course our lives could catch up with us. And it’s also true that addressing some of the biggest diet risks—excess salt and fat in the diet, for example—can still have beneficial effects. By the same token, studies suggest that getting in a couple more servings of fruits and vegetables every day can cut problems related to cardiovascular disease by almost a third.

But for seniors who just aren’t getting enough to eat, such considerations really should be laid aside. Your body needs calories in order to perform basic functions, and if “healthy” foods aren’t appetizing enough for you to get those basic calories, then don’t be afraid to eat cookies, or some other favorite food, in order to boost your intake. Especially as seniors progress through their 70’s and 80’s, favorite foods can be a source of joy and satisfaction as well as essential nutrients.

Don’t be afraid of prepared food:

In a similar vein, for seniors who are having difficulty preparing their own meals, having pre-prepared food available can make it much easier to find nourishment. Since seniors take in less food in general, it’s better to have nutrient rich foods like fruits and vegetables making up significant parts of the diet, but again, if getting enough calories is a problem, don’t be afraid to rely on microwaved meals and other items from the pantry and freezer. In fact, pre-prepared frozen fruits and vegetables can be a great source of vitamins and fiber.

Have more mealtimes:

One easy way to address a lack of appetite and the slowing of the digestive system is to have more, and smaller meals. This can be as simple as making it easier to snack during the day by leaving healthy snacks in easy reach, but it can also mean planning for second breakfasts and lunches. Interestingly, people who snack during the day will often also eat more at mealtimes, so nibble away!

Spice up your food:

As mentioned above, we tend to lose our senses of taste and smell as we get older. Fortunately, though, there’s an easy solution to this problem: spicing up your meals. If possible, avoid using salt to give your food more flavor, but feel free to add more herbs or other spices to your favorite foods, and feel free to exceed the recommended spice levels in your favorite recipes. Finally, food can become more appetizing if it’s attractive to look at, so it can help to add bright, fresh fruits and vegetables to your plate and to individual dishes.

What to Eat, Though? And How Much?

Even if you do find ways of increasing your intake of food, there remains the question of what you should eat. This is obviously a subject of a lot of controversy: every day a new study urges us to eat particular foods, abandon others, and–often–to ignore previously published advice. Even the general nutrition guidelines have changed dramatically over the years, with the government and other researchers releasing new models of how to eat every decade or so.

Pyramid or Plate?

Early attempts by the government to give nutritional guidelines might seem fairly primitive to us now. From promoting the four basic food groups to laying out food recommendations on a “food wheel,” the government’s attempts to clarify what people needed in terms of nutrition could only be as good as the medical research that backed it up.

Then, in 1992, in response to advances in nutrition research, the US Department of Agriculture created a model of nutrition called the “Food Pyramid.” This familiar figure was laid out in six sections, each covering a particular type of food, with the size of each section indicating how much you needed of that type of food every day. The Food Pyramid advice ran along these lines:

  • Cereals and grains: the pyramid suggested 6-11 servings each day.
  • Fruits: 3-4 servings every day
  • Vegetables: 3-4 servings
  • Meat and other non-dairy protein: 2-3 servings
  • Dairy products: 2-3 servings
  • Fats, oils, and sweets: for these extras, the pyramid’s advice was to use them sparingly.

The pyramid was, at times, the subject of controversy: many felt that it placed too heavy an emphasis on grains, and many also suggested that the grain and dairy sections were put into the pyramid—and given such prominence—out of deference to America’s grain and dairy industries. In 2005, partly in response to these criticisms, and also in response to continuing research, the USDA revised their guidelines. They replaced the horizontal sections of the food pyramid with vertical wedges in a figure they called “MyPyramid.” This new pyramid gave less emphasis to grains, dairy, and fruit, and gave vegetables more relative weight in the ideal diet.

MyPlate

Our understanding of our nutrition needs didn’t stop in 2005, however, and in 2011, the USDA changed its approach, got rid of the pyramid, and switched to a new diagram in the shape of a plate. Still, the MyPlate framework goes in the same general direction: fruits and vegetables take up about half of an ideal “plate”—that is, half of a recommended meal or daily diet—with protein and grains taking up the other half, and with dairy relegated to a side dish. Again, this completes a trend that has been obvious since the first pyramid, emphasizing fruits and vegetables and de-emphasizing other elements of our diets.

So What Is a Serving, Anyway?

elderly person adding salad to a plate

elderly person adding salad to a plate

Now that we have this new, improved model of how we should eat, what does it mean? In general terms, MyPlate—and the science behind it—recommends that each meal should include roughly equal servings of fruits, vegetables, grains, and protein. But then the question is: what is a serving? Fortunately, most prepared or packaged foods these days have information on them about “serving size,” and this can be used as a guide. But for those who are making their own dishes, or relying, as per advice, on fresh fruits and vegetables, figuring out the size of a serving can be a challenge. Here are some ways to think about it that might make it easier.

Vegetables

In the MyPlate system, vegetables make up the biggest portion of an ideal meal. So what counts as a vegetable? Basically, any part of a plant (in particular, the stem, root, or flower) that humans can eat that comes out savory rather than sweet after cooking. Overall, vegetables—especially “superfoods” like broccoli and spinach—contain far greater concentrations of vitamins and other essential nutrients than any other kind of food, and that’s one of the main reasons why they take up so much of a plate. But how much is that, really? Well, a standard serving of vegetables is about 3 ounces, and here’s what that could look like:

  • A single tomato (sliced or sectioned works)
  • Half a cup of corn or other fresh, small vegetable, including peas
  • A full cup of leafy vegetables like fresh spinach, arrugala, or endive (lettuce—which is relatively low in nutrients—doesn’t count)
  • Half of a medium sweet potato or potato, or other starchy vegetables like turnips.
  • Half a cup cooked (as opposed to dried, not yet cooked) beans or lentils
  • Half a cup of cooked cruciferous vegetables (think broccoli and cauliflower), squash, root vegetables (think carrots and parsnips), or spinach

Grains

In the MyPlate guidelines, grains make up the second-largest portion. Ideally, the grains you eat should as unrefined as possible in order to provide you with fiber as well as complex carbohydrates. Note, too, that while the term “grains” may make you think of wheat fields, this category also includes things like couscous, quinoa, rice, oatmeal, pasta, and cornmeal. So what does a serving of grains look like?

  • Half a cup of cooked grains such as rice or pasta
  • Half a cup of cooked oatmeal
  • Two-thirds of a cup of breakfast cereals like wheat or cornflakes
  • A quarter cup of heavier cereals such as granola or muesli
  • A single slice of bread, or half a roll

Note: for a lot of people, this may seem like a surprisingly small amount of grains. The key thing to remember, though, is that, especially for seniors, these guidelines can be thought of as minimums, and as suggestions about the ideal proportions for each of these different types of food in your diet. If you’re a senior, and you want a full roll or two slices of bread, bon appetit!

Fruits

Fruit makes up the next largest portion of the MyPlate guidelines. In contrast to vegetables, fruits are supposed to be sweet tasting: they’re usually the seed-bearing part of the plant. In addition to providing essential calories, fruits are low in fat, are even better at supplying you with beneficial fiber than grains, and are a source of essential nutrients. So what does a serving of fruit look like?

  • A single large fruit, such as an apple, banana, peach, nectarine, orange, or pear
  • Two smaller fruits, like plums, apricots, clementines or mandarin oranges, or kiwi fruits
  • A half cup of preserved fruit such as fruit cocktail, or of frozen fruits, such as blueberries, or of diced fruits such as strawberries, or of the smallest types of fruit such as fresh berries and grapes.

Note that dried, canned, and other preserved fruit can work as well as fresh fruit (indeed, frozen fruit can sometimes be even better than fresh). So if you’re worried about the expense involved in buying produce or the possibility of it spoiling, you can always take advantage of fruit that has been preserved for future consumption.

Meat and Other Proteins

While meat makes up the smallest portion of the MyPlate guidelines (apart from dairy and fats, which we’ll get to below), that doesn’t mean it’s unimportant. In fact, it’s a testament to how concentrated meats and legumes are in terms of nutrition. In addition to supplying vital protein, meat provides important minerals like iron and zinc, and important vitamins like B12. In addition to well-known sources of protein such as beef, chicken, pork, fish, and eggs, you can get protein from sources like beans, nuts, tofu, and some dairy products, but fortunately or unfortunately, meat is the most concentrated source of protein commonly available. In terms of portion size, the standard advice to eat a serving of meat that’s about the size of a deck of cards still applies—and it applies to all types of meat, including fish, poultry, pork, and beef. For other types of protein, here are some guidelines for serving size:

  • Six ounces (just under a cup) of tofu
  • Two large eggs
  • One ounce (a handful) of seeds and nuts, and a tablespoon of peanut or other nut butters
  • A full cup of cooked beans, chickpeas, lentils, or split peas.

Dairy, Oils, and Sweets

Apart from dairy products like cheese that can supplement your protein intake, dairy products would, ideally, make up a fairly small portion of your diet, as would fats such as butter, margarine, and oil (and heavily sugared desserts). But for seniors, that just means that it’s best not to rely on them for calories, not that you should eliminate them completely. In fact, milk products can be a good way to get the calcium your body needs, and oils (particularly oils used as dressing rather than for cooking) can provide you with other nutrients essential for health.

Okay, But What Would a Meal Look Like?

Knowing what single servings would look like is useful, but if you’re a senior—or if you’re caring for a senior—you might feel you’d be better off knowing what a full-on meal would look like. Fortunately the National Institutes of Health has this question covered—and has provided some sample menus tailored specifically to the dietary needs of older adults. Here’s a look at a sample day of meals:

Not every day has to be like this, of course, and unless a senior is struggling with issues related to obesity or heart disease, they could always eat more (What? No dessert?), but this should give you some idea of what you really should be eating in a typical day.

Not every day has to be like this, of course, and unless a senior is struggling with issues related to obesity or heart disease

Breakfast

  • Half a whole wheat bagel spread with two tablespoons of peanut butter
  • One banana
  • One cup of coffee with a quarter cup of milk and two teaspoons of sugar.

Snack

  • A quarter cup of raisins
  • A cup of low-fat milk

Lunch

  • One tuna fish sandwich (2 slices bread, 2 ounces—about half a small can—of tuna, 2 teaspoons mayonnaise, 2 tablespoons chopped celery, and a lettuce leaf)
  • Four baby carrots

Dinner

  • Spaghetti and meatballs (a cup of cooked spaghetti, a quarter cup of sauce, a quarter cup of canned diced tomatoes, three medium meatballs, and a tablespoon of parmesan cheese)
    Salad (one cup greens, a quarter cucumber, a quarter of an avocado (cubed), a quarter cup of canned chickpeas, and three tablespoons of shredded cheese, plus a tablespoon of dressing)
  • A cup of water

The Incredible Importance of Nutrition

As we get older, we confront natural challenges to getting enough to eat. And given all the stigma that our society attaches to overeating, it’s easy to ignore the problems that undereating could cause. But they are many, from a lack of energy, to problems with emotions and cognition, to more severe issues like organ failure and the diseases of malnutrition. No matter how old we get, our bodies still need fuel to work effectively.

And not just to work effectively. We also need food in order to maintain the joy of living, to maintain the energy we need to spend time with our loved ones, and to stay as healthy as possible for as long as possible. In short, one of the surest foundations of an independent life for any senior is taking care to eat healthy and eat enough. Just as breakfast is the most important meal of the day, a healthy and adequate diet is the first condition for having a joyful later life.

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Medicare Fraudsters Now Tap Telemedicine In Medical Equipment Scams

Dean Ernest had been living in a nursing home about a year when his son, John, got a call last winter asking if his father was experiencing back pain and would like a free orthotic brace.

The caller said he was with Medicare. John Ernest didn’t believe him, said “no” to the brace and hung up. He didn’t give out his father’s Medicare number.

And yet, not just one, but 13 braces arrived soon afterward at Ernest’s house in central Pennsylvania.

Medicare, the federal taxpayer-supported health care insurance program for older Americans, had paid over $4,000 for 10 of the braces: a back brace, two knee braces, two arm braces, two suspension sleeves, an ankle brace, a wrist brace and a heel stabilizer.

The orders came from four medical equipment companies and were prescribed by four separate health care professionals — a prescription being required to receive an orthotic brace. But Ernest said he didn’t talk to any doctors during the phone call.

That’s how the latest Medicare frauds work, said Ariel Rabinovic, who works with Pennsylvania’s Center for Advocacy for the Rights & Interests of the Elderly. He helped report Ernest’s fraud case to authorities at Medicare. Rabinovic said the fraudsters enlist health professionals — doctors, physician assistants, nurse practitioners — to contact people they’ve never met by telephone or video chat under the guise of a telemedicine consultation.

“Sometimes the teledoctors will come on the line and ask real Mickey Mouse questions, stuff like, “Do you have any pain?” explained Rabinovic. “But oftentimes, there is no contact between the doctor and the patient before they get the braces. And in almost all of the cases, the person prescribing the braces is somebody the Medicare beneficiaries don’t know.”

While prescriptions for durable medical equipment, such as orthotic braces or wheelchairs, have long been a staple of Medicare fraud schemes, the manipulation of telemedicine is relatively new. The practice appears to be increasing as the telemedicine industry grows.

“This has put telemedicine scams on Medicare’s radar with growing urgency,” said James Quiggle, director of communications for the Coalition Against Insurance Fraud.

In the past year, the Department of Health and Human Services Office of Inspector General, the Department of Justice and, in some cases, the FBI, have busted at least five health care fraud schemes that involved telemedicine. Typically in these schemes, scammers use sham telemedicine companies to scale up their operations quickly and cheaply — they can have a couple of doctors remotely writing a large number of prescriptions.

Often the doctors working for these outfits don’t perform medical consultations, but rather write prescriptions without talking to patients, as in Ernest’s case. Of course, that is not how telemedicine is designed to work.

In April 2019, the DOJ announced investigators had disrupted what they called “one of the largest Medicare fraud schemes in U.S. history.” Operation Brace Yourself cracked an international scheme allegedly defrauding Medicare of more than $1.2 billion by using telemedicine doctors to prescribe unnecessary back, shoulder, wrist and knee braces to beneficiaries.

The DOJ charged 24 people, including three medical professionals and the corporate executives of five telemedicine companies.

According to federal court documents, Willie McNeal of Spring Hill, Fla., owned two of the “purported” telemedicine companies, WebDoctors Plus and Integrated Support Plus.

Federal investigators allege that through Integrated Support Plus, McNeal hired and paid a New Jersey doctor, Joseph DeCorso, to write prescriptions for braces. DeCorso recently pleaded guilty to one count of conspiracy to commit health care fraud.

DeCorso admitted to writing medically unnecessary brace orders for telemedicine companies without speaking to beneficiaries or doing physical exams. He also admitted that his conduct resulted in a $13 million loss to Medicare. He has agreed to pay over $7 million in restitution to the federal government.

McNeal got the Medicare beneficiaries’ information for DeCorso to write the prescriptions from telemarketing companies, according to the indictment. Then, authorities allege, McNeal sent the prescriptions back to the same telemarketing companies in exchange for payments described as kickbacks and bribes.

Federal investigators allege these telemarketing companies sold the prescriptions to the durable medical equipment companies, who in turn billed Medicare for the braces.

McNeal’s lawyer said he could not discuss his client’s case because it is pending. DeCorso’s lawyer did not respond to multiple requests for comment.

The U.S. attorneys allege the money made from the scheme was hidden through international shell corporations and used to buy luxury real estate, exotic automobiles and yachts.

It’s clearly a profitable business. Taxpayers are the ones who ultimately pay for Medicare fraud, which often leads to higher health care premiums and out-of-pocket costs.

Medicare spending on back, knee and ankle braces highlighted in the inspector general’s investigations increased by over $200 million from 2013 to 2017, according to an analysis of Medicare data by Kaiser Health News. While the number of Medicare fee-for-service beneficiaries increased slightly, by 5%, from 2013 to 2017, spending on the three types of braces increased by 51% during that same period.

In an April news release about Operation Brace Yourself, Assistant Attorney General Brian Benczkowski of the DOJ’s Criminal Division called the Medicare scheme “an expansive and sophisticated fraud to exploit telemedicine technology meant for patients otherwise unable to access health care.”

Nathaniel Lacktman, a lawyer who represents telemedicine companies and organizations, was quick to point out that the industry does not recognize the fraudsters involved in these schemes as legitimate businesses.

“These are actually really sketchy online marketing companies participating in these schemes who are billing themselves as telemedicine,” said Lacktman, who works in the Tampa office of the law firm Foley & Lardner. “But in fact, they’re companies we’ve never heard of.”

All of this comes at a time when Medicare and Medicare Advantage are expanding telemedicine, though the programs have been slower to adopt it than the private sector, said Laura Laemmle-Weidenfeld, a health care lawyer at the law firm Jones Day.

“I would hate for Medicare to fall even further behind with telehealth,” said Laemmle-Weidenfeld, who previously worked in the Fraud Section of the DOJ’s Civil Division. “The vast majority of telehealth providers are legitimate, but as with anything there are a few bad apples,” she said.

Even with the recent federal busts, the scams continue.

Travis Trumitch, who works for the Illinois nonprofit AgeOptions, which helps report Medicare fraud in the state, said he received three voicemails over a recent weekend reporting suspected durable medical equipment scams.

John Ernest said he still receives calls every day with individuals on the line who say they work for Medicare and ask for Dean Ernest’s information — though his father died in April.

But Ernest can’t change his phone number because it’s the main line associated with his painting business.

“It really drives me crazy,” said Ernest. “How many people are they ripping off?”

KHN data editor Elizabeth Lucas contributed to this report.

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Cracks in Purdue’s proposed opioid settlement as Arizona backs out

(Reuters) – The U.S. state of Arizona withdrew its support for a proposed nationwide opioid settlement with Purdue Pharma LP, saying the maker of OxyContin sought to “undermine material terms of the deal,” according to a court filing on Monday.

FILE PHOTO: Bottles of prescription painkiller OxyContin, 40mg, 20mg and 15mg pills, made by Purdue Pharma L.D. sit on a counter at a local pharmacy, in Provo, Utah, U.S., April 25, 2017. REUTERS/George Frey/File Photo

Since Purdue filed for bankruptcy protection in September, Arizona is the first state to switch sides in the looming showdown over the privately-held company’s proposed settlement, which it has estimated is worth more than $10 billion.

Purdue reached the deal last month with 24 states and the local governments that have filed the bulk of the more than 2,600 lawsuits against the company.

The lawsuits allege Purdue and its Sackler family owners contributed to a public health crisis by aggressively marketing opioids while downplaying their overdose risks, which contributed to nearly 400,000 deaths since 1999, according to U.S. statistics.

Last week, court filings from states and local governments opposing the settlement asserted that Purdue steered up to $13 billion in profits to the Sackler family, more than triple the amount previously cited in litigation.

A lawyer for some of the Sacklers last week said in a statement that much of the money was paid in taxes and reinvested in businesses that will be sold as part of the proposed settlement.

Arizona’s filing offers little explanation of why the state backed away from its initial support. “At nearly every turn during the course of subsequent negotiations, debtors have sought to undermine material terms of the deal,” it said.

Arizona’s attorney general did not immediately respond to a request for comment. Purdue declined to comment.

U.S. Bankruptcy Judge Robert Drain in White Plains, New York, will consider on Friday Purdue’s request for an injunction to pause the litigation for about nine months. Purdue said it needs time to try to settle the remaining cases.

Purdue also asked Drain to shield the Sacklers from litigation, even though they have not filed for bankruptcy, partly because the family has proposed contributing at least $3 billion toward the settlement.

Opponents of the settlement accused the family of using Purdue’s bankruptcy to shield their wealth from victims.

With Arizona, 25 states now oppose the deal. Kentucky and Oklahoma reached prior settlements with Purdue.

In addition to pursuing a case in state court against Purdue, Arizona is also pursuing a novel lawsuit that it filed directly with the U.S. Supreme Court, saying the unusual move was justified by the national importance of the opioid crisis.

Reporting by Tom Hals in Wilmington, Delaware; additional reporting by Mike Spector in New York and Nate Raymond in Boston; Editing by Bill Berkrot

Our Standards:The Thomson Reuters Trust Principles.

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Federally Funded Obria Prescribes Abstinence To Stop The Spread Of STDs

IRVINE, Calif. — Inside Obria Medical Clinics, conviction — not condoms — is summoned to stop the spread of chlamydia.

The Christian medical chain, awarded $1.7 million in federal family planning funds for the first time this year, does not offer hormonal birth control or condoms; instead, its doctors and nurses teach patients when they’re likely to be fertile and counsel them in restraint.

Reproductive health care providers have bristled over Obria’s inclusion in a federal program, known as Title X, established to help poor women avoid unwanted pregnancies. But clinics receiving money also are expected to detect, treat and prevent sexually transmitted diseases and HIV, and Obria’s prohibition against condoms means its prevention efforts — whether for single millennials or aging married couples — rest on abstinence.

In its application for federal funding, Obria pledged to follow the Centers for Disease Control and Prevention guidelines and recognized medical standards for preventing STDs. Used correctly and consistently, condoms are highly effective at preventing transmission of STDs, according to the CDC, a finding echoed by the American College of Obstetricians and Gynecologists and other major medical associations.

But Obria will not advocate or provide condoms. Instead, its staff will “emphasize that avoiding sex is the only 100-percent method to prevent pregnancy and STDs” and teach patients about “high-risk behaviors” and the “risks of using ‘safe-sex’ methods,” according to the group’s application.

Obria representatives declined a request to be interviewed for this article. But in a 2018 interview, Kathleen Bravo, CEO of the Obria Group, described the organization’s approach.

“By reducing sexual risk, you would have less women getting sick with STDs and cancer and pregnancies,” said Bravo, a devout Catholic. “In other words, teach them to not even go down that path.”

Sexual health educators, tasked with reversing four straight years of record levels of gonorrhea, chlamydia and syphilis across the nation, regard Obria’s prohibition against condoms as reckless and dismiss its focus on abstinence as wishful thinking.

“It’s hard to fathom how a health care provider could test someone for an STI [sexually transmitted infection], have the results either be negative or positive and not provide them with information about the efficacy of condoms in STI protection,” said Philip Yaeger, executive director of Radiant Health Centers, a community provider in Irvine that receives Title X funds.

From 2013 to 2017, the number of gonorrhea cases across the country increased 67%; syphilis rose by 76%. The number of cases of gonorrhea, syphilis and chlamydia reached 2.3 million in 2017. About 30,000 people are newly infected with HIV each year.

Left untreated, sexually transmitted diseases can lead to infertility, cervical cancer, blindness and dementia. The number of cases of pregnant women who pass along syphilis to their babies more than doubled from 2013 to 2017 in the U.S., resulting in scores of newborn deaths and hundreds of children with severe health complications.

In Orange County, among the wide boulevards and gleaming office towers where Obria maintains its headquarters, sexually transmitted diseases are an unrelenting force: From 2013 to 2017, gonorrhea cases rose by 129%, chlamydia by 65% and syphilis by 99%.

To confront the epidemic, health educators from Radiant Health Centers set up tables with sound machines and pulsing lights in nightclub parking lots on most weekends. Over the past year, they’ve handed out 25,000 condoms and oodles of lubricant.

Tiffany Hendrix, Radiant’s director of Health Education and Prevention — who takes an unsentimental view of sexuality after becoming a teenage mother — travels from high school to high school with a model penis and vagina instructing students on how to properly use condoms.

“It doesn’t matter what our beliefs are,” Hendrix said. “It’s our job to educate a person so they can make informed decisions, like with diabetes or cholesterol.”

But the conservative Christians helping fuel the growth in religion-based medical care in the U.S. say doctrinal beliefs rightfully determine the services offered in their hospitals and clinics, even when it involves virulent sexually transmitted diseases.

“Contraception is seen as harming the gifts God gave us,” said Theresa Notare, assistant director of the Natural Family Planning Program at the United States Conference of Catholic Bishops. “You can’t put in physical barriers like condoms or chemical substances that are going to obstruct the natural design of the ovaries.”

“There are no exceptions,” Notare said, even for STDs and HIV.

If a spouse is HIV infected, she said, withholding sex becomes a gesture of love. “The very difficult question has to be asked: Do we never have sex again? Quite frankly, because of a life-threatening disease, I would interpret it as yes.”

Catholic and evangelical Christian advocates herald President Donald Trump as an unlikely champion who, after decades of wobbly promises from Republican lawmakers and presidents, is delivering on their agenda.

The administration has worked methodically to appoint judges who oppose abortion rights; stamp out Planned Parenthood and other abortion providers; reverse Obama-era mandates on employers to include birth control in insurance coverage; and give primacy to abstinence sexual education in schools.

In loosening long-standing requirements that clinics provide the full suite of birth control options, including condoms, the Trump administration has allowed what were once makeshift anti-abortion crisis pregnancy centers — which typically offered pregnancy tests and, at most, operated an ultrasound machine — to become certified medical clinics.

Over the next three years, Obria could receive $5.1 million in federal family planning funds for its California clinics. But Bravo, who operates 38 clinics in six states, has grander visions: She wants Obria to become a nationwide alternative to Planned Parenthood, launching a $240 million capital campaign to open more sites.

“We put huge amounts of money into marketing our medical clinics to make sure that women know that we’re here in their city and these are the services that we provide,” Bravo said.

But Obria’s main website and the Obria Direct app for patients do not clearly indicate the organization’s religious convictions or how its religious beliefs limit its medical offerings.

The organization’s homepage portrays a prosaic medical practice “devoted to taking care of you holistically” and providing “the support and answers you need in regards to your sexual health.” The list of services includes STD testing and treatment, HIV testing, well-woman care and health education. Embedded in a lengthy description of the failure rates and possible complications of intrauterine devices, birth control pills, condoms and patches on Obria’s “Birth Control” page are notes that “Obria Medical Clinics does not prescribe birth control” and that natural family planning “is ineffective at preventing STDs.”

Medical facilities are not required to inform patients of religious affiliations or the limits of health care options.

The number of Catholic-affiliated hospitals across the country has grown rapidly in recent years, especially as hospital systems have consolidated. Five of the top 10 hospital systems by net patient revenue are associated with the Roman Catholic Church. But more than a third of women who visit a Catholic hospital for reproductive care are unaware of the religious affiliation, according to researchers from the University of Chicago and the University of California-San Francisco.

David Magnus, director of the Stanford Center for Biomedical Ethics, said clinics such as Obria are essentially pulling a “bait and switch” and raised the specter of potential liability for religiously oriented clinics, funded with public dollars, should a patient be given incomplete advice and then contract an STD.

“Pretending that you’ve given adequate advice is misleading and lying,” he said.

Related Topics

California Health Industry Public Health

Abortion Clinics Contraception Women’s Health

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