Health Insurance Reform

Health insurance reform is a complex issue and many of you have questions about what it means for you and your family. Last night, President Obama addressed the nation in a primetime press conference about health insurance reform. In the event you missed it, here is the video:

http://www.whitehouse.gov/blog/The-Presidents-Press-Conference-Full-Video/?e=8&ref=image

In summary, the bill provides quality affordable health care for all Americans and controls health care cost growth. The key provisions of the House of Representatives Health Care Reform Bill follow below:

1. Coverage and Choice. This bill protects current coverage allowing individuals to keep the insurance they have if they like it. It creates a Health Insurance Exchange allowing individuals and small employers to comparison shop among private and public insurers. It administers affordability credits to help low-and middle-income individuals and families purchase insurance. There will also be a public health insurance option guaranteeing coverage and providing insurance reforms. It limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. A new independent Advisory Committee chaired by the Surgeon General will recommend a benefit package based on standards set in the law. This essential benefit package will become the minimum quality standard for employer plans which will include preventive services with no co-pays, mental health services, and oral and vision care for children.

2. Affordability. In order to insure all Americans have affordable health coverage, the bill provides sliding scale credits available to low and moderate income individuals and families. All new policies will cap annual out of pocket spending to prevent bankruptcies due to medical expenses happening under our current system. The bill will expand the Medicaid program for low income children, individuals with disabilities, and people with mental illnesses. Medicare will be improved by filling of the donut hole in the current Medicare D drug program, eliminating co-pays for preventive services, and will extend the solvency of the Medicare Trust Fund.

3. Shared Responsibility. Once market reforms and affordability credits are in place, individuals will be responsible for obtaining and maintaining health insurance coverage. Those who choose to not obtain coverage will pay a penalty of 2.5 % of AGI (adjusted gross income). Employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. There will be assistance for small employers (payroll that does not exceed $250,000) who will be exempt from the employer responsibility requirement. A payroll penalty will phase in starting at 2% for firms with annual payrolls of over $250,000. A new small business tax credit will be available for those firms who want to provide health coverage to their workers.

4. Controlling costs. Modernization and improvement of Medicare will be implemented to reward efficient provision of health care and aim to decrease preventable hospital readmissions, create new consumer protectons for Medicare Advantage Plans, eliminate the "donut hole", and will improve low-income subsidy programs so that Medicare is affordable for all seniors and other eligible individuals. The public health insurance option will be empowered to be the purchaser of health care to get more value for each health care dollar spent. New tools will be provided to combat waste, fraud and abuse within the entire health care system. The bill will simplify the paperwork burden that adds tremendous costs and hassles for patients, providers, and businesses.

5. Prevention and Wellness will be expanded by the use of Community Health Centers.

6. Workforce Investments will be made by increasing funding for the National Health Service Corp; increase training of primary care doctors; increasing an expansion to promote individuals going into health professions (primary care, nursing, and public health); expansion of scholarships and loans for individuals in needed professions and shortage areas; and redistribution of unfilled graduate medical education residency slots in order to train more primary care physicians.

In listening to the President's remarks about the new emphasis on programs that contribute to health and wellness, I couldn't help but wonder about Medicare's Hospice Program. I would hate to see the much needed non for profit and for profit Hospice programs be cut back in funding as the pre- baby boomer population continues to age. More about Hospice in Part II.

We wish to thank Francine Hardaway of Arizona Health Futures.org for her very concise blog posted on July 14th explaining the proposed House of Representatives Health Care Reform Bill which even I could understand.

If you'd like to leave your comments, we'd love to hear what you've got to say. Follow the link provided below.

Elder abuse done mostly by family, caregivers | Recordnet.com

Having experienced elder exploitation perpetrated against an 80 year old distant relative and now recently against his wife by the same family member, I am compelled to share this article written by Michelle Singletary, Washington Post Columnist.

The annual financial lost by victims of elder financial abuse is estimated to be at least $2.6 billion. The average victim of elder abuse is a woman older than 75 who lives alone. According to Fred Joseph, Colorado's securities commissioner and president of the North American Securities Administrators Association, "Elder financial abuse is becoming the crime of the 21st century as the growing senior population is increasingly targeted."

It is not surprising that the more health issues seniors have, the more likely they will be victimized. Searching media reports of abuse for this year, the writer found numerous cases where family members and caregivers took advantage of seniors with dementia.

A nursing assistant from the state of Washington was charged with stealing more than $770,000 from the elderly woman she was caring for. In a Florida case, a man called authorities to report his 80-year old mother's hairdresser had stolen her checks. They stylist was accused of taking $25,000 from the woman's checking account. But during the investigation, police charged the victim's 52-year-old son - who first alerted police - with fraudulently cashing $6,900 in checks from his mentally incompetent mother.

Last month in Virginia, a home health caregiver was sentenced to six months in jail for taking $15,000 from an 85-year-old woman suffering from dementia. The victim was bedridden.

The financial abuse of seniors has become so prevalent that the North American Securities Administrators Association and the National Adult Protective Services Association recently united to develop tips and strategies to protect them.

"A silent crime is taking its toll on American -- silent because so many of these cases go unreported," said Kathleen Quinn, executive director of the protective services association. "This announcement is the first step in a partnership we hope will grow to close the gap on elder abuse."

Following are some of the ways elder financial abuse can happen:

• Forging an older person's signature.
• Getting a senior to sign a deed, will or power of attorney through deception, coercion or undue influence.
• Using the elder person's property or possession without permission.
• Promising lifelong care in exchange for money or property and not following through on the promise.
• Making charges against victims' credit cards without authorization.
• Confidence crimes in which victims are scammed by gaining their trust.

Following are some red-flag warnings given to adult protective service workers:

• Is the senior receiving information about or being asked to invest in unregistered securities or start up companies? Securities fraud can be detected by checking with your state securities regulator. Contact information available at www.nasaa.org
• Is the investment high risk or possibly speculative, such as oil and gas exploration, new or untested technologies, rare metals or involve currency trading?
• Has the senior been asked to sign blank paperwork or to give discretionary authority over her accounts to an advisor?
• Is the senior complaining that his investment advisor won't give him his account statements or documentation?
• Has the senior made out a check directly to the advisor or broker for the purchase of an investment?

Information is available on the groups' website that will assist you in helping seniors avoid these problems. Go to http://www.nasaa.org and search for "Senior Investor Resource Center."

To report elder abuse, you can contact an Adult Protective Services office at http://www.apsnetwork.org or through the National Center on Elder Abuse at http://www.ncea.aoa.gov or (800) 677-1116.

If you suspect a senior is being financially exploited, report it - even if the suspected scoundrel is a family member. In my family member's case, I took my uncle down to the local police department and charges were filed against the family member who was exploiting him. What broke my heart was that after the seniors death, the wife took in the same family member and he exploited her as well.

Contact Michelle Singletary, a personal finance columnist at the Washington Post, at singletarym@washpost.com.

Why Geriatric Care Managers Should Take ALF Core Training

A number of years ago when I first became a geriatric care manager, I decided to take the CORE training in order to give myself some options if things didn't work out as a care manager. Little did I know that the material learned through my instructor would also serve to make me a better geriatric care manager. Not only did we learn the Florida Statutes and Administrative Code pertaining to licensing and operating an Assisted Living Facility, but I benefited greatly by learning the material about following the Occupancy Cycle which governs the paperwork process for admission into a facility. Up until that point I thought it was similar to renting an apartment and all I had to do was bring my client to the facility with a check on move-in day! Boy, was I wrong. We were taught about age related changes, managing food service in a facility, medications, what is involved in offering personal care to a resident, mental health, Alzheimer's disease, Resident's rights, the Ombudsman program, abuse, neglect, and exploitation, providing stimulating activities, and so much more. Because we practice so independently, learning the State regulations will add a framework for running your practice. Since GCMs basically provide assisted living for our clients in their own homes these regulations remove all ambiguity and offer care managers clear direction when faced with the best course to follow for our clients.

So, if you are a newbie geriatric care manager and feel you could add to YOUR CORE training, get in touch with me at: olga@agooddaughter.com

We are in the process of putting together our calendar for the August schedule. We only teach the CORE training program during the 2 middle weekends of each month. If you would like to learn more, go to: http://olgabrunner.com -- You won't regret it. And you may even have some fun in the process.

Hiring Caregivers for the Home - What You Need to Know.

When frail or elderly parents start having difficulty with every day tasks, it is generally recommended that a private caregiver be brought into the home to assist with ADLs (Activities of Daily Living). These activities can be related to assistance with ambulation, bathing, dressing, driving, eating, finances, food preparation, housekeeping, laundry, medication assistance, shopping, telephone, toileting, and transportation. But before you hire someone, you will need to consider the person's medical and mental status, environmental and safety issues, psychosocial and financial issues which must be considered before deciding that keeping your parent living safely in his/her own home is going to be the best option. A Geriatric Care Manager (GCM) has the expertise to complete a comprehensive assessment to assure the decision is made.

Once your decision is made to age in place at home, a qualified caregiver overseen by a geriatric care manager who has the clinical knowledge to establish a professional plan of care and offer direction to the caregiver would be in the best interest of the older adult. Caregivers of all types do not have the education to function independently without supervision by a qualified professional such as a GCM. How to tell the difference in credentials of your prospective caregiver?

Certified Nursing Assistants (CNAs) have medical training and must pass an exam to get certified. CNA's can check vital signs, care for wounds, have knowledge of transfer techniques, and can help with activities of daily living such as bathing and dressing. CNA's typically have received training under a nurse at a facility such as a hospital or nursing home and can assist with household tasks and meal preparation as well.

Home Health Aides (HHAs) may have some formal training provided by their employer but have not taken a certification exam. They can assist with ADLs but have not had formal training on medical issues unless they have been taught through their own experience. They can also assist with light housekeeping, transportation, and meal preparation.

Companions usually will not provide direct patient care but are available for companionship. They can assist with cooking, cleaning, shopping, transportation, and stimulating activities and outings.

Hiring a caregiver through word of mouth is usually the least expensive option and the one most used but this arrangement can create legal liabilities for the family because the family becomes the employer. For example, the family can be held liable for injuries that may happen on the job. If you choose to hire a private caregiver, have the GCM conduct a background check, check prior employment history and references. If you hire them as an indepdendent contractor you will need to file a 1099 on any wages over $600 yearly. If you hire them as an employee, you will be responsible for paying taxes and benefits such as Social Security and Medicare and federal withholding and unemployment tax. Remember, hiring privately may leave you without a backup if this person leaves unexpectedly or becomes ill. Sometimes there are unscrupulous persons who will take advantage of vulnerable clients, so do not skip any of the steps above. If you have found someone on your own who has met the above criteria it may be a good idea if you have a geriatric care manager oversee the caregiver and make spot visits from time to time to make sure there are no problems if the family lives in another state.

Hiring from an agency may be just a bit more expensive because the agency will pay FICA taxes, cover worker's compensation insurance, and will screen potential employee backgrounds. You will want to make sure the agency bonds and insures their caregivers, that caregivers have received training on CPR and first aid skills, and that the agency has a large number of caregivers offering you a guarantee of a substitute caregiver if your primary is sick or on vacation. A good agency will have a RN who follows up on the plan of care, and will oversee and offer advice to the caregiver.

Remember these employees are not your friends. You may be friendly when you come to town for a visit, but keep it professional. If your employee thinks of herself as your friend, she may take liberties of a friend, not an employee of your vulnerable parent. Make sure there are clear expectations as to what she should be doing at all times. Have them use a notebook for progress notes or observations daily. Have a GCM develop a plan of care and have the caregiver keep a record of how she is following the plan of care. Make sure they are clear about the personal care that should be provided.

Most of the calls received at A Good Daughter Elder Care Management are when a parent has a crisis following a fall or hospitalization. At first, a parent will not acknowledge they need a stranger in their home but children need to convince their parents they need in home care. Use a GCM to mediate the safety issues for an aging parent. GCMs recognize how to respectfully allow the older adult to feel in control of their lives while helping them recognize that accepting help actually allows them to maintain their independence.

To find out how a geriatric care manager can help with your aging parent's need for more help as they age in place, go to our web site: http://www.agooddaughter.com or email: olga@agooddaughter.com We are available via our toll free number: 800-963-3877 on a 24 hour basis, seven days a week, 365 day a year for emergencies.

Johns Hopkins Health Alerts

What is the single most important thing people can do to protect their brains and guard their memory? In this article from the Johns Hopkins Memory Bulletin, Sandra Aamodt, Ph.D and Sam Wang, Ph.D answer this important question.

Q. What is the single most important thing people can do to protect their brains and guard their memory?

Sam: The answer is simple and surprising. It's physical exercise, especially the kind that raises your heart rate and makes you sweat. It's not known exactly why exercise works, but the best idea is that it improves blood flow to the brain. It also stimulates the secretion of neurotrophins, which are signaling molecules that help neurons grow.

A recent meta-analysis of 18 studies reports that a physical exercise program -- even one started when people are in their 70s -- can significantly boost executive function. In this case, the effect size is quite large. To return to our example, if you are an average person out of a group of 20, which would rank you as number 10, exercise can improve your rank to number five -- a huge improvement.

Sandra: What's important to remember is that there have been actual intervention studies reporting that exercise programs can significantly improve executive function and the ability to plan and execute behaviors. A meta-analysis of 18 studies published in Psychological Science concluded that a variety of physical exercise programs improved executive function substantially. Another study, published in the Journal of theAmerican Geriatrics Society, found evidence that exercise also protects cognitive ability.

Older people who had better aerobic capacity -- meaning they were in better physical condition at the beginning of the study -- were most likely to have maintained their level of cognitive functioning six years later. People who were otherwise healthy but had poor aerobic capacity had worse cognitive scores after six years.

Physical fitness also influences brain volume. In a study published in the Journal of Gerontology, researchers asked people ages 60–79 to either walk or perform stretching and toning exercises for one hour three times per week for three months. A third group did not exercise. The researchers used magnetic resonance imaging (MRI) to measure the participants' brain volumes before and after the exercise programs. After three months, brain volume had increased significantly among the people who had walked. The biggest increases were in the frontal lobes, the area of higher-order mental activity like memory and attention. Brain volume did not change in the other two groups.

Q. How much exercise is needed for optimal memory and brain preservation and brain health?

Sam: The meta-analysis of exercise programs and executive function found that 30 minutes of moderate activity three times per week had significant benefits for brain health. The U.S. Surgeon General and most health organizations recommend at least 30 minutes of moderate activity on most days of the week to maintain good health.

Brisk walking is a popular aerobic exercise that has been found to reduce the risk of cognitive decline. In a study published in the Journal of the American Medical Association, researchers asked 2,257 men (ages 71–93 and with no signs of dementia) how far they walked each day. Cognitive assessments performed four to eight years later showed that the men who walked less than a quarter mile a day were nearly twice as likely to have developed dementia as those who walked two miles or more each day.

In the same issue of the journal, a study of 16,466 women found that regular exercise (including walking) reduced the risk of cognitive impairment by 20%, and the more exercise, the better. Women who exercised at least 1.5 hours per week showed less cognitive decline than those who walked 40 minutes or less each week.

Sandra: If you do a half hour to 45 minutes of exercise three times a week, you are well into the effective range. You don't have to spend an enormous amount of time exercising to benefit. Although there's no statistical evidence right now that more exercise would be any better for your brain, it wouldn't hurt. I think we could say with some confidence that it would be better for your heart, so my best guess is that it would be better for your brain, too.

Q. What's the link among exercise, stroke, and memory protection?

Sam: Exercise can dramatically reduce your risk of stroke, which is the brain equivalent of a heart attack. In the most common type of stroke, a blocked blood vessel prevents blood flow to a particular brain region, leading to neuron death and dysfunction. If you survive a stroke, you have a significantly increased risk of cognitive impairment, memory loss, and AD. A report from the Archives of Neurology showed that people with a history of full-blown stroke were about 60% more likely to receive a diagnosis of Alzheimer's disease than were those with no history of stroke.

If you have significant risk factors for stroke -- such as hypertension, diabetes, and smoking -- you may have an increased risk of declines in executive function, according to a study published in Stroke that assessed the 10-year risk of stroke in more than 2,000 men and women. Obviously, a major stroke -- for instance, one in which you get a big clot in a big vessel that cuts off blood flow to a significant portion of your brain—can have a major effect on brain function and memory. But so can so-called microstrokes, which are caused by little blood clots that lodge in little vessels and deprive a small part of your brain of blood. A lot of older people have microstrokes, which are a risk factor for subsequent major strokes.

Most people don't even notice microstrokes, which usually affect only a small number of brain cells. Although microstrokes sometimes show up as tiny spots on brain scans, other times they can't be picked up at all. The bottom line is that there's no way to interpret killing off of neurons as being a good thing, even in small numbers. So it seems pretty obvious that doing anything you can to prevent microstrokes -- especially engaging in regular physical exercise -- is essential for protecting your brain and guarding your memory.

Connect For Healthcare

I am always blown away by the way you have to beg and plead to get medical staff in our Florida nursing homes to connect with the families who have placed their loved ones in their care.

Well, now there is a solution. "Connect4Healthcare.com" has devised a revolutionary new system for long term care providers to stay in touch with long distance family members. Please watch this video: