Happy 48th Anniversary to Medicare!

Medicare provides access to health care for millions of seniors and those with disabilities. Nearly 50 million Americans—15 percent of the nation’s population and growing—depend on Medicare for health security.

New information released this week by the Department of Health and Human Services (HHS) shows a strong Medicare program:

• Over 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act.
• Prescription drug savings have averaged $1,061 per beneficiary in drug costs while a beneficiary is in the “donut hole” coverage gap that the law closes over time. 
• 16.5 million people with traditional Medicare took advantage of at least one free preventive service in the first six months of 2013.
• Recent changes in the new health law have also added additional protections to curb fraud and abuse and extend the life of the Medicare Trust Fund. 

“Medicare is much stronger as a result of the health care law,” said HHS Secretary Kathleen Sebelius. “Spending has slowed to historic levels, as seniors are enjoying enhanced benefits and greater savings on drugs.”

Medicare does face financial challenges and AARP is calling for responsible, commonsense solutions that would help ensure Medicare’s continued success, including fair prescription drug prices and ridding Medicare of waste, fraud, and abuse. AARP released the first in a “commonsense solutions” series on the 48th anniversary of President Lyndon Johnson signing Medicare into law on July 30, 1965.  Click here to see the video.

This year, Medicare Open Enrollment is October 15- December 7, 2013. Just as you are planning for the Open Enrollment Period, you should plan for your future and for your loved ones. If you have not done Estate Planning or Incapacity Planning (or had your Planning documents reviewed in the past several years), or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, call The Fairfax Medicaid Asset Protection Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a no-cost consultation.
 

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Training Needed for Caregivers Is Lacking

Family caregivers and home health care professionals (collectively referred to in this article as “caregivers”) provide in-home care for family members or others who are chronically ill, disabled or elderly. Their goal is to help their loved ones or clients remain in their homes as long as possible, or in residential facilities rather than long-term care institutions.

Most caregivers typically have a genuine desire to help people, along with lots of patience and compassion. The job is often physically demanding and emotionally taxing.  Given all the complicated medical issues and day to day tasks, is there training available for caregivers?

Training can provide fresh ideas and new solutions, but according to a recent NY Times New Old Age blog article, sufficient training for caregivers is lacking. Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, said there is "a huge gap," referring to an absence of available training in demanding caregiving tasks. Training that exists through local Agencies on Aging deals mostly with "activities of daily living", such as helping someone bathe, dress, eat, or use the bathroom -- not the demands of nursing-style care, Ms.Reinhard observed. That leaves the burden on caregivers to be assertive and ask for help or find out what training exists in their area.

These are some available caregiver training options:

• AARP has several free on-line seminars on family caregiving topics such as housing options, the basics of handling caregiving, providing the care, and planning for the care of aging parents. AARP has also prepared comprehensive materials for caregivers called "Next Step in Care." While the focus isn't on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.
• Many home health-care companies, such as Five Star Home Health care, offer a 40 hour Caregiver class, where you can learn personal care assistance; home management; safety and accident prevention; infection control; and food, nutrition, meal preparation and how to help a loved one with activities of daily living like bathing and toileting. 
• The American Red Cross offers a training manual for caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

The NY Times article suggests that the best way for caregivers to learn caregiving techniques is to ask a professional for help. Experts suggest that no videos or written manuals can substitute for one-on-one, hands-on instruction. If your loved one or client is in the hospital, make sure care instructions are clearly explained to you before discharge. If you don't get them to your satisfaction, don't sign the form that says you have been given instructions on what to do. The hospital is legally obligated to ensure that discharges are safe, and this operates in a caregiver's favor. The same goes for the pharmacy: don't sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing if you haven’t been.

Caregiving can be rewarding, but it can also physically and emotionally demanding. The Fairfax Elder Law Firm of Evan H. Farr advises that if you are a caregiver, don’t let your own needs or health take a back seat.  Many caregivers are at the age when they are developing their own chronic issues. Be sure to take good care of the person you are caring for and yourself too! Part of doing so is planning for your future and for your loved one's future. Call the Fairfax Elder Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a no-cost consultation.

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Open Enrollment Period is Approaching: The Medicare.Gov Plan Finder Tool

Open enrollment for Medicare Advantage and Medicare Part D runs from October 15 to December 7. If you are researching and comparing Medicare Part-D and Medicare Advantage plans, the Medicare.gov Plan Finder is a helpful tool. It lists all of the plans available in your area, with details about the premiums, and personalized information about the out-of-pocket costs you’d pay specifically tailored for your drugs and dosages.

 What can you find out using the Plan Finder?

• Get the total out-of-pocket costs, including premiums, deductibles and co-payments, you’d pay over the year under each plan. You might find out that a plan with a low premium and high co-pays for your drugs actually costs more over a year’s time than a plan with a higher premium and lower co-pays for the drugs you need.
• The tool also shows whether a generic is available for any of your medications; whether the plan offers lower rates for using a mail-order or preferred pharmacy; and whether it imposes any restrictions, such as requiring prior authorization for certain drugs.
• Just as you are planning for the Open Enrollment Period, you should plan for your future and for your loved ones. If you have a loved one who is already in a nursing home or nearing the need for nursing home care, call The Fairfax Medicaid Asset Protection Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a no-cost consultation. 

P.S. Read today’s Ask the Expert for more details about Medicare’s Open Enrollment Period and the Affordable Care Act.

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Long-Term Care in the United States- The PACE Program

The following post was written by guest blogger, Carly Lee.
Want to submit a guest blog post? Read the Guidelines here.
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Many people in the U.S. will require some form of long-term care (LTC). Over the decades the population has been continuously increasing mainly due to Americans living longer. More services are required to care for the aging population. Twenty-five percent of individuals, most over the age of 85, will need extensive care that deals with cognitive and functional conditions (Hokenstad, 2005). Many elderly Americans have expressed wanting to retain their independence while still receiving medical treatment and help with activities of daily living.

In Chapter 8, different types of long term care (LTC) are described. The most well-known being nursing homes and assisted-living facilities. In the past, LTC was typically provided at a nursing home but due to the skyrocketing costs, families can end up spending their life savings on these facilities. An article from the New York Times states that “the nursing home model is no longer financially viable or medically justified” (Berger, 2012).

There is an innovative program that provides comprehensive healthcare for the elderly called PACE, Program of All-Inclusive Care for the Elderly. With PACE, the patient has an interdisciplinary team that includes doctors, social workers, nurses, and many other services while continuing to live at home. The program exists is 29 states today and is paid for primarily by Medicare and Medicaid with no deductibles, co-insurance, or copayments (Berger, 2012). PACE care supervisors are focused on preventative care in order to avoid patients being hospitalized or going to a nursing home. Family participation is also strongly encouraged.

According to the Medicaid website (www.medicaid.org), individuals must meet four main eligibility requirements. First, the individual must be 55 years of age or older and able to life in their home and environment safely. In addition they must live in an area where the PACE program is provided. Lastly, the individual has to be eligible for nursing home care as well.

The services make this program extremely efficient in maintaining and improving one’s health. Recipients receive care that is flexible and can accommodate their lifestyles. For example, not only does the program provide transportation for medical appointments, but the driver also assists the participant to and from the vehicle if needed. This service takes a good amount of pressure off of family care givers who have to rearrange their own lives and schedules to assist loved ones. For medications, the program covers all Medicare Part D prescriptions. Participation in the program is completely voluntary and participants can opt out any time. The downside is that the consumer most use a doctor that is in-network with the program.

PACE promotes preventative care by offering activities that encourage nutrition and socialization. Berger briefly describes CentreLight Healthcare, the largest PACE program in the nation, located in New York. CentreLight has day centers which provide nutritious meals, activities, and an opportunity to make new friends. Recently Northern Virginia established the first PACE program in that area, InovaCares for Seniors. With more program locations available along with the rising costs of nursing homes, physicians, family members and Elder Law attorneys are promoting PACE to clients.

Despite recent improvement in the quality of nursing homes care, alternatives choices are becoming increasingly popular (Hokenstad, 2005). Sultz and Young (2011) frequently point out that the health system needs to be continuous, organized, and integrated in order to provide the most beneficial care.

About the author:
Carly Lee is a student at Towson University who wrote this article as part of her class on “Health Care in the U.S.”

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Recent AARP Report Illustrates Need to Address Long-Term Care Demands

A new report released by AARP last week highlights the challenges facing states in providing long-term services and supports (LTSS). The report comes at a time when states are beginning to implement LTSS options in the Affordable Care Act that increase access to Medicaid home and community based services (HCBS).

The report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms that are underway and trends across the country.

The findings in the report signify that:

• States are actively exploring ways to better serve individuals with ongoing health care and support needs;
• More states are increasing participation in HCBS options within the Affordable Care Act as well as initiatives for individuals who are dually eligible for Medicaid and Medicare;
• There is increased demand for non-Medicaid services, including Adult Protective Services, as the caseload for adult protective services – for victims of abuse or exploitation – has increased in the last two years without increased funding in many states;
• State policymakers are committed to advancing a national dialogue for how to best address the increasing demand for services.

“It’s increasingly evident that we need to rethink how we address long-term services and supports in this country,” said Susan Reinhard, Senior Vice President for the AARP Public Policy Institute. “Long-term services and supports are critical not only to the population they serve, but also to the family caregivers who support them.”

 

The new report, “At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint” is available here: http://www.aarp.org/health/health-insurance/info-06-2013/providing-ltss-at-a-time-of-high-demand-AARP-ppi-health.html

 

We here at the Fairfax Elder Care Firm of Evan H. Farr, P.C. believe that with the rising costs and growing need for long-term care, Medicaid Asset Protection Planning is one of the best ways to provide for your future long-term care needs. Call 703-691-1888 to make an appointment for a free consultation. We can meet with you, assess your financial situation, and determine strategies for your long-term care plan.

 

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Nursing Home Use by Medicaid Seniors is Down

Many believe that an aging population means that there will be an explosive growth in the number of Medicaid beneficiaries in nursing homes. But, according to more than 35 years of research (see above), this isn’t necessarily the case. In fact, statistical data shows that nursing home use by Medicaid-eligible seniors has fallen by nearly one-third, from 1.4 million in 1995 to just over 1 million in 2010.

Where are Medicaid seniors living, if not in nursing homes? Studies show that many families are opting for less-restrictive types of care, ranging from assisted living to supervised adult day care. In fact, senior Medicaid beneficiaries are increasingly using home and community-based services (HCBS) options, both private pay and Medicaid-funded.

In 2010, assisted living facilities had about 700,000 residents, and about one in five were receiving Medicaid. Below are some possible reasons why nursing home use by senior Medicaid beneficiaries has declined:

• State Medicaid programs have been shifting care from nursing facilities to home and community-based settings;
• Seniors’ enrollment in Medicaid is growing very slowly even though the overall older population is growing rapidly;
• Nursing homes would rather provide rehabilitation services instead of long-term care because Medicaid pays an average of $125 a day for a long-term care resident, while Medicare pays $500 or $600-a-day for a short-stay patient.

According to Don Redfoot of AARP, “the trend away from Medicaid nursing home stays for seniors is a good one. It is good for seniors, good for the Medicaid program, and even good for many facilities whose real value-added may be in shorter-term rehabilitative care.” Redfoot states that “Older people continue to lag far behind their younger counterparts in their access to HCBS that can enhance independence and generally have lower per-person costs. Over half of Medicaid expenditures for aged beneficiaries (55 percent) still go toward paying for nursing home services, though that is down from 76 percent in 1975. Eliminating Medicaid’s institutional bias could turn the good news about Medicaid use in old age into great news — both for beneficiaries and for the country.” Read Mr. Redfoot’s article on the AARP blog and the recent Forbes article, “Nursing Home Use by Medicaid Seniors is Plunging”, for additional details.

Do you have a loved one who is in a nursing home or nearing the need for nursing home care? Or are you simply looking to plan ahead in the event nursing home care, or one of the other alternatives described in the article, is needed in the future? Nursing homes in Northern Virginia cost $12-$15,000 per month. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Learn more at The Fairfax Elder Law Firm of Evan H. Farr, P.C. website. Call 703-691-1888 to make an appointment for a no-cost  consultation.

 

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Long-Term Care Panel Faces a Tight Deadline

The Commission on Long-Term Care held its first meeting late last month on Capitol Hill. The panel is faced with a three-month deadline to produce a report that offers Congress recommendations on how to finance long-term care services, such as Medicare and Medicaid, for seniors and disabled Americans.

Congress established the panel as part of the Jan. 2 fiscal cliff deal. It took three months for congressional leaders and President Barack Obama to appoint the commission’s 15 members. The group is sharply divided politically with nine members appointed by Democrats and six by Republicans. Under the law, the panel’s recommendations are due to Congress six months after its members are appointed. But nearly three months passed before the commission finally convened.

At the initial meeting, statistical experts explained how the nation's growing population of seniors will become more dependent on long-term care services. Among them was Dr. Bruce Chernof, the commission’s chairman who also heads the SCAN Foundation, a research organization that focuses on elder care. According to Chernof, "We know that 70 percent of people over the age 65 will need some form of long-term services and support." The rising cost of those services threatens to deplete individuals' savings and add to the nation's budget problems because of the expenses borne by Medicare and Medicaid.

Anne Tumlinson, senior vice president of the research firm Avalere Health, estimated that total number of people getting long-term care will be 16.5 million in 2050, a 70 percent increase from today’s numbers.

Medicare, the health care program for the elderly and disabled, does not cover long-term care whatsoever. Medicaid is the federal-state program that covers more than 60 percent of the people living in nursing homes.

Using long-term care insurance to pay expenses is not an option for many Americans, as premiums rise and companies that can’t make a profit leave the market.“We have a very short time line,” said Chernof. “There are a lot of things we would have liked to do as a commission, but we will be done by the end of September.”

We here at the Fairfax Elder Law Firm of Evan H. Farr, P.C. believe that with the rising costs and growing need for long-term care, Medicaid Asset Protection Planning is one of the best ways to provide for your future long-term care needs. Call 703-691-1888 to make an appointment for a free consultation. We can meet with you, access your financial situation and determine strategies for your long-term care plan.

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