Monthly Archives for October 2013

Meals on Wheels Should Be Expanded

 Published in Pawtucket Times, October 25, 2013

            A warm, nutritious meal combined with social interaction can go a long way to putting the brakes to a state’s spiraling Medicaid costs.  According to new study findings detailed in this months issue of Health Affairs by Brown University public health researchers, expanding programs like Meals on Wheels, would save 26 of 48 states money in their Medicaid programs, just by allowing a person to stay in their own homes. 

            Kali Thomas, Assistant Professor of Research in the Brown University School of Public Health, says that if every U.S. state in the lower 48 expanded the number of seniors receiving meals by just 1 percent, 1,722 more Medicaid recipients avoid living in a nursing facility and most states would experience a net annual savings from implementing the expansion.

Put the Brakes to Medicaid Costs

            According to the study’s findings, Medicaid cost savings would be different in every state.  For instance, Pennsylvania would see the greatest net savings – $5.7 million – as Medicaid costs for nursing facility care decrease more than costs rose for delivering the additional meals.  Meanwhile, Florida would see a net cost of nearly $11.5 million instead. Overall, 26 states would stand to see a net savings according to the Brown University Public Health analysis, while 22 would end up spending more.

            Every state would enable more seniors, who could live independently except for meals, to remain in their homes regardless of whether they are on Medicaid.

            Thomas, the study’s lead author, believes the study’s findings can provide guidance for state lawmakers and state policymakers as they hammer out budget funding for home-delivered meals programs, which are conducted under the Older Americans Act.

            “We wanted to provide a roadmap for people,” Thomas said.

             To calculate Medicaid savings, Thomas and co-author Vincent Mor, Brown’s Florence Pirce Grant Professor of Community Health, examined data, including how many seniors in each state receive home-delivered meals and how much it costs each state to provide those meals. She and Mor also took a look at nursing facility and Medicaid data to estimate the number of seniors that Medicaid maintains in nursing facilities who are “low-care,” meaning they may have the functional capabilities to live at home. Finally they looked at the per diem Medicaid pays in each state for seniors to live in nursing facilities.

 Keeping Seniors at Home

             The study findings allowed them to estimate the incremental cost of providing meals to 1 percent more seniors in each state, the number of additional seniors on Medicaid who would no longer need to live in nursing facilities, and how much less Medicaid would have to pick up for the higher level of care in each state.

            The researchers found that the 1 percent expansion nationwide would bring meals to 392,594 more seniors at a cost of more than $117 million. Because 1,722 seniors would no longer have to live in costly nursing facilities paid for by Medicaid, total program savings would total $109 million.

            The reason why the study’s findings indicate that additional food delivery costs outstrip Medicaid savings nationwide, even though most states would save money on a net basis, is that in some very large states with relatively few low-care seniors or relatively low Medicaid per diems, food costs outweighed the resulting Medicaid savings on a relatively large scale.

            “In states like California and Florida where a 1-percent increase in the 65-plus population is a lot of people, it will cost those states a lot more to feed them,” Thomas said.

            But, as she and Mor wrote in Health Affairs, “Our analyses suggest that 26 states with high Medicaid nursing home per diem reimbursement rates, a large proportion of low-care [nursing home residents on Medicaid], and a relatively small population of older adults, could save money.”

            Thomas said states projected to lose money can opt to focus their efforts in ways that are more precise than an across-the-board expansion.

            “We’re not proposing that all states simply increase the proportion of age 65 plus receiving meals by 1 percent,” she said. “But if they were to target these vulnerable people who are at risk for nursing home placement they would likely see more savings. This is a program that has the potential to save states a lot of money if it’s done correctly.”

            Policymakers should consider not only the fiscal implications of providing home-delivered meals, which the study quantifies, but also the impact on individual seniors, said Thomas, who has seen the benefits anecdotally as a Meals on Wheels volunteer in both Florida and Rhode Island.

            Thomas’s research, detailed in this month’s issue of Health Affairs, which was completed last December, is featured in AARP Rhode Island’s award-winning documentary Hungry in the West End. Creator and director John Martin of the AARP

             Rhode Island state office screened the documentary in August at the Meals on Wheels Association of America National Conference in Boston. You can watch Hungry in the West End online at www.aarp.org/hungry.

             Although the quality of life argument is easy to see, other researchers, like Thomas, are closely looking at how the Meals on Wheels program can lower Medicaid costs.

             Based on a study by the Washington, D.C. based Center for Effective Government released in April 2013, every dollar invested in Meals on Wheels today could save taxpayers up to $50 in Medicaid costs down the road.

 Other Benefits of Meals on Wheels  

             Ellie Hollander, President and CEO of the Meals on Wheels Association of America, observes that both Brown University and the Center for Effective Government studies specifically focused on Medicaid savings attributable to nursing homes, but do not take into consideration significant savings that would be realized through reduced Medicare costs as well, through fewer visits to physicians and the emergency room and less hospitalization or reduced readmissions.

             Hollander says, “We have long known that the value of Meals on Wheels goes beyond the social and moral imperative of helping to address the epidemic of senior hunger in America.  “The friendly visit and a safety check are a lifeline enabling seniors to live more independently and healthy in their own homes, which in turn avoids far more costly health care alternatives often paid through Medicare and Medicaid,” she says.

             “The Brown University research proves what our work has long suggested to us: the Home Delivered Meals Program not only makes a positive impact for the senior, it is a good investment for the state as well,” says Executive Director Heather Amaral, Meals on Wheels of RI.

            Another study is in the works to support Thomas’ efforts to closely look at the impact of nutritious home delivered meals.  According to Hollander, a $350,000 grant from the AARP Foundation and the Meals on Wheels Association announced on Oct. 6 will enable Thomas to begin her randomized controlled trial of 600 seniors representing a cross-section of rural, urban, low income and minority populations across the country and a majority of the grant will be used to feed these seniors.            

            In this upcoming study, 200 seniors will receive meals daily, 200 more will receive a delivery of frozen meals once a week and then another 200 will continue on the waiting list as before as a control group. The study will compare quality of life, isolation, and health care utilization among individuals before and after they begin receiving meals and across the three groups.

             Holland says, “Through our generous grant from AARP Foundation, and with Dr. Thomas and Brown University’s help, we will seek to monetize the value add of the “more than a meal” component of Meals on Wheels.”

A Call for Support

            On AARP.org, Kathleen S. Connell, Rhode Island AARP State Director, calls on state lawmakers to take a very hard look at how they fund the state’s Meals on Wheels program.  Connell urges Congress not to put the Meals on Wheels program on the budgetary chopping block as a way to chop the huge federal budget deficit.

            Connell says that “Leaders need to be reminded that Meals on Wheels recipients aren’t unemployed workers waiting to return to jobs that will accompany an economic recovery. They are older retirees living on limited fixed incomes. With the cost of prescription medicines, healthcare and utilities going up, they sometimes can’t afford to eat. Many commonly sacrifice on food because of money worries – real or feared.”

            Connell notes, “Meals on Wheels is a big deal [to seniors]. No one should take it for granted.”

            Herb Weiss, LRI ’12, is a writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

 

 

 

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Aging Groups Gear Up to Oppose Cuts in Social Security

Published in Pawtucket Times & Woonsocket
Call, October 18, 2013

Worried Americans woke up to good news yesterday morning. After weeks of political bickering Congress had finally hammered out a political compromise, one that would keep the nation from free-falling off the fiscal cliff.

Over the weeks, Democrats and political pundits had warned that not raising the nation’s debt ceiling by Oct. 17 could lead to the nation’s credit rating being downgraded. If this occurred, average Americans might see higher interest rates for mortgages, car loans, student loans and even credit cards. Higher business expenses, due to expensive borrowing rates, could even force businesses to stop hiring and start laying people off. Housing prices would drop and retail sales slow.

Because of Congressional gridlock, furloughed federal workers, along with the unemployed, would have less money to spend, reinforcing the negative impact on the nation’s economy.

House GOP leadership, catering to its Tea Party allies, led a political impasse between the Democratic-led Senate and President Obama, with demands that the president’s signature “Obamacare” healthcare law be defunded.

But, on the heels of an 11th hour deal, late Wednesday evening, the Senate passed, 81 to 18, a bipartisan temporary fix, supported by a large majority of Senate Republicans, ending the partial federal government shutdown and the threat of default. Hours later, the Tea Party-controlled House conceded to the political reality that any attempt to derail the Senate compromise would have a serious backlash against the GOP brand, passing the measure by 285 to 144.

On day 16 of the closing of the federal government, President Obama with the flick of his pen signed the bill ending the threat of the nation defaulting on paying its bills along with allowing hundreds of thousands of federal workers to return to their jobs.

This agreement raised the U.S. debt ceiling until Feb. 7 and gave the Treasury Department flexibility to temporarily extend its borrowing if Congress does not act before that date. Also, the measure keeps the federal government’s doors open until Jan. 15.

At the end of the Congressional vote, Senator Ted Cruz (R-TX) and his House Tea Party allies saw their efforts fail to delay or to scrap “Obamacare.” However, the GOP Senator did get lawmakers to make a tiny political concession to require the government to verify the eligibility of people receiving federal subsidies under the health care program.

Domestic Entitlements on Chopping Block

Of concern to aging groups, the agreement calls for creating a 12 member House-Senate bipartisan panel that would identify long-term deficit cuts, either overhauling the nation’s tax code or by identifying cuts in entitlement programs like Medicaid, Medicare or Social Security. The panel, led by Budget Committee heads Republican Rep. Paul Ryan of Wisconsin and Democratic Sen. Patty Murray of Washington, is charged with completing its task by December 13, but they are not required to come to an agreement.

“While Washington’s latest self-imposed crisis is over, this is no time to celebrate as another set of random deadlines loom, says Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare, remarking “Here we go again.”

“Yet another committee has been formed in which Social Security and Medicare are the big bargaining chips on Washington’s political poker table, noted Richtman, making it clear for him the “economic security of millions of Americans isn’t a game” .

“And while the vast majority of the American people do not support cutting Social Security and Medicare benefits, the President and some in Congress appear ready to do just that through proposals like the Chained CPI, expanding Medicare means testing to the middle class and raising the retirement age,” warns Richtman.

According to Richtman, President Obama stated “what’s good for the American people” is what should guide this next debate. “Cutting benefits to millions of middle-class Americans who took the biggest hit in the recession clearly does not fit that stated goal,” he says.

In a letter to Congress, Richtman, called for other ways to rein in the nation’s budget huge deficient rather than putting Social Security on the chopping block. Richtman suggests that “instead of cutting benefits, comprehensive reforms in the Affordable Care Act (ACA) that are containing costs in the entire health care sector, including Medicare and Medicaid, ought to be given a chance to work and to be strengthened.”

“Moreover, Social Security does not face an immediate crisis and is not driving either the short-term deficit or long-term debt. We believe Social Security should be strengthened for the long-term by raising the current payroll tax cap on earnings,” adds Richtman.

AARP, the nation’s largest aging advocacy group, was quick to comment on the bipartisan-brokered legislative deal, saying that “AARP is pleased that the President and Congress temporarily averted an economic crisis that threatened our members’ access to Social Security and Medicare, but we are deeply concerned that harmful cuts to these vital programs are on the table for a new round of budget negotiations.”

The statement acknowledges that “some Congressional lawmakers want to trade cuts to Medicare and Social Security benefits to pay for other government spending. Others are calling for cuts to these vital programs to reduce the deficit.” However, according to AARP polls, “the American people, on the other hand, across all ages and party lines, are strongly opposed to cuts to Social Security and Medicare.”

“Whether it is cutting their programs to reduce the deficit or using them as a piggy bank to pay for other government spending, their message to the President and Congress is clear: “Don’t bargain away my Medicare and Social Security benefits,” says the AARP statement.

As the House/Senate Bipartisan Committee begins to organize, AARP is preparing to mobilize its massive membership to block any attempts to slash Social Security bennies or cut Medicare, specifically through a Chained CPI to determine cost of living increases and any reductions in Medicare benefits.

Susan Sweet, a well-known aging advocate clearly sees that a Congressional tinkering with Social Security could severely hit the pocketbooks of older Rhode Islanders. She asks, “Is it too much to ask that seniors, disabled people and veterans not pay the price of huge farm subsidies for agribusiness corporations, disgraceful and unnecessary tax benefits for gargantuan oil companies that are making their biggest profits ever, and wasteful pentagon spending for projects in war zones that are either never built or are soon destroyed?”

She calls on Rhode Island’s Congressional delegation to “stay strong and not compromise on keeping Medicare and Social Security fulfill its promises to seniors, disabled people and veterans by keeping benefits at current levels.”

“Dollars to cut the federal deficit might just come from extra revenues which could be generated from allowing Medicare to negotiate with drug companies and lifting the Social Security payroll tax cap so that wealthy people pay the same rate as middle class and poor people,“ she says.

AARP Gears Up for a Fight

This week AARP launched a series of radio and print ads opposing a Chained CPI Social Security benefit cut and harmful cuts to Medicare in the nonprofit organization’s latest discussion of the nation’s fiscal issues. The print and radio ads target members of the House and Senate in 18 states. The ads follow letters to Congress and the White House, as well as postcards, e-mails and calls to members of Congress opposing a budget deal that would balance the budget on the backs of older Americans.

“Americans have paid into Medicare and Social Security and they’re tired of their hard-earned benefits being used as bargaining chips in another last-minute budget deal,” said AARP Senior Vice President Joyce Rogers. “They deserve responsible solutions that will strengthen Medicare and Social Security now and for future generations, not harmful cuts that will hurt all of us.”

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer who covers aging, health care and medical issues. His weekly commentaries can be found on his blog, herbweiss.wordpress.com. He can be reached at hweissri@aol.com.

Gridlock Threatens Elder Programs, Services

Published in Pawtucket Times, October 11, 2013

At press time, this week continued heated partisan bickering on Capitol Hill that threatens to unravel a fragile economy, along with putting the brakes to an economic upturn that slowly was pushing the nation out of its financial doldrums. With this stand-off, a partial shutdown of the federal government continues. The Republican-controlled House, captured by the ultra-right Tea Party, has refused to budge, opposing the passage of a continuing resolution (CR) to fund government agencies past Sept. 30. House Republican leadership has demanded that passage of the CR must be tied to either the repeal or partially dismantling of President Obama’s signature achievement, the Affordable Care Act. The Democratic President along with a Senate Democratic leadership say no.

Meanwhile, the Democratic-controlled Senate passed a “clean” CR to provide funding through Nov. 15, not putting ACA on the GOP’s chopping block. Even if both legislative chambers sort out differences and hammer out a compromise agreement to open the doors of the federal government, this would not shield the nation from the disastrous impact of the impending second round of sequester cuts and a Oct. 17 deadline for the government to raise the debt ceiling. No action means a first-ever default on the nation’s debt that could send the stock market tumbling and push the nation’s and the world’s economy into a tailspin.

Treasury officials say that congressional deadlock and no action will result in the federal government running out of cash to pay its bills if Congress does not act to raise the nation’s debt ceiling this month.

Get Your House in Order

With the debt crisis looming, AARP Executive Vice President Nancy LeaMond called on Congressional lawmakers to settle the debt ceiling debate to avoiding default on the nation’s debt, specifically to protect the retirement of seniors and future generations.

In her letter, LeaMond expressed concern that any delay in raising the nation’s debt limit may unnecessarily increase borrowing costs, negatively impact retirement savings accounts and harm the nation’s fragile economy.

“Our members are worried that the benefits they have earned may be cut as part of a deal to reduce the deficit, fund government operations, or increase the debt ceiling, and they are increasingly worried that if there is no agreement very soon, they may not receive their Social Security checks and may lose access to their health care,” noted LeaMond.

Ten days ago, the nation entered a government shutdown, forcing furloughs of 800,000 workers, without pay, and suspending services. The last time this occurred was 17 years ago during the Clinton administration. The Congressional impasse has closed national parks and monuments, federally owned museums, such as the Smithsonian, offices overseas that give visas to foreigners hoping to visit the United States, and even many federal regulatory agencies.

So, how does this impact programs and services for older Americans? Simply put, impact on programs and benefits may vary throughout the federal bureaucracy.

The U.S. Department of Health & Human Services will furlough over 40,512 of its 78, 198 employees. The largest percentage of these employees comes from “grant-making and employee-intensive agencies,” such as the Administration for Community Living. This federal agency would not be able to fund the Senior Nutrition programs, Native American Nutrition and Supportive Services, Prevention of Elder Abuse and Neglect, the Long-Term Care Ombudsman program, and Protection and Advocacy for persons with developmental disabilities.

As reported, Social Security checks will be mailed, Medicare and Medicaid benefits will continue to be paid out, because these are considered mandatory programs, not discretionary ones. Benefits under the Supplemental Nutrition Assistance Program, commonly referred to as food Stamps, will continue in October, despite the federal shutdown.

Food Program Takes Budgetary Hit

Jenny Bertolette of the Meals on Wheels Association of America charges that the Federal Government shutdown “adds insult to injury as Senior Nutrition Programs are already dealing with devastating cuts due to sequestration, funding that has never kept up with inflation, increased food and transportation costs and increased need as significantly more seniors are aging and struggling with hunger than ever before.”

Bertolette says that should a shutdown persist for any considerable length of time, local Meals on Wheels programs that rely on government funding could experience a delay in reimbursements for meals and services delivered. Facing such funding uncertainty, programs could be forced to suspend meal services, create or expand waiting lists for meals, cut the number of meals or days they serve and reduce delivery days.

Jenny Bertolette of the Meals on Wheels Association of America charges that the Federal Government shutdown “adds insult to injury as Senior Nutrition Programs are already dealing with devastating cuts due to sequestration, funding that has never kept up with inflation, increased food and transportation costs and increased need as significantly more seniors are aging and struggling with hunger than ever before.”

Bertolette says that should a shutdown persist for any considerable length of time, local Meals on Wheels programs that rely on government funding could experience a delay in reimbursements for meals and services delivered. Facing such funding uncertainty, programs could be forced to suspend meal services, create or expand waiting lists for meals, cut the number of meals or days they serve and reduce delivery days.

Heather Amaral, Executive Director of Meals on Wheels of Rhode Island, agrees, noting that her Providence-based nonprofit program, has already lost $70,970 in 2013 federal funds due to last year’s sequestration cuts.

Amaral says that as a result of these cuts, to maintain meal delivery at the same numbers as last year (360,299 meals), she had to reduce menu items that were once offered. “Although the government shutdown doesn’t have an immediate impact on our program, I am concerned that it could lead to additional cuts,” she says, noting that should the shutdown continue until year end, the nonprofit agency will be forced to rely on donations and reserves to maintain service levels.

“We provide a safety check along with each home delivered meal and are often the only contact our client has that day, adds Amaral, who stresses that her program may be the only thing keeping a senior at home. “If we are forced to reduce the number of meals we serve, these people may be forced to live with a family member or enter a nursing home,” she warns.

Meanwhile, the U.S. Housing and Urban Development (HUD) agency will be unable to fund additional payments to public housing authorities, many providing shelter to older Americans. HUD expects the 3,300 Public Housing Authorities it funds to have enough funding to get through the month of October. But, if the shutdown continues, some public housing authorities will not be able to maintain normal operation.

Also, Quarterly formula grants will not go out for the Low-Income Home Energy Assistance Program (LIHEAP), the Social Services Block Grant (SSBG), or the Community Services Block Grant (CSBG).

Nutrition programs serving older adults face a double whammy with no FY14 appropriations and no reauthorization of the Farm Bill. The Senior Farmers’ Market Nutrition Program expired along with the Farm Bill on Sept. 30. The Commodity Supplemental Food Program (CSFP) requires appropriations to continue operating.

According to well-known Aging Advocate Susan Sweet, this is a partial shutdown that hasn’t really hit aging programs yet. There are funding reductions in programs for older people, but that is due to the sequester, which will have another round of cuts in October, she says.

Sweet predicts that the negative effects of the shutdown itself will become worse with every passing day. For example, there is doubt that veterans benefits and social security will be paid in or after October absent a funding bill. Death benefits, including burial subsidies, have not been paid to the survivors of fallen armed forces members, she notes. Because of the public outcry regarding this outrage, a private charity has stepped up to pay the benefits with the promise of reimbursement when the government re-opens.

“Reduced to its true absurdity, the United States of America has lost the ability to rationally govern,” states Sweet. “The sequester cuts, previously characterized as “cuts for dummies”, have been implemented, we are in a war yet cannot bury our dead from that war, can’t even agree on a temporary fix, and are arguing whether the US should pay its bills or default,” she adds.

“It is perplexing, and we have heard many, many concerns from Rhode Island members, “ said AARP State Director Kathleen Connell. “Since the U.S. government has never failed to meet its financial obligations, we don’t know what payments it could make if the President and Congress fail to reach an agreement.

“One cannot help but wonder what effects this uncertainty has on people – many of whom struggle enough with health and financial issues,” Connell added. “We’re doing whatever we can to urge Congress and the President to act responsibly.”

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. His weekly commentaries can be found on his blog, herbweiss.wordpress.com. He can be reached at hweissri@aol.com.