Tag Archives for American Health Care Association

LTC Must Be Placed on Candidates’ Radar Screen

Published in the Woonsocket Call on May 29, 2016

Presidential candidates might just think twice about their political campaign positions on long-term care. With the graying of nation’s voters, Congress will be pushed to put long-term care on its policy agenda. When the dust settles after the Democratic and GOP conventions, the winning candidates must address long-term care issues in their debates before the November election.

In 2013, America’s age 65 or older population made up only 14 percent of the total population, but by 2040, this demographic group will nearly double to comprise about 22 percent. According to the U.S. Department of Health and Human Services the majority of these individuals will require some form of long-term care services (specifically, help with activities of daily living—such as cooking, bathing, or remembering to take medicine—that can be provided in a home or institutional setting.)

Misconceptions About Medicare and Social Security

Survey results in a 17 page report, “Long-Term Care in America: Expectations and Preferences for Care and Caregiving, released by Associated Press (AP)-NORC Center for Public Affairs Research, notes that most older Americans expect Medicare and Social Security to pay for long-term care services while these federal programs generally do not. The survey findings also indicate that respondents, age 40 and over, strongly supported public policies that help a person save for long-term care services and for those that defray the cost of care giving, including state paid family leave programs.

“This survey provides much-needed data on how people perceive the issue of long-term care in the United States,” says Trevor Tompson, director of The AP-NORC Center, in a statement released on May 16, 2016 with the survey findings… “The need for long-term care services and support to assist seniors with activities of daily living is increasing exponentially. Financing high-quality services so that the costs are manageable for families and governments will remain a big challenge for decision-makers,” he added.

“Older Americans of today and tomorrow have a 50 percent chance of living with substantial and often expensive daily needs,” adds Dr. Bruce A. Chernof, President and CEO of The SCAN Foundation. “Medicare and Social Security were not built to cover long-term care, leaving American families unprotected, and as the survey shows, unaware of this fact,” he says.

The AP-NORC survey found that while older Americans’ confidence in being financially prepared to pay for long-term care services remains low overall, there has been a slight increase in public confidence over the past four years, consistent with other measures of consumer confidence post-recession, according to the Consumer Confidence Index. In 2013, 27 percent reported feeling very or extremely confident in their ability to pay for long-term care, increasing to 29 percent in 2014, 32 percent in 2015, and 36 percent in 2016.

The polling finds reveal that a widespread misconception as to what Medicare covers for long-term care services. Older respondents, with an annual household incomes less than $50,000, are more likely to expect to rely on government programs such as Social Security, Medicare, and Medicaid, while those with higher incomes expect to rely more on personal savings to pay for their needed long-term care services. Still, 3 in 10 of these wealthier older Americans report that they will rely on Medicare to support their care as they age. This reflects common misperceptions among older Americans about the long-term care services that Medicare covers, notes the AP-NORC survey.

Thumbs Up to Aging in Place

Seventy seven percent of the survey respondents would prefer to “age in place” and receive care in their own home, w with far fewer preferring to receive care in a senior community (11 percent), a friend or family member’s home (4 percent), or a nursing home (4 percent). Among those respondents who prefer to receive care at home, there are gender differences in preferences for who provides that care: men would prefer to receive care from a spouse (51 percent vs. 33 percent), and women would prefer to receive care from their children (14 percent vs. 35 percent).

There is widespread support for policies to help caregivers face the costs of providing long-term care, with 72 percent supporting state programs to provide paid family leave, 83 percent supporting tax breaks for caregivers, and 73 percent supporting a Social Security earnings credit for caregivers taking time out from the workforce to provide care.

According to the AP-NORC survey, forty-three percent of the survey respondents have either been caregivers in the past or currently providing long-term care to a family member or close friend. Among those with experience as caregivers, 4 in 10 report having to miss work to provide care.

The researchers found that prior experience with long-term care is associated with greater support for several public policies to help people finance long-term care and to help alleviate costs for caregivers. These individuals expressed higher levels of concern about aging and are more likely to anticipate that it is at least somewhat likely that a loved one will need care in the next five years, compared to those without direct care giving experience.

Finally, one-third of the survey respondents reported having done no planning at all for their own long-term care needs. This 2016 finding is similar to the 31 percent who said the same in 2015 and remains lower than the 47 percent and 44 percent who said they had done no planning in 2014 and 2013, respectively.
One Size Does Not Fit All

Meghan Connelly, Chief Program Development at Rhode Island’s Division of Elderly Affairs, provides some thoughts about the findings of the AP-NORC survey. “Long-term care options are not “one-size-fits-all”. In Rhode Island, there are a number of choices one can make, ranging from living independently and receiving care at home to nursing home care. This report highlights that consumers want options when it comes to making these decisions for themselves, or assisting loved ones with long term care choices,” she says…

Connelly adds, the AP-NORC survey “supports the findings of past research: that the overwhelming majority of people want to receive long term care services at home,” noting that in the Ocean State there are many home- and community-based care options. She says that”home care may be available through a physician’s office; at the time of discharge from a hospital or nursing home; or through referrals to state-subsidized programs administered by agencies under the Executive Office of Health and Human Services.”

“The AP-NORC survey also underscores the need to adopt progressive financial policies that support family caregivers who provide the greatest percentage of needed long term care to their elderly or disabled loved ones at home,” warns Connelly.

Greg Crist, Senior Vice President of Public Affairs at the Washington, D.C.-based American Health Care Association (AHCA), notes, “This data generally tracks what our own research has shown: Americans don’t think of this topic every day, and honestly, this is a topic they’d rather avoid. No one likes the thought of aging, and with that aging, the increasing likelihood they will help in their later years. No one welcomes a loss of independence. But here’s the good news – the sector is adapting and innovating.”

Crist asserts nursing homes are meeting the challenge of caring for aging baby boomers. “We’re meeting the growing demands of Boomers, particularly as clinical needs grow, but also in offering amenities such as custom dietary menus, social media communities, and personal rehab care plans that speed recovery times. Whether in Rhode Island or elsewhere, this is an evolving health practice, recognizing that change is needed to meet the new preferences of older Americans,” notes Crist.

Listen to the Older Voters

The AP-NORC survey findings mirror other “long-term care perception” studies released by AHCA and AARP. Democratic presidential candidates Hillary Clinton, Bernie Sanders, and GOP standard bearer Donald Trump must not forget the needs of America’s exponentially growing older population. These older voters do not want to fall through the nation’s public policy safety net when they require the most assistance, paying for costly long-term care services. As the survey report notes, older Americans strongly support Family Leave programs and also call for government administered Long Term Care Insurance programs.

For a copy of the report go to http://www.longtermcarepoll.org/Pages/Polls/long-term-care-in-america-expectations-and-preferences-for-care-and-caregiving.aspx..

Delegates Head to D.C.

Published in Senior Digest on December 2005

Forty-seven years ago, Rhode Island Congressman John Fogarty successfully pushed legislation through Congress to create a national conference on aging issues. As a result of his forethought, the fifth White House Conference on Aging (WHCoA) will be held this month.

Scheduled every 10 years this nationwide citizens’ forum focuses public attention on aging issues and consolidates all the policy recommendations originating from the WHOCoA into a report sent to the president and Congress.

According to WHCoA staff, leading up to this conference scheduled for Dec. 11-14, there have been approximately 400 local, state and national events held across the nation, involving more than 130,000 people. The events included WHCoA listening sessions, solution forums, mini-conferences and independent aging agenda events.

The theme for the 2005 WHCoA is “The Booming Dynamics of Aging: From Awareness to Action.” The them reflects the changing face of aging in America. The conference, mandated by the Older Americans Act, focuses on the interests and needs of current seniors as well as the 78 million baby boomers who will begin to turn 60 in 2006. (Rhode Island is home to more than 152,000 seniors who are 65 and older and has the sixth highest concentration of people in this age category in the nation).

Corinne Calise Russo, director of the state Department of Elderly Affairs (DEA) said her staff gathered information about the concerns of seniors by conducting listening sessions during May and June to in Newport, Cranston, Wakefield and Woonsocket.  Russo said 150 seniors attended.

There were seven members of the Rhode Island delegation attending the WHCoA. Russo was appointed to attend the upcoming conference by Gov. Donald Carcieri. She said her experience as a 1995 delegate was “very exciting” and that she is looking forward to going back to D.C>

Other delegates are: Kathleen Connell, director of AARP Rhode Island appointed by U.S. Sen. Jack Reed; Joan Crawley, director of the Leon A. Mathieu Senior Center in Pawtucket appointed by Congressman Patrick Kennedy :William Finelli, a retired teacher and librarian appointed by appointed by U.S. Sen. Lincoln Chafee; Ann Gardella, chairwoman of the state Commission on Aging appointed by Gov. Carcieri;  Angelo Rotella, chairman of the American Health Care Association and a nursing home owner, appointed by Congressman James Langevin; and Dr. Terrie Fox Wetle, associate dean for public health and policy at Brown Unversity and policy at Brown University; appointed by WHCoA officials.

According to Russo, the grassroots input gathered at the four listening sessions was hammered out into nine policy recommendations at a resolution development workshop in September. The 12-page  document was forwarded to the WHCoA policy committee charged with planning the agenda for the conference. That committee will bring 50  resolutions gathered from pre-WHCoA events to the conference floor for a vote.

“The submitted resolutions would have to impact the largest number of seniors and also translate into issues that would affect a large number of baby boomers,” Russo noted.  She believes that some of Rhode Island’s resolutions have a good chance of being selected for consideration by the delegates.

“It is probably the one opportunity in a 10-year period of time that local advocates and seniors from Rhode Island can provide input that could become national policy that could effect future generations of seniors,” the DEA director said.

Russo says that it is important to plan for future generations of people who will choose to remain at home for the rest of their lives. She noted that the No. 1 priority that came out of Rhode Island’s listening sessions was the need to provide for a continuum of care to keep older persons in the community.

Other resolutions include a call for increased access to employment opportunities for seniors, supporting caregivers, adequate funding for chronic disease management programs with an emphasis on prevention and maintaining the independence of older disabled adults by providing programs and services to allow them to successfully “age in place.”

In 1995, the number of delegates was almost double the umber that will be attending the 2005 WHCoA. But Russo has no concerns that this reduction of delegates will diminish seniors’ input and the quality of recommendations that come out of the conference. “Every state this year was concerned with the reduction of delegates,” she said, noting that what it ultimately did was provide the opportunity to gain input form older people and baby boomers via the listening sessions.

Connell does not believe that the WHCoA report will sit on a dusty shelf in federal agencies or in the offices of bureaucrats.

“Much of the future policy direction of the country will be affected by this final report. Because of this, the report carriers the weight of its congressional mandate,” she said.

State Wants its Resolution Debated in Washington

The state Department of Elderly Affairs (DEA) submitted nine resolutions to the White House Conference on Aging Policy Committee. It is hoped that the Policy Committee will recommend some of the resolutions for consideration during the conference. The resolution for national policies that:

  1. Establish standards for Medicaid coverage of both facility-based and community-based services; long-term care insurance portability; incentives for excellent care; federal support for assisted technology; an aggressive campaign to educate employers, caregivers and the public about community-based health care and social service options; state and federal coordination of services.
  2. Encourage employees through incentives to: hire and retain older workers; offer flexible work schedules; allow older workers to buy into benefits and adopt attitudes that value the older workers.
  3. Support proactive and informed retirement and long-term care planning for seniors and caregivers, including tax incentives for professionals who look after or provide services to the elderly.
  4. Establish comprehensive care programs for diverse elders, including education about prevention; accessible immunizations, screenings and treatments without regard to ability to pay; nontraditional culture-specific treatments; culturally sensitive end of life care; and an initiative to require that cultural proficiency be included in basic medical education.
  5. Encourage a proactive approach to the conversation within families regarding the preferences and responsibilities of care giving; mandate the Family Medical Leave Act for all workplaces; support caregivers through tax breaks and other financial incentives; design services that are more sensitive to the needs of caregivers.
  6. Promote flexibility and innovation in services, provide adequate same-day urgent medical transportation; support volunteer driver programs; expand community options such as delivery services and coordinated group trips to consumer destinations; and improve coordination of exiting public transportation.
  7. Address education about healthy lifestyles , which government should support along with chronic disease management. The support should include subsidized gym members and  home adaptation.
  8. Form a task force to review and revise standards of the Adults with Disabilities Act (ADA) to more closely reflect the needs of disabled adults; promote aggressive publicity and posting of ADA standards.
  9. Develop a response to housing needs for the next three decades that will include education of caregivers and baby boomers about housing options and the need for long-term financial planning; incentives for universal design to support aging in place, proximity to services; a commitment to esthetics and opportunities for social interaction.

Bill Seeks to Soften Impact of Medicare Cuts

Published in Pawtucket Times on September 23, 2002

One week to go before the new federal Medicare cuts go into effect – cuts that will slash $1.7 billion in 2003 funding for the developmentally disabled and frail seniors in nursing facilities.

According to the American Health Care Association (AHCA), over the next two year’s cumulative Medicare cuts, called the “Medicare Cliff,” will total a whopping $5.2 billion.

Meanwhile, AHCA, representing 12,000 nonprofit long-term care providers, has been lobbying Congress for federal relief from the draconian reductions.

A new ad appearing in the Capitol Hill newspaper, Roll Call, reminds lawmakers that the upcoming cuts could lead to reduced nurse staffing and puts residents at risk.

In the upcoming November elections, voters might just get riled up too, over Medicare being cut by 10 percent, says AHCA.

The Roll Call ad notes a recent national survey of 800 persons found that 84.6 percent of the respondents opposed cutting Medicare funding for nursing facility care by 10 percent.

Additionally, 64.1 percent were less likely to vote for a candidate running for Congress if they knew that the candidate “voted to cut Medicare funding for nursing facility for nursing facility care by billions.”

Charles H. Roadman, II, M.D., AHCA’s president and CEO noted that a recent study by the University of North Carolina School of Public Health confirms the devastating impact of the impending Medicare cuts.

The study says that cuts could lead to reduced numbers of staff caring for seniors in nursing facilities, thus jeopardizing quality of care.

“At a time when the Centers for Medicaid and Medicare Services (CMS) and nursing care providers are actively pursuing efforts to improve the quality of care in nursing facilities throughout the nation, new federal cuts to Medicare are inconsistent with achieving this important goal,” says Dr. Roadman.

Roberta Hawkins, executive director of the Alliance for Nursing Home Care and state ombudsman agree with Roadman’s assessment.

“Huge Medicare cuts pull the carpet from under the federal quality initiatives that take effect across the country in October,” she tells All About Seniors. “The right hand of the federal government does not seem to know what the left hand is doing.”

According to Hawkins, the staffing shortage in Rhode Island is having a drastic impact on the quality of care delivered to more than 10,000 residentes.

“The upcoming Medicare cuts combined with an outdated Medicaid payment system will only further compromise patient care in the Ocean State,” she says.

U.S. Rep. James Langevin and House colleagues today announced a legislative fix that would delay scheduled cuts for nursing facilities and assisted living facilities in Rhode Island.

Langevin is co-sponsoring the Medicare Skilled Nursing Beneficiary Protection Act, sponsored by Congressman Tom Allen (D-ME), that would extend Medicare reimbursement add-ons for three years, through 2005, to allow the Bush administration more time to implement an adequate reimbursement formula for skill nursing facilities.

Langevin and the other bill sponsors hope this new timetable will obviate the need for further cuts in Medicare reimbursement rates, which would place severe financial burdens on nursing facilities.

Langevin stated that unless Congress acts this year, Medicare funding for skilled nursing care will be cut by 10 percent in 2003 and 19 percent in 2004 – translating to cuts of nearly $ 35 per patient per day in 2003 and $68 in 2004.

The Rhode Island congressman believes that in the Ocean State, the Medicare cuts will be even greater than the national average totaling $ 38.81 in 2003 and $ 76.90 in 2004.

“Difficult decisions were made in 1997 with passage of the Balanced Budget Act, and some of the changes were not implemented as Congress intended,” Langevin said. “The Medicare Skilled Nursing Beneficiary Protection Act will postpone further cuts and ensure that critical funding remains available for thousands of Rhode Islanders who rely on skilled nursing services.”

According to Langevin in mid-1998, the new Medicare prospective payment system (PPS) was implemented for skilled nursing care, as mandated in the 1997 Balanced Budget Act (BBA).

He noted that the new system resulted in cuts far deeper than intended by Congress.

In 1999 and 2000, Congress temporarily restored some of the unintended cuts as part of the Balanced Budget Refinement Act (BBRA) and the Benefits Improvement and Protection Act (BIPA).

These temporary add-ons helped restore beneficiary access to care, but overall Medicare funding levels for skilled nursing facilities continue to be below BBA projections, Langevin said.

“I am wholly committed to making the restorations of 1999 and 2000 permanent,” he said.

“We cannot turn our backs on a generation who built and defended the very foundation of this nation. They answered the call of our nation -now we must answer theirs.”