Cap on out— of-pocket costs for Medicare drug plan enrollees coming soon

Published in RINewsToday on September 2, 2024

Back on Aug. 16th in 2022, President Joe Biden signed into law the Inflation Reduction Act of 2022 (IRA), it’s enactment lowering the health cost for millions of older Americans by lowering the high cost of prescription drugs by granting Medicare the power to directly negotiate drug prices with drug companies. Rising drug costs were forcing some Medicare beneficiaries to cut their expenses by not filling a prescription or even skipping doses. This could lead to complications and side effects resulting in hospitalization, even death.

“AARP was instrumental in Congress passing the prescription drug law of 2022 to lower prices and out-of-pocket costs for Medicare enrollees,” said Jo Ann Jenkins, CEO of AARP in an Aug. 28 statement announcing the release of AARP’s new report. “As we approach January 2025, we want every senior in America to know that, thanks to the new annual cap which limits their out-of-pocket costs, they will have more money to invest in their families, spend on their broader health needs or simply save to achieve greater financial stability.”

Virtual Media Briefing Details Impact on IRA law

Last week, the Washington, DC-based AARP briefed the media on the state-level impact of the historic new federal protection for 56 million Medicare drug plan enrollees. The new law caps out-of-pocket prescription drug costs every year, beginning at $2,000 in January 2025.

The nine-page Public Policy Institute report, released at the virtual media briefing, analyzes the number of enrollees (not receiving the Medicare low-income subsidy) that will benefit from the new cap by state, age, gender, and race between 2025 and 2029.

Nancy LeaMond, the chief advocacy and engagement officer for AARP, say putting the brakes to spiraling drug cost by enacting the IRA put money back into the pockets of millions of America’s retirees purchasing pharmaceuticals for their medical conditions. “Upwards of 95% of Americans, age 65 and older, have at least one chronic condition and close to 80% are dealing with 2 or more chronic conditions,” says LeaMond, like diabetes and heart disease, to debilitating neurological diseases like Parkinson’s and Ms.

“Prescription drugs are a lifeline, said LeaMond, stressing that medicine is only effective if you have the money to pay for it. The passage of IRA two years ago is already having a significant and positive impact on millions of Medicare beneficiaries who now don’t pay more than $35 a month for insulin and get free vaccines for things like shingles,” she noted.

“There are even bigger savings coming down the pike, starting in January 2025. The total amount that folks enrolled in Medicare drug plans pay out of pocket for their prescriptions will be capped at $2,000 a year,” reports LeaMond.

During the media briefing, Leigh Purvis, Prescription Drug Policy Principal, AARP Public Policy Institute, stated “one of the biggest challenges in the original Medicare Part D benefit was the lack of a cap on out-of-pocket spending.” Even after reaching a certain limit, Medicare beneficiaries were still required to pay 5% of their drug costs, with no limit for those on expensive Medications, she said.

According to Purvis, out of pocket expenses could exceed $10,000 per year, “an unmanageable amount for anyone, but especially for a population with a Median annual income of $36,000. Because of this, AARP pushed for the inclusion of a cap on out-of-pocket spending for Medicare Part D, to be included in the IRA, she said. And it was…

Purvis noted that 3 million Part D beneficiaries (who don’t receive the Medicare Part D low-income subsidy are expected to benefit from the $2,000 cap in 2025. This number is expected to grow to over 4 million by 2029. These Medicare drug plan enrollees would see average savings of roughly $1,100, or 56%, in 2025 for their prescription drugs.

Purvis also gave a few other takeaways from the report. On average, approximately 1.4 million (40 percent) Medicare drug plan enrollees who reach the new out-of-pocket cap between 2025 and 2029 are estimated to see annual savings of $1,000 or more, and just over 420,000 (12 percent) will see savings of more than $3,000. In addition, more than three-quarters of Medicare drug plan enrollees who will benefit in 2025 are between the ages of 65 and 84.

Finally, Paula Cunningham, AARP Michigan State Director (discussing results of a state survey) and Diana Devito , who has lived with chronic lymphocytic leukemia for over 19 years, participated in the media briefing. Both reinforced how the report’s numbers aren’t just statistics, they represent real people “who are being forced to make impossible choices.”

Cunningham told a “heartbreak” story about a woman who had lost her husband, and she had to sell her wedding ring in order to pay for her prescription drugs. “She’s now deceased, but I will never forget her story, or the stories of people across this great state that we met who had to make difficult choices between paying rent or buying groceries to pay for their medications,” she said.

After experiencing the high prescription costs for treating life-threatening chronic disorder, Devito came to share how important a $2,000 cap can be “for people like me.” She said, “It’s a real-life changer,” noting that everyone doesn’t understand that. “If you’re not taking one of these expensive drugs, you don’t realize the impact that it has on your life,” she added.

On Another Note…

U.S. Senator Jack Reed brings to my attention another Congressional report that details the Rhode Island specific data as to the impact of IRA on older Rhode Islanders.

According to the Congressional Joint Economic Committee (CJEC), this year, about 57,000 Rhode Island Medicare beneficiaries will save an average of roughly $200 each year because of IRA’s improvement to the Medicare Part D drug coverage. By 2025 this number would increase to 68,000 retirees, saving them an annual average of $340 on prescription drugs.

By allowing Medicare to negotiate with drug companies to bargain down the high cost of many lifesaving drugs, 29,000 retirees use drugs that are with the new negotiated prices, says the CJEC report.

For a copy of AARP Public Policy Institute’s Medicare Part D Out-of-Pocket Spending Cap, go to https://www.aarp.org/pri/topics/health/prescription-drugs/medicare-part-d-out-of-pocket-spending-cap-prescription-drug-costs/.

To learn more about AARP’s work to lower prescription drug prices, visit https://www.aarp.org/politics-society/advocacy/prescription-drugs/.

For a copy of CJEC’s report, go to https://www.jec.senate.gov/public/_cache/files/356ae3d2-af5e-4d32-bd42-fafc548173c5/ri-cost-savings-fact-sheet.pdf

For details how the IRA impacts older Rhode Island retirees, go to https://www.whitehouse.gov/wp-content/uploads/2022/08/Rhode-Island-Health-Care.pdf

Hoarding and seniors: “The Consequences of Clutter” Report

Published in RINewsToday on July 22, 2024

With the number of seniors afflicted with a hoarding disorder expected to skyrocket to over 14 million, on July 2 U.S. Sen, Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, unveiled a report putting the spotlight on its impact on older hoarders and their communities.  For seniors those consequences include health and safety risks, social isolation, eviction, and homelessness. For communities, those consequences include public health concerns, increased risk of fire, and dangers to emergency responders.

According to the report, citing the Administration for Community Living’s 2020 Profile of Older Americans, the number of seniors in the U.S. is expected to increase from about 54 million in 2019 to over 94 million in 2060. “Because hoarding disorder disproportionately impacts older adults, experts worry that aging could fuel a rise in hoarding in the coming decades,” notes the report, quoting NPR Morning Edition’s Rose Conlon.

According to the Majority Staff of the Senate Aging Committee who wrote the report (with a whopping 270 citations), it was developed for information purposes only and does not represent the findings or recommendations formally adopted by the Committee.

Hoarding is a chronic and progressive condition

The report notes that this chronic and progressive condition impacts roughly two percent of the general population, while it affects about six percent of those over the age of 70.

“Hoarding disorder is a heartbreaking condition that is posing challenges to older adults, their families, and their communities across the country,” said Chairman Casey (D-PA) in a July 2 statement announcing his report. “The federal government has an obligation to ensure that Americans can age with dignity and this report makes clear that obligation must include doing more to address hoarding disorder,” he says.

According to Casey, the new report, “The Consequences of Clutter: How Hoarding Disorder Affects America’s Older Adults, First Responders, and Their Communities,” demonstrates the scope and severity of the challenges of this complex mental health condition and offers a path forward for how we can help people, communities, and local governments contend with this condition.

Local communities throughout the United States are already working to address cases of hoarding disorder, including through the formation of hoarding task forces to coordinate response efforts, says

Casey’s report, noting that the local resources  available often do not correspond with the level of challenge communities are facing.

Casey’s report issued a series of nine recommendations for how the federal government can increase support to communities that are contending with hoarding disorder, including expanding access to treatment for the condition, providing local officials with more extensive guidance and training to support afflicted individuals, and expanding the scope of tracking and research about how hoarding disorder is affecting individuals and communities nationwide.

The report compiles 55 requests for information, responses, and stakeholder statements submitted by non-profits, social services organizations as well as state and local governments to gather information to better understand the impact of hoarding in local communities.

“Overall, the report does a good job of outlining the importance of the topic and identifies the federal and state agencies that should be involved in assessment and intervention,” says Randy O. Frost, professor emeritus of psychology at Smith College and a leading researcher on hoarding and related topics.

“Hoarding Disorder is a relatively [recognized] new disorder, having just entered the DSM in 2013. Consequently, there are not identified agencies who can claim ownership of the problem and the potential solutions.” This report legitimizes this problem for attention from these agencies, says Frost, noting that this report also highlights the fact that the prevalence of hoarding is extremely high among the elderly.

“Severe cases are sometimes life threatening for the individual and those living nearby or those called in to provide help,” adds Frost.

An Expert’s take…

According to Frost, the report covers the important issues related to hoarding, including education of the general public as well as family, friends, and people suffering with the problem. It highlights the need to train professionals in best practices for intervention. An important assumption underlying the report is that this is a problem which touches many different social service disciplines, from first responders to assisted living facilities, adult protective services, animal control, mental health, public health, child health, elder services, etc. “When a local case is identified, in current practice, it is not unusual for 4 or 5 of these agencies to be involved, often not knowing what each other are doing. Integration among these agency professionals is crucial for dealing with hoarding efficiently,” he says.

“There is a lot more that could be said about this problem, and a lot more detail could have been included regarding specific recommendations,” he said, stressing that this was not the purpose of the report. “The report was to outline the problem and point different agencies in appropriate directions moving forward. It does so and is a welcome effort from a federal agency,” he says.

Spotlight on Rhode Island

“Hoarding is a serious problem that has apparently not been adequately addressed in Rhode Island as well as in the nation as a whole,” charges long-time advocate for vulnerable and marginalized populations Susan Sweet, former associate director of the Department of Elderly Affairs, and founder of the Rhode Island Minority Elder Task Force (RIMETF).  “While it is present in all age groups, adults over 60 years have the highest level of hoarding behavior and the most risk because of diminished physical and often cognitive abilities,” she says.

“This report outlines the difficult life circumstances that elders with the problem of hoarding face.  The Rhode Island network of aging programs and advocates for older adults do not have the resources to create and implement effective remedies,” warns Sweet. “I hope that shining a light on the issue will encourage policy, funding, and attention to what is a mental health issue and a complication in physical illnesses that create obstacles in attempts to help elders afflicted with the disorder,” she says.

According to Sweet, the Ocean State is one of the few areas and the only state that has organized a Hoarding Taskforce to point the way towards effective client management, education and training of eldercare healthcare, mental health programs and social work entities.  The health and well-being of individuals and communities is greatly impacted by the fire hazards, evictions, safety issues, and other self-neglect problems that occur with hoarding behavior.

“Awareness of the prevalence of hoarding and the danger to our communities and citizens should quicken the pace of funding and support to combat this growing threat,” says Sweet.

Like Sweet, Robin Covington, a member of Rhode Island’s Hoarding Task Force, sees the value of the released Senate Aging Committee’s report on hoarding and its recommendations. “As an adult protective services caseworker I saw firsthand the implications of hoarding,” said Covington, who serves as Coalition Director of Saint Elizabeth Haven for Elder Justice. “Hoarding creates health, fire hazard and safety risks, social isolation, eviction and homelessness,” she said.

“Often times, people who hoard don’t think they have a problem because of their attachment to their possessions, which makes it difficult to deal with”, says Covington. Because of its behavioral aspects a person with this behavior needs clinical assistance, she notes, not just decluttering of personal items.

Covington believes that there is a lack of programs and clinical support in place in Rhode Island to address the increasing problem of hoarding. However, the state’s Hoarding Taskforce is working on helping support case managers and providers by developing a workforce initiative to support individuals with clutter or hoarding tendencies.

Increase funding for Case Manager interventions

But more funding must be given to Community Action Programs who subcontract with OHA to oversee Adult Protective Services. “It’s pricey to cover the costs of visits, intervention and coordination of a clean-up company,” Covington says.

A lot of times when it is someone over 60, a report to Adult Protective Services is provided and a CAP agency case manager goes out and visits the older adult to put eyes on them and to help with an intervention like the coordination of a clean-up company, but that can be expensive, notes Covington.

As a Licensed Clinical Social Worker for over 23 years and RIMETF’s president  Lori Brennan-Almeida has seen the negative impact of hoarding up close.  For over 20 years, she has seen RIMETF provide emergency assistance to seniors age 55 and over to pay for services to clean their apartments to avoid eviction.

“Clinical intervention is necessary to stop seniors from hoarding”, says Almeida, stressing the importance of home-based therapy. “Grief counseling may be needed because a person often forms an attachment to compensate for a personal loss,” adds Brennan-Almeida.

“Without counseling, hoarding may well continue after the debris is gone from their apartment and the senior will just collect more items”, says Brennan-Almeida.

Keeping tabs on hoarding

“This is our first ever hoarding report,” says Misha Linnehan, Deputy Press Secretary for Sen. Casey.  When asked if there would be a follow-up report next year, she stated: “There are currently no plans for another but it is always a possibility.”

Kudos to Chairman Casey and the Majority Staff for putting resources, time and effort into crafting this report.  For those people in the trenches, future reports should be written and formal Senate Aging Committee hearings held to keep tabs on this growing problem and to determine if the recommendations from this first report are being implemented.

Don’t drop the ball on this one.

RI Hoarding Task Force

Janet Spinelli and Kelly McHugh are co-chairs of the RI Hoarding Task Force which is convened through the RI Elder Mental Health and Addiction Coalition co-chaired by Chris Gadbois and Janet Spinelli.

The RI Hoarding Task Force has two committees including the HD Task Force Toolkit Development Committee lead by Christopher Liu, an undergraduate at Brown University and the HD Task Force Website and Outreach Committee.

Anyone interested in joining the Task Force can email RIEMHAC@gmail.com  More information and resources can be found at RIHoardingtf.ri.gov which is supported through the EOHHS Money Follows the Person Program.

For download a copy of the Senate Aging Committee’s hoarding report, go to chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.aging.senate.gov/imo/media/doc/the_consequences_of_clutter.pdf

Volunteering: Your Single New Years Resolution

Published in RINewstoday on January 10, 2023

As the ball dropped in New York’s Time Square, many Americans have already penned New Year’s resolutions for 2023. Making these resolutions as January approaches has become a very common tradition for millions.

According to the Statista 2022 Consumer Survey (413 adults ages 18 to 89 years old surveyed from Oct. 25 to Nov. 2, 2022) living a healthier life style by going to the gym, eating nutritious meals and even losing weight were the top three New Year’s resolutions for 2023.

While resolutions provide us with a road map as to how we can make improvements in our lives, many can’t overcome obstacles to keep them. An Inc. web article, written by Marcel Schwantes, noted only 9 percent will be successful in achieving their goals.

Just “Pick One” – Resolution

Second Harvest Heartland, one of the nation’s largest hunger relief organizations, calls on people to just put one resolution, “becoming a volunteer” on their list. “Picking a cause and getting out to volunteer turns out to be the one single, achievable, sustainable and widely beneficial resolution for New Year,” says the Minnesota-based company.

That’s a great suggestion.

According to Project Helping, research tells us that “volunteering helps improve mood, makes you feel healthier, increases your sense of purpose, and reduces your stress levels. Volunteering can also give us a deep sense of happiness both immediately and long-term,” the research studies say.

“Our volunteers give their time to help others, and rarely ever think about how it can impact their own lives in so many ways,” said Julie Greene, director of volunteer engagement at Second Harvest Heartland. “Of course, they feel a tremendous sense of satisfaction knowing their contributions are making a difference in people’s lives, but the benefits of their actions go way beyond that.

Given the camaraderie people feel by coming together and the satisfaction of working on a common goal, I’m not surprised at all that research has proven the benefits of volunteering—we see it every day with the smiles on our volunteers’ faces,” says Greene.

“Volunteering is Medicine for the Soul”

Being a volunteer can also be a protective buffer from the curve balls that life may throw at us as we age. “Volunteering can be medicine for the soul. It allows you to connect with other people, explore and remedy emerging community issues, make a difference as a caregiver or mentor and change lives.

Volunteering is powerful and can define and redirect your life’s journey,” says Vincent Marzullo, who for 31 years served as RI’s National Service Director and still volunteers weekly at Hasbro Children’s Hospital.

Adds, James Connell, Executive Director, of Age-Friendly Rhode Island: “There’s no better way to reduce tension, combat social isolation, and feel tremendous self-satisfaction than by connecting with others and giving back to the community and your neighbors by volunteering.”

Connell says Rhode Islanders as a population are aging, nearly one in three of us will become age 65 and over by the end of the decade. “Volunteers and volunteerism will be key factors in creating a great state in which to age. Older adults want to stay active, engaged, and remain in their homes; as a volunteer or by being the recipient of volunteers services we can achieve this and so much more,” he says.

“Aging Rhode Islanders need you,” says Connell. “Volunteer to provide supports to stay at home, to connect and provide company to combat social isolation, and to positively impact their overall health and well-being trough connection and service,” he adds.

A sampling of Rhode Island volunteer opportunities

For volunteer opportunities, Connell calls on seniors to contact Retired Senior and Volunteer Program (RSVP), the nation’s largest volunteer network for those age 55 and over. RSVP volunteers serve the community at non-profits, community programs, and service agencies. Volunteers mentor school children, prepare tax returns, knit caps for newborns, participate in volunteer transportation networks, and visit homebound Rhode Islanders, he says.

Why not contact a Community Action Program (CAP) in your region to find out more about volunteer opportunities, suggests Connell, noting that they are located in East Bay (EBCAP), West Bay CAP, East Bay (EBCAP) and at Federal Hill House Providence.

Or you can contact the Diocese of Providence, or other faith communities, to learn more about volunteer opportunities.

The Neighborhood Friendly Visitor Program, a community-based volunteer program, provides weekly visitors to isolated elderly and disabled adults in Rhode Island, seeks older volunteers, says Connell. “The program was developed in 1978 by Sister Rhea Lachapelle of the Sisters of Saint Ann to address the needs of a growing and diverse population of seniors living alone with little or no social support. Any senior age 60 and over, or disabled person who is homebound, residents of any nursing home or assisted living, or patients at hospitals, is eligible for this program. There are no income guidelines and there is no fee for this service,” adds. Connell.

Connell says that Friendly Visitor volunteers are available state-wide. Volunteers have supplied personnel references and passed a background check through the Office of the Attorney General. The program has on-going recruitment of volunteers who make a commitment to visit or call seniors for at least one hour each week. This program is funded in Partnership with the Rhode Island Office of Healthy Aging, he says.

The Senior Companion Program, sponsored by the Rhode Island Office of Healthy Aging (RIOHA) and the federally funded by the Corporation for National & Community Service, also seeks volunteers, says Connell. “Senior companions are over the age of 55 and provide companionship and reassurance with seniors and adults with special needs, he says, noting that these companions visit, and listen.

To request a Senior Companion or to apply to be a Senior Companion contact RIOHA at 401-462.0569.

Connell also directs seniors to investigate volunteer opportunities at The Village Common of Rhode Island (TVC). The nonprofit, volunteer-driven membership organization supports seniors who wish to age in their home via a network of local villages – communities of mutual support – in Rhode Island.

“We currently have villages in Barrington, Edgewood, Providence and Westerly. Our volunteers assist members in a myriad of ways, from driving to medical appointments and running errands, to doing household chores and minor repairs, to providing technology support for TVs, phones and computers, to making friendly calls and visits,” says Connell, noting that TVC and its local villages host an array of social and educational events for our members and volunteers (live, and via zoom).

Finally, Connell also notes that local Senior Centers, Child and Family Rhode Island, located in Newport and Providence, Meals on Wheels, the Rhode Island Food Bank (or local food banks in every city and town, can be a great source for volunteering, too.

For details about the benefits of becoming a volunteer, go to

https://projecthelping.org/benefits-of-volunteering/.

To learn about volunteer opportunities, go to:

A listing of senior volunteer activities, Office of Healthy Aging, go to https://oha.ri.gov/get-involved/volunteer/

AARP Rhode Island, go to https://states.aarp.org/rhode-island/volunteering-aarp-rhode-island

Rhode Island Food Bank, go to https://rifoodbank.org/get-involved/volunteer-in-the-community/ or

Local food banks, https://dhs.ri.gov/sites/g/files/xkgbur426/files/Documents-Forms/FoodAssistanceProviderListFAL-October-16-2020.pdf

Children@FamilyRI, go to https://childandfamilyri.com/

Rhode Island Community Action Programs, go to https://www.ricommunityaction.org/find-your-community-action-agency/

Rhode Island Senior and Volunteer Program, go to https://americorps.gov/serve/americorps-seniors

United Way of Rhode Island, go to https://volunteer.uwri.org/

RI Elder Info, Advocacy Agencies, go to https://rielderinfo.com/advocacy-assistance/