Tag Archives for Medicaid

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.

 

 

 

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.

National Report Grapples with Impending Alzheimer’s Epidemic

Published in the Pawtucket Times, July 25, 2013

.This 56 page report must not sit on a bureaucrat’s dusty shelf.

With the graying of the nation’s population and a skyrocketing incident rate of persons afflicted with Alzheimer’s disease, the Chicago-based Alzheimer’s Association and the U.S. Centers for Disease Control (CDC) and Prevention release a report last week to address a major public health issue, an impending Alzheimer’s disease epidemic on the horizon.

Researchers say that in 2013, an estimated 5 million Americans age 65 and older have Alzheimer’s disease. Unless more effective ways are identified and implemented to prevent or treat this devastating cognitive disorder the prevalence may triple, skyrocketing to almost 14 million people.  Simply put, Alzheimer’s disease is now the 6th leading cause of death and 5th among those 65 to 85 years of age.

A Call to Arms

A July 15, 2013, CDC, the federal agency charged with protecting public health and safety through the control and prevention of disease, injury, and disability, and the Alzheimer’s Association, the world’s leading voluntary health organization in Alzheimer’s care, support and research, unveiled The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018 at the 2013 Alzheimer’s Association International Conference in Boston.

The released report calls for public health officials to quickly act to stem the growing Alzheimer’s crisis and is a follow-up to the 2007 The Healthy Brain Initiative: a National Public Health Road Map to Maintaining Cognitive Health.

“The public health community is now paying greater attention to the Alzheimer’s epidemic that millions of families have been facing for decades and that is poised to drastically increase,” said Robert Egged, Vice President of Public Policy at the Alzheimer’s Association. “On the heels of the 2012 release of the country’s first-ever National Alzheimer’s Plan, the Alzheimer’s Association and CDC have partnered again to create a tool for public health officials to improve the quality of life for those families and advance cognitive health as a integral component of public health,” says Egged.

Released five years ago, the original Road Map addressed cognitive health and functioning from a public health perspective and provided a framework for the public health community to engage cognitive health, cognitive impairment, and Alzheimer’s disease and other dementias. More than 280 experts in the field contributed to this new Road Map report that outlines specific actions steps that state and local public health officials can take to promote cognitive functioning, address cognitive impairment for individuals living in the community and help meet the needs of caregivers.

While federal agencies play a critical role in leading and funding efforts to address Alzheimer’s disease, state and local health departments organize and provide public health services at the community level.

“The goal of the Healthy Brain Initiative is to enhance understanding of the public health burden of cognitive impairment, help build evidence-based communications and programs, and translate that foundation into effective public health practices in states and communities. This Road Map provides guidance to states, communities, and national partners to plan for and respond to this major public health issue,” said Lynda Anderson, PhD, Director of the Healthy Aging Program at CDC.

A former Assistant Secretary at the U.S. Administration on Aging, Bill Benson, now a managing partner of Silver Spring, Maryland-based, Health Benefits ABC, notes that the cost of providing care to people with Alzheimer’s disease will have a drastic impact on the nation’s economy due to the cost of lost productivity, and the care costs for those no longer able to care from themselves. “This does not include the profound personal impact and consequences to those who suffer from Alzheimer’s and to their loved ones,” he says.

“The scope, cost and the extraordinary burden both to individuals and to society make it a true health crisis,” says Benson, stressing that public health officials need to know more about the disease and those who have it, better ways to diagnosis it.  There must also be a better understanding of the economic impact and programs and services that are proven to ease the burden of those who suffer from it and their caregivers, he adds.

Action Steps for Local Communities to Follow

The Road Map report includes more than 30 action steps that the public health community can take at the federal, state and local levels over the next five years to address cognitive health and cognitive impairment from a public health perspective. The actions are intended as a guide for what state and local public health officials could do – on their own or with other national, state and local partners. Agencies are encouraged to select those actions that best fit state and local needs and customize them to match priorities, capabilities and resources.

As to specifics, the Road Map report calls for improved monitoring and evaluation of persons with dementia including Alzheimer’s disease and younger onset as they relate to employment and employers, and defining the needs of these individuals and their caregivers.  Also, increased support should be given to state and local needs assessments to identify racial/ethnic; lesbian, gay, bisexual, and transgender; socioeconomic; and geographic disparities related to cognitive health and impairment.

Public health officials must educate and empower the nation in confronting the epidemic of Alzheimer’s disease by promoting advance care planning and financial planning to care partners, families, and individuals with dementia in the early stages before function declines.  They can and promote early diagnosis.

The Road Map report urges that sound public health policies be developed and partnerships created to collaborate in the development, implementation, and maintenance of state Alzheimer’s disease plans. It also recommends that state and local government integrate cognitive health and impairment into state and local government plans (e.g. aging, coordinated chronic disease, preparedness, falls, and transportation plans).

Finally, the Road Map report also recommends that strategies be developed to help ensure that state public health departments have expertise in cognitive health and impairment related to research and best practices.  Support must also be provided to continuing education efforts that improve healthcare providers’ ability to recognize early signs of dementia, including Alzheimer’s disease, and to offer counseling to individuals and their care partners.

A Local View

Maureen Maigret, policy consultant for the Senior Agenda Coalition of RI coordinator of the Rhode Island Older Women’s Policy Group, agrees with the assessment of theRoad Map report, especially with the Ocean State having the “highest percent of persons age 85 and over in the 2010 Census and this is the population that is growing fast and most likely to have dementia.”

Maigret notes the economic impact will have significant impact across our economy for the state budget and for individual families. “It is imperative for our public officials to promote programs to identify those with early cognitive problems and implement policies to strengthen community and caregiver supports that will help persons to safely remain in home and community settings as long as possible, she says.

The Rhode Island General Assembly passed legislation this year that requires caregiver assessments in the state Medicaid long term care system.  “It’s a good first step in helping caregivers. But we must do so much more to inform the public about available resources, to adequately fund assistance programs such as RIde, Meals on Wheels and respite services and to promote cognitive screening as part of annual wellness visits funded by Medicare,” she says.

“Having a clear active mind at any age is important but as we get older it can mean the difference between dependence and independent living,” says Executive Director, Donna McGowan, of the Alzheimer’s Association-Rhode Island Chapter. “We are excited that the CDC has partnered again with the Alzheimer’s Association to create a tool for public health officials to improve the quality of life for those families afflicted by the disease,” she says.

For more information on The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018, visit alz.org/publichealth. For more information on Alzheimer’s disease and the Alzheimer’s Association, call 1-800-272-3900 or visit alz.org®.