Tag Archives for Medicaid

The Best Of…Many Opting to Pre-Plan, Pre-Pay for Funerals

Published on February 1, 2003

             For me, it was stressful attempting to get my elderly father and my mother with dementia to enter into a pre-need agreement funeral arrangement.  After all, my three siblings and I were only trying to give our parents the opportunity to have a say in their minute details of their final arrangements.

            With my confused mother at his side, my father choose their caskets like he was purchasing a new car.  He checked under the lid, throughly examined the lining and the wood.  Ultimately, he would not buy the cheaper model, but he chose a nice one, a little higher on the price list.

            Of course, my father told the funeral director their services would be held at Temple Emanuel  with the family Rabbi presiding.  But what type of music, vocal or instrumental did they want played?  Or did they want a visitation or to name their  pallbearers.  Closed or open casket?  All these decisions might have been made right there on the spot, but in the end my father backed out.

           A little technicality over paper work derailed the process, causing my father to not sign on the dotted line and walking out of the funeral home in a huff.

           My father’s experience was not the norm because most aging baby boomers make it through the most stressful process of pre-planning and pre-paying in advance.

           According to a 1998 AARP survey, two in five people age 50 and older reported that they were contacted about the advance purchase of funerals.

           About one-third of those responding said that they had prepaid, or were in the process of prepaying, for funerals or burials.  Of this group, 86 percent had prepaid for cemetery plots, mausoleums, or niches, 58 percent had paid for other burial goods or services and 40 percent had prepaid for funeral services.

          For those prepaying for funerals, 30 percent had funds in trust and 30 percent had funds in life insurance policies.  Sixty percent held title to a cemetery plot, and 15 percent said they had that money in a life insurance policy.

         Ted Wynne, funeral director of Pawtucket-based Manning-Heffern Funeral Home, sees a transient society where children are living in different states, fueling the demand for pre-planning and prepayment.  “Seniors want to take the pressure off their children who live thousands of miles away from making the burial arrangement,” Wynne says.  “Thus, they pay up front or set aside money for future funeral and burial payments.”

        Bradford Bellows, funeral director of D.W. Bellows & Sons, Pawtucket and Bellows-Falso Funeral Chapel in Lincoln, says the seniors in nursing  homes are also good candidates for prepaying a funeral.

        “The family watches their parents’ funds dwindle to a point where they are forced to go on Medicaid.”  Prior to being eligible for Medicaid, the senior or their children should prepay the funeral costs.  Assets given the funeral home are allowed under Medicaid eligibility guidelines prior to going on Medicaid.

           “Consumers must understand that pre-arranging a funeral is not the same as pre-paying one,” Bellows adds.

            By pre-paying a funeral you are actually paying  for a funeral at today’s prices, not tomorrow’s, Bellow says.  “If the funeral occurs in the future, the funds will earn interest which will be used to pay for the cost of the funeral at the time of the death.”

           Bellows offers these tips when pre-paying your funeral.

           1.  Make sure that your social security number is indicated on your savings account or insurance policy where the monies are placed to prepay your funeral.  If the funeral home ever goes out of business or goes bankrupt, the funds are still yours and are safe, and can be easily be transferred to another funeral home.

          2.  When you enroll in the Medicaid program, all the funds in your prepayment account must be used.  Any excess funds will be returned by the  funeral home to the State of Rhode Island, to defray health costs incurred by the state of Rhode Island’s Medicaid program.

         3.  Once the funeral home opens the account or insurance policy, don’t forget to get a copy of the Irrevocable Funeral Trust Agreement, showing the bank or credit union account or the original insurance policy that was issued.  This will give you proof that your advance payment has been set up for your funeral needs.

          Herb Weiss is a Pawtucket-based freelance writer who covers, aging, health care and medical issues.

Inaction on RIPAE Proposals Would Be a State Tragedy

Published in the Pawtucket Times on May 20, 2002

Lawmakers are rushing to finalize the state’s business, hoping to adjourn as early as the end of May.

With thousands of proposals in the legislative hopper, each representative was directed by House leadership to choose three of their own sponsored bills to push for in the Senate.

All legislative proposals that do not make the “priority” lists are as good as dead for the year.

At press time, one proposal, Pharmaceutical Assistance for the Elderly Program (RIPAE) moves closely to passage.

The House Finance Committee has put the proposal (H 7291) into the state budget article. Susan Sweet, a consultant and aging advocate said she expects full House passage of the state budget article by the end of the week.

Once passed by the House, the state budget article goes to the Senate for their consideration and approval. Sweet told All About Seniors that she believes that the Senate will quickly pass the budget, too.

With passage, the final state budget will be  forwarded to Governor Lincoln Almond.

Under H 7291, the state Department of Human Services would seek a waiver from the federal government, allowing Rhode Island to use Medicaid funding to pay for prescription drugs for low-income seniors with incomes up to $ 17,720 and couples with incomes up to $ 23,880.

The legislative proposal, authored by Lt. Governor Charles Fogarty and sponsored by Rep. Constantino and House Finance Chairman Gordon Fox, would enroll about 90 percent of the 37,000 seniors now enrolled in RIPAE. Because seniors would now qualify for prescription drug coverage under Medicaid all U.S. Food and Drug Administration (FDA) drugs would be covered not just those currently covered by RIPAE.

Seniors would pay a small copayment rather than the 40 percent co-payment currently charged.

With the passage of the state budget article, then “cleanup” begins on all legislative proposals, Sweet noted, adding that the two other RIPAE proposals have not been acted upon yet.

These legislative proposals would make prescription drugs more affordable to seniors and persons with disabilities who are not covered by the Medicaid waiver.

One bill (H 7290) would allow seniors enrolled in the RIPAE program to buy prescription drugs not currently covered by RIPAE at the discounted state price.

The other (H 7524) would allow low-income disabled persons on Social Security Disability Income who are between ages of 55 and 65 to become members of RIPAE and purchase prescription medications at the state discounted rate. Under booth, the state would be able to obtain the manufacturer’s rebate available through RIPAE.

Sweet along with other aging advocate groups, has called on the Rhode Island General Assembly to pass the three RIPAE proposals, which don’t cost the state one penny.

Not acting on them will continue a tragic trend that is well-documented in Rhode Island and nationwide.

That is, the high cost of prescription drugs forces many seniors on fixed incomes into not taking their prescribed medications at all or using only partial doses.

Moreover, noncompliance can lead to unnecessary hospitalization, nursing home admission and premature death.

Even in the shadow of a huge state budget deficit, lawmakers have the opportunity to lower the spiraling out-of-pocket costs of costs of prescription drugs, at no cost to the state.

The Ocean State is now posed to enact sound public policy that will result in no fiscal impact to state coffers.

If Congress is not ready to tackle this aging policy issue through the creation of a Medicare pharmaceutical benefit, then the Rhode Island General Assembly must take the lead and pass the three RIPAE proposals.

Simply put, it is the right thing to do on behalf of older and disabled constituents.

Staffing Crisis Hits Nation’s Nursing Facilities

Published in the Pawtucket Times on February 25, 2002

A yet-to-be released federal report paints a very bleak picture about the quality of care provided in the nation’s nursing facilities.

According to an article published last week by The New York Times, a draft federal report finds that 90 percent of the nation’s nursing facilities do not have enough nursing staff to properly care for their residents.

Simply, put, the lack of staffing reduces the quality of care provided in nursing facilities, increasing the incidence of bedsores, falls, malnutrition, weight loss, urinary tract infections and blood-borne infections, the report notes.

According to the draft report, which was ordered by Congress, is expected to be officially released by the U.S. Department of Health and Human Services in April, reaching appropriate staffing in nursing facilities would cost the federal government big bucks.

With a $ 7.6 billion annual price tag, about an 8 percent increase over current expenditures – the report – entitled “Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes” – recommends cheaper ways to fix the staffing crunch in the nation’s facilities.

Rather than regulate minimum ratios of nursing staff to residents, the report calls for better management techniques and training of certified nursing aides CNAs) to increase staff productivity and to decrease CNA turnover. Additionally, market demand sparked by an informed public that has access to publicly reported nursing staff data may even increase nurse staffing levels in facilities, the report notes.

The New York Times article does not get to the root of the nation’s staffing problems in nursing facilities, charges Al Santos, executive director of the Rhode Island Health Care Association, the state’s largest trade group that represents nursing facility providers.

“While the article only focused on the inadequacies of staffing levels across the country, it failed to report on its cause – a lack of adequate government reimbursement for nursing facility care,” Santos said.

Santos stated the federal report, which is detailed in the New York Times, is correct in its assessment that the shortage is “likely to become worse.

It should come as no surprise to policymakers that in order to increase wages and to make frontline nursing jobs competitive. Medicaid can no longer pay roughly $ 4 per hour, per patient for shelter, meals, labor costs, special care, certain therapies and other items,” Santos adds. “Costs far outweigh government reimbursements for patient care, and chronic under-funding of Medicaid directly impacts staffing.”

There is no doubt in my mind that the lack of adequate staff in facilities create poor quality of care,” says Roberta Hawkins, executive director of the Alliance for Better Long-Term Care, who also serves as the state’s ombudsman on nursing facility issues. Hawkins said she fears that the continuing staff shortage in Rhode Island facilities will chip away the past 25 years of improved resident care that has resulted from state and federal nursing facility reforms.

Although inadequate pay and benefits are obstacles to retaining staff, Hawkins predicts that it will become even more difficult to recruit CNAs when more horror stories about poor care appear in local newspapers or on state or federal agency websites.

“As a society, all of us are responsible for the care not being provided to nursing facility residents. If we don’t provide that money to pay for the best of care, we are partially responsible for that care not being provided,” Hawkins said.

Hawkins sees as permanent fix to this ongoing staffing shortage found in Rhode Island facilities – tie the reimbursement rate to the level of resident care provided. For instance, facilities with heavy-care residents would receive a higher Medicaid reimbursement rate, which takes into account the increased staffing needs of those residents.

But adequate Medicaid funding is not the only solution to the continuing staff shortage dilemma facilities face, Hawkins warned.

“We need to create upward mobility in nursing jobs, improve training specialty care provided to Alzheimer’s residents, bedridden residents and to those requiring rehabilitation,” she said.

The new federal study doesn’t surprise Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council (LTCCC) and to those involved in providing or regulating nursing facility care in the Ocean State.

Just last year, a statewide LTCCC study found Rhode Island’s nursing facilities reported a shortage of certified nursing assistants, the staff who provide 90 percent of the direct care to residents.

“The report gives us useful information to look at the issue of staffing and quality in Rhode Island nursing facilities,” Fogarty said. “It also should serve as a clear signal to Congress that it must do a better job of planning and funding long-term care.”

A state commission chaired by Human Services Director Jane Haywood, is currently studying how the existing Medicaid reimbursement system can be improved.

Even with a mounting state budget deficit, it is now time for the governor, state lawmakers and state officials to put the energy and resources into tackling this ongoing staff shortage issue.

With major input from the nursing facility industry and from Hawkins and her resident advocates, Haywood’s final blueprint for changes in the state’s Medicaid program must be taken seriously. With a state election looming in November, candidates running for governor, the Rhode Island General Assembly and Congress must do their homework, study the staffing crisis in the state’s nursing facilities, and develop their positions to confront this pressing policy issue.

More than 10,000 nursing facility residents and their families pray that the report to be issued by the Department of Human Services will not end up in some back office on a dusty shelf.