Tag Archives for Medicare

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..

The Growing Incidence of Alzheimer’s

Published in Pawtucket Times on April 26, 2016

While Congress and states are nation grappling with how to put the brakes to one of the largest public health crises in recent times, the escalating Alzheimer’s disease (AD) epidemic, the Chicago-based Alzheimer’s Association releases its annual snap shot detailing statistics on the impact of Alzheimer’s and dementia on caregivers and health care costs..

According to the 2016 Alzheimer’s disease Facts and Figures, released on March 30, 2016, this year nearly 16 million Alzheimer’s caregivers will provide 18 billion hours of unpaid care to 5.4 million afflicted with this devastating disorder. That care had an estimated value of $221.3 billion, says the report.

But that’s not all, this recently released report notes that two out of three people believe that Medicare will help them over costly nursing facility costs. Sorry it won’t. AD also has a direct impact on a caregiver’s pocketbook, too, the researchers found. More than one-third of those surveyed say they were forced by caregiving duties to reduce their hours at work or just quit their job entirely. As a result of these actions their income dropped by $15,000 compared to the previous year. Eleven percent of caregivers were forced to cut back on spending for their children’s education in order to provide support.

The 79 page Alzheimer’s Association report notes that both physical, emotional and financial support required by a person with AD may ultimately deprive family and friend care givers basic necessities, such as food, transportation and medical care. The Facts and Figures report reveals that these caregivers were 28 percent more likely to eat less or go hungry while contributing care to someone with AD, and one-fifth even sacrificed their own medical care by cutting back on doctor visits. Overall, nearly half of the caregivers say they cut back on their own expenses to afford dementia-related care for their family member or friend.

“The devastating emotional and physical effects of caring for a person with Alzheimer’s disease has been well-studied,” said Beth Kallmyer, MSW, Vice President of Constituent Services for the Alzheimer’s Association. “However, this new report shows, for the first time, the enormous personal financial sacrifices that millions of care contributors must make every day. These sacrifices jeopardize the financial security of individuals and families, as well as their access to basic needs and health care.”

This year’s Facts and Figures report found that 13 percent of family or friend caregivers sold personal belongings, such as a car, to help pay for costs related to dementia, while nearly half tapped into savings or retirement funds. On average, caregivers, many of whom do not live with the person they’re caring for, spent more than $5,000 a year of their own money to care for someone with AD; however, amounts varied with many spending tens of thousands of dollars per year.
Incidents of AD is Fast Growing

The Facts and Figures report says that out of the 5.4 million (of all ages) afflicted with AD, an estimated 5.2 million are age 65 and over. Yes, one in nine people having the cognitive disorder. Approximately 200,000, having early onset AD, are under age 65.

Also, the recently released Facts and Figures report warns that we are truly in the midst of an AD epidemic as the baby boomers grow older. By 2050, researchers say that someone in the United States will develop AD every 33 seconds. Without a medical breakthroughs to prevent or cure, the age 65 and over population with AD, the incidence is expected to nearly triple, from 5.2 million to a projected 13.8 million. Some say may be even as high as 16 million. It’s the only disease among the top 10 causes of death in America that cannot be prevented, cured or even slowed. .

Additionally, this year’s Facts and Figure report notes that AD is officially listed as the sixth-leading cause of death in this country. It is the fifth-leading cause of death for people age 65 and older. With the graying of America, AD will become a more common cause of death. At age 70, 61 percent of those with AD are expected to die before the age of 80 compared with 30 percent of people without the cognitive disorder — a rate twice as high, says the report.

The Typical Care Giver

The Facts and Figures report puts the face on a typical caregiver. Approximately two-thirds of caregivers are women, and 34 percent are age 65 or older. Forty one percent have a household income of $50,000 or less.

AD takes a devastating toll on the health of caregivers, says the Facts and Figures report. Nearly 60 percent of those taking care of loved ones with Alzheimer’s and dementia report that their emotional stress being high or very high. About 40 percent suffer from depression. One in five care givers cut back on their own physician visits because of their caregiving responsibilities. And, among caregivers, 74 percent report they are “somewhat” to “very” concerned about maintaining their own health since becoming a caregiver.

A Huge Cost on the Health Care System

The report’s researchers warn that the AD epidemic might just bankrupt the nation’s Medicare program. In 2016, total payments for health care, long-term care and hospice are estimated to be $236 billion for people with Alzheimer’s and other dementias, with just under half of the costs paid by Medicare. Nearly one in every five Medicare dollars is spent on people with Alzheimer’s and other dementias. In 2050, it will be one in every three dollars

Medicare and Medicaid are expected to cover $160 billion, or 68 percent, of the total health care and long-term care payments for people with Alzheimer’s disease and other dementias.

Seeing a huge rise in AD over the last two years, federal and state officials are gearing up to strategize a battle to fight the impending epidemic.

A Call to Action

Yes, the AD epidemic is here, right in Rhode Island. Everyone is personally touched by either caring for a family member with the cognitive disorder or knows someone who is a caregiver or afflicted.

Following the efforts of Congress to create a national strategic plan to address the rapidly escalating AD crisis and to coordinate resources across federal agencies, the Rhode Island General Assembly passed a joint resolution enacted into law to direct the Lt. Governor’s Long Term Care Coordinating Council (LTCCC) to be the vehicle to develop a state plan to address this growing public health crisis in the Ocean State. Ultimately, for over a year former Lt. Governor Elizabeth Roberts along with LTCCC members, former Division of Elderly Affairs Director Catherine Taylor, the state Chapter of the Alzheimer’s Association, universities and health care organizations with the public input gleaned from 8 listening events hammered out the 122 page battle plan with over 30 pages of recommendations.

In 2016, Lt. Governor Daniel J. McKee has picked up the ball and convened a meeting of the Executive Board on Alzheimer’s Disease and Related Disorders, consisting of researchers, advocates, clinicians and caregivers, to begin efforts to implement recommendations from the State’s Alzheimer’s Plan. The group will determine which recommendations are outdated.

With a rising population of Rhode Islander’s with AD, state policy makers must act swiftly and lose no more time in addressing this terrible disease and public health issue.

Congressional Panel Looks Over Medicare

Published in Woonsocket Call on March 20, 2016

Last Wednesday’s hearing of House Ways and Means Health Subcommittee signals the panel’s interest to bring Medicare, a federal health insurance program for people age 65 and over, into the 21st century to meet the needs of its current 55.3 million beneficiaries.

At the March 16 hearing, Chairman Pat Tiberi (R-OH), stated that “Today’s seniors [are] inundated with an array of confusing deductibles, coinsurance and copayments with no protection from high health care costs unless they enroll in a private plan. Despite major improvements and innovations in the health care sector that have transformed how care is delivered, traditional Medicare has barreled through the last 50 years on the same trajectory of increased costs and little innovation.”

In addition to the structural challenges facing the program, critical parts of Medicare are expected to run out of money by 2026. In other words, the benefits Americans were promised stand to disappear if policymakers don’t act soon, says Tiberi.

Putting the Spotlight on Medicare

Tiberi’s March 16 Health Panel hearing, entitled “Preserving and Strengthening Medicare,” held in room 1100 of the Longworth House Office Building, brought together three witnesses to discuss ways to sustain the nation’s Medicare program and to keep it from going bankrupt. From both sides of the aisle and expert witnesses all agreed that the federal government’s current approach to delivering high-quality health care is not working. As a result of an outdated Medicare program and harmful Obamacare policies, today’s seniors “must navigate a disjointed program, face rising health care costs, and have fewer healthcare choices,” says the GOP panel chairman.

“Of federal entitlements, Medicare presents the most difficult challenges,” says Heritage Foundation Senior Fellow Robert Moffit, warning that the Trust Fund “faces insolvency in 2026.”

At the hearing, Moffit gave his fix for revamping Medicare that have bipartisan support and promise to shore up the ailing entitlement program. He called for the Medicare program to be simplified by combining Parts A and B – including catastrophic coverage, an out-of-pocket cap, a single deductible, and uniform coinsurance in a single plan along with bringing reforms to Medigap coverage. Also, retargeting Medicare benefits to low-income enrollees can provide assistance to lower-income enrollees. Increasing Medicare’s eligibility age to 67 (the same eligibility age for Social Security) along with encouraging innovation and cultivating competition through Premium Support can put the brakes to rising program costs.

When it comes to simplifying Medicare and incorporating catastrophic coverage, Tiberi had called the need for reform a “no-brainer.” Moffitt overwhelmingly agreed, stating, “It is a no-brainer. It is absolutely a no-brainer … [seniors] do not have protection from the most important thing that health insurance should deliver, which is that ultimate protection.”

As Moffit explained, the lack of catastrophic coverage in Medicare not only puts financial strain on the beneficiary, but it also causes a significant increase in unnecessary health care spending.

Coming Up with a Commonsense Approach

In her testimony, Katherine Baicker, Harvard University Professor of Health Economic and serves on the Medicare Payment Advisory Commission, also called for commonsense solutions, specifically focused on the need for increased competition. She heighten the role that Medicare Advantage program plays in promoting innovation, as well as providing more seniors flexibility, choice, and quality at an affordable cost.

Baicker emphasized, “A thriving and competitive Medicare Advantage program can be a vital contributor to high quality beneficiary care in a sustainable health care system.”

When Baicker was asked which Obamacare provisions Congress should work to immediately repeal in an effort to protect Medicare Advantage, she replied, “I would like to see the cap on quality bonuses removed … and removing the double bonus for quality so that you’re appropriately rewarding plans for delivering the high-quality care that beneficiaries are seeking out.”

Finally, Stuart Guterman, senior scholar in residence at
AcademyHealth, told the panel that he believes the nation’s largest purchaser of health care can do more to ratchet up quality, enhance quality and coordinate care and control costs. “Because of Medicare’s unique position, it can be an important testing ground for cost and quality innovations. Policies have been put in place that encourage such development, including the expanding the power of the Secretary of Health and Human Services to put pilot programs on a ‘fast track’ and to work with private payers and providers to establish multi-payer initiatives.”

At the conclusion of the two hour hearing, like Baicker, Tiberi stressed the importance of bolstering support for Medicare Advantage, which serves approximately one-third of seniors today. Obamacare cut billions of dollars from Medicare Advantage and redirected those resources toward a one-size-fits-all, Washington-run entitlement, he says.

Tiberi also noted, “If we continue to berate a system that has been widely successful…I don’t think that’s a really good way to try to figure out how we bester serve patients, seniors, in a more cost-effective value-added, comprehensive way.”

Watching from the Sidelines

But, one aging group expressed strong concerns about the Health Panel’s look at Medicare. In his released statement, Max Richtman, President/CEO of the Washington, D.C.-based National Committee to Preserve Social Security Medicare (NCPSSM), viewed the Health Panel hearing as “an Orwellian political exercise in which politicians say preserve when they actually mean privatize, and strengthen when they mean slash.”

“Republicans in the House envision a future in which millions of seniors will lose their guaranteed Medicare benefits in favor of a privatized CouponCare system in which they receive a government coupon to try and buy private insurance. Millions of seniors in Medicaid will lose their benefits due to block-granting to states without providing the resources to pay for it. The repeal of the Affordable Care Act will leave tens of millions without insurance and strip benefits from seniors in Medicare,” says Richtman in NCPSSM’s statement.

Furthermore, “The Republican leadership has offered no plans to improve benefits in Medicare or make reforms to reign in the skyrocketing price of drugs and healthcare costs system wide. Instead, the GOP vision for seniors in Medicare is they must just do more with less. Stagnant wages are grinding away at the middle class’s ability to save for retirement. Many employers have significantly scaled back or eliminated the traditional retirement benefits offered to their employees. As a result, current and future retirees simply cannot afford proposals to cut benefits, raise the eligibility age or privatize the program,” says in the NCPSSM statement.

Finally, the aging advocate warns that the GOP majority on the House Ways and Means Health Subcommittee majority is moving to replace the nation’s traditional Medicare program in favor of a fully privatized system, and the GOP controlled House is in the process of producing a budget that would do just that.

A Democratic or Republican President? Which political party controls the House and Senate? When the dust settles these answered questions may result in a restructuring of the Medicare program, that may either be strengthened and expanded or put on the budgetary chopping block by the new incoming President or Congress. It’s a no brainer…Sitting on the political sideline will ultimately be detrimental to your pocketbook and coverage you receive for your health care.