Universal long-term care coverage included in House Democrats’ new Medicare-for-all plan

March 29, 2019

House Democrats unveiled a plan this week that would offer all Americans a government insurance plan option that would provide coverage for long-term services at no cost.

The Washington Post first reported the ambitious effort late Tuesday, which is backed by more than 100 members of Congress. Spearheaded by Rep. Pramila Jayapal (D-WA), the proposal would move all Americans to one public payer in two years, providing them with coverage for medical, vision, dental and long-term care services.

Though the measure has 106 cosponsors, it has no shot at passing the House or in the Republican-controlled Senate, the Post reported.

“We have a real plan,” Jayapal told reporters this week. “Americans are literally dying because they cannot afford insulin and can’t get the cancer treatments they need … I think this Medicare-for-all bill makes it clear what we mean by healthcare for all. We mean a complete transformation of our healthcare system.”

Critics have said the plan would require a sharp increase in taxes, with one previous estimate projecting that Medicare for all would increase federal expenditures by $30 trillion. Jayapal’s bill is more ambitious than a 2017 single-payer pitch from Sen. Bernie Sanders. Her idea also includes a crackdown on the pharmaceutical industry, aimed at lowering drug prices, and the government-run long-term care option, which also could cover home health services.

Nursing homes, hospitals and other providers would be paid under a fixed annual budget, determined by several factors including historical volume of services, Jayapal told reporters.

Financial Institutions Report Widespread Elder Financial Abuse

March 29, 2019

The Consumer Financial Protection Bureau (CFPB) has released a report on financial exploitation of the elderly. The report compiles information from Suspicious Activity Reports (SARs) submitted by banks, credit unions, casinos, and other financial services providers.

Based upon the SARs, financial institutions have reported that financial exploitation of older adults by scammers, family members, caregivers, and others is widespread in the United States.

Key findings:

  • SAR filings on elder financial exploitation quadrupled from 2013 to 2017.
  • Financial institutions reported a total of $1.7 billion in suspicious activities in 2017, including actual losses and attempts to steal the older adults’ funds.
  • Nearly 80% of SARs reporting elder financial exploitation involved a monetary loss to older adults. The average amount lost was $34,200. In 7% of the cases, the loss exceeded $100,000.
  • One third of the individuals who lost money were ages 80 and older. Adults ages 70 to 79 had the highest average monetary loss ($45,300).
  • Losses were greater when the older adult knew the suspect.
  • More than half of SARs reporting elder financial exploitation involved a money transfer. The second-most common financial product used to move funds was a checking or savings account.
  • Checking or savings accounts had the highest monetary losses. The average monetary loss to the older adult was $48,300 in cases of elder financial exploitation involving a checking or savings account while the average loss was $32,800 in cases of elder financial exploitation involving a money transfer.
  • The elder financial exploitation took place, on average, over a four-month period.
  • Fewer than one-third of older adults who were exploited reported the abuse to a local, state, or federal authority. Only 1% of the SARs stated that the financial institutions involved reported the elder financial exploitation to a government entity such as adult protective services or law enforcement.

The report is is attached here –cfpb_suspicious-activity-reports-elder-financial-exploitation_report .  For additional information concerning elder abuse actions, visit:
https://vanarellilaw.com/will-contests-probate-litigation-elder-abuse-actions-2/

The Cost Of Seniors’ Health Care May Be Moderating But The Need For Long-Term Care May Be Growing

March 28, 2019

The pace of medical spending for older adults is slowing, and one highly-respected health economist gives much of the credit to the increased use of medications that reduce the risk of heart disease. That is good news, but it largely ignores the growing costs of long-term care and the increasing burden on family caregivers, whose assistance is not included in this analysis.

To put it simply: The increased use of drugs such as statins is improving heart health. Not only will that slow the growth of medical costs for seniors, it may help them live longer. However, it will not keep them healthy forever. They will, in effect, live long enough to suffer from frailty of old age. And that means they will need more personal care that most often is delivered by family members.

To oversimplify: Instead of dying of heart attacks at 60, more of us will live to 85, when we will get dementia. That’s why we need to shift resources from medical care to long-term supports and services.

Less heart disease

In the study published in the February edition of the journal Health Affairs, Harvard University health economist David Cutler and his co-authors calculated that the per beneficiary growth rate of Medicare spending slowed substantially from 1992-2012. Until 2004, program spending per enrollee rose by 3.8 percent annually. From 2005-2012, it grew by only 1.1 percent.

Overall Medicare spending grew much faster, largely because so many more people turned 65 and enrolled in the program. But spending for each beneficiary grew far more slowly than many predicted. By 2012, actual Medicare spending was about $3,000 less than forecast.

Cutler and his colleges dug into the data (and made some important adjustments to the available numbers) to try to understand why. This is what they found:

Half of the lower-the-expected spending was due to fewer acute cardiovascular-related medical events, such as strokes, heart attacks, or acute episodes of congestive heart failure. And they attributed half of that savings to greater use of medications that prevent or control conditions such as high blood pressure, high cholesterol, or diabetes.

More use of drugs

Few new drug therapies were developed for these diseases during this period. But consumers used existing drugs more frequently, in part to lower prices and creation of the Medicare Part D drug benefit.

Better heart health means less hospital care, fewer heart surgeries, and less need for post-acute care. Hospital admissions for heart disease are off by 56 percent since 1999, and admissions for strokes declined by 41 percent, the study reports.

And, the authors’ add, there is more opportunity to improve heart health and save money. Only 55-60 percent of American are controlling their risk factors for cardiovascular disease.

While the news on the health cost side is positive, there is another side to the story. Cutler and colleagues looked at a broad definition of medical spending that mimics the government’s National Health Expenditure Accounts. But personal health spending generally excludes long-term care services and supports. And it entirely ignores personal care provided by family members.

And that’s where matters get interesting. Widespread use of medications to prevent heart attacks or strokes keeps us healthier for longer. But it doesn’t make us immortal or immune from the frailty of old age.

A growing challenge

We will live longer in old age, and indeed life expectancy among older adults in the US continues to increase (though it has reversed a bit in the past few years for those under 65). Longer lives, however, make more of us susceptible to chronic conditions of very old age such as Alzheimer’s disease and some other dementias, pulmonary disease, and severe arthritis. It even is true with heart failure. Medications can reduce repeated hospitalizations for the disease but they won’t prevent it from slowly and inexorably sapping a senior’s strength.

We are left then, with a growing challenge. Medical costs for those with chronic conditions and functional or cognitive limitations are two- to three-times higher than for those with chronic conditions alone. Cutler and colleagues attempt to adjust their data for demographic changes but because they looked backward to 2012, they did not capture the coming explosion in the population of those 80 and older—when those limitations are most common.

We are left with a classic good news/bad news story. For example, some dementias, such as stroke-related or vascular dementia, may also become less common as medications prevent the underlying conditions. But Alzheimer’s may become more common as more of us live to a very old age.

While Cutler and his colleagues didn’t put it this way, their research strengthens the argument that the US needs to shift resources from medical care to long-term supports and services.

by Howard Gleckman

People With Disabilities Are Entitled to a Free Lifetime Pass to National Parks

March 28, 2019

NAELA News:

If you or your child has a permanent disability you may be entitled to a free, lifetime pass to visit the National Parks and Federal Recreational Lands.

I actually learned about the program because a friend of mine’s child has Type-1 diabetes and qualities for the program. Qualifying disabilities include physical, mental, or sensory impairments.

The pass can be used at over 2000 Federal recreation sites across the nation. Those include National Parks, National Wildlife Refuges, National Forests, and other federal recreation lands. It also extends that same privilege to everyone in the vehicle with the pass holder. So, if one person in your family qualifies, you can all visit a park for free with that person’s pass.

In order to get a pass you’ll need:

  • A statement signed by a licensed physician attesting that you have a permanent physical, mental, or sensory impairment that substantially limits one or more major life activities, and stating the nature of the impairment; OR • A document issued by a Federal agency, such as the U.S. Department of Veterans Administration, which attests that you have been medically determined to be eligible to receive Federal benefits as a result of blindness or permanent disability. Other acceptable Federal agency documents include proof of receipt of Social Security Disability Income (SSDI) or Supplemental Security Income (SSI); OR • A document issued by a State agency such as a vocational rehabilitation agency, which attests that you have been medically determined to be eligible to receive vocational rehabilitation agency benefits or services as a result of medically determined blindness or permanent disability. Showing a State motor vehicle department disability sticker, license plate or hang tag is not acceptable documentation.

You’ll need to fill out this application, and then either mail it in with a $10 processing fee or go to a federal recreation site in person with proof of disability and residency, in which case you can skip paying the fee and filling out the form. The Access Passes can also be purchased online through store.usgs.gov/access-pass, which is the organization’s preferred way to receive applications.

Once your application is processed, you’ll receive a physical card that can be used for park admission.

Veterans Can Track VA Health Records on Their iPhones

March 28, 2019

NAELA News:

by Edward C. Baig

Active members of the military and those who’ve left the service who receive care through Veteran Health Administration hospitals will be able to view all their personal medical data through the Health Records feature on their iPhones. Apple and the U.S. Department of Veterans Affairs made the announcement on Monday.

Starting this summer, vets will be able to view an integrated snapshot of records from such providers pertaining to allergies, immunizations, vitals, test results, medications, procedures, conditions, and so on. The data is encrypted.

Following a visit to a VA health care facility, the participating vet’s Apple device will automatically receive updated health record information within 24 hours.

The Health app on the iPhone isn’t new, nor is the Health Records feature within the app where the data will be stored. It was updated last year to make it simpler for patients to chase down records from disparate medical providers, and keep them in one convenient repository. The feature is still technically in beta.

Among the growing list of more than 200 providers in the program are institutions such as Johns Hopkins in Baltimore, Cedars-Sinai in Los Angeles, Cleveland Clinic in Cleveland, Stanford Health Care in Palo Alto, Calif., NYU Langone Health in New York, and Rush University Medical Center in Chicago. Quest Diagnostics and LabCorp are also participants.

The latest announcement brings the VA hospitals into the fold.

To add health data from the VA, vets will sign in with their military credentials inside the Health app, just as people seeking records from other medical providers sign in with the credentials used to access the various institution’s respective patient portals. An Apple ID is never used. For the image, go to https://i.prcdn.co/img?regionguid=5e92ba8e-6292-490f-95a4-7218770b28dc&scale=400&file=11522019021200000000001001&regionKey=SgY9Vfk4bb29YqnbaYNK5Q%3d%3d    

The VA indicated a willingness to partner with other companies to bring similar capabilities to other mobile platforms.

SCAM ALERT: Beware of callers impersonating social security employees

March 28, 2019

NAELA News:  The Social Security Administration is warning people to beware of callers impersonating social security employees over the phone.

If you receive a scam call, SSA says you should hang up and report the details of the call to the Office of the Inspector General at 800-269-0271 or online here.

The SSA says reports about fraudulent phone calls from people claiming to be from SSA continue to increase.

In recent reports, unknown callers are using “increasingly threatening language in these calls,” according to the SSA website.

For more information visit here.

How Does Contingent Work Affect SSDI Benefits?

March 27, 2019

NAELA News:

Abstract

Some studies have found that contingent workers – including independent contractors, consultants, and those in temporary, on-call, and “gig economy” jobs – make up an increasing share of the labor force.  How does this group of workers interact with Social Security Disability Insurance (SSDI)?  This project uses the Health and Retirement Study linked to administrative data on SSDI applications and earnings to answer this question.  Specifically, the paper examines how SSDI application, receipt, potential benefits, and insurance status differ for workers who hold contingent arrangements in their 50s and early 60s, compared to those who work in more traditional jobs at those ages.  This study is among the first to examine how contingent work is likely to affect participation in a public program, specifically disability benefits.

The study finds that SSDI application rates are about one-quarter smaller for older eligible contingent workers than for traditional workers of the same ages.  Contingent workers are also about one-third less likely to be awarded disability benefits.  The lower application and award rates are likely due in part to contingent workers’ lower eligibility rates and lower potential benefits.  The application and award rates are also lower for contingent workers who have a chronic condition, work limitation, or limitation in their Activities of Daily Living.  These results suggest that contingent workers would benefit from a greater availability of information and assistance in navigating the SSDI application process.

Seniors Aging In Place Turn To Devices And Helpers, But Unmet Needs Are Common

March 27, 2019

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Bathroom with accessories to help with washing and using the toilet. Bathroom in a care home in England; A new study examines how seniors with deteriorating strength and other physical functions deal with such challenges as taking a shower or getting dressed in the morning. (E+/Getty Images)

NAELA News:  About 25 million Americans who are aging in place rely on help from other people and devices such as canes, raised toilets or shower seats to perform essential daily activities, according to a new study documenting how older adults adapt to their changing physical abilities.

But a substantial number don’t get adequate assistance. Nearly 60 percent of seniors with seriously compromised mobility reported staying inside their homes or apartments instead of getting out of the house. Twenty-five percent said they often remained in bed. Of older adults who had significant difficulty putting on a shirt or pulling on undergarments or pants, 20 percent went without getting dressed. Of those who required assistance with toileting issues, 27.9 percent had an accident or soiled themselves.

The study, by researchers from Johns Hopkins University, focuses on how older adults respond to changes in physical function — a little-studied and poorly understood topic. It shows that about one-third of older adults who live in the community — nearly 13 million seniors — have a substantial need for assistance with daily activities such as bathing, eating, getting dressed, using the toilet, transferring in and out of bed or moving around their homes; about one-third have relatively few needs; and another third get along well on their own with no notable difficulty.

For older adults and their families, the report is a reminder of the need to plan ahead for changing capacities.

“The reality is that most of us, as we age, will require help at one point or another,” said Dr. Bruce Chernof, president of the SCAN Foundation and chair of the 2013 federal Commission on Long-Term Care. Citing Medicare’s failure to cover so-called long-term services and supports, which help seniors age in place, he said, “We need to lean in much harder if we want to help seniors thrive at home as long as possible.” (KHN’s coverage of aging and long-term care issues is supported in part by the SCAN Foundation.)

Previous reports have examined the need for paid or unpaid help in the older population and the extent to which those needs go unmet. Notably, in 2017, the same group of Johns Hopkins researchers found that 42 percent of older adults with probable dementia or difficulty performing daily activities didn’t get assistance from family, friends or paid caregivers — an eye-opening figure. Of seniors with at least three chronic conditions and high needs, 21 percent lacked any kind of assistance.

But personal care isn’t all that’s needed to help older adults remain at home when strength, flexibility, muscle coordination and other physical functions begin to deteriorate. Devices and home modifications can also help people adjust.
Until this new study, it hasn’t been clear how often older adults use “assistive devices”: canes, walkers, wheelchairs and scooters for people with difficulties walking; shower seats, tub seats and grab bars to help with bathing; button hooks, reachers, grabbers and specially designed clothes for people who have difficulty dressing; special utensils designed to make eating easier; and raised toilets or toilet seats, portable commodes and disposable pads or undergarments for individuals with toileting issues.

“What we haven’t known before is the extent of adjustments that older adults make to manage daily activities,” said Judith Kasper, a co-author of the study and professor at Johns Hopkins’ Bloomberg School of Public Health.

The data comes from a 2015 survey conducted by the National Health and Aging Trends Study, a leading source of information about functioning and disability among adults 65 and older. More than 7,000 seniors filled out surveys in their homes and results were extrapolated to 38.8 million older Americans who live in the community. (Those who live in nursing homes, assisted living centers, continuing care retirement communities and other institutions were excluded.)

Among key findings: Sixty percent of the seniors surveyed used at least one device, most commonly for bathing, toileting and moving around. (Twenty percent used two or more devices and 13 percent also received some kind of personal assistance.) Five percent had difficulty with daily tasks but didn’t have help and hadn’t made other adjustments yet. One percent received help only.

Needs multiplied as people grew older, with 63 percent of those 85 and older using multiple devices and getting personal assistance, compared with 23 percent of those between ages 65 and 74.

The problem, experts note, is that Medicare doesn’t pay for most of these non-medical services, with some exceptions. As a result, many seniors, especially those at or near the bottom of the income ladder, go without needed assistance, even when they’re enrolled in Medicaid. (Medicaid community-based services for low-income seniors vary by state and often fall short of actual needs.)

The precariousness of their lives is illustrated in a companion report on financial strain experienced by older adults who require long-term services and supports. Slightly more than 10 percent of seniors with high needs experienced at least one type of hardship, such as being unable to pay expenses like medical bills or prescriptions (5.9 percent), utilities (4.8 percent) or rent (3.4 percent), or skipping meals (1.8 percent). (Some people had multiple difficulties, reflected in these numbers.)

These kinds of adverse events put older adults’ health at risk, while contributing to avoidable hospitalizations and nursing home placements. Given a growing population of seniors who will need assistance, “I think there’s a need for Medicare to rethink how to better support beneficiaries,” said Amber Willink, co-author of both studies and an assistant scientist at Johns Hopkins’ Bloomberg School of Public Health.

That’s begun to happen, with the passage last year of the CHRONIC Care Act, which allows Medicare Advantage plans to offer supplemental benefits such as wheelchair ramps, bathroom grab bars, transportation and personal care to chronically ill members. But it’s unclear how robust these benefits will be going forward; this year, plans, which cover 21 million people, aren’t offering much. Meanwhile, 39 million people enrolled in traditional Medicare are left out altogether.

“We’ve had discussions with the [insurance] industry over the last couple of months to explore what’s going to happen and it’s a big question mark,” said Susan Reinhard, director of AARP Public Policy Institute, which publishes a scorecard on the adequacy of state long-term services and supports with several other organizations.

So far, she said, the response seems to be, “Let’s wait and see, and is this going to be affordable?”

There’s Still Time to Go Back to Traditional Medicare or Change MA Plans

February 27, 2019

Annual Enrollment has ended, but the Medicare Advantage Open Enrollment Period, allowing plan changes or a return to traditional Medicare continues through March 31 – Make sure you are fully informed about the Medicare that is right for you.

When?

  • January 1–March 31

What Can I Do?

  • If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage).
  • You can disenroll from your Medicare Advantage Plan and return to Original Medicare. If you choose to do so, you’ll be able to join a Medicare Prescription Drug Plan.
  • If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without drug coverage) within the first 3 months you have Medicare.

What Can’t I Do?

  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Join a Medicare Prescription Drug Plan if you’re in Original Medicare.
  • Switch from one Medicare Prescription Drug Plan to another if you’re in Original Medicare.

President Signs 3-Month Extension of NAELA Priorities

February 27, 2019

NAELA Advocacy Update

President Signs 3-Month Extension of NAELA Priorities
Last Friday, the President signed an extension of NAELA’s two top legislative priorities for the year:

• $112 million for Money Follows the Person (MFP)

• Extension of the guarantee that Medicaid’s spousal impoverishment protections will apply to home and community-based services (HCBS) through March 31, 2019.

Both policies were extended for a short-time due to a compromise from the last Congress on how to offset the costs to the federal government. Importantly, no new limits to Medicaid eligibility were included, such as limits to community spouse annuities. NAELA is now working with key members of Congress to pass a multi-year extension of both programs.

For more information go to Money Follows the Person (MFP) and Home and Community-Based Services (HCBS)

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