Category Archives: Health

How Low Nursing Home Wages Are Contributing to COVID-19’s Spread

May 22, 2020

In mid-February, a cluster of residents at the Seattle-area nursing home, Life Care Center of Kirkland, came down with a respiratory illness and fever.  On February 28, a 73-year-old female resident tested positive for coronavirus disease (COVID-19).  Over the next month, the coronavirus swept through the 130-resident facility, killing 37 people connected with it.

A subsequent Centers for Disease Control and Prevention (CDC) investigation identified two main contributors to the virus’s rapid spread through the Kirkland nursing home.  One of them was “limitations in effective infection control and prevention” and the other was “staff members working in multiple facilities.”  CDC’s survey of some 100 nearby long-term care facilities found that staff members who worked in more than one facility and/or who worked while sick were among the leading contributors to the facilities’ vulnerability to infection.

Working at more than one facility is a common practice among nursing home workers throughout the country.  “Staff members work in multiple facilities because they do not earn enough money at one facility to support themselves and their families,” says the Center for Medicare Advocacy (CMA).

The Paraprofessional Healthcare Institute reported in 2016 that nurse aides, who provide most of the direct care in nursing facilities, earn “near-poverty wages.”  The median salary at that time was $19,000 a year, with half of workers earning less.  More than a third of them (38 percent) relied on various public benefits, including Medicaid, food stamps, housing subsidies and cash assistance.

When it comes to the spread of infections, low wages are especially dangerous because many of these workers lack paid sick leave.  CMA notes that given their low incomes, many employees work sick.  “If they do not work,” CMA says, “they do not get paid. With low wages, most lack enough savings to fall back on if they are sick and not paid.”

At this point, more than 400 of the nation’s 15,000 nursing facilities have had an outbreak of coronavirus among residents, staff or both, and “[t]here are indications . . . that those reports dramatically understate the situation,” long-term care expert Howard Gleckman writes in Forbes. As of April 2, the Associated Press estimated that “at least 450 deaths and nearly 2,300 infections have been linked to coronavirus outbreaks in nursing homes and long-term care facilities nationwide.”

“The coronavirus pandemic,” the CMA said in a recent article on its site, “brings dramatically into view the problem of allowing facilities to pay workers inadequate wages and to give them inadequate benefits.”

Terming the issue “a national scandal, calling for a national solution,” CMA makes a number of recommendations for raising the wages of nursing home workers and ending what it calls “hidden public subsidies to the nursing home industry” through public assistance paid to its low-wage workers.

CMA suggests that reforms be modeled on legislation introduced but not yet passed in Pennsylvania, the Nursing Home Accountability Act.  Among other things, the Act would guarantee nursing home workers a base hourly wage of $15 an hour, require nursing facilities to provide information to the public on the wages paid to its employees, and have facilities pay an “employer responsibility penalty” for employees who receive public assistance.

CMA is also calling for mandatory paid sick leave policies enacted in the wake of the coronavirus pandemic to be made universal and permanent.

What Can You Do to Protect Your Loved One in a Nursing Home During the Pandemic?

April 21, 2020

As the coronavirus spreads across the United States, nursing home residents are among the most vulnerable to the disease. How to try to ensure that your loved one stays healthy?

The first thing you can do is research the nursing home. While you likely made inquiries before your loved one moved in, you may not have gotten into specifics about the facility’s policies for preventing infection. The Centers for Disease Control (CDC) has a factsheet that covers key questions to ask nursing home officials about their infection prevention policies, including:

How does the facility communicate with family when an outbreak occurs?
Are sick staff members allowed to go home without losing pay or time off?
How are staff trained on hygiene?
Are there private rooms for residents who develop symptoms?
How is shared equipment cleaned?
You can also check on staffing levels. Facilities that are understaffed may have workers who are rushing and not practicing good hand-washing. There are no federal minimum staffing levels for nurses aides, who provide the most day-to-day care, but the federal government recommends a daily minimum standard of 4.1 hours of total nursing time per patient.

The Centers for Medicare and Medicaid Services and the CDC have issued guidance to nursing homes to try to prevent the spread of the coronavirus, including restricting all visitors except in end-of-life situations. You should follow the rules of the facility. If the facility is not limiting or not allowing visitors, do not try to break the rules.

You should check with the facility to make sure it is following the guidance from CMS and the CDC, which includes recommendations to do the following:
• Restrict all visitors, with exceptions for compassionate care
• Restrict all volunteers and nonessential health care personnel
• Cancel all group activities and communal dining
• Begin screening residents and health care personnel for fever and respiratory symptoms
• Put hand sanitizer in every room and common area
• Make facemasks available to people who are coughing
• Have hospital-grade disinfectants available

To read the detailed guidance from the CDC, click here.

Staying Connected to Family Members in a Nursing Home When Visits are Banned

April 17, 2020

The spread of the coronavirus to nursing home residents has caused the federal government to direct nursing homes to restrict visitor access, and many assisted livingfacilities have done the same. While the move helps the residents stay healthy, it can also lead to social isolation and depression. Families are having to find new ways to stay in touch.

Nursing homes have been hit hard by the coronavirus. The Life Care Center of Kirkland, Washington near Seattle was one of the first clusters of coronavirus in the United States and is one of the deadliest, with at least 35 deaths associated with the facility. In response, the Centers for Medicare and Medicaid Services (CMS) issued guidance to all nursing homes, restricting all visitors, except for compassionate care in end-of-life situations; restricting all volunteers and nonessential personnel; and cancelling all group activities and communal dining. While these actions are necessary to prevent the spread of the virus, they can leave families worried and upset and residents feeling isolated and confused.

Families are taking varying tacks to keep in contact with their loved ones, many of whom don’t fully understand why their family is no longer visiting. Nursing homes are also helping to facilitate contact. Some options for keeping in touch, include the following:

  • Phone calls. Phone calls are still an option to be able to talk to your loved one.
  • Window visits. Families who are able to visit their loved one’s window can use that to have in-person visits. You can hold up signs and blow kisses. Talking on a cell phone or typing messages on it and holding them up to the window may be a way to have a conversation.
  • Facetime and Skype. Many nursing homes are facilitating video calls with families using platforms like Facetime or Skype. Some nursing homes have purchased additional iPads, while others have staff members going between rooms with a dedicated iPad to help residents make calls.
  • Cards and letters. Sending cards and letters to your loved ones is another way to show them that you are thinking of them. Some nursing homes have also set up Facebook pages, where people can send messages to residents.

In this unprecedented time, families will need to get creative to stay in touch with their loved ones. For more articles about how families and nursing homes around the country are coping with the new restrictions, click herehere, and here.

As Life Moves Online, an Older Generation Faces a Digital Divide

April 17, 2020

courtesy of NAELAeBulletin:

By Kate Conger and Erin Griffith
Published March 27, 2020
Updated March 28, 2020

For more than a week, Linda Quinn, 81, has isolated herself inside her Bellevue, Wash., home to keep away from the coronavirus. Her only companion has been her goldendoodle, Lucy.

To blunt the solitude, Ms. Quinn’s daughter, son-in-law and two grandsons wanted to hold video chats with her through Zoom, a videoconferencing app. So they made plans to call and talk her through installing the app on her computer.

But five minutes before the scheduled chat last week, Ms. Quinn realized there was a problem: She had not used her computer in about four months and could not remember the password. “My mind just went totally blank,” she said.

Panicked, Ms. Quinn called a grandson, Ben Gode, 20, who had set up the computer for her. Mr. Gode remembered the password, allowing the call and the Zoom tutorial to take place — but not until Ms. Quinn got him to promise not to tell the rest of the family about her tech stumble.

As life has increasingly moved online during the pandemic, an older generation that grew up in an analog era is facing a digital divide. Often unfamiliar or uncomfortable with apps, gadgets and the internet, many are struggling to keep up with friends and family through digital tools when some of them are craving those connections the most.

While teenagers are celebrating birthdays over Zoom with one another, children are chatting with friends over online games and young adults are ordering food via delivery apps, some older people are intimidated by such technology. According to a 2017 Pew Research study, three-quarters of those older than 65 said they needed someone else to set up their electronic devices. A third also said they were only a little or not at all confident in their ability to use electronics and to navigate the web.

That is problematic now when many people 65 and older, who are regarded by the Centers for Disease Control and Prevention as most at risk of severe illness related to the coronavirus, are shutting themselves in. Many nursing homes have closed off to visitors entirely. Yet people are seeking human interaction and communication through the web or their devices to stave off loneliness and to stay positive.

For many seniors, “the only social life they had is with book clubs and a walk in a park,” said Stephanie Cacioppo, an assistant professor of psychiatry and behavioral neuroscience at the University of Chicago. “When they look at their calendar, it’s all canceled. So how do we as a society help them regain a sense of tomorrow?”

To bridge that digital gap, families are finding new apps and gadgets that are easy for older relatives to use. Companies and community members are setting up phone calls and, in areas where lockdowns are not yet in place, in-person workshops to help those uncomfortable with tech walk through the basics.

Officials are also calling for people to pitch in to close the divide. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, urged people this month to help the elderly set up technology to talk to medical providers.

“If you have an elderly neighbor or family member who might have trouble with their laptop or their phone for this purpose, make yourself available to help,” Ms. Verma said in a news conference.

In nursing homes that have stopped visitors from coming in to limit the spread of the virus, workers are leaning on tech to help residents stay connected with their families.

At 23 senior living communities in North Carolina, Maryland and Virginia run by Spring Arbor Senior Living, workers have been triaging family calls — sometimes multiple ones a day per resident — over Apple’s FaceTime, Skype and a software system operated by K4Connect, a tech provider, said Rich Williams, a senior vice president at HHHunt, which owns the centers.

“That line of communication is essential to the resident’s well-being,” he said.

Mr. Williams added that workers had also used virtual activities like Nintendo’s Wii bowling and SingFit, a music singalong program, to help Spring Arbor’s 1,450 residents — whose average age is 88 — pass the time and stay active.

Candoo, a New York company that helps older people navigate technology, has recently taught its customers how to use Zoom and other video calling apps with downloadable guides and phone calls and, in some cases, by taking over their screens and showing them where to click. Candoo charges $30 for a one-hour lesson and $40 for support.

“People are literally relying on technology, not only to keep them healthy and safe and alive, but also to keep them occupied,” said Liz Hamburg, founder of Candoo.

Jane Cohn, 84, who lives alone in New York, has paid for Candoo’s services to help her get connected. Typically active, she has been staying inside because of the virus outbreak. Her doctor’s check-in went virtual, while her therapy session and New York University class on architecture and urbanism moved to Zoom.

Ms. Cohn said she called Candoo twice in one day last week to help her get on Zoom. She had never used the software before, and when she tried to join her N.Y.U. class through the videoconferencing app, she saw only a video of herself and wasn’t able to hear anything.

A Candoo representative walked her through Zoom over the phone. Ms. Cohn, already worried about the virus, said struggling with technology “adds another level of stress.”.

Some people are finding easy-to-use tech to connect generations. Medbh Hillyard recently introduced an electronic speaker called a Toniebox to connect her parents, Margaret Ward and Paddy Hillyard, to her sons, Rory and Finn, ages 3 and 18 months, during quarantine.

While they all live in the same neighborhood in Belfast, Northern Ireland, and frequently saw each other before the outbreak, they have now stopped close contact. Each evening, Ms. Ward, 69, and Mr. Hillyard, 76, instead use an app on their smartphone to record bedtime stories. The app then transmits the stories to the Toniebox so Rory and Finn can listen, Ms. Hillyard said.

“It’s been a really, really good way of having contact each evening and them still being able to do bedtime stories for us, which is really lovely,” Ms. Hillyard said.

Tech-savvy older people have found themselves in great demand, fielding calls from friends and neighbors who need digital help.

Chuck Kissner, 72, a technology executive in Los Altos, Calif., who administers a computer network for his extended family and maintains their 40 or so devices with security updates and software licenses, said he recently had a deluge of requests for tech assistance from his neighbors.

Last week, he spent several hours using remote access to the devices of his homeowner association board to help members, who range in age from about 65 to 85, figure out how to attend a virtual meeting.

One neighbor and board member sanitized his iPad and left it at Mr. Kissner’s front door. The neighbor was having trouble logging into his Apple iCloud account because he could not remember the password. Mr. Kissner could not get into the account, and the neighbor eventually sought support from Apple.

“Everyone got into the meeting,” Mr. Kissner said. “It’s great to see the reaction when it works and it seems so simple.”

After Ms. Quinn’s family helped her get on Zoom, she told her book club about the videoconferences. While some were excited about keeping the club going online during the outbreak, others didn’t want to try it, she said.

“I’m thinking that we won’t do it this month, but when they get tired of not getting together, we’ll probably do it,” said Ms. Quinn, who was also trying to get her bridge club to go virtual.

Her family has certainly embraced the Zoom calls. Jackson Gode, 23, one of Ms. Quinn’s grandsons, lives across the country in Washington, D.C., and used to text her a few times a month. Now they video chat more frequently, he said.

“We’re in this time of great uncertainty,” he said, adding he was “just wanting to make sure that every moment we have counts.”

Experts split sharply over experimental Alzheimer’s drug

February 28, 2020

courtesy of NAELAeBulletin:

SAN DIEGO (AP) — A company that claims to have the first drug to slow mental decline from Alzheimer’s disease made its case to scientists Thursday but left them sharply divided over whether there’s enough evidence of effectiveness for the medicine to warrant federal approval.

Excitement and skepticism have surrounded aducanumab since its developers stopped two studies earlier this year because it didn’t seem to be working, then did a stunning about-face in October and said new results suggest it was effective at a high dose.

During Thursday’s presentation at an Alzheimer’s conference in San Diego, the developers convinced some experts that the drug deserves serious consideration. But others were dubious.

Changes made during the study and unusual analyses of the data made the results hard to interpret. And the newly released results showed the drug made only a very small difference in thinking skills in one study and none in the other.

Alzheimer’s patients and families are desperate for any help, no matter how small, adding pressure on the Food and Drug Administration to approve something.

But with conflicting results, “I don’t see how you can conclude anything other than that another trial needs to be done,” said the Mayo Clinic’s Dr. David Knopman, who was involved in one of the studies.

Laurie Ryan, a dementia scientist at the National Institute on Aging, agreed: “We need more evidence.”

Other doctors who consult for the drug’s developers cheered the results. Dr. Paul Aisen, a dementia specialist at the University of Southern California, said they were “consistent and positive” in showing a benefit at a high dose — “a truly major advance.”

Aducanumab aims to help the body clear harmful plaques, or protein clumps, from the brain. Cambridge, Massachusetts-based Biogen is developing it with Japan’s Eisai Co.

In afternoon trading, the companies’ stocks were up roughly 4%.

The stakes are high for approval or denial.

More than 5 million people in the U.S. and millions more worldwide have Alzheimer’s. Current drugs only temporarily ease symptoms and do not slow the loss of memory and thinking skills.

But approving a drug that isn’t truly effective could expose patients to financial and medical risks and give other drugmakers less incentive to develop better treatments.

The makers of aducanumab undertook two studies, each enrolling about 1,650 people with mild cognitive impairment or mild dementia from Alzheimer’s.

Those with a gene that raises their risk of the disease were started on a lower dose because they are more likely to suffer inflammation in the brain from medicines that target plaque.

But as the studies went on and concern about this side effect eased, the rules were changed to let such patients get a higher dose.

A Biogen vice president, Samantha Budd Haeberlein, said more people got the higher dose in one study, and that helps explain why it succeeded and the other one failed.

But the new analyses were done on partial results, and with methods not agreed upon at the outset, which makes any conclusions unreliable, independent experts said.

Also, the drug’s benefits may have looked more impressive than they really were because patients in the placebo group worsened more in the positive study than in the one that failed.

“It’s hard to know exactly what happened here,” said Dr. Howard Fillit, chief science officer of the Alzheimer’s Drug Discovery Foundation. “I don’t see how the FDA could approve it.”

Questions also arose about the size of any benefit.

The drug did not reverse decline, only slowed the rate of it compared to the placebo group by 22% in one study. Yet that meant a difference of only 0.39 on an 18-point score of thinking skills.

“It’s a very small amount,” Fillit said.

Still, Maria Carrillo, chief science officer at the Alzheimer’s Association, said it was “the largest reduction that we’ve seen to date,” adding: “It may mean that they remember their loved ones a little longer.”

The drug “is worthy of significant, rigorous exploration” and review by the FDA, she said. “This is an important moment for the Alzheimer’s community.”

Some doctors and patients who helped test the drug are convinced it helped.

One was Charles Flagg, 78, a retired minister from Jamestown, Rhode Island, who received aducanumab until the studies were halted in March. Since he was taken off the medicine, “his cognition, his alertness, his interactions have definitely diminished,” said his wife, Cynthia Flagg.

Biogen stressed the need for an effective treatment and suggested that delaying access to a drug that may work could deprive many people of help while further study is done.

Dr. John Ioannidis, a Stanford University expert on research methods, said patients’ need should not drive the FDA’s decision.

“If we go down that path, we’re likely to introduce a lot of ineffective treatments for diseases that are really common,” he said. “It would be a complete mess.”

Our body systems age at different rates, study finds, pointing to personalized care to extend healthy life

February 27, 2020

courtesy of NAELAeBulletin:

One 50-year-old has the nimble metabolism of a teenager, while another’s is so creaky he developed type 2 diabetes — though his immune system is that of a man 25 years his junior. Or one 70-year-old has the immune system of a Gen Xer while another’s is so decrepit she can’t gin up an antibody response to flu vaccines — but her high-performing liver clears out alcohol so fast she can sip Negronis all night without getting tipsy.

Anyone over 30 knows that aging afflicts different body parts to different degrees. Yet most molecular theories of aging — telomere shortening, epigenome dysregulation, senescence-associated secreted proteins, take your pick — don’t distinguish among physiological systems and organs, instead viewing aging as systemic.

Nonsense, say scientists at Stanford University School of Medicine. In a study published on Monday in Nature Medicine, they conclude that just as people have an individual genotype, so too do they have an “ageotype,” a combination of molecular and other changes that are specific to one physiological system. These changes can be measured when the individual is healthy and relatively young, the researchers report, perhaps helping physicians to pinpoint the most important thing to target to extend healthy life.

“This really presents a new framework to think about aging,” said epidemiologist Norrina Bai Allen of Northwestern University’s Feinberg School of Medicine, an expert in the biology of aging who was not involved in the Stanford study. “It’s an important first step toward showing how different parts of a body in different people can age at different rates.”

Call it personalized medicine for aging. “Individuals are aging at different rates as well as potentially through different biological mechanisms,” or ageotypes, the Stanford scientists wrote.

“Of course the whole body ages,” said biologist Michael Snyder, who led the study. “But in a given individual, some systems age faster or slower than others. One person is a cardio-ager, another is a metabolic ager, another is an immune ager,” as shown by changes over time in nearly 100 key molecules that play a role in those systems. “There is quite a bit of difference in how individuals experience aging on a molecular level.”

Crucially, the molecular markers of aging do not necessarily cause clinical symptoms. The study’s “immune” agers had no immune dysfunction; “liver agers” did not have liver disease. Everyone was basically healthy.

If aging is truly personal, understanding an individual’s ageotype could lead to individualized, targeted intervention. “We think [ageotypes] can show what’s going off track the most so you can focus on that if you want to affect your aging,” Snyder said.

Cardio-agers, for instance, might benefit from tight cholesterol control, periodic ECGs, and screening for atrial fibrillation. Immune agers might benefit from diets and exercise to reduce inflammation.

Then again, they might not. The study did not follow people long enough to tell whether their aging biomarkers did them any harm, or were even harbingers of harm, let alone killed them, Feinberg’s Allen pointed out. “There needs to be a lot more work, and replication of the results,” before they can be the basis for anti-aging interventions, she said.

The short follow-up and small sample size — 106 people — gave other experts pause. One said he “will not comment on it in any way” and declined to elaborate.

One concern revolved around what might otherwise be the study’s strength: the dizzying number of measurements the scientists made on their volunteers, ages 29 to 75, over two to four years. Through blood and saliva and urine tests, genetic analyses, microbiome inspections of their nose and gut, and more, the scientists measured 10,343 genes, 306 blood proteins, 722 metabolites, and 6,909 microbes, among other things, and found they clustered into four ageotypes: liver, kidney, metabolic, and immune.

Different people had different “personal aging molecules” and “distinct aging pathways,” Snyder said. But just as every dish on a menu is unique but can be grouped into “meat” or “fish” or “vegan” or other category, so the molecules fell into the liver, kidney, metabolic, or immune ageotypes. (There is probably a cardio-ageotype and a neuro-ageotype, too, Snyder said, but they didn’t have enough data to characterize those.)

“That we don’t all age identically is well-established,” said biologist Judy Campisi of the Buck Institute for Research on Aging, who has helped develop an “atlas” of aging biomarkers. But the new study “furthers our understanding of why.”

All told, the study generated 18 million data points. While that sounds impressive, it raises the risk that some markers seem to be part of one or another ageotype just by chance.

But Snyder said he is “quite confident” the biomarkers are not statistical artifacts. For one thing, the researchers initially found 184 of them. But using stricter statistics, they narrowed that to 87.

One surprise was that some measurements that increased with age when the participants were averaged decreased in some individuals, while some that fell with age in most people rose in a few. For instance, hemoglobin A1C (a marker of how well cells metabolize glucose) usually rises, and so is part of the metabolic ageotype. But in dozens of people it fell — another hint that different systems age at different rates in different people.

In many of those opposites, the reason might be healthy lifestyle changes. People whose A1C fell significantly, for example, either started eating a healthier diet or lost weight, both of which can improve glucose metabolism. “Lifestyle changes, and perhaps medications, can improve some markers of aging and alter an individual’s aging pattern,” said Snyder (who is 64 and has a metabolic ageotype). In fact, 15 people got biologically younger during the study.

That healthy habits can increase both lifespan and healthspan is not exactly news. But the ageotype approach might let people target their dominant aging pathway.

“The hope is that once you identify the main cause of an individual’s aging, it opens the door to interventions — exercise or diet or intermittent fasting or medications,” said Campisi. “Ideally, a 50-year-old could get a blood test and learn that his kidney is 60 but his heart is 40, and do something about [kidney aging]. This is a step in that direction.”

A Change in Medicare Has Therapists Alarmed

January 22, 2020

courtesy of NAELAeBulletin:
by Paula Span

Nov. 29, 2019

Medicare revamped its reimbursement policy for physical, occupational and speech therapy in nursing homes. That has left some patients with less help.

In late September, a woman in her 70s arrived at a skilled nursing facility in suburban Houston after several weeks in the hospital. Her leg had been amputated after a long-ago knee replacement became infected; she also suffered from diabetes, depression, anxiety and general muscular weakness.

An occupational therapist named Susan Nielson began working with her an hour a day, five days a week. Gradually, the patient became more mobile. With assistance and encouragement, she could transfer from her bed to a wheelchair, get herself to the bathroom for personal grooming and lift light weights to build her endurance.

That progress ended abruptly on Oct. 1, when Medicare changed its payment system for physical, occupational and speech therapy in nursing homes. Ms. Nielson, employed by Reliant Rehabilitation, which supplies therapists to almost 900 nursing facilities, said that her allotted time with the woman was reduced from 60 minutes to just 20 or so minutes a day, not even long enough to help her leave her bed.

“I’m not able to do my job,” Ms. Nielson said. “This person had the potential to do more, and I couldn’t help her.”

The same lament is being expressed by therapists nationwide. Professional organizations, including the American Physical Therapy Association and the American Occupational Therapy Association, report that the new Medicare policy has prompted some nursing home chains and rehab companies to scale back the treatment they provide to patients, and to lay off therapists or switch them to part-time status.

The organizations’ members are also speaking out about the pressure they feel to conduct therapy in groups rather than one-on-one. Medicare allows up to 25 percent of patients’ therapy to take place in groups — and some employers reportedly began requiring that percentage on Oct. 1, whether therapists thought their patients would benefit or not.

“Patients’ needs didn’t change overnight,” said Kara Gainer, director of regulatory affairs for the American Physical Therapy Association. “So what changed?” Although some companies have reacted responsibly to the new system, she said, “some are bad actors who put profits before patients.”

Her members have responded with “concern, fear, outrage,” she added. A new Facebook group, Rehab Therapists for a Union, swiftly attracted more than 20,000 members. A petition on Change.org, asking the Department of Health and Human Services to intervene, garnered 80,000 signatures.

Before Oct. 1, Medicare reimbursed nursing homes for therapy based on the number of minutes provided to each patient, up to 720 minutes a week. The goal is to help patients regain mobility and the ability to perform daily tasks, so that they can safely return home.

For years, however, federal investigators and advisers have reported that nursing homes frequently provided the maximum number of minutes of therapy, regardless of whether patients needed that much treatment.

“Therapy was sort of a profit center,” said Sharmila Sandhu, who directs regulatory affairs at the American Occupational Therapy Association. “The more therapy, the higher the reimbursement.”

The new approach, called the Patient-Driven Payment Model, eliminates such incentives; now facilities are paid based on patients’ diagnoses and characteristics. In an email, a spokesman for the Centers for Medicare and Medicaid Services called the P.D.P.M. “a historic reform” that will “appropriately reflect each resident’s actual care needs.”

“This is a well-intended policy, a real sea change in how we pay for care,” said David Grabowski, a health care policy researcher at Harvard Medical School who is organizing a study of the policy’s effects.

But about 70 percent of the nation’s 15,000 or so nursing homes are for-profit and have proved adept at maintaining profit margins despite policy shifts, said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy.

Without volume incentives, nursing homes may direct therapists to administer less therapy and to see patients in groups, reducing the number of professionals required and lowering labor costs.

“The risk before was overprovision of therapy,” Dr. Grabowski said. “Now the real concern is underprovision.”

Medicare Part D: A First Look at Prescription Drug Plans in 2020

December 24, 2019

courtesy of NAELA eBulletin:

During the Medicare open enrollment period  from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D drug coverage, either a stand-alone prescription drug plan (PDP) as a supplement to traditional Medicare, or a Medicare Advantage prescription drug plan (MA-PD), which covers all Medicare benefits, including drugs.

Click here for the entire article and the issue brief

Medicare Premiums to Increase By Almost $10 a Month in 2020

December 24, 2019

After small or no increases the past couple in of years, Medicare’s Part B premium will rise sharply 2020. The basic monthly premium will increase $9.10, from $135.50 a month to $144.60.

The Centers for Medicare and Medicaid Services (CMS) announced the premium increase on November 8, 2019. Not everyone will pay the whole increase, however. Due to a “hold harmless” rule around 70 percent of Medicare recipients’ premiums will not increase more than Social Security benefits, and Social Security benefits are increasing only 1.6 percent in 2020. This “hold harmless” provision does not apply to about 30 percent of Medicare beneficiaries: those enrolled in Medicare but who are not yet receiving Social Security, new Medicare beneficiaries, seniors earning more than $87,000 a year, and “dual eligibles” who get both Medicare and Medicaid benefits.

Meanwhile, the Part B deductible will go from $185 to $198 in 2020, while the Part A deductible will go up by $44, to $1,408. For beneficiaries receiving skilled care in a nursing home, Medicare’s coinsurance for days 21-100 will increase from $170.50 to $176. Medicare coverage ends after day 100. CMS attributed the sudden steep rise in Part B premiums and deductibles on the increased costs of physician-administered drugs.

Here are all the new Medicare payment figures:

  • Part B premium: $144.60 (was $135.50)
  • Part B deductible: $198 (was $185)
  • Part A deductible: $1,408 (was $1,364)
  • Co-payment for hospital stay days 61-90: $352/day (was $341)
  • Co-payment for hospital stay days 91 and beyond: $704/day (was $682)
  • Skilled nursing facility co-payment, days 21-100: $176/day (was $170.50)

So-called “Medigap” policies can cover some of these costs.

Premiums for higher-income beneficiaries ($87,000 and above) are as follows:

  • Individuals with annual incomes between $87,000 and $109,000 and married couples with annual incomes between $174,000 and $218,000 will pay a monthly premium of $202.40.
  • Individuals with annual incomes between $109,000 and $136,000 and married couples with annual incomes between $218,000 and $272,000 will pay a monthly premium of $289.20.
  • Individuals with annual incomes between $136,000 and $163,000 and married couples with annual incomes between $272,000 and $326,000 will pay a monthly premium of $376.00.
  • Individuals with annual incomes above $163,000 and less than $500,000 and married couples with annual incomes above $326,000 and less than $750,000 will pay a monthly premium of $462.70.
  • Individuals with annual incomes above $500,000 and married couples with annual incomes above $750,000 will pay a monthly premium of $491.60.

Rates differ for beneficiaries who are married but file a separate tax return from their spouse. Those with incomes greater than $87,000 and less than $413,000 will pay a monthly premium of $462.70. Those with incomes greater than $413,000 will pay a monthly premium of $491.60.

The Social Security Administration uses the income reported two years ago to determine a Part B beneficiary’s premiums. So the income reported on a beneficiary’s 2018 tax return is used to determine whether the beneficiary must pay a higher monthly Part B premium in 2020. Income is calculated by taking a beneficiary’s adjusted gross income and adding back in some normally excluded income, such as tax-exempt interest, U.S. savings bond interest used to pay tuition, and certain income from foreign sources. This is called modified adjusted gross income (MAGI). If a beneficiary’s MAGI decreased significantly in the past two years, she may request that information from more recent years be used to calculate the premium. You can also request to reverse a surcharge if your income changes.

Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. CMS estimates that the Medicare Advantage average monthly premium will decrease by 14 percent in 2020, from an average of $26.87 in 2019 to $23 in 2020.

For Medicare’s press release announcing the new premium and deductible amounts, click here.

Home Care Costs Rise Sharply in Annual Long-Term Care Cost Survey

December 24, 2019

When it comes to long-term care costs, the charges for home care are now rising faster than those for nursing home care, according to Genworth’s 2019 Cost of Care survey. In the past year, the median annual cost for home health aides rose 4.55 percent to $52,624, while the median cost of a private nursing home room rose only 1.82 percent to $102,200.

Genworth reports that the median cost of a semi-private room in a nursing home is $90,155, up 0.96 percent from 2018, and the median cost of assisted living facilities rose 1.28 percent, to $4,051 a month. But home care services had sharper increases. The national median annual rate for the services of a home health aide rose from $22 to $23 an hour, and the cost of adult day care, which provides support services in a protective setting during part of the day, rose from $72 to $75 a day, up 4.17 percent annually.

Alaska continues to be the costliest state for nursing home care by far, with the median annual cost of a private nursing home room totaling $362,628. Oklahoma again was found to be the most affordable state, with a median annual cost of a private room of $67,525.

The 2019 survey, conducted by CareScout for the sixteenth straight year, was based on responses from more than 15,178 nursing homes, assisted living facilities, adult day health facilities and home care providers. Survey respondents were contacted by phone during May and June 2019.

As the survey indicates, long-term care is growing ever more expensive. Contact your elder law attorney to learn how you can protect some or all of your family’s assets from being swallowed up by these rising costs.

For more on Genworth’s 2019 Cost of Care Survey, including costs for your state, click here.