States React to AARP Scorecard

Much has been made of AARP’s released report 2014 State Long-Term Services and Supports (LTSS) Scorecard. In fact, I covered the results in a recent blog.

Since the report’s release, state politicians and policy makers have been scrambling to either issue statements strongly urging for their state’s commitment to long term care improvement or stridently patting themselves on the back for a job well done.

Louisiana’s Times-Picayune article on nola.com about its senior population being over-institutionalized. Louisiana ranked 37th of the 50 states and Washington, D.C. in its overall long-term care policies. In that state, aging seniors are (predominantly) either placed in nursing homes or cared for at home by unpaid family members. And it ranked dead-last in effective transitions—meaning that a high number of nursing home residents are hospitalized because they’re not receiving the care they need. Funny, the same report found that there are a high number of nursing home residents with low-care needs. No doubt it is because of the lack of alternatives such as adult day care and other home and community-based services.

Not surprisingly, vociferous Louisiana AARP advocates call for increased funding of alternate care choices in an attempt to acquiesce to the majority of older Louisiana residents who wish to age in place, at home. Ironically, despite the article pointing to so many calls-to-action, they conclude optimistically, pointing out that “Louisiana's ranking in 2014 improved slightly from the 43rd slot, when scorecard was last issued in 2011.”

On the flip-side, Minnesota’s Office of the Governor Mark Dayton was quick to issue a press release extolling their number one spot on the scorecard for long term care access, choice, quality, and caregiver support. The release also pointed out that Minnesota ranked in first place on the 2011 Scorecard as well.

In the release, Gov. Dayton cited the following efforts that assist Minnesotans in “providing our parents, grandparents, and people with disabilities the best possible care.”

  • New incentives for providers to increase quality
  • More help for people who want to move from nursing homes and other congregate settings to homes of their own
  • More comprehensive information and referral services for individuals and family caregivers
  • Support for core community services that help people stay in their homes
  • More flexibility for consumers in choosing supports tailored to their needs
  • Promotion of competitive employment for people with disabilities
  • A stronger adult protection system; and
  • Own Your Future, an initiative that encourages Minnesotans to plan for their long-term care and is now exploring new ways Minnesotans can finance this care.


We at Caregiverlist® not only care for the caregiver, we advocate for seniors and their families. I hope that the Long-Term Care Scorecard elicits more than one-upmanship between states. It’s a great opportunity to see where your own system may be lacking and examine and adapt those state policies and approaches to long term senior care that appear to be working best.

Long Term Care Scorecard: Best and Worst States

When I was a kid, Florida and Arizona were the retirement states of choice. My parents and their friends decided that, after decades of Midwestern winters, the promise of warmth and sunshine, coupled with the notion of never picking up a snow shovel again proved too enticing to pass up. At their first opportunity, many of the “snowbirds” declared permanent residency in those sunshine states. Did they make the wrong move?

This week, AARP in conjunction with the Commonwealth Fund and the SCAN Foundation, released the 2014 State Long-Term Services and Supports (LTSS) Scorecard. In it, they rate states based on long-term services and support for the elderly, people with physical disabilities, and family caregivers. State performance was measured across five categories:

  • affordability and access,
  • choice of setting and provider,
  • quality of life and quality of care,
  • support for family caregivers, and
  • effective transitions

The report shows that in terms of quality of long-term care, Florida ranks in the bottom quartile compared to other states, although it fares better than Kentucky, Alabama, Mississippi, and Tennessee in affordability and transitions from nursing home care back to the community. This interactive map shows each state’s ranking:

The top-ranking states for long-term care and services are Minnesota, Washington, Oregon, Colorado, and Alaska; perhaps it’s not quite time to put those snow shovels on eBay.

It’s a well-known fact that few of us prepare for long-term care, although about 70% of people age 65 and up will need some sort of assistance with the activities of daily living. While most people would prefer to age at home, Medicare doesn’t cover the cost of home care provided by a Home Care Agency. Few of those in their 40s, 50s and 60s carry long-term care insurance and Medicaid is available only for low-income seniors with few assets. And before we all decide to retire to Minnesota or Washington, it’s important to note that long-term care is unaffordable for most middle-income seniors in all states.

The authors of the study see the need for a guide at the federal level to establish minimum long-term care performance standards below which no state should fall. No one anywhere in the U.S. should fear that their state cannot provide the needed level of assistance. Susan Reinhard, one of the study’s authors and senior vice president of Public Policy at AARP told Forbes magazine that she is optimistic in the incremental improvements she’s seen since a similar study was published in 2011, but admits all states can do better.

Caregiverlist® champions the need for change in the long-term care arena and urges you to contact your state legislature or your state’s Department on Aging and let them know how important it is to improve services in providing high-quality, well-coordinated, affordable long-term care.

November is National Caregiver Month

Senior caregivers, whether they be Certified Nursing Aides, Home Health Aides, professional and family caregivers, or the community at large, are vital to the care and keep of our aging American population.

November is National Caregiver Month, and is the perfect opportunity to thank those who have made it a priority to provide home and health related services to the elderly, including physical and emotional support and assistance with activities of daily living.

Family (or informal) caregivers provided services valued at $450 billion per year in 2012, according the the AARP Public Institute. In the United States, 65.7 million caregivers make up 29% of the adult population providing care to someone who is ill, disabled or aged, and 50% have full-time employment outside the home.

Family caregivers cannot always fulfill all the needs of their senior loved ones. Future numbers are staggering — the aging population 65+ will more than double between the years 2000 and 2030, increasing to 71.5 million from 35.1 million (in 2000). That explains the incredible surge of senior care industry and the need for qualified professional caregivers.

The number of Senior Home Care Agencies has grown by 40% since 2008, according to a recent Caregiverlist employment index infographic. Caregiver jobs are filled at a rate of three to six hires per week, making professional senior care one of the hottest employment sectors in the United States.

The Administration on Aging (AoA), an agency of the United States Department of Health and Human Services, works to ensure that older Americans can stay independent in their communities. Here are some of their suggested action ideas to show your appreciation for the caregiver in your life, in November and throughout the year:

Action Ideas to Celebrate Caregivers in November

  • Recognize caregivers in your community, in your organization and in your family. Host a get-together to honor caregivers in your family and/or community.
  • Locate a community care center or community space and organize a Caregivers Count awareness event.
  • Attend local town hall meetings and ask your representative what s/he is going to do to promote legislation that will help businesses develop more family-friendly caregiver policies.
  • Send an e-card to a caregiver. AoA offers free e-cards for caregivers.

  • Post on Facebook that November is National Caregivers Month and encourage your network to acknowledge caregivers in their families and communities.
  • Tweet about the importance of caregivers and resources available to caregivers.

We depend on professional and family caregivers. Give a shout-out to the caregivers in your life in the comments below.

Caregiver Support a Future Concern

I’m part of the Baby Boomer generation that provides family caregiving to an aging parent. As such, I and my siblings provide much of my mother’s long term services and support (LTSS) which allows her, at 80, to comfortably age in place, at home. I have three siblings to share in that care. In my old age, family care will be split between two children. As Americans age and their families shrink, there is concern for the future supply of relatively inexpensive family support for elderly individuals.

A recent report released by the AARP Public Policy Institute indicates a rapid decline of family caregivers within the next 20 years. The drop in the caregiver support ratio, or the number of family caregivers (adult children) available to care for their elderly parents, prompts a call for policy action to find new solutions to finance LTSS.

 According to the report, "The departure of the boomers from the peak caregiving years will mean that the population aged 45 to 64 is projected to increase by only 1 percent between 2010 and 2030, During the same period, the 80-plus population is projected to increase by a whopping 79 percent."

The shortage trend continues until 2050, when the population of parents to children is expected to balance again.

The call to action has been to federal and state Departments of Aging to provide more caregiver training and more affordable and quality nursing homes in order to fill the gap left by the decreasing number of family caregivers.

Right now, AARP projects these states to have the best and worst caregiver ratios in 2030:

Best:
District of Columbia: 6.4
Utah: 5.8
Alaska: 5.3
Illinois: 4.9
Georgia, New York and Texas: 4.8

Worst:
Arizona: 2.6
Florida and Hawaii: 2.9
New Mexico: 3.2
Iowa: 3.3
Maine, Nevada, Vermont and West Virginia: 3.4

How about you? Do you provide family caregiving to a senior loved one? With how many people do you share in that care? How many people will you have to care for you in your old age?

Nursing Home Costs Nationwide: Review Daily Costs of Nursing Homes

Senior care costs are an item that many of us do not plan ahead for - we just hope that it will never be a need.  However, the reality is that all of us should plan for needing senior care services for at least 2 years of our lives.  

Medicare, the health insurance program for all American seniors, does not pay for long-term care.  In the event a senior should "spend-down" all of their assets, they may qualify for Medicaid, a version of Medicare insurance for very low-income seniors with few assets.  Each state administers Medicaid benefits in conjunction with federal funding, which means the financial spend-down requirement varies in each state and you may view these financial requirements on Caregiverlist.

Medicaid financial qualification requirements in most states must be no more than $2,000 in assets for a single senior and $3,000 in assets for a couple.  There is an anti-spousal poverty provision that will allow one spouse to maintain more assets while the other spends down to qualify for Medicaid benefits.  This can especially be needed if one senior has memory loss or another age-related illness which requires years of caregiving services.

Nursing homes are often an extension of a hospital stay as Medicare will pay for rehabilitation services in a nursing home after a hospital stay.  However, Medicare does not pay for 100% of all the costs of a nursing home and only pays for the first 20 days of the daily fee (remember, some activities and hair care and other services cost extra) and then from days 21 to 148 the senior must pay $148 per day.  This means, in some instances, switching to one-on-one care in the home can be more cost effective.

Seniors should investigate nursing homes in their area before they need nursing home care, especially since there is a chance if a sudden medical condition such as a stroke or hip replacement, requires rehabilitation, the hospital may do a quick discharge to a nursing home in the area.  You may also receive information from licensed senior home care agencies.

Nursing home costs range from $100 to $400 or more per day.  You may review the daily costs of nursing homes nationwide in Caregiverlist's Nursing Home Directory to plan ahead for your senior care needs.

 

 

Caregiving Jobs and Options for Spanish Speakers

Professional senior caregivers assist seniors with activities of daily living, including companion caregiving for seniors with memory loss and nursing care for seniors who need assistance with bathing and eating.  Many seniors living in the U.S.A. speak Spanish as a first language or second language and this week AARP Viva! Radio invited Caregiverlist's "Caregiver Sherpa" Juan Padilla to host a radio show about senior care options and senior caregiving jobs.

Spanish-speaking senior caregivers may listen to Juan's tips and suggestions on the recorded AARP Viva! Radio program.  

Caregiving jobs are available nationwide and include part-time and full-time positions.  Seniors may research nursing homes in their area and review the daily costs along with ratings or find a licensed senior home care agency as they plan for their senior care.

 

 

AARP VIVA Radio Features Caregiverlist.com Today: 2pm Central Time

Senior care impacts everyone, including Americans who speak Spanish as their first language (or preferred language).   A recent estimates shows more than 50 million Americans enjoy a hispanic heritage and there are 3.7 million residents of Puerto Rico.  This makes people of a Hispanic origin the nation's largest ethnic or race minority.

AARP VIVA, a publication and radio show by the American Association of Retired Persons will highlight Caregiverlist.com's information and services today on their 2:00 p.m. show on VIVA Radio.

Medicare and Medicaid questions and professional senior caregiving options are concerns for all Americans and AARP VIVA Radio will explain Caregiverlist's useful tools for seniors and professional caregivers today.

We hope all those speaking Espanol will be able to listen!  Just turn your dial to or go to AARP VIVA Radio online.

 

Diana Nyad Attempts Cuba to Florida Swim at Age 63

Senior swimmer Diana Nyad isn’t planning on letting anything stop her this time—not jellyfish stings, storms or hypothermia. In her fourth attempt to make the 103 mile swim across the Florida Straights without a shark cage, Diana Nyad is out to prove that it’s never too late to chase your dream.

The endurance swimmer turns 63 on Wednesday. She’s expected to arrive in Florida some time Tuesday, despite being slowed down and pulled off course by storms. Her last attempt at the effort was thwarted by toxic jellyfish stings. She was 28 years old when she first attempted the swim. Diana Nyad is nothing if not persistent in her desire to make the history.

A CNN Health article sums up Ms. Nyad’s indomitable spirit:
In her 60s, she says, she still feels "vital (and) powerful" -- and definitely "not old." A successful swim ideally will inspire people her age and older not to let their age hinder them, Nyad said.

"When I walk up on that shore in Florida, I want millions of those AARP sisters and brothers to look at me and say, 'I'm going to go write that novel I thought it was too late to do. I'm going to go work in Africa on that farm that those people need help at. I'm going to adopt a child. It's not too late, I can still live my dreams,'" she said.

Read about the swim at Diana Nyad’s blog.

Ed. note: At 742am EDT Diana was pulled from the water when a doctor determined that another jellyfish sting could prove life-threatening. She swam 67 nautical miles for over 40 hours before she was forced out of the water. We at Caregiverlist.com salute Ms. Nyad and her spirit. She continues to inspire us all.

 

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Quality Senior Care: AARP Quality Checklist Includes Caregiverlist

AARP Magazine’s June/July issue includes an informative news story about the process of deciding when it is time for a senior to leave their home. The American Association of Retired People (AARP) magazine article includes “The Next Move: A Starter Kit”, highlighting Caregiverlist.com as a resource to use when checking for quality of senior care.  Senior care involves considering both the emotional and financial needs of the senior. Both sides of this coin are equally as important for seniors and their family members. AARP reports that people fare better when they live near what’s dear to them – friends, family and congregation.
Caregiverlist’s online tools, created by senior care industry professionals, make it possible to understand and evaluate the quality factors to consider when choosing senior caregiving services, nursing homes and assisted living communities.

Caregiverlist’s Nursing Home Directory enhances the data available from Medicare by applying the right labels on each nursing home and providing the daily costs of 18,000+ nursing homes nationwide.

Some nursing homes, for instance, only serve certain types of seniors or those with disabilities and some are divisions of a hospital and only accept hospital patients being transferred. Caregiverlist provides labels for nursing homes to make it easy to know if it can be a fit for a senior:

  • Hospitals
  • CCRC (Continuing Care Retirement Community)
  • Veteran's Home (Only Accepts Veterans)
  • Special (Only for Nuns, Seniors w/Hearing Loss, etc.)
  • Medicare:  Accepts as Payment
  • Medicaid:  Accepts as Payment

“Medicare will pay for short-term nursing home stays only,” says Caregiverlist.com CEO Julie Northcutt. As the former owner of a senior home care agency, she found that many seniors and their families do not realize this fact until a medical emergency happens.

“I have spent hours on the phone explaining to a senior’s family members what Medicare does and does not cover,” says Northcutt. As nursing homes have become an extension of a hospital stay, seniors many times are quickly discharged from a hospital to a nursing home. This is when panic sets in and a senior and their family wants to learn the specifics about which nursing home they will be transferred to when leaving the hospital.

“It is important to review the nursing home ratings and costs near you, before you will need one”, says Northcutt. “Remember that nursing homes are a rehabilitation center for seniors after a hip replacement, stroke or major surgery. Medicare will pay for the short-term as long as a medical doctor preapproves the need.”

Caregiverlist also allows users to compare nursing home costs and ratings from one state to another which is useful when it becomes necessary for a senior to relocate to be near a family member.

When evaluating senior care choices, the following options should be considered:

  • Senior Home Care Agency (provides one-on-one caregiver)
  • Nursing Home care (short-term care for rehab and long-term care for chronic needs)
  • Assisted Living
  • Hospice Care (at home or in hospice facility)

Medicare does provide Hospice care services when a senior has been diagnosed to have a terminal condition with less than 2 years to live. Seniors should also understand Medicare and Medicaid benefits.

  •  Medicare pays for only short-term nursing home stays and for short-term skilled home health visits when one of the following skilled certifications or licenses are required: Registered Nurse, Physical Therapist, Speech Therapist, Occupational Therapist, Certified Nursing Aide. A senior must demonstrate they are rehabilitating from a major medical condition to qualify for skilled home health care.
  •   Medicaid is for very low-income seniors and will pay for an ongoing stay in a Medicaid-approved nursing home. Caregiverlist provides the “by-state” Medicaid financial qualifications.

The recent recession has resulted in lower tax revenues for state governments and some states have recently changed their financial qualifications for qualifying for Medicaid. However, the spousal anti-poverty law does allow married couples to allow one spouse to “spend-down” assets to qualify for Medicaid care while the other spouse maintains some savings and home and car ownership. This can be necessary, for example, if one spouse has Alzheimer’s disease and requires around-the-clock care which can cost $80,000 per year.

“Remember, former President Ronald Reagan had full time caregiving services for a decade,” says Northcutt.  This is why it is important to research senior care services ahead of time and evaluate quality standards to allow family members to be prepared. Caregiverlist’s nursing home directory shows the highest and lowest daily cost of a nursing home in each state along with the average nursing home daily rate.

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Elderly Driving Tests: AARP Defensive Driving Safety Courses for Seniors

Senior driving always comes under the spotlight after a major accident happens involving a senior.  However, just as some younger drivers are better than others, many older drivers are also perfectly capable of driving safely.

Aging does present some challenges, as eyesight may diminish if Macular Degeneration has developed or there is hearing loss or slower responses due to difficulty with movement caused by a stroke or arthritis.  As some of the age-related diseases, including memory loss, develop slowly and progress at different rates, it does make sense to check driving skills at least annually, once we are of an age considered "senior".  In the U.S.A., people qualify for Social Secuirty retirement payments at age 62 so that seems like a reasonable age to also start checking driving skills every year.

AARP (American Association of Retired People), now makes it a little easier to test driving skills, by offering a positive approach to this through a course called "Driver Safety Course".  And seniors who are veterans may take this course for free, as AARP's tribute to military personnel.

You may review the senior driving laws in each state - some state's do require in-person tests at a certain age.  Other states, such as California, were unable to pass such laws as some people considered this age-discrimination.  Instead, in California you can report anyone, at any age, as a dangerous driver and request a local law authority to contact them for an in-person driving review.  This law was passed after the elderly man accidentally stepped on the gas pedal, instead of the brakes, and plowed down several people walking through the Santa Monica Farmer's Market. Some people were killed and others were seriously injured.  The saddes part is the elderly man really did not mean to cause the accident and had to live with what happened.

Even though it can be difficult to confront a senior who may have issues with driving, by bringing up the concern for safety, you can begin the conversation.  Then rely on the laws in your area to take action if the senior no longer can safely drive.

You may locate an AARP Driver Safety Course in your area and mention "November's special Veteran's Promotion" to receive the course for free if you are a veteran.

You may also find some humor in all of this by viewing the television show South Park's episode called "Grey Dawn" when the senior citizens got behind the wheel and took over the town.

 

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