Bipartisan Task Force Seeks to Help Seniors Age in Place

Can senior housing issues stretch across the aisle? The Bipartisan Policy Center (BPC) is banking on it by launching its new Health and Housing Task Force. Leading the effort are democrat Henry Cisneros, HUD secretary during former President Bill Clinton’s administration and republican Mel Martinez , HUD secretary during former President George W. Bush’s administration. Joining them in the effort are former Representatives Allyson Schwartz and Vin Weber.

The task force will look at how senior-friendly, affordable housing might reduce healthcare system costs and, at the same time, allow more seniors to age in place at home. Surveys show that most older Americans would prefer to age in their own communities rather than in institutional settings, such as nursing homes. However, the way things stand now, many homes are not equipped for safe, independent living and communities are ill-prepared to provide much-needed services like transportation for seniors who no longer drive.

At the end of the day, it’s all about potential Medicaid and Medicare savings. The current system won’t be able to sustain the growing elderly population. In-home senior care has proven much more cost-effective than institutional care, so it’s in everyone’s best interest to expand home and community based senior care.

“In 2011, only about half of Medicaid-covered long-term services and supports were provided at home or in the community, even though for most seniors, home and community-based care is preferred and often significantly less expensive,” said task force member Allyson Schwartz, a former congresswoman from Pennsylvania.

The Health and Housing Task force’s one-year effort will:

  • Seek cost-effective ways to modify homes and communities to make independent living for seniors available and safe. Finding potential funding sources will be crucial.
  • Bring attention to best practices on state and local levels for integrating housing, healthcare, and long-term services and supports. The task force will find programs that work and investigate how they can be replicated elsewhere.
  • Determine barriers to offering home- and community-based services and supports through Medicare and Medicaid.
  • Explore opportunities for further collaboration between the Departments of Housing and Urban Development and Health and Human Services.

America is an aging nation. According to the U.S. Census Bureau, projections show the population age 65 and older is expected to more than double between 2012 and 2060, from 43.1 million to 92.0 million. The increase in the number of the “oldest old” will be even more considerable— those 85 and older are projected to more than triple from 5.9 million to 18.2 million, reaching 4.3 percent of the total population. The “oldest old” are those seniors who tend to need senior care most.

Caregiverlist believes that a key element to helping seniors age in place is the well-trained, well-paid in-home caregiver. Let’s hope this bipartisan task force takes into account the issue of fair senior caregiver wages in order to help stem caregiver turnover in an effort to provide the best senior home care.

Medicare Open Enrollment Ends December 7th: What You Should Know

Medicare, the health insurance program for America's seniors, makes sure everyone in the U.S.A. receives health care as they age.  Medicare does NOT pay for ongoing long-term care in a nursing home.  However, Medicare offers all seniors the peace of mind of health insurance coverage and provides a few options which can be changed each year.

As Medicare's open enrollment ends in just a few days, here are items you should consider.  You must be age 65 or above to enroll in Medicare health insurance.

First, Medicaid replaces Medicare for very low-income seniors. You may review the Medicaid financial requirements in your state on Caregiverlist's By-State directory.

October 15th through December 7th Medicare Open Enrollment allows all seniors with Medicare to change their Medicare health plan and prescription drug coverage for 2014.

Medicare has a separate plan for health insurance vs. drug coverage.

Medicare's website allows you to research the type of plan that will be the best fit for you plus they have added a feature that allows you to plug in the type of test or item you may need, such as diabetes test strips, to see if they are covered by your Medicare plan.

Visit: www.Medicare.gov

Or, you may actually call Medicare to receive help:  Call 1-800-MEDICARE

Plan ahead for any long-term care needs by researching ahead of time the nursing homes in your area and choosing the ones with the highest ratings and most appropriate costs for your budget.  Remember, Medicare may pay for a portion of nursing home care for up to 100 days and beyond this time period, you will need to privately pay for your senior care at a nursing home, assisted living community or with professional in-home senior care services.  Request a plan of care for your area to be prepared and visit your state's nursing home costs and ratings guide.

 

 

 

 

Medicare Part D Prescription Drug Plan: Take Action by March 7th, 5pm ET

Seniors in America receive Medicare health insurance upon turning age 65 and transfer to Medicaid instead of Medicare if they qualify as a very low-income senior.  Medicare does not pay for long-term care in a nursing home nor at home but it does provide for some prescription drug benefits.  Prescription medications are the 2nd highest financial obligation of senior care, after caregiving services.  Caregiverlist provides the daily costs of nursing homes nationwide to help Americans plan for senior care needs.  You may also view Caregiverlist's By-state Medicaid financial qualifications.

The Centers for Medicare and Medicaid Services (CMS) has proposed a rule to change the Part D prescription drug coverage available to seniors under the Medicare program.  The rule would remove the "protected class" status of anti-depresseants and immunosuppressant drug classes and potentially remove protection for antipsychotic drugs after year 2015.

Seniors with lupus, multiple sclerosis, Crohn's disease, rheumatoid arthritis, HIV/AIDS, psoriasis and other immune disorders may lose access to prescriptions that are needed to treat their conditions.  Likewise, patients and caregivers over the age of 65 facing major depressive disorder and other mental health conditions will have less access to the drugs they need and less flexibility to change drugs if their medication is not working.  

The National Alliance for Caregiving has joined other organizations in asking CMS to reject the proposed rule.  In partnership with the Healthcare Leadership Council, the National Alliance for Caregiving has created a letter to present lawmakers showing support of the current drug benefits for seniors and requesting no changes in this area for the Medicare drug benefit.  Review the letter, indicating no changes should be made based on a 90% approval rating of the Medicare Part D program and other positive benefits.

You may also post your note requesting Part D coverage remains the same by writing directly to Medicare here.

Scooter Store Files Bankruptcy But Will Stay In Business

The Scooter Store will stay in business, it turns out, after pushing hard for seniors to qualify for power wheelchairs and admitting to fraudulent claims.  The Scooter Store continued to operate and continued to push the envelope for "approval" of the medical need for a power wheelchair for seniors, resulting in a raid by federal agents in February of this year.  

Now The Scooter Store blames their former management team for improper business practices (such as requiring their representatives to keep calling new doctors if the first medical doctor turned down an approval for the need for a power wheelchair for a senior).  They went as far as to color-code medical doctors based on how easy or difficult it would be to convince the doctor to approve a senior for a power wheelchair. 

Medicare changed their reimbursements for power wheelchairs to be more in line with what is fair and reasonable and charged in the private sector.  This results in a monthly rental of the power wheelchairs instead of an upfront payment.  Formerly, Medicare payments were in the thousands and The Scooter Store made as much as $5000 or more in profits for each power wheelchair they sold a senior.  In addition, Medicare even created a new category for power wheelchairs to make sure scooters were not substituted, all because of The Scooter Store's fraudulent business practices.

It is interesting The Scooter Store never stepped to the plate to assist the government in ways to innovate and save more money.  Instead they wanted to make a quick buck and profit as much as they could from a program that was meant to truly help those who had lost mobility.

Last year, an independent auditor found The Scooter Store received from Medicare between $46.8 million and $87.7 million in overpayments from May 2009 to May 2011.  The Office of the Inspector General of the U.S. Health & Human Services Department found The Scooter Store's failure to refund the overpayments breached a 2007 agreement entered into to settle charges that it made false Medicare claims and defrauded the government.

Court documents show The Scooter Store wants to sell substantially all of its assets by the end of July but continue to operate on a diminished basis.

Find a local medical supplier if you truly need a power wheelchair.  Remember, many physical exercises can assist with mobility issues and if a serious medical condition prevents mobility, then certainly a senior's medical doctor will recommend and write an approval for a power wheelchair.  It is important to have a local trusted company fit you for the power wheelchair.  I once had a senior client who required more than 4 visits by the medical equipment company to assist with her power wheelchair adjustments.  The company even removed a door for her and assisted with rug placement and rearranging furniture.  Since Medicare is paying for this service, use a company that can visit your home and assist with all the adjustments.

Here is one of The Scooter Store's mailings which shows they were really trying to get any senior they could to tap into qualifications for a power wheelchair which they were promoting as a "scooter".

 If you are able to buzz around in a scooter, you are not going to have a serious enough medical condition to qualify for a power wheelchair.  Medicare made this distinction very clear to prohibit this type of fraud the first time they sued The Scooter Store.  Yet The Scooter Store continued to try to push sales as you can see in this mailing.  All seniors and caregivers can alert The Inspector General's office when they see something that may appear as Medicare fraud by trying to profit from Medicare or know that there are improper needs assessments. 

 

Power Wheelchairs for Seniors: Scooter Store's Pursuit of Medicare Benefit Opens Door to Fraud ($19 Million+)

Taxes should be less, not more, right? It seems like most people, as we approach April 15th, especially, agree with this.  It would also make sense that we would always want to save the government money on any programs, to help make our tax dollars go further.  But as we know, there are those who are looking to profit handsomely from any government program that will allow them to do so. The new healthcare law has been effective in cracking down on Medicare fraud and now it seems The Scooter Store could be the next company to go away, after selling seniors wheelchairs they could not use, did not want or need. So much for trying to save the government money, right? And they took advantage to the tune of $100 million in overcharges. Medicare reimbursements for power wheelchairs increased by more than 350% after The Scooter Store came along.  Scooter Store employees are now sharing stories of how the company color-coded doctors to indicate which doctors would approve of a "power wheelchair" for medical need, paid for by Medicare or Medicaid.

Medicare reimburses seniors for the purchase of a "power wheelchair" when a medical doctor has approved the need for the power wheelchair.  The reimbursement to medical supply companies was generous - so much so that some medical supply companies would call the home care agency I owned for 7 years and offer us $200 for each power wheelchair referral.  They received upwards of $2,000 for the sale of each power wheelchair from Medicare.

However, in 2011, Medicare finally changed the power wheelchair reimbursement to match the payment format for regular non-power wheelchairs which was a monthly rental fee.

A funny thing then happened at The Scooter Store when they were faced with "normal" profit margins.  Cash flow became tight, layoffs began and the push to gain medical doctor "approval" by going from doctor to doctor to doctor began. Former employees say they were urged to go to another more "friendly" doctor and to reach out to as many as 3 doctors if the first medical doctor declined approval for the wheelchairs.

This is why The Scooter Store would purchase television advertisements and announce to seniors that they could keep their wheelchair if it turns out they did not meet Medicare approval.  The Scooter Store scooted off to find wheelchair manufacturers who would go to China to produce wheelchairs for a very low cost and then of course they also helped facilitate the medical doctor "approval" of the wheelchairs.  A whistle-blower at the company took advantage of the government's whistle-blower protection program and shared that The Scooter Store sort of had their own medical doctor network who would approve of the need for the wheelchair. 

Here is the good and bad news.  If you truly do need a power wheelchair, for sure both you and your doctor know this.  It is simple.  You have difficulty with mobility and walking.  If a company needs to buy advertisements on television to convince you that you need a "scooter", which by the way, they can get for you for free from Medicare, well, there is probably "all kinds of wrong" with this, as my Grandmother would say.  A private company is trying to take advantage of a government program and profit at a much higher percentage than they would if truly operating as a private company with out a juicy government payment.  The fact that The Scooter Store could not operate a profitable company once Medicare reimbursements changed in 2011 speaks for itself.  Many, many other power wheelchair companies operate fairly and are profitable and were not impacted by the change in reimbursement from a lump sum to a monthly payment as it also is profitable reimbursement level.

The reality of needing a power wheelchair also comes with the fact that you will need assistance in customizing the wheelchair to fit your height, weight and arm and hand movement capabilities.  What if you also have arthritis?  This means that the medical equipment company fitting you for the wheelchair truly has some work to do to make sure the wheelchair is customized to fit both you and your home.  Then they also need to train you on how to properly use the wheelchair safely.  This is worth having Medicare pay them a fair price for their labor and is why the reimbursements may sound a bit generous to those who don't understand all the customization that is necessary.

A quality medical equipment company will also come to the home as much as is necessary in order to make sure the senior's wheelchair fits them properly and that all the necessary adjustments have been made.

Ordering a wheelchair that is really a "scooter" from a television ad takes away the customization.  In addition, promoting taking advantage of the power wheelchair benefit for use as a "scooter" just because you might want to get around a bit quicker is taking advantage of a program that was set-up to benefit those who truly cannot walk easily.  Used golf-carts might be a better solution for the senior who just wants a scooter to tool around the neighborhood in.

Medicare changed the definition of power wheelchairs precisely because of The Scooter Store.  Even if The Scooter Store's wheelchairs were high quality, it still cost taxpayers a huge amount of money by pocketing the profits from a program that was meant for seniors who truly needed a power wheelchair.

The Scooter Store settled with the government after the whistle-blower case for around $4 million and you may review this case with the Department of Justice here.

And now it seems The Scooter Store has been excluded from a list of 800 companies awarded contracts to supply medical equipment to Medicaid and Medicare beneficiaries beginning July 1, 2013.  In February, 2013, law enforcement officers raided The Scooter Store's Texas headquarters as part of an investigation in alleged fraud.  The Scooter Store founder, Doug Harrison, did step down from his role as CEO in 2011 and while many of us are trying to save the government money, he has in the past been a bit bummed out that the government was being more efficient about reimbursements, as you can see in this news release, when he complained that the government would no longer reimburse for wheelchairs at 6x's their wholesale price.............most retailers, by the way, are happy with 100% mark-ups.

Timothy Menke with the Office of the Inspector General says the investigation involves his agency, plus the Department of Justice, the FBI and the Texas attorney general's Medicaid fraud unit, according to The Associated Press.  

In 2012, an independent auditor determined that the company over-billed Medicare between $46.8 million and $87.7 million, the Express-News reported. The company agreed to repay $19.5 million after the Office of the Inspector General threatened to exclude it from federal health care programs.

We wonder if the U.S. Government will take one more step and hold accountable Mr. Harrison, the founder of The Scooter Store, as well.  Just as the Enron executives were held accountable for their actions.

The U.S. government had to create specific definitions about how a power wheelchair is not a scooter because of The Scooter Store trying to capitalize on the power wheelchair reimbursement from Medicare:

"By representing to physicians that their patients wanted and needed power wheelchairs, The SCOOTER Store obtained thousands of “Certificates of Medical Necessity” from physicians who did not know about the company’s fraudulent practices. The SCOOTER Store then billed government and private health care insurers for power wheelchairs, which were far more costly than power scooters, and collected millions of Medicare and Medicaid dollars.

The SCOOTER Store received $5,000 to $7,000 in reimbursement for each power wheelchair it sold, more than twice the amount for a scooter, which sold for around $1,500 to $2,000. Many beneficiaries had no idea what kind of equipment they were getting, until it was delivered by The SCOOTER Store.

The government’s lawsuit also alleged that The SCOOTER Store knowingly sold used power mobility equipment to beneficiaries and billed Medicare as if the equipment were new, in violation of Medicare regulations. In addition, the U.S. alleged that The SCOOTER Store charged Medicare millions for unnecessary power mobility accessories."

 Note:  The Scooter Store spent $1 million + lobbying Congress to maintain the previous Medicare reimbursements for wheelchairs.

 

Senior Care Planning: Living to be 105-Years-Old

Senior care costs vary widely, based on the care needs required for the senior and the living situation.  Does the senior live in a home that has been paid for fully and receive social security benefits?  If so, they can better pay privately for caregiving services.  If the senior does not own a home and requires full 24-hour caregiving services, they may qualify for Medicaid benefits, for very low-income seniors, and receive care in a Medicaid nursing home.  This is the safety net for all Americans currently.  However, as nursing home daily costs can vary from $100 to $400 per day, even the Medicaid senior care services are predicted to evolve as the number of seniors will quadruple in the coming decade.

Plan ahead for your own senior care needs to smooth the path for your family.  Remember, life expectancy of a child born in the U.S.A. today is 100 years.  Remember also that how you live your life today - eating right, exercising and finding a fulfilling life purpose, all impact the quality of your health as you age.  Nursing homes are often an extension of a hospital stay for seniors who may need rehabilitation and Caregiverlist's nursing home directory provides the daily cost of nursing homes nationwide.

Happy Birthday to this 105-year old senior who shared her photo with us celebrating her birthday at 105 with her great-granddaughter celebrating her 5-year-old brithday:  Birthday twins at 5 and 105!

Caregivers - let us know how old your senior clients are and if you can top age 105 - photos are welcome.  Enjoying sharing special life moments are another of advantage of working as a senior caregiver.

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.

 

 

Seniors Saving Billions a Year on Prescription Drugs Thanks to Affordable Care Act

Doughnut holes are for pastry shops, right?  Wrong.  Not when it comes to our friendly Congress passing legislation that makes no sense.  A doughnut hole was actually included in the previous prescription drug benefit for seniors and recently corrected in the new healthcare law - it was a hole in payouts for benefits.  And when this type of legislation happens, it does spark the thought that lobbying can be very successful.  The prescription drug companies have spent millions lobbying Congress and as Open Secrets publishes, the drug company's lobbying dollars match when the legislation gets passed.

So this silly doughnut hole was labeled as such because as a senior you would have a benefit to pay for your prescription drug until you took a big enough bite and hit the "hole" and then there was no benefit paid until you got to the other side of the hole and then it would pay again.  Meanwhile, for whatever your health condition is, you need this medication so seniors were very stressed about how they would pay for it while in the "doughnut hole".

I was invited to serve on a research panel, which the government paid for just to make sure that seniors really were confused by their prescription drug plan and that everyone thought the doughnut hole was silly.  As I told them, what private paid healthcare plan would ever sell any such thing?  They wouldn't, because nobody would buy it.  


However, the good news is this:  
the new healthcare law - nicknamed "Obama Care", has saved seniors $6 billion dollars in prescription drug benefits because it eliminated this doughnut hole.  Here is the Health and Human Services news release on the announcement.

 

Health and Human Services Secretary Kathleen Sebelius announced this week that more than 6.3 million people with Medicare saved over $6.1 billion on prescription drugs because of the new health care law.

“By making prescription drugs more affordable, the Affordable Care Act is improving and promoting the best care for people with Medicare,” Secretary Sebelius said.

The Affordable Care Act makes Medicare prescription drug coverage (Part D) more affordable by gradually closing the gap in coverage where beneficiaries must pay the full cost of their prescriptions out of pocket. This gap is known as the donut hole.

People with Medicare in the doughnut hole now receive discounts when they purchase prescription drugs at a pharmacy or order them through the mail, until they reach the catastrophic coverage phase.  The Affordable Care Act gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011.  The law will provide additional savings each year until the coverage gap is closed in 2020.

In 2013, the health care law increases the discounts and savings to 52.5 percent of the cost of most brand name drugs and 21 percent of the cost of covered generic drugs.

Also under the Affordable Care Act, those who choose to enroll in Medicare Advantage and Part D now have access to a wider range of high-quality plan choices, with more four- and five-star plans than were previously available.  The Affordable Care Act continues to make Medicare more secure, with new tools and enhanced authority to crack down on criminals who cheat the program.

Learn more about how the Affordable Care Act closes the doughnut hole.

Review state-by-state information on savings in the doughnut hole.

Learn about senior care costs for long-term care and find nursing homes in your area as you plan for all your senior care needs.

Medicare Eligibility Age Removed from "Fiscal Cliff" Debate

Medicare health insurance is a national health insurance provided to seniors beginning at age 65.  Medicare pays for the basic health insurance needs of a senior and provides a sense of security as all seniors qualify for it (no rejections because of pre-existing conditions).  Seniors who have a very low income and nearly no assets can also transfer over to Medicaid, a program operated in conjunction with the federal and state governments.  Medicaid differs from Medicare in that it does pay for ongoing long-term care in a nursing home

Medicare was created when the life expectancy of an American was around age 72.  Today, a baby born in the U.S.A. can expect to live to be 100 years old.  The oldest senior, in fact, just passed away this month at age 116.  People are living longer and this means Medicare must pay for the health insurance for many more years than perhaps what was planned when the program was first developed.

As Congress debates the "fiscal cliff", one of the solutions was to delay the age until 67 for a senior to begin Medicare health insurance.

Today the Senate announced the White House was not in favor of moving the age requirement back for Medicare although the Republicans were holding on to this as a way to curb costs if they were going to finally give in to raising taxes on the very wealthy.

AARP, the association for American seniors, maintains a lobbying foot in Congress and keeps up on the latest developments as the debate continues.

 

 

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Senior Care Costs: Medicare vs. Medicaid and Health Insurance for Caregivers

Senior care costs vary widely, based on which type of senior care health insurance a senior has received - Medicare or Medicaid.  As the presidential election gears into high speed, much talk and confusion is now filling the airwaves around Medicare and Medicaid insurance programs.

American seniors receive Medicare health insurance beginning at age 65, unless they qualify for Medicaid instead, as a very low-income senior.  You may review Medicaid financial qualifications in your state, as Medicaid is administered by each state in combination with federal money.  This is why Paul Ryan, the Republican Vice-Presidential candidate received health care and Social Security payments while he was a minor after the death of his father when he was age 16.  Paul Ryan also requested a grant for a community health center in Racine, Wisconsin, via the new healthcare law. 

This highlights the fact that candidates from both parties know that healthcare is a need for both those who are low-income as well as for seniors.  Moving past the political posturing, the facts are often somewhere in the middle.

Senior caregivers often do not have healthcare as a benefit - if they work part-time or as a direct-hire for a senior.  One benefit of the new healthcare law is the ability for everyone, including small business owners, to have access to affordable healthcare and the benefit of knowing that you will not be dropped from an insurance policy.

As unemployment remains high in the U.S.A., knowing you can both find and purchase individual health insurance and not be dropped from a plan just because you are not part of a group health insurance plan is a comfort to many Americans.  This also will be a comfort for senior caregivers who currently do not have health insurance.  A Caregiverlist survey found that more than 50% of all senior caregivers do not have health insurance.

Medicare's largest cost that can be easily trimmed is Medicare fraud which amounts to billions of dollars each year.  AARP supplies this report on questions to consider for candidates around Medicare.  Meanwhile, remember that senior caregivers often do not have access to health insurance right now.  One of the benefits of the new Affordable Care Act, called the O'bama Care law, is that everyone will have access to health insurance. 

Remember, too, that Medicare does NOT pay for long-term care while Medicaid DOES pay for long-term care in a nursing home.  Review nursing home costs nationwide to plan for your senior care needs.

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