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 Pays Doctors for Integrated Senior Care

Eleanor is 85 years old and spends many of her days in various doctors’ offices. Her osteopath checks her progress after a recent hip replacement. Her rheumatologist helps manage her arthritis pain. She sees her cardiologist after a mild heart episode and her primary care physician treats her hypertension. No one has yet addressed her depression. With each visit, Eleanor receives prescriptions, instructions, and tests — so many that she feels overwhelmed and underinformed. 

Many seniors seeking medical care have multiple chronic conditions. In fact, it’s estimated that three in four older Americans live with MCC. That figure is only going to increase as baby boomers age. This challenges has been recognized by the U.S. Department of Health and Human Services. They are initiating federal programs to prevent and manage MCC.

As one of those programs, Medicare is now paying primary care doctors to coordinate care for their elderly patients. Typically, when seniors see so many different doctors, their care is quite fragmented. MRIs and x-rays can be duplicated (and costly) and results aren’t shared between the various specialists. Dangerous drug interactions can adversely affect patient, leading to more doctor visits and deteriorating health.

Primary care physicians are ideally situated to oversee their patients overall health. Services include non-face-to-face planning and management for patients with two or more chronic conditions. To collect the new fee, doctors would have to create a care plan for their MCC patients and spend time each month working with their various specialty physicians.

"We're hoping to spur change, getting physicians to be much more willing to spend time working on the needs of these patients without necessitating the patient to come into the office," Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services told The Associated Press.

Critics of the plan say the proposed $40 per qualified patient per month is not enough to entice doctors to take on the extra work involved. They suggest it opens the door for even more Medicare fraud. But many doctors, especially those in smaller communities, have for years coordinated care for their senior patients with no compensation. "Quite honestly, I just didn't get paid for it," said Dr. Robert Wergin, president of the American Academy of Family Physicians told the AP. Dr. Wergin spends about 2 hours a day calling on his older patients who can’t make it into his office.

Many times, caregivers also play the part of care coordinator, especially if they accompany their senior to many of their doctor visits. However, it is no doubt helpful if a professional oversees medication prescriptions, possible test duplications, and the coordination of specialists. It’s the hope of Medicare to not only increase the quality of life for patients by strengthening primary care but also, let’s face it, save money on hospital stays, emergency room visits, and post-acute care.

Do you as a caregiver coordinate any of the care for your senior? If so, how involved are you? Do doctors welcome your care coordination? Have you utilized the Caregiverlist Care Consierge to create your own Senior Care Plan?  We’d love to hear from you in the comments.

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.

 

 

 

 

Senior Care Costs: Shop Early Says Senior Living Expert Lisa Sneddon in Forbes Magazine

Senior care needs can arise suddenly.  In fact, I bet if you asked your friends what their retirement plans are, they would share with you some places they plan on traveling, where they want to live and talk about hobbies they would like to develop.  But mentioning the type of senior care they have in mind will probably be last on the list, if it even makes the list.

American seniors should plan on a 30-year retirement, says Senior Living Expert's Lisa Sneddon in Forbes Magazine's Planning to Make The Right Move in Retirement article.  Lisa is a Caregiverlist advisor and owner of Senior Living Experts which assists seniors, at no charge, to evaluate and choose the right Assisted Living Community. 

Assisted living can be an enjoyable option for active seniors, especially now that builders are offering more innovative communities which include spas, gardens and regular activity excursions along with a continuum of care needs.  Some seniors may cringe when they hear that monthly rent for an assisted living community usually requires at least $4,000 to cover all the necessary extra items.  Supportive living communities may only require $2,500 or more.  However, Sneddon points out that maintaining a house that may have become too large for the senior, and paying for the property taxes, may already eat up this amount of money each month.

Remember, nursing homes really are for acute care needs and cost as much as $8,000 or more per month.  This gives some perspective to assisted living costs.

Learn more about assisted living communities in your area by submitting a request for a senior care plan and learn more about assisted living at Senior Living Experts.

Medicare Open Enrollment Deadline on the Horizon

If you or someone you know receives Medicare benefits, now is the time to review that coverage. Open enrollment for supplemental Medicare insurance, also known as Medigap, started on October 15 and ends on December 7. Seniors can change their Medicare supplemental health and drug coverage only during this open enrollment period.

Medicare is the government-sponsored healthcare coverage for Americans over 65 years of age. However, Medicare does not cover all healthcare costs. That’s why, during this open enrollment period, the elderly and senior caregivers can shop around for Medigap insurance.

Medicare supplemental insurance helps pay the "gap" between what Original Medicare (Medicare Parts A and B) pays for your health care and what you pay out of your own pocket, including deductibles, copayments and coinsurance. There are four parts to Medigap insurance:

  • Part A: hospital insurance
  • Part B: medical insurance
  • Part C: Medicare Advantage (offered by private companies approved by Medicare, like an HMO)
  • Part D: prescription drug coverage

If a senior already has a Medicare Advantage plan or a stand-alone Part D plan, they will have received an Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC) from their plan. This is the time to review the plan's costs, benefits and rules for the upcoming year. Changes made to coverage will take effect January 1 of the next year.

It is recommended that you compare prices for all of your supplemental insurance. Caregiverlist has partnered with eHealth Medicare to provide Medicare Supplemental Insurance plan quotes outside “the Marketplace”. We invite you to shop around by going through this trusted Medicare Supplemental site or by calling 888-353-4215.

Understand the difference between the Fall Open Enrollment Period and Open Enrollment for the Health Insurance Marketplaces. The Health Insurance Marketplaces (also known as Exchanges) open enrollment for uninsured or underinsured Americans that began on October 1, 2013 has nothing to do with Medigap or Medicare supplemental coverage. The Marketplaces are not meant for people with Medicare. People with Medicare do not change their Medicare supplemental insurance through the government's HealthCare.gov.

Caregiver Stress Relief Photo of the Week: Beauty from India

Senior caregivers greet each day with new challenges - the one guarantee is that no two days will ever be the same when you are caring for a senior.  Caregiverlist invites professional senior caregivers and family caregivers to take a moment away from the stress of caregiving to enjoy our relaxing photo of the week, of a beautiful scene in India.  Remember, more senior caregivers are needed and if you have taken a break from caregiving and are ready to apply for a part-time or full-time senior caregiving job in your area, you may do so on Caregiverlist.com and you may also refer-a-friend to a senior caregiving job and win prizes weekly. Caregiverlist's Career Center also provides information about working as a senior caregiver and certified online caregiver training.

 

 

 

 

"In the midst of movement and chaos, keep stillness inside of you."

Deepak Chopra

Caregiver Jobs: Shortage of Caregivers Cause for Concern

Caregiving as a profession has grown significantly in the last decade, with a 40% growth in the number of senior home care agencies since 2008.  Caregiverlist's Employment Index profiles the growth in senior home care along with the top cities where seniors age-in-place (or relocate).

Last week, the Wall Street Journal profiled the shortage of C.N.A.'s for nursing homes along with the high turnover and potential need for higher pay and other benefits for certified nursing aides.

Another reason for the shortage of professional caregivers is because many people do not realize caregiving can be a professional job with a career path.  The large growth in senior home care agencies is because senior care is moving to the home.  Seniors often find they prefer one-on-one care in their own home rather than relocating to a nursing home or assisted living community.

This means anyone with a caring personality may be employed by a senior home care agency. In addition, the growth in the number of seniors with memory loss - the Alzheimer's Association reports that nearly 1/3rd of all Americans will have some memory loss, with the risk increasing the longer we live.  This means seniors who are physically healthy -or enjoying healthy aging, will suddenly need caregiving services just to maintain meals and daily activities. 

Companion caregivers assist with medication reminders, meal preparation and daily activities as well as just being a friend to the senior.  Certified Nursing Aides, however, must obtain a certificate in their state by passing a state exam after attending an approved school. C.N.A. programs can be anywhere from 6 to 12 weeks and some programs offer evening courses.

Anyone interested in exploring becoming a senior caregiver can apply for a caregiving job or Refer-a-Friend to be a caregiver to win t-shirts, training and gift certificates each week on Caregiverlist.  Remember, caregiving delivers fulfillment beyond a paycheck while also providing a needed service to seniors.  Online training is also available to gain the necessary skills to provide safe caregiving services and be obtained through Caregiverlist's Certified Training program.

 

 

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.

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