Thanksgiving week brings Americans together, regardless of religious beliefs, to give thanks for all that we have been given.  One of the benefits for American seniors is receiving health care insurance, regardless of your previous medical conditions and financial ability to pay.  All American seniors receive Medicare health insurance at age 65 and very low-income seniors receive Medicaid health insurance.

As the new healthcare law has become a political issue, with many of the pundits tossing around hot sound bites to grab attention, we wanted to take a moment to note something that is a good thing for everyone, in this new healthcare law, called the Patient Protection and Affordable Care Act.

Medicare fraud has resulted in $6 billion dollars - a staggering amount.  Partly because some of the programs simply were not created with enough checks and balances and efficient administration and partly because the good ol' lobbying firms made sure there was enough fat in some of the laws to give them ample reimbursements.

For instance, Medicare home health care visits by Registered Nurses received an extra $2,000 on the 10th visit.  Does it cost $2,000 more to send a R.N. to a senior's home for the 10th visit?  No.  Actually, as the visits increase, the staffing becomes easier as everyone has been trained and knows the services expected.   Usually companies give a discount for more visits or more of anything - we all are familiar with frequency discounts. An annual magazine subscription costs much less per month than purchasing 1 magazine at the news stand.  Why would Medicare do reimbursements differently than the private sector?  It just takes a little lobbying money to get that type of thing accomplished.

The Wall Street Journal investigated some of the reimbursements that were happening and it turns out one public company, Amedisys, made sure all of their R.N. visits to senior's homes happened just 10 times - - darndest thing that all their senior clients needed exactly 10 visits.  Amedisys and other home health care companies who were taking advantage of Medicare simply were tapping into what is called "accidental fraud" in that they were sort of creating more services that were needed but being overly paid according to a fancy reimbursement system that had been created for the companies to profit generously.

The Senate Finance Committee launched an investigation into Medicare fraud and found $6 billion - although it is estimated that the number is even higher than this.

Amedisys, LHC Group, Gentiva Health Services and Almost Family were the 4 companies receiving the most scrutiny for manipulating care in order to get higher reimbursement rates.  Home health care companies should not be confused with private duty senior care services.  Here is the difference:

Home Health Care Companies:  provide "skilled" care professionals to visit a senior's home, reimbursed under Medicare, as long as the services are for rehabilitation and the senior will show improvements.  Skilled professionals include Registered Nurse (R.N.), Physical Therapist (P.T.), Speech Therapist (S.T.), Occupational Therapist (O.T.), Certified Nursing Aide (C.N.A.). Visits are considered "short" - usually less than 2 hours - simply long enough to perform the necessary skilled services. 

Private Duty Senior Care Companies (Senior Home Caregiving Services):  Professional Companion Caregivers, Certified Nursing Aides (C.N.A.'s) or Certified Home Health Aides in a few states such as New Jersey, where this designation was created (C.H.H.A.). Hourly and Live-in care services are provided assisting with Activities of Daily Living (ADL's) such as bathing, personal care, dressing, meals, exercises, housekeeping and errands.

Private duty senior care services are privately paid by the senior and their families.  Thus, there is no fraud.  Some states require special licensing for these companies and unlike a direct-hire caregiver, they also must provide liability insurance and worker's compensation insurance and pay for all the caregiver's payroll taxes. 

The new healthcare law has set-up new reimbursements and requirements for Medicare home health agencies, including a requirement that seniors pay a small amount of co-payment for the home health visits.  If the senior must pay a portion of the service, even a very small portion, this will make sure the senior is aware if a Medicare agency is dragging out the services longer to make more money and aware if they are being billed for services which are not performed.

The Obama Administration has also provided Medicare with an additional $200 million to fight fraud as part of its stimulus package.

This is a good thing - stopping $6 billion in Medicare fraud will benefit the deficit and well, we can't know how this money would be spent if it weren't wasted, but eliminating it can only help.

We wish Google were running Medicare - chances are that they would create an innovative technology to be applied to track services and bill in real-time - and totally eliminate all fraud and make sure more money is going towards actual senior care.

As advocates for quality senior care, we think it is worth reminding everyone about this very positive part of the new healthcare law.  Be sure to report any senior care fraud you encounter to the Officer of the Inspector General.

Marie-Therese Connolly has been chosen as a MacArthur fellow for her work as an advocate for the elderly.  An attorney working for the Department of Justice’s Elder Justice and Nursing Home Initiative, she developed legal strategies and ways to use data to prosecute cases of neglect and abuse.  She says many cases of elder abuse go unreported and this is partly because it is difficult to identify physical abuse since seniors may easily bruise or have falls naturally.  She has lead the way for studying elder abuse and ways to use forensic research to better identify these incidents.

The $500,000 grant from the MacArthur Foundation will allow Connolly to write a book about preventing elder abuse and to travel the country giving speeches and programs.

Seniors can research nursing homes in their area before they may need them, as nursing home stays are often an extension of a hospital stay for those seniors age 65 or older receiving Medicare.  Caregiverlist also provides the ratings and daily costs of nursing homes to allow seniors to analyze if nursing home care or senior home care by a senior home care agency providing a one-on-one caregiver would be a better option.

Many times elder abuse is conducted by a family member.  Senior caregiving can be stressful and this is why hiring a senior home care agency meeting quality standards created by senior care professionals can be valuable.  Many times even individuals who mean well, can begin to take advantage if there is not a care manager to support them after a long day of caregiving.  Some seniors can become difficult and take their anger out on the caregiver when they are dealing with new health problems each day and dealing with more and more of their friends dying.

The MacArthur Foundation supports creative people and effective institutions committed to building a more just, verdant, and peaceful world. In addition to selecting the MacArthur Fellows, the Foundation works to defend human rights, advance global conservation and security, make cities better places, and understand how technology is affecting children and society.

MacArthur is one of the nation's largest independent foundations. Through the support it provides, the Foundation fosters the development of knowledge, nurtures individual creativity, strengthens institutions, helps improve public policy, and provides information to the public, primarily through support for public interest media. 

The MacArthur Fellows Program awards five-year, unrestricted fellowships to individuals across all ages and fields who show exceptional merit and promise of continued creative work. It is limited to U.S. citizens and residents.

Rick Perry had an "oops" in the Republican Presidential Candidate debate and as he said, he stepped into it.  But it is always embarrassing when you forget your lines in front of a boss, a client or a huge audience.

Senior caregivers can be nervous the first time they go to a client's home to meet them.  You are on new turf and meeting someone for the first time who you will need to provide personal care services to in their private home setting.  What do you say and do and what happens if you say the wrong thing?

Just like what happened to Rick Perry, it can be rather easy for the wrong words to come out when you are nervous or to completely draw a blank.  Mikki Williams, a leading speaker's coach who also runs a speaker's training school, says there are certain techniques you can learn to make sure this never happens.

One of these techniques is to always have a story you can tell.  A story you know well and are passionate about and you won't forget it because it is your story.

Practice talking about the experiences that lead you to become a caregiver and share something personal about yourself when you meet a senior client for the first time. It can be something funny or even something sad.  When you share your story, you open the door to allow others to share their story.  You can read senior caregiving stories here and also share your own.

As for speaking, well, in elementary school I made it to the Spelling Bee final at my school.  One person from each grade was able to participate in the big evening Spelling Bee where parents and extended families were invited.  We practiced the day before and were told our first word would be easy.   The night of the Spelling Bee final, I saw my family, including my grandparents and brothers, sitting in the audience.  For the first round, I received the word "knock".  Easy enough.  I walked up and said "n".  My heart sank to my ankles.  I didn't even finish, as I knew the mistake I had made.  I knew how to spell knock but the nerves took over.  And then I saw my brother laughing at me.  The librarian with the tight bun smacked the bell and I was out. 

I can sympathize with anyone speaking in front of a crowd - sometimes you can say the wrong thing. 

But, as we all know, there are many great speakers out there who never say the wrong thing.  While it can come more naturally to some, all the great speakers have had proper speaker's training and have practiced.  That is the secret to their success.

Practice talking about your experiences in caregiving and practice telling a personal story before you meet your senior client for the first time.  Review the caregiver training you have had so that you can talk about your caregiving skills.  Then everything will go smoothly and you will make a great first impression.  As seniors who are receiving caregiving services sometimes get better or pass away, there can be turnover in jobs.  By being prepared to talk about your caregiving skills, you'll always be ready to start a new caregiving job, even if it is a quick turnaround.

Washington state voteres passed an initiative this week that will require 75 hours of caregiver training and FBI background checks, but there is one problem - the state does not have the money to fund this program and also already cut senior care benefits because of a budget deficit.

Meanwhile, the senior care companies already are required by law to provide training and perform background checks, which is why this same initiative which was also passed in 2008, was never implemented.  It seems a union was behind passing this new law, which would benefit them by paying them to provide the 75 hours of training and making sure the caregivers were paid for the 75 hours of training.  The SEIU, Service Employees International Union, spent more than $1 million promoting passage of this legislation.

Senior care professionals agree that quality background checks and training are necessary, but having one union behind the proposed legislation smells a bit fishy.

The governor of Washington also opposed the legislation, stating that there was a lack of money to pay for the program.

It seems there might be better solutions out there - for instance, online training is something that is scalable and affordable and could be piggy-backed with in-person training to test skills.  In addition, competency tests could be given, as certainly some career caregivers will already have much more than 75 hours of training already.  It also seems that maybe the union would partner with other senior care providers to enact something that is affordable, if they truly are going after the training requirements to support better care for seniors, rather than just to benefit their own wallets.  If they had partnered with the entire senior care industry in Washington to observe what the current requirements are and then propose solutions to existing problems, it would also proably be possible to do this in a cost-effective way.  But training is arleady required, along with background checks.

You can learn more about Initiative 1163 in Washington and we will make updates on the implementation.

Medicaid, the health insurance for very low-income seniors, pays for nursing home care ongoing.  Medicare, the health insurance for all seniors who have income over what is deemed low-income by each state, does not pay for nursing home care.  This matters, because nursing homes can cost as much as $400 per day which means someone with substantial savings can spend so much money on senior care services that they will then meet the poverty level for their state and qualify for Medicaid to pay for their nursing home stay for as many years as they may need the care.

The recent recession has resulted in lower tax revenue for states.  And, in Illinois, the former governor who was impeached also made so bad moves that have left the state with a huge debt and behind on paying their bills.  Medicaid is both a federal and state program, meaning the states must be able to help finance the costs.

Paying for a nursing home for as many years as a person may need it can get rather costly.  Right now, in Illinois, there is really no "in-between" care program for seniors on Medicaid.  If you need care services, the state of Illinois will pay for it in a nursing home, not at home. 

The state of Illinois now will now make it possible to "look back" at a senior's finances for 5 years, instead of 3 years.  The lengthening of the look-back period will enable the state to be sure that money wasn't given away if you really could afford to pay for the nursing home care on your own (seniors may gift the money to their children so they will have some inheritance, rather than using this money to pay for their nursing home care and now there are limits on how much money can be "gifted" in order to qualify for Medicaid).  This requirement was added because in the past there were some very wealthy families who were asking for the state to pay for their nursing home care and pretending they had no financial resources when they had really just given all their money away to a loved one.

However, senior care costs can add up.  Many seniors who may suffer from memory loss, can need care for 10 years or more.  Their families must plan ahead to pay for the costs of care and many times spending their assets down to qualify for Medicaid will be a natural progression for them.

Illinois Medicaid may now look at every transaction for the past 5 years to determine whether money was given away.  If money was given away, Medicaid will asseess a penalty period during which it will NOT pay for care.  Families will now need to examine their finances in detail before they apply for Medicaid so that there are no surprises later.  This will require detailed record-keeping inorder to switch from Medicare to Medicaid.

Illinois nursing homes accept Medicare or Medicaid or private funds as payment.  Medicare will pay for a short-term nursing home stay (usually for up to 20 days after a major medical event and hospitalizaton).  Research nursing homes in Illinois to understand their costs and ratings before you need one.

Nursing homes in Illinois range from $471 per day (Covenant Health Center in Northbrook, Illinois) to $102 per day at Grange Nursing Home in Mascoutah, Illinois.  You may view the daily costs and ratings of all nursing homes in Illinois on Caregiverlist's Nursing Home Directory.  Senior home care is another option for seniors who are private paying for senior care, as senior home care agencies provide professionally managed caregivers and this delivers one-on-one care to the senior.  Most nursing homes staff 1 Certified Nursing Aide to as many as 10 or more patients.  You may also request costs and services from senior home care agencies near you to plan ahead for senior home care.

Seniors and caregivers and, well, everyone who votes in Washington state tomorrow will be presented with Initiative 1163.  Washington voters approved this initiative in 2008, but the legislature delayed implementation.  The largest contributor to promoting passing of this initiative was a union, and well, there was a problem in that there was no way to fund the costs of the new initiative, which included 75 hours of paid training for caregivers.  Oops!

What is Initiative 1163? 

A new law in Washington state which would require 75 hours of caregiver training and mandatory multi-state background checks.

Why do many senior care professionals see no need for the initiative?

Caregiver training is already required and provided for professional senior caregivers and background checks are also already conducted.  Senior care companies must also follow certain background check and hiring guidelines in order to meet their insurance coverage protections.  Caregivers moving into Washington from another state already must pass FBI fingerprint checks, as required by law.  Medical professionals already provide caregiver training.

What are the costs of implementing the new initiative?

Numbers that are anywhere from $18 million to $80 million are being tossed around.  Currently, Washington state is operating in the red - the state does not have enough money to pay for their current programs.  The Washington state legislature recently cut, earlier this year, $500 million in medical services and in-home care to seniors and adults with disabilities.

As you examine this initiative, it seems clear that it creates additional training in order to help one group, the Service Employees International Union, profit.  It creates something that is not even needed.  Outdated rules are credited with helping to bring down the automotive industry in  Detroit.  It seems with technology advances, many union initiatives also should be a thing of the past.

The Arab Spring happened because of the availability of social media - it is now that simple to move people together to advocate for change.  This is how we now communicate.  If there is not strong social movement for a cause, that should always be a red flag to look deeper.  In this case, when you look deeper, you find an old fashioned approach to making money where you set-up a government program that your group can profit from and the taxpayers fund.

Caregiver training is also now available online, allowing caregivers to take the training courses at their own pace.  As technology continues to offer new ways to communicate, we will be able to take advantage of these abilities to offer continued training and have the capability to efficiently track everything.

It seems everyone in Washington state would be better off by trying to find ways to increase the ability to give care to seniors at home, instead of spending money on items that are not needed because they already exist.