Wednesday, December 17, 2008

Editorial: Blue Cross reform should wait until '09

by The Flint Journal
Sunday December 07, 2008, 6:00 AM

All good things in time. If you believe that adage, then you have to believe good legislation on the issue of individual health insurance will require more time than the Legislature has between now and the end of the year.

Blue Cross Blue Shield of Michigan has been pushing hard for lawmakers to approve changes in the way the state regulates health insurance that people have to buy individually because they don't have coverage through an employer.

That attempt is meeting opposition, particularly from state Attorney General Mike Cox, who says the proposed changes would hurt consumers and give Blue Cross an unfair advantage over its competitors.

The battle between Cox and the Blues has gotten a little nasty. That's unfortunate, because this highly complex issue can be resolved only with measured debate, not with the snide attacks that both sides have launched at times.

That aside, Cox is arguing that the lame-duck session doesn't allow enough time or the right climate of deliberation to deal responsibly with the issue. On that much he is right.

The state House erred when it passed a reform package that some lawmakers later admitted didn't get the consideration it needed. The Senate approved a more-thoughtful package, but differences between the two haven't been reconciled.

Blue Cross now wants action. We understand the insurer's desire for reform. It recently announced that in the first nine months of 2008, it lost $111 million on individual policies.

As the number of people seeking them grows, those losses will only mount.
The attorney general argues that Blue Cross remains financially sound, but the insurer faces long-term losses that would jeopardize its financial health in ways Cox isn't acknowledging.

Under state regulations, Blue Cross receives special tax benefits and in turn has a special responsibility to the public. It deserves reasonable reforms, but the attorney general's oversight should be preserved in a meaningful way.

In November, a compromise proposal became public, but we don't see how lawmakers can responsibly review such a complex plan in a short lame-duck session, nor do we think the issue should be decided by 46 House members who are leaving office and don't have to answer to voters for something rushed too quickly through the legislative process.

This issue is too complex, and there's too much at stake.

BCBS of Michigan Could use a little Bailing Out

Michigan’s Largest Health Insurer Sings Financial Blues

Detroit’s auto makers aren’t the only ones in Michigan seeking the government’s helping hand. The beleaguered state’s largest health insurer is looking for financial relief too.

Blue Cross Blue Shield Of Michigan wants state lawmakers to give it more leeway over how much it can charge for health insurance to offset losses the not-for-profit insurer says it has racked up as the state’s insurer of last resort, writes the WSJ this morning.

The proposal hasn’t gone down well with for-profit insurers and consumer groups, who claim BCBS of Michigan is exaggerating its financial problems.

Rival insurers don’t like a provision that would require them to pay a penalty for rejecting sick consumers who wind up with Blue Cross. Blue Cross isn’t taking that criticism lying down. “They don’t want to see Michigan change because they know it’s the last free ride,” Blue Cross’ Hetzel told the paper.

Meanwhile, consumer groups fear any future premiums hikes could boost the ranks of the uninsured.

State lawmakers are hammering out a final version of the bill. A vote could come later this week.

From the Wall Street Journal

BCBS of Michigan Tries to Pry Itself From Under Regulation

From the Kaiser Network:

Blue Cross Blue Shield of Michigan is urging the state Legislature to pass legislation that would give the insurer more flexibility in setting premium rates and reduce government regulation, the Wall Street Journal reports. The insurer said that without the changes, increasing per-member costs will lead to financial troubles. As the state's insurer of last resort, BCBS is exempt from $80 million to $110 million in state and local taxes annually in exchange for providing affordable health coverage to all applicants, including those rejected by private insurers. The firm claims that as more people in the state have lost their jobs or employer-sponsored insurance, the number of BCBS policyholders has doubled in the past two years. It says that because it cannot reject any applicants, its per-member costs are four times those of private insurers. BCBS says the company likely will have a $166.5 million loss on individual products in fiscal year 2008 and a $264 million loss in FY 2009.

In addition, BCBS is asking that other insurers be charged a "cherry-picking" penalty for rejecting applicants who end up with BCBS -- which would go to BCBS to help fund their coverage. A version of the firm's proposal was passed last year by the state House and another -- from which some of the more "dramatic" proposals were removed -- was passed this spring in the Senate, the Journal reports. A vote on a final version could be taken this week.

Other insurers, the Michigan attorney general and consumer groups have spoken out against the requests, saying the legislation would allow BCBS to charge higher premiums to sick customers and shirk its social responsibility. Richard Murdock, executive director of the Michigan Association of Health Plans, said, "This does nothing for Michigan's uninsured population, and it only raises the possibility of the worst-case scenario of higher premiums." State Attorney General Mike Cox (R) said that the firm is exaggerating its problems, noting that its reserves have increased by more than $2.96 billion from 2001 to 2007. He also said the firm has been able to cover its losses on individual products in the first nine months with other income and has recorded $110 million in profit (Fuhrmans/Martinez, Wall Street Journal, 12/4).

CyberKnife Recieves Uneven Coverage from Medicare

Geography Has Role in Medicare Cancer Coverage

Published: December 16, 2008

The medical tool’s catchy name, CyberKnife, evokes digital accuracy. But the way the federal Medicare system treats CyberKnife seems anything but precise.

CyberKnife is a new but fast-growing radiation treatment for prostate cancer, spurred by radio and newspaper ads that stress its convenience and results. The chief selling point is that CyberKnife treatments take five days instead of the eight weeks for conventional prostate cancer radiation, although many experts say they believe that the medical evidence is inconclusive on whether it works as well as those older methods.

Read Entire Article from the NY Times

Tuesday, December 16, 2008

More Info on Medicare Programs

This time from Florida.

Time To Change Medicare Programs

Published: December 1, 2008

This is the annual open window period for either signing up for various Medicare programs or to switch from one to another. If you are confused about which plan you should choose, you can get advice from an impartial person trained to help you decide before Jan. 1 which plan is best for you.
The aid is provided by 400 volunteer counselors throughout the state serving with the SHINE (Serving Health Insurance Needs of Elders) program. You can get assistance by calling, toll free, the Elder Helpline at 1-800-963-5337. They will give you the time and place counseling sessions are available. If you are unable to get to any of those places at those times, your phone number will be taken and a counselor will call you to discuss Medicare eligibility, enrollment and coverage issues; health plan choices; appeal rights; Medigap (Medicare supplemental) policies; Medicare prescription drug (part D) plans; long-term care options; prescription assistance resources; or Medicaid details.
A good way to do your own research and comparison of policies is to get on the Internet and look on the official site at Good explanations of the differences between types of policies and comparisons of their features are to be found there.
More than 1.7 million Floridians (that's one of 10 residents) are caring for a frail elder, reports the state's branch of the AARP. That organization's survey found that 77 percent of adults 35 or older would prefer to receive long-term care at home rather than in a nursing home.
So Lori Parham, state director of the AARP, is bucking to change Florida's status as 41st in the nation in achieving a balance between community-based and nursing home care, where Florida spends 91 percent of Medicaid's long-term care funds.
The average cost of a nursing home stay is about $75,000 a year while care at home costs about $20 an hour.
One Florida business ranked in this year's AARP top 10 list for best employers for 50-year-old or older workers. It is Lee Memorial Health System based in Fort Myers where 38 percent of the 9,204 employees are 50 or older.
Those enrolled in the company's health plan receive free generic medications for treating cardiovascular disease, diabetes and high cholesterol. They also have access to free clinics at all of the system's hospitals and, at a minimum cost, personal trainers, dietitians and nurses' supervision in a weight-loss program.
Thanks to the Mortgage Forgiveness Debt Relief Act, you now have up to two years following your spouse's death to sell your jointly owned house and keep up to $500,000 in profits tax free.
Previously, a widowed homeowner had to sell the house the same year as the spouse's death to qualify for the tax break.
In today's economy, 10 percent of Americans 65 years of age or older have turned for help from families or charities, according to a story by Peter Jaret in a recent edition of the AARP Bulletin. But of those eligible for food stamps, only 34.5 percent of them apply for that aid.
The same issue reported that 1.3 million Medicare beneficiaries are having trouble finding a primary care physician because of a shortage of doctors going into general practice.
Since Medicare and insurance companies establish the fees, primary care doctors are forced to take on more patients and work longer hours to generate revenue. Therefore they spend less time — as little as 15 minutes — with each one, the article quotes a spokesman for the American College of Physicians.
In addition, general practice doctors earn half or less than what many specialists earn. Consequently, only 13 percent of first-year residents in internal medicine in a recent survey indicated an intention to enter a general practice.
Adon Taft is a resident of Brooksville. If you have questions about any issue connected with aging, except medical conditions, please write to Life to the Fullest at Hernando Today, 15299 Cortez Blvd., Brooksville, Fla. 34613, or send e-mail to Please include your name and address.

Spending the Holidays with Aging Parents

Elder Care Expert Has the Prescription for Caregiver Stress

For many families, the problem with the holidays is family. Elder care expert Esther Koch provides insight into how caregivers of aging parents can bring the joy of the holiday season to the elder care experience.

San Mateo, CA (PRWEB) December 2, 2008 -- For many families the stress of the holiday season is family, especially aging parents. Gerontologist and elder care expert Esther Koch, founder of Encore Management, has a simple yet highly effective prescription for holiday stress relief….reframe the experience. "Use the holidays to change the focus from all that you have to do for your parent to all the experiences you can have with your parent", recommends Koch who also was the primary caregiver to her mother for ten years.

"Your holidays will be joyful if you intend them to be", says Koch. "You may have to start with forgiveness - forgive your parents, forgive your siblings and forgive yourself." She emphasizes, "A little forgiveness can eliminate years of regret."

Koch continues, "As a caregiver, you do need to recognize your parent's limits as well as your own." Adjust commitments whenever necessary for health reasons and don't forget to schedule time for yourself. "Most of all, be in the moment and don't take for granted that your parent will always be as physically and mentally able as they are now", she says.

Go to Article at PR Web

Medical society head sees gaps in elder care

Sonja Puzic, Windsor Star

Published: Wednesday, December 03, 2008

As a busy family physician, Dr. Nick Krayacich is all too familiar with the growing challenges facing our health care system.

His patient load of about 2,400 includes many elderly people battling chronic illnesses and adults whose health problems are compounded by job losses and the economic crisis.

Krayacich knows what the community needs -- more health care dollars from the government, better communication among local and provincial agencies and a collaborative, multidisciplinary approach to patient care. As the new president of the Essex County Medical Society, he's got several initiatives in mind.

"We are a very well-respected medical society in the province and one of the most active," said Krayacich, who will be formally installed as ECMS president tonight at the society's dinner gathering. "We need to be vocal and advocate for our membership."

One of the first items on Krayacich's agenda is putting together a medical advisory board to work with the Erie St. Clair Local Health Integration Network, which is responsible for allocating government funding for area health care facilities. The goal is to foster better communication with the LHIN, Krayacich said, "so that they can pick our brains before decisions are made and vice versa."

Krayacich said he will also focus his efforts on "connectedness and inclusion" within the medical community, making sure its members, especially those who were recruited from other parts of the country, feel welcome and get involved.

Krayacich said he is not worried about juggling his day-to-day schedule and new responsibilities as ECMS president. Having served on the medical society's executive, most recently as vice-president, Krayacich said he knows what to expect. He will replace outgoing president Dr. Anthony Glanz, chief of cardiology at Hotel-Dieu Grace Hospital.

Krayacich has been practising medicine in the Windsor area since the early 1990s. He treats many geriatric patients who struggle with various chronic conditions such as heart disease and diabetes. Caring for the aging and ailing population with stretched resources and a persistent shortage of family physicians is a complicated process across the province, Krayacich said.

"We definitely don't have enough nursing homes ... we don't have enough hospital beds," he said. "There are still 40 to 50 thousand people in the Windsor area who don't have a family doctor. We're definitely concerned about that."

The Medicare D shell game

One example of the labyrinth that is Medicare. Like it or not, we are all going to have to pay attention to the devilish details - on an annual basis.

It's a pain for seniors to pick from the myriad drug insurance programs, but it pays to do it - every year.

Kim Andrews had just helped a woman save a couple of hundred dollars on her new Medicare drug plan.

"I asked her about her husband," said Andrews, the Delaware County coordinator for Apprise, the Pennsylvania health insurance counseling service. The woman said " 'Oh, my husband loves his plan. He won't change.' "

"Well, I checked his drugs anyway, and it turns out his plan was no longer going to cover two of his drugs," Andrews said. "I found him another plan that would save him $2,771. That's huge. People are just unaware, it seems."

Read entire 3-page report at the Philadelphia Inquirer.

Friday, September 5, 2008

The Coming Shortage of Health Care Providers

Trouble Ahead

As the work force dwindles, who will take care of our aging population?
Sunday, August 17, 2008

Our nation is woefully unprepared to meet the work force challenges posed by an aging population.

There aren't enough workers trained to care for older folks today, let alone 10 or 20 years from now when the elder population will reach record levels. Shortages in nursing, social work, physical therapy and other fields critical to senior care are likely to worsen unless a comprehensive strategy is developed and put into action.

Ironically, many of the baby-boomers who are about to retire over the next few years will leave those very same jobs. In 2000, about 13 percent of the work force was 55 and older. By 2015, that is expected to rise to 20 percent.

Complete Article

Discussing Care Options With Elderly Parents

By Beth Macy

The bank didn’t call until her father tried to draw his third cashier’s check. If he simply sent $98,000 to cover the taxes on a prize he’d won — to a post office box in Canada — the lottery would send him $1 million.

Or so the scam went. Barbara McVi cker rushed to the bank, only to learn that her father had already sent away $68,000 of his life savings. Then came the FBI investigation.

Then, more drastically, what McVicker calls “The Talk.”

She had tried before to initiate the conversation with her elderly parents. But like many, they were reluctant to discuss such an uncomfortable and role-reversing subject.

The elephant was definitely in the room, and he needed some answers:

Complete Article

GE Designing Products for People With Varied Abilities

LOUISVILLE, Ky., Aug 18, 2008 (BUSINESS WIRE) -- Although each of us has a unique profile consisting of height, age, ability, strengths, weaknesses, and preferences, most homes are designed to fit a "standard" person. As a result, many of us struggle to reach or operate sink fixtures, cabinets, and appliances.

Universal Design is a design concept that meets the needs of people with varied abilities. It not only addresses the current difficulties people face, but also the possible physical challenges later in life.
"The time has come for kitchens and homes that fit the real needs of real people--needs that will change over time," observed Marc Hottenroth, Industrial Design Leader for GE Consumer & Industrial. "Our Industrial Design team will continue to take a leadership role in addressing these issues," he said.

Complete Article

Animal Companions for Seniors in California

Creatures comforting

Couple share their wide assortment of adopted exotic animals with seniors

Published: Monday, August 18, 2008 at 4:30 a.m.
Last Modified: Monday, August 18, 2008 at 6:05 a.m.

"It's a magical place."

Rob Lyon and his wife, Robin, help seniors feed some of the 70 animals on their Sonoma ranch. The pair also take their animals, including a camel, to nursing homes and retirement communities to visit with residents.
Robin and Rob Lyon have a ranch, E-I-E-I-O.
And on this most unusual ranch on a hill above Sonoma there is an emu, Doris, that the Lyons adopted after she was found injured and abandoned on the ninth hole of a Rohnert Park golf course.

There's also a locally renowned 1,750-pound camel, named Kazzy, who will duck into the bedroom of an ailing person and rest her great head on the bed, like a golden retriever.

And Chester, an African serval cat that struggled at birth at an Oklahoma zoo but now thrives with the Lyons. And a mellow, black-splotched white dog named Chester, whose master died in the 9/11 attacks. And, a dancing macaw parrot, Theo, that needed a home after its family broke up following a divorce.

In all there are 82 animals on Lyon Ranch, many quite exotic and most as hand tamed and cuddly as a kitten. Every one of the 82 has a story.

And so do the Lyons.

Complete Article

Thursday, May 1, 2008

Book Review - "My Mother, Your Mother"

'My Mother, Your Mother' speaks to many baby boomers who find themselves caring for their parents

Date published: 4/27/2008

THIS BOOK will literal- ly speak volumes to many baby boomers who find themselves helping aging parents through their late-life journey. Geriatrician Dr. Dennis McCullough recommends a new approach to elder care, "Slow Medicine," and his thoughtful observations bring a glimmer of hope to an often bleak scenario.

He focuses on the fastest growing group of elders, those over 80, and notes that there is a "looming tsunami of elder care needs."

McCullough laments the fast, often aggressive pace of American medicine, and points out the incongruity of a diagnosis-based, cure-focused approach to someone who is dying simply because they are old and at the end of their life. He points out the difference between disease and illness. He questions the unlimited use of tests and procedures for elders, and advocates a gentle approach that assesses the patient's mental state, remaining abilities, family situation and quality of life.

Read Entire Review

Local Doctors' Actions Reflect Nationwide Trend

by T.M. Shultz at the Daily Courier
Saturday, April 26, 2008

What primary care doctors are doing in the Prescott area reflects what primary care doctors are doing across the country.

They are:

• Retiring.

• Changing careers.

• Not taking new patients.

• Converting to cash-only practices.

• Refusing to accept new Medicare patients or dumping them when they reach a certain age or, in at least one case, opting out of the Medicare payment system altogether.

• Limiting the insurance they'll take to one or two major companies. In Prescott, it's typically Blue Cross Blue Shield and the Arizona Foundation for Medical Care, which is a provider network for Yavapai Regional Medical Center's employees.

Read Entire Article

In Delaware - Blue Cross must Pay Fines for Late Claims

Judge upholds $100,000 ruling by Del. insurance commissioner

The News Journal, April 26, 2008

A Superior Court judge has upheld a $100,000 fine against Blue Cross Blue Shield of Delaware, which the state insurance commissioner assessed last year after finding the company failed to process thousands of medical claims within a state-mandated time period.

The decision by Judge Peggy Ableman affirms a September ruling by Insurance Commissioner Matt Denn, which found that in the first six months of 2006, Blue Cross Blue Shield of Delaware, the state’s largest health insurer, failed to process 10,467 health insurance claims within the required 30 days.

Read Entire Article

Blue Cross spends big to promote legislation


Blue Cross Blue Shield of Michigan has spent $1.1 million since Jan. 1 on TV ads in seven major Michigan cities to promote a legislative agenda that would allow the nonprofit to set its own rates for individuals buying health insurance policies.

The money bought more than 2,600 TV spots, airing as often as 10 times a night, usually in prime time, including pricier buys during "American Idol," "CSI Miami" and the late-night Jay Leno and David Letterman shows.

By comparison, Put Michigan People First, one of three coalitions of commercial insurers, HMOs and others opposed to the legislation, has spent $65,000 on radio and print ads, according to Mike Nowlin, a Lansing public relations specialist who serves as the coalition's spokesman.

Read Entire Article

Michigan Attorney General Pursues Investigation of Blue Cross

Michigan Attorney General Michael Cox sent a fax on Thursday night to Dan Loepp, president and CEO of Blue Cross Blue Shield of Michigan, asking Loepp to explain by June 2 whether the company violated state laws by purchasing a for-profit insurance company for one of its subsidiaries.

Crain’s reported Thursday that Cox was looking into allegations made Wednesday at the Michigan Senate Health Policy Committee that the Blues may have violated state laws in acquiring several out-of-state insurance companies.

In the letter to Loepp, Cox asked nine questions related to the Nov. 20, 2007, purchase of CWI Holdings Inc., the parent company of CompWest Insurance Co. in San Francisco.

Read Entire Article

Governor Schwarznegger joins opponents of Blue Cross Blue Shield rescission practices.

Blue Cross of California, BC Life, HealthNet, and other large California health care coverage providers have been accused of improperly dropping (rescinding) thousands of health insurance customers using an illegal practice called "post claims underwriting". They do little or no investigation when they issue the policy, but if you run up big bills they scour your medical records to find reasons to rescind your coverage based on alleged "misrepresentations" in a confusing and complicated application. The charge is that they loan you an umbrella and want it back as soon as it starts raining!

Now California's Governor has joined proponents of regulatory action and class action lawsuits in condemning this practice. According to the Sacramento Bee, Schwartznegger said it is "outrageous that innocent patients have to live in fear of losing their health care coverage. I look forward to working with my partners in the Legislature to ensure this egregious practice is stopped."

Read Entire Article

Hospital, Blue Cross Talks Stall


from the New Jersey Herald

NEWTON — Newton Memorial Hospital patients insured by Horizon Blue Cross/Blue Shield received notice late last week that the hospital intends to terminate its contract with Horizon.

"It is the bigger picture that brings us to this point with Horizon. It is the environment of hospitals in the state," said Newton Memorial's Sean O'Rourke, chief operating officer. "Everybody in New Jersey is dealing with it."

The decision came about after several attempts were made by the hospital to negotiate a contract that would provide what it considers more appropriate payment rates for its services.

"This is not new," O'Rourke said, "We have talked with more than 20 insurance companies over the last 18 months. Getting to this point helps both parties focus on the task at hand."

The letter, signed by President and Chief Executive Officer Thomas Senker, stated, "Although this letter will alert Horizon of our intentions, Newton Memorial will continue to negotiate in good faith for rate adjustments to sustain high quality care and accessibility to modern and efficient health care facilities for you and your family."

Horizon Blue Cross/Blue Shield executives did not return phone calls seeking comment.

Under the terms of the current contract, the hospital is in-network with Horizon. The hospital said it will continue to negotiate rate adjustments so that it can sustain care and accessibility to health care facilities for its patients.

The contract states that those who subscribe to Horizon still will be able to utilize their in-network benefits at Newton Memorial Hospital for 90 days, until July 22. After that, Horizon members can continue to go to Newton Memorial Hospital to receive out-of-network services. The reimbursements will depend on individual health plans.

Patients who have HMO coverage will remain in-network for four months after the termination of the contract, until Nov. 22.

BCBS Round-Up

Let's get caught up on some of this weeks Blue Cross / Blue Shield stories.

Senate panel chief may trim Blues bills provisions
By Jay Greene

The Senate Health Policy Committee is expected Wednesday to vote on four controversial bills that seek to reduce premium rates and expand access in the individual health insurance market and give a for-profit workers' compensation insurance subsidiary of Blue Cross Blue Shield of Michigan the right to enter other insurance lines.

But in response to testimony the past two weeks, Sen. Tom George, R-Kalamazoo, who chairs the committee, said last week that he may drastically reduce the number of provisions in the proposed legislative package.

While Blue Cross opposes eliminating major portions of the proposed legislation approved last October in the House, George said he is inclined to push for the following:

Read Entire Article

Tuesday, April 29, 2008

Senators Compliment CMS Website - But Want More Transparency

Senators Compliment CMS on Nursing Website but Push Bi-Partisan Bill for More Info

Democrat Kohl, Republican Grassley push bill to expand transparency

April 28, 2008 – Two U.S. Senators from different parties came together last Friday to compliment the Centers for Medicare and Medicaid Services for increasing the information available on their Website, Nursing Home Compare, but they say the agency has a ways to go to achieve the transparency and information for consumers called for in the Senate bill they have crafted.

Senators Herb Kohl (D-WI) and Chuck Grassley (R-IA) complimented CMS Acting Administrator Kerry Weems for identifying on the site the most troubled nursing homes. They have been designated as Special Focus Facilities (SFF) by CMS.

Kohl and Grassley said that CMS still has a long way to go to meet the demands called for in their bipartisan bill, the Nursing Home Transparency and Improvement Act (S. 2641), which would require Nursing Home Compare to display accurate, timely information in a format that can be easily understood by consumers across the country.

“Americans should have access to as much information about a nursing home as possible," said Kohl.

Read Entire Article

Monday, April 28, 2008

AMA Committed to Enforcement of BCBS Settlement

The American Medical Association (AMA) announced that it will begin enforcement of the national Blue Cross and Blue Shield (BCBS) settlement as a signatory medical society to the agreement. The AMA joins 27 other participating medical societies that are able to provide direct assistance to physicians when a BCBS plan or subsidiary has failed to comply with the national BCBS settlement.

The AMA's participation in enforcement of the BCBS settlement was initiated yesterday when a Miami federal court finalized the settlement of a nationwide physician class action lawsuit brought against Blue Cross and Blue Shield Association and more than 30 affiliated plans and subsidiaries.

Read Entire Article

Doctors Agree: We Need Single-Payer Health Insurance

It's the only system that offers affordable quality care

We have all heard it before. The health care system in the United States is broken. We have all heard it, but when is someone going to do something about it?

Physicians for a National Health Program (PNHP) is a group of 15,000 physicians who believe that there is a solution and it is currently working for Americans — if they are over 65. It is, of course, Medicare, part of the 60 percent of our current health care system that is paid for and administered by the government.

We believe a single-payer system (Medicare for everyone) would be less costly, more efficient and provide all Americans with the health care they need without an increase in overall dollars spent (an amount that is increasing at a rate of 7 percent per year). This would include the 47 million who are currently uninsured and the estimated 50.3 million who are "underinsured" (spending 10 percent or more of their pretax income on health care).

Read Entire Article

Thursday, April 17, 2008

Senior Care in Minnesota at Risk From Budget Cuts

Kim Winnegge, The ForumPublished Sunday, April 13, 2008

With Minnesota facing a projected deficit of $935 million, area advocates warn that program cuts to the health and human services sector will drastically affect the most vulnerable people in the community.

Gov. Tim Pawlenty has proposed a $32 million cut in long-term care funding, with no cost-of-living increases in 2008.

He also wants to repeal rebasing for nursing homes, a process that would phase in rate adjustments over eight years to reflect actual costs in providing services.

See Entire Article

Monday, April 14, 2008

NY Nursing Homes Fill Gaps Left by Hospitals

As New York hospitals experience budget cutbacks and shortages, nursing home operators find themselves picking up some of the slack - caring for people who, though they may not really need a full-time nursing home, are not able to live independently in their own homes.

This role is actually the need we try to fulfill on a long term basis at an Adult Foster Care facility such as Kelso House AFC.

Staff Reporter of the Sun

As New York hospitals wrestle with cutbacks and budget constraints, nursing homes are finding a new role in treating patients who are well enough to be sent home but need additional care.

In a departure from their traditional role, nursing homes statewide in recent years have seen an influx of patients seeking short-term, rehabilitative care, as cash-strapped hospitals treat and discharge patients as quickly as possible. With increasing turnover rates at nursing homes, a number of facilities citywide are responding to the demand, taking on costly renovation projects that shrink the number of long-term beds but add space devoted to short-term care. Last week, the Margaret Tietz Nursing and Rehabilitation Center in Queens broke ground on a $3 million expansion of its rehabilitation space, part of a $14 million top-to-bottom renovation of the facility.

Go to Full Article

District Councillors Shoot Down Nursing Home

From the Midhurst and Petworth Observer

This story about a proposed nursing home in Nyewood, UK, shows that the same obstacles and issues surrounding elder care are present throughout the civilized world. What I found remarkable about this article was the fact that there was so much community support for the project, and yet the city planners found the project to be counter to their designs and went so far as to comment on the aesthetic devaluation of the neighborhood a nursing home would engender.

What lot of Sods!

Nyewood nursing home turned down despite strong village backing

NYEWOOD villagers have lost their fight for a 32-bedroom nursing home which was planned on the former station yard site.
Last week Chichester district councillors (CDC) threw out the plans at a special application referral meeting.

It was called because their colleagues on the north area development control committee in February defied their officers' recommendation and said they wanted to see the plan go ahead.

As this decision went against the council's planning policy it was taken to the special referral committee for a final ruling.

More than 40 villagers turned out when Harting Parish councillors held a special public meeting to hear their views earlier this year.

And members of the north area development control committee were told there was 'universal approval' for the scheme among villagers.

Applicant Bill Richardson said it would use a brownfield site, get rid of an unsightly builder's yard and enhance the whole area.

Harting and Elsted district councillor Andrew Shaxson also spoke out strongly in favour of the development.

But at the referral committee last week officers reported that 'given the remoteness of the site, the very limited nature of public transport in the area and the lack of local services and facilities, the proposal would be contrary to the aims and objectives of a range of planning policies governing sustainable development'.

They said it would also have a serious and detrimental impact on the appearance of the Area of Outstanding Natural Beauty (AONB) and would impact in an 'overbearing' and 'unneighbourly' way on nearby homes.

The committee voted to reject the plans on the grounds they would be an unsustainable form of development and would be harmful to the AONB and residential amenities.

Wednesday, April 9, 2008

Shortage in Senior Housing

By Patricia Breakey - Delhi News Bureau

A crisis is looming in housing for the rising population of senior citizens, with a shortage of beds available for those who are no longer able to live alone but don't require nursing-home care.
Adult foster care homes can be a perfect solution for people who need temporary or long-term non-medical residential care, but there aren't enough of them to meet the growing demand, Susan Aikens, Delaware County deputy commissioner, said Tuesday.

"We are actively recruiting for adult foster care homes," Aikens said. "Right now, we have five homes with 26 beds in Delaware County and we get 4 to 5 requests a month."
Recent closures of adult homes in Delaware County, both voluntary and involuntary, left about 100 people without a home. Of those, only 16 were able to remain in the county because there were no other spaces available.

Read Entire Article

Tuesday, April 8, 2008

Michigan BCBS Proposals Under Scrutiny

Christina Rogers / The Detroit News

A legislative battle in the state's Capitol over new regulations for insurers selling individual policies will resume in mid-April, when members of the Senate Health Policy Committee hold another round of hearings and move to a final committee vote at the month's end.

On the table are several alternatives to a package of bills passed by the House of Representatives last fall. The proposed legislation would among other measures make it possible for the Blue Cross Blue Shield of Michigan, the state's insurer of last resort, to divvy up the financial load of paying for its sickest -- and most costly -- customers by requiring commercial insurers to pay into a high-risk pool.

Last month, the Senate committee's chairman, Sen. Tom George, R-Kalamazoo, pitched a series of substitutes to the Blues-backed legislation.

Read it All Here

New Plan for Michigan Health Insurance Reform

From Our Own Detroit Free Press

State Sen. Tom George offers a well-thought-out plan for health insurance reform
April 6, 2008

On matters of public health, the State of Michigan's overarching goals must be improving it and increasing access to care.

With those guideposts, state Sen. Tom George, a physician, has a better plan for health insurance reform than one put forward by Blue Cross Blue Shield of Michigan and shot through the House last fall with disgracefully little review for an issue of such importance. George, a Republican from Kalamazoo, has, after a series of hearings he chaired in the Senate Health Policy Committee, produced his own set of proposals for the individual insurance market -- and they make sense.

Blue Cross, a not-for-profit agency set up through state law, has been lobbying for changes that the Blues say will enable them to be more competitive in the growing individual insurance market. At the same time, the Blues want less regulation and more freedom to invest in for-profit subsidiaries.

Read The Rest of New Plan for Michigan. . .

Sunday, April 6, 2008

Family Vistors Come to Kelso House

Ailie recently had visitors - family members Jim & Nancy came all the way from Waterford, Michigan to see her. Ailie was so surprised to see them and had a wonderful time. After they left, she just kept remarking, "what nice people."

We welcome and encourage visits from family and friends as often as possible, and we thank everyone who comes to devote their time.

Universal Coverage Law Creates Doctor Shortage

Monday, March 31, 2008

As Population Grows Older, Geriatricians Grow Scarce

Officials, Schools Prod Doctors to Focus on Elderly Care

Mary Boland, 91, can consider herself fortunate. In 2006, the chronically ill former teacher from Cincinnati had a narrow brush with death when she came down with pneumonia. Within minutes, Boland's personal physician, Gregg Warshaw, was called.

"She was weak, confused and breathing abnormally," Warshaw recalls. "Her blood oxygen level was low, and she was suffering a low-grade fever."
In the elderly, pneumonia is often fatal. But instead of rushing Boland to the nearest hospital, as many family doctors might have done, Warshaw, a geriatrician, stabilized the condition and put his patient on antibiotics.

"Luckily, the pneumonia wasn't grave enough to warrant hospitalization," Warshaw says.
Geriatricians have provided specialized care to the elderly for decades, and until recently their numbers have been growing. But despite countless attempts to convince the medical profession and the public of their worth, the number of practicing geriatricians in the United States -- about 7,000 -- is falling seriously behind needed levels.

While the U.S. population age 55 and older is growing rapidly, according to a 2005 census report, the number of medical school grads going into geriatrics has been slow to keep up.

According to one estimate, the nation's teaching hospitals are producing one or two geriatricians for every nine cardiologists or orthopedic surgeons.

Read Entire Story Here

Sunday, March 30, 2008

Florida's Elder Care System Backs Up

ORLANDO, Fla. (AP) - Caring for the elderly is one of Florida's growth industries - nearly a quarter of the state's population is over 60 and almost 10 percent is at least 75.

But caring for the poor among them is a different story - particularly when a patient becomes unable to make his or her own decisions.

To take care of them, Florida, like many states, has a public guardianship system - a government entity that works through the courts to appoint guardians for those without the means to pay for their own.

But it's a skeleton entity, and only about half of Florida's 67 counties are covered. And even in those, there's a waiting list of seniors - 254 people, according to the most recent figures from the Statewide Public Guardianship Office. That was up from 225 in the office's 2007 annual report and 132 people waiting in 2006.

Even then, that might just be a fraction of the problem — the state public guardian estimated in 2004 that 5,000 to 10,000 people who needed its services weren't getting them. That population of endangered adults is expected to rise as more baby boomers age and head here for retirement.

Terry Hammond, a Texas attorney who also serves as executive director of the Pennsylvania-based National Guardianship Association, estimated fewer than 25 states have a public guardian program at all. Florida is ahead of those without one, he said, but barely. Without broad legislative support, it amounts to an unfunded mandate that raises equal protection concerns, he said.
Hammond said he knew of only one other state, New Mexico, with a waiting list for public guardians.

"The question ultimately is, 'What are we willing to pay in human cost to save money for the budget?"' Hammond said. "And if the government isn't willing to spend money on people who need assistance, what is the purpose of that government?"
A guardian is essentially a surrogate decision-maker, appointed by a judge after someone is found incompetent to care for him or herself. To qualify for public help, a person must have limited means and no family or friends willing or able to provide care.

"It's really the office of last resort for the most vulnerable of the vulnerable," said Michelle Hollister, executive director of the SPGO. "They're incapacitated, they have no money and they're basically alone."

Florida does have its success stories.

In 2006, a 69-year-old from Immokalee was suffering potentially fatal septic shock while his wife was out of the country. An emergency guardian was appointed, approved treatment and the man recovered.

A 63-year-old woman with dementia and mild retardation was saved from an abusive caregiver after an Adult Protective Services investigator found her hiding in some bushes. She was appointed a public caregiver and placed in a safe home.

But cases must be referred into the system, and that only happens if someone thinks an individual is exhibiting signs of incapacity. Because the state's wards are by definition alone, the first call often isn't made.

Florida's public guardian system is also chronically underfunded, relying on a county-by-county melange of charities, partnerships and sheer good will.

Some, like the Guardianship Program of Dade County, are almost entirely funded by the county. Others, like the Fifth Circuit Public Guardian Corp., which serves Marion County, rely heavily on the United Way, despite being a "public" agency.

The localities with waiting lists can't simply accept an additional ward or two, because state law limits how many people each guardian can have.
The SPGO is asking for a $1.3 million increase over its roughly $2.3 million budget this year, which would enable it to care for an extra 150 people. It isn't even trying to get the estimated $24 million it would take annually to serve everyone who needs help.

The most severe cases can be taken on by Adult Protective Services, but there are real effects of the waiting list limbo. Perhaps the most tangible is higher public health care costs, because hospitals must keep some patients until the system can accept them.

"As long as we know that they're taken care of," said Andrea Wolfkill, a case manager in Marion County. "If they're in a facility, I don't move as quickly — if they're in a hospital. They've had people two or three months because they don't have a guardian."

That problem — and expense — prompted Martin Memorial Health Systems in Stuart to initiate its own public guardian program for Martin County. Linda Hake, a senior attorney for the hospital who now oversees the program, said she had been trying since 1999 to start a public entity. It opened in 2006, with no county funding.

"Trying to find guardians for people who have no money is impossible," Hake said. "And those are the people that need them, because they're the ones typically that don't have the family resources. They're estranged from their family, they're alcoholics."

Saturday, March 29, 2008

Long Term Care Aims to Feel More Like Home

We found the following article useful in that it depicts many of the same philosophies we hold regarding senior and elder care in a home setting.

By Kay Brookshire,
Monday, March 17, 2008

A nursing home in Jefferson County and a Knoxville architectural firm are in the forefront of a reform movement aimed at taking long-term care out of institutionalized settings.

Jefferson County Nursing Home is adding three long-term care facilities slightly larger than traditional homes, each with private bedrooms and baths arranged around a hearth room, and a large dining table where residents and staff can gather for meals. The homes are designed to offer elders vibrant communities, with sun-filled rooms and a garden to explore, rather than institutions with long halls and sterile environments.

Read the Entire Article Here

What makes a Green House?

  • Architecture: Resembles nearby housing, ranging from single-family homes to high-rise apartment buildings. Private bedrooms and bathrooms, open hearth, dining and kitchen areas, ceiling lifts and fenced yard. Materials and design emphasize home-like setting.
  • Staffing: caregivers provide personal care, meal planning and preparation, light housekeeping, and laundry. A guide serves as a coach and supervisor and might serve one or more homes. Nurses enter and work in the homes much like they would in a home health care setting.
  • Interior design: Residents may bring some of their own furniture and accessories. A large dining table seats staff and residents together for meals. Bedrooms open to the central hearth area.
  • Size: Intentionally small, housing 6-10 people in 6,000-7,000 square feet.
  • Lifestyle: Less scheduled, more privacy and more control of their daily activities than a traditional setting.
  • Relationships: Social interaction is key, and friendship between caregivers and residents is encouraged. Families, children, pets and volunteers are welcome guests.

Monday, March 24, 2008

Is Crisis Looming for Elder Care in Hawaii?

Crisis coming in elder care, AARP warns
Residents pessimistic about health care in state

The number of people age 65 and older in Hawaii is expected to grow by 86 percent between now and 2030.

So says a survey by AARP Hawaii, which urges prompt action to avoid a crisis in long-term care for seniors.

"If nothing is done in the very near future, like right now, to begin addressing these issues in a substantive, systematic way, we're going to find ourselves with an essentially insolvable problem," said Bruce Bottorff, AARP Hawaii associate state director.

AARP Hawaii is urging the Legislature to pass Senate Bill 3255 with $250,000 to create a commission that would determine resources needed to meet long-term care policy goals.

Read Full Story Here

Sunday, March 23, 2008

Images From Kelso House AFC

We thought we should share some photographs taken during the past several months here at Kelso House. Enjoy!

Retired Racers Make Great Senior Companions

NORWALK — A retired racing greyhound’s life took a fortunate turn when she was adopted by the Norwalk Memorial Home last month.
Lexi, the 2-year-old greyhound, was actually adopted by more than 50 residents of the skilled-nursing facility at 272 Benedict Ave., according to Johnna Young and Nancy Nickoli, spokeswomen for Fisher-Titus Medical Center.

There are 54 long-term residents at the facility and many of whom have become ”enthralled” with the rescue dog since her arrival.

When Nickoli, director of the volunteers and activities at the nursing home, began searching for a replacement therapy dog for one that had died last year, she began familiarizing herself with greyhounds, she said.

Continue Article Here

We have a Retired Racer at Kelso House AFC
They DO Make Good Senior Companions!

Let's Talk About the Weather

February 11th, 2008

Kelso House Adult Foster Care is in Northern Michigan, and this time of year can bring some pretty extreme weather conditions to our area. For example, the past two days saw temperatures around -20 degrees Fahrenheit — NOT counting the wind chill. And it WAS windy.

To add to these conditions, the electric power was knocked out for about 2 hours last night. This was right during dinner, so out come the candles. Northern Michigan Adult Foster Care Tip Number One: keep plenty of candles around. Know where a working flashlight is, and know where to find matches or a lighter for just such emergencies.

We have a gas furnace - but, it needs electricity for the thermostat to even kick the furnace on. We finished our dinner by candlelight, then all stayed in one room and wrapped up for the duration. Northern Michgan Adult Foster Care Tip Number Two: have plenty of extra blankets on hand - comforters and feather beds are the best.

Ailie and my wife curled up on the large sofa together with two large blankets over them to stay good and warm, and I got under the feather bed on a smaller sofa and read a book by candlelight.

Kelso House Adult Foster Care is well-insulated and the heat conserved well. It has crossed my mind a few times to have a back up generator. This is not a bad idea. On the other hand, we have been here for over 8 years now, and the electricity has never been out for more than a few hours. This time was no exception. Ailie had actually fallen asleep, when the lights popped back on and the smoke alarms started beeping around 9 pm and roused us all.

Even when the electricity is fully operational, keeping elderly clients warm in rough winter weather is of primary concern. A blanket is kept over them at all times - even while watching television on the cushy sofa. At night, the temperature always drops a little more, and keeping our clients warm in bed is very important. Northern Michigan Adult Foster Care Tip Number Three: Ailie’s bed is equipped with a heated mattress pad, which we keep at a low heat during the night, and she reports that this keeps her very warm and cozy.

Remember that your clients may not always voice their needs to you. You must always be thinking of their needs and asking them if they need such things as blankets while they are sitting on the sofa, for instance. Better yet - just bring it to them, and they will most likely use it once they see it in front of them.

In Northern Michigan, just when you think winter is letting up - that’s when it always can catch you off guard. Be prepared - stock up on batteries - know where to find flashlights and lighters and matches. Keep heavy blanket and comforters handy. And always try to anticipate your aged clients’ needs before they need to ask.

Hoping the rest of YOUR winter is safe and warm,

Kelso House - a Northern Michigan Adult Foster Care Home for the Aged.

How to be Happy (Don't Worry)

January 26th, 2008

Cambridge - The seniors at Cadbury Commons now have a new skill to master: laughing out loud for one minute a day — every day. Even if there’s nothing at all to laugh about.

Last week, retired psychology professor Freda Rebelsky stopped by the independent and assisted-living facility to educate the residents about how to be happier.

Read More Here

Having "that talk" -- Sooner Rather than Later

January 26th, 2008

I picked up a recent post from a site called The author addresses the often prickly subject of procrastination. Specifically — children waiting and avoiding discussion of what to do about aging parents who are becoming increasingly unable to live on their own.

A highly regarded book on just this subject is available from Amazon and many other online sources. It is called, The Parent Care Conversation. Read amazon customer reviews.

More on BC/BS of Michigan and House Bills 5282-5285

In a recent blog post, Jeff Emanuel discusses Michigan House Bills 5282-5285, pertaining to changes in insurance laws being pushed by Blue Cross / Blue Shield of Michigan. His introduction reads:

“In late 2007, after a single perfunctory committee meeting, the Michigan House of Representatives passed a series of four bills which, if approved by the Senate and signed into law by Gov. Jennifer Granholm, will have a very negative effect on the health insurance market in the state.”

. . . and later in his article he writes:

Health care giant Blue Cross Blue Shield (BCBS) has long enjoyed tax-exempt status in Michigan, as the result of a 1938 deal BCBS made with the state to be the “insurer of last resort” for otherwise uninsurable consumers. This means, for tax purposes, that the carrier was treated as a non-profit corporation, while actually operating as a for-profit business.”

To read Jeff’s entire article, go to his blog-entry page.

Besides being a self-described “combat journalist,” Mr. Emanuel is a Research Fellow for Health Care Policy at the Heartland Institute (a free-market public policy organization) - and - the Managing Editor of Health Care News.

Is New Blue Cross Plan Bad for Michigan?

Blue Cross / Blue Shield of Michigan is trying to push a controversial insurance bill through the Michigan state legislature. Michigan attorney general Mike Cox is adamantly opposed to the bill, and he recently wrote an editorial expressing his opinion and his reasons. Here is that editorial. Please take the time to weigh in on this serious topic — the new bill could adversely affect Michigan’s elderly population and hamper the efforts of Senior Care Providers, Assisted Living Facilities, Adult Foster Care Homes, and Nursing Homes, to keep their clients in good health.

Published January 13, 2008 [ From Ingham County Community News ]

Blue Cross plan is bad for Michigan

by Mike Cox — Attorney General for State of Michigan

Michigan citizens could see dramatic changes to their health insurance rates and coverage if the legislature approves a package of bills being pushed by Blue Cross. If signed into law, House bills 5282-5285 will cause subscribers, especially the old, sick and most vulnerable, to pay much more for coverage or lose their insurance altogether, while fattening Blue Cross’ already profitable bottom line.

The Blues were created in 1939 and given a social mission; specifically, to be the “insurer of last resort.” As a result, Blue Cross was also made tax-exempt. By their own admission, this tax-exempt status benefits the Blues by at least $82 million each year.

And Blue Cross has done well. Their share of the commercial health insurance market in Michigan is 70 percent. Their surplus has more than doubled in the last five years, to more than $2.8 billion, the highest in history. Blue Cross makes more than a million dollars a day in profits.

Salaries are on the rise, too. According to data filed with state regulators, Blue Cross paid its top ten officers $11.5 million in salary and compensation in 2006 — that’s a 42 percent increase since just 2004.

Guess what else has been going up? Rates. Individuals seeking health insurance have seen their rates skyrocket by 79 percent since 2003. And for those folks who have converted from group policies, their insurance rates have shot up even more — a 92 percent increase since 2003.

Not surprisingly, these massive rate hikes mean that more and more Michigan citizens and families can’t afford insurance. The number of uninsured in Michigan has gone up 8 percent since 2001. And the number of people on Medicaid has ballooned by 38 percent in that same time period. The result: One out of every four Michigan citizens is either uninsured or on Medicaid.

But Blue Cross says that it is heading for a “death spiral.” So the Blues are pushing a package of bills that will do the following:

# Deny coverage of pre-existing conditions for 12 months, a doubling of denial time;

# Charge new customers with chronic diseases such as diabetes up to 80% more;

# Charge new customers with serious illnesses such as cancer up to 250% more;

# Enable the Blues to triple their margins for administrative expenses and profits; and

# Eliminate oversight by the Attorney General and the Governor’s Office of Financial and Insurance Services (OFIS).

Oversight is crucial. This year, Blue Cross sought a 50 percent hike on the premiums that seniors pay for Medigap insurance. I intervened, saving more than 215,000 Michigan seniors $97.5 million initially, and over $69 million per year after that.

These bills would also eliminate the Governor’s ability to provide oversight of rates, by eliminating the ability of the Commissioner of OFIS to set rates. As a result, all state oversight — the ability to intervene and fight for lower rates — for any of Blue Cross’s future rate hikes would, for all practical purposes, be wiped out.

These bills seriously jeopardize Blue Cross’ social mission to care for the oldest and sickest in Michigan, and they destroy the Attorney General’s mission to protect them. I call upon citizens to contact their state legislators and urge Blue Cross stay true to its traditional — and legally required — mission “to secure for al of the people of this state … the opportunity for access to health care services at a fair and reasonable price.”

Mike Cox is Michigan attorney general.

Number of Presciption Drugs Covered by Medicare Dropped for 2008

Drug coverage - by number of drugs covered - from the four largest Medicare providers have been slashed by an average of 30% from 2007. AARP MedicareRx Preferred, AARP MedicareRx Saver, Humana PDP Standard, and Humana PDP Enhanced have all lowered the number of prescription drugs they will cover for seniors. In the case of AARP MedicarRx, for example, the number has dropped from 3,763 in 2007 to 2,627 different drugs covered for the current year. Of the top ten prescription drug providers, all but two have decreased the total number of covered drugs under Medicare Part D.Seniors and their care providers need to carefully review the changes in policies and their medications to avoid costly shocks at the prescription booth.

A reason for some of the drops is the Center for Medicare-Medicaid Services (CMS) decision to eliminate coverage for drugs either not approved by the FDA, or drugs approved prior to 1962 - when approval was based upon safety but not efficacy. According to CMS policy, drugs approved in the period 1938-1962 which have since been determined to be “less than effective,” should not be covered by Part D plans.

The Official U.S. Government Website for People with Medicare offers a Formulary Finder, organized by state. The Finder allows you to find plans in your state that match your required drug list:

Formulary Finder

Selecting an Adult Foster Care Home

(Originally Posted - 30 December 2007)

The Michigan Department of Human Services has advised the following:

How Do I Choose An Adult Foster Care Home Or A Home For The Aged?

There are many types of AFC and HFA homes. Before making a decision, it is strongly recommended that you visit the home, talk with the residents , consider the neighborhood and question the provider. The agencies listed below may help you in the selection process:

Local Department of Human Services, Adult Services Unit
Michigan Department of Human Services, Bureau of Children and Adult Licensing, Licensing Division

Local Community Mental Health Board

Michigan Department of Community Health
Michigan Rehabilitation Services
Citizens for Better Care
Local Office on Services for the Aging

State Office on Services for the Aging

The numbers and addresses are in your local telephone directory.

When selecting an AFC or a HFA home, it is important that you clearly understand the services to be provided and the cost of those services.

If you are in the Grand Traverse / Benzie / Leelanau regions of northern Michigan, you may find help with placement through The Alliance. The Alliance was featured in a recent article in the Traverse City Record-Eagle:

Published: November 04, 2007 09:46 am Solutions for Seniors

Choosing the right living situation takes research and time

Special to the Record-Eagle

TRAVERSE CITY — For a time after her stroke, it looked as if life might go back to normal for Annabelle Boersma.Always independent and active, the elderly woman spent two months in an assisted living facility for rehabilitation, then came back home to live alone — with her children checking in on her.But after another hospitalization and another return home, Boersma realized that things had to change.“She said she knew when she walked in the house she could never be home alone again,” said Judy Galligan, Boersma’s daughter. “She was frightened.”Historically, older adults have lived on their own, moved in with their children or headed to a nursing home.Today’s senior citizens, however, face an expanding array of housing choices. New programs, services and technology are helping people stay in their homes longer, while a growing number of nursing homes and retirement communities offer in-home services ranging from housekeeping to telemedicine. Meanwhile, the number of assisted-living facilities and continuing-care retirement communities across the nation has grown steadily over the past decade.With all these choices and services, the search for just the right fit can be time-consuming, frustrating, confusing — and overwhelming.But for residents of Grand Traverse, Leelanau, Benzie, Kalkaska, Antrim and Wexford counties, The Alliance can help.“Our mission is to preserve the dignity and independence of the people our clients cherish most, the family,” explained the program’s founder Connie Hintsala. “We help by providing updated information on each home or facility in the area. We’ll come to the family’s home, discuss their needs and offer suggestions, based on their financial situation.”

The service is free to the families, with funding coming from the homes and facilities that Hintsala enrolls in the program.

“We do the footwork on the homes, gather information and photographs and place them into a portfolio,” explained Hintsala. “We continuously update their information by working closely with each home.”

With help from The Alliance, Boersma, 87, chose Country Pleasures, a small group home on six acres run by Deb Banton and her husband, Wayne. Even then, however, it was a difficult adjustment.

“It was a very big adjustment because she gave up her car and everything; she was driving right up until her stroke,” said Galligan, who visits weekly and often takes Boersma for day and overnight outings. “It was debilitating for all of us because she had been so independent.”

Banton said initial reactions vary from resident to resident.

“Sometimes they’re very angry. They feel they’re being forced to move in,” she said. “We get a great variety, from very upset to ‘I don’t want to do this but I have to.’”

For families who are considering making such a choice for their loved one, she recommends talking it out first, then bringing the loved one for a visit.

“I find it’s better if the family is honest with them and open and at least tries to talk to them,” she said.

After placing a loved one in a new housing arrangement, families should visit often, especially at first, she said. To ease the transition, Banton makes extra time for chats with new residents and encourages other residents to share their experiences there. She also offers plenty of activities, including scenic drives around the area with a stop for $1 sundaes at McDonald’s.

After about two weeks, “it’s like, ‘OK, this isn’t as bad as I thought it was going to be,’” she said.

Finding the right fit was crucial for Galligan. So was letting her mother call the shots.

“It’s not a decision that’s easy to make all at once and I can see why,” Galligan said. “This is the last stage in (her) life because there is no moving from here.”

Banton, whose home offers everything from medication set-up and other basic assistance to end-of-life care, likes to interview potential clients and sometimes rejects those she feels won’t get along in the family-like setting.

“I’ve turned down people that the first time I met them I thought, ‘This isn’t going to work,’” she said. “That’s very important in a small home because they really are like a family.”

But even if one housing situation isn’t right, there are plenty of others. In northern Michigan, the housing options for seniors include:

Retirement Centers: Apartments for independent living that often provide meals (which may or may not be included in the monthly rent), light housekeeping, social activities and transportation.

Assisted Living: Units that provide various levels of care, social programs, meals, laundry, housekeeping, transportation, medication dispensing and monitoring, assistance with daily living tasks. Hospice and respite care are sometimes available.

Adult Foster Care: Semi-private to private bedrooms with various levels of care, social programs, meals, laundry, housekeeping, transportation, medication dispensing and assistance with daily living. Respite and hospice care are sometimes available.

“Low-income senior apartments and nursing homes are also available in the region,” said Hintsala. “But low-income senior apartments often have waiting lists of two to eight months and costs are linked to income.”

Hintsala estimated that there are about 70 assisted living and adult foster care homes in the Traverse City region.

“We look for a home based on their needs,” explained Hintsala. “For example, if the parent is very social, we would suggest a home with a more social program, not reclusive. We don’t push families, but help guide them in their choices.”

While many of her clients are referred to The Alliance by doctors, lawyers or social workers, no referral is required. More than 200 families have taken advantage of Hintsala’s program, which also helps provide advice on and interpret insurance and other means of paying for housing.

For more information on The Alliance, call (231) 263-4040.

Record-Eagle staff writer Marta Hepler Drahos contributed to this story.

Defining Adult Foster Care for the Aged

The Michigan Department of Human Services has published the following definitions of Adult Foster Care and Home for the Aged:

Who Needs Foster Care

Out of home and non-nursing home options include Adult Foster Care and a Home for the Aged.

Adult Foster Care (AFC) homes are residential settings that provide 24-hour personal care, protection, and supervision for individuals who are developmentally disabled, mentally ill, physically handicapped or aged who cannot live alone but who do not need continuous nursing care.

  • AFC Homes are restricted to providing care to no more than 20 adults

A Home for the Aged (HFA) provides 24 hour room, board, and supervised personal care to:

  • 21 or more unrelated, nontransient individuals 60 years of age or older.
  • 20 or fewer individuals 60 years of age or older that is operated in conjunction with and as a distinct part of a licensed nursing home.

Note: HFA is restricted to providing care to persons who are 60 years of age or older

If you are uncertain about the level of care needed by the individual seeking adult foster care or a home for the aged, check with the individual’s doctor or the Adult Services Unit of your local Department of Human Services (DHS) for assistance.

Both AFC Homes and HFA provide care to persons who are or have:


Mentally Ill

Physically Disabled

Alzheimer’s Disease or other Dementia Related Disorders

Care may include assistance with bathing, grooming, dressing, eating, walking, toileting or the administration of medication.

Statutory Authority -

Regulation of Adult Foster Care homes—Act No. 218 of the Public Acts of 1979, as amended.

Regulation of Homes for the Aged—Act No. 368 of the Public Acts of 1978, as amended.

Safety in the Adult Foster Care Setting

(originally posted - 30 December 2007)

Winter is fully upon us in northern Michigan — snow and ice present hazards that can lead to slips and falls by a senior client or your older loved one. From the National Center for Injury Prevention and Control:

“ Among people 65 years and older, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma. Each year in the United States, nearly one third of older adults experience a fall.

In 2003, more than 13,700 people 65 years or older died of fall-related injuries. Another 1.8 million were treated in emergency departments for nonfatal injuries related to falls. The total direct cost for falls among older adults in 2000 was about $19 billion. Given the growing population of this age group, this cost is expected to reach $43.8 billion by 2020.”

And this: “From 1988 to 2000, the unintentional fall death rates for both men and women increased significantly (p<.01, test for linear trend). In 2000, rates for men were 20% higher than rates for women.
(Data: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2002.)

There are things you can do to help prevent such accidents. The following is from the guide, “What YOU Can do to Prevent a Fall,” published through the Center for Disease Control and Prevention.

What You Can Do to Prevent Falls

Many falls can be prevented. By making some changes, you can lower the chances that an elderly person may fall.

Four things YOU can do to prevent falls:

1. Begin a regular exercise program

2. Have your health care provider review your medicines

3. Have your vision checked

4. Make your home safer

1. Begin a regular exercise program

Exercise is one of the most important ways to lower your chances of falling. It makes you stronger and helps you feel better. Exercises that improve balance and coordination (like Tai Chi) are the most helpful. Lack of exercise leads to weakness and increases your chances of falling. Ask your doctor or health care provider about the best type of exercise program for you.

2. Have your health care provider review your medicines

Have your doctor or pharmacist review all the medicines you take, even over-the-counter medicines. As you get older, the way medicines work in your body can change. Some medicines, or combinations of medicines, can make you sleepy or dizzy and can cause you to fall.

3. Have your vision checked

Have your eyes checked by an eye doctor at least once a year. You may be wearing the wrong glasses or have a condition like glaucoma or cataracts that limits your vision. Poor vision can increase your chances of falling.

4. Make your home safer

About half of all falls happen at home. To make your home safer:

  • Remove things you can trip over (like papers, books, clothes, and shoes) from stairs and places where you walk.

  • Remove small throw rugs or use double-sided tape to keep the rugs from slipping.

  • Keep items you use often in cabinets you can reach easily without using a step stool.

  • Have grab bars put in next to your toilet and in the tub or shower.

  • Use non-slip mats in the bathtub and on shower floors.

  • Improve the lighting in your home. As you get older, you need brighter lights to see well. Hang light-weight curtains or shades to reduce glare.

  • Have handrails and lights put in on all staircases.

  • Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers.