Kelso House Adult Foster Care

China's Coming Crisis Of Elder Care

2009-12-20T13:24:00.002-05:00

Global Times

As China's one-child policy moves to its next generation, the "4-2-1" problem, namely four grandparents and two parents with only one adult child to look after them, has become a pressing concern for many families.

The one-child policy has severely challenged China's traditional family system. As the old Chinese saying goes, "Raise sons to provide for old age." Under the old system, the younger generation, men in particular, served as the main providers for older family members. This is the logic behind the traditional thinking of having more children, especially boys.

But the one-child policy leaves many families with little choice. Therefore, regardless of gender, the only child faces the challenge of providing for all the aged in the family when time comes. It is like an inverted pyramid – the pointed side has to support all the weight of the whole structure.

However, for many young people in the urban areas, who were born as the only child in the late 1970s or later, the time hasn't come yet. Most of their parents are either working or have social securities and personal savings to support themselves.

Their grandparents are not their problems, since their parents basically take care of the issue by sharing the responsibilities with their brothers and/or sisters and using their own resources.

China hasn't moved to the stage of "4-2-1" yet. The parents of China's first generation of one child are still the main providers now.

Mostly in their late 50s or early 60s, these people are quickly draining their lifetime savings to help their children by buying them apartments, careers, or other things. They stretch themselves to simultaneously care for their children as well as their parents.

But the situation won't last long. With China's living expenses shooting up and the increasing life span of old people, responsibility is going to shift.

Unlike Western countries, which have a developed social support system for the elderly, China is still experimenting with and reforming its public welfare system.

Not everyone in China has social insurance, especially among the rural population. When these social mechanisms fail, the last resort is their only child.

Some young people are acknowledging the challenge ahead of them. It is a daunting task even to imagine how a young couple could support four aged people or more while trying to make ends meet for their own small family.

Many of them can only cross their fingers that their parents won't have any serious illnesses that go beyond the coverage of social insurance or their own personal savings.

Even when the financial needs are not a big concern, how to take care of the other personal and emotional needs of the older generation is going to be a tricky task for these only children.

I am lucky enough to have two siblings, and even then it's hard sometimes to make sure somebody gets home for the Spring Festival with our parents. I can't imagine how bad the situation might be for those one-child families, especially given how scattered across the country many families are.

The living situation is another problem. When parents have aged to the stage where they can't take care of themselves, where to put them becomes a real headache. One can either live with the parents or send them to an old folks home.

But the latter doesn't sound like a good solution as putting parents in a nursing home is totally against Chinese beliefs.

China's elder care industry is also still in the early stage of development, as the Global Times reported yesterday.

My mother joked once that she could go there, but I could tell from her eyes that she didn't mean it.

However, with both sets of parents needing help, young families may face a very awkward situation. It is already very difficult for grown-ups to live with their parents. Living with in-laws could be even worse.

But the worst scenario is to put both sides of the parents under the same roof with the young couple, especially if there is a young grandchild around.

We can only hope that time and reform will solve everything. When the "4-2-1" crunch comes, we must already have a terrific social support system for the aged, no matter where they live or how many children they have.

Human Services Chief: Cuts Hurt Elder Care

2009-12-19T09:38:00.002-05:00

News-Telegram

Fitchburg, MA -- People receiving services and others who provide them testified at a forum at Fitchburg State College last night on how cuts to state aid have affected programs.

The forum, moderated by Secretary of Health and Human Services Dr. JudyAnn Bigby, was one of 19 planned across the state seeking input on the upcoming state budget and how to fill a projected $3 billion deficit in fiscal 2011. A panel comprised of Health and Human Services officials also attended.

In a pre-recorded address played at the start of the forum, Gov. Deval Patrick said his administration was going through the budget line by line to find savings while still providing services to the most vulnerable populations in the state. He said his administration was building a budget around community values.

Greg A. Giuliano, incoming executive director of Montachusett Home Care — an agency that provides in-home and community-based services to the elderly — said cuts in state funding have diminished the agency’s ability to provide services.

“It’s important to back up the rhetoric about building a budget around community values,” he said.

He said the agency’s parent organization, Mass. Home Care, which works to keep elders from having to enter nursing homes, has more than 2,000 elderly on a waiting list for services.

The state, he said, impounded $2.5 million that was targeted for staff who go into hospitals and educate people on their rights to community care that can divert them from nursing homes. Additionally, he said, the group-home model that places four elderly people in a ranch house instead of a nursing home has been derailed by the state for two years; and the elder abuse program was cut by $1 million.

He urged the state to restore funding to those areas and not make further cuts.

Suggestions from the audience to fill the state’s deficit to avoid further cuts to services included legalizing marijuana and taxing it to increase revenues, increasing taxes on tobacco products and just generally increasing taxes.

Linda C. Lolly, a personal care assistant for people with mental illnesses, was a proponent of legalizing and taxing marijuana to save in-home services to those she supports.

“I have seen it over and over again that an elderly person can stay in their home when someone comes in and gives them a bath and gets them dressed for the day,” Ms. Lolly, who works for Arcadia Health Care in Worcester, said. “That’s just a few hours instead of having them go into nursing homes that cost thousands of dollars because there is no one else to do it for them.”

Dr. Bigby said the upcoming budget cycle is going to be even more difficult than last year because fiscal 2010 was balanced on $2.1 billion from one-time revenues. Moreover, there is only $561 million left in the state’s stabilization fund, she said, that may be needed in this budget cycle.

The Health and Human Services budget totals $13.7 billion — 51 percent of the state’s overall budget of $27 billion.

26 Arrests In Medicare Fraud Case

2009-12-18T13:31:00.000-05:00

Associated Press

FORT LAUDERDALE, Fla. — Federal agents arrested 26 suspects in three states Tuesday, including a doctor and nurses, in a major crackdown on Medicare fraud totaling $61 million in separate scams.

Arrests in Miami, Brooklyn and Detroit included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so that he could bill for twice-daily nurse visits.

The U.S. Department of Justice and U.S. Department of Health and Human Services said the indicted suspects lined up bogus patients and otherwise billed Medicare for unnecessary medical equipment, physical therapy and HIV infusions.

Indictments were issued for 32 people in all, but the status of the other suspects wasn't immediately known.

Miami Dr. Fred Dweck, along with 14 people with whom he worked, was accused in an indictment of running a scam to tap a Medicare program that pays very high rates to care for the sickest patients.

Dweck referred about 1,279 Medicare beneficiaries for expensive and unnecessary home health and therapy services, bribing the owners of two Miami clinics to join the scam. He also faked medical certifications, according to the indictment.

A telephone listing for Dweck could not be found and it was unclear if he had a lawyer.

"No matter what type of fraud is committed, there is one common denominator and that denominator is greed," Assistant Attorney General Lanny Breuer said. "Medicare fraud is not a victimless crime. It hurts every American taxpayer by raising the cost of health care."

The raids come a week after a report that Miami-Dade County received more than half a billion dollars from Medicare in home health care payments intended for the sickest patients in 2008, which is more than the rest of the country combined, according to a report by the Department of Health and Human Services' Office of Inspector General. Medicare paid the county about $520 million, even though only 2 percent of those patients receiving home health care live here.

In Detroit's raids, suspects paid recruiters to find patients willing to feign symptoms to justify expensive testing, including nerve conduction studies, federal authorities said.

A mother and son were charged in Brooklyn with billing Medicare $246 per patient for expensive shoe inserts reserved for diabetes patients, even though they only provided cheap, over-the-counter versions.

Including Tuesday's arrests, a Medicare Fraud strike force formed by the Justice and Health departments has now charged suspects accused of bilking Medicare of more than $1 billion in less than two years.

The pilot strike force, which started in Miami in 2007, has indicted more than 460 suspects in Medicare fraud scams. The program is now in Los Angeles, Houston and Detroit. HHS Secretary Kathleen Sebelius also announced Tuesday the operation will expand to Tampa, Fla., Baton Rouge, La., and Brooklyn.

Cleaning up an estimated $60 billion a year in Medicare fraud will be key to President Barack Obama's proposed health care overhaul. HHS and DOJ have promised more money and manpower to fight the fraud.

The New Old Age - Who We Are Now

2009-12-16T10:04:00.002-05:00

NY Times

We’re still, in most cases, female.

We’re still likely to be employed, usually full time.

We spend an average of 19 hours a week at this second job, caring for our older relatives.

Every few years, the National Alliance for Caregiving and AARP team up to survey the nation’s family caregivers and produce a massive, highly detailed study funded by Metlife. The first of these reports appeared in 1997, the next in 2004. The latest, released this week, provides an interesting picture of what’s changed in five years and what hasn’t.

The overall report, “Caregiving in the U.S. 2009” [pdf], includes people taking care of family members of any age, including children with special needs. But the researchers, helpfully, have also published a companion study of people caring for adults over 50.

It shows that elder care remains primarily women’s work and that most caregivers continue to juggle unpaid caregiving and paid work.

What’s changed? The people we take care of are older. In 2004, the proportion of elders over age 75 was 55 percent; now it’s 63 percent. We’re older, too: caregivers’ average age rose from 48 to 50. Unsurprisingly, then, a higher proportion are caring for seniors with Alzheimer’s disease and other forms of dementia.

But we have less paid help. The proportion whose older relatives had aides, housekeepers or other paid workers dropped to 41 percent from 46 percent; the use of paid help also declined among all caregivers. The data don’t specify why families use less paid caregiving, but AARP’s Elinor Ginzler pointed to the most plausible explanation.

“Likely, this is related to the economy,” Ms. Ginzler said this week. “They can’t afford it.”

Perhaps in response, unpaid caregiving supplied by other family and friends has risen.

I’m always a little relieved, since we all hear too many heartbreaking stories of families crushed by their responsibilities, to be reminded by this and other caregiving studies that a majority of families handle the burden without great hardship or crippling trauma. Most respondents in this study said caregiving hasn’t harmed their own health or created much physical strain, and only a third found caregiving highly stressful emotionally. (To which I can hear a chorus of readers replying, “Just wait.”)

What kind of support would families caring for their elders most like to see? Topping the list is a $3,000 tax credit, followed by respite services, a voucher program that would pay family members minimum wages to be caregivers, and transportation services.

Seniors Teach Med Students Finer Points Of Elder Care

2009-12-15T09:34:00.000-05:00

UAB Reporter

Lorain Devito is an expert on the elderly. She knows their tendencies, their likes and their dislikes. She knows how strong their will can be. She also knows their fears.

Devito knows these things because she, too, is elderly. Devito is a resident at Episcopal Place, a Section 202 supportive-housing program that provides seniors and disabled adults with restricted income safe and affordable housing and access to related services in a home-like environment.

She’s a very busy lady. Devito, a diabetic, swims regularly and helps interview potential Episcopal Place residents. She also volunteers for two programs in the School of Medicine — the Senior Mentor Program and the History of Medicine Program — and she meets with medical students to discuss health care.

“I look at this as an opportunity to give back and an opportunity to help the physicians of tomorrow better understand geriatrics,” Devito says.

Both programs have been a part of the School of Medicine and the Division of Gerontology, Geriatrics and Palliative Care for several years and recently received a jolt with a $2 million grant from the Donald W. Reynolds Foundation and a $1 million match from the university. Christine Ritchie, M.D., director of palliative and supportive care, is the principal investigator for the four-year grant, which will improve education for the school’s 875 medical students and for 350 residents, numerous faculty and community physicians.

“Both programs were part of the original grant proposal and are receiving much-needed funding,” says Angela Rothrock, Ph.D., assistant professor in gerontology, geriatrics and palliative care and associate director for the day-to-day operations of the UAB Reynolds Program. “The grant will enable us to change the programs — particularly the Senior Mentor Program — in positive ways. It’s certainly reinvigorated the programs and helped us increase the diversity of our seniors.”

Stan Massie, M.D., associate professor of general internal medicine, oversees the Senior Mentor Program for first-year medical students. Richard Sims, M.D., professor of geriatrics, is the co-director.

Rothrock says Massie and Sims were responsible for starting the program and have kept it going with little funding.

The course is a unique opportunity for first- and second-year medical students to be paired with a senior citizen living in the Greater Birmingham area.

Among the goals of the program:
• Provide students with an opportunity to develop a working relationship with a patient
• Expose students to community-dwelling elders
• Enable students to visit elders outside of UAB
• Provide opportunities for students to practice their interviewing skills
• Make students aware of some of the principles and challenges involved in care of the elderly

Two students are paired with an adult and visit their senior mentors approximately six to seven times in two years.

“There are specific things we want them to learn each visit,” Rothrock says. “One visit might be learning to do history-taking. One might be learning to do a cognitive assessment, a depression scale or a medication review. There are specific clinical skills we want them to learn. But we also want them to learn that all older adults are not sick and frail. There are older, healthy and vibrant adults in our community who they have a lot to learn from.”

Focus on geriatrics

The Donald Reynolds Foundation grant is part of $80 million it gave to UAB and 39 other medical schools to focus student learning on better care for the elderly.

The grant requires internal medicine residents to spend one month in geriatrics training in settings that include acute care for the elderly, a long-term care facility, outpatient clinics and home-care visits. Other programs, including interactive, online training modules and special geriatric training for residents in internal, emergency, family and pediatric medicine, also are in development.

The Senior Mentor Program also will evolve into an interdisciplinary program.

“It won’t just be a medical student working with an older adult, it will also be a nurse, a social worker, a dental and a therapy-based-practice student working in teams,” Rothrock says. “The professionals in training will discuss how to work in an interdisciplinary team to best care for older adults.”

Training in geriatrics, the area of medicine that focuses on diagnosing and treating diseases and problems particular to older adults, is essential for future physicians.

The first Baby Boomers begin turning 65 in 2011, which creates an additional sense of urgency. The Silver Tsunami, or wave of seniors seeking medical care, is expected to increase dramatically during the next decade.

“Given the changing demographics, we’d have to train far more physicians than we are able in order to have enough geriatricians,” Rothrock says. “So even if you’re not a geriatric specialist, you’re going to have to care for older adults. What we can create are geriatric-friendly physicians so that any physician coming out of training is attuned to geriatric needs and able to recognize that caring for older adults requires a different perspective on health care.

“If we don’t train health-care professionals in general to care for older adults, from basic communication skills to very technical clinical skills, they’re not likely to learn it,” Rothrock says. “In the average medical journal you’re learning about outcomes in a 40-year-old white man, and that’s not who’s going to be coming into their clinics.”

Mentors are the teacher

That’s why the mentorship program is so valuable to students. They get an opportunity to begin learning the way seniors live and think.

In fact, Rothrock makes it known when she is recruiting the seniors that they are to make sure they do one specific thing with the students — speak their mind.

“I tell these local residents, ‘You’re the teacher. If you don’t like the way they ask you questions, tell them,” Rothrock says. “This is a collaborative model. The seniors aren’t just guinea pigs. It empowers them and gives them some ownership in the program.”

Devito is more than happy to do that after 14 years without taking charge of her own health. Part of that blame she says is hers, but she also says her physician never pushed her hard for information and never fully educated her on potential outcomes due to her medical issues.

“You go to a doctor because you want answers and direction — at least that’s why you should go,” Devito says. “Geriatrics are not always honest about their health. They think, ‘If I have this problem or that problem and tell the doctor about it, I’m going to wind up in the hospital having surgery.’ Obviously that’s not always the case. I think this program will better prepare these students to treat geriatrics. Because I can assure you, they are going to see patients just like me, who gave very little information and thought they could handle their health on their own. I’m glad I’ve got a doctor now that will ask me questions and tell me what to do.”

Elder Care Survival Key Concern At County Forum

2009-12-14T09:54:00.000-05:00

Courier News

Kane County, Il -- Nearly 100 Kane County elder care providers, senior citizens and their advocates discussed federal and state issues relating to elder care during a legislative forum Monday in St. Charles.

The event was sponsored by Kane County Senior Resources, Asbury Gardens, Countryside Care Center, Heritage Woods of Yorkville, and the Northeastern Illinois Area Agency on Aging.

Among challenges discussed were the state of Illinois' lagging Medicare payments to small businesses that provide elder care and services.

Betty Schoenholtz, executive director of Senior Services Associates, said state payments to elder care providers -- many of whom are small-business owners -- have lagged for months because of the state's budget shortages.

"It is of great concern to me what is happening to our (provider) agencies," Schoenholtz said, adding that those funds would help stimulate the economy through purchases made by small businesses. "When the state of Illinois doesn't pay its bills, we can't buy things from small business ... We hope (state legislators) can step up to the plate and resolve these issues."

She also recommended that legislators change state law to require the Illinois Department of Public Health to allocate at least $750,000 into the ombudsman program, or to implement a "bed fee" similar to Ohio's, which requires a $6-per-bed fee to help offset costs to agencies. Schoenholtz also said the elder abuse program is owed $134,000 from the state and that the figure represents one-third the budget for elder abuse cases.

Lucia Jones, executive director of the Northeastern Illinois Area Agency on Aging, also said she is concerned about how the state's budget issues are impacting service providers.

"The providers are all small-business owners," Jones said. "The numbers they serve are going up tremendously, because of the economy ...â€‰. There are hundreds and thousands of families in the state of Illinois in need of elder care; and if the ombudsman program is cut, those people will have to go into long-term care."

AARP spokesperson Heather Heppner also provided an update. "We have spent a very long time advocating to prevent cuts to community-based services. We know it is more fiscally responsible to care for individuals in their homes than in institutions," she said. "We have providers who have not been paid this entire fiscal year ...â€‰. Senior services need to have a heightened level of priority."

She also noted that AARP endorsed the Affordable Healthcare for America Act.

"On the House bill side, it was not perfect ... but the bottom line is that our health care system in this country is broken, and the things our AARP members have told us are important issues are addressed in that bill," Heppner said. Older adults were at times paying up to seven times more in insurance rates than younger adults, she said, and the health care act would cap age rating at two to one.

Lobbyist Working To Help Senior Citizens

2009-12-11T10:57:00.000-05:00

Wicked Local Harvard

Deb Thomson knows all the ins and outs of Beacon Hill’s workings.

As a lobbyist for elder care and health care issues, Thomson spends her days working on behalf of a growing senior population. As a founder of The PASS Group, a legislative and administrative advocacy organization working for non-profit companies, Thomson says taking care of all its citizens is what a country should do to its best ability. Laws can get bogged down with words and requirements, but in the end, they need to serve the people in the best way possible.

For instance, Thomson is working hard for the spouses of those who need long-term care and have to put themselves into poverty to get it. A nursing home resident gets a monthly allowance of $72.80 to cover everything Mass Health does not — shoes, clothes, telephone calls, transportation, books or newspapers, said Thomson. It is a figure she finds ridiculous and wants to see increase, but it is a fight to just have it remain steady.

“This is a perilous time for human services because of all the budget cuts,” she said.

For anyone interested in lobbying work, Thomson says a good way to start is to be an aide to a legislator. A determined group of people can make a difference.

Q How did you get started in your career?

A I am an attorney and for many years, I worked as an elder law attorney and in legal services which serves lower income seniors. Part of that developed into legislative advocacy work where you pass bills and legislation that would benefit programs that elders rely on for income and health care purposes.

Q What got you started in elder services and health care?

A When I was in law school I volunteered in a clinic for elder clients. I worked for the Alzheimer’s Association for five years working on public policy. And then I left there and went into a legislative and administrative advocacy business. I had a great interest in the issues that confront the elderly in our society.

Q It sounds like you must have your ears open to everything.

A Well, I also used to work for Massachusetts law reform [agency] for several years that was devoted to advocacy on behalf of lower income people. There is a whole community out there, of which you may not be familiar, advocates and people who work on behalf of clients in nonprofit organizations trying to improve society. It is a real specialized niche in both the political and legal world.

One thing that surprised me was how small town Boston is in these circles. State government is people who change hats occasionally, so you really develop a network.

But my clients are not big corporations; my clients are advocacy groups, some small healthcare providers, and day programs for seniors. For instance, lately, there have been terrible budget cuts and they have affected most of the state-funded elder programs. There is a wait list now for health care services for elders. Councils on Aging, which rely on funding, have been affected.

Q All the cuts often seem harsh — your work must make you feel good.

A Oh, absolutely. I used to do a lot of individual representation, but this is more durable. You can pass a law that affects a lot of people. An example of the kind of issues I work on, the seniors for many years had Medicare, but no prescription drug coverage. There was a constant tension between keeping Medicare affordable and providing drug coverage.

Several years ago, they implemented something called Medicare Part B which is a drug program. But Massachusetts, at that time, had enacted a state-based program so seniors would have coverage. When the Part B coverage went into effect, prescription advantage filled the gap that Part B would not cover.

Q How does a lobbyist help them?

A It is very difficult to get anywhere without professional help. I was just at the Mass Councils of Aging annual conference talking about advocacy and how to get a bill through or how to affect a budget item. If you are just a regular layperson and you can develop a relationship with a legislator, then sometimes they can help you through the process. If you have a lobbyist it is better. If you are in a coalition of many groups, you can get the attention focused on an issue.

Q Do you sometimes feel like the underdog?

A The groups I work with do not have the wherewithal to make campaign donations. We have to make a case on its merits; we can’t make it on the fact that we made campaign donations. It has to be a compelling issue that affects the constituents of legislators and that gets their attention. Most legislators are interested in elders and their issues.

Q And it is a growing field.

A It is going to be interesting because I don’t think the government at the state or federal level is prepared to deal with the needs of baby boomers. People are getting older and saving less. The person who has pension benefits now is a rare bird.

Actually seniors take the worst hit for long-term care. Because nursing homes are not covered by Medicare, except for a very short period of care. People end up spending all but $2,000 of their assets in order to qualify for long-term care. You have to impoverish yourself to get there.

Q Elder care is not always at the forefront.

A Right. There is private long-term care insurance, but there are many problems with it. One is that it is too expensive for many people and many people wait too long until they are sick to buy it and then it is too late.

Q Is that the one thing you would like to see changed the most?

A Adequate coverage for long-term care is right up there. I guess the other thing I would like to see is better state coverage of community-based care. Again it is a question of money.

But people who live alone and are isolated really need those services.

Q How do you lobby?

A One of the important things we do is educate. We educate the legislators about the issues we care about. We educate the public about the issues we care about and we try to, at the same time, we are educating them about the importance of these issues we try to get them to advocate on their behalf.

Q So it changes all the time?

A It does. And it is fascinating. You never know quite what to expect.

Waiting Lists Lengthening For Elder Care Services

2009-12-08T23:05:00.000-05:00

Somerville Journal - Somerville, MA

There are more than 2,000 households across the state that have a disabled elderly person who is not receiving home care support.

According to Mass Home Care, which represents the 27 agencies that operate the home care program locally, the waiting list to get into home care has reached 2,002 people. This includes both the basic home care program (1,593 people waiting) and the Enhanced Community Options Program (409 waiting).

Mass Home Care projects that budget cuts enacted by the General Court and the governor will result in as many as 5,000 to 6,000 seniors waiting to get home care by the close of the fiscal year June 30.

“Families will be struggling to figure out how to take care of mom or dad this Thanksgiving,” said Mass Home Care executive director Al Norman, who said the 2010 fiscal year will go down as the worst on record for cuts since the home care program began in 1974. “The irony is that nursing home doors are wide open in most parts of the state, but the door to home care is closed.”

Norman said community programs like home care are a wise investment for the state, because home care has helped drive down institutional services by 20 percent since the year 2000, and two people can be helped at home for the cost of one nursing home placement. The state’s Medicaid program is required to provide care to the disabled in the “least restrictive setting appropriate to their needs,” but Mass Home Care said the community programs are some of the first to be cut.

Along with home care cuts, the administration has recently slashed rates to the adult foster care program — a residential alternative to nursing homes — and reduced access to the personal care attendant program. The group adult foster care program has also been pared back. Cuts to these three community services total $11 million. The home care cuts totaled more than $16 million, for a total of at least $27 million in lost services.

“It will take us years to get back what we have lost,” said Norman. “We are hurting some of the most vulnerable people in the commonwealth. These are people who will show up sooner or later in our institutions, costing the taxpayers much more in the long-term. Not only is this policy forcing people to be unnecessarily segregated from their community, but it’s fiscally short-sighted.”

While these programs are struggling for every penny, the commonwealth provides $1.2 billion in corporate excise tax breaks.

Podcasts Feature Advice For Senior Community Management

2009-12-08T22:47:00.001-05:00

Earth Times

"Best Practices in Senior Care Management" podcast series from Horst Construction discusses trends and challenges facing CEOs, CFOs and executive administrators of senior living communities. Four episodes are now online, focusing on lending and financial issues and the new Five Star rating system for senior housing.

Lancaster, PA (PRWEB) December 6, 2009 -- A series of thought-provoking podcasts developed expressly for CEOs, CFOs, executive administrators and other top decision makers of senior living communities by Best Practices in Senior Care Management and sponsored by Horst Construction is available on iTunes or accessed as an XML feed at http://horstconstruction.com/podcast.asp.

Titled "Best Practices in Senior Care Management," the four-episode podcast series provides ideas, processes and new information from leading thinkers and doers in the field of senior care. Topics such as new regulations, financial measures and management, marketing ideas for increasing occupancy, and operations and planning are part of the podcast curriculum.

In the first two episodes, Steve Jeffrey, regional director of Ziegler Finance, reviews first quarter 2009 results and the present state of lending and then addresses the near-future of financing and acquisitions in the senior care industry. The final episodes are a two-part discussion on the Five Star rating system for senior care facilities in the U.S. Ron Barth, CEO of PANPHA, the largest trade association representing nonprofit providers of housing and health-related service options to Pennsylvania's elderly, and Pennsylvania Secretary of Aging, Mike Hall, debate the benefits of a nationwide rating system for senior care.

The information in the "Best Practices in Senior Care Management" podcasts was originally presented at the Horst Senior Living Conference in April. The 2010 conference is scheduled for April 8 at the Lancaster Country Club in Lancaster, PA. Keynote speaker is Jim Moore, president of Moore Diversified Services, a leading national consultant to the senior housing industry. More information on the 9th annual half-day conference is available by calling 717-581-9981.

Estate Planning: Never Too Early, Often Too Little, Too Late

2009-12-07T11:52:00.003-05:00

Yakima Herald

Eric Gustafson has seen it too many times.

Families estranged or survivors forced to spend large sums of money in the absence of an estate plan or -- just as importantly -- a plan that hasn't been updated to account for changed circumstances such as divorces or deaths.

Such plans should include a durable power of attorney for health care and finances, a will, a community property agreement for a couple and, in some cases, a revocable trust.

"It can destroy relationships if it is not well thought out and planned. You can have family members who will never speak to one another again," said Gustafson, an attorney in Yakima for 36 years and a certified elder care attorney who focuses his work now on estate planning.

"My job as an estate planner is to plan for the worst and then hope for the best," he said.

Yet only a minority of people have taken the steps necessary to see that their wishes are carried out if they die or are incapacitated.

"It amazes me how few people have an estate plan," he said.

Gustafson's experience is borne out in a 2008 poll commissioned by AARP on end-of-life issues.

The poll of more than 1,000 respondents suggests that fewer than half of people have addressed the elements of estate planning. A last will and testament had been completed by 45 percent of those who responded. But for other elements of an estate plan, slightly more than a third had a durable power of attorney or a living will that guides decisions on health care in cases of incapacitation.

People between ages 35 and 49 have a much more spotty record when it comes to estate planning. Fewer than one in three have a will and even fewer -- one-fourth -- have a durable power of attorney for health care.

The percentage of those who have completed estate planning increases with age as people acquire assets. But for younger people with children, an estate plan is even more important.

"It's important for people with children to have a will because you need to provide for children even up to 30 years old," he said. "Clearly, before they are 18 you need that to designate who you want to be guardian and not have a judge do it who doesn't know your wishes."

He said a community property agreement between spouses in a first marriage allows co-owned property to go to the surviving spouse.

"All property co-owned by the parties passes under the contract to the surviving spouse. It avoids probate on the first death," he said. "You can virtually transfer all property under a community property agreement to the surviving spouse."

Estate planning attorneys advise consumers to avoid will kits with fill-in-the-blank forms. Such kits are made generic to try to fit various laws in various states, but they may be too broad to suit a person's needs or can leave questions that must be sorted out later.

"Planning an estate can be a very complex thing depending on what is going on," observed Steve Hartnett of San Diego, the associate director of education for the American Academy of Estate Planning Attorneys. "A proper estate plan integrates all aspects of a person's goals with their assets."

AARP advises against people sitting down at the kitchen table and writing out their own will because of the chance for errors that cause problems later. Few states recognize homemade wills, according to the organization.

But short of an estate planning attorney, there is help available online and the field is growing.

Bankrate.com, a personal finance Web site, reports that some sites offer users access to an attorney to check your work. Others don't.

Prices can range from as little as $20 to as much as $225.

But Bankrate.com discourages those who have significant assets, own a business, have children or are in a second marriage from going the online route.

Financial planners are great at helping clients develop an investment plan, but they lack the expertise to deal with estate plans.

If you use an estate planning attorney, anticipate preparation of an estate plan taking from a month to six weeks to complete.

Keeping the estate plan up to date to allow for changes is also important.

Gustafson recalls one case in which a client whose elderly aunt lived half a state away put her neighbor on her checking account to pay bills and purchase groceries. The aunt, suffering with health problems, also transferred funds from investments to cover medical bills.

When the aunt died, the neighbor received a substantial sum of money as a joint tenant of the checking account.

The money had been intended for Yakima relatives in the woman's will. But having the neighbor's name on the account trumped the will.

"We see it all the time where family members put someone on their bank account or trust account. It changes the legal consequences of where that asset goes," he said.

Beneficiary designations on life insurance and retirement accounts also prevail even if a will prepared years later names a spouse.

And if no estate plan exists, a person who dies intestate -- as the lack of a will refers -- will have the laws of the state determine what happens to their assets.

"You want to control where your assets go," Gustafson said.

Hartnett agreed, saying those who die without a will may have wanted assets to go to a domestic partner, a friend or a charity, none of which is accounted for in state law.

"The best solution is an estate plan that is tailored to your circumstances. While the intestate provisions may satisfy a small number of people, they don't accomplish the goals of the ordinary person," he said.

Based on his experience, Gustafson said he believes people delay taking action because they don't want to face their own mortality or are concerned about cost. But costs for a plan that covers all assets are often lower than buying annual homeowners and auto insurance.

He estimates an average couple can have a qualified estate plan -- with key documents included -- for $600 to $1,000.

"The least cost is when you do good planning," he added.

Choosing Appropriate Senior Care

2009-12-07T11:26:00.001-05:00

Evansville Courier & Press

One of life's landmarks is choosing a nursing home. It should be carefully thought out, but typically the decision is made when a loved one is about to be discharged from a hospital, often with hours notice. Even on that deadline it's possible to make a good choice.

Lee Bowman, medical reporter for Scripps Howard News Service, talked to many top experts on nursing homes to come up with some guidance.

They recommend starting with the U.S. Centers for Medicaid and Medicare Services' Nursing Home Compare, a database that ranks 15,700 nursing facilities on a star system, from one star — "much below average" — to five stars — "much above average." Around 12 to 13 percent of nursing homes have the top rating; slightly more than 20 percent the lowest.

But the star system can be slightly misleading. In a study of the CMS database, Scripps Howard came up with a few general principles to help read between the ratings:

— Homes run by nonprofits, about two-thirds of all, generally score better than those run by for-profits and tend to have more nursing staff per patient.

— Homes with more than 100 beds tend to get lower scores in all categories.

Experts recommend finding a nursing home close to the patient's home because it's easier for family and friends to visit. He recommends meeting the home administrator and making several visits at different times to talk to staff and inspect public areas. Look for longevity among the key caregivers. If more than 25 percent of staff are recent hires, it can be a worrisome sign.

Plan early. Choosing a nursing home is difficult, but knowing the patient's preferences improves chances that the decision will be the right one.

Couties Considering Phase-Out Of Home-Health Care

2009-12-07T11:22:00.001-05:00

the Daily Mail

CATSKILL — With Greene County looking to get through one of its most difficult financial times in recent memory, one program that is facing eventual elimination is the CHHA — certified home health agency — which is provided by the Greene County Public Health Department.

While a final decision has not been made, the Greene County Legislature is currently considering phasing out the CHHA, which provides in-home nursing care to recently discharged patients.

“The majority of our patients are Medicare patients, so they are over 65 and homebound,” said Public Health Director Marie Ostoyich. “They are referred to the certified home health agency through the hospital or nursing home upon their discharge, and they need assistance with things like medication management, dressing change, or some kind of skilled nursing care at home.”

Eliminating the CHHA would save taxpayers approximately $800,000 a year, once it has been fully phased out. The first year of the phase-out program would save around $400,000.

However, county officials say care for current patients would not be impacted, and that the program would be phased out slowly over a period of two to three years.

“It would probably take several years to phase out the CHHA,” said Interim County Administrator Dan Frank. “A lot of people are under the impression that if they are currently getting care under CHHA they would be cut off, but that is not true. We would probably slow down the intake of new patients, and eventually stop it.”

Referrals for care generally cover a sixty-day period, and then need to be reissued should the patient continue to have a medical need for home health care. They would not be affected by the change, should it go through.

“For patients who are getting care right now, their care would continue for as long as it is needed,” Frank said.

Another group of residents who would not be affected by the phase-out of the CHHA are seniors who receive services through the Greene County Department for the Aging. Day-to-day care provided to those senior residents is not part of the phase-out proposal.

One option the county is considering to continue offering in-home care post-discharge is having private nursing agencies take over. Currently, some patients already receive care through The Eddy Nursing Service.

“Another option we could look at would be to have private industry take over the CHHA and let them operate it,” Frank said. “We are very concerned that people have alternatives. A segment of the population is already being served by private industry, so we could look at privatizing it.”

One problem with that option is that The Eddy currently does not provide service to communities on the mountaintop, and the needs of those clients have to be addressed as well.

Frank said the slumping economy has presented the county with serious financial challenges this year, and that it’s expected that things will only get worse over the next year or two. Implementing changes to the CHHA — or any other county program — is one way officials are looking to trim costs, but it’s a balancing act.

“Before we make a decision regarding the CHHA, we have to consider the best interests of our residents,” Frank said. “This will be a very difficult year for the legislature to decide the budget because they will have to balance the financial needs of the residents with the service needs of the residents. We are getting crunched in every direction.”

With the economic stakes high, officials say they want to minimize the tax burden on already stressed-out taxpayers. Frank said they are doing that by cutting expenses as much as possible. Much of that was done in the 2008 and 2009 budgets, and now that the easy changes have been made, the legislature is left with making some tough decisions on programming and services.

“We understand our residents are under a lot of financial pressure — unemployment is high, tax delinquency is up — so adding more tax to that would be difficult,” he said. “The county is already making substantial cuts to staffing — we eliminated positions, and we are proposing more cuts. There are no pay raises, and we are asking our employees to do more but we aren’t giving them more. Now, we need the agencies to share in the pain.”

Mysteriously, Risk Of Stroke Shown To Have Geographic Determinants

2009-12-05T01:20:00.001-05:00

eMax Health

A new study published in the December issue of Neurology reports on the strong influence of birthplace on stroke risk. A person born in the “Stroke Belt" will continue to have a higher risk of stroke even if they have moved away.

M. Maria Glymour, ScD, of Harvard School of Public Health, and colleagues evaluated stroke mortality rates for United States–born black and white people aged 30–80 years for 1980, 1990, and 2000. This data was defined by birth state, state of adult residence, race, sex, and birth year.

Four “Stroke Belt” (SB) exposure categories were defined: born in a SB state (North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, or Alabama) and lived in the SB at adulthood; non-SB born but SB adult residence; SB-born but adult residence outside the SB; and did not live in the SB at birth or in adulthood (reference group).

The researchers findings noted an elevated stroke mortality associated with both SB birth and, independently, SB adult residence. The highest risk was found to be in persons who were born in the SB and continued to live there as an adult.

For African-Americans born in the Stroke Belt and living there as adults, the odds ratio for stroke mortality was 1.55 in 1980, 1.47 in 1990, and 1.34 in 2000. For white individual in the same group, the odds ratios were 1.45 in 1980, 1.29 in 1990, and 1.34 in 2000.

For reasons that have eluded explanation, residents of the southeastern U.S. historically have had a 20% to 50% greater risk of stroke mortality compared with residents living elsewhere in the country. This influence of residence in the Stroke Belt has little association with conventional stroke risk factors, social resources, or access to medical care.

Future studies of stroke risk should include detailed information about movement from one region to another. Such information might show whether people who move have different risk patterns help identify more precisely the point in life when stroke risk begins to increase. That information could aid the development of risk-reduction strategies specific to different regions of the country, the authors concluded.

Senior Care Across The Miles

2009-12-05T01:13:00.002-05:00

The Bend Bulletin

Our society has become increasingly mobile in the past few decades.

Kids move away from home and don’t come back. Parents retire to another state. Family members shift from place to place, looking for work, going to school, building their lives.

Often, adult children end up living some distance from their aging parents. While this leads to increased travel and decreased time spent together, it has another consequence as well. Distance makes it harder to help when a parent is in need. As a result, many adults are finding themselves playing the role of long-distance caregiver.

Raeann Hamon, a professor of family science and gerontology at Messiah College in Pennsylvania, says long-distance caregiving is absolutely a trend that is likely to increase.

“Certainly, as the baby boomers and their parents age, we can expect a large jump in the number of families dealing with such caring across miles.”

These adult children face challenges of trying to find the right role to play, staying involved while not becoming overly burdened.

Starting off

Nancy Turk co-owns Visiting Angels, a local service that connects in-home professional caregivers to older individuals. She says about half their clients have relatives in another region or state. They have been contacted by family members in Alaska, California and Australia who want to hire help for a local relative. Typically, Turk says, a family member realizes they need to step in after visiting. “They are shocked to see the condition their grandparents or parents are living in.”

These relatives, often adult children, believe their parents are doing fine, but the reality is somewhat different. They might find rotten food or dog feces. “It’s traumatic for the kids.”

Turk says oftentimes the family members feel guilty and then hire staff to come in and assist, particularly in cases in which the parents don’t want to leave their own home.

Marion Somers, a geriatric care manager and author of “Elder Care Made Easier,” suggests adult children think about what they can and cannot do. She encourages them to set limits and to delegate. “You have to be honest about your time and resources.” She thinks of it this way: It’s like being on an airplane when passengers are supposed to put on their own air masks first before helping anyone else.

“You have to be organized, you have to prioritize, you have to delegate,” Somers said.

Challenges

Trying to assist a relative living far away can be quite complicated. Hamon says many adult children feel guilty about not being able to help more, while also feel angry about the imposition and feel anxious about future needs. She says many individuals feel guilt because of the “norm of reciprocity.”

“There’s the notion that you should be good to those who have been good to you,” Hamon said.

Figuring out when to visit and to allot resources — both financial and time — is another big issue. Sometimes, resources are better spent hiring someone to help than flying out to visit for a week. Somers point out that a $600 plane ticket could be used to hire someone to come in once a week to help out for a couple weeks or more.

Robert Sachs knows about this challenge from both sides. He has been a caregiver working with adult children who live in another state. And he has been the son, living far from his dying father. His experiences are chronicled in his book “Perfect Endings.”

“We’ve created this kind of quandary for ourselves.”

When Sachs worked in a hospice in New Mexico, he saw many negative reactions from staff to adult children living far away. He says staff members frequently looked on these individuals negatively, thinking, “If you really cared, you would live here and be here all the time.”

Sachs felt these assumptions were unfair. That said, he recognized why it happened. Sometimes, the professional caregiver felt as if the relatives living away were serving as armchair quarterbacks, questioning decisions and making recommendations without really knowing the situation.

Sachs says relatives’ top priority should be to develop a relationship with the primary professional caregivers.

Hamon says it’s also not good to assume an older parent will naturally move to where adult children live. She believes part of it is generational because many older individuals have lived in one place for many years. They can also be entrenched in the community and have social support. “To ask them to move, it’s a challenge.”

Practical steps

Hamon suggests adult children start regular rituals and routines, for instance calling once a week at the same time and day.

Somers agrees, saying, “The voice tells so much. Most older people don’t have the energy to fake it.”

When the son or daughter does visit, they need to really get to know the area. Hamon suggests they learn about the neighborhood and meet the neighbors. Who does the older relative have regular contact with? She suggests the child hand out his or her phone number and ask for theirs. Then if neighbors see anything of concern, they will know who to call. She also thinks adult children should try to assess their parents’ needs, such as help with household tasks, personal care and transportation.

Somers suggests adult children take a “look at the house or apartment with fresh eyes.” What is the lighting like? How is it at night? Are any light bulbs burned out? How easy is the bathroom to navigate? Are there any throw rugs? What about the outside, including the garage and porch? She strongly encourages installing grab bars in bathrooms, putting in sensor lights outside and getting rid of all throw rugs. Somers also believes all kitchen items should be at eye level. She says to banish footstools. She will hire a neighborhood kid to mow the lawn or shovel snow. She also encourages family members to get in touch with the parents’ church, if applicable. Getting the grocery store to deliver is another good option.

Hiring help can bring relief. Turk says many adult children appreciate being able to talk with someone who serves as their eyes and ears.

Turk says sometimes the older individuals may resist outside help, saying, “We don’t need it; we’re fine.” They see help as a sign of the end. Sometimes, however, they “respond better to someone who is not a loved one,” said Turk. With family, older individuals may feel more comfortable saying no or getting angry.

Adult children need concrete information should anything go wrong. This includes a list of their parents’ doctors, medications, insurance information and more. Knowing what they are allergic to, past surgeries, medical issues and what vitamins and over-the-counter items they take are also good ideas.

Not all parents expect their children to be there to provide physical care for them, says Hamon. “Most expect their children to be emotionally supportive.” That is the most important piece. And the good news, according to Hamon, is being a good listener and offering support “is something that’s a bit easier to do at a distance.”

Using The Internet To Transform Elder Care

2009-12-05T01:10:00.002-05:00

Wicked Local Concord

Concord resident Jim Reynolds last month opened Caring Companion Connections, a home services agency that adds a 21st century twist to in-home elder care.

CCC’s caregivers, known as Companions, use smartphones, such as BlackBerrys, to upload photos, activity logs and daily reports to a Web portal tied into a landline at the client’s location and viewable by loved ones in other cities or towns.

Reynolds has hired Debbie Bier as district director of the Concord office. She is responsible for day-to-day operations of Caring Companion Connections, which covers Metrowest, a 45-minute radius around Concord by Reynolds’ definition.

He also plans to open offices in the Falmouth area, which would cover the Cape and South Shore, and on the North Shore around Salem or Gloucester. But Reynolds, whose family operates large non-medical home care agencies in Florida and Kansas, expects Caring Companion Connections will grow beyond Massachusetts.

Tell me about your business.

This is a family business, me and my family. We provide flexible, reliable homecare services to elders who want to remain in their homes as long as they can and stay independent rather than move into a nursing home. My dad started this business 17 years ago, but we have added in as new a feature here in Concord, a Web communications portal, which is unique in the industry. And this allows family members, especially adult children who are far away, to log on at work, or during the day from home, or on a business trip, wherever they are and see the status, to get a window into the living room, of what’s going on at the parents’ house. They know when we log in. They know the activities, meals and medication reminders. That kind of thing.

Why is the Web communications portal so important?

That’s important because typically, in this industry, that information is kept on a logbook on the kitchen table, and it’s useful if you’re standing at the kitchen table. The problem is that in most families the person who needs the information is not at the kitchen table — they’re usually in another city. If their loved one gets ill, or is not taking medications or having trouble moving — any information that needs to be noted — the information doesn’t get where it needs to be as quickly as it should. And even then, only one person has it and you wind up with a range of telephone calls and e-mails and voicemails. So this provides one place, that’s instantaneous, that everyone can go for access to the same information and make decisions and take actions as quickly as possible. Or, even, if no action is required, simply to know that everything’s OK.
Can you talk about who your clients are and what kind of care they require?

There’s a particular phrase in this industry, activities of daily living, or ADLs, and those can range from things like trips to the grocery store to help getting to doctor’s visits to medication reminders and meal separation to more personal things like help with grooming, or help in the bathroom. If someone has limited mobility, and can’t move easily, we can help. If someone has lost use of a limb because of a stroke we can help. If someone is a risk to walk because of dementia, we can help. Typically, the clients are someone in their retirement years, most of them live alone and it’s important for these people to live where they want to live, a place that is familiar, where they have often lived for decades. Statistics bare out that people who live where they want to live have much better healthy, happy retirement years, and people who are involuntarily moved do poorly medically and have much more depression and report being less happy.

The Modern Dilemma Of Elder Care: The Sandwich Generation

2009-12-05T01:06:00.002-05:00

New Jersey Newsroom

More than 25% of American families are involved in elder/parent care at some level. Today, the baby boomers are the "heart" of the sandwich generation.

To understand the significance of the Sandwich Generation, one needs to realize that the Sandwich Generation is THE largest segment of our population.

Who are these sandwich generationers?

Traditional sandwich: those sandwiched between aging parents who need care and/or help and their own children

Club sandwich: those in their 50s or 60s, sandwiched between aging parents, adult children and grandchildren. OR those in their 30s and 40s, with young children, aging parents and aging grandparents. (Term was coined by Carol Abaya)

Open Faced: anyone else involved in elder care. (Term coined by Carol Abaya)

Statistics further demonstrate the importance of understanding the sandwich generation scenario:

$34 billion a year are lost in employee productivity because of elder care responsibilities. More productivity is lost from elder/parent care responsibilities than from child care.

The cost to industry to replace experienced workers who leave their jobs to take care of a sick loved one is more than $7 billion a year.

Of full time employees who are caregivers, today 52% are men and 48% are women. This is a dramatic shift in the caregiver picture because of the high rate of divorce and family being geographically scattered.

77% of caregivers report they work less effectively.

More employees develop health problems from the stress of elder care than from child care.

While the sandwich generation is the largest segment of our population, those over 85 make up the fastest growing segment.

All of these statistics clearly show the undefinable challenges for adult children.

If you are a sandwich generationer, know you are not alone. In order to keep the stress level of sandwich generationers managable, there are a number of important elements that must be understood. These will be addressed in future columns.

A key sandwich generation responsibility is to enable and empower a parent to live as independently as possible as long as possible given true physical and mental capabilities. A sandwich generationer should NEVER take over control of a parent's life and should do as little as necessary to maintain an elder's safe environment and health.

Acknowledge and accept the fact that everyone's emotions will be on a roller coaster forever. As soon as a sandwich generationer thinks things have calmed down, a plunge is inevitable.

No sandwich generationer should do everything alone for an aging parent. This leads down the road to a sandwich generation physical and mental breakdown. Help from other family members and community resources should be identified and used.

Legal, financial and quality of life elements MUST be addressed BEFORE a crisis. If a person (regardless of age) does not protect himself or herself by executing key legal documents, a court can appoint a complete stranger to take over finances, medical decisions, and lifestyle decisions.

Spiritual elements are also important in an elder's everyday life and especially in relation to dying.

Canada Shifting Senior Care Away From Hospitals

2009-10-04T14:30:00.003-04:00

Story from Calgary Herald

CALGARY - Alberta Health Services have announced a three-year plan to add almost 800 "community living options" in the province for senior patients - who would otherwise crowd hospital beds, officials said.

Dr. Stephen Duckett, the provincial body's president and CEO, added that there will be no healthcare staff layoff announcemnts today, and there will be none until Alberta Health Services work through its current care plan.

"The key thing here is that, not only did we identify where we want to go, but also how to get there," Duckett said during a press call at noon. "This is not vapourware, as you call it... it's a concrete thing."

The plan, Duckett says, is to invest about $13 million in both the Calgary and Edmonton CMA to expand community care. The new spaces - about 775 between the two metropolitan areas - will include home care, supportive living and long-term care facilities.

The move of seniors who don't need acute care will allow health officials to free up hospital beds, Duckett says. Officials estimate the shift to community care would save up to $50 million for the cash-strapped provincial body.

Doctor Files Supreme Court Case Vs. BCBS of Texas

2009-10-04T13:57:00.002-04:00

Story from California Newswire

Dr. Dralves Edwards, a board-certified family physician in Dallas today filed a civil case in the U.S. Supreme Court against Blue Cross Blue Shield of Texas, the contractor for Medicare. For the past 13 years, Edwards has challenged the integrity and unethical practices of Blue Cross Blue Shield (BCBS) and is confident that the U.S. Supreme Court will rule in a responsible way such that every Medicare provider and patient benefits.

In 2003, the original suit was filed in Dallas district court alleging that BCBS engaged in fraud, gross negligence, and criminal acts that, according to Edwards, forced him to close his doors. Today, he works as a hospital emergency room physician.

BCBS responded to the suit by removing it to federal court, but the case was remanded back to district court. BCBS then filed a “No Evidence” Motion for Summary Judgment that was granted sovereign immunity by the lower courts.

Edwards acknowledges that lower court decisions have historically disagreed with well established U.S. Supreme Court cases (i.e., Ardary vs. Aetna; Heckler vs. Ringer; and Kelly vs. Advantage Health, Rochester vs. Travelers).

In 1997, Edwards says BCBS caused irreparable harm to his thriving practice and marred his professional name when he was placed on a 100 percent prepayment review. For three consecutive years, 96 percent of his claims were denied; his practice was 90 percent Medicare.

“I provided free transportation and made house calls that saved Medicare millions of dollars,” reports Edwards. “These were patients who probably would have ended up in the emergency room.”

In October 1996, Edwards was featured in USA Today as, “One of the few doctors in America making house calls.”

BCBS denied most of Edwards’ claims as “non-covered services and not reasonable and medically necessary.”

Medical conditions like breast cancer, diabetes, and decubitus ulcers were denied. However, after the course of five years, claims were appealed through Medicare’s administrative process and paid.

“Something was terribly wrong,” Edwards says. “Other doctors were being paid by BCBS for these same medical conditions, but payment continued to be denied to me.”

Edwards alleges that, “BCBS was tested for profiling and got caught.”

He explains what happened. One doctor employed by him applied for a new Medicare group number. Dr. Edwards’ name was deliberately left off of the original application. The group number was granted, 300 claims were submitted, and BCBS paid 98 percent of them. A month later, Edwards’ name was added, 300 claims were submitted and all were denied.

BCBS told Edwards he had a documentation problem. However, after meeting with a Medicare representative to review the denied claims, no problems were discovered. It was recommended that he sign his progress notes and resubmit the claims for payment. He did and they were still denied as “non-covered services and not reasonable and medically necessary.”

Edwards then obtained the list of 100 doctors on the prepayment review list for 1997 through 1998. He contacted most all of these doctors and discovered that they knew nothing about a “prepayment review.”

“This evidence was highlighted in the suit, but ignored by the courts,” says Edwards.

It was becoming apparent that some unethical practices were in play.

To date, this 13-year ordeal has led to thousands of dollars spent; countless hours; a five-year administrative process; five summary-judgment hearings; numerous investigations; nine attorneys; 19 judges; a 100 percent prepayment review; and protectionism from the lower courts.

“Justice for the innocent has not been served,” Edwards says. “The guilty remain in business. Right now, it rests in the hands of the U.S. Supreme Court.”

BCBS Vs Chiropractors

2009-10-04T13:49:00.003-04:00

Story from AIS Health

Chiropractors Bent Out of Shape Over Blues’ Post-Payment Denials

The Blue Cross and Blue Shield Association (BCBSA) and 22 Blue Cross and Blue Shield (BCBS) plans were named as defendants Sept. 11 in a class-action suit alleging they engaged in “abusive practices in using post-payment audits and reviews.” The suit contends that Blues plans made improper repayment demands “to pressure providers to repay substantial sums that have previously properly been paid as health insurance benefits for services provided to BCBS subscribers.”

Providers Want Recouped Funds Returned

Pomerantz Haudek Grossman & Gross LLP and Buttaci & Leardi LLC filed the suit on behalf of the Pennsylvania Chiropractic Association (PCA), the New York Chiropractic Council (NYCC) and the Association of New Jersey Chiropractors as well as 15 independent providers. Hundreds of millions of dollars could be at stake, said co-counsel Vincent Buttaci, who pointed out that BCBS plans’ anti-fraud efforts in 2008 resulted in more than $350 million in recoveries and savings for the plans. He adds, “We believe a substantial portion of this ‘recovery’ falls within the improper practices we are challenging in this action.”

According to the suit — filed in U.S. District Court in Chicago — the post-payment actions are in violation of the Employee Retirement Income Security Act of 1974 (ERISA) and the Racketeer Influenced and Corrupt Organizations Act (RICO). The suit contends that the Blues are in violation of ERISA because the “repayment demands are retroactive determinations that particular services are not covered under the terms of the BCBS health care plans,” and the demands lack a proper appeal process or other protections available under ERISA for both self-funded and fully insured health care plans offered through private employers. The suit also alleges that the insurers’ post-payment audit and review process and “forced withholds of unrelated benefit payments to offset alleged prior overpayments” violate RICO.

The suit seeks an undetermined amount of money. According to the filing, the “Plaintiffs seek appropriate declaratory and injunctive relief to enjoin Defendants from pursuing their effort to coerce recoupment and, further, to order Defendants to return any funds they have received or withheld from Individual Plaintiffs and members of the Classes as a result of their recoupment efforts.” It also seeks interest on the withheld funds.

The suit contends that Blues plans made improper repayment demands “to pressure providers to repay substantial sums that have previously properly been paid as health insurance benefits for services provided to BCBS subscribers.”

Plaintiff’s counsel D. Brian Hufford of Pomerantz tells The AIS Report, “In essence, the BCBS entities are alleging overpayments and then just taking the money from the providers, without valid due-process protections. We believe this is a blatant violation of law.” According to Hufford, some chiropractors have tens of thousands of dollars because of the plan’s alleged repayment practices.

He adds, “We believe they’re withholding money even in situations with self-funded plans when they didn’t pay for the treatment.” And the insurers, he alleges, haven’t repaid the plan sponsor for the money withheld from the provider in these instances.

“We met on numerous occasions with Blues senior management [at Highmark, Inc. and Independence Blue Cross] in an effort to establish a fair and balanced approach to conducting post-payment reviews, but to no avail,” said PCA Executive Director Gene Veno.

According to Pomeranz, BCBSA “is coordinating the recoupment efforts with its state BCBS licensees on a nationwide basis.” The plaintiffs, the law firm adds, seek to enjoin Blues plans from “continuing to engage in impermissible audit and recovery practices and to compel them to return the funds they have improperly withheld.”

BCBSA spokesperson Kelly Miller said the association does not comment on pending litigation. The 22 Blues plans named in the suit are: Blue Cross and Blue Shield of Rhode Island, Blue Cross and Blue Shield of Alabama, Arkansas Blue Cross and Blue Shield, Blue Shield of California, Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield of Georgia, Health Care Service Corp., Blue Cross and Blue Shield of Kansas, CareFirst Inc., Blue Cross and Blue Shield of Massachusetts, Blue Cross and Blue Shield of Minnesota, Blue Cross and Blue Shield of Kansas City, Horizon Blue Cross and Blue Shield of New Jersey, Excellus Blue Cross and Blue Shield, Blue Cross and Blue Shield of North Carolina, Highmark, Inc., Blue Cross and Blue Shield of South Carolina, Blue Cross and Blue Shield of Tennessee, Premera Blue Cross, The Regence Group, Wellmark, Inc., and WellPoint, Inc.

The NYCC and the ANJC had previously joined in a class action filed Aug. 4 against Aetna, Inc. regarding similar post-payment audit practices.

Some Exercise Their Right To Opt Out Of Health Insurance

2009-10-04T13:40:00.002-04:00

AP Story

NEW YORK — Call it a health care gamble: the decision by some people to opt out of health insurance, paying cash for routine care while playing the odds that an accident or catastrophic illness won't plunge them into financial ruin.

President Barack Obama's goal of requiring everyone to carry health insurance has drawn a great deal of skepticism from this group. Many pay far less for health care than they would on premiums, and doubt that insurance would even cover them if they needed it.

It's unknown how many of the nearly 50 million uninsured in the United States voluntarily go without coverage. Researchers at the Kaiser Family Foundation, which studies the uninsured, said most are young, generally healthy adults who are self-employed or in relatively low-wage jobs that do not offer insurance coverage and don't pay enough for workers to afford individual policies.

"Income is key and most of the uninsured have low incomes," foundation researcher Karyn Schwartz said. "If you look at your budget and think you can't afford it or can afford it if you eat only ramen noodles, you may choose not to get it."

All the health care plans that have emerged from the Democratic-controlled Congress would require everyone to have insurance, the way drivers in nearly every state must purchase auto insurance. Proponents say that by bringing everyone into the system, medical risk is spread over a broader population, bringing costs down.

Those who opt out voluntarily might have to pay a penalty. Sen. Max Baucus, D-Mont., who drafted the Senate Finance Committee's plan, set the penalty at $3,800 for a family but cut it to $1,900 amid complaints that the original level was too high.

Republicans have called the insurance mandate a new tax on the middle class. Obama disputes that, saying that whatever plan emerges from Congress must offer subsidies to lower-income people that will make coverage affordable.

In exchange for the requirement that everyone buys coverage, Obama wants a guarantee from insurers that they no longer will deny coverage based on an individual's health or drop coverage when a person gets sick. The insurance industry has signaled it will accept that trade-off, but needs to convince skeptical consumers that it actually means it.

Doubts about what insurers will cover — coupled with the high cost of premiums — have driven some to opt out and take their chances.

Krista Neher, who's starting her own social media and marketing venture, is one.

The 30-year-old from Cincinnati recently left Procter & Gamble Co., where she was covered by the company's health care plan. After researching the costs of an individual policy, she decided to remain uninsured.

"I want to have health coverage, I think it's important. It bothers me that I could be hit by a car," Neher said. "But I have really low confidence that any insurance company would even cover me in that case, even after I paid all the high premiums. It just seems like a lose-lose situation."

Many people who go without coverage have found that health care providers often will cut the price of a procedure if they know they'll be paid in cash rather than through insurance.

Jason Jepson, a self-employed communications consultant based in Southern California, decided against buying an individual policy he said would have cost twice as much as his $1,250 monthly rent. He pays out of pocket for all medical treatment, saving money even after being treated for a broken ankle and severe strep throat.

"If you pay with cash, they do give you a discount — it's the big secret of not having insurance," Jepson, 35, said.

But Jepson said his lack of insurance has meant lifestyle adjustments, such as driving less and staying off freeways to avoid accidents. He says he supports Obama's requirement that everyone carry insurance if it can be made affordable.

"I would pay for it. I'm just not sure it will really cover everything," Jepson said.

To ease fears of an unexpected medical crisis, registered nurse Mary Pitman of Vero Beach, Fla., refuses health insurance and takes the extra cash in her paycheck. Pitman, 54, puts $3,000 per year into a pretax flexible spending account for routine care and another $300 per month in an emergency fund in the event of a major illness.

"I have more control over my money this way, and there's a tax advantage," she said.

As skeptical as many are about insurers, some are equally doubtful about government's ability to do a better job managing health care.

Laura Silverthorn of Tampa, Fla., left a nursing job to start her own business designing and selling temporary tattoos. She and her toddler son have gone without health coverage for nearly two years.

While Silverthorn, 36, said she wishes she could afford insurance — "Just one accident and you're done," as she put it — she's also grown disillusioned with government-run programs after working part time reviewing medical charts for Medicaid.

"I don't know if I want the government running health care when I see how they run Medicaid — there is so much fraud," she said.

The only test case for Obama's plan to bring everyone into the health insurance system is Massachusetts. In 2006, it enacted a program to cover all state residents. Those who opt out must pay a $912 annual tax penalty.

Michael Widmer, president of the nonpartisan Massachusetts Taxpayer Foundation, which researched the effectiveness of the state's health insurance mandate, said most people chose to buy insurance rather than pay the penalty — even those who are "young, healthy and immortal."

"Most are saying, 'If I'm going to have to pay this much in any case, I should be covered,'" he said.

While about 65,000 people in Massachusetts were allowed for financial reasons to opt out of the mandate last year, the state now has the lowest rate of uninsured residents in the country — 4.1 percent, according to the latest census data.

2009-06-18T10:42:00.003-04:00

Moving Closer To Acceptable Public Health Plan
Senator Kent Conrad (D-ND) Introduces a "potential compromise" to the public health plan. Following is an interview with Ezra Klein of the Washington Post.

(Earlier today, Sen. Kent Conrad, the North Dakota Democrat who chairs the Senate Budget Committee, introduced a "potential compromise" on the public plan: A system of federally-chartered co-ops that could offer a non-profit alternative to the for-profit insurance industry. In this telling, the co-ops preserve the central feature of the public plan -- they're a competitor to the traditional insurance industry -- but are free from the baggage of government control.

I spoke to the Senator this evening about the co-op model, and he said a few things that surprised me. First, his search for an alternative was on behalf of the G-11 -- the key Senate powerbrokers on health care. Second, it proceeded from the premise that the public plan doesn't have the votes. All Republicans are opposed and, according to Conrad, "at least three Democrats." And third, he thinks reconciliation is basically out as a viable option for comprehensive health reform. A lightly edited transcript follows.)

Tell me a bit about your idea for chartering co-ops in the health insurance market.

Maybe it would be most useful to tell you how I got into this. The G-11 group, which is the members of the Senate, Republicans and Democrats, chairmen and ranking members of the key committees, who've been given the overall responsibility to coordinate health care reform in the Senate, asked me 10 days ago to come up with something to bridge the divide between those who are strong adherents to the public plan and those who are strongly opposed.

The co-op structure came to mind because it seems to fulfill at least some of the desires of both sides. In terms of those who want a public option because they hope to have a competitive delivery model able to take on the private insurance companies, a co-op model has attraction.

And for those against a public option because they fear government control, the co-op structure has some appeal because its not government control. It's membership control, and membership ownership.

Also the co-op model has proven very effective across many different models. Ocean Spray in the cranberry business, and Land of Lakes in the dairy business, and Puget Sound in the health care business.

How do you respond to someone who says, this is a terrific idea. More competition is always welcome. But why instead of a public option? Why not do it alongside and let a thousand coverage models bloom?

Votes. The problem is this. If you're in a 60 vote environment in the Senate -- and I believe we are, because I believe reconciliation simply won't work -- if you begin tallying up the votes, I believe that virtually all Republicans are against the public option and some democrats are. So how do you get to 60?

How many Democrats would you estimate are against a public option?

I don't know for certain, but I think at least three, and maybe more.

And why do you think that reconciliation won't work for health reform.

Reconciliation was never designed to write substantive legislation. It was designed solely for deficit reduction. The whole idea was you would change numbers, not policy. You would change numbers on the revenue side of the equation and the spending side of the equation.

And so, the way it works, under current rules, if you're in reconciliation, you have to be deficit neutral over five years. Under the budget resolution, health care can be deficit neutral under 10 years. That's a big difference.

Two, under reconciliation, you're subjected to the Byrd rule. The Byrd rule says that anything that doesn't cost money or save money, or that only costs money or saves money in a way that's incidental to the policy, is subject to strike. The result, for instance, is that all the insurance market provisions are subject to strike. All the wellness and prevention provisions are subject to strike. The Senate parliamentarian said to us that if you try to write substantive health reform in reconciliation, you'll end up with Swiss cheese.

Then let's go back to why this works as a compromise. I understand why it would be preferable for Republicans. But for supporters of a public plan, the key advantage is that the public plan is big. It can negotiate discounts with providers. In the form Sen. Rockefeller offered, it can even use Medicare payment rates. These co-ops don't seem like they'd have that size or weight. How would they compete with large private insurers?

They might have that weight. One option is for a national cooperative. That would give it the heft and weight to compete. But you know, one of the interesting things when we talk to experts is that they say critical mass is probably around 500,000 members. Puget Sound is probably around 580,000 and they compete successfully against much larger entities. The experts tell us that there are probably advantages of size up to a point, but after that point, the law of diminishing returns sets in.

Who would charter these? What is the process? Do I go over to my local health insurance exchange and put in an application?

The way co-ops typically are formed, people who feel they're not appropriately served, or not served at all, band together. They form an organization, elect a board, hire people to do the work, pool their money, and the organization goes forward.

These cooperative entities would provide their contracts through the exchange just like everyone else, be subject to the same rules as everyone else, in terms of reserve requirements, in terms of what kind of contracts they could offer. People would go to their exchange, they'd see the option, and if they liked it, they'd sign up, and then they become one of the members, because every member is an owner. And they would have elections and that elected board would choose the leadership.

Would there be regulations on how many of these there would have to be in each state?

We've not contemplated having that in the health care reform law, but there is clearly an economic requirement in order to have the leverage to negotiate with providers to get competitive rates, you need greater bulk. That's where we believe we need 500,000 lives to be competitive.

That's probably one of the two major items of discussion still remaining here. They're various options for consideration if you will. I offered the G-11 group three models. One is state-based, so every state has one. I don't think that works frankly. In states like mine, the pool wouldn't be big enough. The second would be a national entity. That's probably too limiting as well.

What you probably need is a national entity with state affiliates, and the further flexibility so those states can have regional pools. So in our part of the country, you might have North Dakota, South Dakota, Montana, and Wyoming go together. Out east you might have Maine, Vermont, and New Hampshire together. We're consulting with experts tomorrow about that.

Where did this idea come from? I've done a fair amount of health care reporting, and this is the first I've heard of it.

I guess it came out of conversations in my office after we were asked to see if we couldn't come up with some way of bridging this chasm. Part of it is that we're so used to cooperative structures in my state. They were begun by progressives, they came out of the progressive era. And they're so successful in our state. So I can't really say we came up with some brand new idea. We just thought about our own experience.

What has been the reaction of some of your more liberal colleagues to this?

I think it's fair to say mixed. Those who really want public option because they really want single payer, this does not satisfy their position. Others who really want a competitive insurance model kind of like it. Others who are looking at how you put together the votes are intrigued by it. And on the Republican side, a grudging acceptance that this may be one way to increase competition that does not increase government control.

Let me ask you one last question on that. I understand why this proposal wouldn't satisfy liberals who want single-payer. But why does it arouse Republican opposition? It seems, in a way, to be very small-r republican.

Because they don't...ah, you know, you'd have to ask them. It would just be my surmise on why some of them don't like it. They really don't want a competitive model, at least some of them.

2009-06-18T10:38:00.001-04:00

Blue Cross Of Georgia Hit With Class Action Suit
Story from Atlanta Business Chronicle

Blue Cross Blue Shield of Georgia has been slapped with lawsuit seeking class action by Georgia surgery centers that could cost the state’s largest health insurer tens of millions of dollars.

The suit alleges Blue Cross Georgia has discouraged visits to out-of-network providers by reimbursing procedures at a tiny fraction of “usual and customary” charges.

Blue Cross Georgia spokeswoman Cheryl Monkhouse dismissed the allegations as being without merit and said the insurer plans to “defend the suit vigorously.”

Blue Cross Georgia “is committed to providing appropriate reimbursement for out-of-network services, while at the same time protecting its members and group customers against excessive charges by some non-participating providers,“ Monkhouse said.

The suit is similar to one filed earlier this year by a dialysis provider against Blue Cross. That suit was dismissed.

The new suit, filed against Blue Cross Blue Shield Healthcare Plan of Georgia Inc. and Blue Cross and Blue Shield of Georgia, alleges Blue Cross members paid higher premiums in exchange for the flexibility to receive coverage for care from providers who are not part of the plan’s preferred network.

Blue Cross Georgia has targeted these out-of-network providers, including ambulatory surgery centers, “for a drastic and unprecedented slash in reimbursement to a mere fraction of usual and customary charges,” the suit claims. These actions violate federal and state laws protecting patients and providers, as well as Blue Cross Blue Shield’s contracts, the suit claims.

Blue Cross has cut its reimbursement to out-of-network surgery centers by about 80 percent, said Leigh Martin May, attorney with the plaintiff’s firm, Butler, Wooten & Fryhofer LLP.

Blue Cross “has slashed reimbursement rates to non-member surgery centers making it impossible for their insureds to receive the benefits they are paying for,” May said. “[The insurer] is charging for a service it has effectively eliminated. BCBS should honor the contracts they have made with their insureds.”

Plaintiffs are seeking monetary damages -- which, May said, could run into the “eight figures” -- for Blue Cross Georgia’s alleged failure to pay the contracted reimbursement rate and they are asking the court to force Blue Cross Georgia to honor its agreements.

Earlier this year, Nashville, Tenn.-based National Renal Alliance filed a lawsuit against Blue Cross Georgia, claiming the insurer slashed reimbursement rates for out-of-network dialysis services by 88 percent.

National Renal Alliance was acquired by Renal Advantage Inc. last year.

In March, a federal court judge in Atlanta dismissed the suit, saying Blue Cross’ decision to amend its reimbursement rates for dialysis performed at out-of-network facilities like the Alliance’s did not violate the act’s provisions that prohibit insurers from discriminating against individuals with end-stage renal disease.

2009-06-18T10:32:00.000-04:00

License not renewed for York Springs nursing home
State inspectors said they found 33 violations -- many of which were repeats -- at Whispering Pines.

By STEVE MARRONI
For the Daily Record/Sunday News

The Pennsylvania Department of Public Welfare has not renewed the license for an Adams County nursing home for alleged violations that include rodent feces, expired medications and not evacuating all residents during a fire drill.

A parent company, Talex Inc., owns Whispering Pines in York Springs. The department's inspection report listed Julia Harris, a York Springs borough council member, as president.

Harris would not identify other stockholders in the company.

In 2005, the state listed her husband, Phillip B. Harris -- a former borough auditor -- as affiliated with Talex when it alleged that the nursing home failed to have workers compensation insurance. In 2006, he pleaded guilty to five misdemeanors in Adams County Court of Common Pleas and was sentenced to 60 months in the intermediate punishment program.

DPW spokeswoman Stacey Witalec said that, during a March inspection, state inspectors found 33 violations, 12 of which were repeat violations from 2008, at the facility in the 400 block of Main Street.

"It goes on and on," Witalec said about the list of violations.

She said Whispering Pines was already operating under a provisional license, a probationary status that results in more inspections and closer examination.

Julia Harris said Thursday the company has made several changes in upper management at the facility and that numerous policy and procedure changes have been put in place.

An administrator handles the day-to-day business of the nursing home, she said.

"Unfortunately Whispering Pines had numerous violations in their most recent inspection," Harris wrote in an e-mail. "I have been assured that all cited violations have been corrected."

One of the more-serious violations dealt with fire drills, Witalec said. In two separate drills, a resident was left behind, inspectors reported.

"It is absolutely critical to go through a fire drill and know how to evacuate everyone in a timely manner," Witalec said.

Julia Harris, however, said the report does not accurately reflect what happened.

"A specific resident of the facility refused to participate and evacuate the building," she said.

Harris said Whispering Pines documented the resident's refusal, as it was advised to do by the state. Still, the state cited the facility again when a resident refused to leave.

"Whispering Pines is a very good home," Harris said. "But, as usual, DPW makes up new rules, and each inspector looks at them differently."

THE REPORT

Violations at Whispering Pines nursing home, according to the state Department of Public Welfare's report:

--- On several occasions in February, a lone staff member on the overnight shift was not certified in first aid. At least one staff member for every 50 residents must be trained in first aid, according to the report. This was a repeat violation.

--- A large amount of rodent feces was found on the floor and on the shelves in the home's pantry.

--- The fire-alarm system had malfunctioned and displayed five trouble codes, and two fire extinguishers were not charged.

--- Several medication violations were found, including insulin that was not refrigerated, expired medication, unaccounted-for pills and improper documentation.

WHAT'S NEXT

The owners of Whispering Pines have filed an appeal and can operate the facility through the appeal process. However, the Department of Public Welfare has prohibited the facility from taking in new residents during the process.

The first step is a hearing June 23 with the department's Bureau of Hearings and Appeals.

After the appeal, either party -- Whispering Pines or the department -- may ask for reconsideration of the decision from the department secretary. From there, either side can appeal to Commonwealth Court.

ON THE WEB

For inspection violation reports and licensing status of Pennsylvania care homes, visit www.dpw.state.pa.us/ServicesPrograms and click on "Personal Care Homes Directory."

2009-06-18T10:20:00.001-04:00

New Discoveries: Age-Related Macular Degeneration
Story from McKnight's

Researchers at the University of Kentucky have announced a major breakthrough in the prevention and early detection of neovascular age-related macular degeneration (AMD). The condition affects between 10 million and 12 million Americans and is the number-one cause of blindness among seniors.

At the annual meeting of the American Medical Association on Monday, researchers identified a biological marker, known as CCR3, that they say is integral to the development and progression of eye disease. AMD is caused when new, abnormal blood cells invade the retina and interfere with the eye's ability to receive oxygen and nutrients in a process called choroidal novascularization (CNV).

The CCR3 marker, which also plays a role in the inflammation process, was found on the CNV vessels, but not on normal vascular tissue, according to the report. By injecting anti-CCR3 antibodies into mice, researchers were able to see the CCR3 markers on the CNV vessels before the new abnormal blood cells invaded the retinas, causing irreversible damage. Early therapy test results appeared promising, with 70% reductions in CNV among the test mice, according to the report.

The findings were published Sunday in the online version of the journal Nature and will appear in an upcoming print issue.

2009-06-18T10:11:00.002-04:00

Nursing Home Planned For Medical Campus Not Without Controversy
Story from the Buffalo News

By Henry L. Davis

NEWS MEDICAL REPORTER

Kaleida Health is preparing to build a 300-bed nursing home, another big project connected to the Buffalo Niagara Medical Campus that advocates say will significantly improve services for the elderly in the inner city.

The $64 million building, planned for the block bounded by Michigan Avenue and Maple, East North and High streets, will be the first nursing home built in Buffalo in many decades.

It will rank as one of the largest nursing homes in the region and will fill a gap in long-term-care services resulting from the disappearance in recent years of Grace Manor, Nazareth and other facilities in the city.

James Kaskie, president and chief executive officer of Kaleida Health, said the project will benefit the Fruit Belt neighborhood, the hospital system and the medical campus.

“When you step back and think about the investments that are being made, if you understand facilities, what we’re planning is so much more efficient and improved for medicine than what we have now,” he said.

The project will replace two nursing homes operated by Kaleida Health — the 242-bed Deaconess Center on Humboldt Parkway and a 75-bed skilled-nursing unit in Millard Fillmore Hospital at Gates Circle.

The Deaconess buildings date from 1920, and the portions used for nursing home care were constructed in 1959 as a hospital. The facility is antiquated, with obsolete building systems and floor plans.

A state commission ordered Millard Fillmore Hospital closed as part of an effort to reform the region’s inefficient hospital industry. Plans call for moving its hospital services to Buffalo General Hospital and to an adjacent center for heart and vascular care on which construction is expected to start this summer.

As proposed by Canon Design, the nursing home would consist of four connected structures with 20-bed clusters of semi-private rooms and courtyards on each floor. Its four stories are intended to provide a visual transition between the taller hospital buildings on one side and the residential neighborhood on the other side.

It will consist of 200 long-term- care beds, 40 beds for patients with memory impairment, 30 beds for short-term patients rehabilitating from hospital care, 20 beds for children with profound disabilities and 10 beds for residents on ventilators.

Dr. Bruce Naughton described the home as a significant improvement, offering residents green space, smaller groupings of rooms and greater privacy.

“The city needs a quality nursing home. This is where people live. The environment can influence mood and behavior,” said Naughton, chief of the geriatrics division at Kaleida Health and the University at Buffalo.

A new building also should be considered an opportunity to adopt the principles of culture change, he said.

Culture change refers to a growing reform movement that — through staff training, better design and operational changes — is trying to move away from the passionless, poor quality, built-for-efficiency experience that has come to define too many nursing homes.

The construction site in the Fruit Belt neighborhood sits outside the official boundary of the medical campus. The project does not exactly fit the goals in a Fruit Belt Urban Renewal Plan, but advocates say it will redevelop a block that contains 22 vacant lots and an abandoned gas station.

Kaleida Health recently purchased one of the six homes remaining on the block — it paid $180,000 for 316 Maple St. — and officials said they have contracts to buy the others.

Two of the homes, all of which Kaleida plans to demolish, were built in the late 1800s and are eligible for listing on the National Register of Historic Places, although one of them has been altered from its original condition, according to last year’s environmental review of the project.

What criticism the project has received has centered on its design, location and demolition of the historic-eligible homes.

Preservationist Timothy A. Tielman said the design looks too institutional for a neighborhood. He also suggested Main Street as a better location because of its proximity to bus routes and subway stations, as well as nearby businesses.

“I know the block isn’t what it once was. But I look at houses like those and see Queen Anne Victorians or beautiful Italianates that can be restored with some loving care,” said Tielman, executive director of the Campaign for Buffalo History, Architecture and Culture.

A larger concern is with the medical campus and whether designers of the nursing home and other buildings are paying attention to creating a walkable, mixed-use community that includes retail and residences.

The environmental review concluded that the block has lost most of its historic character and that the benefits of the project outweigh the value of attempting to save the homes.

Kaskie said he understood the concerns but defended the design as “pleasant and community- friendly.”

“These people [preservationists] are great stewards of our historic treasures, but the need in this instance trumps that issue,” he said.

Officials at Kaleida Health anticipate construction will start in the fall, after a financing package is completed and final approvals received.

The state Office of Parks, Recreation and Historic Preservation has yet to have a final say. The project also requires rezoning of the Maple Street parcels and city approval to consolidate the parcels into one lot.

Kaleida Health plans to pay for the building with a $12.4 million state grant coupled with debt financing — slated to be part of a larger funding package for medical campus projects — through the sale of bonds insured by the Federal Housing Administration to investors, including banks, private institutions and possibly pension plans.

The future of Deaconess and Millard Fillmore remains unclear, although Kaskie said Kaleida plans to set aside funds to raze Deaconess.

“Deaconess is very old and past the point of rehabilitation. There will have to be a community discussion to talk about reuse of both sites,” he said.

hdavis@buffnews.com

2009-05-30T08:34:00.003-04:00

Health care by the numbers

$2.2 trillion: How much was spent on health care in the U.S. in 2007 ($7,421 per person.)

$4.27 trillion: How much the U.S. is projected to spend on health care in 2017.

$56 billion: The total amount of uncompensated care provided for the uninsured in 2008. (60 percent provided by hospitals.)

86.7 million: The number of people in the U.S. who lived without health insurance for part or all of 2007-08.

1.5 million: How many U.S. families lose their homes to foreclosure per year because of medical bills they can't afford.

14,000: The number of people in the U.S. estimated to be losing their health coverage every day due to recent turmoil in the job market.

$12,680: The average cost of family health coverage through employer-based plans in 2008.

$1,525: The cost of health care built into the price of every General Motors car.

120 percent: How much the employee's share of health coverage through company plans has risen since 2000. (Workers' average out-of-pocket medical costs have risen 115 percent since 2000.)

45: The number of U.S. states in which insurance companies are allowed to spend less than 75 cents of every dollar paid in premiums on their customers' medical care.

25 percent: How many more adults without health insurance are likely to die prematurely than those who are insured.

4.3: America spends 4.3 times more on health care than it does on national defense.

2.5: The uninsured often pay 2.5 times more for their medical care than the insured do, because they don't get the reduced rates insurance companies negotiate for their customers.

Sources: Henry J. Kaiser Family Foundation, Families USA, Illinois PIRG, U.S. Centers for Medicare and Medicaid Services, National Coalition on Health Care, Center for American Progress Action Fund.
Weather

This list of statistics were taken from a larger article regarding the rising number of uninsured in America. Read the entire article here.

2009-05-30T08:22:00.002-04:00

California Budget Deficit Carving Into Health Care
Story from San Fancisco Chronicle

As the budget deficit widens, here's where additional health cuts are expected:

If your toddler gets into the medicine cabinet, no one will answer the phone at Poison Control (all state funding eliminated).

Maybe someone in your family has been laid off - more than 300,000 children lost health insurance in the last year and a half. In response, we're going to add another 225,000 children of working families to that burgeoning number (by cutting existing Healthy Families coverage - $54.5 million).

Maybe your mom with dementia has been beggared by medical bills - the family home sold, not a penny left. Unfortunately, your chances of finding a nursing home that will take Medi-Cal just went from slim to practically none ($750 million in proposed cuts plus an increase of $18.3 million in nursing home fees). But your mom's home assistance and adult day services (which you depend on to hold down your own job) got slashed ($326.5 million).

Or maybe you're doing OK but are downright furious at the homeless people shooting up on the corner. Unfortunately, we're gutting funding for one of the few things that works: substance-abuse treatment ($116.8 million).

Child welfare will be cut, and we're even going so far as to literally take clothes away from children in group and foster homes ($83.9 million).

Widespread reports of wives and children slaughtered by husbands will increase. We're cutting $20.4 million in domestic-violence funds for emergency shelters and restraining orders.

All these problems won't go away. They'll end up jamming emergency rooms, hospitals and possibly prisons, costing us much more in pure dollar amounts. We've even cut funding for family planning services for the poor ($36.8 million).

In contrast, only 5,000 state employees (out of 110,000) are targeted for layoffs, and there are no absolute dollar cuts for prison services (only anticipated savings).

You could argue that the governor and Legislature have spent the last months re-arranging deck chairs on the Titanic.

Now Gov. Arnold Schwarzenegger's revised budget spells out that, in California, when push comes to shove, children, women and the frail are the first to get tossed overboard. No lifeboats for them.

2009-05-25T19:27:00.006-04:00

At Least One Doctor Pushes Back Against Insurance Companies
Story from San Francisco Chronicle

Dr. Bradley Carpentier, a pain management specialist,
founded the group Stop Practicing Medicine

Monterey physician Bradley Carpentier found himself spending so much time fighting with health insurers to get approvals for the treatments he prescribed for his patients that he decided to wage his own lobbying effort.

Carpentier formed a new political action committee - Stop Practicing Medicine - to target the long-standing practice of insurers hiring doctors to review physician decisions, even though the insurer-hired doctors had never seen or talked to the patient whose care they were scrutinizing.

Insurers defend the practice, saying such doctors often serve as a second set of eyes to ensure patients are receiving the most appropriate and effective treatments. But Carpentier, along with patients and other doctors who support his position, says insurers are denying and delaying care.

"We need to let the doctor take care of the patient," said Carpentier, who specializes in pain management. "Pretty much, doctors ultimately do what they want, but it just depends on fighting a lot to get that done. What we've found is fewer patients have access to care in general because we have limited resources. We're being kept so busy fighting and advocating for patients."

Health insurers and doctors have long battled over care decisions, with insurers serving as gatekeepers to set guidelines and control health costs and physicians bristling at being second-guessed and overruled. The tension reached fever pitch in the 1990s when managed care was at its height, prompting a consumer backlash that led to reforms and less restrictive forms of coverage.

Raising awareness

But Carpentier said he's seeing an increase in pushback from health plans, prompting him to refuse most insurers and, instead, treat his patients and submit reimbursement forms on their behalf. He formed Stop Practicing Medicine, he said, to raise awareness of insurance interference as lawmakers and the Obama administration begin efforts to overhaul the health care system. The organization began recruiting patient and physician members last month.

"The prospect of health reform in this particular time in history is what led me to speak out," he said, adding he is calling for restrictions of the practice but not the abolition of health insurers. "I think there is absolute change in the air and we want it to be for the better."

In poll results released last month of 389 California doctors, 87 percent described limits and restrictions that insurance companies place on doctors as a major problem.

The survey, conducted by a Seattle research firm for the California Medical Association, found 84 percent felt pressured to change the way they treat a patient because of a restriction from an insurance company and 86 percent admitted selecting a course of treatment they might not otherwise have chosen because of the pressure.

But insurer groups contend the interests of physicians and health plans are more closely aligned than ever, and that the two groups are working together on many issues such as rewarding physicians for quality rather than just quantity of care.

"It's in everybody's best interest to make sure the patient is getting the right health care treatment in the right place and in the right time," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, a national trade group. He cited studies that have shown patients often don't receive the best care supported by scientific evidence.

Protections in place

California's independent medical review system allows a panel of physicians to resolve disputes between patients, doctors and insurers, said Charles Bacchi, interim president and chief executive officer of the California Association of Health Plans.

"We just believe the most important thing is that the patient is receiving the right care," he said. "And we think there are protections there for consumers already."

Dr. Michael Leong of Los Gatos, who works with Carpentier and at Stanford University, said pain management specialists are particularly vulnerable to insurance hurdles because pain is less quantifiable that other maladies and often requires highly individualized therapies or newer, more expensive drugs.

Leong said he recently saw a patient whose neck pain had flared up, but he was unable to give her an injection she receives several times a year. That's because the insurance company requires him to submit the same paperwork and go through the same authorization process each time, he said.

"I know it will get covered in two or three weeks, but that's another two or three weeks of pain," he said.

Noel Ortiz of Twain Harte (Tuolumne County), one of Leong's patients, said she regularly had to battle her insurer until she was able to manage her pain without drugs after undergoing treatment through a clinical trial. She said she has been on the hook for as much as $15,000 in medical costs while she fought for reimbursement.

The 50-year-old Ortiz, who suffered from lower back pain from years of teaching horseback riding and training horses, said she still doesn't rest easy. "I do keep an account for fear it will happen again," she said.

Learn more

For more information about Stop Practicing Medicine, visit www.drcpainmd.com/giving.cfm

2009-05-25T19:13:00.002-04:00

Focus On Orange County CA Caregiver Resource Center
Story from OC Register

Claudia Ellano knows more about caregiving than she would like.

She spent six years working and also caring for her husband, Moe, who died of chronic obstructive pulmonary disease.

And she is the director of the Orange Caregiver Resource Center, the only Orange County agency focusing specifically on the needs of caregivers who are coping with a loved one's chronic illness.

The Caregiver Resource Center (caregiveroc.org) is a program of St. Jude Medical Center and part of a statewide system of Caregiver Resource Centers for people 60-plus. It is financed through county, state and federal agencies.

A chat with Ellano:

Q. Let's talk about the typical help a caregiver can receive from your agency.

A. Well, we have a staff ready to assist with problem-solving resources and support. Just call (800) 543-8312 .

A care coordinator will talk to them about what the caregiver is needing the most — from the community or for themselves.

Q. How do you know what type of needs the loved one has?

A. We don't assess the patient. We are not here to solve problems for the patient. We are strictly here to help the caregiver with an action plan, including proper referrals, how to talk to the doctors, where to go to get assessments.

But they have to start with a diagnosis.

Q. This is a rhetorical question but — do caregivers need a lot of help today?

A. We've always known caregiving has an emotional and economic impact. But add the issues of today's economy, people losing their jobs for example, and the impact is huge! We want to be the entry point resource center for caregivers, and we are part of a large partnership of agencies ready to help.

Q. OK. But you and I know money becomes the big problem. Unless the person you are caring for has longterm-care insurance, families have to shoulder most of the cost of caregiving.

A. We are woefully lacking in public policy for longterm care in this country.

There is an assumption that Medicare pays for senior care, but in fact it only pays for a specific number of days after an acute episode, such as a stroke.

If someone needs longterm care in the community, it's pretty much out of their own pocket. Medi-Cal might be able to pay for some help, but we know this is where a lot of the cuts are coming.

Some senior HMOs have respite dollars built in, but these are short term and intermittent kinds of funding.

Adult day healthcare, other forms of relief, are almost all private pay.

It's a challenge that isn't going to get easier.

Q. Most people think of nursing homes when they think of caregiving costs.

A. Those costs are high but only impact about 5 percent of those needing care. People want to keep their loved ones at home.

Q. What kind of calls do caregivers make to you?

A. Here's a common one: I only make $12 an hour, but the agency wants $18 to $20 an hour to provide care for my mom.

Now, even if you haven't been laid off, there's a dilemma balancing that cost of care.

Q. Not everyone is equipped mentally to do caregiving.

A. No. It can be a beautiful spiritual journey.

We can help you stay healthy and make sure you have done the legal and financial planning necessary, made your home safe for your loved one, have meals delivered, and so on.

But not everyone wants to go on this journey. Everyone has different stress levels.

Q. How's your budget this year?

A. We slipped by without being targeted. We can still provide services.

There are several networks and agencies ready to help caregivers. Here are a few sites to check out:

•Eldercare.gov – local resources such as transportation, meal delivery, respite care.

•Medicare.gov/caregiving/ - should answer all your questions about Medicare services available.

•Snapforseniors.com – local resources and options in senior housing, including nursing homes, assisted living, senior living or retirement communities.

•Lotsahelpinghands.com – caregivers can sign up for friends, family, neighbors and other volunteer help.

•Caring.com – support groups and social networking.

•AboutEvercare.com – Evercare Solutions for Caregivers – an insurance program – will provide an assessment and care plan for non-members for $580. Care management after the initial assessment to help coordinate ongoing help and support is $115 per hour.

2009-05-25T19:04:00.002-04:00

Americans Spend Millions On Caregiving
Many are forced out of their jobs and homes because of the strain to provide for their loved ones

Story from OC Register

Jodee Kalmen drew the caregiving card four years ago.

She was 50 when her husband, Peter, then 57, was diagnosed with frontal lobe dementia. His ever-worsening symptoms had already cost him his job.

She was a stay-at-home mom with two sons but became a school bus driver. They lived off her small salary, his Social Security Disability, the equity in their home.

Today, she is one of 44 million Americans responsible for caregiving a spouse or parent. The backbone of the nation's long-term care system, they represent $375 billion annual value in the care they provide.

But in these hard economic times, a new survey shows caregivers are facing escalating financial and emotional hardships that are rarely, if ever, addressed in national debates about funding health care.

There are statistics, data and websites offering help, but the truth is caregiving is where childcare was years ago, says Sherri Snelling, senior director of Cypress-based Evercare.

Few employers offer benefits. Many adult children are losing their jobs, forcing them to move in or move home parents who were in care institutions. Most caregivers are not prepared for the expense and the emotional drain.

In the next two weeks, we'll look at the data and the solutions, the questions and the few answers.

The Kalmens thought their future was secure.

"My husband and I did everything we were told to do; buy a home, save money for retirement and open college funds for our boys," Jodee Kalmen says. "What they did not tell us was that dementia was going to enter our lives and devour our financial future.

"Besides watching my husband slowly die, I have had to live on pins and needles riding the uncertainty of the economy."

After 21 years in her home, Kalman says she is down to her last financial resource — her husband's IRA, which has been decimated by the declining stock market. She's already refinanced the home three times.

She has no health insurance because she lost her job.

"I am scared," she says.

She's not alone.

A survey conducted by Evercare by UnitedHealthcare and the National Alliance for Caregiving concludes 43 percent of caregivers have taken a pay cut or have been forced to work fewer hours as a result of the recession.

Some have taken on additional job or are able to work more hours, but almost 50 percent told surveyors they have exhausted their savings and 43 percent have had to borrow money to continue caregiving.

"These people are a significant part of our society, yet their economic impact is often unmeasured and, frankly, they are discounted in the view of the public," says Dr. Alan Sokolow, chief medical officer for United Health Care.

The concern is a potential cutback in individual caregiving, he says. Many have said they are cutting back or might be forced to cut back hours spent caregiving because of employment-related demands.

"There needs to be continuing awareness of the importance of providing assistance for caregivers," Sokolow says.

But the facts are these:

•With 30 years added to the average lifespan in the 20th century, most boomers can expect to spend some years as a caregiver for parent or spouse.

•The increasing number of childless women and others without family ties brings new challenges to financing caregiving.

•Caregiving only recently became an employee benefit for some workers; few caregivers are able to access these benefits today.

•64 percent of caregivers are struggling to pay their own bills.

•63 percent have stopped saving for their own retirement or future caregiving.

•36 percent say they have found that government agencies or nonprofit groups are less able to provide services or outside help.

Next: Where caregivers can look for help today, and in the future.

2009-05-25T08:20:00.001-04:00

Transcript: Health Care Issues Discussed By Panel
Story from the Dallas Morning News

At The Dallas Morning News' invitation, 11 health care experts from the Dallas-Fort Worth area and Texas recently shared their views via e-mail on how to make health care more affordable and accessible.

Options for reforming health care coverage range from a single-payer system like those in Great Britain or Canada to a mostly non-group market where people would shop for their own private coverage, helped by federal tax credits. Which is preferable? Or is there a better middle ground?

DR. RON ANDERSON: I've long been an advocate of the concept of a single-payer system. It's more cost-effective, and its administrative overhead is low. However, I don't think this country is ready for anything that would take away competition. If competition for patient loyalty is possible and if there is still an adequate emphasis on quality, safety and access, I would support it. America uniquely likes competition; we like choices. If the choice of doctor and hospital is made possible, that would be attractive. I think the U.S. will end up being somewhere in the middle of the road. We need to differentiate between socialized insurance and socialized medicine. The former doesn't have to travel with the latter. But to do that we have to change our delivery models to be much more cost-effective than we currently are. But I do think there is a middle ground.

ROSSIA AVERY: As a registered nurse, I have watched insurance companies distort and undermine the delivery of health care in this nation. Patients skip needed medical treatment or appointments or cut pills in half because they can't afford the high cost, even if they are insured. Our physicians are forced to follow protocols that are based as much on insurance profits as on medical standards. And our patients are forced to deal with bill collectors and insurance claims adjustors just as they should be focused on getting better. The insurance companies waste 30 percent of their care dollars on "overhead," although they have never cured a patient and, frankly, deserve no role in the delivery of medicine. The good news is we know how to fix our health care system. Nearly every other industrialized democracy provides quality, universal health coverage from a national nonprofit fund.Think of it as if we expanded and improved Medicare to cover everyone. Under this single-payer system, health coverage and access to care are based on patient need, not your ability to pay. Everyone would be covered for all needed care. You'd be guaranteed your choice of doctor and hospital, and there are meaningful controls on costs. Best of all, medical decisions are in the hands of patients, their families and their doctors and nurses, not private insurance companies. We deserve no less.There are two single-payer bills in Congress, HR 676 and S 703, and Texas is one of many states with statewide bills before the Legislature.

U.S. REP. MICHAEL BURGESS: The guide for reform should be improving what works and fixing what does not. President Barack Obama said on the campaign trail – and this is clearly something that resonated with Americans – that if you like what you have, you should be able to keep it. I take that to mean that whatever reform we undertake in Washington shouldn't force an individual back in Texas to go to a different doctor against their wishes or force anyone to buy insurance they don't want or need. I also believe we need to take a look at the tax code. It's fundamentally unfair that small businesses, the self-employed and individuals do not enjoy the same tax benefit as larger companies when purchasing health insurance. This is a key step in making health care more affordable and giving Americans more choices. We need to ensure that whatever we do doesn't adversely affect the quality and affordability of American health care, and there are some really troubling proposals out there that would do just that.

ANNE DUNKELBERG: Settling on the precise form for an American system to guarantee every one of us access to a decent standard of health care no matter what our job, income or health status is not the most difficult step in reaching health reform or the most important one. The crucial and weighty step needed is the decision as a country to ensure access to health care as a public good, just as we do education, roads, military, fire and police protection. Every taxpayer knows that these public structures on which our civilization relies (and which all but the most diehard anarchists support) are not free, and affordable health care for every American will be just that: affordable but not free. Every American will have to contribute to the health care system no matter what model we pick to deliver and finance care – just as every American has to support schools, roads and the military. The critical change will be the guarantee that Americans will not have to spend more than a predictable upper-limit percentage of their income on health care. This change will eliminate health care bills as the No. 1 cause of U.S. bankruptcies, along with the profound fear American families live with today of not being able to pay for or receive the health care their loved ones need. What Americans desperately need today is a system that will provide every person the same access to a decent standard of care at a price that they can afford and which cannot be taken away if they lose a job or become sick or injured. Once the decision to create such a system is reached, there are many models to choose from, since every other industrialized nation already has such a system. A system that provides the health care security described above could be delivered under a single-payer system like Canada's, under our current system, which includes a major role for the health insurance industry alongside large public insurers (Medicare and Medicaid), or under an infinite number of variations in between the two. In fact, no country has a perfect system, and our U.S. system will not be perfect, either. For health reform to work here in the U.S. with a continued private insurance industry, however, some of the basic ground rules for the industry will have to change.

MARIANNE FAZEN: Most employers prefer a private health care insurance system over a government-run single-payer system. We believe that a private insurance system fosters innovation, competitive pricing, accountability among providers and patients, provider payments that reward superior performance and good patient outcomes, personal responsibility for healthy lifestyles and behaviors, and a wide range of coverage choices for consumers. We've seen just the opposite in government-run programs like Medicare and Medicaid. Although there are few examples where all of these desirable characteristics are in place and working well together, employers believe that the chances of this happening are far greater in a private, tax-favored health insurance system than a government-run single-payer system. However, in order to make the private insurance affordable, everyone who is not covered by Medicare or Medicaid should be required to purchase coverage in order to spread the risks across the sick and the healthy to keep costs down. Government can help by offering tax incentives for individuals and small businesses.

DR. ROBERT FINE: An American version of single payer is the best option not only for achieving universal health insurance coverage but also for improving quality and controlling costs – both of which are necessary to achieve and maintain health care for all. Traditional market-based solutions such as individuals "shopping" for private health insurance cannot accomplish any of these tasks because medical care is not an ordinary commodity and the health care sector is not an ordinary market. The "consumer" (patient) can never be adequately educated or informed about the product, and the provider can never escape the moral obligations intrinsic to medicine – obligations that don't exist in other markets. For the past 30 years since graduating from medical school, I have watched market-based solutions fail to improve access quality or, most important, cost, which has increased from 7 percent to 17 percent of gross domestic product. And why should this matter? Because we can't compete in the global marketplace when so much of our business investment is tied up in an inefficient health care system! The necessities of competition force insurance companies to keep anywhere from 15 percent to 25 percent of every premium dollar for screening out unwanted patients, marketing and sales, private-sector executive salaries and profit. A dollar spent on insurance sales is a dollar not spent on health care services. A dollar spent denying health insurance to a patient betrays the very purpose of health insurance. On the other hand, for every tax dollar devoted to health care, over 95 cents is disbursed for health care services. The middle ground thus is not between a single-payer system and shopping for private coverage but within a single-payer system fostering cooperation rather than competition between providers. Only a single-payer system offers the efficiency of a universal premium collection system, a single risk pool and a universal payment system coupled with the freedom for patients to choose their own doctor and hospital – something they don't have under market-based proposals.

LARRY JAMES: Whether there is a better option for U.S. citizens only time will tell. I do believe that given the fact that so many Americans already enjoy publicly administered health care coverage (Medicare, Medicaid, veterans' health and SCHIP) and given the market realities and preferences of consumers here, it is most likely that our first steps into the world of universal coverage will be a blend of options. It is worth noting here that the public solutions we have already embraced are administered at a fraction of the cost of private coverage and that these groups have been able to negotiate rates that keep health costs lower than would be the case if they didn't exist at such a scale and if they weren't public plans.

STEPHEN MANSFIELD: While I believe free-markets and the associated innovation and competitiveness derived from those markets are hallmarks that have allowed America to accomplish greatness by most any historical metric of societal greatness, I also believe market forces work less effectively in cases where a society deems a good or service to be a right. Studies indicate that the overwhelming majority of Americans view access to basic health care as a right. I am among that group and hence among the group who believe our best option for reforming and improving our overall health care economy is through fiscal policy which ensures health coverage and access for all paid for by all.

J. DARREN RODGERS: Blue Cross Blue Shield of Texas supports changes that will lower the cost of health care, improve the quality and safety of care and ensure that all Americans have health insurance. Today, the federal government and states struggle to maintain programs like Medicare and Medicaid, so it's hard for me to understand how a government-run, single-payer system would improve the cost, quality and safety of health care for Americans covered by private insurance. A government-run, single-payer system would be an unnecessary new bureaucracy that would only create a huge diversion from the true goals of health care reform. A number of alternative reforms are being debated. Guaranteeing access to coverage for everyone is one example. That would have no cost to taxpayers and should be instituted before we disrupt the current system, which works well for many people. Some of the more radical options could have unintended consequences that negatively impact the quality and safety of care.

As more Americans lose their jobs and employer-based health care coverage, they're turning to individual insurance. But they're finding that policies are unaffordable and, if they have certain medical conditions, unavailable. How can we guarantee that these individuals get affordable coverage?

ANDERSON: Currently, there are ways to get individual plans, but many times what you get is a bare-bones plan with a very high co-insurance and deductible. This prevents some unnecessary utilization, but it also prevents necessary utilization. You need a system that's going to be protective of the patients and focus on quality, safety and access, not just cost. It's important to remember that insurance is not the same thing as providership. We can't meet the needs of health reform without expanding capacity to take care of more people. Our focus needs to be broader than just payment reform.

AVERY: We can't, under the current system. Insurance companies only want to cover the healthy and the young, not because they are evil but because their primary goal is not providing care but generating profit for their shareholders. They make that profit by limiting who they will cover and denying claims, even for care recommended by physicians. Thus, tens of millions of people are simply denied the ability to buy insurance if they have ever been sick, are older or considered likely to incur medical costs, and women are charged more primarily because we can have children. Could this system be any more immoral? The best way to guarantee that everyone is able to get coverage is by having one system, such as Medicare, that treats everyone fairly and has one very large risk pool that can share the risk and that also has the strength in numbers to negotiate bulk pricing from the drug companies, medical suppliers and other parties in the health care system to control costs.

BURGESS: I think our goal in reform should be to say, "If you want health insurance, you should be able to purchase it." I think with greater individual control and more equity in the tax treatment of health insurance, more Americans will be able to afford coverage on their own that isn't tied to an employer. There are a number of innovative models for making health care affordable – even outside of traditional insurance – and I think we need to be very careful not to stifle these innovations. I'm also open to some form of premium support for those who cannot afford coverage. I'm willing to consider proposals that will make health insurers reconsider their decision to use pre-existing conditions as a means of denying coverage. This is clearly bad corporate citizenship. I think the best remedy is to provide patients with more choice and control, and then you will see insurance companies actually compete for all patients regardless of health status.

DUNKELBERG: Fundamental reforms of our private insurance market will be needed to create a sustainable health care system. Texas Department of Insurance data reveal that the average cost of a family employer group premium is around $12,000 a year. But under current law our lax regulation of health insurance allows insurers to legally charge as much as $62,000 per person to a small employer group. In practice, the state insurance department data show real-world maximum annual per-person premiums being charged small Texas employers as high as $29,000. In the individual market, there is no legal upper limit on the premium at all, and of course you can simply be turned down for coverage altogether.

The key reforms needed for the private market would end most of the differences between individual and group insurance by establishing the following ground rules for every insurer:

•No person or group can be turned down for coverage ("guaranteed issue" in insurance-speak).

•The difference between the lowest and highest premium charged for the same coverage is limited. For example, the highest premium can't be more than twice the lowest.

•The differences in premiums cannot be based on your health history or status. Rate variations would only be allowed for age, gender and geography – and the final premium would still have to be no more than twice the lowest premium.

•These rules would apply to both group and individual insurance, so that individuals purchasing a policy directly could benefit from the same kinds of shared risk that those of us who work for large employers have.

Of course, regulation of the insurance market is only one key needed change. Many working Texas families earn too little to afford the full cost of coverage, even if they were guaranteed to get that $12,000-a-year average premium. Half of Texas families earn less than $56,000 a year before taxes. The family grossing $36,000 cannot afford to spend more than a third of their income on insurance premiums – not to mention the other health costs those premiums do not cover. And the newly unemployed Texan in our question above probably cannot afford to pay the full cost of coverage with their unemployment insurance benefits. For this reason, a system making coverage affordable for all will also have to set an upper limit, such as 10 percent of income, on what families are expected to pay for health care (not just insurance premiums but all expenses). It will also require intense attention to the many ways in which the costs of health care could be better controlled.

FAZEN: A combination of tax reforms and tax incentives seems like the best way to help individuals obtain affordable insurance. Individuals and small businesses should be able to deduct their health insurance premiums the same as large employers are allowed to do. Individuals could also receive a tax incentive, either as a credit or a deduction, to help offset the cost of insurance that they purchase for themselves. As for guaranteed coverage regardless of health status, the only way this can be affordable is to mandate that everyone purchase health insurance, whether individually or through one's employer, in order to spread the risks broadly across a large population of both the sick and the healthy. That's what insurance is all about.

FINE: We can only guarantee affordable coverage by creating a single risk pool that accepts all patients – and this means creating a single-payer system. The private health insurance market "works" by stratifying risk and excluding any patient who is not profitable for the insurer to cover. Such patients typically won't receive treatment until they are seriously ill, at which point they will come to an emergency room where treatment is much more expensive. The insurance company has denied the patient coverage, but the patient will still be treated – by law, by the inclinations of the healing professions and by ethical concepts embedded in our traditions, such as the admonition to "not stand idly by" the blood of our neighbors and treating "the least of these" brothers (and sisters) among us. The costs of this emergency treatment are then passed on to those still insured, driving up their costs and causing more people to lose insurance coverage. If we believe it is ethical to deny health insurance coverage because of a prior condition – for example, coronary artery disease – then we should believe it is ethical to deny the patient treatment in our emergency rooms and simply watch them die when they come to us uninsured with a heart attack!

RALPH HOLMES: Unfortunately, there are no guarantees that individuals, with or without health conditions, will be able to get coverage that they can afford. We realize that with rising unemployment rates, there are people who are making tough decisions such as putting food on the table or going to the doctor. From Aetna's standpoint, we offer a wide range of plan alternatives, from plans that are comparable to what individuals received from employer-based plans to lower-cost plans that provide coverage for preventative care as well as protection against catastrophic medical expenses. With different options, consumers can choose what would best fit their health and financial situations. For those who have lost their job since Sept. 1, 2008, they should look at taking advantage of the American Recovery and Reinvestment Act that was passed in February. The law provides a substantial subsidy to COBRA, which allows people to retain their health insurance benefits after a job loss. The government will subsidize up to 65 percent of their old employer's insurance premium for up to nine months. For those people who may have pre-existing conditions and are having trouble finding individual plans, this might be a good alternative. However, there might be some consumers who cannot purchase COBRA or individual plans for a variety of reasons. That is why one of Aetna's main goals is to educate people on all of the different options available to them, so that they can make informed decisions. To that end, Aetna and the Financial Planners Association developed Plan for Your Health (www.planforyourhealth.com), which is a free, public-education Web site designed to inform consumers about all aspects of health insurance. The comprehensive site includes such things as the basics of individual health insurance, recent changes to the COBRA program as a result of the stimulus package and tips on what consumers should think about when they are purchasing plans. Other alternatives for coverage to be considered are the Medicaid or the State Children's Health Insurance programs. For the 47 million uninsured in this country, approximately 11 million people are eligible for these types of programs but do not enroll.

JAMES: Only strong public policy decisions will be able to adequately address this hard reality. Health care should not be seen as a publicly traded commodity but more as a human right or at least a "public utility." Only clear, strong regulatory policy that forces restrictions on the private marketplace will solve this problem. Ironically, it likely will be this growing problem that forces us into a new strategy altogether.

MANSFIELD: Health insurance coverage has been in what some refer to as a doom spiral for several years, as more people are uninsured and unable or unwilling to pay for their health care, and the costs for charity and bad debt are passed along to those with insurance in the form of higher premiums. That means that employer-sponsored and individual insurance policies cost more than they should because they include a surcharge for the uninsured. The resulting effect is premiums increasing to substantially more than general inflation. This prices more and more employers and individuals out of the insurance market, contributing to the downward spiral in the number of employers and individuals able to afford insurance. I think the problem must be fixed at its source, providing basic coverage for all. Doing so would reduce insurance premiums and allow more individuals and employers to afford to purchase health insurance and would change the direction of the spiral in a positive direction.

RODGERS: Health insurance is expensive because health care is expensive, so there must be reforms that impact the cost of health care. Of course, these reforms will need to extend far beyond insurance. Blue Cross Blue Shield of Texas believes everyone should have health insurance. To make individual coverage more affordable and available, Blue Cross Blue Shield of Texas supports requiring health insurers to take all applicants regardless of health status as long as there is an effective individual obligation to maintain health insurance, possibly combined with federal subsidies or tax credits for certain individuals. With everyone having health insurance, the insurance will work as it should – spreading risk across a broad population and avoiding the risk of only those who need insurance actually purchasing it. Allowing individuals to waive in or out of the insurance only when they feel they need it would only increase the cost for those who try to maintain the insurance, resulting in more uninsured.

Our health care payment system seems to reward the volume of services provided, not necessarily the quality of the outcome. How do we change reimbursements so that they reward performance?

ANDERSON: Service providers need to be rewarded for practicing prevention and achieving better outcomes. Achieving this means we need to become as evidenced-based as we can, creating incentives for both doctors and hospitals to practice prevention. We need to find a strategy that will create a win-win situation for health care providers, insurers and patients.

AVERY: The current system rewards services that generate the most profit. That's why we have inflated charges and an explosion in boutique services, while far too many of our patients go without appropriate and timely care. We need a system that is based on patient need and prevention. The most cost-effective approach is to ensure that people are encouraged and not financially penalized for getting regular medical, dental and vision checkups and other preventive health care screenings and services. This will lower overall health care costs and reduce long-term pain and suffering, and it will ensure that patients get the care they need when and where they need it.

BURGESS: The payment system is actually one of the reasons I decided to run for Congress. As a physician, I saw the way that Medicare, for example, wasn't paying nearly what it costs to treat a patient. Of course, when you're losing money on every patient you see, you can never make up for the losses with volume. And the problem is even worse in Medicaid. Fundamentally, doctors are focused on using their knowledge and skills to treat their patients in the best ways possible with the latest technology. I think new tools like comparative effectiveness research and best-practice guides are important steps in improving outcomes, but these should never interfere with the patient-physician relationship.While improving quality and efficiency are noble goals, the treatment should always be a decision between doctor and patient. Addressing medical justice reform is a key part of improving the ballooning volume of services. Too many doctors are forced to practice defensive medicine to insulate themselves from lawsuits by trial attorneys. I also like some demonstrations that have enabled doctors to recoup a portion of the savings they've returned to the government as an incentive for participating in quality improvement.

DUNKELBERG: Health economists have been thinking for several decades about how to correct the financial incentive to provide more care in order to make more money. Managed care and HMOs were the first large-scale attempt in the U.S. to change the rewards. Of course, we quickly came to realize that the incentive to deny needed care in order to make profits was just as objectionable. There are no perfect systems, here or abroad, for rewarding "performance," partly because even with the very best lifestyle choices and health care, people will still get injured and sick and eventually die. It is not easy to set goals for performance for health care providers that do not hold them responsible for the failure of individuals to follow medical advice and take care of their own health through diet and exercise. Despite these caveats, our country will be in a far better position to reward performance instead of sheer volume when no American is excluded from care due to financial barriers. One key will be making long-term connections to our health professionals and insurers. When health plans know that they will be with us for the long haul, they will have a far greater incentive to keep us healthy. Information is also key. Currently, no one is tracking the effectiveness of the vast majority of health care being delivered in the U.S. Our knowledge about what works is limited to special studies, and many of those are paid for by someone with a profit motive, which can distort whether and how the findings get shared. A health system that serves everyone will have a far greater ability to collect information about what works and what doesn't. And, without expecting doctors to make us immortal, the new world of information systems can also make sure that best practices, basic standards of care and the latest updates are communicated systematically to all doctors. One of the first steps we are already taking in the U.S. is refusing to pay for medical errors (no pay for poor performance) in Medicare.

FAZEN: There's no question that our current reimbursement system, which rewards providers for the number of services performed regardless of patient outcomes, is topsy-turvy. "Pay for performance" is a relatively new concept that is gaining traction with health plans and employers. This makes sense intuitively, but defining and measuring quality are tricky, publicly reporting providers' performance is rare, and determining a fair payment structure is extremely difficult. Only recently has national consensus been achieved by leading health care experts on how to define and measure performance for selected medical conditions, which may explain the slow start that pay for performance has had. However, health plans are now beginning to segregate providers into tiers with different reimbursement schedules, based on how well they adhere to evidence-based medical practices for certain illnesses, like diabetes and cardiovascular disease, and how well their patients fared under their care. Also, some employers are paying bonuses to physicians for delivering high-quality care and good outcomes. Medicare has a demonstration project in progress that pays bonuses to physicians who demonstrate good performance and good patient outcomes. However, I think there is a lot of concern among physicians and hospitals about "cut-and-dried" performance measurements, which tend to view health care as "pure science" without also considering the "art of medicine." They also are concerned about transparency, or public reporting of performance scores, fearing punitive action by the health plans or, worse, loss of confidence among their patients. Dallas-Fort Worth Business Group on Health members think it's very important for providers to be directly involved in determining how performance is defined, how it will be measured and how and by whom the results will be used. Our communitywide health care improvement collaborative has both hospital representatives and practicing physicians literally at the table with our employers and health plan executives making joint decisions about performance metrics for diabetes care that we will use in the Dallas-Fort Worth area, as well as reporting rules and appropriate use of the information by each stakeholder. I think we need to get the performance measurement issues worked out first before we change the reimbursement structure. But I also think a reimbursement model that rewards good performance and good patient outcomes will soon become the norm.

FINE: I am skeptical about "rewarding performance," which, although well intentioned and reasonable at first glance, is fraught with problems. There is too little agreement on what constitutes good performance, too few reliable tools with which to measure performance and too much uncertainty as to who should be rewarded for good performance. What tool reliably measures the effectiveness of physician communication, one of the essential elements of quality health care delivery? Or consider improved diabetic control. We can measure average blood sugar control, but a reliable, health literate, easily motivated patient is likely to have much better diabetic control than a health illiterate, unmotivated patient. Should one physician or one health care system receive greater rewards because they have more health literate and motivated patients? Overall, I think it probably is best that we stay away from too much emphasis on using reimbursement to "reward performance" at this time and focus on simpler methods of reducing unnecessary procedures. Single-payer systems have clearly already accomplished this. For example, elderly heart attack patients in the United States receive 5.8 times more revascularization procedures than elderly Canadian heart attack patients, but their mortality rates are the same. More is not always better, and single-payer systems are more efficient in curbing nonbeneficial treatments.

JAMES: Unknown to many, Medicare already is imposing quality-control performance metrics on hospitals around issues like readmissions. I know similar outcome performance and quality-of-care issues relate to home health care and other sectors of the health care world. Care standards indexed to patient outcomes will ensure that improvements are made. As President Obama clearly understands, the spread of electronic health record technology will make this much easier and more cost effective. The same electronic record capacity will make best-practice treatment protocols more accessible to doctors and hospitals and outcomes easier to obtain, report and improve upon.

MANSFIELD: We are starting to see some efforts to tie pay and outcomes together from a reimbursement perspective. For example, Methodist has been among a handful of hospitals across the country to receive additional Medicare reimbursement because the quality of our outcomes is in the optimal range. I think tying pay and performance can be a good thing if it is approached as a zero-sum methodology rather than as another veiled attempt to reduce reimbursement without sound scientific reasoning behind the methodology. It is equally important that the models encourage stellar performance and outcomes as it is that they discourage suboptimal outcomes.

RODGERS: Today, ineffective, redundant and inappropriate care is estimated to account for as much as 30 percent of health care spending. Blue Cross Blue Shield of Texas believes the incentives with the health care delivery system must be changed, and it is pursuing a number of initiatives to reward providers for delivering appropriate, cost-effective care. For example, we've converted about 25 percent of our physician agreements to "pay for performance" programs that reimburse physicians for providing the right care in the right place at the right time. Additionally, we've partnered with other organizations such as Bridges to Excellence to recognize and reward physicians for better management of patients with chronic illnesses.

There hasn't been a major federal push for health care reform since the Clinton administration's failed attempt in the 1990s. With the many differences of opinion that exist between all the stakeholders, will President Obama and Congress be able to stitch together a compromise and achieve reform this year? Why or why not?

ANDERSON: For over 15 years a lot of policymakers have decided to not touch health care. Meanwhile, health care costs have skyrocketed compared to wages, salaries, benefits and the gross national product. Hopefully, now we know enough to create a rational approach where we can save money and reinvest that money in reform. It would be better to have a system where care is given based on need rather than on ability to pay. I'm glad to see the Obama administration step up and try to create a reform package. It may not be perfect, but the current approach is not sustainable. We must be prepared to sacrifice "perfect" for "good and improving year by year," or we'll never get anything done.

AVERY: We will achieve genuine and fundamental reform of our system when patients, nurses, physicians and health care activists have constructed a movement that is as powerful as the insurance lobbyists. I believe we're watching that happen around us. For this year, it seems highly likely that President Obama and Congress will pass legislation, particularly if the House and Senate proceed with the same "budget reconciliation" process used by President George W. Bush in 2001 that allows bills to pass by a majority vote of 51 in the Senate. The outcome may also depend on whether congressional leaders fight off poison pills, such as provisions to tax employer-provided health care benefits and to mandate that individuals purchase products from the private health insurers, no matter the cost or quality. Both of these proposals would cause any compromise to lose support among health care activists and make the bill difficult, if not impossible, to pass.

BURGESS: I think we have a tremendous opportunity to reform health care. I am afraid that many Democrats are looking at this as an opportunity to settle old scores with the insurance industry or physicians, but if patient care is kept as the goal and if we remember that we have a responsibility to "do no harm," we'll be able to work toward a product both sides of the aisle can be proud of. Obviously, the numbers favor the president's party, and they can pass any bill they want without a single Republican vote. But the Democrats have indicated that they want to move forward in a bipartisan way, and I am hopeful they are sincere because I want to help. I also think we need to take our message to the American people because this is something that can be won by Republicans in the court of public opinion. I really think there are some important timing considerations, given the nature of our political calendar and the vast array of challenges facing President Obama. Nevertheless, I hope all good ideas are considered.

DUNKELBERG: In favor of health reform, President Obama has the benefit of considerably stronger backing for health reform in Congress, among the American people and in the business sector than was the case during the Clinton administration. The level of insecurity and concern among average Americans has increased dramatically, along with the costs of coverage and health care. From 2000 to 2007, Texans saw their health insurance premiums increase 87 percent, while their incomes increased only 15 percent. With the cost of coverage growing nearly six times faster than incomes, health insurance becomes less affordable for Texas families every year and for employers who are trying to maintain health insurance as an employee benefit. Voters today express a strong desire for change in our health care system, with over two-thirds saying we need a complete overhaul or major reform. While this support is strongest among Democratic voters, 59 percent of independent voters and 52 percent of Republican voters also support major reform. A bedrock concept of the administration's health reform vision is that Americans who are happy with the coverage they have today will be able to keep it, while new coverage choices will be created for those who are uninsured or who have inadequate coverage. The sense that the entire health care system will not be turned on its head overnight is critical. Having said that, every step we take as a nation to reduce the cost of care, eliminate waste and select the most cost-effective drugs and procedures will result in someone's profits being reduced, and we can expect that there will be resistance to specific aspects of change from every sector whose income is affected.

FAZEN: We all have high hopes for transformational change in the health care system, since the current system clearly isn't meeting the needs of many Americans. However, with so many stakeholders in this very rich, $2.4 trillion industry with different opinions and fears of losing out if they must give up something to help another group, I'm a bit pessimistic about achieving any meaningful reform this year. However, I applaud President Obama for making health care reform one of his administration's top three priorities. Although real reform may be beyond our grasp this year, at least this gives us an open forum for meaningful discussion and debate about both the positive and the negative aspects of our current health care system. From this will emerge innovative ideas and solutions, and there will be opportunities to test these ideas in smaller-scale pilot studies in communities and as statewide initiatives before we as a nation decide what type of national health care system we want.

FINE: I am an optimist by nature and believe in the growing good of the world through human endeavor, yet I don't think the type of reform I believe we need is likely this year. There are simply too many special interests and too much fear. Too many politicians – starting with the Clintons in the 1990s and followed by George W. Bush and President Obama – have been unwilling to take on the health insurance industry. In a single-payer system, even though marketing and risk selection services would disappear, other elements such as claims processing or supplements to a basic single-payer insurance package should survive. This remaining work will not likely be enough to keep insurance companies and their lobbyists satisfied. Meanwhile, many insurance company employees, fearful of losing their jobs, will work to scuttle any reform that might leave them unemployed, and who could blame them? Sadly, the "House of Medicine" is also divided by the fear that if primary-care reimbursements rise, subspecialty reimbursements will inevitably fall. Finally, fear among the broad public will help scuttle reform. Although over 15 percent of our population is uninsured and poor quality plus high costs affect rich and poor alike, there is too much fear among the 85 percent of us who are insured – a fear that health insurance reform will hurt more than help. I personally think this fear is illogical and not supported by the evidence, but I also know that fear does not always respond to logic.

JAMES: In my view, this is largely a matter of political will and available political capital. The president seems willing to involve everyone in the debate and the process. The prospect of some sort of "blended" solution that I've already suggested could make the process easier. The most important changes since the Clinton administration's failed attempt to achieve universal coverage relate to this president's popularity and to the impact rising health care costs are having on American business. It is no accident, nor is it surprising, that a growing number of leaders from business, industry and trade are now advocating for universal coverage of one kind or the other.

MANSFIELD: I think getting it done this year is a bit optimistic, but I am of the opinion that President Obama and leaders in Congress have the will and the mandate to substantially reform our health care system. The Clintons' efforts probably failed for two primary reasons: The public mandate for change was less prevalent then than now, and special-interest groups poured lots of money into an effort to negatively influence public opinion regarding the Clinton plan. Reforming health care in a meaningful way is a tremendous public policy challenge, especially given the economic milieu. I believe this Congress and this president have the best chance anyone has had to do so, but it will be a tremendous challenge.

RODGERS: With 45 million uninsured Americans, steadily rising health care costs and unprecedented economic challenges, Blue Cross Blue Shield of Texas believes the time is right for some type of health care reform and is working with Congress to achieve this. The primary question is: Will health care reform be accomplished by addressing the underlying health care cost problem? Blue Cross Blue Shield of Texas administers health insurance for over 4 million Texans, and we've seen hospital charges go up about 50 percent in the past five years and physician charges go up about 20 percent. We can't have meaningful reform unless we find a way to deal with this reality.

What should be done about Medicare to rein in costs and improve quality?

ANDERSON: One of the best ways to improve costs is through risk reduction: to look at patients who become higher risk and make interventions to get them to lower risk. Many times this is as simple as exercise, diet, decreasing tobacco use or taking proper medications. Chronic conditions like obesity, hypertension, heart disease, diabetes and asthma can be addressed through care management and save substantial dollars while improving care. I think Parkland's network of community-based clinics is a model that can be applied other places, creating integrated health care systems where patients have a medical home. We also need to continue to invest in information technology, because the more information we have on outcomes and best practices, the more we can tweak the system to accomplish what we want.

BURGESS: I've long been a harsh critic of the way Medicare reimburses physicians and hospitals. I've also been vocal about my displeasure at the way the annual cuts are dealt with as a political football. Clearly, the low reimbursement rates in the program are affecting patients. This is something I encountered as a physician. Many of my fellow doctors wouldn't see any Medicare patients because of adverse reimbursement. Medicare is a program that gives Americans 65 and older universal coverage, but this doesn't mean they get to see the doctors they want when they want to see them. It drastically reduces their health care choices. Medicare highlights the problem with the notion that increasing funding will improve a government program. It's simply the nature of a program as expansive as Medicare that its heft becomes too difficult to control. At the end of the day, we have to recognize that millions of Americans have planned on Medicare in their retirement and that this is a promise we've made to them. Medicare should be a cautionary tale for those who want to pursue a government-based health care system. This is why I've often said we really do have an obligation to fix the health care programs the government already runs before we create new ones.

DUNKELBERG: The cost challenges for Medicare – and thus their solutions – are not really different from those facing the nation as a whole, but the population served – seniors and disabled adults – is by definition the one with the highest average costs per person. The same question asked above (how to reward health-promoting care and not high-volume care) is a challenge for Medicare just as it is for the rest of the U.S.population. Medicare's recent moves to deny payment for medical mistakes are an important step in providing financial incentives for providers to take more aggressive steps to stop avoidable errors and hospital-acquired infections. Systematic collection and sharing of what really works will help doctors provide the most effective high-quality health care based on scientific evidence, for Americans in Medicare and out. It should also be noted that Medicare already pays much lower rates to doctors and has much lower administrative costs than private insurance. Some specific cost-saving steps for Medicare should include reforming how Medicare HMOs are paid. Even though managed care was conceived of as a way to reduce health spending, Medicare HMOs are now paid about 12 percent more per person than traditional Medicare enrollees cost. Because current medical advances for seniors depend on access to medications, Medicare should take aggressive steps to monitor medications for seniors to avoid overmedication and drug interactions that can result from uncoordinated care. Fixes to the Medicare drug benefit, Part D, should address the bewildering array of options that seniors must wade through and should make sure that seniors can change plans if their Part D plan stops covering the medications they need. Finally, we sometimes confuse the serious issue of the sustainability of Medicare financing with the equally serious problem of the costs of health care services. Even if we can succeed in cutting health care costs, the system of payroll deductions and premiums must always be constructed so that the costs of running the program are fully supported. Of course, the more we control costs of care, the easier it is to keep the books in balance.

Although employer-based health care coverage remains the main source of insurance for working families, rising costs are forcing many businesses to shift more of the burden back onto families. How can we help businesses, especially smaller ones, afford health insurance for employees?

FAZEN: Tax reform should be a priority to help make private health insurance purchased by individuals and small businesses more affordable. Small businesses and individuals should be able to deduct the cost of health insurance from their income tax, just as large employers do. They also should be encouraged to purchase high-deductible health insurance plans that are eligible for tax-favored health savings accounts (so-called "consumer-directed health plans"). These plans are less expensive, give the insured more skin in the game and encourage participants to make informed decisions about where and when to obtain health care.

HOLMES: It is true that employers, mostly small businesses, bear a disproportionate share of medical expenses. A portion of the expense related to the medical care of the uninsured is allocated to private business in addition to costs related to their own employee base. In essence, we are all paying for the uninsured already. Adding this group would improve the risk profile of the entire pool (40 percent of the uninsured are between the ages of 18 and 35). An individual coverage requirement combined with subsidies for low-income people is a potential method for reducing the number of uninsured and minimizing some of the financial burden on private firms. In Texas, only 30 percent of small businesses with 50 or fewer employees offer health insurance to their employees, leaving 70 percent not supplying any type of coverage. Costs and other economics, such as trying to just stay afloat, could be the primary reasons. To lower costs, there need to be more individuals covered, which is why Aetna was the first insurer to support an individual coverage requirement, where the state or federal government would require everyone to have basic health insurance. However, in making this a requirement for those who can afford health coverage, provisions must be in place to assist those who cannot afford it or for whom access is limited. To directly help businesses, creating tax incentives for small employers to continue offering health benefits to their employees is another solution. Aetna offers a wide range of plan designs and price points for both businesses and individuals. In addition, in Texas, insurers are permitted to offer mandate-light plans to small business that exclude some of the state-mandated benefits in order to improve their affordability.

RODGERS: Blue Cross Blue Shield of Texas supports a range of options to help employers offer coverage, including targeted subsidies for small employers and individuals. There are tax credits for low-wage workers in small businesses, tax-deductible insurance premiums for those without access to employer-sponsored coverage, a refundable, advance tax credit for those whose premiums represent a disproportionate share of their income and a refundable tax credit to help those between jobs.

As the population ages and a higher percentage of the population lives with chronic conditions, long-term care will become a greater concern. Should this be addressed as part of health care reform?

AVERY: Yes. But our present, for-profit, insurance-based system is exacerbating the problem. A recent study in California, for example, found that 43 percent of people under 50 had postponed care for a chronic condition due to high out-of-pocket costs. When people delay needed care, they all too often end up in emergency rooms or with longer hospital stays, driving up costs for everyone. Under a genuine universal system not based on the profit motive, such as an expanded and upgraded Medicare system for all, people would be encouraged to seek preventive care or take medications in a timely manner, which would help manage care delivery in a more cost effective – and more humane – manner.

BURGESS: I'm not going to rule anything out. I think all good ideas need to be considered. That's what we're asking the Democrats and President Obama to do – consider our ideas. I want to put patients first. There are good ideas about long-term care out there, and I think we need to consider making long-term care insurance a more popular product. The key is to recognize this increase in life expectancy and disease management as an achievement of our advanced methods and technology in medicine instead of as a problem.

DUNKELBERG: A failure to access early care due to financial barriers leads to avoidable disability for millions of Americans. Better access to early preventive and chronic care under national health reform has the potential to reduce and delay disability and thus the need for long-term care. Again, even with the very best of care, illness and injury can and will leave Americans in need of assistance with their daily living needs. Health reform will represent a major down payment toward establishing public-private systems that allow our elders and disabled adults to live as independently as possible, but there is no question that the U.S. will need to take further steps to get to a real system of care that addresses nonmedical supports. While attacking the long-term care challenge at the same time we set up systems to create and pay for medical care access for all would be ideal, it is probably not politically feasible today.

Growing numbers of physicians are leaving the ranks of primary-care medicine, raising doubts that there will be enough to care for everyone. What can be done to recruit more young doctors to general practice?

ANDERSON: The main reason many are leaving primary care is that it's underfunded. We say it's very important, but we don't pay for it in a way that encourages young people to go into it. One thing we can do is try to decrease their debt coming out of medical school. Many students go into subspecialties that are more lucrative in order to pay for it. In addition, many doctors want a change in lifestyle. They want a healthy family life. They don't want to be burdened by the business of medicine; they just want to practice good medicine. We have to start looking at ways to entice physicians to go to rural and underserved inner-city areas. We're going to have to think outside the box to meet society's needs.

FINE: Until we end the extraordinary income and lifestyle discrepancies between primary care and procedural specialties, the problem will not be solved. All physicians come into medical training on an equal basis as uniquely talented and hard-working individuals. However, the medical student who chooses a procedural specialty can easily earn two to 10 times the annual income of a nonprocedural physician. Until this disparity ceases and physicians are compensated comparably whether or not they perform a test or procedure, we will continue to see inadequate numbers of primary-care physicians.

DR. A TOMAS GARCIA III: Texas has many small towns without primary-care physicians. At the same time, there are many young physicians who are very concerned about their private lives and private time. Clearly, there will have to be some sort of financial incentive for young physicians to consider practicing in medically underserved areas. Here's where common sense comes into play. Students are graduating from medical school with hundreds of thousands of dollars of debt. Why not forgive some of these students' debts if they agree to care for Medicare or Medicaid patients in areas where doctors are in short supply? It will help the communities, and it will help the young doctors. It'll be a win-win situation.

JAMES: This is a thorny problem. One major part of any solution will be to reimburse primary-care physicians – based on clear performance and prevention benchmarks – at a rate that encourages excellence as well as entrance into this sector of health care. Again, strong public policy and investment will be required to address this clear and growing need. Plans to assist with paying medical school debt and a national campaign that rewards the decision to practice family and community medicine must be devised. Reimbursement rates for general-practice doctors should be given due attention. At the same time, we must adopt a new national "frame" for wellness and, with that, the understanding that health and wellness are less about medical professionals than we currently assume. Individuals and communities working together must be challenged to take responsibility for their own health and wellness outcomes. This does not lessen public responsibility. Rather, it creates entire communities of health and wellness advocates.

MANSFIELD: Over the past few decades, the variability between what comparably trained physicians are able to earn has expanded dramatically due to our reimbursement methodologies. This economic model is skewed very negatively against physicians in primary care. A payment system that instills more parity in this equation would help immensely. Personally, I think national health policy has allowed this situation to exist too long and has created a shortage that cannot be overcome in the near term. To meet the growing demand for primary-care services and a medical home in the face of a shortage of the physicians most skilled to provide these functions, we must make more and better use of midlevel practitioners (nonphysicians) to extend the availability of primary care. We have a crisis looming that is getting worse by the day and needs to be a major tenet of our health care reform efforts.

Would you favor a requirement that businesses either cover their employees or pay into a fund that would provide coverage?

FAZEN: The so-called "play or pay" scheme is a bad idea for employers. Employer-sponsored health insurance is and always has been considered a benefit, not a requirement, and offered voluntarily to employees, who in turn are free to accept or reject this benefit. As some states that are experimenting with a play-or-pay model are discovering, the costs associated with the generous coverage that is usually included in such plans are far higher than expected, and the fees that employers pay are usually far too low to offset these costs, so the price to pay or play keeps ratcheting upward. The alternative is to reduce benefits, but it's always much harder for government to take things away from constituents than to increase fees for the players. Businesses are not in business to lose money, so they are likely to offset the increased costs for mandated health insurance with fewer hires, lower wages and layoffs.

HOLMES: Aetna does not favor such a requirement, as it may put additional financial stress on small business, which has been the engine of growth and innovation in the U.S. Yes, we want everyone to be insured, but there are different ways to accomplish that goal, such as an individual coverage requirement.

RODGERS: In some ways, businesses that don't cover their employees pay for it in other ways, such as through increased property taxes. Whether or not businesses provide health insurance for their employees, businesses and individuals are subsidizing the care for the uninsured and underinsured and for Medicare and Medicaid members when their costs aren't fully covered. Some city governments are realizing this and are not providing economic incentives to companies that don't provide health insurance or requiring city contractors to provide health insurance. Projections are that we'll have a shortage of 1 million nurses by 2020, in part because of the limited capacity of nursing schools and the changing needs of the aging population. How can we alleviate this shortage?

Projections are that we'll have a shortage of 1 million nurses by 2020, in part because of the limited capacity of nursing schools and the changing needs of the aging population. How can we alleviate this shortage?

AVERY: The only genuine way to improve the nursing shortage is to improve safety conditions in hospitals to the point where registered nurses feel they can safely practice their profession. The result is that nearly half of all registered nurses don't work in critical-care settings – they work in offices or at home, or they just don't work. Texas hospitals demonstrate the problem. It is not uncommon to hear about a registered nurse being assigned 15 patients. That's not physically possible, and it deprives the patients of necessary nursing care while saddling the nurse with dread and worry over the patient she or he couldn't get to. I am a nurse leader in the National Nurses Organizing Committee – Texas. In recent years, registered nurses across the country have been getting organized and active around the idea of guaranteeing minimum ratios of registered nurses to patients. A model bill passed in California has resulted in safer conditions in hospitals and led to a huge increase in the state's registered nurse workforce. It has nearly ended the shortage in that state. NNOC-Texas has introduced similar legislation here (H.B. 1489 by Rep. Senfronia Thompson), and we hope all Texans will join us and support our nurses by encouraging your legislator to support this bill.

MANSFIELD: Unfortunately, we have far more bright and talented young women and men who are interested in and qualified for a nursing career than our nation's colleges and universities are equipped to train. Federal and state help is needed to support an expansion of nursing faculty and the number of nursing schools. Creative public-private partnerships, such as Methodist Health System's with El Centro College and others in the Dallas-Fort Worth area, are helping to bridge the gap, but so much more is needed. Nursing is an inspiring, worthwhile and rewarding career, but we have to do a better job of making training programs available to those wishing to pursue that career.

Both employers and government are putting new emphasis on wellness and prevention, especially regarding obesity and diabetes. What specific steps should be taken to encourage preventive care?

FINE: At least three steps come immediately to mind: changes in agricultural policy, changes in education and changes within the medical profession. Thanks to government subsidies on foods such as corn, the cheapest calories one can buy tend to be the highly processed, calorie-dense foods that promote obesity, diabetes, heart disease and other maladies. Assume an adult man needs about 2,000 calories of food daily. He can buy 2,000 calories of burgers, fries and a soda for $4 or 2,000 calories of fresh vegetables and fruits for five to 10 times as much. Yes, some people can afford the more expensive fruits and vegetables, but too many cannot. When you do the math, it becomes increasingly apparent why obesity is more a disease of poverty. Agricultural subsidies must change and be more balanced toward a diversity of healthy foods. Another specific step must occur in our education system. We should require daily physical education classes for all students at all grade levels and teach human nutrition starting in kindergarten. Finally, increasing the numbers of primary-care physicians and increasing their knowledge of human nutrition would help. However, as noted earlier, this is not likely to happen as long as physicians are paid more to dilate or bypass a clogged coronary artery than they are paid to teach a patient how to avoid the high-sugar, high-fat, pro-inflammatory diet that clogs the artery in the first place!

GARCIA: We need to reform the health care system so that it offers greater financial incentives for preventive care. It would be a winning proposition for the government, insurers and patients. Our system now often doesn't pay for preventive care. So it ends up costing everyone far more when a patient's condition worsens and must be treated. Take Medicare as one example. If Medicare routinely covered the cost of all annual physical exams, the government might identify problems early on and spare itself larger expenses later. We have a wonderful opportunity with a new administration. The older policies haven't worked. It's time to try something new.

JAMES: Any plan must face the hard challenges of pre-existing conditions among populations with little hope of reversing present physical conditions. Any real progress rests largely with the development of new strategies for young people and for those who have some reasonable chance to reverse and prevent further health deterioration by adopting lifestyle changes. Physicians must be presented with new reasons to help their patients (adults and children). At the same time, community institutions such as public-private schools, faith communities and neighborhood groups should be encouraged to emphasize daily physical activities. Our schools must restore physical education classes immediately. Community-based and relatively inexpensive approaches to health education and chronic disease control must be adopted and paid for. At Central Dallas Ministries, we have learned and documented the real cost benefit and the real health impact of community diabetes educators. One last rather radical idea: What if Americans could earn tax credits based on health improvements? Possibly every other year, a tax form could be validated by a medical professional documenting a person's health improvements, and a relative value could be assigned to this "contribution" to the public health. One thing is certain: We must begin thinking and acting in very different ways.

THE PANELISTS

Dr. Ron Anderson is president and chief executive of Parkland Health and Hospital System.

Rossia Avery is a registered nurse and chairwoman of the Dallas-Fort Worth National Nurses Organizing Committee.

U.S. Rep. Michael Burgess is a Republican from Texas' 26th Congressional District and a physician.

Anne Dunkelberg is associate director of the Center for Public Policy Priorities in Austin.

Marianne Fazen is executive director of the Dallas-Fort Worth Business Group on Health.

Dr. Robert Fine is director of the Baylor Health Care System's Office of Clinical Ethics and Palliative Care.

Dr. A. Tomas Garcia III is a trustee of the Texas Medical Association.

Ralph Holmes is president of Aetna Inc.'s southwest region.

Larry James is president and chief executive of Central Dallas Ministries.

Stephen Mansfield is president and chief executive of Methodist Health System in Dallas.

J. Darren Rodgers is president of Blue Cross Blue Shield of Texas.

2009-05-25T08:05:00.001-04:00

Who's Afraid Of A Public Plan?
Story from the Chattanooga Times Free Press

A new report showing that health insurance premiums in Tennessee rose five times faster than workers’ earnings from 2000 to 2007 is deeply troubling, but it certainly is not surprising. Workers still lucky enough to have access to employer-provided insurance — less than 55 percent in Tennessee still do, as compared to 60 percent nationally and 70 percent a decade ago — are well aware that their premium costs have eaten up their wage gains in recent years, even as their coverage has declined and their out-of-pocket expenses have soared.

Such depressing and clearly unsustainable trends should be fueling national demand for health care reform and the creation of an alternative public insurance plan for voluntary, tax deductible purchase.

The medical industry’s control

The dynamic of the public dialogue on this critical issue, unfortunately, is controlled by the medical industry and its lobbyists. And they are doing everything in their power to kill the concept of a public plan that would help keep insurers, hospitals, pharmaceutical companies, high-end health care providers and medical device suppliers from over-charging — and that ultimately would help reduce spending on health care.

The new insurance cost figures were compiled by a coalition of Tennessee groups that advocate health care reform and creation of a public plan. A spokesman for one advocacy group attributed the sharp increases in insurance costs to the dominance of the state’s two largest insurance providers — Blue Cross Blue Shield of Tennessee, which covers 45 percent of Tennessee’s insurance market, and UnitedHealth Group Inc., which covers 16 percent. A combination of other companies carry the 39 percent balance.

Big insurers rule

Their dominance, he asserted, allows BCBST and UnitedHealth to “set the prices, ... make the rules and call the shots.” It also enables BCBST to boast reserve funds of $1.4 billion, and executives at UnitedHealth to capture obscenely high compensation packages.

A number of other factors, to be sure, contribute to excessively high health care costs. A short list is illustrative: Too little focus on preventive and wellness care, and too much on procedures; excessive use of expensive technology; defensive diagnostic procedures to protect against malpractice claims; excessive hospital and provider costs; needless administrative costs to combat excessive insurance denials; and needless complexity of insurance claims, diagnostic codes and bundled services.

The insurance industry cites many of these factors, but it rarely addresses its own excessive costs and profit margins, and the needless complexity of its pricing rules, claims procedures and denials.

Blue Cross officials here maintain that Tennessee ’s 62 percent increase in premium costs from 2000 to 2007 (vs. the 12 percent gain, to $25,639, in the same period for median wage workers) primarily reflects the growing cost of medical services and the more intensive use of services required by the demographic shift toward a larger aging population.

While the latter may be true, the former is not reflective of medical cost margins in all other highly industrialized countries — all of which offer universal health care under different models, advanced medical services equal to those in the United States, and typically better health indices, more doctors and more hospital beds per capita.

Other advanced countries offer all this while spending between 8-to-11 percent of gross domestic product on health care. America, by contrast, spends nearly 17 percent of GDP on health care — a level expected to reach 21 percent within 10 years — and still leaves 47 million citizens uninsured, and far more citizens under-insured and subject to medical bankruptcy in the event of a medical crisis.

Pharma’s a culprit, too

Prescription drug prices for the top 50 most-used drugs, as well, are two-to-three times higher in the United States than in every other advanced country — and they are rising fast, if not faster, than other insurance and provider costs. This is largely due to Big Pharma’s anticipation of government price negotiations and their urge to set price markers higher now.

Not surprisingly, BCBST spokesperson Mary Thompson told this newspaper’s Dave Flessner that a government-organized insurance plan, available on a voluntary basis to citizens not satisfied with private market and employer-organized plans, ultimately would crowd out private companies and dampen the very competition that reform advocates seek.

Let insurers compete

That’s a disingenuous argument. Such a public plan should spur competition. The proposal is for a public option plan modeled on plans federal workers receive and administered on a Medicare-style model, like those BCBST administers for a profitable administrative service organization (ASO) fee in a number of states. If private insurers can do better than government, they should be able to offer a better product, or a lower cost.

If they can’t or won’t take that challenge, then that would expose the fallacy of relying on high-profit insurance companies to help reduce the unsustainable curve of the medical industry’s profit taking, and the medical miseries it is producing for this nation’s increasingly under-insured and uninsured population.

Given the choice, most citizens, if they had their say, would take a good public plan and peace of mind. Employers, relieved of health insurance costs, would be more competitive in the face of global competition. And workers, liberated by portable coverage that wouldn’t go away if they changed jobs or careers, would find new freedom and bargaining power in their new mobility.

2009-05-25T07:57:00.002-04:00

Opinion From Paul Krugman: Blue Double-Cross
Story from the NY Times

That didn’t take long. Less than two weeks have passed since much of the medical-industrial complex made a big show of working with President Obama on health care reform — and the double-crossing is already well under way. Indeed, it’s now clear that even as they met with the president, pretending to be cooperative, insurers were gearing up to play the same destructive role they did the last time health reform was on the agenda.

So here’s the question: Will Mr. Obama gloss over the reality of what’s happening, and try to preserve the appearance of cooperation? Or will he honor his own pledge, made back during the campaign, to go on the offensive against special interests if they stand in the way of reform?

The story so far: on May 11 the White House called a news conference to announce that major players in health care, including the American Hospital Association and the lobbying group America’s Health Insurance Plans, had come together to support a national effort to control health care costs.

The fact sheet on the meeting, one has to say, was classic Obama in its message of post-partisanship and, um, hope. “For too long, politics and point-scoring have prevented our country from tackling this growing crisis,” it said, adding, “The American people are eager to put the old Washington ways behind them.”

But just three days later the hospital association insisted that it had not, in fact, promised what the president said it had promised — that it had made no commitment to the administration’s goal of reducing the rate at which health care costs are rising by 1.5 percentage points a year. And the head of the insurance lobby said that the idea was merely to “ramp up” savings, whatever that means.

Meanwhile, the insurance industry is busily lobbying Congress to block one crucial element of health care reform, the public option — that is, offering Americans the right to buy insurance directly from the government as well as from private insurance companies. And at least some insurers are gearing up for a major smear campaign.

On Monday, just a week after the White House photo-op, The Washington Post reported that Blue Cross Blue Shield of North Carolina was preparing to run a series of ads attacking the public option. The planning for this ad campaign must have begun quite some time ago.

The Post has the storyboards for the ads, and they read just like the infamous Harry and Louise ads that helped kill health care reform in 1993. Troubled Americans are shown being denied their choice of doctor, or forced to wait months for appointments, by faceless government bureaucrats. It’s a scary image that might make some sense if private health insurance — which these days comes primarily via HMOs — offered all of us free choice of doctors, with no wait for medical procedures. But my health plan isn’t like that. Is yours?

“We can do a lot better than a government-run health care system,” says a voice-over in one of the ads. To which the obvious response is, if that’s true, why don’t you? Why deny Americans the chance to reject government insurance if it’s really that bad?

For none of the reform proposals currently on the table would force people into a government-run insurance plan. At most they would offer Americans the choice of buying into such a plan.

And the goal of the insurers is to deny Americans that choice. They fear that many people would prefer a government plan to dealing with private insurance companies that, in the real world as opposed to the world of their ads, are more bureaucratic than any government agency, routinely deny clients their choice of doctor, and often refuse to pay for care.

Which brings us back to Mr. Obama.

Back during the Democratic primary campaign, Mr. Obama argued that the Clintons had failed in their 1993 attempt to reform health care because they had been insufficiently inclusive. He promised instead to gather all the stakeholders, including the insurance companies, around a “big table.” And that May 11 event was, of course, intended precisely to show this big-table strategy in action.

But what if interest groups showed up at the big table, then blocked reform? Back then, Mr. Obama assured voters that he would get tough: “If those insurance companies and drug companies start trying to run ads with Harry and Louise, I’ll run my own ads as president. I’ll get on television and say ‘Harry and Louise are lying.’ ”

The question now is whether he really meant it.

The medical-industrial complex has called the president’s bluff. It polished its image by showing up at the big table and promising cooperation, then promptly went back to doing all it can to block real change. The insurers and the drug companies are, in effect, betting that Mr. Obama will be afraid to call them out on their duplicity.

It’s up to Mr. Obama to prove them wrong.

2009-05-25T07:38:00.002-04:00

State Budget Cuts Will Hurt County Health Departments
Story from MLive

With unemployment on the rise, residents who have lost insurance benefits are turning to county health departments for help.

But with Gov. Jennifer Granholm proposing to cut $349 million from Michigan's budget, they may need to turn elsewhere for help.

Taking a considerable hit in cuts that heavily target programs for low-income people, is the Michigan Department of Human Services, which will have $92.4 million cut from its budget.

The largest cut to DHS -- $20 million -- will come in subsidies provided to low-income families to help them pay for child care. Emergency services allocations to local DHS offices will be cut $2.3 million and employment and training support services provided to participants in the Jobs Education and Training program will be cut $10.4 million.

Licensing of day care, adult foster care and children's welfare will be cut $3.5 million.

There will be $10 million slashed statewide for mental health services and local officials are waiting anxiously to see how those cuts will affect their operations.

Dave Parnin, clinical director for Muskegon County's community mental health department, said demand for services are at an all-time high, given the economic struggles facing West Michigan.

He said it's a bad time to be dealing with state budget cuts -- especially since a bulk of his department's funding comes from Lansing.

The mental health department offers free or affordable psychiatric services, counseling and case management for children and adults.

"We cannot have a waiting list," Parnin said. "We can't say, 'We'll call you later.' Our staff has not increased at all. How do you keep up?"

With the state cuts set to take effect in July, Parnin said he hopes his department doesn't need to reduce its staffing to keep its $52 million annual budget in the black.

"We certainly hope not," he said. "We have not had to do that in the past. But we'll see what the details look like."

The department has 300 employees.

Parnin said his department is working with lawmakers to learn exactly how much will be cut from the mental health department's share of state revenues.

Legislative leaders and the Granholm administration have been searching for ways to patch a budget shortfall that has grown to $1.3 billion in recent weeks as income and business taxes have come in lower than January forecasts predicted.

The cuts come at the worst time for services like community mental health.

"There's a prevailing sense of hopelessness for a lot of people," he said. "I think we're all hoping this economy turns around."

The mental health department handles Medicaid cases for roughly 35,000 county residents. It also offers free services for people who don't have the means to pay for them.

For example, if someone without insurance needs mental health services, the department provides a free screening to determine the client's needs.

Local DHS officials also are waiting to see how the state cuts will affect their operation and services.

Jane Johnson, local director of Muskegon County's DHS department, deferred questions to Michigan DHS spokeswoman Colleen Steinman.

"Obviously, we're doing everything we can to minimize those impacts," Steinman said. "We want to make sure the safety net remains intact."

Like other state workers, DHS workers will be taking furloughs, meaning there could be longer waits for appointments.

Meanwhile, Ken Kraus, director of Public Health Muskegon County, said he's scratching his head over the latest round of budget cuts.

"If the state keeps cutting its share, I don't know what's going to happen," Kraus said. "People are going to be harmed before they decide to take some sort of action."

In the past year, the Muskegon County Health Department has handled an outbreak of Shigella, an intestinal ailment, and most recently the so-called Swine Flu.

The department receives $3 million from the state to handle restaurant inspections, immunizations, sexually transmitted disease control, sewage management and other services. Its total budget is $7.9 million.

It is unknown at this point how the state's budget cuts will affect Catholic Social Services, Catholic Charities West Michigan -- an organization that has received a number of state grants in the past to help low-income people.

The nonprofit agency in downtown Muskegon hosts more than 30 programs, including Loaves and Fishes food and baby pantries, substance abuse counseling and foster care and domestic adoptions.

A clearer picture hopefully will be in view within the next 30 days, said Deborah McCormack, president and chief executive officer of Catholic Charities West Michigan.

"It's difficult because we don't know how much funding cuts will affect our agency," said McCormack. "A lot of our programs are about family preservation and how to provide them with additional support, such as parenting and housing. We'll try real hard to keep those programs going."

According to 2007 statistics, 85 percent of Catholic Social Service's clientele lived under the poverty level or are considered "working poor."

2009-05-10T08:36:00.003-04:00

A Senior Commune In Boulder CO.
Story from USA Today

Annie Russell lives alone but not in solitude.

While she was laid up for almost nine months by an injured knee, neighbors checked in on her regularly. They brought her ice packs, fetched water and did her grocery shopping.

Twice a week year-round, everyone in Russell's community is assured dinner with friends in the large common house of Silver Sage Village in Boulder, Colo. It's a potluck of sorts. Residents can cook the meal together in a communal gourmet kitchen.

"If somebody just wants a place to live and doesn't want to commune with their neighbors, this is not for them," says Russell, 68.

Projects such as Silver Sage are called co-housing. European-inspired housing built around a common area and a social compact that all residents agree to, co-housing has existed on a small scale in the USA for years. Now, the concept is coming to senior housing, a trend supported by advocates who favor independent living for the old.

The oldest of 79 million Baby Boomers turn 63 this year, and they are "not interested in what their parents had in terms of assisted care, wasting away in a private house or nursing home," says California architect Charles Durrett, author of The Senior Cohousing Handbook.

Pioneered in Denmark

There are only three senior co-housing developments in the USA — compared with 250 built since 1985 in Denmark, a country that has fewer people than the Atlanta metropolitan area.

The first U.S. project opened in Davis, Calif., in 2004. At another in Abingdon, Va., members of The ElderSpirit Community at Trailview believe that spiritual growth is vital in the later stages of life. They vow to help each other and adopt a simple lifestyle. "We better come up with new ideas on how to better accommodate ourselves," says Durrett, who has designed about 50 co-housing developments for all ages.

He hopes it will be soon. More than 20 people from as far as North Carolina attended a senior co-housing workshop he conducted in Boulder last month. A dozen bookstores have invited Durrett to book signings.

"It's very interesting niche housing," says Elinor Ginzler, senior vice president for livable communities at AARP. "It's absolutely an option that should be out there and available. We need as many different kinds of choices as the imagination can bring."

Independent living for the elderly reduces dependence on social services and is a primary goal of most organizations for the aged. "The Danes proved it," says Jim Leach, president of Wonderland Hill Development, the company behind Silver Sage, where he lives. "If you house people that way and let them age together, they not only live longer, they live healthier and cost a lot less."

'Like an extended family'

Think '60s communes meet retirement villages, a description possibly off-putting to some but appealing to others. The key: Residents help design their community and decide what they want it to be. "We do all the management ourselves for the community, and everybody is involved in some way," Leach says. "It becomes a little more like an extended family."

He has built co-housing projects for 20 years. Until recently, they have targeted mostly families.

"There was some resistance in the past to having an exclusive senior community," Leach says. They're gaining in popularity now because they allow residents to shape how they want to live when they're old. Homeowners can hire a caregiver who lives in the common house and tends to all the residents.

"You can come up with a lot of agreements from a social point of view," Durrett says. "What I'll do if you get sick. You can give each other permission to care for each other."

Residents at Silver Sage have their own units — 16 duplexes and attached homes on 1 acre. The homes are somewhat smaller to allow more space for the common house, guest rooms for visitors and gardens.

"Three plagues of aging are isolation, boredom and helplessness," says resident Arthur Okner, 66.

He has no fear of that at Silver Sage. When he had a health issue that took him to the emergency room, "immediately people were checking on me."

Okner says senior co-housing is an alternative to institutional care. "Graceful aging belongs to people who say to themselves: 'I'm going to age, I'm not going to stay the way I am now and I'm prepared for it,' " he says. "We keep each other out of the old-age nursing home as long as is humanly possible."

2009-05-10T08:15:00.005-04:00

Cost Comparisons For Assisted Living And Senior Care
Story from Investment News

Although retirees may envision living out their golden years in sunny California or Florida, they might consider Iowa if they want to save on elder care, according to data from Genworth Financial Inc.

The Richmond, Va.-based insurer yesterday released its annual Cost of Care survey, which provides data on the increasing cost of home care and assisted living, and breaks out cost information on a regional basis.

Iowa is the top state for long term care affordability and choice. A private room in a nursing home in the Iowa City region costs between $130 and $220.

Meanwhile, homemaker services, which include cleaning and cooking, in Des Moines cost between $18 and $25 an hour.

By comparison, nationwide, a private room in a nursing home runs between $90 and $850 a day, while homemaker services cost between $8 and $35 an hour.

South Dakota, Kansas, Nebraska and North Dakota rounded out the top five states in terms of inexpensive care.

The cost of elder care is rising for most Medicare-certified home health aide services. The national average median hourly rate is $46.22, up 35.6% from a year earlier.

The national average median hourly rate for homemaker services is $17.48, up 1.87% from a year earlier.

Nursing home services in a private room cost an average median daily rate of $203.31, up 4.72% from a year earlier. That works out to $74,208 annually.

Meanwhile, a semiprivate room runs an average of $183.25 a day, or $66,850 a year, up 4.49% from 2008.

Those who want to live in areas that embody retirement luxury will have to reach even deeper into their pockets.

A private room in Florida’s West Palm Beach-Boca Raton region costs between $182 and $290 a day. But similar accommodations in Puerto Rico range between $33 and $83 a day.

The most expensive place to obtain assisted-living and nursing home care is Alaska. The average median annual rate of a private bedroom in the state is $57,624 in an assisted-living facility and $187,610 in a nursing home.

Kelso House AFC is able to provide very high value per cost compared to these national averages. Kelso House provides 24/7 care, all home-cooked meals, dietary supplements and special considerations, outings, activities, doctor and dental visits, for an average cost of $2.50 - $3.00 per hour, or Less Than $72 per day. Before you opt for a nursing home or large assisted living facility, consider a home setting such as Kelso House Adult Foster Care in Northern Michigan.

2009-05-10T08:07:00.002-04:00

Health Care Workers And Senior Care Providers Remain In Demand
Story from the Wall Street Journal

With job losses piling up, the prospect of finding a spot may be daunting for college graduates, laid-off workers and employees looking to make a move.

Despite the depressing headlines, companies are still hiring, and you don't have to be a Ph.D. to nab a job. Instead, experts say workers should focus on areas that are adding jobs, as well as turnover within their own industries.

"There's always hiring going on," says Harry Holzer, a professor at Georgetown University and former chief economist at the Labor Department.

"The American labor market is characterized by a lot of churning," says Mr. Holzer. "Beneath the net [job loss] numbers, there are always people quitting, so there's always replacement demand. There's less new demand, but there's still hiring, and that's true in a lot of sectors."

There's a job opportunity out there "for nearly everyone," says Eric Winegardner, vice president of client adoption with job site Monster.com. "If you are in an area with negative growth, don't think there is not an opening, there is just more competition."

More than 410,000 new U.S. job postings were on Monster.com over the 90 days ending April 18. Some of the occupations that were most in demand during that period were computer systems analysts, accountants, registered nurses and sales managers.

Here are four key routes for job seekers:

1 Stay in your field

Even if your field is losing jobs, you don't need to rush into a field such as health care that is adding jobs, Mr. Winegardner says.

"It's not a necessity that you leave accounting and become a nurse," Mr. Winegardner says. "You have a choice."

Workers who are willing to take contract or part-time work may have an edge within their field, says Allison O'Kelly, chief executive of Mom Corps, a staffing firm based in Atlanta that specializes in flexible employment. To get their foot in the door at the right company, some may have to take lower-level jobs, she says.

"It's certainly an employer's market at this point, and in order to get the job, you need to be somebody who is going to be available, flexible and easy to deal with," Ms. O'Kelly says. "[Employers] want to get exactly what they are looking for, and if you are not giving it to them, someone else will."

She adds that contract work can turn into a full-time position once a company sees you in action.

2 Go for growth

Looking for a job in the resilient health-care industry could be a good tactic for the right workers, experts say.

"Everyone knows that health care and elder care are almost completely impervious to the business cycle," Mr. Holzer says. "That means you are going to face more new demand, net growth and gross hiring in that sector."

Health-care workers are among the lucky few who can take advantage of relatively high demand for their services, and move fairly easily from job to job, Mr. Winegardner says.

"If there's a nurse looking to make a change in employer, that's relatively easy to do," Mr. Winegardner says. "In high-growth areas, if you have those skills you are in high demand."

However, workers shouldn't cut themselves off from other possibilities.

Even if you have mostly worked for large companies, consider opportunities in smaller businesses as well. "Small and midsize companies are coming back before large companies because they are more nimble," Ms. O'Kelly says.

3 Stand out

Especially in occupations that are on net losing jobs, competition is fierce, and you have to appear exceptional to receive an offer, experts say. Now is not the time to arrive disheveled to an interview.

"It's about competition, it's about standing out, it's about putting your best foot forward," Mr. Winegardner says.

Emphasizing high skill levels, rather than a general knowledge, can also work to your advantage.

"Where the job requires a certain level of skill or training or education, that's where there's anecdotal evidence for tightness in the labor market," says Conrad DeQuadros, an economist at New York research firm RDQ Economics.

4 Be prepared

In these Internet days, job seekers can get an edge by researching a potential employer. Be prepared to tell an employer what you can do for the company, rather than asking what it can do for you.

"A big part of the job search is not just applying but gathering information," Mr. Winegardner says. "When I get a chance to interview, I need to convey what I know about [the company]. It's not acceptable to come in not prepared."

Mr. Winegardner also recommends that job seekers figure out who the recruiter is at a company.

"The person needs to make a personal connection with you -- that's every bit as important as your qualifications," Mr. Winegardner says.

2009-04-19T10:41:00.002-04:00

BC Raises Costs Of Individual Health Plans in Michigan
Story from the Detroit News

As more Michigan residents flock to Blue Cross Blue Shield of Michigan to buy their own health coverage, the state's largest insurer is replacing several types of individual policies with plans that will cost up to $600 a year more -- and come with higher co-payments and other out-of-pocket costs.

The new insurance plans -- with monthly premiums ranging from $51 to $292 per a person -- are on sale now and take effect Wednesday.

On March 27, Blue Cross stopped enrolling new consumers in several older plans, including Value Blue, a catastrophic coverage policy, and its no-deductible Individual Care Blue. The changes don't affect Blue Cross members enrolled in those plans. Instead, the new rates will apply to newly unemployed residents seeking to replace workplace coverage by buying their own insurance from Blue Cross. The new plans also differ from those for which Blue Cross is seeking state permission to raise rates and would not be affected if that request is approved.

With the rollout of these new plans, Blue Cross has introduced a lengthy application that includes optional health questions and ties insurance agents' commissions to the medical condition of new enrollees.

The changes are so drastic that some insurance agents say Blue Cross is deliberately making its money-losing individual policies less attractive to slow sales. Blue Cross contends that it's simply keeping up with market trends, as well as the rates and plan offerings of its private-sector competitors.

As the state's insurer of last resort -- a responsibility tied to its tax-exempt status -- Blue Cross must cover all Michigan residents, regardless of their medical history. But that arrangement, Blue Cross officials say, leaves them with the state's sickest and costliest members. Last year, Blue Cross lost $133.2 million on individual insurance policies, dragging its bottom line to a $144.9 million loss for 2008.

Insurance agents say the new rates will make it harder to sell the plans. New members aren't going to want to pay more in premiums for higher out-of-pocket costs, especially if there are better deals offered by other insurers.

"It's not good for the consumer," said Patrick Pennefather, president of the Michigan Association of Health Underwriters, which represents health insurance agents and buyers for employer groups. The new plans, he added, are going to slow down sales for Blue Cross, a move that could help stem the rising tide of losses on individual policies.

Some agents are likely to stop selling Blue Cross' individual policies altogether because the commission structure lowers incentives for enrolling sickly customers into its individual plans, Pennefather added.

Blue Cross's new incentive structure offers a 15 percent commission to agents who sign up healthy members and only 2 percent for signing new enrollees with severe medical problems. A 2 percent commission could translate into only a couple of dollars a month on some policies, say insurance agents, and is much lower than the 8 percent commissions previously offered by Blue Cross on all policies, regardless of the applicant's health status.

Blue Cross said the tiered commissions better match incentives offered by their rivals in the individual insurance market.

"It may drive a lot of agents out of the individual insurance business. In fact, many have said they plan to get out of it," Pennefather said, noting that agents can make 20 percent with other private insurers.

Some Blue Cross critics, including Michigan Attorney General Mike Cox, have questioned why Blue Cross is collecting health information, since that is at odds with the company's mission as the state's insurer of last resort. Cox's office has said it's investigating whether the changes are lawful.

Answering the questions about health status, however, is voluntary and won't affect consumer eligibility or rates, but will help applicants qualify for lower co-payments, Blue Cross officials said.

Blue Cross also points out that it still pays at least some portion of the commission to agents for all applicants. Most other insurers pay no commission if they end up rejecting the applicant, said Helen Stojic, a Blue Cross spokeswoman.

As for the new plan prices and coverage, Stojic said Blue Cross hopes to better reflect the marketplace, where deductibles and higher out-of-pocket maximums are common.

The insurer also contends its rates are still better than most plans for people with serious medical conditions.

"Our plans are aligned more closely with those in the market, with one important difference: We still don't medically underwrite and we are still the insurer of last resort," Stojic said.

Unlike rate hikes for existing customers, state regulators don't require Blue Cross to seek public input before introducing new plans or closing new enrollment in existing policies.

Blue Cross is seeking rate hikes on its existing individual policies that cover about 400,000 members. It's asking for an average rate hike on three types of policies: a 56 percent increase on individual plans, 42 percent on group conversion coverage (which extends benefits from a former employer) and 31 percent for Medigap plans.

2009-04-19T10:25:00.004-04:00

Users of Stopain Report Relief From Chronic Pain
Story from Market Watch

ENCINITAS, Calif., April 7, 2009 /PRNewswire via COMTEX/ -- DRJ Group Inc., the makers of all-natural Stopain(R) topical analgesics, today announced the results of an informal study conducted with chronic pain sufferers at two adult foster care facilities.

The test was conducted with residents living at two facilities owned by Leon and Paulette Hanson in Cannon Falls, Minn. The Hansons approached the DRJ Group about conducting an informal study after receiving a complimentary sample of Stopain.

"I was skeptical, but after our test I am convinced that this product works," said Leon Hanson. "I would recommend it--in fact, I have recommended it to others. I am so glad we found Stopain."

"Our business philosophy is to focus on customer feedback when it comes to managing pain," said Bob Miller, president and CEO of DRJ Group, Inc. "When Leon mentioned his residents and their ongoing struggle to manage pain, we were happy to provide Stopain and are very pleased with the results."

Residents began using Stopain in October 2008. Here are Hanson's accounts of two of his residents' experiences with Stopain:

Resident #1: One resident who tried Stopain was a woman in her 90s with shoulder pain that developed after years of manual farm labor. According to Hanson, she had tried a series of pain medications, heat wraps and ointments with no significant relief. When staff at the facility began applying Stopain to her shoulder before her daily nap, she noticed the cooling effect immediately. Hanson says by using Stopain, she was able to sustain relief without needing pain pills.

Resident #2: Another resident who reported relief from Stopain was an 89-year-old woman. Hanson says she developed severe, persistent shoulder pain following a stroke. According to doctors, the shoulder pain did not come from the stroke; the cause of the pain is unknown. After three or four applications of Stopain, she reported significant relief. Hanson explained that the woman used to wince in pain whenever staff lifted her, but the pain subsided after using Stopain.

The active ingredient in Stopain is menthol, recognized by the Food and Drug Administration as an analgesic that provides temporary relief for minor pains and stiffness of arthritis, muscle aches, strains and simple backaches. Stopain products include the top-selling spray and roll-on in the topical analgesics category.

For more information visit www.stopain.com.

SOURCE DRJ Group Inc.

2009-04-19T09:55:00.001-04:00

Restoring Vision to Stroke Victims
Story from the Democrat and Chronicle

Patients who are partially blind after a stroke may be able to retrain their brain after doing months of eye exercises on a computer, according to a small study by University of Rochester researchers.

The study, published in the April 1 issue of the Journal of Neuroscience, found that people who did vigorous exercises every day for several months could coax the healthy regions of their brains to take in visual information, making up for other parts of the brain damaged by strokes.

Neuroscientist Dr. Krystel Huxlin, who led the study at the University of Rochester Eye Institute, said she was surprised by the research results because scientists had long believed that patients could not recover from the type of visual damage done by strokes. Many people are one-quarter to one-half blind after strokes, and though rehabilitation is common for relearning speech and movements, patients rarely receive visual training.

Huxlin studied four women and three men in their 30s to 80s, who had a stroke eight to 40 months before the experiment. All were partially blind and had substantial damage in the primary visual cortex of their brains, meaning their eyes could take in visual information that they could not consciously see.

During the study, they were told to "watch" a group of about 100 small dots move right or left across a computer screen. Though the patients were not aware they could see the dots, they would guess which direction the dots were moving and could improve their success rates over time when told when they've made a correct choice. Eventually, they became aware of the dots and their movements, as their brains relearned how to take in the visual information, the study found.

When they improved, researchers moved the dots deeper into their blind areas and could coax the brain to see more areas.

The five patients who completed the training had significantly improved vision, and several could drive again, shop and exercise after the experiment.

The University of Rochester has filed a patent on the technology.

2009-04-19T09:41:00.004-04:00

New Research Concerning Stress
Story from PR Web

Stressed-out people are told to exercise, meditate or eat right, but stress causes the brain to resist all of those things. A novel, proven approach to stress developed by a University of California, San Francisco researcher provides simple tools that switch the brain from stress to joy. In that brain state people feel like exercising, meditating and eating right. National meeting of researchers and clinicians on the method will be held on April 23, 2009 and sponsored by the Institute for Health Solutions; complimentary public access to web-based learning of the tools begins April 14, 2009.

San Rafael, CA (PRWEB) April 14, 2009 -- Who isn't stressed out? Neuroscience weighs in and finds that the best antidote to stress is a brain state of high-level well-being, or what most of us would call….well, joy. Brain scans show that when the part of the brain associated with joy lights up, the part of the brain associated with stress goes out. In other words, joy swamps stress.

How do you get from stress to joy? Developmental Skills Training, or DST, also known as the Solution Method, has taken what we know from three fields of scientific study - stress, attachment, and neuroplasticity - and created simple tools that enable you to identify your brain state on a 1 to 5 scale. For each state there is a tool that offers the quickest, easiest way to get from stress to joy, given that initial level of stress.

You know how when you're stuck in stress and know that you should: 1) exercise, 2) meditate, or 3) eat right -- but you just can't? Those times when all you can do is: 1) watch television, 2) numb out, or 3) crave sweets? Because of these exciting new scientific insights, now we know why: It's not you! It's your brain state, and in that state our brain is genetically programmed to warn us that hungry lions are chasing us. Something as sensible as taking a walk, relaxing in a meditative state, or getting a sound sleep, would be dangerous to someone who needs that adrenaline rush to stay vigilant and deal with hungry lions in pursuit.

But in the 21st century, there aren't many hungry lions, or many other objective reasons to justify that kind of damaging life or death body response. Yet with repeated episodes of responding as if there were, our brains become sensitized and we overreact; or even worse, we stay stuck in stress.

A national conference of Solution Method researchers and clinical providers who use the method to help people learn the tools to rewire their brain to move through stress toward well-being, will be held in Tiburon, California on April 23, 2009 and sponsored by the Institute for Health Solutions. For a limited time, starting April 14, a complimentary orientation by telephone with a health professional to learn about the method, along with complimentary 10-day membership to the website to lbegin learning the tools, will be available at www.solutionmethod.org.

According to Solution Method developer Laurel Mellin, Associate Clinical Professor of Family and Community Medicine and Pediatrics, School of Medicine, University of California, San Francisco, "The best way to beat stress is to know your number -- the brain state on a 1 to 5 scale - then use the tool that corresponds to that state to naturally switch the brain out of an emotional ditch and toward a state of well-being."

Mellin adds, "Just knowing your number, the state of your brain, can be enormously relieving. For example, when the brain is at 5, a full-blown stress response, it is reasonable to expect to have cravings for sugar and other artificial rewards. Instead of blaming yourself, you can see that it is not you, but your brain state. Then you can use the tools to switch that state so that cravings fade."

Mellin developed this method over the last 30 years, initially targeting pediatric obesity. Results were so positive for both the children in the program and their parents, that she created the adult version, the Solution Method. Stress eating was one of many symptoms that just faded naturally through use of the tools.

Amazingly, the new discoveries in neuroscience have validated how her tools work. They create "positive emotional plasticity" to rewire the brain, so that we are not triggered to go into a full-blown stress response as easily. In addition, the tools enable us to learn to change our emotional setpoint from numbness, discouragement, or irritability to a pure sense of joy more of the time. This creates resilience and reduces the physical ravaging on the body created by chronic stress.

On a societal level, since eighty percent of health problems are stress-related, rewiring the stress response could very well have an enormously positive effect on reducing health care expenditures. Recognizing that stress is at the root of so many health conditions - such as overweight, depression, anxiety, and diabetes - and teaching patients tools to deal with the underlying stress, could herald a new paradigm in health care.

For additional information on the news that is the subject of this release (or for a sample, copy or demo), contact Laurel Mellin or visit www.solutionmethod.org. The method is copyrighted and patent pending. Groups, telegroups, individual coaching, and web-based support are available at www.solutionmethod.org. Programs for childhood obesity are available at www.shapedown.com or www.childobesity.com. New book on the method, Wired for Joy: A Scientific Solution to Stress, author, Laurel Mellin, publisher Hay House will be released in Spring, 2010. Classic book on the method, The Pathway:Follow the Road to Health and Happiness (HarperCollins, Publishers, 2004).

Contact:
Laurel Mellin, Executive Director
Institute for Health Solutions
415-457-3331
http://www.solutionmethod.org

2009-04-19T09:30:00.001-04:00

The Importance of Being Prepared
Story from the Sun Sentinel

If you help care for an elderly parent — or will do so in the future — it's smart to plan ahead for an emergency room visit.

More than 7 million emergency hospital visits each year involve patients 65 and older. A rushed visit to the hospital can be difficult and stressful, and caretakers will be called upon to answer lots of on-the-spot questions related to medical care and payment.

Fortunately, planning ahead can save a world of headache. Even simple things help a lot.

"I usually bring enough Diet Pepsi and snacks to last six hours, since that's how long I am waiting with my mom or dad until they're admitted," said Ann Blanchard, founder and president of HandiRecords.com, which sells low-priced organizer notebooks for medical information. "And some Sudoku or crossword puzzles, since I'm too stressed to concentrate on a novel."

To help, the American College of Emergency Physicians recommends:

Fill out a medical history form (ahead of time): Go to EmergencyCareForYou.org to obtain a form that you and your parent's physicians can complete. On the form you will list what medications your parent is taking, allergies, as well as past and current medical conditions. Bring this form to the emergency department and give to the emergency physician. Also keep track and make sure your parent is taking medications correctly.

Anticipate admission: Bring a change of clothes and some personal items in case your parent is admitted to the hospital. You can always leave them in the car.

Know physician contacts: Do you know all the names of the doctors your parents see? You should. Take some time now and find out their names, contact information, why your mother or father sees them and how long they have been patients. Write it down and hand it to the doctor or nurse in the emergency department. If you are traveling, have copies of the most recent doctor summary and a copy of an EKG if it is abnormal.

Convey parent's state of mind: You know your parent better than the doctor. If he or she seems confused, explain to the physician what "normal" behavior is like. If the doctor is talking to you, make sure you are talking to your parent. The doctors may have to run tests, conduct an examination or admit your parent to the hospital. Keep the conversation open with your parent.

Consider living wills: A difficult issue to discuss, but end-of-life planning is important nonetheless. Do your parents have living wills, and do you know what their wishes are if their conditions become critical? If not, find out now.

Report on recent surgeries: Keep track of surgeries, especially those involving implanted devices such as hip replacements, or pacemakers.

Simplify insurance information: Have a single sheet of paper with insurance and identification information.

Bring reading materials: Make sure you have a book, magazine or a newspaper to read while you are waiting for results or to see a physician. Bring a laptop so you can check your e-mail or do work. Having something to do that will make the time pass more quickly and help keep your stress level in check, too.

For information about elderly emergency care, go to emergencycareforyou.org.

2009-04-12T02:13:00.002-04:00

One Man's Struggle With BCBS
Story from ZDNet.com,
by Paul Greenberg

My wife and I get our health insurance from Anthem Blue Cross & Blue Shield, here in Virginia. Because my wife is a cancer survivor our insurance rates are exorbitant. Last year, we had a $500.00 deductible (each) and were paying more than $1600 a month for coverage that at best was going to get us 80% when the deductible was covered.

Toward the end of last year we made a decision to increase our deductible to $2500.00 which would not only get us 100% coverage when the deductible was done but would lower our rate to around $1279.00.

Quite the bargain (he said entirely sarcastically). But the increase in the deductible was offset by the reduction in the monthly payment so that we were swapping more upfront costs and maybe a couple of hundred dollars more for 100% coverage. Worth it to us. This began January 1, 2009.

However, little did we know what was in store. We got a notice yesterday that said our monthly rates were going up to $1576.00 as of May 1, 2009 - an increase of nearly $300.00 per month. A convenient fact, they forgot to tell us when we were changing our deductible for this year.

To add insult to financial injury this paragraph was in the letter accompanying this rate increase.

“We work hard to keep your costs down

“As health care costs continue to rise, we work hard to find ways to save on the health care services you need. For example, as the largest health insurer in Virginia, we have used our negotiating power to keep local provider and national pharmacy costs as low as possible. But even with cost-cutting initiatives like these, we’re finding it necessary to increase premiums for all members enrolled in your type of plan.”

Their idea of saving us money is to increase our premium by $3500 a year? Their cynicism is breathtaking.

The Nature of the Health Insurance Beast

One would think that with the outcry over the high costs of health insurance, the general health insurance bashing that’s going on, the bad perception as cold and uncaring that they have and the discussion of universal health care, their concerns about actual living, breathing (that of course presumes they had been able to afford health insurance when they got sick) beings - sentient creatures called, drumroll please,…………customers would be paramount.

They are not concerned. Their customers aren’t even a subject of discussion.

This came abundantly clear when I called the customer service line for Anthem and spoke to a very nice representative who was clearly hamstrung by two things a. the company b. regulation. I was absolutely astounded, not just by the magnitude of the increase (around 23 percent) but by what I was told. This was a “policy wide” increase. In other words, my actual health didn’t matter, my wife’s didn’t matter, nor did our track record in any way matter. This premium was raised whether you were a category 4 (high risk) or category 3, 2, and 1 (low risk).

This was raised regardless of any individual whatever. It was a raise whether you paid $1279 per month or $450 per month. You were raised that same nearly $300.00. Why, because it was “against the law” to treat individuals as individuals, when it came to pricing policies for specific insurance programs.

So this increase was based on the performance of the policy itself - not the customers using the policy. You can imagine that, in effect, my human health concerns are reduced to the level of an actuarial table, an algorithm or two and a policy. There is NOTHING human about that. There is NO customer differentiation - actually not even recognition by Anthem that their customers are something more than a name on a policy.

Is there a law preventing this differentiation? My customer rep told me that they have been told there is.

I checked as best as I can and I couldn’t find anything that substantiated that either nationally or in Virginia. That said, that doesn’t mean it doesn’t exist. It could.

But can insurance companies treat their customers individually if they’re blocked by law? They can’t right?

Wrong.

In the 3rd edition of CRM at the Speed of Light I covered another Blue Cross Blue Shield (this would be back in 2004). That was Blue Cross of California and their My LifePlan program which was a customer friendly program that provided a large set of online tools to help you find what you needed without much bureaucracy - be it a specialist, pharmacy or a wellness program.

More germane was this:

“It is in the interest of the insurance company to see that a diabetic customer has regular checkups for blood sugar. Consequently, by institutionalizing CRM processes, the alert will show on an agent’s or other appropriate CSR’s screen that diabetic customer A should take advantage of a free test being given in his area over the next month. Aside from any humanitarian concerns that the insurance may (or may not) have, keeping that diabetic customer healthy is in the insurance company’s interest, simply because if the diabetic is healthy, no one collects and premiums are paid for a longer time. The insurance vendors can also track whether the diabetic took advantage of the free blood sugar test. The response can create the need to adjust the level of risk associated with the diabetic. This is a step better than even the thought-leadership that CRM-driven insurers can provide and is a major step to reducing risk without the cold-blooded approach characterized by State Farm.”

As of 2009, you can substitute Anthem for State Farm. No wait. Add “and Anthem.”

This approach would be aimed at preventing recurrences which benefits the insurance company that doesn’t have to pay out the dollars. Second it would make a policyholder feel like the insurance company gave a crap beyond the money we’re feeding them each month so that we don’t have a catastrophe that we can’t afford to pay for. In other words, this would be a way to treat a customer like an individual that mattered to the company.

Has Anthem ever sent us a notification of something related to preventing a recurrence of my wife’s cancer - either through an email or a direct mail piece?

Noooooo.

All we ever have gotten in the nearly a year we’ve been with them is notices of bills and notices of things that might become bills. And the monthly invoice. And now the notification of the premium increase. I mean this literally. Not metaphorically.

Sure, look, I get the fact that they are a business but if the customer in the highly sensitive area of health is nothing more than an actuarial table and a policy performance tied by an algorithm, then their business doesn’t deserve to survive, much less prosper.

Whether you believe in universal health care or not (I do), I would presume you would see that this is not just an inhumane approach, it is a cold blooded model implemented by heartless creatures who have no concern for their actual policyholders. They are concerned that a. you pay and b. you don’t use the insurance ever.

My wife and I are stuck with this company for awhile. Because of her past condition, it isn’t that easy to guarantee coverage, so the cost of moving is perilous for us. But from a CRM lesson learned here, it should be clear that not only is this a company that should never have its practices emulated, even with nice CSRs, but it should be seen as a model of what not to do when your customers are more engaged and more concerned than ever.

2009-04-12T02:07:00.002-04:00

BCBS of Michigan Says It's Losing Money,
Seeks Bailout From Customers
Story from the Detroit News

Robert Boys is 73 years old, lives on a fixed income, and worries he'll soon have to shell out another $33.20 a month on health premiums.

His insurer, Blue Cross Blue Shield of Michigan, is seeking to raise the rates on his Medigap policy by 31 percent, to $140.29 a month, as part of a broader proposal to increase rates on its entire line of individual insurance plans -- policies for people who buy their own medical coverage. Blue Cross says it needs to raise rates to stem growing losses incurred in the individual market.

"They are hitting the people that can least afford it," said Boys, who lives in Brighton. "I'm trying to live on Social Security right now. What do I cut now?"

Boys is not alone in his worries. Many Blue Cross members are troubled by the insurer's proposed rate increases, which are now under review by state insurance regulators. They say the increases are too extreme and ill-timed with the state's unemployment rate in the double-digits -- the highest in decades.

On Monday, state regulators deemed the Blue Cross rate filing complete and will now go about notifying Blue Cross members, as well as other industry stakeholders and the state's attorney general, of the insurer's request. Once those steps are complete, members will have a chance to weigh in by requesting a rate hearing to challenge the increases.

The rate hikes are among the highest proposed by Blue Cross in the last five years and will affect about 400,000 Blue Cross members, including 209,000 seniors who buy their supplemental Medicare plans, known as Medigap.

Depending on the insurance plan, the proposed increases range from a few percentage points to as much as 72 percent for some of the insurer's age-rated plans, such as Individual Care Blue. Blue Cross's Medigap enrollees will see increases of 31 percent, but the hike won't affect Medicare Advantage members.

Blue Cross says the increases are necessary to stanch red ink flowing from its individual health plans and come as part of several cost-cutting moves announced in January by the insurer, including a work force reduction of about 1,000 positions.

As the state's insurer of last resort -- a responsibility tied to its tax-exempt status -- Blue Cross must cover all Michigan residents, regardless of their medical history. But that arrangement, Blue Cross officials say, leaves them with the state's costliest members because those customers are routinely rejected by other private insurers because of pre-existing medical conditions.

"The need for the increases is driven by a broken regulatory system in the individual insurance market that has not changed in nearly 30 years," Blue Cross spokeswoman Helen Stojic said.

Millions in losses claimed

Blue Cross has spent more than a year pushing for legislation changes to give the insurer more leeway in raising monthly rates, an effort that fizzled last December when state lawmakers let the measure die.

Blue Cross now says its losses in the individual market -- expected to increase in 2009 to $210 million -- could jeopardize the organization's long-term financial health.

Some Blue Cross critics, including the Michigan Attorney General Mike Cox, aren't so sure and have questioned the way the insurer is calculating those losses, saying they aren't as large as Blue Cross claims.

Lidia Abate of Farmington Hills is one Blue Cross subscriber eager to voice her opposition.

At age 59, Abate said she pays $286 a month for her Flexible Blue PPO. Her 89-year-old mother also spends another $107.09 a month for her Blue Cross Medigap policy. Under the proposed rate increase, her monthly premiums will rise only 3 percent but her mother's will go up 31 percent to about $140 a month.

"Luckily, she has us lending her a hand with her rent. Can you imagine how many older people will be in trouble if this happens?" said Abate, who lost her job at a physical therapy firm last year. Any increase to her policy will also strain the family's budget, Abate said. "We do have a mortgage and cars and bills and the 401(k) is in the toilet," she added.

Rate increase OK'd in 2008

Blue Cross received state approval last year to raise rates on about 20,000 members enrolled in individual plans, a hike that ranged from 40.6 percent for the high option to 22.49 percent or the moderate-level plans. The final increases approved by the insurance commission were lower than Blue Cross had requested, but still too high for member Ghada Abraham, who challenged the rate hikes before their approval by the insurance commissioner and continues to fight them on appeal.

"Blue Cross was created to make coverage affordable, yet the opposite is happening," said Joseph Aoun, an Ann Arbor attorney representing Abraham, who has the moderate option of Blue Basic and saw her monthly rates increase from $459 to $562 last year. Now, Blue Cross's request could send their premiums up another 63 percent to $917 a month.

"These increases, on top of the large increase they have received in years past, put coverage beyond the reach of the average resident," Aoun said.

Blue Cross said it sympathizes with its individual members, particularly those on fixed incomes or who have lost their jobs.

"Blue Cross wants to continue providing coverage to the vulnerable. But we need a regulatory system that works," Stojic said, adding that the market for individual policies has grown rapidly, saddling the Blues with a greater financial burden than their private-sector competitors.

Blue Cross expects to add another 76,000 individual members in 2009 and its actuaries project losses of up to $1 billion on its individual policies over the next three years. Financial information released in March by Blue Cross shows the insurer lost about $133.2 million on its individual policies in 2008 -- a slight improvement from the previous year's losses of $134 million. Still, Blue Cross says, the losses incurred on individual insurance dragged down the insurer's bottom line last year, contributing to a net loss of $144.9 million for 2008.

2009-04-12T02:01:00.003-04:00

Subsidies For Private Medicare Plans
On The Chopping Block
Story from the Wall Street Journal

The government late Monday is expected to set in stone the 2010 rates it will pay health insurers to run private Medicare plans. Most signs suggest that cuts are coming in the subsidies that the industry got during the Bush administration.

Stocks of health insurers were sucked into a surprise tailspin in February after Medicare officials signaled they planned an effective 5% cut in those payments after formula adjustments. Insurers, medical societies and others have had six weeks to give regulators their arguments before the payment rates become final for next year.

Their arguments, plus an effort by 17 senators from both parties who on Friday urged Medicare to reconsider the way it calculated the effective cuts, could sway the Centers for Medicare and Medicaid Services to compromise on the new payment rates, as the federal agency has in previous years. But its new management hasn't given any hint of letting up on efforts to rein in federal subsidies for the private-sector Medicare plans.

More than 10 million beneficiaries get their medical and drug coverage through so-called Medicare Advantage plans, which the Bush administration promoted with extra benefits for seniors and by providing subsidies to insurers that offer them. President Barack Obama wants to finance a good chunk of his health-care agenda by cutting those payments over time to the level of traditional Medicare's per-patient outlays. But the rates signaled in February by the new administration caught insurers -- and Wall Street -- off guard by cutting payments so soon.

The stock performance of big Medicare Advantage players on Friday suggested that many investors "don't believe it will be a positive surprise," said Matthew Borsch, analyst at Goldman Sachs. Humana Inc., already down 30% for the year, shed $1.54, or 5.7%, to $25.46 on Friday.

If the payment cuts remain or change little from those proposed, insurers may raise premiums or cost-sharing amounts, such as copayments The Blue Cross Blue Shield Association argues that the cuts could translate into premium increases or benefit reductions of between $50 and $80 a month for seniors. That could slow enrollment in a business that has been critical to many health insurers' profit growth in recent years.

Medicare Advantage wraps physician and hospital services in one. Unlike traditional Medicare, the government doesn't pay providers directly but instead pays insurance plans to manage care.

The Obama administration argues it wants to make sure the plans aren't overpaid while not providing value or better care. Last week, it took steps to tighten screws on the private plans on another front, setting new caps on what insurers can charge sick seniors and ordering them to be more upfront about what they cover.

2009-04-11T09:53:00.003-04:00

Governor Doyle of Wisconsin Discusses Health Care Leadership
Story from NBC26 WGBA

Governor Jim Doyle will discuss his leadership in health care and moderate the first Regional White House Forum on Health Reform on Thursday, March 12, 2009 at 2:00 EDT at the Ford Conference and Event Center in Dearborn, Michigan. Governor Doyle will join Michigan Governor Jennifer Granholm and Melody Barnes, director of the White House Domestic Policy Council.

Governor Doyle has made Wisconsin a national leader in providing access to affordable health care. In a time when many states are cutting back on health care programs, Governor Doyle is moving forward on a bold plan to insure 98 percent of Wisconsin residents through simple, accessible, and affordable plans. Since February 2008, all kids in Wisconsin have been able to get the health care they need at a price their families can afford through BadgerCare Plus. Nearly 70,000 children have enrolled in the program since 2008.

Governor Doyle is also moving forward the state's efforts to provide low-costs prescription drugs to Wisconsin seniors through SeniorCare. SeniorCare is cheaper, easier to apply for and provides better drug coverage than Medicare Part D. The program saves taxpayers and the federal government over $90 million a year, and provides prescriptions to 90,000 Wisconsin seniors.

Wisconsin is making strides in many areas of health care, including long-term care. The state's pilot program, Family Care, serves elders and people with disabilities with a need for a nursing home level of care with a flexible, community-based approach. It saves the Wisconsin Medicaid program an average of $450 per month per person.

Forum participants will include doctors, patients, providers, insurers, policy experts and health care advocates of all kinds - both Democrats and Republicans - who will discuss the urgent need to curb skyrocketing health care costs that are draining our federal and state budgets, devastating families and small businesses and undermining our long-term economic prosperity. People across the country can also visit www.healthreform.gov to submit their questions and ideas and join the debate.

2009-04-11T09:44:00.000-04:00

There is Job Security - If You Enjoy Working With the Elderly
Story from KansasCity.com

Do you want almost slam-dunk-guaranteed job security over the next 10 years?

Take a look at job projections from the U.S. Bureau of Labor Statistics and demographic trends which show — no surprise here — that the big baby boom generation is getting old.

People who provide care for seniors, especially those who require extended care, will be needed in droves.

Look especially for growth in demand for in-home care providers.

Because the cost of nursing home or life-care facilities is comparatively high, many Americans are opting for in-home care, sometimes round-the-clock.

Nationally, that means the personal and home care aide category is expected to grow by more than 50 percent — from 767,000 in 2006 to 1.15 million in 2016.

In Missouri, projections are for a 28 percent growth in the demand for home care aides, from 21,000 jobs in 2006 to 26,920 in 2016. A separate projection calls for demand in Kansas to grow by 35 percent, from 11,400 jobs in 2004 to 15,340 by 2014.

One supplier of such workers, Home Instead Senior Care, says the demand for senior care givers will outplace supply. It expects to have to double its workforce in just three years to handle incoming business.

Now here’s an important note of caution for anyone thinking of jumping into the growing, nearly recession-proof occupation:

Caring for seniors is not for everyone.

To help find out if you have the interest, aptitude or attitude for the profession, you can take a career self-assessment test.

In-home caregivers may be trained nurses, nurse assistants, physical therapists, cooks, housekeepers, errand-runners and companions.

Doug Kisgen, owner of Home Instead, points out that in-home care giving can be a mid-life career change as well as a part-time job opportunity.

If you like old people, if you have some experience as a care giver, or if you have a giving personality, you might consider the field.

2009-04-11T09:21:00.003-04:00

NOAA Weather-Alert Radios Available Free to
Day Care, Adult Foster Care Homes In Ludington Area
Story from Ludington Daily News

Tuesday, March 31, 2009

This week is Severe Weather Awareness Week and a good time to remind state licensed day cares and adult foster care facilities they may receive a free NOAA weather-alert radio.

“It provides a good warning for people who may not have their TVs or radios on,” Elizabeth Reimink, Mason County Emergency Management coordinator, said about the radios.

They are small, about the size of a hand, Reimink said, but loud and are designed to wake people if a warning comes at night.

“They’re programmed to receive alerts from the National Weather Service,” she said, adding that the warnings will start with a tone and then relay messages about potential storms to affected areas. Those messages will include information about the storm, the area that may be affected and the storm’s duration.

Reimink said she received grant money and bought several of the radios and has tried to contact area day care and adult foster care facilities.

“But I want to make sure no one’s missed,” she said, adding they can contact her at 408 Resseguie St., Suite 100, 845-5911.

2009-04-11T09:08:00.008-04:00

Key Choices For Seniors
Story from Ohio.com

While Trying to Save Money, Ohio Seeks to Bridge Gap Between Nursing-Home Care and Assisted Living Care

As a former businessman and member of President Richard Nixon's administration, Fred Rouse is used to being in charge.

But when the 82-year-old lived in the nursing-home section of St. Luke Lutheran Community in North Canton, he couldn't even set his own thermostat.

Thanks to a special state program that lets some low-income seniors use Medicaid to pay for assisted living, Rouse recently moved into the assisted-living portion of St. Luke's after recovering from intestinal surgery and completing therapy.

Now he can set his own schedule — and his own thermostat — while saving the government money.

Assisted-living costs an average of $2,106 per month, compared with $4,231 for nursing-home care, according to the Ohio Department of Aging.

''I'm a conservative, and I don't like wasting money,'' Rouse said. ''And I don't see wasting people's talents to come in and blow my nose.''

Faced with an aging population and rising costs to provide care, the state is trying to expand the options between home care and nursing homes for Ohio's seniors.

The Ohio Department of Aging has been working to enhance its existing community-based programs and develop new options for long-term care, Director Barbara Riley said.

Among the choices that could be added or expanded in the coming years:

• Enhanced community-living programs, which would allow Medicaid recipients in subsidized senior houses to get on-site help 24 hours if needed, similar to assisted-living facilities.

• Adult foster care, which would bring together a small number of seniors who need help with the tasks of daily living to live in a home with 24-hour care available.

• The ''Choices'' waiver program, which allows Medicaid recipients to hire their home-care providers, who could be trained relatives. The program is only available on a limited basis in central and southern Ohio.

• PACE (Program of All-Inclusive Care for the Elderly), which allows one provider to coordinate a recipient's medical care, home care and, if needed, adult day care. There are two approved sites statewide, in Cleveland Heights and Cincinnati.

''We haven't done what we're doing now, which is make a full-force public education effort to help people understand what choices are available and to make sure we have the choices available that people want,'' Riley said.

Burden on Medicaid

Most of the burden for providing long-term care to the state's elderly and disabled population falls on Medicaid, a state-run health insurance program for the poor and disabled that is supported with state and federal tax dollars.

About 74 percent of Ohio residents who received long-term care through Medicaid in 2004 lived in nursing facilities, compared with 61 percent nationwide, according to the most recent estimates available.

Ohio's population is graying — and that's expected to cost the state a lot more green. Each month, about 12,000 Ohio residents turn 60, according to the Ohio Department of Aging.

''The big picture is there's a huge problem and it's getting worse,'' said Joseph L. Ruby, president and chief executive of the Greater Akron-Canton Area Agency on Aging.

The agency coordinates Medicaid long-term care services for residents of Summit, Stark, Portage and Wayne counties.

''The best way to address the long-term care issue is to provide long-term care options,'' he said.

Oregon, for example, has developed a system that provides seniors and disabled residents covered by Medicaid a variety of options outside nursing homes for care, said Barry Donenfeld, executive director of the NorthWest Senior Area Agency on Aging in Oregon.

Donenfeld was among several state and national speakers during a recent seminar in Fairlawn organized by the Greater Akron-Canton Area Agency on Aging.

Oregon residents can get care while living in assisted-living facilities, their own homes, foster-care homes and even with relatives, who can get paid to provide the care, Donenfeld said.

As a result, Oregon ranked second in the nation in 2007 for the percentage of Medicaid dollars spent on community-based services (almost 73 percent) compared with nursing homes, according to data from the U.S. Centers for Medicare & Medicaid Services.

Levels of care

''What Ohio would need to do is make a commitment to developing this middle of the continuum,'' Donenfeld said. ''Just because you leave home doesn't necessarily mean that the next stop is the nursing home. There are other levels of care that allow someone a much more home-like setting.''

Ohio could save about $900 million a year in Medicaid costs if the state could achieve the average balance seen nationally between patients in nursing homes versus home and community settings for long-term care, according to estimates by the Ohio Business Roundtable.

Ohio's skilled nursing facilities ''are supportive of the continuum of long-term care and the ability of consumers to make choices from different settings of care, depending on what their needs are,'' said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents nursing homes and assisted-living facilities statewide.

However, he said, nursing homes need to be appropriately funded, because they will continue to be the right choice for many consumers.

Riley said the state already is taking steps to provide more options beyond nursing homes.

In recent years, the state has eliminated waiting lists for PASSPORT, a program that lets Medicaid recipients who otherwise would require nursing-home care to get services in their homes.

In addition, Ohio is making efforts to sign up more facilities for the assisted-living Medicaid waiver program, Riley said.

In Rouse's case, the former chairman of the Great Lakes Basin Commission under President Nixon got strong enough to move out of the nursing home but still needs help.

He said he has been very satisfied with the care he received in the nursing-home section when needed and now in the assisted-living area.

''I'm in good health, but I need help,'' he said from his new assisted-living room, which soon will be equipped with a recliner chair and personal-sized refrigerator and freezer.

His wife of 58 years, Barbara, has Alzheimer's disease and lives in the nursing-home portion of the facility.

''I want to stay here,'' he said. ''This is where I want to be.''

By later this year, the state also might approve more PACE sites. Participating programs get a set amount of money from Medicare and Medicaid each month to provide and coordinate all the medical care and home assistance that enrollees need.

Summa Health System in Akron is considering establishing a PACE program, possibly tied to its adult day-care program at Cuyahoga Falls General Hospital, said Patricia L. Troyer, Summa's executive director of post acute and senior services.

''Clearly,'' she said, ''people like to get services at home.''

2009-04-11T09:02:00.002-04:00

Service in Escanaba Aids Michigan Residents With Long-Term Care
Story from DailyPress.net

ESCANABA - Trying to find the best and most affordable long-term care for a loved one can be a frustrating and complicated search. That's why the Escanaba-based Upper Peninsula Commission on Area Progress (UPCAP) began its U.P. Long-Term Care Connections (UPLTCC) service - a single point of entry process that assists people in making the decision of how they or their family member will be taken care of.

When it comes to long-term care, there are many options, some affordable, and some costly. There is also the difficult choice between placing a loved one in a nursing home or adult foster care home, or trying to find the proper care for them at home.

In 2006, Michigan funded four pilot programs to demonstrate the effectiveness of the Single Point of Entry concept. UPCAP Services Inc., was selected as one of these pilots and has provided long-term care information, assistance and counseling to people in all 15 counties of the U.P. since January 2007.

The U.P. Long-Term Care Connection utilizes UPCAP's toll-free 2-1-1 Call Center as a starting point for people wanting information about long-term care.

If the person needs further assistance after speaking with an informed call specialist, they can meet with an options counselor. Bomberg said these counselors specialize in knowing as much about long-term care as possible.

"Our responsibilities are two-fold," said Bomberg. "We're there to help the individual or family make an informed choice of where to have long-term care provided, and also to ensure people who are looking to the state for money, that they understand the eligibility criteria. We work with everyone regardless of income."

Bomberg said the counselor's job is to spend time with the person and family client to help them make informed decisions.

Options counselors also address the delicate issue of financing long-term care.

"They meet face-to-face with the client and are very straight forward

about costs," he said. "That really wasn't happening before. There weren't intensive discussions about cost and no talk of less-costly alternatives... how much is it to stay home, or that an adult foster care home may have different pricing packages that may suit a person better..."

There are 20 options counselors working in the UPLTCC program who serve the entire Upper Peninsula. UPLTCC Options Counselor Mary Ross said she received intensive training to become a counselor, and continues her training as new information and situations arise.

"We're trained on anything and everything from the technical Medicaid policies to how to deal with grief and death," she said. "(UPCAP) has pulled counselors from all walks of social work and gives them very intensive training. The counselors all have something to offer and can offer different perspectives."

2009-04-11T08:53:00.002-04:00

Salary Up 26% For Blue Cross CEO
Story from the Boston Globe

Salary, Bonus Totals $3.5 Million as Insurer's Net Income Slides 49%

The salary and bonus paid to Cleve L. Killingsworth, chairman and chief executive of Blue Cross and Blue Shield of Massachusetts, increased 26 percent last year, to $3.5 million, even though the health insurer's membership declined and its net income fell 49 percent.

Based on previous years' retirement benefits - which Blue Cross-Blue Shield did not report for 2008 - Killingsworth's total pay package was likely about $4.3 million, making him by far the highest paid healthcare executive in Massachusetts.

The jump came during a tough year in which Blue Cross-Blue Shield's business was affected by the stock market decline, the recession, and the increasing cost of medical care.

Membership at the state's largest health plan declined about 40,000 to just over 3 million.

"The decline in membership had an impact on results," said chief financial officer Allen Maltz. "In addition, many of our customers changed their benefits plans to products that have much lower margins."

Blue Cross-Blue Shield insures employees of national companies that have locations outside Massachusetts, Maltz said, and those customers accounted for some of the drop-off in membership.

Maltz said Blue Cross-Blue Shield aims for a profit margin of between 1.5 and 2 percent. Last year's margin was almost zero. The firm had operating income from its medical claims business of just $1.6 million.

A new state assessment on reserves lowered income by $21 million, Maltz said. Revenue was flat at $6.7 billion, and medical claims were also unchanged at $6 billion.

Like most health insurers, Blue Cross-Blue Shield also relies on investment income, which fell 28 percent to $111 million. Maltz said the firm managed to avoid losses in the market by investing primarily in bonds and avoiding derivative securities that have declined precipitously in value.

"We made money in one of the toughest economic environments in the last 75 years," he said. "The company seeks to maintain strength to weather just this kind of situation."

Salaries at Blue Cross-Blue Shield were inflated by a complex executive bonus plan in which senior officials get bonuses based on a rolling average of the previous three years.

"These executives and the company performed and exceeded our expectations," said Jay McQuaide, a Blue Cross-Blue Shield spokesman. "They earned these incentives." The key metrics in the incentive plan are membership and net profit, he said.

The insurer's board members also received a 33 percent increase in base pay, from $30,000 a year to $40,000. Most earn far more because of payments for attending meetings and serving on committees.

The insurer recently said it was eliminating executive bonuses for 2009. Senior executives will still participate in a companywide bonus plan.

The company said the cutbacks would reduce cash compensation to senior executives about 30 percent and payments to Killingsworth about 50 percent, exclusive of retirement benefits.

At Harvard Pilgrim Health Care, the state's second-largest health plan, chief executive Charles D. Baker's total compensation, including retirement benefits, rose 24.5 percent to $1.7 million.

Net income for 2008 increased to $48.1 million from $45.6 million in the previous year, and membership grew 38,000 to 1.07 million.

"We did a great job of managing expenses," said James DuCharme, chief financial officer, in a statement. "Our overall administrative spending in 2008 was $15 million lower than it was in 2007."

Tufts Health Plan earned net income of $18.8 million in 2008 despite suffering investment losses of $6.2 million in 2008. In the fourth quarter alone, Tufts lost $27.3 million because of investment losses and an operating loss of $1.3 million. In 2007, Tufts posted net income of $110 million.

Enrollment increased to 698,000 at year-end compared with 678,000 in the first quarter.

"During such a challenging period, we are pleased to end the year with a positive net income," said Umesh Kurpad, chief financial officer, in a statement.

Chief executive James Roosevelt Jr. earned compensation of $1.06 million, excluding contributions to an executive savings plan, down slightly from $1.19 million in 2007.

The state's health plans are among the best nationwide, as ranked by the National Committee for Quality Assurance, a respected nonprofit. Harvard Pilgrim has been ranked best commercial health plan in the nation for four consecutive years. Tufts' plans, excluding its Medicare Advantage plan for seniors, were ranked second nationally last year, and Blue Cross and Blue Shield of Massachusetts ranked ninth.

2009-04-11T08:43:00.002-04:00

Costs For Individual Health Plans Soar
Story from USA Today

At a time when more people are forced to buy their own health insurance because of job losses, costs for many individual policies are soaring.

Advocates say the 17 million Americans who buy their own coverage can't negotiate lower rates the way employers or other large group plans can.

COBRA SUBSIDY NEARS: Employers fear rising health costs

"These folks have their back against the wall," says Jerry Flanagan, a health advocate with Consumer Watchdog, a California-based group.

More people are shopping for coverage: The Golden Rule Insurance Company, a part of UnitedHealth Group, says sales of individual policies are up 24% in the past two months. A website that links people with insurers, eHealthInsurance, says applications are up 18% in the fourth quarter, compared with a year ago.

Among this year's large rate increases on the individual market:

• Anthem Blue Cross in California has notified about 80% of its 800,000 individual policyholders of double-digit increases, many above 30%. Spokesman Ben Singer says rising medical costs are prompting the increases.

• Blue Cross of Michigan is seeking state approval for a 56% increase in individual premiums. Spokesman Andy Hetzel says the company needs to offset losses stemming from state rules making it the sole insurer required to take all applicants.

• Regence Blue Cross Blue Shield of Oregon will raise rates for approximately 10,000 Washington state customers by 27.1% on March 1.

Another Washington insurer, LifeWise, raised rates 17.6% on Jan. 1, according to the Office of the Insurance Commissioner in Washington state.

By comparison, group health insurance premiums paid by employers rose about 5% in 2008, says a survey by the Kaiser Family Foundation.

Some insurers say increases this year for individual policies aren't out of the ordinary. Aetna, for example, says individual policy increases nationwide range from 8% to 22%.

Still, such hikes can cause "sticker shock" for people used to smaller increases under employer plans, says Robert Laszewski, who heads Health Policy and Strategy Associates, a consulting firm.

Premium rates for individual policies vary widely, depending on state rules, the type of coverage and the applicant's age and health. Unlike group coverage, in which all applicants are accepted, insurers can reject applicants for individual coverage in most states if they have medical problems.

A sample of 227,000 individual policies sold by eHealthInsurance found average monthly premiums for single people ranged from $107 to $301 in 2007, the latest data available. The average deductible, the amount paid before coverage begins, was nearly $2,000.

Family coverage ranged from $219 to $494 a month with an average $2,600 deductible.

Insurers face shrinking enrollment in group plans because employers are shedding jobs. They also have deflated investment portfolios and higher costs as patients use more health services, says a report out last week from ratings agency A.M. Best.

Those problems could lead to "higher rate increases than in the past," says Sally Rosen, a managing senior financial analyst at Best.

2009-04-11T08:35:00.003-04:00

Growing Old Far From Home
Story from the Irish Times

The lonely death of an elderly Irish immigrant in New York illustrates the often sad fate of a generation of Irish who moved to the US in the 1950s and 1960s, and who now need support

‘He died alone” was the sad headline in the Irish Voice newspaper. Tony Gallagher, a 72-year-old Irish immigrant from Bellacorick, Co Mayo, was found dead in his apartment in Sunnyside, Queens in New York in late December. It is thought his body was lying there for a week before it was discovered by firefighters after they were alerted by the apartment superintendent who had not seen him for several days.

The New York Irish Center

Gallagher, a carpenter, arrived in the US in 1970. His wife, Josephine, now suffers from Alzheimer’s and has been living in a nursing home for the past three years in Kingston, New York. The couple had no children. Gallagher’s brother Eddie, lives in Holyoke, Massachusetts, and last saw him at Thanksgiving.

Ambrose Gurhy, the owner of an Irish bar in Queens, says Gallagher came in every so often. “You might see him two times a month and you might not see him again for four or five months. He wasn’t a bar person really. It was more for the company rather than a big session.”

The case of Gallagher’s lonely death has focused attention on the plight of elderly Irish immigrants in New York, and the problems of isolation that many of them face.

Ciarán Staunton, a well-known figure in the Irish community and vice-chairman of the Irish Lobby of Immigration Reform, says the death of Tony Gallagher underlines the need for a census of elderly Irish to identify those living in isolated conditions. The census could be done through a volunteer network run with the help of the Church, he says, noting that many elderly Irish in New York attend Mass daily.

According to Staunton, there are probably “a couple of thousand” Irish over the age of 65 living in the city, and many have little contact with each other.

“We need to know where are they? Who are they? We need to get the names, get their numbers and get co-ordinated.”

The New York Irish Center on Jackson Avenue in Queens has become a hugely important social centre for elderly Irish in the borough. The founder of the centre, 73-year-old Fr Colm Campbell, chaplain to the Irish community in the US, points out that the Irish in Queens are more dispersed than they are in the Bronx.

“The Irish who moved to the Bronx mainly tend to live all closely together in a tight little area in Woodlawn,” says Fr Campbell, originially from Belfast and who came to the US in 1992. “In Queens, there is no Irish neighbourhood any more. There was Woodside and Sunnyside, but they have gone.”

Because Fr Campbell lives alone and suffers from ill health, he wears a bracelet on his wrist which will sound an alarm should anything happen to him. At a Mass last weekend at the New York Irish Center in Queens he stressed to the elderly congregation the importance of looking out for each other.

Returning to Ireland is simply not an option for most seniors, says Fr Campbell, because “the Ireland they left is not the Ireland they would return to”. Indeed, one of the regulars at the centre, Pat Sheehy from Woodlawn, who left Glasnevin in Dublin in 1956, tried to relocate to Ireland three times. “It just never worked out,” she explains.

Fr Campbell says there is a great deal of loneliness. “One woman in Woodside, Queens, said to me, ‘My daughter rings me every day. But that’s just 20 minutes.’ The apartment block she lives in used to be entirely Irish but now it’s almost entirely Polish. She says they are lovely people – but she can’t understand a word that they are saying.

Fr Campbell says one of the problems with elderly Irish immigrants is their reluctance to ask for help. “There’s a thing in the Irish that just doesn’t want to admit to being in need.”

CIARÁN STAUNTON AGREES, saying that the generation that came to America in the 1940s and 1950s are “a proud people”. “No one is going to say, ‘I have spent 20 years sending back money and parcels when things were tight and now no one calls me.’”

Every Wednesday the New York Irish Center holds a lunch which is attended by 40 to 50 senior citizens. As they tuck in to their meals donated by a local Irish restaurant, Sidetracks, accordion music plays in the background. When people introduce themselves, they follow their name with the part of Ireland they came from. When I tell them I come from Nenagh, Co Tipperary, they ask if I know various Nenagh families, despite the fact that they had left Ireland in the 1950s. Many have less of an American accent than you would find in the average teenager in south Co Dublin.

Peggy Cooney, 78, originally from Dunshaughlin, Co Meath, and now living in Astoria in Queens, has been coming to the weekly lunch for four years. “I have made a lot of friends here,” she explains. “But it’s only one day a week.” Cooney came to the US in 1960, sponsored by a Jewish family in Riverdale, the Bronx to take care of their children. Later she worked for a nursing agency. She was “very happy living here” in the 1960s and 1970s. There was a lot of dancing in those days, she says and she was also active in Northern Ireland Aid. She retired at the age of 70. She never married and has a brother in Missouri.

“I’m not lacking for a social life,” she says. However, in her apartment block, no one talks to each other. “Everyone goes to work apart from me and an elderly couple. There’s no communication in the block.”

Most of the senior citizens say that the New York Irish Center is a very important part of their social life. There are other activities such as plays and Irish language classes, and the lunches on Wednesday are followed by a game of cards in the basement. One of the women advises that if I want to talk to the men, I should do so before the card game begins, “because there’ll be no talking to them after that”.

Seán Finn (73) from Ballyhaunis, Co Mayo, says the centre, along with the Irish centre in Mineola on Long Island, forms the basis of his social life. He lives alone and says that on some days, when the weather is very cold, he doesn’t leave his apartment at all.

IN WOODLAWN IN THE Bronx, the main organisation caring for the elderly Irish is the Aisling Irish Community Center. Orla Kelleher, its executive director, agrees that the Tony Gallagher case, although an extreme example, does prove that in a city of more than eight million people, “loneliness and isolation do exist, particularly for seniors.

“We have a very active group of over 80 seniors at the centre. However, they are the lucky ones who are physically able to come to the centre for the weekly meetings and events. We have attempted to expand our senior outreach programme over the past three to four years by contacting churches, hospitals, nursing homes, and so on to ensure that the older Irish are being looked after. However, our efforts have been thwarted by a serious lack of financial and human resources.”

The Tony Gallagher case would be unlikely to happen in Woodlawn because it is such a close-knit community, says Martin O’Malley, a retired bus driver from Ballycastle, Co Mayo. He lives in Woodlawn and is active in the Aisling Center and was speaking at the centre on a Saturday as Irish dancing classes took place. “I had heard he was a bit of loner,” he adds.

Hugh McMorrow (72), from Dromahair, Co Leitrim, says “Woodlawn is an area where everyone knows everyone. The people in good shape look out for the people in bad shape.”

The Irish consulate in New York says that dealing with problems of an ageing Irish community in New York is a top priority. It is unable to say how many Irish over the age of 60 are in New York, which underlines the need for a census of Irish seniors, according to Ciarán Staunton.

The consulate agrees there is a need for more information but says the most practicable way to quantify and assess needs of elderly Irish immigrants is through the establishment of a well-resourced outreach programme for seniors and points out that a new service – to include a senior helpline – will be up and running in March and training for volunteers has already begun.

Immigrant voices: lives lived abroad

TOM and MARGARET BEGLEY

Tom was born in Brooklyn to Irish parents from Roscommon and Mayo, who returned to Ireland during the Great Depression. They came back to the US in the late 1940s. Tom’s wife Margaret is from Co Down. She says they have returned to Down regularly over the years, even during the Troubles. Tom worked in the circulation department in The New York Times. The Brooklyn neighbourhood they live in, Midwood, used to be mainly Irish and Italian; today it is largely Jewish and Pakistani.

The Begley’s have three sons: one who lives in Rockland County, New York, and two who live on Staten Island. They come to the New York Irish Center regularly. “You get to hear the news and the craic,” says Tom, with a strong Brooklyn accent.

MARTIN OMALLEY

“I wouldnt leave Woodlawn for the world,” says Martin O’Malley, speaking about the Bronx neighborhood. Originally from Ballycastle, Co Mayo, he left for the US on January 27th, 1957. He had previously worked in London. “It was tough being Irish back in those days in England. ‘There goes Pat,’ they used to say to you as you walked by.”

He fell in love with the US as soon as he came out here. There was dancing “seven times a week.” He met a Galway girl, they married and had six children. He drove a bus for a living and says he would never want one of his sons “doing that crap.” One of his children is a medical doctor, while two others have PhDs. An active member of the Aisling Center, he volunteers each week making sandwiches which are given to the homeless around Manhattan.

2009-04-11T08:21:00.002-04:00

BCBS of Michigan to Cut Up to 1000 Jobs
AP Story Posted to MLive.com

LANSING -- Blue Cross Blue Shield of Michigan said Friday it plans to eliminate up to 1,000 jobs and make other budget cuts this year in another blow to the state's economy.

The nonprofit health insurance giant said the moves are necessary to preserve its financial health. Blue Cross had hinted at possible layoffs last year after the Michigan Legislature did not pass changes to insurance rules sought by the company.

The job eliminations could affect more than 10 percent of the Blue Cross system's roughly 9,000 Michigan employees, including its subsidiaries.

Blue Cross Blue Shield employs 250 in its downtown Grand Rapids office.

Blue Cross has said it wants law changes because it is losing millions of dollars each year on health insurance policies that cover individuals.

Blue Cross customers also could feel the brunt of the company's actions. Blue Cross plans to request average rate increases of 55 percent for individual plans, 42 percent for group conversion plans and 32 percent for Medicare supplemental plans.

"We should not ask our individual subscribers to pay more without first demanding sacrifices from ourselves," Blue Cross Blue Shield of Michigan President and CEO Daniel Loepp said in a statement. "Our goal is to move forward as a strong and financially stable nonprofit company, committed to fulfilling our mission and delivering the best value in health insurance products and services to our customers."

Loepp said the company faces losses of $1 billion through 2011.

Blue Cross plans to trim 400 jobs from its core business and its Blue Care Network HMO subsidiary within the next 60 days. The other job cuts would come later in the year.

Some senior executives will face a salary reduction, the company said, while other executive pay will be frozen. Salaries of non-union employees will be frozen, and the United Auto Workers will be asked to delay a 3 percent pay increase planned for the Blue Cross employees it represents.

The company plans to reduce advertising and lobbying by 25 percent. Discretionary spending such as travel also will be cut by 25 percent.

Blue Cross is a nonprofit organization playing a unique role in the state's health care system. It can't deny any customer health insurance as long as the customer pays for it, making it the state's insurer of last resort.

In exchange for a mission of improving access to health care coverage, the nonprofit company is exempt from many state taxes.

The company's annual revenues were about $19 billion in 2007.

2009-04-11T08:16:00.002-04:00

Crain's 2008 Newsmaker of the Year:
Daniel Loepp, CEO Of BCBS Michigan
Story from Crain's Detroit Business

As a former Lansing insider, Daniel Loepp, now CEO of Blue Cross Blue Shield of Michigan, must have been disappointed that a handful of Republican state legislators stymied Blue Cross’ 14-month effort to pass two bills to reform the individual health insurance market.

After a session that began Dec. 18 and lasted into the wee hours of Dec. 19, legislators failed to come up with a compromise on a controversial set of bills to reform the individual market.

The two bills, substitute House Bills 5282 and 5283, died. Legislative leaders promised to address what many consider to be a broken individual market in the 2009 session, which begins this month.

It was a bitter defeat for Loepp, Blue Cross’ CEO since July 2005, when he succeeded Richard Whitmer, who retired after leading the company for 18 years.

Earlier in his career, Loepp served as chief of staff for Michigan Speaker of the House Curtis Hertel and director of communication for Michigan Attorney General Frank Kelley.

Detroit native and Wayne State University-educated Loepp, who went to Blue Cross in 2000 as vice president of governmental affairs, passionately believes that Blue Cross stands alone against a herd of hungry, for-profit health insurers.

He charges these insurers are “cherry-picking” healthy people for coverage while sending the sickest and costliest people to Blue Cross. As a result, he says, Blue Cross is losing millions of dollars.

Loepp also has argued that Michigan needs a wide range of consumer protections that will benefit thousands of individuals, especially the sick, women and the elderly. He also believes Blue Cross needs regulatory reform to shorten the time it now takes for proposed rate increases to take effect.

Commercial carriers and other nonprofit health insurers, such as Health Alliance Plan or Priority Health, do not have to go through a public process as the Blues does to increase rates.

Look for the Blues to take another crack at the legislative process this year.

2009-04-11T08:09:00.002-04:00

Test Assesses Effectiveness of Alzheimer's Drugs
Story from Science Daily

A test developed by physician-scientists at Washington University School of Medicine in St. Louis may help assess more quickly the ability of Alzheimer's drugs to affect one of the possible underlying causes of Alzheimer's disease in humans, accelerating the development of new treatments.

Scientists used the test to show that an Alzheimer's drug given to healthy volunteers reduced production of a substance known as amyloid beta (A-beta), a normal byproduct of human metabolism that builds to unhealthy levels forming brain plaques in Alzheimer's patients. The drug candidate, LY450139, which is also known as semagacestat, is being studied in clinical trials by Eli Lilly and Company.

Ongoing clinical trials are studying the effect that semagacestat may have on cognitive function and biochemical and brain imaging biomarkers in patients with Alzheimer's disease. Washington University researchers wanted to see whether the new measurement technique, stable isotope-linked kinetics (SILK), could detect the study drug's impact on A-beta synthesis in healthy volunteers.

"Bringing an Alzheimer's disease drug into clinical trials from tests in animal models has always been challenging," says study director Randall Bateman, M.D., a Washington University neurologist who treats patients at Barnes-Jewish Hospital. "We haven't had a way to quickly and accurately assess a drug's effects, and that meant there always had to be some degree of educated guesswork when it came to setting the optimal dosage for humans. SILK may help to eliminate much of that guesswork."

Scientists are unsure whether increased A-beta production, reduced clearance or a combination of the two lead to the A-beta buildup in the brain, a process that many believe triggers Alzheimer's disease. Bateman and his colleagues are currently using SILK to try to answer this question.

Until SILK, there has not been a way to directly measure the production or clearance of A-beta. The efficacy of potential new Alzheimer's drug candidates has been assessed by monitoring the cognitive functions of patients with the disease for extended periods of time, which require large, lengthy and expensive studies.

In their double-blind study, scientists gave 20 healthy volunteers varying doses of either a study drug or a placebo. At the start of the SILK test, volunteers were connected to an intravenous drip that gave them a slightly altered form of the amino acid leucine, which is a component of A-beta.

Over the course of several hours, cells in the brain picked up the labeled leucine and incorporated it into the new copies made of A-beta and other proteins. The scientists took periodic samples of the subjects' cerebrospinal fluid to determine how much of the A-beta included altered leucine.

Tracking the rise of the percentage of labeled A-beta over time reveals the A-beta production rate. Scientists then stop the leucine labeling but continue analyzing spinal fluid samples. As the body removed old A-beta and made new A-beta, the percentage of A-beta containing altered leucine dropped, revealing the A-beta clearance rate.

The results suggest a dose-dependent drop in A-beta production, with an 84 percent reduction in A-beta production being measured with the highest study drug dose.

The SILK procedure takes 36 hours, but provides scientists a more detailed assessment of amyloid beta production and clearance levels than they can obtain through conventional methods.

"You could use a spinal tap to look directly at the amount of A-beta present in the cerebrospinal fluid, but we've shown that natural processes cause A-beta levels to change dynamically," says Bateman. "Such changes make it more difficult to assess the effects of a drug in that fashion."

The study was funded through a Lilly grant from a funding program that allowed Bateman to propose the research and retain control of it. Five of the paper's 12 authors are Eli Lilly employees.

Washington University in St. Louis licensed its pending patents on SILK to C2N Diagnostics, LLC, a St. Louis diagnostics company started by Bateman and senior author David Holtzman, M.D., the Andrew and Gretchen Jones Professor and Chair of Neurology. Bateman and Holtzman's financial interests in the company are governed by the university's conflict-of-interest policies.

Funding from Eli Lilly and Company supported this research.

2009-04-11T08:06:00.001-04:00

How Old is Too Old to Work?
Story from Forbes

Debate about the ideal age to retire has been going on for years. But with the U.S. economy in a dramatic slump, the flip side of that question -- how old is too old to work? -- has become uppermost in many people's minds.

As workers young and old fret about dwindling retirement accounts in the wake of the mortgage crisis and stock market tumbles, they joke that they'll have no choice but to work until they're 90 or beyond.

But many also wonder: Will I be able to?

Research has offered some reassurances. Researchers have learned that there is no ideal retirement age and that older adults who keep their thinking skills sharp by learning new things off the job can stay more competitive in the job market, too.

"In today's economy, it becomes more of a necessity than a luxury to keep working," said Dr. Joseph Sirven, a professor of neurology at the Mayo Clinic in Scottsdale, Ariz. The short answer to the question, "How old is too old to work?" is, Sirven said, "when you are not able to do the job."

But there's much you can do to prevent that from happening, he and other experts have found. "What we find now from research and a neurological perspective is [that] the secret to good aging is, you have to keep busy," Sirven said. "Sometimes that means exercise, physical activity. But it means a lot of mental and cognitive activity" also, he said.

Today, Sirven said, older adults frequently retire from one career and transition into another -- something that's matched to their skills and experience and takes into account any age-related disadvantages.

His advice for people who plan to work well beyond the traditional retirement age of 65: "Focus on what work can you do that you can keep up with as you age."

Take stock of your attributes and drawbacks: "You may not be the quickest or most agile," Sirven said, "but you could be the wisest or the most experienced, which also counts."

That wisdom might be doubly appreciated by co-workers, even younger ones, in our shaky economy, he said. Older workers, after all, have been through several recessions. "That stability of wisdom, of living through it [before], can be the most important of all," he said.

Joy L. Taylor, an associate clinical professor of psychiatry at Stanford University, stressed that keeping skills sharp can make a difference in on-the-job performance. She studied 118 noncommercial pilots, age 40 to 69, to determine how age affects cognitive performance in the real world.

She did the study as the Federal Aviation Administration was proposing that the mandatory retirement age for commercial airline pilots be raised from 60 to 65, which was later signed into law.

Though she did find that the older pilots, those 60 to 69 years of age, initially performed worse than the younger pilots, she also found that the older pilots showed less of a decrease in their overall flight summary scores. And over time, they improved more on their "traffic avoidance" performances than did the younger pilots.

The study was published in the journal Neurology, accompanied by an editorial co-authored by Sirven.

Now, Taylor and her team are studying whether extra training for pilots helps them overcome age-related changes in motor performance skills they need, such as flying in a holding pattern.

So, how to best ensure that you can work longer than average, if you have to or want to?

Try constantly to learn new skills, Sirven suggested. "Pick up a new language, learn a new instrument," he said. "Give yourself a push to try something new."

And Taylor had additional ideas. "Keep your work-related skills, exercise, and eat the best diet, a heart-healthy diet," she said. "Our emphasis is on physical health as well as cognitive health and stimulation -- both being equally important."

Editorial: Blue Cross reform should wait until '09

2008-12-17T08:37:00.000-05:00

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

2008-12-17T08:29:00.004-05:00

Michigan’s Largest Health Insurer Sings Financial Blues

Posted by Victoria E. Knight

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

2008-12-17T08:26:00.001-05:00

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

2008-12-17T08:16:00.002-05:00

Geography Has Role in Medicare Cancer Coverage

By STEPHANIE SAUL

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

More Info on Medicare Programs

2008-12-16T07:37:00.001-05:00

This time from Florida.

Time To Change Medicare Programs

By ADON TAFT, Life to the Fullest

Hernando Today

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 www.medicare.gov. 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 adontaft@yahoo.com. Please include your name and address.

Spending the Holidays with Aging Parents

2008-12-16T07:33:00.001-05:00

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

2008-12-16T07:29:00.001-05:00

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

2008-12-16T07:17:00.002-05:00

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.

By Robert Strauss

For The Inquirer

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.

The Coming Shortage of Health Care Providers

2008-09-05T11:33:00.000-04:00

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

2008-09-05T11:20:00.002-04:00

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

2008-09-05T11:18:00.001-04:00

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

Kelso House Adult Foster Care

China's Coming Crisis Of Elder Care

Human Services Chief: Cuts Hurt Elder Care

26 Arrests In Medicare Fraud Case

The New Old Age - Who We Are Now

Seniors Teach Med Students Finer Points Of Elder Care

Elder Care Survival Key Concern At County Forum

Lobbyist Working To Help Senior Citizens

Waiting Lists Lengthening For Elder Care Services

Podcasts Feature Advice For Senior Community Management

Estate Planning: Never Too Early, Often Too Little, Too Late

Choosing Appropriate Senior Care

Couties Considering Phase-Out Of Home-Health Care

Mysteriously, Risk Of Stroke Shown To Have Geographic Determinants

Senior Care Across The Miles

Using The Internet To Transform Elder Care

The Modern Dilemma Of Elder Care: The Sandwich Generation

Canada Shifting Senior Care Away From Hospitals

Doctor Files Supreme Court Case Vs. BCBS of Texas

BCBS Vs Chiropractors

Some Exercise Their Right To Opt Out Of Health Insurance

Raising awareness

Protections in place

Learn more

Story from OC Register

Jodee Kalmen drew the caregiving card four years ago.

The Nature of the Health Insurance Beast

Millions in losses claimed

Rate increase OK'd in 2008

Editorial: Blue Cross reform should wait until '09

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

BCBS of Michigan Could use a little Bailing Out

BCBS of Michigan Tries to Pry Itself From Under Regulation

CyberKnife Recieves Uneven Coverage from Medicare

Geography Has Role in Medicare Cancer Coverage

More Info on Medicare Programs

Time To Change Medicare Programs

Spending the Holidays with Aging Parents

Elder Care Expert Has the Prescription for Caregiver Stress

Medical society head sees gaps in elder care

Sonja Puzic, Windsor Star

The Medicare D shell game

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

The Coming Shortage of Health Care Providers

Trouble Ahead

Discussing Care Options With Elderly Parents

GE Designing Products for People With Varied Abilities

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