China's Coming Crisis Of Elder Care

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

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

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

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

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

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 ... . 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 ... . 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

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.