Thousands More Medicaid Enrollees Could Get Home And Community-Based Care Under New Rule

housands of Medicaid beneficiaries who were previously limited to receiving care in an institutional setting may now be given the option to receive that care in their homes and communities, under a proposed rule published by the Centers for Medicare & Medicaid Services (CMS).

The Deficit Reduction Act of 2005 (DRA) gave states a new option to provide home-and-community based services (HCBS) to Medicaid beneficiaries without applying for a demonstration waiver. The proposed rule provides guidance to states on how to implement this provision of the DRA.

Under this option, states will now be able to set their own eligibility or needs-based criteria for providing HCBS. Previously, to qualify for assistance with personal care, home health care or other services in the home or community setting, beneficiaries were required to be at imminent risk of institutionalization. The DRA provision eliminates this requirement and allows states to cover Medicaid recipients who have incomes no greater than 150 percent of the federal poverty level, or $15,600 per individual in 2008, and who satisfy the needs-based criteria.

"Thousands more Medicaid beneficiaries may now be able to opt for needed long-term support services in their homes rather than institutions," said CMS Acting Administrator Kerry Weems. "Breaking the historic link between long-term care and institutions will level the playing field and give beneficiaries new choices for how they receive care."

The proposed rule emphasizes "person centered" care, giving individuals an active role in developing their care plans, and the "self-direction" option in which states can allow individuals to take charge of their own services. The services states may make available under this benefit include case management, homemaker, home health aide, personal care, adult day health, habilitation, and respite care. The DRA also allows states to provide special services to individuals with chronic mental illness, including day treatment or other partial hospitalization, psychosocial rehabilitation, and clinic services.

Medicare's Immediate And Long-term Problems Demand Congressional Attention

"Once again, Medicare's Trustees have rung the alarm bell that the long-term fiscal solvency of the program is in serious trouble. It is critical that lawmakers ensure that Medicare will be a viable safety net for future generations of seniors. Seniors who rely on Medicare now also need Congress to take immediate short-term action to preserve their access to physician care this year.

"Findings from the latest Medicare Trustees report point to the critical need to reform the broken physician payment system. Cutting Medicare physician payments 41 percent over nine years while practice costs increase is penny-wise and pound foolish. Trying to save Medicare money by slashing physician payments will ruin the physician foundation of Medicare for current and future generations of seniors. A startling sixty percent of physicians say this year's cut alone will force them to limit the number of new Medicare patients they can treat. Couple this fact with a physician shortage and the huge influx of baby boomers soon to enter Medicare, and the outlook for Medicare patients' access to care is grim.

"Congress must take immediate action to preserve seniors' access to care as the first cut begins this July - and will total more than 15 percent by the end of 2009. The AMA supports the Save Medicare Act of 2008 (S.2785), which will replace 18 months of cuts with payment updates that better reflect medical practice cost increases. To demonstrate physicians' support for the legislation, nearly 1,000 physicians from across the nation will make a 'House Call' on Congress next week to call for action."

DRA and long-term care for senior Americans with disabilities

Here is the conclusion to her article:

There is no question that this nation needs to look closely at the means by which long-term care for elders with disabilities-indeed, all heath care, for everyone-is financed. Many options for restructuring the financing of long-term care for the elderly are available-including adding a long-term care benefit to Medicare or following the leads of Japan and Germany in creating a separate social insurance program to provide long-term care for older Americans. These will require additional taxes and may involve some general cost-shifting back to consumers who use government-financed health care services. But such cost-shifting should impact everyone, not just the elderly and disabled.

The DRA's solution to a crisis (that at the moment is largely manufactured) entailing the shifting of additional burdens onto groups that already bear most of the tremendous economic and emotional burdens that long-term disabilities implicate should not be considered acceptable. Nor should taxpayers be forced to support the long-term care partnerships, which amount to government sponsored discrimination benefiting a small group of wealthy, non-disabled Americans. The asset-transfer and LTCP provisions of the DRA should be repealed while Congress seeks gender- and ability-neutral solutions to the nation's future financing of long-term care for the millions of seniors who will need it in the coming decades.

A New Internet Based Solution for Caregivers of the Elderly

Tender Tidings, Inc. announced today the launch of a new Internet based solution for caregivers of the elderly. Caregivers will be able to visually monitor their aged loved ones via streaming video from any computer with a high speed Internet connection.

Whether at work, at home, or traveling, caregivers now have the ability to check on their senior loved ones through a convenient, affordable, easy to install wireless camera that can be placed in any room of the senior's home.

Besides the high-quality wireless camera, TenderTidingsSeniors.com offers a collaborative, on-line calendar so family members can keep up with important appointments and events. They also have access to convenient notepads and reminder tools for communicating with in-home caregivers.

TenderTidingsSeniors.com was created by a mother/daughter team: Elaine Osteen, whose mother-in-law with the early stages of dementia lives right around the corner, and Amy Howell, who lives two hours away from her grandmother.

Because so many caregivers share that responsibility with siblings or other family members, the whole family can share one subscription. The main caregiver, or the Guardian, can issue passwords to other trusted friends or family members and each can access the video of their elderly loved whenever it's convenient for them.

Home Guardian Releases Innovative Sensor System To Keep Seniors Safe

Home Guardian, LLC has announced the release of a suite of sensors that non-intrusively monitor the health status of seniors in their homes while enabling professional caregivers to focus on providing needed care. This includes the detection of falls, which constitute the largest cause of injuries for people over age 65 in the United States.

The systems were developed by a team of researchers originally from the University of Virginia's Medical Automation Research Center (MARC) in partnership with two nationally recognized not-for-profit senior care and service providers, The Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD) and the Volunteers of America (VOA) National Services (Alexandria, VA).

Immediate benefits of the sensor systems-as shown in carefully controlled studies done by The Evangelical Lutheran Good Samaritan Society and the Volunteers of America National Services-include:

-- A reduction of the cost of care of nearly 75 percent
-- Increased feelings of safety and security in participants
-- Less job-related stress for caregivers

Health Insurance Boosts Retention in Washington State

Providing health insurance makes consumer-directed home care workers more likely to stay, both on the job and in the field as a whole, according to a study from Washington state.

Evaluation of Interventions to Improve Recruitment and Retention (pdf) reports on a survey to evaluate a series of initiatives instituted by the Home Care Quality Authority (HCQA). The changes were aimed at improving recruitment and retention of the so-called individual providers (IPs) who participate in the state's consumer-directed home care program, many of whom are related to the people they care for.

The most expensive initiative - and the one the researchers expected would have the greatest effect - was subsidized health insurance. To qualify for the insurance, IPs had to have been working for the program at least 86 hours a month for at least three months. In general, though some exceptions were made, they also had to be ineligible for health insurance from any other source.

Researchers at Washington State University surveyed IPs and the consumers who employed them about their experiences from 2004, when the program began, to 2006. Among their findings:

* Average monthly turnover declined a statistically significant amount (from 1.53 percent to 1.27 percent);

Proposed Federal Background Checks on LTC Workers

On March 17, 2008, McNight's Long-Term Care News posted a news article entitled "Senate budget to include $160 million for elder abuse prevention".

It reported: "The [U.S.] Senate has set aside funding in its fiscal year 2009 budget resolution for a national system of background checks to keep those with abusive and criminal histories out of nursing homes and long-term care facilities."
The Senate approved an amendment for the funding last week, but the money, which would total $160 million, will only be available upon the Senate's passage of the Patient Safety and Abuse Prevention Act of 2007 (S. 1577). The act would set up a comprehensive nationwide system of background checks for long-term care workers.

Both the Senate and House passed nonbinding budget resolutions late last week. The two bodies plan to reconcile their plans this spring.

Survey Finds 3 In 5 Caregivers Say Their Children Help Care For Loved Ones With Alzheimer's Disease

Results from the third annual Alzheimer's Foundation of America (AFA) ICAN: Investigating Caregivers' Attitudes and Needs Survey suggest that Alzheimer's disease care is a family affair. Most "sandwich caregivers" - the parents or guardians of children under 21 who also care for an aging parent, other relative or friend with Alzheimer's disease - say their children are assisting with caregiving responsibilities that range from attending doctors' appointments to feeding and dressing their loved ones.

Survey results ound that about three in five caregivers say their children aged 8 to 21 are involved in caring for a loved one with Alzheimer's disease. Of the caregivers who feel they do a good job balancing the care of their loved ones with Alzheimer's disease and children under 21, more than one-third (36%) specifically cited support from children as a contributor to their success.

Among children, ages 8-21, who are involved in caregiving, many are reported as taking on significant tasks:

* About one-third of young adults (ages 18-21) assist with doctors' appointments;

* 42% of young adults assist with transporting loved ones with Alzheimer's disease;

* About one-quarter of young adults and teens (ages 13-17) assist with activities of daily living, such as feeding and dressing;

* Nearly 90% of pre-teens (ages 8-12) visit and entertain a loved one with Alzheimer's disease (please use caution when interpreting results due to small base size);

* Approximately 85% of teens pay visits to the person with the disease.

Brain-damaged woman at center of Wal-Mart suit

JACKSON, Missouri (CNN) -- Debbie Shank breaks down in tears every time she's told that her 18-year-old son, Jeremy, was killed in Iraq.

Even though the 52-year-old mother of three attended her son's funeral -- she continues to ask how he's doing. When her family reminds her that he's dead -- she weeps as if hearing the news for the first time.

Shank suffered severe brain damage after a traffic accident nearly eight years ago that robbed her of much of her short-term memory and left her in a wheelchair and living in a nursing home.

It was the beginning of a series of battles -- both personal and legal -- that loomed for Shank and her family. One of their biggest was with Wal-Mart's health plan.