LTC Reform

Wednesday, March 21, 2007

Issue Brief Discusses Long-Term Care Partnership Programs

"Long-Term Care Partnerships: An Update," Alliance for Health Reform: The issue brief presents information from a November 2006 briefing to examine the Long-Term Care Partnership Program, which allows people to retain assets equal to the amount of their long-term care insurance policy and apply for Medicaid after their private benefits are used. The brief also discusses other initiatives and future challenges to encourage U.S. residents to purchase private long-term care insurance (Alliance for Health Reform, "Long-Term Care Partnerships: An Update," March 2007).

A webcast of the Alliance briefing is available online at kaisernetwork.org.

Tuesday, March 20, 2007

Cost Of Benefits For Seniors Limits Ability Of Federal Government To Provide Health Insurance For Children, Report Finds

The federal government's spending on children's programs, including health care and education, is limited by the growing proportion of the budget spent on older U.S. residents, according to a study released Thursday by the Urban Institute, USA Today reports. The report examined federal spending since 1960 and found that among more than 100 federal programs for children, the share of domestic spending and tax breaks they received declined from 20.1% in 1960 to 15.4% in 2007. Without a shift in policy, that share will drop to 13.1% by 2017, while the spending percentage of the gross domestic product for children's programs will drop from 2.6% in 2007 to 2.1% in 2017, the report projected. The percentage of the GDP spent on adults receiving Social Security, Medicare and Medicaid will grow from 7.6% in 2007 to 9.5% in 2017.

Monday, March 19, 2007

Designing the Cash and Counseling demonstration and evaluation

Coverage of personal assistance services for Medicaid program participants with long-term functional disabilities has been available since the late 1960s, but, during the 1980s, coverage options were expanded and more states elected to offer these services. Over the past quarter century, program participants' access to these benefits has greatly expanded. When personal care services (PCS) were first offered as an optional state plan benefit, in 1968, coverage was limited to in-home aide services and followed a "medical model" that required physician authorization and nurse supervision. Congress eliminated these federal requirements in 1993 in response to a campaign by disability-rights activists. They successfully argued that, whereas medical conditions cause disability and make PCS medically necessary, which provides the rationale for medical insurance coverage, a physician is not needed to make a disability determination and PCS themselves are not "medical" and should not be regulated as such. Nevertheless, many states continued to mandate physician authorization and nurse supervision and, as of the mid-1990s when the CCDE was being designed, approximately half of the 33 states and federal territories offering Medicaid PCS stipulated that only licensed home health care agencies could provide them.

Putting the consumer first: an introduction and overview

If anything best describes recent trends in the complex world of long-term care (LTC), it is the growth of interest and investment in home and community-based services (HCBS). Various forces have driven efforts to shift from disproportionate investment in nursing homes to a more diversified set of institutional and noninstitutional services, including home-based services, day care, respite services, case management, and others. The Cash & Counseling Demonstration and Evaluation reported in this Special Issue examines a new approach to the provision of increasingly important home-based personal assistance services (PAS) to people with disabilities of all ages.

Commentary: Cash and Counseling in an international context

Health and long-term care policy in the United States is almost always carried out without knowledge of how other countries address similar problems. American public policy is the poorer for this ethnocentrism because other countries often have already implemented ideas which have only been proposed in the United States. To be sure, the cross-national differences in culture and the financing and organization of services do not allow for a simple transfer from one country to another, but the experiences of other countries can provide important insights.

Nursing home industry has powerful grip on legislature

Seventeen years ago this month, without realizing a newspaper reporter was present, an Ohio lawmaker told a group of nursing-home owners that merit just doesn't matter much in dealing with the state legislature.

Big campaign contributions - and lots of them - matter much more, then-State Rep. Mike Fox told those gathered. And he dispensed some advice on working with the General Assembly:

"Reach deep . . . give early, give often," Fox told the nursing-home operators. "You can't afford not to."

Sunday, March 18, 2007

Caring For The Oldest Is The Price Of Affluence

ith the number of carers for frail elderly people set to fall steeply, researchers in the BMJ propose a way to help plan for the deficit.

Many people fear that population ageing will generate a demand for long term care that will outpace the supply of formal care. So to anticipate the future long term care needs of the oldest people, researchers in Switzerland suggest introducing the "oldest old support ratio."

Their ratio is based on four age groups - the young, those of working age, younger retired people (aged 50-74), and the oldest people (aged 85 and over) - and provides information on the number of people potentially available to care for one person aged 85 or over.

Based on current trends, they estimate that the young retired generation will have to play a greater caring role in the future.

New Pervasive Systems Centre Could Make Independent Living A Reality

Pervasive computing technology which can monitor the welfare of the elderly will be made available within the next 18 months.

The technology is to be developed by the University of Southampton's new Pervasive Systems Centre which is being launched this month.

The Centre, co-directed by Professor Bashir Al-Hashimi and Professor David De Roure, both from the University's School of Electronics & Computer Science (ECS) brings together multidisciplinary expertise from across the school's research groups, ranging from sensors and wireless communications to computer science theory and practice.

Saturday, March 17, 2007

Nursing homes warn of cuts under Spitzer reform

ALBANY, N.Y. -- Faced with a $263,000 deficit, workers at the St. Cabrini Nursing Home in Dobbs Ferry mailed out Christmas cards last year with ornaments, seeking donations.

They say this and other fundraisers worked to protect their 420 jobs serving 304 residents in the Westchester County home, but it won't be enough to stave off what they say will be layoffs under Gov. Eliot Spitzer's health care reform.

Clinical Trial Finds MindFit Software Significantly Improves Short-Term Memory, Spatial Relations And Attention Focus In Baby Boomers, Seniors

For the first time, a double-blind clinical trial has shown that computer-based training improves the cognitive functions of the 50-plus crowd.

Against conventional wisdom, the computer training in MindFit(tm) cognitive skill assessment and training software, created by CogniFit, Ltd. (http://www.cognifit.com), was found to improve short-term memory, spatial relations and attention focus--all skills used in driving and other daily activities that maintain our independence as we age.

Wednesday, March 14, 2007

Penn Study Finds Inhaled Anesthetics Could Lead To Early Onset Of Alzheimer's Disease

Researchers at the University of Pennsylvania's School of Medicine have discovered that common inhaled anesthetics increase the number of amyloid plaques in the brains of animals, which might accelerate the onset of neurodegenerative diseases like Alzheimer's. Roderic Eckenhoff, MD, Vice Chair of Research in the University of Pennsylvania's Department of Anesthesia and Critical Care, and his co-authors, report their findings in the online edition of Neurobiology of Aging.

Every year over 100 million people undergo surgery worldwide, most under general anesthesia with an inhaled drug. These drugs clearly affect cognitive ability at least in the short term, but the growing concern is that inhaled anesthetics may affect a person well beyond the perioperative period, even permanently. Several factors appear to play a role in this subtle loss of cognitive ability, most notably age.

A specific effect of these drugs on dementias like Alzheimer's disease, though suspected for many years, has only been recently supported by data. In 2003, Eckenhoff's group showed that the inhaled anesthetics enhance the aggregation and cytotoxicity of the amyloid beta peptide. Just last month, a study reported that these drugs also enhance the production of amyloid beta in isolated cells. But these protein and cell culture studies are a long way from showing that an effect occurs in vivo. This new study provides the first evidence that the predicted effect occurs in animals.

Service Employees International Union President Stern Discusses Changes To Health Care System In Interview

The Los Angeles Times on Sunday interviewed Service Employees International Union President Andrew Stern, an "outspoken and unconventional" supporter of "health care changes to guarantee coverage for all while reining in costs." Stern said, "It seems impossible to imagine how you can have an employer-based health care system with the incredible creative destruction and change in the nature of work in our economy," adding, "It's not an ideological issue; it's really just a practical, real-life, 21st-century issue." According to Stern, although a single-payer approach "would be the most efficient system," the U.S. likely will not implement it because residents do not "feel comfortable that government's going to solve their problems" (Alonso-Zaldivar, Los Angeles Times, 3/11).

Depressed Elderly Risk Early Mortality, Study Finds

In a project involving more than 300 elderly people who had been discharged from hospital, 17% were found to have previously undiagnosed depression and of that figure, 7% died within two years of leaving hospital.

The study also showed that 41% of elderly people who have depression are often later re-admitted to hospital with other illnesses, possibly a result of not receiving appropriate treatment for their depression.

Issue Module Outlines National Long-Term Care Costs, Effects On Federal Programs, Private Insurance

"Financing Long-Term Care," Kaiser Family Foundation: The issue module, posted on kaiserEDU.org, contains links to various data, reports, headlines and other literature on the costs and financing of long-term care. The module examines the roles of Medicaid and Medicare in paying for long-term care, as well as private insurance. The module also discusses policy issues to contain costs and share spending among payers (Kaiser Family Foundation, "Financing Long-Term Care," March 2007).

The Retail Health-Care Solution

Imagine a future in which the health-care system provides consumers high-quality care in a variety of convenient forms at competitive prices. In this vision, insurers, employers, and governments offer consumers financial incentives to take better care of themselves — to exercise, eat right, stop smoking, and follow treatment regimens for chronic problems such as asthma and diabetes. The system encourages consumers to plan for the health-care needs they can anticipate (i.e., nonemergencies) by “shopping” for products and services much as they do for a new car; consumers make informed decisions based on readily available reports on quality, service, and price. Providers and product manufacturers compete for different segments of the market using a variety of channels, formats, and business models. And consumers confused by the profusion of offerings can turn to agents who help them design the most suitable health-care programs for themselves and their families.

Tuesday, March 13, 2007

Disruptive Innovation: Can Health Care Learn From Other Industries?

Clayton Christensen is one of America's most influential businessthinkers and writers. A professor at Harvard Business School,Christensen is perhaps best known for his writings on disruptiveinnovation in such books as The Innovator's Dilemma and TheInnovator's Solution. In this interview with the CaliforniaHealthCare Foundation's Mark Smith, he argues that the answerfor more affordable health care will come not from an injectionof more funding but, rather, from innovations that aim to makemore and more areas of care cheaper, simpler, and more in thehands of patients.

Elderly Care Costs Rising, Require Prevention, Study Says

The cost of caring for aging U.S. residents by 2030 will add 25% to the nation's overall health care costs unless those residents actively work to stay healthy and preventive services are provided to help them, according to a CDC report released Thursday, Reuters reports. The report, titled "The State of Aging and Health in America 2007" and funded by Merck's charitable foundation, found that 80% of U.S. residents age 65 or older have at least one chronic condition that could lead to early death or disability

Medicare Advantage HMOs Gearing Up for Payment Cuts--Could They Come as Early as 2008?

Bill Boyles--Publisher of Health Market Survey--returns as a guest commentator. Bill keeps a sharp eye on the Medicare Advantage business and on Capitol Hill. Here's his take on what the Congress--and the health plans --are up to:

We are hearing that the health insurers are getting ready to dump markets in response to the Democratic threat to cut Medicare Advantage payments. But first they will try to stop it. The word is that millions of dollars have already been raised to fund a major grass roots campaign to lobby Congress against making any major cuts to the popular—and profitable—program.

Some of the insurers are not waiting.

Monday, March 12, 2007

Department Of Defense Memo Calls For Changes To Brain Injury Treatment

The Pentagon needs to overhaul its approach to treating the tens of thousands of U.S. troops who might have traumatic brain injury, the most common injury of the Iraq war, according to a previously undisclosed Department of Defense memorandum obtained by USA Today. The memo was released this week in response to a Freedom of Information Act request by USA Today. According to the Aug. 11, 2006, memo -- signed by Wayne Lednar, an epidemiologist, and Gregory Poland, chief of the Defense Health Board -- troops with mild and moderate brain injury are of the greatest concern because their injuries are difficult to recognize and can limit mental performance.

Saturday, March 10, 2007

Democrats Discuss Eliminating Medicare Advantage Plan Overpayments To Fix Scheduled 10% Reduction In Medicare Physician Rates

Democrats this year are making "concerted efforts" to cut Medicare Advantage payment rates "as a way to finance other spending priorities," such as fixing a scheduled 10% reduction in Medicare physician payments, CQ HealthBeat reports (Carey, CQ HealthBeat, 3/6). House Energy and Commerce Health Subcommittee Chair Frank Pallone (D-N.J.) on Tuesday said he supports eliminating overpayments to Medicare Advantage plans to prevent the physician payment reduction, which is scheduled to take effect next year (Johnson, Congress Daily, 3/7).

Tuesday, March 6, 2007

Toward Real Medicaid Reform

n this paper we argue that there is a real need for Medicaidreform primarily because of the large differences among statesin coverage and benefits and because of the program’shigh and rising costs. We describe and develop several optionsfor Medicaid reform that would expand coverage, provide fiscalrelief to states, shift responsibility for some or all of thecare of dual eligibles to the federal government, and eliminateor restructure disproportionate-share hospital (DSH) payments.We conclude with a discussion on a number of other issues, particularlyMedicaid cost containment and the federal matching payment structure.

Full Text available through link.

Monday, March 5, 2007

Health Plans Can Learn From VHA Turnaround

In 1990, ABC News "Primetime" won an investigative reporters and editors award for a hidden camera account of patient neglect, abuse, and unsanitary conditions at a Veterans Health Administration hospital in Ohio. That same year, JCAHO found that VHA hospitals were at least 20 percent more likely than others to fall below quality standards.

Article 99, starring Kiefer Sutherland, appeared two years later. It was a movie drama about a group of Kansas City VHA hospital doctors forced to contend with bureaucratic red tape, inefficiency, and a paperwork abundance that left patients in the lurch.

Despite the negative publicity, the bloated, politicized VHA system remained impervious to gripes about substandard care and service at its 172 hospitals, 194 outpatient clinics, and 128 nursing homes.

Often, veterans continued to wait an entire day to be seen, arriving at 9 a.m. with a book and a sandwich. Prescription refills were not usually permitted without a personal appearance. A hospital stay was sometimes required to pick up crutches. One vet reported it took him more than five years to obtain a hearing aid. At the lowest point, decomposed remains of several patients were found near a Salem, Va., VHA hospital a year after their last disappearance. They had wandered into the woods. It is no wonder that 90 percent of eligible veterans chose private alternatives over the VHA.

"Care was lousy across the board," says Rick Weidman, executive director for policy and government affairs for the Vietnam Veterans of America. "Older vets felt no matter how bad it was, that was their lot," says the one-time Vietnam War army medic.

Series Examines Assisted Living Facilities In Pennsylvania

The Philadelphia Inquirer recently published a four-part series, titled "A Failure To Care," that examined problems with assisted living facilities in Pennsylvania. Summaries of the articles appear below.

"'Shame of the State': Troubled Facilities and Lax State Oversight Have for Years Put Residents of Pennsylvania's Assisted Living Homes at Risk of Assault, Neglect -- and Tragedy": The article, published on Sunday, examined the results of an eight-month investigation of assisted living facilities in Pennsylvania. The investigation, based on an examination of thousands of pages of public records and hundreds of interviews, found that since 2000 at least 55 residents of assisted living facilities in the state have died because of possible neglect. In addition, the investigation found "a long list of health and safety violations, a history of substandard care, and a system of state oversight that ... often allowed deficient operators to violate safety rules with virtual impunity," the Inquirer reports (Dilanian, Philadelphia Inquirer, 2/25).

There is a Health Care Reform Plan That Doesn't Duck the Big Issues--and More Than 100 Heavyweight Stakeholders Support It!

http://healthpolicyandmarket.blogspot.com/2007/02/there-is-health-care-reform-plan-that.html

NYT Examines 'Gray Market' For In-Home Long-Term Care Aides

Many middle-class families facing the "crushing burden of indefinite home-care expenses" have begun to hire in-home long-term care aides through the "gray market," an "over-the-back-fence network of women," although the practice "is fraught with risks," the New York Times reports. According to the Times, aides hired through the gray market are "usually untrained, unscreened and unsupervised," but they are more affordable than bonded, insured and certified aides hired through agencies. Aides hired through the gray market might cost about $12 per hour, compared with about $20 per hour for those hired through agencies.

Saturday, March 3, 2007

Proposed Cuts To Medicare Advantage Plans Would Lead To Higher Costs, Reduced Coverage For Beneficiaries, BlueCross BlueShield Assoc. Officials Say

BlueCross BlueShield Association officials at a press briefing on Tuesday said that proposed federal cuts to the Medicare Advantage program could lead to sharp increases in beneficiaries' premiums, the Pittsburgh Post-Gazette reports. Congress has approved $13 billion in cuts to the program starting this year. In addition, legislators are considering further cuts to the program as they work to balance spending priorities (Sherman, Pittsburgh Post-Gazette, 2/28). A Congressional Budget Office report released this week estimated that Medicare could save about $65 billion over 10 years by equalizing payments to Medicare Advantage plans and fee-for-service providers. BCBS officials said that cuts to the program could lead to negative consequences for seniors enrolled in Medicare Advantage plans, including premium increases, significant benefit reductions and perhaps a total loss of their plans.

Thursday, March 1, 2007

At Disability Briefing, Sen. Harkin Says "In The Home" Policy Must Change, Comments On Restoring ADA - USA

A February 27 briefing about disability policy issues sponsored by a Washington law firm included remarks by Senator Tom Harkin (D-Iowa), committee staff from key healthcare committees in Congress, and disability organizations. Senator Harkin, who chairs the Labor, Health and Human Services, and Education Subcommittee of the Senate Appropriations Committee, said the new Congress may pursue restoration of the Americans with Disabilities Act (ADA). Sen. Harkin said the ADA needs to be restored because the law has been interpreted more narrowly than Congress originally intended.

Dallas Morning News Looks At 46,000 Texans On Waiting List For Home-based Alternative In Medicaid

A headline from a recent Dallas Morning News story by Bob Moos says it all: "Moving toward Home Care: Shift away from institutions is cheaper, popular and taking a long time to execute." In a look at long-term care issues in Texas, Moos cited a number of compelling facts. He quotes Amanda McCloskey, advocacy manager for AARP in Texas, "Home care costs Medicaid just half of what nursing home care does - $1,318 vs. $2,570 per month - and it's what most people prefer."

Moos notes that, "An AARP survey of people 50 and older found that 73 percent preferred receiving care in their homes. Only 6 percent favored nursing homes. Yet the current system favors institutional care." The article said that end of last year, the waiting list for the community-based alternatives program in Texas had grown to 46,556, with an average wait of 17 months.

Newspapers Address Issues Related To Long-Term Care Insurance

Three newspapers recently published articles and an opinion piece on issues related to long-term care insurance. Summaries appear through the link.

CBO Report Outlines Possible Savings In Medicare, Including Estimated $64.8B From 2008 To 2012 By Equalizing Payments To Managed Care Plans

The Congressional Budget Office has released its biennial report on policy options that contains more than 250 proposals on federal spending and revenue, including several for Medicare, CongressDaily reports. Some of CBO's Medicare savings options are similar to proposals that have been offered by President Bush, such as reduced payments to hospitals and home health care agencies, reduced rental periods for oxygen treatment and higher premiums for federal prescription drug plans. Proposals that might be "more palatable to Democrats" include eliminating subsidies to private insurers to encourage them to participate in Medicare in underserved regions, which CBO says could save $3.5 billion over 10 years, CongressDaily reports (Cohn, CongressDaily, 2/27). According to CBO, $64.8 billion could be saved between 2008 and 2012 by equalizing payments to Medicare Advantage plans and fee-for-service providers. The CBO report notes that that proposal "could lead many plans to limit the benefits they offer, raise their premiums or withdraw from the program." The CBO document also finds that between 2008 and 2012, the following savings could be obtained: