Tag Archives: health care system

Medicaid: Long Term Care Security

As a gerontologist and a member of the Baby Boom generation, I think about what the state of long term care may be in seven years when I join the older-old, those above age 75.  Most of us would prefer to remain in our own homes as long as possible, but ultimately many of us will need more supervised care in a residential setting.  Most people don’t realize what various types of long term care cost, and many have not accumulated enough retirement savings to pay for all of the long term care they will need, especially given the extended lifespan that is now possible.  In addition, there are a lot of misperceptions about the scope of long term care benefits available through Medicare.

logo-genworth-desktopGenworth Financial Insurance Company conducts an annual survey of long term care costs in the United States.  In 2016, the national median annual cost of homemaker services in an individual’s private home came to $45,756.  The median annual cost of assisted living was $43, 536, and the median annual cost of a semi-private room in a nursing home was $82,128.  The median annual 2016 costs in Michigan were generally somewhat higher than the national median.  Genworth is predicting a 34% increase in costs in ten years, and an 80% increase in twenty years.

Americans are not great retirement savers compared with other nations, but there are reasons for that omission.  For the middle classes especially, wages have been stagnant since the 1970s, while the cost of living has increased.  The cost of a college education is more than eight times gregg-chicken-eggs-raw-eggs-eggshell-128885eater than it was in the 1970s, while the Consumer Price Index rose approximately four times  higher during the same period.  Pensions, which guaranteed retirement income for life, have virtually disappeared.  As a consequence, workers have lost one source of retirement income, since the pension replacements, the 401(k) or 403(b) plans, result primarily from employee savings, rather than employer contributions.  Finally, the economic downturn, which began earlier in Michigan than in much of the rest of the country, eroded the savings of many unemployed mature workers.

Our family story is no different; we experienced layoffs in the 2000s, which used up our retirement savings, up to then.  I paid off my student loans two years ago, and my husband just paid off his this year. We’re still paying on Parent PLUS loans for our son’s college education.  We expect to keep working as long as possible, and we’re also working hard to stay healthy so that we can do so.  But health is a result of past exposure and lifestyle, as well as present health practices, and we don’t know what lies ahead.

We do know that we can’t count on Medicare to cover our long term care expenses; it wasn’t designed for that.  Medicare will pay for skilled care, such as rehabilitation services, at home or in a nursing home,  for a limited period of time.  It will also pay for hospice care.  It does not pay for  assistance with managing personal care or housekeeping or ongoing nursing support in any setting, except for the brief period in which skilled care is also needed.  Each of us will have to manage those care expenses out of our retirement savings.  But when we live longer than expected, or health care expenses are greater than anticipated, or when both spouses require custodial care, then income and retirement assets often prove insufficient, and people rely on Medicaid to pay for their care.

Medicaid pays for the health care costs of qualifying poor people of all ages.  Low income older adults most often have Medicare coverage, and Medicaid helps them pay for the considerable out-of-pocket premiums, deductibles and coinsurance costs that Medicare does not cover, estimated to average between $1,700 to $3,000 per year.  Those costs can escalate quickly with surgery or expensive long term medications.  It also helps the low income elders receive care at home, rather than a nursing home, if they are lucky enough to qualify for a Medicaid waiver program.  The Medicaid waiver program allows for case management, in-home services, and community-based services for low income ill or disabled persons who would otherwise require nursing home placement.  In Michigan it’s called the MI Choice Waiver Program, and it’s about one third less costly than nursing home care.

But most areas have long waiting lists for Medicaid waiver services, and rural areas generally do not have sufficient supply of community-based services to keep people in their homes.  At a cost of more than $82,000 a year, most people needing custodial care in a nursing home will run out of personal savings and assets in a relatively brief period of time.  At that point more than half of nursing home residents apply for assistance from Medicaid.  Because of Medicaid older adults worry less at night about where they may end up when the money runs out.

A fixed cap on federal Medicaid payments to states could remove that sense of security.  With increasing health care costs, increasing numbers of older adults, lengthening lifespans, and a stagnant economy, states will have to reduce Medicaid spending considerably.  What will we do with ill, disabled, and poor older people who no longer receive payment for their nursing home bills?

It is these thoughts that keep me exercising most days of the week, meditating daily, and keeping up my license and professional credentials.   However, these are just stop gap measures, and I don’t feel nearly as secure.

Reinventing Senior Centers – Presentation

Here’s the presentation I made at the Michigan Association of Senior Centers conference in Mt. Pleasant on November 6, 2015.  The presentation discusses social, political, and economic trends and how they represent opportunities for senior centers to reinvent themselves by responding to these trends and offering relevant programming to address them.

2015 White House Conference on Aging

logo-WHCOA2015This is the year for the decennial White House Conference on Aging.  However, the Older Americans Act, which traditionally has outlined the Conference process, has not been reauthorized and the President’s budget has not been approved.  As a result, there are very little structure and no additional funds for the 2015 Conference.

nora-super-140Ms. Nora Super is the Executive Director of the Conference.  Her background includes more than twenty years experience in aging policy and community outreach.  The four themes that have emerged from community input, so far, are Retirement Security, Healthy Aging, Long-Term Services and Supports, and Elder Justice.  There is a blog for the Conference at  http://www.whitehouseconferenceonaging.gov/blog/   A number of regional forums are also scheduled.  The closest one to SE Michigan is the conference in Cleveland, OH on April 27th.

The Administration is using social and electronic media as much as possible to receive grass roots input and conduct informational meetings.  Everyone can participate by going to the web site and signing up to receive notices of events, such as webinars, and opportunities to participate.  You can also provide your thoughts and/or a story about your experience with aging or aging services, such as Medicare, Social Security, or in-home services, by submitting them through the following link:  http://www.whitehouseconferenceonaging.gov/submissions/register.aspx

Here’s the contact information if you have specific questions:

White House Conference on Aging
200 Independence Avenue SW, Suite 637D
Hubert H. Humphrey Building
Washington, DC  20201
(202) 619-3636
info@whaging.gov
www.whitehouseconferenceonaging.gov

Aging touches everyone.  I encourage you to participate in this opportunity for civic engagement at a time when our society includes the greatest proportion of older adults in history.

Sue Sweeney, Chair, Department of Aging Studies, Madonna University

Affordable Care Act Across the Generations

ACALogoThe Affordable Care Act is a very complex piece of legislation that is changing the health care landscape.  Jim Luke and I are offering a presentation on some of the significant provisions of the Act on November 12, 2014 from 10 am to 11:30 am for the Michigan Intergenerational Network.  The Villa of Redford is hosting the event at Villa at Redford, Village of Redford, 25340 Six Mile Road, Redford Township, MI 48240.

 

Health Insurance Coverage

With Medicare open enrollment ending on December 7th this year and the health care marketplaces gaining enrollees, health insurance coverage is the topic of the day.  For those eligible for Medicare, the National Council on Aging (NCOA) has launched more of their Web tools.  MyMedicareMattersLogoTheir Medicare Web site, My Medicare Matters, has a Medicare Quick Check tool in which you enter some basic information about your current Medicare plans, and the tool returns suggestions for how to save money on your coverage and where to go for help.  One caveat: NCOA appears to be encouraging the use of one healthcare navigator, AON Hewitt Navigators, although other options for assistance are also listed.   It appears that AON Hewitt has agreed to meet NCOA standards of service in return for supporting an NCOA subsidiary firm, NCOA Services.

Another NCOA tool now available is a prescription drug savings estimator.  For this to work, you enter your zip code, the name of your Part D plan, and your prescription drugs.  When you enter the drugs, a window will open with dosage options for you to select.  The estimator will tell you whether you may be able to save on the drugs, and approximately how much, by choosing a different Part D plan.  However, not all drugs are included in the estimator’s database.  For example, I tried Advair, a commonly prescribed asthma medication, and it didn’t show up.

MichiganDrugPricesLogoFor those who are uninsured, don’t qualify for Medicare or Medicaid, and haven’t managed to complete enrollment through the Marketplace, the Michigan Department of Community Health has a useful Website called MichiganDrugPrices.com.  It has three parts: a search engine to compare drug prices among pharmacies, a list of retail discount drug programs, and a list of assistance programs for uninsured persons.  For the drug prices comparison, you enter your zip code and your drugs.  For each drug, a window will open with the drug name.  When you select it, in another window, there will be a list of the drug in each of its dosage strengths.  Unselect all but the dosage needed.  Then you’ll get a list of the pharmacies in the area with their price for the drug.  The drug database contains the 150 most prescribed medications in the Michigan Medicaid program, so a number of drugs are not included.

Even if you don’t live in Michigan, the site may be helpful, since the retail discount drug programs may be regional or national, such as Walmart or Kroger, and several of the assistance programs are national in scope.  There are also Helpful Links, which include some of the drug company assistance programs.  There are many more options than I had imagined.  Now people need to know how to find and apply for the assistance that’s available.  Sue Sweeney, Chair, Gerontology Department, Madonna University

Evidence-Based Chronic Disease Self-Management Programs

We are living longer in large measure because society has worked hard to control the spread of infectious diseases and medicine has developed treatments to cure acute illness.  As a consequence, it is chronic disease that is costing us in later life, in dollars, productivity, and suffering.  Most chronic diseases can be managed to improve outcomes and quality of life.  Drugs and medical treatments contribute to management of these illnesses, but most of what is needed is a change in a person’s daily routines and habits.  Achieving such lifestyle alterations is not as easy as taking a pill.  It takes education, practice, support, and some resources.  Our health care system is not primarily organized to provide the structure needed to promote chronic disease self-management.  However, a number of programs have been successfully demonstrated and evaluated, and are becoming more widely available.

The evidence-bOlder_adult_exercise_with_tin_can.ased Stanford Chronic Disease Self-Management Program is disseminated in Michigan through the Michigan Department of Community Health, as the PATH program (Personal Action Toward Health).  The program provides classes with information about medication and treatments, problems solving techniques, coping strategies, nutrition information, exercise and physical activity promotion, and ways of working with health care professionals.  The relationships that form among class members are also an important aspect of support fostered by the program.  Each area of the State has a contact person who knows about PATH programs implemented in that area.

At the national level, the National Council on Aging (NCOA) was recently named the National Resource Center on Chronic Disease Self-Management Education Programs to act as a clearinghouse for state and local organizations involved in chronic illness management.  Contact the NCOA’s Center for Healthy Aging for more information on evidence-based programs and how to offer one.  Sue Sweeney, Chair, Gerontology Department, Madonna University

When People with Dementia Are Hospitalized

adear_topIt can be a nightmare when a person with dementia is hospitalized.  The environment is strange; the person is frightened and sick; family members may not be able to stay; and “problem” behaviors are almost inevitable. The Alzheimer’s Disease Education and Referral Center, a branch of the National Institute on Aging, has a downloadable publication called “Acute Hospitalization and Alzheimer’s Disease: A Special Kind of Care  which is aimed at healthcare providers.  it would be a handy document to take to the ER or hospital when a family member with dementia needs care.  It offers suggestions for hospital personnel on how to communicate with the patient, ways to manage ADL’s, how to camouflage tubes and dressings, and numerous other helpful tips.  Sue Sweeney, Chair, Gerontology Department, Madonna University