Whenever I’m depressed about the state of the long term care (LTC) system in America, my mind wanders to other countries. What’s it like in Uganda, France, or Kazakhstan? Is it better, worse, or about the same?  Apparently, Howard Gleckman heard my cry. A senior research associate for the Urban Institute (and author of “Caring for our Parents”), he tackled this topic (in response to a Washington Post piece) in a recent column for Kaiser Health News.

Starting with a nutshell history, Gleckman states that, even just 20 years ago, most developed countries approached LTC in much the same way that our current Medicaid system operates. If you’re poor enough or sick enough, you’ll get the care you need. But if you are a person of modest means, well – give us a ring when you’re broke or too sick to manage on your own. Not really a great system, and certainly not financially sustainable.

Purchasing private long term care insurance has yet to turn the system around for the US, despite a strong government push towards this solution. Even today, only 7 million Americans have a policy.

European countries built on their existing national health systems to integrate a social insurance approach to paying for long term care, rather than the welfare bent so familiar to American citizens. But countries like Germany and the Netherlands have been forced to reduce benefits in response to rapidly increasing costs… so I guess the grass isn’t necessarily greener there.

In Japan, the creation of a national long term care insurance system – funded by taxes and premiums based on income – successfully covers 90% of the cost of care for their 65+ citizens. Despite this achievement, Japan is also struggling to keep up with the rising costs of LTC like their European friends mentioned above.

So who’s got it right?  The Washington Post seemed to think England had done a bang-up job, but Gleckman disagrees, stating, they “may face the biggest mess of all.”  Entrenched in a failing welfare model and in need of reform (sound like any place we know?), the United Kingdom has struggled for more than a decade to improve its LTC system.

I’m afraid, Mr. Gleckman, that I’m just as depressed as I was before I found your article. It seems that long term care is and will be the elephant in the room for years to come, both here and abroad. The global population is aging as rapidly as the costs for care are exploding. Nothing, especially health care, is getting cheaper, and seniors aren’t getting any younger. Maybe no one has it right yet (has anyone checked that island where good health and longevity seems to be the norm?), but someone needs to figure it out soon.

SFL followers, what are your ideas for improving the massively flawed LTC system? Any thoughts on how we got in this mess in the first place?

-Michelle Seitzer

Back in November, 60 Minutes tackled a controversial and timely topic: “The Cost of Dying,” and the topic has stuck with me. That’s because end-of-life issues are taking a more prominent place in discussions about health care.

As per the report, Medicare paid $50 billion for doctor and hospital bills during the last two months of patient’s lives – an amount that surpasses the budgets for the Department of Homeland Security and the Department of Education. About 20 to 30 percent of these expenses have no meaningful impact; most bills are paid by the federal government – no questions asked.

Few issues are as undeniably bipartisan as death/dying, yet the way we go about the process (i.e. hospice & palliative care, ventilators, feeding tubes, etc.) and paying for care at the end of life has become highly politicized. Everyone will ultimately face death, albeit in different ways and at different times. So how can the federal government rein in costs like the aforementioned $50 billion? Check out the article for deeper analysis of this thorny topic.

Dr. Ira Byock, who treats and counsels patients with advanced illnesses, puts it plainly in the 60 Minutes report:

“Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, it’s having someone you love die badly.”

Sort of changes your whole perspective on death/dying, doesn’t it?

Although it’s an uncomfortable subject, family members should definitely hash out these action plans, especially when they are gathered together, before they find themselves facing a tough situation. So when the Sunday dinner plates have been packed away, call the family members back to your home to talk about it. It may be difficult to get the dialogue rolling – who wants to break the ice on that subject? – but these conversations are absolutely crucial. If you ever find yourself pacing through the ER or the ICU while a loved one is in limbo, you won’t feel quite as helpless if you know your loved one’s wishes.

Ever heard of Five Wishes? Check out http://www.agingwithdignity.org/five-wishes.php for an excellent tool that makes discussing your wishes for the end-of-life much more palatable.  Five Wishes lets your family and doctors know:

• Who you want to make health care decisions for you when you can’t make them.
• The kind of medical treatment you want or don’t want.
• How comfortable you want to be.
• How you want people to treat you.
• What you want your loved ones to know.

Also, revisit last year’s Seniors for Living post on “The D-Word: Discussing Death” for more ideas on starting this complicated yet critical conversation in your home.

-Michelle Seitzer

Understanding the ins and outs of Medicare is about as easy as understanding nuclear physics.  And now that the annual open enrollment period has closed for 2009, some may be scratching their heads regarding the changes to coverage that they have elected – or perhaps what changes they missed out on. While some did not need to do anything (provided that their coverage was working for them and hadn’t changed), hundreds of options were available during this period. Although we don’t know what the future of Medicare may hold, let’s take a look at these options in preparation for the next open enrollment period and clarify what changes have been put into effect.

Walencia Konrad of the The New York Times gave enrollees a practical guide to sorting through this overwhelming process in her article, “Now Is the Time to Weigh Medicare Options.” She referenced a previous piece advising Medicare first-timers: “Nearly 65? Time for the Medicare Maze”. In the open enrollment article, Konrad lays out the facts on staying put and choosing a new plan, all the while encouraging enrollees to move quickly if they plan to move at all.

By now, you have probably received your copy of the 2010 Medicare and You handbook. The booklet outlines changes to this year’s enrollment period and offers information on Medicare alternatives. Konrad recommends a close look at the publication along with a careful consideration of the specifics she presents in her piece.

You can also go straight to the source, www.medicare.gov, and find out what’s new, what’s available, what’s covered, and more.

Here’s a basic outline of the different types of Medicare coverage… but you’ll want to consult www.medicare.gov or Konrad’s article for more detailed breakdowns of each:

• Medicare Part A – traditional coverage provided at no charge to enrollees; covers hospitalizations
• Medicare Part B – covers medical care; requires a monthly premium (most new enrollees will pay 15% more than current enrollees for these premiums, due to the lack of a Social Security cost-of-living increase in 2010)
• Medicare Part C – covers extra benefits like vision, hearing, dental, and prescription drug coverage via Medicare Advantage Plans (these plans may charge different copayments, coinsurances or deductibles); typically bundled with Medicare A & B and a drug plan; offered via private insurers
• Medicare Part D – prescription drug coverage offered for an additional monthly premium; can be added, changed or dropped during open enrollment

Of note in Konrad’s article is this year’s changes to Medicare Part C, since CMS (the Center for Medicare and Medicaid Services) eliminated about 18% of existing Medicare Advantage plans because they were similar to other plans offered or had low enrollment. As a result, Allsup (an Illinois-based provider of Social Security and Medicare consultations services) estimates that nearly 600,000 Medicare recipients will be forced to change plans because their former Medicare Advantage plans are now extinct.

If you’re the type of person that can read all the articles in the world about Medicare but just won’t get it until a trained expert can sit down and explain it to you, check your local Area Agency or State Office on Aging. Many of these state-run agencies offer free, confidential counseling to guide enrollees (or enrollees to be) in these complicated programs. Don’t know how to find your local office?  Visit http://www.eldercare.gov/Eldercare.NET/Public/Home.aspx and plug in your city, county or zip code.

Clear as mud, right?

SFL followers, sound off here with your advice on navigating the Medicare maze.

-Michelle Seitzer

The health care reform buzz may be front and center in the news these days, but with so many media outlets and so many opinions, it’s not easy to keep up. And yet it is most certainly an issue that many of us are watching with great concern and curiosity.

A number of senior advocacy organizations are offering valuable resources for the general public to stay current on the latest and greatest, specifically in terms of the impact on seniors. I’ve listed a few of them here:

- The Senate Special Committee on Aging held a briefing on “How Health Reform will impact seniors” on September 17, 2009.  To view the archived webcast of the hearing, visit http://aging.senate.gov/.

- If you’re like me, you want to see things on paper (or read it on a computer screen). To see a comprehensive, side-by-side comparison of major health care reform proposals, check out this excellent tool from the policy experts at the Kaiser Family Foundation (KFF): http://www.kff.org/healthreform/sidebyside.cfm.

- Another great side-by-side comparison from KFF takes a specific look at key Medicare provisions in the health reform proposals. To view the tool, go to http://www.kff.org/healthreform/upload/7948.pdf.

- AAHSA (American Association of Homes and Services for the Aging) explores a number of topics relating to seniors and health reform on their advocacy page – including an overview of the CLASS Act/Affordable Health Choices Act legislation: http://www.aahsa.org/classact.aspx

- You can also visit AARP’s home page to “Get the Facts on Health Reform” (go to http://www.aarp.org/health/articles/health_reform_get_the_facts.html) or to read a feature article on the impact of changes to Medicare at http://bulletin.aarp.org/yourhealth/medicare/articles/medicare_question.html.

- Most likely, your Member of Congress or U.S. Senator has a number of links or articles on their home page, outlining their position on and understanding of the reform debate. Many legislators have and continue to host Town Hall meetings to garner input and feedback from their constituents; some have been met with great success while others have encountered some heated opinions that have certainly made the news. Visit http://www.house.gov and http://www.senate.gov/ to find your elected official’s home page. Visit http://www.thomas.gov/ to access the actual legislation (you can do a keyword search, or get the bill numbers from the KFF’s report above).

Proposals are just that – so they are liable to change as the debate goes on. But for now, you can get up to speed by accessing a few of the above resources.

- Michelle Seitzer

Vice President Joe Biden chairs a task force called A Strong Middle Class that is targeted at raising the living standards of middle-class, working families in America. One of their initiatives is more stable and secure health care for seniors.

The middle class task force recently held a health care reform discussion in Alexandria, VA with the goals of lowering costs, cutting waste, creating stability, and improving quality for seniors. Sounds pretty promising, right?

It couldn’t come at a better time, either, as seniors face rising health care cost increases on a fixed income. And there’s another group that is also profoundly affected by the increase — early retirees (aged 50-64). They are all too familiar with the rising costs of health care and stand to benefit from this reform:

Americans aged 50-64 are often the most at vulnerable and at risk in the current health care system. Too young for Medicare, they experience sky high insurance premiums and costs because of their age. Premiums for 50-64 year olds buying coverage on the open market were three times that of their peers who were lucky enough to have employer coverage. And that’s for people who aren’t automatically excluded because of a pre-existing condition.

Health care reform will lower costs for 50-64-year-old Americans by providing assistance to employer health plans to encourage them to cover recent retirees and by giving individuals access to an insurance exchange where participants will be able to compare prices of health plans ” including a public plan – and decide which option is right for them. Individuals will be eligible for help paying for insurance in the exchange based on their income. And in order to market a plan in the Exchange, insurance companies will have to comply with its rules: no denial of coverage for pre-existing conditions; no discrimination based on age; and fair prices, for good benefits.

While no one can predict what will and won’t work, I think it’s an important step for the government to look at those affected most by increasing costs, and make the effort to provide some stability in the system as Americans age.

–Elizabeth Thielke

What are your thoughts?

Health reform is one of the hottest topics on the federal docket right now, and as to be expected, the range of opinions and proposals on how to do it right further intensifies the debate. And who could forget the $1 trillion price tag from the Congressional Budget Office?

The cost is spread out over 10 years, but in our present economic state, it’s not easy to think about spending $1 trillion dollars, even for the best of causes.

According to a special edition update from NCOA (National Council on Aging), “lawmakers are working to draft and pass bills in both the House and Senate before the House adjourns on July 31 and the Senate adjourns on August 7 for the August recess.”  A tall order, given the aforementioned range of opinions and proposals, but there seems to be overwhelming support from President Obama for at least taking a step forward. Fiscal crisis or not, the continual sharp increases in health care costs – both for providers and patients – will slowly (or maybe not so slowly) erode any economic stability we acquire.

NCOA’s update gives a thorough and extensive analysis of the legislative process that the numerous bills must go through, along with the provisions that their organization is most focused on as the process moves forward. Of note:

“The Affordable Health Choices Act includes provisions from Senator Ted Kennedy’s CLASS Act (S. 697), which would create a new, voluntary national insurance program with a cash benefit to help individuals remain in their communities if the time comes when they need assistance with activities of daily living (see NCOA’s summary).

S. 434, the Empowered at Home Act, introduced by Senators John Kerry (D-MA) and Grassley, to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes.

Project 2020 (S. 1257), introduced by Senators Maria Cantwell (D-WA) and Debbie Stabenow (D-MI),would provide funding through Medicare and Medicaid savings for aging network initiatives on evidence-based health promotion and disease prevention, single-point-of-entry information and referral for long-term services and supports, and nursing home diversion programs.

Senator Jeff Bingaman (D-NM) and a coalition of groups are working to include provisions from the Senator’s bill, the Medicare Financial Stability for Beneficiaries Act (S. 1185).  The bill would significantly improve both the Medicare Part D Low-Income Subsidy (LIS) and Medicare Savings Programs (MSP).”

I understand the need to “do something” about our health care system. I agree that it’s a complicated and expensive undertaking, no matter how you do it. I know that there are many, many pieces to this puzzle, and just as many players. But here’s my beef: Why isn’t there more discussion around managing Medicare fraud? The headline from an MSNBC.com article in 2007 (almost ancient history at this point) shouted “Blatant Medicare Fraud Costs Taxpayers Billions” and there have been a plethora of stories in recent months of fraud rings exposed in Houston, Detroit, and Miami.

A Washington Post article published on June 25^th indicates that the Justice Department, the FBI, and the Department of Health & Human Services are taking this issue seriously.

According to the article, Attorney General Eric H. Holder Jr. said, “We will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising health-care costs.”

I would think we could shave a nice chunk off that $1 trillion price tag if we weren’t losing billions of dollars to fraudulent providers preying on vulnerable elders… and regardless of the cost savings, it is the right thing to do.

What are your thoughts about the health care reform debate? What issue(s) do you think are absolutely crucial to making reform a reality?

- Michelle Seitzer

There will come a day when your aging parent may need someone to handle his or her care, and that someone will very likely be you. In fact, many adult children expect that such a day will come when they must assume responsibility for their parents’ well being. After all, that’s the circle of life, and morally the right thing to do. Of course, what happens when you’re not on speaking terms with a parent? Or when you’re already maxed out financially and physically caring for your own family? What if someone was to tell you that it’s too bad — you’re legally responsible to deal with your parents, no matter what?

That could very well happen, believe it or not, as 30 states currently have laws making adult children responsible for their parents’ care if their parents can’t afford to take care of themselves. Though these “filial responsibility” laws are not often enforced, there is some speculation that they will be in order to save Medicaid money. According to the National Center for Policy Analysis (NCPA), those states with filial responsibility laws:

Twenty-one allow some sort of civil court action to obtain financial support (or cost recovery) and 12 specify a criminal penalty for filial nonsupport; three states allow both civil and criminal actions. Of course, in many cases state filial responsibility laws limit children’s liability under a variety of conditions, such as whether the adult child has enough income to actually contribute, or if the adult child’s financial circumstances change, or if they were abandoned or deserted by the parent.

If filial responsibility laws are enforced, it will affect the common practice of exhausting or transferring a senior’s assets so that a senior may qualify for Medicaid, often prior to entering long term care. Currently, Medicaid only looks at the assets of the individual, but since Medicaid is in financial trouble, the government is looking at the filial responsibility laws to help deal with the crisis.

The New Old Age Blog looks at the filial responsibility topic as well, and there is some interesting discussion in the comments. It’s a tough topic to legislate because so many people are taking care of their own families, but then again, many adult children are able to contribute toward their parents care and they don’t, even when their parents’ situation is less than desirable. I also know that government resources aren’t unlimited, either, it’s a complicated topic.

Someday, I will be responsible for my dad. I will do everything that I can, but I also have my own family to consider. I’m fortunate that he has planned very well, but I can’t help but feel for others who might not have that luxury. Especially now that the government may be putting all of the burden on them.

What do you think — should your aging parents be your responsibility no matter what?

-Elizabeth Thielke

By now, many senior citizens have received their $250 stimulus checks from the U.S. Government in the mail.

The American Recovery and Reinvestment Act of 2009 provides for a one-time payment of $250 to adult Social Security beneficiaries, and to SSI recipients, except those receiving Medicaid in care facilities.  To receive the payment, the individual must have been eligible for Social Security or SSI during the months of November 2008, December 2008 or January 2009.

Though the payment is separate from the regular monthly Social Security payment, it is being sent in the manner the senior normally receives the regular Social Security payments -– by direct deposit or check.

If you didn’t receive payment yet (the “target” date was June 4, 2009), contact your local Social Security office to tell them your payment has not arrived.

Check the Social Security website for answers to more question about the stimulus check.

-Elizabeth Thielke

“Older Americans have carried our Nation through great challenges and triumphs. They have enriched our national character and strengthened the Republic for those who have followed. During the month of May, we pay tribute to the wisest among us.”

From a proclamation by President Barack Obama, May 2009

Established in 1963 by President John F. Kennedy, Older Americans Month (initially called “Senior Citizens Month” before President Jimmy Carter changed the name) is an annual tradition sponsored by the Administration on Aging (AoA). This year, the theme of “Living Today for a Better Tomorrow” highlights the importance of prevention efforts and programs for older Americans. Chronic disease, disability and injury plague our nation’s elders; therefore, the national network of aging services and other community providers must include a focus on prevention in the programs/services they offer. Across the country, area agencies on aging and other aging service providers will participate in a number of activities (community events, fairs, ceremonies, etc.) during the month of May to honor those in the 65+ bracket.

When JFK designated May as Senior Citizens Month,” about 1/3 of older Americans were living in poverty. Few programs were available to meet their needs, and senior issues were moving up on the national agenda and onto the public’s radar screen, hence the dedication of an entire month for a national focus on these challenges. Now, although there is still much work to be done in terms of strengthening programs/services, raising awareness, and defying myths/stereotypes, aging is a hot topic. You can’t go very far without hearing about some issue that relates to seniors. Even aging-related terms have become a part of our day-to-day vocabulary (i.e. sandwich generation, aging in place, caregiver burnout, etc.).

It is truly amazing to think about how fast our country has “grayed.” When Older Americans Month was established in 1963, there were a mere 17 million Americans who were over 65. I say “mere” because the most recent estimate (from 2006) indicated that 37.3 million Americans – that’s about 12.4% of the population, or 1 in 8 persons – had blown out 65 candles on their birthday. But wait, there’s more! By 2030, there will be 71.5 million older citizens, representing 20% of the population (for more aging statistics, http://www.aoa.gov/AoARoot/Aging_Statistics/index.aspx). Wow!

I recently attended a meeting of the Pennsylvania Bar Association’s Elder Law Section, where the state Secretary of Aging, Mike Hall, gave a presentation on the status of aging affairs in the Commonwealth. He spoke about the challenge of rebalancing the state’s long-term care system to include more equal funding for home & community-based services and skilled nursing care. According to Hall, achieving this balance is a huge paradigm shift just by nature of the aging demographic explosion (thanks to increased longevity). Toward this end, Hall shared that when he started working in the aging services network about 30 years ago, most nursing home residents were about 60 years old.

These days, with 60 being the new 50, it’s hard to imagine someone at that age needing skilled care. Most nursing home residents in the year 2009 are in their eighties or beyond. Hall also made the point that just a few decades ago, it was quite uncommon to hear about centenarians. But now, Willard Scott can barely fit all the 100+ birthdays into his short time slot on the Today Show.

America is aging rapidly, and it’s going to take more than one month of every year to solve the problems and celebrate the successes of this gold & silver generation. Let’s get to work!

Visit www.aoa.gov for more information on Older Americans Month, and be sure to celebrate the elders in your life year-round.

- Michelle Seitzer

Maria Shriver. Newt Gingrich. Sandra Day O’Connor. These high-profile advocates testified before the Senate Special Committee on Aging on Wednesday, March 25th with one common goal: Congress must act now to address the public health crisis of Alzheimer’s. And for a disease as devastating (and with effects as far-reaching) as Alzheimer’s, it will take more than just the efforts of Congress and all the high-profile leaders in the country to do it. Shriver, Gingrich, O’Connor and a number of other testifiers confirmed that that reality as they spoke to the Committee.

On that morning, the Senate Dirksen hearing room was filled not only with members of the press wanting to catch a glimpse or get a quote from Shriver or Gingrich, but also with a strong contingent of Alzheimer’s Association staff and volunteers donning purple sashes and armed with data from the Association’s newly released (as of March 24th) Facts & Figures report. This grassroots network had also been inspired and empowered by educational sessions at the two-day Public Policy Forum (sponsored by the Alzheimer’s Association) that preceded this Senate hearing, and everyone in the room was exhilirated by the passion and commitment set forth by Shriver and her colleagues on the Alzheimer’s Study Group (ASG, a high-level, bi-partisan task force co-chaired by Gingrich and former Senator Bob Kerrey from Nebraska).

Shriver shared her personal experience with Alzheimer’s in the shape of her father, Sargent Shriver, who is still battling the disease at age 93 (diagnosed in 2003).  Recommendations laid out by the ASG were shared by Gingrich, Kerrey and O’Connor, and included the need for public-private partnerships and better coordinated care for those with Alzheimer’s.

During the hearing, hundreds of Alzheimer advocates met with their individual members of Congress, seeking their support on three priority policy issues. It was truly a banner week in terms of awareness, media coverage, and attention from legislators and the public on all things Alzheimer’s; I was thrilled to be right in the middle of it all, thanks to my position as an Alzheimer’s Association staff member.

I was inspired by Maria Shriver, but I also found great inspiration in mentoring first-time advocate attendees from my home state of Pennsylvania – many of whom had never before made a legislative visit. Although exhausting, it was a phenomenal three days, and I returned from our nation’s capital invigorated and ready to take the Alzheimer cause to the next level.

For a compilation of the week’s events (including a link to the Facts & Figures report, Forum photos, and a webcast of the Senate hearing), visit www.alz.org. To find out more about Alzheimer’s Care options near you, click into our Alzheimer’s Care portal.

-Michelle Seitzer