Social Security, Medicare 'train-wrecks:' Warnings

by Mark Silva

Train wrecks ahead:

The Social Security trust fund will run out of assets in 2041, the program's trustees said today, repeating an earlier projection. And spending on Medicare will reach a legal limit much sooner -- by 2014 -- requiring the next president to propose changes to avert the first train wreck.

"As the baby boom generation moves into retirement, these programs face progressively larger financial challenges," Treasury Secretary Henry Paulson, one of the trustees, said at a press conference today. "The Medicare program poses a far greater financial challenge than Social Security."

Social Security will also start paying out more in benefits than is collected in payroll taxes by 2017, according to the report of the Social Security trustees released today. In order to keep the program on track, Paulson said, the payroll tax rate will have to be raised by 3.2 percentage points or benefits cut.

""This report confirms the need for action,'' Paulson said. "The sooner we take action to strengthen Social Security's financial footing, the less drastic the needed reforms will be, and the fairer reforms will be to future generations.''

The reports brought quick commentary from the White House as well as the presidential campaign trail.

"The trustees report yet again triggers a funding warning in Medicare – signaling the program is in serious straits as it faces a $36 trillion unfunded obligation,'' saidJim Nussle, director of the White House Office of Management and Budget – pointing to proposals the president has made to curtail spending.

"In each of the last three years, the president has proposed responsible steps to slow the growth rate in Medicare – offering a more aggressive proposal each year to reflect the growing magnitude of the problem,'' Nussle said. "It is disappointing that congressional Democrats have once again chosen to ignore entitlements in their budgets. Inaction is irresponsible. But there is still an opportunity during budget negotiations for the House and Senate to help prevent this oncoming fiscal train wreck.''

President Bush's proposed budget for fiscal year 2009 proposes cutting the growth in Medicare spending from a rate of 7.2 percent to 5 percent over five years.

Presidential candidates are not stepping up as forcefully as they should, according to Isabel Sawhill, a Brookings Institution scholar.

"The latest report from the trustees shows once again that the aging of the population along with rising health care costs per capita threaten to bankrupt the country if nothing is done,'' Sawhill said today. "Yet, none of the presidential candidates has been honest with the American public about the magnitude of the challenge and the importance of dealing with it sooner rather than later."

Sen. Hillary Clinton (D-N.Y.) today was focusing on Arizona Republican Sen. John McCain's talk of opening Social Security accounts to personal savings accounts – a plan that the Bush administration has promoted without success.

"Sen. McCain said something stunning the other day,'' Clinton said today. "He pledged to continue President Bush's attempts to privatize Social Security. He said, and I quote, 'as part of Social Security reform, I believe that private savings accounts are a part of it, along the lines that President Bush proposed.' '

"Social Security privatization is a bad idea whose time has come and gone,'' Clinton said.

Sen. Barack Obama (D-Ill.) said this today:

"Today's report should give Americans confidence that we can keep Social Security strong for future generations if we come together and address its real but manageable long-term cash flow issue.

"But the report also shows the cost of Washington's failure to overcome the special interests and pass health care reform that expands coverage and lower costs, which would keep Medicare strong and affordable for America's seniors. As president, I will reduce costs in the Medicare program by enacting reforms to lower the price of prescription drugs, ending the subsidies for private insurers in the Medicare Advantage program and focusing resources on prevention and effective chronic disease management.

"I'll also bring Democrats and Republicans together to provide every single American with affordable, available health care that reduces health care costs by $2,500 per family. By investing in proven measures to improve the health of all Americans and reduce health care cost across the economy, we can ensure that the Medicare program remains strong for future generations."

Yet Clinton and Obama already are members of the Democratic-led Senate.

House Republican Leader John Boehner (T-Ohio) suggested the Congress has ignored repeated warnings about the crisis spelled out in the trustees' reports.

"The need to reform Medicare and Social Security to preserve the programs' benefits for future generations of American seniors is clear,'' Boehner said. " The Social Security and Medicare Trustees have repeatedly warned Congress and the American people that the programs must be reformed or future benefits will be threatened, and today's report is no exception. We face a demographic tsunami of nearly 80 million retiring Baby Boomers and rising healthcare costs.

"Congress can't sit idly by while these programs go bankrupt,'' he said. "We must act now.''

Posted by Mark Silva on March 25, 2008 5:00 PM | Permalink

Local caregiving company joins AARP's national employer team

Home Instead Senior Care   3/24/2008

Home Instead Senior Care, a local company serving Duluth, Superior, Cloquet and the Iron Range has joined AARP's National Employer Team (NET) – a network of employers who value the experience and skills of the 50+ worker, according to AARP.

The NET program connects 50+ workers with employment opportunities at companies that now include Home Instead Senior Care, an international non-medical caregiving company with more than 760 offices worldwide including the local franchise.

To join this elite team, employers must undertake a detailed application process to demonstrate their interest in hiring mature workers. AARP's website (www.aarp.org/employerteam) provides information on the employers and the positions they have posted on their websites, along with links to each employer's AARP career page.

"We have always valued the mature worker and are thrilled to be a part of this program," said Mary Andrews, owner of the local Home Instead Senior Care office. "We are proud to be an employer that recognizes the many contributions mature workers bring to the workforce, not only in our community but throughout the world."

Home Instead Senior Care strives to help keep seniors independent. The company's non-medical services include companionship, meal preparation, medication reminders, light housekeeping and escort for errand and shopping. More than 50,000 Home Instead CAREGivers are screened, trained, bonded, insured and have successfully passed thorough criminal background checks.

"Our National Employer Team members recognize the changes occurring in the labor force," said Deborah Russell, AARP's Director of Workforce Issues. "AARP's NET members come from fields ranging from retail to travel to security with positions spanning the gap from tax examiners for the Internal Revenue Service to country directors for the Peace Corps," added Russell.

"Boomers' experience provides a valuable resource to employers who face worker shortages in many diverse areas."

Others recently named to the NET are the IRS, the U.S. Small Business Administration, the Peace Corps, Scripps Health, Bright Horizons Family Solutions, Synergy HomeCare, AnswerNet and Vedior North America.

For more information about Home Instead Senior Care, log onto www.homeinstead.com. To Learn about job opportunities with the company, visit www.aarp.org/employerteam or contact Lisa Wivinus at Home Instead in Duluth, 218-727-8810 Monday through Friday 8 a.m. to 4:30 p.m.

HomeCare Agency vs. Private Duty

Written by Betsi Brimer, RN

Monday, 24 March 2008

As the owner of Synergy HomeCare in the heart of Denver, I am traveling around Denver and the metro area talking and with current clients, caregivers, and potential new clients. I am frequently asked why it is better to hire a Home Care Agency, when it would be less expensive to hire a friend or a private individual to help a parent or loved one. Keep in mind that the majority of older adults want to remain in their own home, with their own belongings, their own surroundings, and their own routines. Currently, one of the utmost long-term needs of our elderly and those with chronic or acute illnesses is for in-home care services. Home Care Aides can provide a variety of services, such as assistance with activities of daily living (ADLs) which include bathing, dressing, grooming, feeding, assistance with transfers, and ambulation. Additionally, they may assist with instrumental activities of daily living (IADLs), such as meal preparation, shopping, making appointments, transportation, and laundry. Also, companionship is a key component with all home care. There would be nothing worse than having someone you don't like spending the day with you and in your home. Unfortunately, many families hire private individuals or friends rather than a home care agency. While at first blush this appears advantageous, this may cause unexpected problems and liabilities for the family down the road.   When the family hires privately, the family then becomes an employer and is required by state and federal law to pay Social Security, payroll taxes and unemployment, as well as provide worker's compensation insurance. Additionally, I have met several individuals working in the home care industry who represent themselves as "independent contractors," allegedly relieving the family of these tax obligations. In all of the individuals I have met, they do not meet the criteria of an independent contractor. It is the family's responsibility to be sure that the aide truly meets the definition of an independent contractor and is paying their own taxes. If the aide does not meet the legal criteria as an independent contractor and they have not met their tax obligations, the responsibility once again falls to the family as the caregiver's employer. This can be a very nasty obligation, as it may involve interest on back taxes, civil fines, and even criminal penalties are possible. If the family still desires to hire privately, they should receive advice from a labor law attorney and accountant to insure appropriate hiring practices and taxation. Unfortunately, the home care industry is rife with work-related injuries. The family, now considered the employer, is liable for any work-related injury that occurs while on the job. Keep in mind this may include the cost of all medical expenses and possibly any disability payments should they be applicable. Additionally, should there be an injury to the person being cared for or any other person on the premises, the family retains any liability that comes from the injury. Basically this means that if the caregiver were to cause an injury or a loss to any other family member, the family, as the employer, would carry the full burden of the responsibility for all costs and compensation. As much as I hate to talk about this, there is a potential for physical or emotional abuse as well as financial exploitation. Keep in mind when services are performed on behalf of a frail, cognitively impaired and often functionally limited person, there is always one individual who could see this as a potential opportunity to take advantage. This abuse is especially easy when the caregiver and client are somewhat isolated with little to no supervision. Please know that most families don't fail to provide supervision because of no interest or neglect, but it may be difficult due to geographic distance, work schedules or the close bond (emotionally) that the caregiver and client may have established. Keep in mind as well that families may not have the wherewithal to perform criminal background checks, the I-9s, or check work and personal references. Sadly, there are times when the families are so appreciative of the caregiver's care that they are vulnerable as well to the manipulation and exploitation of a caregiver. Unfortunately, as the owner of Synergy HomeCare, I have spoken to many clients and non-clients who have been victimized by private individuals. While most caregivers do care, giving out of the sincere desire to be of service to someone, there are others who see this as an opportunity to take advantage of the client and gain financially. Some of these caregivers are family members, or friends of a friend, who have had a run of bad luck or just need a little break. Some move from community to community, they are able to ingratiate themselves into the community by offering to lend a hand with yard or housework, etc. By talking with them, the person becomes an expert for caring for people with the exact same illnesses and soon is caring for your family member. Before you can even think fully about the situation, this caregiver has moved in. They are assisting in paying bills, shopping, getting their names on all the bank accounts, arranging for home or auto repair, as well as fixing up the home. While some of this sounds wonderful, think about the phone being left off the hook for "quiet" time, for the caregiver not allowing for company because the client is "resting" or feeling "ill," or family heirlooms being "misplaced". I recently read a book by Sue Grafton entitled "T for Trespass." The book, basically, was about a person representing themselves as a quality, private caregiver. Without giving the book away, let's just say the book was scary. I would suggest if you are going to hire a private caregiver, read the book first. Should the family not be able to fulfill all of the above responsibilities, it would be in the client's best interest for an Agency to be hired - although this decision needs to take into consideration the type of assistance required, the financial and tax implications, as well as the supervision necessary. As the owner of Synergy HomeCare, I have the responsibility to supervise all of my employees. I make visits to all of my clients, both when the caregivers are there as well as when they are not present. This gives me feedback on each of the caregivers involved, helps me understand the changing needs of the clients, and allows me to offer suggestions regarding procedures, care, and additional resources if necessary. The caregivers often work in very challenging environments as well as family dynamics. Therefore, my supervision is often key for the caregiver and family. My supervision assists in clarifying the roles of the caregiver, and clarifies the expectations of the family and client as well as the caregiver. Keep in mind that there are often different cultural and faith traditions, eating preferences, and expectations about personal schedules the supervision may clarify. My supervision and support may assist the caregiver and family in explaining the disease process and behavioral changes. There are occasions when personality issues arise due to the cognitive changes of the client. My supervision may lend guidance and support to all parties involved. Supervision is a key component in making a challenging situation work. Synergy HomeCare also has immense responsibility in hiring, training, background checks, financial and legal obligations. Communication with the family, caregiver, and client are absolutely necessary. If the communication is not available, the care provided won't be optimal. While the Agency may provide daily hands-on care, family involvement is crucial in assuring proper care and a relationship that is mutually supportive. Betsi Brimer, RN Synergy HomeCare

Article published Wednesday, March 19, 2008
Ohio deaths tied to insurance lack

About 750 working-age Ohioans died in 2006 because they lacked health insurance and could not afford medications or preventative care, according to a report released yesterday.

Because they often skip checkups, screenings, and other measures that could diagnose cancer or other diseases and increase their chances of survival, two working-age Ohioans without health insurance die daily, according to Families USA, a nonprofit organization that advocates affordable health care for all.

Between 2000 and 2006, more than 5,100 Ohioans aged 25 and 64 died because they did not have health insurance, Families USA estimated.

Nearly 13 percent of Ohio's 6.1 million residents between the ages of 25 and 64 did not have health insurance in 2006, when 750 of them died, it said.

Families USA is releasing state-specific estimates on the number of residents who die because they lack health insurance.

Nearly two Michigan working-age residents die daily because they lack health insurance, or about 650 people in 2006, the organization estimated.

Walgreen Continues March Into Health-Care Delivery

Posted By Jacob Goldstein On March 18, 2008 @ 9:09 am In PBMs, Pharmacists, Retail Clinics | 4 Comments

Walgreen may be on its way to your office. The drug store chain is buying its way into the business of providing on-site health care for employers.

Walgreen execs said yesterday that the company's buying a shop called I-trax for about $260 million and another company called Whole Health Management for an undisclosed amount, the WSJ reports.

Like its archrival CVS, Walgreen is no longer content with its retail business selling prescriptions, over-the-counter drugs and a random assortment of groceries and novelty items. Walgreen and CVS have both been busy opening retail clinics to provide health care in their stores. And last year, CVS merged with the giant pharmacy benefits manager to get into the business of managing companies' prescription drug benefits.

After the deal goes through, Walgreen will have more than 500 health centers, including both its existing retail clinics and the on-site health centers its buying, the WSJ says. I-trax provides worksite health services for more than 160 employers, including familiar names such as Lowe's and Toyota. Whole Health Management has work site centers for Continental Airlines and Sprint Nextel Corp., among others.

The deal could mean that some people will have not only a doctor down the hall from where they work, but also a whole Walgreens store. "Is there also an opportunity longer-term to have Walgreens outposts in some of these corporate facilities?" an analyst asked on a conference call yesterday, according to a transcript from Thomson Financial. "Yes," CEO Jeff Rein answered. "It's not just on the medical side of course, but it is on the pharmacy side. It could be on the OTC side. There could be other opportunities, particularly when people are so rushed for time."

Walgreens Neon Sign by puroticorico via Flickr

---

Article printed from Health Blog: http://blogs.wsj.com/health

Memory loss for many falls short of dementia

 

BY STEVEN REINBERG • HEALTHDAY • March 18, 2008

More than one-fifth of Americans over 70 years old have some memory impairment that isn't classified as dementia, a new study finds.

While an estimated 3.5 million Americans suffer from dementia, another 5.4 million over 70 have some memory loss that affects their lifestyle but isn't severe enough to limit their ability to function normally, the study authors said.

"An estimated 22% of individuals over age 70 have some type of cognitive impairment that does not reach the threshold of dementia," said lead researcher Brenda Plassman, an associate research professor of psychiatry at Duke University School of Medicine.

The findings are published in the March 18 issue of the Annals of Internal Medicine.

For the study, Plassman's team collected data on 856 people 71 years old and older. The participants completed a neuropsychological exam, and close family members were asked about their relatives' memory and ability to do daily activities. The participants were followed from July 2001 through March 2005.

The researchers found that 22% of the participants had some form of memory loss that didn't reach the threshold for dementia. Among these people, about a quarter had chronic health problems such as diabetes or heart disease that may have been the cause of their cognitive impairment.

"The people with cognitive impairment without dementia were at higher risk of progressing to dementia within a year or so," Plassman said.

"However, during the same time period, about 20% reverted back to normal cognition," Plassman said. "That's important, because these numbers are rather startling, and we don't want to give the impression that there's not hope out there," she added.
 

Skyrocketing Fuel Prices Force Budget Crunch for Many Home Health Caregivers
Pennsylvania Homecare Association

HARRISBURG, Pa., March 17 -- In 2003, the last time the Commonwealth
increased its reimbursement to home health care providers, gasoline
was selling for $1.35 a gallon. Today, with gasoline at $3.30 and more
in many parts of Pennsylvania, homecare agencies are still getting the
same $77 per home visit and eating the skyrocketing cost of fuel or
cutting corners in other areas. And, according to the Pennsylvania
Homecare Association, providers are fresh out of corners to cut.
Homecare has been hailed by Gov. Edward G. Rendell as the "next big
thing" to keep down the costs of health care by providing quality
service, personal attention, and nursing skills without the overhead
of large bricks-and-mortar institutions. But critical funding has not
yet followed favorable reviews. The Commonwealth has increased the
payment for home health care Medicaid recipients just once in the past
16 years. The current Medicaid reimbursement rate is $77, while the
actual average cost per home visit according to a two- year-old study
-- is $118, a $41 loss every time a nurse provides care to a patient.
Record high gasoline prices have made the gap even wider.

"According to a University of Pittsburgh study, a typical registered
or practical nurse making home calls can expect to drive a total of 60
miles a day between appointments," said Vicki Hoak, executive director
of the Pennsylvania Homecare Association. "You can do the math. Figure
an average of 20 miles per gallon for the nurse's car and that works
out to three gallons of gas a day just getting between patient homes.
That's $9.90 they must pay just for gasoline -- but the typical
homecare agency reimburses the staffer at the Internal Revenue Service
rate of 50.5 cents a mile -- or $30. It's not a number that our
providers can swallow or ignore."

With a loss for services already stretching homecare agency budgets,
Medicare and private pay customers help to offset costs and reduce
monetary losses for the agencies, allowing them to stay in business.

According to the State of the Homecare Industry in Pennsylvania
report, released last year by the University of Pittsburgh, homecare
agencies staff, including nurses, physical, speech, and occupational
therapists and home health aides traveled 210 million miles in 2005.

The Pennsylvania Homecare Association is seeking a $10 million
increase in the state's 2008-09 budget allocation to increase the
Medicaid reimbursement to $100 per visit for skilled services. The
increase will help offset the cost of nursing and therapeutic care,
rising gasoline prices, and workers' compensation premiums for home
health agencies. Last year alone, Pennsylvania home health agencies
spent an additional $6.7 million to help cover the rising gasoline
costs.

"On any given day, a home health nurse sees five patients a day,
averaging 12 miles per day between each patients home. Mileage can be
even higher if a nurse is working in a rural area of the state," said
Hoak. From the $77 reimbursement amount provided by Medicaid for a
nursing visit, agencies pay salaries, mileage, workers compensation,
insurance premiums for employees, medical supplies, and many other
overhead costs. "In addition to the increase in gasoline prices, our
cost of doing business has risen 15 to 25 percent since the last
increase."

Medicaid provides basic health care for low-income individuals under
the age of 60 and for the elderly under the state's Aging Waiver
program. Nearly two million people are covered by Medicaid in
Pennsylvania, but only about 10,000 of those receive at-home health
care and another 12,000 people under the Aging Waiver, she said. "It's
clear that the Governor would like that number to grow because even at
$100 per visit, homecare is less costly than hospital or nursing home
care," Hoak said. "But our members can't afford to shoulder an even
larger caseload and more losses."

Hoak called the situation the "invisible crisis."

"Unlike other healthcare providers, home health care is invisible to
the community at large. We don't have any big, imposing edifices to
drive by daily. We're the quiet solution," Hoak said. "We're critical
when it comes to helping people stay out of hospitals and nursing
homes. And we're cost effective: To provide in-home care to a senior
citizen so that they don't have to go to a nursing home costs Medicaid
$23,000 compared to Medicaid's cost for a person in a nursing home at
$56,000 a year."

The Pennsylvania Homecare Association is headquartered just outside of
Harrisburg and represents more than 300 agencies that deliver care and
support directly in the homes of more than a million elderly and
disabled citizens in the state of Pennsylvania. To learn more about
in-home care, visit the PHA website at http://www.pahomecare.org.

SOURCE Pennsylvania Homecare Association

Eric Kiehl, Public Affairs Director of Pennsylvania Homecare
Association, +1-800-382-1211 ext. 26, or mobile, +1-717-422-2025,
ekiehl@pahomecare.org,

2 die each day in Mich. for lack of insurance

By PATRICIA ANSTETT • FREE PRESS MEDICAL WRITER • March 13, 2008 Not having health insurance can be deadly, a growing problem that accounts for deaths of 650 Michiganders a year, nearly two a day, a national report released Thursday concludes. Uninsured people "live sicker and die earlier," said Ron Pollack, executive director of Families USA, a national nonprofit consumer health organization, speaking in a telephone news briefing. He said that premature deaths among the uninsured nationwide are twice the rates of people who are killed by homicide. The problem is growing in Michigan as more employers drop health coverage and people find insurance premiums too costly to purchase their own coverage. The report used mathematical methods used by two highly reputable agencies, the Institute of Medicine, a nonprofit federal agency which studied the issue in 2002, and the Urban Institute, which updated the figures in 2006. Both reports took federal statistics on people who lacked insurance and estimated that 25% died prematurely. The problem is largely unrecognized, said Sister Mary Ellen Howard, director of the Cabrini Clinic, a free clinic in Detroit that is the nation's oldest such center in the United States. "You will never read that this person died because they are uninsured," she said. The cause of death will be listed as stroke or cancer, for example, she said. "It won't say this person didn't have screening for cancer, was diagnosed late and not treated appropriately because she was uninsured." Howard said legislation pending in Lansing to allow Blue Cross Blue Shield of Michigan to set its own rates without prior approval from the state's Office of Financial and Insurance Services would make problems worse by extending from six months to 12 months the time in which the insurer can choose not to enroll people with chronic health problems, as commercial insurers can. "I'm afraid that in 12 months many people will die because they don't have insurance," she said. "We have to protect them even more." Blue Cross is seeking the changes to offset losses from its individual policies and to allow more flexibility in their pricing from year to year, rather than seeking prior state approval, a time-consuming process. Rep. Debbie Stabenow, D-Mich., called the report "a wakeup call for all of us, that we have got to make a commitment to universal health care coverage and access in this country." Contact PATRICIA ANSTETT at 313-222-5021 or panstett@freepress.com.

India's elderly feel freer

PUNE, INDIA -- She grew up listening to her grandparents' stories over
dinner, three generations gathered in the house they shared, like
nearly every Indian family she knew.

But now that Uma Paranjpe is a grandmother, she finds herself living
alone in a small apartment, her children abroad, her grandchildren far
from her cooking and her stories.

And she's thrilled.

"Grandparents also want their own independence," said the 62-year-old
widow, who lives in a bustling retirement community in this
southwestern Indian city. "We want freedom. We would like to travel,
to pursue our hobbies."

A cultural revolution is underway in India, led by an unlikely
gray-haired vanguard that is dramatically changing what it means to be
old here, and what it means to be a family. In a country where family
is society's strongest cultural anchor, the thought of the elderly
living alone has long been anathema, but many older people today are
embracing the notion.

With the economy booming, children are moving away for jobs, leaving
elderly parents on their own. Although some lament the breakdown in
family as a sign of cultural decline, others -- especially the
well-off -- are happy to devote their old age to themselves instead of
their grandchildren.

The new retirement communities so far are available only for the rich.
There's nothing between the high-end faux Florida facilities and bleak
government-run homes for those with nowhere else to go.

About a dozen development companies across the country offer sparkling
facilities complete with badminton courts, lap pools and game rooms to
the wealthiest sliver of the country's 80 million people older than
60.

"I don't think my son or my daughter will look after me -- and I'm
damn happy about it," said Minoo Shroff, 72, who lives in a housing
complex for seniors in Pune, a city popular with retirees because it's
more temperate than much of the rest of India. "I'm independent,
they're independent."

Seniors in India traditionally occupy a role somewhere between family
pillar and dependent hanger-on, with more than 71% of the elderly
living with their children or grandchildren, according to the 2001
national census.

Grandparents can be revered keepers of family lore or ghostly
presences cooking nearly forgotten recipes. But from teeming cities to
sleepy villages, caring for one's parents is to most Indians a duty as
important as caring for one's children, and home after home across the
country is crowded with the same mix of generations.

The arrangement is one borne out of custom and financial necessity --
the Indian government provides no Social Security-type benefits, and
less than 10% of the population receives even a small pension.

Experts say the new prosperity flooding into India is weakening the
"joint family" system, in which the next generation lived with the
last, because the pace of life is speeding up and people are becoming
Westernized.

"The younger generation is very busy. They don't have time to spend
with older people," said Harvinder Bakshi of HelpAge India, a major
activist group for the elderly. "The joint family system is
disintegrating."

Newspapers frequently carry lurid stories of children abandoning their
parents to the street, and activists have called on the government to
open more affordable old-age homes.

Bakshi says his group gets half a dozen calls a month about abandoned
seniors, but he doesn't think that is an alarming trend.

Even the expensive retirement homes can't make up for the joy of
growing old among family.

"I miss that bonding, that security, that comfort, the love, the
shelter. We don't feel that here," said Madhukar Gokarn, 73.

She and her husband live in an exclusive retirement community called
Golden Nest in Pune, but her afternoon walks on the building's roof
are small consolation for what she has lost. "Who wouldn't want to be
with their own children as long as possible?"

Shashank Paranjape, the real estate developer generally credited with
introducing retirement homes to India, opened his first project,
Athashri, in 2003 in Pune as a complex explicitly modeled on Western
retirement homes.

With about 1,000 residents in four branches, Athashri is a thriving
community that looks as though it was plucked straight from Florida,
right down to the early-bird specials -- spicy lentils and rice.

Paranjape plans to build retirement homes in five more Indian cities,
but he and other developers face major hurdles.

To most Indians, communities exclusively of old people seem as
impractical as neighborhoods of children would be. Also, the buy-in
prices of $75,000 to $125,000 rule out the vast majority of the
population, though with the economy growing every year, developers are
betting the market will increase.

The communities buzz with card games, book clubs and music lessons --
activities all but unthinkable in generations past, when old age was
spent helping with grandchildren and household chores.

"My mother used to love the violin, but she never had time to play,"
said Pushpa Salem, 67, who has become an avid butterfly collector
since moving to Athashri nearly five years ago. "She would have loved
it here."

"When we stay with our children we feel very old," she said. "Here, we
feel young."

Peddling Healthful Street Food To Eco-Urbanites: Will It Fly?

By Thomas Heath
Washington Post Staff Writer
Monday, March 10, 2008; D01

Like lots of business plans, the one for a bug-like contraption
offering healthful food on the streets of Washington bubbled up from
some buddies kicking ideas back and forth.

As they mulled their quest for selling the perfect pizza slice on the
streets of Washington, Gabe Klein, who had worked for Zipcar, the
by-the-hour car rental company, began to think about other
possibilities. Pizza soon evolved into health food, and On the Fly was
born.

"People are used to a much higher quality street food experience than
you can get in D.C.," said the Connecticut native. "We looked at that
need and said that is something we can fill."

Klein, 37, and two friends founded On the Fly, offering locally
produced, good-for-you food in both mobile and bricks-and-mortar cafes
-- "smartkarts" and "smartkafes" -- that are showing up in downtown
Washington.

This is not your father's hot dog stand.

On the Fly says its target audience is the earth-loving,
health-conscious, exercising, frugal-but-affluent urbanite who lives
or works in downtown Washington.

Starting at a 2,500-square-foot central kitchen on Capitol Hill, On
the Fly creates a menu ranging from homemade hummus to a four-soy
salad with tofu and shiitake mushrooms. The macaroni and cheese
includes whole wheat pasta and low-fat smoked gouda. You can get
organic smoothies and fresh-cut pineapple, but there's no sugary corn
syrup in the house.

They also sell specialties from local restaurants, such as a chicken
barbecue sandwich from Rocklands on Wisconsin Avenue or a veggie
empanada from Julia's Empanadas in Adams Morgan. The bread is whole
grain, but good luck finding mayonnaise or butter to smear on it.

"It's Whole Foods meets 7-Eleven," said On the Fly finance chief
Michel Heitstuman, 48, an engineer who once worked for IBM and AOL.

On the Fly hasn't arrived without controversy.

D.C. Council member Jim Graham (D-Ward 1) voted to change the city's
licensing laws to allow On the Fly and similar businesses to operate
on the streets, which angered some vendors already doing business.

"I wanted to allow more creative vending opportunities," Graham said.

George Harrop, who started and sold a group of upscale espresso bars
in downtown Washington, said that aside from controlling costs, which
is the bugaboo of most food businesses, On the Fly must become
something special to its customers in order to be a success.

"The demographic looking for health food is looking for experience,"
Harrop said. "If they can provide that, they might have a chance of
success. But does the perception of health food fit with a truck on
the street?"

In this case, a truck that resembles a fly.

The "smartkarts" are electric vehicles built by a Chrysler division in
Fargo, N.D., and are specially outfitted with steam wells, holding
ovens and refrigeration so that On the Fly can serve hot food at
regular locations. Two are in service: the Diego specializes in Latin
food and is stationed at Eighth and H streets NW, while Smokin' Joe at
Seventh and F NW has a barbecue menu. A third vehicle, Ms. Miyagi,
will arrive later this month and offer Asian Fusion cuisine at a
location yet to be named.

The conventional cafes are above the Farragut North Metro station and
at the Results Gym on G Street SE.

Klein, Heitstuman and their partner, Christopher Lynch, 38, owner of
L'Enfant Cafe, divide up duties: Klein knows transportation and the
city; Lynch knows food; Heitstuman minds the money. They raised about
$1 million to get their business off the ground, including nearly
$500,000 borrowed from banks. The three partners chipped in $100,000,
and investors made up the difference

"I am in it for the long haul," said Jenny Crawford, a real estate
agent who invested in the firm because she said there's a niche for
good street food in D.C. "We have the option of reinvesting or pulling
out at the end of 2009, and then annually after that."

Heitstuman said the firm hopes to be cash positive this year,
depending on how fast it grows. The company, which employs 15, within
months plans to have eight food carts stationed around the city at a
cost of up to $40,000 per truck. A third cafe may open this summer.

There could be more after that, depending on revenue and demand. They
also have their eye on a spot somewhere near the new Washington
Nationals Park, the baseball stadium that opens March 30.

"Our business plan is to provide great food for people of D.C. and
other cities as we move forward in an environmentally conscious way,"
Klein said. "We are trying to provide a healthy alternative where
people live, work and play in high-density areas with the highest
traffic. And if we do the right thing for our customers, and do the
right thing for the environment, they we will get a good return."

Your rights to health insurance

BY PATRICIA ANSTETT • FREE PRESS MEDICAL WRITER • March 10, 2008

Your rights to health insurance:

• State law requires Blue Cross Blue Shield of Michigan year-round,
and HMOS during a 30-day open enrollment period each year, to sell you
insurance. Check with HMOS about when enrollment is open.

• COBRA, the Consolidated Omnibus Budget Reconciliation Act (COBRA),
is a federal law that gives you the right to continue temporary
coverage under your health plan if you left a company that had
workplace coverage for 20 or more workers. COBRA does not apply to
plans sponsored by the federal government and some church-related
organizations.

Here's how COBRA works: You pay the full premium plus up to 2% for
administrative expenses. Coverage usually ends after 18 months,
although it can last as long as 36 months in some circumstances. Check
out options and compare COBRA to any plan you can buy on your own.
COBRA coverage may be more expensive.

• If you had workplace coverage considered credible, you are eligible
for a group conversion policy. The health plan cannot turn you down
because you had a prior health problem.

For more information about COBRA, contact the U.S. Department of
Labor, Employee Benefits Security Administration, at 866-444-3272 or
www.dol.gov/ebsa.

Source: Michigan Department of Labor and Economic Growth, Office of
Financial and Insurance Services

A rude, expensive awakening

BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER

For the first time in his working career, 44-year-old Nevin Speerbrecker has no workplace health benefits.

After changing jobs last month -- from an employer that offered health insurance to one that doesn't -- Speerbrecker found out how costly many health policies are. He also was shocked to find many health plans wouldn't insure him because he recently had cataract surgery. "It looks like insurers are looking for any excuse not to cover you," said Speerbrecker of Eaton Rapids.

Working with Livonia insurance agent Mike Coliton, Speerbrecker purchased a policy for his wife and son through Madison National Life Insurance Co., based in Madison, Wis. It costs $241 a month with coverage for 80% of their expenses, once they pay a $1,500 yearly deductible.

Speerbrecker has a temporary policy through American Community Mutual Insurance Co., based in Livonia, that costs $159 a month but provides fewer benefits.

Speerbrecker said he prefers a national health plan. Any limitations "certainly would be a heck of a lot better than what anyone in America can get on their own without spending a lot of money," he said.

Some tips for buying your own health plan

BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER

Determine what your household budget can afford and what your medical needs are.

Find an insurance broker who sells policies for as many insurance plans as possible. That way, you will have the benefit of hearing about the most options, not just for a few companies. To check on what policies a broker is able to sell, go to www.dleg.state.mi.us/fis/ind_srch/ins_agnt/insurance_agent_criteria.asp.

Compare rates on your own, or be hooked up to independent brokers through the Internet. Three local firms with sites include www.lowcostinsur.com, a site sponsored by Allchoice Insurance, Northville, 800-889-2659; www.myinsuranceexpert.com, a Farmington Hills firm, 800-732-5569, and www.rickyounginsurance.com, a Rochester Hills firm, 888-909-7425.

Consider a limited coverage plan or one with higher deductibles if you are healthy.

When looking at a plan that offers some routine and preventive care, find out answers to questions like: What will your out-of-pocket costs be for a doctor visit, a medical service or prescriptions? Are any types of prescriptions or services excluded or affected by a lifetime cap on benefits? How many doctor visits are you allowed per month, per quarter, per year and per family? Are wellness visits and services such as immunizations, mammograms and Pap smears covered for all family members?

Find out your maximum out-of-pocket costs for a major operation.

Check a company's complaint ratio. That's a good gauge of whether other policyholders are dissatisfied with a plan. You can find listings on the Web site of Michigan's Office of Financial and Insurance Services. Go to www.michigan.gov/dleg, click on Financial & Insurance Services, then Consumer Services, then Insurance Company Complaint Ratios.

Get answers to your questions in writing.

ePerscription

DETROIT, March 7 /PRNewswire/ -- According to new data released today,
more than 90 percent of the 2.5 million electronic prescriptions
written in the state of Michigan in 2007 came from doctors within the
seven counties of the Southeast Michigan ePrescribing Initiative
(SEMI) -- helping drive Michigan to fifth in the nation in the
adoption and utilization of ePrescribing technology. The findings are
part of the Electronic Prescribing Progress Report, a national
assessment of the adoption of electronic prescribing in the United
States, published by SureScripts, operator of the Pharmacy Health
Information Exchange(TM).

SEMI is a coalition that includes General Motors, Ford Motor Company,
Chrysler LLC, the United Auto Workers, Blue Cross Blue Shield of
Michigan, Health Alliance Plan, Henry Ford Medical Group, Medco Health
Solutions, Inc., CVS Caremark Corporation, RxHub, LLC and
SureScripts(R).

"The SEMI program has played an integral role in advancing the
adoption of electronic prescribing technology in the state of
Michigan," said Karl Dalal, Director of Healthcare, Insurance and HR
Programs, Ford Motor Company. "Electronic prescribing clearly leads to
safer pharmacy care and lower costs for physician practices,
employers, and consumers; advancing the adoption of this technology
will continue to play a key role in treating the ills of the
antiquated paper-based healthcare system in America."

Michigan received the Safe-Rx(TM) Award for finishing 5th among the
top 10 ePrescribing states in the nation. Safe-Rx Awards are given
each year to the 10 states that transmit the most electronic
prescriptions as a percentage of the total number of prescriptions
eligible for electronic routing over the Pharmacy Health Information
Exchange(TM) operated by SureScripts. Michigan has been rising in the
ranks since the Safe-Rx awards began in 2006. Last year, the Wolverine
state came in sixth nationally, and in 2006 was 10th in the nation in
use of the technology.

Doctors: Safer prescribing, better care come with electronic prescribing

A recent survey of physicians in the SEMI program revealed that
improved patient safety and quality of care topped the list of key
benefits of the technology. According to the survey, conducted by
HaldyMcIntosh & Associates:

-- Three out of four prescribers believe strongly that ePrescribing
improves safety for their patients. -- Nearly 70 percent of
respondents say it improves the quality of care. -- More than 80
percent of all prescriptions written by those surveyed are currently
written electronically; four of 10 practices now only write
ePrescriptions. -- More than 70 percent saw a reduction in
communications with pharmacies over prescription questions. -- More
than half strongly agree that ePrescribing saves clinicians time and
increases productivity.

The study also found that nearly 65 percent of physicians changed at
least one prescription in response to a safety alert that warned of
potentially harmful drug-drug interactions and drug-allergy risks at
the time of prescribing. According to a 2006 report from the Institute
of Medicine (IOM), at least 1.5 million preventable adverse drug
events occur each year in the United States. The IOM recommends that
all doctors adopt ePrescribing by 2010 to help alleviate this number
and avoid the many mistakes that accompany handwritten prescriptions,
including illegible handwriting, abbreviations and sound-alike
pharmaceutical names.

Based on the survey findings, the SEMI partners will extend the
initiative and continue to enroll physicians through June 30, 2008.

About SEMI

Launched in February 2005, The Southeast Michigan ePrescribing
Initiative is one of the largest, employer-driven ePrescribing
initiatives to encourage the adoption and use of ePrescribing, and
validate the impact of ePrescribing technology on improving patient
safety and reducing prescription drug costs. SEMI is a joint
collaboration between General Motors, Ford Motor Company, Chrysler
LLC, the United Auto Workers (UAW), Blue Cross Blue Shield of
Michigan, Health Alliance Plan, Henry Ford Medical Group, Medco Health
Solutions, Inc., CVS Caremark Corporation, RxHub, LLC and
SureScripts(R).

Physicians interested in joining SEMI may call 1-800-722-8979 for more
information.

About GM

General Motors Corp. , the world's largest automaker, has been the
annual global industry sales leader for 77 years. Founded in 1908, GM
today employs about 266,000 people around the world. With global
headquarters in Detroit, GM manufactures its cars and trucks in 35
countries. In 2007, nearly 9.37 million GM cars and trucks were sold
globally under the following brands: Buick, Cadillac, Chevrolet, GMC,
GM Daewoo, Holden, HUMMER, Opel, Pontiac, Saab, Saturn, Vauxhall and
Wuling. GM's OnStar subsidiary is the industry leader in vehicle
safety, security and information services. More information on GM can
be found at http://www.gm.com/.

About Ford

Ford Motor Company , a global automotive industry leader based in
Dearborn, Mich., manufactures or distributes automobiles in 200
markets across six continents. With about 260,000 employees and about
100 plants worldwide, the company's core and affiliated automotive
brands include Ford, Jaguar, Land Rover, Lincoln, Mercury, Volvo and
Mazda. The company provides financial services through Ford Motor
Credit Company. For more information regarding Ford's products, please
visit http://www.fordvehicles.com/.

About Chrysler

Chrysler LLC, headquartered in Auburn Hills, Mich., produces Chrysler,
Jeep, Dodge and Mopar(R) brand vehicles and products. Its product
lineup features some of the world's most recognizable vehicles,
including the Chrysler 300, Jeep Wrangler and Dodge Charger. The
Company sells and services vehicles in more than 125 countries around
the world. The operations outside North America have been experiencing
year-over-year sales increases since 2004, with a record number of
vehicles sold in 2007. The Chrysler Foundation - the primary source of
charitable grants made by Chrysler - annually supports hundreds of
charitable organizations with an emphasis on community growth and
enrichment, education, arts and culture, public policy, youth
development and disaster relief programs throughout the United States
and, increasingly, the world. Chrysler is a unit of Cerberus Capital
Management.

About HAP

Headquartered in Detroit, Health Alliance Plan is a nonprofit health
plan serving 545,000 members and 2,000 employer groups. HAP is a
subsidiary of the Henry Ford Health System, one of the nation's
leading regional health care systems. The health plan serves companies
of all sizes through the flagship HMO, PPOs, Medicare Advantage plans,
experience-rated, fully insured and self- funded products, SOLO
individual plans and high-deductible health plans with compatible
health savings accounts. The National Committee for Quality Assurance
awarded HAP's commercial HMO and HAP Senior Plus, its Medicare
Advantage HMO, Excellent Accreditation.

About Henry Ford Medical Group

The Henry Ford Medical Group is one of the nation's largest group
practices, with 1,000 physicians and researchers in more than 40
specialties who staff Henry Ford Hospital and 25 Henry Ford medical
centers in Southeast Michigan. It is part of Henry Ford Health System
(http://www.henryford.com/), one of the country's leading health care
systems, that integrates primary and specialty care with research and
education.

About Blue Cross Blue Shield

Blue Cross Blue Shield of Michigan (http://www.bcbsm.com/), a
nonprofit organization, provides and administers health benefits to
more than 4.6 million members residing in Michigan in addition to
members of Michigan- headquartered groups who reside outside the
state. The company offers a broad variety of plans including:
Traditional Blue Cross Blue Shield; Blue Preferred, Community Blue and
Healthy Blue Incentives PPOs; Blue Care Network HMO; BCN Healthy Blue
Living; Flexible Blue plans compatible with health savings accounts;
Medicare Advantage; Part D Prescription Drug plans, and MyBlue
products in the under-age-65 individual market. Blue Cross Blue Shield
of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.

About Medco

Medco Health Solutions, Inc., is the nation's leading pharmacy benefit
manager based on its 2007 total net revenues of more than $44 billion.
Medco's prescription drug benefit programs, covering one in five
Americans, are designed to drive down the cost of pharmacy health care
for private and public employers, health plans, labor unions and
government agencies of all sizes, and for individuals served by the
Medicare Part D Prescription Drug Program. Medco, the world's most
advanced pharmacy(TM), is positioned to serve the unique needs of
patients with chronic and complex conditions through its Medco
Therapeutic Resource Centers(R); its diabetes pharmacy care practice,
Liberty Medical; and its specialty pharmacy operation, Accredo Health
Group, Inc. Medco is the highest-ranked independent pharmacy benefit
manager on the 2007 Fortune 500 list. On the Net:
http://www.medco.com/.

About CVS Caremark

CVS Caremark is the largest provider of prescriptions and related
healthcare services in the nation. The Company fills or manages more
than 1 billion prescriptions annually. Through its unmatched breadth
of service offerings, CVS Caremark is transforming the delivery of
healthcare services in the U.S. The Company is uniquely positioned to
effectively manage costs and improve healthcare outcomes through its
6,200 CVS/pharmacy stores; its pharmacy benefit management, mail order
and specialty pharmacy division, Caremark Pharmacy Services; its
retail-based health clinic subsidiary, MinuteClinic; and its online
pharmacy, CVS.com. General information about CVS Caremark is available
through the Investor Relations portion of the Company's website, at
http://investor.cvs.com/, as well as through the pressroom portion of
the Company's website, at http://www.cvs.com/pressroom.

Southeast Michigan ePrescribing Initiative

Drugs for Elderly More Costly, Study Finds

By Kevin Freking
Associated Press
Wednesday, March 5, 2008; D02

Drugmakers increased prices by an average of 7.4 percent last year for the brand-name medicines most commonly prescribed to the elderly, according to the advocacy group AARP.

The increase far exceeded inflation, continuing a longtime trend.

AARP said prices charged to wholesalers have been slightly higher since the Medicare drug benefit started on Jan. 1, 2006. Since then, the outcry over prices has diminished, with the government picking up much of the tab.

"Unfortunately, many manufacturers have taken the absence of an outcry as a green light to go ahead and raise prices even more," said John Rother, AARP's policy director.

The wholesale prices of all but four of the 220 brand-name prescriptions in the study rose last year. Among the 25 most- popular drugs on the list, the sleep aid Ambien, by Sanofi-Aventis, had the largest price increase, 27.7 percent.

The price of Merck's cholesterol drug Zocor did not change in 2007, and the price of Bristol-Myers Squibb's blood thinner Plavix rose 0.5 percent.

The manufacturer's wholesale price is the most substantial component of a prescription drug's retail price. However, insurance companies, such as those that cover Medicare beneficiaries, typically negotiate confidential rebates from the manufacturer, and the plan's customers benefit.

The trade group representing drugmakers, the Pharmaceutical Research and Manufacturers of America, said AARP's numbers reflect neither the true amounts consumers pay for medicine nor a slowing in the growth of drug prices when taking into account generics.

Since 2000, prescription drug prices have increased more slowly than overall medical prices, said Ken Johnson, senior vice president of communications for the trade group.

The government's price index for medicines includes a blend of brand names and generic drugs that represents what "consumers actually buy -- rather than the few selectively highlighted by AARP," Johnson said.

Government economists say about two-thirds of all prescriptions now are generics, a trend that federal officials say has accelerated because of the Medicare drug benefit.

"That's been the good-news story," Rother said. "The plans have done what we hoped they would do, which is shift people to lower-cost generic drugs. However, savings from people shifting to generics are being offset by these higher prices for brand names."

Older caregivers fill the gap

As the pool of aides shrinks, healthy retirees are filling paid and volunteer positions.

By Shari Roan
Los Angeles Times Staff Writer

March 3, 2008

A scarcity of paid caregivers means that, in the future, older people may have to band together to help each other.

Older Americans are already pitching in to care for their more frail or even older counterparts as either paid or volunteer workers. That's because finding younger people to work as caregivers is becoming more difficult.

Demand for home health aides during the next decade is expected to increase by more than 50%, according to the International Longevity Center-USA, a nonprofit research policy organization based in New York City.

Even now, about 20% of adults needing assistance are unable to find either paid or voluntary help, according to a 2006 report from the center.

"There is a real crisis in finding enough people to care for seniors," says Loren Shook, chief executive of Silverado Senior Living, a San Juan Capistrano-based company that specializes in serving older people with memory impairments. The company provides hospice and home care and operates assisted living centers.

But a large group of healthy, older adults who are retired from their jobs might fill the bill.

At Silverado, 12% of the paid staff are people over age 55, says Shook. Some work full time, others part time. Many have flexible schedules that allow for extended time off if, for example, they want to travel or have health needs of their own.

"The labor pool that exists within the senior population is a phenomenal untapped resource," he says. "We're in a world where people age 65 today are generally in good health. They have a lot of energy. These are people who want to make a difference in others' lives."

Seniors who have a caregiver have a five times better chance of remaining in their homes, says Peter Notarstefano of the American Assn. of Homes and Services for the Aging.

Family members aren't always available, but a network of similarly aged friends and neighbors might bridge the gap.

The Naturally Occurring Retirement Community supportive services program in Park La Brea relies on dozens of seniors. Volunteers answer the phone, visit people who are shut in and sit on councils that direct the program's goals and activities, says Sally Miller, a senior living in Park La Brea who volunteers with the program.

"You give, but you receive so much back," she says.

The challenge of aging in place

Making small changes in how one functions in the home can greatly improve the quality of life.

By Shari Roan
Los Angeles Times Staff Writer

March 3, 2008

One piece of the puzzle is missing from the aging in place trend -- healthcare.

The nation's healthcare system is simply not designed to help seniors remain living independently, says Laura Gitlin, director of the Center for Applied Research on Aging and Health at Thomas Jefferson University in Philadelphia. "We know what helps people," she says. "What helps them age in place is not covered by insurers at this point."

Many seniors have chronic health conditions, such as dementia, diabetes or urinary incontinence, and must take multiple medications. But their medical care is often disjointed. Their primary care doctor doesn't have the time to coordinate that care, and nurses, home aides, geriatric care managers and technological devices are rarely covered by insurance.

"Growing old is challenging," Gitlin says. "Our whole approach to geriatric care must be multidisciplined and integrated and coordinated. Only when we have that approach will older people be able to age in place with a good quality of life."

Gitlin published a study in 2006 that tested a relatively inexpensive program to help seniors age in place. The study participants -- normal seniors who were not receiving home care -- received six visits from therapists who identified problems they were having functioning at home and offered coping skills, such as balance exercises or better ways to hold a book. The program provided inexpensive items including bathing devices and home improvements such as handrails.

"These were people who were beginning to experience small changes, such as having difficulty bending down to pick up the mail or reaching the dinner plates or getting in and out of the tub," Gitlin says. "But these very small difficulties compromise quality of life. It's highly associated with depressed symptoms that can lead to social isolation and promote further decline."

The study, published in the Journal of the American Geriatrics Society, found that after one year, 1% of people receiving the intervention had died compared with 10% in a control group. Among seniors who were hospitalized before the intervention (an indication of frailty), there were no deaths in the year after the intervention. The death rate in a control group, however, was 21%.

Homeward bound

A movement is gaining momentum to help seniors retain their independence by remaining in their homes as they get older.

By Shari Roan
Los Angeles Times Staff Writer

March 3, 2008

THE broken rib could have been a disaster for Claire Soroko. She had been saying goodbye to friends Christmas Day when she stumbled from an outdoor step and banged into an iron handrail, breaking a bone in her chest. Afterward, she couldn't clean, drive or even dress herself.

"I really don't have anyone," says Soroko, a Park La Brea resident in her 70s. "My daughter and son-in-law are very busy. I couldn't ask them to come and stay with me."

Such accidents can often mean the end of living independently. Twenty percent of falls among elderly people require medical attention, and serious injuries, such as hip fractures, often require nursing-home care.

But today's older Americans are increasingly adamant in their desire to avoid nursing homes or assisted living. And they now have a movement to back them up. Called "aging in place," it has a beautifully simple premise: Keep seniors safe, well-cared for -- and in their homes.

In Soroko's case, more than 500 Park La Brea residents 60 and older have formed a novel network to ensure that its members can remain in their homes despite illness or physical decline -- homes that many have known since the complex opened during World War II. Soroko called the agency's office upon returning from the hospital. By the end of the day, the staff had lined up daily caregivers, transportation to doctor's visits and the hair salon, and visits from neighbors who brought meals and encouragement.

As the nation's demographic shifts to the old and older, such community associations are at the forefront of redefining how older Americans live. About 10% of Americans 65 and older live in nursing homes, assisted living or residential care settings. But that number rises dramatically among people who reach their 80s or 90s. Americans are living longer than ever--and their ranks are growing. The number of people 65 and older is expected to double in the next 2 1/2 decades as 78 million baby boomers, the oldest of whom are turning 62 this year, enter their golden years.

Together with businesses and technological advances, these associations could change the portrait of growing old in America.

Where the heart is

THERE is simply no place like home -- living surrounded by favorite photographs and worn furniture, familiar smells and the comforting rhythm of the neighborhood, from the thud of the mail arriving each morning to the whoosh of the school bus passing by each afternoon.

"We have an image in our heads that as soon as you retire you sell your home and move to Florida," says Elinor Ginzler, director of livable communities for AARP. "But according to census data, less than 10% of people 60 and older had moved in a five-year period. We're connected to the house we're living in and the neighborhood we're living in."

In fact, 90% of adults 60 and older say they want to stay in their home or community rather than uproot themselves late in life, a 2006 AARP study found.

In the past, there were few resources to help people remain at home amid the problems and frailties of old age. But changing demographics, economics and attitudes are making "aging-in-place" ever more possible.

"The baby boomers are a generation of problem-solvers," says Peter Bell, president of the National Aging in Place Council in Washington, D.C. "We use education, technology and resources to change things -- not just accept them as they are. I think we also recognize we can do things better collectively rather than individually."

Remaining in one's home might even help put the brakes on aging. Older people report a better quality of life, more control, more independence and feeling less stigmatized when they live on their own -- less old, in other words.

Says Peter Notarstefano, director of home- and community-based services for the American Assn. of Homes and Services for the Aging in Washington, D.C.: "I think we have more of an independence mentality now. . . . The seniors now are very different than the seniors 25 years ago. They are more active. Can you see Bob Dylan in a nursing home? I think this generation will want something else."

The marketplace and local governments have begun to respond to these new demands, Ginzler says.

Referrals and requests

THE telephone rings every few minutes in the cozy LIFE (Living Independently in a Friendly Environment) office in building 49 in Park La Brea. Seniors call with questions:

"Can you refer me to a dentist within walking distance?"

"What is the name of that company that installs shower grab bars at a decent price?"

"Can I still sign up for the field trip to the Natural History Museum?"

News filters in. Mrs. Abraham went to Cedars last night with back pain. A new play that seniors might like is showing at UCLA. Mr. Barker is going to visit his daughter in Arizona for two weeks.

A volunteer -- usually another senior living in Park La Brea -- answers the telephone and provides information and referrals. Between calls, the volunteer has a list of seniors to check up on -- friendly telephone calls to battle loneliness and isolation.

Social worker Rosalie Rapas, one of two paid staffers who run the program, handles the more serious stuff, talking to faraway family members concerned about aging parents and making home visits to assess the needs of members. "We are as cutting edge as you can be," Rapas says.

LIFE started in 2005 as a federally funded pilot project designed to see if such communities -- called naturally occurring retirement communities -- could help people remain in place as they age. Loosely defined, the communities are neighborhoods in which a large segment of the residents are older adults. The goal of such a supportive services program is to help these seniors maintain their independence, safety and connection to the community as they age in their own residence. The programs are operated by a lead agency, often a nonprofit organization, but are directed and propelled by the community itself.

"You know the saying, 'It takes a village to raise a child'? Well, it takes a community to support an older adult," says Susan Alexman, director of senior services for Jewish Family Service of Los Angeles, which operates the LIFE program at Park La Brea.

About 80 supportive services programs have sprung up in naturally occurring retirement communities in recent years in the United States, Notarstefano says. About half were funded by Congress as pilot projects. Another elderly services program exists in West Hollywood, and Jewish Family Service is exploring opening another LIFE community in the Valley later this year. Two programs recently opened in the Bay Area, and another exists in San Diego.

Though many programs are nonprofit organizations that do not charge member fees, others are springing up in affluent areas of the country that operate with dues paid by members. One of the first supportive services programs was established by residents in the Beacon Hill neighborhood in Boston in 2000. A nonprofit corporation, Beacon Hill Village operates with annual membership fees that give people preferred access to vendors who have been pre-screened.

Such programs tap into existing services wherever possible -- fitness classes at nearby senior centers and long-established Meals on Wheels programs, for example -- and create new services only when a gap is identified.

The LIFE staff at Park La Brea was initially surprised to find a disjointed community behind the gates. Even though many people had lived there for decades, most didn't know their neighbors. Older adults, roughly 15% of the residents, largely fended for themselves.

The staff began to knit those seniors together. Employees launched several social initiatives, including regular field trips, the telephone call line and a friend-to-friend home visitation program. They also started a balance-and-gait exercise class because a fear of falling was one of the biggest concerns about living alone.

"We found people were hungry for interaction," says Laura Diepenbrock, LIFE program manager. "The neighbors now not only know one another, they can rely on one another in case of emergencies. It's really neighbor helping neighbor."

The model is efficient and cost-effective.

"Maybe all you need is someone to come to the house three hours a day to help with a bath and meal preparation," she says. "That is appealing to people. They decide what they need and how much they want. Feeling in control of the world is one of the best goals."

Keeping LIFE going

PARK LA BREA seniors have grown attached to their program. When it briefly lost its federal funding last year, members worked together to save it, says Sally Miller, 75, a LIFE member who also volunteers in the office. They wrote to lawmakers and sold note cards decorated with their own artwork to raise money. The program survived and has received a fresh infusion of federal funding.

"People feel even more ownership of the program now," Miller says.

Park La Brea has changed because of the program, she says.

"This is a big community," she says. "It's easy to be isolated. This program has brought us a new sense of community and connectedness. You walk around and see people you never would have known if it were not for the program. Before, you might only know a neighbor or two."

shari.roan@latimes.com