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

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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,