Malden Villiage Concept for Consideration

Malden Villiage Concept for Consideration
Sat, November 21, 2009 8:36:40 PMFrom: Howard McGowan View Contact
To: howard_m_02148@yahoo.com; MSAC OrganizerPam Edwards ; Charles Toomajian
Cc: Malden asst to Mayor Debbie Burke


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Villages are community-based, non-profit organizations that address
the rapidly growing demand among baby boomers and the elderly to
remain living in their own homes among friends and neighbors while
also fulfilling their health care needs related to aging. Each Village
is customized to local needs and preferences providing services and
discounts on anything from groceries and health care to repairs and
transportation assistance. Additionally, Villages organize a host of
social activities. To date, Villages have sprouted up in over 40
communities nationwide.

AGING IN PLACE

I read your article in Malden Observer
As an active member of Mass Senior Action Council in Malden I have been getting interest in an "aging in place"
program for Seniors and their families in Malden.
I have been in contact with the Mayor, City Councillors and Chamber of Commerce along with our non-profits
charged with Senior service and have had some interest in proceeding.
The program envisioned is modeled after the Beacon Hill Villi age concept and you can get info at their Web Site if you have any
interest
Your input would be appreciated.


--
Howard McGowan
MaldenSenior

Home Care in Medicare

Home Care in Medicare
We at Mass Senior Action have been advocating for Home Care VS nursing home care.
We have pointed out the reasons and the disparity in costs with the gap between costs of Nursing homes with keeping the Seniors in the home care system
We now are deeply disturbed to find that the Home Care Industry now seems to be taking advantage of the fact that this differece in cost is a fact and are taking undue advantage by making unreasable increases in the overburdened health care costs
without regard for the clients services.
This was pointed out in the following article in the New York Times Editorial
We must take action here in Massachusetts to protect those in Medicare from
being taken advantage of by the faulty system. Our Seniors are more vulnerable after hospitalization or when needing home care to avoid hospitalization under the presents action of the Home care Industry.
We have made our wants known to the Governor and the Massachsetts State Legislators
with a rally at the State House now lets follow through.
We look for adaguate funding but we should also urge our representatives to look to accountability.
Lets get our membership and the General public to express an opinion on this issue

March 23, 2009
Editorial
Costly Home Health Care
Health care reformers have long advocated providing more care to patients in their own homes or communities instead of treating them in costly institutions like hospitals and nursing homes. So it is disturbing to learn that charges have risen well above reasonable levels in one segment of the home health care market — short-term care provided to Medicare beneficiaries after, or sometimes instead of, hospitalization. The problem is compounded by fraud.

In its annual report to Congress this month, the Medicare Payment Advisory Commission, a group of independent experts, concluded that home health agencies have been paid significantly more than their cost of providing the services in recent years. Their average margins were about 16.5 percent a year between 2002 and 2007, and, even after some rate adjustments, are expected to exceed 12 percent this year in the midst of a recession. Experts say there is room to reduce payments substantially without harming the provision of such services as skilled nursing care, physical or occupational therapy, speech therapy and medical social work.

The overpayment problem is exacerbated by fraud and manipulation, according to a report issued recently by the Government Accountability Office. The G.A.O. looked at seven states that experienced the highest growth rate in Medicare home health expenditures from 2002 through 2006 and found a substantial number of abuses. These included overstating a beneficiary’s condition to get an improperly high reimbursement, billing for patients who were not homebound and thus not eligible for home health care, and making unnecessary visits.

Some of the worst abuses were in Texas and Florida, where spending growth was highest. In Houston, more than 90 percent of the beneficiaries reviewed in one audit had improperly been given the most severe clinical rating. In Miami-Dade County, a disproportionately high number of diabetics were getting skilled nursing visits every day to administer their insulin shots despite lack of evidence that they needed any help; some were coached on how to lie about their need for assistance.

Federal officials are taking steps to reduce fraud, and Congress is pushing them to do more. The bigger cost issue — paying too much across the board for home health services to Medicare beneficiaries — would largely be solved by President Obama’s budget proposals. His budget plan calls for saving a hefty $37 billion over the next decade by reducing Medicare’s projected home health care expenditures in order to help finance his broader health care reforms.

Home health care companies are already complaining that the cuts will hurt patients, but their industry is one of the most profitable parts of Medicare; it needs to do its fair share to curb the relentless surge in Medicare spending. If the nation’s health system is to move toward greater reliance on home care, it needs to be sure it is paying the right price.

Howard McGowan
349 Pleasant Street
Malden, Ma 02148
781 324 8076

PERSONAL HOME ARE AIDES

OPINION FROM NY TIMES ARTICLE FOR CONSIDERATION OF OUR HOME CARE COMMITEE MASS SENIOR ACTION.
Time for action within the present administration to open the dialog

In its last days in office in 2001, the Clinton administration proposed a revision to the labor rules to allow federal protections to apply to personal home care aides, but the Bush administration promptly threw that out and reasserted the status quo. A 2007 Supreme Court ruling upheld the rules, and a push that year by House and Senate Democrats to pass a bill to update the law went nowhere.

According to the Labor Department, personal and home care aides are expected to be the second fastest-growing occupation in the United States from 2006-2016, increasing by 51 percent, slightly behind the expected growth in systems and data communications analysts.

Most home care aides are women, low income and minority, and many of them are immigrants. Some states have taken steps to provide them with basic labor protections. Efforts to unionize home care workers in some states also has led to wage gains and better conditions. But the progress is incomplete without a federal law to recognize and protect the home care work force. It is unconscionable that workers who are entrusted with the care of some of the nation’s most vulnerable citizens are themselves unprotected by basic labor standards.

It is also unwise, because poor pay for long hours leads to high turnover, which undermines the quality of care. Turnover also drives up the cost of providing home care — a needless drain on Medicaid, which pays for many home care services. And that is not the only way that poor quality home care jobs end up costing taxpayers. Nearly half of home care workers rely on food stamps or other public assistance, so taxpayers ultimately compensate for their low pay and inadequate benefits.

Medicare coverage of home Care

Medicare coverage of home care may be limited.
All four of the following criteria must be met before a client can receive Medicare home health care:

A doctor must decide that care at home is necessary and make a plan of care that the staff of the home health care agency will carry out. The doctor will work with the home health care nurse to decide what kind of services are needed (including medical equipment and special foods), how often the services are needed, and what type of health care professional should provide these services. The plan may also include what the doctor expects from the treatment. The client will receive home health care as long as he is eligible and as long as the doctor says he needs it.


The client must need either intermittent (part-time) skilled nursing care (performed only by a registered nurse or licensed practical nurse), physical therapy, or speech language pathology services. There are limits on the number of hours per day and days per week the client can receive skilled nursing care.


The client must be homebound. This means he/she is normally unable to leave home except for infrequent short visits or to get outside medical care.


The client must receive care by a Certified Home Health Care Agency approved by Medicare,

Seniors At Home:A continuim of Care for every need

Amy Rassen, LCSW
The hospital discharge planner has a problem. Despite her most persuasive efforts, your patient, Mr. J., an 88-year-old with a broken leg and no friends or relatives to care for him, is adamant. He will not go to a board-and-care facility; he wants to go home. To resolve this impasse, you contact the Seniors At Home division of Jewish Family and Children's Services (JFCS) to do an assessment and either provide Mr. J with home care support, or help him make the transition to a board-and-care or assisted-living facility.

How Seniors At Home Solves the Problem
Sounds simple? Unfortunately, in addition to his physical injury, Mr. J. is also in the early stages of dementia. Consequently, he is unable to remember how long he has lived in his apartment, how much money he has, or even what bank he uses.

A Seniors At Home care coordinator (geriatric care specialist) meets with Mr. J. at the hospital and learns that he has a neighbor who has, on an informal basis, been helping him with bill paying. Later that day the care coordinator meets with the neighbor to enlist his continued involvement and support and works out a formal arrangement for the neighbor to assume durable power of attorney for Mr. J., with oversight from Seniors At Home, to help manage his financial affairs.

Through the neighbor, Seniors At Home also learns that Mr.J.'s house has not been cleaned for some time and has become not only unhealthy, but also dangerously cluttered for someone in Mr. J.'s physical and mental condition. Accordingly, the care coordinator arranges for a grant to pay for a single heavy cleaning prior to Mr. J.'s release from the hospital.

This accomplished and the support of the neighbor in place, Mr. J. is able to move back home to a safe, familiar living environment. To help him maintain independent living, the Seniors At Home care coordinator arranges for a home care worker to help Mr. J. on a regular basis with housecleaning, laundry and meal preparation. A Seniors At Home escort driver is also provided to take Mr. J. to doctors' appointments and shopping and he is able to remain safely at home until his death several years later.

This care is typical of hundreds of clients Seniors At Home handles each year-referred to us by physicians, health plans, hospital staff, family members and friends of the Bay Area's elderly. For the senior, Seniors At Home is affordable. Often health plans or long-term care insurance pays for these services and we have a sliding scale for people who pay privately.

Options: Staying At Home or Assisted Living
Luckily for the seniors who live in the Bay Area, many options are available to them. Our goal at Seniors At Home is to carry out the wishes of the seniors and their families, either helping them live safely at home or helping them move to a facility with an appropriate level of care. The Seniors At Home team of professionals works with seniors and their families-often in the language of their choice-to create a personalized assessment and a plan of care designed to meet their unique individual needs.

Staying At Home
Care provision at home is the method of choice for most elderly, so much so that Americans spend $100 billion a year out of their own pockets and 26 percent of caregivers spend up to 10 percent of their monthly income on caregiving. Twenty-six percent of home health and home care expenses for the elderly are paid out-of-pocket; 28 percent are paid by Medicare; 23 percent are paid by other government sources and 23 percent are paid by Medicaid.(1) Community-based care (versus institutional care such as skilled nursing facilities) has developed and expanded rapidly in the past decade. As a result of the increasing number of women in the work force-our country's primary caregivers for both children and elderly-fewer women are available to assume the on-site support of their aging parents. Increasing numbers of elderly are forced to rely less on "informal" support mechanisms and more on "formal" support systems.

Seniors' problems and needs vary greatly, too. If frail, they may need help with daily chores and transportation. If homebound and isolated, they may require ongoing care management as well as volunteers to bring them warmth and caring. If well, they may feel depressed because someone close to them died and need counseling. And if poor, they may need financial support including help with food and shelter. But regardless of their individual circumstances, they all need to feel that the community cares about them, understands their special needs, believes in their inherent value and is committed to providing services that are culturally appropriate and responsive. This is what we do at Seniors At Home.

Working with the physician, the senior, and his/her family members, our care coordinators arrange for and monitor the full spectrum of services needed to create a comfortable and safe environment and enable your patient to successfully manage at home. This involves using your patient's own informal network as well as community resources, such as Meals on Wheels or Paratransit, enrolling him/her in adult day health centers and providing private home health aides, counseling, and even durable medical equipment-everything that is needed to fulfill the agreed-to plan of care. Especially helpful to many seniors is our corps of dedicated community volunteers who provide companionship and help with out-of-the-home errands, transportation to medical appointments and reassurance through telephone contact.

Assisted Living
The unprecedented growth of the retirement industry is another reliable indicator of the shift from informal to formal care arrangements. Once only for the poor, senior services and senior housing complexes are developing all over the Bay Area. Most congregate and assisted living facilities are geared toward the moderately healthy senior who is financially independent, approximately 80 years old, requires some help with activities of daily living, but is no way immobilized.

Since Medicare and Medicaid do not pay for assisted living, accessibility to assisted-living facilities is restricted to seniors with the ability to pay an average of $3,500 to $4,500 per month for rent, food and services, or to those with several hundred thousand dollars to purchase their living unit at a life-care facility. These seniors now frequently choose assisted living settings before they experience declining health. It is the "next step" for those seniors who want the security of 24-hour professional staff, three meals a day, easy opportunities for socialization and help when they need it.

Seniors At Home Continuum of Care
Seniors At Home's continuum of care for seniors is both comprehensive and substantive and includes an extensive range of services that help seniors to live at home with a quality of life appropriate to their age and health. In-home assessments, long-term care planning, home care and skilled care, care coordination, counseling and bereavement services, money management (including conservatorship), adult day health, volunteer services and most recently, assisted living at Rhoda Goldman Plaza (2) are some of the many services that are available through Seniors At Home.

Rhoda Goldman Plaza is a residential community located at 2180 Post Street in San Francisco. The building is a well-appointed, seven-story, competitively priced rental community with 155 one- and two-bedroom residences, studios and alcove apartments. For the ever-growing number of elderly with dementia or Alzheimers, the Terrace, located on the fourth floor, is designed with suite-style rooms clustered in neighborhoods with additional staff available for personalized care and supervision. It offers many resources to nurture independent living. Residents are also able to take full advantage of Seniors At Home services because JFCS is located right next door at 2150 Post Street.

Amy Rassen, LCSW, is the associate executive director of Jewish Family and Children's Services of San Francisco, the Peninsula, Marin and Sonoma Counties. She initiated the SeniorsoAtoHome managed care division and has been responsible for ensuring its growth throughout JFCS' five county service area. She is responsible for the quality of services and new program development in a $24 million multi-county agency with 16 offices, 40 programs and over 800 staff. She provides vision, direction and leadership for strategic planning, priority setting and program development. She also develops and ensures revenue-generating streams, including fee for service income and grant funding, and is on multiple local and national boards of directors and task forces. Her phone number is 415/449-1219 and e-mail is arassen@jfcs.org.

References:
1. Through the Medicaid 1915 ( c ) waiver program, states provided home care services to approximately 135,000 aged and disabled persons in 1991. The Long Term care Campaign, P.O. Box 27394, Washington, D.C., 20038. 1996.
2. Rhoda Goldman Plaza was founded by JFCS and Mt Zion Health Fund and is incorporated as a non-profit licensed residential care facility (RCFE# is 385600125).