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April 1, 2008
Advocacy Kohl and Schumer Introduce Our Housing Bill Senators Herb Kohl (D-Wis.) and Charles Schumer (D-N.Y.) introduced the Section 202 Supportive Housing for the Elderly Act, which AAHSA initiated to promote new construction and preservation of affordable housing for seniors and facilitate the conversion of existing 202 facilities into assisted-living facilities. The bill is similar to legislation already passed by the House, but several provisions have been strengthened. Now, the legislation needs as many cosponsors as possible in order to get it to the Senate floor for a vote. Please contact your Senators and ask them to sign onto this vital legislation. Contact: Alayna Waldrum, (202) 508-9476 or Nancy Libson, (202) 508-9447. So Far So Good on the 2009 Budget The House and Senate have passed fiscal year 2009 budget plans that rejected most of the cuts President Bush had proposed for funding of Medicaid, senior housing and Older Americans Act programs, although there is a worrisome provision for a six-year, $1.3 million reduction in Medicare. Many of you contacted your legislators urging them to adopt a budget plan that fully supports services for aging Americans, and these messages have been enormously helpful. Our work isn't over yet. Now, members of the House and Senate still must resolve differences in their resolutions to develop a final version. Please keep using our Contact Congress and reach out to your legislators today. Contact: Marsha Greenfield, (202) 208-9488. President Bush Releases Plan to Curb Medicare Costs President Bush was required to issue his recommendations for legislation to cut Medicare costs as a result of the Medicare "trigger" being reached. The President's plan includes: introducing value-based healthcare into Medicare, revising healthcare liability laws, and reducing the federal subsidy for Part D prescription drugs (thus increasing prescription costs for some Part D enrollees). As a rule, the President's plan must be considered by Congress with a vote coming by June 2008. Senate Aging Committee Holds Hearing on Rx Drugs The Senate Aging Committee recently held a hearing to gather information to help Senate Special Committee on Aging Chairman Herb Kohl (D-Wis.) and Sen. Richard Durbin (D-Ill.) create legislation that they intend to introduce in the spring that would "create a federal academic detailing program, which would provide physicians and other prescribers with evidence-based, objective information on prescription drugs." This legislation is in response the claims by many that pharmaceutical companies often misrepresent their product to physicians in an effort to persuade the doctor to prescribe the drug to their patients. Many believe that the tactics used by some pharmaceutical representatives are questionable and should be investigated to ensure that older adults are being prescribed the correct medication. Medicaid and Medicare News Medicaid Waivers Can Help Fund Home Care for Older Adults The nation's governors met at their annual meeting on February 24th in Washington to discuss how to use Medicaid waivers to fund home care for older adults. The experts met before Vermont Gov. Jim Douglas, a Republican, and New Jersey Gov. Jon Corzine, a Democrat, both of the governors' Health and Human Services Committee. It was agreed that moving a patient from a nursing home into their own home does reduce costs, but there was debate about the 'woodwork effect,' where, if you provide benefits to people in their homes, a lot more people may claim the benefits than would have gone into the nursing home. Vermont, which allows Medicaid patients to receive home care, has not experienced this problem. It was reported that controls can be put in place to reduce the "woodwork effect", such as placing patients with "lighter-care needs" on a waiting list and using a screening process that grants monthly allowances to patients to purchase in-home services. For more information contact Peter Notarstefano, (202) 508- 9406 or Morgan Gable, 202 508-9427. Study Finds that Medicaid Funded Home Care Reduces Nursing Home Use A recent study has found that states with high funding for home and community-based services, like the state of Oregon, experience less of a use in nursing home care. Many of the nursing home stays that did occur in this situation were a result of needing acute care or end of life care. The study, entitled, "Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002," was conducted by Mathematica Policy Research for the Office of Disability, Aging and Long-Term Care Policy for the U.S. Department of Health and Human Services. Please review the entire study. Reduction in Medicaid Payments Would Cost States $50 Billion In response to recent Medicaid regulations released by CMS, state Medicaid directors are claiming that the new regulations would cost states $50 billion over the next five years. CMS has countered that the numbers are not accurate, insisting that the OMB's estimate of $15 billion over five years is more on the mark. The regulations that would cause a cut in reimbursements include: restrictions on payments to public and teaching hospitals; narrowing Medicaid coverage for outpatient hospital services, rehabilitation services, school-based administrative and transportation services, and case management services; and restricting how states raise funds for Medicaid. The shifting of more Medicaid costs to the states could result in a reduction in the availability of home and community-based services. For more information contact Peter Notarstefano, (202) 508- 9406 or Morgan Gable, 202 508-9427 Per-State Cost of Impending Medicaid Regulations The House Committee on Oversight and Government Operations has issued a report detailing the amount of federal Medicaid funding each state stands to lose due to seven Medicaid regulations promulgated by CMS. These regulations include the new restriction on targeted case management and the elimination of intergovernmental transfers (IGTs). Congress imposed a moratorium on the IGT and other regulations last year, but that delay will expire at the end of May. The Senate recently adopted an amendment that would impose a similar moratorium on the targeted case management regulation, which is already in effect. We oppose these administrative efforts to cut federal Medicaid funding at a time when many state Medicaid programs are feeling the dual stress of falling state revenues and increased demand from those who have lost jobs and employer-provided health insurance. We are working with members of Congress to prevent these damaging regulations from going into effect. Read the report. Note that CMS questions the calculations contained in the report and disputes its credibility. For more information. Peter Notarstefano, (202) 508- 9406 or Morgan Gable, 202 508-9427. Four States Challenge Targeted Case Management Rule The state Medicaid agencies of Maine, Maryland, New Jersey, and Oklahoma filed suit against the federal Department of Health and Human Services on February 29, asking the U.S. District Court for the District of Columbia to strike down a new rule restricting reimbursement for case management services. The interim final rule, which went into effect March 3, will cost Maine $16 million over the next two fiscal years. States are concerned that the TCM rule will limit state flexibility to provide effective case management. For more information. Peter Notarstefano, 202 508-9406 or Morgan Gable, 202 508-9427. Medicare to Reimburse Anticoagulation Monitoring Machines Medicare has decided to reimburse for home anticoagulation monitoring machines and supplies in order to help people on Coumadin better monitor their INR numbers. The testing is similar to how diabetics check their insulin levels. Microsoft, Google, and RevolutionHealth are all quickly trying to develop technologies that will help individuals accurately check their medication levels while also reporting the results to doctors, thus decreasing the number of doctors appointments. Critics of these machines cite various difficulties with home monitoring, including a lack of ability to transmit data directly to a physician and a lack of training to show older adults how to properly use these devices. Private Medicare Plans May Cost More Then Traditional Medicare The GAO has found that many private plans (Medicare Advantage) are more expensive than traditional Medicare in terms of paying for home health care, nursing homes, and hospital stays. Currently there are 9 million people who have Medicare Advantage plans across the United States. CMS and the Bush administration claim that these MA plans save an average of $1100 in costs and services. It is projected that 27 percent of all Medicare beneficiaries will be enrolled in a Medicare Advantage plan by 2017. Critics of the GAO numbers insist that MA plans are good for those with a low income because it prevents them from having to purchase expensive, supplemental policies. Medicare Will Still Cover Heart Scans In a reversal of an earlier decision, CMS has announced that it will continue to cover a popular heart scan used to identify heart disease. The scan, a type of CT scan, can cost more than $600 in some cases. Opponents of CMS's plan to continue coverage believe that more studies need to be completed to determine the effectiveness of the tests. However, proponents have argued that studies have already been done that confirm that the test does in fact detect heart disease. Adult Day Services An article entitled, "Growing old, but with choices" in the LA Times, discussed the many changes that are taking place in adult day services. Businesses, technology, and governments are becoming involved in providing innovative adult day services to continue to foster the "aging in place" movement that is gaining more and more recognition across the country. Please read this article in the LA Times. Information for Older Adults on How to Receive Stimulus Check Filing the REQUIRED 1040A for low-income seniors who are eligible to receive economic stimulus checks (up to $300 for individuals and $600 for couples) can prove to be a daunting task. An excellent idea for an adult day center would be to have a "Stimulus Check Day" where a volunteer, or someone from a free tax assistance organization, is available to help older adults fill out their 1040A form. Low- and moderate-income workers, including veterans, can receive free tax help through the Volunteer Income Tax Assistance (VITA) program by calling 1-800-906-9887 to locate the nearest VITA site; The Tax Counseling for the Elderly (TCE) Program provides free tax help to people age 60 and older. To find the location, dates and hours of the closest TCE site, call the IRS toll-free number at 1-800-829-1040. Also, as part of the TCE program, AARP offers the Tax-Aide counseling program at many sites nationwide during the filing season. To locate the nearest AARP Tax-Aide site, call 1-888-227-7669 or visit AARP's Web site. Many who need to file will only need minimal assistance filling out the paperwork which could easily be provided by an adult day care center volunteer! For more detailed information on how to file. Home Health Care How to Recruit and Retain Case Managers in HHA According to an article published by Home Health Line, there are several innovative ways to recruit and retain quality case managers in a Home Health Agency. They have found that allowing for case managers to have a flexible schedule is beneficial. Suggestions they give regarding the implementation of flexible schedules in HHAs, include: using a "mini-team model" to ensure continuity of care, not expecting all case managers to want the same schedule, being open to different start and end times, and promoting flexibility during the hiring and recruiting process. Home Care Jobs to Increase Dramatically as Boomers Age As baby boomers age, jobs in the home care industry are expected to continue to increase by more than 50 percent from 2006 (767,000 workers) to 2016 (1.7 million workers). In addition to general home care programs, the need for financial services and financial planning is also emerging as boomers plan for their retirement. Hospice/End of Life Care MedPAC Eyes Growth of Hospice Spending Warily The Medicare Payment Advisory Commission (MedPAC) is questioning the rising costs of Medicare spending on the hospice benefit, a benefit designed to ease suffering in the last stages of life and to serve as an alternative to intensive treatment. The amount that Medicare has spent on hospice has tripled between 2000 and 2007, currently totaling about $10 billion yearly. One of the many contributing factors to the rise in expense is growing lengths of stay for hospice care. The lengths of stay grew an average of 30 percent between 2000 and 2005. Many of the commissioners believe that for-profit hospices are achieving excessive payment margins in comparison to margins at not-for-profits. The commissioners discussed many ideas as to how to decrease the profit gap between these two provider types. News from the States California The Harden Foundation was established to assist charitable organizations in Salinas Valley, California. They have recently funded grants for equipment (automated external defibrillators, portable pulse oximeters, and more) for an adult day center in the area. For more information on future grants. Connecticut Governor M. Jodi Rell is encouraging Connecticut residents to visit the Connecticut state site for information to help them deal with long-term care issues. The site offers information on home and community-based services, affordable housing, legal issues, planning options for long-term care, and a directory of long-term care-related providers. Connecticut Adult day center managers are advocating to the state to provide more money for adult day centers. There are currently 50 certified day centers, but many are shutting down due to insufficient state reimbursement rates. The current state rate is at $63.55 per day. It has been reported that the daily cost of paying to take care of an older adult in Connecticut is $78. Transportation costs have been identified as one of the leading factors causing the increase in costs to the provider of adult day services. Connecticut The Connecticut state legislature is considering Senate Bill 561, to expand the Money Follows the Person demonstration project and establish a long-term care trust fund to provide funds to finance long-term care. State Representative Kevin M. DelGobbo (R-Naugatuck) co-sponsored the legislation and is an ardent proponent of the Money Follows the Person program. The current programs serves 700 Medicaid recipients, and the new bill would authorize funds to provide another 5,000 people with the opportunity to choose home and community-based services over nursing home placement. To read the entire Senate Bill 561. Iowa Iowa's Deputy Attorney General, Tom H. Miller, is requesting additional resources to combat his state's escalating elder abuse problems. Many of the instances of elder abuse, including a recent spike in financial abuse, often go unreported in Iowa. In addition to an increase in general funds, Iowa is also looking to hire a full-time prosecutor and a full-time investigator to work on elder abuse in the state. Kentucky Medicaid services will soon be approved for Kentucky adults who have suffered a brain injury in an effort to keep them in their own homes and out of nursing homes through a Medicaid waiver that was recently approved by CMS. The money would help 65 people live in apartments or group homes with staff and nurses, and also provide financial support to another 135 people who currently live in their own homes to obtain adult day care services, home health, and housekeeping. Nebraska Nebraska unveiled a new Long Term Care Savings Plan that is the first state-initiated long term savings plan in the United States. The plan, according to Nebraska State Treasurer Shane Osborn, provides tax incentives for Nebraska citizens to enroll, and each participant can save up to $165,000 tax-free for the life of the account, adjusted for inflation. They can use the account for either savings or investment. To read the article and also get more specifics about the plan. New York As part of a study conducted by AARP, more than half of Westchester County residents have expressed their desire to age in place. Westchester County is unveiling a livable community initiative to help residents achieve that wish. Nine Livable Community Connection sites have been set up as part of the initiative to determine which factors and issues that they need to focus on to help keep older adults in their communities. Read a copy of the AARP report. North Carolina The Department of Social Services is taking applications for its Community Alternatives Program, which helps Medicaid-eligible patients get home and community-based services. The Department allotted $3 million for the program, and still has $1.5 million left for this year. The Cabarrus County program still has room for an additional 118 participants. All participants in the program will also receive case management services and will be assigned a social worker to help them coordinate care. Learn more information on the Cabarrus County program. Ohio and Pennsylvania Ohio and Pennsylvania are now involved with the "Own Your Own Future Campaign" designed by the HHS, CMS, and AoA to raise awareness and provide education on the importance of long-term care. Ohio is starting by giving free in-home consultations on long-term care and Pennsylvania is creating an education and outreach program. There are currently sixteen other states that are already in the campaign. For more information on the "Own Your Own Future Campaign" in OH and PA. Ohio The Ohio Department of Aging is expanding its "Choices Medicaid Waiver Home Care Program" to include Toledo-area counties in addition to the 26 counties that are already a part of the program. Eligible recipients must be at least 60 years old and capable of deciding which services they need and directing and hiring those providers that they choose. Oregon Oregon will hold a lottery to add 3,000 uninsured, low-income residents to its Medicaid program. Its current enrollment limit of 24,000 residents has dipped below that level, so state officials will add 3,000 more people by conducting a lottery by choosing them from the 91,675 uninsured people currently on the reservation list. Tennessee Governor Phil Bredesen highlighted the importance of the Long-Term Community Choices Act of 2008 as a way to reform the state's current system of caring for older adults. According to an article in the Chattanooga Times Free Press, "Plans call for a dramatic expansion of the state's home- and community-based services waiver program, which now covers 2,700 people with "wrap around" services such as house cleaning and Meals-on-Wheels-type programs. Over the next six to 10 years, officials hope as many as 50 percent of people needing long-term can remain in home settings." Read the entire article about Long-Term Community Choices Act of 2008. Virginia Residents of three counties in western Virginia won't have to travel far to access screening, diagnostic, care and educational services from the University of Virginia (UVA) Health System. Using a $63,537 grant from the Verizon Foundation, UVA is expanding its telemedicine services to more than 11,000 patients served by clinics in Nelson, Dickenson and Grayson counties. In addition to receiving more services, clinic patients will wait only two weeks, instead of several months, for an appointment with a specialist. Read more information about services available. News, Resources, and Publications Resources Available to Enhance Quality Whether you provide transportation or in-home services, the Leading-Edge Care and Services section of the Quality First Web site can provide you with resources to enhance the quality of care and life for the people you serve. Please review to see what is available. Cultivating Emerging Leaders in Aging Services… Apply Today for the Leadership AAHSA Class of 2009 Leadership AAHSA offers a challenging and engaging year-long learning experience, designed to help aging services professionals accelerate their leadership development so they are better equipped to serve our field and bring this knowledge back to their sponsoring organizations. Fill out an application to apply for the Leadership AAHSA Class of 2009. Strengthening the Role of Family Caregivers in Low-Income Housing IFAS will soon be developing and evaluating a training program aimed at strengthening the role of family members who care for older adults living in independent, publicly subsidized housing communities. Read more on family caregivers caring for older adults in Low-Income housing. 1 in 8 Baby Boomers Will Get Alzheimer's Disease A new study has been released by the Alzheimer's Association that states that 5 million older adults already have Alzheimer's and they believe that 10 million more Baby Boomers will be diagnosed with this debilitating disease. They are also projecting that by 2050, there will be one million new cases yearly. Some of the other startling statistics revealed by the study include: every 71 seconds, someone in America develops Alzheimer's, women are almost twice as likely to develop the disease, there are 1 to 1.4 million "long distance caregivers" in the US providing care for relatives with Alzheimer's, and Alabama leads all states with an 8 percent increase from 2000 to 2010 in the number of residents diagnosed with Alzheimer's. Please read the full report on Alzhemiers. Grant Opportunities/Funding Sources Grants Available from the Brookdale Foundation Group The Brookdale Foundation Group has sent out an RFP to anyone interested in forming a "social model Group respite" program for those with Alzheimer's and their family caregivers. The Brookdale Foundation Group will give out a total of 40 grants, $7,500 each for the first year, with a possible $3,000 for the second year. Proposals are due July 2, 2008. The proposals must be based on 2 separate Brookdale Foundation manuals. Order the manuals and get more information on the Brookdale Foundation. Grants Available from Autodesk Worldwide Community Relations Autodesk Worldwide Community Relations has recently given grants to an adult day provider to help fund their Tai Chi program. Established in 1989, the Autodesk Community Relations program offers assistance to qualifying nonprofit organizations through monetary donations, in-kind contributions and volunteerism. Learn more about possible future grants. Funding Available Through the Lilly Endowment The Lilly Endowment Inc. is an Indianapolis-based, private philanthropic foundation created in 1937. It recently funded a major expansion of an adult day center. While the Endowment mostly supports non-profits and charities in Indiana, it has sponsored other major projects in the past. To find out more about the Lilly Endowment. UPCOMING MEETINGS AAHSA Annual Meeting October 12th to October 15, 2008 Philadelphia, PA View past issues of the HCBS Report. AAHSA · 2519 Connecticut Ave. NW · Washington DC 20008 · www.aahsa.org
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