Long Term Health Care/Custodial care

As a follow up to my blog of November 15th, I would like to discuss custodial and long term care. As I had mentioned earlier the cost of providing basic care to meet the daily needs for yourself or a loved one can be quite exorbitant. Unless you have an involved family that is able and willing to provide care, or have enough financial resources available the cost of providing care for yourself or a loved one is very difficult indeed. This custodial care could include assistance at home with activities of daily living, bathing, dressing, meal preparation, housekeeping, laundry or shopping or attention to these same basic needs in a nursing home or assisted living facility.

This is particularly difficult because when you are disabled or older and income is limited the greatest need is for long term custodial care. Most long term care is provided by families but few families today can sustain the financial and emotional burden of long term care and contrary to popular belief Medicare does not cover all medical costs and only covers about 2% of long term care.

To determine the average cost for Medicare please check the Medicare Rights Center
http://www.medicarerights.org/newmedicarecosts.html


To be eligible for limited nursing home coverage from Medicare certain criteria must be met:

• You must be in an acute care hospital for 3 days prior to entering a Skilled Nursing Facility. An acute care hospital is licensed by the state to provide skilled care.
• The Skilled Nursing Facility must be Medicare certified to provide care by or under the supervision of licensed personnel.
• Your care under Medicare must be skilled care not custodial. Most nursing home care is custodial not requiring licensed personnel for skilled treatment such as intravenous infusion or skilled rehabilitation.
  
  As indicated in my earlier blog the average yearly nursing home cost exceeds $77,000. The cost at average of $19 per hour for home health aide services added onto costs for medication, deductibles, medical supplies or equipment as well as costs to maintain a household can quickly deplete savings when living on a fixed income.

Medicaid, a national program for individuals and families with low incomes and resources is another alternative to paying for long term care. Medicaid is jointly funded by the states and federal government, and is managed by the states. Medicaid is the largest source of funding for medical and health-related services for people with limited income. While Congress and the Centers for Medicare and Medicaid Services set out the main rules under which Medicaid operates, each state runs its own program. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.

Over 42 million people a year receive assistance from Medicaid but Medicaid guidelines are based on the poverty levels and to qualify for Medicaid, you must meet income and asset limits set by your state. In most states, income must be below $851 a month (individuals) or $1,141 a month (couples). In some states, you can also qualify if health care costs reduce your income to the state limit. Call your State Health Insurance Assistance Program to find out the Medicaid rules for your state and to check eligibility.

Most people when they reach their 50s should consider adding a long-term care policy to their insurance coverage. Long term care insurance can be costly but can provide you with a payout to cover nursing home costs as well as a variety of in-home health care expenses.

It is however difficult to consider paying these high rates at 50 for insurance you may or may not need for another 25 or 30 years. However if purchased later you will face much higher premiums, as well as run the risk of being denied coverage if you have a pre-existing condition. We all look forward to our retirement and believe we will be able to continue to be healthy and independent well into our later lives. People don’t want to think of getting old and disabled. We buy car insurance on the chance of an accident when only one in 240 will use their car insurance, yet at least one in three will use their long term care insurance.

Many things need to be considered when buying long term insurance:

• Cover the catastrophic need. Lifetime coverage is most desirable, since you will not outlive the benefits.
• Know which policy benefits are important to you.
• Pick a long term care company that is financially strong enough and large enough to be around in 20 or 30 years when you need it.
• Consider Cost of Living Adjustment (COLA) Rider to allow your benefits to keep pace with inflation.
• Pick a premium you can afford and purchase a Long Term Care Insurance plan based on your budget. Remember 50% coverage is better than no coverage. It's important to select a policy where you will be comfortable paying the premium not just today but 20 or 30 years from today.
  
  Long-term care insurance is meant to merely supplement your other income sources such as 401k’s, Social Security and retirement accounts.
  
  For more information check AARP report on long term care.
  
  http://www.aarp.org/research/longtermcare/costs/fs27r_ltc.html
  
  
  

Good Health Habits to Prevent colds and flu

The best way to prevent seasonal flu and pneumonia is to get vaccinated each year.

There also are flu antiviral drugs that can be used to treat and prevent the flu but good health habits like covering your mouth when you cough and washing your hands often can help prevent respiratory illnesses like the flu and colds.

Many people equate the cold winter weather with colds and flu and feel that being cold and wet from the chill of winter is what makes people catch colds and flu. This myth must be true because everyone gets sick in the winter, right? No.

Although the cold wet weather of winter is very uncomfortable and the stress of getting around in the snow and ice may reduce our immunity or resistance, it is not the weather that causes our colds and flu. It is germs, bacteria and viruses that cause our misery. As the weather gets colder we spend more time indoors, children return to school and with vacations over more people are huddled closer together as activities move indoors.

This proximity to one another leaves us vulnerable to passing and sharing infections with each other. As the children play at school they pass around germs which they bring home to the family. Cramped buses and trains leave us no where to escape as a sick passenger unwittingly passes germs with each sneeze or cough. At work we cover our mouth when we cough or sneeze but each time we answer the phone, touch the employee coffee pot, our keyboard or the handle to the rest room we share our germs with our coworkers.


Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by coughing or sneezing.

According to the Center for Disease Control, between 10% and 20% of people in the United States become ill with the flu each year. Infants, the elderly and those with immune system conditions are usually at risk but these organisms can have an impact on seemingly healthy folks. About 3 to 6 million people are affected each year.

The World Health Organization estimates that cost of influenza to the U.S. economy in terms of health care costs and lost productivity can range from $71 billion to $167 billion a year.

Below are some basic good health habits to help keep you and your family healthier this holiday season. These are simple things we each can do daily to protect our selves and others.


• Cover your mouth and nose.

Cover your mouth and nose with a tissue when coughing or sneezing and dispose of the soiled tissues properly. Teach your children to use tissues and be sure they have tissues in their schoolbag. If you have no tissues do the sleeve sneeze. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands..It may prevent those around you from getting sick.

• Clean your hands.

Washing your hands often will help protect you from germs. Wash with soap and water or Clean with alcohol-based hand cleaner.

• Avoid close contact.

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

• Stay home when you are sick.

If possible, stay home from work, school, or activities when you are sick. Just as you try to avoid being near sick people to prevent You will help prevent others from catching your illness.

• Avoid touching your eyes, nose or mouth.

Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Don’t use the phone, computer, or desk supplies of a sick coworker. Advise children not to share drinks or toys with sick friends.

• Practice other good health habits.

Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. All of these actions help maintain your immunity to fight off illness. See your doctor for regular checkups, vaccinations, and appropriate treatment to decrease the duration of symptoms.


For additional information see :

http://www.cdc.gov/flu/

Advance Directives for Health Care

Advance directives are documents signed by a competent person giving direction to health care providers about treatment choices in certain circumstances. As a competent adult, you understand your condition and the results your decision may have. Advance directives allow you to verbalize your wishes while you are in a position to make health care decisions. These advance directives tell your doctor what kind of care you would like to have if you become unable to make medical decisions, such as if you are in a coma. If you have not given any instructions, no one will know what you would have decided.

The Patient Self Determining Act requires many Medicare and Medicaid providers such as hospitals, nursing homes, hospice programs, home health agencies, and Health Maintenance Organizations (HMO’s) to give adult individuals, at the time of inpatient admission or enrollment, certain information about their rights under state laws governing advanced directives.

These include:
· the right to participate in and direct their own health care decisions
· the right to accept or refuse medical or surgical treatment
· the right to prepare an advance directive
· information on the provider’s policies governing the utilization of these rights.

The act also prohibits institutions from discriminating against a patient who does not have an advance directive and requires institutions to document patient information and provide ongoing community education on advance directives.

There are two types of advance directives:

· A durable power of attorney for health care which allows you to name a patient advocate or proxy to act for you and carry out your wishes.

· A living will allows you to state your wishes in writing, but does not name a patient advocate.

A living will is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.


A durable power of attorney (DPA) for health care identifies whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A durable power of attorney for health care is a signed, dated, and witnessed legal document commonly called a “health care proxy”. This document differs from other durable powers of attorney in that it is specifically limited to health care and medically related decisions. It might be necessary to also have a durable power of attorney assigned to handle financial issues as well. A financial DPA can access your accounts to assist in payment of your bills when you lack capacity and are unable to do so.

A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. An example would be a do not resuscitate (DNR) order. Advance Directives can also say that you want a certain treatment no matter how ill you are. An example would be to continue feedings.

Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.

Any person 18 years of age or older can prepare an advance directive which allows you to make your preferences about medical care known before you're faced with a serious injury or illness. People who are seriously or terminally ill are more likely to have an advance directive injury or illness to express their wishes and spare their loved ones the stress of making decisions about their care when they are dying. Even if you are in good health an accident or serious illness can occur suddenly and if you already have a signed advance directive, your wishes are more likely to be followed.

Ask your doctor, lawyer or state representative about the law in your state.

Additional information and forms can be obtained from:

AARP Advance Directive Information

601 E Street NW Washington, DC 20049 1

888-OUR-AARP

email: http://www.aarp.org/bulletin/yourhealth/resources_wills.html


U.S. Living Wills Registry

523 Westfield Ave., P.O. Box 2789 Westfield, NJ 07091-2789

1-800-LIV-WILL

email: http://www.uslivingwillregistry.com/


http://www.caringinfo.org/stateaddownload


or call your local health department or state department on aging to get a form.

Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care.

Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.

You may change or cancel your advance directive at any time, as long as you are still able to think rationally and communicate your wishes in a clear manner. Any changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them.

It is a good idea to review your advance directive each year to be sure it still says how you want to be treated and names an advocate you trust.

The Patient's Health Care Bill of Rights

Do you know what to expect from a Health Care Provider or a Health Care Facility?

Do you know your rights as a patient?

In 1997 the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry set up a set of principles that have been adopted by many health care facilities and organizations.

The basics include:

• Respect and Nondiscrimination. You have a right to considerate, respectful and nondiscriminatory care from all health care providers, including your doctors, hospital or medical facility staff or health insurance representatives.

• Information Disclosure. You have the right to know by name all health care providers and to accurate and easily understood information about your health care providers, health care professionals, and health care facilities and health plans. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance must be provided to allow you to make informed health care decisions.

• Choice of Providers and Plans. You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care. This means you can change doctors or hospitals or health care agencies. You can also change health plans or insurance.

• Access to Emergency Services. If you have severe pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.

• Participation in Treatment Decisions. You have the right to receive from your physician your diagnosis, prognosis, and treatment options and any information necessary to give informed consent prior to the start of any procedure or treatment. You have the right to be informed of any alternative or experimental protocols. You have the right to refuse to refuse treatment or to refuse participation in research programs, and you have the right to be informed of the medical consequences of these actions including possible dismissal from a study and discharge from a health care facility or physician’s care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

• Confidentiality of Health Information. You have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician change your record if it is not accurate, relevant, or complete. You have a right to access your medical records and this information must be kept confidential unless disclosure is authorized by you. This is the basis of the Health Insurance Privacy and Portability Act (HIPPA).

• Complaints and Appeals. You have the right to a timely and objective review of any complaint you have against a hospital or health care agency, health care insurer, doctors or other health care personnel. Your individual appeal is usually evaluated by a physician or peer group of health care reviewers that are not affiliated with those involved.
  

Additional information can be found:

President’s Advisory Commission on Consumer Protection and Quality in the Health CareIndustry

http://www.hcqualitycommission.gov/

But as per any right there are also responsibilities. These are the responsibilities suggested by the president’s commission. :

• Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
• Become involved in specific health care decisions.
• Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans.
• Disclose relevant information and clearly communicate wants and needs.
  Use the health plan's internal complaint and appeal processes to address concerns that may arise.
• Avoid knowingly spreading disease.
• Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
• Be aware of a health care provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
• Become knowledgeable about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
• Show respect for other patients and health workers.
• Make a good-faith effort to meet financial obligations.
• Abide by administrative and operational procedures of health plans, health care providers, and Government health benefit programs.
• Report wrongdoing and fraud to appropriate resources or legal authorities
  

Long term Care- The Uncovered cost of health care.

When we consider health care costs, we think of costly procedures or medication. Magnetic Resonance Imaging or MRIs is an example costing $2,000 - $4,000 with doctor’s fees additional. Medications used for anemia such as procrit can run over $6,000 for one course of medication.

What is rarely thought of is the cost of day to day long term care. Most people tend to think they will never need long-term care; however the fact is that more than 60% of Americans are expected to need some form of long-term care at some point in their lives. When they do need long term care, they are not prepared for the financial burden it may cause.

Most Americans believe that their private health insurance or Medicare will cover for all their health care needs. Contrary to this belief, insurance does not cover the greatest need for long term care: custodial care.

When you or a loved one is stricken with a chronic or degenerative condition such as diabetes, cancer, a stroke or Alzheimer's performing simple Activities of Daily Living becomes impossible without the assistance of another person. Chronic illnesses and disabilities require personal care, meal preparation, assistance with bathing and ambulation. This type of care is custodial care not medical care therefore it is usually not covered by health insurance.

Custodial care is a term for care provided to patients on an on-going maintenance basis. Most care at home and the majority of care in nursing homes is considered custodial. Non-medical care that helps an individual with his or her activities of daily living, preparation of special diets and self-administration of medication not requiring constant attention of medical personnel.

MetLife Mature Market Institute reports that the cost of private and semi-private nursing home rooms in the United States increased an average of more than three percent, in 2007.
The average cost of a private room in a nursing home this year was $213 a day ($77,745 a year), compared with $206 a day in 2006. A semi-private room cost $189 a day in 2007, compared to $183 a day last year. This rate generally reflects just room and board in a nursing home with therapies, tests, physician visits and medication charged in addition to the basic rate.

Alaska had the highest nursing home rates ($510 daily or $15,300/monthly) in 2007, while Baton Rouge, La., had the lowest rates ($123 daily or $3690/monthly). I am from New York which averages $ 340 a day or $10,300/ monthly.

Assisted living rates nationwide were $2,969 monthly in 2007 ($35,628 yearly) in 2007. Assisted living rates were highest in the Washington, D.C., area ($5,031 monthly) and lowest in Indianapolis ($1,963 monthly).
Another study by MetLife reported that the national average cost of Home Health Aide Services nationwide was $19/hour and the national average hourly rate for a companion or homemaker is $18/hour. The highest rates being in Rochester Minnesota at $30/hour for Home Health Aide and $25/hour for Companion or homemaker. The lowest rate in Shreveport, Louisiana was $13/hour for Home Health Aide and $12 for a companion or homemaker.

• To find out the cost in your area for Home Health Aide, Assisted Living Facilities and Skilled Nursing Home rates check the following MetLife Studies:

Assisted Living
http://www.metlife.com/WPSAssets/12768452431193759307V1F2007NH.AL.pdf
Home Health Aide
http://www.metlife.com/WPSAssets/56853157701190812646V1F2007ADSHCCStudy.pdf
Skilled Nursing Homes
http://www.metlife.com/WPSAssets/21052872211163445734V1F2006NHHCMarketSurvey.pdf

Medicaid will eventually pay for your long term care expenses; however the benefits only begin after the majority of your assets have been depleted.

In my home state of New York Medicaid does cover custodial care for Home Attendant Services, Housekeepers and Homemakers but Medicaid and most public long-term care (LTC) programs vary from state to state. In most states Medicaid covers custodial care only as long as it is provided within a nursing facility. Custodial care at home is typically covered only under LTC insurance - not by Medicaid in most states.

Medicare, on the other hand, covers only medically necessary, skilled care and will cover at-home custodial care only if it is provided in conjunction with skilled care. This means that as long as there is a need for a registered nurse or therapist to visit intermittently limited Home Health Aide services can be covered by Medicare. Medicare can cover nursing home for up to 100 days a year if there is a skilled need for short term rehabilitation or intravenous antibiotics therapy.

This leaves private pay or long term care insurance as the primary options for care. Even if you are financially independent custodial care can be costly. A Home Health Aide in Rochester Minnesota to cover just custodial care for a loved one or yourself for 24 hours a day would cost $ 720/day or more than a quarter of a million dollars a year. Consider also that almost 60% of the nursing home residents were institutionalized more than a year with the average stay in a nursing home being 2.5 years. In Alaska that length of stay could run almost a half a million dollars.

Long term care options will be discussed in a future article but check out the following sites for information on Long Term Care.

Long Term Care
http://www.investopedia.com/articles/04/112904.asp?partner=answers

http://www.mrltc.com/

Medicare
http://www.medicare.gov/

Medicare Long term care
http://www.medicare.gov/LongTermCare/Static/Home.asp

National Clearing house founded by the US Dept Health and Human Services.
http://www.longtermcare.gov/LTC/Main_Site/index.aspx

War on Health Care

President Bush 2008 Budget has vowed to spend taxpayers’ dollars wisely. He also vowed to make health care fairer, more affordable, more accessible, and flexible.

http://www.whitehouse.gov/infocus/budget/2008/index.html

On October 22, a request was made for a further $45.9 billion in war-related spending for fiscal year 2008. This request is on top of $147 billion already requested for the Department of Defense and $3.6 billion for other agencies for the fiscal year. If appropriated by Congress, the vast majority would be spent on Iraq. Total spending for the Iraq War would rise to approximately $611 billion.

According to testimony by the Congressional Budget Office, if one includes debt service costs in long-term U.S. deployment scenarios, the total cost for U.S. operations in Iraq and Afghanistan will reach between $1.765 trillion and $2.365 trillion by 2017.

The United States accounts for half of all the military spending in the world.
Congress and the White House allocate $522 billion a year to the Defense Budget. The country with the next highest military budget is China with $63 billion dollars per year.


To put it in perspective the proposed spending budget for the Iraq War for the year 2008 is $155.5 Billion but if these tax dollars were put into Health Care could provide 44,330,909 People in the United States with Health Care.

President Bush vetoed the SCHIP Child Health Insurance which could have provided health care for 5 million children. The cost of the Iraq war for the year 2007 is $ 137.6 billion which if spent for children’s health could have covered 58,681,896 children for a year.

To find out the trade off in education, housing, or health care for our defense budget by state or congressional district check out the following site:

http://www.nationalpriorities.org/Trade-Offs.html

Is this the best use of taxpayers’ money, Mr. Bush?
$611 Billion for the Iraq War- YES
Children’s Health Insurance- NO

Children's Health Care -Trick or Treat

On Halloween, President Bush announced that the State Children's Health Insurance Program (SCHIP) reauthorization bill currently pending in the Congress was a "trick." Congress passed bipartisan legislation to expand SCHIP and help children get the coverage they need. The bill would have covered almost 4 million additional children. The federal cost of the program would have been an additional $35 billion over 5 years. The program has helped reduce the number of uninsured, low-income children by one-third. However due to inadequate funding another 6 million children who qualify for SCHIP or Medicaid remain uninsured as a result.

Is the SCHIP reauthorization bill a "trick" or is the president just failing to medically “treat” millions of children? Make your opinion known.