Category Archive

On Wednesday, the House Committee on Energy and Commerce is expected to mark up H.R. 6357, the Protecting Records, Optimizing Treatment and Easing Communication through Healthcare Technology Act of 2008.

The measure, also known as the PRO(TECH) Act, was introduced by Rep. John D. Dingell (D-Mich), who said he introduced the measure in an effort to give “the federal government a leadership roll in developing communication standards that allow for the electronic communication between providers, health insurers and others.” Dingell said the bill would “extend federal privacy laws” to reduce the number of new entities able to stockpile electronic health information, while making the U.S. healthcare system more efficient.

According to the representative, would encourage a nationwide adoption of a health information technology (HIT) infrastructure as well as encourage members of the health care community, such as doctors, hospitals, insurers, to utilize electronic exchange of health information.

H.R. 6357 also would make the Office of the National Coordinator for Health Information Technology (ONCHIT) a permanent entity at the U.S. Department of Health and Human Services (HHS).

Finally, Dingell’s bill would push for the use of an electronic health record by each person in the United States by 2014.

“Your grocery store automatically knows what brand of chips you bought last year, but your cardiologist doesn’t automatically know what prescriptions your family doctor prescribed for you yesterday.” Dingell said. “That’s problematic for healthcare quality and costs.”

Another way to ensure that long-term care financing reform is included in the platforms of the Democratic and Republican parties is to contact the members of the parties’ respective platform committees.

The members of both committees are listed below. If you are connected to these individuals, please consider sharing your version of the AAHSA platform statements with them by Aug. 1. If you’re affiliated with a not-for-profit organization, it’s important to identify yourself as an individual and not a representative of the organization that you serve.

Republican Platform Committee:

• Republican National Committee Chairman Mike Duncan
• Committee Chair U.S. Representative Kevin McCarthy
• Committee Co-Chair U.S. Senator Richard Burr

Democratic Platform Drafting Committee:

• U.S. Representative Tammy Baldwin
• State Representative Dan Blue of North Carolina
• Maryland Lt. Governor Anthony Brown
• Columbus Mayor Michael Coleman
• U.S. Representative Rosa DeLauro
• DNC Secretary Alice Germond
• Michigan Governor Jennifer Granholm
• Donna Harris-Aiken, a National Education Association Policy Advisor
• Platform Policy Advisor Heather Higginbottom
• Platform Policy Advisor Chris Jennings
• Florida Tallahassee Commissioner Allan Katz
• AFL-CIO Policy Director Thea Lee
• UFCW Local 1428 President Connie Leyva
• U.S. Representative Patrick Murphy
• Speaker Emeritus of the California State Assembly Fabian Nunez
• Obama for America Foreign Policy Advisor Susan Rice
• U.S. Representative Linda Sanchez
• Youth Representative Giancarlo Sopo of Florida
• Ron His Horse is Thunder, Chairman of the Standing Rock Sioux Tribe of North Dakota.

Democratic Platform Standing Committee:

Chairs

• Patricia Madrid
• Judith McHale
• Deval Patrick, Governor

Members

• Danny Abraham
• Elizabeth Frawley Bagley
• Tom Buffenbarger
• Rev. Tony Campolo
• John Chiang, State Controller
• Ingrid Duran
• Maria Elena Durazo
• Peter Groff, State Senator
• Kamala Harris, District Attorney
• Marjorie Hill
• Voncille Trotter Hines
• Joseph P. Hoar, General, USMC, Ret.
• Chuck Hoskin, State Representative
• Nancy Keenan
• Denise King
• Mark Macarro
• Edward McElroy
• Chris Owens
• Douglas Palmer, Mayor
• Diego Sanchez
• Ricardo Sanchez, General, USA, Ret.
• Smita Shah
• Lillian Tamayo
• Patricia Todd, State Representative
• Reginald Weaver

Over the next two weeks, the Democratic and Republican parties will be forming their platforms. It’s essential that long-term care financing reform is included in their platforms. That’s why we need your help.

AAHSA recently developed platform statements to share with both parties on the Long-Term Care Solution. Please share you own versions of the following platform statements by July 25.

Whatever your political affiliation, please consider submitting information to both parties.

Democratic Party

• Visit My Barack Obama.
• Enter your zip code under “Find a Listening to America Event Near You” (It’s best to check this site as soon as possible. Many of these events are happening within the next few days).
• Select an event to attend and share your own version of the following platform statement:

AAHSA’s Platform:

Any initiative to reform health care must also include long-term care financing reform to address the need of seniors and persons with disabilities for supportive services. The responsibility of care giving will only increase as the baby boom generation ages and the number of people who need services multiply. A fiscally sound, long-term care financing strategy, based on a national insurance model like the CLASS Act, must be developed to provide cash benefits that maximize choice, dignity and independence for seniors and those with disabilities, regardless of income. The plan should support those who need services and those who provide them, without a bias toward institutional care.

Republican Party

• Visit GOP Platform 2008.
• Click “create platform account.”
• Create an account.
• Click on “submit text entry” and enter your own version of the following platform statement:

AAHSA’s Platform:

Any effort at health care reform must also include long-term care financing reform. The responsibility of care giving will only increase as the baby boom generation ages and needs additional services. America needs a fiscally responsible approach for long-term care financing based on the principles developed in the successful state-based Cash & Counseling programs. These principles, including a cash benefit, offer the maximum choice, independence, and personal responsibility for seniors and persons with disabilities, while ensuring fiscal integrity.

On Tuesday, the Fairness in Nursing Home Arbitration Act (H.R.6126) was approved with a 5-to-4 vote by the House Judiciary Subcommittee on Commercial Law and Administrative Law. The bill would invalidate pre-dispute arbitration agreements between a long-term care facility and a resident or client.

“Long-term care advocates oppose the legislation, arguing that arbitration agreements allow them to channel limited Medicare and Medicaid resources to providing quality care instead of funding lengthy court trials,” McKnight’s reports.

Later today, the Senate Judiciary Committee is expected to mark up its version of the bill, S. 2838.

For our Long-term Care Solution, that is.

 We want to show policy makers and the public that providers are helping individuals receive the care they need in their homes for $75 a day, which we believe a national insurance trust could offer individuals when they need LTC. The services can be accessed through Medicare, Medicaid (including state waiver programs) or other home and community-based service programs.

We’ve already heard from Chateau Cushnoc in Augusta, Maine who’s helping two residents of their senior housing facility receive personal care services, therapy and other support for just $34 a day.

Do you know someone in a similar situation? Let us know so we can share how you are making it affordable to care.

Congress today voted to override President Bush’s veto of the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), legislation that would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates.

The House approved the override with a vote of 383 to 41, while the Senate results were 70 to 26. The Senate, which previously rejected a cloture motion, reached the veto-proof majority of 60 votes last week after Sen. Edward Kennedy (D-Mass.), who is recovering from a brain tumor, returned for a second attempt at cloture.

Before the second cloture vote, Sens. Harry Reid (D-Nev.) and Mitch McConnell (R-Ky.) agreed that if the motion passed, the bill as a whole would be considered approved. The House approved the bill with a veto-proof majority on June 24.

Explaining his veto, President Bush said in a statement that while he is not opposed to the “primary objective” of preventing reductions in physician payments, he said that the bill’s proposed cuts to Medicare’s privately run insurance plans, known as Medicare Advantage, were essentially “taking choices away from seniors to pay physicians.” The president described the bill as “fiscally irresponsible,” and said “it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem.”

However, at AAHSA we believe the bill will ultimately protect the elderly by helping to, as Rep. Rahm Immanuel (D-Ill.) said before today’s vote, “preserve the doctor and senior patient relationship.”

Larry Minnix, AAHSA’s president and CEO, said, “Thanks to Congress’ decision today, millions of Medicare beneficiaries will continue to receive the physical and occupational therapy they need without fear their care will be rationed or capped.”

We’ve unveiled our 2008 Award winners. Each year we honor individuals and organizations for their excellence and innovation in aging services. The awards, which will given during our annual meeting in Philadelphia, Pa., on Oct. 12, 2008, include the Excellence in Leadership Award, the Excellence in the Workplace Award, the Leading-Edge Care and Services Award, the Hobart Jackson Cultural Diversity Award, the Dr. Herbert Shore Outstanding Mentor Award, the Public Trust Award, and the Outstanding Advocacy Award.

This year’s Award of Honor will be bestowed upon Laverne R. Joseph, president and CEO of the Retirement Housing Foundation in Long Beach, Calif. Mr. Joseph has a long-standing record of leadership in aging services, particularly affordable senior housing.

“Our award winners combine leadership, creativity and commitment to make great strides for the people they serve and those who serve them,” AAHSA President & CEO Larry Minnix said. “We honor them for their commitment to quality and more important, the inspiration they offer our members to create the future of aging services.”

On Tuesday, July 15, H.R. 6126, the Fairness in Nursing Home Arbitration Act of 2008, is expected to be marked up.

We at AAHSA oppose this bill, as well as its Senate companion, S. 2838, because the measure would prohibit arbitration clauses in long-term care admissions agreements. Supporters argue that nursing home/assisted living residents and their families should not be asked to waive their right to go to court before a dispute arises. In essence, the bill’s sponsors take the position that this type of waiver can never be done fairly (knowingly and voluntarily). The sponsors are responding to examples of over-reaching by providers that in fact were thrown out by courts (e.g., provisions limiting damages when the state does not have a damages limit, provisions prohibiting the arbitrator from awarding punitive damages when state law allows it, and so forth). The sponsors also appear to be claiming that arbitration agreements have a negative impact on quality.

However, there is no relationship between the forum where a dispute is resolved (arbitration or court) and the requirement to provide quality care. Moreover, a blanket prohibition against arbitration clauses is unnecessary. Courts are already doing their job of policing these agreements to ensure that they are fairly entered into and the provisions are not unconscionable.

There is in the field a rough consensus of best practices which takes a balanced and responsible approach, mirroring case law — for example, not mandating signing an arbitration agreement as a condition of admission but allowing the agreement to be rejected and providing for a period of time to rescind the agreement after it is signed; not changing state law on medical malpractice/negligence; etc.

Click here to watch the House Subcommittee on Commercial and Administrative Law’s hearing on H.R. 6126.

Margaret Mead once said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”

So, when we embarked on the mission to create a sustainable funding model for aging services through public insurance instead of government imposed welfare, we soberly asked ourselves, “What can AAHSA — with our 5,800 members and $3 million dollars in funding — do to change the world of long-term care?”

A year into this transformational agenda we now call the “Long-Term Care Solution” made possible by members like you — we offer this report of our efforts:

Presidential Campaign Awareness

Both Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) now recognize that long-term care must be included in health reform, as evidenced by position statements on their Web sites. This is a major achievement, as the previous prevailing wisdom (or lack thereof) was that the country needs to “fix” health care first. We constantly hammer the proposition that “health care” and “long-term care” are inextricably intertwined.

We met with Sen. McCain’s top domestic health advisor, who has actually written articles about long-term care financing. We have his attention, but he warns we cannot create an “entitlement.” We agree.

We have been promised a meeting with Sen. Obama’s top person as well. Sen. Obama has endorsed Sen. Edward Kennedy’s (D-Mass.) CLASS Act, which began as a disability benefit and now more closely aligns the principles espoused in the Long-Term Care Solution to embrace both elderly and younger disabled populations. Sen. Kennedy has touted our Moran Report study as evidence of the feasibility of creating a sustainable financing model.

Therefore, we have achieved, at least with verbal commitments, our initial goal of including long-term care in health reform. Our next goal is to get a statement in both party platforms to this effect.

Congressional Interest

The CLASS Act is a potential vehicle for the addressing financing of long-term care. Sen. Kennedy chairs the Senate Committee on Health, Education, Labor, and Pensions. We continue to work with the senator’s staff while he recovers from his illness. Sen. Kennedy is one of the few heirs to the Great Society vision, and he is a stalwart in his commitment to this country successfully addressing the problems you and I see everyday.

Sen. Max Baucus (D-Mont.) chairs the Senate Finance Committee. The credibility that our Montana members have with Baucus is commendable. We met with Sen. Baucus and he wants to conduct a forum on this issue in Montana. He has also asked his staff to work with us and Sen. Kennedy’s staff to refine our framework around the CLASS Act principles. This is great news. Sen. Baucus believes long-term care must be included in overall health reform, and he was complimentary of the quality and seriousness of our work. Meetings with other senators are being planned, but the combined interests of Sens. Baucus and Kennedy are powerful because health reform inevitably flows through their key committees.

On the House of Representatives side, we are working through several of our members to schedule meetings with key leadership. We have already met with Reps. Henry Waxman (D-Calif.) and Rep. F. Allen Boyd (D-Fla.) with subsequent meetings planned. These are in addition to the over 100 meetings that AAHSA members have had with their members of Congress.

State and National Forums and Speaking Engagements

A major public and political awareness strategy provided for in the money you gave us is the hosting of forums in strategically selected states. The goal is to generate pressure to reform long-term care financing through local consumer understanding and political action. Two forums have been held in Michigan and Minnesota, with forums scheduled in California and New York. Additional forums are being planned in other states. The plan is to conduct between eight and 12 forums in the next year.

The most recent Minnesota forum at the Humphrey Institute was a home run. More than 200 participants listened to three panels of thought leaders, which included AAHSA members Dan Lindh and Kathryn Roberts, Minnesota State Executive Gayle Kvenvold, and AARP. Three state commissioners and elected representatives from both parties participated and there was excellent press coverage. The event did what it was supposed to do: gin up interest to be cultivated. The Minnesota “formula” for a forum holds much promise.

On Friday, July 11, we will participate in a forum on Capitol Hill entitled, “Reforming Long Term Care: Improving Quality and Ensuring Sustainability.” The forum is sponsored by the Engelberg Center for Health Care Reform at the Brookings Institution and will be co-chaired by former Sen. Bob Kerrey (D-Neb.) and former Speaker of the House Newt Gingrich (R-Ga.), who chaired the National Commission on Quality Long-Term Care. The Engelberg Center, which is under the leadership of Dr. Mark McClellan, expects to draw 175 congressional staff members, media and other leaders.

We have now trained more than 80 ambassadors who have made dozens of presentations on our behalf. Jo-Ann Constantino, CEO of The Eddy in Albany, N.Y., was on the panel at the New York Association’s Spring Institute to discuss the initiative. Constantino has also given the presentation to her organization’s board and members of the Health Care Association of New York State. David Bannerman, CEO of The Ohio Masonic Home, has traveled across his state speaking to Masonic lodges.

In addition, Bannerman gave a presentation about the Long-Term Care Solution to Ohio state Senator Steve Austria (R-Beavercreek), who is also candidate for the U.S. House of Representatives. Jerry Kuyoth from National Church Residences in Columbus, Ohio, has given presentations on the initiative to the Chillicothe Rotary Club as well as the Kiwanis and Rotary Clubs in Waverly, Ohio. Several ambassadors have placed letters to the editor in their local newspapers.

Ambassador training events have taken place in Washington, D.C., Denver, and Atlanta. We have future trainings coming in Seattle, Sacramento and San Diego. More to come!

Focus Groups and Polling

A big question going into this project is whether or not the public is aware of long-term care financing problems and/or whether they would pay for a solution. Political leaders have wondered why there is no public out cry for change. So, we retained two experienced polling groups to discover answers.

The Mellman Group, a noted Democratic firm, and American Viewpoint, their Republican partner on this project, just concluded their focus group work, which centered on Baltimore, Detroit, and Philadelphia, and included caregivers, non-caregivers and two special groups of 20-30 year olds.

Selected findings thus far:

So, there is significant public awareness because of personal experience, and there is emerging support for change.

Polling comes next. In September, Mark Mellman and Gary Ferguson, our lead pollsters, will be discussing the project and its findings on a conference with all those interested. Stay tuned!

Fund Raising

A total of $2.7 million has been committed by our members toward this 3-4 year campaign. Several member decisions are forthcoming to reach our $3 million goal. The money is being spent boldly yet wisely to get the issue of financing long-term care on the front burner of national reform.

Perspective and What’s Next

Our efforts are creating a buzz and our plan is being referenced in public media and professional publications. A recent example is an article by former Business Week writer Howard Gleckman, who is now with the Center for Retirement Research at Boston College. Gleckman cites Dr. Barbara Manard’s work and mentions our frameworks throughout his article. Our work is being taken seriously, and the initial hurdle of whether or not long-term care is part of health reform debate has been overcome in many circles.

The next steps are party platform inclusion, search for a legislative vehicle (such as the CLASS Act), continued cultivation of stakeholder interest/support, and the stoking of public and political awareness.

So, why is AAHSA doing this? Well, Ronald Reagan’s quote, paraphrasing the great Rabbi Hillel, comes to mind: “If not us, who? If not now, when?”

David Ferguson, CEO of American Baptist Homes of the West (ABHOW), recently told a small gathering of our colleagues, “I support this effort because I want my association to be thought leaders on major problems and issues that we face in our work.”

If small groups of people change the world, I wonder what we can accomplish with 5,800 members and $3 million. It is us who must transform how long-term care is financed, because if not us, then who?

With a vote of 69 to 30, the U.S. Senate on Wednesday approved a cloture motion for H.R. 6331. According to The Hill, Sens. Harry Reid (D-Nev.) and Mitch McConnell (R-Ky.) agreed that if the cloture motion passed, the bill as a whole would be considered approved.

Sen. Edward Kennedy (D-Mass.), recovering from surgery on a malignant brain tumor, was able to return for the vote. The Hill quoted Kennedy as saying, “I return to the Senate today to keep a promise to our senior citizens – and that’s to protect Medicare.”

Kennedy’s presence was important as the previous cloture motion failed by one vote.

The bill, which would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates, now heads to President Bush.

The U.S. Senate today is expected to once again consider a cloture motion for H.R. 6331, the Medicare Improvement for Patients and Providers Act of 2008. The bill, which failed to reach cloture by one vote on Jun. 26, needs 60 supporters to proceed.

The bill would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates which will begin this month.

Senate GOP members say their main area of contention is how the bill would be funded.

Responding to Republican requests to amend to measure, Senate Majority Leader Harry Reid (D-Nev) on Tuesday said that “75 percent of the Republicans in the House voted for it. And it seems a little unusual to me that this bill, they want to change it now.” Reid added that “every day that it’s not passed, seniors are being affected, doctors are being affected, and veterans are being affected.” Reid said, “If we don’t get 60 votes, the Republicans are going to have to live with that.”

We’ll update you as soon as Congress moves forward.

Since my last post, there have been even more AAHSA members getting letters to the editor published about AAHSA’s Long-term Care Solution as a way to alleviate the high costs of providing long-term care. Check these out:

• Today, the Boston Globe published this letter from Elissa Sherman, executive director of MassAging, about an article regarding rising caregiving costs.
• Jim Leich with the Indiana Association of Homes and Services for the Aging had this letter published in the July 6 edition of the South Bend Tribune.

Have you seen a similar story in your paper? Let us know and we can help you draft a letter of your own.

A few weeks ago, I blogged about a USA Today story on rising bankruptcy rates among the elderly. Today, the paper featured an article with much broader implications: the impact of rising prices on the lives of elderly people living on fixed incomes.

Across the country, seniors are cutting back and seeking out programs and services to help them save money on everything from food to home repairs. Take some of the stories heard at one San Diego food bank. Jannie Hicks, 75, is eating more canned vegetables to compensate for the rising costs of fresh produce.  To save money on gas, Hicks only drives to the grocery store, church and the food bank. Phone calls have replaced regular visits to her friends. Carmen Gonzalez, another senior at the food bank, slashed her grocery bill to just $50 a month. She survives by making tamales and enchiladas with cheese instead of meat.

There are statistics behind these stories. In a recent survey, AARP found that 59% of Americans over 65 reported having more trouble paying for food, gas and medicine. Researchers believe that’s why a growing number of older people are headed to places like credit-counseling centers to find help.

What about Social Security? Well, amount individuals receive is indexed with inflation, but some argue that this isn’t enough because they have a disproportionate need for some goods, like medications. According to the Centers for Medicare & Medicaid Services, premiums for Medicare and its newer drug coverage, as well as the money needed for co-pays, deductibles and any other related costs, eat up 26% of a typical Social Security check.

Other factors, like giving adult financial help, lowering home equity and of course, the high costs of long-term care are affecting the economic strain these seniors are feeling.

While there is no quick fix to this problem, what our country can do to help these individuals is support federal programs, like Section 202 affordable housing, that can help these individuals ensure that their basic needs are fulfilled while avoiding premature, and costly, institutional care. That’s a smart investment.

On Monday, the Bush administration announced that it would give Congress more time to deliberate on the proposed cut to physician payments by the Centers for Medicare and Medicaid Service (CMS). Originally scheduled to take effect today, CMS spokesman Jeff Nelligan said the agency “will not be making any payments on the 10.6 percent reduction until July 15, at the earliest.”

However, at a meeting with therapy provider groups late yesterday afternoon, the agency’s deputy administrator, Herb Kuhn, advised that the administrative payment relief CMS is providing for physicians does not extend to the Medicare therapy caps exceptions process.

This means that any outpatient therapy claims submitted as of today will begin to count against a beneficiary’s allowance of $1,810 per year for speech and physical therapy combined and another $1,810 for occupational therapy. Therapy provided in a hospital outpatient setting does not count against the caps.

Furthermore, CMS will count any therapy a beneficiary may have received since January 1, 2008 against the cap. This means that many beneficiaries will already have exceeded their annual cap, even though they obtained an exception from the cap at the time they received their therapy.

Kuhn suggested that therapy providers could hold claims and not submit them to CMS for the next 10 days, by which time we can hope that Congress will have reconvened and passed an extension of the therapy caps exceptions process.

At AAHSA, we’re encouraging our members to Contact Congress. You may also call the U.S. Capitol at (202) 224-3121 (not a toll-free call) and ask to be connected to your legislators.

He may not be David Letterman, but Eric Schubert with Ecumen’s Changing Aging Blog can sure put together a top 10 list…and today’s topic is an important one: why our country must change the way we finance long-term care. Take a look:

1.  The Age Wave is Unprecendented:  About 10 million Americans need long-term care today.  (Note: Long-term care is an array of services, from home care to assisted living, not simply nursing home care.)  By 2020, 12 million older Americans will need long-term care.

2.  Americans Want More Choice:  People want more choices than ever in how they live and receive care.  The nursing home isn’t a place they want to choose. Guess what?  Many states rely on institutional nursing homes for long-term care.   To pay for choices that today’s consumer desires, we have to have new ways to pay for care.

3.  The Costs are Unsustainable: According to the independent, non-partisan Government Accounting Office (GAO), Medicare, Medicaid  (which pays nearly half of all long-term care expenditures)and Social Security will nearly double as a share of the economy by 2035.  Today long-term care alone costs federal and state governments $116.8 billion every year.  We’ve been able to sustain these entitlements because of a low-depression era birth rates and a large postwar workforce.  No more.  Absent substantive change, Medicaid, Medicare and Social Security will overwhelm the rest of the Federal budget.

4.  America’s Savings Rate is Deplorable:  Americans are horrible savers.  In fact, 2005 and 2006 marked the first time since the Great Depression that American’s charted a negative savings rate in back-to-back years.  By 2030, many retirees will not have enough income and assets to cover basic expenditures or any expenses related to aging services.

5.  Business Production is Taking a Hit:  According to the Metlife Mature Market Institute and National Alliance for Caregiving, American businesses lose as much as $33.6 billion in annual revenue because of employees’ need to care for their loved ones.  That is approximately $2,110 per full-time employee who is also a caregiver.

6.  Busting State Budgets:  On average, state governments spend 18% of their budgets on Medicaid, which pays for all most half of all long-term care costs.  These costs are only rising and if left unchecked will crowd out all other spending.

7.  Americans are Clueless as to What Care Costs:  In 2006, according to AARP study, only 8 percent of Americans over 45 could estimate the average monthly cost of what care costs within 20 percent of its actual cost.  In an Ecumen study of baby boomers, nearly a third of boomers think that they will use Medicare to pay for their long-term care costs.  Sorry . . . . Medicare won’t pay for costs such as memory care and assisted living.

8.  Long-Term Care Insurance isn’t the Whole Answer.  Only one in five Americans can afford the long-term care insurance policy needed to meet their long-term needs.  And even if everyone purchased the best private coverage he or she could afford, Medicaid costs still would triple by 2045.

9.  A Worker Shortage:  According to the U.S. Department of Health and Human Services, the next four decades will see a need for more than 4 million care professionals in the U.S.  Who will pay their salaries?  We need to change the financing system to attract great professionals to this profession for the long-term. 

10.  Voters Want Change:  The vast majority of Americans say that our health care system is broken and they desire a well-coordinated, integrated, cradle-to-grave system.  To have such a system, long-term care/aging services must be part of the solution.  According to a 2007 national poll by Genworth and the Mellman Group, voters want long-term care/aging services to be part of national health care reform.  Nearly 8 in 10 voters (78%) stated that the presidential candidates should make this part of their health care proposals.

Here is my addition to the list.

11. It is unaffordable to care: Most Americans have been or will be caregivers, providing support for an elderly or disabled relative or friend. These individuals assume enormous emotional and logistical burdens to care.  A recent National Alliance for Caregiving survey found that caregivers spend more than $5,531 per year to pay for loved ones’ food, transportation and medicine. That’s more than most spend on their own health care. Long-term care insurance is a partial solution for one in five Americans who qualify. But what about the rest of us?  We have to spend down life savings to go on welfare through Medicaid or live with unmet needs. These personal problems are compounded by the crazy and inadequate ways long-term care is financed.  Simply put, it’s time to make it affordable to care.

I know there has to be more than 11 items on this list. Let us know your reasons.

Yesterday, the U.S. Senate rejected a cloture motion on H.R. 6331, a bill that would extend the Medicare therapy caps exceptions process for 18 months. The bill also would place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates which begin on July 1. The motioned failed 58-40, with Sens. John McCain (R-Ariz.) and Edward M. Kennedy (D-Mass.) not voting.

However, the bill is expected to be addressed after Congress returns from its July 4th recess, as Majority Leader Harry Reid (D-Nev.), following a procedural rule, changed his vote to the winning “no” side, allowing the bill to be brought up at a later time, Congressional Quarterly explains.

Congressional Quarterly is reporting that Senate negotiators have brokered a deal on a bill that would block the scheduled 10.6 percent cut to Medicare physician reimbursements, but that would not be vetoed by President Bush. According to Sen. Debbie Stabenow (D-Mich.), several concessions were made to Republicans on the issue of Medicare Advantage funding.

Sen. Orrin G. Hatch (R-Utah) “confirmed that a key part of the compromise dropped restrictions on private fee-for-service plans, a subset of the Medicare Advantage plans,” CQ adds.

The U.S. House of Representatives today voted with a two-thirds majority to approve H.R. 6331, legislation that would, among a plethora of amendments, place an 18-month moratorium on a scheduled 10.6-percent cut to physician reimbursements from the Centers for Medicare and Medicaid Services (CMS). The measure would also provide a 1.1 percent increase to Medicare physician reimbursements in 2009.

Based on Sen. Max Baucus’ (D-Mont.) last Medicare bill, the House measure removes some of the beneficiary enhancements that the Baucus bill contained. Of primary concern to us at AAHSA is the 18 month extension of the Medicare therapy caps exceptions process contained in the bill and the fact that it allows for the full 2009 market basket update for nursing homes and home health agencies in 2009.

We are strongly supporting the legislation, in view of the impending July 1 reimposition of Medicare therapy caps.

The House voted on the bill under suspension of the rules, which is a procedure designed to prohibit amendments and to require a two-thirds majority for passage.

On Wednesday, the Centers for Medicare & Medicaid Services (CMS) announced that it plans to launch a “five star” ranking system for nursing homes not unlike the way hotels and restaurants are rated. The new system will be part of the agency’s Nursing Home Compare Web site.

According to CMS Acting Administrator Kerry Weems, “The new ‘five-star’ rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily.”

While many in the nursing-home field support a system to rate the quality of a provider, one area of concern about Mr. Weems’ plan is that it is based on inconsistent data taken from state surveys of homes. State surveyors are often underfunded and undermotivated. A GAO report issued in May reflects this fact, finding “approximately 70 percent of federal comparative surveys identified state surveys missing at least one deficiency at the lowest level of noncompliance, and in all but five states the number of state surveys with such missed deficiencies was greater than 40 percent.”

At AAHSA, we believe a rating system that helps consumers identify both high and low performing nursing homes is essential. Consumers deserve nothing less than a reliable seal of approval for the best nursing homes in America.

To be reliable, it’s important that a rating system be based on four essential pillars: resident and family satisfaction, staffing based on resident needs that measures nursing hours and staff satisfaction, clinical quality outcomes, and public oversight. Each of these pillars needs to be based on up-to-date and valid data.

We’re already working with CMS and other stakeholders on the Advancing Excellence in America’s Nursing Homes campaign to strengthen all four of these pillars, enhance quality in nursing homes and increase the public’s trust. We believe there should be two types of nursing homes: the excellent and the non-existent.

Public health emergencies were declared by Department of Health and Human Services (HHS) Secretary Michael Leavitt in the states of Iowa and Indiana, after heavy flooding began affecting health care services.

Leavitt, who is empowered by the Public Health Services Act, said the move will assist Medicare beneficiaries by enabling hospitals and nursing homes in neighboring communities to expedite the intake of evacuees by allowing facilities to act “under a presumption of eligibility.”

Centers for Medicare & Medicaid Services (CMS) Administrator Kerry Weems said that certain operating procedures of the agency “will be relaxed to speed provision of health care services to the elderly and persons with disabilities who depend upon these services.”

According to CMS, the agency will “waive certain program requirements” for Skilled Nursing Facilities, including the “three-day prior hospitalization requirement for admission for evacuated patients.” The agency will also ease “limitations on the benefit period for those evacuated patients.” In addition, CMS said it will broaden the definition of “home,” allowing alternative sites to accept Medicare beneficiaries receiving home health services.

To read the more about the CMS emergency relief effort, visit: www.cms.gov.

Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians.

Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.

The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.

Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.” The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.

AAHSA’s Long-term Care Solution is gaining ground, state by state. The first state on the “LTCS” tour is Minnnesota. On Wednesday, AAHSA partnered with our Minnesota state association, AARP and several of our members, including Ecumen, hosted a forum about the topic. I found a great summary on Ecumen’s Changing Aging blog about it to share. Hopefully, our forum in California next week will be as successful.  

Financing Long Term Care in America: There’s Common Ground in Aging

Our CEO’s communications to AAHSA members, known better as “Larry Letters,” are the most popular publication we produce. Why? I think it’s because Larry’s got a knack for telling stories that inspire us to make a difference.

Take a look at his latest letter. It starts with a simple story, but by the end, you’ll be ready to contact your member of Congress with a simple message: make it easier, and more affordable, to care.
May 7, 2008
Recently, I was invited to teach a class at George Mason University’s masters in public administration program. The regular faculty member is Frank Shafroth, my good neighbor and chief of staff of our Congressman Moran (D-Va.).

Frank represents the best of public service. A distinguished career in the Peace Corps, House of Representatives, U.S. Senate, National Governors Association and county government. Frank is a lawyer by training and a teacher-gardener by constitution.

Frank is intrigued by AAHSA’s Long-term Care Solution, so he invited me to teach his class one evening and share the framework with his students. There were 11 students, ages 20-something to 60-something. Mixed backgrounds, employed in a variety of businesses from government intelligence to the funeral industry.

I asked the class how many had experiences in their lives as caregivers. Seven of eleven hands went up. I asked who would mind sharing their situation. One young woman had experience early in life as a kid. An older Caucasian man had been a long-distance caregiver for his mother. An African-American woman said her family tradition is that the caregiving falls to her because her mother says that caregiving is a daughter’s responsibility (her two brothers agree). There were multiple ethnic backgrounds represented in this small class - and there seemed to be ethnic traditions that differ quite a bit when it comes to expectations about caregiving.

One woman’s story caught my attention. She is 32, a newlywed of three months. She and her husband agreed to move her 97-year-old great-grandmother into their two-bedroom townhouse. They love her a lot. She and new hubby became the caregivers because the grandparents can no longer do the job due to health problems of their own. Her mother and aunt now have responsibility for grandparents and great aunt. I asked her about the “burdens” of caregiving. “My great-grandmother isn’t a burden. It’s just what you do as a family,” she said. “Finding the community resources to help us see about her during the day while my husband and I work is the real burden.” She’s also worried about her parents, so she pays for long-term care insurance for them.

Several in the group could identify with the maze of what I call “yellow pages” assistance with confusing options and no guidance to help make good choices. Several could identify with the hospital discharge crisis of not knowing where to turn when an older person has their Medicare coverage terminated. Getting help in another state with programs that differ from state to state is a common theme. No one to help make choices, make decisions and pursue options. Transferring assets, what’s covered by Medicare or Medicaid or long term care insurance - a mish-mash of financial issues.

Recently, a former member of Congress was referred to me by a Congressional staff member. Her mother almost died a few months back from an infection. The mother suffers from a neurological disease, may also be depressed, can’t go home but may not need the nursing home she’s in and she’s bounced around the acute and long-term care system in a large city.

I asked the former Congresswoman if her mother had received a comprehensive geriatric assessment. “No,” she said, “I didn’t know a comprehensive assessment was even an option.” So, we offered to help her set that up. The Congresswoman loves her parents very much. She just doesn’t know what to do.

The class at George Mason and the former Congresswoman are among 34 million families today that need our help beyond the boundaries of our traditional services. And policy leaders offer few answers. One state seems to believe heavy fines for nursing homes should be a priority in long-term care. Others believe almost everybody can be cared for at home, so let’s close down the nursing homes. Still others are slow to support home-and community-based services because people will come out of the woodwork to take advantage of government programs. Many believe we can regulate good care and services. Others believe the marketplace will sort all of this out, whatever that means. Some think tax breaks are the financial answer while others believe a universal plan is in order. Others even say that long-term care is such an overwhelming issue that we can’t address it politically.

It is my belief that few policy makers really know what they are talking about because they don’t connect their own families’ caregiving experiences with an opportunity to change policies or a chance to win voters’ hearts. I heard of one member of Congress with a “graying” district who wants to avoid the aging agenda because of appearances to his constituents. Perhaps he’s denying his own aging.

I’d like to ask each and every one of you to convene a community forum that helps people understand and access community resources and brings to light why we must demand that policy makers create a better system that empowers consumers instead of burdening them. We can help you structure the forum and ask the right questions.

Real people are willing to take responsibility for their elders, but they often find the current system a nightmare to navigate. Even people who make laws don’t know the options. Let’s get the really good public servants like Frank Shafroth to help create the policy story that addresses the critical policy problems that make it difficult to care.

If AAHSA members don’t help families make connections and don’t help policy makers make connections to get the help they need, and if we don’t help policy makers create policy and programs based on the needs of real people, then who will?

Caring for our loved ones and friends is our personal responsibility. Making it not a burden is ours. Hopefully, we will all live long enough to be somebody’s great-grandparent, and hopefully, a great-grandchild is there to care. Let’s make it easier.

William L. Minnix, Jr.
AAHSA President & CEO

When I think of the New England Journal of Medicine, my first thought isn’t long-term care. New medication for a disease? Yes. A study linking my favorite food with some kind of unpleasant health condition? Possible. But long-term care? Not so much.

That’s why I was surprised to see this article about LTC and the 2008 election in this month’s issue. In it, Dr. David Stevenson analyzes a variety economic, social and political factors that all come down to one conclusion: long-term care is here to stay, and candidates for political office have to start talking about it. Steveson said it best here:

“If the upcoming election truly is about creating sustainable change, then presenting an efficient and humane plan for the reform of long-term care should be viewed as an important test of the candidates’ vision for our country. ^”  

Then it came to me: like a new medication or research study, our long-term care crisis isn’t a stagnant situation. It’s dynamic and our politicians, like medicial researchers, must discover how can we can make  long-term care affordable in America.

I think investigating AAHSA’s Long-term Care Solution would be a good start. Do you have any suggsetions to share?

Watch out, Washington.  Everyone’s favorite domestic diva/lifestyle mogul is coming to town. And she isn’t her to share a new recipe or helpful housekeeping hint. She’s here to tell Congress why we must support those who care for our nation’s most vulnerable citizens.

Martha will join noted aging experts, including Dr. Robyn Stone from our Institute for the Future of Aging Services, at a Senate Special Committee on Aging Hearing entitled, “Caring for Seniors: How Can We Support Those on Our Frontlines?”

During the hearing, the committee will review a major Institute of Medicine report that features major recommendations for improving and expanding the skills and preparedness of the long-term care workforce.

Martha’s no stranger to caregiving. She care d for her beloved mother, “Big Martha,” until her death last year. That experience inspired the corporate giant to establish the Martha Stewart Center for Living at Mount Siani Hospital in New York in 2007. The clinic services as a model for coordinating outpatient geriatric care services for seniors across the city.

The hearing will be held at 3 p.m.  on Wednesday in the Dirksen Senate Office Building. Be sure to catch the Webcast if you can.

From from baking perfect pies to transforming our workforce. Is there anything Martha can’t do?!?!

When Bill Pierce, an AAHSA board member and CEO of Baptist Retirement Communities, read an article in the The Daily Oklahoman about growing state Medicaid costs, for long-term expenses, he knew that readers should know

 That’s why Bill wrote this letter to the editor describing AAHSA’s Long-term Care Solution, a plan to  create a national insurance trust with premiums that provide individuals with cash benefits to pay for their long-term care expenses - as much as $27,000 a year per person.  Multiply that times the millions of seniors and disabled individuals who need long-term care and you’ve got a new way to help individuals receive the care they need at a price that our people and our states can afford.

Does this sound like a solution that will stick? Let us know what you think.

I don’t claim to know much about long-term care financing, but two Florida lawmakers are proposing the most interesting idea I’ve ever heard about the topic.

What’s their plan? To put a dollar tax on all strip club admissions in the state and give the money to low-income nursing home residents who receive Medicaid for their personal expenses (like haircuts and movie tickets).

Call me old-fashioned, but I’m not sure I’d want to tell my Grandma that a strip club’s profits paid for her weekly perm.  There’s got to be a better way to pay for Mom’s manicure or Uncle Frank’s favorite food than this. A way that isn’t dependent on ticket sales or schedules. A way that gives these individuals a sense of choice when it come to how and where their money is spent.

Luckily, AAHSA has a plan that would do just that. And I know I’d be happy to share with the elderly people I love.

Forget Mardi Gras. The excitement around here goes by another name: Super Tuesday. A day when 24 states have their presidential primaries and nowadays, each party’s presidential candidate will be determined. For us political junkies, it’s like Super Bowl Sunday and the Final Four combined.

But it’s also an important day for America’s seniors. Why? Because the votes cast today could determine how our country’s government and its citizens take on challenge of providing and paying for the care these individuals deserve. Not a small task.

That’s why I was relieved when I saw this article in today’s Ledger. It includes several resources people can use to figure out where a candidate stands on issues ranging from Social Security to paying for long-term care.

 Even if you’re a twenty-something like me, checking them out is great way to find out the vote you cast today will affect your older loved ones tomorrow. I know I’ll be before I vote next week.

…or at least their new program to promote person-centered care for low-income seniors. The program is called Putting People First. It’s a simple, but powerful, name for a type of public policy will soon make it “across the pond.”

The program, which will start in April 2008, will allow seniors or a person of their choosing to set up a bank account for funds associated with their care costs.  After the person is means-tested, the government will pay money into the account and allow the seniors or loved ones to use for the care and services that meet the older adults’ needs.

While the program is similar to “Cash and Counseling” initiatives in several states, there is little movement among policy makers to take it nationwide. 

Government officials said that they developed the plan based on British baby boomers’ desire for choice as they age.  Those same boomers liked The Beatles and The Stones before the “British Invasion” hit the states. Why would American boomers not want the same kind of “invasion” in their health care?

From bakers to bankers, it seems like Americans working in all types of professions are concerned about caring for their aging loved ones. And the people running for president are no exception.

This article in December’s AARP Bulletin offers an inside look into these individuals’ caregiving experiences, and how it has influenced their work for their elderly constiuents and those who care for them.

Take Arkansas’ Governor Mike Huckabee. His mother, who sold her home so she could afford assisted living, was mere months away from exhausting her resources while living in a nursing home. That experience, Huckabee says, inspired him to support  Project IndependentChoices, an innovative program where “you can live in a facility or with a relative, and the state would reimburse [the family member] for the cost of care.”

Then there’s Senator Hillary Clinton (D-N.Y.) Clinton’s mother, Dorothy, wanted to stay in her own home for as long as possible, but she was having difficulty getting around. ““She (told us) couldn’t always be asking people to take her places. ” Clinton says,  I think that was what really convinced her that she should come and live with us.”

That experience was part of Clinton’s inspiration for developing a long-term care platform that includes, among other policies, tax-credits for caregivers whose family members live with them.

But it’s not just about parents. Sen. Christopher Dodd’s (D-Conn.) brother moved in with his family after suffering a stroke. Together, Dodd tells the Bulletin, “we decided that it was the best option.” That experience must have inspired for his plan, which promises a ““A Secure, Dignified Retirement for Every Senior.”

Democrat, Republican or somewhere in-between, caregiving will affect us all where we live, including the White House.

That’s the first thought I had when I read about Hillary Clinton’s proposed plan for long-term care.

Politics aside, Clinton is the first presidential candidate to address this important issue outside of an interview or a nursing home visit. And I respect her for doing it. Her plan tackles issues that all of us face, like caring for an aging loved one or preparing for our own care needs, regardless of partisanship. My only hope is that more candidates will follow her lead and develop plans of their own. After all, aren’t politicians known for their making plans? (keeping promises, well that’s for another post…)

For the past two years, we’ve been all about storytelling here at AAHSA. Why? Because telling stories turns numbers into names and facts into faces about our members mission-driven work for older adults. And it makes a difference for members like Del Zook. Here’s an e-mail he recently wrote to Larry about a story in our FutureAge magazine he shared with his county’s tax appraiser.

What’s the “bottom line?” That telling your story can mean a happy ending in your community, on the front page of the newsletter, at the statehouse and even on your organization’s tax return.

Dear Larry,
Just an interesting happening to share with you. First, I appreciate so much AAHSA’s emphasis on the “mission” and “not-for-profit” focus. I sense a real connection with