Graying Caregivers

My last post was about a middle-aged son caring for his older father. I think I've written before (or if I haven't, I guess I should) about the fact that the average age of nurses and social workers is increasing (we're a decidedly middle-aged lot).

Here is a good article about paid caregivers getting (and being) older themselves. It's a trend that will likely continue, as the population continues to age; as older women find they must continue to work past retirement; as the pay for professional caregivers remains low; for too many other reasons to list here.

Letting Go of My Father - Magazine - The Atlantic

Letting Go of My Father - Magazine - The Atlantic

Here is an article that I think is just too important not to share. I don't think it's enough to say that being a caregiver is hard work. It is a job that is almost impossible to do in some circumstances. Jonathan Rauch of the The Atlantic writes very poignantly about his experience as a caregiver, and argues that caregivers are invisible in our society. He writes, "There should be no need for anyone to go through this alone, and no glory in trying."

Observation vs. Admission

For those who don't know, traditional Medicare will cover a short time (up to 100 days) in a skilled nursing facility. In order to qualify for this benefit, a person has to have a three day (midnight) stay in the hospital, and have a medical or rehab need.

This benefit is a lifesaver for many families. Hospital lengths of stay have been getting shorter and shorter, so sometimes when Mom or Dad has been hospitalized due to an accident or planned surgery, they need a bit more time somewhere before they go home, and this has usually been the local skilled nursing facility.

Something that is happening with increasing frequency is people going to the emergency room and never actually being admitted to the hospital, even if they are in the hospital for 3, 4 or more days. If you are wondering how that can be, let me tell you in a word--observation.

It is possible to spend days in the hospital without ever actually being admitted, and this has been a hot topic this week in a list serve I belong to. Geriatric care managers from all parts of the country are running into this problem, and it is a problem for older adults, because in more and more instances they don't find out that they were never admitted to the hospital until after they have spent time in the skilled facility (sometimes to the tune of $375/day) and get the bill, because Medicare tells them, correctly, that they did not meet the admission criteria.

The reasons this is happening are varied, and as is usually the case, boils down to money. Hospitals are under great pressure to decrease inappropriate admissions--when the person doesn't really need to be in the hospital; AND they get penalized for re-admissions--when a patient is discharged, only to show up back in the ER a few days later. So, instead of admitting people, they just "observe" them, sometimes for days.

So, the moral of this story: if a loved one is hospitalized (especially an older adult), make sure you know their admission status. If the doctor doesn't know, and don't be surprised if he doesn't, ask the case manager, because she usually will. It's better to bug the people at the hospital about admission status than it is to run the risk of a hefty skilled nursing bill.

More Health Reform Updates

I got my hands on some more information about the Health Care Reform Bill; this comes from the Kaiser Family Foundation. These benefits will be available in 2010:

• Medicare beneficiaries will receive a $250 rebate when they reach the doughnut hole in 2010. I reported earlier that the doughnut hole will be phased out, and this will occur by 2020.
• Medicare coverage will be expanded to individuals who have been exposed to environmental hazards in areas subject to an emergency declaration made as of June 17, 2009, and who have developed certain health conditions.

These are benefits that will be available in 2011:

• A national, voluntary insurance program for purchasing community living assistance services and supports (CLASS) has been established. My understanding is that this is basically long term care insurance.
• Medicare Advantage plans will be prohibited from imposing higher cost-sharing requirements for some approved benefits than is required under traditional Medicare.
• Freeze the income threshold for income-related Medicare B premiums for 2011-2019 at current levels, and reduce Medicare D premium subsidies for those with incomes above $85,000/individual and $170,000/couple.

There are more changes that will affect Medicare that will be phased in beyond 2011, but I'll cover some of these in later posts.

Health Care Reform and Medicare

OK, folks, I'm gonna try and tackle health care reform, but only as it will affect Medicare and Medicare beneficiaries (sorry, everyone else).

First, let me tell you it's kind of hard to find objective, unbiased information. What I know is that almost everyone has a very strong opinion about this topic, but my intent here today is just to state what changes we can expect. It's too soon to know how things will end up, and with anything of this scale, there are sure to be unintended consequences, good and bad.

Most of this information is taken from the website www.healthreform.gov.

• Subsidies to Medicare Advantage plans will be reduced. Some years ago, in an effort to move more Medicare beneficiaries into Advantage plans, Medicare paid these private insurance companies higher rates to offer plans. This idea never really took off in Texas; Secure Horizons is still the largest and most well-known Advantage plan in North Texas. My suspicion is that reducing these subsidies will result in some of the smaller plans going away. Since we don't have that many smaller plans in North Texas, there may not be much effect, but who knows?
• Closing the doughnut hole. If you have Medicare D, you probably know about the doughnut hole. This will be phased out over several years, and in the meantime, beneficiaries will get a 50% discount on brand name medications while they are in the doughnut hole.
• Free preventative services. Deductibles and co-payments will be eliminated on preventative services like colonoscopies. This will hopefully encourage beneficiaries to use these services, therefore allowing problems to be identified early, when they are treatable.

This is just a start. I will continue to look for information and share it as I find it.