Health Care Reform

Health Care Reform, Lauren Reynolds, North County Home Care, San Diego Caregivers, San Diego Home Care / 08.02.2012

On February 21, 2011, hundreds of employees and owners of home care agencies will gather in Sacramento to lobby against harmful home care legislation that threaten to drastically increase the costs seniors pay for in home care. One bill, SB411, co-sponsored by the SEIU, the Service Employees International Union, and Senator Cullen Price,(D- Los Angeles) calls for licensing home care in California and also certification of home care aides.While reputable home care companies, who are members of the California Association for Health Services at Home, support licensing the growing home care industry, they oppose this bill unless two very harmful provisions are amended.First, in this home care services act, SB 411 will require that employers pay for training for their employees, and then pay an annual fee of up to $180 per employee. This is an exorbitant fee and it’s higher than any other fee we can think of imposed on companies in California.    This added expense to have an “annual” certification will cost the average home care agency an estimated $20,000 to $50,000 per year, an expense that will have to be passed onto consumers who already struggle to be able to afford care to stay in their homes.Secondly, the bill will require all home care aides to have their names and where they work posted publicly on a website, which invades their privacy and threatens their personal safety.  In addition, it provides a launching pad for identity thieves who will already be able to gather a great deal about the home care workers.One employee, Georgetta, a former nurse, said “that’s not safe; I don’t want anyone who goes online to know where I am working.”Home care agency owners and their employees instead want to support licensing, but to have home care workers names and employers not posted publicly.Also, it’s a waste of time and money to force companies to renew the certification of their employees “annually”.  A much better plan would be to have the certification revocable if there was any crime, similar to what happens with Certified Nursing Assistants and nurses.On top of those two harmful provisions, SB 411 would cost the state an estimated $25 million dollars, at a time when the state is cutting services and grappling with a massive budget deficit.A much lower cost option is AB 899.   The California Association for Health Services at Home is supporting AB 899 by Assemblywoman Mariko Yamada (D-Davis), chair of the Assembly Committee on Aging and Long Term Care.  It would license home care agencies and would not post employees names and placed of work online.As the elderly population is expected to double over the next 20 years, costs must be controlled or seniors will be forced to find care in the underground economy, or worse, they'll end up in nursing homes paid for by Medicaid.  We urge those who are concerned about these issues to contact their State Senator or Assembly member and urge no on SB 411, unless amended until it makes common and economic sense. ...

Aging Parents, Alzheimer's/Dementia, At Home Care Solution, Health Care Reform, North County Home Care, San Diego Caregivers, San Diego Home Care / 13.01.2012

A recent USA Today article states that there is an increase in seniors living over the age of 90.  According to author Haya El Nasser “The number of people living to age 90 and beyond has tripled in the past three decades to almost 2 million and is likely to quadruple by 2050”. Seniors who live longer generally have some sort of disability or need help at some level of living. Sandy Markwood, CEO of the National Association of Area Agencies on Aging, indicates that the focus needs to be on being able to help these seniors live at home as long as possible as nursing home cost could rise to average $72,000 a year.Long Term Care at any level, in the home, assisted living or nursing home can add a tremendous cost to seniors and their families.Government Programs Only Pay For About 16% Of Long Term CareGovernment programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home if there is a skilled (medical) need. The Veterans Administration will cover the cost of nursing home care indefinitely if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need.Medicaid will cover both medical and non-medical related long-term care but in order to qualify for Medicaid a person has to have less than $2,000 in assets and income that is insufficient to pay the cost of care.Funding Long Term Care with your Life Insurance PolicyDrawing cash from life insurance or changing a life insurance policy should only be done after reviewing with an expert advisor.  Loss of the policy and death benefit could prove to be a detriment.  If, however you have accumulated cash in a life insurance policy and no longer need the coverage you may consider using the cash for long term care or purchasing a LTC rider to your current policy.New insurance products are being developed to cover both life insurance and long term care insurance. ElderLawAnswers reports: “A new law makes the purchase of products that combine annuities or insurance policies with long-term care insurance more attractive. These "hybrid" products are gaining in popularity due to a law that went into effect January 1, 2010, making distributions from life insurance and annuities tax-free when used to pay for long-term care. The same law also allows owners of annuities or life insurance policies to exchange their old policies for insurance for long-term care or hybrid policies without being taxed.” Combination sales which include life insurance, annuities and traditional long-term care coverage are becoming popular with insurance companies and may prove a method of financing long term care.  Investigate closely, however to find what exactly will be covered.  Some policies do not cover home care costs or complete costs of nursing homes.Long Term Care Insurance Funding for All Long Term Care NeedsThe first long-term care...

Aging Parents, Alzheimer's/Dementia, At Home Care Solution, Health Care Reform, Lauren Reynolds, North County Home Care, San Diego Caregivers, San Diego Home Care / 21.12.2011

On December 15th, The Department of Labor announced a new proposed rule that could dramatically change how seniors and those with disabilities access home care.  The proposal would eliminate a long standing federal labor code exception that allows home care agencies and private families to avoid paying overtime and minimum wage to live-in caregivers.    (In California and many other states, minimum wage is already mandated by state law and paid, but the overtime exemption still exists.  Most reputable agencies in California already pay higher than minimum wage for hourly home care workers.)The overtime exemption dates back to 1974 and it was intended for domestic employees who “provide companionship services for individuals who (because of age or infirmity) are unable to care for themselves…”The idea was to allow a family or individual to hire a “caregiver” and set a wage for live-in, allowing the family to avoid excessive regulations regarding mandatory breaks, paperwork, etc.   Over the last three decades, the exemption has also been used by third party employers, such as home care agencies, to put caregivers in the home for so called “live-in” shifts.   The caregiver is typically paid for 16 hours of work per day and is given 8 hours of rest. The caregivers take meal breaks in the home and have access to restrooms, a phone, tv, and rest as needed.  However, regular labor codes, such as providing a 15 minute break every five hours of work, are not applicable.The Labor Department cited a large growth in the home care industry and a growing number of workers employed as caregivers as a reason to re-examine the live-in overtime exemption.Under the rules proposed December 15th, home care agencies and registries would no longer be able to use the exemption for live-in workers.   It’s not yet clear if that would mean live-in caregivers would have to be paid minimum wage the first 8 hours, time and a half the second four hours, then double time the next four hours.  If that is true, the cost to seniors and their families would go up by roughly 50 percent per day.   The result could be that families would turn to the underground economy for care and would perhaps hire unscrupulous individuals who are not vetted, trained, or supervised.Under the proposed new rules, Individuals and families could still use the exemption if they hired privately, however, that use would be narrowed.  For example, they could not hire a “professional” caregiver, or someone who provides care as a vocation.   They’d be able to use the exemption only if they hired a family member, friend, or someone who doesn’t ordinarily earn income from caregiving.The proposed rule clarifies that only incidental housework could be performed by the live-in caregiver.  Tasks such as cleaning dishes or doing a load of laundry would be okay.  Vacuuming would not be okay.Other incidental tasks to be allowed would include bathing, dressing, grooming, toileting, driving to appointments, feeding, etc.It’s also not clear what affect this would have on nannies or babysitters,...

Aging Parents, Alzheimer's/Dementia, At Home Care Solution, Health Care Reform, Lauren Reynolds, North County Home Care, San Diego Caregivers, San Diego Home Care, Uncategorized / 13.12.2011

There is no question health care spending is a critical issue.   Approximately 17 % of our gross domestic product is related to expenditures in health care, an amount that's seen a steady rise.Health care reform was proposed as a solution to the rising costs, but Steve Espinoza of the Hospital Association of San Diego and Imperial County warns the road ahead is clouded with fog and haze.Take Accountable Care Organizations for example.  Espinoza explains them this way, "It's like a unicorn, everyone knows what it is, but no one has ever seen one."What is Health Care Reform? The Health care reform is a 10 year process, with a watershed year being 2014, assuming the constitutional challenges are met and an individual mandate to buy insurance or face a penalty survives.Accountable Care Organizations are one part of the plan.  Put simply, ACO's are a way to reduce costs, by reducing unnecessary tests or procedures.  Those in the organization would share the cost savings and the potential risks of getting less reimbursement for undesirable outcomes.  Another major goal is to reduce hospital readmission rates within a 30 day period for the same diagnosis.Espinoza likens the idea to a TV Manufacturer, say Sony for example.  Sony uses lots of different vendors for the parts...

Aging Parents, Alzheimer's/Dementia, At Home Care Solution, Caring for Elders, Health Care Reform, Holiday Visits, Lauren Reynolds, North County Home Care, San Diego Caregivers, San Diego Home Care / 26.08.2011

When we are young, falling is a fact of life, a normal rite of passage.   It’s something that happens the moment we start toddling and continues through the new bike years of childhood.  By the teenage years, our falls are pretty much limited to the “head over heals” kind or those caused by sports.  As young people, we only think of really violent falls as serious, the ones where our heads hit concrete or when we fall off something from a high distance.The young boy with the broken arm loves the attention he gets from his classmates for a fall that caused damage that is temporary.  It will likely heal in six weeks.Seniors, on the other hand, want no attention for falling.  Many fear the consequences not just to their bodies, but to their way of life.   A fall might mean a loss of independence, a sign of growing physical weakness, an “excuse” for the “kids” to start talking about nursing homes.It’s true, falls are far more devastating, on average, for older people.  Falls are the number 1 reason for admission to skilled nursing facilities and they are a major factor in 40 % of all admissions for any reason.   1 in 3 seniors fall each year.In San Diego County, in 2008, there were 12, 535 seniors treated in the emergency department for falls.  In 2007, falls were the cause of 186 deaths.Why so many falls?  First, let’s look at how our balance system works.  We have our sense of vision, or sence of touch, and our vestibular/inner ear.   Our eyesight and our inner ear help keep us stable.  Information from our eyesight, inner ear, and our sense of touch is coordinated in our brain to give us balance.    The problem is, as we age, our vision and our ability to sense the ground through our shoes are diminished.   Also, changes in our strength and flexibility affect our ability to quickly “right ourselves” if we start to fall.Factors that may hinder our balance and make us more likely to fall include medical issues, physical issues, and cognitive issues.From a medical standpoint, here are some common reasons a person’s balance is compromised.  Arthritis can make it difficult or painful to move around.   High or low blood pressure may lead to dizziness.   Diabetes can lead to nerve damage and numbness in the feet.  Osteoporosis, or brittle bones, makes injury from a fall more likely.  Parkinson’s causes a person to have diminishing control over their movements.  Stroke or brain injuries affect balance.  Even incontinence can cause falls, because the senior may rush to get to a restroom and move too quickly.Medications are another big issue, with side-effects and interactions.  Blood thinners like Coumadin make even the slightest of falls very serious.  Sedatives, pain meds and antidepressants can also lead to falls.  One way to deal with this issue is to talk to your doctor or pharmacist, keep an updated list of all your medications and post a Vial of Life on the fridge.Some physical causes of falls include generalized weakness, a simple loss of muscle over time.  This...

Aging Parents, Alzheimer's/Dementia, At Home Care Solution, Caring for Elders, Health Care Reform, Holiday Visits, Lauren Reynolds, North County Home Care, San Diego Caregivers, San Diego Home Care / 26.08.2011

Jewelry theft and financial abuse are most common problemsDeputy District Attorney Greenwood, head of the elder abuse prosecution unit in San Diego County, has never been busier.  He credits the testimony on March 2nd of 90 year old actor Mickey Rooney.“Within two days of Mickey Rooney testifying before Congress on March 2nd, my phone was ringing,” Greenwood said to a crowd of investigators, attorneys, and elder care professionals attending an educational seminar at Somerford Place Alzheimer’s Assisted Living.  The seminar was sponsored by Somerford Place and At Home Care Solutions, owned by RSF resident Lauren Reynolds.Rooney’s testimony about being deprived of food and medicine, allegedly by his step-children, brought elder abuse into the national spotlight, Greenwood said, illustrating that it’s a growing national problem.“You are going to see many more people who are potential victims,” Greenwood explained, based on demographics.  In San Diego County, about 16 % of the population is over 65, roughly half a million people.“The problem is that people are being looted in San Diego County every day,” he said.He explained that jewelry is the number one item being stolen from seniors in San Diego.  One recent case involved a housecleaner/caregiver in Poway.  When a homeowner reported the jewelry missing, sheriff deputies installed a video camera in the bedroom and actually caught the housekeeper on tape taking items from a drawer.“Turned out that housekeeper worked for 12 other people,” Greenwood said, “and 9 of the 12 had jewelry missing.”His advice is that seniors keep an inventory of jewelry including pictures.  Valuables should be kept in a locked drawer or safe.   And he said there is a pattern for whom is doing the stealing.“The #1 culprit is a convicted felon turned caregiver,” he explained.There is no law requiring background checks on caregivers and some unscrupulous agencies hire them based only on “self-reporting” of any past criminal history. (At Home Care Solution, a fully certified home care agency, runs local, state and federal background checks on all of their employees.)Secondly, Greenwood said, adult sons who are lazy, unemployed and addicted to drugs or alcohol tend to be the thieves, followed by tradesmen who are in the home to provide a service.“In one case, a carpet cleaner used his high powered hose to actually vacuum the jewelry out of the drawer and into his van,” Greenwood said.The criminals prey on confusion and fear.  One local man called up an elderly woman, claimed to be her grandson and convinced her that he needed $100,000 to be wired to China.  The fake grandson told the woman he desperately needed the money for a legal settlement.  Greenwood blamed the bank for allowing the suspect transaction to go through.There is an Adult Protective Services hotline to call for those who suspect elder abuse, 1-800-510-2020.  However, Greenwood admitted the strapped state budget has left the hotline understaffed and the wait can be up to an hour. He hopes the state legislature will soon pass a pending bill that would allow reports of elder abuse...