The Brown University Center for Gerontology and Healthcare Research has launched a new nursing home comparison website designed for professional nursing home researches, but which is readily accessible to consumers, advocates and administrators. Whereas the Medicare Nursing Home Comparison site compares survey data collected from each state, Brown University’s new site, LTCfocus.org, supported in part by the National Institute on Aging, crunches data from a variety of sources:

• State Policy Data – Brown University research team survey
• Online Survey Certification and Reporting system (OSCAR) – administrative data collected by the Centers for Medicare and Medicaid Services
• Minimum Data Set (MDS) – resident level data related to clinical and functional status
• Area Resource File (ARF) – a national county level health resources database maintained by the Health Resources and Services Administration
• Residential History File – a data resources developed at Brown University that tracks individuals as they move across the long-term care system

It’s an interactive database that lets the user create tables and charts to compare information about individual nursing homes, counties, states, etc. There is a wide range of variables accessible for comparison allowing greater research capabilities. Those variables include:

• for-profit versus non-profit organizational structure
• bed capacity
• percentage of Medicare and Medicaid approved beds
• Alzheimer’s specific units
• occupancy rates
• age ranges
• resident gender and race statistics
• staffing levels
• MDS quality measures
• resident admission sources (home or hospital)
• 30-day re-hospitalization rates

According to the LTCfocus.org site:

These data will allow researchers to examine the relationship between state policies and local market forces and the quality of long-term care. Researchers can use this website to examine care processes and resident outcomes within the context of their local markets and regulatory practices. Policymakers can use the information to shape state and local guidelines, policies, and regulations that promote high-quality, cost-effective, equitable care to older Americans.

They have plans to add additional information about other sectors of the long-term care industry at a future date.

Individuals looking to use the database to compare local nursing homes for purposes of long-term care decision making will find the site a bit cumbersome to navigate, but the savvy user should have no problem. The more likely impact for consumer-level decision making will be the downstream effects improved information sharing made available to policy makers and elder advocates. Consumers will likely still find Medicare’s Nursing Home Comparison site to be the most useful and straightforward. Contacting their Long-Term Care Ombudsman Program (contact information available through the Resources by State page) is an even consumer-friendlier method to gather information on area nursing homes.

Effective January 1, 2010, Medicare beneficiaries will have an easier time qualifying for Extra Help Medicare Part D prescription drug coverage. Extra Help assists low income people pay the monthly premiums, deductibles and co-payments associated with the Medicare prescription drug plans. Eligibility criteria was changed in 2010 so that:

• the cash value of any life insurance policy you have is no longer counted as a resource, and
• any financial help received from others to pay for household expenses (food, mortgage, rent, heat, electricity, utilities and taxes) is no longer counted as income.

Who qualifies for Extra Help?

Any Medicare beneficiary can get Medicare Part D benefits, but those with limited income and assets may qualify for Extra Help. As of the writing of this post, to qualify for Extra Help the beneficiary must:

• live in in the United States
• your available resources (bank accounts, stock and bonds) must be no more than $12,510 for an individual or $25,010 for a married couple living together.
• your annual income must be no more than $16,245 for an individual or $21,855 for a married couple living together. The income stated above may be higher if you or your spouse support other family members living with you, have pay from work, or if you live in Alaska or Hawaii.

To apply for Extra Help visit www.socialsecurity.gov or apply at your local Social Security office.

Visit the BenefitsCheckupRx website for a thorough analysis of the full range of prescription drug benefit programs that could help you.

There are a few publicly financed programs that help individuals pay for long-term care services, and each has its own specific set of rules and/or income criteria associated with it. Following are the largest publicly funded programs that help pay for long-term care.

Medicare

Medicare is a Federal program that covers health care for peopled age 65 and older, or for certain individuals with disabilities under the age of 65. While Medicare does not cover most long-term care services, it does help pay for limited skilled nursing services in a facility, hospice care and other home health care services under certain conditions.

Medicare pays for services in a skilled nursing facility when:

• you were just discharged from a hospital where you stayed for at least 3 days,
• you are admitted to a Medicare-certified nursing facility within 30 days of your hospital discharge,
• you need skilled services like wound dressing, physical therapy, occupational therapy, etc.

Medicare will pay 100% of the costs for the first 20 days, then a portion of your costs up to 100 days. You are responsible for the entire cost after day 100.

Home Health Care

Medicare coverage for home health care is limited to medically necessary, doctor ordered part-time nursing care, home health aides, physical therapy, occupational therapy, and speech-language pathology services. Coverage includes social services, wheelchairs, walkers, oxygen, and related medical equipment. Medicare will continue coverage so long as the service and equipment is medically necessary.

Hospice Care

Coverage for hospice services is available to people with a terminal illness that are not expected to live more than 6 months. Hospice services include drug coverage, medical support, social services, etc.

You can learn more about Medicare Coverage by downloading the Medicare and You Handbook.

Medicaid

Medicaid pays for long-term services in both institutional settings and in the home. Coverage begins when the individual meets Medicaid’s general eligibility, functional, and financial eligibility requirements. Services in the home are  covered so long as the individual would need those services in an institution if not provided in the home. The specifics of Medicaid coverage varies from state to state.  The application process can be confusing for some. Contact your Area Agency on Aging or your state’s Medicaid Office for more information, find them through the Resources by State page.

Veterans Affairs

The Department of Veterans Affairs provide long-term care services to veterans that are eligible, typically through meeting certain disability criteria, or to those who have service-connected disabilities. Visit the Department of Veterans Affairs to see what programs and services are available to you.

The federal Department of Health and Human Services has released the 2010 Medicare and You consumer handbook. This is the official government benefit description manual issued to Medicare members. The handbook contains information on the following:

• What’s new in 2010
• Medicare costs
• Medicare coverage
• Health and prescription drug plans
• Medicare rights
• Health information technology

Download the Medicare and You 2010 Handbook

There will inevitably be changes to Medicare benefits and information as 2010 progresses. For the latest information about changes to Medicare, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

The roughly 50 million retired and disabled Americans that receive monthly Social Security benefits are not projected to receive a Cost of Living Adjustment (COLA) for the next two years according to trustees who oversee Social Security. This would be the first time that Social Security beneficiaries haven’t received a cost of living adjustment since automatic increases were established in 1975.

Federal law mandates that Social Security benefits cannot go down – but here’s the catch: Medicare prescription drug program costs are set to rise. The costs associated with the Medicare prescription drug benefit are typically automatically deducted from monthly Social Security payments. Thus, if Social Security stays the same, and the automatically withdrawn costs for the prescription drug program go up – monthly checks will go down.

MSNBC reports:

Critics argue that Social Security recipients shouldn’t get an increase when inflation is negative. They note that recipients got a big increase in January — after energy prices had started to fall. They also note that Social Security recipients received one-time $250 payments in the spring as part of the government’s economic stimulus package.

“Seniors may perceive that they are being hurt because there is no COLA, but they are in fact not getting hurt,” said Andrew G. Biggs, a resident scholar at the American Enterprise Institute, a Washington think tank. “Congress has to be able to tell people they are not getting everything they want.”

Perhaps this is true, but today’s elders are in a precarious situation in that they spend a disproportionate amount of their income on health care needs, an industry that has expenses far exceeding inflation. Rising health care costs hit elders hard. Many seniors cannot just pick up more work hours to account for increased costs, and most have seen their investments and homes decrease in value. Is it any wonder that adults age 65 and older are the ones with the fastest growing credit card debt?

According to the public policy research group Demos, seniors at or below middle class income levels now bear an average of $10,235 in credit card debt. Mainstreet.com reports:

It’s not like the older set is blowing their credit card balances on frivolous items like Viagra or Virginia Beach golf vacations. Demos says that seniors are using their cards as a “plastic” safety net. Medical expenses are a common factor – the Demos study says that Americans 65-and-older have an average of $2,194 in credit card related medical expenses.

Think the Medicare prescription drug program cost increase won’t hurt? Think again.

The results of a Medicare cost saving project that tried to successfully manage older adults with chronic diseases was, if you’re reading this MSNBC article, a failure. I’ll beg to differ with the article’s assessment in a moment, but here is what happened:

• Centers for Medicare and Medicaid Services (CMS) selected 15 test-site programs in 2002 that tried keep sick, aging patients out of hospitals and cut costs
• The sites developed their own programs, enrolling a total of 18,309 fee-for-service Medicare patients
• About half received standard care, and the rest received managed care with a nurse available to advocate, encourage, and educate the patient
• Many patients had more than one chronic disease
• Only two sites cut the number of times patients were hospitalized
• None saved Medicare money

So the goal of the project was not met, but does this mean all was lost? I think not, for what it illustrated is the difficulty in trying to change patient behavior. The project’s failure was not the delivery of effective case management, but the patients’ inability or unwillingness to adopt a healthy lifestyle.

The article states:

“The only way you can really do it is by changing patients’ behavior and by changing physicians’ behavior, and both things are really hard to do,” said study author Randall Brown, a researcher at Mathematica Policy Research Inc., in Princeton, N.J., which was hired to evaluate the programs.

Often, these patients need to stop smoking, or lose weight, exercise more, eat healthier foods — a challenge even for generally healthy people. Those changes are especially tough for sick, older patients who often are set in their ways.

The story cited one success story within the various projects, however. A 74-year old retired man from Pennsylvania followed the case manager’s advice, ate healthy meals and exercised. He lost 60 pounds, his blood pressure and cholesterol improved, and his pre-diabetes evaporated.

The results of this study then begs the question: How does one get another to change his/her lifestyle for him/herself AND for the system supporting everyone?