What New Managed Care Regulations Will Mean For Frail Elders

Federal regulations are finally catching up with a decade of seismic change in the delivery of Medicaid services. More than 650 pages of proposed new rules are aimed at overseeing managed care, which has become the standard health care delivery system for low-income adults and children, and is now being expanded to include both medical care and long-term supports and services for older adults and younger people with disabilities.

Many of the new regulations are aimed at boosting consumer protections for those enrolled in these managed care plans, including frail elders.

What Medicare and Medicaid’s Ratings Say About Nursing Homes

For all of its flaws, Medicare and Medicaid’s Nursing Home Compare five-star rating system gives consumers a head-start when searching for a facility. Now, the Kaiser Family Foundation has taken a closer look at the ratings, and reached some interesting conclusions:

  • In a system that rates facilities from 1-5 stars, about one-third have low 1 or 2 star ratings, while about 45 percent received 4 or 5 stars.
  • Non-profits, which represent only about one-quarter of nursing facilities, generally get higher ratings than for-profits.
  • Smaller facilities score higher than larger ones.

Senators Want To Improve Medicare For Seniors With Chronic Diseases, But Are Ignoring Half The Problem

A powerful bipartisan group of U.S. senators wants to improve medical care for older Americans with chronic disease. By doing so, they are taking an important step in improving the health and quality of life of these seniors.

But so far at least, they are focusing on only half the problem. While older people with chronic conditions do need improved medical care, they also need better social supports, personal assistance,  access to services such as transportation, and safe and affordable housing.  Improving delivery of medical care without including social supports is like pumping air in a flat tire without first fixing the puncture.

Why Old People Get Such Bad Medical Care

In a recent essay in The Washington Post, geriatrician and author Jerald Winakur described the recent hospital experience of his 91-year-old mother. You won’t be surprised to learn it was a nightmare: Poor pain management, overworked staff, insufficient training, little communication among physicians and no communication between his mom and the waves of medical professionals who treated her each day.

She survived her two-month hospital stay but, Winakur suggests, only because he and his brother were constantly at her side.

Hill Republicans Won’t Try To Restructure Medicare—Yet

Congressional Republicans agreed to a non-binding budget framework yesterday that would slow projected growth of Medicare, but not completely restructure the program as the House GOP wanted.

House Republicans tried to use the budget process to fundamentally rewrite Medicare, turning it from an open-ended entitlement program to a model known as premium support. But the move was blocked by Senate Republicans, who feared a political firestorm.

In the premium support model, the federal government would provide a fixed subsidy (or a voucher) to help seniors buy insurance on the open market. Participants would gradually pay a much greater share of the program cost than they do today.

AARP’s New Evidence That Medicare’s Hospital Observation Rules Are a Mess

Of all the complex rules that plague fee-for-service Medicare, few are harder to understand and potentially more important for seniors than observation status. By now, many older adults have heard the phrase. But they are still not clear what it means.

A new study by AARP sheds some light on the consequences for seniors of hospital observation stays. But they turn out to be a muddle, in part because Medicare pays for hundreds of millions of dollars of skilled nursing facility care that probably should be billed to patients.

The High Costs of Family Caregiving

Over a 12 year period, nearly 6 of every 10 adult children age 51 or older will provide some care for an aging parent or in-law and nearly one in five will help an ailing spouse. And those who do are less likely to work, more likely to see a decline in their financial well-being, and more likely to fall into poverty, especially if they provide high levels of personal care for long periods of time.

The Long-Term Care Insurance Industry Ponders Its Future: Seven Trends To Watch

I recently returned from a few days at the long-term care insurance industry’s national conference, held this year in Colorado Springs. The organizers asked me to participate in a panel discussion on policy solutions to the challenges of financing long-term supports and services. But I also had an opportunity to listen to what insurance company executives, brokers, and actuaries had to say about their industry’s future.

In short, they see a very uncertain world. Carriers are experimenting with new products but few are making major commitments. They are struggling to identify new buyers and are more concerned with reducing risk than opening new markets. And, in a major shift from a few years ago, many attendees were looking for ways to partner with government and create some form of public/private insurance.

“If This Is An Emergency, Go To The Emergency Department”

Want to know what’s wrong with the health care system for older adults in the US? It can be summed up in that 10-word response on a physician’s voice mail.

One evening last month, I got a panicked call from a friend: She came home from work and discovered that her widowed mother, who has been living with her for the past year, had—for the first time—an episode of bowel incontinence. Her mom, who was distressed and almost certainly embarrassed,  wanted to go to the emergency department of the local hospital. What should her daughter do?

What the Medicare “Doc Fix” Means for Seniors: Six Things To Know

The House yesterday easily approved some of the biggest changes to Medicare since Congress created the drug benefit a decade ago.  While the measure still must be approved by the Senate and signed by President Obama (who supports it), it represents a significant shift in the way many seniors get—and pay for—their health care.

The measure, known in Washington-speak as the “doc fix,” is primarily aimed at repairing the way Medicare reimburses physicians for the services they provide. But it is a complicated proposal that would do much more than that. It would raise Medicare premiums for high-income seniors, limit some benefits under Medicare Supplement (Medigap) insurance, continue funding some information services programs for older people, and begin a process aimed at changing the way doctors are paid by focusing more on quality care and health outcomes instead of simply paying by the procedure.