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The federal government is mailing $250 checks this week to seniors who fall into the gap in Medicare's prescription drug coverage. The first checks will be sent June 10, three weeks earlier than scheduled, to about 80,000 people. The rebates are the first step in closing the Medicare "donut hole." The Department of Health and Human Services estimates that about 4 million seniors will get the rebates in 2010. The move is one of the first tangible results of the health reform law. At a press conference last month, HHS Secretary Kathleen Sebelius said closing the donut hole is "one of the biggest ways the new law is going to help seniors." Seniors get stuck in the donut hole if their prescription drugs cost too much to be paid for through basic Medicare coverage, but aren't expensive enough to qualify for catastrophic coverage. "We think our members will see these checks as a good faith down payment on what they've been looking for so long: closing this coverage gap," said Cheryl Matheis, AARP's senior vice president for health strategy.

To qualify for Medical Assistance to help pay for long term care costs, seniors must qualify financially. One of the financial requirements is that the senior’s income must be low enough to meet the Medicaid program’s guidelines. Another is that senior who is receiving Medicaid financed nursing home care must contribute from their income towards the cost of care.

In determining income qualification for elderly residents of long-term nursing facilities, Pennsylvania is one in a number of states that permits an individual to “spend down.” This means that residents whose income would otherwise be too high for them to qualify for Medicaid are permitted to deduct their medical expenses from income to “spend down” to the income qualification threshold. This is referred to as a “medically needy” methodology for determining Medicaid income qualification.

Once a senior qualifies for Medical Assistance for nursing home care, the senior must use his or her income as a co-payment towards the cost of care.  However, a Medical Assistance recipient can retain certain amounts that are allowed as “deductions” for purposes of determining the co-payment obligation. One of these allowable income deductions is for medically-necessary expenses incurred by the nursing home resident which are not paid by Medicaid. These are sometimes known as “Other Medical Expenses” or “OME.” 

In the past, Pennsylvania had tried to a place a dollar limit on the amount of OME an individual can deduct in calculating the co-payment obligation.  But this type of dollar cost limitation was determined to violate federal Medicaid requirements.

Because there is no dollar limit on the deduction of OME, individuals have been able to use medical expenses incurred during transfer penalty periods and medical expenses incurred at the private pay facility rate for extended periods of time as medical expense deductions. This can effectively reduce or even eliminate an individual’s payment toward the cost of long-term care services for an extended period of time. Those costs end up being paid by Medicaid.

Act 54 of 2009 was enacted to address this issue and reduce the potential cost burden on Medicaid. Although Federal law does not permit the kind of dollar limitations on deductibility that Pennsylvania once imposed, it does allow Pennsylvania to place “reasonable limits” on the ability to deduct OME. Act 54 of 2009 (Senate Bill 47 enacted December 17, 2009) revised Pennsylvania law to establish limitations that are intended to be in accord with federal Medicaid requirements.

On March 24, 2010, DPW issued OPS100303 which is the Department’s guidance to County Assistance Office caseworkers on the new rules for the limitation on the OTE that can be deducted when calculating the required payment towards cost of care. The guidance states that medical expenses are not deductible if the expense was incurred (1) for long term care expenses incurred six months or more prior to the application for MA, or (2) for long term care expenses incurred as a result of an imposed penalty.

In addition to impacting some seniors, these limitations may have a negative impact on nursing facilities which sometimes must rely on the OME rules to get paid for expenses a resident incurred prior to qualifying for Medical Assistance. 

The biggest news of the past several weeks has been the enactment of health care reform legislation. The legislation was passed in two stages: the “Patient Protection and Affordable Care Act” and the “Health Care and Education Reconciliation Act of 2010.”

Although many seniors have been frightened by the disingenuous political debate surrounding reform, the law includes many provisions of benefit to older Americans. Some of these provisions will take effect within the coming year, while others will be phased in over longer periods. Among the early changes of significance to older adults are:

1. Provisions to close the Medicare prescription drug donut hole. A $250 rebate will be paid to Medicare beneficiaries who hit the donut hole in 2010. In 2011 there will be a 50% discount on brand-name drugs in the donut hole. The donut hole is to be completely eliminated by 2020.
2. Expanded coverage of preventive care under Medicare. Co-payments for preventive services are eliminated and preventive services are exempted from deductibles under the Medicare program effective January 1, 2011.
3. Help for Early Retirees. The law creates a temporary re-insurance program (until consumer friendly health insurance exchanges are available) to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64 (effective 90 days after enactment).
4. Health plans may not drop people from coverage when they get sick (effective 6 months after enactment).
5. Health plans are prohibited from placing lifetime limits on coverage and restricted in the use of annual limits that would impede access to needed care (effective 6 months after enactment). In 2014, the use of any annual limits will be prohibited.
6. States are barred from imposing new eligibility barriers for Medicaid. So-called “maintenance-of-effort” (MOE) provisions in the new law prohibit states from making it more difficult for people to become eligible for Medicaid. These MOE requirements will apply until the major components of health reform go into effect on January 1, 2014. They will help assure that budget-strapped states do not try to save money by imposing new eligibility limitations on Medicaid as health reform is being implemented.

The signature feature of the new law is its complicated provisions intended to achieve near universal health insurance coverage beginning in 2014. In addition, it extends the solvency of the Medicare Trust Fund by at least nine years. For a summary of other key provisions of the law, click here or see the resource links below.

Now that we are bringing tens of millions of uninsured into our health care system, and reforming some of the worst of the abuses of our free market insurance system, we need to turn to the hard part – controlling costs. The new health reform laws take only tentative steps in this direction.

The US has the most privatized free market based health care system in the world.  Not coincidently, the US has by far the most expensive health care system in the world. Unless we get our costs under better control, financial disaster awaits. The good news is that it is apparently possible to provide better overall care at a lower per capita cost.  Most other countries do so.  But the US has never been able to rationally address how we deliver and pay for health care.  Politics, self-interest, sloganeering and emotions have always been in control.  

Whether we seek to control costs through market forces or government mandates, the hard truth is that everyone involved with our health care system will have to accept fundamental change. To succeed, change must involve not only payment systems, but most importantly, how we deliver care. Right now care delivery is driven by our payment system. The result is high cost and low quality.

Cost reduction will be difficult to achieve because interests that benefit from the current system will vigorously defend their turf and oppose any change that they perceive as disadvantageous to them. But if we are to avoid bankrupting our health care system and our country, specialty physicians may have to suffer reductions in their incomes, pharmaceutical companies may have to get by with lower profits, insurance companies with high overheads may have to be driven from the marketplace, trial lawyers may have to be forced to live with medical malpractice reform, and consumers may have to get use to fewer expensive tests, more emphasis on prevention, less reliance on physicians and hospitals, and more care in the home.

I don’t know where we will go from here. But it seems to me that the recently enacted recent health care reform legislation needs to be just the beginning of the beginning.

Here are some links to additional resources and information on the new health reform laws:

Full Text of the Patient Protection and Affordable Care Act (P.L. 111-148)

Full Text of the Health Care and Education Reconciliation Act of 2010  

Democratic Policy Committee Summary & Analysis of the two enactments

The Patient Protection and Affordable Care Act, Section by Section Analysis

Summary of The Health Care and Education Reconciliation Act

Health Insurance Reform: A Guide for Seniors

Several changes are coming to Medigap plans, which supplement Medicare's coverage. In June 2010, four current plans will be dropped and two new plans will be added, bringing the total number of available Medigap plans to 10.

Between copayments, deductibles, and coverage exclusions Medicare does not cover all medical expenses. To supplement Medicare coverage, you may purchase a Medigap policy from a private insurer. There are currently 12 Medigap plans that are identified by letters A through L. Each plan package offers a different combination of benefits, allowing purchasers to choose the combination that is right for them.

Beginning June 1, 2010, plans E, H, I, and J will no longer be sold. Individuals who already have one of the plans can keep it as long as they like, but no new policies will be sold. At the same time, two new plans -- M and N -- will be added. Plan M will pay 50 percent of the Part A deductible and some of the cost of foreign travel emergencies. It will not cover the Part B deductible. Plan N will pay the full Part A deductible, but it will require a $20 copayment for Part B office visits and up to a $50 copayment for emergency room visits. Plan N will also cover foreign travel emergencies.

There will also be some changes to the benefits offered by plans. The home health recovery benefit and preventive care benefit offered by some plans will be dropped. The preventive care benefit is duplicative of services that regular Medicare offers. The home health recovery benefit covered some personal services for individuals receiving skilled care through Medicare, but was underused. In addition, all plans will include an additional benefit to cover the out-of-pocket costs imposed by the Medicare hospice benefit.

A million low-income seniors have become eligible for a big assist on prescription drug expenses this year under a newly expanded federal program. The subsidy can defray thousands of dollars in costs, and in many cases eliminate prescription drug expenses entirely for participating seniors.

The Extra Help program which is administered by the Social Security Administration subsidizes Medicare Part D prescription drug premiums for eligible seniors. While the program is not new, eligibility rules have been changed this year in a way that expands its availability dramatically.

The government estimates the average annual benefit to Extra Help participants at $3,900. That should be welcome news for low-income seniors coping with soaring Part D premiums. Average monthly premiums jumped 11 percent for 2010, and they have risen 50 percent since 2006, according to the Kaiser Family Foundation.

Seniors are eligible for Extra Help if their income is no greater than $16,245 a year for singles, and $21,855 for married couples living together. The value of stocks, bonds and bank accounts cant exceed $12,510 for singles and $25,010 for married couples. The income definition does not include the value of homes or automobiles.

But there are two significant changes in eligibility rules this year. The cash value of life insurance policies is no longer counted as a resource, and assistance received from friends and relatives to pay for household expenses such as food or utilities also no longer are included. The Social Security Administration is urging anyone who did not meet the income standards in the past to re-apply.

The assistance helps with monthly premiums, any annual deductibles, co-insurance and co-payments. The program even plugs the notorious doughnut hole the current coverage gap in Part D that starts when beneficiaries exceed $2,830 in total drug costs for the given year. At that point, the beneficiary pays 100 percent of costs up to $6,440, when so-called catastrophic coverage kicks in.

Unlike standard Part D enrollment which occurs annually between Nov. 15 and Dec. 31, seniors can apply for Extra Help anytime during the year. But you will receive the maximum benefit if you are in a Part D plan with a monthly premium below a certain benchmark monthly premium set by Medicare for each region of the country.

If you are already enrolled in a Part D plan and enter the Extra Help program, you will be informed whether your premium is entirely covered, or that you need to pay the difference between the premium and the benchmark amount. However, you also have the right to change to a different plan at any time.

Low-income seniors who are not already enrolled in a Part D plan should apply for the Extra Help subsidy, and simultaneously enroll in a drug plan. If you are eligible, the benefit is retroactive to the first day of the month when you apply.

If you are switching plans or enrolling in Part D for the first time, use the Medicare websites plan finder to select a plan that maximizes your Extra Help benefit. You will input data about your specific prescriptions and some other personal data; the tool will take into account the expected subsidy when it presents Part D plan options to you. You will be looking for the plan with the fewest restrictions on your specific prescriptions, and one that works with a pharmacy you want to use.

You can also get free counseling and assistance in selecting a plan from your local State Health Insurance Assistance Program (SHIP), a government-sponsored counseling service for Medicare beneficiaries. To find the SHIP near you, visit http://www.hapnetwork.org/ship-locator/.

To apply for Extra Help, visit this page Social Security Administration website, call Social Security at 1-800-772-1213 or visit your local Social Security office.

Most doctors don't talk about end-of-life issues with their cancer patients when those patients are feeling well, a new survey has found. Nor do they talk about them until treatments have been exhausted. Those delays mean patients might not be able to make truly informed choices early in their treatment.  The study, published online Jan. 11 in the journal Cancer, surveyed 4,188 physicians about how they would talk to a hypothetical cancer patient with four to six months to live. A majority of respondents (65%) said they would discuss prognosis, but only a minority said they would discuss do-not-resuscitate status (44%), hospice (26%) or preferred site of death (21%) at that time. Rather, they would wait until symptoms were present or until there were no more treatments to offer.   Current guidelines, from the National Comprehensive Cancer Network, a not-for-profit alliance of 21 of the world's leading cancer centers, say that such conversations should be initiated whenever a patient has been given less than a year to live, if not at diagnosis.  Doctors gave various reasons for not following the guidelines. Some didn't want to dash patients' hopes; some wanted to continue treating patients. In addition, said lead author Dr. Nancy Keating of Harvard Medical School: "There's at least some evidence to suggest that patients don't want to hear about these things."

 

Source: Los Angeles Times (January 25, 2010)
Link to full story

In today’s age of the worldwide web, we engage in a great deal of Internet commerce.  We order office supplies, buy books, pay bills, transfer funds, check account balances, sell things, check email, and need a password to access a laptop or office computer.  We all have difficulty keeping track of our own passwords, let alone other people’s passwords.  Therefore, what would happen if you were to become incapacitated or were to die?  Who would have knowledge of your computer passwords?  We generally supply our loved ones with bank account information, safety deposit box key location, location of life insurance papers, wills, etc.  However, it is time that we know include passwords in otherwise confidential information.

 

My family personally experienced this situation upon the January 6, 2010 death of my father-in-law, Alan Feinberg, age 68.  Luckily, he had hand written his passwords on a peace of paper that was readily available.  However, were unable to access a few of his accounts and had to spend significant time determining the status of some accounts.

 

I urge you to have a system in place, as part of organizing your estate, for your loved ones to access your passwords in a time of crisis.  As more and more commerce is transacted electronically, this will take on increasing importance.                     

 

 

 

Despite continued studies that report the aging of Americans, the number of available nursing home beds continues to decline. Several states reported double digit declines in the number of available beds. A new report from the American Association for Long-Term Care Insurance (AALTCI) indicates the number of available beds at the beginning of 2009 was 1.67 million, a two percent decline from the prior year. Financial executives predict that if population and economic trends continue, the nation may face a two-class system of providing long-term care for millions of aging and disabled individuals. Those with savings or private insurance will have options including access to private facilities established for individuals who are not dependent on government programs, Medicare and Medicaid. Skilled nursing facilities that depend on government payments face a projected Medicaid shortfall in 2009 of $15.64 a day or almost $6,000 per-resident on an annual basis according to the AALTCI report. While experts report that the under-funding is not increasing sharply for 2009, it is expected to expand wider in 2010 as state budget shortfalls affect Medicaid shortfalls. States recently received $87 billion in increased federal medical assistant percentage (FMAP) funding as a result of the economic stimulus package. Many have not used the funds to increase Medicaid rates paid to facilities. Instead, they have used it to balance their budgets according to several experts who monitor the long-term care industry. Looking forward, a total of 48 states face budget shortfalls. The number of certified licensed nursing facility beds in the United States was 1.669 million as of December 2008. At the end of 2002, there were some 1.7 million nursing home beds. Texas had the largest number of nursing home beds (122,635), California had 121,950 followed by New York with 120,101. Alaska had the fewest beds with 725.

Source: EMax Health News (26 October 2009) Full story: http://www.emaxhealth.com/1/28/34234/long-term-care-insurance-association-reports-fewer-us-nursing-home-beds.html <http://www.emaxhealth.com/1/28/34234/long-term-care-insurance-association->

Best of luck to the Phillies in their attempt to repeat as 2009 World Series Champions.

Lawmakers this week will consider measures to enhance protections for assisted living residents in New Jersey to ensure they aren't discharged simply because they pay with Medicaid.  The legislation comes in response to an investigation by the Public Advocate's Office that found an assisted living firm wrongly showed New Jersey residents the door once they exhausted their savings and were about to go on Medicaid, despite promises to allow them to stay.  Wisconsin-based Assisted Living Concepts has eight facilities in New Jersey and more than 200 nationwide.  "It's appalling, yet also apparently reality, that assisted living facilities would break the trust they have with elderly patients who believed investing what they had left of their life-savings would bring them quality care for years to come," said Assemblyman Nelson Albano, D-Cape May Court House.  Albano, along with Assembly members Matthew W. Milam, D-Cape May Court House, Celeste Riley, D-Bridgeton, and Connie Wagner, D-Paramus, have sponsored a package of bills aimed at strengthening protections for seniors in such facilities.  The measures would urge the state health and senior services commissioner to make Medicaid-eligible residents more financially and administratively attractive to assisted living facilities; make information about assisted living facility services and options more accessible to consumers; and request the health commissioner and consumer affairs division director recommend how to use the state's consumer fraud law to more effectively protect assisted living residents.

 

A new study that looked at obituary photographs published in one metropolitan newspaper suggests that Americans may have become more biased toward youthful appearance, particularly for women. The study found that the number of obituary photographs showing the deceased at a much younger age than when he or she died more than doubled between 1967 and 1997. And women were more than twice as likely as men to have an obituary photo from when they were much younger. In 1967, about 17 percent of the obituary photographs surveyed in the The Plain Dealer (a daily newspaper in Cleveland, Ohio) were “age-inappropriate” – meaning they showed the deceased at least 15 years younger than when they died. By 1997, the number had increased to 36 percent of the surveyed obit photos. “Obituaries and their photographs are one reflection of our society at a particular moment in time,” said Keith Anderson, co-author of the study and assistant professor of social work at Ohio State University.

Source: Ohio State Research News (13 May 2009)
Full story: http://researchnews.osu.edu/archive/obitphoto.htm

 

People who serve as representative payees for individuals who receive Social Security or Supplemental Security Income (SSI) benefits now have more options for their annual reporting of how the funds are used.  Representatives, who in the past had to complete a paper Representative Payee Reporting Form each year, can now report online.  You may log onto www.socialsecurity.gov/payee.

A representative payee is someone who receives Social Security or SSI payments on behalf of a person who is not capable of managing the funds on their own. Representative payees must use the funds for the benefit of the person entitled to benefits. For example, a payee must use the funds to provide the beneficiary with food, clothing, and shelter.

If it's your first time using this service, you'll need to take a few minutes to register. Once you do, keep your identification and password in a secure place. You can use it to submit reports in future years.

When you're ready to complete the report online, you'll need to key in the unique code that appears on the paper form social security will mail you. Then you'll be able to key in the information. Online features make completing the report easier than doing it on paper.  Once you submit the report, you'll receive a confirmation number as proof that your report was received by Social Security.

 

U.S. Secretary of Commerce Carlos M. Gutierrez announced today that residents of licensed nursing homes, intermediate care facilities, and assisted living facilities will be eligible to request coupons from the TV Converter Box Coupon Program. The rule change takes effect 30 days after publication in the Federal Register. “Allowing nursing home residents and households who rely on a post office box for their mail to request coupons helps those most in need to make the switch to digital television,” Gutierrez said. “Ensuring that no one is left behind is our top priority and I encourage those who need a coupon to apply soon, and buy a converter box when their coupon arrives in the mail.” Applicants living in licensed nursing homes, intermediate care facilities and assisted living facilities will be required to provide their name, address of the facility and whether they receive television exclusively with an antenna, or through cable, satellite or other pay television service. A family member or a representative from the licensed facility may apply for one coupon for a nursing home resident, but the coupon will be mailed directly to the nursing home resident. A special application will be made available for nursing home residents to fill out once the rule becomes effective.
To address the possibility of waste, fraud and abuse, the Coupon Program will be vigilant and will deny applications that appear to be fraudulent. The address of each applicant will be checked against a third-party database to assist in validating eligibility.

After decades of partial solutions to fire threats in nursing homes, regulators are finally requiring sprinkler systems for the 2,466 facilities that still don't have them fully installed.  On Aug. 13, the Centers for Medicare and Medicaid Services issued a rule declaring that the $144 billion long-term care industry has five years to install the systems. Some 1.4 million residents live in 16,000 U.S. nursing homes.  The government, which has adopted fire standards developed by the nonprofit National Fire Protection Association since 1971, was spurred to action by the deaths of 31 nursing home residents in incidents in Nashville and Hartford, Conn., in 2003.  "It is 35 to 40 years overdue," said Janet Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform, a Washington group that works to protect residents' rights.  The Department of Health and Human Services recently began listing on a Medicare Web site, under "nursing home compare," whether a facility has sprinklers, when fire-safety inspections took place, and the number of deficiencies found and corrected.

The Wall Street Journal on Thursday examined how U.S. nursing homes are "forcing out frail and ill residents" in an effort to "replac[e] them with shorter-term residents likely to bring more revenue." Federal law allows nursing homes to evict residents for six reasons: they are healthy enough to return home; they require care not offered at the nursing home; they risk the health of other residents or staff; they endanger the safety of other residents or staff; they do not pay their bills; or the nursing home closes. However, some state officials and patient advocates say that nursing homes "often go too far, seeking to evict those who are merely inconvenient or too costly," such as residents with dementia or demanding families.  Medicaid beneficiaries are at greater risk of eviction because Medicaid reimbursement rates are as little as half of what nursing homes make from residents who pay their bills out-of-pocket, with private coverage or through Medicare, according to the Journal. The Journal reports that Medicaid reimbursement payments to nursing homes in 2007 were $4.4 billion less than the cost of treating beneficiaries. According to Michael Wiederhorn, a health care analyst for Oppenheimer, approximately two-thirds of nursing home residents who stay in facilities more than 90 days depend on Medicaid to pay their bills.

Assisted Living Facility Costs as Tax Deductions

A recent NAELA News article by Robert Anderson discusses the process for deducting assisted living facility (ALF) costs on federal individual income tax returns. Internal Revenue Code (IRC) § 7702B provides rules for deducting certain qualified long-term care costs as medical expenses. Normally, the costs of nursing home care should be deductible, but the status of ALF costs has not been as clear.

For ALF residents, qualified long-term care costs are “necessary rehabilitative services, maintenance or personal care services that are (1) required by a chronically ill individual, and (2) provided pursuant to a plan of care by a licensed health care practitioner.” The ALF resident must first qualify as a chronically ill individual. The resident can meet this definition if within the previous 12 months, a licensed healthcare practitioner certifies that the resident meets one of two descriptions pursuant to IRC § 7702B(c)(2):

1. The resident is unable to perform at least two activities of daily living (ADLs) without substantial assistance from another individual for at least 90 days due to a loss of functional capacity. ADLs are eating, toileting, transferring, bathing, dressing, and continence.

2. The resident requires substantial supervision to be protected from threats to health and safety due to severe cognitive impairment.

Maintenance or personal care services provide assistance for a chronically ill individual with his or her disabilities; therefore, if an ALF resident needs help with two ADLs, then the assistance provided by the ALF qualifies as personal care services. Likewise, if the ALF protects the individual from safety and health threats due to severe cognitive impairments, then the assistance provided by the ALF qualifies as personal care services. The certification of the chronic illness requirement must be done within the preceding 12 months. The certifying licensed care practitioner can be any physician, registered professional nurse, or licensed social worker, and this practitioner does not have to be an employee of the ALF, although this practitioner could be. The licensed care practitioner must personally examine the resident and provide a written opinion. The opinion should be obtained prior to admission to the ALF.

The plan of care is not defined within the Internal Revenue Code. Federal statutes require that nursing facilities have a written plan of care for each resident. Although written care plans for ALFs are not required by federal statutes, most ALFs prepare them. The plan of care must be prepared by a licensed care practitioner, and it should be prepared at or as soon after admission to the ALF as possible.

If these requirements are satisfied, then 100% of the costs of the ALF (including room and board) are deductible on the resident’s 1040, Schedule A, to the extent that the costs are not reimbursed by government benefits or insurance. Under IRC § 213 (a), the resident can claim an itemized deduction for unreimbursed medical expenses to the extent that such expenses exceed 7.5% of adjusted gross income. These expenses include the qualified long-term care expenses, as well as insurance premiums and other eligible medical expenses.

If the resident does not meet the requirements of IRC § 7702B, then the resident can still deduct the percentage of the ALF costs attributed to nursing services, pursuant to IRC § 213. The room and board and personal services costs would not be deductible. The ALF should provide an estimate of the deductible portion of its costs, and the taxpayer can attach the statement to the Schedule A. Typically 30% to 40% of the ALF costs are for nursing services.

Being physically fit could hold back the advance of Alzheimer's disease, University of Kansas researchers have suggested.  Their study, published in the journal Neurology, looked at 121 people aged over 60, around half of them in the early stages of the disease.  Those with Alzheimer's who were less fit had four times more signs of brain shrinkage than those who were fit.  The Alzheimer's Research Trust said other research showed exercise reduced the risk of dementia.  People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly.  Other studies looking at the relationship between dementia and exercise have tended to focus on whether being active can reduce the risk of the condition developing in the first place.

 

By 2025, the wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn't increase soon, according to a new University of Missouri study. Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians.  Today, generalist physicians are a third of the U.S. physician workforce and are responsible for more than half of all patient visits at doctors' offices.  "Concern about the supply of generalists is not new," said Colwill, who also is a member of the National Academy of Sciences Institute of Medicine. "It has been with us since the 1960s and was gradually improving. However, during the past decade, the number of generalist graduates has fallen by 22 percent and declines continue as medical school graduates enter other specialties. At the same time, the U.S. population is increasing by about one percent each year, and the baby boomer generation will significantly increase the number of Americans older than 65 by 2025.  Typically, older adults seek care from generalists nearly three times each year, double the rate of adults younger than 65. Because of this, Colwill and his researchers expect the number of doctor visits to increase by 29 percent by 2025. At the same time, they project that the supply of general internists and family physicians will increase less than 5 percent.

On Wednesday, May 14, 2008, the New York Times publihed an article regarding finding long-term care placement for those over 18 - "For the Disabled, Age 18 Brings Difficult Choices in Finding Health Care."

In our Elder and Disability Law practice, we are working with more and more clients who are under age 70 and suffering from some  form of cognitive impairment.  For these individuals, searching for suitable housing is not always an easy task.

Long-term care housing generally is not designed for younger individuals in need of nursing home care.  Yet, more and more younger individuals are in need of a nursing home level of care.  We need to be able to provide proper care for these individuals and develop a new clinical model for facilities to work with a younger population.

One solution is to develop a more homelike setting, especially for those over the age of 18 who have aged out of pediatric facilities.  Caring for a younger population is yet another challenge facing us in the long-term care field.  

 

Last week I saw the movie,Young @ Heart.  Young @ Heart is a documentary regarding the lives of a group of senior citizen members of a choir in New England as they prepare for a performance.  If it sounds a little boring to you, you will be thoroughly surprised that the movie is both moving and inspirational.

What unfolds from the opening scene is a group of seniors, some struggling with serious ailments, making the most of their lives.  Often, seniors are portrayed as frail and sedentary.  This movie is a welcome respite from this stereotype.  

Participation in the choir gives its members a reason to wake up in the morning.  A reason to continue to live life to the very fullest.  Young @ Heart will leave you with the feeling that maybe the best years are ahead in all of us.        

 

 

 

On Sunday, January 6, 2008, my mom, my two nine year old twin daughters, and I spent the afternoon at the Academy of Music in Philadelphia.  The Broadway show Rent was playing at the Academy.  Our afternoon goal, however, was not to spend the afternoon at the Academy to attend the great show.  We were there as volunteers for the National Marfan Foundation to staff an information table and collect donations at the end of the show.

 

Rent's creator, Jonathan Larsan, died suddenly from Marfan Syndrom at the age of 35 immediately before the hit show made it to Broadway.  My family became involved with the National Marfan Foundation because my father died from Marfans at age 56 exactly 11 years ago.  My sister also has Marfans.

 

I thought volunteering our time today would be a great experience for my daughters who never had the opportunity to meet their grandfather.  My daughters had a blast. They had a great time collecting donations at the end of the show.  

 

Many of our firm's clients are stroke survivors, suffer for Alzheimer's, Parkinson's, or many other chronic illnesses.  It is a wonderful activity to to do as a family to unite the generations by participating in a charitable outing to honor the memory of a loved one.  The outings can include charitable walks, receptions, and local fundraising activities like my family particpated in today.  Today was a day I will remember sharing with my daughters and family for quite some time.              

Thanks to all of you who have attended our caregiver and professional seminar series thus far in 2007. We are going to continue the seminar series in 2008. We would love to hear from you regarding topics for seminars in 2008. Please email me at JRothkoff@rothkofflaw.com. Thanks!

We're moving to 911 Kings Highway South.