Charles Dickens on Successful Aging

Father Time is not always a bad parent, and, though he tarries for none of his children, often lays his hand lightly upon those who have used him well.

- Charles Dickens, Barnaby Ridge, 1841

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A Living at Home/Block Nurse Perspective on Long-Term Care Financing

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Transforming Long-Term Care Financing: Perspectives from Missouri

Mary Alice Ryan is president and CEO of St. Andrew’s Resources for Seniors, a multi-faceted non-profit senior housing and services organization in St. Louis, Missouri. She wrote a great article on transforming long-term care financing that you can read here.

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Presidential Candidates Deathly Silent on Long-Term Care Financing Reform

It’s unfathomable that Sen. John McCain and Sen. Barack Obama are not discussing long-term care financing reform as part of their health care and economic policy and visions. Ecumen today distributed a news release that gives them 10 Reasons to Start Discussing Long-Term Care Financing Reform. Below is a copy of it.Ecumen Provides Presidential Candidates 10 Top Reasons to Discuss Long-Term Care Financing ReformSenior housing and services provider Ecumen highlights reasons for financing reforms necessary in the American age wave'10 Reasons Long Term Care Financing Needs to Be Reformed in America,' a recent post to Ecumen’s Changing Aging blog gives the campaigns of Sen. Barack Obama and Sen. John McCain 10 reasons to discuss long-term care financing. The blog also outlines a financing plan put forth by the American Association of Homes and Services for the Aging (AAHSA), which would provide an annual cash benefit of $27,000 for less than a cup of coffee per day. Also posted are reform ideas by AARP.

'If we’re going to have a truly coordinated health care system in America, that promotes wellness from cradle to grave, then long-term care financing reform must be part of American innovation,' says Kathryn Roberts, a baby boomer and president and CEO of Ecumen. 'This is a health care issue, a fiscal issue, a life quality issue, a personal responsibility issue, a business issue, and it impacts every single American - we’re all aging.'

'The issue of such care is perfect for both candidates who want to bring change to America,' said Roberts. 'The age wave represents millions of people who want to age in place and want services that are not institutional. To meet that huge desire for change and new choices, we have to also transform how we pay for people’s desire for independence.'

About 10 million Americans need long-term care today, while 12 million will need it by 2020. Long-term includes an array of services and supports people need when they can no longer care for themselves. Medicaid pays for 42 percent of all long-term care expenditures. According to the Kaiser Commission on Medicaid and the Uninsured, this costs federal and state governments $116.8 billion every year. And according to a new AARP report, most states allocate a greater percentage of their Medicaid dollars to institutional care rather than home and community-based services. Combined with Americans deplorable savings history, many Americans are at risk of not producing enough income to cover basic expenditures related to aging services.And therein is tremendous opportunity for McCain and Obama. According to the Long-Term Care National Survey conducted by the bi-partisan polling team of The Mellman Group and Public Opinion Strategies, 8 in 10 voters state that presidential candidates should make long term care an integral part of their health care proposals.

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Ecumen Invites You to a Long-Term Care Financing Event on Aug. 13th

Drowning or Surfing in the Silver Tsunami-

It’s Up to Us

Presented by Ecumen, the Citizens League, Minnesota Chamber of Commerce and 2020 Conference (a bi-partisan group of 60 legislators)

On August 13th,

Learn about Nebraska’s New Long-Term Care Savings Plan

And Insights for Minnesota

What:

Nebraska State Treasurer Shane Osborn and Trent Fellers, Director of the Nebraska State Long-Term Care Savings Plan, will present a new option to help Nebraskans live the good life, longer. Ecumen CEO Kathryn Roberts will provide introductory remarks The Nebraska Long-Term Savings Plan is the country’s first to offer tax incentives for people to save and pay for future long-term care expenses, personally direct savings on choices from technology to home services to insurance and more, and transfer unused benefits to beneficiaries.

When:

Wed., August 13, 2008

7:30 a.m. registration/light breakfast,

8 a.m. - 9 a.m. presentation/Q&A

Where & Registration:

The Wilder Foundation, 451 Lexington Parkway North (near I-94), Saint Paul, 55104 (free parking)The Event is Free, But Pre-Registration is Required by Aug. 6th:Register online at www.citizensleague.org, look for 'Silver Tsunami' under 'Upcoming Events, or call Catherine Wood at 651-293-0575, ext. 10.

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Long-Term Care Financing Progress Report

The other day we wrote about the long-term care financing solution put forth by the American Association of Homes and Services for the Aging (AAHSA).AAHSA CEO Larry Minnix has just blogged an update on the work in this reform area, including discussions with the McCain and Obama campaigns.Good stuff.

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Is Slow Medicine For You?

I used to think that I wanted to live to 100 or beyond. If I’m enjoying life, I’m still for it. But if moving my body makes me miserable and chronic illness rules my day, I’m pretty sure I’ll opt for slow medicine.Is slow medicine something that is appealing to you or do you say 'no way!' … ?Slow Medicine is an approach that encourages less aggressive and less costly care at the end of life. It’s a strategy similar to hospice - focusing on comfort - not cure. Kendal at Hanover, a senior community connected to Dartmouth Medical School, has become a leader in slow medicine. According to a recent N.Y. Times story, which you can read on Kendal’s website here, most residents there don’t opt for 'medical heroics,' the hugely expensive, pull-out-all-the-stop medical interventions to keep people living.I like how Hanover provides customer 'choice' to the very end of life. It seems like a very healthy approach to health care.

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Long-Term Care Financing Reform: The AAHSA Plan

Following are highlights of the American Association of Homes and Services for the Aging (AAHSA) framework for financing long-term care, which was presented at the recent forum at the University of Minnesota Humphrey Institute. Earlier we outlined the AARP plan here. To read more about The Long-Term Solution by AAHSA, go here:Key Features

• Cash should be the one, if not the only, choice of benefits to be used at the beneficiary’s discretion.
• Benefits should be tied to a simple level of need based on functional status, not age.
• Benefit levels should provide for a foundational level of services for people in the community and in residential settings, consistent with keeping the program actuarially sound.
• Systems to ensure that beneficiaries can access with appropriate help selecting and securing needed services must be available.

The Solution: National Insurance Trust Financed by PremiumsThe foundation of a long-term financing strategy should be a broad-based national insurance trust with low overhead costs and an all-inclusive risk pool. This insurance should be financed by premiums, not by general tax revenues, with premiums and benefits aligned to produce an actuarially sound program. This approach would allow baby boomers to prefund their long-term care needs. An independent, federally-charted organization could manage the premiums, investments and payments to ensure the funds are used only to pay benefits for this program.Benefits Available Regardless of SettingBenefits should be available regardless of setting. The dollar value of benefits should be tied to simple level-of-need determination that consumers can easily understand and focuses on a person’s need for assistance with activities of daily living (ADLs), including bathing, dressing and eating.Even if all or most Americans are enrolled, the benefits would not cover all long-term care costs. Some may wish to purchase extra wraparound insurance to cover full costs, and some may pay the difference with private funds. People with very low incomes will continue to need financial assistance.Wraps Around Medicare, Doesn’t Replace ItThe optimal financing plan is one that wraps around and extends, rather than replaces, existing Medicare benefits, which will continue to provide for the more intensely medical and shorter-term rehabilitation needs.Future expected Medicaid costs could be mitigated, helping to ensure the sustainability of Medicaid as a safety net. But near universal participation will be required, which could be achieved through a mandate or - perhaps more likely - through a strategy in which people are automatically enrolled in the plan and can opt out if they wish.Could a National Insurance Trust Work? Yes, For the Cost of a Cup of Coffee a DayAAHSA commissioned The Moran Company, a nationally known economics consulting firm, to model a long-term care insurance trust that would provide a daily cash benefit for people needing assistance with two or more ADLS and be fully funded for at least 75 years. The model provided premium prices for one, two, three and five-year benefits as well as a lifetime benefit. For simplicity, participation was determined to be mandatory for all adults.The study found that for about the cost of a large cup of coffee each day for each of us, we can create a national insurance trust that would pay a benefit of about $27,000 per year to each adult who needs assistance with two or more ADLs.

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The New Old Age: With The N.Y. Times' Jane Gross

Here’s another sign that aging and aging services is elevating on the national scene. Distinguished N.Y. Times writer Jane Gross (left) earlier this week launched a blog called 'The New Old Age.' One of her first posts already has 492 comments … Thanks, Jane. Below is her inaugural post, which gives you a flavor for her writing. If you’re in aging services and you want some free market research, follow the comments on her blog …

Jim’s mother-in-law has fallen again. For the fourth time this year.He and his wife meet the ambulance at the emergency room, then try to keep the frightened, old woman distracted through the long wait. They check her into the hospital with several broken bones and an unsteady heartbeat. They spend days at her side, jolly her through the rigors of rehab and finally take her back to her apartment, as they have so many times before.Along the way, the 60-something couple, friends of mine in Los Angeles, learn which pain medications make an 87-year-old woman delirious and which leave her in a stupor. They learn that Medicare covers orthopedic surgery but not long-term care at home. They learn about stage-three bedsores. They learn that out-of-town siblings can be summoned for a few days respite but don’t fully grasp the relentlessness of the caregiving task.Nobody wants the old woman to die, but her misery is a heavy blanket muffling many lives. Each mad dash to the ER, each hospitalization, takes a toll. On top of the cost of assisted living, Jim’s mother-in-law needs private duty home care, or else the next fall could be her last. But what happens if and when even 24/7 help isn’t enough? A nursing home? Who pays, at upwards of $100,000 a year? And how long will the money last?These are the trials many of us face during the final years of our parents’ lives, as we lurch, ignorant, from crisis to crisis. When my brother and I began this journey with my mother, who went from feisty independence to utter reliance on her children in a matter of months, we were making it up as we went along.We knew nothing about entitlement programs. What do you mean Medicare doesn’t cover the cost of home care or assisted living or a nursing home? We knew nothing about the advantages and disadvantages of hiring companions and aides through agencies or word-of-mouth. What do you mean that the agency aide needs permission from a supervisor before picking my mother off the floor if she falls?We knew nothing about hospital discharge planning. What do you mean she has to leave tomorrow when we have no place to take her? We knew nothing about geriatric medicine. What do you mean emergency rooms and intensive care units can cause a form of psychosis in the elderly, or that a catheter can lead to an undiagnosed urinary tract infection and even death?We knew nothing about Medicaid spend-downs, continuing care retirement communities, in-hospital versus out-of-hospital do-not-resuscitate orders, Hoyer lifts, motorized wheelchairs or assistive devices for people who can neither speak nor type. We knew nothing about “pre-need consultants” who handle advance payment for the funerals of people who aren’t dead yet, or “feeders” whose job it is to spoon pureed food into the mouths of once-dignified men and women.At the time, between 2000 and 2003, my brother and I felt terribly isolated. As leading edge baby boomers and the children of older parents, we were the first of our friends to go through the drawn-out process of watching a mother or father grow more helpless with each passing day until the role reversal put us squarely in charge of everything. Once in charge, we had to rely on each other as never before €” sometimes perfectly in synch, other times at each other’s throats.At work, the assistance available to new parents did not readily extend to our situation, which was as laborious as child care but without the joy or the promise for the future. When I asked for a four-day week here at The New York Times, exhausted from my dual labors, the person in charge of such matters, who readily agreed, noted that I was the first employee to make such a request but surely wouldn’t be the last.How right he was. Today, in the newsroom at The Times and at places of business everywhere, middle-aged men and women in growing numbers are juggling their jobs, their parents’ increasing needs, frequent emergencies and all the other moving parts of their lives. They look stunned and very tired. I remember it well. Because I chose to write about aging and caregiving in the wake of my mother’s death, gaining a level of expertise I didn’t have when I needed it, they come to me with questions.How can they find a reliable home health aide? What should they look for in an assisted living community? How long is the waiting list at top-notch nursing homes? How onerous is the paperwork for applying for Medicaid? Is it worth spending money for the guidance of a geriatric case manager? How do you persuade a parent that it is no longer safe to drive, or that the time has come for live-in help at home? What can be done about siblings who won’t carry their weight? Or about siblings who disagree over end-of-life or financial decisions?The experience of fielding those questions inspired this blog. I intend for it to be a source of information and community for grown children faced with these new responsibilities, for the elderly adjusting to unwelcome limitations and dependency, to employers interested in easing the burden, for professionals in the field and for anyone else who wants to chime in. Whining is permitted. Wisdom, and humor, are especially welcome.But most of all, I hope you will tell me, and each other, what problems you face and how you have solved them; what changes in American health care policy, in the workplace and in the community would make your lives easier; what has surprised and inspired you; and how your family has changed, for better or worse, as a result of this intergenerational experience.

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Seeking Study Participants in Caregiving Dementia Study

HealthPartners' research foundation and the Center for Spirituality and Healing at the University of Minnesota are recruiting participants through the summer for a study that will seek better means of stress management for people who are caregivers to a family member with dementia. To learn more or sign up, contact Dana McGree at 952-967-5031 or dana.a.mcgree@healthpartners.com.

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