Both CBS News and CNN have featured reports on “elder orphans” this week, seniors who are living alone without children or nearby family. On Tuesday evening, CBS News featured the story of an 81 year old Florida man who had recently been released from a hospital following prostate cancer treatment. He had no food in the house and was desperate so he called 911 to ask for help in getting groceries delivered to him. Fortunately, there was a huge outpouring of support and lots of food arrived for him.
A North Shore Long Island Jewish hospital study estimated that nearly a quarter of current seniors may be elder orphans and that a third of those aged 45-63 have no children and may end up that way when they are older. This situation highlights much of what we senior advocates have been concerned with and discussing in recent years. Of particular concern is the discharge planning in the hospital. This situation of the Florida senior shows how important it is to make sure that patients returning home have follow up visits or contacts to connect the services needed to live independently and not return to the hospital.
So much of what the health and aging networks are focusing on here in New York State is on care transitions and care coordination as well as preventing hospital re-admissions. The state has launched its “DSRIP” (Delivery System Reform Incentive Payment Program) Medicaid waiver to reduce re-admissions by 25% and is awarding large grants to health systems that collaborate with providers and community based organizations to improve health care outcomes in their areas.
The elder orphan situation also points out the need to continue to focus on supporting local seniors and community organizations to develop self help projects like the “village movement” and NORCS or “naturally occurring retirement communities” which allow older persons to age in the community of their choice. With so many people living alone or not having nearby relatives, a strong local support system that keeps people connected is critical. All the key research shows that people live longer and in better health when they have social interaction and a strong network of support.
Contrary to the perception that today’s older generation has it made, the reality is that while many may have more financial security and health security, the reality is there is a lot of silent suffering and loneliness. It is up to us as senior advocates to continue to draw attention and speak up to make elder care and caregiving a state and national priority.
Here is a link to the CBS News story aired last night
Doctors are sending letters to their patients informing them that the doctor’s practice is participating in a Medicare Accountable Care Organization (ACO). The ACOs are a new feature of Medicare that aims to get doctors, hospitals and health care providers to work together to better coordinate a patient’s care. One such letter states, “By helping your doctors and primary care providers to communicate more closely with your other health care providers, ACOs can deliver high quality, more coordinated care that meets your individual needs and preferences.” In addition to the care coordination, another lure for doctors and providers is “shared savings” they will achieve if they succeed in lowering health care costs for their patients.
The purpose of letters sent out to patients is to get them to approve sharing of information. A letter sent out from a North Country doctor participating in HealthCare Partners of the North Country, asked the patient to allow doctors to share the patient’s medical records with Medicare and other doctors participating in the ACO. The patient can refuse to do so. The heading on the letter says: “Notice to Patients: Your Provider is Participating in a Medicare Shared Savings Program Accountable Care Organization.”
The letter stresses that the ACO is not a Medicare Advantage Plan and that “your Medicare benefits aren’t changing… You still have the right to use any doctor or hospital that accepts Medicare at any time.” Medicare will automatically share information with doctors participating in the ACO unless the patient affirmatively opts out and does not want the information shared by either contacting the doctor or Medicare. To opt out at the doctor’s office, the patient needs to sign a form called “Declining to Share Personal Health Information.”
Medicare recently announced that it is planning to move away from the fee for service payment model and have most payments be based on coordinated care in the future. It will be important for consumer and patients advocates to monitor how this is working to see if care is better coordinated. This is a very difficult situation for patients. Doctors may decide that certain tests and procedures are not needed or are ineffective and that may be appropriate to not authorize them. However, denials also will produce financial benefits for doctors and providers and conflicts might arise if patients feel they have a problem and want a test and it isn’t authorized.
We will need to follow this and see what the studies and personal experience shows about how ACOs are operating. Ideally, by sharing information with other providers and making sure to follow up with patients when they go home from the hospital, overall care should be better. If doctors practices decide to hire additional staff to check in on patients with chronic conditions or those who have left the hospital recently that will be a great benefit. It only makes sense and should have been happening anyway.
With five weeks to go in the state legislative session, the paid family leave campaign is entering the final stretch and highlighting different constituency groups each week to voice support. This week, the faith community is taking a leading role. “Moral Mondays” which is sponsored by the Labor Religion Coalition of New York State has been gathering religious leaders, activists and supporters at the Capitol to bear witness to a number of issues that focus on the needs of the poor and vulnerable since the beginning of the year. Today, at 5:30 p.m. in the War Room on the second floor of the State Capitol just steps from the Governor’s office, the weekly event will be held on paid family leave.
“Paid family leave is necessary for our communities. No one should have to choose between keeping their job and caring for an an injured loved one. Faith mandates compassion toward the suffering and their caregivers,” remarked Rev. Brooke Newell of the New York State Council of Churches.
There is significant interest in the legislation. The Assembly has already passed the bill and Senator Jeff Klein, the head of the Independent Democratic Caucus says the issue is a priority for him. Republicans are also in dialogue with many groups which lobbied them on May 6th and many senators are hoping to find a way to work with the business community to find an acceptable bill. Many small businesses are supporting the Assembly bill.
Prospects for passage of many bills are unclear now since the Senate turmoil last week that resulted in a new majority leader, Senator John Flanagan of Long Island, being elected. Please voice your support for this bill (A3870/S3004)with your Senator.
A decade ago seniors were boarding buses for Canada to buy cheaper prescriptions. Some are still ordering drugs from Canada and other countries. The passage of Medicare Part D drug coverage helped to address the issue of drug costs. And, many drugs lost patent protection in recent years with many lower cost generics coming on the market. Now the backlash against drug pricing is getting hot again.
It is probably only a matter of time before a legislator in New York State introduces a bill calling for drug companies to provide financial details and profit reports on drugs that cost $10,000 per year. Drug companies say they have created miracle drugs that cure hepatitis C but at a cost of close to $100,000 for treatments. Many consumer advocates believe the cost is arbitrary and designed to maximize profits. President Obama’s budget for Medicare Part D shows a 30% increase because of escalating prices.
Legislators in California, Massachusetts, Pennsylvania, North Carolina and some other states have bills introduced to require reporting on profits and expenses for high priced drugs. Business groups and health insurers and joining consumer advocates in supporting the legislation.
It is clear that this situation could only get worse as drug companies develop biotech drugs that are more customized for individuals and cost much more. However, it is also clear that the costs to Medicaid, Medicare and private insurance are unsustainable and something has to give.
Meanwhile companies are consistently and significantly raising the price of older drugs that have been on the market for years and require no additional investment. New generic drugs are coming on the market at very high prices as well and drug companies continue to try to thwart generics.
The other big issue being raised is about international trade. Many members of Congress are questioning whether new free trade agreements will allow drug companies to go to international trade courts to enforce their patents in some countries, especially those with lower drug prices. Eli Lilly became the first drug company to use the NAFTA trade agreement to sue Canada for $500 million saying it had violated its patents. The Canadian government accused the company of trying to turn the North American Free Trade Agreement’s arbitration panel into a “supranational court of appeal.”
Rich Fiesta, the Executive Director of the Alliance for Retired Americans told its New York State chapter at its biannual meeting on Wednesday that the House and Senate GOP leadership has changed rules in their chambers that will make it harder to avert a funding crisis for the Social Security disability fund. Fiesta said that the new Congress is again trying to push reforms in Social Security and Medicare that will hurt beneficiaries. He said that the Social Security retirement and survivors fund is solvent through 2037 but the disability fund which is also part of Social Security may run out of money by the end of 2016.
Fiesta said it is clear the GOP leaders are trying to “manufacture a crisis” so that they can seek concessions on overall entitlement spending. The ARA says that new House and Senate rules “establish a point of order prohibiting reallocation from the Old Age and Survivors Insurance (OASI) trust fund to the Disability Insurance (DI) trust fund within the Social Security program. This procedural change to the House rules is unprecedented. It will have the effect of holding the DI trust fund hostage, and is a direct attack on seniors, disabled Americans and the Social Security trust fund.” Fiesta noted that the Treasury Department has transferred between those funds numerous times in the past.
This sounds like a losing strategy for those who dislike Social Security and hopefully it will backfire just as efforts to shut down the federal government backfired on opponents who demanded major changes in the Affordable Care Act and risked a national default as well.
Fiesta said the Alliance for Retired Americans wants to lift the cap on Social Security earnings which is currently $118,500 per year. Doing so would enable Social Security to actually provide an $800 a year increase in benefits for those receiving the lowest benefits and would extend solvency of Social Security trust funds.
Advocates for increasing the minimum wage also note that raising the minimum wage to its 1968 equivalent value would add $35 billion in wages that would be subject to the Social Security and Medicare taxes.
For more information on how lifting the earnings cap helps the trust funds, here is a link
Several hundred seniors, nurse leaders and union activists came to Albany Tuesday for a lobby day to push for the “Safe Staffing for Quality of Care Act” sponsored by Assembly Health Chair Richard Gottfried and his counterpart Senator Kemp Hannon. (A1548/S782). Gottfried addressed the gathering at the Convention Center of the Empire State Plaza and said while it is an uphill fight, “safe staffing is kind of basic.”
The advocates argued that better health outcomes result when staffing is sufficient to provide quality care and said “the number of patients assigned to a nurse has a direct impact on the ability to appropriately assess, monitor, care for and safely discharge patients.” The Gottfried/Hannon bill requires nurse to patient ratios in hospitals. The ratios would take into account changes in patient acuity and required that nurses have competency. In long term care facilities, the staffing requirements are base on a minimum number of care hours per resident.
The lobby day was jointly sponsored by New York State United Teachers (NYSUT), Communications Workers of America (CWA), New York State Nurses Association (NYSNA), Public Employees Federation (PEF) and New York StateWide Senior Action Council which represents patients and consumers. Leaders of all the organizations addressed the group in the Convention Center.
While hospitals oppose the bill’s strict ratios, the reality is that health care transformation is increasinglly being tied to outcomes such as reducing hospital readmissions. This focus on patient outcomes and improved quality of care will require a more intensive patient centered approach by hospitals and adequate staffing will be necessary. The failure to improve outcomes will reduce reimbursements for hospitals.
Governor Cuomo is seeking an end run around the Legislature since they haven’t approved a hike in the minimum wage. He is convening a wage board to review whether fast food workers are getting a fair wage.
There also needs to be a whole look at the wage scales for those who are providing care for seniors, disabled and children. Many are not making a livable wage and most are below $15/hour which is the minimum wage being sought by labor advocates. Just like those in the fast food industry and other low paying private sector employees who must rely on public assistance of some sort the same can be said of those who are taking care of our most vulnerable family members.
Here is a report on wages in the home care sector
Skelos Likely to be Replaced Next Week
More Republican senators are refusing to support Senate Majority Leader Dean Skelos as he tries to stay in power. In fact, the consensus among many in the media is that Skelos will follow the fate of Assembly Speaker Sheldon Silver after lawmakers return to Albany from a weekend at home listening to constituents. There will also be more motions by the Democrats to have a leadership vote and even Republican freshman Robert Ortt says he will introduce a motion as well. One report says that Senate Finance Chair John DeFrancisco of Syracuse is making calls to line up support to be elected Majority Leader. Senator John Flanagan and Senator Catherine Young have also been mentioned. The Long Island delegation will want Flanagan to replace Skelos but there are more members upstate and DeFrancisco may be the frontrunner.