Save Money On Prescription Drugs
Many families who are either uninsured or under-insured face high prescription drug costs. With so many uninsured and under-insured people in the United States and the high cost of prescription drugs, you hear stories about people who have to make a decision about whether to pay for their groceries or their prescription medications. You also hear of people who cut their pills in half because they cannot afford their medications. Unfortunately, patients taking multiple medications or receiving treatment for conditions like Cancer, HIV-AIDS, Multiple Sclerosis, Rheumatoid Arthritis, and other serious illnesses may face hundreds and even thousands of dollars in prescription costs each month. Read more
Health Insurance Reform Weekly Medical cost trends for 2012
PricewaterhouseCoopers and Medco Health Solutions released two new views of cost trends in health care during the past week, building on the release of the Milliman Medical Index. PwC Health Research Institute’s “Behind the numbers: Medical cost trends for 2012,” examines the medical cost trends for employers in 2012. This new report found “Medical cost trend is expected to increase from 8 percent in 2011 to 8.5 percent in 2012.” And two main drivers identified by PwC are provider consolidation and cost-shifting to the private sector.
Providing a view of prescription drug utilization and pricing trends, Medco’s Annual Drug Trend Report showed this week that while the overall growth of prescription drug prices is at an historic low (as a result of increased use of generic drugs), the cost of specialty treatments is still increasing at an alarming rate. According to Medco’s report “Specialty drug trend was 17.4 percent in 2010, fueled by unit cost growth of 11.5 percent.”
Federal
There is no Federal report for this week.
States
ARIZONA: The Department of Insurance (DOI) held a public hearing on rate review as part of its Health and Human Services (HHS) grant activities. The DOI has retained Mercer Consulting to assist in performing a gap analysis to identify areas that need to be addressed in order to comply with the requirements of the Affordable Care Act (ACA). During the hearing, it was noted that the state’s current statutory scheme does not authorize the DOI to review a health insurer’s medical loss ratio, potentially not allowing the state to meet the HHS requirement of having “an effective rate review process.”
The Director of Insurance and the Governor’s office also hosted their first workgroup on the implementation of an exchange. Despite the legislature’s refusal to pass an exchange bill, there is concern at the executive level about a lack of preparedness in the event the ACA is not repealed or found unconstitutional. This week’s topic was the qualified health plan certification, and participants focused on not adding requirements beyond the ACA minimum benefit requirements.
CALIFORNIA: The Appropriations committees of both houses are wading through many bills that would have varying impacts on state finances. Bills meeting certain dollar thresholds are sent to “suspense” filing for consideration at later hearings. Most of the legislation that Aetna and other allies have opposed has been sent to the “suspense” filing, including a bill on rate regulation and all bills on benefit mandates, because of the fiscal impact of each bill and potential conflicts with federal guidance on essential benefits. These bills may be revived at a later date, or they may be held by the committees. We expect the majority of the bills to be voted off the suspense file by the end of the month, including.
Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least million to DMHC and CDI.
Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least million to DMHC and CDI.
Autism mandate – According to the committee analysis, this bill would result in annual costs to the following state entities:
CalPERS: million
Medi-Cal, for enrollees in managed care plans: 4 million
MRMIB plans (Healthy Families, AIM, MRMIP): million
In state budget news, the governor will release his May revision to the state budget next week, taking into account new revenue figures that show the state taking in more than billion in unanticipated new tax dollars. The governor still believes that asking voters to extend the higher tax rates set to expire this summer is the right thing to do because the higher revenue forecasts would not close the entire budget shortfall. Republicans, however, have been quick to argue that higher revenue forecasts mean that extending tax rates is not needed at this time.
CONNECTICUT: The legislative session adjourns June 8, but the legislature has yet to reach a conclusion on several major issues, including an exchange bill, a rate review bill and the SustiNet bill. Although the SustiNet compromise bill language is not public, the Administration and press reports have said that the bill does not include a public option but would create an advisory board on health reform implementation and examination of future state reforms. In addition, an anti-most favored nation clause bill has passed the House and now goes to the Senate for its consideration. Aetna supported the bill with amendments. The bill is expected to pass. Additionally, the recently released HHS rate review rule may push legislators to advocate for adoption of the federal 10 percent trigger for rate review in Connecticut, just in case the federal law is repealed.
DELAWARE: The Department of Insurance (DOI) submitted a medical loss ratio (MLR) waiver application to HHS for its individual health insurance market. The DOI-requested adjustment proposes a three-year phase-in of the MLR as follows: 65 percent for 2011, 70 percent for 2012, and 75 percent for 2013.
GEORGIA: Governor Deal has signed legislation that applies state prompt-pay standards to self-funded plans. Aetna will be working with self-funded customers who have questions about the validity of the new law and its application to their plans, which are generally covered by ERISA.
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INDIANA: Insurance Commissioner Stephen Robertson submitted an MLR waiver request to HHS seeking relief from the MLR regulation for the individual market and for consumer-directed health plans in both the individual and small group markets. Specifically, for the individual market, Indiana is requesting that the MLR be waived for the individual market through 2014, or, as an alternative, that it be phased in as follows: 65 percent in 2011, 68.75 percent in 2012, 72.5 percent in 2013, 76.25 percent in 2014, and 80 percent in 2015, with an exemption from the MLR requirement until 2014 for new market entrants (defined as those that have not previously sold individual major medical health insurance products in Indiana for the previous 10-year period). For consumer-directed health plans in the individual and small group markets, Indiana is requesting a permanent waiver from the federal MLR requirements.
MAINE: Governor LePage has signed into law an Act to Modify Rating Practices for Individual and Small Group Health Plans. The new law is designed to open up Maine’s individual and small-group insurance market to competition. It also is supposed to:
help lower health insurance premiums by broadening Maine’s community rating system and allowing insurance companies to base their premiums on a more flexible set of criteria.
allow Maine residents to purchase insurance in four New England states beginning in 2014.
set up a reinsurance pool to cover individuals with serious illnesses. The pool would be subsidized by a covered lives assessment capped at per member per month.
The Maine People’s Alliance (a progressive advocacy group), the Maine Democratic Party, and others are looking into the feasibility of initiating a referendum on the new law. In order to get a referendum on the November ballot, opponents would have to file approximately 60,000 signatures with the secretary of state no later than 90 days after the enactment of the bill on May 17, 2011.
MONTANA: Governor Brian Schweitzer has decided to reconsider his amendatory veto of legislation that prohibits the state from enforcing the individual responsibility requirement contained in the ACA. Noting the critical role that the individual mandate plays in lowering the cost of coverage, the Governor’s amendatory veto argued that the prohibition against enforcing the mandate in Montana should be contingent on whether residents have access to affordable coverage. However, on May 13, the Governor reversed his position and signed the bill into law, as permitted under Montana’s statutory procedural guidelines. The provisions of the law include legislative findings stating that the ACA individual coverage requirement will cause unnecessary expense and inconvenience to individuals and employers, and therefore the legislature prohibits any agency of the state from enforcing the provisions of the ACA and subsequent federal regulations that relate to the individual coverage requirement. The law specifies that the prohibition extends to requiring public employees to purchase or maintain coverage and state officials or employees from participating in boards, commissions, or entities of the NAIC that are assigned to recommend provisions that implement the individual mandate.
NEVADA: HHS informed the Nevada Division of Insurance that the state’s application for a transitional waiver from the MLR provisions contained in the ACA has been denied and amended.
In its response letter, HHS admits that application of the ACA MLR standard could in fact lead to destabilization of the state’s individual market but argues that the transitional waiver requested by the state (72 percent) exceeds the amount necessary to prevent destabilization and would ‘deny consumers an excessive amount of benefit.’ For this reason, HHS determined that Nevada should be granted a one-year transitional waiver under which the MLR for the state’s individual market will be 75 percent in 2011.
SB 440, which would create the Silver State Exchange, had its first hearing on March 18 in the Finance Committee, but no action to advance the measure was taken.
NEW JERSEY: Last week the Department of Banking and Insurance (DOBI) announced that Horizon Blue Cross Blue Shield of New Jersey has officially withdrawn its application to convert to a for-profit entity.
In the final round of public budget hearings, the non-partisan Office of Legislative Services (OLS) and State Treasurer, Andrew Sidamon-Eristoff, testified that state revenue is now expected to exceed forecast by 0 to 0 million due to higher income tax collection. This was welcome news as the legislature and the Christie Administration wrestle with various program cuts under the current budget proposal. Leadership in the legislature has called for restoration of property tax rebates and reconsideration of the proposed changes to the Medicaid program. It has been reported the Administration is seeking to change Medicaid eligibility to 33 percent of the federal poverty level. Democratic legislators have come out en masse opposing this change.
NEW YORK: James Wrynn will be the deputy superintendent for Insurance under the Department of Financial Services (DFS) after the consolidation of the New York State Insurance Department, of which he is currently superintendent, with the Banking Department. Benjamin Lawsky was nominated to be the superintendent of the DFS. At packed confirmation hearings, Lawsky appeared before the Senate Insurance Committee and then the Senate Banking Committee. Lawsky said he understands that prior approval has become “overly politicized.” He said he would make addressing this his “number one priority.” He also said he planned to meet with all stakeholders on this issue in the coming months. He was unanimously approved by both Insurance and Banking Committees but must still appear before the Senate Finance Committee for its approval.
The NYS Department of Insurance held public hearings on exchanges that reports say were not well attended. The New York Health Plan Association testified that the success of any health insurance exchange boils down to the affordability of coverage it can offer. The HPA said the best way to preserve affordability is through an independent authority, which could be created by passing very limited exchange legislation before the end of the legislative session. Such legislation could establish the governance and infrastructure of the exchange and charge it with conducting research to make recommendations regarding the policy issues that need to be addressed by 2014. A key issue to address is how to ensure that the exchange is financially sustainable by 2015, as the law requires.
NORTH CAROLINA: Legislation implementing an Exchange Advisory Board met with some consumer opposition last week. Opposition centered mostly on the way in which the exchange will be funded.
OKLAHOMA: In the final week of the legislative session, leadership in both chambers announced the formation of a special joint legislative committee to study how the new federal health care law affects Oklahoma. Senate Pro Tem Brian Bingman and House Speaker Kris Steele ordered the formation of the joint committee and announced that “studying this issue in more depth makes for healthy legislative process. The scope of this law is vast, so we need to make sure we are prepared to address this law in a conservative way that is best for Oklahoma.” The committee will have bipartisan membership. The joint committee will hold a series of public meetings over the legislative interim focusing on how the ACA affects Oklahoma. The committee will also explore how to best approach the law as the state awaits the outcome of its lawsuit challenging the law’s constitutionality. The committee will then make recommendations on how the state should address the federal health care law.
As a result, legislation that would create an Oklahoma health insurance exchange will not be heard this year.
TEXAS: The health care collaboratives that would be set up by pending legislation (Senate Bill 
authored by Senate Health and Human Services Chair Jane Nelson are intended to promote higher quality of care at lower cost. The collaboratives would allow groups of providers, such as hospitals and doctors, to bargain collectively with the people who pay them. The goal is to give providers more leverage in price negotiations with an eye to cutting overall health care costs. But staff at the Federal Trade Commission (FTC) say giving these collaboratives antitrust protection could have the opposite effect and could harm consumers. Staffers have flagged this key provision of the Lieutenant Governor’s health care agenda for the session, indicating that a tool intended to improve the efficiency and quality of care in Texas might in actuality “lead to dramatically increased costs and decreased access to health care for Texas consumers.” To get around any antitrust issues, SB 8 specifically gives collaboratives exemption from antitrust laws. The bill is in the final stages of passage and could be headed to the House floor at some point in the last 10 days of the legislative session.
Meanwhile, uncertainty hung over the Texas Capitol at the end of last week as budget negotiators worked to bridge the gulf between the House and Senate spending plans and avert a special legislative session. What had been a billion difference Wednesday was narrowed to a few hundred million dollars as the House agreed to the Senate’s proposal on public education. To help pay for the billion added into the budget, the House relies on the .2 billion of additional state revenue announced by Comptroller Susan Combs this week. Lt. Gov. David Dewhurst said he was optimistic that a deal was in the offing. Negotiators are taking it down to the wire trying to complete their work by the end of the legislative session on May 30.
WISCONSIN: The Wisconsin Office of Free Market Health Care’s (OFMHC) survey to gather stakeholder input on the design of a potential Wisconsin Health Insurance Exchange closed last week. Now, the OFMHC will develop its plan for the exchange. OFMHC has been tasked to design and implement a Wisconsin Health Insurance Exchange that utilizes a free-market, consumer driven approach.
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Health Care Reform Weekly June 6 2011
Week of June 6, 2011
While the Affordable Care Act’s (ACA) medical loss ratio (MLR) and rate review provisions have been getting most of the media attention, a new coalition of business organizations has come together to draw attention to another important requirement of the ACA. Calling themselves Stop the HIT on Small Business, more than 25 national business organizations have joined forces to work toward repeal of new taxes the ACA would impose on private health insurance starting in 2014. Business leaders behind the effort say that small business owners, their employees and the self-employed will ultimately bear the brunt of billion in additional health care costs in the first 10 years as a result of the new taxes. The group is planning Capitol Hill outreaches and grassroots efforts.
Federal
Support is growing in Congress (over 80 co-sponsors) for Mike Rogers’ (R-MI) and John Barrows’ (D-GA) legislation that would exclude agent commissions from the MLR calculation. Currently, commissions count as administrative expenses in calculating insurers’ MLRs. This support was highlighted in a House hearing last week before the Health Subcommittee of the Energy & Commerce Committee, where the larger issue of the MLR burden was front and center. Witnesses representing agents and brokers, insurers and academia all testified against the unintended, negative consequences of the MLR requirement, with agents and brokers in particular noting the direct financial impact to small business and individual agents and their families. The Rogers/Barrows bill would simply not factor commissions into the MLR calculation. The day before the hearing, Congressman Tom Price ((R-GA) introduced an even more aggressive bill, as his proposal would repeal outright the MLR provision of ACA. While it is unlikely that either bill will get traction in the Senate on its own, bipartisan support for the agents and genuine concern about unintended consequences puts this issue in play as part of any potential mega-deal on the budget/deficit/debt ceiling issue over the next few months. The Senate was not in Session last week; and the House is out this week.
States
COLORADO: Governor John Hickenlooper last week signed into law a bill establishing the Colorado Health Benefit Exchange. The legislation created a fair amount of controversy during the session, particularly among “Tea Party” Republicans. However, the final product represents the culmination of a bipartisan effort that remained inclusive of the business, advocacy and insurance industry constituencies.
CONNECTICUT: Although adjournment is set for June 8, a number of significant bills are still in process. The legislature passed a bill over the weekend that would create a health insurance exchange. The bill is expected to be signed by Governor Dannel Malloy, as the legislation, as passed, is an amended version of a bill proposed by the Malloy administration. It would create an 11-member exchange board and set rules and responsibilities for the exchange, but many policy decisions would be left for resolution at a later time. The exchange must be financially self-supporting by 2015, and the bill would allow the exchange to charge assessments or user fees to health insurance carriers to fund operations. Some lawmakers questioned the cost of the exchange. However, the nonpartisan Office of Fiscal Analysis says the planning process is not expected to require additional state money. The bill calls for exchange board members to have expertise in specific subjects, including small employer health insurance coverage, health care delivery systems, access issues that self-employed people face, barriers to individual health care coverage, health care finance and benefits plan administration.
Additional bills yet to be passed by both Houses include the SustiNet bill, now amended to create a health care reform advisory board and allow municipalities and not-for-profits to join the state employees plan. Also, a prohibition on “most favored nation” clauses in provider contracts and a broad rate review bill that would require public hearings for all rate increases over 10 percent have yet to be acted on.
ILLINOIS: A spring session of the General Assembly dominated by redistricting, workers’ compensation, budget, pensions and gambling adjourned on May 31, 2011. Minimal health care legislation passed by both chambers is awaiting signature by the governor. One important legislative development is that Aetna helped turn back attempts to amend the “non-participating” physician law that was passed last year and went into effect on June 1, 2011. The law protects consumers from being overbilled by certain out-of-network, hospital-based physicians (i.e., anesthesiologists, radiologists) who provide direct services in hospitals and ambulatory surgery treatment centers. Under the law, the patient is taken out of the middle as it ensures patients will pay no more than they would have paid to one of their carrier’s participating providers. In addition, the law allows either the physician or the insurer to use binding arbitration to resolve disputes over the reasonableness of charges or reimbursements.
Other health care bills defeated including taxes/insurance assessments; reporting of extensive premium loss data; and health insurance rate review. Bills currently awaiting the governor’s signature include changes to the mental-health parity and clinical trials mandates, as well as insurer recoupment requirements that the industry ultimately agreed to. Also, a health insurance exchange bill passed both chambers that would establish an exchange and appoint a study commission of legislators to report back to the Assembly by Sept. 30, 2011 regarding parameters for an exchange. Follow-up legislation could potentially be considered in the fall veto session, beginning at the end of October 2011.
MAINE: Gov. Paul LePage and the legislature’s Republican leaders found a way to avoid an override of the Governor’s recent veto of the most-favored nation prohibition bill. The bill would bar insurers from requiring a health care provider to charge an insurance company the lowest rate the provider negotiates with any other insurance carrier. In his veto message on the bill, LePage said he strongly believes that businesses have a right to contract with each other as they deem appropriate. After some Republicans complained, LePage met last week with GOP leaders and co-chairs of the legislature’s Insurance and Financial Services Committee, which unanimously endorsed the bill last month. Republican lawmakers agreed to vote to sustain the governor’s veto when the House acts on it, and the Governor agreed to submit compromise legislation. The new bill would ban most-favored nation clauses but also allow Maine’s superintendent of insurance to issue a waiver. It is unclear what conditions an insurer would have to meet to earn a waiver. The bill’s language is not yet available to the public. With session scheduled to adjourn June 15, the legislature is likely to wait until next year to take up the bill.
Governor LePage announced that Eric Cioppa, Deputy Superintendent of the Bureau of Insurance, Department of Professional and Financial will serve as Acting Superintendent effective immediately. Cioppa replaces former Superintendent Mila Kofman who resigned recently. In his former role as deputy superintendent, Cioppa was responsible for the Examination, Market Conduct, Financial Analysis, Alternative Risk Markets, Producer Licensing, Administrative Support Unit, and Research and Statistics Units of the Bureau.
MICHIGAN: In the next couple of weeks, the state Senate is expected to vote on a 0 million paid-claims tax that would be levied on insurers and third-party administrators as proposed by Governor Snyder. Specifically, the bill would establish an entirely new tax on health insurance claims as a way to match federal Medicaid funding. The 1 percent on tax on all medical claims paid under health, dental, automobile and workers’ compensation coverage would impact fully and self-insured business. Ultimately, the cost of the tax will be borne by the sponsor of that coverage – the employer or the individual who already pays for the coverage. As introduced, the tax would begin on October 1, 2011. While working with lawmakers to help them understand the impact the tax would have on constituents, Aetna has mobilized its grassroots employee network to contact their state legislators regarding the issue. The bill has a strong chance of passing, and Aetna is urging all its constituents in the state to contact the Governor’s office and legislators to express any concerns they may have about the tax.
NEW YORK: Session is scheduled to adjourn June 20, and no official exchange legislation has been advanced. The Senate Republican majority is said to have a bill draft ready that supports a market-based exchange, but it has not been introduced yet. The Administration plans to introduce a more expansive model that reportedly will include giving the governor the majority of the board appointments, the exchange de facto rate-setting authority, and the exchange authority to selectively contract and require plans to participate. The bills are expected by the second week in June. However, with many other significant issues still on the table, compromise on an exchange bill may be swept up into a larger negotiation.
A very broad autism mandate is still in play. A set of amendments was introduced to ensure that an autism coverage mandate not be broader than for any other disease coverage mandate, For example, a pharmacy rider would be required to get pharmacy coverage, and there would be a limitation on visits but no dollar or age limits. The bill is still more expansive than last year’s version, which was vetoed by then-Governor Paterson due to its million fiscal note. Governor Cuomo has not announced his position on the proposal.
NEVADA: The 2011 legislative session is winding down toward adjournment on June 6. Governor Brian Sandoval has on his desk a rate review bill that would implement a prior approval scheme, require greater transparency and public access to rate filings, and allow a Consumer Advocate to request a public hearing. The measure is sponsored by the Democratic Speaker and has the support of the commissioner who says that some aspects of the bill are needed for the state to comply with HHS rate review requirements. The Senate-sponsored bill creating the Silver State Health Exchange continues to move toward passage in the Assembly.
PENNSYLVANIA: State government had another better-than-expected revenue collection month in May and headed into the final month of the fiscal year with a nearly 0 million surplus. The news came last week as the debate in the Capitol intensified over the depth of spending cuts sought by Governor Tom Corbett. Legislative budget analysts said the state’s updated revenue collection figure through the end of May was 2 percent, or about million, over the official estimate. That means the state has collected almost .3 billion through 11 months, or 2.3 percent above the official estimate. However, the state continues to face a projected multi-billion-dollar budget deficit in the fiscal year beginning July 1. The disappearing federal stimulus money that temporarily helped buttress the state’s recession-wracked tax collections is one of the largest contributing factors.
TEXAS: A special session of the legislature, called by Gov. Rick Perry to address education and health care issues left pending when the 140-day regular session ended May 30, got off to a slow start last week. But by the end of the week, the Senate Appropriations Committee unanimously voted in support of a massive health care measure that combines three weighty regular-session bills. Now headed for a full Senate vote, the package seeks .5 billion in Medicaid savings by expanding managed care to South Texas and restructuring insurance payment systems. It also would charge Medicaid patients for unnecessary emergency room visits and penalize doctors and hospitals for preventable complications.
Late Tuesday, Perry added another issue to the 30-day session: redrawing boundaries for Texas’ 36 congressional districts. School finance remains the main event of the overtime session. Another bill would resurrect the interstate health care compact, favored by Republicans because it would allow member states to opt out of the federal health care reform law. Democrats oppose the effort, saying Texas would save money by cutting more low-income people from Medicaid coverage. A bigger hurdle would be Congress, which must approve the compact. The special session will last a maximum of 30 days but could conclude earlier if the legislature finishes business and adjourns.
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Fact Sheets Home Health Care
Home health care helps seniors live independently for as long as possible, given the limits of their medical condition. It covers a wide range of services and can often delay the need for long-term nursing home care.
More specifically, home health care may include occupational and physical therapy, speech therapy, and even skilled nursing. It may involve helping the elderly with activities of daily living such as bathing, dressing, and eating. Or it may include assistance with cooking, cleaning, other housekeeping jobs, and monitoring one’s daily regimen of prescription and over-the-counter medications.
At this point, it is important to understand the difference between home health care and home care services. Although they sound the same (and home health care may include some home care services), home health care is more medically oriented. While home care typically includes chore and housecleaning services, home health care usually involves helping seniors recover from an illness or injury. That is why the people who provide home health care are often licensed practical nurses, therapists, or home health aides. Most work for home health agencies, hospitals, or public health departments that are licensed by the state.
How Do I Make Sure That Home Health Care Is Quality Care?
As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community.
In looking for a home health care agency, the following 20 questions can be used to help guide your search:
How long has the agency been serving this community? Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one. Is the agency an approved Medicare provider? Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations? Does the agency have a current license to practice (if required in the state where you live)? Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for? Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary? Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver? How closely do supervisors oversee care to ensure quality? Will agency caregivers keep family members informed about the kind of care their loved one is getting? Are agency staff members available around the clock, seven days a week, if necessary? Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day? How does the agency ensure patient confidentiality? How are agency caregivers hired and trained? What is the procedure for resolving problems when they occur, and who can I call with questions or complaints? How does the agency handle billing? Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services? Will the agency provide a list of references for its caregivers? Who does the agency call if the home health care worker cannot come when scheduled? What type of employee screening is done?
When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have. For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first.
Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem (see the Respite Care fact sheet for more information about these services).
In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:
Illnesses/injuries, and signs of an emergency medical situation Likes and dislikes Medications, and how and when they should be taken Need for dentures, eyeglasses, canes, walkers, etc. Possible behavior problems and how best to deal with them Problems getting around (in or out of a wheelchair, for example, or trouble walking) Special diets or nutritional needs Therapeutic exercises.
In addition, you should give the home health care provider more information about:
Clothing the senior may need (if/when it gets too hot or too cold) How you can be contacted (and who else should be contacted in an emergency) How to find and use medical supplies and medications When to lock up the apartment/house and where to find the keys Where to find food, cooking utensils, and serving items Where to find cleaning supplies Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure) Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them).
Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.
The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance.
Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met:
The patient must be homebound and under a doctor’s care; The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously) The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary” The home health care agency providing the services must be certified by the Medicare program.
To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at http://www.medicare.gov.
There are several national organizations that can provide additional consumer information about home health care services. These include the following:
The National Association for Home Care, which can be reached at 202-547-7424 or by visiting its website at www.nahc.org. The postal address is: 228 7th St., SE; Washington, DC 20003. The Visiting Nurse Associations of America, which can be reached at 617-737-3200 or by visiting its website at http://www.vnaa.org. The postal addresses are: 99 Summer St., Suite 1700; Boston, MA 02110.
To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging (at 1-800-677-1116 or http://www.eldercare.gov can help connect you to these agencies.
Because it is not always clear to the average person when an ailing senior needs home health care and when he or she needs nursing home care, it is usually best to consult a medical professional for advice. The following case study describes one situation in which home health care proved to be the right choice.
Francis is 84 years old and recently had a stroke. She was hospitalized briefly and then discharged to continue recovering at home. To enable her to return home, her doctor called a home health care agency, and the agency gave Francis a complete home health care plan for six weeks. Since the doctor ordered the home care for Francis, Medicare paid for it.
For the first week after Francis went home, a nurse visited her every day. The nurse met with Francis’s family to discuss her special dietary needs and to arrange for exercise therapy to help Francis regain her strength. Once that was done, the nurse visited Francis twice a week to check on how well she was recovering. The home health care agency also sent a homemaker, a personal care attendant, and a physical therapist to visit Francis several times during the week. The homemaker would do the shopping and cook light meals. The personal care attendant would help Francis bathe, get dressed, and walk. The physical therapist would keep Francis moving and see to it that she got some exercise to aid in her recovery.
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Let us meet your everyday needsWe can be reached at 972-346-2013 or http://www.palomahomehealth.com
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Health, Safety, and Nutrition for the Young Child
HEALTH, SAFETY, AND NUTRITION FOR THE YOUNG CHILD, 8th Edition, covers the contemporary health, safety, and nutrition needs of infant through school-age children in one comprehensive volume, with extensive coverage of topics critical to the early identification of children’s health conditions and the promotion of children’s well-being. Concepts are backed by the latest research findings and linked to the key professional standards of the field. Collaboration with families, sensitivity to individual differences, and the critical importance of health, safety, and nutrition education continue to be stressed. Written in a clear, concise, and thought-provoking manner, this time-proven book is filled with easy-to-access checklists, guidelines, and lesson plans that no early childhood student or professional should be without!
Pain in Our Legs for Continuous Time Then That is Called as Restless Leg Syndrome(RLS)
When we feel lot pain in our legs for continous time then that is called as restless leg syndrome(RLS). It occurs mainly during the early evenings or late in the evenings.Due to severe person cannot sleep and which results in insomnia. The increasing pain in leg will result in the arms pain. So, to avoid it we have varios types of treatments and various medications available. The most commonly used is mirapex. It is used to treat the the restless leg syndrome(RLS). If by any chance we have missed the dose than there is no need to take extra medicine to cope up. skip that dosage and take next one. Read more
Self Help For Panic Attacks Coping with Panic Attacks and Anxiety
If you’ve been looking into self help for panic attacks, I will show you a few simple ways of coping with anxiety syndrome or panic attacks real quick. The most general treatments are: Cognitive Behavioural Therapy (CBT), Presciption Medication & Breathing into a Paper Bag.
Cognitive Behavioural Therapy is usually the first route of treatment. Read more
Individual Health Insurance Reform Future Proceedings Easy To Insure Me
This Week in Health Care Reform
Health care reform legislation passed the House this week on a party-line vote. Late Sunday night, House Democrats approved the Senate health care reform package, sending the legislation to President Obama for his signature. On Tuesday, President Obama signed the underlying bill into law, yet the House has yet to finalize the package of “fixes” that will alter the final implications of the legislation.
Health Care Reform Negotiations Read more
Health Insurance Quotes Reform Obamacare & Buying Individual Health Insurance
This Week in Health Care Reform
Following the election of Republican Scott Brown to the Massachusetts State Senate last week and the resulting loss of Senate Democrats’ supermajority, lawmakers continue to pave the way for health care reform – with limited progress. In addition, polls indicate that the public would rather lawmakers focus more on the economy than on health care.
State of the Union Address Read more