Health All Day

Archive for December, 2009

Home Health Care Benefits – Find the Right Home Health Care Agency

Recovering from an illness or injury can be a stressful time for both the patient and the patient’s family. That stress is compounded when chronic illness or disability is involved. Research has consistently shown that, when at all possible, recovering at home is the best option for the patient’s physical and mental health. Unfortunately, when the patient is elderly or too injured or ill to care for themselves, recovering at home is sometimes not an option.

Finding friends or family members to assist with daily tasks is not always feasible. Even when family members are in a position to assist, the burden placed on them often puts a strain on their other family relationships, as well as their career and personal life.
Right Home Health Care Agency

Finding the right agency can be a daunting task, but not impossible, says Tilly Gambill, Manager of Marketing and Communications for the American Association for Homecare.

“People often receive home health services following a hospitalization or care in other care settings. Often the hospital discharge planner or social worker provides information on home health agencies,” Gambill says. “Ask the hospital for a list of home health care agencies in your community. In some communities, there may fewer available agencies. Physicians, friends, and family can recommend home health agencies, as well.”

The family got 2 references from the hospital and one from a family friend whose father with hypertension and diabetes receives home care services weekly.

To help them select the right provider, the National Association for Home Care suggests asking the following questions:
Questions to Ask a Home Care Provider

•    What are the qualifications and experience?
•    How long has the agency been in business?
•    Is the agency evaluated and accredited by a governing agency such as The Joint Commission’s Home Care Accreditation Program?
•    Is the agency licensed by the state?
•    Can the agency provide references? Ask for a list of doctors, hospital discharge planners and former clients who have experience with the agency.
•    How does the agency protect client confidentiality?
•    Is the agency inspected by any outside organization? May I see the results of the last inspection?
•    Does the agency perform a customer satisfaction survey? May I see the results of the last survey?

Questions About Caregivers

•    What are the credentials of the caregivers who work for the agency?
•    How does the agency select and train caregivers?
•    Do caregivers work directly for the agency? How are they supervised?
•    Are caregivers subject to criminal background checks?
•    Will the same caregiver be sent to my home for each visit?
•    Are nurses or therapists required to evaluate the patient’s home care needs?
•    If so, what does this entail?
•    Do they consult the patient’s physicians and family members?
•    Is the patient’s course of treatment documented, detailing the specific tasks to be carried out by each caregiver?
•    Will the agency schedule care at any time of the day or night that my physician says is necessary?
•    Can the agency provide me with written information about the rights and responsibilities of the providers, patients and caregivers?
•    Whom should I call with questions or complaints? How will the agency respond?

Questions About Services Provided

•    Can the agency provide me with written information about the services available?
•    Is there a written plan of care for each patient?
•    Does the agency involve the patient and caregivers in designing this plan and educate them about the care provided?
•    How does the agency respond to emergencies? How long does it take to respond to calls?
•    Will the agency help me find other community services such as Meals on Wheels or homemakers services, or help find medical equipment I may need?

Questions About Financials

•    Is the agency certified by Medicare?
•    Is the agency approved or accepted by my insurance plan or supplemental insurance?
•    How does the agency handle expenses and billing?
•    Does the agency provide detailed explanations of all the costs associated with home care?
•    What resources does the agency provide to help me get financial assistance, if needed?
There are several internet based referral companies available online. This type of service has you complete a form listing the type of services you are looking for such as home care

Finding the right person for the right job is never the easiest thing to do but hopefully these tips will help you.

Health-Care Reform to Dump Poor Kids?

Oleta Fitzgerald, director of the Children’s Defense Fund’s Southern Regional Office, says she is concerned over the welfare of Mississippi children if either of the two health-care reform packages considered by the U.S. House and Senate ever make it into law.

The House passed H.R. 3962 earlier this month, and Senate Democrats managed to beat back the threat of a Republican filibuster a few weeks ago, allowing the Senate to move forward with debate on the Patient Protection and Affordable Care Act, H.R. 3590. Both bills promise big reforms in the health-care and health-insurance industries. The Association for American Medical Colleges states that nearly 15 million people will be newly eligible for Medicaid and the Children’s Health Insurance Program under H.R. 3590, at an estimated cost of 4 billion over 10 years.

Fitzgerald says both bills contain huge holes regarding CHIP coverage for Mississippi children: “Right now, the fight over health-care reform in the House and Senate is all about abortion and the public option, but the children are getting lost in this discussion,” Fitzgerald said.

The issue, she said, centers on Mississippi’s unconventional requirement for CHIP eligibility.

Many states recently expanded their Medicaid program requirements to accept people who are a little further from the federal standard for poverty. Eleven states recently extended CHIP-eligible families’ income levels up to 200 percent of the federal poverty level, or higher. (,800 for an individual or ,200 for a family of three).

But instead of expanding Medicaid, Mississippi set up a new health insurance program that contracts with private insurance companies. The states that expanded Medicaid will continue to receive federal support for those programs under both the bills under discussion in the House and Senate. But in Mississippi, all children and their families over 150 percent of the federal poverty level (,245 a year for an individual and ,465 a year for a family of three) would go into an insurance exchange created by the House and Senate bills. The Senate bill plans to put CHIP-eligible kids in an exchange by the year 2019, while the House bill has them transferred by 2013.

Insurance exchanges do not promise the reliability of a government health program, Fitzgerald warns.

“Going into the exchange could require co-pays and premiums, the children would get lumped in with adults, and it’s not clear what requirements the insurance companies would have for their benefit packages,” she said.

There is also the question of permanence. Exchanges like the ones proposed by the House and Senate bills have not always been long-lasting. Texas, Florida, North Carolina and California all attempted—and failed—to create enduring insurance exchanges, primarily because private insurers tampered with the market.

A July report issued by the California HealthCare Foundation tried to pinpoint some of the factors that killed the California insurance exchange, which closed its doors in 2006. According to the report, the California exchange became too expensive when the clients it served became too costly. An exchange requires a certain number of healthy individuals to complement the more sickly participants of the exchange’s customer base; otherwise the cost of participation becomes too high for all participants.

But insurance companies in California lured healthy customers with lower premiums and steered the more sickly individuals into the exchange, creating a disproportionately expensive customer base.

“People involved in operations of the California exchange agreed that when there is competition for the same customers within and outside the exchange, the exchange is in ‘extreme peril’ of becoming a victim of adverse selection,” the report states. “If an exchange attracts a disproportionate share of higher risk individuals and groups as the California exchange did at various times, it cannot succeed.”

Fitzgerald said Mississippi’s eagerness to boot CHIP-eligible children from the program to keep down state costs is another factor complicating the new bills.

“Another problem is enrollment. We need enrollment in the exchanges to be simplified, because enrolling in state health programs have a history of being anything but simple in Mississippi,” Fitzgerald said, referencing a Medicaid policy championed by Republican Gov. Haley Barbour, which requires Medicaid recipients to meet Medicaid personnel “face-to-face” to be considered for program renewal.

CDF is working with its national office in trying to insert an amendment in the Senate bill though Democratic Sens. Robert Casey and Jay Rockefeller, which would keep all children up to 300 percent of the federal poverty level in the CHIP program until the new insurance exchange is thoroughly vetted.

Extending health care to more kids

OneWorld Community Health Center is looking for 6,000 kids.

The agency that generally provides health care to the underserved has received 6,264 from the federal government to create a program to enroll thousands of children in either of two government insurance programs for low-income children.

Many metro-area children are eligible but aren’t enrolled because their families don’t know the programs exist or don’t know their kids could qualify, said Andrea Skolkin, chief executive officer of OneWorld. That means some of those children are going without health care or are getting far less than they could.

OneWorld’s goal is to enroll at least 6,000 children. The agency’s outreach effort has just begun.OneWorld will place staff members in day care centers, schools, after-school programs, churches, food pantries, organizations and other places.

“We want to be where people are versus making people come to us,” Skolkin said.

They will contact families at those sites and determine whether they have children who qualify but aren’t enrolled in Medicaid or the state’s Children’s Health Insurance Program.

The staff members will have laptops to take down information and scanners to scan in citizenship documents and proof of Nebraska residency. Children must be citizens to receive the health care benefits.

The agency also will take referrals. For information, call 502-8888.

OneWorld, based in the Livestock Exchange Building, 4920 S. 30th St., has hired a director and will employ five full-time staffers for the program. OneWorld also has a clinic in Plattsmouth.

President Barack Obama this year allocated million to agencies in 42 states and Washington, D.C., for programs to conduct enrollment efforts over the next two years.

Through a competitive process, OneWorld was one of 69 entities to receive money. Iowa doesn’t have a program among the 69. An additional million will be distributed in 2012.

Enrollment among children in Medicaid and the Children’s Health Insurance Program has gradually risen in Iowa and Nebraska. The economy has worsened and awareness of the programs has broadened, spokesmen in Iowa and Nebraska say.

A child qualifies for Medicaid if his family’s annual income is at or somewhat above the federal poverty level, which is ,310 for a family of three.

Qualifying for CHIP isn’t as stringent. In Iowa, the state raised the CHIP ceiling this year to 300 percent of the federal poverty level, or ,930 for a family of three. Nebraska raised its income ceiling for CHIP from 185 percent this year to 200 percent, or ,620 for a family of three.

The Nebraska Department of Health and Human Services has estimated there may be close to 15,000 eligible children who aren’t enrolled. The Iowa Department of Public Health estimated there could be as many as 38,000 children who aren’t covered.

Paying for Home Health Care: What Do Medicare and Medigap Cover?

Prescribed only by a physician, home health care is skilled nursing care that aids in the recovery from illness, injury, or surgery in the patient’s home. And fortunately for many seniors who are now opting for care at home, Medicare insurance covers most costs related to home health care.

The government, however, has set some limitations on payouts – you are only eligible if you need intermittent care (usually defined as seven days a week or less than eight hours a day over 21 days or less) (1), physical/occupational therapy or speech language pathology; you are homebound; and the home health care agency providing care is approved by your Medicare insurance program.

In addition to medication administration, general supervision, and therapy services, the Medicare home health benefit covers a number of other necessities, including medical aids and supplies to aid in recuperation. On the occasion, though, you may be required to cover some of the costs associated with home health care. But what can you expect to pay out-of-pocket that’s not covered by Medicare dollars?

Medicare Insurance: Part A and Part B

Hospital Insurance (Medicare Part A) helps cover the costs of your inpatient care at hospitals, skilled nursing facilities, or religious non-medical health care establishments. Part A can also help cover hospice and home health care services. Individuals aged 65 and older are usually automatically enrolled in Medicare Part A and do not have to pay a monthly premium if Medicare taxes were paid while working. If you did not pay taxes, you are still eligible, but you will be required to pay a monthly premium.

Medical Insurance (Medicare Part B) helps cover services such as those offered by your physician and outpatient care. Many seniors maintain their enrollment in Part A, but elect not to use Part B, which requires a monthly premium that is dependent upon income, the requirements of which change yearly. Unfortunately, if you didn’t sign up for Part B when you were first eligible for insurance, your premium may be slightly higher (2).

For questions on your Medicare insurance benefits, you should contact 1-800-MEDICARE or read the handbook mailed to you each year entitled “Medicare and You.”

What’s Covered and What’s Not

Medicare insurance pays for physical and occupational therapy and speech language pathology services, counseling, some medical supplies, durable medical equipment (which must meet coverage criteria), as well as general assistance with daily activities which include dressing, bathing, eating, and toileting. For most other medical equipment, Medicare insurance will cover 80% of its cost (3).

However, Medicare will not cover twenty-four hour care at home, meals delivered to your home, and services unrelated to your care such as housekeeping. Of course, as mentioned above, you will be required to pay 20% for medical equipment not fully covered by Medicare insurance such as wheelchairs, walkers, and oxygen tanks (4).

In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse – the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.

Medigap and Other Out-of-Pocket Expenses

Medigap, a supplemental insurance policy, is sold privately and covers the services and supplies not paid for by Medicare insurance. When used in conjunction, Medigap and Medicare can often cover a large majority of the costs of your home health care. Insurance companies offer a variety of different Medigap policies (A through L), but since each one comes with specific benefits, you’ll need to compare the highlights closely. Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).

For seniors with both Part A and Part B Medicare, your home health care situation is usually covered, save for the 20% out-of-pocket expenses for medical equipment. Just remember to keep track of your Medicare insurance benefits (and Medigap if applicable) by verifying with your physician, home health care agency, and insurance representative. Paying for home health care does not have to cost you an arm and a leg, but do be prepared for the occasional (but necessary) out-of-pocket medical expenses.

Sources

1. Centers for Medicare and Medicaid Services, Medicare and Home Health Care, page 6
2. http://www.medicare.gov/Publications/Pubs/pdf/10116.pdf
3. Ibid.
4. Ibid.
5. http://www.medicare.gov/medigap/Default.asp

Health Care Bill Would Bring Higher State Medicaid Costs

The health bill passed by the House of Representatives Sunday would cost Nevada taxpayers an extra 3 million from 2014-2019, to provide health care to the needy.

According to early state estimates, the bill would make an additional 70,000 residents eligible for Medicaid. The state would be mandated to cover another 8,000 individuals who are now eligible but have not applied to be covered by the state health insurance program for the poor.

About 209,000 Nevadans are currently covered by Medicaid.

Including state and federal money, “the total cost of reform is .3 billion,” said Mike Willden, director of the state Department of Health and Human Resources.

Willden went through the numbers for the Nevada Vision Stakeholder Group, formed to develop a plan for the future, looking ahead as much as 20 years.

Meanwhile, Gov. Jim Gibbons railed against the costs of the bill in a written statement Monday: “The bill disguises its true cost by shoving Medicaid expansions down to the state level and shuffling Congressional Budget Office estimates into later years so it appears to save federal tax dollars. It is an insult to those who truly care about meaningful health care reform.”

But Jon Sasser of Washoe Legal Services said during the Vision Stakeholder meeting the bill will expand the number of people eligible for Medicaid and that should put less stress on counties, which handle medically needy cases. “It means extra millions of federal dollars coming into our state,” Sasser said.

Most of the health care bill doesn’t kick in until 2014, Willden said. Some states are starting early, but Willden said he doesn’t see Nevada doing that because of its budget shortfall.

The federal-state dollar match for Medicaid is 50-50. Federal stimulus funds pushed that to a 64 percent federal match, saving the state million to million a quarter. But after the stimulus money expires Nevada will be back to picking up the 50 percent share, Willden said.

Willden said only 8 percent of the population is covered compared to 14 percent in other states. The state spends 5 per capita compared to the national average of ,021.

What Science Tells Us About In-Home Health Care

Historically, most humans in the world used to pass their evenings together around a fire.  While this is still the case in many places, for many cultures the fire has been replaced by the television set.  Prior to the Industrial Revolution, Western societies were generally structured such that the young and the elderly, the sick and the healthy, all lived together, taking care of one another.  But as societies became increasingly stratified, these connections dwindled.  The extended family home gave way to the home of the nuclear family.  How have these changes affected the quality of health care? 

Today, in Western industrial societies, most young children pass their time in childcare outside the home.  Many people living with chronic illnesses or cognitive disabilities pass their days far away from their loved ones and family members.  Likewise, the vast majority of seniors reside in an institutionalized assisted living situation rather than with their extended family.  In Central Europe, one in every two people ends their life outside the home. These trends are perplexing, considering that in-home care is more cost effective than institutionalized care and science tells us that those who receive care in their homes are more likely to have better health care outcomes. 

Anthropologists who specialize in the study of aging adults, for example, tell us that seniors who remain in their own homes with the assistance of in-home health care have the best of both worlds.  Their research shows that people who remain in their own homes during their elder years are happier, healthier and more active than their counterparts who enter assisted care facilities or nursing homes, while at the same time enjoying the benefits of in-home help with tasks that have become difficult, such as housecleaning, meal preparation, transportation and keeping track of medications.   On average, their cognitive abilities also remain intact longer, as they go about their usual daily activities and make decisions about what they will do each day, from what they eat to what they wear.  Elders who remain in their own homes with the assistance of in-home health caregivers stay more engaged with their families and with their long-time friends and neighbors, which stimulates the parts of the brain involved with memory, communication and a sense of identity.  Depression is far less likely among this group. 

Moving to an assisted living facility or nursing home is a traumatic event for most elders, who must part with many of their cherished possessions and become oriented to a whole new way of life in a new place.  The unfamiliar setting and the challenges of adapting to scheduled meals and activities can overwhelm seniors, who often react by slipping into a passive state of depression and dependency.

An older person or couple who can stay in their own home, with the assistance of an in-home caregiver, continue to feel independent and in control of their lives, which boosts their self-esteem.  Studies show that a sense of control of one’s life is an important factor in preventing depression.  Elders in their own homes are more likely to keep up with world events through newspapers and television, use the telephone to stay in contact with friends and family, enjoy their long-time hobbies and even take up new activities. 

So why is care so often taken outside the home?  The way industrial societies are structured plays a huge part.  As German sociologist Reimer Gronemeyer explains: “Those societies that see themselves as productive societies tend to ‘marginalize,’ or even to suppress…elderly citizens and their interests because their needs could be perceived as an unacceptable pressure on the budget.“  While medical developments have dramatically increased the life expectancy in industrialized societies, with people over 65 constituting the fasted growing segment of the U.S. population, these societies have not yet adapted to embrace family models that account for this increase. 

The problem may lie in how these societies conceive of personhood.  This question is one of the most telling tools by which anthropologists can make cross-cultural comparisons.  Is the value of a human life based on how much a person produces or on how that person treats others?   Likewise, for Gronemeyer, the manner in which a society “responds to the weak, needy and fragile members within its own structures measure[s] the sense of humanity of any society.”