Medicare expands access to in-home support for seniors

Nov 11, 2018

WASHINGTON — Medicare is experimenting with a new direction in health care. Starting next year, seniors in many states will be able to get additional services such as help with chores and respite for caregivers through private Medicare Advantage insurance plans.

There’s a growing recognition that such practical help can have a meaningful impact on patients’ well-being — and reduce some costs for taxpayers. A couple of hundred dollars to install grab bars in the shower can prevent a fall leading to a broken hip, a life-changing injury.

That may also help elderly people stay in their homes longer.

The newly covered services are similar to what people might need if they required long-term care, said Howard Gleckman, a senior researcher at the nonpartisan Urban Institute think tank.

‘‘It begins to break down the wall between long-term care and Medicare, which, with very few exceptions, has never paid for long-term care,’’ Gleckman said.

Change is starting slowly. Policymakers have yet to figure out how to bring similar benefits to traditional Medicare, still the choice of 2 out of 3 seniors.

The new services will be offered by some Medicare Advantage plans in more than 20 states next year, and that’s expected to grow over time.

There has to be a health-related reason to qualify, and costs will vary among plans. In some plans, there’s no added cost. But limits do apply. For example, a plan may cover one day per week at an adult day care center.

Nearly 23 million Medicare beneficiaries, or more than 1 in 3, are expected to be covered by a Medicare Advantage plan next year. The private plans generally offer lower out-of-pocket costs in exchange for limits on choice of doctors and hospitals and other restrictions such as prior authorization for services. It’s a growing business for insurers.

Medicare Advantage open enrollment for 2019 ends Dec. 7. But it’s not easy to use Medicare’s online plan finder to search for plans with expanded benefits, so beneficiaries and their families will have to rely on promotional materials that insurers mail during open enrollment.

For years, Medicare has permitted private plans to offer supplemental benefits not covered by the traditional program. Think free gym memberships, transportation to medical appointments, or home-delivered meals following a hospitalization.

The new benefits take that to a higher level, with Medicare’s blessing.

‘‘It is a big concept, in the sense that it is officially encouraging plans to get across the line into the many, many things that affect the health and well-being of beneficiaries,’’ said Marc Russo, president of insurer Anthem’s Medicare business. ‘‘I, for one, who have been in and around Medicare for decades, believe it pays.’’

Insurers under Anthem’s corporate umbrella are offering different packages in 12 of 21 states where they operate Medicare plans. They can include alternative medicine, like acupuncture, or adult day care center visits or a personal helper at home.

Other major insurers like UnitedHealthcare and Humana are participating. It’s a calculated gamble for insurers, who still have to make a profit.

And the limited new benefits are no substitute for full long-term care coverage, which many people need for at least part of their lives and remains prohibitively expensive. Seniors trying to get long-term care through Medicaid, the program for low-income people, must spend down their life savings.

The changes represent a rare consensus at a time when health care issues are among the most politically divisive. Republican and Democratic lawmakers, as well as Seema Verma, the Trump administration’s Medicare chief, are pulling in the same direction.

The idea of broader services through Medicare Advantage was embodied in a bipartisan Senate Finance Committee bill to improve care for chronically ill seniors. The Trump administration issued regulations in the spring trying to accelerate the changes.

According to Medicare, 12 insurers will be offering expanded supplemental benefits next year through 160 plans in 20 states. In four other states and Puerto Rico, such benefits may be available to seniors with certain health conditions.

‘‘The guidance came out fairly late in the annual planning process, and that’s one reason why some of these benefits may start out small,’’ said Steve Warner, head of Medicare Advantage program development for UnitedHealthcare.

Medicare estimates that some 780,000 beneficiaries will have access to the new benefits next year. In-home helpers and support for caregivers are the most popular.

Consumer advocates recommend that seniors carefully weigh whether Medicare Advantage is best for them. If they don’t like it, they can go back to traditional Medicare, but those with a pre-existing condition may not be able to buy a Medigap policy to help cover out-of-pocket costs. They can also switch to another Medicare Advantage plan.

Medicare doesn’t pay the insurers more for offering added benefits. Under a complex formula, they’re primarily financed out of the difference between bids submitted by insurers and Medicare’s maximum payment to plans. If the companies bid below Medicare’s rate, they can return some of that to beneficiaries in the form of added benefits.

SOURCE: Boston Globe

Senior Citizens Are Replacing Teenagers as Fast-Food Workers

Nov 05, 2018

The sullen teenager grinding through a restaurant shift after school was once a pop culture cliche—as American as curly fries.

Nowadays, Brad Hamilton, the teen played by Judge Reinhold in “Fast Times at Ridgemont High,” would probably be too young to work at the fictional Captain Hook Fish and Chips. That’s because senior citizens are taking his place—donning polyester, flipping patties and taking orders. They’re showing up at casual dining chains such as Bob Evans and fast-food operators like McDonald’s Corp., which says it plans to make senior citizens one hiring focus in the coming year.

Restaurants are recruiting in senior centers and churches. They’re placing want ads on the website of AARP, an advocacy group for Americans over 50. Recruiters say older workers have soft skills—a friendly demeanor, punctuality—that their younger cohorts sometimes lack.

Two powerful trends are at work: a labor shortage amid the tightest job market in almost five decades, and the propensity for longer-living Americans to keep working—even part-time—to supplement often-meager retirement savings. Between 2014 and 2024, the number of working Americans aged 65 to 74 is expected to grow 4.5 percent, while those aged 16 to 24 is expected to shrink 1.4 percent, according to the U.S. Bureau of Labor Statistics.

Golden Gigs Older Americans are joining the workforce faster than their younger peers

Source: U.S. Bureau of Labor Statistics

*projected 2014-2024

Stevenson Williams, 63, manages a Church’s Chicken in North Charleston, South Carolina. He’s in charge of 13 employees, having worked his way up from a cleaning and dishwashing job he started about four years ago and sometimes works as many as 70 hours a week when it’s busy. Williams is a retired construction worker and had never worked at a restaurant before, but was bored staying at home.

“It’s fun for a while, not getting up, not having to punch a clock, not having to get out of bed and grind every day,” he says. “But after working all your life, sitting around got old. There’s only so many trips to Walmart you can take. I just enjoy Church’s Chicken. I enjoy the atmosphere, I enjoy the people.”

Hiring seniors is a good deal for fast-food chains. They get years of experience for the same wages—an industry median of $9.81 an hour last year, according to the BLS—they would pay someone decades younger. This is a considerable benefit in an industry under pressure from rising transportation and raw material costs.

James Gray from Calibrate Coaching says older people are also a good deal financially because they aren’t always looking to move up and earn more.

They’re not “necessarily looking for a VP or an executive position or looking to make a ton of money,” he says.

Seniors typically have more developed social skills than kids who grew up online and often would rather not be bothered with real-world interactions. At Church’s Chicken, Williams coaches his younger co-workers on the niceties of workplace decorum. “A lot of times with the younger kids now, they can be very disrespectful,” he says. “So you have to coach them and tell them this is your job, this is not the street.”

AARP has become a veritable recruiting hub for the industry. In June, American Blue Ribbon Holdings LLC, which owns several casual dining chains, paid $3,500 to list hourly and management jobs on the non-profit’s website and hired five people for its Bakers Square and Village Inn dining brands. Bob Evans, a 500-plus-store sit-down chain that serves pot roast, biscuits and other homey fare, also recently advertised with AARP. Older hires typically work as hosts who seat customers and are “a nice fit with our brand,” says John Carothers, senior vice president of human resources.

Honey Baked Ham Co. is looking to churches and senior homes to help fill its 12,000 seasonal jobs for Thanksgiving and Christmas this year. The glazed-ham seller, which has more than 400 domestic locations, says older Americans are a key part of its staff, especially amid the labor crunch.

Toni Vartanian-Heifner, a 67-year-old former teacher, works part-time at a Honey Baked Ham restaurant in the St. Louis suburb of Kirkwood, Missouri. She often walks to work for four- or five-hour shifts that start at 7 a.m. She makes only about $10 an hour but gets a 50 percent discount on food.

Vartanian-Heifner is gearing up for the holiday season. “I enjoy the social part of it,” she says. “I think I’m going to work for at least five more years.”

SOURCE: Bloomberg

Language Barrier Means Millions Of Elderly Can't Access Alzheimer's Trials

Oct 31, 2018

My grandmother, Bella, a former nurse in the Ukraine, moved to the United States to help raise me when I was 7 months old. She was diagnosed with Alzheimer's disease last year.

There was nothing to do to prevent her inexorable loss of memory and independence, her Massachusetts General Hospital memory specialist told our family, except to take a drug called memantine that slightly improves cognition in Alzheimer's patients, but does not treat the underlying disease.

Only one other type of drug, which acts on how nerve cells communicate, has been approved to treat the cognitive problems that come with Alzheimer's. Notably, both drugs have been around more than 15 years. And neither one changes the course of the disease.

While there are no drugs to treat the underlying disease, there are a number of clinical trials underway. And those trials are in desperate need of patients to enroll. Trials can be risky for patients and are far from guaranteed to help them, but there is no other way medical researchers learn whether their experimental therapies are safe and effective.

But it turns out that many patients like my grandmother, who do not speak English fluently — and millions of other immigrants, mainly Spanish speakers — can't participate.

According to interviews with doctors, government officials and pharmaceutical companies, few Alzheimer's studies include medical interpreters to help patients complete the specialized neuropsychological testing component required.

One of the challenges is that clinicians and researchers have strongly cautioned against using interpreters to facilitate neuropsychological testing based on clinical experiences, observations and anecdotal evidence that they affect outcomes, according to a study published in Clinical Neuropsychology.

Dr. Benjamin Sommers, who studies health policy for vulnerable populations at the Harvard T.H. Chan School of Public Health, says the problem goes beyond clinical trials and affects diagnosing as well. He recently had trouble arranging for neuropsychological testing to diagnose a Spanish-speaking patient who did not speak English fluently.

Scientists Start To Tease Out The Subtler Ways Racism Hurts Health SHOTS - HEALTH NEWS Scientists Start To Tease Out The Subtler Ways Racism Hurts Health The language barrier is a "real issue for mental health disparities," says Sommers, who is also a primary care physician at Brigham & Women's Hospital in Boston. "It's very hard to find a hospital in the [Boston] area that does Spanish-language dementia testing," he says. "There are months-long waiting times — sometimes up to six months. And sometimes such testing is not available at all."

The barriers to Alzheimer's trials may be felt most acutely by Hispanics in the U.S. According to census data, almost 6 million Americans age 60 or over, including about 2.2 million Spanish speakers who are 65 or older, do not speak English very well.

The challenges are likely to get worse in the coming decades, says Jason Resendez, executive director of LatinosAgainstAlzheimer's and chief of staff at UsAgainstAlzheimer's, an organization that lobbies to find a cure for the disease.

Latinos represent the country's fastest-growing over-65 demographic and are predicted to be 50 percent more likely to get Alzheimer's than non-Latino whites, according to a report released by the University of Southern California, he notes.

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Getting people of different ethnicities and cultural backgrounds into clinical trials is not only one of equity, Resendez says, "it's also a scientific imperative. We need to know whether a drug developed for Alzheimer's is going to work the same in Caucasians as it does in African-Americans and other cultures."

UsAgainstAlzheimer's has launched an initiative called the Alzheimer's and Dementia Disparities Engagement Network that aims to track disparities in access to Alzheimer's and dementia care for minorities and display them publicly on a ZIP code map.

"We'll be able to look at whether there's language-accessible services and research in these areas, and if not, what we can do about it," Resendez says. "We think that making the data accessible and actionable is going to be the foundation for addressing these issues at a national level."

LatinosAgainstAlzheimer's is also helping build the government's new Latino task force on Alzheimer's, whose goal will be to determine how to improve outreach and recruitment in the Spanish-speaking dementia community, he adds.

Infectious Theory Of Alzheimer's Disease Draws Fresh Interest SHOTS - HEALTH NEWS Infectious Theory Of Alzheimer's Disease Draws Fresh Interest Currently, there seems to be little government policy on the issue.

Dr. Eliseo J. Pérez-Stable, the director of the National Institute on Minority Health and Health Disparities, says that the National Institutes of Health has no policy on clinical trial access for non-native English speakers, while acknowledging that it would be humane to include them. "I don't think we have an easy answer for this yet," he says.

A glimmer of hope for non-English speaking dementia patients may lie in the work pharmaceutical companies such as Eli Lilly are doing. Joe Kim, senior adviser in patient experience and design innovation at Eli Lilly, says that his team is exploring telemedicine as a way to enable broader access to clinical trials.

"If we can virtualize trials and allow patients to enroll remotely, not only would it lower the burden on patients but it would also expand the patient population that's eligible for the trial."

Kim is optimistic that in the future, a group of patients more representative of the American population will have access to clinical trials. "We've done one virtual trial already, and we found we can get a more diverse population," he says. "With the rise of digital health care, I think we have a lot of tailwind. This will enable medical care to be democratized."

Meanwhile, time is not on my grandmother's side. I have noticed in our weekly phone conversations that she is forgetting common words and idioms in Russian. They are on the tip of her tongue, but beginning to recede from memory.

Indeed, she herself is receding.

Josh Eibelman, a junior at Cornell University, was born and raised in Boston. You can email him here.

SOURCE: NPR

Hang up on spoofed SSA calls

Oct 29, 2018

October 29, 2018 by Lisa Weintraub Schifferle Attorney, FTC, Division of Consumer & Business Education

If you get a call that looks like it’s from the Social Security Administration (SSA), think twice. Scammers are spoofing SSA’s 1-800 customer service number to try to get your personal information. Spoofing means that scammers can call from anywhere, but they make your caller ID show a different number – often one that looks legit. Here are few things you should know about these so-called SSA calls.

These scam calls are happening across the nation, according to SSA: Your phone rings. Your caller ID shows that it’s the SSA calling from 1-800-772-1213. The caller says he works for the Social Security Administration and needs your personal information – like your Social Security number – to increase your benefits payments. (Or he threatens to cut off your benefits if you don’t give the information.) But it’s not really the Social Security Administration calling. Yes, it is the SSA’s real phone number, but the scammers on the phone are spoofing the number to make the call look real.

What can you do if you get one of these calls? Hang up. Remember:

• SSA will not threaten you. Real SSA employees will never threaten you to get personal information. They also won’t promise to increase your benefits in exchange for information. If they do, it’s a scam.

• If you have any doubt, hang up and call SSA directly. Call 1-800-772-1213 – that really is the phone number for the Social Security Administration. If you dial that number, you know who you’re getting. But remember that you can’t trust caller ID. If a call comes in from that number, you can’t be sure it’s really SSA calling.

• If you get a spoofed call, report it. If someone calls, claiming to be from SSA and asking for information like your Social Security number, report it to SSA’s Office of Inspector General at 1-800-269-0271 or https://oig.ssa.gov/report. You can also report these calls to the FTC at ftc.gov/complaint.

For more tips, check out the FTC’s How to Stop Unwanted Calls and Government Imposter Scams. If you think someone has misused your personal information, go to IdentityTheft.gov to report identity theft and find out what steps to take.

SOURCE: FEDERAL TRADE COMMISSION

Buyer Beware: New Cheaper Insurance Policies May Have Big Coverage Gaps

Oct 01, 2018

If you're looking for cheaper health insurance, a whole host of new options will hit the market starting Tuesday.

But buyer beware!

If you get sick, the new plans – known as short-term, limited duration insurance — may not pay for the medical care you need.

"These are a niche product, always have been," says Doug Badger, a visiting fellow at the conservative Heritage Foundation in Washington, and a senior fellow with the Galen Institute. "It's simply another choice for consumers that for many is more affordable than the other products available," he says.

Short-term health insurance isn't entirely new. But the Obama Administration issued regulations that limited them to just three months, and they couldn't be renewed.

The Trump Administration has changed that. Now people in some states will be able to buy policies that last a year, and consumers can renew them twice, for a total of three years' coverage.

The administration says that Affordable Care Act insurance is too expensive for some people and this provides people a way to buy a less expensive health insurance policy.

"They give people an additional option. Instead of remaining uninsured, they have a product that makes sense for them, a product that they can afford," Badger says. "It is something that in my view ought to be available to them."

But if you're considering one of these plans there's a few things to keep in mind. Short-term policies are regulated by the states, so they don't have to comply with the consumer protections laid out in the Affordable Care Act. This means insurers can refuse to offer these policies to people with pre-existing health problems, or charge people more who are likely to need medications and health care.

They also don't have to cover all the of the 10 essential health benefits that must be included in Affordable Care Act policies. Those benefits include maternity coverage and mental health care.

The average monthly premium for a benchmark Affordable Care Act policy was $481 this year, according to the Kaiser Family Foundation. But most people don't pay that much. Eighty-three percent of people who bought a plan during the open-enrollment period for 2018 qualified for subsidies from the government to help lower that cost.

You can find out what an ACA plan would cost, and if you qualify for a subsidy, by going to HealthCare.gov.

For those who don't qualify for subsidies, Badger says these short-term plans could help them.

But Allison K. Hoffman, a professor at the University of Pennsylvania Law School, says the plans aren't the solution to the problem of high priced insurance.

"The way that these plans answer that problem is saying, 'Well, we'll give you an alternative but that alternative is coverage that people call junk coverage or skinny coverage,' " she says. "So people have something called health insurance but it doesn't necessarily pay for all of their health needs."

Depending where you live, short-term plans vary widely. Massachusetts and Rhode Island, for example, require extensive coverage even for short-term policies. Maryland and Vermont passed laws to keep them limited in duration. Other states, like California and New York, effectively don't allow them at all.

But in some states, the options are plentiful. If you're considering one, be sure you understand what's covered, Hoffman says.

In Virginia, for example, short term plans are available for less than $70 a month, with a $5,000 deductible. One policy, offered by Stamford, Conn.-based IHC Group on the web site eHealthInsurance.com, doesn't cover prescription drugs unless you're inpatient in a hospital, and it doesn't cover prenatal care, mental health care or annual physicals.

UnitedHealthCare says it plans to offer short-term plans in several states. The company's web site shows policies that range from one with a $12,500 annual deductible for less than $80 a month to one with a $1,000 deductible for about $250 a month. The policies don't cover prescription drugs and only pay about 60 percent of the cost of hospital visits after the deductible and co-payment. And patients may have to get a physical to qualify at all.

A report by the National Association of Insurance Commissioners shows that short-term policies paid out an average 55 percent of their premiums in actual health care last year. Under the Affordable Care Act, insurance companies are required to spend 80 to 85 percent of their premiums on health care or refund money to their customers.

Aetna said it doesn't plan to offer short-term policies and four other major health insurers didn't respond to inquiries from NPR.

Hoffman worries that people who have become accustomed to the kind of coverage required under the ACA will be surprised when their short term plans leave them with big unpaid bills if they have an accident or become sick.

Still, President Trump and Health and Human Services Secretary Alex Azar say the whole point of expanding access to short-term insurance is to give people more choice, including the choice to buy insurance with few benefits.

HHS estimates that about 600,000 people will buy short-term policies next year and as many as 1.6 million could own them after five years.

The Congressional Budget Office, the nonpartisan research office that estimates the budget effects of policy proposals, gives a larger figure, estimating that about 2 million mostly healthy people will buy short-term plans. This could have the effect of driving premiums slightly higher on the ACA exchanges, because healthier people will leave the market, according to the CBO.

SOURCE: National Public Radio