Rajiv Nagaich and his staff are continually monitoring the latest developments in the aging-oriented heath, housing, financial, legal and family sectors. Each week the most insightful and thought-provoking articles and news items from their research and reading are gathered here to keep you up to speed in this ever-changing socio-economic-political environment.
Half of the hospitals in America will see Medicare payments go down
A less than one percent change in payments either way wouldn’t seem like much of a carrot or stick in the effort to improve quality of care in the nation’s hospitals but when you’re talking about $1 billion dollars the differences can add up. Which is what Medicare is hoping will happen under its Value-Based Purchasing Program.
Don’t be penny-wise but pound foolish when it comes to Medicaid asset transfers
“Work with an elder attorney when transferring assets to qualify for Medicaid because even a small miss-step in the timing of transfers can be very expensive,” said Jerrica Pierson Seeger, an attorney at Johnson and Nagaich. Of course a lawyer would say that, you might say because who will benefit? The lawyer. You have some cause to be skeptical; after all you’re reading that opinion on a site operated by a lawyer. Here’s something to keep in mind though. If you value your own time at least as much as you value your own money, you want to avoid having something called into question due to a Medicaid technicality and then spending time and other resources trying to prove that nothing untoward was happening because that’s exactly what people end up doing time and again. Here’s yet another example, there’s a case out of New York in which the daughter of a Medicaid applicant transferred money out of a joint account to her own account. Then the nursing home where the Medicaid applicant resided applied for Medicaid benefits for her. The state issued a 13-month penalty period due to the transfer of funds and to top it off then the nursing home argued that the daughter improperly gifted herself and exceeded her authority as her mother’s attorney-in-fact under a power of attorney.
Eating healthy has major cardiovascular benefits
There are a lot of things you can do to preserve your health but one of the biggest steps you can take to avoid health risks such as heart attacks, diabetes or Alzheimer’s disease is to watch your diet. Heart attacks and diabetes are largely preventable diseases (and there is a strong correlation between diabetes and/or cardiovascular problems and Alzheimer’s).
Heart disease is the number one killer of men and women in America, and is a major threat to the health of seniors. About 84 percent of Americans 65 and up will die from heart disease. Many seniors take medication of one form or another to lower their blood pressure and cholesterol, but once they get those numbers under control they don’t believe they need to follow a healthy diet or exercise to keep their condition under control. However, new data from a five year study done at the Population Health Research Institute; McMaster University in Hamilton, Ontario, Canada indicates that eating a heart healthy diet can reduce the risk of cardiovascular death by as much as 35 percent. The study looked at 31,546 adults with cardiovascular disease or end organ damage. Read the article here.
Court affirms judgment against daughter for misappropriating funds
A Tennessee couple (Garnette and William Kidd) moved into the daughter’s mother’s home in order to care for her. The mother (Lola Lee Duggan) eventually moved into a nursing home and received Medicaid benefits. After Duggan died the state of Tennessee filed a claim against her estate to recover Medicaid expenses. See article here about Medicaid liens. The estate’s administrator (Duggan’s brother) sued the couple for misappropriating Duggan’s funds. The trial court issued a judgment and the Kidds appealed. The court affirmed the judgment against Garnette Kidd but reversed the judgment against William Kidd. Read the court document here.
Court affirms caregiver not liable for nursing home care
In 2006, an Armenian home health aide, Araxie Symeonidis agreed to allow Eugenia Baboudjian, also an Armenian to move in with her so that Symeonidis could provide care for her. As part of the move in, Baboudijian’s lawyer drew up documents including a medical power of attorney and a financial power of attorney. When Baboudjian fell and ended up being hospitalized, her doctor released her to a nursing home rather than to Symeonidis. Symeonidis was not consulted about the move. Baboudjian refused to sign the nursing home’s admissions agreement and so the home required Symeonidis to sign the document even though she had limited ability to read or write English. While in the home, Symeonidis applied for Medicaid benefits twice for her client and the home also applied for benefits. Baboudjian racked up over $272,000 worth of services which the home then tried to get from Symeonidis. The home lost the court case and appealed.
Medicare providers and beneficiaries may appeal decisions related to claims for health care services and items but according to a report out by the U.S. Department of Health and Human Services, health care providers who appealed at the third level (the first two levels are decided by contractors, the third level includes a hearing before a judge) won more often than patients did. Providers included physicians, suppliers and hospitals. They are also far more likely to file an appeal than beneficiaries, making up 85 percent of the cases with a small number (96) accounting for nearly one-third of all appeals even though they represented only two percent of all providers. One provider filed 1,046 appeals. Several staff indicated that some providers appeal every payment denial as the cost is minimal and a favorable decision was likely. Beneficiaries on the other hand made up 11 percent. The report made 10 recommendations for CMS (the Centers for Medicare & Medicaid Services) and the Office of Medicare Hearings and Appeals (OMHA) included developing and providing training on policies, clarifying policies that are unclear and standardizing case files. You can read the rest of the story here or if you want to exercise your heart and really get the blood flowing read the report here.
Confused about what’s entailed in an advance directive? You’re not alone. According to an article on amednews.com, an online version of American Medical News, doctors and emergency room personnel have many of the same misunderstandings about living wills, advance directives and do-not-resuscitate orders as the rest of us, a situation that could be the life or death of the patient. QuantiaMD, an online physician learning collaborative found in a series of surveys that nearly half of health professionals misunderstood the components of living wills. Ninety percent of the individuals surveyed were doctors. A similar study in May by the Journal of Emergency Medicine, found that 78 percent of physicians misinterpreted living wills as DNRs. Doctors may attempt to interpret DNRs but receive little to no training on how to follow directives. Adding to the confusion, each state has its own laws on when directives apply and what content is required.
A Gallup Poll of nearly 600,000 adults in the U.S. showed an increase in the number of people rated obese since a similar study four years ago. The highest jump in obesity rates occurred in individuals in their 40s, 70s and 80s.
According to the study authors, obesity among middle-aged adults is particularly troubling because these older adults face health risks associated with that weight such as lower quality of life, more health problems and a shorter lifespan.
Experts at Gallup recommended that more effort be made to encourage and help seniors stay active and informed about nutrition. Read the article here