Friday, April 30, 2010

CMS data shows that most Medicare Advantage beneficiaries are not enrolled in quality Part C plans; more on 2010 Part D Donut Hole

Avalere Health, a major consulting firm, issued a report today analyzing the quality of Medicare Advantage plans. According to Avalere, a majority of Advantage beneficiaries are enrolled in programs rated as low or medium by CMS, the Centers for Medicare and Medicaid Services. Only about 0.3% of enrollees belonged to top plans. The link is here.

I could not find a reference on CMS for the “Part C Report Card”; Part C does refer to Medicare Advantage.

Part of the problem lies with the incentives in the market; agents make a living selling Medicare Advantage with quotas to meet and may not always be objective in assessing the plans they sell and get cuts of.

More on the Part D Donut Hole (or coverage gap) in 2010

I couldn't find a conclusive post on the Medicare Part D Coverage Gap or Donut Hole in 2010, on this blog, but here is a great reference by Michael Bihari from, "Understanding the Medicare Part D Donut Hole", link here. The best example here is "Sarah" where the example writes: "•Since she has already spent $708 out-of-pocket, she will be responsible for an additional $3,842 while in the donut hole ($4,550 - $708 = 3,842) ".  People or caregivers managing senior's drug plans should plan for about $4600 out of pocket drug expenses a year.

Thursday, April 29, 2010

Social Security projects a person's "full lifetime average earnings level" for Social Security Statements

U.S. News and World Report has an article on “Your Social Security Statement in Bing/MSN today at this link.  The key concept is said to be a “Full Lifetime Average Earnings Level”. That term is defined as “a person's 35 years of highest earnings, indexed for wage inflation, with the assumption that they survive at least to age 65 without becoming disabled.”

Social Security has provided various illustrations to help younger workers predict benefits at various earnings levels, even if these are somewhat unpredictable in this economy.

In my case, I had a gap of 19 months if government employment in 1971-1972, when Civil Service had its own retirement (until Reagan's catch-up in the 1980s to handle the deficit then). The report taht I got before starting early retirement in 2005 showed that.

Wednesday, April 28, 2010

Americans born today have a life expectancy of 78 years, with a recent growth of several months, according to a new CDC study described in this ABC video.

Bradley Blackburn has a story on ABC today to the effect that some groups of Americans are a full century ahead of the poor on quality of life and longevity, with the link here. The study came from the a report called “A Century Apart” from the American Human Development Project, here.  Upper income Asians in some parts of the country (such as New Jersey) fared the best in longevity; black men in poor areas and Native Americans in some rural areas fared the worst.

The National Institutes of Health issued a disappointing report today on progress in preventing Alzheimer’s Disease, which increases as people live longer. Various vitamins and supplements seem to make little difference. Today there are 5 million people with Alzheimer’s, which has risen to the seventh leading cause of death.

Tuesday, April 27, 2010

Roger Mitchell ("Free Money"): it's ok to print money for social security, Medicare benes

Here’s an interesting perspective from Roger Mitchell (“free money”) on “saving” social security and Medicare. Basically, print more money. Become like Argentina. Mitchell argues that still our biggest threat is deflation, not inflation. The link for his treatise is here.

He proposes extending Medicare for all Americans and writes “ The solution is to make it possible for all Americans to pay more for medical care, not less.”.

Yet, tonight on NBC Nightly News, Brian Williams mentioned new calls to cut social security and Medicare benefits to bring down the burden on the national debt, without a full video story or recognition of the accounting gimmicks behind the social security trust fund.

Friday, April 23, 2010

Kiplinger provides updated list on what adult children should know about their parents' finance; also, prevention of POA abuse (with third parties?)

Cameron Huddleston, a contributing editor at Kiplinger, has a new list (April 23, 2010) of items that adult children should know about their parents’ finances, while their parents are still able to manage their own affairs. The link is here .

The tips are pretty basic, but less financially savvy parents (especially when widowed) might not have kept good track of individual stocks and bonds. It’s a good idea to consider having them consolidated into investment or brokerage accounts that all major banks offer. It’s particularly important to know whether they have already set up a living will, and/or a living trust, and have already conferred a power of attorney to anyone.

The new article links to an important piece by Kathryn A. Watson, “Prevent Power of Attorney Abuse”, dated Aug. 1, 2009, link here.   The topic came into public attention after the NYC trial of Anthony Marshall for fraudulent handling of the affairs of his mother Brooke Astor when she died at 105.

A couple of pointers stand out here. The article places much more emphasis on third-party supervision than is often expected, and urges the parent to pay close attention to a potential POA-holder’s own financial problems, especially debt. The relative with the POA should be behaving well by “Suze Orman’s” standards. (Maybe the parent ought to know the person’s FICO score.)  In most states, comingling or POA abuse can be considered a form of criminal elder abuse.  It's possible that in the future some states will consider requiring third-party accountability.

A potentially troublesome conumdrum can occur. The adult child should be able to prove that he or she can live on his or her own separate resources (without the expectation from a will or from comingling), but the demands of eldercare can make this (such as continuing to remain well employed in an already difficult economy) itself challenging, and it can affect fundamental decisions the adult child must make about his or her own life. As people live longer, the adult child may well himself or herself have "retired" presenting double generations in retirement.

Tuesday, April 20, 2010

AARP Magazine offers article on male caregivers

The May & June 2010 issue of AARP Magazine has a provocative article (on p. 43) by Gail Sheehy, “The Secret Caregivers: Men care for their loved ones more often than we know. Why do they hide it? Inside their silent burdens—and bittersweet rewards,” link hereThere's an unpleasant noun one can use here -- shame.

The article notes that the number of unpaid caregivers in the United States is now 65 million, and one third of these are men. In some cases, men are more likely to focus on business issues, and hire outside services for the more personal matters, but not always. There has to be money, or at least long term care insurance (whose terms may be difficult to meet). Generally, Medicaid is available only when resources are spent down, and in many states adult children are legally responsible for their parents care bills.

(If the elder does have enough funds, it may be proper for the adult child to compensate himself/herself for labor and report it as income; talk to an elder or tax attorney in your state.)

The article relates the story of a particular family in Pennsylvania where a son leaned on his sisters to share sacrifice to keep their mother out of a nursing home. In the particular story, the nursing home sounded negligent, but there are many well run homes. I hate to see accounts of this kind of not-chosen sacrifice if a facility cannot do its job. But demographically, the problem is only going to grow. Politicians (and the youthful president) need to take this up, although the Class Act (part of the recent health reform package) is a start.

Sunday, April 18, 2010

Filial Responsibility Laws: Oregon, Arkansas

I haven’t put up a page on specific states’ filial responsibility laws for a while, but I checked a couple more.

Oregon has section 109.010 here, “Duty of Support”, link here,  worded simply

“Parents are bound to maintain their children who are poor and unable to work to maintain themselves; and children are bound to maintain their parents in like circumstances.”

It appears from context that the statute must refer to “adult children.”

I looked up Arkansas, because of Mike Huckabee’s firestorm (see my GLBT blog April 13, 2010), and found it a bit confusing. It appears that until 2001 Section 20-47-106, given in the “Everyday Simplicity” blog (linked on July 12, 2007), Arkansas held adult children and grandchildren responsible for mental health services for elders provided by the state, but then the wording was changed to be posited in terms of “persons legally liable for the support, care and maintenance…”.   The link for the PDF of the Arkansas mental health code document is here.

I could not easily find a definition of “legally liable for support” in the Arkansas code generator (here ). Presumably with eldercare it would be defined in terms of guardianship or possibly being a “responsible party” under a POA.

But I found a comment from “Elder Justice Advocates for National Guardianship Reform” on the “Everyday Simplicity” blog that read sternly: “When are they going to warn the adult children of the elderly "the baby boomers" that this is the law?: They are already destroying us in guardianships that are corrupt now this? What happened to America?” Good point. You can find that EJA blog here.

Picture (unrelated): how to fake a UFO photo.

Saturday, April 17, 2010

Five states still deduct social security offsets from unemployment benefits; VA recently reinstated offset (AARP)

A column called “The Short Answer: Benefits in the Balance” on p. 24 of the May-June AARP Magazine asks if someone can collect social security benefits and unemployment benefits at the same time.

The answer is that five states still apply a “social security offset” similar in concept to what some private pension plans do (even at age 62, assuming early retirement -- discussed on this blog July 1, 2007). They subtract 50% of the person’s weekly social security benefit from the unemployment check. These states are Illinois, Louisiana, South Dakota, Utah, and Virginia. In fact, Virginia recently reinstated the social security offset because of budget problems. Utah has postponed ending its law, and eight years ago, 22 states, including these, had offset laws.

Social security will not count unemployment as wages in the “earnings test” for early retirees, but these states penalize people for receiving social security, so residents in these states may want to consider postponing starting social security (eventually making the monthly benefit actuarially larger) to maximize their unemployment.

The article suggests checking your state at the “Service Locator” website here.

I could not find this article online yet at AARP, but I found an older story by Trish Nicholson from July 15, 2008 (just before the financial crash) at AARP, “A few states hold on to unemployment offset laws”  here.
Picture: near Yankee Stadium, where they filmed "The French Connection" around 1971.

AARP points out that many veteran seniors may be missing out on benefits due them

Seniors who are military veterans, even those who did not serve in combat, may be in line for a surprising potential list of benefits, particularly if their income is now below certain threshold levels, according to a major story in the May/June 2010 AARP Magazine by David Lindorff, “Giving Back to Vets”, p. 28, link here.

Some of the points include the fact that service disability compensation does not require that the injury have occurred in combat and is unrelated to current income; low-income veterans can qualify for pensions with surprisingly liberal rules about deductions; and eligibility for health care in VA hospitals is not limited to those who served during wartime. Also, low-income senior or disabled veterans may qualify for assistance with in-home care or assisted living, and even prescription drugs.

The VA's home page for benefits eligibility is here.

Eligibility for veterans benefits probably could be seen as point to unequal treatment of LGBT people (or even of women). However, over the decades encompassing WWII, Korea and Vietnam, leading into present day, many LGBT people served uneventfully in the military, long before the issue became politicized.

Friday, April 16, 2010

GQ has article on the Methuselah figurehead Aubrey de Grey: can man become immortal? Will the number of born souls max out?

The May 2010 issue of GQ has an article on p 140 by Chris Buck, “Life begins at 140”, about the work of Aubrey de Grey on extending human life spans essentially into immortality. GQ apparently hasn’t posted it online, but there is a similar story by Alex Madrigal at Wired in 2008, “The Fight to End Aging Gains Legitimacy, Funding,” (web url) here.

One can peruse the challenge from the Methuselah Foundation to find the solution to organ failure, here.

Evolution would say that there is very little reason for us not to age once we pass our reproductive years. Longevity is a scientific and cultural choice, based on all kinds of genetic and mitochondrial and interstitial therapy, as well as lifestyle. Buck argues that we could some day be aiming toward a world where we do not procreate, where there exists a finite number of instantiated souls (with a java constructor for each one). Even now, there are (mathematically) more people who have lived than who are on Earth today (so we don't reincanate eveyone).

I had reviewed Barbara Walter’s “Live to be 150” on my TV blog on April 1, 2008. Walters is a very vigorous 80 herself now. Queen Elizabeth II turns 85 soon.

Does GQ suggest that cover boy Jake Gyllenhaal (the Pie Charts man) can become a Methuselah? The GQ article gives some time lapse photos of de Grey up to age 500. But a time lapse of how a man ages, maybe with one year for every ten seconds, would be a provocative video to watch.

The May/June 2010 AARP Magazine has a cover story "Get healthy with Dr. Oz" on p 34. Longevity with vigor is presented as a matter of lifestyle and "Blue Zone" personal habits.

Wednesday, April 14, 2010

AARP Bulletin answers health reform questions for pre-Medicare older workers and retirees

Susan Jaffe has a column in the AARP Bulletin, “Health Care Reform Explained: Your Questions Answered”, that provides some useful information for older workers, particularly those forced to retire early by downsizings and struggling with the health insurance issue (whether COBRA or retiree) until they are old enough for Medicare. The link is here.

It’s important to note that there is a temporarily funded federal program for those who have not been able to buy private health insurance for six months because of pre-existing conditions. However, older people can still be charged up to four times what younger people pay in this “high risk pool”, similar to that offered by many states. The mechanics of the federal program resemble that of many states having high risk pools already in place. The temporary federal program ends in 2014, when insurance companies must sell the same policies to anyone regardless of pre-existing conditions.

The article also addresses the shortage of primary care doctors.

Monday, April 12, 2010

The American Academy of Neurology is advising that mild dementia is no longer a reason by itself to demand the car keys!

The American Academy of Neurology is advising that mild dementia is no longer a reason by itself to tell someone (usually elderly) to stop driving. 76% of people tested with mild dementia could pass a driving simulator test. The story appeared on ABC World News Tonight, with the written story by Joseph Brownstein, link here.  The full title of the story is “New Guidelines Issued For Drivers With Dementia: Neurology Group Says Some With Alzheimer's Can Stay Behind The Wheel”.

A common sign of driving difficulties is inability to stay in a lane, which will often result in a police pullover, or make the driver more vulnerable to a sideswipe accident.

The AAN paper, “Evaluation and management in driving risk with dementia”, has link here.

Caregivers (especially “responsible party” relatives) may feel that they risk liability if they don’t take away the keys. The negligence laws in some states may support that concern. But this paper probably would countermand the concern. However, the instinct of a family caregiver (adult children) is often the most reliable indicator as to ability to drive safely. It would not appear that taking anti-dementia medication early during symptoms ought to disqualify someone from driving, since some of these medications, however expensive, seem quite effective.

Picture: unrelated, from DC Cherry Blosson season, April 2010.

Saturday, April 10, 2010

Caregivers could use help of medication records automation

Family caregivers and those with medical powers of attorney should be aware that some pro-activity is necessary in working with an elder’s physicians.

Specialists nearly always ask for lists of medications, but these need to be kept up manually at every visit. And generally family caregivers need to be pro-active is learning about the medications, asking about generics, cross-reactions, side-effects, schedules, and other issues.

This becomes even more true when someone changes physicians, or even sees a different physician at the same office during a vacation period. Different physicians often have varied views on how many medications actually work. And as human beings, physicians are often influenced by how they perceive the caregiver and the dynamics of the family.
This is also the case if the elder person goes into Hospice, which is supposed to be possible when the expected lifespan for a diagnosis is less than six months. Hospices sometimes change medications, because life-extending treatments (especially surgeries or chemotherapies) may stop. However, medication which extends life without causing significant side effects or discomfort should, as a matter of ethics, always be continued. Life expectancy in practice is often very difficult to predict from laboratory results and patients will vary widely, sometimes based on their own motivation and the perceived motivation of the family. Some medication is offered under hospice that is not offered under normal Medicare: sometimes oxygen is offered earlier, and some controlled substance painkillers are offered, to be used in individual cases with telephone permission from nurses. Medicare typically pays completely only for medication related to the hospice admission diagnosis, but other appropriate medications are still covered by Part D (with the notorious but shrinking “doughnut hole” or coverage gap) in a normal manner.

The president’s plan for improving health care records as part of health care reform needs beefing. All physicians ought to have access to a centralized database (mainframe, secured, HIPAA compliant, and separate from the Internet) of medications. Such a database should be updated when prescriptions are filled, and it should include information on the physical location of refills at various pharmacy branches. This would make medication management much easier for caregivers in complex situations. However, some people will fear loss of privacy and possible invitation to government intrusion, which I maintain is there already because of Medicare anyway.

CNET has an article from May 2009 about automation of medical records at Kaiser Permanante here.

Saturday, April 03, 2010

MetLife study predicts better times ahead for older workers by 2018. Explanation: demographics

The national unemployment rate for workers 55 and older reached 7.2% in December, which sounds lower than that for the general population. But better days are ahead for seniors, especially those in the 55-75 range, by 2018, according to a new study by the MetLife Foundation. That’s because baby boomers are retiring (some really want to), and there are demographically fewer workers.

The biggest demand will come in health care, education (the demand for teachers will recover as school districts settle down) and the environment. Many of the jobs will tend to emphasize “people skills” and personal contact, jobs that cannot be exported overseas.

The story by Elizabeth Pope appears on the AARP Bulletin, link here.

In the past, AARP has partnered with some companies, such as Home Depot, to hire seniors. The companies chosen are more likely to be in the hands-on, customer service business.