Thursday, April 26, 2007

The latest on SeniorCare

Yesterday (April 25), state Senator Jim Sullivan held a town hall meeting to discuss SeniorCare at the West Milwaukee "Senior Center" at 47th and Greenfield. The room was packed with seniors eager to hear what the panel had to say--and to let panelists know what they thought!

Two of the three state representatives from Sullivan’s Fifth District, David Cullen and Tony Staskunas, were there, along with representatives for Jim Sensenbrenner, Herb Kohl, Russ Feingold, and Jim Doyle. Elder advocates Gail MacInnes from the Coalition of Wisconsin Aging Groups and Matt Hayes from SeniorLaw completed the panel. (Apologies to any panelists I may have missed.)

Advice to seniors
• If you have SeniorCare, hold tight for a few weeks to see what happens. Even if there’s no extension (the worst-case scenario), you’ll have 60 days after the end date, June 30, to choose a new plan.

• At the same time, it would be a good idea to start examining Part D plans now so you have time to process information and choose.

• SeniorLaw advocates are available at no charge to Milwaukee County seniors to help evaluate which of the 50+ Part D plans might work best for them, as everyone’s situation is different. Remember that how well the plan will work for you depends on your other coverage as well, so all of it needs to be considered together.

Other take away points from panelists and audience members
State support for SeniorCare is bipartisan and nearly universal, and everyone has been lobbying hard for its continuation. But the power to extend the program lies with the Bush administration, which does not want the program to go forward for reasons that appear to have more to do with serving pharmaceutical companies than serving seniors.

Senators Feingold and Kohl placed a 2.5 year extension for SeniorCare into an Iraq study bill. President Bush will veto the bill, however. They are exploring other legislation.

While getting the several year extension is unlikely, it’s very likely that SeniorCare will be extended six months to give people time to change and the state time to develop a “wrap-around” program for a smooth transition to Medicare Part D.

Wisconsin elected officials and senior advocacy groups continue to fight for SeniorCare and explore all possible approaches to saving it.

The lack of reimbursement for preventive care is a serious flaw in our healthcare system that creates greater costs during the senior years. Reform of the whole system is imperative.

The governor and others made promises that SeniorCare would continue. They need to honor those promises, whatever it takes to do it.

The federal government has called for state innovations and models as a way of finding out what works and what doesn't. But for that to work, they have to be willing to adopt the best practices, not pass them over for programs that are more expensive and less effective.

Links
Medicare information
Centers for Medicare and Medicaid Services (CMS)
SeniorLaw
Coalition of Wisconsin Aging Groups

Tuesday, April 24, 2007

Your chance to go to Harvard!

by Amy Ambrose, Executive Director, Milwaukee Aging Consortium

A year ago, I attended an executive education program at the Harvard Business School. The program is called Strategic Perspectives in Nonprofit Management (SPNM), and it’s a weeklong intensive just for executive directors.

This was an incredibly valuable experience, and I recommend it for anyone who is interested in advancing their leadership skills, refining the strategic vision of their organization or learning from other nonprofit leaders from around the world.

The program this year will be held July 15-21, 2007 in Boston. The fee for the course, which includes meals and housing for the week, is $4,500.

Don’t let the cost stop you if you feel this is what you really need. I was fortunate to receive a scholarship from the Hansjoerg Wyss Fund for Social Enterprise at Harvard which covered my entire fee. Applications for SPNM are requested four weeks before the program start date, but if you are interested in scholarship funding, apply early. Call 1-800-HBS-5577 for more information, or visit the Harvard Business School Executive Development website.

A local Harvard Business School Club in Milwaukee also has invited nonprofit leaders to apply for scholarships to attend the program. The club typically gives two or three scholarships. This year's deadline (in February) has passed.

To be eligible for this scholarship, applicants must be "head of a Wisconsin nonprofit organization serving the public in arts, education, environment, health care, human services, community development or related areas." Scholarships cover tuition, books, room and board, and all institutional materials, with agencies responsible for travel and personal expenses.

Monday, April 23, 2007

When is SeniorCare ending?

A reader asked for SeniorCare's end date. That information might be available this week, according to a radio interview with Governor Doyle last week.

More information from an article in the April 18 Milwaukee Journal Sentinel, "After a meeting Wednesday with U.S. Health and Human Services Secretary Mike Leavitt, Gov. Jim Doyle and U.S. Sen. Herb Kohl (D-Wis.) said they were hopeful that Leavitt would grant Wisconsin a six-month extension for the SeniorCare prescription drug program."

They're asking for a December 31 date, giving the state time to craft a plan that "matches or exceeds any wraparound program in the United States," according to Governor Doyle.

What the new plan won't have is the ability to negotiate with drug companies for discount rates. This substantial limitation appears to be non-negotiable.

I'll be attending a SeniorCare Town Hall Meeting Wednesday, April 25, with 5th District state senator Jim Sullivan and will let you know what I learn.

If you live in the 5th district and want to attend, the meeting is at 3 pm, West Milwaukee Community Centre, 1345 S. 47th St., West Milwaukee.

Tuesday, April 17, 2007

Flat funding and growing demands: a nursing home administrator's dilemma

Five percent can make the difference between staying in a job—or in business—or not.

I’m reproducing here with permission the complete letter of testimony one nursing home administrator, Bonnie Zabel, gave to the state Joint Finance Committee during its budget hearings around the state last month. The letter came across my desk in The Wisconsin Longterm Care Workforce Alliance newsletter April 15.

It speaks eloquently for itself, and I suspect for many.

Joint Finance Committee

My name is Bonnie Zabel and I am the administrator at Marquardt Memorial Manor in Watertown, Wisconsin. We are a not for profit organization affiliated with the Moravian Church. I’ve been employed at Marquardt for almost 20 years, as Director of Nursing and now Administrator for 13 years.

Marquardt is a 140 bed skilled nursing facility, which is part of a retirement community of approximately 600 seniors. We also have independent senior apartments, assisted living, home health, supportive home care and hospice.

Twenty years ago our private pay rates and our T-19 rates were equal. Our T-19 reimbursement has doubled over that time and our private pay rate has tripled to cover our T-19 deficits.

We are currently 66% T-19. Our actual costs are $185 per day and T-19 pays us $125 per day. We lose $2,000,000 per year by serving Medicaid seniors.

Watertown is a blue collar farming community. Our seniors are not wealthy. People are moving into our apartments @ age 85. They utilize our support services and enter the skilled facility at 90+. Their retirement savings have typically been exhausted after 20+ years of retirement. At this point they require excessive skilled services.

Our 140 residents:
3 can dress independently
25 can feed themselves independently
15 can toilet independently
21 can transfer independently
98.5 % have unstable medical conditions
83.8 % have no discharge potential

This population is very labor intensive. Besides their physical and medical needs, dementia is a factor for most. Staff endure wandering, hitting, kicking spitting, biting on a daily basis- in addition to the physically demanding work. These are not sought after jobs. They deserve a living wage and benefits.

Our health insurance rose 17% this month. Routine costs are up 6%. Utilities are through the roof.

Federal legislation created Medicaid. The Federal government pays 60% of the costs. The state of Wisconsin has increased GPR spending on Medicaid only 1 time since 1993. What other cost center has to fund their own increases? $13.8 million dollars of that self funding has been diverted to other state budget needs. The governor is proposing 3-5% increases to care management organizations, Family Care etc., but 2% for skilled nursing facilities. How can you justify that? Do our seniors have no value at the end of life? We need 5% just to stay in business.

Legislation is in place requiring that you provide Medicaid. Without adequate reimbursement, more and more facilities are limiting or eliminating entirely T-19 services. The choice is yours. If you can’t fund it, eliminate the legislation that created it. We could return to the poor farms of the 50’s.

I invite any of you to visit my facility to see your constituents whom we serve. We have a mission and so do you.

Thank you.

Monday, April 16, 2007

What’s the value of unpaid work?

In the field of aging, an enormous amount of valuable work is not paid for by wages. But if it were, what would it cost? And who would pay it?

We can answer at least the first question.

According to Independent Sector (IS), the value of a volunteer hour in 2006 was $18.77, up from $18.04 per hour in 2005. That’s a national average: in Wisconsin, where pay rates are lower, the value of an hour is listed as $15.63.
The figure is calculated using the average hourly wage for all non-management, nonagriculture workers from tables compiled by the Bureau of Labor Statistics. Twelve percent is added for fringe benefits.

If your organization uses volunteers, the figure can help you give a better picture of the value you receive or give—or in many of our cases, both. The site also links to Financial Accounting Board Standards for determining the value of volunteer services for financial statements. Generally, only special skills work your organization would have to purchase if it were not donated is covered.

IS is a "nonpartisan coalition of approximately 575 organizations leads, strengthens, and mobilizes the charitable community in order to fulfill our vision of a just and inclusive society and a healthy democracy of active citizens, effective institutions, and vibrant communities.”

A lot of food for thought here. What do you think about unpaid work in your field or other parts of your life?

Thursday, April 12, 2007

The crystal ball: Centers for Medicare & Medicaid Services (CMS) look to the future

For a glimpse into the "mind" of CMS, look at the online speaker presentations from the 7th New Freedom Initiative Conference “Access to Community Living: Promoting Independence and Choice” in March.

According to the program, “Choice and Independence is a key pillar of the CMS vision for a person-centered long term services and supports system for the future. The 2007 conference focused on the policies, programs, and tools – including opportunities authorized by the Deficit Reduction Act of 2005 – available to shape and carry out the vision.”

Presentations are provided in both PDF and accessible text format by the National Academy for State Health Policy, which conducts policy analysis; provides training and technical assistance to states; produces informational resources; and convenes state, regional, and national forums.

The complete list of sessions, descriptions, and speakers also is available at the site.

There's a wealth of interesting information here. Available topics include:


Creating Flexible Funding Streams: What Does It Mean?
Transparency: 20/20 Traversing of the System
Developing a Mental Health System that Maximizes Recovery
Quality Assurance in HCBS: Federal Vision, Approaches and Resource
Consumer Control and Systems Change: The Positive Impact on State and Federal Policy
Supportive Housing Strategies: HUD and State Perspectives
Application of CMS Quality Management Strategy: Self-Direction and Risk
The 36 Hour Day: The Overlooked Workforce
Coordinating Institutional Transitions and Diversions: Changing the Direction of LTC System Pathways
Driving Toward a More Balanced LTC System: The Important Role of Transportation Services
Expanding Options for Home and Community Based Services
Self-Direction: Functions in Support of Self-Direction
Benefit Flexibility through Benchmark Plans: Rightsizing It for Consumers
Benefits Counseling: A Proven Strategy for Promoting Independence and Self-Sufficiency for Individuals with Disabilities
Building Natural Supports by Connecting Individuals with Disabilities and Community Members
Promoting Choice and Independence through Employment
Rebalancing Long Term Supports: Measuring Your Progress

Wednesday, April 11, 2007

What to tell seniors about SeniorCare

The denial by the Centers for Medicare & Medicaid Services (CMS) of an extension for SeniorCare is a disappointment, though not a surprise. The feds had made it pretty clear that they weren’t really going to consider extending Wisconsin’s Pharmacy Plus Demonstration for reducing drug costs to seniors.

The state has requested extending the program until the end of the year to allow for a better transition. Likely, that extension will be granted.

Tom Frazier of the Coalition of Wisconsin Aging Groups (CWAG) suggests:

As you talk with seniors about the news . . ., please tell them that there is more than enough time to decide what they need to do. CMS has offered to tend the waiver until the end of the year so, until you hear differently, I would assume that this will happen. . .

In addition, several Wisconsin Members of Congress are exploring legislative possibilities for extending SeniorCare, and I am working with the Governor’s office and DHFS on efforts to develop an alternative that I hope will be better than existing Part D plans.


Frazier also urges SeniorCare enrollees to be aware of insurance sales people saying that you will need to enroll in a Part D plan right away. "This is not true and you should remain on the SeniorCare program as long as possible," adds Frazier. "SeniorCare enrollees will hear officially from the Gov. Doyle or the department of Health and Family Services (OHFS) regarding their options."

CWAG offices are a reliable source of information, so check there if you wish to verify any rumors you might hear.

(608) 224-0606
(800) 366-2990
(888) 758-6047 TTY/Texnet
(608) 224-0607 fax
Email: cwag@cwag.org

Tuesday, April 3, 2007

Major changes needed in Medicaid, says Center for Retirement Research

Here’s a thought-provoking new report: Medicaid and Long-Term Care: How Will Rising Costs Affect Services for an Aging Population?, Howard Gleckman, Center for Retirement Research at Boston College, April, 2007.

From the conclusion:

The goal of government long-term care policy should be to provide the best possible quality of life for the elderly and disabled in the most cost-effective way. It should not merely become an exercise in saving money. However, unless policymakers are willing to make major changes, Medicaid will threaten to crowd out spending for other services citizens have come to expect from government, force substantial tax increases, or both.

This brief described the existing Medicaid system, its cost pressures, and experiments aimed at reducing cost growth. Subsequent briefs will look at the role of private long-term care insurance, describe how other developed nations provide such care, and explore ideas for fundamental change in the way long-term care is financed and delivered in the United States. The fundamental question that reformers must answer is whether this care should be provided as part of the nation’s structure of social insurance, whether it should be an individual responsibility, or some combination of the two.

A Boomer reflects on senior “engagement.”

No, I’m not talking about late-life romance, although someday I’d like to experience it!

I’m talking about what we are going to do with the rest of our lives.

As a person over 50 who is still “growing” her career, I’m keenly interested in senior workforce issues.The big question seems to be not whether we can work (we can) or if we want to work (many of us do—or must), but who will hire us.

Especially for jobs that don’t involve wearing red vests and shopping carts.

The other buzz word for seniors is “civic engagement.” Why not, the thinking goes, harness all that wisdom and time to do the really important work of the world that’s so often unpaid?

I’ve been impatient with my Boomer generation for a long time because it seems so many of us are working mainly on our flesh tone and our golf swings. We seem to have forgotten that we were going to transform the world.

Of course, the senior as full-time player is a media image, so it’s not really “true.” Besides working, plenty of Boomers are volunteering in schools, driving more senior seniors to appointments, serving in city governments, setting up angel funds to help seed important social causes, building houses in inner cities and Costa Rica.

Now it seems like everyone wants to harness our energy. Here’s what Civic Ventures has to say:

Now arriving: the experience generation

The first of 77 million baby boomers turn 60 in 2006. They are on the front edge of the largest, healthiest, best educated population of Americans ever to move through and beyond their fifties.

They are pioneers in a new stage spanning the decades between middle and late life. Neither young nor old, they represent an extraordinary pool of social and human capital. And, in large numbers, they want to do work that serves a greater good. . .

But too often, their individual enthusiasm is stymied by perceptions, policies, and practices that discourage the sharing of experience. As a result, this growing number of Americans represents a largely untapped resource in a nation with many unmet needs.

Imagine unleashing their potential.


It’s that last line that gets me: just who is going to unleash our potential? Shouldn’t we be doing that ourselves?

It would be great to present a better picture of what’s actually going on already, formally and informally. Please share your stories of civic engagement by seniors in the Milwaukee area, whether “young” or old seniors. You can write them in the comments section and I’ll transfer them to the blog body.