Category Archives: Articles

Raising the minimum wage by as little as 10 percent would significantly improve the safety and health of nursing home residents, according to new research.

Most direct care in nursing homes is provided by nursing assistants, who make up about 40 percent of the nursing home workforce and are among the lowest-paid workers in the U.S. economy. Nursing assistants help residents with activities of daily living like eating, bathing and dressing, and and work with certified nurses and elder care teams to monitor patients’ conditions.

Due in part of their low wages, nursing assistants frequently change jobs for better pay or working conditions.  “Between 60 percent and 85 percent of nursing assistants leave their employers each year, most often to go work in other nursing homes,” writes Krista Ruffini, a visiting scholar at the Minneapolis Federal Reserve. Nursing homes frequently report difficulty in recruiting and retaining staff, she says.

Ruffini recently looked at the impact increasing the minimum wage has on nursing home staff turnover and quality.  She compared facilities in hundreds of U.S. counties that had increased their minimum wage with those that hadn’t between 1990 to 2017.

In findings based on her preliminary data published in a working paper, Ruffini found that “increasing the minimum wage by 10 percent would reduce the number of health inspection violations by 1 percent to 2 percent, the number of residents with moderate to severe pressure ulcers [bed sores] by about 1.7 percent, and the number of deaths by 3 percent.”  The 3 percent reduction in deaths, she notes, translates to 15,000 fewer deaths in nursing homes each year.

Ruffini found that raising the minimum wage reduced turnover and increased tenure among nursing assistants.  This greater continuity of care, she says, translated into improved health and safety conditions for the patients.  At the same time, nursing home profits held steady because the extra costs were passed on in the form of higher fees.

Ruffini notes that her findings have particular relevance in a time when the coronavirus pandemic is overwhelming nursing homes.  Comparing a facility’s number of COVID-19 deaths with its quality-of-care performance, she concluded: “The data provide some suggestive evidence that higher service quality is associated with fewer deaths from COVID-19 in nursing homes.”

For Ruffini’s paper, click here.  For an article she wrote about her findings, click here.

For a New York Times article on Ruffini’s research and another minimum wage study, click here.

 

Medigap policies that supplement Medicare’s basic coverage can cost vastly different amounts, depending on the company selling the policy, according to a new study. The findings highlight the importance of shopping around before purchasing a policy. 

When you first become eligible for Medicare, you may purchase a Medigap policy from a private insurer to supplement Medicare's coverage and plug some or virtually all of Medicare’s coverage gaps. You can currently choose one of eight Medigap plans that are identified by letters A, B, D, G, K, L, M, and N (If you were eligible for Medicare before January 1, 2020, but not enrolled, you may also be able to purchase Plans C and F, but those plans  are no longer available to people who are newly eligible for Medicare). Each plan package offers a different menu of benefits, allowing purchasers to choose the combination that is right for them. 

While federal law requires that insurers must offer the same benefits for each lettered plan–each plan G offered by one insurer must cover the same benefits as plan G offered by another insurer–insurers set their own prices for each plan. This means that the price of each plan varies considerably depending on the insurance company. 

The American Association for Medicare Supplement Insurance compared costs of plans in the top 10 metro areas and found huge cost differences. Using the most popular plan–Plan G–for comparison, the association found that in Dallas the lowest price for a 65-year-old woman to purchase a plan was $99 a month while the highest price was $381 a month. This is a yearly difference of more than $3,000 for the exact same plan. 

The association also found that no one company consistently offered the lowest or highest price. In their study, investigators discovered that 13 different companies had either the lowest or highest price. This means you can’t rely on just one company to always have the better price. 

When looking for a Medigap policy, make sure to get quotes from several insurance companies. In addition, if you are going through a broker, check with two or more brokers because one broker might not represent every insurer. It can be hard work to shop around, but the price savings can be worth it.

 

The coronavirus pandemic has had a devastating impact on the elderly, particularly those in nursing homes and other long-term care facilities. This has raised questions about how the virus has influenced the costs and provision of long-term care insurance, which covers care in facilities and sometimes at home as well. 

If you have a long-term care insurance policy, you may wonder how it is affected by the pandemic. If you don’t have a policy, you may wonder if the pandemic will make it more difficult to get one. An article by US News and World Report, examines issues with long-term care insurance that have arisen in the last few months, including the following:

  • Qualifying for insurance. It is already more difficult to qualify for long-term care insurance the older you get. Because older individuals are at a higher risk for coronavirus, this can affect your long-term care application as well. Some insurers have been limiting applicants’ ages or putting additional restrictions on applicants who have been in contact with the virus. If you had a positive COVID-19 test, you may have to wait for three to six months before qualifying for insurance. These policies vary by company. 
  • Premiums. Insurers can’t raise rates for customers due to individual circumstances. To raise rates, insurers must obtain approval from the state and raise them for the entire group. However, if you are considered high risk due to exposure to coronavirus, you may not qualify for the best rates when you first apply for long-term care insurance. 
  • Moving out of a nursing home. If you have a policy and want to move out of a nursing home, you will need to check what your policy will pay for. Some policies pay for long-term care in a variety of settings, including home care, but others are more restrictive. On the plus side, you may be able to use your policy to reserve your bed, allowing you to keep your nursing home spot.
  • Home care. If you have a policy that was paying for home care, there may also be changes. Some home care workers are charging more for work during the pandemic, which could exceed your policy coverage. Another change may be to the number of people entering your home. You may want family to provide care, rather than an outside home health care worker. Unfortunately, most long-term care policies don’t pay for family members to provide care. However, if you aren’t using the insurance to pay for care, your coverage may last longer–depending on the policy. 

There are lots of uncertainties regarding long-term care, insurance, and coronavirus. To read the full US News and World Report article about what we do know, click here.

For more information about long-term care insurance, click here

 

The Federal Trade Commission (FTC) is warning residents of long-term care facilities and their families that some facilities may unlawfully require residents who are on Medicaid to sign over their $1,200 pandemic relief checks.

“This is not just a horror story making the rounds. These are actual reports that our friends in the Iowa Attorney General’s Office have been getting—and handling. Other states have seen the same,” writes Lois Greisman, the FTC’s Elder Justice Coordinator, in a May 15 alert.  

The Coronavirus Aid, Relief, and Economic Security (CARES) Act included one-time payments of up to $1,200 to millions of eligible individuals, based on their income. Ordinarily, nursing home and assisted living residents receiving Medicaid benefits must give all their income to the facility, minus a small “personal needs allowance.” However, the economic impact payments that are part of the CARES Act are a tax credit. According to tax law, tax credits don’t count as “resources” for federal benefit programs like Medicaid. The money belongs to the resident, not the facility. 

The FTC says that if a loved one lives in a nursing facility and you’re not sure what happened to their payment, talk with them soon.  If the facility took the payment already, get in touch with your state attorney general and ask them to help you get it back, and then tell the FTC at ftc.gov/complaint.

For the FTC's alert to consumers, click here.

For the agency’s companion alert to businesses, titled “Nursing homes and assisted living facilities: Hands off residents’ stimulus checks,” click here.

For a fact sheet from the National Center on Law & Elder Rights (NCLER) titled “Nursing Home Residents, Medicaid, and Stimulus Checks: What You Need to Know,” click here.

For an NCLER fact sheet for those receiving Medicaid in assisted living facilities or in the community, click here.

 

 

The closure of Social Security offices has caused problems and worries for recently unemployed seniors who need to apply for Medicare after losing their employer coverage. In response, the federal government has announced that seniors affected by the crisis have additional time to enroll in Medicare or change plans.

With millions of people out of work and losing their employer health insurance due to the coronavirus pandemic, the need for Medicare coverage is critical. While it is possible for some seniors to apply for Medicare online, others need to provide more information, including individuals who did not sign up for Medicare Part B initially because they had health insurance through an employer. Seniors who are applying for Medicare Part B after losing their job need to provide proof of their employer policy along with their Medicare application to ensure they aren’t subject to substantial penalties. With Social Security offices closed, Medicare applicants may have difficulty figuring out how to submit the necessary information or getting answers to their questions about their application. 

The Centers for Medicare and Medicaid Services (CMS) has announced changes to Medicare enrollment periods to help seniors affected by the coronavirus pandemic. Those who missed their opportunity to enroll in Medicare will have additional time to apply. CMS is providing “equitable relief” to seniors who:

  • were in their Initial Enrollment Period (IEP), General Enrollment Period (GEP), or Special Enrollment Period (SEP) between March 17, 2020, and June 17, 2020; and
  • did not submit an enrollment request to the Social Security Administration (SSA).

Seniors have until June 17, 2020, to submit an application. Applications can be submitted via fax to 1-833-914-2016 or mailed to the local SSA field office. Although SSA offices are closed for in-person service, offices are still processing applications received by mail. For the SSA’s Social Security Office Locator, go here: https://secure.ssa.gov/ICON/main.jsp

For questions and answers on how to submit a Medicare application and what information is needed, click here.

In addition, CMS has announced an SEP for people to make changes to their Medicare Advantage and prescription drug plans if they missed the open enrollment period or a special enrollment period due to the coronavirus pandemic. The SEP is available until July 13, 2020. 

For more information from CMS, click here

The centerpiece of the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law March 27, 2020, is its one-time $1,200 payments to millions of eligible individuals. When can you expect your payment and how much will it be? The answer to the first question has been changing on an almost daily basis, but finally seems to have come into focus.  Here’s the latest word.

How Much Will You Receive, If Anything?

Under the bill, one-time checks in the amount of $1,200 will go to individuals ($2,400 for couples who filed joint taxes) who earned less than $75,000 ($150,000 for joint filers) on their most recent tax returns, which is either the person’s 2018 or 2019 returns, depending on if they have already filed for this year. Individuals earning up to $99,000 ($198,000 for joint filers) will receive smaller relief checks. Families are entitled to an additional $500 per child under age 17 in the household. The bill also increases weekly unemployment payments by $600 per week for four months.

When Can You Expect the Money?

Those people for whom the Internal Revenue Service (IRS) has direct deposit information will receive their relief money quickest. The first wave of direct deposits went out on April 11, starting with low- and middle-income earners. How long it takes for the funds to hit your account depends on how long it takes your bank to process direct deposits.  

What If the IRS Doesn’t Have Direct Deposit Information for You?

The IRS has direct deposit information for only a minority of relief payment recipients. Those who don’t have deposit information on file have two options: they can wait for their paper check to arrive – which could take a long time – or they can enter their direct deposit information using a new portal the IRS just set up.

Those who don’t provide their bank information to the IRS can expect to receive paper checks, which may take up to 20 weeks to arrive. In other words, some needing quick financial relief may not get their money until September. The IRS is expected to begin issuing paper checks on April 20, with about 5 million checks mailed per week, although the checks may be further delayed because the Treasury Department has ordered that President Trump's name appear on them. Checks will be prioritized to reach low-income earners first. 

If you filed a tax return, your check will be issued automatically to the address the IRS has on file for you and you don’t have to do anything to get it. If you haven’t filed a tax return this year, you should do so as soon as possible so you can receive any relief payment coming to you.

What About Those Who Don’t File Tax Returns?

Initially, the IRS declared that it would have to have a tax return on file for anyone receiving a relief payment.  Many low-income people, however, do not file tax returns because they simultaneously earn too little and lack sufficient employment history to be eligible for a refund. This population includes some of the most vulnerable to the coronavirus — the elderly and people with disabilities. It is estimated that more than 15 million Social Security beneficiaries did not file tax returns last year. 

After protests from AARP, lawmakers, seniors, and other advocacy groups, the IRS reversed course and said that Social Security retirement and disability recipients, some veterans, and many others who don’t file tax returns would automatically receive their checks using information the IRS gleans from Form 1099.  However, that still left plenty of people who don’t receive 1099s – including recipients of Supplemental Security Income (SSI) and veterans disability compensation — out to dry because they don’t receive 1099 forms. A few days later, the IRS announced its new non-filers portal, where recipients can enter pertinent information to receive their checks, and on April 15 the Department of the Treasury announced that SSI recipients will have the  $1,200 emergency COVID-19 relief checks automatically deposited in their bank accounts just as they would normally receive their SSI benefit. . 

According a Social Security Administration notice issued on April 10, “people who receive Social Security retirement, survivors, or disability insurance benefits and who did not file a tax return for 2018 or 2019 and who have qualifying children under age 17 should now go to the IRS’s webpage to enter their information instead of waiting for their automatic $1,200 Economic Impact Payment.  By taking proactive steps to enter information on the IRS website about them and their qualifying children, they will also receive the $500 per dependent child payment in addition to their $1,200 individual payment.  If Social Security beneficiaries in this group do not provide their information to the IRS soon, they will have to wait to receive their $500 per qualifying child.”

What About Those Who Lack Internet Access?

Not everyone, especially low-income people, has access to a computer and the Internet, and so won’t be able to fill out the form on the IRS portal. The IRS has not yet announced a solution for these people.

You Can Check Your Relief Payment’s Status

On April 17, the IRS launched a “Get My Payment” Web tool where relief payment recipients can check the status of their payment and when it is expected to arrive via direct deposit or mail. If you filed a tax return in 2018 or 2019 and didn’t sign up to receive a refund via direct deposit (or didn’t receive a refund at all), you’ll be able to provide your bank information to the IRS using this Web tool, in addition to the non-filers portal the agency previously set up.

 

 

 

 

 

With the coronavirus pandemic hitting nursing homes and assisted living facilities especially hard, families are wondering whether they should bring their parents or other loved ones home. It is a tough decision with no easy answers.

The number of coronavirus cases in nursing homes and assisted living facilities across the country continues to grow. A Washington state nursing home was one of the first clusters of coronavirus reported in the United States, with at least 37 deaths associated with the facility.  The State Reporting of Cases and Deaths Due to COVID-19 in Long-Term Care Facilities continues to indicate a steady rise in coronavirus deaths in long-term care facilities. Their data collection effort finds that in the 23 states that publicly report death data as of April 23, 2020, there have been over 10,000 reported deaths due to COVID-19 in long-term care facilities (including residents and staff), representing 27% of deaths due to COVID-19 in those states.

In an effort to contain the virus’s spread, most long-term care facilities are limiting or excluding outside visitors, making it hard to check on loved ones. Social activities within the facility may also be cancelled, leading to social isolation for residents. In addition, long-term care facilities face staffing shortages even in the best of times. With the virus affecting staff as well as residents, facilities are having trouble providing needed care. Assisted living facilities, which are not heavily regulated, may have greater trouble containing the virus than nursing homes because their staff is not necessarily medically trained.

With this in mind, many families are considering bringing their loved ones home. A Harvard epidemiologist is warning that nursing homes are not the best place to house the vulnerable elderly at this time. And a local judge in Dallas has recommended that families remove their loved ones from infected facilities. Before taking this extreme step, however, you need to consider the following questions:

  • Is your family able to provide the care that your loved one needs? Some patients require help with eating, dressing, medication, and going to the bathroom. You need to consider whether you can adequately provide that care at home. In addition to your loved one’s practical needs, you need to think about your physical and emotional stamina. Also, is your house set up to safely accommodate your family member? Are there a lot of stairs? Does the bathroom have rails? If your loved one has dementia, there may be other considerations to take into account.
  • How well can you prevent infection? Will you be better able to prevent infection than a nursing home? If your entire household is homebound, you may be in a good position to prevent bringing home the virus. However, if one or more members of your household is working outside of the home, you will have to take extra precautions to make sure you don’t bring the virus to your loved one. Are you taking the necessary precautions to keep your house and yourself disinfected?
  • Will the resident be allowed to return to the facility when the threat of the virus has abated? If you take your family member out of the nursing home or assisted living facility, the facility may not let your family member back in right away. You should check with the facility to determine if your loved one will be able to return.

Bringing a family member home is a hard decision and it depends on the individual circumstances of each family. For more on the considerations involved, click here and here.

 

With coronavirus dominating news coverage and creating alarm, it is important to know that Medicare and Medicaid will cover tests for the virus. 

The department of Health and Human Services has designated the test for the new strain of coronavirus (officially called COVID-19) an essential health benefit. This designation means that Medicare and Medicaid will cover testing of beneficiaries who are suspected of having the virus. In order to be covered, a doctor or other health care provider must order the test. All tests on or after February 4, 2020 are covered, although your provider will need to wait until after April 1, 2020, to be able to submit a claim to Medicare for the test.

Congress has also passed an $8.3 billion emergency funding bill to help federal agencies respond to the outbreak. The funding will provide federal agencies with money to develop tests and treatment options as well as help local governments deal with outbreaks. 

As always, to prevent the spread of this illness or other illnesses, including the flu, take the following precautions:
•    Wash your hands often with soap and water
•    Cover your mouth and nose when you cough or sneeze
•    Stay home when you're sick
•    See your doctor if you think you're ill

For Medicare’s notice about coverage for the coronavirus, click here.

 

As part of its response to the coronavirus pandemic, the federal government is broadly expanding coverage of Medicare telehealth services to beneficiaries and relaxing HIPAA enforcement. This will give doctors the ability to provide more services to patients remotely. 

Medicare covers telehealth services that include office visits, psychotherapy, and consultations provided by an eligible provider who isn't at your location using an interactive two-way telecommunications system (like real-time audio and video). Normally, these services are available only in rural areas, under certain conditions, and only if you’re located at one of these places:

  • A doctor’s office
  • A hospital
  • A critical access hospital (CAH)
  • A rural health clinic 
  • A federally qualified health center
  • A hospital-based dialysis facility
  • A skilled nursing facility
  • A community mental health center

Under the new expansion, Medicare will now pay for office, hospital, and other visits provided via telehealth in the patient’s home. Doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers will all be able to offer a variety of telehealth services to their patients, including evaluation and management visits, mental health counseling, and preventive health screenings. In addition, relaxed HIPAA enforcement (the law governing patient privacy) means doctors may use technologies like Skype and Facetime to talk to patients as well as using the phone. 

In addition to Medicare’s expansion, states are also allowing doctors to provide telehealth services to Medicaid beneficiaries. For example, New York will now cover telephone-based evaluations when an in-person visit is not medically recommended. Many other states are following suit. 

This expansion of telehealth services will allow older adults who are particularly vulnerable to COVID-19 to stay home and still get medical advice. If you need to see a medical provider during this health emergency, check to see whether they are employing telehealth services. To use telehealth services, you need to verbally consent and your doctor must document that consent in your medical record. For information from AARP on what you might expect during a virtual doctor’s visit, click here

The spread of the coronavirus to nursing home residents has caused the federal government to direct nursing homes to restrict visitor access, and many assisted livingfacilities have done the same. While the move helps the residents stay healthy, it can also lead to social isolation and depression. Families are having to find new ways to stay in touch.  

Nursing homes have been hit hard by the coronavirus. The Life Care Center of Kirkland, Washington near Seattle was one of the first clusters of coronavirus in the United States and is one of the deadliest, with at least 35 deaths associated with the facility. In response, the Centers for Medicare and Medicaid Services (CMS) issued guidance to all nursing homes, restricting all visitors, except for compassionate care in end-of-life situations; restricting all volunteers and nonessential personnel; and cancelling all group activities and communal dining. While these actions are necessary to prevent the spread of the virus, they can leave families worried and upset and residents feeling isolated and confused. 

Families are taking varying tacks to keep in contact with their loved ones, many of whom don’t fully understand why their family is no longer visiting. Nursing homes are also helping to facilitate contact. Some options for keeping in touch, include the following: 

  • Phone calls. Phone calls are still an option to be able to talk to your loved one. 
  • Window visits. Families who are able to visit their loved one’s window can use that to have in-person visits. You can hold up signs and blow kisses. Talking on a cell phone or typing messages on it and holding them up to the window may be a way to have a conversation. 
  • Facetime and Skype. Many nursing homes are facilitating video calls with families using platforms like Facetime or Skype. Some nursing homes have purchased additional iPads, while others have staff members going between rooms with a dedicated iPad to help residents make calls. 
  • Cards and letters. Sending cards and letters to your loved ones is another way to show them that you are thinking of them. Some nursing homes have also set up Facebook pages, where people can send messages to residents. 

In this unprecedented time, families will need to get creative to stay in touch with their loved ones. For more articles about how families and nursing homes around the country are coping with the new restrictions, click here, here, and here