Medicare Needs
Attention
Fairness for Home Health
Care
Ask Elder Services
Health Insurance
Questions & Answers
Letters to the Editor
Dr. Shouldice
Discusses Eye Care
The Calcium and
Vitamin D Story
Age Smart
Elder Services Honors Volunteers
From the Director: Medicare Needs Attention
The longevity of Americans first led to the establishment
of Medicare in 1965; in 1998 increasing longevity has led to Medicare no
longer being a solution but to Medicare itself being defined as a major
national problem.
Medicare costs have soared since the 1980s, home
health costs in particular grew nearly tenfold since 1988; with these home
health increases fueled by the original Medicare belt-tighteners, (DRGS
or diagnosis related groups) which require shortened hospital stays.
Hospitals nationwide are worried about projected
losses based on Medicare reductions; shorter stays, empty beds, and the
need for fewer staff worries both providers and consumers of health care.
Medicare is a federal program: the only way Medicare
issues can be addressed is at the federal level. Unfortunately, there
seems little will to adequately and fully examine Medicare and reconfigure
it into an effective health care program for older Americans, although
a commission on Medicare has just begun work.
The 17 member National Bipartisan Commission on
the Future of Medicare is off to a slow start. This bipartisan group,
ten of whom are members of Congress, is already seriously divided, with
the eight Republican members reportedly pledged to oppose any call for
new revenues.
The Commission plans no hearings outside Washington
and has no consumer representation.
The Commission met for its first meeting in March
and again in April, at which plans called for dividing the group into three
task forces; one to deal with projections on costs and numbers of enrollees;
the second, a "reform" task force to deal with short term changes in Medicare,
and the third, a "restructuring" task force to deal with long term structural
changes in the program.
The third task force is the critical group; their
recommendations will, if implemented by a Congress seemingly without any
willingness to deal with Medicare issues, make or break health care for
older Americans.
The activities of this commission bear watching;
Medicare truly needs attention. Media coverage has not been extensive.
Names of Commission members are printed below:
Chairman: Sen. John Breaux (D-LA)
Administrative Chairman: Rep. Bill Thomas (R-CA)
Members appointed by the Administration: Stuart
Altman, Professor National Health Policy, Brandeis University; Laura D'Andrea
Tyson, former Chair of the National Economic Council under Clinton and
current Professor of Economics at the University of California at Berkeley;
Bruce Vladeck, former HCFA Administrator and Professor of Health Policy
of Mt. Sinai School of Medicine in New York; and Anthony Watson, Chairman
and CEO of Health Insurance Plan, New York.
Members appointed by congressional Republicans:
Rep. Bill Thomas, Rep. Michael Bilrakis (R-FL); Sen. Bill Frist (R-TN);
Rep. Greg Ganske (R-IA); Ilene Gordon, state office staffer for Sen. Trent
Lott (R-MS); Sen. Phil Gramm (R-TX); Samuel H. Howard, Chairman of Phoenix
Healthcare Corporation and Deborah Steelman, attorney and former Senior
Policy Advisor for the Republican National Committee.
Members of the commission appointed by congressional
Democrats: Rep. John Dingell (D-MI); Sen. Bob Kerrey (D-NE); Rep. James
McDermott (D-WA); and Sen. Jay Rockefeller (D-WV).
Fairness for Home Health Care by Senator Edward M. Kennedy
Congress was aiming primarily at Medicare fraud and
abuse when it included provisions in last year's Balanced Budget Act on
home health care. Unfortunately, the policy changes missed their
mark, and they are now jeopardizing the legitimate operations of many home
care providers.
The current controversy and confusion over the provisions
should not obscure the fact that the basic laws on the amount and duration
of benefits for home care were not changed.
The burden of initial attempts to implement the
1997 payment changes has fallen especially unfairly on Massachusetts, with
its historic tradition of non-profit community-based providers that deliver
high-quality home care at low cost. Many of the state's home health
agencies are not being treated fairly by the revised Medicare payment structure.
Some of these agencies are concerned that they will not be able to continue
to provide high-quality home care at the lower payment levels. I
am working with my colleagues in Washington to address this problem, to
ensure that Massachusetts' agencies are treated equitably, and that senior
citizens across our state receive the home care services they need and
deserve.
Last November, our Massachusetts congressional delegation
sent a letter to the Health Care Financing Administration, the agency in
the U.S. Department of Health and Human Services that administers the Medicare
program. We expressed our strong concern over the new lower payment
levels for home care under Medicare. In addition, Congressman Jim
McGovern and I have introduced legislation in the Senate and House of Representatives
(S.1643/H.R.3205) to delay the most controversial changes and buy time
to make reasonable modifications in the new rules to reduce their unfair
impact.
According to estimates from the Home & Health
Care Association of Massachusetts, this legislation will preserve access
to home health care for many elderly persons in Massachusetts. Our
bill has been endorsed by national and Massachusetts-based home health
organizations and senior citizens' organizations, including the Medicare
Advocacy Project in Boston, the Home & Health Care Association of Massachusetts,
the Massachusetts Hospital Association, and the National Association for
Home Care.
Our legislation was the first bill in Congress to
call attention to these home health payment issues, and others in Congress
are now also proposing legislative corrections. Bipartisan support
is developing to solve these serious problems, and I am optimistic that
Congress and the Administration will work out corrective action as expeditiously
as possible. We can deal with Medicare fraud and abuse and adjust
to needed payment changes, without jeopardizing legitimate home health
care providers or the patients who depend on them.
Ask Elder Services
Q: I take care of my wife - she has Alzheimer's. I need to do the shopping, go to the bank and go to appointments. My wife cannot stay alone anymore and I cannot always take her with me. Also, I am very tired and I need some time to myself. Are there any services that can help me?
A: An adult day program may offer the help that you need. In Berkshire
County there are three Adult Day Health and six Social Day Care Programs
as well as a Community Care Center for Veterans. These programs provide
a safe, supervised place for an elder to spend the day, allowing the caregiver
some free time. All offer social activities, exercise, and recreational
activities. The activities are tailored around a participant's needs and
abilities. Lunches and snacks are provided. Social
Day Care Programs are located at:
Great Barrington Social
Day Care
148 Maple Avenue, Gt. Barrington - 528-3198
Pittsfield Adult Day
Health Center
33 Bradford Street, Pittsfield - 442-4978
Adult Social Day Program
Girls Inc.
165 East Street, Pittsfield - 442-5174
Social Day Care Froio Senior
Center
330 North Street, Pittsfield - 499-9346
Senior Day Program
Adams Council on Aging
Community Center, 20 East Street, Adams - 743-8333
Social Day Care
North Adams
420 Curran Highway, North Adams - 664-4048
The Adult Day Health programs have a nurse who monitors health status
and medications. Adult Day Health also offers physical therapy, occupational
therapy, speech therapy, and can assist with personal care and toileting
when needed. Adult Day Health Programs are located at:
Great Barrington Adult Day
Health
148 Maple Avenue, Gt. Barrington - 528-3198
Pittsfield Adult Day
Health Center
33 Bradford Street, Pittsfield - 442-4978
Adult Day Health North
Adams
420 Curran Highway, North Adams - 664-4048
The Veterans Community Care Center offers a Day Program providing occupational
therapy for veterans and respite for their families. They serve breakfast
and lunch daily. This program is open to Veterans who have an honorable
discharge. It is located at:
Veterans Community Care
Center
199 South Street, Pittsfield - 499-2672
Q: I will be having an operation next week, and I will not be able to
cook for myself for a least a month. Will I be eligible for Meals
on Wheels? Do I have to be low income?
A: Meals on Wheels are available to anyone over 60 who is unable to
prepare a well balanced nutritious meal. There are no income limits - it
does not matter if your income is high or low. Additional eligibility criteria
include:
1) Physical impairments:
a. poor mobility
b. impaired vision
c. shortness of breath
d. problems with muscle control
2) Mental impairments such as forgetfulness or confusion
3) Inadequate kitchen facilities
4) Recent hospital discharge
5) Elder cannot attend a Congregate Meal Site
6) Elder has no formal or informal support for noon meal preparation
A donation of $1.50 per meal is suggested.
Health Insurance Questions & Answers
Q: "I'm 65, but still working! What are my options?"
A: You may be able to obtain health insurance coverage through your
current employer.
If you continue to work for an employer who has 20 or more employees,
the employer is required by law to offer you and your spouse the same choice
of health care plans offered to employees under age 65.
Q: Do I need to enroll in Medicare Part B?
A: No, you may delay enrolling in Part B without penalty if the group
health plan is based on your continuous and current employment. This
waiver of penalty also applies if you are covered under a working spouse's
plan.
Q: Choices?
A: Some companies offer their employees only one health insurance option.
Or, your employer may ask you to choose which of several plans you would
like for the coming year.
Q: Benefits?
A: The employer plans available to you might be more comprehensive
and less costly than you can get in a Medigap (non-group) plan or Medicare
HMO. Since employment-related plans are individualized for each company,
there are literally thousands of them in force, with no two alike in benefits
and costs. If you do not have a current copy of your plan's benefit
booklet, contact your employer's human resource department or employee
benefits coordinator.
Q: If I decide to continue with my employer health plan and enroll
in Medicare Part A only, who pays first?
A: If you are actively working, the employer plan will pay first on
your hospital and medical bills. If the employer plan does not pay
all of your expenses, Medicare may pay secondary for Part A covered services
such as hospitalization, skilled nursing facility care, home health and
hospice care.
Q: What are my alternatives if, after 65, I decide to retire or my
health insurance becomes too expensive?
A: First, you'll need to enroll in Medicare Part B. If your coverage
is terminated or you stop working, whichever comes first, you will have
eight months in which to enroll in Medicare Part B without a penalty surcharge.
Once you have Medicare, like most people you will probably want
additional health coverage that helps pay for what's not covered by Medicare.
Keep in mind, no system of enhancing Medicare coverage is right for everyone.
All plans have benefits and limitations which must be evaluated relative
to your lifestyle and personal preferences.
Q: What are my options if I have a retiree plan and Medicare?
A: Roughly one third of retired Americans have this piece of the health
care puzzle - a health insurance plan from their former employer.
When you become eligible for and enroll in Medicare, your retiree plan
will be the secondary payer after Medicare. You'll use this retiree
piece to supplement Medicare, to pay some of the costs Medicare does not
pay.
Q: Benefits?
A: Your retiree plan is not a Medigap policy, but it may pay like one.
Or it may pay more, providing additional benefits, for example. Retiree
plans, like employment plans, are all unique. Contact your employee
benefits representative for a benefits booklet and learn your benefits,
your lifetime maximum benefit, and your (or your spouse's) ability to continue
coverage if the retiree dies.
Elder Services:
I was reading the March issue of Berkshire Senior
(which is a great publication!) when I ran across something that needs
to be updated for your readers. In the Your Dollars section there
was a question/answer relating to how often Medicare pays for a screening
mammography. Your readers will be pleased to know that the Balanced
Budget Act, passed in August, 1997, included some provisions regarding
screening tests for Medicare recipients who have Part B coverage (which
the majority do, I understand). Those covered by Medicare Part B
may now receive a screening mammogram every year.
The following are now, or will be, covered preventive
services available to Medicare Part B members for 1998:
An annual screening mammogram for women over age 39.
A screening pap smear and pelvic examination (including a clinical
breast examination) every three years, or annually for high-risk members.
A colorectal screening. Based on age and medical necessity,
coverage includes: blood tests, sigmoidoscopies, colonoscopies, and other
procedures, such as screening barium enemas.
Diabetes self-management. This includes coverage for outpatient
educational and training services that will provide you with the necessary
skills and knowledge to manage your diabetes. This also includes
coverage of blood glucose monitors and testing strips for all diabetics.
Effective July 1, 1998.
Bone mass measurements. Covers procedures for members
with an estrogen deficiency and members who may be at risk for osteoporosis,
have vertebral abnormalities, receive long-term steroid therapy, have primary
hyperthyroidism, or require monitoring while taking a prescribed osteoporosis
drug. Effective July 1, 1998.
I am the Berkshire County chairperson of the Breast
Health Team of the American Cancer Society. We are trying to promote
mammography to all women in Berkshire County. Since age increases
a woman's risk, those in the over-65 age group are very much at risk.
It is a great step to now be able to screen this age group every year.
A good source for more information would be MassPRO
at 1-800-882-1228. I am hoping that you may be able to print the
correction--and perhaps some of the other information contained in the
enclosure. Please contact me if I can provide you with more information.
Wearing my more common hat, I can be reached at the Lee Visiting Nurse
Association weekdays, 413-243-1212.
Betty Chludzinski, RN, MS
Chairperson, Berkshire County Breast Health Team
Dr. Shouldice Discusses Eye Care
Dear Dr. Shouldice:
Question: What are the recommended screening and prevention procedures
for older adults?
Answer: Generally, older adults should have a medical eye examination
every two years. If you have visual symptoms such as blurred or decreased
vision, glare problems, or if there is a family history of cataracts, glaucoma,
macular degeneration, or diabetes, then the frequency of eye exams may
increase. Your ophthalmologist is able to determine this.
Question: What role does genetics play in eye diseases that affect
older adults?
Answer: Genetics does play some role in eye diseases. Glaucoma,
cataracts and macular degeneration may be inherited. Your ophthalmologist
may monitor you more frequently if you have a family history of one of
these conditions.
Question: What are some predetermining and risk factors in age-related
eye disease?
Answer: Two common age-related eye diseases are cataracts and macular
degeneration. Macular degeneration is generally thought to be due
to the natural aging process. Most researchers believe that age-related
cataracts are caused by a number of insults to which the human lens is
subjected for a number of years. Other than the aging process, ultra
violet light exposure, high blood pressure, cardiovascular disease and
smoking are also possible risk factors for these two conditions.
Question: What can older adults do to preserve their vision?
Answer: Older adults should try to maintain a diet rich in leafy green
vegetables. They contain natural antioxidants necessary for the health
of the eye. Most retinal specialists will suggest this over vitamin
supplements to protect organs against macular degeneration. Sunglasses
with ultraviolet protection may prevent harmful rays from causing cataracts.
Lastly, early detection of eye problems can lead to more effective treatment.
Periodic eye examinations by an ophthalmologist should be a regular
part of general health care to detect problems before they become serious.
This is especially critical if you are over 50 or your family has a history
of cataracts or retinal problems.
Dr. Gregory Shouldice is an ophthalmologist at the Berkshire Eye Center on Williams Street in Pittsfield.
The Calcium and Vitamin D Story
Calcium is the essential mineral for building and
maintaining strong bodies. It functions to help muscles to contract,
the heart to beat, and to regulate nerve function. No matter what
one's age, calcium is a very important dietary nutrient. However,
without vitamin D, calcium not only cannot be absorbed, but vitamin D deficiency
will accelerate bone loss and increase the risk of bone fracture.
The National Academy of Science Panel on Calcium
and Related Nutrients recently issued its outcome report of a three year
clinical trial that affirmed that as we get older we become more at risk
for bone loss and resultant bone fracture. In the report, increased
intake of both calcium and vitamin D by a group of men and women aged 65
and older resulted in significantly less bone loss and fewer fractures
compared to a similar group who took lower levels of these nutrients.
The NAS recommends that men and women 51 to 70 plus
years of age need 1200 mg of calcium daily and need a daily intake of 400
IU of vitamin D. Anyone over 70 years of age should aim for at least
600 IU of vitamin D daily.
The primary source of calcium is dairy products
such as milk, yogurt, and cheese. For those who need to cut down
on fat, reduced fat and fat free products are available and preferred.
Other sources of calcium include dark green leafy vegetables, sardines,
and salmon with bones, as well as calcium fortified fruit juices, soy milk
and Tofu.
Most foods have little or no vitamin D. The
major source of vitamin D is fortified milk and some fortified cereals.
Luckily the skin synthesizes vitamin D if exposed to the sun. As
we get older the skin's ability to make vitamin D in sunlight declines.
By the time one is 70 years of age the vitamin D synthesized is 30% less
than what it was at 25. Many seniors, especially those who are homebound,
do not get much sun exposure.
With careful planning it is possible to get calcium
and vitamin D from the food we eat, but reality is that most seniors who
cannot drink 3-4 glasses of milk daily along with other fortified foods
and/or don't get enough sun exposure cannot achieve the recommended intake
with foods alone, especially if they have dietary restrictions that preclude
using some foods. It is worthwhile considering enhancing a healthy
balanced diet with calcium and vitamin D supplements.
A word of caution: MORE IS NOT BETTER. Too
much calcium can cause kidney stones, high blood calcium, or impaired absorption
of iron, zinc or magnesium; excess vitamin D can cause calcium deposits
in kidneys and arteries.
Age Smart
By Harriet Vines, Ph.D.
I found the keys; now, where's the car? Sound
familiar? People forget things at all ages, but when you're eight
years old or 18 to 38, you don't worry -- it happens to everyone.
Why then at age 58, do you wonder if forgetting a word or name means you're
losing it, or, worse, the beginning of Alzheimer's?
Sometimes your mind feels a little unclear, out
of focus; for a moment, you're not sure exactly what you're doing or why.
Or you find, as Tom L., a recently retired teacher said, "It now takes
four of us to complete a sentence."
Does it have to be this way? Is there anything
to do to improve the situation, prevent it from getting worse? There
is.
The good news is: research shows much cognitive
loss in late mid-life, long blamed on aging, is caused in part by factors
over which you have control. Unless there is illness or injury, much
of the loss is caused by life style - poor nutrition, over-eating, smoking,
too much alcohol, and lack of regular physical and mental exercise, all
of which you control. The mind/body connection is well recognized
today.
You cannot reverse or stop the aging process - no
one can - but you can shape and control much. Instead of passively
letting the years pass, use the power and ability within you to prevent
many negatives associated with living longer. You don't have to "grow
old" - if you Age Smart by exercising the "muscles of the mind."
The brain's job is to mind the body; your job, keep
it strong. Just as there are exercises to strengthen the muscles
of the body, there are exercises to strengthen the muscles of the mind.
Two major muscles are attention and concentration. Strengthening
them will make a big difference.
First, loosen up so you work better, more smoothly, more naturally.
Relax your body, and the mind will follow; it's that connection.
Sit comfortably, breathe slowly, steadily, and mentally tell your body
to "relax." You will feel it happen. Next, take a mental inventory
of any tension points; tell them to relax, too. When relaxed, take
20 breaths, counting on the exhale from 1-10 and then from 10-1.
Now work on attention, probably the most important muscle of your mind.
This mental function provides our sense of continuity, coordinates memories
and gives us perspective. To do this, it has to wander, recall and
anticipate. Unfortunately, attention's tendency to roam also interferes
with concentration, another significant mental muscle. That's why
it is necessary to strengthen both.
You can work them in tandem with the following exercise. Write
these figures in a column:
56, 33, 29, 82, 44. Try to add them while repeating the days
of the week. See how difficult it is to focus on two fairly easy
tasks at once?
With exercise, you will strengthen your ability to
master attention and concentration.
A simple drill is to carefully note details of objects
within your view while you're waiting on line at the supermarket, bank
or bus stop. For example, closely examine the head of the person
in front of you, the packaging of items you're buying, bank decor, store
fronts, whatever you chance to notice. Try focusing for one minute
before you tune out. Work up to three minutes. Do this daily,
anywhere, as often as possible. It gets easier with practice.
Elder Services Honors Volunteers
On April 21st, at a dinner-dance at the Berkshire Crowne
Plaza, Elder Services of Berkshire County honored 300 volunteers who participate
in its programs to help Berkshire elders remain independent.
Rose Crittendon, of Otis, was presented with the
Reynolds Metal Meals-on-Wheels Volunteer Award which included a donation
of $1000.00 in her name to the Elder Services Meals-on-Wheels program.
Rose and a friend instituted a volunteer delivery route for elders in Otis
in 1994. Though her friend has since died, Rose has continued to
oversee the route which often involves hours on the phone to convince volunteers
to participate in delivering hot meals daily to frail elders in Otis.
Each year, Elder Services honors a different aspect
of measuring volunteer service. In 1997, volunteers were honored
for longevity. Three volunteers, Elizabeth and George Corio of Lanesboro
and Madeline Troumpe of North Adams were presented with corsages for twenty
years of service.
This year volunteers were honored, by program, for
the highest number of hours donated to the elders of Berkshire County.
Corsages and boutonnieres donated by Elm Street Florist were presented
by Catherine R. May, Executive Director to Richard Arpante, Pittsfield,
for Money management; Margaret Armstrong, Pittsfield, for help in the office;
Dick Mongeon, North Adams, Meals-on-Wheels packing; Sophie Carlo, Pittsfield,
for volunteering at the Elder Services of Berkshire County luncheon site
at the Froio Center; Rose Crittendon, Otis, Meals-on-Wheels; Margaret Walker
and Barbara Palma, both of Pittsfield, for Direct Services to elders such
as grocery shopping, companionship and transportation. Special commendations
were given to the volunteers from BAROCO and Berkshire County Association
for Retarded Citizens who demonstrate that everybody has the ability to
help others even if they themselves are disabled. Between them, the
volunteers from these agencies donated over 2300 hours to grocery shopping
for homebound elders in the past twelve months.
Ms. May said that volunteers for Elder Services
had given 53,139 hours of service to 3674 Berkshire elders in the past
twelve months! If it were not for the services provided by volunteers,
many of these elders would be living much more restricted lives.
Many more would be in institutions when, with just a little extra help
provided by a volunteer, they could be living in the community.