Visiting Our Aging Parents for the Holidays: Something You Didn’t Expect Courtesy of Forbes

.....but how do we spot the trouble signs when they first show up in our loved ones?

It’s sort of like noticing wear and tear on a car. When the first thing wears out, you start noticing lots of other things. “I never noticed so many of those rattles before”, you might say to yourself. Your consciousness of the problem is raised. You’re aware. You spot other signs because you’ve spent time thinking about the age of the car. It’s the same with our parents. We need to think about their vulnerabilities, the changes in their habits, the wear and tear of life. We need to raise our own consciousness.

What should we be looking for? We should be checking out our parents for things that are subtly or obviously different from what we’re used to seeing in them. Memory problems are the first and early warning signs. Did Mom forget a part of the meal, or lose track of cooking? Are there unopened bills on the kitchen table? Is the yard or house in disrepair? Did either parent forget that we were coming to visit?

All of these may be signs of early disease process, depression or other conditions that need our attention and our action. We must not fear insulting our parents by asking them about what we observe. It’s a loving act to bring it up in a respectful way. We can’t stand idly by pretending that nothing is changed. Families who do this may end up with parents who have been financially abused, due to dementia, or whose parents are seriously neglected. Parents may be less able to care properly for themselves lately and it’s up to us to protect them as best we can.

From AgingParents.com, here are Ten Warning Signs Your Parent Needs Help Handling Money. Look for them on your next visit:

1. You find late notices from a utility company, cable TV, or other monthly recurring bill in your parents’ home.
2. Your aging parent repeats himself or herself in speaking to you, telling you the same thing or asking the same thing over and over in a single conversation.
3. Your aging parent shows signs of unusual paranoia, suspicion, or mistrust of something or someone he/she has always trusted. (It could be you!)
4. You aging parent has a new “friend” who is hanging around a lot, and seems to pressure your parent into doing things he/she would not normally do, including writing checks.
5. Your parent is not well groomed as she has always been. You see dirty clothing, unkempt hair, or other clues that she has forgotten to take care of herself.
6. Your parent is suddenly very interested in contests, sweepstakes, and other “get rich quick” offerings and has been giving out personal information and his phone number to enter them.
7. There is a change in your parent’s giving habits for charitable organizations, which have resulted in large, unusual contributions, out of the norm for your parent.
8. Your parent is recently widowed, and has never handled the family finances before. She is avoiding the subject of money.
9. Your aging parent is socially isolated, due to losses, by geography or by choice. There is little activity outside the home and he seems lonely.
10. Your aging parent has always been proud, stubborn and secretive about money. Even though he’s having trouble keeping track of his bills, he strongly resists asking for your help.

Going home for the holidays can still be a fine experience. And, it may create a new responsibility for us boomers. Watching over Mom or Dad becomes another task we need to undertake. Setting aside time for a frank talk with aging parents about their finances, adding a day to our visit, and creating an opportunity to plan ahead can save untold heartache for our future.

From forbes.com

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Aging Network to Embark on New Level of Volunteerism

Collaboration of Aging Organizations to Create
“Engaging Volunteers in the Aging Network:
A National Resource Center”
www.n4a

Volunteers in the Aging Network* have been delivering for over 40 years. Delivering meals to homebound seniors, delivering rides to doctor’s appointments, delivering counseling to seniors on benefits, in addition to countless other vital roles. With the rapidly aging population, the demand for volunteers to deliver these services and others continues to grow. Based on this impending need, the U.S. Administration on Aging (AoA) recently awarded a grant of nearly $1 million to create a National Resource Center to further develop and support the work of volunteers providing services to older Americans and their family caregivers. The National Resource Center will deliver the assistance and expertise volunteers need to bring their efforts to a new level in the Aging Network.

“Volunteers have always been the backbone of the Aging Network. But we want to ensure that volunteers, especially older Americans, have the opportunities to use their lifetime of learning and skills to help address America’s challenges and to enrich their own lives,” said Assistant Secretary for Aging, Greenlee. “This Center will help us better understand the changing needs of volunteers.”

The AoA grant was awarded to a collaboration of aging organizations that are dedicated to serving older adults and the Aging Network. The collaboration, led by the National Association of Area Agencies on Aging (n4a), includes the National Association of States United for Aging and Disabilities (NASUAD), the AARP Foundation, Senior Service America, Inc. (SSAI), the Council for Certification in Volunteer Administration (CCVA) and the University of Michigan (for evaluation). AoA will work with these organizations to expand the capacity of the Aging Network to engage volunteers nationwide.

“This strong collaboration is uniquely positioned within the Aging Network and with older adults across the country to create the necessary leadership and infrastructure to develop effective and replicable civic engagement efforts for older adults, especially boomers,” said n4a CEO Sandy Markwood.

The three-year project will: conduct research on civic engagement; convene thought-leaders to help develop a plan of action on volunteerism for the Aging Network; develop communication and outreach tools to reach aging services leaders and volunteers across the country; create training programs and technical assistance resources for volunteers and volunteer coordinators; and identify and promote best practices.

“Volunteer engagement is a natural fit for the Aging Network, and the time is now to bring the leadership, skills and connections of the Aging Network fully into the civic engagement arena,” said Markwood. “Our collaboration must create a new vision of community service along with a persuasive call-to-action to attract the attention of Americans, letting them know their help is needed and there are many opportunities for them to get involved.”

"The Era Of Deficit Denial In Washington Is Over"

Social Security Cuts Are Part Of Deficit Plan
By ANDREW TAYLOR, Associated Press Andrew Taylor, Associated Press

WASHINGTON – Divisions remain within President Barack Obama's deficit commission on politically explosive budget cuts and slashes in Social Security benefits, even as the panel's co-chairmen go public with a revised plan to tame the runaway national debt.

The new plan by co-chairmen Erskine Bowles and Alan Simpson, to be unveiled Wednesday, faces an uphill slog. Resistance is certain, not only because of the idea of raising the Social Security retirement age, but also because of proposed cuts to Medicare, curtailment of tax breaks and a doubling of the federal tax on a gallon of gasoline.

Though the plan appears unlikely to win enough bipartisan support from the panel to be approved for a vote in Congress this year or next, Bowles has already declared victory, saying he and Simpson have at least succeeded in initiating an "adult conversation" in the country about the pain it will take to cut the deficit.

The plan faces opposition from many commission members. House Republicans appear uniformly against tax increases, while liberal Democrats like Jan Schakowsky of Illinois appear unlikely to be able to accept big cuts in federal programs for seniors.

Obama named the commission in hopes of bringing a deficit-fighting plan up for a vote in Congress this year, but it appears to be falling well short of the 14-vote bipartisan super-majority needed.

A new version of the plan, obtained by The Associated Press on Tuesday, makes mostly minor changes to a draft that whipped up enormous controversy when unveiled earlier this month. Some domestic spending cuts are modestly higher than previously proposed, and health care savings from overhauling the medical malpractice system would reap less than proposed earlier this month.

Unlike their original proposal, Bowles and Simpson stop short of calling for caps on medical malpractice awards. Instead they recommend changes in how awards are made.

But other proposals remain the same. Among them are a gradual increase in the Social Security retirement age to 68 by 2050 and 69 by 2075, using a less generous cost-of-living adjustment for the programs and increasing the cap on income subject to Social Security taxes.

The plan also retains a 15-cent-a-gallon increase on gasoline, a three-year freeze on federal worker pay and the elimination of 200,000 workers from the federal payroll through attrition.

The proposal obtained by the AP was a draft that was still undergoing changes Tuesday evening.

Other recommendations:

• Eliminate congressional pet spending projects known as "earmarks."
• Reduce the corporate income tax rate to 28 percent from 35 percent and stop taxing the overseas profits of U.S.-based multinational corporations.
• Overhaul individual income taxes and corporate taxes, giving Congress the choice of reducing the top rate to as low as 23 percent and no higher than 29 percent. The lower the rate, the fewer the tax credits and deductions that would be available to taxpayers.

Under one scenario proposed by Bowles and Simpson, taxpayers would face three tax brackets of 12 percent, 21 percent and 28 percent. Taxpayers would still be able to claim an earned income tax credit and child tax credit as well as all standard deductions and exemptions. Capital gains and dividends would be taxed at ordinary income tax rates. Taxpayers could claim a mortgage interest deduction up to $500,000, but only on their primary residence.

If Congress does not undertake a comprehensive overhaul of the tax system by 2013, the plan calls for a "fail-safe" provision that would trigger across-the-board reductions in tax breaks, designed to raise revenue by $80 billion in 2015 and $180 billion in 2020.

Bowles was White House chief of staff when former President Bill Clinton negotiated a balanced budget plan in 1997; Simpson is a former GOP senator from Wyoming.

Only Bowles and Simpson are guaranteed to support the plan when the panel votes. None of the 12 House members and senators named by Obama have committed to the proposals, though Bowles and Simpson could pick up support from non-elected deficit hawks like Democrat Alice Rivlin and Honeywell International's chief executive, David Cote, a Republican, who won't have to defend themselves to voters. Republican senators seem more likely to vote for the plan than their rigidly anti-tax increase House counterparts.

"I don't know if we're going to get two votes or five votes or 10 votes or 14 votes," Bowles told reporters. "There are enough reasons to vote 'no' in this plan for anybody to vote 'no.'"

A super-majority of 14 of the 18 panel members would have to approve recommendations for a possible vote in the lame-duck session of Congress. That seems out of reach, but Bowles says it's just as important to have jump-started a national debate on what it'll really take to bring the deficit under control.

"Our goal in this whole process has been really simple," Bowles said. "It's basically been to start an adult conversation here in Washington about the dangers of this debt and the deficits we are running."

He added, "The era of deficit denial in Washington is over."

Virtual Dementia Tour

Second Wind Dreams Virtual Dementia Tour

When a loved one is diagnosed with Dementia, it affects everyone in the family, friends and the community. The Alzheimer’s Association states that Alzheimer’s is being diagnosed every 72 seconds in the U.S. alone, and 7 out of 10 Alzheimer’s patients live at home where family and friends provide 75 percent of the care. Yet studies show that these caregivers are not formally trained to provide the support needed for those living with dementia. The purpose of the Virtual Dementia Tour™-I for Individuals (VDT-I) is to help families better identify with their loved one’s day-to-day struggles, thereby improving their ability to provide care.

This six minute film tracks the life of a man, who at age 80 is living with Alzheimer's; and a son who is trying to understand what it is like to live with the disease. Virtual Tour allows you to see and feel what it is like to live with dementia.

Choices about Life-Sustaining Medical Treatments

Jena Bauman Adams, MPH MOLST Project Director Hearing that you or a loved one may be nearing the end of life because of a serious illness or injury is very difficult. It often takes time to adjust to the situation and to consider what it may mean. In addition, medical information – especially about one’s health status, what can happen next and the potential benefits and risks of treatment – can be confusing or overwhelming.

All adults have a legal and ethical right to make choices about medical treatments they want or do not want to receive when they are nearing the end of life. However, patients’ wishes are often unspoken, unknown, or unavailable to health providers at the time treatment decisions are made. That is why it is so important for individuals to have conversations with their loved ones and doctors about all of these matters – not only when they are very sick, but also before an unexpected illness or injury may occur.

In Massachusetts, all adults ages 18 and older are encouraged to fill out a health care proxy form to appoint a person they trust as their “health care agent.” In Massachusetts, if an individual is not capable of making medical decisions as determined by their clinician (e.g. because they are unconscious or due to dementia or other mental limitations), it is their “health care agent” officially named in a health care proxy who is authorized to make medical decisions on their behalf. It cannot be assumed that a family member or next of kin will be authorized to make medical decisions in every situation or setting.

Therefore, appointing a health care agent is the first essential step in advance care planning for every adult after they have turned 18 years old, even if they are perfectly healthy. The next step is to have conversations with your health care agent about your values and goals for medical care, so he or she can make the medical decisions you would have wanted should the need occur.

For individuals with serious advancing illnesses, especially those who may be nearing the end of life, physician-patient conversations about life-sustaining treatment preferences are of particular importance. Such conversations are often difficult for everyone involved; however, they serve to help patients, their loved ones and health care providers better understand the patient’s medical condition, treatment options and goals for care. In fact, these discussions have proven to improve quality of life scores for patients near the end of life and bereavement outcomes for their caregivers. (1)

To assist seriously ill or injured individuals communicate their wishes about end-of-life medical treatments, a new process is being tested in several Worcester-area health care institutions. Called Medical Orders for Life-Sustaining Treatment, the process entails conversation between a patient and the patient’s loved ones and doctor to explore and establish the patient’s treatment goals and preferences. One possible outcome of these discussions is completing and signing a “MOLST” form. A MOLST form is filled out and signed by a patient and doctor together to communicate the patient’s treatment wishes. MOLST instructions are honored by all health professionals across health care settings (e.g. at home, by emergency responders, in nursing homes, at hospitals).

The MOLST process involves:

1. Discussing your medical condition, treatment options, and your values, hopes, expectations and goals for care with your doctors and loved ones
2. Learning about the types of medical treatments you might be given if your heart or breathing stop – including the benefits or risks of such treatments and how effective they might be
3. Identifying any preferences you may have about receiving or not receiving certain types of life-sustaining treatments
4. Deciding whether or not to document your preferences by completing a MOLST form with your doctor
5. Completing the MOLST form with your doctor and signing it to confirm that the form reflects the treatment preferences you expressed to the doctor (the doctor also signs the form)
6. Keeping the MOLST form with you in a location where it can be easily seen or found by your loved ones and health professionals
7. Telling your loved ones, health care agent and caregivers about your MOLST instructions and the location of your MOLST form

Completing a MOLST form is voluntary and individuals may decide to wait until another time to consider MOLST, or not to complete a MOLST form at all. Individuals can also change their minds about treatments any time, even after signing the MOLST form.

For more information about Medical Orders for Life-Sustaining Treatment, you may ask your doctor, visit: www.molst-ma.org, or call the MOLST program at 508-856-5890.
--------------------------
(1) Wright, A.A., et al., Associations between end of life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 2008. 300(14): p. 1665-73.

Congressman McGovern Holds Press Conference in Worcester

FOR IMMEDIATE RELEASE:
Seniors, Advocates criticize Marty Lamb’s ‘radical’ stance on Medicare, Social Security

Local seniors and senior advocates criticized Marty Lamb today for his “radical and dangerous” stances on Medicare and Social Security.

Citing experts, the McGovern Campaign said that Mr. Lamb’s “10th Amendment Pledge” would undermine the very basis of those vital programs.

“Despite his disingenuous claims of sticking up for seniors, Mr. Lamb is actively working to destroy the constitutional underpinnings of the programs most important to them,” said McGovern spokesman Scott Zoback.

In a statement, University of Chicago Constitutional Law Professor and former Supreme Court Clerk Geoff Stone said that Lamb’s pledge would “threaten the very premise of constitutional government.”

“If American constitutional law had embraced the position now asserted in the Tenth Amendment Pledge, the federal government could not charter federal banks, it could not enact laws prohibiting racial and religious discrimination, it could not establish minimum national standards for protecting the public health and safety,” wrote Stone.

Similarly, Ian Millhiser, a legal research analyst with the Center for American Progress Action Fund wrote in American Prospect last year that “tenthers” read the constitution “too narrowly...to permit much of the progress of the last century.”

Bob Dwyer, Executive Director of the Central Massachusetts Agency on Aging, said that seniors’ “quality of life would be irreparably damaged,” by Lamb’s pledge.

At the press conference at the Worcester Senior Center, McGovern pledged to fight for Social Security and Medicare.  “I have always stood up for seniors, and I pledge to you today that I will continue to do so.”

Governor Signs FMAP Bill With $7.1 M in Home Care Funding

Patrick Signs Budget Bill,
Sticks To Revenue Estimate
By Michael Norton/Statehouse News Service
http://www.statehousenews.com
GateHouse News Service

Gov. Deval Patrick on Friday signed a $420 million spending bill that adds to the three-month-old $27.6 billion state budget and his administration opted to stick with its estimate of tax collections for the fiscal year, which are running $200 million ahead of budget benchmarks.

Services for the disabled, the state's massive MassHealth budget and the State Police and prison system received funding infusions under the $420 million budget bill that Patrick signed without fanfare, shortly before attending a governor's race candidate forum at Emerson College.

The bill, paid for through federal stimulus funds that won’t be available next fiscal year, deploys accounting methods aimed at putting nearly $200 million into a state rainy day fund that lawmakers and Patrick have drained more than $1.5 billion from during the recession.

Patrick returned with an amendment a section of the bill requiring insurers to reimburse ambulance companies directly for services, regardless of whether the companies are members of contracted networks.

"I am concerned about the impact of this section on health care costs because it lacks guidelines government reasonable charges for ambulance services," Patrick said in a letter to lawmakers.

The amendment would set limits on the costs non-network ambulance companies may charge insurers.

House and Senate leaders steered the bill through the Legislature during informal sessions, overcoming concerns about the bill voiced by Republicans, who ultimately agreed to allow the bill to pass.

A year ago today and only three months into fiscal 2010, Patrick lowered the state’s tax revenue estimate by $600 million, calling for emergency spending cuts over the final eight months of the fiscal year that he said could result in the elimination of 2,000 state jobs, unilateral budget cuts, consolidation of state agencies, collaboration on energy purchases, and broader reductions across government.

This year, with tax collections running $200 million above fiscal 2011 budget benchmarks, the Patrick administration is sticking to its tax collection estimate, officials confirmed Friday.

Administration officials are trying to manage heavy, caseload-driven exposures in this year’s budget, especially in health care.

"Estimated revenues continue to be sufficient to meet budgeted expenditures," Administration and Finance Secretary Jay Gonzalez said in a statement.

State finance law calls for the administration by Oct. 15 of each year to signal to legislative leaders any revisions in anticipated revenues for the year, unless there’s no significant change in estimates.

Fiscal 2009 was marked by a string of supplemental budgets that both added government spending and made changes aimed at bringing outlays in line with available revenues. Additional supplemental spending bills are likely this year.

Fiscal analysts and candidates for governor have estimated next year’s state budget gap at between $2 billion and $3 billion, although Senate President Therese Murray, during a debate this week, pegged it at $1.5 billion. Extra federal funds that were critical to efforts to plug huge budget holes this fiscal year and during fiscal 2010 are not expected to be available next fiscal year.

CMS: Medicare Advantage Enrollment To Jump Next Year, Premiums To Fall

CMS: Medicare Advantage Enrollment To Jump Next Year,
Premiums To Fall (The Hills Health Care Blog By Mike Lillis) Enrollment in the controversial Medicare Advantage (MA) program will increase by 5 percent in 2011, while average premiums will drop by 1 percent, the Obama administration announced Tuesday. White House health officials said the numbers indicate that — despite threats from conservatives and the insurance industry that the new healthcare reform law will cripple MA plans at the expense of seniors — both patients and taxpayers will benefit from the reforms. "Despite the claims of some, Medicare Advantage remains strong and a robust option for millions of seniors who choose to enroll or stay in a participating plan today and in the future," Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), said in a statement. “The Affordable Care Act gave us new authority to negotiate with health plans in a competitive marketplace. As a result, our beneficiaries will save money and maintain their benefits." The MA program — under which the government pays private insurance companies to cover Medicare patients — has been a lightening rod of controversy since its creation in 2003. Seniors have flocked to MA plans because many of them cover services, like dental and eye care, that Medicare doesn't. But the extra care hasn't come cheap. Despite promises that private plans operating under MA could eventually save money, the cost to treat the average MA patient is roughly 14 percent higher than the cost to treat the average senior under traditional Medicare. The Medicare Payment Advisory Commission, an independent panel that suggests reforms to Congress, has noted that part of the additional cost “consists of funds used for plan administration and profits and not direct health care services for beneficiaries.” Such statements have fueled criticisms from patient advocates and consumer groups that MA is just a giveaway to insurance companies. Many Democrats tend to agree, and the new reform law cuts MA subsidies substantially over the next decade. As part of that effort, Medicare will freeze payments to MA plans next year, before actual cuts take effect further down the line. The freeze has done little to discourage plan participation, CMS said Tuesday, largely crediting the insurance companies themselves. "The plans are making very strong commitment to their programs," Jonathan Blum, director of CMS’s Center for Medicare, told reporters in a phone call. "We're seeing better value for beneficiaries and for taxpayers." Among the other revelations Tuesday:

• About 5 percent of MA enrollees will have to choose new plans in 2011, largely resulting from MA reforms enacted in 2008. Of those seniors, all but 2,300 will have the option of choosing another MA plan;
• 99.7 percent of Medicare beneficiaries will have access to an MA plan in 2011;
• Of the roughly 2,100 MA plans submitting 2011 bids, CMS identified 300 that had proposed to hike premiums or other cost sharing on seniors, while also increasing their profit margins. After CMS threatened to deny those plans, all but seven plans reworked their bids to the benefit of seniors. To Read Original Article, CLICK HERE!

Study on Risk Factors for Indoor and Outdoor Falls May Help Tailor Fall-Prevention Strategies

Hannan and her colleagues found that:

• Risk factors for indoor falls included being female, older age, inactive lifestyle, disability, having lower cognitive function, taking more medications, and overall poorer health.
• Risk factors for outdoor falls included being male, being younger and more physically active, having more education, and having average or better-than-average health.
• Among all the falls that were recorded, 9.5% resulted in serious injury, including 10.2% of indoor falls and 9% of outdoor falls.
• The majority of outdoor falls occurred on hard concrete surfaces, including sidewalks, streets, curbs, outdoors stairs, and parking lots. Fourteen percent of outdoor falls occurred in yards or gardens.

The study participants included 765 men and women, ranging in age from 64 to 97; 36% were male and 64% were female. 

The findings could have implications in how patients are identified for being at risk for falling. Current fall prevention programs overlook risk factors associated with outdoor falling, the researchers note. They should be updated to consider a person's activity level as well as other characteristics. 

"Most fall prevention programs emphasize the prevention of indoor falls, particularly through strength, balance, and gait training; use of assistive devices; treatment of medical conditions; reduction in the use of certain medications; improvement in vision; and the elimination of home hazards," Hannan and her colleagues write. "More attention needs to be paid to the elimination of outdoor environmental hazards involving sidewalks, curbs and streets, such as repairing uneven surfaces, removing debris, installing ramps at intersections, and painting curbs."

The entire article, courtesy of WebMD, can be read at WebMD.

Check our Calendar of Events Page for a list of Medicare Update Meetings with trained SHINE Counselors.

Straight Talk: Frequently Asked Questions

National Council on Aging (NCOA) Straight Talk

• Will the new law cut my Medicare benefits?
  • The new law will not cut basic Medicare—and, in fact, it will give you more benefits. For example, everyone who has Medicare will receive a free annual wellness visit starting in 2011. And Medicare's screening and preventive services will be completely free next year. People with Medicare's drug coverage who fall into the coverage gap, known as the "donut hole," will receive a check for $250 this year to help with their drug costs, plus they'll see significant discounts to their drug costs starting next year. [Section 3301]
• Will the new law cut Medicare spending?
  • Medicare spending is growing rapidly and will continue to grow. But over the next 10 years, the new law will slow the rate of growth—from 6.8% per year to 5.5%. These figures come from the independent, non-partisan Congressional Budget Office (CBO), which is the group responsible to Congress for health reform cost estimates. Average yearly spending increases per person will be reduced from about 4% to 2%, adjusted for inflation.
• How will the new law affect Medicare solvency?
  • CBO projects that the new law will save Medicare about $400 billion over 10 years and extend the solvency of the Medicare Trust Fund for an additional nine years—from 2017 to 2026.
• How will the new law affect the federal budget deficit?
  • Under the new law, Medicare spending increases will slow down and new revenues will be raised, primarily from taxes paid by people with incomes over $200,000. Together, the savings and dollars coming in are expected to be greater than the money going out to pay for new benefits. Therefore, the CBO has estimated that the new law will reduce the budget deficit by $124 billion over 10 years.
• Will the new law make it easier to receive and pay for long-term care at home?
  • Yes, the law provides new incentives for states to make it easier for lower income people who are on Medicaid to get long-term care at home instead of in a nursing home by providing extra federal funds to provide in-home services. Also, the law creates the CLASS Act (Community Living Assistance Services and Supports), which allows full and part-time workers with incomes of at least $1,200 per year to enroll in a program that provides a cash benefit averaging $75 per day to help them stay at home when they become unable to care for themselves. Workers can choose to participate and have premiums deducted from their paychecks. [Section 8002]

Will the new law improve care for older adults in other ways?

• Starting in 2010, companies can get tax incentives if they continue to offer early retirees health insurance, thus lowering the cost of premiums for these individuals.
• Starting in 2011, Medicare will pay bonuses of 10% to primary care doctors (general practitioners), which will improve access to these doctors. [Section 5501]
• There will be improvements in some nursing home quality standards. [Sections 6101-6114]
• There will be improved training for workers who care for seniors. [Sections 5302 and 5305]
• There will be new protections against elder abuse, neglect, and financial exploitation. [Section 6703]

How does the new law improve the quality of care for Medicare beneficiaries with chronic illnesses, such as diabetes and high blood pressure?

• The law includes new pilot projects that will lead to better quality, communication, and coordination among doctors, specialists, and other providers for people with chronic health conditions. If you must be hospitalized, the law will help you return home successfully—and avoid going back into the hospital—by providing incentives for hospitals to make sure that you get the services you need in your community and by teaching you to take good care of yourself. [Sections 3021, 3024, 3502]

How will the new law improve health insurance coverage for younger Americans who don't have Medicare?

• According to the CBO, the new law will provide health insurance to 32 million citizens who previously did not have it, starting in 2014. New consumer protections will also be provided to prevent discrimination and ensure that insurance companies cannot drop coverage for people who become ill.

How does the new law improve preventive care for Medicare beneficiaries?

• A new, free, yearly wellness checkup will allow you and your doctor to develop a prevention plan to keep you healthy. And a range of prevention services, such as cancer and diabetes screenings, will be provided free – no more cost sharing. Additional funding will be provided for a range of prevention services for Americans of all ages. [Sections 4103 and 4104]

Will Medicare Advantage plans cut benefits and increase premiums?

• We don't know. This year, private insurance companies running Medicare Advantage (MA) plans are paid about $1,100 more per person than what is paid for people in original Medicare. As a result of health reform, starting in 2012 payment rates to MA plans will be gradually reduced in many parts of the country, so that they are about the same as rates under original Medicare. It is unclear how MA plans will respond to these changes. They may choose to increase premiums, reduce extra benefits, or even leave the Medicare program. However, they are not allowed to cut any benefits provided under original Medicare. If you are in a MA plan, it makes sense to review your options during the fall annual enrollment period, just like everyone with Medicare should do each year, to see which way of getting Medicare best meets your needs.

How does the new law impact Federal Employee Health Benefits?

• According to the Office of Personnel Management, it has been preparing to implement health reform since the day it was signed into law. Federal employees, retirees, and their families will be impacted in the same way that all other individuals are impacted, with one exception. The provision that requires adult children up to age 26 to be eligible for health insurance coverage under their parents' plan will not go into effect until Jan. 1, 2011 for FEHB plans.

How does the new law impact military health benefits, like TRICARE for Life and VA benefits?

• The new law does not impact military health benefits.

Diabetes

Over 9 million women in the U.S. have diabetes.
And 3 million of them don't even know it!
by The Food and Drug Administration
Did you know ...?

• Women with diabetes are more likely to have a heart attack and have it at a younger age.
• Some women get diabetes when they are pregnant.
• Women who have diabetes are more likely to have a miscarriage or a baby with birth defects.
• Women with diabetes, according to recent studies are more likely to be poor, which makes it harder to manage the disease.
• Most people with diabetes die from heart attack or stroke.

What is diabetes?

• It is a disease that changes the way your body uses food. The food you eat turns to sugar. The sugar then travels through the blood to all parts of the body. Normally, insulin helps get sugar from the blood to the body's cells, where it is used for energy.
• When you have diabetes, your body has trouble making and/or using insulin. So your body does not get the fuel it needs. And your blood sugar stays too high.

What are the types of diabetes?

• Type 1 --The body does not make any insulin. People with type1 must take insulin every day to stay alive.
• Type 2 --The body does not make enough insulin, or use insulin well. Most people with diabetes have type 2.

Are you at risk for diabetes?

• Do you need to lose weight?
• Do you get little or no exercise?
• Do you have high blood pressure (130/80 or higher)?
• Do you have a brother or sister with diabetes?
• Do you have a parent with diabetes?
• Are you a woman who had it when you were pregnant. OR have you had a baby who weighed more than 9 pounds at birth?
• Are you African American, Native American, Hispanic, or Asian American/Pacific Islander?

If you answered yes to any of these questions, ask your doctor, nurse, or pharmacist if you need a diabetes test.

What are the warning signs?

• Going to the bathroom a lot
• Feeling hungry or thirsty all the time
• Blurred vision
• Losing weight without trying
• Cuts or bruises that are slow to heal
• Feeling tired all the time
• Tingling or numbness in the hands or feet

Most people with diabetes do not notice any signs
What can I do if I have diabetes?
Watch What You Eat and Get Exercise

• There is no one diet for people with diabetes. Work with your health care team to come up with a plan for you.
• You can eat the foods you love by watching serving sizes. The "Nutrition Facts" label on foods can help. Many packaged foods contain more than 1 serving.
• Carbohydrates raise your blood sugar the most. Cut back on these. For example bread, cereal, rice, and pasta.
• Be active at least 30 minutes a day most days of the week. Exercise helps your body's insulin work better. It also lowers your blood sugar, blood pressure, and cholesterol.

Use Medicines Wisely

• Sometimes people with diabetes need to take pills or insulin shots. Be sure to follow the directions.
• Ask your doctor, nurse, or pharmacist what your medicines do. Also ask when to take them and if they have any side effects.

Check Your Blood Sugar and Know Your ABCs

• Help prevent heart disease and stroke by keeping your blood sugar, blood pressure, and cholesterol under control.
• Check your blood sugar using a meter (home testing kit). This tells what your blood sugar is so you can make wise choices.
• Ask your doctor for an A-1-C ("A-one-see") blood test. It measures blood sugar levels over 2 to 3 months.
• Talk to your health care team about your ABC's:
  • A-1-C
  • Blood pressure
  • Cholesterol

To learn more: Contact the American Diabetes Association 1-800-342-2383 (1-800-Diabetes)

Becoming Over Heated

Tips for Preventing Heat-related Illness

Prevention is critical to protecting your health. Here are tips to safeguard your health during the hot weather:

• Drink more fluids. It’s very important to keep hydrated. Don’t wait until you’re thirsty to drink. Warning: If your physician limits the amount of fluid you drink or has you on water pills, check with him on how much you should drink while the weather is hot.
  
• Don’t drink liquids that contain alcohol or large amounts of sugar. These types of liquids make you lose more body fluid.
  
• Stay indoors and, if possible, stay in an air-conditioned room. If your home does not have air conditioning, visit a shopping mall or public library. You can also contact your local health department to find out if there are any heat-relief shelters in your area.
  
• Electric fans may offer some comfort. However, when the temperature reaches the high 90s, fans will not prevent heat-related illness. Taking a cool shower or bath, or spending time in an air-conditioned place is a much better way to cool off.
  
• Wear clothing that is lightweight, light-colored, and loose-fitting.
  
• NEVER leave anyone in a closed, parked vehicle, including pets.
  
• Some people are at greater risk for heat related illness. Check regularly on:
  
  • Infants and young children
    
  • People aged 65 or older
    
  • People who have a mental illness
    
  • Those who are physically ill, especially people with heart disease or high blood pressure
    
• Visit adults at risk twice a day or more. Watch them for signs of heat exhaustion or heat stroke. Infants and young children will need more frequent watching.

What You Can Do to Help Protect Elderly Relatives and Neighbors

If you have elderly relatives or neighbors, you can help them protect themselves from heat-related stress:

• Visit older adults at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke
  
• Encourage them to increase their fluid intake by drinking cool, nonalcoholic beverages regardless of their activity level
  
  

Warning: If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot.

• Take them to air-conditioned locations if they have transportation problems.

Courtesy of CDC and AOA

Closing the Prescription Drug Coverage Gap

You Could Be Eligible For A $250 Rebate This Year to Help with your Medicare Drug Costs
www.aoa.gov

The Affordable Care Act passed by Congress and signed by President Obama this year contains some important benefits for Medicare recipients.

If you have Medicare prescription drug coverage, and aren’t already getting Medicare Extra Help, Medicare will automatically send you a one-time $250 rebate check after you reach the coverage gap (also called the “donut hole”) in 2010. This rebate is the first step toward closing the Medicare prescription drug coverage gap.

What is the coverage gap and how will I know if I’ve reached it?

Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit).

The Explanation of Benefits notice, which your drug plan mails to you each month when you fill a prescription, will tell you how much you’ve spent on covered drugs and whether you’ve entered the coverage gap.

Will I need to do anything to get this rebate check?

No. There are no forms to fill out. Medicare will automatically send a check that’s made out to you. You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check. Don’t give your personal information to anyone who calls you about the $250 rebate check. Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

When will I get the rebate check?

If you reach the coverage gap this year and enter the Part D “donut hole”, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help. These checks will begin to get mailed to beneficiaries starting in mid-June.

Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap. However, this is a one-time benefit and beneficiaries who qualify will only receive one check after they reach the coverage gap.

What if I don’t get the rebate check when I should?

Beneficiaries who hit the donut hole after the program has begun should expect to receive their check within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should call your Medicare drug plan to make sure all of your information has been sent to Medicare.

If you don’t get your rebate check, contact Medicare. Individuals receiving Medicare Extra Help will not receive a rebate check.
You can also check to make sure Social Security has your correct home address. Call 1-800-772-1213 or your local Social Security office. TTY users should call 1-800-325-0778.

What’s Next ….Coming in 2011

If you reach the coverage gap in 2011, you may get a 50% discount on your brand name prescription drugs at the time you buy them. Stay tuned for more information from Medicare.

Help us spread the word about this important benefit

And help stop scams against seniors

Remember- there are no forms to fill out to receive this benefit once you qualify for it. Medicare will automatically send a check that’s made out to you.

You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check. Don’t give your personal information to anyone who calls you about the $250 rebate check. Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

Go to stopmedicarefraud.gov to learn more about how Medicare is working with law enforcement to stop scams against seniors.

Have other questions about the $250 rebate check or the Affordable Care Act and Medicare?

Please refer to the brochure Medicare and the New Health Care Law--What it Means for You that Medicare has sent you. You can also visit www.medicare.gov, or call 1-800-MEDICARE.

HHS Launches New Consumer Focused Health Care Website, www.HealthCare.gov

A Powerful New Information Tool That Will Give Consumers More Control Over Their Own Health Care and Allow Them to Compare Their Coverage Option

The U.S. Department of Health and Human Services today unveiled an innovative new on-line tool that will help consumers take control of their health care by connecting them to new information and resources that will help them access quality, affordable health care coverage. Called for by the Affordable Care Act, www.HealthCare.gov is the first website to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool.

"HealthCare.gov helps consumers take control of their health care and make the choices that are right for them, by putting the power of information at their fingertips,” said HHS Secretary Kathleen Sebelius. “For too long, the insurance market has been confusing and hard to navigate. "HealthCare.gov makes it easy for consumers and small businesses to compare health insurance plans in both the public and the private sector and find other important health care information.”

"HealthCare.gov is the first central database of health coverage options, combining information about public programs, from Medicare to the new Pre-Existing Conditions Insurance Plan, with information from more than 1,000 private insurance plans. Consumers can receive information about options specific to their life situation and local community.

In addition, the website will be a one-stop-shop for information about the implementation of the Affordable Care Act as well as other health care resources. The website will connect consumers to quality rankings for local health care providers as well as preventive services.

“This website is unlike any government website you have ever seen or used before,” said HHS Chief Technology Officer Todd Park. “It was developed with significant consumer input and is remarkably easy to navigate. This is despite the sheer volume of content it offers consumers: billions of health care choices through the insurance finder and more than 500 pages of new content, all of which is designed to grow with ongoing consumer feedback and as our health care system improves.”

As the health care market transforms, so will "HealthCare.gov. In October, 2010, price estimates for health insurance plans will be available online. In the weeks and months ahead, new information on preventing disease and illness and improving the quality of health care for all Americans will also be posted. The website also includes a series of opportunities where users can indicate whether pages were helpful to them and we will continue to seek user feedback to grow and strengthen the site.

“People need to see what choices are offered, what options cost, and how coverage works in practice,” said Karen Pollitz, Deputy Director for Consumer Support, Office of Consumer Information and Insurance Oversight. “Today "HealthCare.gov takes an important first step in that direction. In the coming months and years, we will add pricing and plan performance information so that consumers can see and understand and make meaningful choices about their health coverage.”

Fatality Crash Rate Falls for Older Drivers

Tanya Mohn, The New York Times

The rate of older drivers involved in fatal road crashes plunged during the last decade, according to a report released on Tuesday by the Insurance Institute for Highway Safety.

The fatal crash rate of licensed drivers 70 and older fell 37 percent from 1997-2008. The most striking decline occurred among drivers 80 and older, whose involvement in fatal crashes fell by almost half during the same time period.

Older drivers were also less likely to have a severe crash, and there was a greater likelihood that they would survive when they did crash, the report said.

"We expected to see the opposite," said Anne McCartt, senior vice president for research at the institute and co-author of the report. She said the road safety community anticipated an increase in deaths and serious injuries because of the growing population of older people, who are driving more and holding on to their licenses longer.

The reasons for the steady decline were unclear, Dr. McCartt said. The poor economy was thought to have a minor role. Significant factors included the fact that older drivers were doing a better job restricting their driving, they might be healthier and in better shape, allowing them to reduce their risk of crashing in the first place and a greater chance that they would survive when they did crash. Safer vehicles and better emergency medical services and trauma care were also thought to have contributed to the decline.

She said the institute had done a separate study, released earlier this year, that reinforced the idea that older drivers tended to do a good job restricting their driving when they had impairments. The study focused on an innovative program in Iowa, which showed how the state used a variety of ways to identify drivers at risk. Many of the drivers identified by the state had already been limiting their driving late at night or on high-speed roads, Dr. McCartt said. Drivers did tend to be more compliant after state involvement, however, she said.

"Part of the message of our study is older drivers are doing better without very strong restrictions," she said. "They are staying safer."

Bella Dinh-Zarr, the North American director of Make Roads Safe, a global initiative, said the study was important because it highlighted a common misconception that older drivers are a danger to others.

"They are probably the safest and wisest drivers on the road," she said, with a lifetime of driving experience, who tend to hurt themselves more than others when they are in a crash.
She said older drivers today are more aware and have greater access to refresher courses and tools to counteract the natural decline in vision, cognitive and physical abilities as people age. In addition, she said, improvements to road infrastructure - better lighting, striping and crash barriers - have also helped.

"Maybe now we are starting to see some of the rewards," Dr. Dinh-Zarr said. "It brings a lot of hope."

Employer Support for Care Giving Employees

From The National Care Planning Council

“There are only four kinds of people in this world. Those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.” Rosalynn Carter, Former First Lady

The U.S. Department of Labor estimates that in the year 2010, 54% of workforce employees will provide eldercare for a parent or parents and that nearly two-thirds of caregivers will experience conflict between demands at home and demands from employers.

Today’s employed Baby Boomers are the caregiver generation for their parents. They are finding themselves juggling care responsibilities around their employment obligations. Sometimes employees find they have no option but to take leave from work or use sick time to meet their caregiving demands.

Employers also feel the toll it is taking on their employees. A report by the AARP describes the cost to employers:

“Companies are also seeing the emotional and physical toll that caregiving takes on their workers. In one study, 75% of employees caring for adults reported negative health consequences, including depression, stress, panic attacks, headaches, loss of energy and sleep, weight loss, and physical pain. Businesses suffer, too, by having to pay high health insurance costs and in lost productivity. That doesn’t count the promotions or assignments workers turn down that require travel or relocation away from aging relatives."

Businesses that don’t offer benefits or address eldercare wind up paying for them. A recent study by the MetLife Market Mature Institute and the National Alliance for Caregiving states that U.S. companies pay between $17.1 billion and $33.6 billion annually, depending on the level of caregiving involved, on lost productivity. That equals $2,110 for every full-time worker who cares for an adult.

Eldercare cost businesses:

• $6.6 billion to replace employees (9% left work either to take early retirement or quit)
  
• Nearly $7 billion in workday interruptions (coming in late, leaving early, taking time off during the day, or spending work time on eldercare matters)
  
• $4.3 billion in absenteeism" AARP

Typically, human resource departments work with employees on many issues that may affect their work productivity. There are programs for drug and alcohol abuse, domestic violence, illness, absenteeism and child care; but, help with eldercare issues is not normally provided.

The AARP report follows several companies who are providing help with eldercare issues and what they are doing for their employees.

• “Freddie Mac has a free eldercare consultant and access to subsidized aides for a relative up to 20 days.
  
• Verizon Wireless offers seminars on eldercare issues and allows full-time workers 80 hours a year in back-up care, 40 hours for part-time, and $4/hour for in-home help.
  
• At the Atlanta law firm Alston & Bird LLP, workers can donate vacation time to colleagues who have used up theirs to care for family members. “ AARP

A growing number of companies nationwide are directing their HR departments to provide resources, education and group help for caregiving issues by:

• Providing materials from community resources such as phone numbers to their local Senior Centers or Area Agencies on Aging.
  
• Making available brochures and booklets on specific programs and services by eldercare experts
  
• Providing speakers to educate employees on caregiving options
  
• Allowing options to use paid sick leave, employee job sharingand flexible hours
  
• Allowing employee caregivers to use business computers for caregiving research
  
• Contracting with companies who provide eldercare services to help employees

Eldercare service providers are also reaching out to help employee caregivers by providing informational presentations at the work place during lunch time or other times set up by employers. One such presentation provided information on reverse mortgages. Jason, who had been trying to help his parents pay for home care, learned at a work site presentation that a reverse mortgage was one way to cover caregiver expenses.

The HR Department of a local business in Utah, invited the Salt Lake Eldercare Planning Council to present a “Brown bag, Lunch and Learn” during their employees' lunch hour. In 30 minutes time, those who attended learned how the services of a Care Manger, Home Care Provider, Elder Attorney, Medicaid Planner and Financial Consultant can help with caregiving decisions. Problems were discussed, questions answered and employees left armed with information and the names of professional people they knew could help them.

“This was the most productive lunch I have ever attended”, related Mary, one of the attendees.

“I had been very hesitant to contact an attorney to discuss my parents' estate, because of the cost involved. The attorney at our 'lunch and learn' answered my few basic questions which will allow me to prepare what I need before I meet with him to finalize my parents' estate planning.”

Besides workplace help for employers and employees dealing with caregiving, the internet is also a great research tool. The National Care Planning Council website at www.longtermcarelink.net is a comprehensive resource for eldercare, senior care and long term care planning. It contains hundreds of articles on all aspects of eldercare. Professional providers list their services on the NCPC website. Each of their listings provides unique information on specific eldercare services and how to obtain help.

Employers, employees and eldercare service providers working together can make parent or senior caregiving a workable solution for all.

Recognizing Symptoms of Dementia

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.

Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma's mental state?

One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?

An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia.

"Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

• Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
  
  
• Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
  Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
  
  
• Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
  Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
  
  
• Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
  
  
• Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
  
  
• Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
  Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
  
  
• Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.

"The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.

The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support." The Four Steps of Long Term Care Planning

Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.

The National Care Planning Council supports caregiving services throughout the country.
www.longtermcarelink.net

Can Fosamax and Other Osteoporosis Drugs Contribute to Bone Fractures?

What you need to know

by: Katharine Greider | from: AARP Bulletin | May 28, 2010

For years women, especially postmenopausal women, have been prescribed osteoporosis medications called bisphosphonates (a group of drugs that includes Fosamax, Boniva, Actonel and Reclast) to strengthen their bones. But recent reports have raised questions about whether long-term use of these drugs might be linked to an unusual fracture of the thighbone.

Two studies presented this spring at the annual meeting of the American Society of Orthopaedic Surgeons added to that concern as they pointed to changes in bone quality among women taking bisphosphonates for several years.

Doctors stress, though, that these medications do prevent fractures—especially hip fractures—in large numbers of women who have osteoporosis, and that the thighbone fractures are relatively rare.

Here’s what we know so far.

What did the new studies show?

These small studies were designed to explore whether prolonged use of these osteo drugs changes bone quality in ways that might promote thighbone fractures.

In one study, researchers at Columbia University Medical Center examined 111 postmenopausal women to measure the strength of their thighbones. About half of the women were not taking the drugs, and the other half had taken them for at least four years. The study found that for those on the medicines, bone strength improved during the first four years of drug therapy. But as they continued to take the drugs beyond four years, those improvements deteriorated, although not all those gains disappeared.

In the other study, researchers at the Hospital for Special Surgery in New York examined samples from the thighbones of 21 postmenopausal women; 12 had taken bisphosphonate drugs for an average eight-and-a-half years. The age of the bone tissue from women taking the drugs showed less range—there was more old bone and less soft, flexible newer bone—compared with women not on the drugs.

What do these findings mean?

Bisphosphonates work by suppressing the natural process in which bone tissue is removed and replaced with new bone. In osteoporosis, bone removal outstrips replacement and results in light, fragile bones. It’s possible, the studies’ authors suggest, that long-term drug therapy sometimes produces bone that’s thick and hard but harbors tiny flaws from accumulated damage or structural irregularities, which reduce the bone’s resistance to cracking.

Why did doctors first begin to be concerned about these drugs?

Certain kinds of bone fractures are considered typical for those who have osteoporosis. These include fractures in various places on the hip and spine.

But over the last several years physicians have published a series of reports of cases where women taking bisphosphonate drugs for a number of years experienced unusual breaks or cracks in the thighbone several inches below the hip.

Joseph M. Lane, M.D., an orthopedic surgeon at the Hospital for Special Surgery and NewYork-Presbyterian Hospital and a coauthor of one of the studies presented in March, says that in past decades this kind of break was so rare that few of his colleagues had ever encountered it. Since about 2000, he says, that’s changed. It’s still unusual, representing about 1 in 100 to 1 in 50 hip fracture cases treated at NewYork-Presbyterian Hospital between 2002 and 2007, says Lane. But, it’s a serious, hard-to-treat problem that seems to affect mainly younger, active postmenopausal women.

I’ve been taking a bisphosphonate for years. Should I stop?

Both the American Society of Orthopaedic Surgeons and the Endocrine Society have issued statements urging patients with osteoporosis not to stop taking their medications without consulting their physicians. To do so could expose them to the potentially disabling and even deadly fractures the drugs are meant to prevent in the first place.

“What we have to keep in mind,” says Elizabeth Shane, M.D., a Columbia University endocrinologist and co-chair of a major professional task force reviewing these thigh fractures, “is that garden variety fractures can be just as devastating as this type of fracture, but much, much, much more common—and these drugs do a pretty good job of preventing those types of fractures.”

If you treat 10,000 women with osteoporosis for longer than five years, research shows, you’ll prevent about 100 of these common fractures, says Shane, while perhaps—if bisphosphonates are indeed promoting the thighbone breaks—leading to two of these more unusual fractures. Two very small studies have followed women taking these drugs for up to 10 years, without uncovering serious problems.

Do I have to take the drugs indefinitely to maintain stronger bones?

Not necessarily. An important study published in late 2006 in the Journal of the American Medical Association compared results among women who discontinued Fosamax after five years versus women who continued taking the drug. Up to five years later, those who had gone off medication had roughly the same risk for most types of fractures as those who kept taking it.

“From the studies it would appear that once you’ve taken Fosamax for five years, if you stop for a year, probably nothing much changes,” says Ethel Siris, M.D., a past president of the National Osteoporosis Foundation who directs the Toni Stabile Osteoporosis Center at Columbia University Medical Center. The benefit appears to continue, she says, “probably because you’ve accumulated enough drug in your system. Once you’ve been off for two years, there’s a slight reduction in the hip density. It’s as if the effect is starting to wear off.”

Given these results, some physicians recommend a drug “holiday”—stopping the medications temporarily—to avoid unnecessary expense and inconvenience, if nothing else.

Who’s most at risk for the femur fractures? What can I do to avoid this problem?

Experts suspect that a small, specific group of women may be more at risk for unusual thighbone fractures. Perhaps these women have other conditions besides osteoporosis, have taken additional medications or have a genetic vulnerability. Unfortunately, no one can say at this point just what those risk factors are.

What doctors do know is that many women who suffered this type of upper-thigh fracture complained of thigh pain beforehand, sometimes for months.

“Since these cases have been published, I routinely ask all my patients if they have pain in their thighs,” says Shane. Such pain in osteoporosis patients taking bisphosphonates should prompt an x-ray of both thighs, and, if the images indicate a problem, referral to an orthopedic surgeon.

Are we certain osteoporosis drugs are causing these unusual fractures?

No. Studies haven’t been done to confirm that these unusual fractures are on the rise, nor is it clear that they are caused by Fosamax and other bisphosphonates.

In response to news reports on the studies, the U.S. Food and Drug Administration released a statement saying the agency would continue to investigate this “potential safety signal,” but so far hadn’t found evidence that women taking the osteoporosis medicines are at an increased risk.

Katharine Greider lives in New York and writes about health and medicine.

Spouses Face Challenges in Caring For Themselves and Their Ailing Partners

By Paula Span
Kaiser Health News
Tuesday, May 25, 2010
Published in the Washington Post.

They met on a blind date in 1949 and married two years later. They lived in the same Cape Cod-style house in Silver Spring for nearly 50 years. So when Leonard Crierie was diagnosed with Alzheimer's disease in 2005, there was no question that his wife, Betty, would take care of him at home for as long as she could.

Betty led him into the shower, helped him dress each morning and took him everywhere with her because, once he started wandering, as some dementia patients do, she dared not leave him alone. She learned how to change the colostomy bag he wore since he'd survived rectal cancer years earlier. She slept, fitfully, with a monitor by her bed so that she could respond if he needed her at night.

"It was difficult, but I was able to take care of him," says Betty, now 80. "Because it happens slowly, you don't realize how bad it's getting."

She agreed to have Leonard attend an adult day program at nearby Holy Cross Hospital -- he enjoyed socializing there -- so that she could get a few hours' break several times a week; she found a Holy Cross caregivers support group very useful. But she refused the pleas from her three adult children to hire an aide to help at home. "I always felt like I had it under control," she explains, though her children thought the $18-an-hour cost also troubled a frugal woman who shops at dollar stores.

As the months passed, "we could see the stress level affecting her," recalls her daughter Linda Fenlon. "The frustrating part was, we wanted her to have some independence, some quality of life. But she saw it as her duty in life to take care of him."

For four years, Betty Crierie rarely asked for or accepted her family's help, until a Wednesday last June. As she left her support group meeting, she remembers, "I got this funny feeling in my chest." It worsened on the 10-minute drive home. She called her daughter and said, "I'm calling 911. I think I'm having a heart attack."
'In sickness and in health'

Caring for a sick or disabled elderly relative exacts a toll -- physical, emotional, financial -- on any family member, but being a spousal caregiver brings particular challenges.

"Spouses are older and dealing with their own age-related health limitations," says Steven H. Zarit, a Pennsylvania State University gerontologist. The tasks they shoulder have grown more demanding: Family caregivers now administer arsenals of medications and undertake procedures, from wound care to dialysis, that were once the province of medical professionals.

Moreover, today's longer life spans, in which once-fatal conditions such as heart disease have become manageable chronic illnesses, mean that the "sickness" part of "in sickness and in health" can last for many years. Spouses determined to single-handedly honor their vows, says Suzanne Mintz of the National Family Caregivers Association, "are using their old rules to fight a new problem."

The medical and psychological literature have long reported that caregivers face risks to their own well-being, especially when they're caring for people with dementia. Caregivers under stress have higher levels of depression and anxiety; their immune systems suffer. A 2005 Commonwealth Fund overview found that caregivers of all ages reported chronic conditions -- including heart disease, diabetes, cancer and arthritis -- at nearly twice the rate of non-caregivers, 45 percent vs. 24 percent.

In an oft-cited study published in the Journal of the American Medical Association in 1999, University of Pittsburgh researchers followed nearly 400 elderly spousal caregivers for four years and reported that those experiencing mental or emotional strain had 63 percent higher mortality rates than non-caregivers. (Caregivers not experiencing emotional or mental strain did not have elevated mortality rates.)

And a study published this year by a team from the University of South Florida and the University of Alabama at Birmingham found that high caregiving strain among spouses increased the risk of strokes by 23 percent; the association was particularly strong among husbands caring for wives.

"Spouses are likely to take on more than they can reasonably do," Zarit says.

Betty Crierie was the classic example: Caring for her increasingly disabled husband, trying to shelter their adult children from the burden, unwilling to bring in a costly home-care aide when she felt she was doing fine on her own -- until she had her heart attack. "We didn't realize how much she was doing until we took turns taking care of Dad ourselves," Linda Fenlon says. "It was so labor-intensive. We very quickly realized she couldn't continue."

While their mother recovered, the children moved their father into a nursing home, a wrenching act for all concerned. Betty visited Leonard there two or three times a week, continuing to do his laundry at home, until he died five months later at age 83.
Depression-era values

Why is it so difficult for older caregiving spouses to seek help? Zarit's research has shown that compared with adult children taking care of an ailing parent, spouses don't turn to adult day programs until later in the course of illness, and they're more apt to withdraw the participant after a short time.

Sister Kathy Weber, who leads the Holy Cross support group that Betty Crierie attended, sees a Depression-era-bred reluctance to spend money on care, even when couples can afford it. "They're supposed to get along somehow and squirrel it away for their kids -- who want them to use it now, for their care, which would make the children's lives easier, too," Weber says.

Spouses don't want to lose control of their homes or their relationships. Sometimes they hope to protect their partners' dignity, not wanting children to see how diminished they've become. "There's a lot of pride there," Weber says.

What might help, caregiver advocates say, is for health providers to regard older couples as a unit, recognizing that a caregiver's compromised health could prematurely institutionalize an ailing spouse. Some geriatric practices already do so. "On the intake forms in doctors' offices, there should be questions to identify whether someone is a family caregiver," suggests Mintz. "That would alert the physician and the staff to the situation and raise questions about that person's own health. Is she taking care of herself?"

Meanwhile, President Obama's proposed 2011 budget would add $102.5 million for family caregiving programs, "a step in the right direction," Mintz says. The money would boost existing programs that serve family caregivers, including training and counseling, referrals, respite care, transportation, adult day programs and home care. AARP analysts estimate the increased funding could help an additional 200,000 families. Family caregivers can use the help: Medicare pays for doctors and hospitals but provides only very limited post-hospitalization home care, and Medicaid (which covers only the poor) allots most of its dollars to nursing homes. The financial burden of caring for a spouse at home falls mostly to families themselves.

But even with better support, watching a partner decline is difficult. "They are about to lose their lives as they've known them," Weber explains.

That's what happened to Sheila Fridovich, whose husband, Bernard, developed Pick's disease, a form of dementia, in his late 60s. Sheila kept him at home in Annapolis, eventually hiring a daytime aide, for nearly six years.

"I couldn't eat; I couldn't breathe; I didn't have a moment's peace," she acknowledges. Yet she refused to see a therapist or join a support group. "I needed to iron it out in my own head," she says.

"We grew up in a generation where getting help from a therapist is not stigmatized," theorizes her daughter Lauri Fridovich Lee, who joined a support group online. "For the older generation, it is."

Eventually, consulting with a Veterans Affairs physician about drug coverage, Sheila discovered that Bernard, a Navy veteran, was eligible for admission to a specialized dementia unit at the VA Community Living and Rehabilitation Center in Baltimore. She moved Bernard there in 2006. At 79, he's still a resident and gets excellent care, she says. But after a stroke, he cannot speak, and she's not sure, on her Sunday visits, if he knows who she is.

"It's a traumatic experience for a husband and wife, far more than for their kids," Fridovich says now. She's only 71, still working part time as an educational consultant, but "the way I live is not the way I lived before. I'm married but I'm not; I have a husband but I don't. I'm in no man's land."

Span is the author of "When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions." This article was produced in collaboration with Kaiser Health News. KHN is an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan health-care policy organization that is not affiliated with Kaiser Permanente.

Does Older = Happier?

Below is an interview with Susan Turk Charles, Associate Professor of Psychology & Social Behavior, Ph.D. University of Southern California, conducted by Laura Rico, University Communications

Q: Why does happiness increase with age?
A: One reason why people over 60 tend to be happier is that they're more capable of regulating their emotions. Avoiding negative or stressful experiences plays a major role in their success. For example, when young people disagree with close friends or family members, they're more likely to argue their point of view. Older people are more prone to let it go and walk away, and they feel better about their actions as a result. Our research also shows that seniors spend less time thinking about negative aspects of a situation than do younger adults.

Q: Why are older people more adept at controlling their emotions?
A: We think it has to do with their perspective on life. They realize that time left is getting shorter. In contrast, younger people often must engage in unappealing activities to serve the future. They may think, "I need to interact with this unpleasant person because it might be good for my career," whereas older folks have the freedom to select emotionally meaningful activities and only associate with people they like. Plus, life experiences have taught them what they'll regret and how best to avoid problematic situations.

Q: What role does memory play in older adults' happiness?
A: It's key to emotional regulation. Research has shown that how people remember events from their past may be as important as the events themselves. We find that the recollections of older adults are more positive than those of younger adults. They recall unpleasant emotions as less intense and reappraise memories in a better light. Even when asked to relate a bad experience, seniors are more likely to mention positive angles along with the negative.

Q: Why are depression and isolation often associated with aging?
A: If an older adult in your life has become despondent, you need to recognize that this is not a normal age-related change. A physical exam may find an underlying condition that's causing the dark mood. Psychotherapy could also help. Regular exercise and social relationships are crucial to preventing depression in older people.

Q: How did you become interested in studying aging and emotions?
A: When I was an undergraduate at Stanford University, the prevailing view was that emotional development ended at 18 to 20 years of age. It was frightening to think that at 65 you'd be just the same as at 18! I wanted to explore the changes that occur in the last seven decades of life.

Q: Why is it important to understand aging?
A: By the year 2030, one in five Americans will be older than 65. Currently, Europe and Japan have aging populations that aren't being fully replenished by births or immigrants. Imagine the implications for society and public health! In the U.S., you can see how advertising and marketing have moved in that direction, with frequent TV commercials about pharmaceuticals, medical supplies, life insurance and estate planning.

The face of aging has changed too: Celebrities in their 50s and 60s look amazing. Older people are more physically active than ever, and it's not rare to see them doing things such as yoga previously associated with only the young. At the same time, a rise in obesity jeopardizes longevity and quality of life for many. An older population also means a greater number of people with dementia or who care for loved ones with dementia. We face both great opportunities and great challenges as our society grays, and we need to maximize health and well-being for this growing demographic. Successful aging in the U.S. will benefit not just seniors but everyone.

PATRICK RELEASES $2.5 M IN FUNDING FOR ELDERLY "OPTIONS" COUNSELING PROGRAM

The Patrick Administration today released $2.5 million in state funding to expand a provision of the 2006 Equal Choice law for the eldelry and disabled which had not been implemented.

According to Mass Home Care, which has been pushing for the release of this funding, this program represents 'smart money' because it helps guide elders away from nursing homes into less costly forms of community care.

The 2006 law requires people who are seeking nursing home admission to have a free counseling session to talk about their options to remain living in the community. Despite legislative efforts to fund this program, is has only been available in three pilot sites.

But because of today's announcement, the Long Term Care Options program will be spread statewide---more than two and a half years after the mandate was created.

"This is a win for the Governor," said Al Norman, who helped write the 2006 law that created the Options counseling program. "It will give seniors a better chance to live at home, and save taxpayers millions of dollars in the process."

"We applaud the Governor for putting this money out into circulation," Norman said. "It gives families hope that they can find an alternative to institutional life."

The funding for this program will be administered by 11 Aging & Disability Resource Consortia (ADRC).

MassHealth Exemption Bills By Nicholas G. Kaltsas, Esq.

Currently, there are three identical bills pending in the Massachusetts legislature on nursing facility and long term care. These bills are as follows: House Bill No. 1069 (HB 1069) which has been presented by Christopher G. Fallon on the petition of 19 house members; Senate Bill No. 309 which has been presented by Harriette L. Chandler on her own petition; and Senate Bill No. 572 which has been presented by Robert A. O'Leary on the petition of 6 senate members.

The law as it exists currently in the Commonwealth of Massachusetts states you must have two (2) years of long term care insurance coverage on your policy when you enter a Nursing Home. In essence, under the current law, if an individual’s long term care insurance policy provided home care benefits, and those benefits were accessed, it could be that the exemption currently provided in the Code of Massachusetts Regulations from Estate Recovery for receipt of MassHealth could be jeopardized. Let me give you an example: Let us assume Sally had 3 years coverage under a long term care insurance policy. Let us further assume that policy not only provided benefits in the event Sally were to go into a nursing home, but also provided benefits to Sally in the event she needed home care services so she was able to remain in her home. Under the current scheme, if Sally accessed her long term care insurance for home care and she had less than two (2) years of coverage at $125.00 a day at the time she entered a nursing home, she would lose the exemption against Estate Recovery as currently provided by regulation.

The currently proposed revisions to the Massachusetts law state that you need two (2) years of coverage at $125.00 a day when you purchase your long term care insurance, and not at the time you enter a Nursing Home. This bill would allow a policyholder to protect their home from the Medicaid lien as long as they buy $125/day for 2 years, even if they use up all of their policy coverage at home before entering the Nursing Home and qualifying for Medicaid.

House Bill No. 1069 (HB 1069) which has been presented by Christopher G. Fallon and Senate Bill No. 572 which has been presented by Robert A. O'Leary are in the Health Care Financing Committee. Senate Bill No. 309 which has been presented by Harriette L. Chandler is in the Elder Affairs Committee.

Hopefully the Massachusetts legislature will see the wisdom that it is far more cost effective to provide care at home (rather than in a long term care facility) and will stop penalizing Massachusetts citizens who try to stay in their homes for as long as possible by accessing their long term care insurance coverage. SUPPORT THESE BILLS!

Attorney Kaltsas practices law at Elder & Disability Law Advocates in Worcester and Framingham, Massachusetts
and hosts WTAG’s Saturday morning talk show ”The Senior Focus” at 11:00 AM.
”The Senior Focus” can be heard on True Talk Radio -- 580 AM or 94.9 FM

Please feel free to call Attorney Kaltsas in Worcester at 508-755-6525 or Framingham at 508-620-4525.
Or listen to The Senior Focus and call your comments or questions into the show at 508-755-0058.

Be Wary of Tax Relief Scams

You may have seen them on television and the internet companies promising to reduce your tax debt, stop garnishments, remove tax liens, or settle your debt.

Individuals in debt to the Internal Revenue Service (IRS) are regularly preyed upon by scam tax relief companies who charge thousands of dollars and deliver nothing. In many cases these scams involve a personal tax evaluation costing several thousand dollars only for the taxpayer to be told that there is nothing that can be done. The IRS has issued warnings about these companies.

If you cannot pay your taxes by the April 15 deadline, you should contact the IRS as soon as possible, as they will listen to your case and offer the best solution to your situation.

The IRS has many options for you to pay your taxes, including:

1. The IRS may give you an extension of time to pay from 30 to 120 days.

2. An installment plan that allows you make regular monthly payments until your tax bill is resolved.

3. Request an offer in compromise, an agreement between you and the IRS to settle your tax debt for less than you owe.

4. Plan ahead for next tax season: Adjust your withholding or increase your estimated tax payments so you will have a lesser tax obligation next year.

For more information about your personal income taxes and/or tax relief, contact:

Barbara Anthony, Undersecretary 10 Park Plaza Suite 5170 Boston, MA 02116
Hotline 617-973-8787 888-283-3757 www.mass.gov/consumer

Internal Revenue Service (IRS)
Phone: toll-free (800) 829-1040

Massachusetts Department of Revenue (DOR)
Phone: toll-free in MA (800) 392-6089, (617) 887-MDOR

DOR’s customer service call center hours for tax help are 10 am - 1 pm and 1:30 pm - 4 pm, Monday through Friday.

How the new Health Reform legislation will affect seniors.

The Medicare prescription-drug benefit would be improved substantially. This year, seniors who enter the Part D coverage gap, known as the "doughnut hole," each would get $250 to help pay for their medications.

Beyond that, drug-company discounts on brand-name drugs and federal subsidies and discounts for all drugs would reduce the gap gradually, eliminating it by 2020. That means that seniors, who now pay 100 percent of their drug costs while they're in the doughnut hole, would pay 25 percent.

Further, as under current law, once seniors spend a certain amount on medications, they'd get "catastrophic" coverage and pay only 5 percent of the cost of their medications.

Government payments to Medicare Advantage, the private-plan part of Medicare, would be cut sharply starting next year. If you're one of the 10 million enrollees, you could lose extra benefits that many of the plans offer, such as free eyeglasses, hearing aids and gym memberships. To cushion the blow to beneficiaries, the cuts to health plans in high-cost areas of the country such as New York City and South Florida — where seniors have enjoyed the richest benefits — would be phased in over as many as seven years.

Beginning this year, the bill would make all Medicare preventive services, such as screenings for colon, prostate and breast cancer, free to beneficiaries.

If Reform Fails

This editorial from The New York Times, is a part of a comprehensive examination of the debate over health care reform. You can read all of these editorials at: nytimes.com.

As the fierce debate on President Obama’s plan for health care reform comes to a head, Americans should be thinking carefully about what happens if Congress fails to enact legislation.

Are they really satisfied with the status quo? And is the status quo really sustainable?

Here are some basic facts Americans need to know as Congress decides whether to approve comprehensive reform or continue with what we have:

HOW REFORM WOULD WORK: Let’s be clear, the changes Mr. Obama and Democratic leaders in Congress are proposing are significant. But, despite what the critics charge, this is not a government takeover. And the program is not only fully paid for, it should actually reduce the deficit over the next two decades.

Under the new system, all people would be required to have health insurance or pay a penalty. If you are poor or middle class you would also get significant help through Medicaid coverage or tax credits to pay the premiums.

The legislation would create exchanges on which small businesses and people who buy their own coverage directly from insurers could choose from an array of private plans that would compete for their business. It would also require insurance companies to accept all applicants, even those with a pre-existing condition. And it would make a start at reforming the medical care system to improve quality and lower costs.

46 MILLION AND RISING: If nothing is done, the number of uninsured people — 46 million in 2008 — is sure to spike upward as rising medical costs and soaring premiums make policies less affordable and employers continue to drop coverage to save money.

The Congressional Budget Office projects 54 million uninsured people in 2019; the actuary for the federal government’s Centers for Medicare and Medicaid Services projects 57 million.

It should be no surprise that people without insurance often postpone needed care, and many get much sicker as a result. That is morally unsustainable. It is also fiscally unsustainable for safety net hospitals — which foist much of the cost on the American taxpayer when the uninsured end up in the emergency room. As the number of uninsured rises, that bill will rise.

The Senate’s reform bill would reduce the number of uninsured by an estimated 31 million in 2019. The Republicans’ paltry proposals would cut the number by only three million.

To read this story in its entirety, please visit The New York Times