Top 10 Stories of 2011

Huffinton Post
Here Are 2011's Top 10 Stories, In Order, From Ballots Cast, Huffingtonpost

OSAMA BIN LADEN'S DEATH: He'd been the world's most-wanted terrorist for nearly a decade, ever since a team of his al-Qaida followers carried out the attacks of Sept. 11, 2001. In May, the long and often-frustrating manhunt ended with a nighttime assault by a helicopter-borne special operations squad on his compound in Abbottabad, Pakistan. Bin Laden was shot dead by one of the raiders, and within hours his body was buried at sea.

JAPAN'S TRIPLE DISASTER: A 9.0-magnitude earthquake off Japan's northeast coast in March unleashed a tsunami that devastated scores of communities, leaving nearly 20,000 people dead or missing and wreaking an estimated $218 billion in damage.

ARAB SPRING: It began with demonstrations in Tunisia that rapidly toppled the longtime strongman. Spreading like a wildfire, the Arab Spring protests sparked a revolution in Egypt that ousted Hosni Mubarak, fueled a civil war in Libya that climaxed with Moammar Gadhafi's death, and fomented a bloody uprising in Syria against the Assad regime. Bahrain and Yemen also experienced major protests and unrest.

EU FISCAL CRISIS:

US ECONOMY:

PENN STATE SEX ABUSE SCANDAL: One of America's most storied college football programs was tarnished in a scandal that prompted the firing of Hall of Fame football coach Joe Paterno.

GADHAFI TOPPLED IN LIBYA: After nearly 42 years of mercurial and often brutal rule, Moammar Gadhafi was toppled by his own people. Anti-government protests escalated into an eight-month rebellion, backed by NATO bombing, that shattered his regime, and Gadhafi finally was tracked down and killed in the fishing village where he was born.

FISCAL SHOWDOWNS IN CONGRESS: Partisan divisions in Congress led to several showdowns on fiscal issues. A fight over the debt ceiling prompted Standard & Poor's to strip the U.S. of its AAA credit rating. Later, the so-called "supercommittee" failed to agree on a deficit-reduction package of at least $1.2 trillion — potentially triggering automatic spending cuts of that amount starting in 2013.

OCCUPY WALL STREET PROTESTS:

GABRIELLE GIFFORDS SHOT: The popular third-term congresswoman from Arizona suffered a severe brain injury when she and 18 other people were shot by a gunman as she met with constituents outside a Tucson supermarket in January. Six people died, and Giffords' painstaking recovery is still in progress.

To Read Entire Article, Click Here!

Why You Should Care About The 'Medical Loss Ratio'

Atlantic Wire - Ted Mann - December 3rd
Unless you are a health care worker or a health care industry employee, you likely haven't given a ton of thought to the medical loss ratio. That is, simply stated, the percentage of health insurance company spending that actually goes to pay for the medical care delivered to people.

If you are a health care industry employee, particularly one of the executive variety, you have likely given a lot of thought to the medical loss ratio in the last several years, and especially in the past day. That's because the federal Department of Health and Human Services just issued its final rule on the topic, implementing an aspect of the Obama health care law that played little part in the public debate, but matters tremendously to insurance companies.

Under the new rules, insurers must spend at least 80 percent of the money they take in from insurance premiums (less taxes and fees) toward providing health care to their customers. If they don't spend that percentage, insurers will now be required to send rebates back to the people paying the premiums.

A thorough explanation of the rule and its effects is at Health Affairs. Over at Forbes, Rick Ungar writes that this is the actual "bomb" health insurers were worried about in the otherwise not-all-that-radical Obamacare bill.

Should There Be Sales Taxes On Internet Purchases?

This Nation.com
American Government and Politics Online

An increasingly large number of Americans are shopping online, browsing catalogues, selecting items and making purchases from the comfort of their own homes. Beyond convenience, one of the most attractive aspects of online shopping, at least to consumers, is that very few online "stores" charge sales tax, meaning that shoppers pay even lower prices for what they buy online than they would in a traditional store. The days of tax free Internet shopping, however, may be short-lived. Should there be sales tax on Internet purchases or should web shopping remain "tax free"?

To answer this question fairly, it is important to put the sales tax in its proper perspective. Most state and local governments rely heavily on sales tax revenues to fund a wide variety of government functions and programs. All but five states collect a sales tax of some kind or another. The states that collect sales taxes do so in a variety of different ways--some states tax virtually all purchases while others tax a narrower range of purchases. The most commonly exempted class of purchases is food. Tax rates also vary quite widely, from as low as 0.5% in Hawaii to 7.25% in California. Additional sales taxes are also collected in many counties and cities on top of established state sales tax rates.

State and local governments have generally established their taxation and spending patterns over long periods of time, adjusting for local and regional economic conditions and spending requirements when necessary. While it is impossible to anticipate every possible contingency, one of the most important functions of state and local governments is to plan ahead and establish taxation systems that will work down the road as well as today. Each state and local government has developed a mixture of sales, income, property and other taxes to bring in the revenues each needs to maintain roads and highways, build schools, pay teachers, etc. When one or more of a state or local government's expected revenue sources is curtailed or eliminated, its budget plans are no longer useful and it must either scramble for new revenue or cut spending. Neither one of these tends to be very popular with the public.

So, should sales tax be collected on Internet purchases? Ultimately, the answer comes down to this: Most state and local government tax systems and budget plans would be seriously disrupted if sales tax revenue disappeared altogether. If an increasingly larger proportion of purchases are made sales tax-free on the Internet, there will be a fiscal crisis in most states and localities. State and local governments will either have to raise revenue in other ways, by increasing income or property taxes, for example, or by cutting spending.

Most of the uproar over taxation of purchases made on the Internet seems to arise from the perception that any tax on online purchases would be a new form of taxation. This is simply not the case. Purchases off-line have been taxed for decades. Shopping online may be different in many ways, but money is still being exchanged for goods and services. Those purchases would be taxable under any other circumstances, i.e. if the purchases were made anywhere but on the Internet.

Taxing Internet purchases is further complicated because most purchases are made across state borders. In such cases, where should the tax be collected? At the point of sale or the point of delivery? If the tax is collected at the point of sale, there would probably be a migration of online stores to sales tax-free states. The most workable idea would probably be to require the tax to be paid to the state or local government where the purchaser lives. The drawback to this, however, is that at least one rationale for collecting sales taxes in the first place is to provide state and local governments the money they need to build roads, sewers and provide other services that allow businesses to do what they do. If sales taxes are collected in the states and localities where buyers live, the states and localities where sellers are located may not be able to collect the revenues they need.

The issue of sales tax collection on Internet sales is a complicated one. If people want to shop online--and more and more are doing so every day--and they don't want to be charged a sales tax when they do so, they should realize that they will either have to pay those taxes in other ways or be prepared to see reductions in state and local government services. And as states and local governments come to grips with the evolving nature of commerce, they will have to develop new ways of thinking about and administering tax systems.

CMAA Sponsors Food Drive

Veterans Transportation and Community Living Initiative

WASHINGTON – U.S. Transportation Secretary Ray LaHood today announced $34.6 million for 55 projects in 32 states and Guam to enhance access to local, affordable transportation services for military families and spouses, and wounded warriors.

Many military families live in suburban and rural communities where filling the gas tank for long commutes is expensive and public transportation is limited. Projects funded by the Veterans Transportation and Community Living Initiative will bridge the gap by enabling states and communities to build or expand so-called “one-click, one-call” centers that offer comprehensive information on local transportation options, and other community services, with just a single phone call or click of the mouse. Typically, such information is not available in one convenient place, and better local coordination will result in better services for veterans and nonveterans alike.

• $2 million to the Montachusett Regional Transit Authority in central Massachusetts to expand an existing one-call center by adding agencies serving local veterans. The center will offer an array of traveler and community services and act as a one-stop shop to military families and spouses who need them.

In addition to USDOT, the Department of Veterans Affairs is contributing up to $3 million for the VA health care network to coordinate veterans’ transportation needs with community transportation systems. The Department of Labor’s Office of Disability Employment Policy is contributing $250,000 for social media tools and training to include veterans and the military in community transportation decision-making. The Department of Health and Human Services and the Department of Defense are also lending critical support, in part through their extensive networks of community-based advocates. Additional in-kind support is provided by over a dozen national veteran service organizations.

See Secretary LaHood’s blog post here

Medicare Open Enrollment: Better Choices, Sooner

Centers for Medicare & Medicaid Services
By Don Berwick, Administrator, Centers for Medicare & Medicaid Services

Every year, people with Medicare get to explore new choices and pick the plans that work best for them. This year, this Open Enrollment period is starting early – on October 15 – and ending sooner – December 7.

As health plans start their marketing and advertising activities in just a few weeks, we want people to know that the Medicare program is strong and, in 2012, they have a broad array of choices. And, there are lots of new benefits thanks to the Affordable Care Act.

Every person with Medicare will have to choose a “Part D” plan to help them pay for prescription drugs. And people who have chosen to enroll in a “Part C” Medicare Advantage plan for their basic health care services have the option of staying in that plan, choosing a different plan, or going back to the Original Medicare program. These are important choices that should be made with care.

The good news is we have strengthened consumer protections and improved plan choices. We’re making it simpler for people to choose a new health or drug plan by reducing the number of duplicate plans. We’ve also worked with plans to reduce cost sharing on important benefits like inpatient hospitalization and mental health services.

And, thanks to our enhanced bargaining power we can report that average premiums for a Part D plan will be the same in 2012 as in 2011. The average premium for Part C plans is going down by 4 percent. That’s great news for people on Medicare who have a fixed income.

As with last year, people with Medicare will continue to have a variety of Medicare Advantage plan choices. Consumers in every part of the country will have a wide variety of Part D plan choices in 2012, including many plans with zero deductibles and plans with some form of generic gap coverage.

People with Medicare are also enjoying important new benefits. Every person is entitled to an Annual Wellness Visit with their doctor so that they can discuss their health and their health care needs. Prevention services like mammograms and other cancer screenings are now available with no cost-sharing. And people who reach the donut hole in their drug costs will get a 50% discount on covered brand name drugs and a 14 percent discount on generics. That puts money back in your pockets.

More good news for consumers is the fact that we’ll be closely monitoring marketplace performance to protect people from misleading information or prohibited tactics by a small minority of unscrupulous plans. Medicare plans are on notice: we’ll move quickly to take action against plans found to be violating marketing rules.

In short, there’ll be a wide range of health and drug plan options available across the country, including Original Medicare. People can turn to www.medicare.gov, call the 1-800-MEDICARE hotline, or consult with a local State Health Insurance Assistance Program (SHIP) for help. We want to make sure people can identify and enroll in the coverage option that suits their needs in 2012.

Debt Ceiling Deal: The Good, the Bad and the Ugly

n4a’s initial analysis

This afternoon, the Senate passed legislation to raise the debt ceiling, reduce the deficit and create a special committee to determine a second round of deficit reduction decisions. The bill represents the deal agreed to by the White House and Congressional Republicans and Democrats late on Sunday and approved by the House on Monday. The measure was just signed by President Obama, thus narrowly averting a federal government borrowing crisis.

The deal has multiple components, virtually all of which affect aging policy and funding in the short and long-term. n4a CEO Sandy Markwood released a statement today about the deal, which can be found under Policy News at www.n4a.org.

What is in the Deal?
In exchange for raising the debt ceiling limit, Republicans won several concessions, including immediate and long-term cuts to discretionary spending without any of the increases in revenues that Democrats wanted. In a nutshell:

• Stage 1: The bill caps discretionary spending over 10 years, driving $900 billion in deficit reduction. For the first two years, the caps have to be applied equally between security and non-security spending (i.e., firewalls).
• Stage 2: A Congressional Joint Select Committee on Deficit Reduction will be created to agree upon at least $1.2 trillion and up to $1.5 trillion in additional deficit reduction measures. This 12-member bipartisan committee must produce this legislation by November 23; it will then be subject to an up-or-down vote without amendments. Everything is on the table for this committee’s consideration: revenues, entitlements or further cuts to discretionary programs.
• Possible Stage 3: If the joint committee or Congress fails to act by the end of the calendar year, $1.2 trillion in automatic, across-the-board cuts would take effect through a sequestration process. If this occurs, several programs are exempted: Social Security, Medicaid and several low-income entitlement programs. (Medicare benefits could not be cut either, but provider payments could be reduced by up to 2 percent.)

The Good

• The raising of the debt ceiling averted significant and numerous economic consequences had the government defaulted.
• As desired by the White House, the measure puts off the need to repeat this battle over raising the debt ceiling until 2013 (the debt ceiling would be increased again before then, but under agreed-upon parameters).
• Medicaid HCBS programs, Medicare and Social Security were spared immediate cuts, as the first $900 billion in deficit reduction comes entirely from the discretionary side of the ledger.
• If automatic sequestration occurs, Social Security (which has not contributed to the deficit), Medicaid, costs for Medicare beneficiaries and several low-income programs are spared.
• If automatic sequestration occurs, half of the cuts must come from security, thus preventing unfair routing of non-security programs.

The Bad

• Discretionary programs like the Older Americans Act could face painful cuts under the spending caps—the best case scenario for FY 2012 and FY 2013 OAA funding would be only minor cuts but all programs are at risk of being significantly reduced, as appropriators struggle to keep total spending under the cap. With the caps in place for 10 years, there is no immediate relief in sight from reduced or frozen funding levels that do not take into account population growth, human need or other factors that increase demand for programs and services. (It is too early to speculate as to when the economy might recover enough to phase out the caps early, as has been done in past years.)
• Discretionary programs are not protected from the second round of drastic cuts, as the joint committee can opt to further reduce either side of the ledger.
• The joint committee merely continues the partisan battle over whether revenues should be considered in deficit reduction. If committee members cannot agree on a package, the potential for using revenues to help reduce the deficit is effectively dead, as the sequestration process does not contain that option.
• If revenues are not included in the second round of deficit reduction, the cuts to entitlements will need to be that much deeper. To reach $1.2 trillion in cuts alone, the joint committee would have to make significant cuts to Medicaid, Medicare and possibly Social Security.

The Ugly

• While details such as final FY 2012 spending levels or what that second round of $1.2-1.5 trillion of deficit reduction would look like will not be known for months, it is apparent the size and scope of this deal is a game changer. But we do know this: the deal will reduce the amount of federal funding available for community-level aging programs at a time when our economy is still struggling and our nation’s population is rapidly aging.
• For the older adults and caregivers AAAs and Title VI programs serve, this will mean more people will face waiting lists for critical OAA services—such as home care, home-delivered meals and medical transportation—as well as less help with heating/cooling bills from LIHEAP, reduced availability of affordable senior housing, and similar strains to other federally funded community-level programs.
• If Medicaid cuts come to fruition, home and community-based services (HCBS) waivers are particularly vulnerable. If HCBS programs are reduced, older adults will have difficulty getting the supports they need to live in the community and may risk premature institutionalization. Not only is this detrimental to consumers, it also could turn back the clock on national efforts to rebalance Medicaid.
• If Medicaid cuts go as deep as is feared, nursing home–provided long-term care could no longer be considered an entitlement and older consumers could no longer have access to this vital safety net for long-term services and supports.
• The select committee can consider Medicare and Social Security as other sources of deficit reduction dollars. Reduced benefits or raised costs will place a burden on millions of older adults who rely upon these social insurance programs for economic and health security.

Caregiver Sign-Up Form(Click on the form twice to enlarge)

Latest Medicare Plan Proposes Shift of Eligibility Age to 67

Doorland Health
By Emily Mullin

In the ongoing debate over how to fix the country’s Medicare entitlement program – which is predicted to be insolvent by 2024 – lawmakers have introduced yet another plan to overhaul the program.

Senators Joe Lieberman, I-Conn., and Tom Coburn, R-Okla., proposed a plan June 28 that would alter Medicare funding and reduce the national debt.

The plan could save more than $600 billion over 10 years, based on estimates by the Congressional Budget Office, and up to an additional $100 billion in savings from implementing other provisions in the plan. But some are still skeptical of the impact the plan could have on seniors.

One of the more controversial proposals in the plan is to adjust the eligibility age for Medicare from 65 to 67 to reflect changes in average life expectancies. According to the Centers for Disease Control, when Medicare was passed in 1965, the average lifespan for Americans was 70.2. In 2006, the average lifespan for Americans was 77.7 – an increase of 10.6 percent. Lieberman and Coburn argue in their plan that increasing the eligibility age is consistent with the increase in the average lifespan in the U.S.

To read the entire article, please Click Here

WHO: Cell Phone Use Can Increase Possible Cancer Risk

(CNN) -- Radiation from cell phones can possibly cause cancer, according to the World Health Organization. The agency now lists mobile phone use in the same "carcinogenic hazard" category as lead, engine exhaust and chloroform.

Before its announcement Tuesday, WHO had assured consumers that no adverse health effects had been established.

A team of 31 scientists from 14 countries, including the United States, made the decision after reviewing peer-reviewed studies on cell phone safety. The team found enough evidence to categorize personal exposure as "possibly carcinogenic to humans."

What that means is they found some evidence of increase in glioma and acoustic neuroma brain cancer for mobile phone users, but have not been able to draw conclusions for other types of cancers.

"The biggest problem we have is that we know most environmental factors take several decades of exposure before we really see the consequences," said Dr. Keith Black, chairman of neurology at Cedars-Sinai Medical Center in Los Angeles.

"What microwave radiation does in most simplistic terms is similar to what happens to food in microwaves, essentially cooking the brain," Black said. "So in addition to leading to a development of cancer and tumors, there could be a whole host of other effects like cognitive memory function, since the memory temporal lobes are where we hold our cell phones."

To read entire article, Click Here".

Partnership for Patients: Better Care, Lower Costs

HealthCare.gov

Doctors, nurses and other health care providers in America work incredibly hard to deliver the best care possible to their patients. Unfortunately, an alarming number of patients are harmed by medical mistakes in the health care system and far too many die prematurely as a result.

The Obama Administration has launched the Partnership for Patients: Better Care, Lower Costs, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable, and less costly.

The two goals of this new partnership are to:

• Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.
• Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

Achieving these goals will save lives and prevent injuries to millions of Americans, and has the potential to save up to $35 billion dollars across the health care system, including up to $10 billion in Medicare savings, over the next three years. Over the next ten years, it could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings. This will help put our nation on the path toward a more sustainable health care system.

Building on Local and National Work to Improve Patient Safety

In 1999, the landmark Institute of Medicine study, “To Err is Human,” estimated that as many as 98,000 Americans die every year from preventable medical errors. Despite many successful efforts, this statistic has not improved much in the following decade. And many more patients get injured or sicker from preventable adverse events after being admitted to a hospital. After more than a decade of work to understand and address these problems, promising examples of better practices exist, but patients too often are still injured in the course of receiving care. There is much more work to be done to prevent unnecessary harm to patients.

• At any given time, about one in every 20 patients has an infection related to their hospital care.
• On average, one in seven Medicare beneficiaries is harmed in the course of their care, costing the government an estimated $4.4 billion every year.
• Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days – that’s approximately 2.6 million seniors at a cost of over $26 billion every year.

Consensus Recommendations for the 2011 Older Americans Act Reauthorization

General Recommendations

• Raise or increase the authorized funding for all titles of the OAA. Additionally, any new programs added to the Act should be given specific authorization levels. With the population of older individuals expected to grow exponentially in the coming years, the Aging Network faces incredible challenges associated with the influx of older individuals into OAA programs. The scope of the OAA is vast and expanding to cover additional populations while the investment in its mission has been severely, and consistently, underfunded.

• The Aging Network should be considered the focal point for aging related matters at all levels of government. Amend the OAA to explicitly recognize the principal role that State Agencies on Aging have in planning for the social and physical needs of older adults at the state level, and Area Agencies on Aging at the local level.

• Where possible in the OAA, lesbian, gay, bisexual and transgender older adults should be included as a vulnerable population with greatest social need as a result of a lifetime of bigotry, stigma and discrimination.

• The underserved, vulnerable communities of all racial and ethnic groups, as well as, lesbian, gay, bisexual and transgender older adults should be explicitly addressed in the OAA in ways that account for their unique family structures and collective experiences. Terms such as “adult care,” “family,” “family caregiver,” “spouse,” “underserved area,” “vulnerable elder,” and “family violence” should be defined to account for the variety of family and care structures of all racial and ethnic communities, and LGBT communities, which include partners and families of choices, as well as spouses and biological families.

• Where appropriate and practical in the OAA, data collection, project assessments and reporting requirements should ensure that racial groups, as well as lesbian, gay, bisexual and transgender older adults, are studied and appropriately served.

If you would like to read the entire Consensus Recommendations for the 2011 Older Americans Act Reauthorization, Please Click Here!

UMass Boston Study Examines why Elders in Home Care Switch to Nursing Homes

A new study released in February by the Gerontology Institute at the University of Massachusetts Boston with assistance from Al Norman, Mass Home Care, looked at why elders leave home care programs and transfer to nursing homes.

The study finds that many elders have made the switch because they lacked sufficient informal caregiver support, needed 24/7 care, were considered a safety risk, or had medical and functional problems that overwhelmed their caregivers.

Other key findings of the study, Massachusetts’ Home Care Programs and Reasons for Discharge into Nursing Homes, include:

• Doctors and hospitals account for very few referrals for home care services, 2.5 percent and 9.4 percent, respectively.
• Approximately 3,627 elders, or 14.5 percent of those leaving the program, were discharged to nursing homes during fiscal year 2010.
• Over a third of home care clients were taking nine or more medications.
• Twenty-nine percent of home care clients report problems with short-term memory.
• Seventy-five percent of home care clients are not physically able to shop, cook, or feed themselves.
• Eighty-five percent of home care clients do not have any advance medical directives, and 55 percent have no one designated to make health care decisions for them if they become incapacitated.

One of the goals of the study was to examine why home care clients go into nursing facilities, and what types of services could help them avoid entering institutions.

Nursing home patient days in Massachusetts have fallen by nearly 30 percent compared to year 2001. “Mass Home Care, which represents 30 home care agencies across the state, is seeking additional ways to develop services to fill in the ‘care gaps’ in the current range of community options,” said Mass Home Care Executive Director Al Norman.

The Gerontology Institute study included interviews with care managers conducted by gerontology students in the College of Public & Community Service, an analysis of aggregate data for over 42,000 consumers provided by Executive Office of Elder Affairs representing three different home care programs, and a review of journal notes kept by care managers for terminated clients.

According to Norman, who served as Community Partner for the study, “Our goal is to reduce the number of elders who leave home care heading for institutions. To do that we need to learn more about what they need and how we can provide it. This is the first study that really focuses on elders at the point of discharge from home care, and from these data, we will begin to develop better programs to keep elders aging in place. We can continue to spend tax dollars smarter by mastering this issue.”

View the full report at the Gerontology Institute website.

Letter of Intent

For Interested Parties Applying For A Grant

The Letter of Intent should be no more than 2-3 pages, and address the following:

1. Purpose of the program

2. Which of the priorities does the program address?

3. Estimate the amount of Title III funding you will be seeking.

4. Estimate the TOTAL amount of funding needed to run the program.

5. What other funding sources will be providing money to run the program?

6. How is the program intended to operate?

7. What service area/towns do you expect to serve?

8. A brief demonstration of the need for the targeted service(s).

Need can be demonstrated by reference to CMAA, local or existing program data** that shows an increase in demand or a high level of continuing demand for the service(s) the program intends to provide.

** appropriate data might include program service statistics, CMAA needs assessment data (e.g. http://www.seniorconnection.org/pdf/areaplan_06.pdf), needs data collected in specific local service areas, and other relevant sources.

Should you have further questions, please contact John Belding at CMAA.

Highlights - Profile of Older Americans: 2010

• The older population (65+) numbered 39.6 million in 2009, an increase of 4.3 million or 12.5% since 1999.
• The number of Americans aged 45-64 – who will reach 65 over the next two decades – increased by 26% during this decade.
• Over one in every eight, or 12.9%, of the population is an older American.
• Persons reaching age 65 have an average life expectancy of an additional 18.6 years (19.9 years for females and 17.2 years for males).
• Older women outnumber older men at 22.7 million older women to 16.8 million older men.
• In 2009, 19.9% of persons 65+ were minorities--8.3% were African-Americans.** Persons of Hispanic origin (who may be of any race) represented 7.0% of the older population. About 3.4% were Asian or Pacific Islander,** and less than 1% were American Indian or Native Alaskan.** In addition, 0.6% of persons 65+ identified themselves as being of two or more races.
• Older men were much more likely to be married than older women--72% of men vs. 42% of women (Figure 2). 42% older women in 2009 were widows.
• About 30% (11.3 million) of noninstitutionalized older persons live alone (8.3 million women, 3.0 million men).
• Half of older women (49%) age 75+ live alone.
• About 475,000 grandparents aged 65 or more had the primary responsibility for their grandchildren who lived with them.
• The population 65 and over will increase from 35 million in 2000 to 40 million in 2010 (a 15% increase) and then to 55 million in 2020 (a 36% increase for that decade).
• The 85+ population is projected to increase from 4.2 million in 2000 to 5.7 million in 2010 (a 36% increase) and then to 6.6 million in 2020 (a 15% increase for that decade).
• Minority populations are projected to increase from 5.7 million in 2000 (16.3% of the elderly population) to 8.0 million in 2010 (20.1% of the elderly) and then to 12.9 million in 2020 (23.6% of the elderly).
• The median income of older persons in 2009 was $25,877 for males and $15,282 for females. Median money income (after adjusting for inflation) of all households headed by older people rose 5.8% (statistically significant) from 2008 to 2009. Households containing families headed by persons 65+ reported a median income in 2009 of $43,702.
• The major sources of income as reported by older persons in 2008 were Social Security (reported by 87% of older persons), income from assets (reported by 54%), private pensions (reported by 28%), government employee pensions (reported by 14%), and earnings (reported by 25%).
• Social Security constituted 90% or more of the income received by 34% of beneficiaries in 2008 (21% of married couples and 43% of non-married beneficiaries).
• Almost 3.4 million elderly persons (8.9%) were below the poverty level in 2009. This poverty rate is statistically different from the poverty rate in 2008 (9.7%).
• About 11% (3.7 million) of older Medicare enrollees received personal care from a paid or unpaid sour

FY 2011 and FY 2012 Labor-HHS-Education and Other Appropriations As of February 14, 2011 (Dollars in thousands)

CLICK TWICE TO ENLARGE

5 Secrets Not To Keep From Your Cardiologist

1. If you are taking vitamins or supplements

   Alternative medicine and herbal remedies may be great for some to help manage chronic conditions, but cardiologists warn certain supplements can pose serious risks to people who are also taking medications for heart disease.

   From alfalfa to yohimbine, a study in the Journal of the American College of Cardiology lists more than two dozen herbal products patients with cardiovascular disease should avoid.

2. If you have undergone tests from other doctors

   Patients may sometimes be shy about admitting to their physician that they have received a second opinion or additional testing, says Dr. Richard Stein, a national spokesperson for the American Heart Association.

   "Your goal walking out is to get the best health care -- not to make the doctor feel good," he says. If you've had a blood test, EKG, echocardiogram or angiogram, Stein says to keep your own patient file and bring it with you to your appointment.

   "It's not fair to expect a doctor to understand the seriousness of your condition if they don't have all of the information."

3. If you have skipped your medications

   "Patients often lie about taking blood pressure or cholesterol medication," says Dr. Nieca Goldberg, director of the Women's Heart Program at New York University. She says sometimes they believe these drugs aren't necessary if they alter their diet. While that may be true in the long term, the effects of diet change are not as immediate, and the patient may be prolonging the problem.

   Goldberg also says another potential problem arises when your cardiologist reads blood pressure and checks your cholesterol levels and notices no change. "You don't want to accidentally be given a prescription for a higher dose, when you're not even taking the lower dose," she explains.

4. If you are going through hard times

   A patient says during the time of her first heart attack, she had been grappling with years of domestic violence and abuse, and she was at a breaking point.

   However, it wasn't until 2007, one year after having another stent implanted, when she finally brought this up to her doctor.

   "When you're under stress you have extra adrenaline that can stimulate the heart to skip beats and have palpitations," says Dr. Alfred Bove, past president of the American College of Cardiology.

   He says patients who have experienced some serious life trauma -- like a death, layoffs, divorce, or even just a stressful job -- may have elevated blood pressure and should be monitored more vigilantly.

5. If you haven't really stuck to your diet

   "Everyone wants to put their best foot forward, so it's easy to come in and say you've started an exercise program when it really didn't happen," says Goldberg. "But just saying you exercised doesn't improve your cardiovascular health."

   In fact, it could be harmful, says Stein.

   "If a patient tells me they don't have chest pains, but they are doing nothing in terms of physical activity, then I'm not getting an accurate picture of the shape their heart is really in," he explains. "I may want to do a stress test to see what really happens when you exercise."

The entire article can be read at www.CNN.com.

Some Highlights From the Governor’s 2012 Budget Submission

• The Governor’s budget level-funds most of the Elder Affairs line items at the level of the FY 2011 budget as it finally ended up after the restorations of federal matching funds (FMAP) and the supplemental budget.
• One notable exception, however, is the home care purchased services account (1630), which drops from $101.68 million to $96.781 million, a loss of $4.9 million (the FMAP restoration and supplemental funding was removed), or a drop of -4.8%. This line item is one of the more popular on Beacon Hill, and we hope to lift it back to at least the FY 2011 level.
• The Prescription Advantage program (1455) lost the most money: $9.88 million in funding. But EOEA indicates that current benefits levels in the program should be maintained, because more coverage under the donut hole is being picked up by the federal government. In FY12, the Prescription Advantage program will receive considerable cost relief from provisions in the Affordable Care Act (ACA). Despite a 31% (9.9m) decrease from FY11 funding levels, the FY11 Prescription Advantage Benefit design remains fully intact. There are no changes being made to the Prescription Advantage program.
• The protective services/elder abuse account is level funded at $15.25 million. Mass Home Care has made this elder abuse line item its top funding priority for the spring budget session. 53 new reports of elder abuse are received every day, and spending on child abuse and domestic violence is 31 times greater than elder abuse.
• The Enhance Community home care Program (ECOP) and care management accounts are also level-funded.
• The meals on wheels, supportive housing, Councils on Aging, and supportive housing line items are all level funded at 2011 levels.
• In the MassHealth accounts, the Adult Day Health programs are going to be restructured so that only “complex” clients are accepted into the program. This is a serious change that may require legislative advocacy to restore.

“In general, we appreciate the Governor’s commitment to home care for the elderly expressed in this budget,” Mass Home Care Executive Director Al Norman said. “We were braced for the worst---so we can live with these numbers.”

Administration Cuts $15.5 Million From Key MassHealth Elderly Services

Just hours before a major snowstorm hit the State, the Patrick Administration released a blizzard of cuts to MassHealth programs targeted to poor people and the elderly.

At a short meeting on the afternoon of January 11, 2011, the Patrick Administration announced a series of rate cuts in several key MassHealth programs. The rate reductions come with more than half the current fiscal year already over. A total of roughly $3.25 million will be cut from key programs in the remaining months of FY 2011, plus another $12.3 million will be cut from the FY 2012 budget as a result of rate cuts that will take effect on the Ides of March.

Here are the impacts of several of the major cutbacks announced.

Adults Foster Care: AFC is a program that provides daily assistance with personal care and case management oversight by the provider in caregivers home on a 24/7 basis. The proposed amendments decrease the payment rates for all adult foster care (AFC) services by 6.2% effective March 15, 2011.

• the proposed rate for AFC Level I services will decrease from $47.13 to $44.21
• the rate for AFC Level II services will decrease from $83.09 to $77.94
• the rate for Alternate Placement Level I services will decrease from $37.47 to $35.15
• the rate for Alternate Placement Level II services will decrease from $74.93 to $70.28
• the rate for Intake and Assessment services will decrease from $242.38 to $227.35

The Division of Health Care Policy and said it was proposing these amendments “to ensure that the payment rates are consistent with efficiency, economy, and quality of care, while maintaining access to services.” DHCFP estimates that the AFC rate cuts will result in aggregate annual expenditure reductions in FY 2012 by MassHealth of approximately $4 million or 6.2% as a result of this proposal. Since the cuts begin on March 15th, they will be in effect for three and a half months in FY 2011, and will reduce payments to AFC providers by $1 million this fiscal year.

In May of 2008, when the Patrick Administration proposed cutbacks in AFC rates, Mass Home Care testified against the rate cuts. “The fact remains,” Mass Home Care said, “that at the end of the day, the core of this program---the caregivers---are making $9,281 per year for level I, and $18,137 per year for level II. When caregivers apply for this program, it will not take them long to calculate these annual rates.” Mass Home Care said two things were certain: “These caregivers are enormously undervalued compared with people doing similar work in state agencies, and the new rates will not be enough to attract the caregivers needed to expand this program, and the ultimate losers from this situation will be the state’s taxpayers, who will foot the bill for more costly placements.”

Mass Home Care concluded in 2008: “Adult Foster Care holds the promise of becoming one of the critical growth programs under Governor Patrick’s “Community First” initiative. Yet today, this program is still largely unknown, and marginally utilized. AFC will become more important because it is a 24/7 residential alternative, and as such, is highly targeted towards those who are in need of significant personal assistance. The level II program in fact, is targeted to those who would otherwise need expensive institutional care. However, if this program continues to remain obscure, with rates that do not reflect the level of care and attention required by its clients, then the Commonwealth will lose the opportunity to keep people in the least restrictive setting, and pay the price for that loss.”

Adult Day Health: ADH is a community based day program providing nursing and therapeutic services and oversight for members in an effort to postpone nursing facility placement. Services provided include nursing, therapy, nutrition, dietary counseling, case management, activities, and assistance with activities of daily living. The proposed amendments decrease the payment rates effective March 15, 2011 for adult day health (ADH) services by an average of 7.8%. The proposed rate for Basic ADH services will decrease from $53.93 to $49.98 per day (7.3%); the rate for Complex ADH services will decrease from $68.68 to $62.95 per day (8.3%); and the rate for Health Promotion and Prevention (HPP) services will decrease from $27.86 to $25.69 per day (7.8%). Rates for ADH services are calculated based upon the median of industry unit costs as reported by ADH providers, to which efficiency standards for productivity and administrative costs, and a cost adjustment factor are applied. The proposed rates for Basic and Complex ADH services are based on 2009 reported costs. The proposed rate for HPP services decreases the current rate by 7.8%.

The Division estimates that aggregate annual expenditures by MassHealth in FY 2012 for ADH will decrease by approximately $3.32 million or 7.49 % as a result of this proposal. Because these rate cuts will take effect for 3.5 months in FY 2011, the cuts are projected to save roughly $968,000 in the current fiscal year. In October of 2009, Mass Home Care testified before DHCFP against cuts in Adult Day Health rates. “ADH is helping almost 7,000 individuals to remain living in the community,” Mass Home Care said, “saving state and federal taxpayers millions of dollars annually. If 7,000 people had to be institutionalized due to lack of ADH services, the cost would be roughly $408.8 million annually. The entire spending for the ADH program for FY 2009 is $90.49 million (including transportation). It is clearly more cost effective to keep people in the community, even when you combine ADH with other in-home supports that these individuals may be receiving.”

Group Adult Foster Care: GAFC is a program providing daily assistance with personal care services and case management oversight by the provider in an elderly/disabled housing complex, or Assisted Living Residence. Because this program does not operate with a set of regulations, it does not have to go through the same public hearing, rate setting process. The Administration has proposed cutting GAFC rates by 7.6%, which will reduce program expenditures in the remaining months of FY 2011 by $1.25 million, and cut FY 2012 expenses by $5 million.

In addition to these listed services, the Administration has proposed cuts to MassHealth dental services, day habilitation, and other services targeted to low-income people.

“Cutting community based services for the elderly is fiscally wrong-headed,” said Mass Home Care Executive Director Al Norman. “Day care and foster care programs keep seniors out of more expensive institutions. At a time when revenues are limited, it makes sense to invest in programs that save taxpayer’s money. As budget strategy, these cuts are inexplicable. On a human level, these cuts are indefensible.”

U.S. Alters Rule on Paying for End-of-Life Planning

By ROBERT PEAR

New York Times,
January 4, 2011

Entire Article Can Be Read Here!

WASHINGTON - The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.

The move is an abrupt shift, coming just days after the new policy took effect on Jan. 1.

Many doctors and providers of hospice care had praised the regulation, which listed "advance care planning" as one of the services that could be offered in the "annual wellness visit" for Medicare beneficiaries.

While administration officials cited procedural reasons for changing the rule, it was clear that political concerns were also a factor. The renewed debate over advance care planning threatened to become a distraction to administration officials who were gearing up to defend the health law against attack by the new Republican majority in the House.

In a recently published article by Arthur Caplan, Ph.D, msnbc.com contributor, 'Death panels' alive - and that's good news for all of us, he says, ...Washington, D.C., is not the place to talk about end-of-life care - your doctor's office is.

Death Panels' Alive — And That's Good News For All Of Us!

Washington is not the place to talk about end-of-life care — your doctor’s office is
By Arthur Caplan, Ph.D. msnbc.com contributor

Watch out! The "death panels" are back. They are going to be used by Obama and his horde of federal health reformers to make sure that if you are old, very sick and go into a hospital, you will never return. So goes the line of utter malarkey put forward with a straight face and Twitter finger last year by Sarah Palin, who notoriously and ridiculously coined the term "death panels" to vilify efforts to legislate paying doctors to talk with Medicare patients about their health care options if they become terminally ill. Her critique worked. The provision to pay doctors for the time involved to talk about end-of-life care for older Americans was dropped from the health reform bill.

But it has come back, this time in the form of regulations to be issued on Jan. 1 by the Department of Health and Human Services. If an elderly person is offered a chance to do advance care planning by their doctor and wants to do so, then Medicare will pay the doctor for the time involved.

Some conservatives and right-to-lifers see rationing afoot. They think encouraging these discussions is simply a way to get old folks to save the federal government money by slyly tricking them into saying that they don’t want a lot of medical care if they are terminally ill. Not only are they wrong, they are dead wrong. Talking with your doctor about what you want to happen and who you want to make decisions for you if you become terminally ill is something every American, young and old, should do.

If you want aggressive care to the very end then you need to say so. If you don’t want to be kept alive with technology should you have a deadly cancer that does not respond to treatment then you need to let your doctor and your family know.

Story: Obama enacts end-of-life plan that drew 'death panel' claims

Few people are comfortable with the topic of death. Some, like Sarah Palin, seem to think that if they pull the covers over their head the Grim Reaper will go away. Not so. Each of us will face end-of-life decisions if not for ourselves then for our family or friends.

Anything, including Medicare money, that can encourage doctors, many of whom do not want to have this conversation with their reluctant patients, to do so is a sound, moral and prudent policy.

No one is telling you what you must say. No regulation says that you cannot insist that everything possible be done. No bureaucrat is whispering in your doctor’s ear to spin the conversation toward insuring your premature demise.

You can change your mind at any time about your views and wishes including during your time in a hospital, nursing home or hospice. Nothing is locked in stone by having this initial conversation about what you want and who you want to make decisions for you if you cannot do so.

If Terri Schiavo taught us anything, it was that you need to specify to your doctor and family who should make decisions for you about your medical care if you are unable to communicate.

If the political conversation over death panels and advance care planning has taught us anything, it is that Washington, D.C., is not the place to talk about end-of-life care — your doctor’s office is.

Article courtesy of MSNBC, contributed by By Arthur Caplan, Ph.D.