Affordable Care Act, Medicare, and Seniors
Many Americans are still very confused by the regulations associated with the Affordable Care Act. Adding to this confusion is the initial glitches associated with HealthCare.org, the federal health insurance website, and scammers looking to benefit from individuals’ lack of comprehension pertaining to the new policy. Unfortunately, with so many changes being made to Medicare, seniors are particularly susceptible to fraud.
How the Affordable Care Act Impacts Medicare Patients
The first thing for seniors to know is that the Affordable Care Act, also known as “Obamacare,” does not directly affect Medicare. Those enrolled in Medicare don’t have to replace their Medicare coverage with Marketplace coverage. No matter how Medicare coverage is obtained, whether through Original Medicare or a Medicare Advantage Plan, seniors will still have the same benefits they have now. That means, patients of Liberty HomeCare & Hospice that utilize Medicare to cover the cost of their home health care services or hospice services will still receive the same great care they have come to expect.
Watch Out for Scams
Another scam that has been utilized is people claiming to be a Medicare representative who needs to update the senior’s information because of the new legislation or send them their new “Obamacare insurance card.” Seniors should be suspicious of these types of inquiries. There is no card associated with the Affordable Care Act, and the federal government rarely calls Medicare recipients regarding their coverage. If updates need to be made to a Medicare account, the federal government typically sends an official letter requesting that an individual contact them directly.
Know the Facts
The best way to ward off scammers is to become knowledgeable on how the Affordable Care Act impacts Medicare and what it requires. Additionally, seniors should be wary of any unsolicited calls, emails, or direct mail marketing from so-called government agencies or pushy insurance salesman. It's important to never ever give personal information, including a Medicare insurance number to someone that makes direct contact via phone. If you do receive a call, ask to call back and confirm the phone number or website is accurate.
There is a lot of uncertainty associated with the Affordable Care Act and it’s important that our seniors remain safe from fraud.
Liberty Social Workers of Lee County
March is National Social Worker Month
While many of us may not know that March is National Social Work Month, chances are great that our lives have been touched by the work that social workers do. Governor McCrory has proclaimed March 2015 as national social work recognition month for the state of North Carolina. Social workers serve in our local schools, in our Hospice, hospitals, and nursing facilities, as well as other local government and community settings.
Liberty HomeCare & Hospice in Lee County
At Liberty HomeCare & Hospice in Lee County, it is a privilege to be served by an incredible team of social workers: Patricia, Wendy, Nicole ,and Shenora. They advocate for patients and their families facing challenges and choices for end-of-life decisions, concerns, and healthcare needs. No concern or question is too minor. When the weather was cold and space heaters rare, they found one to give to a family in need. We are humbled by our Liberty Home Care & Hospice social workers and their willingness to meet with clients, at any time of the day and night. Indeed, they are dedicated to the needs of the patient and family. Liberty Hospice social workers are experts and professionals in their vocation, and their care for our patients is vital to our goal of providing quality care, dignity, and respect to patients’ lives.
Lee County is healthier because our social workers are on the job. Regardless of their specific fields, social workers are an important link between people and necessary services. In any setting, social work is a high calling, and we should hold social workers in high regard. While the month of March provides us an occasion to recognize their great work, these tireless advocates for the care of their clients deserve to be recognized and appreciated all year long.
Robin Saenz
Liberty HomeCare & Hospice
Hospice Volunteer Coordinator
February Is Patient Appreciation Month!
Patient Appreciation Month
Liberty Hospice of Pinehurst recognizes patient appreciation the month of February. Each of their staff members deliver red roses to their patients and families. As reported in The Aberdeen Times, Liberty Hospice expresses their appreciation for their patients and the joy it is to work with each of them by making special deliveries to each patient with beautiful, red roses.
Meet Mittie Williamson
Mittie Williamson is a 100 year old Liberty Hospice patient who is an absolute joy to care for. Mittie’s nurse reported that a beautiful smile appeared on Mittie’s face when she received the rose as she stated “these roses are so pretty!” Mittie was dressed to the occasion in her beautiful red sweater! Like all of Liberty Hospice patients, Mittie brings great joy and reward to the staff upon each visit that is made with her. Mariah Turner, Volunteer Coordinator and Bereavement Coordinator for Liberty Hospice in Southern Pines says, “We had very rewarding reactions from all of our patients which made it even more special for all of us.” These are the moments that matter to Liberty!
Talk About Your Five Wishes
Do you know who will speak for you if you can no longer speak for yourself? A loved one? A stranger? A nurse? Do you know when you will need someone to speak for you because you cannot speak for yourself? None of us really do- it could be a sudden stroke, a traumatic accident, head injury or end of life disease which causes this to occur.
You can speak up for yourself with a simple document; the Five Wishes.
Five Wishes lets your family and doctors know:
- Who you want to make health care decisions for you when you can’t make them.
- The kind of medical treatment you want or don’t want.
- How comfortable you want to be.
- How you want people to treat you.
- What you want your loved ones to know.
Why Bother with a Healthcare Power of Attorney or Living Will like the Five Wishes?
Living wills such as Five wishes is an endowing gift which allows individuals to speak out for themselves and help their family have peace of mind when the end of life decisions are necessary. Living Wills such as the Five Wishes take the burden of hard decisions off the shoulders of family members, spouses, adult children, and other loved ones, by stating the exact wish of the individual near or long prior to the end of life. Everyone can easily provide this loving gift to others at any age above 18 and at any time in life. The only requirements are a desire to speak for yourself, being competent to sign, and complete a legal document, and have someone you trust who can speak as your power of attorney should the need arise.
Who Can Help Fill Out the Form?
Liberty chaplains, social workers and staff have assisted patients and individuals in filling out the Five Wishes documents and have shared with multiple families. One patient was assisted by our Liberty Hospice social worker to complete her Five Wishes. The patient was 55 years old with 3 adult children. The patient requested the social worker to leave three additional five wishes booklets with her as well. That night at the dinner table, our patient, in her “matter of fact” way, informed her children that she wished to be cremated with no heroic actions at her time of death. After a brief pause, the children laughed at their mom’s usual less than tactful discourse and light-heartedness and began the conversation for end of life choices. The family read the five wishes together and discussed their wishes with their mom around a familiar and comfortable dinner table filled with care and love. Our patient enjoyed telling the social worker the family’s story at the next visit.
Not all families are comfortable with this kind of discussion or very little discussion at all at times. When our hospice chaplain approached his 72 year old male patient with making life decisions, he was glad to talk with the chaplain and completed the Five Wishes. This patient seldom conversed well with his family and making this plan was no exception. The Five Wishes document was on file if the need arose for decisions to be made. The need did not arise; until the patient’s funeral.
One of the wishes is: “What you want your loved ones to know.” At the funeral, our chaplain read what the patient had written in his last wish in the patient’s own words. “I want my family to know I am sorry. I was harsh or seemed uncaring. I love each of you with all I am. It has been difficult for me to express myself all my life…” The Five Wishes that day touched hearts needing healing.
Indeed, it is everyone’s right to speak for themselves and be cared for and treated with dignity and respect to their desires. To help assist our patients and their loved ones, Liberty Home Care and Hospice staff provides information packets and educates families and community on how to complete the process of the Five Wishes living will and health care power of attorney. Last week, our sister company, Brightmore of Wilmington, posted a news article, Five Wishes, about a presentation made to their residents by members of our Hospice office in Wilmington. Kelley Wheat-Rivers, Liberty Hospice Chaplain and Teresa Hall, Liberty Hospice Volunteer Coordinator, started the conversation with the residents at Brightmore of Wilmington and provided the information that they would need to continue that conversation with their loved ones. This uncomfortable discussion is made simpler in an easy to understand and personalized way.
We want to spread the opportunity to allow everyone to give a gift that gives reassurance and comfort to those you love. Contact any hospice staff member for a personal copy or to set up a presentation in your facility for staff or families. There is no fee for this service or copy of the Five Wishes from Liberty Home Care and Hospice. Our gift to you is to be a gift to those you care about.
Chipping Away at Home Care Funding Hurts Everyone
Home care can help relieve some of the rising costs of health care. However, the approach that has been used in recent years is not the proper solution.
Proposed Rule Impacts Home Health Services
The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule that would trigger a 14 percent reduction in payment rates for vital home health services. This huge cut comes on top of the 14 percent rate cuts to Liberty HomeCare & Hospice since 2008. Indeed, this would leave providers across the county with an average margin of -9.77 percent by 2017. The overreaching proposed rate cuts will result in payments far below the cost of services, thereby jeopardizing care to homebound elderly and disabled Medicare beneficiaries.
The National Association of Home Care and Hospice has identified that under the CMS proposal, in the first year alone nearly 50 percent of home health agencies will be paid less than the costs of care. By 2017, over 70 percent of providers will be paid less than cost.
Cutting reimbursements can have dramatic and dangerous effects for patients. It will affect the care they receive and even determine whether or not they receive home care at all. To compound the reductions to home health agencies, there is also a recommendation that the care will also increase the cost to home care patients. President Obama has recommended that the cost of home care be passed on to the patient, beginning with a $100 co-pay in 2017.
Reduction for Home Care Funding Harms Patients
That could greatly affect patient care. A study in the New England Journal of Medicine found that seniors who faced higher copays for office visits had fewer office visits but more, and longer, hospitalizations. This strategy makes no sense, especially when home care itself can both benefit patients and reduce the rising costs of health care.
Over the past several years, there have been significant regulatory increases in costs to home health agencies. Instead of cutting reimbursements and implementing co-pays, Medicare should encourage more patients to receive home care. Home care helps patients heal faster, in the environment they prefer, and is also a proven way to reduce costly hospital readmissions.
Six straight years of cuts exemplifies the continuing of a misguided policy that is not serving the best interests of patients. They deserve better.
Investing in Hospice Care Is the Right Choice for Everyone
The Centers for Medicare and Medicaid Services announced on April 29 that the 2014 hospice reimbursement rate would include an “increase of 1.1 percent.” The CMS announced the proposed “increase” because it cited the fact that spending on hospice services has increased 500 percent since 2000.
That sounds like great news and is fiscally sound, but a closer examination of the numbers reveals the real truth. The current sequester has already mandated a 2 percent decrease in all Medicare reimbursement across the board. That means that the actual reimbursement for hospice would decrease by almost 1 percent year over year. Indeed, this is well below the actual increase in the direct cost of doing business next year. It is that kind of “fuzzy math” that has plagued the CMS and has put providers in a vulnerable position and ultimately put the care at risk.
Cutting the reimbursement rate for hospice does not reduce the overall costs for healthcare. CMS has been promoting Hospice for terminally ill patients for well over a decade. There should be no surprise that this strategy has resulted in more hospice care being provided throughout the country and it has also significantly improved outcomes and cost savings overall to Medicare.
Benefits of Hospice Care
New research published in March by Mount Sinai found that hospice enrollment saves money for Medicare and reduces emergency room stays and hospital readmissions. In that research, providers saved Medicare between $2,500 and $6,000 per patient depending on when the patient begins hospice care. That can more than offset any increase in the hospice reimbursement rate.
Patients need hospice care, because of the positive impact it has for end-of-life care as well as its impact for caregivers. Quality of life is improved, patients actually live longer than those who don’t receive hospice care, and caregivers have also seen tangible benefits. Our patients and their caregivers have given testimonials about how much hospice care has helped them.
This is not the time to manipulate numbers, and in turn, manipulate the end results for patients. Hospice care needs a stronger investment from the CMS, because that investment will pay the most dividends for all.
Rural Doctors Need More Support than Ever
National Doctor's Day
National Doctor’s Day is celebrated annually March 30th. This is a great time to remember the value of physicians throughout North Carolina, South Carolina, and Virginia. Doctors throughout our coverage area provide countless valuable services, and do all they can to help patients get better.
Rural Doctors Face Challenges Too
But many of those doctors face challenges that need to be addressed soon. For rural doctors, an individual practice can be “just not sustainable,” due to the increased paperwork, decreased reimbursement, and surge in workload. A study by the U.S. Department of Health and Human Services illustrates that 20 percent of the American population live in a rural area, but only 10 percent of physicians work there.
That creates difficult decisions for those physicians. They typically see more patients than urban doctors, but often can’t spend as much time per patient. With reduced staff, they must do much of the mounting paperwork themselves and face long hours. Add in the declining reimbursement rates for insurances, such as Medicare and the problem will continue to grow.
Recent efforts to grow the number of rural doctors have failed, a recent study in Health Affairs revealed. There are programs in place, similar to the Kansas Bridging Plan, a loan forgiveness program for doctors who agree to practice for three years in rural areas. In North Carolina, rural doctors can receive some loan forgiveness or even a service bonus of $50,000 for a 4-year commitment in high needs areas.
There needs to be more done. Rural doctors need higher reimbursement rates from insurance companies, and other measures are also on the table. Rural doctors must be appreciated through the long-term and not just on National Doctor’s Day. Providing an incentive for them is not only an investment in their practice, it is an investment for all who live in those areas.
Simple Gestures Make Major Impacts for Hospice Patients
National Patient Recognition Week
Liberty Hospice recently celebrated National Patient Recognition Week by handing out roses to all of its patients. It has become a tradition for us, and to see the smiles and gratitude that patients and their families express reminds us what an impact a small gesture can do.
That’s a good reminder for anyone who has a loved one in hospice care. Any kind of gesture can make a big impact. We have helped coordinate other kinds of surprises for our hospice patients, from a puppy to a shopping trip, to a ride on a horse. Those moments have helped rekindle a favorite memory, while at the same time creating a new one.
Many people don’t know where to start, but sometimes the best gesture you can do for a loved one occurs even before hospice care begins. By talking to your loved one about hospice care, and its many benefits, you can build a valuable communication that can educate them, as well as yourself, on what is right for your family. If you’re not sure how to start that conversation, feel free to contact us to learn how to explore the conversation.
Honor Patients
Once your loved one begins hospice care, there are many different ways to honor them. Our staff is always looking for ways to help. Our chaplains may sing with them, or our volunteers may help them write a story. There are many ways we honor our hospice patients, but many times, the involvement of a family member makes those events even more meaningful. Sometimes, just seeing a family member is just as impactful for the patient.
You may not believe you are prepared for such visits, but our volunteers, social workers, and other staff can counsel you through it all. We understand there are new, difficult emotions that come with hospice care. We also realize how hospice care improves the quality of life for patients and for their families too. Let us help you get started.
How Home Care and Hospice Can Make a Difference
News headlines have been splashed recently with terms, such as “fiscal cliff” and “debt ceiling.” Congress has been negotiating for months on ways to reduce spending while also still providing the best services to their constituents. In many instances, finding those solutions can be incredibly challenging. However, there is one obvious step to help alleviate the some of the rising costs of healthcare, while still providing top-notch service - home care and hospice.
Positive Impact of Home Care and Hospice
Home care and hospice are both proven ways to help reduce costs. A recent study showed that when used as the first post-acute setting after a hip fracture, home care saved Medicare an average of more than $5,000 per patient. Home care can also help reduce costs through lowering rehospitalization rates and improved chronic care management, as the Alliance for Home Health Quality and Innovation demonstrated in this video in November.
Hospice care can also reduce costs. A recent Duke study stated that hospice care reduced spending by more than $2,300 per patient compared to normal care, which typically included costly hospitalizations near death.
Improve Your Loved One's Quality of Life
Most importantly, both home care and hospice care improve quality of life while providing cost benefits. The overwhelming majority of patients prefer to receive treatment in their own homes, and both home care and hospice care allow that for patients. Studies have shown that hospice patients live longer than other patients in similar conditions. Furthermore, home care patients recover faster than similar patients.
These two vital care choices should be more receptive to new patients and not more restrictive. Ending costly rehospitalizations through home care and expensive hospital stays at the end-of-life should be a primary focus of how to reduce costs in healthcare. By utilizing home care and hospice services to a wider group of patients, we can look past “cliffs” and “ceilings” and optimistically consider a large potential of savings, all at great benefits to patients.
Exploring a Challenging Conversation
Educating patients and their loved ones about hospice care, and how it can boost quality of life, is one of our goals at Liberty HomeCare & Hospice Services. Hospice care is not an easy topic to address. After all, many patients feel like they are giving up, or fear that end-of-life conversations may create anxiety or added stress for loved ones.
Tips for Starting the Conversation about Hospice
End of life conversations can be difficult to address, but understanding the rewards from the quality of life that follow can help make starting those conversations a little easier. Most people prefer to have their end-of-life care at home, and those at the end of life typically live longer under hospice care than without it. Determining that care, and what tactics will be used in a patient’s final days, can create peace of mind and alleviate some of the stress that inevitably comes when a family member’s condition worsens.
Start the Conversation Early
It’s also important to start talking about end of life as early as possible. Indeed, this gives loved ones the best opportunity to express their wishes before there may be a time when they are no longer able to speak on their own behalf.
How do you start the conversation?
Consider these tips below to start the dialogue with a patient’s doctor, which may be easier than starting that conversation with a loved one. These tips includes questions to address and valuable links to make the conversation a little easier. It discusses questions about advance directives, medical treatments, and other preferences that a patient may have.
The following questions can help you determine what’s right for you as you begin end-of-life care conversations with your doctor:
- When it is your time to die, where you like to be, and with whom?
- If your preference is to die at home, what would you need to make that happen? Who would be your caregiver?
- How do you feel about depending on others at the end of life?
- Do you want to know if you have a terminal illness? Do you want others to know? Why or why not?
- What do you think a physician’s role should be in discussing end-of-life issues?
- What are your greatest fears about end of life? What would help reduce those fears?
- If faced with a terminal illness, what would be most important to you? What would it mean to live well for however much time you have left?
- Do you have an advance directive (i.e., a living will or power of attorney for healthcare)? Do you know how to get one? Do you know how, and when to update your advance directives?
- How do you think you would react if your doctor tried to discuss end-of-life care options with you? Would you feel your doctor wasn’t doing everything possible to cure your illness and save your life?
- If it was determined that you were terminally ill and could no longer eat and drink on your own, would you want artificial nutrition and hydration (e.g., a feeding tube and intravenous fluids)?
- If you could no longer breathe on your own, would you want to be hooked up to an artificial breathing device (a medical ventilator)?
- Do you feel comfortable talking to your physician about end-of-life issues?
- Have you had the conversation about your end-of-life wishes with your family members and healthcare providers? If not, are you going to discuss these matters with them, and if so, when?
- What do you know about hospice? How did you learn about it? What experience have you had with hospice?
- Do you know what hospice services are available to you?
For more information about initiating end-of-life conversations, visit http://www.considertheconversation.org/.
Creating a clear plan of action will help families make the most of the remaining time they have with a loved one.
That’s what end of life care is about: increasing the quality of life for all involved.