Archive for August, 2010

Are You Getting the Long-Term Care Training You Need?

Long-term care training is crucial now more than ever before. With the OIG and CMS zeroing in on long-term care facilities, you and your staff need to take extra care in getting the training that can mean avoiding fraud, abuse and Stark law problems.

Long-term care training — specifically in how to prepare for an OIG or CMS compliance audit — should be your top priority right now. CMS and the OIG are getting generous funding to enhance their Medicare and Medicaid enforcement efforts, with a main focus on long-term care facilities.

Watch Your Quality of Care, Medication Policies

Among the most common long-term care targets are quality-of-care issues, deals with medical directors and suppliers, and medication policies. The OIG and CMS are directing a critical eye toward Stark law violations in long-term care settings. Your long-term care training should focus on these issues, plus the crucial step of creating and properly using a compliance committee.
Of special concern for federal investigators is any deals or contracts you might have with medical directors, doctors and suppliers. You’ll need make aggressive efforts to unwind or modify these problematic deals — before they send up red flags.

What FY 2010 Has in Store for SNF PPS

Your long-term care training should also encompass coding, billing and related compliance issues. Medicare’s final rule on the Prospective Payment System (PPS) for Skilled Nursing Facilities (SNFs) has a plethora of changes in store for your coding and billing.
When planning your long-term care training on these coding, billing and compliance issues, keep in mind these major changes to the SNF PPS:

The RUG IV system will replace the current RUG III system; FY 2010 payment rates will include a 2.1-percent market basket increase, but the adjustments will result in a negative rate update worth hundreds of millions of dollars; MDS 3.0 will be implemented; and The ADL scoring range will change to 0 to 16 instead of 4 to 18.

Incorporate these major issues with your fraud, abuse and Stark law education in your long-term care training to keep your facility out of trouble and running smoothly.

How Long Will You Have to Pay Long-Term Care Insurance Premiums?

No one likes to pay insurance premiums of any kind and long-term care insurance is no exception. We pay these premiums because the alternative leaves our investment assets and retirement income exposed to high risk if long-term care becomes necessary and we have to pay for the care ourselves. It is no secret that the cost of nursing facility care can quickly drain a retirement nest egg and force a retiree into financial ruin. By purchasing long-term care insurance, a policyholder is accepting a small loss each year in the form of premiums paid. This relatively small loss helps ensure that he or she will not be wiped out financially by unmanageable long-term care costs in the future. Choices for Premium Payment Periods People who are unfamiliar with long-term care insurance often wonder how long the premiums will need to be paid. The answer is that there are three choices for the premium payment period usually offered by insurance carriers. The most popular choice by far is a “lifetime” payment period that requires the payment of premiums until death or until the policy is activated. Some object to paying these premiums for such a long period of time. In response to that objection I usually ask prospective clients to consider other forms of insurance that they most likely own. For instance, would they expect to only pay premiums for health or major medical insurance for a short time, or do they plan on paying those premiums for life? Wouldn’t they expect to pay auto insurance premiums for as long as they drive? Isn’t it reasonable to pay homeowners insurance premiums for as long as they own a home? As long as the financial risk is present, the payment of insurance premiums is prudent. Since the risk of needing long-term care is present for as long as we live, the premiums for long-term care insurance can be expected for the remainder of our life. Shorter Premium Payment Periods Equal Higher Premiums The second and third options for payment of long-term care premiums allow the policyholder to condense all of those expected premium payments into a shorter time period. For those under fifty-five years of age, a “pay to age sixty-five” option may make sense. For others a “ten-year pay” option may be a good choice. Because the expected premium payments over a lifetime are simply condensed into a shorter timeframe, the cost of these premiums is much higher. Therefore, these options usually make sense for policyholders who can take advantage of tax deductions that help them reduce the overall cost of their long-term care insurance.

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Benefits Of Having A Living Trust

If you’re thinking about setting up a living trust, here are some of the advantages. Your own personal set of circumstances will determine if any of these advantages actually applies to your own situation.

Avoiding Probate

This is considered the most important advantage of the living trust, to keep your estate out of probate upon your death. Having your assets already in a trust will save your heirs the time and expense of probate. You can only gain this benefit for assets placed in the trust while you are still living.

Save Money

Up front, it will cost you more money to prepare a living trust than to have a simple will drawn up. However, if the trust is funded during your lifetime, the cost savings could be dramatic after you pass away and your heirs do not have to probate your any assets in your living trust.  But the question is whether or not it will cost more to use a living trust when compared to probate after your death. The more assets you have, the more likely it is that a trust will be the most cost-effective move for you.

Asset Management

If you are unable to manage your affairs, due to an accident or other emergency, your assets can be handled by the trustee. This even applies after death, since the trustee has already been established. You (or your heirs) can avoid guardianship proceedings.

Privacy

One advantage that many aren’t aware of is that a living trust can help shield your assets from creditors or unhappy heirs. The trust makes it difficult for anyone to challenge how you distribute your estate.

Flexibility

Unlike a regular testamentary trust created as part of a will, you have more flexibility with a living trust. A normal trust created as part of a will generally cannot be changed without all the hassle and expense of drafting an entirely new will.  A living trust, on the other hand, is separate from the will, and can be changed more easily and with fewer formalities.

Disinherit a Relative

If you are distributing your assets in way that may not be acceptable to certain family members, a living trust is more private than a will and makes it far more difficult for disgruntled relatives to challenge your decisions.

Operates Before Your Death

Being able to create and manage your trust while you are still living is a huge advantage. You can change the beneficiaries or the trustees, or rearrange your assets to work better for you.

Taxes

One final word about taxes. A living trust, in and of itself, will not provide any tax advantage as compared to a regular testamentary trust would, so that isn’t really a benefit from using a living trust.

I would like to thank Annie Tyler, of Affordable Living Trusts in Saratoga, for taking the time out to provide us with some valuable information on Living Trusts and their application as a security measure and for a piece of mind should an unfortunate event happen. Some of the things Annie reviews are: – What is a Living Trust and how does it work – What’s in a Living Trust package – Living Trusts Roles and Terminology – How do I get started – … and many other things If you have any questions, or may be interested in starting a living trust, give Annie a call (408) 741-1627. You can also visit their Living Trust Workshop page to attend their next session. I have attended this session and is informative and allows you to ask the important questions you may have. There is no cost for attending, just call (408) 741-1627.
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Long Term Care Insurance

Long term care insurance is sold in United Stated and United Kingdom, rarely sold in rest of countries. It’s not only protects individuals but also his loved ones, in the event of that extended health care is required in the future. In short, it helps to provide the cost for long term care. It is the best option for the middle income earners.

Buying a long term care insurance is in mind of many peoples, in particular those very close to retiring and need extra cover in their life. Another fact is that the people buy to take care of loved ones over a longer period of time. Age is not determining factor, but people in good health purchasing long term care insurance at the age of 55 years can get better deal.

Most of people assume that health insurance will pay their long term care cost. But it is valid for limited period of time and cover limited scenarios. The policy covers the individuals who are not able to perform the basic activities of life due to chronic illness, injury, disability. It includes bathing, eating, dressing, walking, etc. Long term care insurance is the only way of helping to pay for these expenses.

Generally, long term care insurance cover home care, hospital care, adult care, nursing home care and Alzheimer’s diseases. Many people feels uncomfortable to keep a support for their family and children’s long term care insurance is a better to cover out of pocket expenses.

Talking about the premium, it is considerably higher and depends upon insured’s age, health status and desired benefits from the policy. The premium paid for a long term care insurance may be eligible for tax deduction. Many insurance companies are in the market to do their business, so available long term care insurance policies are in different rates and discounts. Just doing some work you can choose precisely, and at the lowest possible cost.

These videos, developed specifically by and for long-term care professionals, demonstrate essential skills related to ten vital inservice topics. Each 8-10 minute video, set in an actual long-term care facility, features the most up-to-date training available. You can buy each of the 10 videos separately, or together as a complete inservice training program. For more information, visit hcmarketplace.com

Senior Citizen & Alzheimers Disease

For us over 65 it can be a common occurrence to forget where you put the missing keys or even forget a long time friend’s name. As we get older in our life, we sometimes worry if these common occurrences can be the first signs of Alzheimer’s disease or if it is just the natural process of aging. You must know what Alzheimer’s is before you can make a determination as to your concerns.

What is Alzheimer’s? Well Alzheimers is the slow process of losing ones memory. One who has Alzheimer’s will gradually become unable to perform routine everyday household tasks and errands. The disease will also affect ones ability to learn new things. Someone with this disease can also expect to eventually lose their loss of language skills, and as we sometimes see on the local news channel those with Alzheimer’s may sometimes get lost in the mall or at the beach due to the loss of their judgment and decision making skills.

To put it in its simplest terms, Alzheimers is a disease that affects the mind. If you have reason to believe that you may have Alzheimer’s you will want to see your Physician to discuss treatments. Now some good effective treatments will slow down the disease and help to make life much easier. Below we will discuss some possible red flags that may be symptoms to Alzheimer’s.

Red Flag: At work, do you find yourself forgetting your basic responsibilities and tasks, as this could be an indicator of the early signs of Alzheimers. Is your absentmindedness becoming too much of an obstacle to complete your duties?

Red Flag: Do you know someone who is having problems with words and names. Are they constantly forgetting names of people in their own household, do they routinely substitute one word for another. Do you find that you must always guess at what they are truly trying to say?

Red Flag: Has ones judgments seem to have changed. Be on the alert if a usually private responsible person now trusts someone who he or she does not know very well to handle their finances, or all of the sudden is allowing the grand kids to take the credit or debit card.

Red Flag: Has ones mood seem to have suddenly changed, what once was a well-mannered easygoing individual. Is there now the tendency to be abruptly angry with the smallest issues?

The red flags listed above should serve as a guide to assist you with your concerns only as they are not a diagnosis, please make sure to always discuss your symptoms and concerns with your physician.

Related Alzheimers Disease Articles

Official Program Name: LoneStar Select II Contracting Program 1915(b)
State: Texas
Waiver Authority: 1915(b)
Date Originally Approved: 03/10/1995
Medicaid Waivers and Demonstrations List

During the week of February 17, 2002, headlines screamed the news – more than 92% of US nursing homes fail to have an adequate number of staff to provide quality care for elderly residents. Newspapers and radio programs based their stories on the new study the Health Care Financing Administration (HCFA) recently provided to the Senate’s Special Committee on Aging.

Interesting findings led us to reexamine our current data set of nursing home deficiencies. What we found may surprise you; there was no relationship between the level of staffing and the number of deficiencies reported for nursing homes. However, there was a relationship between level of staffing and percent of residents with pressure sores and physical restraints.

This article is provided to you so you’ll have a greater understanding of what these findings mean.

The HCFA Study

Purpose – HCFA’s study was performed at the request of the Senate’s Special Committee on Aging to determine what minimum level of nursing home staffing was required in order to provide quality care.

Findings – The study reported that a minimum level of staffing, determined to be 2.9 hours of Certified Nursing Aide (CAN) time per resident was required for quality care. A number of measures went into this finding. Among them, a time and motion study examined the time required for basic services such as dressing and toileting.

A correlational study that examined the relationship between pressure (bed) sores and staffing found that a higher level of staffing was related to lower levels of pressure sores. This study was somewhat limited by the fact that homes with very low levels of staffing refused to participate; it may be inferred that the correlational findings would have been stronger with the participation of these homes.

In addition, the HCFA study examined the accuracy of reported level of staffing in survey and cost reports. They found that cost reports were more accurate than survey results in reflecting an accurate level of staffing as determined by nursing home payrolls.

Limitations – The report was limited by the extent of the data gathered (3 states included) and may not be generalizable across all states.

When Should Staffing Concern You

When the best is yet.net began examining long-term care, we attempted to gather data on staffing and found that it was extremely difficult to acquire accurate information. Then a well-respected administrator advised us that while staffing was important, it was not as good as measure of quality as the level of care residents actually received. We have learned through experience how right his advice was.

So what should you look for when determining the quality of care residents receive?

• Look for residents who are well groomed and not lethargic.

• Look for residents actively engaged in activities; although each nursing home is required to have an activities director, this does not mean that scheduled activities actually occur.

• Check the latest survey ratings for the percent of residents with pressure sores. Look for a rating close to zero. We also suggest that you examine the percent of residents with physical restraints because physical restraints may be used as a substitute for staff. Again, look for a rating close to zero.

• Look for the quality of interactions between staff and residents. Even though a minimum level of staffing is required for quality care, merely having staff at that level does not guarantee quality care. Homes may have high numbers of staff that do not interact appropriately with residents.

• Listen for reactions to resident complaints. Staff who ignore requests and complaints are not providing quality care.

What You Can Do to Find Good Care

• Check nursing home ratings and visit only those with few or, still better, no deficiencies.

• Call your state’s long-term care ombudsman to get information on resident/family complaints. Although these complaints are not standardized and may include wide variations in severity, a large number of complaints should warn you away from homes receiving them.

• Consider non-profit care first. In general, non-profit homes have fewer reported deficiencies and higher levels of staffing than do for-profit homes.

What Else Can You Do?

The current growth in an aging population means that more and more people will require long-term care unless we do something about it now. That something becomes very personal for those of us in the Baby Boomer generation who will, within a few years, be part of the generation potentially needing nursing home care.

So, how’s your health? Do what you can to ensure that your later life will not be complicated by any of the three leading causes of nursing home stays: heart disease, stroke and cancer.

About The Author

Phyllis Staff, Ph.D. – Phyllis Staff is an experimental psychologist and the CEO of The Best Is Yet.Net, an internet company that helps seniors and caregivers find trustworthy residential care. She is the author of How to Find Great Senior Housing: A Roadmap for Elders and Those Who Love Them. She is also the daughter of a victim of Alzheimer’s disease. Visit the author’s web site at http://www.thebestisyet.net” target=”_new

pando19 @ yahoo .com

Nursing Home Staffing Levels: How Much Is Enough?

When the Elderly are Abused in Any Way, It?s Time for You to Fight for Their Rights

When many of us hear of an elderly person being neglected, normally what comes to mind is the thought of physical abuse and the injuries that are sustained from this type of abuse. Physical abuse among the elderly unfortunately does happen way too often, however physical abuse and bodily injury is not the only type of abuse that our elderly can suffer from.

If one of your loved ones has become a victim and has suffered from any type of elderly abuse, your first move should be in retaining experienced attorneys who specialize in elderly abuse cases, the injuries that can be inflicted upon them, and wrongful death cases.

Types of abuse that many of our elderly have suffered from and become victim to year after year include:

Physical abuse and physical assault such as being physically hit, pushed or beaten, restrained, tortured and even deprived of food.

Neglect such as in being malnourished, dehydration, bedsores, or other types of ailments that would result from not being taken care of in a proper manner. Commonly known as bedsores, Decubitus ulcers are a pressure sore that is generally preventable and normally occur due to some type of neglect.

Financial abuse such as when another person has fraudulently or illegally taken money from an elderly person.

Attorney elder abuse such as dishonest attorneys deceiving the elderly into unknowingly signing over their entire savings to them.

Mental abuse such as intimidating an elderly person psychologically using confusion, fear or other means of mental abuse, as well as verbal abuse.

In many situations it is someone that we care about and trust who is the guilty party in inflicting these types of abuse upon our elderly family members or friends. If you were injured in a California city like Los Angeles, you should contact. IF it was OC, Orange County nursing home abuse lawyers. Nursing homes are also a very common place that elderly abuse can occur. Often times we put our complete trust in a nursing home for the care of our elderly, thinking they will receive the utmost in care and gentleness. It is heartbreaking when we learn those are the very people who are mistreating and abusing elderly patients.

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Senior Housing Costs… Know Before you Go

In my 10 years as a senior specialist , the two questions I run into most when I’m helping people research housing are, “How much does it cost?” and, “Can I afford it?” The best way to find the answer to those two questions is my simple golden rule: “Know Before You Go.”

If you go shopping for a car, you need to know if you can shop at the Ford dealership, the Cadillac dealership or look for a good deal on a second hand vehicle. And it’s the same with senior housing.

There’s a wide range of housing and lifestyle options for all budgets, and you absolutely must know how much money your parents have to work with BEFORE you start looking at specific options. What you want to avoid is showing your parents options they fall in love with, only to find out afterwards that they are not financially viable.

To get you started, I’m going to tell you about two specific numbers that are critical points for the marketing professionals you’ll be speaking with, so having them handy will speed up the process and allow you to get more specific information from them.

The information you’ll need will fall into two categories: Assets and Income. With Assets, the number you’re looking for is your parents’ total Net Worth, also referred to as Total Combined Capital Assets. This is the total combined value of all the assets they own, such as Cash, Saving Accounts, Checking Accounts, Money Market Accounts, Certificates of Deposit, Stocks & Bonds, IRAs, Annuities, Real Estate, Cash value of insurance policies.

What you should NOT include are things like the car, china and crystal, furniture, etc. These are considered commodities and don’t factor into the official financial picture. A good rule of thumb is to not include anything they use for daily living, the primary exception being their current home.

Also, it’s not important that each of these areas is specifically broken out. The people you will be dealing with are looking for one, bottom-line number. If a portfolio already exists simply get the value of the portfolio. You simply need to know the total asset base you have to work with.

When calculating Income it is important to focus on AVAILABLE income. The actual term used by senior housing professionals is “Total Available Monthly Income.” So when doing your calculations, count ALL income, regardless of whether the person is using it now or letting interest and dividends roll into the principal.

The most common sources of income are Social Security and Pensions. Often older adults will live very comfortably on their pension and social security and consider that to be their ONLY income. But to be accurate in your research process, you have to dig deeper and look at the entire picture, adding ALL income into one pot. Other sources may include: Interest and Dividends earned from assets, IRA Income and Rental Income.

When you have tallied all of the annual income from these sources, add it all up and divide by 12. This number is the Total Available Monthly Income. It doesn’t mean they have to spend it or take the payout on it. It just has to exist. What you want to know is how much money is available each month without starting to spend down the asset base.

Whether you are considering purchasing traditional real estate or moving to a retirement community, know before you go! Do this homework in advance and you’ll save yourself stress, emotional anxiety and valuable time in your research process.

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A Brief History of Scooters

Scooters were first known as a child’s vehicle that dates back
to before 1920. Although scooters were being manufactured, the
majority of older children fashioned their own out of
miscellaneous used parts. Remember the Little Rascal movies with
scooters made out of produce crates? Technology and economies
have changed since that time, allowing for today’s mass produced
scooters to offer a variety models and to be sold at a
reasonably low cost.

Modern scooters not only include the push scooters that require
a little bit of exercise, but also feature electric and gas
motorized models. Advancements in technology have made way for
many physically impaired individuals to replace wheel chairs
with motorized scooters and mobility scooters. Competition among
scooter manufacturers has led to unique design features as well
as miniature low-powered motorcycles.

Motorized scooters are considered low-power motor vehicles by
many municipalities and are subject to state and local
regulations. Some scooters meet Department of Transportation
regulations for operation on streets and roadways while others
are prohibited from being on the streets. Any time a motorized
vehicle is introduced into traffic areas, appropriate cautionary
measures must be taken and proper safety gear must be worn.

Scooters can be easily found in the retail market, however not
all retailers will carry all styles. Major discount or
department stores may only carry a couple of models that they
believe will be the most popular among their shoppers. A scooter
store could specialize in a variety of recreational scooters,
while another store will specialize in the mobility scooters.
Retailers also offer scooter accessories to enhance the
experience as well as replacement parts and service. Any style
of scooter can be purchased online for retail pricing. The
current market demand for scooters makes it hard to find them at
wholesale prices for a single purchase, but there are many
opportunities for an individual to become a scooter dealer

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