CAPABLE means Home, not Nursing Homes, for Seniors

Source: Newswise (6/26/2012) — Nursing homes do not have to be inevitable destinations for frail older adults. Many—even those with long-term health problems—can remain at home and be independent. All it takes is a little help to change “disability” to “capability”.

A handyman with a few nails to fix a wobbly bannister can make the difference between staying at home and a nursing home stay. Visits from a nurse or occupational therapist can help simplify a bewildering medication regimen or improve the ability to get around the house and neighborhood. Simple, inexpensive steps may change the equation for thousands of seniors, but in reality, services like these are rarely available for many at greatest need—the poorest and sickest older adults receiving Medicare and Medicaid.

CAPABLE, short for “Community Aging in Place, Advancing Better Living for Elders,” and a $4 million Health Care Innovation Award from the U.S. Department of Health and Human Services Center for Medicare and Medicaid Services, is about to change that reality. Read More …

It’s Fall – Time for Talking Turkey about Healthcare…


Medical Economics - follow the Money

We need to talk about healthcare, the role of funding, the need for healthcare teams, and core infrastructure from workplace culture to technology.  Parts of this post began as a comment in Employee Benefit News, a LinkedIn group.  Let’s start with the money.

There’s a pattern here—banks collect a 5% margin on health insurance cash flow.  This is not small potatoes.  Healthcare insurance, mostly self-insured employer costs, was about 33.5 percent of the $2.3 trillion spent on healthcare in 2008, i.e., almost 70 percent of the half of health cost not paid by Medicare and Medicaid (see National Health Expend Data). This annual $770 billion allows the 5% margin to feed some $38 billion into the banking sector’s P&L statement.  And, the annual $770 billion flow is money banks can invest in securities markets, or can lend.


In Snake Bit, I took a different look at annual health insurance evaluation and the danger of getting Snake Bit if we don’t dig into the details, compare plans, and consider our historical and anticipated medical costs.

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Putting Patients at the center of their Health Care

HealthITBuzz logoHere is full text of an article by by by Jodi G. Daniel / JD MPH, Director of the Office of Policy and Planning at the U.S. Department of Health & Human Services. It is provided with full attribution and a link to the original article but without copyright concerns, because I believe it’s important enough to be promoted widely and don’t expect any complaints. If, however, the Office of the National Coordinator for Health Information Technology (ONC) asks me to remove it, I will surely do so.

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What do you Want from Health Care?

World HealthI posed the following challenge to the Innovations in Health group on Linkedin and got some interesting responses, including a well crafted wish list from Colleen that inspired this blog post.


As a fun exercise to stimulate creative, out-of-box thinking, pretend you have all been been appointed to the new World Health Commission by the new King of the World (or whatever title you prefer). You have absolute power to determine health strategy, for the whole world. Think like a child, and forget the constraints you’re used to dealing with as adults. There are no financial hurdles, no political worries, no cultural barriers, no legacy to contend with, no managers looking over your shoulders, and no imposed time frames.

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In Sickness and in Health, till Death do us part

read the Pat Robertson story at MSNBC

Rev.Pat Robertson, by Clem Britt/AP

I’ve written occasionally about Medical Ethics and the misalignment of incentives that pay doctors & hospitals for treating symptoms rather than keeping us well. As we consider reforms to contain runaway deficit spending, we must come to grips with many ethical questions. Since individual choices can determine our health and well being, and therefore the cost of care, we’re less sympathetic of people still smoke, drink or eat too much of the wrong things. We know that obesity is America’s #1 health & financial risk and that it can cause heart disease, stroke, diabetes and certain cancers. Since half of our population is overweight from lifestyle choices, should they get the same level of care at taxpayer expense?

A new question arose this week about medical ethics and marriage when religious leader Pat Robertson told his 700 Club television audience that divorcing a spouse with Alzheimer’s disease is justifiable. He was taking questions from the audience when Robertson was asked how to advise a man who began seeing another woman after his wife started showing symptoms of Alzheimer’s.

“I know it sounds cruel,” he said, “but if he’s going to do something, he should divorce her and start all over again, but make sure she has custodial care and somebody looking after her.” After all, it’s “a kind of death.”

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ONC: Helping Consumers Be Partners in Their Own Health

HealthITBuzz logoHere is full text of an article by Lygeia Ricciardi, Senior Policy Advisor for Consumer e-Health at the U.S. Department of Health & Human Services. It is provided with full attribution and a link to the original article but without copyright concerns, because I believe it’s important enough to be promoted widely and don’t expect any complaints. If, however, the ONC asks me to remove it, I will surely do so.

Helping Consumers Be Partners in Their Own Health

by Lygeia Ricciardi, Senior Policy Advisor for Consumer e-Health

We at the Office of the National Coordinator for Health Information Technology (ONC) know that patients are asking themselves, “How do I manage my health information?” We are working to bring the U.S. health care system into the 21st century through technology to address that concern. We understand that it’s not all about health care providers and hospitals—it’s also about you: the patient, the individual, the person who should be the focus of the health care system.

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States Slash Home Health Care & Services for the Neediest

Senior with Home Care Bound for Adult Day Care States Slash Home Health Care & Adult Day Care Services for the Neediest; Likely to Increase Costs

Republished with permission from

Several reports recently have noted that across the nation, U.S. states are slashing Medicaid dollars for home health care services and adult day care services that help keep the elderly and disabled out of nursing homes. State lawmakers cite budget shortfalls, yet these cuts may end up costing Medicaid and taxpayers more in forced nursing home costs, authorities say.

According to a July 16 report by the Associated Press, “Aging and disability services in three out of four states have been reduced over the last two years or face cuts, even though demand is increasing.”

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AARP Finds Toll On Family Caregivers Is ‘Huge’

AARP: Join the Fight for Medicare and Social SecurityValuing the Invaluable: The Growing Contributions and Costs of Family Caregiving is a new study by the AARP that estimates a value of $450 billion a year for work done by more than 40 million Americans caring for an elderly or disabled loved one. That may be a bargain for society, but it’s a “huge” burden on the family members.

Cymando Henley’s mom was diagnosed with Multiple Sclerosis as he started college. Now she’s in a wheelchair, and Henley has been taking care of her ever since – for nearly twenty years now – helping her in and out of bed and onto the toilet, and even rolling her over in the middle of the night if she gets uncomfortable. Social programs help pay for about 35 hours a week of in-home health care, but Henley puts in at least that much himself for free, on top of working at a full-time job. Such non-medical care from a professional can cost tens of thousands of dollars a year.

Listen to the story or read about it at

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When Healthcare Hits Home

illustration of gall bladder with stonesGuest article by Jessica Wapner (, @jessicawapner), from WorkInProgress blog.

Jessica gained a new perspective of our healthcare system when a relative needed emergency surgery in a small village in Cyprus to remove gall stones and her gall bladder. Her story is included because it relates to Health Concerns for Oversees Travel. If you’d rather not see this type of story, reply below.

Over the course of the decade-plus that I’ve been writing and editing material on healthcare (cancer research and treatment, in particular), people have asked from time to time whether my interest is driven by some personal stake in the matter. Read More …

Does Medicare Cover Home Health Care?

By Shannon Martin (reprinted with permission)

Nothing is more discomforting than not knowing if you or a loved one will receive the adequate care for a full and safe recovery after hospitalization.  Neither Medicare nor traditional medical insurance cover many of the home care services that can help reduce otherwise preventable injuries and hospital re-admissions. These services, usually referred to as long term care, or “custodial care,” include companion services, general supervision for health and safety and long term home help with personal care and hygiene, meal preparation, transportation and errands.

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You Really Are Paying a lot More For Health Care

Julie Rovner posted this article on the NPR Health blog, but she didn’t include my reader comments, so I’m summarizing key points here and adding my comments afterwards.

  • The good news – Health costs rose 7.3% last year, which was the slowest rate in more than a decade but still nearly 5 times faster than the Consumer Price Index.
  • The bad news – Since 2002, the annual health care cost for American families has more than doubled from about $9,000 to over $19,000.

So what’s driving the increases? It’s not Obama Care, the new federal health law.

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Understanding the Healthcare Law

Yesterday Yvonne heard a great presentation by Dr. James Rohack on Health System Reform. Rohack is a practicing cardiologist and Director of Scott & White Center for Healthcare Policy. He is also a professor at Texas A&M Health Science Center and was the president of the American Medical Association from 2009 to 2010 during debates over Obama’s Healthcare Law. [Note that the AMA was a powerful lobbying force “against” healthcare reform since the 1930s.]

The presentation was held in Sun City, a planned community north of Austin for retirees with active lifestyles. It didn’t include handouts, but I was able to find some of Rohack’s slides online and offer them below with my notes.

Understanding the Health Care Law, by Dr. James Rohack



The New York Times provides this timeline of nearly 100 years of legislative milestones and defeats, summarized below:

1912 – Theodore Roosevelt campaigned on the Progressive Party ticket promising national health insurance, along with women’s suffrage, safe conditions for industrial workers, and other social issues.

1929 – Baylor Hospital in Dallas started a prepaid program to create the nation’s first example of modern health insurance.

1931 – The average family spent $250/year on health care. Farmers’ Union Co-operative Health Association pioneered the H.M.O. movement with a flat fee whether or not treatment is needed.

1932 – The Wilbur Commission found adequate medical attention beyond reach of millions of Americans and recommends group insurance to spread the risk. Critics denounce that as “socialist.”

1934 – Franklin D. Roosevelt’s New Deal included Social Security and unemployment insurance but was unable to include health insurance, thanks largely to opposition from the AMA and doctors.

1938 – Prepaid hospital insurance increased in popularity but excludes the unemployed and people 66 and older.

1945 – Harry S. Truman proposed a health care overhaul, but again the AMA and other critics called his plan “socialized medicine.”

1946 – Congress passed the Hill-Burton Act to finance rural hospital construction, require charity care, and prohibit discrimination based on race, religion or nationality.

1949 – The Supreme Court upheld a National Labor Relations Board ruling that health benefits can be part of collective bargaining.

1951 – The Health Insurance Council, an industry trade group, estimated that 77M Americans have purchased some type of voluntary accident or sickness insurance.

1954 – The Internal Revenue Act exempted employee benefits, like pensions and health insurance, from income taxes. That tax exemption has been hotly debated ever since.

1962 – John F. Kennedy took up the issue of health benefits for Social Security recipients, but his proposal stalls in Congress due to powerful lobbying by the medical industry.

1965 – After a Democratic sweep of Congress, Lyndon B. Johnson signed Medicare and Medicaid legislation for people over 65, the poor, blind, and disabled.

1968 – Health costs began to increase.

1971 – Edward Kennedy began a career-long push for universal single-payer health reform, as Richard Nixon wanted employers to provide insurance to workers but maintain private insurer competition.

1973 – Nixon promoted Health Maintenance Organizations with $375M public financing.

1974 – Congress passed the Employee Retirement Income Security Act (ERISA) to exempt large corporations’ self-insured health plans from state regulations.

1976 – Jimmy Carter called for a comprehensive national health insurance system, but a deep economic recession consumed lawmakers’ priorities.

1986 – Congress required hospitals to screen and stabilize all ER patients and passed COBRA, a s system that allows employees to continue their group health plan up to 18 months after losing their jobs.

1988 – Ronald Reagan signed The Medicare Catastrophic Coverage Act, which set ceilings on Medicare patients’ payments. It had overwhelming congressional support.

1989 – Congress surprisingly repealed The Medicare Catastrophic Coverage Act a year later because affluent seniors resented paying a surtax to help finance it and protested in town hall meetings.

1993 – Bill Clinton pushed for universal coverage based on the idea of “managed competition” with private insurers competing in a tightly regulated market.

1994 – Clinton’s Health Security Act fails in Congress due to fierce partisan politics, special interest lobbying, and congressional distraction by other major issues.

1996 – Congress established HIPPA standards for medical record privacy and protected people in group insurance plans from being barred for pre-existing conditions.

1997 – Clinton signs the Children’s Health Insurance Program (CHIP).

2002 – The cost of health care, which had stabilized in the mid-1990s with the advent of managed care, climbed rapidly again. Employers passed on more of the costs to employees.

2003 – George W. Bush expanded Medicare to include prescription drug coverage called Part D., but a significant and confusing gap in coverage became known as “the doughnut hole.”

2006 – Health spending toped $2 trillion, or $7,421 per person and 16.2% of GDP.

2008 – 46M Americans were estimated to lack health insurance coverage. Obama, campaigning on Health Care Reform, is elected president.

June 2009 – Senator Edward Kennedy proposes that all Americans have “essential health care benefits” with no annual or lifetime limits. (The time-line condenses from here out. Follow link for details.)

July 5, 2009 – House Democratic leaders introduce a bill to expand insurance coverage and slow Medicare growth. Three House committees announced plans to begin the process in the same week.

July 22, 2009 – Obama delivers speech to rally public support for health care reform (follow the link to watch the video).

August 2009 – The health debate turned hostile and intensely partisan at town-hall-style meetings. (And you thought our current town halls are contentious.)

Sept. 29, 2009 – The Senate Finance Committee voted to reject the Democratic proposal for a public option.

Oct. 29 2009 – CBO said the 1,990-page bill would cover 36 million people and cost $1.05 trillion over 10 years, but with cuts to Medicaid growth and new fees and taxes, it could reduce deficits by $104B over 10 years.

Nov. 3 2009 – Republicans present their own health care plan, which would reward states for reducing the number of uninsured, limit malpractice damages, and allow small businesses to band together and buy insurance exempt from most state regulation.

Nov. 7 2009 – With only one Republican vote, House Democrats pass their bill.

Dec. 24 2009 – Senate Democrats pass their version of the health care bill 60-39.

Jan. 19 2010 – Republican Scott Brown shocks Dems by winning a special election to fill Senator Edward Kennedy’s vacated seat, denying Dems a 60-vote filibuster-proof majority.

Feb. 13 2010 – Anthem Blue Cross tells subscribers in California that average individual insurance premiums would rise 25%, with some rates going up 39%. Obama said that’s why the ACA was needed.

Feb. 22 2010 – Prior to a Health Care Summit meeting, Obama laid out a compromise plan, blending House and Senate bills.

March 3 2011 – Obama calls for Congress to set aside political gamesmanship and allow an “up or down vote” on health care reform.

March 21, 2010 – After an abortion deal, House Democrats passed the Senate bill 219-212, sending the bill to Obama’s desk for signature on March 23, 2010.