Aging Wisely’s team of patient advocates brings you the latest news and information relevant to caregiving, healthcare and disability care. Our weekly blog posts are designed to inform and answer some of the most frequently asked questions we get from families. We also send out a monthly “Wise Words” newsletter, and if you’d like to receive it you can contact us online with a request.

As we wrap up 2013, we thought we would share some of the top news stories we reviewed this year and their implications for you.

Healthcare Reform and Obamacare

Obamacare was one of the stories that clearly got a lot of press in every type of media outlet. A lot of the current/coming changes related to Obamacare are not directly related to most seniors, however. All the press about the changes did have one negative effect on some seniors, however, in that scammers used it to their advantage. They preyed on the confusion over Obamacare in order to obtain personal information or extract unnecessary fees from elders.

Seniors who are covered under Medicare are not affected by Obamacare mandate. There were various changes made to the Medicare program with the health reforms, such as the gradual closing of the Part D doughnut hole and expanding preventative care benefits. Medicare recipients do not have to choose new healthcare plans under the exchanges, as they will continue to be covered by Medicare. As usual, Medicare recipients have annual opportunities to make changes to plans and there likely will be some changes to the Medicare Advantage landscape as incentives/pay structure changes. To read more on this subject, check out “What to Expect from Medicare in 2014” and “The Aging Wisely Medicare 2014 Fact Sheet“.

On the other hand, Aging Wisely’s patient advocates work with many disabled, chronically or critically ill clients who are not currently covered under Medicare. Some of the Obamacare changes offer new options for these clients. You can get an overview of the changing healthcare landscape here and contact us if you need help navigating these issues.

Assisted Living Exposé Reveals Problems in the Senior Living Industry

PBS Frontline did a piece entitled “Life and Death in Assisted Living” which exposed information behind several lawsuits against Emeritus Senior Living. The piece examined the larger picture of regulation and consumer protections in this massive industry. As we know as advocates, there is good and bad care in any setting. These types of issues have been uncovered in hospitals, nursing homes, in-home care and all types of institutional care over the years. Much of the financial abuse and neglect that elders face is actually perpetrated by family members, but this special did uncover some issues within this industry that should not be ignored. Assisted living was virtually non-existent 30 years ago so this is still a relatively new industry adapting to a drastically changing clientele. The population in most assisted living facilities is now much older and sicker than originally envisioned.

In our article on this topic, we focused on what we think is most important to families about this story. Rather than simply instilling fear, we hope to provide concrete ideas of how you can better evaluate care options and advocate for your loved ones. As long time elder advocates, we provide some of our key advice on finding quality assisted living care and ensuring quality eldercare after moving in to assisted living.

The World’s Aging Population

Florida has been a unique place for our Aging Wisely team to work. Our demographics in Florida have been “ahead of the curve” with a large elder population well ahead of the much discussed Baby Boom/Age Wave. Clearwater and St. Petersburg, Florida lead the statistics in terms of elder populations among similar cities of their sizes. We also have a large demographic of people who have retired to Florida from other locations, often with family members living elsewhere. These types of demographics are becoming more widespread as the Baby Boomer generation ages and society becomes ever more mobile. On a larger scale, this phenomenon is international in nature. While developing nations may still have lower life expectancies and higher birth rates, many nations are facing an aging population and drastically lower birth rates as people marry later and have fewer children.

In the European Union, for example, life expectancy (which rose by eight years between 1960 and 2006) could continue to increase by a further five years between 2006 and 2050 and would thus result in a larger proportion of people surviving to the ages of 80 and 90. The average number of children per women stands at 1.5 whereas the replacement level is 2.1. Immigration is offsetting these lowered population numbers in many countries. Therefore we are looking at very different dynamics in terms of issues like pensions, the makeup of the working population and family caregiving.

Japan has the world’s highest percentage of population over age 65 and this occurred in the shortest time span (again related to both higher life expectancy and lower birth rates). China is a different case, where declining birth rates have been, at least in large part, caused by government policy (the “one child policy”). Of course, rapid economic/lifestyle improvements have impacted the other side of the equation, with greatly extended life expectancy. This has led to what is known as 4-2-1 conundrum, in which each (only) child has four grandparents and two parents to care for. Filial piety is a traditional value and many families live in multi-generational households, but migration and the one-child policy have put strains on this system of family care. China has been dealing with this in various ways, from a policy in which parents can sue children for not visiting to small subsidies for elders whose only child died or is disabled. Institutional and private care options are also beginning to develop, with home care companies providing in-home support, the first private assisted living facilities opening, and Buddhist temple-based nursing homes. There is also an interesting eldercare volunteer program being tested.

With globalization and shared information, nations should be able to learn from each other and determine the best options to care for their older citizens. The U.N. began looking at these issues in 1982. In 2002 the Second World Assembly on Ageing in Madrid led to the plan of action on ageing which “called for changes in attitudes, policies and practices at all levels to fulfill the enormous potential of ageing in the twenty-first century.  Its specific recommendations for action give priority to older persons and development, advancing health and well-being into old age, and ensuring enabling and supportive environments.”

We want to extend our wishes for a happy, healthy 2014 to all our clients and friends! We hope that 2014 will be a year of good news and progress toward active aging and improved quality of life for all. We encourage you to check back with us for the latest news and information and contact us any time we can help!

You can reach our advocacy team via online contact or by calling 727-447-5845. We’re here to help with your Florida elder and disability care questions, patient advocacy issues, Medicare and much more!

Medicaid reform legislation that was proposed in Florida in 2011 was designed to move management of Medicaid benefits to private, for-profit managed care companies. In the time since, there have been many meetings and debates, various changes, pilot programs and challenges to overcome in getting this concept implemented. However, the time is now here…and Florida Medicaid recipients will soon be receiving letters asking them to enroll in a particular plan (if they have not already). The state is rolling these changes out on different dates in the various counties. The roll out date for Pinellas, Pasco and Hillsborough counties is February 1, 2014.

What does this mean for Florida seniors?

If you are receiving Medicaid benefits or you have applied, this change affects you…and means you will have some decisions to make. If you care for an aging parent in Florida and/or serve as a decision maker (for example as guardian, P.O.A., healthcare surrogate) for a Florida elder or other person receiving Medicaid benefits , you should understand these changes so that you can assist and understand what choices need to be made. Essentially, all Medicaid beneficiaries will now be receiving benefits through a managed care company. So, they will have to choose which plan they wish to enroll in to manage their benefits. If a senior does not make a choice, Florida will choose a plan for that person. Enrollment is mandatory. The plan will oversee your benefits and care plan for determining how much/which benefits and services you receive. Once enrolled in a plan, a representative will meet with you and develop a care plan (you are entitled to have an advocate with you at this meeting and to have input in developing your care plan). If you have problems with your plan or the care being provided, there are specific processes for complaints and changes (the consumer guide below provides information on this; it is important to note that you have limited time frames for making changes and filing complaints).

What do I need to do?

You will have some decisions to make and it is very important to clearly understand these decisions and how they may affect your care. There have also been numerous program glitches that could cause issues for you. If you work with an Aging Wisely care manager currently, your care manager can help you through this process and provide resources to help at various stages. Our team has been studying the changes and getting training from some of the top experts, so we can be best prepared to help you. As always, we also work collaboratively with expert providers so we can refer you for help in specific areas.

Consumers can get some excellent information on these Florida Medicaid changes on the website Foundation for LTC Solutions. This group of Florida elder advocates has created resources like a decision tree and guide for the enrollment decisions. If you want to understand more about the program and decisions involved (as well as some of the pitfalls and important tips), you can download their Florida Medicaid Managed Care Consumer Guide. The guide is divided up in to sections based on your situation (answer a couple simple questions to be guided in to the correct section), so that while there is a lot of information you should only need to review the section that is applicable to your (or your loved one’s) situation.

Because Medicaid benefits will now be managed by the specific plan in which you enroll, the decisions can have a big impact on the care you receive. For example, if you are currently receiving home health benefits or care at assisted living, you may have to switch providers or move if your new plan is not contracted with these providers. We want to draw your attention to the importance of this major change, while not panicking you. Advocates have worked hard to spot the difficulties with the process and fight for protections. There are some safeguards built in and options if you encounter problems. Having a good care team is essential for each elder… you need strong advocates and resources to help (whether dealing with issues related to Medicaid managed care or just eldercare in general).

If you are working with Aging Wisely, your care manager will be reaching out to you about these changes as they apply to you and offering assistance. The resources above offer great insight for Medicaid recipients and their loved ones/decision makers to get an overview and answers to key questions.

If we can help with any questions or resources about Florida Medicaid, Medicare or other patient advocacy issues, please contact us at 727-447-5845.