New Federal Rules for Home Health Agencies

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Man and CaretakerHome health agencies will be required to become more responsive to patients and their caregivers under the first major overhaul of rules governing these organizations in almost 30 years. 

The federal regulations, published in January 2017, specify the conditions under which 12,600 home health agencies can participate in Medicare and Medicaid, serving more than 5 million seniors and younger adults with disabilities through these government programs.

They strengthen patients’ rights considerably and call for caregivers to be informed and engaged in plans for patients’ care. These are “real improvements,” said Rhonda Richards, a senior legislative representative at AARP.

Home health agencies also will be expected to coordinate all the services that patients receive and ensure that treatment regimens are explained clearly and in a timely fashion.

The new rules are set to go into effect in July 2017, but they may be delayed as President Donald Trump’s administration reviews regulations that have been drafted or finalized but not yet implemented. The estimated cost of implementation, which home health agencies will shoulder: $293 million the first year and $234 million a year thereafter.

While industry lobbying could derail the regulations or send them back to the drawing board, that is not expected to happen, given substantial consensus with regard to their contents. More likely is a delay in the implementation date, which several industry groups plan to request.

“There are a lot of good things in these regulations, but if it takes agencies another six or 12 months to prepare let’s do that, because we all want to get this right,” said William Dombi, vice president for law at the National Association for Home Care & Hospice (NAHC).

Home health services under Medicare are available to seniors or younger adults with disabilities who are confined to home and have a need, certified by a physician, for intermittent skilled nursing services or therapy, often after a hip replacement, heart attack or a stroke.

Patients qualify when they have a need to improve functioning (such as regaining the strength to walk across a room) or maintain abilities (such as retaining the capacity to get up from a chair), even when improvement is not possible. These services are not for patients who need full-time care because they are seriously ill or people who are dying.

Several changes laid forth in the new regulations have significant implications for older adults and their caregivers:

Patient-Centered Care

In the past, patients have been recipients of whatever services home health agencies deemed necessary, based on their staffs’ evaluations and input from physicians. It was a prescriptive “this is what you need and what we’ll give you” approach.

Now, patients will be asked what they feel comfortable doing and what they want to achieve, and care plans will be devised by agencies with their individual circumstances in mind.

“It’s much more of a ‘help me help you’ mentality,” said Diana Kornetti, an industry consultant and president of the home health section of the American Physical Therapy Association.

While some agencies have already adopted this approach, it’s going to be a “sea change” for many organizations, said Mary Carr, NAHC’s vice president for regulatory affairs.

Patient Rights

For the first time, home health agencies will be obligated to inform patients of their rights — both verbally and in writing. And the explanations must be communicated clearly, in language that patients can understand.

Several new rights are included in the regulations. Notably, patients now have a right to receive all the services deemed necessary in their plans of care. These plans are devised by agencies to address specific needs approved by a doctor, such as speech therapy or occupational therapy, and usually delivered over the course of a few months, though sometimes they last much longer. Also, patients must be informed about the agency’s initial comprehensive assessment of the patient’s needs and goals, as well as all subsequent assessments.

A patient’s rights to lodge complaints about treatment and be free from abuse, which had already been in place, are described in more detail in the new regulations. The government surveys home health agencies every three years to make sure that its rules are being followed.

NAHC officials said they planned to develop a “notice of rights” for home health care agencies, bringing greater standardization to what has sometimes been an ad hoc notification process.

Caregiver Involvement

For the first time, agencies will be required to assess family caregivers’ willingness and ability to provide assistance to patients when developing a plan of care. Also, caregivers’ other obligations — for instance, their work schedules — will need to be taken into account.

Previously, agencies had to work with patients’ legal representatives, but not “personal representatives” such as family caregivers.

“These new regulations stress throughout that it’s important for agencies to look at caregivers as potential partners in optimizing positive outcomes,” said Peter Notarstefano, director of home and community-based services for LeadingAge, a trade group for home health agencies, hospices and other organizations.

Plans Of Care

Now, any time significant changes are made to a patient’s plan of care, an agency must inform the patient, the caregiver and the physician directing the patient’s care.

“A lot of patients tell us ‘I’ve never seen my plan of care; I don’t know what’s going on; the agency talks to my doctor but not to me,’” said Kathleen Holt, an attorney and associate director of the Center for Medicare Advocacy. The new rules give “patients and the family a lot more opportunity to have input,” she added.

In another notable change, efforts must be made to coordinate all the services provided by therapists, nurses and physicians involved with the patient’s care, replacing a “siloed” approach to care that has been common until now, Notarstefano said.

Discharge Protections

Allowable reasons for discharging a patient are laid out clearly in the new rules and new safeguards are instituted. For instance, an agency cannot discontinue services merely because it does not have enough staff.

The government’s position is that agencies “have the responsibility to staff adequately,” Carr of NAHC said. In the event a patient worsens and needs a higher level of services, an agency is responsible for arranging a safe and appropriate transfer.

“Agencies in the past have had the ability to just throw up their hands and say ‘We can’t care for you or we think we’ve done all we can for you and we need to discharge you,’” Holt said. Now a physician has to agree to any plan to discharge or transfer a patient, and “that will offer another layer of protection.”

Boomerang Seniors and Aging Parents

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SENIORBOOMERANG7

Like many peers in their 70’s, Lois and Richard Jones of Media, Pa., sold their home and downsized, opting for an apartment in a nearby senior living community they had come to know well. For 13 years, they have visited Lois’ mother, Madge Wertzberger, there.

Wertzberger, 95, is in assisted living at Granite Farms Estates. Lois, 73, and Richard, 76, who have been married 56 years, moved into an adjoining building in October 2016.

“It doesn’t take me more than three minutes to walk to where my mother is,” said Lois. “I don’t have to drive anywhere to help her or to meet with her [medical] team. I’m right here.”

The Joneses are great-grandparents. Yet they’re among a growing group of seniors with a living parent, which means these 21st-century post-retirement years might well include parental care. Expectations are altered amid the new reality of longer life expectancy and growing numbers of aged Americans.

“I pop in when I need to take something to her or discuss things. We see each other minimally once a week, and it can be more,” Jones said. “My youngest sister normally takes her to the doctor, but I do some sharing on that. Just because I’m here doesn’t mean I have to take her to her doctor’s appointments.”

Caregiving for an older family member is not what it was when first studied and coined as the “sandwich generation,” those people squeezed between aging parents and young children, said Amy Horowitz, a professor of social work at Fordham University in New York City.

“Now it’s the children who are on the verge of retirement or who have retired and are still having the responsibility of older parents,” she said. “In New York City, I know someone whose almost-90-year-old mother is living in the same apartment building. It becomes, how do you balance your own life?”

Kathrin Boerner, an associate professor of gerontology at the University of Massachusetts, Boston, discovered a recurring theme in her research on centenarians and their adult children — that is, very old parents and their elderly children. Even if their children are not direct caregivers, they still must monitor their parents’ welfare.

“With the demographics we’re looking at, I refer to it as ‘aging together,’ — the parent-child constellation will be a lot more frequent,” Boerner said.

“For a lot of people, that is the time — if you’re in good enough health — you hope for a time of greater freedom. You’re past all the other caregiving tasks and, for most people, they can dedicate to their own needs,” Boerner said. “But for those with very old parents, it just doesn’t happen.”

“The very old are the fastest-growing segment of the population in most developed countries, with an expected increase of 51% of elders age 80+ between 2010 and 2030.” And, two-thirds of these very old have advanced-aged children, who typically serve as their primary caregiver.

“We heard things from someone like an 80-year-old — ‘I don’t have a life.’ Imagine that. You’re 80 years old, and ‘I don’t have a life because I’m caring for my mother,’” Boerner said.

Sometimes, it’s the older adult child with more health issues than the parent.

Carol Pali, 71, moved into Fort Washington Estates in Fort Washington, Pa., in October 2014, prompted by a blood disease diagnosis, around the same time she retired from full-time teaching.

“It got to a point where I was in and out of the hospital all the time,” she said. “I just decided I might as well move in here, too. It’s better than having to take care of the house.”

Pali had lived in a townhouse around the corner from the community, where her mother, Peg Henrys, who recently turned 97, had moved three years earlier.

“My mom moved from New Jersey to be closer to me,” she said.

“We get to see each other every day at dinner time, but she’s got her life here and I’ve got mine. We’re not with each other all the time,” Pali said.

“She’s in better shape than I am except that she can’t hear very well,” Pali said. 

 

Jones said she and her two sisters (one lives 10 minutes away; the other, 40 minutes away) have a weekly knitting date with their mother.

“We all knit and spend a good portion of the day with her,” Jones said of the Thursday sessions.

She also stays busy with Bible study, church services and programs featuring professors from local colleges — all on-site.

“We have joined in so many of the activities here,” she said. “We have a whole new social group. There are a lot of activities we participate in here at Granite Farms, but we haven’t given up our outside friends or activities.”

Jones said she and her husband sought to escape from the worries associated with a larger home and assume control over their future while they could. Living near her mother lets them blend caregiving with a relatively carefree lifestyle.

“We were looking to exchange responsibility for fun,” she said.

Dentistry Advocates Aim for Medicare Benefits

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Dentist Photo

Carolyn Thompson’s tight-lipped smile hides a health care problem the 81-year-old retired nurse cannot afford to correct and that Medicare will not cover.

She needs dentures. Her missing bottom teeth make chewing difficult, so she avoids most of the fresh fruits and foods that provide valuable nutrients. Thompson has not seen a dentist for many years.

“While working I always took care of my teeth, but in the last couple of years have found it difficult to pay for care,” said Thompson.

Thompson’s predicament is common. About 1 in 5 people 65 and older have untreated dental problems. But Medicare rarely covers dental care and fewer than half of elderly Americans see a dentist even once a year — often because they cannot afford to — according to a Johns Hopkins University study published in Health Affairs last year. Just 12 percent of Americans over 65 have dental insurance, that study reported.

Dental benefits were not recognized as a priority when Medicare was enacted in 1965. Back then, nearly half of Americans ages 65-74 had lost their natural teeth; today, 87 percent in that age group still have some or all of their teeth, according to the American Dental Association.

Research shows that untreated dental problems can exacerbate health problems such as diabetes and heart disease, leading to costlier bills for Medicare. That’s why a nonprofit think tank devoted to improving oral health is working toward an audacious goal: Medicare-paid dental care for America’s seniors.

The Santa Fe Group’s objective looks daunting in post-election Washington, where repealing the Affordable Care Act and cutting federal health spending are priorities for both the Trump administration and Congress’ Republican leadership.

Moreover, the costs of expansion would be significant. Such a benefit would likely be heavily used in an aging America whose 65-and-older population is projected to grow at least 30 percent by 2030. Also, while dentures were (and are) relatively inexpensive, newer techniques to preserve natural teeth, such as dental implants, are costly.

The Santa Fe Group’s members include academics, dental industry executives and former government officials. Among the sponsors are Colgate-Palmolive, DentaQuest and Henry Schein.

Santa Fe understands the uphill climb for coverage, but its sights are set on on its strategy to start building public demand for a Medicare dental benefit spearheaded by Dr. Claude Earl Fox, a former senior health official in the Clinton administration.

“We have a long road to go, but we think it’s doable and there will be a growing audience for this,” said Fox, who worked as a professor at both Johns Hopkins and University of Miami medical schools after his career in federal government.

The Johns Hopkins study estimated a dental benefit could cost from $4.4 billion to $16.2 billion a year, depending on what is covered, how much seniors pay out-of-pocket and the level of premium subsidies provided to low-income beneficiaries.

“Most of the talk in Medicare reform is how do we reduce cost rather than expand costs, and adding a dental benefit can make people [on Capitol Hill] very nervous,” said Amber Willink, the study’s lead author and assistant scientist at the Johns Hopkins Bloomberg School of Public Health.

Prescription drugs were the last major benefit Congress added to Medicare. That was in 2006 after more than a decade of pleading from advocates.

Without Medicare to help, seniors have few options to get comprehensive coverage. Private coverage is typically too expensive for many seniors.

Medicare Advantage, private plans that cover about one-third of seniors, sometimes offer a limited dental benefit for additional costs but typically only for a small network of dentists.

“It is important to show a benefit can be structured to save money for Medicare,” Fox said.

Supporting evidence from large studies is limited, however. It is uncertain whether the Congressional Budget Office — the official scorekeeper on federal legislation — would agree with the dental industry’s savings estimates from a Medicare benefit.

Politics aside, some advocates point to firsthand experiences to show that older adults’ health improves with regular dental care.

A retirement community in Alabama, which includes a nursing home and an assisted-living facility, added a dental clinic in 2012. Pneumonia rates dropped soon after, said Lillian Mitchell, a dentist who oversees the office and is the director of geriatric dentistry at the University of Alabama, Birmingham. Mitchell and other faculty oversee dental students who treat patients at the clinic.

“Taking care of oral health affects their overall health by reducing inflammation that has been linked to heart disease, diabetes and other chronic conditions common to the elderly,” Mitchell said.

The clinic’s services cost about half the price of private dentists.

Patients say easy access to the clinic in the building where they live makes a big difference. “This is such a comfort knowing we can go to the dentist without having to leave the facility,” said Peggy Batcheler, 87, a former nursing professor. “We feel so fortunate.”

The Santa Fe Group hopes to draw the American Dental Association, AARP and other seniors’ groups into its campaign for a Medicare dental benefit.

“It is not our No. 1 issue, but it is on top of our conversation list,” said Joseph Crowley, a Cincinnati dentist and president-elect of the American Dental Association. He is very optimistic.

 

Prescribing Opioids to Seniors: A Balancing Act

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Dr. Carla Perissinotto ImageNational conversation about the opioid epidemic has focused mostly on young people who buy drugs illegally on the street. But the real scrutiny of opioids has also inevitably changed the way physicians are prescribing medications to the elderly.

Over the past decade, a growing number of seniors have been prescribed opioids including hydrocodone, codeine and oxycodone. A recent study found that in 2011, 15 percent of seniors were prescribed an opioid when they were discharged from the hospital.

As concern grows about a national opioid epidemic, however, some seniors now find it harder to get medications they need from doctors and pharmacies. Some medical practices refuse to accept patients already taking an opioid for pain.

Beyond the obvious dangers of addiction, opioids can pose serious risks for seniors. But opioids can also be a critical tool in treating debilitating pain that leaves seniors immobilized and homebound.

Carla Perissinoto, a geriatrician at the University of California San Francisco, says prescribing opioids to seniors is often about helping them maintain their independence and the delicate balancing act of prescribing opioids.

The following questions were asked of Dr. Perissinoto:

Q: How do you decide whether to prescribe an opioid to an older adult?

One of the tenets in geriatrics with prescribing any medication is the idea that you start low and go slow. For someone who is older, there’s a different biology of aging with medications that take longer to metabolize. They affect people differently. For someone who’s younger, you may be able to start at a dose, for example, of 10 milligrams. In an older adult you often have to start at 2.5.

But how I decide really depends on what are this person’s goals? How is the pain affecting their life? What have I tried and what is not indicated for them? 

Ultimately, my goal with using opioids when I have to is, “Can I relieve this person’s pain well enough so that they can maintain their function?” Because ultimately in older adults, their function and ability to live independently is one of the greatest predictors of health. I have patients who unless they take their opioid really cannot get out of bed. And if that small dose of opioid is going to help them get out of bed and move around their house and cook for themselves, then that is absolutely something worth doing. Their biggest risk is going to be if they stop moving and [decline more]. That’s going to have a bigger consequence on their health than prescribing an opioid at a reasonable dose and with close supervision.

Q: What are some of the risks of prescribing opioids to seniors?

As with any person taking opioids, there are real side effects of becoming addicted. Constipation also ends up being one of the biggest challenges, and frankly many of my older adults don’t want to be on opioids because of the fear of constipation. The other thing is, of course, that opioids can be sedating and so they can put people at risk for falls and an increased risk of confusion.

What’s interesting though is that there are some people with dementia who at times appear to be more confused or delirious. And it turns out it can be from uncontrolled pain. So this is where it’s so tricky for geriatricians to figure out, are we giving enough pain medication or not enough? And how do we figure out that balance? And it’s a very close relationship you need to have with the patient to really figure out, “Am I doing the right thing?”

Q: What are some of the other tools you have available to treat pain for seniors?

There are some topical agents that work for some people. Understandably, many patients don’t like taking that many pills, and so the idea of being able to put something on the joint or on the skin is really fantastic. There are other modalities that I think work for people, for example massage. Some people get benefit from acupuncture and chiropractic care.

The challenge is that many of the additional therapies, even some topical therapies, are not covered by insurance. And that actually brings up an interesting point in how we prescribe, in that there are times that I would prefer to prescribe something topical and it’s not covered by insurance, but yet the opioids are. So it also limits you as a physician in terms of “What am I able to prescribe? What can I do for this person that is covered by insurance?” So unfortunately that is one of the unspoken things — that how things are paid for still makes a big difference.

Q: How do seniors fit in with the larger national conversation about opioids?

I do not want to undermine the national efforts which are very real in terms of the serious consequences of opioids. At the same time, for many older adults, these are very reasonable treatment modalities.

What I’m seeing from the national perspective is that because of this real concern about opiate overuse, many patients are being discriminated against. I have patients who are on opioids, they’re on low doses, they’re very stable. There’s no evidence of abuse. And if I’m out of town and they are out of medications, no one wants to refill them. And that actually puts someone at risk for withdrawal. And what happens is someone then comes to the office and requests an opioid refill for something they’ve been on, and they’re labeled as drug seeking.

It’s very sad. And I think that the challenge is how do we keep this national dialogue going so that we educate providers to prescribe safely? How do we educate patients to know how to look for signs of withdrawal and look for signs of overdose? So that we’re not discriminating against people with chronic illness and chronic pain who really do need these medications to function when other therapies have failed.

Q: Are you seeing patients come into your practice for the first time who are taking too many opioids?

I absolutely have received or have started taking care of people that are frankly incorrectly dosed on too many variations of opioids, and it can be risky. And it’s really hard when someone is on them to really try to take someone off and taper down. But it’s something that can be done if there’s significant trust.

I think that part of it is education of providers in terms of safe opioid prescribing. Because of the national concern over opioid use, we’ve swung away where it’s never prescribed … and I think as a result our physicians in training aren’t being taught how to prescribe correctly.

Q: Some people say there are no situations in which opioids should be prescribed long-term. What would you say to them?

I completely disagree. Palliation, which is the relief of symptoms, is something that is incredibly important with older adults. There are many illnesses in older adults that cannot be cured. And if you are trying to maintain someone’s independence, there are very reasonable times where people may be on opiates; osteoarthritis or severe spinal stenosis. Some of those things do not have great treatments and there are times where opioids do have a positive effect on someone’s relief of pain so that they can maintain their function.

I think that unless you have lived [with] pain yourself, it’s very easy to judge and very easy to assume that someone can just get over it. And I hear this time and time again from some of my patients who were being judged … : “I’d like for that person to walk in my shoes and see what it’s like to live with pain and maybe they would think differently.”

Why Computer Hackers Invade Health-Care Providers

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Male Hacker Using ComputersLast year the dizzying news of a computer hack at MedStar Health, one of the largest medical providers in the Baltimore/Washington area, forced the organization to shut down most of its online operations. 

The exact nature of the attack was suspected as ransomware and MedStar is just one of the the victims in a string of cyberattacks that have hit the health-care industry hard. Here’s what you need to know about how health-care providers became a digital battleground.

Why would cybercriminals go after the health-care industry?

The health-care sector has a lot of information that could be valuable to criminals and that makes them a juicy target.

First, they often have a bunch of personal information that could be used for traditional financial fraud — things like your name, social security number, and payment information. But they also have health insurance information, which can be sold for even more on online black markets because it can be used to commit medical fraud — things like obtaining free medical care or purchasing expensive medical equipment — that often isn’t caught quite as quickly as credit card or bank account fraud.

A particularly aggressive cybercriminal could even find a way to leverage compromising medical information guarded by health-care providers into a blackmail scheme — although that has not become a major avenue for attack yet, according to Ben Johnson, co-founder and chief security strategist at cybersecurity Carbon Black.

However, several U.S. hospitals have also now been hit with ransomware, a type of malicious software that basically lets an attacker hold a computer hostage. Once ransomware gets in a system, it starts quietly using hard-to-break encryption to lock up the information stored there — making information inaccessible to the legitimate user. After the software has finished locking things up, it typically pops up with a message demanding a payoff in a difficult-to-track digital currency like bitcoin in exchange for the digital key needed to get back into the data.

This is a particular type of nightmare scenario for health-care providers because more and more of them rely on electronic medical records to keep things up and running.

“Health care is a bit unique in that up-time is really important,” said Johnson, which means providers may be more likely than other targets to pay quickly so they can get back to work.

Just how vulnerable is the health-care sector to cyberattacks?

Things are not looking good.

According to cybersecurity firm TrendMicro, health care was the sector that was hit hardest by data breaches from 2010 through 2015. Not all of those breaches involved hacks — two-thirds were actually due to the loss or theft of things like laptops, smartphones, or thumb drives — but it still demonstrates a major problem with the way the industry approaches keeping data safe.

“It’s a big environment with a lot of different pieces — and not a lot of investment in cybersecurity,” said Johnson.

Part of the problem is that hospitals and doctors’ offices often need to oversee a mishmash of different types of equipment running different types of software — and they cannot always apply standard security practices, like regular updates, without risking instability because it might break the connections between systems, according to Jay Radcliffe, a senior security consultant at cybersecurity company Rapid7.

The FBI actually warned health-care providers that they needed to increase their digital defenses in April of 2014. “The healthcare industry is not as resilient to cyber intrusions compared to the financial and retail sectors, therefore the possibility of increased cyber intrusions is likely,” said a private notice the FBI distributed to the sector.

In 2015, several big health insurers suffered major breaches. One hack at Anthem, the nation’s second-largest health insurer, left information on up to 80 million people exposed. Another at Premera exposed data on 11 million people, including medical information in some cases.

Also last year a ransomware attack hit Hollywood Presbyterian Hospital in California. Staff was forced to resort to paper record-keeping for a week and divert patients to other hospitals. The hospital eventually paid the attackers roughly $17,000 to get access back to their data.  Two other hospitals in Southern California were also reportedly hit with similar ransomware — as was a Kentucky hospital, which declared an “internal state of emergency” after the attack.

And to make matters worse, the health-care providers are also having to grapple with the problem of securing connected medical devices: A hacked pacemaker or drug pump could have potentially life-threatening consequences for patients, and even other types of networked devices could end up helping a cybercriminal find a furtive way to get access to a hospital’s computer systems.

“That can be the weak spot in your network — and in a lot of cases, a hospital might not even realize it was connected,” said Radcliffe.

What is the health-care sector doing to fix this problem?

The industry has its own groups dedicated to helping coordinate how it responds to cybersecurity threats, including the National Health Information Sharing and Analysis Center, or NHISAC, which was founded in 2010. These sort of efforts are useful because they can help industries work together to help stem the spread of a particular type of threat early.

And there is at least one bright side to all the breaches and hacks in the health-care sector: “They are really waking up to the fact that they are a huge target,” said Johnson.

But, unfortunately, that awareness is just part of the problem. Even once an organization has committed the funds to build up their digital defenses, it can be difficult to plot the best path forward, according to Johnson, because it takes time to figure out which tools to put in place and whom to hire.

The latter part can be difficult for health-care providers because there’s a shortage of security professionals across all industries.

“I’ve literally talked to health-care organizations that have 300 open security positions, and are struggling to fill even a handful of them,” said Johnson.

“It’s going to continue being a rough period of time,” he said.

Common Traits of Financial Fraud Victims

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Man with credit card on phone“I am an older male and married. I’m also a war veteran who values wealth accumulation as a significant measure of success in life. Although I’m idealogically conservative, I’m willing to take risks and am open to unsolicited telephone and email pitches.” 

This is the demographic profile of Americans who are most likely to become victims of financial fraud, according to a new survey by the AARP Fraud Watch Network.

“While previous surveys in this area have developed a demographic picture of investment fraud victims — usually older, financially literate males who are more educated and have higher incomes — our goal with this survey was to learn about why people fall prey and how it can be avoided,” says Doug Shadel, Ph.D., lead researcher for the AARP Fraud Watch Network. “Meanwhile, today’s sophisticated technology makes it significantly easier for scammers to reach large numbers of investors.”

The Fraud Watch Network survey, conducted in August and September 2016, included interviews with more than 200 known victims of investment fraud and 800 interviews with members of the general investing public.

According to Shadel, “what emerges from this study is a well-rounded profile of the kinds of mindsets, behaviors and demographic characteristics that are correlated to falling prey to investment fraud.”

The financial fraud universe

The world of financial abuse and identity theft is a vast one. Sometimes the thieves manufacture alluring Ponzi schemes. Other popular scams involve fake IRS phone calls, emails from oversees ‘royalty,’ or tactics that are closer to home — an appeal on behalf of a family member with an eye on their loved one’s nest egg.

The amount of thievery taking place in America varies as well. Many studies estimate the money lost to elder financial abuse alone at $2.9 billion. A 2016 study by True Link Financial, a San Francisco-based company that provides tools and services for seniors, and adults with disabilities, found that number to be a gross understatement.

The True Link Financial research revealed that seniors lose $36.5 billion each year to elder financial abuse with approximately 37 percent of seniors affected by financial abuse in any five-year period. Here is a breakdown of the problem:

        • Financial exploitation: $17 billion is lost annually to financial exploitation, defined as when misleading or confusing language is used — often combined with social pressure and tactics that take advantage of cognitive decline and memory loss — to obtain a senior’s consent to take his or her money.
        • Criminal fraud: $13 billion is lost annually to explicitly illegal activity, such as the grandparent scam, the Nigerian prince phishing scam, or identity theft.
        • Caregiver abuse: Nearly $7 billion is lost annually to deceit or theft enabled by a trusting relationship — typically a family member but sometimes a paid helper, friend, lawyer, accountant or financial manager.

A perfect storm for fraud

AARP’s survey notes that economic forces have converged to make the current environment ideal for investment swindlers to practice their craft.

“The decline in traditional pensions has prompted millions of relatively inexperienced Americans to take on the job of investing their own money in a fast-moving and complex market,” says Shadel. 

The AARP survey found stark differences between the past investment fraud victims and regular investors in three areas:

        1. Psychological Mindset: More victims reported preferring unregulated investments, valuing wealth accumulation as a measure of success in life, being open to sales pitches, being willing to take risks, and describing themselves as ideologically conservative.
        2. Behavioral Characteristics: Victims reported that they more frequently receive targeted phone calls and emails from brokers, they make five or more investment decisions each year, and more of them respond to remote sales pitches — those delivered via telephone, email or television commercials.
        3. Demographics: Somewhat replicating the previous industry studies, higher percentages of victims were found to be of older age, male, married and military veterans.

To further educate yourself, one suggestion is to take the AARP Fraud Watch Network’s online quiz. There you can learn whether or not you possess the characteristics that may predict likely fraud victimization.

According to AARP, “Investors who score high on the quiz are urged to apply a new level of caution if they receive unsolicited investment overtures.” Also investors should adhere to the following investor protection tips:

        • Do:  Invest only with registered advisors and investments.
        • Don’t:  Make an investment decision based solely on a TV ad, a telemarketing call or an email.
        • Do:  Put yourself on the Do Not Call list.
        • Do:  Get a telephone call blocking system to screen out potential scammers.
        • Do:  Limit the amount of personal information you give to salespersons until you verify their credentials.
        • Don’t:  Make an investment decision when you are under stress.  For example, when you’ve recently experienced a stressful life event such as the loss of a job, an illness or death of a loved one.

Friendly fire

According to the True Link Financial study, risk and vulnerability can play an equal role in putting consumers in the greedy hands of financial criminals. “People often assume that those perceived as most vulnerable — widows, the very old, people with severe memory loss — are at greatest risk. In fact, risk equals vulnerability plus exposure. Seniors who are young, urban, and college-educated lose more money than those who are not.”

Unfortunately, those who are friendly and welcoming to others, including strangers, are most at risk. “Seniors described as extremely friendly lose four times as much to elder financial abuse, perhaps because they are approachable and may give strangers the benefit of the doubt.”

Does Your Insurance Cover Alzheimer’s Care?

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Senior man sitting on a wheelchair with caregiverOne in eight individuals 65 and older suffers from Alzheimer’s disease –quite a sobering statistic for the growing number of baby boomers rapidly crossing that age threshold. And the costs can be an “overwhelming financial burden,” says Carol Steinberg, executive vice-president of the Alzheimer’s Foundation of America.

Private and government insurance programs may cover some costs. Here’s a primer on your options.

Medicare

Many people are shocked to discover that Medicare does not cover the long-term custodial care that Alzheimer’s patients need. Custodial care is the non-medical care associated with activities of daily living, such as bathing and dressing.

Medicare does cover limited care in a nursing facility or at home. For home care, the patient must require skilled-nursing care or physical or occupational therapy to help with the recovery from an illness or injury — not to help an Alzheimer’s patient with daily-living activities. “One of the most difficult situations is when a loved one needs personal or custodial home care, but Medicare will only cover that if there is some type of skilled-care need,” says Frederic Riccardi, director of programs and outreach for the Medicare Rights Center, an advocacy group.

At-home services in most cases can be provided for fewer than seven days each week or less than eight hours each day over a period of 21 days or less. Limited custodial care could be provided during these visits — perhaps if an Alzheimer’s patient treated by a registered nurse for a broken hip needs help bathing. Medicare pays the cost of a skilled-nursing facility, but only to provide continuing treatment following a hospital stay of at least three days. Skilled care in a facility is limited to 100 days.

While Medicare offers little by way of custodial care, it does provide diagnostic and medical treatment that Alzheimer’s patients need. The new annual wellness physical exam, which is free and part of the health care law, includes testing for cognitive impairment. “This is a critical, yet hardly known, provision,” Steinberg says. Medicare also covers visits to a geriatric assessment clinic.

Alzheimer’s patients and their families need to carefully choose a Medicare Part D prescription-drug plan or private Medicare plan. Alzheimer’s medications are generally covered under Part D, but plans vary regarding co-payments. The Alzheimer’s Association offers a guide about coverage for common Alzheimer’s drugs.

If you choose a Medicare Advantage plan, make sure your neurologist and other physicians you see often are covered as in-network providers. Otherwise, you will pay higher out-of-pocket costs or ask about Medicare supplement plans.

Long-term-care insurance

These policies provide coverage for the custodial care that Alzheimer’s patients usually need. Benefits typically trigger if the patient needs help with at least two activities of daily living or if a doctor provides evidence of cognitive impairment. Because most people with Alzheimer’s receive care in their own homes, look carefully at the policy’s home-care requirements. Typically, a patient must wait 60 or 90 days before benefits begin. But policies differ on when the clock starts ticking, which could be a big headache for caregivers. 

Some long-term care insurance policies start the 60-day waiting period on the day the doctor certifies the cognitive impairment — and benefits trigger 60 days later. But other policies count only the days a patient receives care from a qualified caregiver during the waiting period. If the caregiver visits two days a week, the policy only counts those two visits toward the 60-day waiting period — and benefits will not trigger for 30 weeks. In the meantime, the family has to pick up the tab for the caregiver.

Before you hire a caregiver, check the policy’s fine print on the type of caregiver the insurance company will cover. Some policies pay for any caregiver who is not a family member, while others only pay for licensed caregivers who work for an agency. Some families who hire an unlicensed caregiver later discover that the caregiver doe not qualify under the policy.

Do not expect a policy to pick up round-the-clock home care. Daily coverage is based on the daily benefit. A policy with a $200 daily benefit, for example, will likely cover the cost of eight to ten hours of a home health aide. If a family caregiver cannot fill in the gap, a nursing home may be a better option.

You cannot use more than your daily benefit in a day, but you can stretch your daily benefit over longer periods. Say you choose a benefit period of three years, at $200 a day. If you only use $100 a day, your coverage can last for six years. Some policies cover adult day care, which can cost a lot less than daily caregivers. “Many adult day services specialize in care for those with Alzheimer’s disease and similar disorders,” says Kathy O’Brien, senior gerontologist with the MetLife Mature Market Institute.

An alternative and more cost-effective option for long-term care insurance in today’s expensive health care environment is a short-term custodial care policy.

Medicaid

This program, whose costs are shared by federal and state governments, is the primary payer of long-term-care services for the elderly. Unlike Medicare, it provides custodial care for Alzheimer’s patients. Custodial care typically is provided in Medicaid-eligible nursing homes, but many states’ Medicaid programs now pay for home care and sometimes adult day care or care in assisted-living facilities, says O’Brien.

 

The downside: You need to be virtually impoverished to qualify. Many people end up qualifying after spending their retirement savings on care. While state laws differ, generally you cannot have more than $2,000 in countable assets, including investments. A spouse who lives at home can generally keep about $113,000. You’re allowed to keep your home, car and assets in certain kinds of trusts. (Visit www.medicaid.gov to find eligibility requirements in your state.)

To protect more of your assets, you can buy a state-approved long-term-care policy that is “partnership” eligible. The policy would allow you to qualify for Medicaid without having to spend almost all of your money first. For example, if you buy a partnership policy that covers $200,000 of care, you would pay out of pocket until you have $200,000 left and still qualify for Medicaid. Go to the National Clearinghouse for Long Term Care Information to see if your state allows these policies.

 

 

 

 

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