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As Senior Population Swells, State Needs to Lift Moratorium on Adult Day Care

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As Senior Population Swells, State Needs to Lift Moratorium on Adult Day Care

¬†By Roberto Mu?±iz, President and CEO, The Francis E. Parker Memorial Home Inc.

 The NJ Department of Health and Human Services has documented the many financial abuses in the adult day care system, reporting numerous providers who have scammed Medicaid to reap small fortunes off the backs of taxpayers.

Negative stories abound in the media:   Day care providers telling the elderly to lie to state investigators about their needs, people with disabilities placed in wheelchairs when they are able to walk, and even one case where a client with alleged heart failure and severe asthma was spotted cutting the center’s grass.  All these examples illustrate the extent that unscrupulous providers will go to collect Medicaid payments.  

With investigators suspecting that nearly one-third of the state’s adult day care centers committed some form of Medicaid fraud, according to published reports, it was no surprise that the state stopped issuing new licenses for adult day care centers in 2008. And, in an April 16th decision, that moratorium will be in place until at least November 1st of this year.

But while the NJ Department of Health and Human Services remains hesitant to allow any new centers to open, the demand in New Jersey for home and community-based long term care services is growing and adult day care is a cost effective option.

 Adult day care centers, if operated honestly and ethically, are enormously beneficial.  They make life easier for older New Jerseyans, giving them a safe and supportive place to receive quality care throughout the day.  Services vary among centers, but include medical care, stimulating activities and exercise, and nutritious meals and snacks.  They also provide transportation within a designated service area, making care and support accessible, and give caregivers, such as a spouse or child, a break from 24-hour-a-day care.

 Center staff is trained to monitor medical issues and communicate changes in health to caregivers.  For example, a scratchy throat or a fever could ultimately become a costly stay in a hospital if left untreated. Having a hot, fresh, nutritious lunch supports a daily balanced diet minimizing risk of dehydration or malnourishment.  An engaging walk with friends around the grounds can replace another inactive hour in front of a television.

Adult care centers, which receive $78.50 a day from Medicaid for each person served, are saving taxpayers a small fortune. Consider this: if not for these adult day care centers, many more seniors would be placed in skilled nursing homes, where the government would be spending significantly more to care for them, 24 hours a day, seven days a week.  Aside from cost, adult day centers honor every senior’s wish to remain home for as long as possible.

  Around New Jersey there are a variety of adult day programs.  At Parker, we offer two types, supporting both the social and medical needs of seniors.   The social program available five hours each weekday is for socially isolated elderly, who need motivation and support to maintain an active lifestyle while managing aging issues. Participants benefit from the wellness center, take in a movie, use the hair salon, attend rehabilitation therapy and engage in a host of other stimulating activities. 

 We also offer a medical program, available eight hours each weekday that provides health services, such as monitoring glucose levels, managing medications and providing clinical support for elderly with functional or cognitive challenges. Additionally, the program provides many activities that support the social and emotional needs of participants. 

 In addition to the much needed respite from the challenges of daily caregiving, Parker offers supportive education to caregiver families and assistance with long-term care options as participant needs grow.   

 The time is now for New Jersey officials to plot a future for adult day care, as statistics show there are now 1.13 million seniors living in the state and the numbers are quickly growing. As the Baby Boomers age and hundreds of thousands of New Jerseyans require care, there will be an enormous burden placed on the system.

  We are grateful that the state identified the unethical sources of fraud in adult day health services, and put corrective actions in place.  Now it’s time for state officials to lift the moratorium on new adult day centers, so that more high quality adult day programs can become available. 

 As the state is encouraging long-term care funding to move to home-and-community based services, supporting the growth of adult day programs makes fiscal sense andis the right thing to do for a growing demographic of New Jerseyans who want to remain at home with the support of affordable community resources.  

Roberto Mu?±iz, MPA, LNHA, FACHCA

President and CEO, The Francis E. Parker Memorial Home, Inc.

¬†Roberto Mu?±iz has more than 20 years of senior executive experience with health care and long-term care service providers.¬†¬† In addition to his current role as Present and CEO of Parker, Mr. Mu?±iz is extensively engaged in leadership positions with several New Jersey state and national associations that foster the availability and quality of aging services.¬† Mr. Mu?±iz holds a bachelor‚Äôs degree in public health administration and master‚Äôs degree in public administration from Rutgers University. He is a licensed nursing home administrator (LNHA) in both New Jersey and New York states.

Roberto Mu?±iz is the Chair of the Board of Trustees of the New Jersey Foundation for Aging, Inc.¬†

Learn more, connect with others and get involved.

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Learn more, connect with others and get involved.

 Affordable housing, job availability, livable wages, food security these are all key pieces to living and aging well in NJ. A recent article in the Trenton Times highlights the struggle of the homeless in accessing services at three key organizations that provide shelter, food and many other services. In navigating this “triangle” as they call it (due to distance traveled between each organization) some of the homeless in Mercer County have hope of escaping the street and having a home, a job, food, their health.

 Certainly Mercer County is not alone in this problem, throughout the state there are many homeless who find themselves navigating their way through the services available in each area. In addition to the homeless there are those living on the edge of homelessness, they are unemployed, under-employed and living pay check to pay check wondering if this will be the week they end up on the street.

There are many supports available to the homeless and working families, like SNAP (food stamps), SRAP (State Rental Assistance), Family Care (Medicaid/Health insurance) and of course there are many non-profit, charitable organizations that are doing their part to help those in need through various programs and supports. But is it enough?

 There are ways to get involved, to learn more and to connect with other advocates. The Anti-Poverty Network of NJ, a group of like-minded organizations and individuals that meet to strategize on advocacy efforts is holding a summit, Poverty Summit: A Call to Invest in the People of New Jersey on Monday, May 21, 2012 from 9 am to 12:30 pm at the War Memorial in Trenton, NJ. At this summit you will hear statistics on poverty in NJ, you’ll hear from service providers as well as community members who have experienced poverty, but you’ll also here about advocacy efforts and opportunities for you to join in those efforts.

So, please join us to learn more, connect with advocates and get involved. For more details and to register go to http://apnpovertysummit.eventbrite.com/

 PS- You can follow this up by coming to NJFA’s Annual Conference on June 14, 2012 to discuss affordable housing and many other important topics for aging well in NJ! www.njfoundationforaging.org/events.html

Affordable Care Act: Fact 4

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Affordable Care Act (ACA) Facts: Follow this Series

This is part 4 of our ongoing series, so please see Fact # 1 in a post dated, Feb 8, 2011, Fact # 2 in the post dated 2/24/11 and Fact # 3 in a post dated 3/8/11.

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and their families.

Fact # 4: The law will improve care for older adults in other ways besides changes to Medicare.

There are improvements beyond Medicare that will help you and your family.  In a previous blog post we discussed the long term care changes that will improve for older adults such as changes to Medicaid that will allow people the choice of home and community based care and regulations that will prevent a spouse from becoming impoverished if their spouse is receiving home and community based care through the Medicaid Program.

There are also measures written in the Affordable Care Act (ACA) that will help early retirees. To help offset the cost of employer-based retiree health plans, the new law creates a program to preserve those plans and help people who retire before age 65 get the affordable care they need. By providing financial relief to businesses that provide health coverage to early retirees, health reform will make it easier for early retirees to obtain health care coverage. Health insurance reform will guarantee that you will always have choices of quality, affordable health insurance even if you retire early and lose access to employer-sponsored insurance. It will create a health insurance exchange so you can compare prices and health plans and decide which quality affordable option is right for you.

The ACA also sets up protections for people with pre-existing conditions. The new law provides affordable health insurance through a transitional high-risk pool program for people without insurance due to a pre-existing condition. The Dept. of Banking and Insurance in NJ as already begun working on the high-risk pool program. Insurance companies will be prohibited from denying coverage due to a pre-existing condition for children starting in September, and for adults in 2014. Insurance companies will be banned from establishing lifetime limits on your coverage, and use of annual limits will be limited starting in September.

And if you are concerned for the young people in your life who may be struggling to find a job in this economy, the ACA didn’t forget them either. According to the Law, young people up to age 26 can remain on their parents’ health insurance policy starting in September of 2011.

Information in this blog was gathered from the Affordable Care Act, Centers for Medicaid and Medicare and the National Council on Aging.

Healthcare Reform information from

The White House:

http://www.whitehouse.gov/assets/documents/Pages_from_Health_Insurance_Reform_PDF-4.pdf

Medicare

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

National Council on Aging

http://www.ncoa.org/public-policy/health-care-reform/straight-talk-for-seniors-on.html

Affordable Care Act (ACA) Facts: Part 2 in a Series

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Affordable Care Act (ACA) Facts: Follow this Series

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare. We decided to do a series of blog posts about the facts; this is our second post, so please see Fact # 1 in a post dated, Feb 8, 2011.

Fact # 2 The ACA will reduce Medicare spending growth, extend Medicare solvency and is projected to reduce the budget deficit.

While Medicare spending will continue to grow, over the next 10 years the healthcare law will slow the overall rate of growth. Average spending per person will grow at about 2% per year, according to the Congressional Budget Office (CBO) this is compared to the current rate of 4% per person per year. This slight decrease will be a result of reductions in waste, fraud and abuse.  The CBO also projects that the ACA will save Medicare about $400 billion over 10 years and will extend the solvency of the Medicare Trust Fund until 2026.

What you need to know:

In 2011, the ACA will slow payment increases that are made to Medicare providers such as, hospitals, nursing homes and home health agencies. Please note that doctors are not included in that group. The ACA does not reduce payments to your primary care doctor.

Also in 2011, payments to Medicare Advantage (MA) will be reduced. Approximately 25% of seniors are enrolled in MA plans, HMOs or PPOs offered by private insurance companies, the other 75% have traditional Medicare. The ACA will gradually lower payments made to MA plans, which on average cost 13% more than original Medicare. Another change that ACA makes to Medicare Advantage (MA) plans is that those plans will not be able to charge you more than what you would pay if you were on original Medicare for services such as kidney dialysis, chemotherapy, or skilled nursing home care.

Because of these laid out in the Law, MA plans may cut some of the extra benefits they offer that are not covered by traditional Medicare and some may increase their premiums. Please note that MA plans cannot cut any basic benefits under Medicare, such as doctor visits and hospital care. You will also have the same right to switch out of your MA plan to original Medicare, the new law will not affect your right to Medicare benefits.

Another way that Medicare savings will occur according to statements in the Affordable Care Act, is for higher income individuals to pay higher prescription drug premiums. This will affect about 5% of Medicare recipients in 2011, single people with incomes above $85,000 and couples with adjusted gross incomes above $170,000.

The ACA states that in 2014 a Payment Advisory Board will be created. This board of experts will recommend specific ways to reduce Medicare costs without cutting benefits or increasing out-of-pocket costs.

Information in this blog was gathered from the Affordable Care Act,  Congressional Budget Office, Centers for Medicaid and Medicare and the National Council on Aging.

For more information check out the following links:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/

More about NJFA’s 12th Annual Conference!

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Offering welcoming remarks at the New Jersey Foundation for Aging’s conference this year was Patricia Polansky, Assistant Commissioner from the Dept. of Health and Senior Services.  We were pleased to have Pat join us and kick off the day! Her remarks began with comments about the budget and fiscal concerns for the State. However, the Assistant Commissioner transitioned to big changes coming to NJ as a result of Healthcare reform. Ms. Polansky advised that as a result of President Obama signing into law the healthcare reform bill, also known as the Affordable Care Act, “$60 million in grants are being made available for states to help individuals and their caregivers better understand and navigate their health and long-term care options”.  Adding, “the purpose of this grant program authorized by the Affordable Care Act is to create streamlined, coordinated statewide systems of information, counseling and access that will help people find consumer-friendly answers they seek to meet their health and long-term care needs”.

The Assistant Commissioner went on the describe what NJ is already doing, “New Jersey has achieved excellent results in building on existing programs and implementing new approaches for supporting home and community based services”. Pat was referring to the Independence, Dignity and Choice in Long-Term Care Act, stating that, “the state’s long-term care funding structure is being adjusted to provide more options for older adults through budgetary rebalancing”. She followed up this statement by pointing out that there is a growing population of older and disabled persons who desire to stay at home with care rather than going into a nursing home, she stated that policy changes have been made to support that.

Pat added, “The State’s effort to expand home and community based services options for individuals who qualify for Medicaid Institutional Care, started with consolidating 3 Medicaid Waiver Programs into a single line item now know as Global Options for Long-Term Care. Pat added, “we have seen an increase of 1,840 or 23% more participants served; yet well within the SFY 2010 budget”.  She informed the crowd that GO serves 10,000 aging and disabled clients, but that is was actually a cost savings.  She pointed out to the audience, “The average Medicaid rate for a NJ nursing home is $63,541 per year, whereas the annual cost is $17,112 for the Medicaid Waiver, Global Options. Clearly this demonstrates a more cost-effective approach”.

The conference attendees were glad to have heard these valuable updates from the Assistant Commissioner. Many people came up to us during the day to say how wonderful it was to have the Assistant Commissioner share these details with the group.

We hope you have also found this synopsis of the remarks offered by the Assistant Commissioner helpful and informative, please stay tuned for more details and excerpts from the conference.

NJ’s Budget Impact on Seniors

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May 26, 2010

New Jersey’s budget is in the midst of a heated debate. Governor Chris Christie has proposed the new budget and made many cuts. There have been many groups affected by the cuts that have reacted with press releases, meetings and rallies. NJFA and its partners have done much research and speaking out about the impact on our most vulnerable populations, including seniors.

Some of the proposed cuts included PAAD, NJ’s prescription drug assistance program, seniors would have been forced to pay a $310 deductible and face a co pay increase for brand name drugs from $7 to $15. Thanks to the efforts of many groups, the message of the impact of these cuts got to the legislators and they were successful in getting Gov. Christie to remove those cuts from the budget and keep the PAAD program the way it had been.

While that victory feels pretty good there are still many issues regarding the budget and seniors. The Senior Freeze program, a property tax reimbursement program, will not be given out in 2011, that is approximately $1,000 that many low to middle income seniors rely on to help make ends meet. Another item in the proposed budget that will affect the low income senior in NJ is the addition of a $5 co pay for medical day care services with a monthly cap of $25 and the elimination of medication administration as a criteria for medical day care attendance. Many caregivers rely on medical day care as part of a senior or disabled persons care plan, this will be a hardship for those who need it most.

A decrease in the provider reimbursement rate for the PCA program, a home care program that services 29,000 disabled persons and seniors, has been a hot topic in regard to Gov. Christie’s budget. The cut, which decreases the rate by approximately $2, has been the subject of budget hearing testimony due to the fact that this will cause many providers to withdraw from this vital service, leaving many clients in need without services.

With the Elder Index NJFA highlighted an issue regarding some of our most vulnerable seniors and that is the NJ SSI State Supplement which is just $31 a month and has been since 1986, a payment that is meant to help disabled persons make ends meet on a fixed income and just doesn’t cut it at that level. Recently a budget item has come to our attention that is equally troubling, the spousal supplement for caregivers of disabled persons is due to be eliminated in the proposed budget. Again, many of the cuts in this budget are affecting seniors, the disabled and their caregivers, many of whom are already living on the edge.

NJFA and many of our partner organizations have put out press releases, op eds and fact sheets, sending them to newspapers, legislators and community groups, hoping to get the word out about the proposed budget cuts and their impact on seniors. NJFA encourages everyone to contact their representatives in the legislature to make their voice heard.

You can find contact information for your local representatives at www.njleg.org

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What the budget cuts mean for NJ Seniors

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We are sure you’ve heard all about the proposed budget cuts from Gov. Christie for Fiscal Year 2011. What you may be wondering is how does this affect me? You may ask what it all means to you, your children, your parents, or your community?

NJFA has been looking at the proposed budget and doing some research with some of our stakeholders. What we’ve found is that there will be some significant impact for NJ’s seniors. Especially for those most vulnerable, who may already be living on the edge.

Some of you know that in 2009 we advocated, along with many others, for the change in the eligibility level for the NJ Senior Property Tax Freeze program, making the requirement for time you’ve lived in your home to 1 year instead of 3 years. It was disappointing to learn that among the cuts was a freeze on Senior Freeze (also known as Property Tax Reimbursement Program). In the proposed budget those eligible would not receive a property tax reimbursement in 2011. The average reimbursement payment for this program is $1042. So, NJ’s seniors can add that to their cost of living for 2011.

Another cut that is going to add to a NJ senior’s expenses is the increase in co-payments for PAAD. Those who participate in this program do so to save money on medications, because they have limited income. The proposed increase in co-payments for brand name drugs will go from $7 to $15, When you factor in the deductible of $310 a year this will mean another $430 a year added to their cost of living.

Cost of living for a single elder renter in NJ according the NJ Elder Index =$25,941.

Add on the $1042 they won’t receive from the Senior Freeze program  =$26,983

Add on the $430 due to increased PAAD co-pays/deductible  = $27,413

Will there be some safety net or increase to another program such as senior housing to help offset this increase to the NJ senior’s cost of living?