Daily News: Study Links Acetaminophen to Asthma

From Nurse.com

Researchers from the University of British Columbia have discovered an increased asthma risk for children and adults among acetaminophen users. In a review of 19 previous studies involving more than 425,000 participants, the researchers found a greater risk among adult acetaminophen users, children who used acetaminophen in the year before asthma diagnosis, and for children in the first year of life. A slight risk also was found in the risk of asthma and wheezing with prenatal acetaminophen use by mothers.

The study was published in the November issue of CHEST, the journal of the American College of Chest Physicians.

Thankful for "Chicken"

This story is especially humorous to me because as a child my mom fixed chicken every way imaginable. I swore, I would never eat chicken once I left home.. LOL … Of course, while I was a big talker, today, it is one of my favorites! As moms we all have the immeasurable experiences of witnessing how our children interpret and think of things. This week, my 5 year old son brought home a project. They are asked to think of one thing they are thankful for and decorate a feather for a large turkey to be posted in the school hallway. As Hilton and I sat down to discuss what we are “thankful” for, I explained how mommy is thankful for both of my kids, my family and my friends. He asked, “what else are you thankful for?” I told him that I feel thankful and blessed to have good health that our family has a roof over our heads, food on our table and the freedom to make choices in life. He asked me if daddy is thankful for the same and I replied, “why sure he is.” Then he asked what about Haley? (his sister) I went on to say that while I cannot speak for her, I am sure that she too, is thankful for her family, friends and life. “So buddy”, I said, “what are you thankful for”? He said, “that’s easy momma… I am thankful for chicken. I love chicken”.

HomeCare Today: Growing Options and Risks

With an estimated 4.2 million Americans

currently over age 85, an expected 78 million baby boomers to reach age 65 by 2030; almost 25% of Americans are in the process of dealing with elder/care issues, it is no surprise that the home care industry is exploding.

A Question of Quality & Ethics

Home care is a very personal choice and can be an invaluable service. Too often, we are witness to heart wrenching cases where neglect, abuse, theft and lawsuits have occurred as a result of families trying to save money by privately hiring their own caregivers. Like any other service, you pay for what you receive. In addition, if someone is offering to buy items to gain or keep your business, question their ethics. Peace of mind is worth the price. Call and interview agencies. Ask for references. Take your time and be sure that you feel a connection with them. Visit their office. Trust and confidence in your agency, its internal staff and its caregivers is critical. Make informed decisions based on your own research. After all, they spend a great deal of time in the home, and truly become an extension of your family!

Leading Education & Ethics in Charlotte and Across the Country

Serena Brock—nationally recognized entrepreneur/ speaker and focuses on the importance of the synergistic relationship between attorney’s, financial planner’s and home care owner’s supporting the fast growing baby boomer population. An advocate for children/seniors, she currently is a member of the North Carolina Association for Home and Hospice Government Affairs Committee, the North Carolina Guardian ad Litem Foundation and the World Orphans Day, Global Click Campaign. Brock lends her expertise to several national organizations including the National Private Duty Home Care Association, Medicaid Practice Systems, Elder Law Answers and The National Network for Estate Planning Attorneys.

Simple Tips to Avoid Colds and Flu

Avoiding colds and flu this season is at the top of everyone's list. Here are 14 tips to help you keep healthy and happy as compiled by medical experts who want to keep you out of their offices and safe at home and work.
1. Wash your hands often, including every time you shake someone's hand.
2. Do not touch your nose and eyes.
3. Feeling bad? Go to bed and get some sleep.
4. Get a flu shot (you may need two this year with H1N1 widespread).
5. Eat fresh fruits and vegetables.
6. Exercise to enhance immune function.
7. Stay away from sneezers, coughers and sick people.
8. Use alcohol-based hand wipes often.
9. Stop smoking if you have not already done so.
10. Avoid 'double dipping' with chips or watch out for those who may be dipping double.
11. Use a purse that can be wiped down, like leather or vinyl.
12. No nail-biting.
13. Get happy!
14. Sneeze into the crook of your arm and not your hands.

Special Dates

January:

20-25 National Activity Professionals Week

February:

American Heart Month

March:

National Professional Social Workers Month

National Brain Injury Awareness Month

National Kidney Month

National Multiple Sclerosis Education and Awareness Month

April:

20-26 National Volunteer Week

May:

Older Americans Month

National Arthritis Month

National High Blood Pressure Month

6-12 National Nurses Week

11-17 National Hospital Week

11-17 National Nursing Home Week

28 National Senior Health and Fitness Day

June:

22-28 Helen Keller Deaf-Blind Awareness Week

July:

UV Safety Month

August:

Cataract Awareness Month

MedicAlert Awareness Month

October:

National AIDS Awareness Month

November:

National Alzheimer's Awareness Month

American Diabetes Month

National Hospice Month

December:

1 World AIDS Day

3 International Day of Disabled Persons

Flu Fighters Recipe from Women's Health Magazine

Carrot-Ginger Bran Muffins

Prep: 15 min Cook: 20 min

You may still be sporting sandals, but cold and flu season will be back faster than you can say "Gesundheit!" Protect yourself with this spicy triple threat. Carrots are rich in immune-boosting vitamin A, zinc-packed pumpkin seeds ward off infection, and apple juice flows with sniffle-stifling vitamin C. Another weapon: yogurt. Studies show that its good-for-you bacteria provide another line of defense against microbes.

1/4 can (3 oz) frozen unsweetened apple juice concentrate

1/2 c wheat bran

1 1/4 c whole-wheat or other whole-grain flour

1 tsp baking soda

1 1/2 tsp baking powder

1 tsp ground cinnamon

1/2 tsp ground dried ginger

1 egg, beaten

1/2 c yogurt (such as Dannon Activia)

1/2 c shredded carrots

1 tsp grated fresh ginger

3 Tbsp molasses

1/4 c pumpkin seeds

1. Preheat oven to 375 degrees F

2. Boil juice over high hear until it becomes syrupy. Set aside and let cool.

3. In a large bowl, whisk together wheat bran, flour, baking soda, baking powder, cinnamon, and dried ginger.

4. In a separate bowl, combine reduced juice, egg, yogurt, carrot, fresh ginger, and molasses. Combine mixtures and then fold in pumpkin seeds.

5. Spoon batter into paper-lined muffin cups. Bake for 18 to 20 minutes or until tops spring back when lightly touched. Cool on a wire rack.

Makes 12. Per Muffin: 109 Calories, 3 g fat (0.5g sat), 177 mg sodium, 20 g carbs, 3 g fiber, 4 g protein

AARP Flu Season Question of the Week

When the time comes for me to get the H1N1 vaccine, should I get the nasal spray or the shot?

Some people shouldn't get the nasal vaccine, which contains a live, weakened virus. This group includes all those 50 and older, pregnant women, children under two and those with a medical conditions that puts them at higher risk for flu-related complications.

Avenue's Christmas Gift-The Angel Tree

You remember Christmas. Christmas could not get here fast enough and you tried extra hard to be good so that Santa Claus would bring you wonderful gifts. Christmas was a magical time of year where anything was possible. It’s the time of year when we all put aside our differences, we travel long distances to see family and friends. For so many Christmas is the most wonderful time of year, but for so many it’s also full of longing.

So many children, here in our own state, our own county will go without this Christmas, simply because their families must choose between keeping a roof over their heads and buying them Christmas gifts. You remember Christmas, give the gift of that Christmas to a child and I can guarantee you will feel the miracle that only Christmas can bring. Donation boxes are in our office. Please bring a new, unwrapped toy to help us bring a smile to the faces of the less fortunate. Help our own Mecklenburg county kids! Last year, you helped us provide gifts for 220 children. This year – that number is 700. I can’t imagine these children going without, can you? Any donation will help!

AVENUE OFFICE HOLIDAY SCHEDULE

November 26th and 27th (closed for thanksgiving)

December 23rd (closed at noon)

December 24th and 25th (closed for christmas)

December 30th (closed at noon)

December 31st and January 1st (closed for New Year’s)

We hope you have a wonderful holiday season!

-Avenue HomeCare

Vivaglobin Home Sub Q Infusion training

Friday, November 13, 2009

12:30 PM - ?? PM EST

Training will be held at the Avenue HomeCare office in Charlotte 1230 W. Morehead St., Ste 110

Lunch will be provided. Training may also be done on-line for those who are unable to attend. Please contact our office for more information (704) 971.2800.

IVIG/Hemophilia In-Service

Thursday, November 19, 2009

11:00 AM - 1:30 PM EST

Training will be held at the Avenue HomeCare office in Charlotte 1230 W. Morehead St., Ste 110

For more information please call our office (704) 971.2800

“Ingredients for Hemophilia Health 101” is a continuing education program, developed by clinicians with more than 50 years of school nursing and hemophilia treatment center experience. The objectives of the program are to educate and enlighten individuals in a school environment on the causes/treatment of hemophilia, care plan opportunities for the student/staff, and ways to ensure a safe, healthy and supportive environment for the child with a bleeding disorder.

The course defines IVIG and its effects, provides a history of discovery and treatments, and presents current information on intravenous and subcutaneous immune globulin therapy. The program’s objective is to educate and enlighten individuals about primary immunodeficiency and immune globulin therapy.

Halloween Contest

Calling All Kids!!
All entries must be in
before October 28th!
Kids
Halloween
Coloring
Contest
Sheets and rules can be
picked up in our office

Avenue HomeCare infusion training

Avenue HomeCare RNs infusion drug training October 13th. Visit facebook.com/avenuehomecare or call 704-971-2800

How does the flu spread?

Both novel H1N1 flu and seasonal flu are thought to spread mostly from person to person through the coughs and sneezes of people who are sick with influenza. People may also get sick with influenza. People may also get sick by touching something with flu viruses on it and then touching their mouth or nose.

How Serious is the Flu?

The flu can be very serious, especially for younger children and children of any age who have one or more chronic medical conditions. These conditions include asthma or other lung prolbems, diabetes, weakened immune systems, kidney disease, heart prolbems and neurological and neuromuscular disorders. These conditions can result in more severe illness from influenza, including the new H1N1 virus.

What is the H1N1 flu?

Novel H1N1 flu is a new and very different influenza virus that is spreading worldwide among people. This new virus was called "swine flu" at first becuase it has pieces of flu viruses found in pigs in the past. However, H1N1 has not been detected in U.S. pigs.

Influenza is unpredictable, but scientists believe that the new H1N1 virus will cause illness, hospital stays and deaths in the United States over the coming months. The flu season, the new virus may cause a lot more people to get sick than during a regular flu season. It also may cause more hospital stays and deaths than flu seasonal flus.

Power Of Attorney

Top 5 Questions about Powers of Attorney

Powers of attorney are an effective estate planning tool but the attorneys at Garrity & Gossage often field questions about powers of attorney. The questions we are most often asked are below.

1. Are there different kinds of powers of attorney?
Yes. You should have a Health Care Power of Attorney to designate the person or persons who will make health care decisions for you if you are unable to communicate those decisions to your doctors. Thanks to increased privacy laws, many doctors will not even consult your spouse or your children unless you have a Health Care Power of Attorney on record with the doctor first.

You should also have a Durable Power of Attorney to name someone to make financial decisions for you if you are unable to do so for yourself.


2. What is a springing power of attorney?
A Springing Power of Attorney goes into effect when your doctor - either a doctor of your choosing or your attending physician - determines that you are no longer able to manage your own affairs. Not all powers of attorney are springing.


3. Who should have copies of my powers of attorney?
You should give copies of your Health Care Power of Attorney to your agents (the people you named to make decisions for you) and to your doctors. You should give copies of your Durable Power of Attorney to your agents, but you might also want to provide copies to your bankers, financial planners and accountant.


4. Does a power of attorney have to be filed at the courthouse?
Your Health Care Power of Attorney does not have to be filed at the courthouse, though you might want to consider registering it with the North Carolina Secretary of State to allow your family and doctors to access it easily in an emergency. Information about the Secretary of State's program can be found at Advance Directive Registry.

Your Durable Power of Attorney does not have to be filed with the court but should be filed with the Register of Deeds of your county.


5. What happens if I don't have powers of attorney?
If you become incapacitated, whether because of an illness or an accident, someone will have to step in to make decisions on your behalf. If you have not signed powers of attorney, the next option is to ask the court to appoint a guardian or guardians to manage your health care and your finances. Because the court must first declare you incompetent, the guardianship proceeding tends to be very emotional for your family and, of course, can become costly. The easier, less expensive approach is to execute powers of attorney now to save your family the emotional distres and financial burden later.

Protect other persons in the home

• The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
• If possible, have only one adult in the home take care of the sick person. *People at increased risk of
severe illness from flu should not be the designated caretaker, if possible.
*http://www.cdc.gov/flu/about/disease/symptoms.htm
• If you are in a high risk group for complications from influenza, you should attempt to avoid close
contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick
individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more
information, see the *Interim Recommendations for Facemask and Respirator Use.
*http://www.cdc.gov/h1n1flu/masks.htm
• Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of
influenza-related complications and immunity can be suppressed during pregnancy).
• Avoid having sick family members care for infants and *other groups at high risk for complications of
influenza. *http://www.cdc.gov/flu/about/disease/symptoms.htm
• All persons in the household should clean their hands with soap and water or an *alcohol-based hand
rub* frequently, including after every contact with the sick person or the person’s room or bathroom.
*http://www.cdc.gov/h1n1flu/qa.htm#antibacterial
• Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the
household. For example, have different colored towels for each person.
• If possible, consideration should be given to maintaining good ventilation in shared household areas
(e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
• Antiviral medications can be used to prevent the flu, so check with your health care provider to see if
some persons in the home should use antiviral medications.

Home Care Today– Growing Options and Risks

With an estimated 4.2 million Americans currently over age 85, an expected 78 million baby boomers to reach age 65 by 2030; almost 25% of Americans in the process of dealing with elder/care issues, it is no surprise that the home care industry is exploding.

Growing Options

It's not easy to become elderly or a parent to your parent(s). The “Sandwich Generation”, those sandwiched between aging parents and their own children, face a number of key areas, critical to elder care; aging, legal, medical, financial and living arrangement issues. Support from an in home caregiver can help to assist with the activities of daily living, while providing companionship, whether it is your own child, spouse, sibling or an aging parent.

The type of home care service needed depends on several factors: mental/ physical health condition, support from family or friends, residential location, availability of finances. Financing may be long term care policies, money from a trust, state funded programs, insurance, Veterans aid and attendance benefit or private pay. Licensed home care agencies provide qualified caregivers such as companions, certified nursing assistants, nurses and rehabilitation therapists. Their services cover: activities of daily living, nursing/wound care; rehabilitation, case management, pre/post operative care, errands, etc. In addition to elder care, services can include pre/post operative care, new moms and multiples support, short term disability and illness. For employers, some agencies offer packages to help save on lost time/revenue as a result of employees forced to miss work to care for sick parents and/or their own children. Imagine the comfort and peace of mind knowing your loved one is in good hands whether you live near, with or far from your loved one.



Risks

With many home care agency choices, all making the same promises, it is critical to carefully select your agency. Unfortunately, not all are honest and ethical. We recommend you ask to see the policy on orientation, screening, testing and supervision. NAHC, The National Association for Home Care and Hospice, is a great resource in each state.



A Question of Quality and Ethics



Home care is a very personal choice and can be an invaluable service. Too often, we are witness to heart wrenching cases where neglect, abuse, theft and lawsuits have occurred as a result of families trying to save money by privately hiring their own caregivers.

Like any other service, you pay for what you receive. So, if someone is offering to buy items to gain or keep your business, question their ethics. Peace of mind is worth the price. Call and interview agencies. Ask for references. Take your time and be sure that you feel a connection with them. Visit their office. Trust and confidence in your agency, its internal staff and its caregivers is critical. Make informed decisions based on your own research. After all, they spend a great deal of time in the home, and truly become an extension of your family!





Leading Education & Ethics in Charlotte and Across the Country

Serena Brock - nationally recognized entrepreneur/speaker and focuses on the importance of the synergistic relationship between attorney’s, financial planner’s and home care owner’s supporting the fast growing baby boomer population. An advocate for children/seniors, she currently is a member of the North Carolina Association for Home and Hospice Government Affairs Committee, the North Carolina Guardian ad Litem Foundation and the World Orphans Day, Global Click Campaign. Brock lends her expertise to several national organizations including the National Private Duty Home Care Association, Medicaid Practice Systems, Elder Law Answers and The National Network for Estate Planning Attorneys.

Recipient Medicaid Identification Cards

Beginning September 8, 2009, the N.C. Medicaid Program will begin issuance of one Medicaid identification (MID) card per year to each recipient. The annual cards will be printed on gray card stock.

Because the new gray-colored card will not be issued prior to September 8, 2009, current recipients will be issued an old version (blue, pink, green, or buff-colored) of the monthly card for September. Individuals approved for Medicaid prior to September 8, 2009, will also be issued an old version of the monthly cards. Therefore, during the month of September, providers will continue to see the blue, pink, green, and buff-colored cards and may also begin to see the new gray-colored card. Old monthly cards with September or earlier eligibility dates will continue to serve as proof of eligibility for the months shown on the card.

Example of New MID Card

Additional information is available through the Medicaid Bulletin:

Notice of Medicaid Identification Card Changes , August 2009
Notice of Possible Medicaid Identification Card Changes , July 2009


Attention: All Providers
Notice of Medicaid Identification Card Changes
Upon approval of the State budget, the N.C. Medicaid Program will begin issuance of one Medicaid identification (MID) card per year to each recipient. The effective date of this change may be as early as September 8, 2009. The annual cards will be printed on gray card stock; DMA will no longer have blue, pink, green, and buff-colored MID cards. The cards will include the individual’s name, MID number, and CCNC/CA primary care provider information (if applicable).

This change means that the MID card will no longer serve as proof of recipient eligibility. At each visit, providers must verify the cardholder’s:

Identity (if an adult)
Current eligibility
Medicaid benefit category
CCNC/CA primary care provider information
Other insurance information

However, once eligibility has been verified during a particular month, the provider may assume that the cardholder’s identity, eligibility, PCP and other insurance information remains valid for the remainder of that month.

To verify eligibility, a provider can choose to use the “real-time” Eligibility Verification System (EVS) to submit and receive the HIPAA 270/271 transactions through an approved Value Added Network (VAN), use the batch EVS to submit and receive the HIPAA 270/271, or call the EDS Automated Voice Response (AVR) system at 800-723-4337.

For additional information on health eligibility benefits inquiries and responses, refer to the article titled Recipient Eligibility Benefit Inquiry and Response . For information regarding real-time and batch eligibility, contact the EDS Electronic Commerce Services (ECS) unit at 1-800-688-6696 (option 1). Information about the AVR system is available in the July 2001 Special Bulletin, Automated Voice Response (AVR) System Provider Inquiry Instructions .

The methods listed above will not only serve to verify eligibility, but also to inform the provider as to whether the recipient is entitled to any special services, such as the Program of All-inclusive Care for the Elderly (PACE) or the Community Alternatives Program (CAP), or is enrolled in a restrictive program, such as Family Planning Waiver or Medicaid for Pregnant Women. Recipients enrolled in PACE receive their medical care exclusively through the PACE organization. When using the AVR system, it is therefore important that providers listen to the entire recorded message and follow prompts as directed or important parts of eligibility information may be missed.

An exception to the one-card-per-year rule will be made for those managed care recipients who change their primary care physician and for those recipients who legally change their name. Recipients will also be able to ask the county department of social services to submit requests for replacement cards, if needed.

Medicaid Eligibility Unit
DMA, 919-855-4000

Automated Voice Response (AVR) System Provider Inquiry Instructions , July 2001 Special Bulletin
Recipient Eligibility Benefit Inquiry and Response
Sample of New Medicaid Identification Card


In September 2009 the N.C. Medicaid Program will implement North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool. This tool will allow providers to access electronic recipient eligibility via the North Carolina Electronic Claims Submission (NCECS) Webtool. https://webclaims.ncmedicaid.com/ncecs/

Use of this tool will allow providers to immediately verify recipient information such as

Current eligibility
Medicaid benefit category
Medicare participation
CCNC/CA (Carolina ACCESS) participation
Transfer of asset information
Other insurance information

This will be the same information that providers receive today through the Automated Voice Response (AVR) system but quicker and easier. In order to use this tool, providers must have access to the NCECSWeb Tool. DMA encourages you to begin immediately the process of obtaining this access.

Providers who currently have an NCECSWeb logon ID and password can utilize this same logon information to access recipient eligibility verification. You do not need to take any further action.

Providers who do not currently have access to the NCECSWeb must take the following action.

Step One:
Submit a completed and signed Electronic Claims Submission (ECS) Agreement to CSC. (Refer to the NC Tracks website at http://www.nctracks.nc.gov/provider/forms for a copy of the form and instructions.

*Providers who have previously submitted the ECS Agreement do not need to resubmit the form.

Step Two:

Contact the EDS Electronic Commerce Services Unit (1-800-688-6696 or 919-851-8888, option 1) to obtain instructions and a logon ID and password for the NCECSWeb Tool.

For additional information on verifying recipient eligibility refer to the Basic Medicaid Billing Guide on DMA's website at http://www.ncdhhs.gov/dma/basicmed/. For detailed information on the NCECSWeb Tool, refer to the September 2009 Special Bulletin, North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool Instruction Guide, on DMA's website at

A Word about the Flu

Germs can be spread when a person touches something that is contaminated with germs and then touches his
or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air.
Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk,
for example, and then touches their own eyes, mouth or nose before washing their hands.
Steps to Lessen the Spread of Flu in the Home
When providing care to a household member who is sick with influenza, the most important ways to protect
yourself and others who are not sick are to:
• Keep the sick person away from other people as much as possible (see “placement of the sick person”)
especially others who are at high risk for complications from influenza
• Remind the sick person to cover their coughs, and clean their hands with soap and water or an alcoholbased
hand rub often, especially after coughing and/or sneezing
• Have everyone in the household clean their hands often, using soap and water or an alcohol-based hand
rub. Children may need reminders or help keeping their hands clean
• Ask your health care provider if household contacts of the sick person—particularly those contacts who
may be pregnant or have chronic health conditions—should take antiviral medications such as
oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu
• If you are in a *high risk group for complications from influenza, you should attempt to avoid close
contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick
individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. Infants
should not be cared for by sick family members. For more information, see the * Interim
Recommendations for Facemask and Respirator Use
*(http://www.cdc.gov/flu/about/disease/symptoms.htm and http://www.cdc.gov/h1n1flu/masks.htm

Levine Hospital gets $500K for cancer program

Levine Children’s Hospital has received $500,000 from the Adam Faulk Tanksley Foundation to support advanced pediatric-cancer research.

The foundation was established in honor of Tanksley, a 5-year-old cancer survivor.

The contribution will expand local access to high-level clinical trials, including the testing of cancer therapies and cancer-related research studies for pediatric-cancer patients.

Levine Children’s Hospital is a 12-story, 234-bed facility on the campus of Carolinas Medical Center in Charlotte, flagship of Carolinas HealthCare System.

Since opening in 2007, the $85 million children’s hospital has seen 500 new patients in its Pediatric Hematology Oncology Center.

“We can place Levine Children’s Hospital among the best in the nation in the fight against childhood cancer,” says Dr. Leonard Feld, the Sara A. and Smoky H. Bissell Endowed Chairman of Pediatrics at the children’s hospital.

The center treats patients with brain tumors, kidney cancer, bone and soft-tissue tumors, lymphoma and leukemia. The program most recently added neuro-oncology services and blood and marrow transplants.

The expanded pediatric-oncology program includes a team of six board-certified physicians and four mid-level providers, including physician assistants and nurse practitioners.

Charlotte-based Carolinas HealthCare is the largest health-care system in the Carolinas and the third-largest public system in the nation. It has more than 44,000 full- and part-time employees and about 1,750 physicians.

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Final Push for Co-Signers of House Letter to President Seeking Permanent Restoration of Hospice BNAF

Call for More Signatures Ends Friday, May 15

Representatives Chris Van Hollen (D-MD) and Ginny Brown-Waite (R-FL) plan to collect all of the promised signatures on Friday, May 15 and send the letter www.nahc.org/NAHC/CaringComm/eNAHCReport-mbrs/Attachments/nr040209_hospicevanhollen.pdf, asking President Obama to permanently restore the budget neutrality adjustment factor (BNAF) to the hospice wage index. They want the President to get the message that members of the House of Representatives recognize the great danger the cut in hospice reimbursement will be to the hospice industry and the thousands of terminally ill being served in their communities.

There are currently 126 co-signers of the Van Hollen/Brown-Waite letter in the House. Click here to go to the National Association for Home Care & Hospice (NAHC) Legislative Action Network (LAN) for the complete listing, if your representative is not there, please ask that their signature be added. NAHC urges all hospices to ask their Member of the House to sign on to the letter. As many signatures as possible are urgently needed by this Friday!

US Senate Co-signers Also Sought for Hospice BNAF Restoration Letter to Obama Senators Arlen Specter (D-PA), Tom Harkin (D-IA), Pat Roberts (R-KS) and Ron Wyden (D-OR) have written a Dear Colleague sign-on letter similar to that in the House of Representatives asking President Obama to make permanent restoration of the budget neutrality adjustment factor (BNAF) to the Medicare Hospice wage index. They are also seeking co-signers for that letter. Click here for letter.

Thanks to the efforts of hospice advocates in Congress, the American Recovery and Reinvestment Act of 2009 contained a provision postponing elimination of the BNAF until Oct. 1, 2009 to give the Obama Administration time to reconsider the appropriateness of this cut. However, if Congress does not act, CMS will again begin the 2010 phase-out of 75% of the BNAF with complete elimination in 2011, resulting in a hospice cut in reimbursement.

The elimination of the BNAF creates a serious risk of loss of access to hospice care. The Medicare Payment Advisory Commission (MedPAC) has reported that the average hospice margin was 3.4% in 2005; elimination of the BNAF decreases hospice reimbursement by 4 percent. There is a very real danger of putting community hospices out of business resulting in a lack of access to the hospice benefit, particularly in rural areas.

MedPAC’s March 2009 Report to the Congress contained a set of recommendations that included changing the hospice payment system by 2013. However, MedPAC is relying on CMS to gather the data needed to ensure responsible analysis prior to making any refinements/changes. CMS is in the process of collecting data on hospice services and costs. MedPAC has not recommended a cut in the hospice benefit.

The Medicare budget also will suffer through the loss of hospice care. A recent Duke University study showed that patients who died under the care of hospice cost the Medicare program an average of about $2,300 less compared with those that did not.

NAHC urges everyone in the hospice community to ask their senate members to cosign the letter to President Obama. It is very important to do this today. As many signatures as possible are needed within the next couple of weeks to ensure the President understands the urgency for him to act.

If your senator is not included on the following list, please follow steps below to make contact:

Arlen Specter (D-PA)

Tom Harkin (D-IA)

Ron Wyden (D-OR)

Pat Roberts (R-KS)

Sam Brownback (R-KS)

Susan Collins (R-ME)

Herb Kohl (D-WI)

Russ Feingold (D-WI)

Bob Casey (R-PA)

Tim Johnson (D-SD)

John Kerry (D-MA)

For contact information for your Senator, click here . When calling, ask the receptionist to connect you with the staffer who handles Medicare issues. If the staffer says he or she has not seen the Dear Colleague and sign on letter from Specter/Harkin/Wyden/Roberts, offer to forward it (View the Dear Colleague letter by clicking here ).

You may send a message to your members of Congress asking them to sign onto the Specter/Harkin/Roberts/Wyden letter in the Senate and if your Representative has not yet joined the Van Hollen/Brown-Waite Dear Colleague letter, through the NAHC Legislative Action Network (NAHC LAN) by clicking here .

What epidemiological investigations are taking place in response to the recent outbreak?

April 29, 2009, 10:55 PM ET

CDC works very closely with state and local officials in areas where human cases of H1N1 (swine flu) infections have been identified. In California and Texas, where EpiAid teams have been deployed, many epidemiological activities are taking place or planned including:

Active surveillance in the counties where infections in humans have been identified;
Studies of health care workers who were exposed to patients infected with the virus to see if they became infected; Studies of households and other contacts of people who were confirmed to have been infected to see if they became infected; Study of a public high school where three confirmed human cases of influenza A (H1N1) of swine origin occurred to see if anyone became infected and how much contact they had with a confirmed case; and Study to see how long a person with the virus infection sheds the virus.

What is the CDC doing in response to the Swine Flu Outbreak?

What is CDC doing in response to the outbreak? April 29, 2009, 10:55 PM ET

CDC has implemented its emergency response. The agency’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by the new virus. CDC continues to issue new interim guidance for clinicians and public health professionals. In addition, CDC’s Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak.

H1N1 Flu (Swine Flu) and You

April 29, 2009, 10:55 PM ET

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near Guadalupe County, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well. An updated case count of confirmed swine flu infections in the United
States is kept at http://www.cdc.gov/h1n1flu/investigation.htm CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Can I get swine influenza from eating or preparing pork?No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

How can someone with the flu infect someone else?Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
- Avoid touching your eyes, nose or mouth. Germs spread this way.
- Try to avoid close contact with sick people.
- If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus through coughing or sneezing?- If you are sick, limit your contact with other people as much as possible.
- Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. We recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most
supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
Fever with a rash
In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting

How serious is swine flu infection?Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New
Jersey occurred in 1976 that caused more than 200 cases with serious illness
in several people and one death.

WSJ Article - By AVERY JOHNSON and KELLY EVANS

Employment in health care, the only major industry outside the federal government still adding jobs, is succumbing to the recession.

In the latest sign, the president of New York City Health & Hospitals Corp. wrote Friday to community organizations as well as employees and unions at its 11 hospitals and four nursing homes, saying the agency will lay off more workers even after slashing 400 jobs last month.
[health]

"We now project that HHC's deficits will worsen, even if we are spared further state cuts," Alan Aviles wrote to the staff of 39,000. "The challenges will deepen." He blamed the job losses on state cuts in Medicaid payments to the public-health system.

Across the country, hospitals are taking financial hits. They are seeing losses in the portfolios that they rely on for investment income. The number of uninsured patients is rising. Elective procedures -- which reap big profits -- are down at a third of hospitals nationwide. Nursing homes are trimming payrolls. And with state governments continuing to cut budgets and talk of health-care reform from Washington, industry executives are preparing for even leaner times.

More than 16 million people -- one in eight workers on U.S. payrolls -- work in health care today, up from just 1% of the work force 50 years ago. Employment in health care and social assistance -- which includes hospitals, doctors offices, nursing homes and social services such as day care -- has grown by half a million jobs since the recession began in December 2007, while the rest of the economy has shed 5.1 million jobs.

But the pace of job growth in health services has slowed sharply this year. The sector added an average of 17,000 jobs per month in the first three months of the year, less than half last year's pace. Health care usually weathers downturns better than many other industries because consumers tend to cut spending on cars or clothes before they forgo trips to the emergency room or pharmacy. But this recession is the deepest in a generation.

"To the extent that health care might have been recession-proof, it is no longer," said Paul Levy, chief executive of Beth Israel Deaconess Medical Center in Boston, a teaching hospital for Harvard University. The hospital last month announced 140 job cuts, salary freezes, and reductions in vacation allowances and retirement-fund contributions to make up a $20 million budget shortfall.

Mr. Levy began to get worried in October, when Massachusetts cut Medicaid payments to his hospital by $7 million. In November, he noticed researchers weren't applying for grants as actively as usual, anticipating less government funding; that cost another $7 million in revenue for the hospital, which gets some of the grant money to cover overhead. Then in January, patient volume slowed. During the first three months of this year, hospital discharges -- a standard measure of patients treated -- dropped to 112 a day from a targeted 122, which translates into $20 million less in yearly revenue.

Big hospitals such as the University of Pittsburgh Medical Center and Akron General Health System in Ohio have announced layoffs recently. In February, the number of mass layoffs for hospitals was double what it was a year ago, according to government data.

In Tarboro, N.C., Kim King, a 49-year-old contract worker in the hospital laboratory at Heritage Hospital, received a letter from her manager last Monday cutting her contract short by three weeks and asking staff to voluntarily reduce hours. The letter cited the economic pressures facing the hospital. Ms. King isn't sure what she is going to do when her job analyzing blood and other fluids in the hospital lab ends in June. She is looking for work and considering going on unemployment.

She and her ex-husband, a corrections officer, "used to joke that we had the most secure jobs out there, because people always need health care and prisons. It's not true anymore," she says. "I've never seen it so bad. It's the one thing you would think wouldn't be affected by the recession."

Wick Baker, president of Heritage Hospital, says the hospital is being financially responsible by looking at all of its costs, including replacing contract employees with less expensive full-time staff.

The squeeze isn't limited to hospitals. Pharmaceutical firms and health insurers also are shedding jobs. On Thursday, health-care conglomerate Johnson & Johnson said it would lay off 900 workers.

Since the Labor Department began tracking monthly unemployment figures in 1958, there have been nine recessions, but employment in health services has declined only a handful of times. The only significant losses to date occurred in mid-1984, as the industry shed 41,000 jobs, based on slightly different historical data, following the double-dip recession of the early 1980s. Since then, no month has seen a drop of more than 4,000 jobs in health care, and there have been no back-to-back declines.

As manufacturing employment has declined, many cities have come to see health care as the employer of last resort. Rochester, Minn., home to the Mayo Clinic, is one illustration of the industry's power to turn around regional fortunes and revitalize downtowns. Forty years ago, Mayo employed 4,000 workers; today, the international destination for top-tier health care employs some 35,000, more than a third of the city's total work force.

But Mayo, like the rest of the industry, is now struggling to meet it its capital and payroll obligations. Last month, the ratings agency Standard & Poor's downgraded Mayo's debt, citing the hospital system's large unfunded pension liability and break-even operating margins.

Mayo is freezing salaries for doctors and senior administrators, reducing travel and overtime expenses, and cutting capital spending this year by $150 million, says Chief Financial Officer Jeff Bolton. There have been no layoffs, though temporary staff are being pared back and only essential positions are being filled. Mayo is delaying occupying one floor of a new outpatient exam building on the Rochester campus, since finishing the interior of each floor costs $12 million.

The decline, while unusual, is still likely to be a temporary break in the industry pattern. Growth in health-care spending, and thus employment in the sector, is likely to rebound when the recession ends, a function of the enormous advances in medical technology and Americans' strong appetite for health care. President Barack Obama has also named the sector one of his three pillars of the future U.S. economy, alongside energy and education. Health expenditures as a share of gross domestic product have more than tripled in the past 50 years to about 16% today, and the government's Centers for Medicare and Medicaid Services say that figure is likely to hit 20% within a decade.

"It's a long-term shift reflecting changes in technology and what consumers want," says Robert Fogel, a Nobel laureate and professor at the University of Chicago's Booth School of Business. "Health care is the growth industry of the 21st century."

NC Senate budget proposal hits schools, Medicaid By GARY D. ROBERTSON Associated Press Writer

RALEIGH, N.C. — The Senate's version of the North Carolina state government budget cleared key committees Tuesday despite significant cuts to health and public education programs and confusion among lawmakers and lobbyists as to how they would be carried out.

The Senate Appropriations Committee approved the plan that narrows a $3.4 billion budget gap for next year in part through spending reductions, federal stimulus money and $500 million in tax increases. It passed the chamber's finance and pension committees later Tuesday.

Budget writers said the plan would seek to get the unemployed back to work by providing funds to train students in still-growing health care sectors and inject funds into small towns seeking help with economic development projects.

"We believe with this budget, we're attacking the (bad) economy in North Carolina," said Sen. Linda Garrou, D-Forsyth, co-chairwoman of the Senate Appropriations Committee. She made her remarks at the beginning of more than three hours of debate.

But the tax details won't be added to the budget before it's heard on the Senate floor as early as Wednesday. Senate Democrats who control the budget process said the details - which are likely to include higher cigarette and alcohol taxes and possible taxes on some services for the first time - are still being worked out, frustrating Republicans.

"There's a half-a-billion per year ... tax increase in there and nobody know what taxes they're talking about," said Senate Minority Leader Phil Berger, R-Rockingham. "For members of the Senate to vote for a budget proposal that has that kind of provision just strikes me as being irresponsible."

The $20.05 billion spending plan for the coming year, coming three weeks after Gov. Beverly Perdue offered her own two-year proposal, would save money by laying off 712 state workers and keep another 910 positions vacant for the fiscal year starting July 1.

Perdue and the North Carolina Association of Educators oppose a Senate provision that would increase the average size of public school classrooms by two students through the 2010-11 school year, at a savings of $322 million annually.

But child care advocates are worried about a provision that would essentially phase out the More at Four program, which provides free, high-quality preschool to 32,000 at-risk 4-year-olds, and merge it with an initiative that sets ratings for child care programs.

"We're trying to look at some efficiencies there but we also believe strongly it's important to prepare our children to go to school," Garrou said Monday. "We decided that this was a good year to look at combining some of these areas and try to make it more efficient."

More at Four, which receives $85 million from state lottery profits, would lose $40 million but take in $37 million in stimulus funds.

Roz Savitt, a lobbyist with the North Carolina Childcare Coalition, said the provisions were confusing but appear to erode the value of More at Four.

"In the end, it's less money and lower standards," Savitt said. "No. 1, it's going to hurt children."

The budget also left providers of personal care services for Medicaid patients living at home scrambling to block a $55 million cut in state funding.

Combined with federal matching dollars for Medicaid, the proposal would reduce the $361 million program for next year by 60 percent, according to legislative staff.

Workers assist patients with bathing and other tasks. The reimbursement cost of about $15 per hour is much less than the cost for Medicaid if that patient must be sent to a nursing home, lobbyists for service providers said.

"It defies logic," said Tim Rogers, chief executive officer of the Association for Home & Hospice Care of North Carolina. "We cannot balance the budget of the state of North Carolina on the backs of 84-year-old grandmothers."

A recent audit of the personal care services program found that more than 40 percent of the cases reviewed shouldn't have qualified for the service, said Sen. Bill Purcell, D-Scotland, co-chairman of the health budget subcommittee.

Rogers said those findings were misleading and that doctors and registered nurses must sign off on such personal care treatment.

Purcell said it's not surprising that the industry is unhappy with such a cut given the state's bad fiscal situation.

"Who's not upset right now?" Purcell said.

Senior Programs Expect More State Cuts

Florida legislators are expected to trim services for the elderly, even as demand skyrockets in a weakened economy.
BY ANA VECIANA-SUAREZ
aveciana@MiamiHerald.com

For Jose Rodriguez, the twice-a-day visits from a home health aide are a godsend. The retired accountant has been caring for his wife, Ana, since 1999, when her erratic behavior and memory loss were diagnosed as Alzheimer's Disease. It is the only respite he gets from his round-the-clock job.

''I cannot handle my wife by myself,'' says Rodriguez, 70, of Miami. "She doesn't walk. She doesn't talk. And she needs two people to move her. Doing it alone is mission impossible.''

Rodriguez, however, may lose that help soon. Legislators already trimmed 4 percent of the $13.3 million budget for the Alzheimer's Disease Initiative, which provides in-home help for caregivers like Rodriguez. Legislators trimmed funding for other programs during January's special session cuts, but Gov. Charlie Crist vetoed cuts to the popular Community Care for the Elderly and limited others to a 2 percent trim.

More cuts are expected when the Legislature convenes March 3, though the proposed dollar amounts and percentages won't be known until mid-March, when lawmakers find out the state's projected revenue. Some estimate that as much as 15 percent will be slashed from some programs, while others may be closed for months.

''This is a tough year. We have less money, so everybody should expect that they'll have less,'' says Rep. Marcelo Llorente, the Republican House budget chief who oversees health spending.

Advocates, however, warn that thousands of Florida's elderly will be left without services, from adult day care to free meals. ''What we have been saying is that you cannot continue cutting these programs without deeply affecting the population,'' says Leslie Spencer, lobbyist for AARP in Tallahassee. "These are real people with real needs. For many it's a life or death situation.''

Florida's 4.3 million seniors are not alone. Elderly in nearly 70 percent of the other states are anticipating cuts in programs even as the demand for services skyrockets in a weakened economy.

''We have a decidedly unambitious and unaggressive wish list this year,'' says Jon Peck, spokesman for the Florida Department of Elder Affairs. "Our hope is to maintain service levels at what they are. We recognize the reality of the economic downturn.''

Now advocates have focused their efforts on saving a few of the more cost-effective programs, reforming the way the state delivers long-term care, and providing palatable funding alternatives:

• Home and community-based care. Advocates want to prevent cuts to Community Care for the Elderly, Alzheimer's Disease Initiative and others that provide in-home help with meals, bathing, medical transportation and chores. When these services help seniors remain in their homes instead of moving into an institution, the savings can be considerable. These services often provide the safety net for those whose physical and cognitive health could worsen without the extra help.

The Florida Council on Aging estimates that the average annual cost of care provided by the program runs $4,680 per person, funded entirely by the state's general revenue pot. Institutional care: $65,251 annually, most of it from federal monies.

''It doesn't make economic sense,'' says Max Rothman, executive director of the Alliance for Aging for Miami-Dade and Monroe counties. "They're cutting services that enable people to remain at home where they want to be and that cost taxpayers less money.''

In addition to continued funding for these services, advocates want state agencies to be given the authority to shift funds between nursing home and community-based care budgets in order to maximize services and cost.

''There's very strong support for that,'' says Republican Juan C. Zapata, chair of the house's human services appropriations committee, "but it's an implementation issue. You want to do it slowly and you want to do it right. First, we have to see how it works and not do it all at once when you can possibly lose the quality we expect.''

• Medicaid reform. Many seniors in a two-year-old Medicaid pilot program that provides medical services to the poor and elderly in five counties, including Broward, have complained it takes too long to see a doctor under the new program. Advocates don't want to expand the program until there is independent data to assess how well it delivers health care.

Under the regular Medicaid program, Florida's 2.26 million recipients usually see their own physicians, who are then reimbursed by the government. Under the pilot program the government pays private companies a set amount for treating a specific number of residents. Though the idea was to improve services and cut costs, affected patients, particularly those in populous Broward, say too many doctors have dropped out of the program and they're struggling to get prescription drugs.

• Alternative funding. To pump more revenue into state coffers, advocates have proposed increasing the cost of cigarettes by $1 per pack, generating an estimated $1 billion this fiscal year alone. They're also asking legislators to look at taxing Internet sales ($3 billion more) and expanding the sales tax system ($1 billion more).

''We're taking a two-prong approach,'' explains Spencer of AARP, which has joined forces with other organizations, including Florida Tax Watch and Children's Home Society, to offer revenue-producing proposals. "We're not just asking them not to cut. We're also bringing alternatives.''

In Broward, Edith Lederberg, executive director of the Aging and Disability Resource Center, is also hoping to convince legislators to approve a local-options real estate tax, levied at the county level and earmarked for senior services. Local option taxes have come in the form of a sales tax or a real estate tax in the past. If the legislature OKs the concept, the county commission must vote to put it on the ballot. Voters then have final approval. Seven counties have already passed this special tax for seniors, Lederberg says.

Women and Nursing Home Care

Article printed with permission by Dale M. Krause, J.D., LL.M., of Krause Financial Services

Recent statistics clearly show that in the average nursing home, women residents will outnumber men by three to four. Why is this case? The answer is simple, women live longer than men. The result of living longer, at a time when most are frail and without someone in the home to provide simple care, makes them most vulnerable to enter a nursing home. A simple slip and fall can change the world.

With the high risk, there is also a high cost. Nursing homes in Wisconsin charge $6,500 per month for typical nursing home care. Furthermore, with the average stay lasting 36 months, the total cost can reach $250,000.00. For those with Alzheimer’s and dementia, the stay will last longer, and will cost in excess of $400,000.00. Are most women prepared to pay these amounts? The answer is, “no”. In most cases, to raise the funds, family members will be forced to liquidate assets, including the family home. Is this a good result? Not quite!

Is there a better way to prepare for the potential expense? The easiest way to prepare is to purchase long term care insurance policy, which is more commonly known as “nursing home insurance”. Is it a good buy? Without question, the answer is, “yes”. Over the last 15 years the policies, with the government forcing insurance companies to provide quality policies at a reasonable cost, the policies have finally come in vogue.

Today, a policy should include 5 years worth of coverage, for all levels of care, including: home health, assisted living, and nursing home care. The policy should offer a monthly benefit, which, when added to social security and pension income, will allow a person to privately pay the actual long term care costs. The policy should include an inflation rider, which allows the policy to keep up with future long term care costs. The policy should include a return of premium rider, which allows for a full return of all premiums paid, if the insured should not use the coverage. Finally, in order to eliminate pay premiums forever, the policy should be structured so that it is paid up – no more premiums after either a single payment, 5 year’s worth of annual payments, or 10 year’s worth of annual payments. For most women, the aforementioned long term care insurance policy will provide the benefits that they need, when they need them most.

Hospice and the Stimulus Package

We just got word from Congressman Chris Van Hollen’s (D-MD) office that a provision blocking the implementation of the CMS rule that cut hospice payments, promulgated October 1 of last year, has been included in the House Ways and Means Committee economic stimulus package.

This CMS hospice rule, which eliminated the budget neutrality adjustment factor to the hospice wage index, would be delayed until October 1, 2009, providing time for the new administration at CMS to reconsider the rule. The moratorium on the implementation of this rule would be retroactive to October 1, 2008.

You may click here to access the Ways and Means package: http://waysandmeans.house.gov/media/pdf/110/sbill.pdf. The hospice section is Subtitle E, Section 4501 (near the end).

Although Congress is just beginning the process that it hopes will result in the passage of an economic stimulus package by February 13, the inclusion of this hospice provision in the Ways and Means stimulus package is very encouraging. We’ll keep you posted in NAHC Report on further developments.

Thanks to all of you who have weighed in with your Members of Congress about this important hospice issue.


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