Consumer Directed Care

Research & Thoughts

Moving a parent into a care facility is often a wrenching decision for families. Despite the emotions involved, it’s important to remain clear-eyed when it comes to signing the contract. Otherwise, adult children could find themselves on the hook for much more than they bargained for.

via How a parent’s health-care bills could hurt you – Elizabeth O’Brien’s Retire Well – MarketWatch.

The Rosenkranz Law Firm has sought to shift Vets from Medicaid to the VA health care system for almost 15 years.  In a rare press release on the topic Kaiser Health News reports:

“It is commonly accepted that many poor veterans and their families find themselves on Medicaid, even though, in many cases, they would qualify for more generous benefits from the Department of Veterans Affairs.

The VA’s Aid and Attendance program, for instance, helps wartime veterans receive the care they need to stay in their homes or assist with long-term care expenses. But many who are entitled to this benefit end up on Medicaid — which has significant implications for the veteran’s family members.

In 2003, the state of Washington began a pilot program to identify veterans who were falling through the cracks. In the years since, the program has served thousands of people who qualified for this assistance. At the same time, it has helped relieve some of the fiscal pressure placed on the state’s Medicaid program by shifting these costs to the federal VA. Viewed as a win-win, the program has become a model for other states.

KHN asked two state officials invovled in the program’s operations to explain the basics of the Veterans Benefit Enhancement Project — how it came to be and why it is making a difference for both the state’s veterans and its budget. Commentaries follow from Bill Allman, who developed and now manages the Washington State Health Care Authority’s program, and from Alex Deluao of the Washington State Department of Veterans Affairs.

Allman
How PARIS Is Helping Veterans In Need

Bill Allman writes: “About 10 years ago, I first heard about a federal databank called PARIS — the Public Assistance Reporting Information System. … Astonishingly, a broader use of such a databank had gone unrealized until I started asking questions, particularly about the military and veteran program information available to the states. With my background in medical assistance for the state of Washington, I was well aware of the fact that many poor veterans and their families were winding up on the rolls of Medicaid, never realizing that they might also be eligible for richer federal benefits.”

For more information click here

The medicaid transition program is one of Florida responses to the US Supreme Court case named Olmstead.  The Olmstead case brought ADA rights to those in nursing homes paid for by Medicaid. I find it important to recall the Haddad case from the Jacksonville US District Court.  In the Haddad case an adult who was disabled living at home, refused to wait 60 days of residing in a nursing home. She argued that she would lose her supportive care network that had been established for years if she relocated.  The federal court found her pleas had merit and ordered the state to provide the transition program.  Currently Florida Citizens are forced to wait for care in the community. The Rosenrkanz law firm seeks to be creative during the 60 day wait for Transiton.

By Jack M. Rosenkranz, J.D.

How do we imagine the aging experience?  What will it be like for us and how will we know what to do when our aging parent requires our help?  Howard Gleckman attempts to answer these questions in his new book, Caring for our Parents, published this year (2009) by St. Martin’s Press.  Gleckman collects stories of aging adults and their families who are navigating their way through the complicated and fragmented long-term care system.  Most of the aging adults in Gleckman’s text suffer from Alzheimer’s; their children find themselves caregiving and searching for care and services that are difficult to organize even when family members have the ability to pay for them.  The loved ones of these aging adults do not know where to turn as they are faced with the challenges of choosing appropriate care and of having multiple insurers, providers and funding sources.
As the population ages, more Americans will be faced with taking care of their aging parents and making sure that they themselves will be taken care of in their twilight years.  While the book provides numerous important references for adults taking care of an aging parent, it illustrates that caring for our parents is complicated and often requires an insider’s knowledge of the health care system.  Gleckman’s illustrations are cautionary tales about the importance of getting help when maneuvering through the long-term care system.  None of the families in his text seem to know beforehand that the aging process can be tailor-made with the help of individuals experienced in the health care process. 

This headline ran over a Wall Street Journal article about rationing of health care in Canada.  It offers a sad outlook if the US Health Care System follows the Canadian “Too Old for Hip Surgery” model.  Preventive care will be the focus of the future.  Quality of Life depends on having a supportive and conscientious environment within which to age.  Recognizing the risks in the American system, scholars and policymakers have begun to differentiate between the fundamental causes of healthcare disparities – access, education, poverty – and patient level disparities.  Scholars Peter Franks, MD and Kevin Fiscella, MD use the term “downstream reforms” in an effort to describe the disparities that occur at the patient level.  In the January 2008 edition of The Journal of Internal General Medicine, they highlight downstream reforms that are important to improving the health care for the chronically ill. 
These Doctors argue that disparities can be addressed by examining both the provider-patient interaction and the manner in which clinical decisions are made.  Much of their discussion centers on what individual doctors and patients can do to change their own biases and actions.  The Baby Boomers are moving to individualize health care where personal preferences, desires and comfort are often just as important as clinical factors.
Until widespread reforms are made that affect physician and clinical decision-making, elders and their families will need to implement their own downstream reforms through self-education and advocacy to improve care and prevent disparities.  The Rosenrkanz law firm may be able to help build a supportive care environment that does not financially exhaust the family.

Many elders are concerned about the existing and potential disparities in the American health care system.  One’s quality of life depends on having a supportive and conscientious environment within which to age.  Recognizing the danger that healthcare disparities represent in the American system, scholars and policymakers have begun to differentiate between the fundamental causes of healthcare disparities – access, education, poverty – and the disparities that occur at the patient level.  Scholars Peter Franks, MD and Kevin Fiscella, MD use the term “downstream reforms” in an effort to describe the disparities that occur at the patient level.  In the January 2008 edition of The Journal of Internal General Medicine, they highlight downstream reforms that are important to improving the health care for the chronically ill – something that is of disproportionate importance to elders. 
Franks and Fiscella argue that disparities can be addressed by examining both the provider-patient interaction and the manner in which clinical decisions are made.  Much of their discussion centers on what individual doctors and patients can do to relieve their own biases and actions that result in healthcare disparities.  They explain what is part of a larger effort to individualize health care where personal preferences, desires and comfort are often just as important as clinical factors.
While elders experiencing a chronic illness find themselves in difficult situations because health care knowledge and information are often limited, physicians are not always able to individualize care to patient needs because their information about patient preferences and lifestyle are also limited.  Until widespread reforms are made that affect physician and clinical decision-making, elders and their families will need to implement their own downstream reforms through self-education and advocacy to improve care and prevent disparities.  With Health Care Advocacy, the Rosenkranz law firm is dedicated to helping elders and families in this process. 

Powered by WishList Member - Membership Software