Friday, November 29, 2013

Elder Planning Numbers for 2014 – Pennsylvania

Each year cost of living adjustments are made to income, expense, tax and program qualification numbers that are particularly significant in planning for seniors. Here are some of the key adjustments for 2014. 

Medicaid Long Term Care

2014 Amount
Community Spouse Resource Allowance (Minimum)
Community Spouse Resource Allowance (Maximum)
Community Spouse Income Allowance (Minimum)
$1,939 month (adjusts on July 1, 2014)
Community Spouse Income Allowance (Maximum)
$2,931 month
Community Spouse Housing Allowance
$581.63 (adjusts on July 1, 2014)
Aging Waiver and LIFE Program Income Cap
$2,163 month
NMP-MA and Aging Waiver Resource limit
MNO-MA Resource limit
Average Daily Private Pay Rate
Average Monthly Private Pay Rate
Excess Home Equity Limit

Medicare Premiums and Deductibles

2014 Amount
Part A Hospital Stay deductible
$1,216 per benefit period
Part A Skilled Nursing Facility deductible (days 21-100)
$152 per day
Part B Monthly Premium (varies with your income – most people pay the standard)
$104.90 per month - standard
Part B deductible
$147 per year
Part D Monthly Premium (varies with your income – most people pay their plan premium)  
Your plan premium

Estate and Gift Taxes

2014 Amount
Federal Estate Tax Basic Exclusion
$5.34 million
Federal Gift Tax Lifetime Exclusion
$5.34 million
Annual Gift Tax Exclusion (per donee)

(Note: the above numbers are applicable in Pennsylvania. Some of the figures may be different in other states.)
Monthly Social Security and Supplemental Security Income (SSI) benefits will increase 1.5 percent in 2014. Nearly 63 million Americans (41.5 million over age 65) receive benefits from either or both of these programs. See: Social Security Monthly Statistical Snapshot, October 2013.

Monday, November 25, 2013

Hospitals Receive Quality Care Bonuses/Penalties from Medicare

In the United States we have the most expensive health care system in the world. Unfortunately, the highest cost does not translate into the highest quality care. Much of the health related spending we do does not result in improved outcomes for patients. 
There is bipartisan agreement that we need to improve the quality of the health care we get for the dollars we spend. The political disagreement is over whether we should seek this improvement through marketplace competition or through the imposition of government standards.   

Pay for Performance

One of the health reform law's strategies for improving the value we receive for our health expenditures is referred to as “pay for performance.” The idea is to pay providers based on quality standards rather than on the volume of services provided.  
In October 2012 Medicare initiated a Quality Payment Incentives model for hospitals. The Medicare hospital reimbursement system now includes pay for performance incentives to encourage hospitals to provide better quality care at lower cost.
A recent Kaiser Health News article describes two current Medicare payment incentive programs for hospitals which are “part of an effort to make them accountable on quality. One gives bonuses and penalties to hospitals based on how well they performed on 24 quality measures. That program is called Value Based Purchasing. The second penalizes hospitals which have too many patients readmitted within a month. Both programs are in their second year.” See, Interactive Chart: Bonuses And Penalties For U.S. Hospitals Kaiser Health News, November 14, 2013.
The bonuses or penalties are based on the hospital's prior year’s performance. They are applied to hospital reimbursements for the following year. 
Recently Medicare announced the payment incentives for hospitals for the upcoming year (October 2013 through September 2014). See, Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality, Kaiser Health News, November 14, 2013, which gives the following overview: 
To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals. A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement. It won't be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.

Individual Hospital Performance Results

The Kaiser Health News articles include access to a chart which shows the data for individual hospitals. I have put together the following listing showing how a number of hospitals in Northcentral and Northeastern Pennsylvania fared for the upcoming year. 
Here are the positive or negative percentage changes in performance bonuses/penalties our area hospitals will be receiving from Medicare for the period October 2013 through September 2014:
Facilities with Positive Change
Total Bonus/Penalty Change
Memorial Hospital
Dubois Regional Medical
Soldiers And Sailors
Lock Haven Hospital
Lock Haven
Williamsport Regional Medical Center
Hershey Medical Center
Evangelical Community
Moses Taylor Hospital

Facilities with Negative Change
Total Bonus/Penalty Change
Geisinger Medical Center
Geisinger - Community
Geisinger Wyoming Valley
Wilkes Barre
Tyler Memorial Hospital
Mount Nittany
State College
Pocono Medical Center
East Stroudsburg
Wilkes-Barre General
Wilkes Barre
Gnaden Huetten
Regional Hospital of Scranton
Geisinger - Bloomsburg
Berwick Hospital Center
Clearfield Hospital
Hazleton General Hospital
Sunbury Community Hospital

The full data for individual hospitals is available on the Kaiser Health News website along with details on the methodology used by Medicare to determine the payments. Nationally, 1,231 hospitals will receive increased payments from Medicare while 1,451 hospitals will be paid less.  
Further Reading:

Monday, November 18, 2013

Who Will Care for the Baby Boomers?

Most of us will need significant care support as we get old. The risk of needing long-term services and supports (LTSS) rises rapidly with age. “Among people age 85 and older, half need some long-term care.” Who Needs Long Term Care, Georgetown University Long-Term Care Financing Project, May 2003).  

The main providers of LTSS are family of the care recipients. “Family caregiving was estimated to be worth $450 billion in 2009, as compared to $211 billion in spending on all paid caregiving in 2011.”  Report of the Long Term Care Commission (September 30, 2013).

The reality is that the care needs of age 80+ seniors are currently being met in large part by their family members, especially their children – who are members of the baby boomer generation.   
But what will happen a few years from now when the baby boomers transition from care providers to care recipients? Baby boomers who are now reaching age 65 face a 70% chance that they will need LTSS at some point during their remaining lives. Will they be able to count on the next generation to give them the care and support they will need? Probably not.
As the over 80 population increases rapidly during the next 20 years, “the number of people in the primary caregiving years (ages 45 –64) is projected to remain flat, due in part to changing family size and composition. As a result, the availability of potential family caregivers (mostly adult children) to arrange, coordinate, and provide LTSS is expected to decline dramatically and overall care burdens will likely intensify especially as baby boomers move into late old age.” The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers (AARP Public Policy Institute, 2013).
Policy analysts refer to this demographic reality as the decline in the Caregiver Support Ratio. The Caregiver Support Ratio is defined as the number of potential family caregivers (mostly adult children in the 45 to 64 age group) who are available to care for those who are over age 80. 

This ratio is set to decline steeply, from 7 to 1 today (2013) to only 4 to 1 in 2030. It is expected to fall to below 3 to 1 thereafter. Just when the baby-boomers will be most in need of care assistance, the potential source of that assistance will have dried up.
The recent Report of the Long Term Care Commission (September 30, 2013) acknowledges the growing problem of a lack of caregivers (as well as the problem of the inadequate support caregivers currently receive).
Family caregivers today provide the majority of LTSS. Those who take on this unpaid role risk the stress, physical strain, competing demands, and financial hardship of caregiving, and thus are vulnerable themselves. Due to declining birthrates that will result in fewer family caregivers than in years past, there could be greater reliance on fewer family caregivers and the availability and quality of paid caregivers will become increasingly important.
The Report makes a number of recommendations to enhance the ability of family caregivers to fulfill their role as a focus of services and supports. These include a recommendation that the Department of Health and Human Services develop a national strategy to support family caregivers, similar in scope to the national strategy developed to address Alzheimer’s disease.
But none of the Commission’s recommendations seems likely to dramatically increase the number of human caregivers who will available to provide LTSS in 2030.
Is there any answer to our growing caregiver deficiency?  
Can Technology Help Alleviate the Caregiver Deficit?
I remember those atom bomb “duck and cover” drills we had when I was in grade school in the 1950s. At that time it seemed that technology was my enemy and nuclear weapons would likely prevent me from ever reaching my “golden years.”
But the world has so far avoided Armageddon. And I’ve now made it past 65. I no longer need to worry about dying young, and being cheated out of my life. Instead, I’m worried about who will take care of me as my needs increase with my advancing age. 

Is the oncoming caregiver deficit destined to put overwhelming burdens on my children and damage the quality of my life?  
Or could it be that technology will become my benefactor? Will I be able to rely on devoted electronic caregivers? Will technology provide me with the affordable long term assistance I am most likely to need?

Current Technological Supports

There are already a lot of technological devices to help seniors age in place. A report by Laurie M. Orlov for Aging in Place Technology Watch divides current tools into four categories:
Communication and Engagement.  E-mail, chat, web surfing, Facebook, Smartphones, video games, web cameras, and texting allow seniors to be in touch with family and other supports and stay involved in the outside world. These tools can provide companionship and ease loneliness, which are especially important concerns for the 40% of the 85+ population who live alone.  
Safety and Security. Security systems, mobile personal emergency response systems with passive fall detection, and sensor-based home monitors help monitor and reassure both seniors and caregivers.
Health and Wellness.  From medication reminders, to games like the WiiFit, to systems that remotely monitor chronic diseases like diabetes and congestive heart failure technology is helping seniors maintain wellness.  
Learning and Contribution. Computers, including smart phones and tablets, are allowing seniors to read, learn, take courses, and contribute through work and volunteering. Elite Universities like MIT, Stanford and Yale are making many of their courses available for free online. (See, 25 Colleges and Universities Ranked by Their OpenCourseWare).
But the use of technology to care for elders is only just beginning.  According to Orlov, the marketplace for technology to assist aging adults will grow sharply from $2 billion to more than $20 billion by 2020 including an explosion of smart phone and tablet applications for caregiving of older adults. 
The current technologies are great aids that can help seniors maintain their independence and quality of life. But they do not yet provide the hands-on caregiving services that are often required. Will robots and other technological tools become available that can help seniors with the more physical tasks of daily living?
Already service robots (like the vacuum cleaner Roomba) are being widely marketed.  But while we are specifically designing robots like Hector to provide companionship and assistance to the elderly, we are not yet close to developing a true robotic nurse’s aide. We still need people for hands-on care like assistance with toileting, bathing, dressing and feeding.
Overall, I’m hopeful. Technology has advanced in ways that I could never have predicted when I was in school, or even when my children were more recently in school.  There is tremendous promise for long-term low cost support that remains patient and tireless in the face of constant demands.
So, while my kids are not completely off the hook, I think that it is likely that robots and other technology will be critical supports for me as I grow to need more assistance.
Given the dearth of future human caregivers, it is clear that we need to maximize technology centered care. I can’t wait to see what has developed by the time I (hopefully) reach my 80th birthday.
Further Reading
Technology for Aging in Place, 2013 Market Overview (Aging in Place Technology Watch, July 2013)

Robot caregivers: Should machines look after our loved ones? (CBC Radio, August 6, 2014)

Can Robots Help Care for the Elderly? (Psychology Today, June 17, 2013)

Robots: The future of elder care? (CNN’s “What’s Next” blog)
Grandma and Her Robot (Over 65 Blog, Sept 30, 2013)
Age and Sex Composition: 2010 (US Census Briefs) (computer and Internet education for adults over 55)
Open Courseware (free online course materials)