ElderWeb

The Medi-Cal Policy Institute has issed a new report, "Understanding Medi-Cal Long Term Care." It answers questions like:
- What is Medi-Cal?
- Who is eligible for Medi-Cal long-term care?
- How is long-term care funded and administered?
- Which services are covered by Medi-Cal?
- What policy issues lie ahead?

The state of California has unveiled a new state website, and as a part of that new site they have posted an online directory to licensed nursing homes, residential care facilities, home and community based services, adult day care, and other services for older Californians. The searches provide names, addresses, phone numbers, and information about the licensure status of the facility.

Governor Gray Davis announced a new initiative to pay premiums of approximately 40,000 elderly and disabled Californians who faced disruption of their health care when nine Medicare+Choice HMOs in California implemented price increases on January 1, 2001. Last fall, nine Medicare+Choice HMOs in California and others nationwide announced plans to increase premiums to cover rising costs of health services. These increases affected beneficiaries who are eligible for both the state's Medi-Cal program and the federal Medicare program. By ending enrollment in their plans these individuals would have returned to a fee-for-service health care plan. These plans are more costly to the beneficiaries and the state.

Under the new program, California will pay the premiums for these individuals, effective January 1. The state is paying the HMOs directly, eliminating the need for individuals to make a payment each month. The payments are comprised of 50 percent General Funds and 50 percent federal matching funds. Initial annual cost projections for the program are $8 million in the current fiscal year and $17 million in subsequent years.

The Sacramento Bee reported that the state of California is suing Susan Gollas for $120,000 to recoup the cost of caring for her father, Sadao Yorita. Susan placed him in a nursing home when she was no longer able to care for him at home. She found that he qualified for Medi-Cal, since he didn't have the resources to pay for his own care. However, Gollas said she wasn't aware that she would have to pay back the state when her father applied for Medi-Cal. She said she will be forced to sell the 20-acre family farm she inherited from him and now works with her husband, Mario, and their three children.

Many people are unaware that federal law requires states to pursue repayment of nursing home costs from the estates of Medicaid recipients. The program in California collected about $40 million last year from more than 2,400 estates. County welfare offices give Medi-Cal applicants for long-term care printed information explaining that the costs will eventually be recovered, but the regulations are complex and advocates say an estate planner or attorney may be needed to help some understand the consequences. Some of those who are surprised the most have very modest estates, and may not have the education or resources to get professional help.

One thing the article did not mention is that the Federal guidelines provide that states should not recover costs if they cause "undue hardship," for example in the event that the estate is the only income-producing asset for the surviving family. It specifically mentions family farms as an example. Hopefully, Ms. Gollas will retain professional help to protect her family farm, but this story illustrates the fact that many people are unaware of all the consequences of relying on Medicaid for nursing home costs.

Governor Gray Davis of California signed AB 1731, a bill which will increase nursing home oversight and enforcement. As a part of the bill, nursing home staffing requirements will also be increased. Existing law provides that the minimum number of actual nursing hours per patient required in a skilled nursing facility shall be 3.2 hours.

This bill would declare the intent of the Legislature to increase the minimum number of direct care nursing hours per patient day in skilled nursing facilities. The bill would require the department to determine the need, and provide recommendations, for any increase in the minimum number of nursing hours per patient day and perform designated analysis. The bill would require the department, on or before May 1, 2001, to prepare a report on its analysis and recommendations and submit the report to the Legislature.

California SB2111 has been passed by the legislature. It will add agents and company representatives to the working group responsible for helping state insurance regulators come up with the content and format for the state's annual LTC rate stability guide. The bill would also allow insurers to focus consumers' attention on rate increases affecting California LTC policies, rather than on increases affecting policies sold throughout the United States.

Current law requires insurers to report and the consumer guide to include summaries of coverage of any policy sold in any state for the last ten years. The bill's author, Senator Joseph Dunn, believes this voluminous amount of information is of little use to California consumers since they can only purchase those policies which are sold in California. Dunn believes the bill makes it clear that the rate guide is intended to have two sections: a rate comparison section of all policies sold in any state in the last ten years, and a policy comparison section comparing policies available for purchase in California.

The California legislature has enacted a new law consolidating several previous law related to advanced healthcare directives. Advanced directives are used to allow people to influence decisions about how they will be cared for in the event they become unable to make their wishes known directly.

The new allows people to appoint another person to be their health care "agent." This person, called an "attorney-in-fact", will have legal authority to make decisions about their medical care if they become unable to make these decisions for themselves. The law also allows people to document their health care wishes in the Advance Health Care Directive form, for example, a desire not to receive treatment that only prolongs the dying process in the event of a terminal illness.

The Advance Health Care Directive is now the legally recognized format for a living will in California, replacing the Natural Death Act Declaration. The Advance Health Care Directive is more comprehensive than a living will, which only states a desire not to receive life-sustaining treatment if the person is terminally ill or permanently unconscious. The Advance Health Care Directive can be used to state the person's desires about their health care in any situation in which they are unable to make your own decisions.

The Advance Health Care Directive has also replaced the Durable Power of Attorney for Health Care (or "DPAHC") as the legally recognized document for appointing a health care agent in California. Previously executed Durable Powers of Attorney for Health Care or Natural Death Act Declarations will remain valid unless replaced with the new Advance Health Care Directive.

The California Legislature has enrolled AB 2107, which requires that all insurers, brokers, agents, and others engaged in the business of insurance owe a policyholder or a prospective policyholder a duty of honesty, and a duty of good faith and fair dealing.

The bill stipulates that if a life agent offers to sell to an elder any life insurance or annuity product, they must advise the client writing that the sale or liquidation of financial assets to fund the purchase of this product may have tax consequences, early withdrawal penalties, or other costs or penalties as a result of the sale or liquidation, and that the elder or elder's agent may wish to consult independent legal or financial advice before selling or liquidating any assets and prior to the purchase of any new products.

A life agent who offers for sale or sells a financial product to an elder on the basis of the product's treatment under the Medi-Cal program may not negligently misrepresent the treatment of any asset under the statutes and rules and regulations of the Medi-Cal program, as it pertains to the determination of the elder's eligibility for any program of public assistance. A life agent who offers for sale or sells any financial product on the basis of its treatment under the Medi-Cal program shall provide, in writing, a specified disclosure that indicates it is not necessary to expend all of their savings before applying for Medi-Cal, and outlines the financial eligibility rules for Medi-Cal.

The bill also clarifies that "Financial abuse" of an elder or dependent adult occurs when a person or entity takes, secretes, appropriates, or retains, or assists in taking, secreting, appropriating, or retaining real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud.

This bill underwent substantial revisions in response to concerns expressed by the insurance industry and other professionals. The original version of this bill would have forbidden lawyers to sell annuities to their clients, or to receive compensation for referring clients to insurance agents or brokers, and would have restricted agents? ability to recommend that older customers sell assets to pay for LTC arrangements. If the original version had been enacted, agents would be allowed to make LTC recommendations involving asset sales only if they held Series 7 licenses from the National Association of Securities Dealers and were certified financial planners or certified financial analysts, according to the bill text.

In the final week before they recessed, the California Legislature sent AB 1731 to the governor. This bill is intended to increase nursing home oversight and consumer protection measures in the state. The bill addresses several areas:

Fines for class "AA" citations of long-term care facilities are increased to $25,000 to $100,000 per incidence.

Additional protections for residents are established in the event that a facility changes ownership or enters receivership, by restricting the ability of new owners to transfer or move residents, and allowing the State increased latitude in setting up a temporary manager. It also provides for additional facility inspections if there are changes in key personnel, like the administrator or director of nursing.

The Department of Health Services (DHS) is instructed to investigate and implement higher minimum nursing hours requirements for nursing homes.

DHS is instructed to create a consumer information service system to provide updated and accurate information to the general public and consumers regarding long-term care facilities in their communities, including an on-line inquiry system accessible through a statewide toll-free telephone number and the Internet, with long-term health care facility profiles, a history of all citations and complaints for the last two full survey cycles, and ownership information.

The bill provides that if a long-term health care facility is sanctioned for violation of state or federal requirements, they must provide written notification of the action to each resident, the resident's responsible party and legal representative, and all applicants for admission to the facility.

The California Citizens for Nursing Home Reform opposed the bill as it was introduced, but some of their concerns were addressed in amendments to the final bill.

House members from the San Francisco Bay area of California -- Fortney Pete Stark, Anna G. Eshoo, Tom Lantos, Barbara Lee, Zoe Lofgren, George Miller, Nancy Pelosi, Ellen O. Tauscher, and Lynn C. Woolsey -- asked the minority staff of the Committee on Government Reform to investigate the conditions in nursing homes in the Bay Area. There are 288 nursing homes in the Bay Area that accept residents covered by Medicaid or Medicare. These homes serve approximately 22,000 residents. This is the first report to evaluate their compliance with federal nursing home standards.

The report found that there are serious deficiencies in many Bay Area nursing homes. Only 18 nursing homes in the Bay Area were in full or substantial compliance with federal standards during their most recent annual inspection. In contrast, 119 nursing homes in the Bay Area -- more than one out of every three -- had violations that caused actual harm to residents or placed them at risk of death or serious injury.

Researchers have found that people with a genetic high risk for Alzheimer's disease had to use more of their brains to perform memory tasks than those at normal risk. Thirty subjects aged 47 to 82 with normal age-appropriate memory performance were tested, and those with higher brain exertion demonstrated noticeable decline in their verbal recall abilities two years after initial testing. The results add to other evidence that physical changes to the brain begin years before dementia. The study was lead by Gary W. Small, director of the Center on Aging at the University of California at Los Angeles, and appears in the New England Journal of Medicine (NEJM).

California Governor Gray Davis signed the state's 2000 budget, which includes $270 million for programs which target the elderly and disabled. Among other things, the budget includes:

$319.9 million to help elderly persons remain at home and lead independent lives and to improve the quality of nursing home and in-home care. Approximately 52,800 more low-income seniors will receive no-cost Medi-Cal, so they can spend less of their resources on health care costs and better afford to remain at home. Nursing home workers funded by Medi-Cal will receive wage and benefit increases. Increased oversight and incentives will improve the quality of nursing home care.
$221.6 million to further supplement the Aging With Dignity Initiative by improving the quality of provider services and strengthening provider recruitment and retention.

The Department of Aging will over see some of this spending, including:

$14.8 million for one-time challenge grants to fund innovative models that provide more options to seniors and younger, functionally impaired adults in need of long-term care assistance to remain in their own homes and communities.

$1 million to establish a Senior Housing Information and Support Center to provide information to seniors and their families concerning home modification and assisted technology alternatives that will allow seniors to live more independently or with their families.

$1 million for a statewide Senior Wellness Education Campaign to educate seniors, their families, and health professionals on healthy aging practices, with information about community-based and in-home care alternatives to institutional care.

$1.3 million in funding for the Health Insurance Counseling and Advocacy Program (HICAP) to increase the state-funded portion of this program to more than $4.7 million.

Bladder control problems that cause older women to rush to the bathroom at night may increase their risk of falls and fractures, researchers report. Researchers, led by Dr. Jeanette S. Brown of the University of California, San Francisco, found evidence that weekly or more frequent incontinence independently boosts an older woman's risk of falls and bone breaks. In a study of more than 6,000 women aged 72 and older, those with frequent urinary incontinence were about 25% more likely than women without the condition to suffer a fall. They had a one-third greater risk of fractures not involving the spine.

Specifically women with "urge incontinence" carried a higher risk of falls and fractures. People with this condition feel an overwhelming need to empty their bladders, but often cannot make it to the bathroom. Weakened pelvic muscles, bladder dysfunction, and certain medications may underlie the problem.

In an editorial, the Journal said that this study made a "compelling argument for urge incontinence as an additional risk factor for fall-related occurrences...Vigorous study should be devoted to combining drug therapies for incontinence with injury-prevention strategies like strength and balance training."

Medicare recipients can now use any California pharmacy that accepts Medi-Cal and receive prescriptions at the Medi-Cal rate plus a 15 cent processing fee for each prescription, in a new program that went into effect on February 1, 2000. Senate Bill 393 enables Medicare recipients to obtain their prescription drugs at a cost no higher than Medi-Cal rates.

When a Medicare beneficiary has a prescription filled, he or she should present the pharmacy staff with the Medicare card. If the doctor phones the prescription in, ask the doctor to notify the pharmacy that the patient is a Medicare recipient. Beneficiaries should ask their regular pharmacies to put a note on their record stating that they are a Medicare recipient so that they will be charged the Medi-Cal rate for future prescriptions.

The Los Angeles Times reports on a growing problem in the Los Angeles area. Elderly people are being evicted from low-income housing projects financed by the Department of Housing and Urban Development (HUD). The problems are erupting in rental properties where the former owner defaulted on HUD-backed loans and HUD has assumed the title. HUD is evicting the residents and attempting to re-sell the property, and putting elderly tenants on the street as a result. One example is the pending eviction of 70-year-old Evelyn Eberhardt. She was in the hospital after undergoing two major cancer surgeries last summer when she was told she had 30 days to move out of the two-bedroom, rent-stabilized unit she has lived in for 10 years.

The Senior Worker Advocate Office, formerly known as the California Task Force for Employment of Older Workers, has pledged to improve employment and training opportunities for senior workers forty and over and to raise public awareness of the issues and problems that confront senior workers. The office works directly with the public and the private sector to afford all senior workers in California access to employment-related resources.

The Web site include information for both employers and senior workers about rights and responsibilities, benefits, training, and job search.

When an elderly person suddenly slips and falls, it may be called an accident and blamed on old age. But researchers in California suggest such falls could in fact be the result of disorders of the inner ear. Dr. Gail Ishiyama, a neurologist at the University of California, Los Angeles, says her research indicates that some falls can be traced to Meniere's disease and related disturbances of the inner ear, and to call these falls "accidental" could result in the patient's receiving the wrong sort of treatment while the real cause remains untreated.

72,000 home care workers in Los Angeles County received news that Governor Gray Davis agreed to meet their demands for a pay raise to $7.50 per hour plus health insurance, and $1 per hour increases in each of the next four years. But the increase won?t be final unless the county Board of Supervisors agrees to chip in more money for the matching fund program, which they indicate they are unwilling to do. Los Angeles County home care workers account for more than half the home care workers in the state. The majority of home care workers in Los Angeles County are African American, or Latino or Asian immigrants, and most are women. Until last year, they earned minimum wage.

California Assembly Bill AB 2107 was introduced on February 22, and has been referred to the Insurance Committee. The bill would only permit a licensed life agent who has a National Association of Securities Dealers Series 7 license and who is either a certified financial planner or certified financial analyst to advise an elder or his or her agent to purchase long-term care planning with the proceeds from the sale of assets. The bill would only permit those life agents to sell or offer for sale to an elder or his or her agent any financial product on the basis of the product's treatment under Medi-Cal. It would also prohibit a lawyer from selling an annuity to an elder with whom the lawyer has or has had an attorney-client relationship.