A Few Examples of Unusual, Humane Senior Care

by LAS

Here are a couple examples of humane senior care programs around the country. These are not the only ones out there, but we just wanted to let you know that you have choices when it comes to placing an aging parent in some kind of facility.

DAY CARE – at NIGHT

The Elder-Serve at Night program offered by The Hebrew Home in the Bronx, New York.

Similar to senior day care where adult children drop off a parent while they go to work, this one allows adult children to sleep when the senior is prone to wandering at night.

Patients can just socialize with the other patients, paint, do yoga, listen to live music. Therapies are offered – physical therapy, light therapy, and even aromatherapy.

Staffers are present at all times to provide services, and dispense medications if needed.

NO RULES for DEMENTIA PATIENTS

The Beatitudes Campus in Phoenix is flexible enough to accommodate patients who want a late dinner and a bath at 3 am. There are nurses who can play the piano, so that patients who remember little else can sing the lyrics to old songs. If a patient does better without medications, then he or she may be taken off the drugs.

The Campus provides a calming atmosphere that helps everyone to remain calm and engaged in things that they enjoy.

RURAL RETREAT for SENIORS

The Life Care Cneter of Nashoba Valley is a rural facility in the Littleton, MA area. A resident llama named Travis allows residents to pet him.

Staffers work at figuring out what triggers upsets and what kind of prop or activity will soothe them. For one person, music is soothing. For another, who was a former librarian, just holding a book is comforting.

Best wishes in finding the right place for a beloved but brain-damaged or senile parent.

Hospital “Merger Mania” Leading to Higher Bills for Patients

by LAS

Nationwide, we are seeing more and more concentration of medical care via mergers, acquisitions, joint operating agreements, and partnerships with doctors and other providers. However, these mergers rarely result in a cost savings for either the consumer or the hospitals themselves.

Over 100 hospital mergers took place in 2012, and the pace shows little sign of slackening. What advantage does this have for the hospitals? One effect is that by banding together, hospitals have greater bargaining power – but not, as you might hope, to negotiate lower prices with suppliers. Nope. The hospitals band together to bargain with the insurers for HIGHER payments.

This is partly due to less competition in a given city or county. With fewer providers or networks, the consumer cannot just go across the street for a knee replacement.

Less competition translates as higher costs to the consumer – a study published in 2011 showed that private insurers paid 13 to 25 percent more for procedures done in areas with less competition.

The increased cost is often paid by hapless consumers in the form of higher copays, higher insurance premiums, higher deductibles, and miscellaneous fees.

The real insult is that the quality of care has little relationship to the cost of care. Studies have not found any improvement in quality to match the increase in costs. 

A similar hospital merger boom in the 1990s resulted in increased patient costs of anywhere from 5 to 40 percent.

Another End-Run Around ObamaCare that Employers May Try: Cutting Hours Down to Part-Time

By LAS

It is well for workers to be aware that if ObamaCare does in fact become the law of the land for group plans as currently scheduled, employers may try yet another end-run to get out of having to comply – a risky end-run, but nevertheless, they could be tempted to try it.

That end-run is to cut affected employees' hours to less than the mandated 30 hours-per-week work schedule which triggers qualification for benefits.

I am told that “countless” employers and advisors are seriously considering this game-playing, this strategy to undercut the unpopular (among corporations) costs of ObamaCare.

However, employees who face loss of eligibility for any benefit should know that this may trigger legal ramifications that could prove costly to the employer if he should try this strategy. 

Employees are covered by provisions of the ERISA law – specifically, Section 510 (which in turn refers back to Section 502).

The pertinent paragraph of ERISA Section 510 states:

“It shall be unlawful for any person to discharge, fine, suspend, expel, discipline or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan – or for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan.”

Aha! We gotcha now, you think. Well, maybe – depending on how much of a junkyard dog your attorney is.

Now, this is not affected by a short-term cut in hours due to a slow period. Many industries have slow periods in the spring or summer, and then ramp up sharply for the fall or winter. This is true of retail, for example, or of the tire business.

BUT if the SINGLE MOTIVE for cutting hours is to deprive employees of qualifying for any employment benefit – which includes ObamaCare – then the company faces legal shaky ground and fines for doing so.

The company stands to be assessed penalties for violating ERISA law. The Department of Labor can assess these fines if the company is found guilty of violating ERISA law, and these penalties are assessed FOR EACH INSTANCE of such violation of the law. Put into other words, the company will have to pay for each employee affected by their shenanigans.

How do you go about exercising your rights under the ERISA law? First you have to start a civil action against the company complaining of the loss of your ERISA rights, or complaining of their retaliation for exercising your rights under ERISA.

Keep a little diary or journal for each day from the moment that the company announces that some employees will have a cut in hours. Keep copies of any newsletters or memos related to this action. Note how many hours a day you worked. Keep this and other pertinent papers together in a little file or large envelope.

And good luck!

We Will Have to Watch Congress like Hawks to Keep Them from Repealing ObamaCare

by LAS

While the current political situation (i.e. – factional infighting) keeps any one party from being able to repeal the Affordable Care Act outright – that will not stop them from attempting the “death by a thousand cuts.” In other words, according to the National Association of Underwriters (an arm of the insurance industry), lobbyists will attempt to get individual provisions of the act repealed by inserting lines into other bills.

The insurance industry will be working with friendly members of Congress to insert language repealing just one given provision of the Affordable Care Act into bills that may about entirely unrelated matters. And they will do this for each provision of ObamaCare until it looks like Swiss cheese and totally useless for providing healthcare to those who need it. 

Supreme Court decisions on DOMA rules will affect gays' insurance, pensions, and more

by LAS

The recent Supreme Court decisions on the Defense of Marriage Act (DOMA) solidifies gays' rights in the 12 states that recognize same-sex marriage, but still leaves unclear areas in the other states. However, in those 12 states, gay couples will see personal benefits in healthcare coverage, pensions, annuities, 401(k)'s, and might possibly extend to COBRA and the Family Medical Leave Act.

It is pretty clear now that gay couples who live in those 12 states, who have for example, a pension plan in effect, will be able to draw survivors annuities rights. If the plan provides for a maximum benefit of $1500 per month, then the survivor could apply for a benefit check of at least $750 per month. Also, if a surviving spouse had already been receiving such survivor benefit checks, and those were taxed by the federal government, the survivor can now apply for a refund of that tax now that the benefit is not taxable.

Persons affected by these changes will still have to wait while employers prepare updated materials and forms related to these medical and pensions plans. So please, be patient, because this is not going to happen overnight – and typically employers have until the end of the year after such a ruling to get things in order. Again, be patient, because the employers have to make sure all the i's are dotted and t's crossed, and there are a lot of legal and tax implications to be thought through.

Still unclear are all the implications and applications when the couple was married in a state that recognizes gay marriage but no longer reside in a state that recognizes gay marriage. That could easily happen if a couple worked in New York, which does, and retires to Florida, which does not. Companies are still unclear on how a change in residence would affect coverage. Another area that needs clarification is in the case of companies that operate in several states – are they only bound by the laws in states where they have offices, or only the state where they are incorporated? In any case, it will be a tangled mess to prepare paperwork for employees in the several states where they have employees.

It is always a tangled mess that the courts weave, and employers and insurance companies will need some time to untangle it. 

set this one for 9 pm Sat., July 6

by LAS

California recently crowed that premiums for the new insurance exchange plans would be lower than current plans offered. However, that is because some of the most expensive doctors and hospitals were cut out of the provider networks covered by the exchange plans. Also, copays and other out-of-pocket charges will cost more for the patients.

With less than 90 days now remaining until the Oct. 1 target date for getting the states' exchanges up and running, it seems likely that even if they do get activated, consumers will likely find glitchy websites and application processes, and rather high premiums.

Still, coverage will be a relief for people who previously could not get a healthcare plan at any price, or at a prohibitive price. 

Buying All Your Health Insurances From Same Company May Not Be Best Strategy

by LAS

Unlike with casualty insurance, where the consumer is usually entice with some very nice discounts for buying both Home (or Renter's) insurance from the same company as your Auto insurance, bundling all your health insurances usually does not offer the same savings.

Buying both Health and Dental, or Physician and Hospital, insurances through the same carrier may be more convenient for you to pay the premiums every month, but they offer no savings otherwise.

In fact, because you automatically assumed that there was a discount offered and given, you may have failed to even shop around for a better deal or better coverage.

I recommend the following strategy---

IF you are carrying a High-Deductible, High-Copay policy, then by all means get yourself a voluntary policy that will cover Hospitalization. By this I mean a policy through a company other than one that serves your employer -- a fully portable plan that will go with you wherever you work.

My reasoning is this. Your current plan is leaving you vulnerable to mounting bills for high copays on hospitalization, the most expensive type of medical bill there is. To help close that gap, a voluntary policy will cover whatever costs are not paid by your primary carrier.

The second benefit to having this type of voluntary policy, is that the Hospitalization plan will cover you no matter what the reason for your inpatient stay. You may face cancer treatment, wind up in the hospital as a result of a non-workplace accident, or even go in for elective surgery. (Some policies will even cover elective medical care, so check around.)

No matter what the reason is for your stay, that policy will help cover the costs of your medical treatment. And isn't that nice to know?