Heart Association Raises Its Blood Pressure Guideline

46 percent of U.S. adults are now considered to have hypertension

by William E. Gibson, AARP, November 14, 2017 | Comments: 9

Blood Pressure Standard

PETER DAZELEY/GETTY IMAGES

The AHA’s new guideline is designed to encourage people to take earlier steps to control their blood pressure.

Under a newly released scientific guideline, nearly half of American adults could be considered at risk of major health problems because of high blood pressure, the American Heart Association reported on Monday.

Blood pressure readings of 130 as the top number or 80 as the bottom number now are considered to be high. High readings had been defined as 140/90.

Applying the new standard, 46 percent of American adults have high blood pressure, far more than the 32 percent under the previous definition. A reading of less than 120/80 still will be considered normal, but levels at or above that will be classified as “elevated.”

The AHA’s new guideline is designed to encourage people to take earlier steps to control their blood pressure, a major risk factor for heart disease and stroke, the leading causes of death.

“Yes, we will label more people hypertensive and give more medication, but we will save lives and money by preventing more strokes, cardiovascular events and kidney failure,” said Kenneth Jamerson, professor of internal medicine and a hypertension specialist at the University of Michigan Health System. He is among 21 experts on the guideline-writing committee, the AHA said.

“If you are going to put money into the health care system,” Jamerson said, “it’s to everyone’s advantage if we treat and prevent on this side of it, in early treatment.”

Congress… keep the Senior People 1st!

Americans oppose efforts to increase prescription drug costs for seniors

Man looking at pills

GETTY IMAGES

En español | The giant pharmaceutical lobby is pressing Congress to roll back a recent budget deal provision that gives some financial relief to millions of Medicare beneficiaries with high prescription drug costs.

The deal that federal lawmakers passed in February is supposed to help lower prescription drug costs for older Americans by requiring that brand-name drug companies pick up more of the cost of their medicines for beneficiaries who are in the Part D “donut hole.”

Medicare Part D enrollees find themselves in the donut hole when their total spending on medicines reaches a certain threshold, which had been set at $3,820 for 2019. Once a beneficiary reaches that limit, he or she enters the donut hole, where they pay 25 percent of costs for brand-name drugs and 37 percent of the cost of generics. Beneficiaries continue to pay this share until their out-of-pocket spending reaches $5,100. Once they hit that limit, they exit the coverage gap and enter catastrophic coverage, where they pay no more than 5 percent of their drug costs for the rest of the year.

The coverage gap was scheduled to close in 2020, but under the bipartisan budget deal, that is supposed to happen in 2019. In addition, Congress required brand-name drug manufacturers to pay more of the cost of their medicines for beneficiaries in the donut hole. Currently, these drugmakers pay 50 percent of the cost of their brand-name drugs for enrollees in the gap. Under the budget law, starting in 2019 they are supposed to pay 70 percent. The higher discounts would help lower drug costs for seniors, reducing the amount they have to pay out of pocket to reach catastrophic coverage.

The pharmaceutical industry has been trying to overturn the agreement since it was passed and has been lobbying lawmakers in both parties. A recent ad from the drug lobby claims the budget deal “threatens” Medicare’s “successful competitive structure.”

But AARP and other advocates for affordable drug prices say the Pharmaceutical Research and Manufacturers of America (PhRMA) is trying to get Congress to overturn the donut hole deal for increased profit.

“Big drug companies want to boost their profits by raising Medicare drug costs,” says Nancy LeaMond, AARP executive vice president and chief advocacy and engagement officer. “Seniors have worked hard and paid into Medicare their whole lives. It would be shameful to raise their costs when so many are struggling.” This is yet another way, AARP officials say, that drug companies want to increase profits while forcing American consumers to continue paying the highest drug prices in the world.

The pharmaceutical industry is now targeting the lame duck session of Congress in its efforts to break the donut hole deal. Lawmakers have to pass a budget bill by Dec. 7 to prevent a partial shutdown of the federal government. A spokesman for House Democratic leader Nancy Pelosi told Axios, “Republicans are just desperate to get their multibillion-dollar giveaway to Big Pharma done before a Democratic majority takes over the House” in January.

AARP members across the country are reaching out to Congress and the president to demand that they stand by the donut hole deal and their constituents. In last week’s midterm elections, 56 percent of those who voted were over age 50. Throughout the campaign, health care  — especially the cost of prescription drugs — was cited as a key concern among those voters

Rude hiring tactics from Home Health Care Companies

Home Care Companies Increase Use of Noncompetes, Other Contract Restrictions

By Bailey Bryant | December 2, 2018

For decades, companies have used noncompete clauses to retain top executives and protect trade secrets. But now, similar agreements are becoming more common among low-wage home care workers, which experts say can be a double-edged sword.

As the caregiver shortage continues and the demand for home care increases, restrictive agreements will only become more common, according to Angelo Spinola, a shareholder and attorney who represents home care companies at international labor and employment law firm Littler Mendelson.

“You’re going to have lots of companies [with] lots of clients and a great pipeline of work,” he told HHCN. “The issue [they’ll] have is that they don’t have enough of a labor force to satisfy their client demands, so you’re going to see noncompetes, nonsolicits and direct hire provisions.”

Currently, the latter two options are most common among Spinola’s clients. When presented to caregivers, nonsolicit agreements usually allow them to work for competitors but restrict workers from taking clients or employees with them. Meanwhile, direct-hire provisions are client agreements that require customers to pay the company a fee, usually $5,000 to $10,000, if they hire an agency caregiver directly.

Without that fee, companies are out the money and time spent vetting and matching the caregiver, as well as processing the customer.

As such, Spinola recommends all home care agencies use direct-hire provisions. Otherwise, customers can cut out companies and hire caregivers directly with no recourse.

“The client says ‘I no longer need your services,’ the caregiver resigns, and then later [the company] finds out the client and caregiver are working together,” Spinola told HHCN. “If there was an agency fee of $6 an hour, the client may have said to the caregiver, ‘I’ll pay you an additional $3 an hour and keep the other $3, and we won’t use the agency for anything.’ ”

Companies without direct-hire provisions often come to Spinola’s firm after being burned. But when contractual direct-hire terms are clear from the get-go, agencies have fewer problems, Spinola said. Many direct-hire agreements also include an attorney fee, in the event companies must litigate.

Nonsolicit agreements are another way companies can also protect agency assets without restricting workers’ mobility.

“I think that’s probably the most common trend, with the idea being that the agency is trying to protect the client relationship,” Spinola told HHCN. It prevents caregivers from “being introduced to the relationship and then taking that relationship either independent or to another agency.”

If agreements are violated, caregivers receive cease-and-desist types of letters followed sometimes by requests for damages, which must be proven by the agency.

The problem with noncompetes

While nonsolicits are appropriate at the caregiver level, noncompete agreements, which prevent employees from working for competitors within a certain time frame and region after they leave a job, should be reserved for high-ranking employees with access to critical and confidential trade secrets, Spinola told.

A report by the U.S. Treasury backs up his opinion.Noncompete agreements can “protect trade secrets, reduce labor turnover, impose costs on competing firms, and improve employer leverage in future negotiations with workers,” the report says. But for low-wage workers without access to trade secrets, noncompete agreements reduce employees’ leverage in wage negotiations and offer fewer opportunities for career advancement, it explains.

“Our concern is that noncompete agreements could force workers more and more into poverty because they would have fewer options,” said Robert Espinoza, vice president of policy at PHI, an advocacy group for direct care workers. “When direct care workers make $11 an hour and many providers don’t offer full-time hours to give workers a decent living standard, these workers often have no other choice but to seek other jobs to bolster their incomes.”

Rather than retain talent, he worries noncompete agreements could prevent workers from entering the home care industry altogether.

“Why would they enter the sector?” Espinoza said. “That’s especially troubling in a time in which providers are increasingly struggling with recruitment and retention challenges.”

Such struggles are the very reason restrictive agreements, such as direct-hire provisions, nonsolicit agreements and noncompetes, will become more common in the years to come, according to Spinola.

Don’t Miss this New NAHC Film to Celebrate Home Care!

The National Association for Home Care & Hospice (NAHC) has produced a new film to help celebrate Home Care and Hospice Month by shining a light on the nurses who do whatever is necessary to bring the best health care into the homes of their patients. You will see real nurses deliver care and real patients talk about the difference home care has made in their lives. Watch the film below.

The best states for people aged 55 and older

Age-Friendly States Movement Gains Steam

By Bailey Bryant | November 20, 2018

New York, Massachusetts and Colorado are pioneering what could become a new trend: age-friendly states. All three received age-friendly state designations from AARP within the past year.

The movement could be good news for home care providers, if it means that states invest more in systems and infrastructure to enable aging in place and community-based services.

Achieving an “age-friendly” designation doesn’t necessarily mean these states are the best place to grow old — but if they keep their word and execute on plans to be more age-friendly, they will be. More than a designation, this is an enrollment program, Danielle Arigoni, director of livable communities at AARP, told Forbes.

“It’s a commitment to growing in an age-friendly way, not a certification that we stamp and then you’re done,” she told the magazine.

New York Governor Andrew Cuomo made that commitment last week. On Nov. 14, he issued an executive order to “improve health and well-being of New Yorkers across the lifespan.”

In addition to a commitment from the governor, which includes assessments and action plans, states requesting an age-friendly designation must also complete an application. New Hampshire, Rhode Island, New Jersey, Tennessee, North Carolina and Oregon may soon follow suit, according to Forbes.

Depending on location, implementation of initiatives looks different, even within states. To best serve older people, different areas within age-friendly states can adopt different policies and programs while drawing on each other for resources and expertise. For example, in Massachusetts, state leaders researched older residents’ wants and needs by conducting listening sessions across the state.

There is no one-size-fits all and that becoming age-friend is partially about combating ageism, Alice Bonner, Secretary of Massachusetts’ Executive Office of Elder Affairs, told Forbes. Broadly, the goal of AARP’s designation program is to get more groups to cater to older people, from recreation to transportation to employment. Now, age-friendly states hope to lead the charge.

“We need to figure out how to care for one another as we get older,” Bonner told the magazine. “This is not about somebody else; a bunch of 90-year-old people over there. This is about you — however old you are — and it’s about us.”

Written by Bailey Bryant

Making Medicars Advantage Plans harder for Seniors to find.

Trumpeted New Medicare Advantage Benefits Will Be Hard For Seniors To Find

By Guest Contributor | November 12, 2018

Home Health Care News Perspective: With certain non-skilled in-home care services allowable under the Medicare Advantage program in 2019, the home care industry has made landing partnerships with health plans a top priority. But significant opportunities may not arise until 2020, experts predict. Just 3% of MA plans will next year offer in-home support services such as personal care and housekeeping, according AARP. A new report from Kaiser Health News sheds further light on the topic.


By Susan Jaffe, originally for Kaiser Health News

For some older adults, private Medicare Advantage plans next year will offer a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars or air conditioners for asthma sufferers.

But the new benefits will not be widely available, and they won’t be easy to find.

Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.

That means even for the savviest shoppers it will be a challenge to figure out which plans offer the new benefits and who qualifies for them.

Medicare officials have touted the expansion as historic and an innovative way to keep seniors healthy and independent. Despite that enthusiasm, a full listing of the new services is not available on the web-based “Medicare Plan Finder,” the government tool used by beneficiaries, counselors and insurance agents to sort through dozens of plan options.

Even if people sign up for those plans, they won’t all be eligible for all the benefits. Advantage members will need a recommendation from a health care provider in the plan’s network. Then they may need to have a certain chronic health problem, a recent hospitalization or meet other eligibility requirements.

Medicare counselors from California to Maine say key details are not included on the government’s website. In some cases, if insurers offer the new benefits, the plan finder “will indicate ‘yes’ or ‘no,’” said Georgia Gerdes a health care choices specialist at AgeOptions, the Area Agency on Aging in Oak Park, Ill., outside Chicago. That’s hardly enough, she said.

“There is a lot of information on the plan finder, but there is a lot of information missing that requires beneficiaries to do more research,” said Deb McFarland, Medicare services program supervisor at the Southern Maine Agency on Aging.

Nonetheless, officials say the added benefits will help Advantage members prevent costly hospitalizations. Federal approval of additional benefits is “one of the most significant changes made to the Medicare program,” Seema Verma, the head of the Centers for Medicare & Medicaid Services, told an insurers’ meeting last month. She said she expects plans to expand services in coming years.

Medicare Advantage plans, which are an alternative to traditional Medicare, serve 21 million beneficiaries and limit their out-of-pocket expenses. But they also restrict members to a network of doctors, hospitals and other medical providers. They often offer benefits not available in traditional Medicare, such as dental and vision care, hearing aids and gym memberships.

The federal government pays a set amount to the plans to help cover the cost of each member. The Trump administration gave insurers more money to spend on benefits next year — an average pay raise of 3.4 percent, seven times more than the rate of increase in 2018.

Enrollment is underway for Medicare Advantage plans, as well as for people in traditional Medicare who want to buy a policy for drug coverage. The deadline for choosing either type of plan is Dec. 7.

Among the new benefits that some Medicare Advantage plans said they will offer are:

— trips to the pharmacy or fitness center in addition to doctor’s appointments for plan members, depending on where they live or their health conditions

— a monthly or quarterly allowance for over-the-counter pharmacy products such as cold and allergy medications, eye drops, vitamins, supplements and compression stockings

— house calls by doctors or other health care providers, under certain conditions

— a home health care aide for a limited number of hours to help with dressing, eating and other daily activities, possibly including household chores and light housekeeping

However, plans offering these and other services will likely have only some of the options and will have different eligibility criteria and other limitations. The same services likely won’t be available in every county the plan serves.

For example, next year an estimated 150,000 Humana Medicare Advantage members in Texas and South Florida — two of the 43 states Humana serves — who cannot be left alone at home will be able to get a free in-home personal care aide for up to 42 hours a year, so that their regular caregiver can get a break. And more than half of the members in Cigna-HealthSpring Advantage plans will have access to free transportation services in all but five of the 16 states and the District of Columbia where the company sells coverage.

To find these supplemental benefits, seniors can use the online plan finder. After they enter their ZIP code and get a list of plans available locally, they can click on a plan name. That will take them to another page that offers more details about coverage, including a tab for health and drug plan benefits. That page might say whether the new services are offered.

But often the website will simply indicate that specific benefits are available — and perhaps not name them — and advise consumers to contact the plan for more information. A Medicare spokesperson confirmed that there is currently not an indicator on the plan finder for plans offering these expanded health-related supplemental benefits.

In addition to extra benefits, other variables should be considered when choosing an Advantage plan, such as which health care providers and pharmacies participate in a plan’s network, which drugs are covered and the costs.

Where available, several insurers say the new services will be free with no increase in monthly premiums.

“We certainly believe that all of the ancillary benefits we provide will help keep our members healthy, which is good for them, and it’s good for us in the long run,” said Steve Warner, head of the Medicare Advantage product team at UnitedHealthcare, which insures about 5 million seniors or 1 in 4 Medicare Advantage members.

Insurers are betting that services will eventually pay for themselves.

Dawn Maroney, consumer president at Alignment Healthcare, which serves eight counties in Southern California, said it’s much cheaper to give an air conditioner to someone with congestive heart failure to keep that patient healthy than to pay for more expensive medical treatment.

But if the new benefits are such a good idea, they should be available to the majority of older adults in traditional Medicare, said David Lipschutz, a senior policy attorney at the Center for Medicare Advocacy

What happens if/when the largest Retailer buys the largest Health Care Provider?

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How Home Care Could Be Re-Shaped if Walmart Acquires Humana

By Tim Mullaney | April 1, 2018

In the midst of acquiring a stake in the largest home health provider in the nation, insurance giant Humana (NYSE: HUM) might also be in early stage talks to itself be acquired by retail behemoth Walmart (NYSE: WMT). The combination of Humana and Walmart, though far from certain, would potentially be a game-changer for home care and the overall health care delivery and payment system for U.S. seniors.

On Thursday, The Wall Street Journal was the first to report that Louisville, Kentucky-based Humana and Bentonville, Arkansas-based Walmart are negotiating, citing an unnamed source familiar with the matter. Details remain scarce, but subsequent reporting from Bloomberg indicated that Walmart and Humana have been discussing a “wide range of options,” and that at this point, an outright combination is not likely.

Still, the rumors were enough to send Humana’s stock surging, with shares jumping from $263.21 on Thursday morning to $268.83 mid-day Friday, bringing the company’s market capitalization to around $41 billion. Walmart was up 1.48% on Friday afternoon, trading at $88.97 a share.

Humana had not responded to requests for comment as of press time. Walmart does not comment on rumors or speculation, the company stated in an email to Home Health Care News.

The Walmart rumors began swirling on the same day that shareholders of Louisville-based Kindred Healthcare (NYSE: KND) began casting votes to approve or reject a proposed deal with Humana. In that $4.1 billion transaction, first announced in late December, Humana would acquire a 40% stake in Kindred at Home, the largest U.S. home health provider. Two private equity firms would acquire the other 60%, but Humana would have the chance to fully take over Kindred at Home over time. The shareholder voting is scheduled to close on April 5.

Walmart could be interested in tying up with Humana as a defensive move against Amazon, its fierce retail rival.

Though known primarily for its e-commerce platform, Amazon has been making inroads into health care recently. It is teaming up with JP Morgan Chase and Berkshire Hathaway on a new venture that will seemingly manage insurance benefits for the companies’ roughly 1.5 million employees, although the exact nature of the three-way partnership has not yet been clearly defined.

In addition, Amazon has been active in the pharmacy space, leading to chatter that it might be interested in acquiring a pharmacy benefit management (PBM) company.

Acquiring Humana would hypothetically be a way for Walmart to answer both these plays by Amazon.

Humana is “by far the largest PBM” that realistically could be acquired at the moment, Bloomberg reported. Other major pharmacies such as CVS and Express Scripts are already in the midst of mega-mergers with insurers Aetna and Cigna, respectively. Walmart and Humana have partnered on some prescription plans, under which Humana beneficiaries can pay as little as $1 for medications picked up at Walmart locations.

Furthermore, owning one of the largest U.S. insurers would be a way for Walmart to internally manage the benefits of its own 1.5 million employees.

“Walmart has an opportunity to leverage their own massive employee health care needs to beat Amazon to the punch of re-imagining health care first for employees and eventually for consumers,” Brittain Ladd told Home Health Care News. Ladd is an independent consultant who specializes in digital, operations and supply chain management, and he previously focused on these areas in jobs with Amazon and accounting/advisory firm Deloitte.

Home care is a piece of the puzzle

These potential moves by Amazon and now Walmart have put home care providers—both Medicare-certified and private-duty agencies—on alert.

Most obviously, an outright acquisition of Humana would make Walmart a de facto home health provider, assuming that Humana’s acquisition of Kindred at Home is completed as planned. Jarring as it might be to think of Walmart as a home health company, lines are already being blurred between insurance, retail and home care.

For example, CVS and Aetna are joining forces, with one goal being to transform CVS pharmacies into one-stop shops where seniors could buy a greeting card, pick up a prescription, and receive health care services—helping them to manage chronic conditions, avoid hospitalizations, and improve the bottom line for Aetna’s large Medicare Advantage business.

Walmart and Humana could execute a version of this model on an even larger scale. Humana is the second-largest Medicare Advantage provider in the nation, behind only UnitedHealthcare. And Walmart is the largest retailer in the world, with $485 billion in annual sales, according to the Forbes Global 2000 rankings for 2017. CVS ranked as the second-largest retailer on the list, with about $178 billion in sales.

“The reason why I recommended [in a piece last June] that Walmart acquire a health insurer is because of the fact 90% of Americans live within 10 miles of a Walmart store,” Ladd told HHCN. “Acquiring Humana provides Walmart with an imperative to greatly expand their pharmacy, clinics, health care, and insurance capabilities within their stores to give seniors and others easier access to a provider capable of meeting the majority of their health care needs.”

In the long run, Walmart has the potential to be a huge driving force not only for transforming home care but the whole senior care ecosystem, he believes. He painted a picture of Walmart fulfilling Meals on Wheels deliveries from its stores, offering house cleaning, and doing on-demand wellness and welfare checks of seniors living at home. Already, tech-forward home care startup Honor has opened storefronts inside some Texas Walmarts.

Walmart could eventually even acquire nursing homes or develop its own alternative to nursing homes, powered by its supply chain, technology platforms, and health care services, Ladd postulated.

Home care providers and industry stakeholders have already been envisioning this type of large-scale disruption, in light of Amazon’s recent moves.

If Amazon were to leverage its retail services, technologies, and customer support to enable aging-in-place, it could theoretically reduce the need for traditional caregivers, posing a threat to established providers. On the other hand, Amazon is already boosting home care in certain ways—its voice-activated technologies like Echo are proving valuable in supporting in-home care, for example. And its experiment with Chase and Berkshire Hathaway could lead to more in-home care, if the three corporate giants try to lower costs by covering services delivered at home rather than inpatient settings.

Similarly, though home care providers might tremble at the thought of Walmart becoming a direct competitor, transforming retail stores into robust health care hubs is not necessarily bad for the industry, if it enables more seniors to live at home for longer periods of time. The trend can be seen as a “validation of the home health pitch,” which is that the volume of patients will increase in the coming years as more people will be able to age in place, Brian Tanquilut, analyst with investment bank Jefferies, told HHCN after the Aetna-CVS deal was announced in December.

Of course, Walmart acquiring Humana is far from certain, no matter how compelling the arguments might be. And there are drawbacks and obstacles as well.

Operationally, Walmart would be expanding outside its core competencies in retail. Financially, the price tag on Humana could run to $50 billion, but Walmart ended 2017 with only $6.76 billion in cash on hand, the WSJ reported. If Walmart were to issue stock rather than take on debt for the acquisition, the Walton family’s ownership stake likely would drop below 50%, which could be an impediment. There would be inevitable regulatory hurdles to clear as well.

Even if this particular deal does not go through, the writing appears to be on the wall that home health and private duty providers need more scale and sophistication than ever before, both to compete against and potentially partner with the massive corporate entities taking an interest in the sector.It’s a point recently made by several CEOs of home health companies, including AccentCare CEO Stephan Rodgers, and is one reason for consolidation in the space. As Kindred’s shareholders were casting their votes on the Humana deal, two other heavy hitters—Lafayette, Louisiana-based LHC Group (Nasdaq: LHCG) and Louisville-based Almost Family (Nasdaq: AFAM)—on April 1 closed on a merger that will create the second-largest home health provider in the nation.

By Tim Mullaney | April 1, 2018

Taking more away from our Seniors…This is totally UNEXCEPTABLE.

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Medicaid Bill Would Prevent Spousal Impoverishment as Route to Home Care Coverage

House lawmakers have taken a step toward extending crucial — but expiring — financial protections to seniors receiving long-term care in home or community settings. They did so with backing from more than a dozen health care and provider organizations.

In general, to financially qualify for Medicaid long-term services and supports (LTSS), an individual has to meet certain low-income and asset requirements. Marriage often complicates those eligibility requirements, however, potentially putting husbands or wives in the position to “spend down” or bankrupt themselves to secure care support for their partner.

Medicaid is currently the primary payer for long-term care services and supports in the U.S. health care system.

As of August 2018, more than 73 million individuals combined were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), according to federal Medicaid data. More than 66 million individuals were enrolled in Medicaid, while about 6.5 million were enrolled in CHIP.

To prevent self-induced bankruptcy for the purpose of continuing a spouse’s Medicaid eligibility, Congress created spousal impoverishment rules in the late 1980s.

Originally, the rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, according to the Kaiser Family Foundation. States, though, were also given the option to apply the rules to home and community-based services (HCBS) waivers.

Section 2404 of the Affordable Care Act (ACA) changed that stipulation, mandating that the spousal impoverishment rules treat Medicaid HCBS and institutional care equally. That provision is set to expire at the end of December, meaning individual states would once again become the decision-makers when it comes to spousal impoverishment in home care.

In 2018, all 50 states were applying the spousal impoverishment rules to HCBS waivers, according to Kaiser Family Foundation. Five states — Arkansas, Illinois, Maine, Minnesota and New Hampshire — plan to stop applying the spousal impoverishment rules to some or all of their HCBS waivers if Section 2404 expires at the end of 2018.

With support from LeadingAge, the National PACE Association, the National Council on Aging and several other groups, U.S. Reps. Debbie Dingell (D-Mich.) and Fred Upton (R-Mich.) on Friday introduced the Protecting Married Seniors from Impoverishment Act.

If passed, the bipartisan piece of legislation would permanently extend spousal impoverishment protections for Medicaid beneficiaries receiving long-term care in a home or community care setting.

“Our long-term care system is broken,” Rep. Dingell said in a statement. “Seniors and their families already face too many challenges when navigating long-term care, and they should not have to get divorced or go broke just to be eligible for the care they need.”

While it is unclear how much Congressional support the Protecting Married Senior from Impoverishment Act will ultimately draw, the fact that most states plan to continue protections on an optional basis is encouraging, LeadingAge President and CEO Katie Smith Sloan said in a statement provided to Home Health Care News.

“As a national organization, LeadingAge has consistently supported federal law establishing protections against spousal impoverishment,” Sloan said. “We support the legislation to extend the current protection.”

Washington, D.C.-based LeadingAge is an industry association that represents more than 6,000 not-for-profit senior care providers. If the Dingell-Upton bill fails, LeadingAge members in states that do not plan to continue impoverishment protections will likely be impacted negatively, Sloan said.

The National Academy of Elder Law Attorneys, Inc., the National Association for Home Care & Hospice and AARP are among the groups that have lobbied on issues including “spousal impoverishment” in the past two years, an HHCN review of lobbying records found.

A bill previously introduced in the House in 2017 — H.R. 181 — also sought to change Medicaid eligibility requirements pertaining to spousal relationships.

Specifically, the bill sought to amend Medicaid to count as available income, for purposes of determining the Medicaid eligibility of an institutionalized individual, portions of certain annuity income made in the name of the individual’s spouse.

The bill was last forwarded from the House Energy and Commerce Subcommittee on Health to the full committee by a 19-13 vote.

By Robert Holly | November 19, 2018

If you are taking any kind of RX “Statins”…READ this!

You’ve probably heard about the many amazing ways that taking a Coenzyme Q10 supplement can benefit your health, from increased energy and mental clarity to significantly improved heart health. In fact, the effects of CoQ10 are so well established that it has become one of the most popular supplements, and many doctors, even conservative ones, are starting to recommend it.

However, what many people don’t realize—even some doctors—is the important link between CoQ10 and many pharmaceutical drugs, especially cholesterol lowering statins that leave many older Americans feeling tired, sluggish and achy.

CoQ10 Is Fuel for Your Heart

Your heart beats about 100,000 times a day to get its job done and is fueled by CoQ10, which is why so many scientific studies[1] have shown that it confers powerful support for your entire cardiovascular system. When your heart has the high levels of CoQ10 it needs, it works like a charm. You see, your mitochondria (the cells’ energy factories) need CoQ10 to generate ATP energy to keep your heart cells functioning and healthy.

But when levels get too low, your heart strains to do its job, and ultimately your entire body suffers.[2]

Suboptimal heart function can play a role in a variety of health problems that plague us as we get older. That’s why taking the right CoQ10 can play a major role in making sure your body has the cellular energy you need to maintain a strong, healthy heart to live an active, healthy lifestyle as you age.

By Age 50, Your CoQ10 Levels May Be in Decline

According to leading experts on the cutting edge of natural health, it’s critical to supplement with CoQ10 as you age. After the age of 30, natural levels of CoQ10 begin to diminish. By the age of 50, this depletion of CoQ10 continues to accelerate and by age 70, your natural CoQ10 levels may be 50% lower than they were when you were a young adult![3]

We all know that as we age, our bodies do not perform as well in certain areas. But in many of these cases, there’s little we can do about it. That’s why I get so excited about CoQ10. It’s one tool that enables us to fight back against aging, and provide our bodies with a nourishing antioxidant that it is struggling to produce!

However, age isn’t the only factor that accelerates the loss of CoQ10. You may be shocked to learn that one of the worst culprits is pharmaceutical drugs, especially statins.

Statins and Other Drugs Can Quickly Deplete CoQ10 Levels

If you are taking a cholesterol-lowering statin drug such as Lipitor®, Zocor®, Crestor® or Pravachol, then you’re probably trying your best to stay on top of your cardiovascular health. However, I have important news to share with you today.

While statins aren’t for everyone (due to some well-established side effects), there is a hidden side effect that is not detailed on the warning label. And your doctors, in their rush to see the next patient, may have simply neglected to warn you, or even worse don’t even know about it in the first place.

It is widely known that statins severely deplete your body’s natural levels of CoQ10, which can be very dangerous. A Columbia University study found that within 30 days, your levels of CoQ10 can be decreased by half.[4]

Statin drugs aren’t the only culprit. In fact, there is a long list of pharmaceutical drugs that rob your body of CoQ10. And since nearly 50% of American adults take at least one prescription drug daily, it’s more important than ever to supplement with CoQ10 so you can be sure your body has the necessary levels needed for proper cellular energy function and a strong cardiovascular system.

Why You Need the Right CoQ10?

I can tell you firsthand that once you start taking the right kind of CoQ10, you’ll know it without a shred of doubt.

You’ll experience a noticeable boost in your energy levels as you feed your mitochondria the fuel they crave. This increased energy production will, in turn, improve your heart health since an active, healthy heart has such high energy demands. And the benefits don’t stop there. CoQ10 may in fact support both optimal brain and skin health.

As I explained above, the older you get, the more likely you are to have reduced levels of CoQ10. This is why I recommend a high-quality CoQ10 supplement to help slow the signs of aging. But please don’t grab the first CoQ10 bottle you see on the shelf believing it will provide these incredible health benefits.

6 Benefits of CoQ10

  • Improves Cardiovascular FunctionCoQ10 can support your heart as you age, keeping it pumping strong while supporting normal blood pressure and reducing LDL cholesterol oxidation.
  • Boosts Energy and StaminaCoQ10 fuels the energy-producing mitochondria found in every cell in your body.
  • Supports Cognitive FunctionCoQ10 keeps brain cells healthy, while supporting mental energy and clarity.
  • Fights Free-Radical DamageCoQ10 is a powerful antioxidant that helps reduce oxidative stress to fight harmful free radicals.
  • Supports Healthy Vision and HearingCoQ10 protects the delicate tissues of your eyes and ears from free radical damage.
  • Improves Oral HealthResearch has shown that CoQ10 keep the cells of your mouth and gums healthy.

It’s been confirmed time and time again that CoQ10 is amazingly safe and well tolerated by the human body. There appears to be no toxicity whatsoever, even at very high levels, and it has virtually no side effects.

The Supplement Industry’s DIRTY Little Secret

You can find CoQ10 supplements virtually everywhere. And unfortunately, most people are tricked into thinking all CoQ10 is the same. But there’s a dirty little secret that they won’t tell you on the label. Most of the major studies supporting the benefits of CoQ10 have been conducted with natural CoQ10. But many supplements are made with synthetic CoQ10.

Worse yet, guess what synthetic CoQ10 is synthesized from? Believe it or not, tobacco leaves are the primary source! This synthetic junk is called the “cis” form, and there is absolutely no good data out there proving its effectiveness or safety. I don’t know about you, but I don’t want to put anything in my body that’s used to make cigarettes.

You might be surprised, but 100% natural CoQ10, known as the “trans” form, is usually no more expensive than synthetic CoQ10—you just need to know how to look for it. It’s easy if you follow my simple “cheat sheet.”

How to “Read Between the Lines”

Discount brands, such as those found in drugstores or big-box retailers, take advantage of labeling requirement loopholes, and do a great job hiding the source of their CoQ10. Don’t fall victim to their cost-cutting.

Here’s my foolproof guide that will prevent you from being scammed:

  1. Look for the words “trans-form” on the label. Trans-form CoQ10 is identical to the CoQ10 produced naturally within the body, and if you read the studies on CoQ10 like I have, you’ll notice that most research is conducted using trans-form CoQ10.
  2. Also check to see if the CoQ10 is made using a natural fermentation process, which yields by far the most natural form. This is a patented process used by only the most reputable, higher quality producers of CoQ10.
  3. Seek out a supplement that contains piperine, an extract of black pepper. One problem with CoQ10 is that it’s not always well absorbed within the body. However, research shows that piperine significantly increases CoQ10 absorption by up to 30%![5]
  4. Finally, make sure it is manufactured in an FDA-inspected facility here in the U.S. Who needs CoQ10 bottled overseas in facilities of questionable integrity? It’s just not worth the risk.

CoQ10 May Be the Solution Your Doctor Overlooked

I’ve read hundreds of CoQ10 studies from around the world, and it’s been confirmed time and time again that CoQ10 is amazingly safe and well tolerated by the human body. There appears to be no toxicity whatsoever, even at very high levels, and it has virtually no side effects.[6,7] Also, it doesn’t make you jittery or upset your stomach, and it doesn’t conflict with any other medications or supplements.

What it does is nothing short of a health miracle:

  • Energizes your heart and keeps it pumping strong[7]
  • Supports brain health and mental clarity[8]
  • Increases cellular energy and effectively combats fatigue[9]
  • Fights off harmful free radicals that accumulate in your body[10]
  • Supports optimal skin health
  • Helps to keep your eyes healthy[11]
  • Promotes optimal gum and oral health[12]

More “Home Health Care” help is on the way.


Surging Functional Impairment Costs Could Mean Big Business for Home Care

By Robert Holly | November 12, 2018

Functional impairment is, perhaps, far more costly to the U.S. health care system than previously thought.

Functional impairment is broadly defined as a condition or status that interferes with one or more basic life activities, such as bathing, eating or dressing. To help carry out these activities, individuals living with functional impairments often turn to home care providers and personal care aides.

Roughly 39.5 million adults have some degree of difficulty when it comes to physical functioning, according to the U.S. Centers for Disease Control and Prevention. Of adults aged 75 and over, nearly 11% need assistance with personal care specifically.

Medicare beneficiaries with both multiple chronic conditions and functional impairments are twice as expensive to the Medicare program than individuals who have multiple chronic conditions alone, new data from Anne Tumlinson Innovations (ATI) has found. The findings suggest that the Centers for Medicare & Medicaid Services — and even Medicare Advantage (MA) plans — will fail to reduce health care spending if they don’t prioritize functional ability

“This data analysis shows that the population most likely to be receiving long-term services and supports — that is, people who have difficulty with basic life activities — are the ones who are also using the most health care,” Anne Tumlinson, ATI CEO and founder, told Home Health Care News.” Health plans need help identifying this population, assessing them and determining which interventions will have the greatest impact on costs and outcomes.”

In general, home care agencies are in the best position to care for individuals with functional impairments and multiple chronic conditions, Tumlinson said. It’s a value proposition that many home care agency leaders have touted in the past — and one that traditional home health providers have been widely pursing as well.

ATI is a Washington, D.C.-based research and advisory services firm that specializes in businesses, communities and public programs focus on older, frail adults.

“The very reason someone needs to hire a home care provider is the very same reason that person is using a lot of health care,” Tumlinson said.

Medicare spends, on average, half as much annually on beneficiaries with multiple chronic conditions as the program does on individuals who dually have multiple chronic conditions and functional impairment, according to the ATI data. Comparatively, that ends up being about $11,600 annually compared to nearly $27,000.

Additionally, health care utilization and spending also increases as the level of functional impairment increases, ATI data suggest. Indeed, individuals with the highest level of need — people who require help with two or more activities of daily living — use inpatient hospital services much more frequently, with Medicare spending nearly three times as much on them as the overall Medicare population.

“In-home care, together with care coordination, support for family caregivers and the involvement of primary care providers can make a big difference in reducing functional decline, avoiding unnecessary hospitalizations and addressing the underlying chronic conditions,” Tumlinson said.

To tackle these spending trends, functional ability should be included in the eligibility criteria for non-medical supplemental benefits available under the CHRONIC Care Act of 2018, ATI maintains. Among its provisions, the CHRONIC Care Ac gives MA plans more flexibility to target non-medical benefits to eligible Medicare beneficiaries.

CMS announced in April that non-skilled in-home care services will — for the first time — be allowed as supplemental benefits in MA plans starting next year.

Previous research has highlighted the cost of functional impairment as well.

A 2017 study published in the Journal of the American Geriatrics Society, for example, determined that functional impairment is associated with greater Medicare costs for post-acute care and may be an unmeasured but important marker of long-term costs that cuts across conditions. In the study, researchers found that the most severely impaired participants cost 77% more than those with no impairment.

Considering costs attributable to co-morbidities, only three conditions were more expensive than severe functional impairment, according to the 2017 study: lymphoma, metastatic cancer and paralysis.

Written by Robert Holly