Today's Q&A on ElderCareMatters.com is about housing options for a low-income Elder with Dementia

Question: My elderly mother has Dementia, and is about to lose her home and only has SSI for income. I've got someone looking into a place for her but was informed it would cost more than what she can afford. I don't know where to turn to find help for my mom. Can you please provide some guidance?

 

Answer: Supplemental Security Income (SSI) is a federal program that provides stipends to low-income people who are either aged (65 or older), blind, or disabled. Usually, an eligible person has no or little income and total assets of less than a few thousand dollars (excluding a home used for self-support, an automobile, household goods and personal effects, and life insurance). The individual also must have U.S. citizenship or qualified alien status and be a resident of the United States.
The majority of the states in our country provide additional cash benefits to supplement the federal SSI payment, depending on the living situation of the individual. For example a person living independently may receive one amount; someone receiving home care may receive a different amount, and a person in an assisted living residence a third amount. States determine the eligibility of an individual for SSI state supplements, but most states use the same eligibility criteria as the federal program.
If your mother is disabled, she may qualify for Medicare and Medicaid. Medicare is a federal health insurance program for individuals age 65 and older and certain disabled people, but it does not pay for assisted living.
Medicaid is a joint Federal-State program, varying from state to state, which pays for certain medical services to eligible low-income individuals and families.

It may be possible for SSI and Medicaid together to pay for assisted living for your mother. If your mother is a military veteran, or is the widow of a veteran, she may qualify for the Aid and Attendance Program to help cover the costs of her living situation and care. There are attorneys who specialize in elder law matters, so it also may be beneficial for you to meet and discuss your family’s situation with an attorney, many of whom can be found on ElderCareMatters.com – America's #1 online Directory of Elder Care / Senior Care Resources.

Millions of Americans affected by doctor shortage

A new study finds that 44 million people reside in areas of the U.S. where estimated demand for primary care access outpaces supply by 5%, while about 7 million Americans live in areas where demand is expected to exceed supply by 10% as coverage expands. Researchers said Texas, Mississippi, Nevada, Idaho and Oklahoma were among the states expected to see sharp increases in physician demand. The study was published in Health Affairs. BeckersHospitalReview.com

Study: Mediterranean-style diet reduces cardiovascular risks

A Mediterranean-style diet may prevent about 30% of heart attacks, strokes and deaths from cardiovascular disease in high-risk patients, according to a study published on the website of The New England Journal of Medicine. University of Vermont nutrition professor Rachel Johnson called the study from the University of Barcelona "really impressive" because it used meaningful end points rather than just risk factors such as cholesterol, hypertension or weight. The New York Times (tiered subscription model)

Today's Q&A on ElderCareMatters is about Medicare's rules regarding payment for ambulance services

Question: My brother has Medicare as his primary insurer and Plan F as his Secondary Supplement (Mutual of Omaha). He has congestive heart failure, requires oxygen, kidney failure, problems with vision, diabetes and is unable to walk. He is confined to his home. His wife provides his care. He is unable to ride in a car. He cannot walk or support himself to get in and out of car and he needs supervision and oxygen when mfacility due to medical necessity. If he has any type of surgery, Medicare provides an ambulance. When he goes for a follow up visit after surgery or when he has anaking a trip. He also requires a bariatric stretcher due to his weight. He has dialysis three days a week and Medicare provides ambulance service to and from the  appointment with a specialist, the ambulance service states that Medicare will not pay under any circumstances. I have called Medicare and received conflicting answers to this question. I need clarification. I have also received conflicting answers from different ambulance services. He lives in a small town and there is only one ambulance service available with a bariatric stretcher. How does a person who cannot ride in a car get ambulance service for follow up appointments after surgery and to specialist's offices when needed? He has had two cataracts removedneeds to see an ophthalmologist that is about 43 miles from his home. What are our options? He is unable to pay for this service himself and from what I read on the Medicare site, the ambulance trip should be covered if medically necessary. 

 

Answer: The rules regarding Medicare payment for ambulance services can be complex. Medicare will pay for the emergency transportation to a hospital or a skilled nursing facility when other transportation could endanger your health. Medicare will also cover ambulance services in certain specific circumstances, one of which is if you have End-Stage Renal Disease, need dialysis, and need ambulance transportation to or from a dialysis facility because other transportation could endanger your health. That is why your brother receives the services when going for dialysis.

In addition, in some cases, non-emergency ambulance transportation may be provided when you need ambulance transportation to diagnose or treat your health condition and use of any other transportation method could endanger your health. Medicare may cover limited non-emergency ambulance transportation if you have a statement from your doctor stating that ambulance transportation is necessary due to your medical condition. This would seem to apply to your brother cannot ride in a car and needs an ambulance with a bariatric stretcher. The ambulance company needs to fully document why your brother needs the ambulance transportation. If it fails to properly document it, Medicare will deny coverage. If this happens, contact the doctor who treated you or the discharge social worker at the hospital to get more information about your need for ambulance transportation. Then have the ambulance company resubmit the bill to Medicare. If you or anyone else needs more information regarding what Medicare covers regarding ambulance services, Medicare has a publication on the subject at www.medicare.gov/Pubs/pdf/11021.pdf. Good luck.

Companies consider helping and encouraging employees to use apps on there phones to help with health and wellness applicaitons.

mHealth Apps

 

As of today, there are more than 700,000 apps for smartphones and tablets available via the Apple App Store, close to that number on Google Play and more than 120,000 Microsoft apps. Of those, an estimated 23,000 are mHealth apps designed to assist with a variety of health-related matters, including exercise regimens, pregnancy tracking, medication reminders and dieting. One in five smartphone owners have downloaded an app to track or manage health) According to Juniper Research, the number of healthcare and medical app downloads were estimated to reach 44 million by the end of 2012! Medical and healthcare apps are the third-fastest-growing app category for both iPhones and Android phones.

 

mHealth apps typically fall into one of two categories: medical or health/wellness. Because many of these apps are developed to encourage changes in behavior, your clients could potentially investigate the options and incorporate apps into their wellness programs. Although many apps are free, some of the more complex ones come at a cost.

Your company may consider covering the costs associated with employee downloads as an extra step to show their interest in employee health and well-being. It may be easier for your company to navigate through the mHealth app options by evaluating apps from health, pharmacy and medical product brands with which they are familiar.

Here are just a few standouts from 2012 to provide you with a brief overview of the mHealth landscape:

Preparing for an upcoming race? If your client has a number of employees who are beginner-level runners or are preparing for an upcoming 5K race, Couch-to-SK promises to have them ready in nine weeks. Couch-to-SK features virtual coaches, access to your playlist and motiva­tional mantras while tracking progress and workouts.

Can't remember to take meds? If your client has a number of employees who are having a hard time sticking to their medication regimens, MedCoach can assist them by providing reminders. It tracks usage and can connect directly to a pharmacy for refills.

Want to make healthier selections at the grocery store? if your client has a number of employees who are undertaking a weight-loss challenge, Fooducate can as­sist by providing details on grocery items that are scanned using the app and offering healthier alternatives. With the largest database of UPCs (product bar codes), Fooducate recommends minimally processed, real foods that are naturally rich in nutrients and antioxidants.'

Need to unwind? if your company has employees looking for stress relief techniques, Simply Being—Guided Medi­tation can assist with a voice-guided, five- to 20-minute meditation session. Users have the option of listening with music, without music or with nature sounds.

Want a virtual personal trainer? if employees are interested in beginning or enhancing their workout rou­tines, Nike Training Club can assist by providing detailed instructions and audio guidance on 114 workouts. It helps with strength, cardio, interval and core training. Workout options are presented based on the user's goals and fitness level. Apps like this one may also have a social component that adds another layer of motivation, as friends and col­leagues can compete and cheer each other on.

Ready to quit smoking? If your client has a smoking-cessation program in place or is looking to start one, there are a number of apps dedicated to assisting people in their efforts to quit smoking. Apps in the marketplace can measure a variety of things, including the impact that cessation has on their health and finances, the number of cigarettes they haven't smoked since quitting and even an estimate of life extension, while enabling them to docu­ment the challenges they face during the process.

To see positive long-term health results, app usage requires a level of commitment from people beyond the initial step of downloading the app. To encourage routine usage, many apps have been designed with features to grab and maintain interest, such as rewards for achieved goals, alerts, alarms and even emails. These features make using apps more fun and engaging.

Some apps are required to be regulated as medical de­vices because of their capabilities; however, it is important to remind clients that apps do not replace care and ad­vice from doctors. The Food and Drug Administration is working to develop stricter guidelines to ensure consumer safety and to stay on top of this rapidly expanding market. Currently, if an app is used to diagnose a condition or replace the role of a doctor, the FDA will review the app prior to its release to the marketplace.

In addition to health regulation, the Federal Trade Commission has published recommendations for pri­vacy and data security. Several apps have been removed from the market because of false and misleading medical claims. As you make recommendations to your clients, it is also important that you are recommending trusted apps from reliable sources.

Like other wellness initiatives, the ultimate goal is to change behaviors for a healthier lifestyle. mHealth apps are having a significant impact on how individuals ad­dress their own health and well-being. It is likely that your clients are looking for additional tactics to reinforce the importance of employee health and overall wellness. With you as their valued and trusted partner, your clients expect you to keep them in the know. The insights you provide will enhance their communications with their employees, so take advantage of every opportunity to strengthen those relationships.

Although your company and employees may already have a few mHealth apps on their phones, they may not have considered incor­porating them into their official workplace wellness efforts or internal communications. By making mHealth app rec­ommendations based upon what you know about your cli­ents' internal efforts and what you learn from valued sources outside your agency, you will exhibit your commit­ment to their business as well as strengthen your role as their trusted health benefit advisor. Oa

Small Business Health Care Tax Credit for Small Employers

 

 

What You Need to Know about the Small Business Health Care Tax Credit How will the credit make a difference for you? For tax years 2010 through 2013, the maximum credit is 35 percent for small business employers and 25 percent for small tax-exempt employers such as charities. An enhanced version of the credit will be effective beginning Jan. 1, 2014. Additional information about the enhanced version will be added to IRS.gov as it becomes available. In general, on Jan. 1, 2014, the rate will increase to 50 percent and 35 percent, respectively. Here’s what this means for you. If you pay $50,000 a year toward workers’ health care premiums – and if you qualify for a 15 percent credit, you save … $7,500. If you save $7,500 a year from tax year 2010 through 2013, that’s total savings of $30,000. If, in 2014, you qualify for a slightly larger credit, say 20 percent, your savings go from $7,500 a year to $12,000 a year. Even if you are a small business employer who did not owe tax during the year, you can carry the credit back or forward to other tax years. Also, since the amount of the health insurance premium payments are more than the total credit, eligible small businesses can still claim a business expense deduction for the premiums in excess of the credit. That’s both a credit and a deduction for employee premium payments. There is good news for small tax-exempt employers too. The credit is refundable, so even if you have no taxable income, you may be eligible to receive the credit as a refund so long as it does not exceed your income tax withholding and Medicare tax liability. And finally, if you can benefit from the credit this year but forgot to claim it on your tax return there’s still time to file an amended return. Click here if you want more examples of how the credit applies in different circumstances. Can you claim the credit? Now that you know how the credit can make a difference for your business, let’s determine if you can claim it. To be eligible, you must cover at least 50 percent of the cost of single (not family) health care coverage for each of your employees. You must also have fewer than 25 full-time equivalent employees (FTEs). Those employees must have average wages of less than $50,000 a year. Let us break it down for you even more. You are probably wondering: what IS a full-time equivalent employee. Basically, two half-time workers count as one full-timer. Here is an example, 20 half-time employees are equivalent to 10 full-time workers. That makes the number of FTEs 10 not 20. Now let’s talk about average wages. Say you pay total wages of $200,000 and have 10 FTEs. To figure average wages you divide $200,000 by 10 – the number of FTEs – and the result is your average wage. The average wage would be $20,000. Also, the amount of the credit you receive works on a sliding scale. The smaller the business or charity, the bigger the credit. So if you have more than 10 FTEs or if the average wage is more than $25,000, the amount of the credit you receive will be less. If you need assistance determining if your small business or tax exempt organization qualifies for the credit, try this step-by-step guide. How do you claim the credit? You must use Form 8941, Credit for Small Employer Health Insurance Premiums, to calculate the credit. For detailed information on filling out this form, see the Instructions for Form 8941. If you are a small business, include the amount as part of the general business credit on your income tax return. If you are a tax-exempt organization, include the amount on line 44f of the Form 990-T, Exempt Organization Business Income Tax Return. You must file the Form 990-T in order to claim the credit, even if you don't ordinarily do so. Don’t forget … if you are a small business employer you may be able to carry the credit back or forward. And if you are a tax-exempt employer, you may be eligible for a refundable credit.		Versión en Español Información acerca del Crédito Tributario por Cuidados de Salud para Pequeñas Empresas Questions and Answers Got questions? We have answers. Forms and Step-by-Step Instructions Form 8941, Credit for Small Employer Health Insurance Premiums and Instructions for Form 8941 YouTube Video Small Business Health Care Tax Credit 　 Additional Guidance Additional guidance on the credit is available in Notices 2010-44 and 2010-82. News Releases Affordable Care Act News Releases, Multimedia and Legal Guidance. Widgets IRS small business health care tax credit Widgets available on Marketing Express. Information Flyer Flyer on the Small Business Health Care Tax Credit for small employers. Postcard from the IRS In 2010, small employers received postcards alerting them to the credit.

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How to Prevent Employee Problems from Impacting the Workplace

What happens when a valued employee is going through a major life change? Perhaps he or she is in the middle of a divorce, on the verge of bankruptcy, or distracted by a troubled teenager. Or maybe you have a worker who is dealing with a death in the family or battling depression. Sure, these situations are difficult and emotional, but are these personal problems a concern for an employer?

In most cases, the answer is yes. Personal stressors often result in major distractions at work. A lack of focus, lost productivity, attitude problems, coworker conflicts, increased sick days, and safety issues can arise when an employee is struggling with a traumatic situation at home. An employee’s personal life can significantly affect job performance — and potentially the company’s bottom line.

Getting help outside the workplace
At one time or another, most employees will have a personal issue arise that is unplanned and unintentional. Although employers may feel inclined to approach their employees with offers of support, many employees feel this is a violation of their personal boundaries. Often, discussing problems with a manager or HR staff adds additional stress, and it can disrupt professional relationships.
To address personal struggles, employees should receive assistance outside the office. As an employer, it’s a good idea to have a support system in place for helping employees better manage difficult personal situations in a private and safe manner.

The simple solution for employers
HR EAPLink is a comprehensive and affordable Employee Assistance Program (EAP). An EAP gives employees access to resources that help reduce stress at home, allowing them to engage more fully when they are at work. With HR EAPLink, employees receive unlimited access to online resources, unlimited telephone consultations, and three local face-to-face consultations for each member of their households.
HR EAPLink provides anonymous assistance. Employers provide the service to increase productivity, but a third-party provider works directly with employees. Contact with HR EAPLink is never disclosed to the employer, so using the service doesn’t have negative consequences or affect employer/employee relationships.
Work-related issues, marital and family problems, anger and stress management, conflict resolution, parenting challenges, and alcohol and drug problems can all be addressed anonymously through HR EAPLink.
In addition, WorkLife services offered by HRAnswerLink include parent education, adoption assistance, daycare referrals, college planning, senior housing referrals, legal counseling, and financial advising. Often, HR EAPLink also provides community resource referrals.
It’s easy and affordable
Many of our affiliates offer HR EAPLink as a no-cost, value-added service to increase sales in other areas of their HR business. However, others offer the service for between $2.50 and $3.00 per employee, per month. Client companies can then offer HR EAPLink as a free or very low-cost employee benefit.
Costs associated with employee retention, missed work days, lost productivity, increased sick days, and office conflict are tremendous. For just pennies per day, HR EAPLink is a no-brainer investment in keeping employees healthy and happy — at home and at work.

Ask about our complimentary value HR Platform: see demo here

Giving employees a "nudge" increases wellness participation

Wellness plans can use behavioral economics to drive participation, giving employees a "nudge" to get them going, says Evive Health CEO Peter Saravis. DTE Energy in Michigan used a Weight Watchers mailing aimed at couples to encourage them to keep each other committed to dieting, and the State of Nebraska sent employees a scratch-off mailer that showed how much money they would save by enrolling in a PPO option as a way to get them to act. TrainingMag.com

Report cites growth for health savings accounts

The number of health savings accounts reached 8.2 million in 2012, an annual increase of 22%, Devenir Group says. Assets in such accounts increased by 27% to $15.5 billion, with contributions of about $13.2 billion and withdrawals at $10.2 billion. "With both record contributions and withdrawals in HSA accounts in 2012, we continue to see that not only are people using their HSA dollars for current medical expenses, but more importantly they are actually accumulating savings for future medical expenses," Devenir's Jon Robb said in a statement. for more informtion  HSA Plans