What happens when a loved one in a nursing home is not receiving proper care?

Question:  3 months ago my sisters and I reluctantly placed our mother (who is 81 years old) in a local nursing home.  Now she is about 30 pounds thinner, doesn’t speak, smells terribly and has bed sores.  We believe that this is the result of poor care provided by the nursing home.  Is there anyone we can contact to “check out” this nursing home and to help us resolve these quality of care issues?  Several of our friends have suggested that we contact the State Long Term Care Ombudsman’s office.  We are not sure what the role of the Ombudsman’s office is.  Can you please educate us on this elder care agency?

Answer:  The Long Term Care Ombudsman program is administered by the Administration on Aging (AoA), and each state (plus the District of Columbia, Puerto Rico and Guam) has a Long Term Care Ombudsman program. 

Long Term Care Ombudsmen are advocates for the residents of long term care facilities, including nursing homes, board and care homes and assisted living facilities.  They are trained to help residents (and the families of residents) resolve problems that they may be experiencing with long term care facilities.

Long Term Care Ombudsmen can help families address the following long term care concerns:

• Violation of  the resident's rights or dignity
• Physical, verbal or mental abuse
• Poor quality of care
• Inappropriate use of restaints

A Dun & Bradstreet study surveyed more than 12,000 failed businesses to find out why businesses fold.

What they found was that 97.5% of the failures were caused by factors involving the human element including incompetence, inexperience and human frailties such as death. The death of a Key Person can and most often will cause the following: ·         Disruption of management ·         Impairment of credit ·         Loss of profits ·         Loss of company confidence Now is the time to review your businessKey Person coverage or put it in place if they do not already have it. We have a “turn-key” tool kit that will help you identify their need and walk you through the process.

Small Businesses Hold Off On Hiring Due to the ACA

 

Forty-one percent of small business owners say they are holding off on hiring because of the Affordable Care Act, according to a Gallup poll. Thirty-eight percent have pulled back on plans to grow their business; 19% have reduced their number of employees; 18% have cut employee hours; and 24% have thought about eliminating healthcare coverage for employees.

Forty-eight percent say the ACA will be bad for their business, compared to 9% who say it will be good, and 39% who expect no impact. Fifty-two percent say the ACA will lower the quality of healthcare; 13% say it will improve care; and 30% say it will have no impact.

Fifty-five percent of small business owners expect to pay more for healthcare as a result of the ACA. Five percent expect their healthcare costs to decline while 37% say the health law will have no effect on what they pay for healthcare. For more information, visit www.gallup.com.

Life Combo Products See Double-Digit Growth

 

More than 86,000 life combination policies were sold in 2012, an increase of 19% over 2011, according to a LIMRA report. Consumers under 59 held more than half of in-force polices in 2012. Sixty percent of life combination policies are insuring women. Life combination products accounted for 11% of new premium for individual life insurance.
Sales of life combination products continue to grow at a remarkable rate as new carriers enter the market and existing players refine products to remain competitive, said Catherine Ho, LIMRA product actuary. “This segment of the market weathered the storm pretty well during the recession when individual life sales declined significantly. Now that sales growth has returned for individual life, we anticipate life combination products to continue their steady growth,” she said.

All life combination product lines experienced growth in 2012, with whole life (WL) and universal life (UL) combination premium each growing 10% and variable combination premium growing 3%. Whole life combination policy count rose 23%; UL policy count rose 19%; and variable policy count rose 4%.All but one distribution channel experienced double-digit growth in 2012 (independent RIA). Banks and savings institutions posted the largest premium growth, rising 21%; affiliated agents recorded 30% growth in policy count.

Consumers Are Not Prepared for a Critical Illness

 

Ninety percent of middle-income Americans say they are not financially prepared for a critical illness diagnosis, according to a study by the Washington National Institute for Wellness Solutions. The study surveyed 1,001 Americans ages 30 to 66 with annual household incomes of $35,000 to $99,999. The following statistics reveal that many have little, if any, savings to fall back on in the event of a critical illness:
• 75% have less than $20,000.
• 50% have less than $2,000.
• 25% have no savings.
To pay for out-of-pocket critical illness costs, middle-income Americans say they would need to use credit cards (28%) or loans from family/friends (23%) or financial institutions (19%). Another 23% don’t know what resources they could use to pay their expenses. Millennials and Gen Xers anticipate greater reliance on credit cards and loans to pay for critical illness expenses. Thirty-eight percent say they might never recover financially from a battle with cancer and 45% believe they would never recover financially from an Alzheimer’s/dementia diagnosis.
Eighty-eight percent of middle-income Americans have had no conversations with loved ones or advisers about potential care-giving options and 60% have not discussed financial planning for critical illness. Only 12% have explored care-giving options.

Individual Rates to Soar In California

 

Expanded enrollment of a sicker population will drive up rates for individual health plans in 2014, according to a study by Milliman for Covered California, the state’s health exchange. The average premium increase will be an astounding 30.1% for people who make too much to receive the subsidy (more than $93,700 for a family of four or $45,960 for an individual).

However, Californians who will qualify for the highest premium tax credits, due to their income, will see an average drop of 85% in what they pay for health coverage. Depending on the individual’s choice of health plan, this premium tax credit could cover a higher percentage of the premium. There are 1 .6 million people uninsured and eligible for subsidies. Many of them could have 100% of their premiums covered through the Affordable Care Act. Those who make less money will be eligible for larger federal tax credits to make their health care more affordable. Households earning from 138% to 250% of the federal poverty level will likely see an average drop of 85% in what they pay for health coverage. Households earning 250% to 400% of federal poverty level will pay on average 45% less, for more coverage with lower copay and deductibles, than what they would have paid for an individual plan in 2013. The hope is that, in future years, Californians will see decreases in their health care costs as they no longer pay for the burden of the millions of uninsured and benefit from improvements in how care is delivered, according to Covered California.

Do You Have YOUR Income Protected?

http://www.youtube.com/watch?v=LHC2R94i3VI&list=PL2FDFB00D1E5B39D1

Good Health Can Be Fun; Teach Your Children

 

Become the hero of your own health story! Habit Heroes like Agent Dynamo can show you how to practice healthy habits. Eating well, exercising and having a positive attitude can turn you into a Habit Hero too — and Anthem can be your helpful sidekick. Choose one of our wellness programs to help. And be the BEST YOU that you can be!

           

Anthem is proud to bring the message of good health to people of all ages by co-sponsoring the Habit Heroes exhibit in the INNOVENTIONS Attraction at Epcot® in the Walt Disney World® Resort. Promoting healthy habits is the goal. And you do it with healthy foods, exercising, and a positive attitude.

As to Disney artwork/properties: ©Disney.

What bothers patients most when visiting the doctor?

A U.S. survey of 1,000 people found the top complaints of patients included long wait times to see physicians, unclear descriptions of problems, slow test results and billing issues. The Consumer Reports study found women were more bothered than men when physicians used electronic devices to record notes and when conversations were held within earshot of other patients. PhysiciansBriefing.com/HealthDay News

Certified Care Manager answers family's question on ElderCareMatters.com

 

Question: Will my parents’ long term care insurance policies pay for day care for my father. Mom is the primary caregiver and needs this “time off” from dad in order not to become totally exhausted. Please advise.

Answer: Without seeing your parent’s specific policy, it is impossible to know what is or is not covered. Some policies only offer payment for specific services such as a non-medical caregiver in the home, a Geriatric Care Manager or the monthly cost for a facility. In addition, many companies sell riders to the basic policy to cover additional types of services beyond what the basic policy covers. Some of the newer policies pay a flat amount of money each month and allow the insured to determine how the money is spent. I recommend you review your parent’s insurance policy to determine the specific benefits allowed to them under their policy. 

It may also be helpful to talk with the agent directly to ensure you are taking full advantage of the benefits they are entitled to receive.
ElderCareMatters.com – America's National Directory of Elder Care / Senior Care Resources for Families.

ACA Will Test Consumers’ Loyalty to Their Doctors

 

Half of consumers would switch their doctor if they could save a certain amount in annual health care costs, according to a survey by HealthPocket. Thirty-four percent would switch if they could save $500 to $1,000; eight percent would switch if they could save $1,000 to $2,000; and 8% would switch if they could save $3,000 or more.

Consumers and small employers will face an array of new health plan choices in 2014. Other than cost, one of the key factors in consumers’ selection process is whether their doctor participates in a plan’s provider network. Cost pressures are moving insurers to limit their provider networks. They are seeking to negotiate lower rates to healthcare providers in exchange for a larger volume of patients.

HealthPocket is offering a physician search component on its site at http://www.healthpocket.com/doctor-finder. It allows consumers to compare all commercial health plans, Medicare plans and Medicaid programs that their doctor may accept.

Special Needs Trusts for special needs children?

Question: "My wife and I (who are in our 60s) have been encouraged to set up a Special Needs Trust for our disabled adult child. Could you please tell us why this would be necessary? Also, could you please provide us with a little background information on this type of legal instrument?"
Answer: Among the many challenges facing parents of children with special needs is planning for the time when the parents will no longer be around to act as the primary caregivers. Advance planning by parents can make all the difference in the life of the child with special needs, as well as for siblings who may be left with caretaking responsibilities.
A Special Needs Trust for your disabled child should be part of an overall plan for your child. If the parent is the legal guardian for the disabled child, it is essential as part of the planning is to arrange for the orderly transfer of the guardianship to a successor. A Special Needs Trust is a trust created for a chronically disabled beneficiary, which supplements government benefits like Medicaid. Medicaid and other government benefit programs consider the resources and income of an individual for purposes of determining eligibility and the amount of such assistance. With a Special Needs Trust, however, someone may establish a trust for a disabled individual without jeopardizing that individual’s eligibility for government benefits. Special needs trusts allow a disabled beneficiary to receive inheritances, gifts, lawsuit settlements, or other funds and yet not lose his or her eligibility for certain government programs. Such trusts are drafted so that the funds will not be considered to belong to the beneficiary in determining eligibility for public benefits.
Often, special needs trusts are created by a parent or other family member for a child with special needs, even though the child may be an adult by the time the trust is created or funded. Such trusts are set up as a way for an individual to leave assets to a disabled relative. As their name implies, special needs trusts are designed not to provide basic support, but instead to pay for comforts and luxuries that could not be paid for by public assistance funds. These trusts typically pay for things like education, recreation, counseling, and medical attention beyond the simple necessities of life. However, the trustee can use trust funds for food, clothing, and shelter if the trustee decides doing so is in the beneficiary’s best interest despite a possible loss or reduction in public assistance. Special needs can include medical and dental expenses, annual independent check-ups, necessary or desirable equipment training and education, insurance, transportation, and essential dietary needs. If the trust is sufficiently funded, the disabled person can also receive spending money, electronic equipment and appliances, computers, vacations, movies, payments for a companion, and other self-esteem and quality-of-life enhancing expenses.
It is important to plan to ensure that your child receives appropriate therapies and medical treatments. It is essential to take the time necessary to find appropriate caregivers who will carry out your wishes and respect your child's goals, dreams and life expectations. At the same time, Predators are particularly attracted to vulnerable beneficiaries, such as the young and those with limited self-protective capacities. When you plan with trusts, you decide who has access to the information about your children's inheritance. This protects your child and other family members, who may be serving as trustees, from predators.
It is important that special needs trusts not be unnecessarily inflexible and generic. Although an attorney with some knowledge of trusts can protect almost any trust from invalidating the child's public benefits, an attorney without special needs experience may not customize the trust to the particular child's needs, and the child may not receive the benefits that the parent provided when they were alive.


James C. Siebert, Attorney at Law

Is it possible to pay the medical expenses of a parent and deduct on your tax returns?

 

Question: My mother is 87 years old and lives in an assisted living facility, which cost about $4,000 per month. She has no assets to speak of and very little income, i.e. she has a small monthly Social Security check and a very small monthly pension. I have been paying for her care in the assisted living facility. Is there anyway that my husband and I can deduct what we pay for mom's medical care in the assisted living facilty on our individual income tax returns? Please provide your answer as soon as possible because we are about to file our 2012 individual income tax returns.
Answer: Yes, a child can deduct medical expenses that they paid on behalf of their parent (even if the parent doesn't qualify as one of their dependents, doesn't live with them and has a gross income that exceeds $3,800 (for tax year 2012)) if the child provided over half of the parent's total support during the tax year. Assuming that the child paid more than 50% of their parent's total support during this tax year, then the medical expenses paid on the parent's behalf in excess of 7.5% of the child's Adjusted Gross Income (AGI) are deductible on the child's individual income tax returns as itemized deductions.

Survey: Exchanges gain interest among employers, retirees

Health insurance exchanges are gaining favor among employers. Some 60% of those responding to a survey say they are reconsidering health coverage options for their Medicare-eligible retirees and are open to using exchanges. According to the survey, almost 20% of respondents are connected with a private insurance exchange and two-thirds are looking into the use of private exchanges in the future. Business Insurance (tiered subscription model)


Ask about our private health care exchange, Cal Choice and soon the California Exchange.  info@amsinsure.com or get a quote at www.amsminsure.com

800-334-7875

Hospital Prices Drive Health Care Costs

 

Inpatient Hospital prices increased 8.2% per year from 2008 to 2010 with wide variation in price levels and growth rates across states and localities. The study published in the March issue of the American Journal of Managed Care (AJMC) was conducted by researchers at America’s Health Insurance Plans (AHIP).
Taking into account the complexity of treatment and the number of procedures performed, the authors estimate that 1.3% to 1.9% of this increase could be attributed to increased intensity per admission. Thus intensity-adjusted price increases ranged from 6.2% to 6.8% annually during this period.
The price for a spinal fusion increased the most (15.2% per year) from 2008 to 2010. That was followed by bronchitis and asthma treatment (10.3% per year) and uterine laparoscopic procedure for non-malignancy (9.8% per year).
A recent report from the Health Care Cost Institute found that despite some increases in utilization, spending growth was driven primarily by increases in the prices paid. Last year, the S&P Healthcare Economic Composite Index showed the average per capita cost of hospital services in the commercial market had increased by nearly 8%.
Data show that increasing provider consolidation is one contributor to rising hospital prices. When hospitals consolidate, merging with other hospitals or buying up physician practices, they have greater negotiating strength and competition is limited. The result is higher prices for services, higher costs for patients, and often no improvement in the quality of care delivered. AHIP recently filed an amicus brief on the affect of hospital consolidation in the Court of Appeals for the Sixth Circuit in support of the Federal Trade Commission (FTC). For more information, visit www.ahip.org.

Americans Are Still in the Dark About Health Reform

 

Americans are not sure how the health reform law will affect them and few are paying attention to state-level decisions about implementation, according to the latest Kaiser Health Tracking Poll.
Though opinion on the law remains nearly evenly divided, opponents’ attacks seem to have taken a toll on the public’s expectations. Americans are now more likely to say the law will make things worse rather than better for their families. While most of the law’s individual provisions remain popular, many of the most well-liked elements are the least well-known among the public. Public knowledge of the ACA’s provisions has not increased since 2010. In fact, awareness of some key provisions has declined since the law’s passage when media attention was at its height.
The public hasn’t been paying much attention to the decisions of state and federal policymakers about Medicaid expansion and health insurance exchanges. Forty-eight percent have hear nothing about their state’s decision on whether to create a state run exchange; 15% have heard some; and 7% have heard a lot about it.
While health care cost growth has slowed in recent years, a majority of the public perceives that the country’s health costs have been going up faster than usual. While health care cost growth continues to outpace inflation, the rate of growth in national health expenditures has slowed markedly in recent years. The public’s perception is quite different, however. Fifty-eight percent say that, the cost of health care for the nation has been going up faster than usual over the past few years.
Thirty-four percent say that their own family’s health care costs have been going up faster than usual while 24% say the costs been going up about the same amount as usual, and 32% say their costs have held steady in recent years. Only 2% say their costs have been going up more slowly than usual or have come down. For more information, visit www.kff.org.

How to help a family member who develops Alzheimer's Disease

 

Question: "Help! My mother has been diagnosed with Alzheimer's Disease and my family and I have no idea how to proceed in helping her. At what point do we consider nursing home care, and how will we afford this, etc?? Please provide us with some guidance as to how we should proceed and what our options may be."
Answer:The first place to start is with your mother’s doctor. He will be in the best position to assess your mother’s need for long-term care. This could be an immediate need or one that will develop over a period of time. If the doctor feels that she needs immediate long-term care then he will complete the necessary paperwork to have your mother’s condition reviewed by the Medicaid people in your state.
Assuming that Medicaid agrees that your mother needs long-term care at this time, your next step is to sit down with an experienced Medicaid planning attorney. The Medicaid planning attorney will review your mother’s legal documents –particularly her durable power of attorney- to make sure that they comply with current law. Of course, if your mother is still married, then the attorney will review your Dad’s documents as well. If not, then he will prepare a new durable power of attorney for her (again, she must be competent at this stage to avoid a guardianship proceeding) and perhaps your Dad as well.
The Medicaid planning attorney will review your mother’s monthly income and overall wealth to determine what type of Medicaid planning tools are needed to protect her estate. If she has too much monthly income (over $2130 per month), then he will prepare a Qualified Income Trust to insure that she passes the income test. If she received less than $2130 per month, then this step will be unnecessary.
Next, the attorney will review her assets. As a Medicaid applicant she is only allowed to retain $2,000 in assets (cash or cash equivalents, stocks, bonds, etc.). If excess assets exist, the attorney will look to see what other avenues are available to protect the remaining assets. This may include a personal services contract, trusts for the benefit of a disabled adult or minor child, purchasing a pre-paid funeral contract, setting aside and designating a burial fund, purchasing a burial plot and arranging for and paying for the headstone. There may be other purchases for clothing, etc. that may come into play to get her down to the $2,000.00 limit. If Mom is married this will be somewhat easier as she can transfer property to your father without incurring a penalty.
Either your Mother’s doctor or the attorney that you pick to help you should be able to recommend the proper living environment for your mother. I would suggest that you personally visit all of the facilities that are discussed to make sure that you get the proper fit for your mother.
The Medicaid application can be completed by any number of people. Your attorney may do it, a paralegal can do it or someone at the assisted living facility or nursing home can do it for you. The attorney and the paralegal, of course, will charge you for this work. It is best to seek their help as they should have the needed experience to do it properly and to avoid the pitfalls that you might see.
As long as you put together a good team of doctor and attorney you should not find the application process to be all that difficult. The difficulty usually comes up with searching for the back-up documents that support your answers on the Medicaid application. Just remember that each application is different from the last one so do rely on the help of the individuals mentioned in this answer.

What is the difference between Continuing Care and Skilled Care?

 

Question: My sister and I are caregivers to our mother and have been for quite some time. However, we still don't understand what the difference is between Continuing Care and Skilled Care. Would you please define these two elder care terms for us?
Answer: Skilled care is ideal for patients who cannot live independently due to fairly pronounced physical or cognitive ailments. Although the level of care delivered is not the same degree as in an acute care situation that necessitates a hospital visit, a patient receiving skilled care must generally be monitored by a team of skilled nurse providers and other health team members, twenty-four hours a day. The most common location for a patient to receive skilled care is in a nursing home, which is now commonly referred to as a skilled nursing facility (“SNF”).
In contrast, the term “continuing care” generally refers to care provided in some sort of a facility that can accommodate a wide variety of capabilities in its residents – ranging from complete independence to a need for quite a bit of care and assistance. There are now many so-called continuing care retirement communities (“CCRC’s”) that offer this sort of spectrum of care to residents. In a CCRC, seniors can “age in place,” meaning the resident does not need to relocate when their deteriorating health means an increasing level of care is required. That can give residents a sense of comfort and can decrease their anxiety about what will happen in a health crisis.
Sometimes, a health issue is so pronounced there is no other option than for a brief of long-term residency in a SNF, since a CCRC may have an upper limit to the level of care they are equipped to handle. Sometimes, a CCRC may have a separate portion of the facility that is effectively its own skilled nursing facility. There, a resident may be able to stay in their original residence from full independence up until assisted living, but then relocate when skilled nursing is required. A small move to a different area within the same facility would likely be less traumatic than relocation to an entirely different, unfamiliar SNF.
What are the advantages and disadvantages of a CCRC? The obvious advantage is the desirability of living somewhere where the resident can likely receive whatever type of care they need for the near foreseeable future. Because many residents in a CCRC need little or no care, it will be easier to participate in activities to stay active and to find peers with which to socialize. The main disadvantage of a CCRC is they can be quite expensive and they do not accept residents on Medicaid.
What are the advantages and disadvantages to a skilled SNF? The main “advantage” so to speak is a SNF may be the only place in which a resident can be taken care of properly. For example, many CCRC’s simply cannot care for a resident who developed pronounced dementia, whereas many (but not all) SNF’s may be equipped for that sort of patient. A disadvantage of SNF’s is that almost all the residents will be quite frail and/or very ill. For a senior who is only moderately weak or having slight difficulties, it will probably be demoralizing to now be surrounded by the very sick.
Financially speaking, the private pay cost for SNF’s are extremely expensive, so expensive that patients are unable to bear the costs out-of-pocket for very long. However, almost all SNF’s can and do accept residents on Medicaid. For those that have the financial means, and assuming a senior’s heath conditions permit it, residency in a CCRC can be highly desirable.
The key point to bear in mind is it is undoubtedly advantageous to start planning for long-term care long before there is a health care crisis. For some seniors, their primary concern is to make sure they are well-cared for, and in the residence setting they find most desirable. Many seniors would also like to take steps to make sure the assets they have worked a lifetime to accumulate are not squandered unnecessarily. I highly recommend that a senior and/or the family of a senior consult with a competent elder law attorney as soon as they can, when they are financially sound and they are in good health. That is the ideal time to devise a good plan that addresses both health needs and financial issues, for the present and for the future, that is also flexible enough to be updated and adapted when family circumstances do change.

 

New

Habit Heroes™ experience aims to

teach families about healthy choices!

Habit Heroes™.

Everyone has the potential to be a habit hero. That’s why we’re

co-sponsoring

Habit Heroes™ in

INN OVENTI ONS at  Epcot® and Walt Disney World®

Resort. The HabitHeroes™

interactive exhibit was reviewed by health experts and is

designed to help families make healthy choices a part of everyday

life. Centers for Disease Control (CDC) research showed 17% of

 

U.S. citizens age 2-19 are obese, and nearly 80% of the kids who

 

were overweight at 10-15 years of age were obese by age

25. A CDC report said that unhealthy lifestyle choices

like poor nutrition and lack of exercise radically impact

employers’ costs. This is because they can lead to

chronic conditions, which account for 75% of U.S.

health care spending each year.* Promoting

Habit Heroes™

is one way we’re working to reverse these

trends. It’s a fun, yet effective way to help families

focus on building good habits like eating well, moving

more and staying hydrated. It’s also an extension

of how we support our members through wellness

programs and plans with 100 percent coverage for

preventive care.

What is Habit Heroes™?

 

Habit Heroes  

aims to entertain, inspire and inform

Families about the benefits of living a healthy lifestyle.

Habit Heroes™

is an interactive comic adventure that aims to teach families about

 

healthy habits and it

includes the exhibit at IN OVENI ONS at Epcot® at

Walt Disney World®

Resort as well as a cool

mobile app.

~

~ Families who experience the exhibit can

take part in hero missions alongside a

cast of

Habit Heroes™.

~

~ Each mission is focused on an important

health habit — nutrition, activity and

hydration.

~

~ And the fun continues outside of the

theme park. At home, families can take

part in the adventures with the

Habit

Heroes™

mobile

app that anyone

can download

from

habitheroes.

com

, iTunes

or GooglePlay.

The mobile app

features the

Habit

Heroes™

comic

and provides

users with fun

tools that can be

used to track and

build their hero

power.

Ready to Unlock Your Hero Potential?

Visit

anthem.com/habitheroes to learn

more about how Anthem’s health and

wellness tools can help build good habits.

We all have a role in improving our health

and

Habit Heroes™ is a terrific first step

towards helping families, especially kids,

learn about and develop good health

habits at an early age. Be a habit hero. Visit

habitheroes.com

, or iTunes or GooglePlay

to download the Mobile App.

As to Disney artwork/properties: © Disney

* Centers for Disease Control: Chronic Diseases at a Glance

Hospital care costs jump 8.2% annually over 2 years, AHIP study finds

Hospital care costs per admission across the U.S. grew from $13,016 in 2008 to $15,236 in 2010, according to an AHIP study. New York saw the greatest increase at 10.5%, while Texas and Tennessee followed at 9.3% and 8.8%, respectively, according to the report. The work was published in The American Journal of Managed Care. "The price of health care services is the major driver of overall healthcare cost growth," said AHIP President and CEO Karen Ignagni. Read the AHIP press release. HealthLeaders Media (3/20)

Good Health Can Be Fun

Become the hero of your own health story! Habit Heroes like Agent Dynamo can show you how to practice healthy habits. Eating well, exercising and having a positive attitude can turn you into a Habit Hero too — and Anthem can be your helpful sidekick. Choose one of our wellness programs to help. And be the BEST YOU that you can be!

Anthem is proud to bring the message of good health to people of all ages by co-sponsoring the Habit Heroes exhibit in the INNOVENTIONS Attraction at Epcot® in the Walt Disney World® Resort. Promoting healthy habits is the goal. And you do it with healthy foods, exercising, and a positive attitude.
As to Disney artwork/properties: ©Disney.

From Anrthem and Disney, new healthy choice's app for google and iphone!

New Habit Heroes™ experience aims to teach families about healthy choices!

We collaborated with Disney to bring you Habit Heroes™. Everyone has the potential to be a habit hero. That's why we're co-sponsoring Habit Heroes™ in INNOVENTIONS at Epcot® at Walt Disney World® Resort. The Habit Heroes™ interactive exhibit was reviewed by health experts and is designed to help families make healthy choices a part of everyday life.

Centers for Disease Control (CDC) research showed 17% of U.S. citizens age 2-19 are obese, and nearly 80% of the kids who were overweight at 10-15 years of age were obese by age 25. A CDC report said that unhealthy lifestyle choices like poor nutrition and lack of exercise radically impact employers' costs. This is because they can lead to chronic conditions, which account for 75% of U.S. health care spending each year.* Promoting Habit Heroes ™ is one way we're working to reverse these trends. It's a fun, yet effective way to help families focus on building good habits like eating well, moving more and staying hydrated. It's also an extension of how we support our members through wellness programs and plans with 100 percent coverage for preventive care.

What is Habit Heroes™?

Habit Heroes™ aims to entertain, inspire and inform families about the benefits of living a healthy lifestyle. Habit Heroes™ is an interactive comic adventure that aims to teach families about healthy habits and it includes the exhibit at INNOVENTIONS at Epcot ® at Walt Disney World® Resort as well as a cool mobile app.

Visit anthem.com/habitheroes to learn more about how Anthem's health and wellness tools can help build good habits. We all have a role in improving our health and Habit Heroes ™ is a terrific first step towards helping families, especially kids, learn about and develop good health habits at an early age. Be a habit hero. Visit habitheroes.com, or iTunes or GooglePlay to download the Mobile App.

View the Habit Heroes™ article in the quarterly employer eZine My Anthem News.
As to Disney artwork/properties: © Disney
* Centers for Disease Control: Chronic Diseases at a Glance 2009

Is your health plan have ACA required benefits?

Few insurers now cover services required in 2014 under health care law

Will they be prepared for the new system? | Elizabeth Flores/Minneapolis Star Tribune/MCT

By Tony Pugh | McClatchy Newspapers

By Tony Pugh McClatchy Newspapers

WASHINGTON — Just 2 percent of health plans available to consumers in the private insurance market offer all the coverage that will become mandatory next year under the health care overhaul, a new analysis has found.
That means that only about one in 50 plans are now in compliance with the main requirements of the Patient Protection and Affordable Care Act, according to HealthPocket Inc., a Sunnyvale, Calif., technology firm that “compares and ranks” health plans.
And consumers and the federal government might end up paying the cost of those new requirements in higher premiums.
The analysis found that basic benefits, including doctor visits, emergency room care, hospitalizations and lab tests, were standard offerings for nearly all the 11,000 plans in the study.
But only one in four offered pediatric care and only 8 percent covered dental checkups for children. About one-third covered maternity and newborn care and just over half covered services to deal with substance abuse.
These and other coverage areas are considered “essential health benefits” under the health care law. All health insurance plans in the individual and small-business market must offer them beginning next year. But “we couldn’t find a single plan that had every feature fully satisfied,” said Kev Coleman, the head of research and content at HealthPocket.
Unless a health plan is exempted from the health care law’s requirements, “It will have to change to survive,” Coleman said. “Consumers will be entitled to more health benefits in 2014 than ever before, and this will require existing health plans to expand coverage or close and be replaced by entirely new plan designs.”
The law, which critics have long labeled “Obamacare,” requires that health plans offered to individuals and small employers provide coverage in 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Unsurprisingly, Massachusetts health plans, on average, offered more than most plans around the country, the analysis showed. The Obama administration has often cited the state’s health insurance program as the model for its own initiative.
The Bay State’s insurance plans covered 94 percent of the essential benefits, on average, followed closely by Rhode Island’s, which provided about 93 percent. Hawaii plans covered 90 percent of mandatory benefits and plans in California, Maryland and Vermont covered 89 percent.
Alaska plans had the worst showing, covering only 66 percent of essential benefits. They were followed by Wisconsin at 67 percent and Texas and New Hampshire at 68 percent.
The insurance industry said the new requirement would raise the cost of coverage for consumers.
“Anytime you add benefits to a policy, it adds to the cost of health care coverage,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade association for large insurers. “And many people will be getting coverage that’s more comprehensive than they have today, but it will also be far more expensive than what they pay today.”
The health care law’s requirement that all citizens have insurance or pay a fine will increase competition among insurers, which will help lower premiums for individuals, according to the Congressional Budget Office.

 

Experts say exercise myths persist until people see results

Fitness experts say it is not always easy to separate fact from fiction in exercise science but people get a better understanding when they see results from their workouts. Two common myths are that women who lift weights will build big muscles and that low-intensity exercises burn more calories than intense workouts. Reuters

Today's Q&A on ElderCareMatters.com is about the legal and ethical questions surrounding the refusal of CPR to a California Independent Living Facility Resident

Question: "We have been following the story about the nurse who refused to give CPR to a dying woman at a California independent living home. The story has sparked great debate here in our Senior Living Community. Can you tell us whether she was legally right to refuse giving CPR?"

Answer: This unfortunate story is disturbing on many levels and raises important legal and ethical questions for debate and review. Whether the ‘nurse’ could legally refuse to give CPR depends on several circumstances. Was she a licensed nurse acting in that capacity? Did the resident have a DNR (Do Not Resuscitate order) in place? Was the facility an independent living facility or an assisted living facility?
Starting with the issue of the facility type first, Glenwood Gardens is an Independent Living facility. Independent living facilities may consist of fully contained apartments or even stand-alone residences and are sometimes called retirement communities. Some facilities have a communal dining rooms and provide housekeeping and laundry services, and while many have emergency call buttons in the apartments, typically there are no nurses or medical professionals on staff. The residents are presumed to be able to fully care for themselves.
In California, Independent Living facilities are not licensed and not subject to any of the Department of Social Services or Community Care Licensing regulations for assisted living. Even if Glenwood was an assisted living facility, there are no regulations that require CPR, even in assisted living. The facilities are therefore free to create their own policies regarding handling of emergencies.
There is conflicting information regarding whether the facility employee is a licensed nurse or not. If she is a licensed nurse her duties and obligations may be different than if she is not. In addition, her obligations may also depend on whether her position with the company was specifically as a nurse who was expected to render medical care to residents. Since this is an Independent Living facility it is unlikely that the course and scope of her position, even if she was a nurse, would include rendering emergency medical assistance.
California, like many states, does have “Good Samaritan” laws (California Health and Safety Code 1799.102 9)) to protect those who render emergency medical or nonmedical care at the scene of an emergency from civil liability resulting from any act or omission. However, these laws do not compel medical personnel to act in such situations, but simply provide encouragement to act.
Finally, the issue of a DNR. If there was a DNR the nurse’s actions may have been appropriate to carrying out the wishes of the resident. However, it was determined that the resident did not have a do-not-resuscitate order – thus, one would assume that she wanted to be resuscitated, but that is a big assumption, since the deceased's own daughter said she was "satisfied with the care provided."
This sad incident brings to light many ethical and legal issues. Choosing the best senior living situation can be tricky. Understanding the different types of facilities, their licensing, and the services provided is paramount to meeting the resident’s and family’s expectations. When choosing a facility it is important to understand the facility’s policies on emergency management.

Office pets may help reduce stress

More employers are letting workers bring pets to the office, as at least one study has indicated that pet-friendly policies can help reduce stress, Raygan Swan writes. Seventeen percent of workers said in a 2008 survey that their workplace allowed pets. The Indianapolis Star (tiered subscription model)

Wellness spending has doubled since 2009

 

By Kathryn Mayer

February 27, 2013 • Reprints

More employees are requiring employees to undergo biometric screening or fill out a health assessment (Photo credit: Keattikorn)

Employers have doubled their spending on wellness incentives in the last four years, new research finds.

According to a new employer survey conducted by Fidelity Investments and the National Business Group on Health out Wednesday, employers plan to spend an average of $521 this year per employee on wellness-based incentives within corporate health care programs, double the per employee average of $260 reported in 2009. That’s also a 13 percent jump from the average of $460 reported for 2011.

Growth is particularly evident in the mid-sized market, as 77 percent of employers plan to offer wellness-based incentives in 2013, more than double the 38 percent of mid-market employers that offered wellness-based incentives in 2010.

“As the cost of providing health care continues to increase, employers recognize one of the key ways to manage their company’s costs is to incent their workforce to lead a healthier lifestyle,” Adam Stavisky, senior vice president of Fidelity’s benefits consulting business, said. “Employers of all sizes have embraced wellness-based incentives to help control costs, and companies are now looking at ways to design and optimize their programs to maximize their positive impact on health for both the organization and employees.”

The survey also found that the overall use of wellness-based incentives among corporate employers continues to increase. Nearly nine out of ten employers surveyed indicated that they currently offer wellness-based incentives (86 percent), an increase from 73 percent from 2011 and 57 percent from 2009.

The most popular wellness-based incentives continue to be a decrease in premiums (61 percent), cash or gift cards (55 percent) or an employer-sponsored contribution to a health savings account or similar heath care-based savings vehicle (27 percent).
This year a majority of employers (54 percent) will expand their wellness-based incentives to include dependents, up from 45 percent in 2011. And roughly half will now include spouses/dependents in communications about wellness programs.

But employers want employees to do some of the work, too: 15 percent of employers surveyed are requiring employees to complete some sort of health activity—such as an employer-sponsored biometric screening or health risk assessment—in order to determine their eligibility for one or all of the company's health plans in 2013.

The survey results also show that 10 percent of employers will be requiring employees to complete an HRA or risk being defaulted into a less attractive subset of the company's health plan, while 7 percent of employers indicated failure to complete a biometric screening would result in being defaulted into a less attractive subset of their company's health plan. In addition, 3 percent of employers indicated that failure to complete an HRA or biometric screening would result in loss of benefits for 2013.

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)