Art & Science of Aging Conference 2014
The HEART & SOUL OF AGING WELL
February 14 Grand Valley State University
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Healthcare Reform, Medicare,
Caregiving, Choosing, Paying
Andrew Farmer, AARP Michigan
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The Patient Protection & Affordable Care
Act
Medicare
Health Spending
Caregiving in the U.S.
Michigan Long-Term Care Supports Services
Options for Coverage & Payment
Deciding for Others: Advance Directives
Resources for Learning, Choices & Planning
Questions, Discussion & Advocacy
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Affordable Care Act
◦ Government
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Marketplaces for Private
Insurance
Expanded Medicaid for
Low Income Families
Medicare Benefits
Enhancements
Protections &
Affordability
Slowed Federal Spending
Mandates
Current System Reforms
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“Obamacare”
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Death Panels
Medicare Cuts
Jobs Killer
Biggest Tax Increase in
History
Exploding Deficits
Free Care to “Illegals”
Free Abortions
Care Rationing
Government Takeover
…or Destroying America
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Long ago, in a land far away (Europe)
everybody believed the World was flat. They
believed this for only a few reasons:
◦ No one ventured far enough to discover it was
otherwise – or came back alive who did.
◦ It’s what everybody said.
◦ It wasn’t safe to disagree.
Funnier Story: Most of us have flat worlds of our own
we probably still live in – especially when we don’t
realize it.
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Check Sources of Information: footnotes on research, data +
methodologies = ingredients!
Check Organizations’ backgrounds using or reporting the
information for possible biases.
Check Individual Authors’ developing and/or reporting the
information for professional competence.
Check Funding Sources relied on to pay for and produce the
information for possible values and influences.
Check if Additional Sources and Reporters have similar, validating
conclusions; the more, the better.
Indeed, check a wide variety of sources and organizations, always.
Check if the Source(s), Organization(s) and/or Individual(s) have
been Externally Recognized with reputable awards or other, widely
recognized, independent honors.
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Read up on AARP’s information on the Affordable
Care Act at: www.healthlawanswers.org
Read The Patient Protection and Affordable Care
Act itself: www.healthcare.gov + Enrollment
The 2009 Pulitzer Prize-winning website
PolitiFact.com, published by the St. Petersburg
Times, is a non-partisan fact-checking resource
on politicians and pundits. To learn what’s true
(and how true) and what’s not (and how much it’s
not), go to: www.politifact.com
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Understanding Medicare
 Enrolling in Medicare
 Issues in Medicare Advocacy
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Part A: Covers portions of Hospital, Nursing
Home, Home Health, Hospice, Hospital
Psychiatric, Blood
Part B: Covers portions of Physician Services,
Medical Equipment, Outpatient Hospital Services,
Outpatient Mental Health, Laboratory
Tests/Screenings, OT/PT/ST, Home Health (nonhospital), Preventive Services, Blood
Part C: Private Managed Care Plans approved by
Medicare
Part D: Private Prescription Drug Plans approved
by Medicare and subsidized for low income
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50.7 million current beneficiaries, will reach
64 million by 2020 and 81 million by 2030.
17% of beneficiaries are under 65: recipients
of Social Security Disability Insurance also
join Medicare after 24 continuous months of
SSDI.
40% are in poor health = 3+ chronic
conditions
Half of all beneficiaries are poor and have
limited savings: <200% FPL
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20% of medical charges generally not paid by
Medicare = must be paid by beneficiaries, which
can be high + add up fast.
Half of beneficiaries spend 16% of their income
on these ($3,320 in 2010).
The poorest and sickest spend the most = 26%.
Not-so-poor and well = 14%.
High income people pay more Part B and D
premiums + payroll taxes= 5% of beneficiaries.
Medicaid picks up cost-sharing for lowest
income Medicare beneficiaries.
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Part A is administered via The Medicare Hospital
Insurance Trust Fund [H1], generated mainly by
payroll taxes, also by interest from Social Security
assets; high income wage earners started paying
an additional .9% on Payroll Tax in 2013.
Part B is administered via Supplemental Medical
Insurance Trust Fund [SMI], generated by
beneficiary premiums (25%) and federal general
revenues (75%).
Part C (private Medicare Advantage plans)
benefits are paid out of both H1 and SMI Trusts.
Part D (private Medicare Prescription plans)
benefits are paid via a separate SMI account; 11%
premiums, 89% general revenues + states.
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Medicare Spending
1%
Hospital
11%
33%
12%
Rx Drugs
Post-Acute
Private Medicare
22%
12%
9%
Plans
Physician
$574 billion spent on benefits in 2012
2013 Medicare Trustees Report
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Per Capita Medicare spending is projected to
slow to 1% above inflation through 2022.
But Total spending growth will be rapid due
to rising enrollment of aging baby boomers
(3.9% of GDP).
The Affordable Care Act further slows
spending growth even though it enhanced
several benefits and made other changes,
adding over a decade of new solvency to the
Trust Funds.
-- Congressional Budget Office
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General Health Spending Trends
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Health Price Inflation at 50 Year Low.
Health Purchasing down due to Recession.
Structural Changes to Healthcare under
the ACA also making intended impacts.
Lower cost growth seen across Medicare,
Private Insurance and Medicaid.
“Spillover” effects from the ACA also
helping: wealth freed from healthcare
available again to the general economy.
“Health care spending is growing at the
slowest rate on record.”
2013 Council of Economic Advisors
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Provide 57% of all
caregiving = 65.7 million
caregivers or 29% of all
U.S. adults
Mostly Women & Getting
Older too
Put in @4 years of care
74% also work
Yet provide ~19
hours/wk caregiving
$450 billion impact
◦ National Alliance of Caregivers &
AARP Public Policy Institute
Family Caregiving
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156,000 Michigan direct
care workers = the
state’s largest
occupational group
Found in all settings, inhome to facilities.
Provide up to 80% of
ADLs, dementia help
Uncompetitive wages &
health coverage = 46%
below 200% FPL
◦ Paraprofessional Healthcare Institute
Paid Caregiver Workforce
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YOUR HITCHHIKER’S GUIDE TO LONG TERM CARE ATTRACTIONS
TRADITIONAL LEVELS OF CARE IN LTC
- ADLS/IADLs +
Complete Dependence
Full Independence
TRADITIONAL SETTINGS FOR LEVELS OF CARE
Hospital
Nursing Home
Adult Foster Care/Home for the Aged
Own Home/Apartment
POTENTIAL SOURCES OF LTC PAYMENT (per LoC)
Medicare
LTC Insurance
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Personal Funds
Medicaid
(better scenario)
(not so much)
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LONG TERM CARE HITCHIKER’S RESOURCES & REST AREAS
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Licensed Facilities – Nursing Homes, Adult Foster Care and Homes for the Aged:
(866) 485-9393
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MICHIGAN STATE LONG TERM CARE OMBUDSMAN PROGRAM
Program of All-Inclusive Care for the Elderly (“PACE”) – In-Home Multidisciplinary Nursing:
(517) 373-6313
LONG TERM CARE & OPERATIONS SUPPORT SECTION
MEDICAL SERVICES ADMINISTRATION, STATE OF MICHIGAN
[Available only through seven PACE Centers across southern and western lower Michigan]
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Area Agencies on Aging & The MiChoice Home and Community Based Waiver Program:
(800) 677-1116
ELDERCARE LOCATOR
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Michigan Adult Home Help Program: County Department of Human Services offices
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Michigan Centers for Independent Living:
(517) 339-0539
MICHIGAN DISABILITY NETWORK
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Legal Hotline for Michigan Seniors: (800) 347-5297
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Michigan Medicare Medicaid Assistance Program: (800) 803-7174
Assistive Technology and Strategies (800) 760-4600 MICHIGAN DISABILITY RIGHTS COALITION
AARP Caregiver Resource Center: www.aarp.org/home-family/caregiving
Decision: Stay Informed.
Decision: Get Help.
Decision: Change Your Mind.
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Assessment All Over Again: Many causes of
“dementia” can be treatable and reversible!
Assess YOURSELF: know your limits -- mentally,
emotionally, physically, financially and with other
relationships.
 Michigan Office of Services to the Aging - Caregiver
Assessment Resources “TCARE®” & “Confident Caregivers™”:
517-373-8230
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“Plan A” is always planning: discuss the future
with the person as far ahead of time as possible;
gather information, talk with experts, include the
person in those activities, use Person Centered
Planning.
 www.aarp.org/othertalk [Check out print or e-book]
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Know the choices and alternatives in services
and settings in their/your community,
including accessing assistive technologies:
the right care strategy can also prevent or
delay the need for legal intervention.
Major in-home care programs are: Adult
Home Help, “MiChoice” Home & Community
Based Waiver, Area Agencies on Aging &
Centers for Independent Living.
Advocate continually for your desired options
with your elected officials.
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Durable Power of
Attorney
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Advance Directive Type
Must be executed
while the person is still
“competent.”
Employs “springing
authorities.”
Scope and Limits
defined under “Letters
of Authority.”
Vulnerable to
Challenge if not
Updated.
Elements & Limits
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Guardianship
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Advance Directive Type
Must apply through
Probate Court.
Must prove
“incompetence” to
make informed choices
and decisions.
May be temporary
and/or limited in scope
and authorities.
Generally confers total
decision-making.
Elements & Limits
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Conservatorship
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Advance Directive Type
Likewise apply through
the Probate Court.
Must prove
“incompetence” to make
informed financial
choices and decisions.
May be temporary or
limited.
Often conferred along
with Guardianship
powers.
Elements & Limits
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Living Wills
Patient Advocate (DPOA)
Resident Representative
Living Trusts
Person Centered Independent Facilitator
Talk with a Qualified Attorney Licensed in
Michigan. Consult the Legal Hotline for
Michigan Seniors at ElderLaw’s (800) 3475297 and/or the Michigan State Bar Lawyer
Referral and Information Service at (800)
968-0738.
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Not All “Homes” are Licensed in Michigan: the
State licenses Nursing Homes, Homes for the
Aged and Adult Foster Care Homes.
“Assisted Living” is an industry marketing
term which can mean any of the above OR an
unlicensed operation.
SHOP: visit as many “homes” as possible, as
many times as possible, as many different
times of day as possible, to get your sense of
which Homes have seem to have mostly good
days.
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Your Michigan Long Term Care Ombudsman
Program can assist you with State inspection
reports and other background information,
assistance and advocacy: 1-866-485-9393.
Placement into these facilities can be
considered temporary.
Your caregiver roles will still be needed after
you move someone into a facility but they will
need to shift in some ways.
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Continuing ACA Implementation: Enrollment
Periods, Payment Reforms, Quality Initiatives,
Utilization, States Medicaid Expansions, 2015
Small Business Mandate, Shift to Primary Care
Rising Healthcare Costs & Deficit Debates
Most current projection by Trustees for
Medicare Trust Fund H1 insolvency is 2026
“Doc Fix” SGR Legislation…or Not = $$$
Michigan Dually Eligible Integration Project
Direct Care Worker Shortage Crisis
What’s in your Watch List?
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No Stupid Questions
Maybe Some Stupid Answers
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 THANK
YOU
Andrew Farmer
 AARP Michigan
 (517) 267-8921
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afarmer@aarp.org
www.healthlawanswers.org
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