MONAELA OUTSTANDING MEMBER OF THE YEAR: SAMANTHA SHEPHERD OF KANSAS CITY!

From the Missouri chapter of NAELA, kudos go to Samantha Shepherd, current MoNAELA Chapter Treasurer, for being elected MoNAELA Outstanding Member of the Year! Samantha will receive her award at the Seattle NAELA Annual Conference in April.

Among her many contributions to the Chapter:
Successful establishment of our websites, http://www.monaela.com and its identical twin,
http://www.monaela.org. For several years the Board discussed and brain-stormed about creating and maintaining a MoNAELA Chapter website. But the person who actually got it done (at significantly less cost than “market rates”) was Samantha. The site is maintained, updated and monitored by our staff assistant Diane Carey (who replaced retiring Ann Bickel). If you have suggestions for adding to the website, feel free to contact the Chair of the Publications Committee (currently Christine Gilsinan, cag@solaw.com)Samantha and Mike Weeks (a former recipient of the MoNAELA Member of the Year) are co-chairs of the annual NAELA Conference which will take place in Seattle April 25 -28, 2012. This is a HUGE undertaking which anyone who has attended a national NAELA event can attest to.

Working to promote this year’s National Health Care Decision Day, Samantha has organized attorney volunteers, staffed senior centers, independent and assisted living facilities in the Kansas City, Missouri area, spoken on a radio show, blogged and sent out a newsletter highlighting the importance of completing your health care directives.

Congratulations (and thank you) Samantha!

5th Annual National Healthcare Decisions Day - April 16, 2012

Federal Patient Self-Determination Act

The Federal Patient Self-Determination Act requires that all Medicare-participating healthcare facilities inquire about and provide information to patients on Advance Directives; it also requires these facilities to provide community education on Advance Directives. See 42 C.F.R. § 489.102. All healthcare facilities are required to: 

• Provide information about health care decision-making rights.
• Ask all patients if they have an advance directive.
• Educate their staff and community about advance directives.
• Not discriminate against patients based on an advance directive status.

AHRQ

The U.S. Agency for Healthcare Research and Quality, in a 2003 article, “Advance Care Planning: Preferences for Care at the End of Life,” found the following:

• Less than 50 percent of the severely or terminally ill patients studied had an advance directive in their medical record.
• Only 12 percent of patients with an advance directive had received input from their physician in its development.
• Between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed.

Pew Research

"More Americans Discussing – and Planning – End-of-Life Treatment. The Pew Research Center, January 2006.

• 42% of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years and for a majority of these people and 23% of the general public, the issue of withholding life sustaining treatment came up.
• An overwhelming majority of the public supports laws that give patients the right to decide whether they want to be kept alive through medical treatment.
• By more than eight-to-one (84%-10%), the public approves of laws that let terminally ill patients make decisions about whether to be kept alive through medical treatment.
• One of the most striking changes between 1990 and 2005 is the growth in the number of people who say they have a living will – up 17 points, from 12% in 1990 to 29% now.

Annals of Internal Medicine

Brief Communication: The Relationship between Having a Living Will and Dying in Place. Howard B Degenholtz, PhD, YonJoo Rhee, MPH, PhD; and Robert Arnold, MD. Annals of Internal Medicine. 2004; 141:113-117.

• Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community.
• During advance care planning, physicians should discuss patients’ preferences for locations of death.

Appropriate Use of Artificial Nutrition and Hydration – Fundamental Principles and Recommendations. David Casarett, MD, Jennifer Kapo, MD and Arthur Caplan, PhD. New England Journal of Medicine. 353; 24.

• Patients and families are often not fully informed of the relevant risks and potential benefits of artificial nutrition and hydration (ANH). In addition, financial incentives and regulatory concerns promote the use of ANH in a manner that may be inconsistent with medical evidence and with the preferences of patients and their families.
• Because ANH is associated with uncertain benefits and substantial risks, it is essential to ensure that decisions about its use are consistent with the patient’s medical condition, prognosis, and goals for care. Therefore, decisions about ANH require careful consideration of its risks and potential benefits.

The Older Americans Act Should Be Reauthorized by Congress This Year

Pass This Mom, Grandmom, and Apple Pie Bill
By Craig Reaves, CELA, CAP

Halfway through the 112th Congress, it appears unlikely that it will be remembered as the “MVP” of legislative sessions. With Americans frustrated with Congress’ inability to coalesce around almost anything, why not spend a little time on reauthorizing one of the most successful community-based service programs in our nation's history? The Older American Act (OAA) authorizations expired in September 2011. The services and programs funded by the OAA keep older adults in their homes and communities by providing home-delivered and congregate meals, home care, transportation, information and referral/assistance, case management, adult day care, legal services, senior centers, senior employment, caregiver support, elder abuse prevention, and many other services. For those who live in nursing homes or assisted living facilities, the OAA provides help to ensure their quality of care by investigating and resolving resident complaints. The OAA programs protect and improve the health and security of older adults, while reducing the strain on Medicare and Medicaid resources.

These programs require a relatively modest level of assistance (about .02 percent of federal discretionary spending), but often make the difference between living with dignity in the comfort of one’s home and community, and needing costly assisted living, nursing home placements, or expensive hospital stays.

Here are some quick facts about a few of the programs based on data from the Congressional Research Service and the Department of Health and Human Services.

Bipartisan Support

The OAA has always enjoyed bipartisan support because of its overarching goals and success at the local level. Rep. Fred Upton (R-MI), Chair of the House Energy and Commerce Committee, said in August 2011, "I know the importance and value of folks staying at home with quality care. I believe we can save taxpayers' money and give them a better quality of life. I look forward to supporting it again."

The OAA has intergenerational support because it helps families take care of aging parents without having to quit their jobs. It makes political sense too. In January, public approval for Congress was at 13 percent, up from 11 percent in December – record lows. One would think that showing support for the OAA might win over some voters who consider this a “do-nothing Congress.”

Congress Should Make the OAA and Its Critical Services a Priority

So one might ask: Why can't this Congress do what others have and reauthorize this successful program and use this opportunity to make the improvements that aging experts have recommended? The National Academy of Elder Law Attorneys and other Leadership Council of Aging Organizations (LCAO) developed a consensus document to help Congress and the Obama Administration reauthorize the OAA. The Assistant Secretary for Aging, Kathy Greenlee, who runs the Administration on Aging and disburses the funds to the aging network, traveled across the country conducting listening sessions on how to improve the OAA…that was in the summer of 2010.

Unlike previous bipartisan reauthorizations, the House of Representatives has not held any committee hearings concerning the OAA. The Senate is moving forward with reauthorization, under the leadership of Sen. Bernie Sanders (I-VT), Chairman of the Subcommittee on Primary Health and Aging in the Senate Health, Education, Labor and Pensions (HELP) Committee. The HELP committee began the reauthorization dialogue by inviting stakeholders to share reauthorization priorities with both Democratic and Republican congressional staff members during listening sessions this past summer. This work led to the January 26, 2012, introduction of Sen. Sanders’ bill, S. 2037, to reauthorize the Older Americans Act.

In his bill, Sen. Sanders identifies his priorities and calls for a 50 percent increase in funding for the four core programs:

• Meals;
• Supportive services;
• Jobs; and
• Health promotion.

The bill also:

• Strengthens the long-term care ombudsman program;
• Strengthens legal services and resources centers;
• Modernizes senior centers; and

·         Requires better data collection and program evaluation.

Others who have stepped up with OAA ideas:

• Sen. Robert Casey (D-PA) S.1982
• Sen. Al Franken (D-MN) S.1750
• Sen. Amy Klobuchar (D-MN) S.1744
• Sen. Herb Kohl (D-WI) S.1819
• Rep. Laura Richardson (D-CA) H.R. 3749

·         Rep. Debbie Wasserman Schultz (D-FL) H.R. 2786

Get the OAA Back Into Law

Now that Sen. Sander’s bill has been introduced, it’s time to get the process moving forward with input from both sides of the aisle, negotiations on the final bill’s content, and passage by the HELP Committee and the full Senate. The Senate certainly has a good chance to complete its work on the reauthorization this spring. The House needs to start its work in earnest, or the two bodies will never have a chance to come together in a conference committee.

Elder Law attorneys often connect their clients with the "aging network" for services. Some serve on Area Agency on Aging boards (these are the agencies funded by the OAA and states to be the focal point for aging services in each area), work as volunteer ombudsmen, handle referrals from the local service providers to provide help with advance directives, living wills, Medicaid and Medicare eligibility questions or cases, and some are legal services providers funded by the OAA. Elder Law attorneys know the value of these programs and urge Congress to act now to reauthorize the Older Americans Act. If you agree, tell Congress to pass the OAA this year.

Contact the House and Senate. 

Craig Reaves, CELA, CAP, is an Elder Law attorney practicing in Kansas City, Mo. He is a Certified Elder Law Attorney (CELA) and former president of NAELA.

Read the OAA Reauthorization Bill.

See a video of Sen. Sanders’ introductory remarks.

This publication is written for policy makers, consumers, aging and special needs network professionals, lawmakers, and members of the media. We welcome your comments.

Please share with your networks! Post to Facebook/Twitter/Google+ too! Thank you for your support!

New Poverty Guidelines Announced

2012 Poverty Guidelines: How Poverty Levels Affect Eligibility for Many Federal Public Benefit Programs

Federal poverty level (FPL) guidelines for 2012 were published in the Federal Register on January 26, 2012.[1]  The guidelines provide the baseline for eligibility levels for many public benefits, including health benefits for older people and people with disabilities.

The published poverty levels merely state a dollar figure for different-sized family units.  They do not address issues of what income is included, what deductions from income are allowed, who is included in a family unit or other use issues.  These questions are addressed by the individual programs relying on the poverty guidelines.  The amounts given below apply to the 48 contiguous states and Washington, DC.  Rates for Alaska and Hawaii are slightly higher.  A complete list of FPLs is available at http://aspe.hhs.gov/poverty/12poverty.shtml

Federal Health Programs Affecting Older People and People with Disabilities that Rely on Federal Poverty Guidelines:

1. People with Full Medicaid:

Poverty Level Aged and Disabled (PLAD):  States can choose to provide full Medicaid benefits to aged and disabled individuals with incomes up to 100% of the federal poverty level (FPL).  For states choosing 100% FPL as their ceiling, eligibility levels for 2012 will be $930.83/month ($11,170/year) for an individual; to $1260.83/month ($15,130/year) for a couple.

Amounts protected for the at-home spouse of a Medicaid nursing facility resident:  Medicaid law allows for certain levels of income and resources to be protected for the community spouse of a nursing facility resident whose care is paid for by Medicaid and who otherwise would have to pay most of her/his income to the facility.  The minimum amount of income protected is 150% FPL for two people ($1,891.25/month), effective July 1.  Until that time, the amount is $1,838.75. Other protected amounts for 2012, not linked to FPL, are maximum monthly protected income,$2,841; minimum resource allowance, $22,728; and maximum resource allowance, $113,640.

2. People in Medicare Savings Programs:

Qualified Medicare Beneficiaries (QMBs):  States must pay all Medicare cost-sharing for Medicare beneficiaries with incomes up to 100% FPL and limited resources.  For this group, the 2012 level is $930.83/month ($11,170/year) for an individual; $1,260.83/month ($15,130/year) for a couple.

Specified Low-Income Medicare Beneficiaries (SLMBs):  States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% FPL and 120% FPL and limited resources. The limit for this group is $1,117 /month ($13,404/year) for an individual; $1,513/month ($18,156/year) for a couple.

Qualified Individual (QI): States have a limited amount of money from which they must pay, on a first come, first served basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120% FPL and 135% FPL and limited resources.  The limit for this group is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

3. Qualified Disabled and Working Individual (QDWI)

States must pay the Medicare Part A premium for certain working disabled Medicare beneficiaries who have exhausted their entitlement to premium-free Part A benefits and whose incomes do not exceed 200% FPL.  The limit for this group is $1,861.67/month ($22,340/year) for an individual; $2,521.67/month ($30.260/year) for a couple.

Add $20 to each of the monthly amounts listed above to determine the actual eligibility limit, since applicants are allowed a $20 disregard from any income before their income is measured against the poverty levels.  Couples only get one $20 disregard.  The $20 disregard applies nationally, but states also have the option of increasing the disregard, which has the effect of increasing the eligibility ceiling and, thus, making more people eligible for benefits.  Check with your State Medicaid Agency for details on your state's specific policy.

4. Part D Low-Income Subsidies:

Full Subsidy:  Medicare Part D provides a full drug subsidy with low co-payments to Medicare beneficiaries with incomes up to 135% FPL and limited resources.  For those individuals, the 2012 eligibility limit is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

Partial Subsidy: Medicare Part D provides a partial subsidy of premium, deductible and co-insurance to Medicare beneficiaries with incomes up to 150% FPL and limited (but higher than allowed for full subsidy) resources.  The income limit for this group is $1,396.25/month ($16,755/year) for an individual; $1,891.25/month ($22,695/year) for a couple.

As with the Medicaid and MSP monthly amounts, add $20 to account for the disregard.

Unlike rules for Medicare Savings Programs, which allow (but do not require) states to measure income against the amount for a family unit of only one or two, eligibility rules for  Part D subsidies recognize larger family units, to the extent that those family members rely on the applicant or her spouse for one half of their financial support.  To calculate the levels for larger family units, start with the yearly amount for one ($11,170), add $3,960 for each additional family member, multiply by the applicable percentage of poverty (135% or 150%) and divide the result by 12 for a monthly amount.

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http://www.medicareadvocacy.org/2012/02/02/2011-poverty-guidelines-issued-poverty-levels-affect-eligibility-for-many-federal-public-benefit-programs/

Missouri Medicaid Allowance has been Raised

Missouri’s Medicaid personal needs allowance has finally been raised. Though this change is much appreciated, the effects on Missouri seniors will be minimal. The personal needs allowance which was previously set at $30 a month, has been raised to a monthly allowance of $35.
    This Missouri allowance is one of the lowest in the country and is in stark contrast to that of the neighboring state, Kansas, which has a monthly allowance of over $60.
    This amount is meant to cover all of the personal needs when in a nursing home. This includes all toiletries and room supplies, all hair and nail appointments (and we all know mom and grandma need to get their hair done weekly), all meals out, bingo money and birthday cards. With Hallmark cards nearing $5 a pop, we better hope that there aren’t too many birthdays in one month.
     The point of realization that mom, or dad, or grandma needs to be in a nursing home is never easy, and not being able to afford it is another stressor. This hard transition should not be exasperated by forced destitution. When moved out of a lifelong home, it is the small comforts such as hair appointments or birthday cards to grandchildren that make all of the difference.     Though this increase will only make the difference of one extra toothbrush, Missouri finally seems to be moving along the right track to a more reasonable personal needs allowance.

A prison hospice program

As some of you know, one of the boards of directors on which I serve is that of Kansas City Hospice & Palliative Care, a wonderful agency that is the non-profit gem of Kansas City's many hospices.

Through that work and other experiences I've learned a lot about death and dying and the comfort that quality hospice care can provide. But I'd never thought about the need for hospice care in prison.

Until, that is, a fellow KC Hospice board member, the Rev. Bob Hill of Community Christian Church, gave me a copy of Grace Before Dying, by Lori Waselchuk.

In a series of amazing photos and accompanying text, it tells the story of the prison hospice program in Louisiana's Angola State Prison.

Until Jan. 31, photos from the book and quilts connected to the hospice program in that prison are on display in the Steeple of Light Gallery at Community Christian, 4601 Main St., Kansas City. The gallery hours are 9 a.m. to 4 p.m. Monday through Friday and 8:30 a.m. to 1 p.m. on Sundays. There is no charge to see the display, called "And You Came to Me."

What comes through this photo work so powerfully is the humanity not just of those dying in prison but also of their fellow inmates who have become caregivers in the hospice program. The whole hospice ministry (for that's truly what it is) is transformative. It changes the one receiving care and the ones giving it in radically life-affirming ways.

As Waselchuk writes in the book's introduction, "This project is not about death. It is about life, its limits, and the choices made within those limits."

I encourage you to see the display at Community Christian and then learn about hospice care options here in Kansas City.

Source:http://billtammeus.typepad.com/my_weblog/2011/12/12-27-11.html

More Changes in Medicaid Allowances

In Missouri the personal needs allowance has been increased from $30.00 a month to $35.00. Though only a slight increase, this change affects many seniors in our area.