SEPTEMBER 5, 2011 VOLUME 18 NUMBER 31
Queens (New York) resident Lillian Baral was in her early 90s. She lived at home, but she required full-time assistance with her care. In 2007 she paid two caretakers a total of $49,580 for live-in care (one lived with her for five weeks while the primary caretaker took a vacation). Were the payments deductible on her income tax return?
The short answer, according to the U.S. Tax Court: yes. Not surprisingly, the more complete answer is complicated and depends on the specific facts of Ms. Baral’s case.
Ms. Baral had been diagnosed as suffering from dementia as early as 2004, three years before her long-term care costs became a tax issue. In December, 2006, her physician wrote an evaluation of her then-current mental status. He found her to be confused, unable to communicate clearly and at risk of falling in her home. Because of her memory deficits she would require assistance with the activities of daily living, he wrote. She needed full-time assistance and supervision for medical and safety reasons if she was going to stay at home.
Ms. Baral’s financial affairs were being handled by her brother David, relying on a power of attorney she had signed some time before. He paid all her bills, handled her checking and other accounts, and hired the nursing service to care for her in her home. By the end of 2006, in an effort to save money, he had discharged the nursing service and hired one of their caretakers directly to live with his sister and oversee her care.
Mr. Baral did not, however, remember to file his sister’s income tax returns for 2007. The Internal Revenue Service noticed, and near the end of 2009 they filed a “substitute for return” based on records available to the IRS. The form indicated that her income for 2007 had been $94,229; after including a personal exemption and a standard deduction, the IRS calculated that Ms. Baral owed $17,681 plus interest and penalties.
By the time the IRS sent out its notice, Ms. Baral had died. Her brother had been appointed as personal representative of her estate; he argued that (a) she had not been required to file a tax return at all, and (b) she was entitled to a medical expense deduction for the long-term care costs she had incurred. The IRS disagreed on both scores.
The dispute ultimately found its way to the United States Tax Court, which hears claims and defenses regarding income tax returns (along with other tax-related proceedings). The Tax Court ruled that the key legal question was whether Ms. Baral was a “chronically ill individual.” If she was, then her caretakers’ salaries would be “qualified long-term care services” and therefore deductible. The court noted that there are three ways to identify a “chronically ill individual”:
Was Ms. Baral unable to perform at least two of the six “activities of daily living”? The six ADLs are: eating, toileting, transferring, bathing, dressing, and continence. Although her physician had said that she required assistance with her ADLs, he had not identified which ones — and therefore the court could not determine whether she was deficient as to only one, or as to two or more. She did not meet this standard.
Did Ms. Baral have a level of disability “similar to” the ADL standard? Again, the court found that the physician’s evaluation was not clear.
Did Ms. Baral require substantial supervision to protect her from threats to her health and safety because of “severe cognitive impairment”? Applying this test to Ms. Baral’s condition and circumstances was a little easier for the court. Because her physician had described her as demented, and at risk for falls or failure to take prescribed medication, Ms. Baral met this test.
Fortunately for Ms. Baral’s tax situation, only one of the three standards had to be met. Because of the evaluation by her primary care physician in 2006, the cost of her live-in caretakers would be a legitimate deduction on her income taxes — or at least it would be deductible to the extent that it exceeded 7% of her adjusted gross income.
Ms. Baral’s brother had also argued that he should be able to deduct the $760 paid in 2007 to her physicians (the Tax Court agreed) and the $5,566 she paid to caretakers for reimbursement of expenses they incurred on her behalf. The Tax Court denied the deduction for reimbursement, since there was no evidence that the payments were for medical items. If Mr. Baral had been able to show that they were, for example, co-payments on prescription medications, or over-the-counter medications at the direction of her physician, or medical supplies, they would have also been deductible. Estate of Baral v. Commissioner, July 5, 2011.
What does Ms. Baral’s case tell us about tax issues surrounding home care? Several things:
Keep good receipts. To the extent possible, segregate clearly deductible expenses from questionable or non-deductible expenses, and make sure the purchases are identifiable.
Get a good doctor’s letter. Ask the attending physician for a letter that specifically addresses ADLs, the need for caretakers to protect the patient’s safety AND a general description of limitations on the patient’s abilities.
If you are in charge of the patient’s finances, file their income tax returns. Someone with $95,000 of income — even if much of it is Social Security and pension income — is almost certainly going to need to file a return. Mr. Baral would have had a much easier time if he had filed the return claiming the deductions, rather than having to argue about the IRS’s “substitute for return” after the fact. Note that the IRS action was delayed, too — it can be that much harder to prove the taxpayer’s condition two (or three, or four) years after the fact, and it is not uncommon to be addressing these issues after the taxpayer’s death.
A new study commissioned by the American Health Care Association confirms what most senior advocates have long suspected: funding for long-term care services (and particularly nursing home care) is insufficient to pay the actual cost of care. While there is significant variation among the states, the federal-state Medicaid partnership program underpays providers by more than $3 billion each year.
The AHCA study was actually completed by accounting firm BDO Seidman, based on data collected from individual state Medicaid agencies. Arizona’s AHCCCS program failed to respond to the study, but 36 states did provide information from which the accounting firm could determine rough national figures for the Medicaid underpayment.
Most analysts agree that slightly less than half of all 65-year-olds can expect to spend at least some portion of the rest of their lives in a nursing home, so the payment system for nursing home care is important to a large portion of the senior population. A majority of nursing home residents (over 67% nationally and 63% in Arizona) receive Medicaid benefits, making the program’s reimbursement rates critically important for ensuring future quality in long-term care facilities.
The AHCA study looked at 1999 reimbursement rates for the 36 states providing data. On average, Medicaid’s shortfall was a little more than $9 for each day a Medicaid patient spent in the nursing home; with just over a million Medicaid patients in nursing homes nationwide on any given day, the annual shortfall exceeds $3.3 billion nationwide.
New Jersey and New York showed the largest shortfall per patient and total shortfall, respectively. Alabama was the only state which paid more in Medicaid benefits than the cost of patient care; its reimbursement of $102.78 per Medicaid patient day was actually $2.48 more than the facility’s costs.
Although most states in the West (notably Nevada, Oregon, and Utah) underpaid by more than the national average, Colorado, California and New Mexico helped keep the region’s average underpayment lower than the national figure. The South (including Texas, Alabama and Virginia, three of the states with the lowest underpayment rates) demonstrated regional rates closest to the allowable Medicaid costs—despite including Florida, one of the least generous states. Underpayments in the Northeast exceeded the national average in every state except Connecticut and West Virginia. The average shortfall for states in the Midwest was almost identical to (and slightly below) the national average shortfall.
The AHCA website (www.ahca.org) contains more detail about the study as well as other statistical details.
Two recent studies demonstrate that children of the frail elderly spend more time and money on care of their parents than is widely supposed. Despite the popular image of “baby-boomer” children as self-involved and neglectful of their elders’ needs, the research indicates that the amount of effort invested in elder care has actually increased over the past decade.
In 1987, according to one of the studies (sponsored by the American Association of Retired Persons, the National Alliance for Caregiving and others), seven million families were involved in providing long-term care for parents or other relatives. That number has more than tripled, to 22.4 million.
Fully half of employed caregivers have missed work time to care for their elders in recent years, reflecting an increase from just over two-fifths a decade ago. Another surprise: almost half of long-distance caregivers are male, despite the stereotype of daughters providing all the care for aging parents. The average age of long-distance caregivers: 46–which places the average caregiver solidly in the baby boom generation.
Long-distance caregivers make up a distinct portion of the children providing care for elderly relatives. 70% of those out-of-town care providers are employed, and they provide assistance with everything from bill-paying to hiring and managing on-site caretakers.
The second recent study, commissioned by the National Council on Aging, shows similar results. The NCOA focused its study on caregivers who live at least an hour from their elders. While that study showed that only 15% of caregivers have taken unpaid leave from their jobs to deal with elder care responsibilities, it suggests that out-of-town caretakers provide more than just their time to support aging elders. In fact, the NCOA caretakers had spent an average of $196 per month of their own money to provide or oversee care, and spent 35 hours per month on making the arrangements and visits necessary to keep their elders safe and provided for.
The NCOA study (funded by the Pew Charitable Trusts) also revealed another important detail about long-distance elder care: the length of time such arrangements continue. According to the study, the average long-distance caretaker had been involved in helping out for just over five years.
Both studies demonstrate the reality of caregiving at a time when public policy debates focus on the spiraling costs of long-term care. According to the conventional wisdom, children (and especially baby boomers) are interested primarily in receiving their depression-era parents’ estates as quickly as possible. That is the view that invests policy determinations, from Congress’ recent attempt to make criminals out of parents who give away property before institutionalization to Medicaid’s refusal to provide any substantial home care alternative to nursing home placement.
Even as the American population ages inexorably, the public debate shifts away from reasoned solutions of the growing funding problem associated with long-term care and toward demonizing of the segment of society most likely to require assistance. The long-term care insurance industry, eager to develop a market in this growth field (a tiny fraction of long-term care costs is currently paid by insurance, with the majority of funding coming from the federal Medicaid program), has led the charge with a two-fold attack: accusing children of the frail elderly of greed while trying to frighten the elderly themselves with visions of bankrupt government programs and allegedly substandard care. Unfortunately for those who make the first claim, the AARP and NCOA studies clearly demonstrate that the elderly receive tremendous assistance from their children, even across long distances.
With nursing home costs approaching $40,000 per year for most residents, the government’s Medicaid program has for decades been the “safety net” for families with long-term care needs. In recent years, escalating Medicaid costs and increases in the portion of national nursing home bill paid by the program have resulted in Congressional efforts to reduce Medicaid eligibility and coverage. Prudent elders should be considering other ways to ensure that nursing home stays can be paid for if needed.
A relative handful of individuals have long-term care available from religious or service group affiliations. Another small portion of the population can rely on government programs other than Medicaid, but for most elders the only alternatives are to accumulate substantial personal wealth (a common goal, though sometimes difficult to realize) or purchase long-term care insurance (LTCI).
A recent review of LTCI purchasing strategies by Elder Law Forum (a newsletter published by Legal Counsel for the Elderly, Inc., and sponsored by AARP) points out some of the considerations for typical buyers. The review makes several points for the “typical” LTCI buyer:
About half of 65-year-old women and a third of the men will spend some time in a nursing home.
Most nursing home stays will be short, with the median length of institutionalization being slightly less than one year.
LTCI premiums currently average about $1,000 per year for 60-year-olds, and rise to $1,500 for 65-year-olds and $2,000 for 70-year-olds.
If you (or a relative or client) are concerned about long-term care costs, some pertinent questions to consider include:
When should you buy? The average age of new policyholders is currently 67. Many employers now offer group plans, and a few younger people may buy policies. But for most people, waiting until age 60 to make the purchase is probably reasonable.
Should both a husband and wife buy policies? In many cases, one spouse or the other may be uninsurable due to illness or age. The “well” spouse should particularly consider LTCI, since she (most commonly) is likely to survive the “ill” spouse, and therefore have no spouse to care for her. Of course, this is another way of saying that the well spouse is likely to spend some considerable time providing care for the ill, uninsurable spouse, as well.
Does family history matter? If a potential LTCI buyer has a family history of strokes, high blood pressure, dementia, Parkinson’s or other conditions likely to require long-term care, insurance is more strongly indicated. Such persons should make the initial purchase at younger ages, since the onset of disability will usually make them uninsurable.
Does net worth make a difference? Couples with a net worth of less than $100,000 (not counting the family home), and individuals worth less than $50,000, may not need to consider LTCI, since (current) Medicaid rules will permit them to receive government assistance within a year or two of nursing home admission. Prospective LTCI buyers with large estates may not need the insurance, particularly if their estates generate $40,000 in annual income over and above their (or their spouse’s) other living expenses. In other words, LTCI is primarily of interest to the middle-class elderly.
How important are individual policy provisions? Very. Some policies provide excellent coverage for home health care, while others do not; a policy without home care provisions might unnecessarily force the owner into an institution.
A checklist for comparison shoppers can help frame some of the issues. For a helpful checklist, contact FLEMING & CURTI at the fax, e-mail or street address below.
330 N. Granada Avenue, Tucson, Arizona 85701
520-622-0400 / FAX: 520-203-0240
National policy considerations regarding long-term care of the elderly and disabled are beginning to be noticed by business and political leaders. When the business-oriented Wall Street Journalwrites about the issue, conservative politicians and policy makers can not be far behind.
In a December 11, 1996, article titled Families of Elders Have a Lot Riding On Budget Debates, the Journal recognizes the profound effect Congressional action can have on the quality of life for elders and their caregivers. Of particular interest is the analysis of the recent Kassebaum-Kennedy law criminalizing some gifts by those facing long-term care expenses (see Elder Law Issues, August 19, 1996). The Journal article refers to the new law as the “throw-Granny-in-jail” law.
Although Medicaid now pays for approximately half of all formal long-term care for seniors and the disabled, the Journal article points out a more profound statistic: as much as 80% of long-term care is provided directly by family members. Nearly all of that care is provided in the home, where Medicaid is the least likely to be considered as a possible substitute.
Government involvement in long-term care has focused primarily on nursing home placement. In the past five years, however, the government’s role has begun to shift. While Medicaid provided $3.4 billion in home care services in 1990, by 1995 the figure had tripled (to $10.33 billion). At the same time, Medicare (which has traditionally provided more home care services than Medicaid, but still has focused on institutional care) increased its home care benefits from $3.66 billion to $14.90 billion, a four-fold increase.
Now Congress is seeking ways to cut the federal budget, and particularly the federal-state commitment to Medicaid care. The “throw-Granny-in-jail” law is an early attempt to restrict payments for long-term care (though some discussion is being undertaken in Congress about repealing the new law altogether). Any significant change in government benefits is likely to have a devastating effect on the ability of families to provide some care to their aging seniors. As theJournal article points out, it could also lead to the paradox of increasing nursing home costs as the family members providing 80% of care find themselves unable to make their care plans work.
1997 Medicare Figures
Beginning with the Social Security checks due January 3, 1997, Medicare premium deductions will increase to $43.80 per month (up from $42.50 per month in 1996). Since the new year also brings a 2.9% increase in the Social Security benefit, most people will still see a larger total check.
Other Medicare figures will also change beginning with the new year. The initial hospitalization deductible increases from $736 (1996) to $760 (1997). Coinsurance (the amount which Medicare beneficiaries must pay for their 61st through 90th days in the hospital) will increase from $184/day (1996) to $190/day (1997). “Lifetime reserve” days will have a copayment increase from $368 (1996) to $380 (1997).
Skilled nursing care copayments will also increase, from $92/day (1996) to $95/day (1997). Since Medicare has no deductible or copayment from the first twenty days of skilled nursing care, however, the copayment amount only applies to the 21st through 100th day of nursing home placement.
Medicare HMO participants will not be affected by the new copayments and deductibles. HMO programs are permitted to charge less than Medicare copayments and deductibles, and most (in the Tucson area, at least) charge only a single per-visit copayment. Similarly, Medicare beneficiaries with Medigap coverage will not be directly affected by the increases.
Congress has acted once again to make it more difficult for families to secure government assistance with the costs of long-term nursing care. This time, the changes from Washington add a much more punitive element.
In enacting the Health Reform Bill (usually referred to as the Kassebaum-Kennedy bill, after its original sponsors), Congress included a provision turning ordinary citizens in crisis into criminals. Under the new act, it becomes a crime to transfer assets (or to assist someone else to transfer assets) when the transfer causes a period of ineligibility for Medicaid long-term care.
Curiously, the criminal sanctions are imposed for actions which already cause a period of Medicaid disqualification. The new law does not extend that disqualification or change the method of calculation in any way. Apparently, Congress believes that the principal cause of the runaway cost of long-term health care is the occasional practice of giving one’s assets away to qualify for assistance. Increases in per-patient costs, and demographic shifts adding tens of thousands of older patients to nursing home beds have once again been ignored as causes of a difficult social, medical and tax problem.
The criminal sanction for making disqualifying gifts is chillingly severe. Although the new law is so poorly drafted that it is impossible to tell whether the offense is a misdemeanor or felony, the lower penalty is up to a $10,000 fine and one year in prison; sanctions might be as high as a $25,000 fine and five years in prison. Cynical observers have already noted that the new law actually provides for easier access to public support; those who make transfers causing periods of ineligibility will be disqualified from receiving Medicaid assistance for a period of months or years, but could spend the intervening period in penal institutions at public expense. The supposed new practice is being referred to, with black humor, as “penitentiary planning.”
Who is targeted by this new law? Two groups are at immediate risk: the middle class elderly and their lawyers. Poorer patients need not worry about transfers of assets–they will qualify for public benefits relatively easily. Wealthier patients will have sufficient resources to avoid any ineligibility problems associated with transfers. Congress apparently hopes to terrorize the rest into using every penny of their savings for nursing home care, without regard to how hard they may have worked to accumulate their modest wealth, or the needs of those relying on them (including spouses, disabled children or family members who may have contributed mightily to care before institutionalization).
But the real targets of the new law are elder law attorneys. While tax attorneys routinely counsel clients on how to avoid paying millions of dollars to the government in legal, ethical and financially sound ways, Congress wants to prevent elder law attorneys from giving similar kinds of information to their middle-class clients. Because the law makes criminals out of transferors and anyone who aids or abets them, lawyers, spouses, family members and care providers are all at risk of prosecution. Congress apparently hopes that by imposing this draconian penalty they can make the problem of health care for an aging population simply go away.
Who benefits from this new provision? Arguably, insurance companies (middle-aged consumers are now supposed to buy more long term care insurance policies) and nursing home operators (more patients paying higher private-pay rates means more revenues). Unfortunately, Congress has ignored root problems in both industries. Insurance is too difficult to obtain and too expensive for most prospective patients. And nursing homes will lose more to Medicaid cost cutting than they can hope to make up from higher private-pay rates.
Many political and public policy analysts argue that an important component of the funding for long term care in the future will be the private insurance industry. The cost of long term care continues to rise, and the share of the federal budget devoted to such care is expected to increase dramatically in the next few decades.
In order for insurance to be an effective tool for payment of long term care costs, purchasers will need to begin buying policies in larger numbers and at younger ages. Currently, long term care insurance pays for a tiny fraction of the total cost of care.
A new study published by the Agency for Health Care Policy and Research brings the need for younger customers to purchase long term care policies into stark relief. The study considered whether current insurance underwriting practices permitted substantial numbers of seniors to acquire such policies.
According to the study, 65-year-olds should expect to be rejected for long term care insurance between 12% and 23% of the time. At age 75, the rejection rate rises to between 20% and 31%. In other words, at least one out of ten concerned seniors who wait to purchase long term care insurance will find that they are unable to secure coverage at any price.
The study assumed that insurance companies would apply their current underwriting policies to all applicants, even if the pool of potential customers were to increase dramatically. Specifically, the study found that an applicant would be unable to purchase a policy if he or she was already in a nursing home, or if he or she suffered from cognitive impairments (such as Alzheimer’s Disease), cancer, cirrhosis, diabetes, chronic obstructive pulmonary disease or other major illness. Those applicants who were unable to perform activities of daily living, regardless of the cause of their disability, were also found to be uninsurable under present standards.
While it begins to be difficult to purchase long term care insurance at age 65, that is precisely the age group currently buying policies. As Elder Law Issues reported last February, a recent study by the Health Insurance Association of America found that half of new long term care policy purchasers are over age 70, and only one in five of those over age 55 even consider long term care insurance.
When Can You …
Some important ages for seniors to know:
55–You can withdraw funds from IRAs, 401(k)s, Keoghs, SEPs and other retirement plans without paying the 10% tax penalty if you retire, quit or are fired.
59½–You can withdraw funds from retirement plans without the tax penalty in any event.
60–You are eligible for Social Security benefits if you are a widow or widower.
62–You are eligible for early retirement (at a reduced rate) for Social Security; many private pension plans permit retirement.
65–You are eligible to retire with full Social Security benefits. You are eligible for Medicare. Most private pension plans provide full benefits. (Note, however, that the age for full Social Security retirement will increase gradually to 67 over the next quarter century; Medicare’s eligibility age is likely to change as well, though it is not presently scheduled to do so.)
70–You can receive full Social Security benefits regardless of how much you earn from employment. Until this age, your benefits are reduced if you have earned income over certain threshold amounts.
70½–You must begin withdrawing money from your IRA or other tax-deferred savings plan. The minimum required withdrawal is calculated by dividing the present value of your IRA by your life expectancy, taken from IRS actuarial tables.
Discussions about the future of long-term care in the United States are obviously dependent on the current and projected extent of the need for care. While many working in the field have an intuitive feel for the frequency of use of nursing homes, the statistics can nonetheless be surprising.
Admission Rates
According to a 1991 article in the New England Journal of Medicine, 33% of men turning 65 in the prior year would spend at least some time in a nursing home. For women, that number grew to 52%.
While total admissions for women are significantly higher, short-term admissions are much less sex-dependent. Of that same 65-year-old group, 21% of women and 19% of men will be admitted for stays of less than one year. But for longer stays, women begin to dramatically outnumber men.
10% of men and 18% of women will spend between one and five years in the nursing home. Only 4% of the 65-year-old men will spend more than five years in the nursing home, while 13% of their female counterparts will do so.
Nursing Home Financing
According to the American Association of Retired Persons, over half of the cost of nursing home care is paid by the federal-state Medicaid program (ALTCS in Arizona). The actual figure is 51.7% of all nursing home costs, compared to 8.8% for the Medicare program and 2.2% for other public programs.
Long-term care insurance and medical insurance account for 2.4% of nursing home costs, with private programs (such as charities) provide 2.2%.
The remaining 33% of nursing home costs are paid by patients from their income and savings. It is not clear, however, whether the patients’ “share of cost” contributions to Medicaid coverage are included in this statistic.
1996 Medicare and Social Security Rates
Although numbers may change as the budget compromise takes final shape, 1996 numbers for Medicare and Social Security are currently in place. Until further changes, the following figures apply:
Medicare Part A
Hospital Deductible $736/illness
Daily Coinsurance (Hospital)
Days 1-60 $0
Days 61-90 $184
Lifetime Reserve $368
Daily Coinsurance (Skilled Nursing)
Days 1-20 $0
Days 21-100 $92
Premium (for those not otherwise qualified) $289/month
Medicare Part B
Premium $42.50/month
Deductible $100/year
Coinsurance
20% of approved charge
Balance Billing
15% of approved charge
Social Security
Cost of Living Adjustment 2.6%
Retirement Earnings Limits
Age 65-69 $11,520/year ($960/month)
($1 in benefits withheld for every $3 of earnings over the limit)
Under 65 $8,280/year ($690/month)
($1 in benefits withheld for every $2 of earnings over the limit)
Maximum SSI Benefit
Individuals $470/month
Couples $705/month
Republicans in Congress have made it clear they hope to trim $270 billion from anticipated Medicare increases in future years, but have so far failed to explain how they intend to accomplish this result. It has become clear, however, that they expect about $60 billion of that savings to come from higher premiums charged to Medicare participants.
Currently, Medicare beneficiaries pay $46.10 per month for Part B. Usually, this premium is deducted from Social Security benefits. On average, this premium pays 31.5% of the government’s cost to provide Part B coverage.
Congressional Republicans have proposed indexing Medicare premiums so that the percentage of remains fixed at 31.5%. Based on best estimates of future Medicare costs, that means premiums would jump to $97.50 per month by 2002.
Medicare’s premium rates were originally set to cover 50% of the cost of the program, but rising costs led to a reduction in the percentage recovered through premiums in recent years. Current premium rates were set five years ago and were intended to provide 25% of the cost of coverage; since costs increased more slowly than expected, the premiums actually covered a larger share of the cost than intended.
The White House has proposed returning the premium level to 25% of the cost of Medicare. Under that proposal, beneficiaries could expect to pay about $77.40 per month by 2002. Clinton’s plan would only raise $16 billion to help reduce the anticipated Medicare shortfall in the next five years, but would save beneficiaries slightly more than $20 per month in premiums.
Restraints In Nursing Homes
About one of every five elderly nursing home residents will be restrained for some part of their nursing home stay. At least that is the estimate of Professor Marshall Kapp, recognized as a leading expert on long-term care issues.
Nursing home rights advocates have fought for reduction of the use of restraints for several years. Among the arguments Kapp makes:
Serious injuries are more common when mechanical restraints are used long-term. Residents are often hurt when they become agitated and attempt to escape from the restraints, or when staff fails to monitor and adjust restraints in time.
Facilities using restraints frequently provide inadequate training in how to use, monitor and adjust the devices.
Nursing homes have made more dramatic strides in reducing restraints than hospitals or other acute care facilities.
More proposals considered by Arizona delegates to the White House Conference on Aging (by topic area):
Health Care and Mental Health
Permit reimbursement for direct care provided by nurse practitioners and physician’s assistants, for home care, preventive care and wellness programs.
Reduce duplication and coordinate services, particularly for those who access special services such as Veteran’s programs, Indian Health Services and Medicaid.
Control prescription medication costs.
Avoid rationing of health care by caps on service reimbursement and cost-benefit analysis of the true value of high-cost medical procedures.
Use excess hospital capacity for alternative services, such as extended care and assisted living.
Share medical resources, particularly high-tech equipment.
Consider means-testing Medicare (though a strong minority voice opposed any discussion of such a step).
Expand health programs to include mental health services.
Promote greater patient involvement in medical decisions.
Deal more creatively with substance abuse and suicide among the elderly.
Encourage medical professionals to work in rural and under served populations.
Institute a single-payor national health program (though this one did not make it into the final report).
Long Term Care
Shift emphasis from long term care in medical institutions to home care.
Provide tax incentives for family caretakers.
Encourage innovation in state and local programs by granting federal program waivers.
Promote prevention practices, among both elderly and young.
Encourage seniors to volunteer in their communities, to help them stay vital and involved.
Develop a wellness check program for homebound seniors.
Provide loans and incentives for home repair and adaptation for the homebound elderly.
Increase recreational programs for the elderly.
Expand case management programs.
Provide respite care for family care givers.
Promote congregate housing alternatives to reduce care costs.
Promote family and community responsibility for the elderly.
These are just a few of the myriad of suggestions considered by Arizona delegates. Next issue, we will discuss “special populations” and “elder rights.”
