Posts Tagged ‘respite care’

Family Caregivers: Elder Care in a Post-Federal Era?

APRIL 15, 1996 VOLUME 3, NUMBER 42

Since the adoption of Medicare and Medicaid in the mid-1960s, nursing home placement has become the norm for seniors needing nursing services. Now that legislators are actively working to scale back the cost and scope of both federal and state programs providing elder care, new approaches to caregiving are being considered.

According to a recent Wall Street Journal article, one of those “new” approaches to elder care is decidedly old-fashioned. The article reports on a budding trend toward family members providing care in their own homes.

The article reports on the Bodlander family in Washington, D.C. Mother Lucy Bodlander, 80, requires assistance with activities of daily living, but family members have decided to provide that assistance at home. Mrs. Bodlander’s two children, Deborah and Gerald, alternate caring for their mother, moving her between their homes each month. Along with Mrs. Bodlander’s personal effects, they transfer one other thing each month: a full-time caretaker who lives with Mrs. Bodlander at whichever child’s house she currently calls home. The children also pay the cost for the caregiver, which averages about $2,000 to $3,000 per month.

With federal cutbacks in Medicaid and Medicare, such arrangements may become more commonplace. Currently, elders and their families pay about two-thirds of in-home care costs (up from slightly over half in the early 1980s). Elders, family and friends account for over three-quarters of all long-term care already, much of that through unreimbursed caregiving.

The Wall Street Journal article also reported on several trends which may assist with family caregiving in the future:

  • Better support for caregivers. Government, employers and others are recognizing the importance of family caregiving and the need for support and respite.
  • More flexible long-term care insurance. Home care benefits are becoming more common and more flexible, though the cost of policies remains high.
  • Technology. In-home monitors, telemedicine and other technologies promise to make care more effective and less expensive.
  • Innovative programs. In-home services, ranging from snow removal to home repair, are being developed in select elder markets.

Arizona White House Conference on Aging


The Arizona White House Conference on Aging held in Phoenix last month dealt with issues facing the full White House Conference on Aging when it meets in May. Arizona’s delegation dealt with several issues expected to dominate the national aging agenda.

Long Term Care

Everyone knows that the proportion of elderly citizens is expected to grow dramatically in the next two decades. What many do not appreciate is that the greatest growth is projected for the “old old”; those over age 85. Currently one-quarter of all women (but only one-seventh of men) over age 85 live in nursing homes. Those who turn 65 in any given year have about a 40% chance of spending some portion of the rest of their lives in a nursing home. About 10% of those will spend five or more years there.

Another tremendous segment of the population requires long-term care, but receives care at home. About 70% of all long-term care of the elderly is provided solely by family and friends, without institutionalization.

For those who can be cared for at home, the cost of assistance may be prohibitive. Simply bringing an aide into the home three times a week for meal preparation and light housekeeping can easily cost in the range of about $600 per month. Since about 20% of Arizona’s elderly live at or near the federal poverty level, even such small assistance may be unaffordable.

For those placed in nursing homes in Arizona, the cost of care will typically vary from $30,000 to $40,000 per year. Many seniors expect Medicare to pay some portion of that cost; in fact, Medicare pays only about 3% of the total nursing home bill in this country. Private long-term care insurance (still a relative rarity) and Veteran’s benefits account for another percent or two each; the remaining portion of long-term care costs are paid roughly equally by Medicaid and patient’s private savings and income.

Although nursing homes care for less than one-fifth of those requiring long-term care, they are responsible for more than half of the cost of care. Seniors are reluctant to enter the nursing home, and much prefer to be cared for (and die) in their homes.

Cost effective alternatives to institutionalization exist, especially in urban areas. Adult day care, respite care, hospice and assisted housing programs can keep many nursing home candidates in less expensive settings and more comfortable. Unfortunately, such programs are too rare and are seldom funded by public dollars. Paradoxically, it becomes less expensive for most patients to move into the nursing home and qualify for Medicaid (ALTCS in Arizona) than to secure care at home or in a more home-like setting.

Local Alzheimer’s Support Project


Tucson’s Jewish Family and Children’s Service Center and the Southern Arizona Chapter of the Alzheimer’s Association have announced the receipt of a $46,809 grant from the Flinn Foundation. The grant money will be used to establish a program to provide relief for family caregivers of dementia, Parkinson’s and stroke patients.

The program will utilize volunteers to provide respite care. Volunteer recruitment, supervision and retention will be the responsibility of the Jewish Family and Children’s Service Center, and the Alzheimer’s Association will develop a training program for the volunteer caregivers.

Once established, the program will provide volunteer relief caregivers for some families. There will be no fee, but families will be permitted to make contributions toward the cost of the program.

State Medicaid Waivers Challenged

States may have a more difficult time securing federal waivers to permit experimental Medicaid programs in the future. A lawsuit filed by a group of community health clinics against state plans in Tennessee and Oregon challenges the use of such waivers.

Under federal Medicaid administrative rules, states must secure specific waivers before implementing variations on Medicaid funding or service delivery structures. Arizona has operated under such a waiver since the establishment of its AHCCCS program.

The Clinton administration has indicated its intention to permit state experimentation by making the waiver process easier for states to navigate. The Tennessee experiment, for example, would transfer Medicaid recipients into health maintenance organizations and other discount-price networks of health providers. Similar waivers have already been granted to Hawaii and Rhode Island, and another half dozen states have either applied for waivers or are considering doing so.

The lawsuit alleges that the effect of the waivers is to permit state-by-state health care reform, rather than to encourage Medicaid improvement. The clinics also claim that low-income patients are hurt by placing them in HMOs, because they need health education and encouragement to seek care. Since HMOs are rewarded when patients make fewer visits to the doctor’s office, they are not a good way to deliver care to the poor, according to the suit.

Legislative Changes

JUNE 27, 1994 VOLUME 1, NUMBER 31

The 1994 session of the Arizona legislature ended in mid-April. Most of the new laws adopted during that session will become effective in about three weeks, and newspaper articles about those changes should begin appearing soon.

Several new laws are of particular importance to the elderly and disabled. The changes include:

Private Fiduciaries
Senate Bill 1103 directed the Arizona Supreme Court to develop a system for registration and regulation of private fiduciaries. Any person or organization serving as guardian, conservator or personal representative of a person or estate, unless related to the ward or decedent, must meet the Supreme Court’s standards.

In response to the new law, the Supreme Court has established a committee to draw up minimum standards, disciplinary rules and other regulatory provisions. It is unlikely that the rules will be ready by July 16 (the next meeting of the Committee is set for August 1), but some protection will be provided for incapacitated adults, children with substantial estates and heirs in the near future.

Pima County representatives on the Supreme Court committee include Robert Fleming, Hon. William Sherrill (the presiding Pima County probate judge) and Eleanor terHorst (the Court’s Probate Law Counsel). Any of the three would be happy to hear from concerned citizens, particularly those with first-hand knowledge of abuses and concerns with private fiduciaries in the past, or with suggestions for protective regulations.

Age Discrimination Cap Removed
Senate Bill 1226 removes the present cap of age 70 from Arizona’s Age Discrimination in Employment Act. Older employees are now protected from discrimination under the law.

Investment Advisors
After particularly complicated legislative wrangling, House Bill 2271 passed both houses and was signed by the Governor. This legislation creates a regulatory structure for investment advisors, requiring them to register with the Arizona Corporation Commission. Minimum qualifications were also established, and a mechanism to report abuses and suspend advisors from practice.

Respite Care
House Bill 2317 created a pilot project to provide respite care for the frail elderly. The primary focus of this legislation is on attempting to show whether respite care permits caregivers to function in their home-care roles for a longer period. Only $75,000 was allocated, and the pilot project was limited to Maricopa County, but it may signal an acknowledgement on the part of legislators that respite care is an important issue for the future, and perhaps a willingness to expand such a program.

State Retirement COLAs
Senate Bill 1058 introduced the concept of an automatic (or perhaps semi-automatic) cost of living adjustment to the Arizona State Retirement System. COLAs will be limited to half the increase in the Consumer Price Index (or 3%, whichever is less) and will only be available in years when funds are available (according to a formula adopted as part of the law). The COLA legislation automatically ends in five years.

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