Towns' Support Buoys Cape Care Cause; 'Now The Fun Begins' To Craft Program
Encouraged by a favorable non-binding supportive vote in nine of 12 Cape communities where the issue appeared on Town Meeting ballots, the Cape Care Working Group is taking the next step to make its case to Barnstable County's two governing bodies, the Cape Cod Commissioners and the Assembly of Delegates.
Mary Zepernick, community activist from Yarmouth and coordinator of the Working Group's resolution campaign committee, said support for this initiative to create a regional universal health care program was stronger than might appear. "Although we don't have figures because many of these were voice votes, in most of those towns that did pass the resolution, the margin was overwhelming. The votes were much closer in those towns where it was defeated," she told members of the working group during a June 24 meeting at the Harwich Senior Center. "I think overall the vote was about nine-to-one in favor."
According to the Cape Care box score, Provincetown, Yarmouth, Wellfleet, Truro, Brewster, Eastham, Harwich, Bourne and Orleans passed the resolution. The vote was unanimous in Provincetown; described as "overwhelming" in Yarmouth, Wellfleet and Truro; and 174-74 in Bourne. There was no comment on favorable votes in Brewster, Eastham and Harwich.
Negative votes were recorded in Sandwich, 134-110; Chatham, 187-129; and Dennis, which listed no vote tally, but the comment, "moderator disallowed discussion."
The resolution was not on the ballot in Falmouth and Mashpee while Barnstable does not have a town meeting as such but a representative form of governance. Ms. Zepernick expressed confidence these three towns would support the proposal in the future.
"I think the fact that the vote was non-binding and did not require the expenditure of any money probably helped," Ms. Zepernick said, "but now the fun begins as we fill in the blanks."
"Now we have to provide the basic product," said Dr. Brian O'Malley," the Provincetown physician who has been spearheading this Cape Care initiative.
Cape Care will be designed to serve as a county-wide primary health insurance plan to cover all Cape Codders with a full range of services, including prescription drug coverage as well as mental health and dental care. With minimal administrative overhead and a Cape-wide customer pool, costs to consumers would be much more reasonable than private insurance.
"This will be win, win, win; with no losers," Dr. O'Malley said. "and the county has said, 'We hear you,' and they're comfortable with moving forward."
"We're going with the county because we need a place to hang our hat, but we don't expect them to fund or administer it," Ms. Zepernick added.
At a scheduled meeting with the commissioners, the Working Group planned to raise these topics: recognition of the precept and agreement to participate in the process; help publicize developments as they occur; facilitate public forums; possibly assist with staff support and help in obtaining grants; and, finally, facilitate an eventual county-wide referendum.
"This is not the last word," Dr. O'Malley said, "We promised the towns we would come back to them for approvals, but now we feel we can go forward with the (detailed) feasibility studies."
He indicated that Cape Cod Healthcare has expressed general support for the concept. But the reaction of individual physicians is a future question as well as some sort of individual opt-out provision for those happy with their current coverage.
State's Innovative Senior Care Options Program Gains Favor As Alternative With Needy Elders
By Jennifer Davis Carey, Secretary
Massachusetts Executive Office of Elder Affairs
With medical costs rising and insurance premiums keeping pace, health care providers and government officials are looking for ways to slow spiraling costs by decreasing the number of long-term care cases involving the elderly confined to nursing homes or extended care facilities due, in part, to a lack of consistent health screenings and preventive measures.
One new initiative designed to stem the tide is the state's Senior Care Options (SCO) Program. Nine years in the making, the pilot program was the first of its kind in the country when it was launched two years ago to provide health care alternatives to low-income seniors. SCO combines the benefits of Medicare and MassHealth, and offers individualized services with a coordinated care approach. Individuals currently enrolled in MassHealth, the state's Medicaid program, are eligible.
New health care opportunities like the SCO program are geared towards meeting the needs of seniors in all settings, with a special focus on those most in need of long-term medical supervision. Many of the current enrollees live in the poorest parts of the state, a sizable portion are non-English speaking, and most have not had consistent health care.
There are many elders who have not received the treatments and drugs they need for chronic conditions like high blood pressure and diabetes. Others are too frail to make it to a doctor on a regular basis, and end up in nursing homes because of insufficient or inconsistent outpatient care. This puts pressure on an already strained system, one that costs more to maintain in the long run.
Seniors on the SCO program have no co-payments for prescription drugs and do not have to worry about navigating the maze of Medicare Part D, the prescription drug plan program initiated with passage of the Medicare Modernization Act of 2003. There is also less extensive paperwork, such as is often required for MassHealth screenings.
Other benefits of the program include:
- 24/7 access to a nurse case manager who can quickly retrieve patients' records;
- Choice of personal care physician (PCP) and SCO network;
- Access to vision and hearing services;
- Flexible care planning and service delivery to meet individual needs and preferences;
- Routine podiatry and dental care;
- Transportation based on assessed needs.
Seniors enrolled in SCO are pleased with the results. Caregivers and children experience peace of mind in the knowledge that someone is coordinating round-the-clock care for their loved one. Other states, including Vermont, Rhode Island, and California are looking into replicating the SCO program for their elderly population, confident that it is one of the best new health care options to come along in many years. Harvard University agrees-SCO recently was named one of the "Top 50 Government Innovations for 2006" by the John F. Kennedy School of Government.
Currently, there are three SCOs operating in Massachusetts: Commonwealth Care Alliance, Evercare, and Senior Whole Health. Enrollments are increasing rapidly across the state. Each SCO taps into a strong network of physicians and other care providers.
Consistent and coordinated preventive care and screening represent the first steps toward helping elders live lives of health and dignity. Offering the frailest seniors reliable, long-term care with as few restrictions as possible is the second step. Giving seniors the ability to be well cared for in either stage is the best of both worlds.
SHINE On:
Some Tips On Purchasing Long-Term Care Insurance
By Sheila Curtis
The average cost of nursing home care in Massachusetts is almost $300 per day, more than $100,000 per year. These are very frightening figures as one grows older and the real possibility of requiring such care increases.
Those who saved all their lives are horrified to learn that nursing home care will deplete assets, impact the ability of a spouse to live with economic dignity and prevent the transfer of property and assets to children. It becomes even more frightening as one discovers that Medicare provides coverage only for short-term care in a skilled nursing home facility; Medicare also restricts home care benefits to skilled nursing of a limited duration.
Paying for long-term custodial care is often the responsibility of the individual requiring such care. Medicaid, a governmental welfare program, pays for such care when individuals do not have enough assets and/or income to pay for services or when they become impoverished by "spending down" assets to qualify for this assistance. Medicaid pays when people are "poor." Most of us would prefer to avoid such a situation.
Purchasing long-term care insurance is an alternative to utilizing personal assets to receive care at home, at an assisted living facility or applying for Medicaid to pay for nursing home care.
However it's important to recognize that long-term care insurance is not for everyone.
Premiums for those purchasing long-term care insurance are based on the criteria of health, age and the various insurance options one chooses. Some with limited assets and/or income may not be able to afford it. Others may have waited too long to purchase so that health-related issues will disqualify them. This insurance must be purchased before one requires long-term care. Current health issues of individuals applying for this insurance are carefully scrutinized, and anyone who is already ill most likely will be deemed uninsurable.
With many differing policies from which to choose, it has become more difficult to be sure that you're selecting one that is best for you. This guide will help you understand long-term care insurance and obtain the coverage that best fits your individual needs.
1. What is the best way to calculate how much coverage you should buy?
The amount of coverage depends on considering both what you need and what you can afford. As a rule, you should not spend more than five to seven percent of your income (both earned and unearned) on long-term care insurance premiums. In terms of the size of the daily benefit you purchase, it should make up in the shortfall between your income and the average cost of nursing home care in your area.
2. How long a period should I insure myself for?
Again, there is no one right answer for everyone. Most people buy what gives them peace of mind and is affordable. One should consider buying as much daily benefit for as long a period as one can afford.
3. Will the agent provide you with a sample policy?
It's in your best interest to request a sample policy so that you and a family member, friend or adviser can review it with you before you buy. Be sure the sample policy matches the policy quoted by the agent; look for a policy series number.
4. Is the policy tax qualified?
Long-term care premiums may be deducted from your federal income tax within certain limits and to the extent you have medical expenses (including these premiums) that exceed seven and one-half percent of your adjusted gross income. Any benefits received under a tax-qualified policy are not taxable if the policy meets certain guidelines.
5. Are the benefit triggers clearly spelled out?
A benefit "trigger" represents the inability of the policyholder to perform specified Activities of Daily Living (ADL), such as transferring, toileting, bathing, continence, dressing and eating. Ask your insurance agent for a copy of the actual policy in order to see for yourself how those benefit "triggers" and ADL performance are described. Moreover, check policy language to be sure pre-existing conditions are covered.
6. Does the policy cover homemaker services?
Homemaker services include cooking, shopping, changing beds, cleaning the house, and doing laundry. Not all policies provide coverage for homemaker services and some require that they be specifically included in a plan of care. Look for policies that clearly define these services and provide you with a choice.
Because the purchase of this type of protection is so important, we recommend that you do business with a broker who is knowledgeable, experienced and who has an established reputation in this area of insurance. Long-term care insurance is a complex product. Also, you want a broker who represents a number of insurance carriers so you can choose from a variety of policies.
The answers to these questions do not cover every possible issue, but they provide a guide for helping make the decision that's best for you.
(Ms. Curtis is regional director for SHINE, a state agency Serving the Health Information Needs of Elders. Certified Long-Term Care Insurance Counselors are available to review your Long-Term Care Insurance options and answer your questions. For office appointments or telephone conference call SHINE at 1-800-334-9999 or 1-508-394-9326)