Medicare coverage of home care may be limited.

All four of the following criteria must be met before a client can receive Medicare home health care:

A doctor must decide that care at home is necessary and make a plan of care that the staff of the home health care agency will carry out. The doctor will work with the home health care nurse to decide what kind of services are needed (including medical equipment and special foods), how often the services are needed, and what type of health care professional should provide these services. The plan may also include what the doctor expects from the treatment. The client will receive home health care as long as he is eligible and as long as the doctor says he needs it.


The client must need either intermittent (part-time) skilled nursing care (performed only by a registered nurse or licensed practical nurse), physical therapy, or speech language pathology services. There are limits on the number of hours per day and days per week the client can receive skilled nursing care.


The client must be homebound. This means he/she is normally unable to leave home except for infrequent short visits or to get outside medical care.


The client must receive care by a Certified Home Health Care Agency approved by Medicare,

Neighborhood Hometown

am an avid reader of Globe North to follow local area issues. Reading your article in this Sunday's (8/3/08)
Globe North (slow motion" about the shift in population i can see how this applies to all parts of the Commonwealth. We all realize that the state has a major problem with funding from the Federal Government
if this trend continues.
In the article you point out the movement of population from Lynn to neighboring Peabody (Brooksby Villiage)
which is an assisted living for Seniors mostly affluent long time residents of Lynn looking for a safe and affordable upscale community. I assume Most would rather have rremained in their home and take the next available alternative remaining in the neighboring town in Essex County. We all want to improve our lifestyle.
A followup to your piece on the growing Senior population and their contribution to stability of a city and towns
and what the programs that could be put in place keeping long term residents it their neghborhood and particularly in home environments.
Example Mass Senior Action an advocate group for Seniors have supported with success protecting the rights and needs of elders in Senior and Disabled in subsidized housing. I would like to see them expand to help long time residents not only remain in familiar localities but in the home environment of a familiar neighbor hood.
IN MALDEN:
The Mayor Richard C. Howard, the Malden City Council, The Malden Revelopment Authority, Council on aging after urging from senior groups have plans to opening a new Malden Senior Community Center (Dec 8 2008)
in the downtown Area to improve the economic climate and revitalize Malden Center.
I would suggest their would be much interest to have Globe North do an in depth article of what is happening in Malden to retain our population is a safe and enjoyable city.
I have talked to the Mayor and he is for an outreach program to have a promotion and participation of all non profits in the New Senior Community Center. The concept is to have services to "keep independent living in the neighborhood"
How we can help home caregivers. We need the cooperation of all the non profits who are charged with servicing the Seniors our City Council who represent the citizens throughout the city all the citizens with a Vision For Malden
I would call it a declaration of Independence.
Right now I am trying to get a Focus group to gether for Ideas Interest and comments.
We have a model of several village concepts as guides of what can be done.
As an example:
Beacon Hill Village an all encompassing concierge service created by residents who want to grow old in the homes they have lived in for years.
This could be done on a regional basis or City wide even in a neighborhood.
This is what needs to be determined.
In the service by an organization they can deal with almost any contingency
large of small
without relying on relatives of friends. To preserve their Independence, they
can turn to the village as the non profit association is known
At Beacon Hill they have 320 members find virtually any service, large of small
from 24 hour nursing care to help with a home meal. all at a discounted fee or
from an "entitlement program"
Dan O'Leary Executive director(Mystic Valley Elders ) is on board and has already
had a focus group in Melrose to a standing room only crowd Keven Duffy of Healthy Malden has expressed interest. And Phil Gerioux of Tri Cap is considering his roll. All the city councilors and been briefed. Jim Nestor has all the information and was to contact Chris Depietro Dirtector of Elder Affairs Malden for her input. It would be a help if you and your members would find out from Jim his progress (Jim Nestor) and get a status report
REMEMBER NEW SENIOR COMMUNITY CENTER IS IN WARD 4 VITAL to economic development
of the downtown area.

Any neighbohood resident is asked to participate with membership between 50 and older.
Anyone with a parent needing sercie should be involved.
MaldenSenior
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Howard McGowan
MaldenSenior
349 Pleasant Street
Malden, Ma 02148
781 324 8076

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Welcome to Reverse Mortgage Seniors

The Basic Requirements for a Reverse Mortgage
The Basic Requirements Reverse Mortgage The first qualification for a reverse mortgage in America is the borrower has to be at least 62-years-old. Although there are absolutely no credit requirements or minimum income, there are certainly no other requirements and homeowners should ensure they qualify for the loan prior to investing time and money into the entire process. The funds can be used for any purpose for most reverse mortgages. However, the financial borrower must pay off any mortgage which exists with the reverse mortgage proceeds and personal additional funds if necessary. A pending bankruptcy normally slows the whole process.

Applicants must seek free financial counseling from an approved source by HUD (Department of Housing and Urban Development). The financial counseling actually provides a safeguard for the financial borrower and the family. This assures the borrower comprehensively understands the purpose of the reverse mortgage and how it’s obtained. The AARP (American Association of Retired Persons) has proposed a complete plan—which must be approved by the federal US government—for maintaining closing costs low for senior citizens that qualify for reverse mortgages.

Acquiring the Mortgage Program
Homeowners normally learn about reverse mortgages from an advertisement, word-of-mouth, a news article or on the Internet. The owner usually contacts a reverse mortgage lender or even the National Reverse Mortgage Lenders Association for an upfront education. Financial counseling is a requirement for all reverse mortgages as it may be conducted by telephone or face-to-face. By US federal law, a financial counselor must completely review options which are available to the prospective borrower—this includes social services, housing, financial and health alternatives.

The homeowner completes a loan application and chooses a payment plan—whether lump sum payment or fixed monthly payments, line of credit or a combination. Once all pertinent data is received, the lender finalizes parameters of the loan with the homeowner, which can take 4-8 weeks to underwrite the loan package. If the loan package is fully approved, signing of the loan is scheduled.

The homeowner has three business days subsequent to the closing to cancel the loan. The reverse mortgage loan is repaid when the homeowner ceases to be occupant of the principal residence. Of course, the repayment obligation can’t be more than the sale’s price or value of the home.

The Massachusetts Home Care Program

Home Care Program overview

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provides support services to elders with daily living needs to remain at home in their communities. The services are designed to encourage independence and to ensure dignity. The program also supports families caring for elders in order to encourage and to relieve the ongoing care giving responsibilities.
The Home Care Program is administered by the Executive Office of Elder Affairs in coordination with local Aging Services Access Points (ASAPs) located in communities throughout the Commonwealth of Massachusetts. Some of the services provided by the program include homemaker, personal care, day care, home deliver meals, transportation, and other community support services to help maintain an elder in his/her home. The ASAPs conduct comprehensive needs assessments to determine eligibly for the Home Care Program and other programs and services as appropriate. An individualized service plan is developed with the elder and his/her family and the ASAP reassesses the elders needs and monitors the services on an ongoing basis.

Eligibility for the Home Care Program is based on age (60 or older), financial status, and ability to carry our daily tasks such as bathing, dressing and meal preparation.

Long Term Care Insurance

Baby boomers beware: The safety net you might be relying on to take care of you when you're old and sick is full of holes, a new study warns.
Many are relying on Medicaid, the government's health-care program for the needy, to pick up the tab for their nursing home and other long-term care expenses one day.
But there's a catch: Medicaid won't cover long-term care until your own resources are exhausted, warns Jeffrey Brown, director of the Center on Business and Public Policy at the University of Illinois College of Business and a co-author of the study.
"Medicaid basically forces you to impoverish yourself before it will pay for long-term care," he said. "Then you come out of care, and you've got nothing left."
What's more, the study contends, the government is encouraging people to rely on Medicaid by loading the program with disincentives to buy private long-term care insurance – which would be a better option because it protects assets and provides broader coverage.
Brown said economists have been puzzled about why so many Americans spurn long-term care insurance when they typically insure themselves against other financially damaging events and they face about a 40 percent chance of needing care in a nursing home one day.
"And if they need it, it can be financially devastating for many families, because a nursing home can cost $60,000 or $70,000 a year," he said.
As it turns out, the study found, Medicaid is choking the demand for private insurance because people prefer bad benefits at no charge to good benefits they'd have to buy.
And even for those who want private insurance, Medicaid makes it "not a good deal" for many, Brown said.
Once the benefits Medicaid picks up for free are factored in, the net benefits of long-term care insurance are just 20 cents to 40 cents on every dollar spent on private coverage premiums, the study found.
Another disincentive: Medicaid is a secondary payer, meaning it pays only after a private policy has paid first. So even when people do invest in private coverage, they might still end up exhausting all their resources.
"It will just take them longer to do so," Brown said.
Why not just rely on Medicaid, then?
Because it's not free. Taxpayers are footing $135 billion worth of long-term care expenses a year through Medicaid, and the burden can only grow as more baby boomers age, the study points out.
If there's a good way out of this conundrum, Brown said he hasn't found one yet.
The country could eliminate Medicaid coverage and let taxpayers spend their money on their own long-term care coverage, but there will always be people who won't have coverage and won't be able to afford nursing home care, Brown said.
"Are we as a society prepared to tell these people, 'You didn't insure, you didn't save enough, you're on your own?' I don't think this country is prepared to do that," he said.
Should Medicare, the government's health program for the elderly, take over long-term care expenses?
Talk about really breaking the federal budget, Brown said.
"We've already got under-funded (Medicare) benefits," he added.
Should the government require people to purchase long-term care insurance?
How could that be enforced? Brown said.
"One of the difficult things about this study is we've identified a very difficult public policy problem for which there is not an obvious solution," he said.
The nation's long-term care insurance industry is a bit more optimistic that more Americans will buy policies.
Some 400,000 long-term care policies were purchased last year, says Jesse Slome, executive director of the American Association for Long Term Care Insurance.
"It's growing slowly and steadily," he contends.
Last year, long-term care insurers paid out $3.5 billion in claims, about $200 million more than 2006, Slome said. As more people have positive experiences with this kind of coverage, he predicts more will want to buy it.
But it's going to take time. Before the baby boomer generation, the elderly lived closer to their children and didn't need to rely so heavily on nursing home care. People didn't live quite so long, either, Slome said.
"Prior generations didn't have to think about long-term care," he added.
Slome thinks the real impediment to buying long-term care insurance is human nature: Many folks just aren't good planners, and they procrastinate.
"The fact of the matter is, first of all, people don't live their lives planning to go on welfare. They live their lives without planning, but nobody who's 65 looks and says, 'Gee, I've worked my whole life. I was independent. I saved. I had a retirement plan. I did everything I was supposed to, and in my last years, I want to go on welfare to see what it's really like,'" he said.
The long-term care industry's challenge is to convince more people to start thinking about the costs of nursing home care before they become so old, or their health deteriorates so much, that insurance is going to be prohibitively expensive, he said.
Nearly 45 percent of people applying for long-term care coverage in their 50s qualify for good health discounts, but only about 19 percent of those who wait to apply in their 70s qualify for these discounts, a 2006 report done by Slome's association found.
Another challenge may be today's economy.
Slome said a single person at age 55 can buy decent long-term care coverage for about $1,000 a year, and a married couple at that age can buy decent coverage for both people at about $1,300 a year.
But with the rising cost of health care, many people are finding it difficult enough to pay for insurance they need right now, let alone pay for coverage they may need in their golden years.
Slome's advice for getting the best deal: Work with a professional who can find you the best long-term care insurance coverage for your needs and lock in the rates. The price of coverage varies widely, and every company has its own premium rate sweet spot depending on the client's age, marital status and health status, he said.
"Medicare and Medicaid are already strapped, and it's only going to get worse," Slome warned. "The government can only tax so much."
Should you buy long-term coverage?
It depends on what you've got to lose, says Paul McNamara, a professor and Extension specialist at the University of Illinois Department of Agricultural and Consumer Economics.
His advice:
— Consider buying coverage if you can afford it and want to have assets to leave your heirs or a surviving spouse.
— Know the premiums are more reasonable before you become elderly and fall into poor health. But keep in mind when you buy coverage younger that you're going to have to keep up the premium payments for a long time.
— Don't neglect the bigger picture: Consider long-term care insurance as part of your overall retirement planning. It wouldn't make sense to pay for a long-term care policy if you can't afford to fund your retirement savings.
— When it's not a good deal: If your income is anywhere near Medicaid eligibility level, you don't have a lot of assets now and likely won't have enough assets at retirement to protect.
Find this article at: http://www.news-gazette.com/news/2008/04/13/seniors_warned_about_longterm_care
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