Re-Balancing
the Long Term Care System
Written
By: Attorney
Jeffrey
A. Marshall
,
CELA*
[The
following article is drawn from Attorney Marshall's address to over 300
attorneys and other professionals at the Pennsylvania Bar Institute's
Elder Law Institute in
Harrisburg
on
July 15th.]
Pennsylvania
has embarked on a
transition from a system of publicly-funded long term care that favors
institutional care to one that prefers home and community based care.
This is a most interesting and significant change that is going to
affect seniors and elder care network professionals in ways we have not
yet begun to understand.
The
shift towards publicly-funded care in home and community rather than
institutional settings is the result of many forces. Nursing facilities
are the last place consumers want to receive long term care. Financially,
care delivered in home and community settings can cost a lot less per
capita than nursing facility care, especially if it being supplemented by
unpaid family caregiving. And, from a legal standpoint, five years ago the
United States Supreme Court held in the Olmstead case that
unnecessary institutionalization constitutes illegal discrimination based
on disability in violation of the Americans with Disabilities Act.
These factors have combined to give
Pennsylvania
a strong incentive to
remove the institutional bias in funding long term care.
Still,
last year in
Pennsylvania
about 80% of Medicaid
and other public funding of long term care was paid for institutional
services. The goal, as
expressed by DPW Secretary Richman, is to re-balance this system so that
60% of the public funding of long term care goes to provide home and
community based care and only 40% goes to institutional care.
So,
right now we are in the early stages of a radical multi-billion dollar
redesign of our system of providing and paying for long term care.
As a result, new concepts are being tested and many new programs
and options are being initiated.
To
keep up with these new options, the elder care network professionals will
need to maintain close, continuing relationships with other elder care
network providers, local offices of aging, local county assistance
offices, and other sources of updated information. The Pennsylvania
Department of Aging and local area agencies on aging are particularly
important sources of program information. [We hope that you agree that the
Marshall & Associates' Elder Care Alert is another.]
The
re-balancing is a big social policy gamble.
It is clear that publicly financed home and community-based
services will help families who are attempting to avoid or delay expensive
institutional care. Less certain is whether increased public financing of
home based care will reduce the overall public cost of long term care.
The
Rendell Administration's theory is that long term care can be provided
to two seniors in their homes for the same cost as one person in a nursing
home. However, there are
concerns about the so-called "woodwork effect." This is the fear
that publicly financed home care will substitute for "unpaid"
informal care-a fear that people who would otherwise get by somehow will
"come out of the woodwork" to demand home based services, and thereby
place unsupportable pressures on public budgets.
In
any event, we appear to be irrevocably embarked on this redesign project.
Pennsylvania
has begun to
experiment with creating programs and procedures to facilitate the
delivery of home and community based services in an effective and
cost-efficient manner. It is going to be a significant challenge for those
of us who advise seniors to stay on top of these changes, so that we are
providing our clients with the best, most timely and up to date advice and
planning.
Attorney
Marshall can be reached at webmail@paelderlaw.com
or at 1-800-401-4552.
Drug
Re-Importation Legislation
Written
By: Attorney
Jeffrey
A. Marshall
,
CELA*
The
failure of Medicare discount drug cards to provide meaningful drug savings
to seniors is adding pressure on Congress to directly authorize
re-importation of drugs from
Canada
. It's an election
year and our Congressional representatives want to be appear to be
interested in meeting the needs of senior voters.
Two
competing bills have been introduced to legalize the re-importation of
drugs from Canadian pharmacies. Senate Bill 2328 is being co-sponsored by
a bi-partisan group of Senators including Democrat Byron Dorgan and
Republican Olympia Snow. The Dorgan/Snow bill is backed by consumer
advocates and by AARP. It is vehemently opposed by the pharmaceutical
companies.
The
Dorgan/Snow bill would allow US consumers to directly purchase drugs from
FDA-approved Canadian pharmacies. After 90 days, US pharmacists and drug
wholesalers would be allowed to re-import medications from
Canada
. The bill would also
prevent pharmaceutical companies from reducing drug supplies to countries
willing to export lower-cost pharmaceuticals to the
US
. Additional
legislation would address safety concerns regarding the purchase of drugs
over the internet.
While
the Dorgan/Snow bill has bi-partisan support, it does not have the backing
of the Administration nor that of Senate leadership and is unlikely to
become law. Instead, Senate Majority Leader Frist has indicated some
support for a bill by Republican Senator Judd Gregg of
New Hampshire
. Gregg has introduced
a bill that is much more conservative than the bi-partisan bill that AARP
endorsed. The Gregg bill would allow limited drug re-importation and
includes provisions that would require greater regulation of internet
pharmacies.
While
it is unlikely that Congressional leaders will allow the bipartisan
Dorgan/Snow bill to proceed, there is some chance that the more
conservative Gregg bill will move forward in the short time remaining this
year. However, there is concern that the pharmaceutical companies may try
to "hijack" this legislation by including provisions that would
actually protect the pharmaceutical industry from cost-competition from
re-imported drugs by making drugs from foreign pharmacies more expensive
for American consumers. So, re-importation legislation could turn out to
be a wolf in sheep's clothing.
While
the re-importation legislation has been getting a lot of press, the Bush
Administration has been quietly pursuing a different approach to drug
re-importation issue. It has
been including language in trade agreements that will restrict
re-importation and even prevent other countries from negotiating for lower
prescription prices than what exist in the
US
. The purported
rationale is that US consumers are bearing the brunt of drug company
research and development costs. This
burden should be shared by consumers in other countries if trade
agreements force our trading partners to raise the prices paid for
pharmaceuticals in other nations. Under the trade agreements, importing
low cost drugs into the
US
would be seen as a
unfair trade practice. Congress is currently considering a trade agreement
with
Australia
that has been
negotiated to include this type of provision.
At
the very least, the argument goes, these trade agreements should help
protect the pharmaceutical companies'
US
profit margins.
The drug companies will apply some of these excess profits to
research and development, and maybe even reduce prices in the
US
a little.
This may make some sense if you trust the drug companies to watch
out for the interests of consumers. On
the other hand, you are not alone if the "make prices higher around the
world" argument makes you feel like
Alice
in Wonderland.
Here
are links to contact your Congressional representatives if you want to
express your opinion on legislation allowing seniors to purchase lower
cost drugs from
Canada
:
For
information on members of the U.S. House of Representatives, click
here.
For
information on Senators click
here.
For
more information, news articles on the re-importation legislation are
available at:
http://www.thehill.com/news/071304/reimportation.aspx
and
http://www.ama-assn.org/amednews/2004/07/05/gvsa0705.htm
and
http://www.kansascity.com/mld/kansascity/news/9169985.html
Attorney
Marshall can be reached at webmail@paelderlaw.com
or at 1-800-401-4552.
Does
Your Club Or Organization Need A Speaker?
If
you are interested in having an attorney or geriatric planning specialist
from
The
Elder Law Firm of Marshall & Associates speak to your group, or at an
upcoming event, please contact
our
Public
Ed
ucation
Coordinator, Melissa Bottorf
at
mbottorf@paelderlaw.com
or 1-800-401-4552
Meet
the Marshall & Associates Staff
This
Month.
Planning
Specialist Lisa Barner
Lisa
has been a Planning Specialist with Marshall & Associates since
July 1996. As a geriatric planning specialist, she helps clients and
their families with long term care issues such as home care needs and
nursing home or assisted living facility admissions.
A graduate of
Curwensville
Area
High School
, Lisa earned her Bachelor's
Degree in Social Work from
Lock
Haven
University
in 1993. Lisa's parents
continue to reside in Curwensville. However, after graduation, Lisa
moved to
Jersey
Shore
and married Mike Barner (they will
be celebrating their 11th wedding anniversary on July 30th)!
Lisa has a daughter, Kayla, who just celebrated her 7th
birthday on May 28th. She will be going into the 2nd
grade at the
Walnut
Street
Christian
School
.
Anyone who
knows Lisa will tell you that she loves to bake. She also enjoys
spending time with her daughter, shopping, and walking her dogs. She
has a 9 year old Blue Merle Collie, Rosco, and a 2 year old Golden
Retriever, Max. Lisa is a member of the Christian and
Missionary
Alliance
Church
in
Jersey
Shore
. She teaches Sunday school
and has been a Pioneer Club teacher for the past five years. Lisa is
also President of Beta Sigma Phi Sorority and served as Secretary for the
Jersey Shore Elementary PTO.
CMS
Issues Proposed Regulations to Implement the New Medicare Law
On
Monday, July 26th, the Centers for Medicare & Medicaid
Services (CMS) issued proposed regulations implementing the new Medicare
Act of 2003. The regulations
themselves will be published next week in the Federal Register.
Meanwhile, you can read CMS' Fact Sheet regarding the proposed
regulations online at
http://www.cms.hhs.gov/media/press/release.asp?Counter=1129.
Alzheimer's
Association's Memory Walks Slated for October
Join
us in taking steps to end Alzheimer's Disease
Help
raise money and awareness about Alzheimer 's disease at the 2004 Memory
Walks slated for early October.
Did you know that an estimated 4.5 million Americans have
Alzheimer's disease? According to the Alzheimer's Association website
(www.alz.org),
the number of Americans with Alzheimer's has more than doubled since
1980 and it is estimated that by 2050 the number of individuals with
Alzheimer's could range from 11.3 million to 16 million.
Join us in
taking steps to end Alzheimer's Disease.
Proceeds from Memory Walk go directly to improve the lives of those
affected by Alzheimer's and promote research and effective treatments.
The
Alzheimer's Association is looking for sponsors, walkers, and donations
to make this year's walks the most successful yet.
Go to the Memory
Walk website or contact
Estella Killian at 570-822-9915 for more information on how you or your
company can get involved!
Some
of the Local Memory Walks Include.
Montoursville
Sunday, October 3rd, 2004
at
11:00AM
Indian
Park
Contact
Melissa Bottorf at mbottorf@paelderlaw.com
Wilkes-Barre
Saturday, October 2nd,
2004
at
9:30AM
Kirby
Park
Contact
Estella Killian at estella.killian@alz.org
Bloomsburg
Saturday, October 9th, 2004
at
11:00AM
Town
Park
Contact
Estella Killian at estella.killian@alz.org
"Paying
for Long Term Care" Presentations Set in Lock Haven and
Jersey
Shore
G
etting good information about options for long term care is critically
important for seniors. Four out of every ten people reaching age 65 will
spend some time in a nursing home and many more will require home care and
assistance with daily living.
The
Elder Law Firm of Marshall & Associates is known throughout
Pennsylvania
for the expert help we provide
seniors who are faced with long term care needs. We help families
struggling to care for their loved one at home find the programs and
financial help they need.
If
nursing home placement becomes necessary, we work with the facility to
help make the transition go as smoothly as possible. We make certain that
the nursing facility gets paid in a timely manner while helping the family
qualify for government programs that help pay the costs.
Marshall
& Associates occasionally holds free educational forums to help
educate families about the options that are available to pay for long term
care in the home or a nursing home. Join
us for one of these free presentations and learn what you need to know
about how to get the help you need and protect your family's financial
security when your spouse or parent is faced with a long term illness.
Each
presentation is FREE and open to seniors, their families, elder care
professionals, and anyone else who needs to learn more about this complex
subject. Each presentation
lasts about 1 ½ hours, including a "Question & Answer" Session.
-
Thursday,
July 29th, 2004
at
6:00
PM
Ross
Library Community Room, Third Floor
232
West Main Street
Lock
Haven
,
PA
17745
Or
-
Wednesday,
August 11th, 2004
at
6:30PM
Jersey
Shore Elks Community Room
203
North Main Street
Jersey
Shore
,
PA
17740
Reservations
are suggested, but not required. SIGN
UP ONLINE
or call 1-800-401-4552 for more information or to reserve your spot for
one of these free seminars!
Back
issues of The
Elder Care Law Alerts
are available on our website.
You
can even search our site by a keyword
or phrase!
Do
you have a friend or colleague who would enjoy reading the
Elder Care Law Alert? If
so, please feel free to forward it to them. Simply use the "Forward"
button on your e-mail program.
To
subscribe or unsubscribe to the Elder Care Law Alert,
simply
send your request to:
webmail@paelderlaw.com
*Attorney
Marshall
is
certified as an Elder Law Attorney by the National Elder Law Foundation
under authorization from the Pennsylvania Supreme Court
© 2000-2005
Marshall & Associates www.paelderlaw.com
