Posted by admin on January 25, 2017 · Leave a Comment
Bill is considering bringing in a home health aide to help with his mother, Nancy, who has limited mobility from Parkinson’s disease. He was a little hesitant at first, because he was concerned about quality of care. He has been the one who has been solely caring for her for years, and was worried that she wouldn’t receive the same treatment from a stranger he hires through an agency. Now, for people like Bill and Nancy, there are new rules to ensure that home health care providers meet certain standards for in-home care, and patients have more rights.
Currently, there are more than 5 million Medicare and Medicaid beneficiaries receiving home health care from nearly 12,600 Medicare and Medicaid-participating home health agencies nationwide. Home health care is designed to allow patients to receive needed health care and custodial care services within the comfort and safety of their own homes. Patients receive coordinated services including assistance with activities of daily living, skilled nursing, physical therapy, medical social services, and more — all under the direction of their physician.
This month, the Centers for Medicaid & Medicare Services finalized a
rule that sets minimum standards for home health agencies. The rule is aimed at improving the quality of care for Medicare and Medicaid beneficiaries and boosting patients’ rights. According to Kate Goodrich, MD, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality for CMS, “Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies. The announcement was the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholders and medical evidence.”
The 374-page rule sets out conditions for home health agencies to be able to participate in federal Medicare and joint federal-state Medicaid programs. The rule includes requirements in training, competency, and patient rights. The following is included in the final rule:
◾A comprehensive patient rights condition of participation that clearly enumerates the rights of home health agency patients and the steps that must be taken to assure those rights.
◾An expanded comprehensive patient assessment requirement that focuses on all aspects of patient wellbeing.
◾A requirement that assures that patients and caregivers have written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform and the name and contact information of a home health agency clinical manager.
◾A requirement for an integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines and that there is active communication between the home health agency and the patient’s physician(s).
◾A requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that continually evaluates and improves agency care for all patients at all times.
◾A new infection prevention and control requirement that focuses on the use of standard infection control practices and patient/caregiver education and teaching.
◾A streamlined skilled professional services requirement that focuses on appropriate patient care activities and supervision across all disciplines.
◾An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.
◾Revisions to simplify the organizational structure of home health agencies while continuing to allow parent agencies and their branches.
◾New personnel qualifications for home health agency administrators and clinical managers.
“We are revising the home health agency requirements to focus on a patient-centered, data-driven, outcome-oriented process that promotes high quality patient care at all times for all patients,” the final rule says.
Home health agencies must meet these requirements and others laid out in the rule to be eligible to provide services to Medicare and Medicaid beneficiaries. The regulations are set to take effect July 13, 2017.
Choosing a Home Health Care Provider
There are many important factors to consider in choosing the best agency to meet your needs, most important of which is to assess what types of services you or your loved one will need.
When selecting an agency, it is important to ask the appropriate questions during your initial meeting. Below is a list of sample questions:
• How many years has the agency been serving your community?
• Does the agency offer printed material describing its services and costs? (i.e. brochures, flyers)
• Is the agency an approved Medicaid provider?
• Is the agency accredited? In other words, has their quality of care been surveyed and approved by an outside accrediting organization (such as CHAP, JCAHO or Medicare)?
• Will the agency provide a list of references?
• Is the agency licensed by your state (if required)?
• Does the agency provide patients with a “Bill of Rights” that outlines the rights and responsibilities of the agency, patient, and caregiver alike?
• Is there a written plan of care for the patient’s treatment that the patient, physician and family participate in developing?
• Is this plan updated over the course of the treatment?
• Does the patient get a copy of the plan?
• Does the agency staff educate the family members on the care being administered to the patient and ways they can assist?
• Is the patient’s course of treatment documented, detailing the specific tasks to be carried out by each professional? (i.e. medicines, exercises, daily activities)
• Are supervisors assigned to oversee care to ensure that the patient receive quality treatment?
• Are agency caregivers available seven days a week?
• Does the agency have a nursing supervisor on call and available 24 hours a day?
• Does the agency ensure patient confidentiality? How?
• How are agency employees hired and trained?
• Does the agency require criminal record background checks and communicable disease screens for its employees?
• What is the procedure for resolving issues that may arise between the patient/family and home healthcare staff?
• Who can you call with questions or complaints regarding patient care, caretaker issues or general questions?
• What happens if a staff member fails to make a scheduled visit?
• What should the patient do in this situation?
• Who does the agency call if the agency caretaker cannot come when scheduled? (i.e. patient or family member)
• What is the agency caretaker required to do? (i.e. inform patient, reschedule)
If you purchase home healthcare services from an individual rather than through an agency, it is important to screen the individual person(s) providing the scheduled care. Interview the caregiver to be sure he or she is qualified for the job. It is helpful to ask for references, as well as, to have a list of required tasks the caretaker may have to perform with the patient (i.e. getting in and out of a wheelchair, bathing, administering specific types of medicine). This way you know that he or she can indeed perform these tasks. It is also important to have a Caregiver Contract in place.
Please see our article on this topic.
When Aging in Place is No Longer an Option
Most people want to stay in their home for as long as possible, with or without the assistance of a home health aide. However, if you or a loved one cannot live independently and are showing signs that living alone is a strain, it may be time to consider other alternatives.
Whether the outcome is assisted living or nursing home care in the future, it is always wise to plan ahead.
Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Please know that The Law Firm of Evan H. Farr, P.C. is here when you need us — just call to make an appointment for a no-cost initial consultation:
Fairfax Medicaid Asset Protection Attorney: 703-691-1888
Fredericksburg Medicaid Asset Protection Attorney: 540-479-143
Rockville Medicaid Asset Protection Attorney: 301-519-8041
DC Medicaid Asset Protection Attorney: 202-587-2797
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Posted by admin on January 21, 2017 · Leave a Comment
The amount of your Social Security benefit is calculated by averaging the earnings from your 35 highest income-generating years. The maximum monthly Social Security check that you can earn is $2,639 per month in 2016. To sign up for Social Security benefits, it is recommended that you apply three months prior to your retirement date.
When to Collect Social Security Benefits
Nearly six in 10 retirees claim Social Security benefits before they reach full retirement age, according to a recent survey by Franklin Templeton Investments. Only about 16% claim their benefits when they hit full retirement age. (7% of people surveyed delayed their benefits past full retirement age, 4% were eligible for benefits but haven’t taken them yet, and 14% weren’t eligible.)
Here are some things you should know:
• You may choose to retire as early as age 62, but doing so may result in a reduction of as much as 30% of your benefits, according to the Social Security Administration (SSA).
• For early retirees, the SSA reduces a retirement benefit by 5/9 of 1 percent for each month before normal (or full) retirement age, up to 36 months. If the number of months exceeds 36, then the benefit is further reduced by 5/12 of 1 percent per month.
• The Social Security Administration also imposes limits on income for early retirees. For instance, if early retirees earned more than $15,720 in 2016, their benefits would be reduced by $1 for every $2 they earn above the limit.
• Each year you wait past full retirement age to claim Social Security benefits up to age 70, you earn an 8 percent delayed retirement credit that will increase your Social Security benefits in addition to cost of living adjustments.
What’s Your Full Retirement Age?
If you’re born between 1943 and 1954, your full retirement age is 66. Then the full retirement age increases in two-month increments each year for those born between 1955 and 1959. For example, if you were born in 1956, your retirement age is 66 and 4 months. For those born in 1960 and later, the full retirement age is currently 67. (The SSA offers a calculator to help with the math.)
For additional information about how and where to apply for Social Security benefits, go to http://www.ssa.gov/.
Changes in 2017
The nation’s more than 65 million Social Security recipients will get a 0.3 percent cost of living increase in payments in 2017. For the average retired worker, who has a monthly benefit of $1,355, this translates to an increase of just over $4 per month.
Cost of living increases are tied to the consumer price index, and low inflation rates and gas prices means smaller increases. The cost of living change also affects the maximum amount of earnings subject to the Social Security tax, which will increase to $127,200 from $118,500. For highly paid employees, this means that the maximum Social Security tax in 2017 is increasing by about $540. For self-employed individuals, who pay both the employer and employee portion, the maximum Social Security tax bill is increasing by twice that amount.
These are some additional changes:
• Full retirement age is increasing: For seniors reaching the age of Social Security eligibility over the past decade or so, full retirement age (FRA) for Social Security has been 66 years old. In 2017, however, full retirement age will begin to increase for eligible beneficiaries.
Specifically, for people born in 1955 — and therefore turning 62 in 2017 — full retirement age will increase by two months, to 66 years and 2 months. Why is this important? It’s a well-known fact that claiming Social Security before full retirement age results in a permanently reduced benefit. Now, people who claim Social Security as early as possible won’t be four years early — they’ll be four years and two months early, which results in an even bigger reduction.
As an example, let’s say that your Social Security benefit at full retirement age is estimated to be $1,500 per month. If you turned 62 in 2016, you would be entitled to $1,125 per month if you claimed your benefit as soon as possible. On the other hand, if you’ll turn 62 in 2017, your benefit at that age would drop to $1,112.50.
• People who claim Social Security before full retirement age and continue to work are subject to the “earnings test.” If these beneficiaries earn more than a certain threshold, their benefits can be reduced. Fortunately, both thresholds of the earnings test have increased significantly for 2017.Beneficiaries who will reach full retirement age after 2017 can earn up to $16,920 for the year ($1,410 per month) with no benefit reduction. Beyond this amount, $1 in benefits is withheld for every $2 in earnings. Beneficiaries who will reach full retirement age during 2017 can earn up to $44,880 per year ($3,740 per month) with no benefit reduction. Beyond this amount, $1 in benefits will be withheld for every $3 in earnings. This test only applies in the months prior to the month the beneficiary will reach full retirement age. These annual income thresholds are up from $15,720 and $41,880, respectively, so this could make a big difference for working Social Security recipients.
• New retirees could get a higher maximum benefit: The maximum initial Social Security benefit for a worker retiring at full retirement age has increased, thanks to the higher taxable wage limits of recent years.Specifically, the highest possible benefit a new retiree can get if they claim at full retirement age is now $2,687 per month, $48 higher than last year. Keep in mind that to get this amount, the worker would need to have earned more than the Social Security taxable wage limit for 35 years.
Social Security is Complex
As you can see, Social Security rules and strategies are very complex. Before making any decisions, be sure to educate yourself. Below are tools related to Social Security and retirement planning, that can provide more details:
• For lots of additional details about Social Security, including spousal benefits, please visit our Social Security FAQ page.
• Read our articles: Ask the Expert: Can You Explain Social Security, please?, Can You Retire On Social Security Alone?, and What She Doesn’t Know About Social Security Could Cost Her Thousands.
• Check out AARP’s Social Security Planning guide.
It’s important to consider your options when filing for Social Security benefits. It is also important to keep in mind what could happen if you are living on Social Security alone and you or a loved one becomes incapacitated. You must take this into account when planning for retirement. Every adult over the age of 18 should have an Incapacity Plan that includes a Financial Power of Attorney, an Advance Medical Directive, and an Advance Care Plan. If you don’t have an Incapacity Plan in place, now is the time to get started. Please call the Farr Law Firm as soon as possible to make an appointment for a no-cost consultation:
Fairfax Retirement Planning: 703-691-1888
Fredericksburg Retirement Planning:: 540-479-1435
Rockville Retirement Planning:: 301-519-8041
DC Retirement Planning:: 202-587-2797
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