Advocacy

Medicare: Lawsuit charges government with denying care to thousands of chronically ill

San Jose Care Resource Guide: Yes,  we sometimes have to sue Medicare, i.e. our government, to get proper care.  Here is a link to the article in the  Chicago Tribune. This article was brought to our attention by Ernest A. Wahrburg, BA(PSY), MSW, LCSW (NC & NY)/LinkedIn

Quoting the Chicago Tribune: “…The  Center for Medicare Advocacy, which filed the lawsuit with Vermont Legal Aid on behalf of the National Multiple Sclerosis Society, Parkinson’s Action Network, Paralyzed Veterans of America, National Committee to Preserve Social Security and Medicare, and American Academy of Physical Medicine and Rehabilitation…”

So what is the Center for Medicare Advocacy? Seems like a large well organized pro-Obamacare health care advocacy site. In fact one one their article’s title is “HEALTH CARE REFORM DOES NOT CUT MEDICARE BENEFITS” ….

So why are they suing Medicare, A.K.A, the (Obama) government?

Quoting the Tribune, quoting them,

“…Under the law, Medicare is obligated to provide health care and therapy that are “reasonable and necessary for the diagnosis or treatment of illness or injury,” according to the legal complaint. Yet through the years, program administrators have decided that services will only be reimbursed if patients show signs of getting better, the complaint notes…..”

San Jose Care Resource Guide: This Medicare policy, of course, choose to ignore that , for many  chronically ill, not getting worse is the name of the game!

San Jose Care Resource Guide: Fact is, bombast or not, liberal government will cut and/or weazzle out of social obligations like anybody else….Particularly when the group targeted for cuts does not seem politically significant. I.e. the disabled….The Obama admistration will rather spend our healthcare money on worthy  causes like

See our previous posts on the topic

• With Medicaid waiver, California dives into health care reform (stateline)
• Multiple sclerosis and it’s Financial Burden: Comments on the Guardian’podcast
•  HealthCare: California’s Gov. Brown’s proposed steep healthcare cuts
• Ways The New Health Law May Affect You in 2011 (KHN)
• Health Care Law Should Help With Jail Inmate Treatment (thecrimereport)
• Medi-Cal and Gender Reassignment Procedures

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Palliative Care and End-of-life: How it’s Done

San Jose Care Resource Guide:  In End-of -Life decisions, it is important to realize how the “patient”  would  be

1.  Euthanized, or
2. Terminated, or
3. Killed.

 Pick your choice of terms according to your belief system,  (yes, atheism is a belief system too…)

San Jose Care Resource Guide: 

Since a lot of patients are on respirators at the time this would be done. [We use the word "done"  instead of "happen" because this is an active decision on the part of the patient (if conscious), the medical palliative care  team, and of the family.]   We found this article in the  Journal of Pain and Symptom Management .  This study is about  the influence of morphine injection on time to death after withdrawing ventilation from a terminal patient. Click  Here Article is from East Carolina University.

San Jose Care Resource Guide,  quoting:  “…The mean time to death after terminal extubation was 152.7 ± 229.5 minutes without correlation with premorbid diagnoses..After extubation, each 1 mg/hour increment of morphine infused during the last hour of life was associated with a delay of death by 7.9 minutes …”(Extubation: remaval of the respiration devices}

San Jose Care Resource Guide: So,

• 152.7 + 229.5 minutes=382.20min  6.37 hrs:       We are kinder to criminals with lethal injections…see below
• 152.7 - 229.5 minutes=382.20min=-76.8 min:       Negative time a little confusing??

Compare the duration of death by extubation we mentionned above,  to the duration of the death penalty procedure by lethal injection.  

Quoting Medscape Today:   “….According to the North Carolina Department of Corrections, once the ECG monitor displays a flat line for 5 min, the warden declares death and a physician certifies that death has occurred. Execution start times and declaration times were available for 33 of the 42 lethal injections conducted in North Carolina … Mean times to death [for lethal injection ececutions] were 9.88 ± 3.87 min for Protocol A, 13.47 ± 4.88 min for Protocol B, and 9.00 ± 3.71 min for Protocol C…..”

San Jose Care Resource Guide: You can draw your own conclusions…

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Multiple sclerosis and it’s Financial Burden:Comments on the Guardian’podcast

San Jose Care Resource Guide:The Guardian brings us a podcast on the worsening financial  burden of  MSers. True, this is about NHS in England, but the austerity tidal wave has certainly hit the US too. For starters, look at our recent post on the cuts in California social and health safety net  by Gov. Brown (Click Here for that post)

San Jose Care Resource Guide: The guardian’s podcast is not going to make MSers feel better about their plight. Maybe it could emphasize the need to advocate for them and their family caregivers. Here is the link to the ‘cast

San Jose Care Resource Guide:  The recent change in the US Health Care system has emphasized dilution of the concept of disability and included questionnable ills in the society’s network. Just check out some of our previous posts:

• Ways The New Health Law May Affect You in 2011 (KHN)
• Health Care Law Should Help With Jail Inmate Treatment (thecrimereport)
• Is your government draining money away from the benefits of the highly disabled?

We must force the government to distinguish between true the true hardship of the auto-immune diseases such as Multiple Sclerosis, Parkinsons’,  Rheumatoid Arthritis, Lupus as well as all the forms of Cancers and Spinal cord Injury from more benign ills. The culprit? Here you have it :

“SUMMARY OF KEY PROVISIONS: EEOC’S NOTICE OF PROPOSED RULEMAKING (NPRM) TO IMPLEMENT THE ADA AMENDMENTS ACT OF 2008 (ADAAA)”

Please help hep Advocate for the truly disabled and/or chronically ill! CLICK HERE TO CONTACT US

Either way, we would love to hear your comments!

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HealthCare: California’s Gov. Brown’s proposed steep healthcare cuts

San Jose Care Resource Guide: Gov. Brown announces “painful” [for whom?] cuts in California’s healthcare system. Click Here for the Kaiser Health News/California Healthline link

Quoting:

The cuts, which total $12.5 billion, include some large reductions in health care services, including:

• $1.6 billion cut from Medi-Cal;
• $1.5 billion savings from reducing eligibility period for state health services;
• $1 billion cut from developmental services;
• $1 billion cut from In-Home Supportive Services; and
• $ 716 million reduction in child care services, including reduction in levels of subsidies.

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Ways The New Health Law May Affect You in 2011 (KHN)

San Jose Care Resource Guide: Kaiser Health News bring us a good summary of the Obama administration’s changes in Health Care Policies taking effect in 2011.

In a nutshell: 

• Seniors will get big discounts on prescription drugs 
•  Free preventive care      (Wallet neutral for you, and medically  questionable)
  • Studies abound on the cost effectiveness of preventive care, with varying enthusiasm
    • Robert Wood Johnson Foundation:  Some Health benefits, No Cost Benefit
    • Dr Joseph W. Stubbs, Amrican College of Physicians   : “..Too often our patients extract a psychological reassurance from screening tests that is not grounded in reality..”
• Food calorie counting more transparent: Might help obesity epidemic, limited value for seniors
• Some in Medicare Advantage plans may lose coveted extra benefits such as vision and dental coverage
• News taxes on drug companies: KHN/Fox  : That will help Research for that new treatment? , …not

Source: KHN

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Obama Returns to End-of-Life Plan, blames ol’ Bush… (NYT,WSJ)

San Jose Care Resource Guide: So Obama is after Grandma again (Ok, maybe Great-Grandma).

Quoting the New York Times:

“…When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1…”

Hey, we have the bully pulpit: If we can’t get it voted in, let us decree !

“…Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment…”

Question is:  Why does  the Obama administration want to take the risk of substantial fallout? For the possible Medicare savings, so that it continue catering to pet constituencies?

Answer:  Maybe, but more like social engineering and liberal credo  above all and   ”Damn the torpedoes” !

 Quoting the Wall Street Journal    (Dec,27,2010):

“…The new Medicare rule, issued Dec. 3, is less specific. It says advance-care planning includes a discussion of setting up an advance directive that would tell doctors what to do if the patient is too ill to make medical decisions…”

“… It [the White House] said the George W. Bush administration had already put in place guidelines allowing for Medicare to pay for end-of-life consultations….”      So, Obama tries to blame President Bush for this shameful attempt at pressuring the eldely and/or very sick to call it quits. Facts are a little bit different.  Quoting the WSJ’s article  again:

“…Corrections & Amplifications :
Congress passed a law making changes to Medicare in 2008 by overriding President George W. Bush’s veto. A previous version of this [WSJ] article incorrectly said Mr. Bush signed the legislation…”     Ooops! 

Let us now imagine the Dialogue Doctor and sick elderly. It would go something like this:

Medicare Doctor: Good morning Ms Jane Doe! How are we this morning?

Sick Elderly: Oh not so good: I feel weak and in pain.

Medicare Doctor:  Well, Jane, I afraid it is not go going to get better. Probably worse….

Sick Elderly:  What can you do for me?

Medicare Doctor: Jane there is this [expensive] chemotherapy , but the side effects will be hard. More [expensive] surgery is possible, but there are no promises that you will feel better, in fact probably worse….

Sick Elderly: But I will see my grand kids for a little longer….

Medicare Doctor: You might not be able to enjoy them through the coming pain…In fact it might be a traumatizing sight for them.

Sick Elderly: Really, I did not think of that….

Medicare Doctor: I am authorized to let you know we can help you part with dignity and less pain. Think of it…

Was the Sick Elderly lied to?  Probably not.  Was she led to believe it is OK to end a life softly and at will?  Probably so. You see, folks, it boils down to your philosophy: In a G-dless world were life is just an accident of nature, euthanasia  or the killing softly of the very sick could make sense to a lot of people. To a lot of  people turning their back on the Bible that is…..

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Innovative Day-Care Program Seeks To Keep Frail, Low-Income Seniors In Their Homes

San Jose Care Resource Guide: From  Patricia Grace , (Aging with Grace)  this link to a Kaiser Health News/washington post   article on the  Adult Care Program PACE,  was brought to our attention.

San Jose Care Resource Guide:  This article by KHN underlines the efforts of the PACE program.What is PACE?  A government-subsidized day-care program for adults. Quoting the article:

“…One of PACE’s biggest boosters is Donald Berwick, a physician who heads the federal Centers for Medicare and Medicaid Services, or CMS, which oversees the PACE sites….”

Most important question: What are the income ceiling requirement to be eligible for a PACE program: Click Here for the requirement :

“..To be eligible for PACE, a single person’s income must be $14,500 or less; a couple’s income must be $17,000 or less.”

However,  Another blurb for the PACE program has a slightly different take on the elegibility issue:

“…Does PACE serve only the low-income elderly population? There is no income eligibility for participating in PACE. However, most current PACE participants have lowincomes and are eligible for Medicaid. In many states PACE originally was developed specifically to serve adual-eligible population. Participants not eligible for Medicaid pay that portion of the capitation privately. Long term care insurance, if available, also may pay all or a portion of this premium..”

That “portion of capitation”  could be very large!   As always, the US middle class is ignored, and left to their grief….. In our two careers family structure, cases where elderly parents and other family members require low level  daytime caregiving can present a substantial amount of stress to their relatives. Nevermind the risk to the elderly…chances are if the family or the elderly are above minimum wage/poverty level incomes, this beautiful PACE program could be a myth…

Life at the window: at least he's safe....

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Caregiving: Carer’s and Disability Allowances decreased in Ireland, but non existent in US

San Jose Care Resource Guide:

Irish caregivers are upset because their allowance is decreasing. Click Here for link to the IrishTimes….. 

But compare with  the help to caregivers receive (not) in the US : Essentially limited to destitute individuals!

• Click Here for  a link to SSI [Social Security's  Supplemental Security Income (SSI)] :
• Click Here for the SSI max resource threshold for elegibility:
  • “To get SSI, your countable resourcesresources must not be worth more than $2,000 for an individual or $3,000 for a couple. We call this the resource limit.”

It is cold out there!

NOTE: The San Jose Care Resource Guide Just  Created an ADVOCACY Page.

Check out on the top Menu!

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About Caregiving and divorced parents (Huffington)

SJCRG: Another painful side effect of divorce. Click here for the link to the article in the Huffington Post

SJCRG: I could go on an old curmudgeon’s  rant about the causes of divorce, but I would probably loose you guys in the process.  So I will be quiet, but you get my drift…

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Is your government draining money away from the benefits of the highly disabled?

SJCRG: To know  what has happened, we will quote from this link at Occupational Health and Safety site

“….Since the enactment of the Americans with Disabilities Act (ADA) twenty years ago, the definition of “disability” has shifted from an underlying physical or mental condition to a complex interaction between a person and his or her environment….”

The full extent of the difference is summarized in this text from the EEOC: “SUMMARY OF KEY PROVISIONS: EEOC’S NOTICE OF PROPOSED RULEMAKING (NPRM) TO IMPLEMENT THE ADA AMENDMENTS ACT OF 2008 (ADAAA)”

Bottom line the definition of disability is now much broader and the burden of proof much lighter: good or bad.Think in terms of a shrinking economy, more people entitled, with less money to go around.

We believe the truly disabled, i.e. , those who fit  the strictest definition, have been short changed. A typical impact can be seen in our post on the wheelchairhealth site on the greater difficulty that highly disabled have to get the high tech power wheelchair they need!

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