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Nursing Homes Say: Hold the Meatloaf...Pass the Lo Mein, Please

There’s a growing trend among the nation’s more than 15 thousand nursing homes to break away from rigid meal schedules and standard menus to individualized meals which acknowledge their residents’ dietary, ethnic and cultural diversity.  Rather than chicken and mashed potatoes Tuesdays imagine instead a Thai-style soup with fresh ginger, vegetables and thin-sliced beef as an option.

The Associated Press reports:

“...the federal government is proposing regulations that would require facilities to create menus that reflect religious, cultural and ethnic needs and preferences, as well. Further, the proposed rules would empower nursing home residents with the "right to make personal dietary choices."

The government acknowledges that the nation's 1.4 million nursing home residents are diverse and that ‘it may be challenging’ to meet every preference. But it wants facilities to offer residents ‘meaningful choices in diets that are nutritionally adequate and satisfying to the individual.’ “

Advocates have argued for these changes for decades but cost is a challenge. 

“Janet Burns, chief executive at Sunny Vista, said the cost of fresh food is lower than prepackaged meals, but labor costs are higher. Her dietary costs were $1.08 higher than the nation's average in 2014. However, she said, higher costs are offset by things like preventing weight loss, a problem experienced by many nursing home residents. For example, she said, medication to increase a resident's appetite is more expensive than preparing a special meal. Costs aside, Burns said, ‘It's the right thing to do.’"

The benefits of more appealing and healthier food options could improve not only the quality of life but the health of residents.

“Sandra Simmons, a professor at Vanderbilt University who studies quality of care and life in institutional settings, says studies have shown that the daily caloric intake of 50 percent to 70 percent of nursing home residents is below recommended levels, she said.”

Something as simple as providing more appealing menus could make the difference. 

The Cruz/Fiorina Plan for Social Security and Medicare

Here’s a “Throwback Thursday” reminder of what a Cruz/Fiorina administration would mean for millions of Americans and their families who depend on Social Security and Medicare.

...at least what they’ll admit to today, anyway.  


New Medicaid Rules Designed to Put Care Over Profit

CMS has announced tightened Medicaid rules for private insurance plans that administer most Medicaid benefits for the poor. The Obama administration says the rules will limit profits, ease enrollment, require minimum levels of participating doctors and eventually provide quality ratings.  However, those ratings would still be years away as the industry continues to fight against such measures. 

Kaiser Health News provides details on the biggest changes for Medicaid managed care in a decade.  The new rules will:

  • Require states to set rules ensuring Medicaid plans have enough physicians in the right places. The standards will include “time and distance” maximums to ensure doctors aren’t too far away from members.
  • Limit insurer profits by requiring rate setting that assumes 85 percent of revenue will be spent on medical care. Unlike a similar rule for other plans, such as insurance sold through Obamacare marketplaces, the requirement would not compel Medicaid insurers to rebate the difference if they don’t hit 85 percent. Future rates would be adjusted instead.
  • Make plans regularly update directories of doctors and hospitals. A 2014 investigation by the Department of Health and Human Services’ inspector general found that half the doctors listed in official insurer directories weren’t taking new Medicaid patients.
  • Push plans to better detect and prevent fraud by providers, including mandatory reporting of suspected abuse to the states.
  • Tighten rules for Medicaid plans and states to collect patient data and submit it to HHS.
  • Make it easier for states to offer managed-care plans incentives to improve clinical outcomes, reduce costs and share patient information among hospitals and doctors.

Nearly two-thirds of Medicaid’s 72 million member are enrolled in private managed-care plans.  Consumer advocates have pushed HHS to set stricter rules for managed-care plans, which they said too often favored profits over patients. The industry and some state Medicaid directors resisted, saying plans needed flexibility to serve different members in different states.

The rules will be phased-in over the next three years, starting next summer. 


New Report Shows Ethnic Discrepancies in Medicare Advantage

For the first time, the Centers for Medicare and Medicaid Services has released data on the racial disparities reported by Medicare Advantage patients. 

Despite advances in healthcare access, increases in spending, and improvements in quality over the last decade, there is well-documented evidence that members of racial and ethnic minority groups continue to experience worse health outcomes, CMS said.

The data in disparity of care for eight patient experience measures shows that in seven areas, Asians and Pacific Islanders rated their experience in scores worse than that of whites, compared to five areas for Hispanics, three areas for blacks and only two areas for American Indians and Alaska natives...Healthcare Finance News

The CMS report surveyed customer service responses in a variety of categories. In categories of how easy it is to get needed care; getting needed prescription drugs; and getting information from their health plan about prescription drugs, whites gave the highest ratings, according to the survey.

In a question of getting appointments and care quickly; getting customer service from a health plan; and care coordination, American Indians/Alaska natives gave the highest scores. Blacks gave the highest score when asked how well doctors communicate with them. Asians and Pacific Islanders gave the highest score in a question of getting an annual flu vaccine.

"These data are a good first step in understanding disparities in Medicare Advantage," said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. "We look forward to working with plans in closing the differences in the quality of care that people with Medicare Advantage receive." 

Achieving Health Equity will also be the topic of a Congressional forum later this week, hosted by House Energy and Commerce Committee Democrats in partnership with the Congressional Black Caucus (CBC), Congressional Hispanic Caucus (CHC), and Congressional Asian Pacific American Caucus (CAPAC). 

Unequal Pay’s Lasting Legacy: Lost Income from Your 1st day at Work until the Day You Die

Max Richtman, NCPSSM President/CEOMax Richtman, NCPSSM President/CEO

It’s certainly not news that American women continue to earn less than men for the same work, typically 79 cents on the dollar.  But what’s less understood is the devastating impact those lost wages have over time.  In fact, over a working woman’s career, that pay gap could accumulate to a half million dollars in lost income and even more for women of color.  A comprehensive analysis of gender pay inequality, released by the Joint Economic Committee’s Democratic staff, shows how the gender pay gap grows over time.  It’s not just an issue for working women because this inequality can also have a compounding and devastating impact on retired women.

The thought of running out of money in retirement keeps 57% of women awake at night. That’s not a surprise when you consider the many combined factors which make retirement especially challenging for American women. Women earn less than men even when doing the same jobs, they more often work part-time or in jobs that do not offer retirement savings plans, and they tend to spend more time out of the workforce as a consequence of their caregiving responsibilities. Women could lose $430,480 in earnings over the course of a 40-year career due to the wage gap alone.  For Latinas the career losses mount to $1,007,080, and for African American women the losses are $877,480. Lower career earnings also translate to fewer savings for many women in retirement. At the same time, their longer lifespan and higher chances of disability means that they will have higher retirement costs, both for everyday expenses and necessary medical care.

These financial obstacles facing older women explain why women are 80% more likely than men to be impoverished at age 65 and over. The median income of women age 65 and older is 44% lower than the median income of men of the same age and that poverty gap widens over time due to decreasing income for women at older ages. Women aged 75 to 79 are three times as likely and those over the age of 80 are twice as likely to live in poverty compared to men. While it’s self-evident that working women must be aware of the unique challenges they could face in retirement, simply understanding these issues won’t be enough to bridge the very real gap created by systemic and demographic forces far beyond their control.  That’s why the National Committee to Preserve Social Security and Medicare launched our Eleanor’s Hope initiative.  We’re not only educating but also advocating for legislation that addresses the inequities threatening millions of retired women while also working to elect lawmakers who share our vision of retirement equity for women. 

There are a number of proposals which, if adopted, could significantly level the playing field for women and reduce the threat of poverty in their old age: 

Gender Pay Equity. Eliminating the wage gap that limits women’s earnings is essential to helping our daughters and granddaughters save for their own retirement. Congress should strengthen and reform the “Equal Pay Act” by putting an end to pay secrecy, strengthening workers’ ability to challenge discrimination and bringing equal pay law into line with other civil rights laws.  

Caregiver Credit. Compute the Social Security benefit by giving an annual caregiver credit for each year of caregiving so that total earnings for the year would equal 50 percent of that year’s average annual wage. Caregiving service years would be those in which an individual provides care to children under the age of six or to elderly or disabled family members. Up to five family service years could be granted to any worker.

Improve Survivor Benefits. Increase the benefit paid to a surviving spouse to an amount that is equal to 75 percent of the total combined benefits that were paid to the couple prior to the spouse’s death, capped at the benefit level of a lifelong average earner.

Consumer Price Index for the Elderly. Adopt the Consumer Price Index for The Elderly (CPI-E) for the purpose of determining the amount of the cost-of living adjustment (COLA) adjustment for Social Security benefits. This is especially important for women who tend to receive benefits longer because they live longer.

It’s been more than 50 years since our nation acknowledged and attempted to address, with passage of the Equal Pay Act, the gender wage gap which unfairly targets half of our population with billions in lost wages.   Yet, at the current rate of change, it will take another 40 years to close that gap.   That’s simply not an option for generations of American women who will continue to face the consequences of income inequality from their very first day on the job until they die.  

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