The Law Will Require Development Of A Strategy To Recognize And Support Family Caregivers
In January, Congress passed and President Donald Trump signed the RAISE Family Caregivers Act. The law creates a strategy to support millions of people who help loved ones remain in their homes.
Here is what the new law will require.
- Require HHS to develop, maintain and update a National Family Caregiving Strategy, offering resources and education opportunities to family caregivers in the United States;
- Require HHS to convene a Family Caregiving Advisory Council to advise it on recognizing and support family caregivers;
- Promote greater adoption of person and family centered care in all health and long-term services and supports settings; and
- Ensure older adults with disabilities and illnesses receive high quality care in their homes.
Senators Susan Collins (R-Maine) and Tammy Baldwin (D-Wis.) and Representatives Greg Harper (R-Miss.) and Kathy Castor (D-Fla.) spearheaded the legislation.
The bill as it moved through congress was also backed by AARP. “Family caregivers are the backbone of our care system in America,” said Nancy A. LeaMond, AARP’s chief advocacy and engagement officer. “We need to make it easier for them to coordinate care for their loved ones, get information and resources and take a break so they can rest and recharge."
These family caregivers have a big job, but some basic support — and commonsense solutions — can help make their big responsibilities a little bit easier.
We are grateful to Congress and “This is forward progress, but it should not be the end of the journey. - Charles Fuschillo, Jr., President and CEO of the Alzheimer's Foundation of America
Across America, family caregivers help parents, spouses, children and adults with disabilities and other loved ones to live independently. They prepare meals, handle finances, manage medications, drive to doctors’ appointments, help with bathing and dressing, perform complex medical tasks and more — all so loved ones can live at home.
So What Will The RAISE Family Caregivers Act Really Do?
The RAISE Family Caregivers Act requires the U.S. Secretary of Health and Human Services (HHS) to develop, maintain and update an integrated national strategy to support family caregivers. According to the Act, HHS will create a national family caregiver strategy by bringing together federal agencies and representatives from the private and public sectors (like family caregivers, health care providers, employers and state and local officials) in public advisory council meetings designed to make recommendations. The agency will have 18 months to develop its initial strategy and then must provide annual updates.
So we can say that the aim of this new law is certainly needed, well intentioned and could be of great help to the 40 million family caregivers with an elder or disabled loved one at home. What could be wrong with that?
What We See Is Wrong With The RAISE Act
Funding, simply put. Implementing any national strategy will create a large cost that our polarized Congress is unlikely to fund. The RAISE Act is supposed to help family caregivers keep working outside the home. The question is: Who is going to pay for the replacement caregiver when the family caregiver goes back to work? Respite options are to be included as part of the Act. That means that the family caregiver gets time off to rest. And what happens to the elder or disabled person when the family caregiver is getting that break? Someone has to pay for the actual cost of placing the care recipient in a facility temporarily or paying someone by the hour to care for them temporarily. We have no such national programs now. Strategizing about programs is not the same as paying for programs.
Age Related Illness and Disease
Alzheimer’s disease and Dementia are affecting seniors in growing numbers. The result is literally millions of people become family caregivers and are quitting their jobs to care for their loved ones part time or full time. Passing a law requiring an integrated strategy is fine, however funding research to find a cure for the sixth leading cause of death in the U.S., Alzheimer’s disease, is hugely important. Caregiving for a loved one with Alzheimer's can last 20 years.
The RAISE Act is an important step toward more fully recognizing the impending crisis in caregiving as the aging population continues to grow. As improved guidelines and policies develop from the legislation, funding will be required to relieve the 2015 AARP estimate of $470 billion in unpaid care and the 2016 AARP estimate of $7,000 in out-of-pocket expenses provided annually by family caregivers. - Kathleen Kelly, Executive Director - Family Caregiver Alliance
We have not seen as part of this new law, any mechanism for Funding caregiver relief, disease research, housing assistance for seniors or any other important caregiver related need. Referring this lack of funding, Charles Fuschillo, Jr., President and CEO of the Alzheimer's Foundation of America is quoted in a press release from GlobeNewswire: “We are grateful to Congress and “This is forward progress, but it should not be the end of the journey.”...This encouraging development is only the tip of the iceberg. A dire need remains for the federal government to pass a Fiscal Year (FY) 2018 budget which includes $2 billion—up from the current amount of $1.4 billion—for Alzheimer’s disease research at the NIH." (National Institutes of Health).
Caregiver Training, Medical Assistance And Financial Relief
According to AARP, family caregivers “commonly experience emotional strain and mental health problems, especially depression, and have poorer physical health than non-caregivers.” And they rarely receive training in providing care.
And 78% of them incur out-of-pocket costs due to caregiving, spending $6,954 a year, on average, according to AARP. That’s estimate of $470 billion in unpaid care each year. Recognizing and strategizing about this with a new law is not the same as funding a solution.
What Concerns Me Is What’s Missing In This Law
To be effective and not just a list Advisory Councils, Strategies, and Unfunded Departments, I see several main things that could be put in place rather quickly and which would provide much needed help for families faced with a senior caregiving situation. Consider the following:
- Allow family caregivers an amount stipulated on their tax return that funds their lost wages in regards to social security. In other words fill those gap years in their ss earnings with a stipend so they do not lose benefits they will need when they themselves retire.
- Congress needs to pass a law allowing Medicaid funds to be used to pay for Adult Foster Care Homes and not just nursing homes. These homes cost on average ½ of the cost of a nursing home, which is the only option open to those whose funds have run out. The care in these homes as good and many times proven to be better than traditional nursing homes. The smaller environment can be a great benefit to patients with forms of dementia and Alzheimer’s disease and the staff to patient ratio usually much better. Just ask, me I am a huge advocate for these homes.
- Allow family caregivers who leave work to care for a loved one to draw a caregiver wage from the government if they meet certain income requirements. If a person cannot financially leave a job to care for someone, that person ends up in a nursing home and that cost the government and the economy on average 8-10,000 per month per resident! Again you could pay a family caregiver a fraction of that, save money and the patient gets better care! It’s a win win solution.
Senior Homes - What are the Options in Your State
In your search for a place for yourself or a place for mom or dad to live, you are seeing so many different names and terms for various types of senior homes and senior living. These terms and names have changed over the years and what we may have at one time called a 'Nursing Home' or 'Old Folks Home' are now called many other things. At one time thoughts of white-walled, institutional settings we we’re hesitant to visit are now independent and assisted living options offering a wide range of appealing amenities, features and socializations.
Assisted Living, Adult Foster Care, Nursing Home, Board and Care Homes.
The different levels of care available today will depend on you or your loved one's needs, and various options, depending on a senior's health, age and financial status.
What is very important however, is that most if not every state in the U.S. has it's own definitions - descriptions and usually licensing requirements for senior living options. This is where we provide you with an important and useful resource for finding what your states options are.
To discover what senior living options are offered in your state:
Information updated regularly.
When it comes time to choose a home for you or your senior Loved One, you may discover it is a difficult task. Your goal is to find the best home possible yet you may be looking at many, even dozens of homes on a list. How will you make the right decision?
Across the country, thousands of nursing home residents face this situation every year:
"You had to go to the hospital, and when it came time to return home, to your nursing home, you were told you couldn't move back in"
This news is according to an article on the website NPR – National Public Radio.
I was on the forums these past few days and one of the threads was talking about how many days are covered by Medicare in a Nursing Home or Rehab after a hospital stay. The answers were all over the map and quite confusing I must confess, so I thought I would do a post about it to clear things up. I have always told my readers I am no expert, but when it comes to this subject I know it all to well. You see my mom has been in and out of rehab 3 times in the past 2 years so we know the rules by heart.
According to Medicare rules a person must have a qualifying hospital stay of at least 3 days, ( 24 hours) and be in need of further skilled nursing or rehab care in order for them to pay for the stay. The doctor and the physical therapy department at the hospital must agree that the patient would benefit from continued care or therapy at a nursing home or rehab facility.
It is important to note at this point that the patient needs to be an inpatient at the hospital for 3 days, and time spent in observation or the ER does not count. They have to be admitted to the hospital. This is very important!
Insurance companies and Medicare are putting increased pressure on doctors so that they do not admit patients. They have narrowed the guidelines for admittance and now many patients are ending up in observation for 1, 2 or 3 nights and then they do not qualify to go to rehab under Medicare.
If a person has a qualifying stay of 3 days then Medicare will pay for nursing home or rehab as follows:
1. Day 1-20 Covered 100%
2. Day 21-100 partial coverage with a 161.00 a day co-pay
3. Day 101 and beyond no coverage
Many Medicare supplement policies like the one my mother has will cover the copay on days 21-100 so there is no out of pocket for the patient. However this is something you should look into ahead of time so you know your coverage should you or a loved one be in this situation.
During the time in rehab the patient must continue to show that the services provided are helping them to improve. So if at anytime during their stay the team feels they have done all they can for the patient the team is obligated to discharge them, even if they have days left.
Now there is something to be said about having days left over. If the patient leaves rehab or nursing care and they need to be readmitted to the facility within 30 days and have days remaining they will have coverage through Medicare. If they use up all their days then they would have to wait 60 days and have another qualifying hospital stay of 3 days before Medicare would pay for skilled nursing care or rehab again. This would start their 100 day benefit period over again.
I am providing a link here that goes to the Medicare.gov site for skilled nursing care. It has more information for you.
I do hope this information helps you understand the process a bit better. If you have any questions or comments please feel free to contact me or leave a comment at the bottom. We always love to hear from you. Remember you are not on this journey alone.