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Geriatric Care Services Industry Projected to Exceed $1.1 Billion by 2023

As more baby boomers shift into retirement age, the emphasis on geriatric care services to meet the elder population’s growing needs becomes greater. According to a statement released by Global Market Insights, Inc., the geriatric care services market size is estimated to see revenues of $1,101,800,000 by 2023. The elder care industry reached $684 billion in 2015, and will steadily increase over the next couple of years due to the increase in the retirement-age population, in conjunction with growing disposable incomes.

The largest contributor in the geriatric care services market is Medicaid’s institutional care centers, which reached $279 billion in revenue in 2015. Medicaid is a federally funded program administered by the states that provides medical coverage and long-term care to middle-to low-income persons, including the disabled and the elderly.

Institutional care centers covered by Medicaid are residential facilities and around-the-clock, comprehensive elder care services. Medicaid coverage may include hospital and physician care, prescriptions, home care, nursing home care and other health-related expenses. Medicaid eligibility is based on income and resource restrictions and, although anyone may submit an application, an individual’s criteria must be reviewed and approved through the application process.

P&P Medicaid assists clients in the preparation of Medicaid applications for eligibility. Our company also provides a full range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs. Please contact P&P Medicaid Consulting, Inc. at (516) 541-4770 for more information.

New York Medicaid Expands its Services for Women’s Health

Effective June 1, 2016, New York State Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) will begin covering breast ultrasonography following a patient’s diagnostic mammogram with an abnormal or suspicious finding. Additionally, those enrolled in New York Medicaid FFS and MMC with breast cancer diagnoses will receive their mastectomy and lumpectomy procedures at high-volume facilities. According to research, five-year survival rates increase for women who have their breast cancer surgeries performed at high-volume facilities and by high-volume surgeons.

Breast ultrasonography, also known as ultrasound, is an imaging method that uses sound waves to evaluate breast tissue. It is non-invasive and may aid in distinguishing normal findings like simple cysts or fat lobules from suspicious breast findings that may require a biopsy.

Once the New York Medicaid’s new program initiative comes into effect, breast ultrasonography following a diagnostic mammogram will no longer require an additional order from the primary provider when performed in a hospital setting. Instead, a note in the radiologist’s report will fulfill this requirement.

High-volume facilities that will be able to perform mastectomy and lumpectomy procedures associated with a breast cancer diagnosis for New York FFS and MMS patients are defined as averaging 30 or more all-payer surgeries annually over a three-year period.  Low-volume facilities will not be reimbursed for breast cancer surgeries provided to Medicaid beneficiaries. This policy is an ongoing effort to reform New York State Medicaid and to ensure the purchase of cost-effective, high-quality health care and better outcomes for its beneficiaries.

Medicaid is a federally funded program run by the state and the county which provides medical insurance and long-term care for middle- to low-income persons, including the elderly and disabled. P&P Medicaid Consulting Inc. specializes in preparing applications for Medicaid eligibility, guiding you through the document acquiring process and will appear on your behalf at all interviews with the Department of Social Services (Medicaid).

If you are interested in learning more about applying for Medicaid or any of our additional services, call (516) 541-4770 or visit www.ppmedicaid.com.

The American Geriatrics Society Focuses on the Future of Elder Care

With an estimated 20 percent of the United States population accounting for those 65 and older by 2030, the American Geriatrics Society (AGS) is focusing on how to improve medical care in the geriatric community. One concern is the low number of doctors specializing in geriatric care. U.S. News and World Report-Health estimates that approximately 17,000 geriatricians are necessary to care for the growing elderly population, but that there is currently only about 7,500 or more certified in America.

One goal of AGC is to find additional funding to support medical students studying to be a geriatrician. One of the reasons why many graduating medical students choose other medical specialties is that private insurance has higher payouts. When it comes to Medicare and Medicaid, the reimbursement rates are lower. With high debt upon graduation, going into geriatrics may not be an option for new doctors. With more educational funding, the number of doctors entering the geriatric field is apt to increase.

Additionally, there is a focus on other skilled professional fields which care for the elderly. This includes occupational therapists, physical therapists, nurses, social workers, and home health care aids. Often these health care providers must work together to support an elderly individual who suffers from multiple chronic issues. With the elderly, often a more holistic approach is better because much of the medical care will focus on daily functionality, such as getting dressed and eating.

Understanding the options for an elderly loved one can be challenging. Applying for Medicaid and making sure necessary needs are covered can be a complex process. P&P Medicaid provides Medicaid application services. The company also provides a full range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs.  Please contact P&P Medicaid Consulting, Inc. at (516) 541-4770 for more information.

Pooled Trusts Help You Protect Your Disabled Loved Ones

A trust is a way to distribute assets to a beneficiary where a trustee, or the person in control of the working trust, is assigned.  There are different types of trusts that are set up for specific purposes.  One type of trust is a special needs trust, which is created for beneficiaries with disabilities.  Under a special needs trust, there is what is known as a pooled trust, also called community or master trusts.

A pooled trust is where the trust assets of multiple individuals are combined, and then distributed proportionately.  Some pooled trusts are created in order to care for the disabled beneficiaries, and others are set up just to manage money properly.  Typically, these trusts are run by a nonprofit organization, and no two are identical.  When setting up a pooled trust, an individual contract is written to reflect individual circumstances.

When it comes to Medicaid, a pooled trust is a way to enable an individual to qualify while still being able to use their income to pay bills. Typically, to qualify for Medicaid, and individual must “spend down” their income to $825.00 for singles and $1,210.00 for couples, after a $20 income disregard. Any money above these amounts must be paid back to Medicaid, or to other medical bills. The issue with this in New York is that the cost of living is so high, individuals are unable to pay basic bills, such as rent and electric, on the Medicaid allowed spend down amount. This is the reason why many people are unable to afford to go on Medicaid, or why they do not qualify.

With this in mind, pooled trusts offer a solution. A qualifying disabled individual can participate in a pooled trust by depositing the amount of their spend down/overage amount. This can then be used to pay necessary bills, allowing the individuals to use all of their money in some fashion. There is an initial fee of $300.00, and a monthly banking and yearly fee, but all-in-all, a pooled trust can allow for Medicaid coverage without a spend down.

There are some other advantages in choosing a pooled trust.  One, a trustee is not named as in a regular trust.  There are directors of the trust who likely have experience in the area, but not a specific trustee.  Sometimes it is difficult for family members to choose a trustee, and this alleviates the pressure of having to do that.  Another advantage is that a pooled trust does not require individuals to have a large amount of money as regular trusts require.  Lastly, with a pooled trust, the organization is well versed on agency law and how social security insurance and Medicaid programs work.  This knowledge can help the beneficiary fully understand how the programs and the trust intertwine.

There are some disadvantages to a pooled trust as well.  A few of the basic drawbacks include the inflexibility of the pooled trust, infrequent distribution of funds, and limitations on the types of investments it allows.  However, these issues are generally specific to the pooled trust in which you choose to participate.

Understanding the advantages and disadvantages thoroughly and consulting with an experienced advisor is essential to ensuring access to care while protecting your assets.  P&P Medicaid Consulting, Inc. has been helping clients structure pooled trusts so that there is a reduction in monthly income overages.  P&P Medicaid provides Medicaid application services. The company also provides a full range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs.  Please contact P&P Medicaid Consulting, Inc. at (516) 541-4770 for more information.

How New York Residents Can Choose a Long-Term Care Plan for Loved Ones

In caring for an elderly loved one, it can be challenging to choose whether an outside long-term care option is best, or to offer care from within the home. Often, financial burdens and how much Medicaid will cover becomes a main consideration. Medicaid can cover both nursing homes and home and community-based services. Planning ahead and knowing what factors to weigh when choosing a long-term care plan is vital to reduce the stress on your loved one as they start requiring more assistance.

First, it is important to compare what Medicaid will cover for both home-based care services and institutional services. Medicaid offices, which are state run, set out eligibility for specific benefits. Professional agencies can assist you in understanding your various options.

After narrowing down available options, if it is best for your loved one to enter long-term care at a nursing home facility, there are resources to help you find the best location. To research the quality of life at a nursing home, you can contact the New York State Department of Health. This is the agency which investigates complaints and oversees health and safety standards in nursing homes participating in Medicaid.

Once you have compared the quality of the nursing homes in a given area, it is important to visit them and make sure they meet the care needs you are searching for. Comparing each home’s policy, such as visiting hours, how the staff treats the patients, and types of activities available, are all important in choosing the right facility.

Instead of a nursing home facility, you may choose to care for your loved one at home. This may require modification to the home, such as handicapped bathrooms and ramps. Hiring nurses and therapy aids may also be necessary, unless community adult day care is a better option. Medicare may not cover all of the necessary costs for home health care, so it is important to research all alternatives. Another alternative is to have an assisted living facility care for your loved one. However, Medicaid does cover this type of care.

Understanding the options for long-term care for an elderly loved one can be challenging. Applying for Medicaid and making sure necessary needs are covered can be a complex process. P&P Medicaid provides Medicaid application services. The company also provides a full range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs.  Please contact P&P Medicaid Consulting, Inc. at (516) 541-4770 for more information.

The Financial Burden of Elderly Care on Long Island’s Middle Class

As Long Island’s baby boomers reach retirement age, there is an influx of adults who require long-term care and Social Security benefits. As it stands, two-thirds of Americans age 65 and over will soon fall into this category. This trend was not unexpected, but perhaps unprepared for. With limited funds supplied by Social Security and private or Medicaid insurance, the burden falls to younger family members, who, buried by inflation and the slow-moving economy, are often already struggling to make ends meet.

In the last 10 years, the cost of long-term care has risen dramatically.  According to a report by insurer Genworth Financial, the median bill for an assisted living facility is nearly $50,000 a year and for a semi-private room in a nursing home, it’s now over $100,000 a year. To lend perspective to these figures, the median household earns $52,000 in the U.S.

It’s not easy to see a parent or loved one’s health care needs rise, and even more uncomfortable to face the financial realities associated with that care. Many people turn to Medicaid to relieve some of the cost, but it is oftentimes difficult to secure the coverage necessary to support their aging loved ones. This phenomenon is particularly felt among the middle class, who feel they are left without any viable options.

More and more people rely on home healthcare for more extended periods of time. The option to hire in-home aides, although primarily out of pocket, is promising, since the cost is much lower than it is in institutionalized facilities such as nursing homes. Yet at a rate of $20 per hour (a conservative estimate), the cost of just eight hours a day of home health support tallies to $58,240 a year — an unaffordable price tag for 50 percent of American households. Round-the-clock in-home care at the same rate would come in at $174,720 per year, which only wealthier families could even consider.

If you’re unsure about the right kind of care for a loved one, or have questions about how to afford their care, contact elder care professionals at P&P Medicaid. In addition to assisting with Medicaid applications on behalf of clients, our company also provides a full range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs.  Please contact P&P Medicaid Consulting, Inc. at (516) 541-4770 for more information.

Long Island Veterans to Face More Difficulties Securing Long-Term Care Assistance

With the baby boomer generation in the heart of retirement age, private resources to support older Americans have begun to feel the strain. Among these is the Veteran’s Administration (VA), which faces impending regulations that will make nursing care benefits available to even fewer veterans.

The administration currently offers a pension called Aid and Attendance (A&A), an underused resource that supplies those who have served and are current nursing home residents or require geriatric home care assistance. For the first time, new regulations will limit the services ONLY to those whose asset levels qualify and will impose a look-back period, restrictions on gift or transfers of assets that will subjugate violators to penalties.

The current income and assets of a veteran and their spouse currently determines eligibility for these benefits. The proposed regulations will set the amount at a limit of $119,220, with only homeowner properties of two-acres or less will be excluded from this evaluation. While this was the previous limit set for veteran’s spouses, the limit will now extend to both beneficiaries.  Similar to Social Security benefits, these VA benefits will be indexed based on inflation.

An applicant who transfers assets to a non-beneficiary within three years of applying for A&A will face a penalty period of up to 10 years, double for spouses, unless clear and convincing evidence can be proven that the transfer was not in the interest of qualifying for the program’s benefits.

An alternative to A&A is Medicaid, a state and federally funded health insurance program that pays for the medical care of people who have low income and resource levels, or for the elderly. Although we caution applicants that there are still strict rules regarding transfers of assets and limits of income, Medicaid regulations are much less stringent than the A&A rules.

P & P Medicaid is available to assist retirement-age veterans and their families apply for Medicaid, Aid and Attendance and other programs or services. P & P Medicaid handles everything in the application and document-acquiring processes and will appear on behalf of the applicant at a governmental agency. The company can also provide guidance in selecting home healthcare or nursing home placement options, along with assistance in applying to the long-term care facilities.

For more information on how to begin the Medicaid application process, call (516) 541-4770 or visit www.ppmedicaid.com.

Half the World’s Elder Population Lacks Long-Term Services

Most will agree with the statement that all people should have equal access to physicians, hospitals, and medical tests in their communities. Yet despite the world’s recognition of health care as a fundamental necessity, not everyone receives proper healthcare.

Recently, The International Labor Organization released findings that more than half of all people 65 and older in the world have no long-term health care. The 46 countries studied account for 80 percent of the world’s population of older people. The study brought to light the lack of protection for elderly people as well as a lack of industry caregivers.

According to the study, more than 300 million older adults require higher-level care and cannot access professional health services when needed. Despite the growing international demand for elderly long-term care, the report revealed that most countries are neglecting to meet their population’s needs with lack of funding and services.

The United States is no exception. The Commonwealth Fund reported that, out of 11 counties surveyed, the American Healthcare system ranked last in comparison. One of the most prevalent concerns revealed by the study was that that Americans over the age of 65 reported that high cost was the main reason they had skipped medical care or treatment. This finding is significant because Medicare is often thought of as free, universal health coverage for elderly Americans. Medicare, which is available to anyone over the age of 65 or to the certified disabled who have worked and paid into the Social Security system, differs from Medicaid.

Medicaid is a federally funded program run by states and local government, which provides medical insurance and long-term care for middle-to low-income persons, including the elderly and disabled. If one is eligible, based on income and resource restrictions, Medicaid will pay for all medical care (including doctors and hospitals), prescriptions, home care, nursing home care and other health care-related expenses. Medicaid is based on income and resource levels, and although anyone can apply, eligibility needs to be approved via an application process.

Many Americans who are eligible for Medicaid are unaware that these services are available to them or do not know how to begin the application process. P&P Medicaid is committed to helping people through this application and document-acquiring process and will appear on your behalf at all interviews with the Department of Social Services (Medicaid). P&P Medicaid utilizes its industry expertise and experience to expedite your application and to maximize the opportunity for success.

For further questions or to speak to a P&P Medicaid representative about Medicaid qualification call (516) 541-4770 or contact us by email.

What Level of Care is Best for My Loved One or Me?

As people reach retirement age, they may also encounter lifestyle changes and increased risks for serious medical conditions. Determining what retirement solutions (including everything from healthcare plans to living arrangements) will meet a person’s future needs can be challenging and stressful for everyone.

When choosing a plan for retirement that’s right for you, it’s important to consider not only your current needs but also to try to foresee issues that may arise in the future. For example, you may need assistance with physical needs that are part of your daily routine. This can range from cooking and cleaning to shopping and dressing, among many others.

Sudden medical conditions – such as stroke, heart attack or a progressive condition – should also be accounted for in the planning. This is especially true for those that hinder physical and cognitive abilities; such is the case for those with diseases such as Multiple Sclerosis or Alzheimer’s. In these situations, it is often recommended to pre-plan to hire a Home Healthcare Aide (HHA) or Personal Care Aide (PCA).

As a person ages, their social surroundings may also change as they might not have access to public or self-transportation that will enable them to visit with friends and family members. Some seniors will seek exposure to additional social settings to avoid becoming housebound or isolated.

For those who do not need constant supervision but want to live in a social community of seniors while receiving help with day-to-day tasks, an assisted living service may be ideal. Most typically set up with apartment-style housing or in a large home with individual bedrooms, assisted living residents are encouraged to act independently. Services available at these locations include food prep assistance, housekeeping, planned social and physical activities, multiple levels of care and full-time staff available to meet additional needs.

Individuals with high-level personal and medical care needs should opt instead for a nursing home, which can provide full-time care and address all lifestyle changes. These facilities usually serve residents who need to rely on staff for most basic needs, including bathing, toilet, dressing and eating. These facilities feature licensed medical professionals on premises who can provide individualized medical care as well as high levels of safety features, including access ramps, oxygen tanks, hospital beds and nurse pagers. To keep residents active, nursing homes also offer peer and interest-oriented activities

If you are looking to secure a home healthcare aide or need assistance determining which assisted living facility or nursing home is ideal for you or a loved one, P & P Medicaid has a full staff of professionals who can help you in your search, council you on the ideal type of care and guide you through each step of the process.

P & P Medicaid also offers a range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs. For more information regarding this, or any of our services please, contact us at 516-541-4770 or by email at paul@ppmedicaid.com.

How Medicaid Programs are Combating Antibiotic-Resistant Bacteria

Antibiotic resistance is a growing cause of concern in the United States and is attributed to the misuse of antibiotics. To address this, the Centers of Disease Control (CDC) has enacted the Get Smart campaign for Medicaid programs in all states, including New York, to ensure that antibiotics are administered only when they are absolutely necessary and used as prescribed. This program will not only combat levels of antibiotic-resistant bacteria, which are fueled by ineffective antibiotic treatments, but also improve the well being of all Medicaid patients.

According to 2013 Medicaid claims data, 55 percent of provider visits across 11 New York counties resulted in antibiotics being prescribed for upper respiratory conditions despite that the drugs are considered to be ineffective against such viral diseases. Some providers had attributed the high prescription rate to the pressure placed on them by their patients who would in turn deliver poor satisfaction reviews if denied the medication.

The New York Department of Health (DOH) collaborated with the CDC to address the issue by educating the Medicaid providers on illness circumstances in which antibiotics do not have to be prescribed. Antibiotics are inefficient as treatment in instances of cold and runny nose, bronchitis or chest colds (in otherwise healthy adults and children), flu, sore throat (except strep) and fluid in the middle ear (otitis media with effusion).

New York Medicaid’s efforts follow the White House’s action plan to combat antibiotic-resistant bacteria. The CDC estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone.

According to E Medicine Health, aside from the antibiotics not helping patients with viruses feel better, cure the illness or prevent others from catching the infection, they may also cause side effects such as nausea, diarrhea, stomach pain, allergic reactions or swelling of the large intestine or colon.

Medicaid is a federally-funded program run by the state and the county, which provides medical insurance and long-term care for middle-to low-income persons, including the elderly and disabled. P&P Medicaid Consulting Inc., specializes in preparing applications for Medicaid eligibility, guiding you through the document-acquiring process and will appear on your behalf at all interviews with the Department of Social Services (Medicaid).

If you are interested in learning more about applying for Medicaid or any of our addition services, call (516) 541-4770 or visit www.ppmedicaid.com.