The preventive benefit is covered by Medicare free of charge when obtained by a participating health care professional because of the Affordable Care Act.  As of January 1, 2011, Medicare beneficiaries no longer have to pay a deductible, co-insurance, or copayment for many preventive services covered by Medicare as well as recommended services newly covered by the program.

The report also shows that this enhanced preventive benefits coverage will lower costs, including lowering Medigap premiums for employers, states and people with Medicare. Many more people with Medicare are expected to receive annual wellness visits and other recommended preventive services thanks to the Affordable Care Act.

“The Affordable Care Act is bringing new preventive benefits and savings to millions of Medicare beneficiaries this year,” said Secretary Sebelius. “Seniors and others with Medicare are already taking advantage of these important preventive services and wellness visits, which can help lower costs, prevent illness, and save lives.”

The report also shows that an average of 2,800 people with Medicare have received an annual wellness visit per day between January 1 and February 23, 2011. Because Congress has eliminated the part B coinsurance and deductibles for the annual wellness visit and many other preventive services, the report says that the use of these services should increase.

View a copy of the report here.

At least six states made major changes including Idaho, Kentucky, Oregon, Pennsylvania, South Carolina, and Texas.

Focal points of state assisted living policy development include life safety, disclosure of information, Alzheimer’s/dementia standards, medication management, background checks, and regulatory enforcement.  Other areas of change include move-in/move-out requirements, resident assessment, protection from exploitation, staff training, and tuberculosis testing standards.

Pursuant to legislation enacted in 2007, Pennsylvania implemented new assisted living regulations on January 18, 2011, thereby creating a second level of licensure alongside personal care homes. Oregon developed new rules for the endorsement of Memory Care Communities. Endorsement rules focus on person-centered care, consumer protection, staff training specific to caring for people with dementia, and enhanced physical plant and environmental requirements. Rhode Island passed legislation that, once implemented, will expand the types of assisted living residents that may receive skilled nursing care or therapy and the length of time they may receive such services.

Washington state clarified that boarding homes must fully disclose to residents a facility’s policy on accepting Medicaid as a payment source. New Jersey passed legislation requiring an assisted living residence or comprehensive personal care home that surrenders its license and promised not to discharge Medicaid residents to escrow funds to pay for care in an alternate facility.

To view the report, see here.

With the investment, the company will continue to expand the company’s software-as-a-service (SaaS) product offerings and advance its market leadership through organic and inorganic growth.

PointClickCare’s web-based products and services are uniquely designed to help long-term care providers manage the complete lifecycle of resident care. The company serves over 5,000 facilities throughout North America, from single-home independent facilities to seven of the ten largest operators. PointClickCare’s SaaS offering seamlessly integrates clinical, billing and administrative processes to maximize reimbursements, enhance quality of care, improve operating efficiencies and increase staff productivity and satisfaction.

“We are excited to have JMI Equity as an investor in PointClickCare due to their long track record of helping SaaS companies manage their growth and expand their customer offerings,” said CEO Mike Wessinger. “This investment reinforces our commitment to customer success by enabling us to expand the breadth of our solution suite to meet the evolving needs of long-term care providers. We look forward to building upon the market leadership momentum we have experienced over the last few years and are pleased to have JMI Equity on board for our next stage of growth.”

As part of the transaction, JMI Equity Founder and Managing General Partner Harry Gruner will join PointClickCare’s board of directors. “Mike and the rest of the PointClickCare team have done an excellent job positioning the company for continued success,” said Mr. Gruner. “The company’s SaaS offering provides customers with an affordable platform to manage the complete lifecycle of resident care, and its offerings align well with the market’s demand for tools that yield greater efficiency while improving patient care. We look forward to working with Mike and his team to build on the company’s success, further develop the company’s offerings and realize the many growth opportunities in front of the company over the long term.”

RBC Capital Markets served as placement agent to PointClickCare. Harris + Harris LLP served as legal advisor to PointClickCare, while Goodwin Procter, LLP and Stikeman Elliott LLP served as legal advisors to JMI Equity.

The big change has caught the eye of U.S. senior-housing developers like Emeritus Corp., Life Care Services LLC, hedge-fund giant Fortress Investment Group LLC and even John C. Erickson, an industry pioneer whose empire of retirement communities toppled in the wake of the financial crisis to head to China in search of an opportunity.

According to the article:

In January, about 30 Chinese business representatives toured retirement communities in Arizona and Maryland and attended a lunch held for them at the annual meeting of the American Seniors Housing Association in Phoenix.

At the lunch, the Chinese group presented U.S. senior-housing operators with some stark demographic trends: China already is home to 167 million people over the age of 60, more than the total population of France and Germany, while nearly half of older adults live alone. The number of Chinese senior citizens will increase by about eight million a year over the next five years, while their share of the total population will rise to 15% in 2015 from 12.5% in 2009, according to real-estate consultant DTZ.

Read the rest at the link below.

Housing Operators Put Focus on China

In a first-of-its-kind study, nearly 100 paid, non-family caregivers were recruited in the Chicago area and their health literacy levels and the health-related responsibilities were assessed, said Lee Lindquist, MD, assistant professor of geriatrics at Northwestern University Feinberg School of Medicine and physician at Northwestern Memorial Hospital.

“We found that nearly 86 percent of the caregivers perform health-related tasks,” said Lindquist, lead author of the study. “Most of the caregivers are women, about 50 years old. Many are foreign born or have a limited education. The jobs typically pay just under $9 per hour, but nearly one-third of the caregivers earn less than minimum wage.”

Lindquist found that despite pay, country of birth, or education level, 60 percent of all the caregivers made errors when doling medication into a pillbox. This is an alarming statistic because patients who don’t take certain medications as prescribed could end up in the hospital, Lindquist said.

“Many of these caregivers are good people who don’t want to disappoint and don’t want to lose their jobs,” Lindquist said. “So they take on health-related responsibilities, such as giving out medications and accompanying clients to the doctor for appointments. Most physicians and family members do not realize that while the caregiver is nodding and saying ‘yes’, she might not really understand what is being said.”

Right now there isn’t a standard test family members or employment agencies can use to gauge a caregiver’s ability to understand and follow health-related information, Lindquist said.

“Currently we are developing tests consumers can use to evaluate caregiver skills as well as studying the screening processes caregiver agencies use,” Lindquist said. “But, if you really want to know if the caregiver is doing a good job and is taking care of the health needs of your senior, start by going into the home, observing them doing the tasks, and asking more questions.”

Elder Care Concerns from Northwestern News on Vimeo.

The company announced that Bethesda Health Group, a leading senior care and services organization in St. Louis, Mo., selected Cerner’s technology for skilled nursing facilities.

Realizing the growing need for healthcare information technology (HIT) in long-term care environments, this conversion marks the company’s initial deployment of the Cerner BeyondNow® software architecture, on which Cerner’s SNF solution is built, into a skilled nursing facility.

The Cerner BeyondNow architecture enables providers to coordinate and manage care across the post-acute continuum, including long-term, home health, private duty and hospice.

At the core of Cerner’s solution is a person-centric, integrated electronic health record (EHR), which serves as the single source of truth for resident health information. The EHR and associated resident care plan are fully integrated into the federal MDS 3.0 assessments that drive revenue cycle management and quality reporting systems. This system empowers providers to improve care by increasing safety, while enhancing operational efficiency by holistically managing the clinical and logistical needs of the resident.

“Providing superior quality of care to our residents will always be our highest priority,” said Larry Hickman, corporate vice president and chief information officer with Bethesda. “Not only will Cerner’s innovative solution streamline the ease in which we are able to share information with our hospital and physician partners about their patients – our residents – but will ultimately allow our caregivers to spend less time managing and disseminating data and more time taking care of our residents.”

“We are very excited to be ‘the first’ to begin using a system that we believe will prove to be an industry–changing solution in the area of senior care data management,” Hickman added.

Two Bethesda facilities are currently utilizing Cerner® solutions, with plans to expand to the other seven facilities. The first two facilities are utilizing Cerner to handle operations, from back-office functions to resident care encounters. This includes:

• A single, integrated EHR for residents
• Development and tracking of resident care plans
• MDS 3.0 assessment tools for scheduling, completing and submitting MDS reports
• Revenue cycle management for billing/accounts receivable, that supports unique skilled nursing facility capabilities for Medicare 100-day tracking and therapy minutes tracking for Medicare Part A and Part B
• Support for facility operations through complete census and bed management, dining logistics and referral processes

Later this year, Bethesda will begin utilizing Cerner’s solution for home health, private duty and hospice care, providing a fully integrated system for managing their business and a single EHR for their residents. Utilizing these solutions will position Bethesda to easily exchange health information with physician’s offices and hospitals, empowering better coordination of resident care and allowing the continuum of post-acute care to connect with acute care environments.

Phillips, owned and managed nursing homes, provided nursing home staff, and provided in-home care services and failed to pay $4.7 million in payroll taxes he did not tender to the Internal Revenue Service

He pleaded guilty previously to one count of failure to pay employment taxes from 2001 to 2005. He admitted his companies withheld the tax payments from workers’ checks, including federal income taxes and social security taxes but failed to make about $4 million in payments to the IRS, prosecutors said.

The companies Phillips owned included:

JP Holdings, LLC, formed in Shawnee, Kan., in 2002, which was the sole or primary shareholder for other entities.

Citadel Holdings, LLC, which operated a nursing home in St. Joseph, Mo.

Citadel Partners, LLC, which provided employees to a nursing home in St. Joseph, Mo.

Rainmakers, LLC, a management company.

Elk Manor, LLC, which provided management services for a nursing home in Moline, Kan.

LTC-ES, a payroll company providing services to nursing homes.

LVCO, LLC, which provided employees and management services to a nursing home in Leavenworth, Kan.

Bladen Foods, LLC, a meat processing plant in El Dorado.

Lush Farms, LLC, which purchased, bred and raised show cattle on 80 acres near McLouth, Kan.

ViaCare Home Health, LLC, a home health care company.

Elf Support Services, LLC, an in-home nursing service in Emporia.

Midwest Nursing Home Investors, LLC, which provided employees to in-home nursing services.

Jewell Healthcare, LLC, which provided employees to nursing facilities.

“The problematic quality of direct-care jobs continues to undermine America’s capacity to produce a caregiving workforce that can deliver the basic hands-on services and supports demanded by millions of elders and persons with disabilities needing assistance with basic daily activities and tasks,” said PHI Director of Policy Research Dorie Seavey, Ph.D.

In 2008, there were more than 3.2 million direct-care workers. By 2018, this workforce is projected to increase to over 4.3 million, making direct-care workers the nation’s second largest occupational grouping.

A few interesting facts are:

• The majority of the workforce is female (89 percent), over half (53 percent) is non-White, and nearly a quarter (23 percent) is foreign born. The average age of direct-care workers is 42 years old.
• Almost half (45 percent) of direct-care workers live in households earning below 200 percent of the federal poverty income level.
• Nearly half (46 percent) of direct-care workers depend on public assistance, such as food stamps; Medicaid; or housing, child care, or energy assistance — up from 41 percent the year before.
• In 2009, an estimated 900,000 direct-care workers did not have any health coverage.
• The median hourly wages for home health aides have declined over the past nine years to under $8, while personal care aides’ hourly wages have remained stagnant at $7.50 (both adjusted for inflation).

To view a copy of the full report, see here.

The report, written by Stephen A. Moses, suggests that New York’s Medicaid program could ultimately save up to $2.9 billion in combined federal, state and local funds by tightening eligibility criteria, enforcing federally mandated recovery of paid benefits, promoting home equity conversion prior to Medicaid eligibility, and encouraging the purchase of private long-term care insurance.

“Access to Medicaid funding for LTC in New York State has been too easy for too long” the report says. “The combination of an aging population with greater care needs, a flagging economy, and dwindling federal support will soon bring Medicaid LTC spending up short. Instead of trying to provide a full range of LTC services to nearly everyone in the state, New York Medicaid will have to prioritize.”

“The preferable course is to funnel scarce Medicaid resources to the neediest people and encourage wealthier individuals to plan early and save, invest, or insure against the risks and costs of LTC,” it concludes.

Entitled “Long-Term Care Financing in New York: How to Save Money While Serving the Needy,” the exhaustive 28-page report is a joint product of the Empire Center and the Seattle-based Center for Long-Term Care Reform, of which Moses is president. In the course of his research, Moses interviewed 58 people directly involved in the long-term care field in New York, including senior state and local Medicaid administrators, social workers and policy analysts; insurance industry executives and consultants; and representatives of organizations representing practitioners and providers.

Several of the report’s key recommendations have been adopted by Governor Andrew Cuomo’s Medicaid Redesign Team.  These include:

Close the “spousal refusal” loophole, through which the assets of a chronically ill elderly person can be shifted to his or her spouse, who can then refuse to take responsibility for paying for that person’s long-term care;

more aggressive efforts to pursue estate recoveries on a statewide basis; and

stronger incentives to promote the purchase of private long-term care insurance.

Adoption of the governor’s amended Medicaid proposals would equate to “important steps in the right direction, but much remains to be done to put long-term care policy in New York on an economically and financially sustainable footing,” the report says.

Founded in 1994 and headquartered in Easley, South Carolina, HMR provides post-operative therapy to long-term skilled nursing. The company has 21 centers located in South Carolina, North Carolina and Georgia.

Behrman Capital established Memphis, TN-based Ark Holdings in July 2007 through its acquisition of Covenant Dove Holding Company, LLC for approximately $250 million. Since that time, Ark has continued to execute a build-up strategy in the post-acute care sector with several smaller scale acquisitions, including the operations of 7 facilities formerly managed by Mariner in January 2008 and 3 Texas-based facilities owned by Sulik Healthcare Services in June 2008.

Following its acquisition of HMR, Ark will own and operate one of the largest privately held platforms of skilled nursing facilities in the country, with 59 homes and more than 6,000 patient beds.

Larry Deering, Chairman of Ark Holdings, is a Behrman Capital Operating Partner. He previously served as Chairman and CEO of Tandem Healthcare, a former Behrman Capital portfolio company. During Behrman’s 8-year ownership, Tandem’s revenues and profitability grew from $25 million and $3 million, respectively, to more than $550 million and $84 million.

Ark’s acquisition of HMR was primarily financed by Walker & Dunlop, utilizing the U.S. Department of Housing and Urban Development’s 232/223(f) loan program, which provides low-interest-rate, long-term financing with flexible prepayment options and no financial covenants. In addition to the HUD financing of $104.7 million, Capital Source also provided a 5-year $35 million revolving credit facility.  The loans were underwritten to a 2.60 debt service coverage with occupancy greater than 90%.Walker & Dunlop, a Bethesda real estate finance firm that recently went public, closed on a $104.7 million loan allowing the Ark Holding Co. to acquire a portfolio of 18 skilled nursing homes in South Carolina, North Carolina and Georgia. The financing was Dunlop’s second for more than $100 million for nursing homes. In August, Walker & Dunlop financed a deal for 16 facilities in Florida.  In August 2010, the company funded a 16 facility refinance of the IBHSAR facilities in Florida for $162.2 million.