The True Benefits of Elder Care Services

Elder care has turned into a highly preferred solution and is being increasingly accepted in the majority of the countries having a largely growing elderly population. Provided the choice the maximum seniors wish to spend their twilight years within the familiarity and comfort of their own sweet home. The good news is today with the easy availability of elder care services an elderly person no longer require to shift to a hospital or nursing home. Nowadays these services are available in different forms ranging from nursing, basic assistance with day to day living to medication management.

Explore the top benefits of elder care services

Below is a list of the top benefits of availing the services of professional elder care. These include,

• Save precious time- there are different types of elder care services and these are quite time consuming. Often it becomes challenging for a caregiver in being capable of juggling the time needed. Thus, elder care assistance turns into a necessity that helps a family caregiver in investing more time on other vital priorities instead of the routine tasks that can be performed via a home specialist who has been trained specially for this task

• Professional assistance- a home caregiver can handle the routine as well as critical situations far better as they possess the needed training and experience

• Social interaction- No matter how close the caregiver may be to the patient there is indeed a limit to the amount both of communication and socialization with one another. To have someone from the outside will offer some benefits. It will allow the elderly in staying communicated and interacting with someone else and this will work wonders for his/her emotional well-being

• Uphold the old lifestyle- a caregiver can assist the senior in upholding the lifestyle which she or he was accustomed to at one point of time. In fact, it is a part of the caregiver’s training in sustaining the momentum

• Quality of life- Via the assistance of a caregiver the senior adult can enhance their quality of life. Instant help is accessible, thus there is no requirement of struggling with the day to day household work. A caregiver is specially trained for anticipating the requirements of the senior who is in their charge. The best part is the care level can be selected as per the requirement from merely a few hours daily to 24/7 assistance and companionship.

All these factors throw light that hiring professional elder care services are indeed worth it.

America’s Health/ Medical Care: Some Alternatives/ Options

For nearly a decade, politicians have seemingly, buried their heads, in the sand, and considered this nation’s approach to treating the health, and well – being of our citizens, and responded with bipartisan, politics – as – usual! Wouldn’t we be better served, if the response of some, was not, merely, articulating a message, about so – called, socialism, etc? It seems, many Republican opponents, to the Affordable Care Act, spent a disproportionate amount of time, merely opposing that law, rather than fixing its flaws, etc. While that law, certainly needs, tweaking, it attempted to address the fact, the richest country in the world (the United States of America), did not come, even close, to the best statistics, regarding morbidity, mortality, infant survival, and other, health – related items, as well as having the most expensive costs, for prescription drugs, in the world. Why are we, the only place, where citizens go bankrupt, trying to pay their medical bills? Why do we pay, so much more, for prescription drugs, than others pay for the exact medications? With that in mind, this article will attempt to consider, review, examine, and discuss, some of the alternatives, we might adopt, to improve upon, what we currently have.

1. The pre – ACA, status quo: Why was the Affordable Care Act, passed, during the early part of the Obama administration? What was its intent? Why was it needed? Prior to enactment, health care, in this nation, was often about, the haves, and have – nots! More and more, health insurance companies, appeared to be, wagging the dog, instead of health professionals! Individuals with pre – existing conditions were often, denied coverage, rates often accelerated, as we aged, and every year, quality medical/ health insurance, became more, and more expensive! Many millions had no, or very limited insurance coverage, and we often witnessed, people being forced to choose between quality care, and eating! Those supporting the act, seemed to believe, our citizens needed, and deserved, better care, and, quality treatment/ care. For many, they felt, medical/ health care, should be, a right and guarantee, rather than a possibility, only for the richest!

2. ACA passage: When the act, was passed, it was largely among party lines, and at the time, Democrats were the majority party. While the basic intent of the legislation, was well – intended, because of the nature of our political system, it was somewhat flawed, and many ramifications and contingencies, were not fully considered, etc. The costs did not decrease, as promoted, and while, they probably increased at a slower pace, it still hurt many of us! Instead of improving the details, and fixing it, properly, the Republicans devoted their time, and energy, to constantly, trying to repeal it, but, without offering any viable alternatives, and/ or solutions, to solve the challenges.

3. The Trump alternative/ strategy: When Donald Trump, ran for President, he articulated a message, declaring, he would fix the health care system, and it would be better, and less expensive. He promised, it would be easy, and created a slogan, Repeal and replace, as if, he had the secret formula! Rather than admitting the plan, his supporters proposed, was different, but worse, and was defeated, he reverted to his customary, blaming and complaining, and settled for subtle ways, to destroy it. One of these steps, was having the mandatory coverage, eliminated, which, made everyone’s insurance, more expensive, Another was reducing/ eliminating, subsidies, for the neediest, and creating an Affordable Care, alternative system. The ramifications of these steps, was hurting, rather than helping! Now, Trump’s Justice Department, is supporting, legal actions, to declare the entire act, unconstitutional, without seeming to realistically, consider, the potential negative ramifications, if they get, what they seek. It seems, a lot like, someone, who kills both his parents, and pleads for mercy, because he was an orphan!

4. Proposed Medicare – for – All: While, to some, this seems wonderful, the overall analysis, appears to be, over – simplified! Medicare, itself, is a flawed system, which taxpayers, contribute to, throughout their working lives, and, still requires over $1,600 additional contribution, per year, after we turn 65. In addition, it only covers about 80% of the Part B, part, and the supplemental insurance, which completely covers, most of these expenses, now costs over $3,600 per year. Even after these expenses, one needs, either additional policy, for a prescription plan, or, risks extreme, out – of – pocket costs. One further consideration is, believing doctors, will accept these reduced Medicare rates, for their entire patient base. Doesn’t it make sense, to tweak, and improve, rather than trying to re – invent, the wheel?

Is quality care, a right or a privilege? If, like most Americans (based on many polls), you feel it’s a right, demand your elected officials proceed, accordingly, rather than, in a politics – as – usual, manner!

"Religious" Care Packages For Deployed Troops

“[There must be] a wall of separation between church and state”-Thomas Jefferson, 1802

When I was a Marine company commander in South Vietnam in 1967, my unit regularly received “care” packages addressed to “Any soldier, sailor, airman or Marine.” The packages contained such items as disposable razors, toothbrushes, toothpaste, Lifesavers, factory-packaged snack items and paperback novels. The care packages were normally prepared by various civic and veterans’ organizations and if approved by the Department of Defense they were eligible for expedited shipping overseas. The care packages were always appreciated by those in uniform.

Care packages that are now being sent to members of the armed forces in Iraq and Afghanistan are similar in many ways to the packages that were sent to our forces in South Vietnam 40 years ago – with one exception. Nowadays, religious extremists are attempting to proselytize by including Bibles, religious books and even religious video games in care packages.

Church & State newsletter explains it this way: “A Dallas-based group called Operation Straight Up (OSU) planned to include a video game called ‘Left Behind: Eternal Forces’ in care packages for the troops. The game, based on a series of apocalyptic novels by Religious Right activist Tim LaHaye, allows players to kill opponents in the name of Christianity or the Antichrist. It has been criticized for violent content.”

According to an Aug. 22 article in the Los Angeles Times, OSU is a fundamentalist ministry headed by former kickboxer Jonathan Spinks. It is also an official member of the Defense Department’s “America Supports You” program. The group has staged a number of Christian-themed shows at military bases, featuring athletes, strongmen and actor-turned-evangelist Stephen Baldwin. But thanks in part to the support of the Pentagon, Operation Straight Up has now begun focusing on Iraq, where, according to its website, it planned an entertainment tour called the “Military Crusade.”

OSU personnel were obviously unaware of Muslim sensitivities about Americans going on a “crusade” in the Middle East.

Max Blumenthal, writing in The Nation, said “The Left Behind video game is a real-time strategy game that makes players commanders of a virtual evangelical army in a post-apocalyptic landscape that looks strikingly like New York after 9/11. With tanks, helicopters and a fearsome arsenal of automatic weapons at their disposal, Left Behind players wage war against . . . armies of the Antichrist.” To win the game, players must kill or convert all non-believers. They also have the option of reversing roles and commanding the forces of the Antichrist.

OSU’s plan was initially approved by the Department of Defense Chaplain’s Office, but after Blumenthal’s article was published in August, the approval was revoked. Former Reagan Administration White House Counsel Mikey Weinstein has been highly critical of OSU, telling Navy Times that the organization “is the IED [improvised explosive device] that is blowing up the constitutional wall separating church and state in the Pentagon and throughout our military.”

Barry W. Lynn, executive director of Washington DC-based Americans United for Separation of Church and State said of OSU’s activities: “There appears to be a very deep connection between this allegedly private group promoting evangelical Christianity and the military itself. It doesn’t matter what the religion is. The government is supposed to be neutral. It is supposed to be hands-off on that.”

As a 27-year-old Marine captain in South Vietnam, I always tried to lead my Marines “by example,” but that never extended to religion. My religious beliefs were private and mine alone. I never attempted to proselytize or to convert others to my way of thinking. Religious fundamentalists should do the same. Our young men and women in uniform are quite capable of thinking for themselves about this important subject.

Health Care Fraud – The Perfect Storm

Today, health care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or endeavor touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

– “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

– The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

– The National Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. [NHCAA, web-site] NHCAA was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David Hyman, professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from payor to payor – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated (ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used when seeking compensation from payors for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs recognize – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed, payors of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased pre- and post-payment audits of selected providers to detect fraud, and have created consortiums and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act (HIPAA). It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse. HIPAA purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.

In 2009, the Health Care Fraud Enforcement Act appeared on the scene. This act has recently been introduced by Congress with promises that it will build on fraud prevention efforts and strengthen the governments’ capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance by sentencing increases; redefining health care fraud offense; improving whistleblower claims; creating common-sense mental state requirement for health care fraud offenses; and increasing funding in federal antifraud spending.

Undoubtedly, law enforcers and prosecutors MUST have the tools to effectively do their jobs. However, these actions alone, without inclusion of some tangible and significant before-the-claim-is-paid actions, will have little impact on reducing the occurrence of the problem.

What’s one person’s fraud (insurer alleging medically unnecessary services) is another person’s savior (provider administering tests to defend against potential lawsuits from legal sharks). Is tort reform a possibility from those pushing for health care reform? Unfortunately, it is not! Support for legislation placing new and onerous requirements on providers in the name of fighting fraud, however, does not appear to be a problem.

If Congress really wants to use its legislative powers to make a difference on the fraud problem they must think outside-the-box of what has already been done in some form or fashion. Focus on some front-end activity that deals with addressing the fraud before it happens. The following are illustrative of steps that could be taken in an effort to stem-the-tide on fraud and abuse:

– DEMAND all payors and providers, suppliers and others only use approved coding systems, where the codes are clearly defined for ALL to know and understand what the specific code means. Prohibit anyone from deviating from the defined meaning when reporting services rendered (providers, suppliers) and adjudicating claims for payment (payors and others). Make violations a strict liability issue.

– REQUIRE that all submitted claims to public and private insurers be signed or annotated in some fashion by the patient (or appropriate representative) affirming they received the reported and billed services. If such affirmation is not present claim isn’t paid. If the claim is later determined to be problematic investigators have the ability to talk with both the provider and the patient…

– REQUIRE that all claims-handlers (especially if they have authority to pay claims), consultants retained by insurers to assist on adjudicating claims, and fraud investigators be certified by a national accrediting company under the purview of the government to exhibit that they have the requisite understanding for recognizing health care fraud, and the knowledge to detect and investigate the fraud in health care claims. If such accreditation is not obtained, then neither the employee nor the consultant would be permitted to touch a health care claim or investigate suspected health care fraud.

– PROHIBIT public and private payors from asserting fraud on claims previously paid where it is established that the payor knew or should have known the claim was improper and should not have been paid. And, in those cases where fraud is established in paid claims any monies collected from providers and suppliers for overpayments be deposited into a national account to fund various fraud and abuse education programs for consumers, insurers, law enforcers, prosecutors, legislators and others; fund front-line investigators for state health care regulatory boards to investigate fraud in their respective jurisdictions; as well as funding other health care related activity.

– PROHIBIT insurers from raising premiums of policyholders based on estimates of the occurrence of fraud. Require insurers to establish a factual basis for purported losses attributed to fraud coupled with showing tangible proof of their efforts to detect and investigate fraud, as well as not paying fraudulent claims.

5. Insurers are victims of health care fraud

Insurers, as a regular course of business, offer reports on fraud to present themselves as victims of fraud by deviant providers and suppliers.

It is disingenuous for insurers to proclaim victim-status when they have the ability to review claims before they are paid, but choose not to because it would impact the flow of the reimbursement system that is under-staffed. Further, for years, insurers have operated within a culture where fraudulent claims were just a part of the cost of doing business. Then, because they were victims of the putative fraud, they pass these losses on to policyholders in the form of higher premiums (despite the duty and ability to review claims before they are paid). Do your premiums continue to rise?

Insurers make a ton of money, and under the cloak of fraud-fighting, are now keeping more of it by alleging fraud in claims to avoid paying legitimate claims, as well as going after monies paid on claims for services performed many years prior from providers too petrified to fight-back. Additionally, many insurers, believing a lack of responsiveness by law enforcers, file civil suits against providers and entities alleging fraud.

6. Increased investigations and prosecutions of health care fraud

Purportedly, the government (and insurers) have assigned more people to investigate fraud, are conducting more investigations, and are prosecuting more fraud offenders.

With the increase in the numbers of investigators, it is not uncommon for law enforcers assigned to work fraud cases to lack the knowledge and understanding for working these types of cases. It is also not uncommon that law enforcers from multiple agencies expend their investigative efforts and numerous man-hours by working on the same fraud case.

Law enforcers, especially at the federal level, may not actively investigate fraud cases unless they have the tacit approval of a prosecutor. Some law enforcers who do not want to work a case, no matter how good it may be, seek out a prosecutor for a declination on cases presented in the most negative light.

Health Care Regulatory Boards are often not seen as a viable member of the investigative team. Boards regularly investigate complaints of inappropriate conduct by licensees under their purview. The major consistency of these boards are licensed providers, typically in active practice, that have the pulse of what is going on in their state.

Insurers, at the insistence of state insurance regulators, created special investigative units to address suspicious claims to facilitate the payment of legitimate claims. Many insurers have recruited ex-law enforcers who have little or no experience on health care matters and/or nurses with no investigative experience to comprise these units.

Reliance is critical for establishing fraud, and often a major hindrance for law enforcers and prosecutors on moving fraud cases forward. Reliance refers to payors relying on information received from providers to be an accurate representation of what was provided in their determination to pay claims. Fraud issues arise when providers misrepresent material facts in submitted claims, e.g. services not rendered, misrepresenting the service provider, etc.

Increased fraud prosecutions and financial recoveries? In the various (federal) prosecutorial jurisdictions in the United States, there are differing loss- thresholds that must be exceeded before the (illegal) activity will be considered for prosecution, e.g. $200,000.00, $1 million. What does this tell fraudsters – steal up to a certain amount, stop and change jurisdictions?

In the end, the health care fraud shell-game is perfect for fringe care-givers and deviant providers and suppliers who jockey for unfettered-access to health care dollars from a payment system incapable or unwilling to employ necessary mechanisms to appropriately address fraud – on the front-end before the claims are paid! These deviant providers and suppliers know that every claim is not looked at before it is paid, and operate knowing that it is then impossible to detect, investigate and prosecute everyone who is committing fraud!

Lucky for us, there are countless experienced and dedicated professionals working in the trenches to combat fraud that persevere in the face of adversity, making a difference one claim/case at a time! These professionals include, but are not limited to: Providers of all disciplines; Regulatory Boards (Insurance and Health Care); Insurance Company Claims Handlers and Special Investigators; Local, State and Federal Law Enforcers; State and Federal Prosecutors; and others.

What is a Medical Flight, and Why Should You Care?

Typically, a medical flight involves an air evacuation, or air evac service offered for the ill and injured. This important information for you to know because someday it could substantially reduce the time needed to transport you from the scene of an accident to a hospital. Keep reading to learn a little bit about medical flights – you might even learn some things that could help you decide on one in the future.

Generally speaking, the most typical passengers on these flights are individuals who have sustained serious trauma, respiratory failure, brain injuries, or heart complications.You will find that air evac services and other types of medical flight offer 3 levels of care to best treat the individual on board:

  1. Simple life support: This sort of attention is perfect for individuals with somewhat mild medical conditions, possibly needing breathable air or IV supplementing.
  2. Advanced life support: patients in need of this category of treatment require higher amounts of consideration. There may be need for multiplied checking of the issue on a continual schedule together with the means to access intravenous amenities and medicine dispensaries.
  3. Critical care support: a ailing person in need of this kind of specific assistance will need continuous inspection, typical drug maintenance, utilization of highly specialized equipment and various specialized gizmos that help to preserve life in a crisis.

While not every air evac provider maintains the same standard for care, the more responsible companies will share the following principles:

Specifications. Aircraft should be chosen for both cost efficiency and fuel economy. Wide entryways are also essential because they allow for convenient entry/exit from the aircraft.

Training. Medical staff on board will undergo arduous training programs prior to working on the aircraft. Such rigorous standards ensures patients receive only the best care.

Regulations. Compliance with Federal Aviation Administration (FAA) policies for all aircraft flying above 29,000ft. These practices are important because flying at this elevation means a faster journey and comfort and ease to the affected person.

If you or someone you know finds themselves in a situation requiring air ambulance service, having the most basic understanding of medical flights could help you decide on a carrier and know what to look for. Of course, if you’re not sure if you need medical flight services, you can always consult with the company to determine whether using a road ambulance or an air ambulance is needed.