Things To Consider
A number of figures used in tax and retirement planning have been updated for 2010. Most limits for pension and IRA contributions have been unchanged. For example:
1. The maximum contribution that can be made to a defined contribution plan in 2010 under Section 415 is the lesser of $49,000 or 100 percent of compensation-the same limit as in 2009.
2. The limit on employee elective deferrals to Section 401K and Section 403b plans has remained at $16,500 in 2010. For those over 50 this is increased an additional $5,000. The limit for Section 457 plan salary reductions has likewise kept steady at $16,500.
3. The maximum elective deferral for a SIMPLE or 401 K SIMPLE plan is $11,500 in 2010.
4. The limit on IRA contributions remains at $5,000 for 2010. Those 50 and older can still contribute an extra $1,000 under the special catch-up provision.
Here are a few of the income tax changes:
The standard deduction for joint filers and surviving spouses who do not itemize in 2010 is $11,400, the same as 2009. For heads of household, the deduction is $8,400, and for unmarried individuals it's $5,700. The aged and the blind get an additional $1,100 or $1,400 added to their standard deductions, depending on their filing status.
The personal exemption has remained steady at $3,650 for 2010. The exemption started to be phased out at $250,200 of adjusted gross income for married filers, $208,500 for heads of household, $166,800 for unmarried individuals and $125,100 for married individuals filing separate returns in 2009. The phase-out has been eliminated in 2010
The phase-out of itemized deductions began at $83,400 of adjusted gross for married individuals filing separate returns, and $166,800 for all other taxpayers. The phase-out has been eliminated in 2010.
And here are some other items that may be important to your clients.
The social security tax rate for individuals stays at 7.65% in 2010. The rate for self-employed individuals also remains constant at 15.3%. The taxable wage base for the OASDI portion is $106,800 in 2010-and that gets hit with the full 7.65% tax for individuals. Any additional compensation over that limit is subject to only the 1.45% for the Medicare portion.
In 2010, the federal annual gift tax exclusion amount has remained at $13,000. The lifetime gift tax exemption has stayed at $1 million; however the rate on gifts above $1 million is reduced to 35%.
The federal estate tax exemption was $3.5 million in 2009, and as of right now is unlimited in 2010. Watch for probable action on federal estate taxes by the Congress and President. Most experts expect the federal estate tax exemption for 2010 to be reinstated at $3.5 million. Many of those same commentators are suggesting that the federal estate tax exemption in 2011 will return to $1 million in 2010.
These changes may affect your client's retirement, tax plans and estate planning.
AS ALWAYS, PLEASE FEEL FREE TO CALL TO DISCUSS THESE OR OTHER FINANCIAL SECURITY ISSUES OF CONCERN.
Sincerely,Weatherby & Associates, PC
Henry C Weatherby
www.careconnecticut.org
Friday, February 26, 2010
Friday, February 19, 2010
U.S. Cracks Down on ‘Contractors’ as a Tax Dodge
By STEVEN GREENHOUSE
Published: February 17, 2010
Federal and state officials, many facing record budget deficits, are starting to aggressively pursue companies that try to pass off regular employees as independent contractors.
President Obama’s 2010 budget assumes that the federal crackdown will yield at least $7 billion over 10 years. More than two dozen states also have stepped up enforcement, often by enacting stricter penalties for misclassifying workers.
Many workplace experts say a growing number of companies have maneuvered to cut costs by wrongly classifying regular employees as independent contractors, though they often are given desks, phone lines and assignments just like regular employees. Moreover, the experts say, workers have become more reluctant to challenge such practices, given the tough job market.
Companies that pass off employees as independent contractors avoid paying Social Security, Medicare and unemployment insurance taxes for those workers. Companies do not withhold income taxes from contractors’ paychecks, and several studies have indicated that, on average, misclassified independent workers do not report 30 percent of their income.
One federal study concluded that employers illegally passed off 3.4 million regular workers as contractors, while the Labor Department estimates that up to 30 percent of companies misclassify employees. Ohio’s attorney general estimates that his state has 92,500 misclassified workers, which has cost the state up to $35 million a year in unemployment insurance taxes, up to $103 million in workers’ compensation premiums and up to $223 million in income tax revenue.
“It’s a very significant problem,” said the attorney general, Richard Cordray. “Misclassification is bad for business, government and labor. Law-abiding businesses are in many ways the biggest fans of increased enforcement. Misclassifying can mean a 20 or 30 percent cost difference per worker.”
Employers deny misclassifying workers deliberately. The businesses say the lines are unclear between employee and independent contractor.
Workers are generally considered employees when someone else controls how and when they perform their work. In contrast, independent contractors are generally in business for themselves, obtain customers on their own and control how they perform services.
Many businesses are dismayed about the tougher federal and state scrutiny.
“The goal of raising money is not a proper rationale for reclassifying who falls on what side of the line,” said Randel K. Johnson, senior vice president with the United States Chamber of Commerce. “The laws are unclear in this area, and legitimate clarification is one thing. But if it’s just a way to justify enforcing very unclear laws against employers who can have a legitimate disagreement with the Labor Department or I.R.S., then we’re concerned.”
Among the most often misclassified workers are truck drivers, construction workers, home health aides and high-tech engineers.
Portraying regular workers as contractors allows companies to circumvent minimum wage, overtime and antidiscrimination laws. Workers classified as contractors do not receive unemployment insurance if laid off or workers’ compensation if injured, and they rarely receive the health insurance or other fringe benefits regular employees do.
“This denies many workers their basic rights and protections and means less revenues to the Treasury and a competitive advantage for employers who misclassify,” said Jared Bernstein, who as executive director of Vice President Joseph R. Biden Jr.’s Middle Class Task Force has helped orchestrate the administration’s campaign against misclassification. “The last thing you want is to give a competitive advantage to employers who are breaking the rules.”
Organized labor, a strong supporter of Mr. Obama, has long complained about the practice. No administration has undertaken as big a crackdown as Mr. Obama’s, although administration and state officials deny they are doing it as a favor to labor.
California’s attorney general, Jerry Brown, is seeking $4.3 million from a construction firm he accused of misclassifying employees. Last April, he won a $13 million judgment when a court ruled that two companies had misclassified 300 janitors, cheated the state out of payroll taxes and not paid minimum wage and overtime.
Last November, the Illinois Department of Labor imposed $328,500 in penalties on a home improvement company for misclassifying 18 workers, saying it had pressed them to incorporate as separate business entities.
The Obama administration plans to expand investigations by hiring 100 more enforcement personnel. The I.R.S. has begun auditing 6,000 companies to see whether they are in compliance with the law.
U.S. Cracks Down on ‘Contractors’ as a Tax Dodge
Published: February 17, 2010
(Page 2 of 2)
The administration also plans to rewrite a three-decade-old I.R.S. rule that lets companies indefinitely classify employees as independent contractors — even when the government knows they are misclassified — so long as the company once had a reasonable belief that the workers were contractors.
One worker who welcomes stricter enforcement is Fritz Elienberg, who spent five years installing cable and Internet service for RCN in Boston.
Mr. Elienberg said he and a dozen other installers reported to an RCN office six mornings a week, shortly after 6:30, where they received their daily assignments and the equipment to do installations. He said he typically worked 10 to 14 hours a day and never received time-and-a-half pay for overtime.
“I didn’t feel like an independent contractor. I didn’t feel like my own boss,” Mr. Elienberg said. “I always believed I was an employee. It’s a win-win situation for them and a lose-lose for us. We didn’t get overtime, sick days, vacations, health insurance or pensions.”
Mr. Elienberg said his foot was seriously injured when a ladder fell on it, but workers’ compensation did not cover his medical bills because he was considered a contractor. He is suing RCN for overtime pay and the value of lost benefits.
Michele Murphy, an RCN spokeswoman, said the company often contracted with outside service providers but did not misclassify workers.
A Harvard study found that 4.5 percent of Massachusetts workers were misclassified, while a Cornell study concluded that 10 percent of New York’s private-sector workers were.
Last October, the attorneys general of New York, New Jersey and Montana threatened to sue FedEx Ground, asserting it had misclassified its drivers. The Teamsters union has long pressed officials to pursue the company. The Teamsters hope to unionize these drivers, but independent contractors, unlike regular employees, cannot form unions.
FedEx argues that these drivers are contractors because they own their trucks and can sell their routes.
One factor in the push for more aggressive enforcement is the Labor Department’s new top law enforcement official, M. Patricia Smith. As New York’s labor commissioner the past three years, she was known for cracking down on misclassification.
Ms. Smith oversaw a task force comprising various state agencies that conducted 2,413 misclassification investigations and 65 joint sweeps in which teams descended on companies’ offices to examine payroll records.
In a Feb. 1 report to New York’s governor, Ms. Smith noted that since late 2007, the task force had identified more than 31,000 instances of misclassification and assessed $11 million in unpaid unemployment taxes and $14.5 million in unpaid wages.
Published: February 17, 2010
Federal and state officials, many facing record budget deficits, are starting to aggressively pursue companies that try to pass off regular employees as independent contractors.
President Obama’s 2010 budget assumes that the federal crackdown will yield at least $7 billion over 10 years. More than two dozen states also have stepped up enforcement, often by enacting stricter penalties for misclassifying workers.
Many workplace experts say a growing number of companies have maneuvered to cut costs by wrongly classifying regular employees as independent contractors, though they often are given desks, phone lines and assignments just like regular employees. Moreover, the experts say, workers have become more reluctant to challenge such practices, given the tough job market.
Companies that pass off employees as independent contractors avoid paying Social Security, Medicare and unemployment insurance taxes for those workers. Companies do not withhold income taxes from contractors’ paychecks, and several studies have indicated that, on average, misclassified independent workers do not report 30 percent of their income.
One federal study concluded that employers illegally passed off 3.4 million regular workers as contractors, while the Labor Department estimates that up to 30 percent of companies misclassify employees. Ohio’s attorney general estimates that his state has 92,500 misclassified workers, which has cost the state up to $35 million a year in unemployment insurance taxes, up to $103 million in workers’ compensation premiums and up to $223 million in income tax revenue.
“It’s a very significant problem,” said the attorney general, Richard Cordray. “Misclassification is bad for business, government and labor. Law-abiding businesses are in many ways the biggest fans of increased enforcement. Misclassifying can mean a 20 or 30 percent cost difference per worker.”
Employers deny misclassifying workers deliberately. The businesses say the lines are unclear between employee and independent contractor.
Workers are generally considered employees when someone else controls how and when they perform their work. In contrast, independent contractors are generally in business for themselves, obtain customers on their own and control how they perform services.
Many businesses are dismayed about the tougher federal and state scrutiny.
“The goal of raising money is not a proper rationale for reclassifying who falls on what side of the line,” said Randel K. Johnson, senior vice president with the United States Chamber of Commerce. “The laws are unclear in this area, and legitimate clarification is one thing. But if it’s just a way to justify enforcing very unclear laws against employers who can have a legitimate disagreement with the Labor Department or I.R.S., then we’re concerned.”
Among the most often misclassified workers are truck drivers, construction workers, home health aides and high-tech engineers.
Portraying regular workers as contractors allows companies to circumvent minimum wage, overtime and antidiscrimination laws. Workers classified as contractors do not receive unemployment insurance if laid off or workers’ compensation if injured, and they rarely receive the health insurance or other fringe benefits regular employees do.
“This denies many workers their basic rights and protections and means less revenues to the Treasury and a competitive advantage for employers who misclassify,” said Jared Bernstein, who as executive director of Vice President Joseph R. Biden Jr.’s Middle Class Task Force has helped orchestrate the administration’s campaign against misclassification. “The last thing you want is to give a competitive advantage to employers who are breaking the rules.”
Organized labor, a strong supporter of Mr. Obama, has long complained about the practice. No administration has undertaken as big a crackdown as Mr. Obama’s, although administration and state officials deny they are doing it as a favor to labor.
California’s attorney general, Jerry Brown, is seeking $4.3 million from a construction firm he accused of misclassifying employees. Last April, he won a $13 million judgment when a court ruled that two companies had misclassified 300 janitors, cheated the state out of payroll taxes and not paid minimum wage and overtime.
Last November, the Illinois Department of Labor imposed $328,500 in penalties on a home improvement company for misclassifying 18 workers, saying it had pressed them to incorporate as separate business entities.
The Obama administration plans to expand investigations by hiring 100 more enforcement personnel. The I.R.S. has begun auditing 6,000 companies to see whether they are in compliance with the law.
U.S. Cracks Down on ‘Contractors’ as a Tax Dodge
Published: February 17, 2010
(Page 2 of 2)
The administration also plans to rewrite a three-decade-old I.R.S. rule that lets companies indefinitely classify employees as independent contractors — even when the government knows they are misclassified — so long as the company once had a reasonable belief that the workers were contractors.
One worker who welcomes stricter enforcement is Fritz Elienberg, who spent five years installing cable and Internet service for RCN in Boston.
Mr. Elienberg said he and a dozen other installers reported to an RCN office six mornings a week, shortly after 6:30, where they received their daily assignments and the equipment to do installations. He said he typically worked 10 to 14 hours a day and never received time-and-a-half pay for overtime.
“I didn’t feel like an independent contractor. I didn’t feel like my own boss,” Mr. Elienberg said. “I always believed I was an employee. It’s a win-win situation for them and a lose-lose for us. We didn’t get overtime, sick days, vacations, health insurance or pensions.”
Mr. Elienberg said his foot was seriously injured when a ladder fell on it, but workers’ compensation did not cover his medical bills because he was considered a contractor. He is suing RCN for overtime pay and the value of lost benefits.
Michele Murphy, an RCN spokeswoman, said the company often contracted with outside service providers but did not misclassify workers.
A Harvard study found that 4.5 percent of Massachusetts workers were misclassified, while a Cornell study concluded that 10 percent of New York’s private-sector workers were.
Last October, the attorneys general of New York, New Jersey and Montana threatened to sue FedEx Ground, asserting it had misclassified its drivers. The Teamsters union has long pressed officials to pursue the company. The Teamsters hope to unionize these drivers, but independent contractors, unlike regular employees, cannot form unions.
FedEx argues that these drivers are contractors because they own their trucks and can sell their routes.
One factor in the push for more aggressive enforcement is the Labor Department’s new top law enforcement official, M. Patricia Smith. As New York’s labor commissioner the past three years, she was known for cracking down on misclassification.
Ms. Smith oversaw a task force comprising various state agencies that conducted 2,413 misclassification investigations and 65 joint sweeps in which teams descended on companies’ offices to examine payroll records.
In a Feb. 1 report to New York’s governor, Ms. Smith noted that since late 2007, the task force had identified more than 31,000 instances of misclassification and assessed $11 million in unpaid unemployment taxes and $14.5 million in unpaid wages.
Wednesday, January 6, 2010
Remote Electronic Patient Monitoring Could Save $197 Billion Over 25 Years
Remote Electronic Patient Monitoring Could Save $197 Billion Over 25 Years
by Tim Rowan stored in: Tim Rowan's Home Care Technology Report and tagged: Telehealth
The United States is faced with a choice to spend more on healthcare — money that does not exist — or cut costs over time, according to a report underwritten by AT&T and conducted by Kauffman Foundation and Brookings Institution economist Robert E. Litan. $197 in savings would result from implementing telehealth systems. Failure to make policy adjustments that encourage healthcare providers to take advantage of remote monitoring technologies will cut estimated savings by nearly $44 billion.
Both forecasts consider results over a 25-year span. Litan is Vice President for Research and Policy at the Kauffman Foundation, a Senior Fellow in the Economic and Global Economics Programs at the Brookings Institution, and a Consultant to Empiris. He conducted the study of financial implications of remote monitoring technologies in 2008 but the report was recently published by the “Better Health Care Together” coalition (BHCT).
Widespread use of remote monitoring over broadband networks, located in both institutions and homes, to track vital signs of patients with chronic diseases such as congestive heart failure and diabetes is a critical and urgent development. “Remote monitoring can spot health problems sooner, reduce hospitalization, improve life quality and save money,” Litan said at a health care forum sponsored by BHCT.
During his remarks at the BHCT forum, Litan warned that adoption of remote monitoring technologies will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet privacy, security and reliability requirements for telemedicine applications.
“Hospitals and doctors can’t provide services unless they get paid. We need insurance reimbursement policies, beginning with Medicare and Medicaid, that cover remote monitoring,” Litan told the BHCT audience. “We also need policies that deliver broadband, including ’smart networks’ that ensure that patients’ critical data is secure and that communications are not disrupted.”
Jody Hoffman, Executive Director of Better Health Care Together said Litan’s study illustrates how new directions in health care can enable the United States to deliver quality care at lower costs. “Our first priority is to make sure every American has quality, affordable health coverage,” Hoffman said. “In order to do that we also need to get better value for our health care dollars and we believe information technologies can help in a big way.”
Litan’s savings estimates are tied to four specific conditions – congestive heart failure, diabetes, chronic obstruction pulmonary disease, and chronic skin ulcers and wounds.
Following is the Executive Summary from Litan’s report. The entire, 60-page document is available from BHCT at http://www.betterhealthcaretogether.org/study.
VITAL SIGNS VIA BROADBAND: REMOTE HEALTH MONITORING TRANSMITS SAVINGS, ENHANCES LIVES
For the millions of people around the world who have embraced the Internet, the transformational effects of modern communications technologies are well known. Using search engines to access information, attending classes and college lectures online, conducting financial transactions and shopping, and enjoying music, video and games over the Internet are increasingly routine. But other Internet-based activities have yet to reach their full potential; among the most significant is telemedicine – the use of modern communications to deliver a wide range of health care to patients at locations that are physically distant from the caregiver.
By enabling more regular contact between patient and caregiver, the use of IT technologies can mean earlier detection of health problems and better outcomes that enable people to live longer and more satisfying lives. Telemedicine can help those with chronic illnesses to lead normal work and personal lives and enable older Americans to remain in their own homes instead of moving to institutional settings.
Remote Monitoring Detects Problems Earlier; Means Better Outcomes and Less Hospital Time
These benefits of telemedicine, and in particular remote monitoring, are well-documented. Remote monitoring helps chronic disease patients avoid hospitalization and enables those in geographically isolated settings to access specialized and preventive medicine. Distant monitoring has special efficacy for patients with chronic ailments such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, and chronic skin ulcers for which changes in vital signs can signal a need for medical intervention. Remote monitoring technologies can transmit data on a regular, real time basis and prevent hospitalizations by identifying and treating problems by triggering adjustments in care before negative trends reach crisis stage.
The improvements in patient experience can be dramatic. For example, a widely cited study by Meyer, Kobb, and Ryan reports that the combination of home telemonitoring, video visits, and coordinated care resulted in substantial improvements in health outcomes among a group of elderly veterans with a variety of chronic diseases. These gains included a 40 percent reduction in emergency room visits, a 63 percent reduction in hospital admissions, and a 60 percent reduction in hospital bed days of care, along with similar reductions in nursing home care.
These types of outcomes also deliver significant savings to the health care system, particularly for the chronic illnesses that account for roughly 80 percent of increases in Medicare costs.
Widespread Remote Monitoring Can Cut Health Care Costs By $197 Billion
Upon examination of existing literature and experience to date, I estimate that a full embrace of remote monitoring alone could reduce health care expenditures by a net of $197 billion (in constant 2008 dollars) over the next 25 years with the adoption of policies that reduce barriers and accelerate the use of remote monitoring technologies. The policy enhancements boost savings by almost $44 billion over the 25-year period, an improvement of almost 29 percent compared with continuation of the current policy baseline.
The savings are largely attributable to better management of chronic diseases because of remote monitoring. Widespread implementation of remote monitoring means key vital signs can be transmitted to a caregiver or a data center in real time and trigger an instant alert when readings change in a medically significant way. Caregivers also say that addition of two-way video to monitoring programs can further enhance the quality of interaction between patient and caregiver and can encourage patients to observe treatment regimens with greater consistency.
When broken down by condition, I estimate the following net savings over the 25-year period:
Congestive Heart Failure
$102.5 billion
Diabetes
$54.4 billion
Chronic Obstruction
Pulmonary Disease
$24.1 billion
Chronic Skin Ulcers
$16.0 billion
Savings Can Be Accelerated With Smart Policy in Medical Reimbursement and Technology
Success in translating potential savings into real savings depends in part on public policy decisions that speed the acceptance and penetration of remote monitoring. The realignment of reimbursement policy for telemedicine is among the most critical requirements. For example, Medicare and insurance reimbursement policies that recognize the value of investments in telemedicine equipment and expertise can spread the use of remote monitoring by reducing out-of-pocket costs and encouraging buy-in among practitioners. [For full set of policy recommendations see pages 50-51 and 54-55]
Right now, like other preventive care, telemedicine is only covered by current private and public health insurance plans to a limited extent. For example, remote consultations with physicians are reimbursed if they are conducted over two-way video. However, physicians are not reimbursed for examining remote monitoring data as a preventive measure. Right now, patients and insurers are capturing many of the quality improvements and cost savings from telemedicine, but paying for few of them. The costs are largely incurred by health care providers, but not fully reimbursed. This circumstance will not encourage optimal levels of investment in and commitment to the provision of telemedicine infrastructure and services. Quite simply, we need policy incentives that ensure that institutions and practitioners who invest in telemedicine are sufficiently compensated for the resulting improvements in both care and costs.
Smart communications policy also can expedite the adoption of remote monitoring and other telemedicine technologies. Policies that increase the public’s fluency with advanced communications technology will make telemedicine more effective and easier to implement. Policies that bring broadband technologies into more homes also will help bring in remote monitoring, video visits with providers, and self-care education. Investments in networks provide needed capacity for live video and continuous monitoring, and policies allowing quality-of-service offerings allow doctors to treat their patients without interruption.
In particular, the long-term success of remote monitoring requires telecommunications policies that encourage widespread deployment of broadband and accelerated private investment in “smart networks.” Policy should promote network investment and allow operators to tailor services to the needs of telemedicine, including data privacy and reliable real-time connectivity.
www.adhomehealthsolutions.com
www.ctcarecouncil.org
by Tim Rowan stored in: Tim Rowan's Home Care Technology Report and tagged: Telehealth
The United States is faced with a choice to spend more on healthcare — money that does not exist — or cut costs over time, according to a report underwritten by AT&T and conducted by Kauffman Foundation and Brookings Institution economist Robert E. Litan. $197 in savings would result from implementing telehealth systems. Failure to make policy adjustments that encourage healthcare providers to take advantage of remote monitoring technologies will cut estimated savings by nearly $44 billion.
Both forecasts consider results over a 25-year span. Litan is Vice President for Research and Policy at the Kauffman Foundation, a Senior Fellow in the Economic and Global Economics Programs at the Brookings Institution, and a Consultant to Empiris. He conducted the study of financial implications of remote monitoring technologies in 2008 but the report was recently published by the “Better Health Care Together” coalition (BHCT).
Widespread use of remote monitoring over broadband networks, located in both institutions and homes, to track vital signs of patients with chronic diseases such as congestive heart failure and diabetes is a critical and urgent development. “Remote monitoring can spot health problems sooner, reduce hospitalization, improve life quality and save money,” Litan said at a health care forum sponsored by BHCT.
During his remarks at the BHCT forum, Litan warned that adoption of remote monitoring technologies will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet privacy, security and reliability requirements for telemedicine applications.
“Hospitals and doctors can’t provide services unless they get paid. We need insurance reimbursement policies, beginning with Medicare and Medicaid, that cover remote monitoring,” Litan told the BHCT audience. “We also need policies that deliver broadband, including ’smart networks’ that ensure that patients’ critical data is secure and that communications are not disrupted.”
Jody Hoffman, Executive Director of Better Health Care Together said Litan’s study illustrates how new directions in health care can enable the United States to deliver quality care at lower costs. “Our first priority is to make sure every American has quality, affordable health coverage,” Hoffman said. “In order to do that we also need to get better value for our health care dollars and we believe information technologies can help in a big way.”
Litan’s savings estimates are tied to four specific conditions – congestive heart failure, diabetes, chronic obstruction pulmonary disease, and chronic skin ulcers and wounds.
Following is the Executive Summary from Litan’s report. The entire, 60-page document is available from BHCT at http://www.betterhealthcaretogether.org/study.
VITAL SIGNS VIA BROADBAND: REMOTE HEALTH MONITORING TRANSMITS SAVINGS, ENHANCES LIVES
For the millions of people around the world who have embraced the Internet, the transformational effects of modern communications technologies are well known. Using search engines to access information, attending classes and college lectures online, conducting financial transactions and shopping, and enjoying music, video and games over the Internet are increasingly routine. But other Internet-based activities have yet to reach their full potential; among the most significant is telemedicine – the use of modern communications to deliver a wide range of health care to patients at locations that are physically distant from the caregiver.
By enabling more regular contact between patient and caregiver, the use of IT technologies can mean earlier detection of health problems and better outcomes that enable people to live longer and more satisfying lives. Telemedicine can help those with chronic illnesses to lead normal work and personal lives and enable older Americans to remain in their own homes instead of moving to institutional settings.
Remote Monitoring Detects Problems Earlier; Means Better Outcomes and Less Hospital Time
These benefits of telemedicine, and in particular remote monitoring, are well-documented. Remote monitoring helps chronic disease patients avoid hospitalization and enables those in geographically isolated settings to access specialized and preventive medicine. Distant monitoring has special efficacy for patients with chronic ailments such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, and chronic skin ulcers for which changes in vital signs can signal a need for medical intervention. Remote monitoring technologies can transmit data on a regular, real time basis and prevent hospitalizations by identifying and treating problems by triggering adjustments in care before negative trends reach crisis stage.
The improvements in patient experience can be dramatic. For example, a widely cited study by Meyer, Kobb, and Ryan reports that the combination of home telemonitoring, video visits, and coordinated care resulted in substantial improvements in health outcomes among a group of elderly veterans with a variety of chronic diseases. These gains included a 40 percent reduction in emergency room visits, a 63 percent reduction in hospital admissions, and a 60 percent reduction in hospital bed days of care, along with similar reductions in nursing home care.
These types of outcomes also deliver significant savings to the health care system, particularly for the chronic illnesses that account for roughly 80 percent of increases in Medicare costs.
Widespread Remote Monitoring Can Cut Health Care Costs By $197 Billion
Upon examination of existing literature and experience to date, I estimate that a full embrace of remote monitoring alone could reduce health care expenditures by a net of $197 billion (in constant 2008 dollars) over the next 25 years with the adoption of policies that reduce barriers and accelerate the use of remote monitoring technologies. The policy enhancements boost savings by almost $44 billion over the 25-year period, an improvement of almost 29 percent compared with continuation of the current policy baseline.
The savings are largely attributable to better management of chronic diseases because of remote monitoring. Widespread implementation of remote monitoring means key vital signs can be transmitted to a caregiver or a data center in real time and trigger an instant alert when readings change in a medically significant way. Caregivers also say that addition of two-way video to monitoring programs can further enhance the quality of interaction between patient and caregiver and can encourage patients to observe treatment regimens with greater consistency.
When broken down by condition, I estimate the following net savings over the 25-year period:
Congestive Heart Failure
$102.5 billion
Diabetes
$54.4 billion
Chronic Obstruction
Pulmonary Disease
$24.1 billion
Chronic Skin Ulcers
$16.0 billion
Savings Can Be Accelerated With Smart Policy in Medical Reimbursement and Technology
Success in translating potential savings into real savings depends in part on public policy decisions that speed the acceptance and penetration of remote monitoring. The realignment of reimbursement policy for telemedicine is among the most critical requirements. For example, Medicare and insurance reimbursement policies that recognize the value of investments in telemedicine equipment and expertise can spread the use of remote monitoring by reducing out-of-pocket costs and encouraging buy-in among practitioners. [For full set of policy recommendations see pages 50-51 and 54-55]
Right now, like other preventive care, telemedicine is only covered by current private and public health insurance plans to a limited extent. For example, remote consultations with physicians are reimbursed if they are conducted over two-way video. However, physicians are not reimbursed for examining remote monitoring data as a preventive measure. Right now, patients and insurers are capturing many of the quality improvements and cost savings from telemedicine, but paying for few of them. The costs are largely incurred by health care providers, but not fully reimbursed. This circumstance will not encourage optimal levels of investment in and commitment to the provision of telemedicine infrastructure and services. Quite simply, we need policy incentives that ensure that institutions and practitioners who invest in telemedicine are sufficiently compensated for the resulting improvements in both care and costs.
Smart communications policy also can expedite the adoption of remote monitoring and other telemedicine technologies. Policies that increase the public’s fluency with advanced communications technology will make telemedicine more effective and easier to implement. Policies that bring broadband technologies into more homes also will help bring in remote monitoring, video visits with providers, and self-care education. Investments in networks provide needed capacity for live video and continuous monitoring, and policies allowing quality-of-service offerings allow doctors to treat their patients without interruption.
In particular, the long-term success of remote monitoring requires telecommunications policies that encourage widespread deployment of broadband and accelerated private investment in “smart networks.” Policy should promote network investment and allow operators to tailor services to the needs of telemedicine, including data privacy and reliable real-time connectivity.
www.adhomehealthsolutions.com
www.ctcarecouncil.org
Wednesday, November 11, 2009
Recognizing the Need for outside Help in Caregiving
Caregivers often don’t recognize when they are in over their heads, and often get to a breaking point. After a prolonged period of time, caregiving can become too difficult to endure any longer. Short-term the caregiver can handle it. Long-term, help is needed. Outside help at this point is needed.
A typical pattern with an overloaded caregiver may unfold as follows:
· 1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.
· 20 to 36 months--the caregiver is taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.
· 38 to 50 months--Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.
It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled in a facility. Without intervention, the caregiver may become a candidate for long term care as well.
It is also important to use outside professional help in a caregiver setting. A financial planner, care funding specialist or a reverse mortgage specialist may find the funds to pay for professional help to keep a loved one at home. A care manager can guide the family and the caregiver through the maze of long-term care issues. The care manager has been there many times the family is experiencing it for the first time.
An elder law attorney can help iron out legal problems. And an elder mediator can help solve disputes between family members. Having competent advice can often make the difference between allowing a loved one to remain in the home or being forced to seek out government welfare assistance.
Due to pride or sheer determination some caregivers allow the situation to go beyond their control. They have gotten to a point where depression and fatigue have clouded their judgment. At some point the caregiver will have to admit that he or she can't handle it alone and a better solution must be found.
Dan Fisher RN, BSN
Connecticut Care Planning Council
A & D Home Health Solutions
A typical pattern with an overloaded caregiver may unfold as follows:
· 1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.
· 20 to 36 months--the caregiver is taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.
· 38 to 50 months--Besides needing tranquilizers or antidepressants, the caregiver's physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.
It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled in a facility. Without intervention, the caregiver may become a candidate for long term care as well.
It is also important to use outside professional help in a caregiver setting. A financial planner, care funding specialist or a reverse mortgage specialist may find the funds to pay for professional help to keep a loved one at home. A care manager can guide the family and the caregiver through the maze of long-term care issues. The care manager has been there many times the family is experiencing it for the first time.
An elder law attorney can help iron out legal problems. And an elder mediator can help solve disputes between family members. Having competent advice can often make the difference between allowing a loved one to remain in the home or being forced to seek out government welfare assistance.
Due to pride or sheer determination some caregivers allow the situation to go beyond their control. They have gotten to a point where depression and fatigue have clouded their judgment. At some point the caregiver will have to admit that he or she can't handle it alone and a better solution must be found.
Dan Fisher RN, BSN
Connecticut Care Planning Council
A & D Home Health Solutions
Thursday, October 29, 2009
Providing more options for seniors
POINT OF VIEW Project 2020
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BY JUDY LEITNER AND JIM KILLACKEY Comments 0
Published: October 24, 2009
Keeping Oklahoma’s senior citizens healthy and in their homes and their communities for as long as possible without needing nursing home care is a primary goal of Project 2020, proposed legislation that has the backing of U.S. Rep. John Sullivan, R-Tulsa, and numerous statewide eldercare organizations.
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Supporters say that if Project 2020 becomes part of national health care reforms, it could reduce Medicare and Medicaid expenditures by some $2.7 billion during its first five years.
Funds could be used to open more adult day care centers, establish additional senior center programs, provide meals and transportation to their doctors for seniors without vehicles, start more elder abuse-prevention programs, and offer more legal assistance to the growing number of Americans age 65 and older.
Medical equipment covered by Project 2020 could be used in the home to aid in a better quality of life. That could include items such as oxygen tents, nebulizers, sleep machines, catheters, diapers, hospital beds, wheelchairs, blood-testing strips and blood-glucose monitors for diabetics.
Project 2020 also would prevent people from spending their life’s savings to qualify for Medicaid nursing-home eligibility. It might be used, supporters say, to promote fall-prevention strategies, physical fitness activities, better nutrition and chronic-disease management for seniors.
"I believe it’s important for us to re-think the way we deliver care to the elderly. This bill provides a community-based strategy to ensure we meet long-term-care challenges ... and avoid more costly institutional care,” said Sullivan, co-sponsor of the Project 2020 initiative, which got its name because by the year 2020, one in six Americans will be 65 and older.
According to the National Association of State Units on Aging, initial estimates indicate that Project 2020 has the potential to reach more than 40 million Americans.
The bill also would help make sure the health care work force will be ready to care for an aging population; that could be done by expanding training for geriatric physicians.
No price tag has yet been attached to Project 2020.
A recent AARP report said Medicaid dollars spent on home- and community-based services can support nearly three people for every one person in a nursing home, according to Sean Voskuhl, AARP associate state director.
Another survey, Voskuhl said, showed that 89 percent of Americans age 50 or older prefer to live in their homes for as long as possible. Oklahoma has 317 nursing homes with about 18,000 residents.
In addition, Voskuhl said, Project 2020 should improve assistance for family caregivers who help seniors with daily living responsibilities.
Nearly eight in 10 Americans say they would be more likely to support a health care reform proposal if that initiative included home- and community-based long-term care coverage for seniors. Sullivan is the lead Republican sponsor of HR 2853, also known as Project 2020 and the Empowered at Home Act of 2009.
Leitner and Killackey are members of the Oklahoma the Oklahoma State Council on Aging, the advisory board to the Aging Services Division of the Department of Human Services.
Supporters say that if Project 2020 becomes part of national health care reforms, it could reduce Medicare and Medicaid expenditures by some $2.7 billion during its first five years.
Read more: http://newsok.com/providing-more-options-for-seniors/article/3411425#ixzz0V8OhNA2C
Dan Fisher RN, BSN
President
A & D Home Health Solutions, Inc
Phone: 860-667-2275
Fax: 860-667-2276
Check out these articles
http://seniorcare101.blogspot.com
www.adhomehealthsolutions.com
www.ctcarecouncil.org
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BY JUDY LEITNER AND JIM KILLACKEY Comments 0
Published: October 24, 2009
Keeping Oklahoma’s senior citizens healthy and in their homes and their communities for as long as possible without needing nursing home care is a primary goal of Project 2020, proposed legislation that has the backing of U.S. Rep. John Sullivan, R-Tulsa, and numerous statewide eldercare organizations.
Multimedia
Photoview all photos
Supporters say that if Project 2020 becomes part of national health care reforms, it could reduce Medicare and Medicaid expenditures by some $2.7 billion during its first five years.
Funds could be used to open more adult day care centers, establish additional senior center programs, provide meals and transportation to their doctors for seniors without vehicles, start more elder abuse-prevention programs, and offer more legal assistance to the growing number of Americans age 65 and older.
Medical equipment covered by Project 2020 could be used in the home to aid in a better quality of life. That could include items such as oxygen tents, nebulizers, sleep machines, catheters, diapers, hospital beds, wheelchairs, blood-testing strips and blood-glucose monitors for diabetics.
Project 2020 also would prevent people from spending their life’s savings to qualify for Medicaid nursing-home eligibility. It might be used, supporters say, to promote fall-prevention strategies, physical fitness activities, better nutrition and chronic-disease management for seniors.
"I believe it’s important for us to re-think the way we deliver care to the elderly. This bill provides a community-based strategy to ensure we meet long-term-care challenges ... and avoid more costly institutional care,” said Sullivan, co-sponsor of the Project 2020 initiative, which got its name because by the year 2020, one in six Americans will be 65 and older.
According to the National Association of State Units on Aging, initial estimates indicate that Project 2020 has the potential to reach more than 40 million Americans.
The bill also would help make sure the health care work force will be ready to care for an aging population; that could be done by expanding training for geriatric physicians.
No price tag has yet been attached to Project 2020.
A recent AARP report said Medicaid dollars spent on home- and community-based services can support nearly three people for every one person in a nursing home, according to Sean Voskuhl, AARP associate state director.
Another survey, Voskuhl said, showed that 89 percent of Americans age 50 or older prefer to live in their homes for as long as possible. Oklahoma has 317 nursing homes with about 18,000 residents.
In addition, Voskuhl said, Project 2020 should improve assistance for family caregivers who help seniors with daily living responsibilities.
Nearly eight in 10 Americans say they would be more likely to support a health care reform proposal if that initiative included home- and community-based long-term care coverage for seniors. Sullivan is the lead Republican sponsor of HR 2853, also known as Project 2020 and the Empowered at Home Act of 2009.
Leitner and Killackey are members of the Oklahoma the Oklahoma State Council on Aging, the advisory board to the Aging Services Division of the Department of Human Services.
Supporters say that if Project 2020 becomes part of national health care reforms, it could reduce Medicare and Medicaid expenditures by some $2.7 billion during its first five years.
Read more: http://newsok.com/providing-more-options-for-seniors/article/3411425#ixzz0V8OhNA2C
Dan Fisher RN, BSN
President
A & D Home Health Solutions, Inc
Phone: 860-667-2275
Fax: 860-667-2276
Check out these articles
http://seniorcare101.blogspot.com
www.adhomehealthsolutions.com
www.ctcarecouncil.org
Wednesday, September 30, 2009
Understanding Long Term Care Planning
Mary is trying to prepare her son to avoid the mistakes she made with her husband Bill. Five years ago, Bill lost his ability to communicate due to Alzheimer's. He also suffered from heart disease and diabetes. As his caregiver, Mary was never quite sure she was making the right choices about his long term care and medical treatment. Eventually Bill needed life support and Mary agonized over how Bill really would have wanted his life to end since they had never discussed it.
Bill died last year. So many things were left undone regarding his care.
Mary has decided to plan for long term care and medical treatment before it happens. She has designated her son as her personal care coordinator. She has given him written instructions regarding different care scenarios and how to prepare for care giving. He also has copies of her will and trusts as well as other legal care documents. She has provided him an extensive source of long term care information as well as a list of her personal financial resources. Mary has implemented the financial solutions to pay for her care. And finally, she has provided her son with a detailed list of government and private long term care service providers.
By planning in advance for long term care, Mary has removed the guilt that loved ones feel in making care choices for her. She has researched and given direction on the types of care she desires, she has given direction and guidance to would-be caregivers and lastly she has planned for the means to pay for that care.
An article on the AARP website titled, "Talking about Independent Living" states, "Research has shown that, as people age, they prefer to continue living independently, preferably in their own homes. While adult children often worry about their parent's situation, it can be difficult to know if parents really need, or want, help from their children."
Children and parents should talk about all these things, except the parents should be the instigators and set the plan for the children to follow. What do you want your children, or friends to do in your behalf? When it comes time for them to help, you may not be physically or mentally able to execute your wishes. This is where your long term care plan comes into effect.
The time to start planning is now. Don’t wait until the choice is no longer yours!
Dan Fisher RN, BSN
President
www.adhomehealthsolutions.com
Connecticut Care Planning Council
Advisory Board
Bill died last year. So many things were left undone regarding his care.
Mary has decided to plan for long term care and medical treatment before it happens. She has designated her son as her personal care coordinator. She has given him written instructions regarding different care scenarios and how to prepare for care giving. He also has copies of her will and trusts as well as other legal care documents. She has provided him an extensive source of long term care information as well as a list of her personal financial resources. Mary has implemented the financial solutions to pay for her care. And finally, she has provided her son with a detailed list of government and private long term care service providers.
By planning in advance for long term care, Mary has removed the guilt that loved ones feel in making care choices for her. She has researched and given direction on the types of care she desires, she has given direction and guidance to would-be caregivers and lastly she has planned for the means to pay for that care.
An article on the AARP website titled, "Talking about Independent Living" states, "Research has shown that, as people age, they prefer to continue living independently, preferably in their own homes. While adult children often worry about their parent's situation, it can be difficult to know if parents really need, or want, help from their children."
Children and parents should talk about all these things, except the parents should be the instigators and set the plan for the children to follow. What do you want your children, or friends to do in your behalf? When it comes time for them to help, you may not be physically or mentally able to execute your wishes. This is where your long term care plan comes into effect.
The time to start planning is now. Don’t wait until the choice is no longer yours!
Dan Fisher RN, BSN
President
www.adhomehealthsolutions.com
Connecticut Care Planning Council
Advisory Board
Friday, August 14, 2009
Caring for a Loved One at Home Can Be Challenging
Informal caregivers are family, friends or volunteers who provide care for a loved one. Informal caregivers are rarely paid directly for their services. They may receive indirect payment through sharing a loved one's income or assets. Although informal caregivers may provide services in a facility, in most cases they are providers of care in the home.
Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. The financial impact is another challenge. The financial burden depends on who the informal caregiver is. For a spouse there is typically no financial cost since income and assets will be the same with or without a need for care. However, if a spouse offering informal care is employed and has to quit his or her job to provide care there is a significant impact on that family's finances.
Despite the fact that there may be no significant financial impact on a spouse caring for the other spouse at home, there can be significant impact on the emotional and physical health of the caregiving spouse. Because of the strain and burnout often associated with caregiving, the healthy spouse may experience deteriorating health and eventually require long term care services as well. In some cases healthy spouses have succumbed drastically to the pressures of caregiving and died prematurely, well before their care recipients have died.
Another caregiver challenge may be the need of constant surveillance on a spouse with advanced dementia. Still another caregiving challenge could be a son living 500 miles from his disabled parents and constantly traveling to and from his home, trying to manage a job and his own family as well as taking care of the parents. Other challenges to home care may be caregivers who simply don't have the time to watch over loved ones and those loved ones are sometimes neglected.
The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:
· Inadequate care provided to a loved one
· Lack of training for caregivers
· Lack of social stimulation for care recipients
· Informal caregivers unable to handle the challenge
· Depression and physical ailments caused by caregiver burnout
In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must understand the problems outlined above, deal with them and correct them. This often involves bringing in so-called formal caregivers such as care managers, home care companies or other long term care advisors. The responsibility for recognizing home care challenges and solving them is shouldered by the team of specialists and advisors that have been invited in to offer their help.
Dan Fisher RN, BSN
http://www.adhomehealthsolutions.com/
www.careconnecticut.org
Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. The financial impact is another challenge. The financial burden depends on who the informal caregiver is. For a spouse there is typically no financial cost since income and assets will be the same with or without a need for care. However, if a spouse offering informal care is employed and has to quit his or her job to provide care there is a significant impact on that family's finances.
Despite the fact that there may be no significant financial impact on a spouse caring for the other spouse at home, there can be significant impact on the emotional and physical health of the caregiving spouse. Because of the strain and burnout often associated with caregiving, the healthy spouse may experience deteriorating health and eventually require long term care services as well. In some cases healthy spouses have succumbed drastically to the pressures of caregiving and died prematurely, well before their care recipients have died.
Another caregiver challenge may be the need of constant surveillance on a spouse with advanced dementia. Still another caregiving challenge could be a son living 500 miles from his disabled parents and constantly traveling to and from his home, trying to manage a job and his own family as well as taking care of the parents. Other challenges to home care may be caregivers who simply don't have the time to watch over loved ones and those loved ones are sometimes neglected.
The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:
· Inadequate care provided to a loved one
· Lack of training for caregivers
· Lack of social stimulation for care recipients
· Informal caregivers unable to handle the challenge
· Depression and physical ailments caused by caregiver burnout
In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must understand the problems outlined above, deal with them and correct them. This often involves bringing in so-called formal caregivers such as care managers, home care companies or other long term care advisors. The responsibility for recognizing home care challenges and solving them is shouldered by the team of specialists and advisors that have been invited in to offer their help.
Dan Fisher RN, BSN
http://www.adhomehealthsolutions.com/
www.careconnecticut.org
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