Finding a quality long-term care facility can be a daunting task. The options are many, so how do you know if one is better than any other?

Starting in the New Year, you may be getting some help.

In 2011, California nursing homes will be required to publicly post their federal ratings and information explaining the ratings. They will also have to tell patients and family members how to obtain information about the nursing home’s state licensing record from the California Department of Public Health’s website.

The federal Centers for Medicare and Medicaid Services oversee the rating system. Facilities are inspected annually and judged on a number of licensing factors, including the quality of medical care, staffing levels, sanitation, and bedsore mitigation.

The star system went into effect in 2008, but California is the first state in the nation to mandate posted rankings about the quality of care in nursing homes. Currently, California has 1,235 federally rated facilities, of which 195 got the lowest rating – one star – and 187 got the highest rating of five stars.

The ratings are not perfect, though. Patient advocates and nursing home officials have found fault with the system and are appealing to the federal government for reform.

California Advocates for Nursing Home Reform initially supported the state legislation that mandated the public disclosure of the star ratings, but the group is concerned that the system encourages nursing home administrators to cover up their facilities’ flaws to boost their ratings. And officials with the California Association of Health Facilities say that ratings tend to skew against facilities with larger populations of chronically ill residents.

Imperfect though they may be, the star system at least provides a starting point for patients and families wading through their long-term care choices.

James D. Perry

There has been much news in recent days about the need for Long Term Care (LTC) Insurance and the recent reports of large increases in premiums and big insurance companies announcing that they will not sell any new policies.

The subject deserves more time and space than one blog article, so today I will touch on the need. I will follow this blog next week with interviews with Long Term Care Insurance Brokers and Financial Planners discussing the problems the LTC insurance industry is going through.

People are living longer these days, but the human body still continues to break down.  As such, more and more seniors – an estimated 9 million in 2008 – need long-term care.  But do you need long-term care insurance?  It’s a smart way to defray the enormous costs of care, but really, it depends.

Premiums this year cost individuals an annual average of $2,180, but the average rate this year for a private nursing home room is $229 per night, or $83,585 a year, and the average rate for a home healthcare aide is $21 per hour.  The New York Times had an article last week (“Ignore Long-Term Care Planning at Your Peril”) reporting that some major long-term care insurance companies are looking to raise premiums by as much as 40 percent.  And, the longer you wait the more likely rates will rise, and the older you get, more likely you’ll develop a so-called pre-existing condition that affects plan availability and premiums.

There is a misconception that Medicare will cover long-term care costs.  While Medicare may pay for short-term nursing home stays in certain circumstances (for example, while you are convalescing after surgery or undergoing rehabilitation after a qualified hospital stay), it will not pay for long-term care.  And, Medicaid will cover nursing home costs, but only after you’ve expended most of your own finances, and then your access and options in care providers becomes severely limited.

The new Class Act, passed under the health care bill, provides long-term care insurance through the government, but enrollment doesn’t start until 2012 and benefits aren’t likely to exceed $100 a day and then only after you’ve paid premiums for 5 years prior.  However, it may be easier to qualify under the Class Act, as some private plans won’t cover care for certain pre-existing conditions.

One up-side is that there are tax breaks available for qualified long-term care insurance premiums where benefits received under such policies are tax-free.

So, how likely are you to need care to make purchasing an insurance plan worth it?  It largely depends on your family’s health history and your financial situation.  If you’re at risk for a serious illness that requires regular care, and you want to leave something to your children or grandchildren upon your death, it’s probably smart to at least investigate the specifics of a LTC policy.

Next time, update on the Long Term Care Policies and Insurance Companies.

James D. Perry

You may have seen the commercials. Medicare fraud costs the taxpayers billions of dollars every year, and the government is working to crack down on fraud.

A recent New York Times article gave highlights from some of the more outrageous and costly Medicare scams: a crime syndicate engaged in identity theft billed the government for more than $100 million in services supposedly rendered by over 100 bogus health clinics; and a chain of mental health clinics claiming $200 million in group therapy sessions that authorities say were either unnecessary or never provided.

But, frauds like these are perpetrated by ambitious criminals.

A senior citizen is more likely to fall victim to some unscrupulous individual collecting Medicare numbers by offering free medical screenings or trying to sell them unnecessary or not-covered medical supplies that they will never receive. Instead, the scammer bills the government under the patient’s Medicare number and pockets the reimbursement.

Preventing Medicare fraud is a lot like preventing identity theft.

Just as you protect your bank account and credit card numbers, you need to protect your Medicare card – or “Guard Your Card” as the fraud-prevention campaign goes. This means carefully reviewing your credit report and your Medicare statements for suspicious activity.

Your statements are available at MyMedicare.gov. You only need to set up a log-in ID and password for the secure website. Seniors who are not web savvy may need help in this area, and only they can authorize their children or caretakers to assist them with this.

Also, beware of freebies. Anyone offering free services does not need your Medicare card number, nor do they need your Social Security Number. If you mysteriously receive free medical supplies or services, report it to Medicare immediately.

Scammers are likely out in force around this time of year because, beginning Nov. 15, Medicare recipients can enroll in Medicare or change their plans. There will be a lot of fake plans out there, so be sure to check the plan finder under Medicare.gov.

If you suspect Medicare fraud, report it immediately by calling 1-800-HHS-TIPS (1-800-447-8477) or email HHSTips@hhs.gov.

James D. Perry