Tag Archives: long-term care insurance


Getting Better Takes Commitment

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The title of this post can mean a lot of things. If we are ill, we have to commit to getting better, being compliant with medications and clinicians guidance, making the effort. If we are golfers, it means beating balls, … Continue reading


“What Working Family Caregivers Need”

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Just saw an interesting little survey done by Denise of CareGiving.com with family caregivers who also work. There are no surprises in the results, but it reinforces our own experience, at Support For Home In-Home Care. Denise asked working family … Continue reading


We Told Them So

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I have written a number of articles over the last couple of years concerning the cost of home care in California increasing dramatically as the Legislature passes new laws governing wage and hour issues for caregivers, including: Overtime Exemption for … Continue reading


Nursing Home Medicaid and Transferring Assets

As a state coordinator for California, I am proud that Support For Home In-Home Care is a member of the Elder Care Matters initiative. The ethics of its members and the advice offered there is pretty darned solid. That continues … Continue reading

What Happened to Accountable Care Organizations?

The term “Accountable Care Organization” (ACO) first showed up at a 2006 conference and was part of the Affordable Care Act (“Obamacare”) when it was enacted. For a while, it looked as if it was going to become a dominant model for health care delivery.

Wikipedia delineates three core principles, for an ACO:

  1. Provider-led organizations with a strong base of primary care that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients;
  2. Payments linked to quality improvements that also reduce overall costs; and,
  3. Reliable and progressively more sophisticated performance measurement, to support improvement and provide confidence that savings are achieved through improvements in care.

For those of us in non-clinical home care, such as Support For Home, implicit within these principles are the elements of a new approach to health care that would be extremely beneficial to patients and providers.

First, the “organization” to which ACO ties does not have to be a single business or corporation. In fact, most of us expected the formation of ACOs involving a complex, integrated set of organizations, spanning the entire health care delivery system, from clinical to non-clinical. Sadly, many ACOs were formed by single businesses, to protect or enlarge their own interests. Tough statement, but … There are, we are delighted to note, a few exceptions, where ACOs have been formed with the right approach, focused on integrating providers across all relevant clinical and non-clinical disciplines.

Second, we thought ACOs would change the funding model, opening up Medicare funding to non-clinical health care providers. That would reduce the extreme pain faced by families paying for long-term care privately. It would also support the articulated goal of reducing the overall cost of health care delivery. That opening up has not happened.

Thankfully, the third element, performance measurement, has shown more results and more promise over the past few years. Metrics are becoming more and more important, around both health care outcomes and the cost of health care delivery.

All in all, however, the inclusion of ACOs in the Affordable Care Act has not been as beneficial as many of us had hoped. Part of the problem is that forming ACOs and making them work is extremely difficult. We are aware of only one successful, on-going ACO in northern California – Golden Life Healthcare. How can that possibly be the case, when 4-5 years ago ACOs were the promise of the future? CMS (Medicare) needs to take a thorough (but quick) look at what needs to be changed in order for the promise of ACOs to become a reality, in the future.

Your thoughts?

Best wishes. Bert


Yes, Aging at Home Costs Money

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Market Watch, of The Wall Street Journal, recently published an article on the financial costs of aging in place (in our homes). As the article points out, “Because so many people want to stay put during retirement, it’s becoming more … Continue reading


California Caregiver Laws, A Followup

As noted in prior posts, as a home care company in California, until January 1, 2014, Support For Home employees were able to work as many hours as they wished, without incurring overtime. he obvious question is, “Why was that … Continue reading