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October 18, 2006; 1 note posted today



Older Americans Act reauthorization bill is signed by Bush

10/18: On October 17th, the Older Americans Act reauthorization bill was signed into law by Bush. This is a 5-year reauthorization. The U.S. House of Representatives' Education and the Workforce Committee issued a press release describing the highlights of the Older Americans Act reauthorization legislation (H.R. 6197). The press release can be accessed directly by clicking above. For more on the Older Americans Act reauthorization, including a link to H.R. 6197, go to our OAA Reauthorization web site by clicking here.

Differing again on Part D: Federal officials say improvements made to Medicare, but critics anticipate many similar issues as last year

10/17: The following is from an Oct. 16th NY Newsday story: Federal officials say they are offering better coverage for seniors signing up for the 2007 prescription drug plan offered by Medicare, which last week posted online tools to help consumers find the plan they want. But advocates warn that Medicare Part D could be as confusing as it was last year. The program, which in January began providing prescription drug coverage to seniors and those with disabilities, was heavily criticized for presenting a confusing array of choices, offering incorrect information and making it difficult to sign up. Pharmacists often had to contend with further glitches once consumers tried to fill prescriptions after Jan. 1. But Medicare officials say next year should be better. "In 2007 there will be more plans ... more drugs covered and more help from Medicare ...," U.S. Health and Human Services Secretary Mike Leavitt said in a statement. Medicare Part D enrollment for 2007 begins Nov. 15 through Dec. 31. In New York, 61 drug plans are being offered - up from 46 last year. The average monthly premium is $24, about the same as this year. If seniors are happy with their plan they don't have to do anything, Medicare said. Last year, more than 10 million seniors nationwide signed up for a Medicare Part D plan; another 6 million dual eligibles -- those who were on Medicare and Medicaid -- were automatically enrolled in a Part D plan. An additional 250,000 have become eligible this year. A gap in coverage -- widely known as the doughnut hole -- is also changing, but not going away. This year, once yearly drug costs exceed $2,250 in many plans, seniors have to pay the full cost of covered drugs until the total drug costs reaches $5,100. Next year, the gap is reached at $2,400 up to $5,451.25. In 2007, 17 of the 61 plans cover the gap, up from six plans that offer coverage this year in the doughnut hole. The online plan finder, which was made available at www.medicare.gov Friday, has also been made easier to navigate and compare plans, Medicare said. Despite reassurances from the government that seniors can stay with their current plan if satisfied, Deane Beebe, spokeswoman for the Manhattan-based Medicare Rights Center, said consumers should check their plans regarding costs and coverages. "Assume nothing," she said. She cited a Humana plan that last year cost $47.93 and this year will cost $82.10. Last year, the plan covered all drugs in the gap, but this year it only offers generic drugs in the doughnut hole, she said. She also pointed out that in New York, of the 17 plans that cover prescription drugs in the gap, 15 offer only generic drugs; the other two cover generics and "preferred brands," those brands that the plan has chosen to include. Jeanne Finberg, directing attorney for the National Senior Citizens Law Center in Oakland, Calif., said she is worried that seniors will again be faced with too many choices to make in too little time. "This is crazy. It's just impossible for anyone who isn't a health policy computer wonk to study these plans and make a meaningful choice," she said. Click above for full article.

Medicare drug plan stability disputed

10/17: According to an Oct. 13th USA Today report: Medicare leaders misled seniors last month when they said premiums for Medicare drug plans would remain about the same in 2007, Rep. Henry Waxman, D-Calif., said Thursday. Waxman says his staff's analysis shows an average 13.2% increase for next year. But Medicare officials Thursday stuck to their estimate that rates will remain about the same -- so long as beneficiaries are willing, in some cases, to drop traditional Medicare and sign up for an alternative, such as an HMO. The back-and-forth comes about a month before seniors and the disabled begin enrolling in plans for next year and provides new insight into how Medicare officials calculate drug plan premium estimates. "The only thing everyone can agree on is seniors will need to go out and carefully reassess their options for 2007, because there are fundamental changes in the marketplace," says Dan Mendelson, president of Avalere Health, a consulting firm in Washington. In a letter to Health and Human Services Secretary Michael Leavitt, Waxman says monthly costs for stand-alone drug plans will rise on average from $25.69 to $29.09 a month. Rates for the lowest-cost plan in each state will rise an average of 44%, to $13.58 from $9.46. Increases will affect 77% of seniors who remain in the same plan as they chose this year, Waxman said. By contrast, the Centers for Medicare & Medicaid Services issued a press release Sept. 29 saying that the "monthly premium beneficiaries will pay in 2007 will average $24 if they stay in their current plan, about the same as in 2006." Who's right? It all depends on what you include in the premium calculations. Click above for full story.

New $18.1 Million to Fight Housing Discrimination to be Distributed by U.S. Department of Housing and Urban Development to 102 Organizations Including Legal Services Programs

10/16: According to a note from the Brennan Center for Justice: Civil legal aid programs throughout the country will receive grants from the U.S. Department of Housing and Urban Development (HUD) this year to reduce housing discrimination. The Fair Housing Initiatives Program (FHIP) is distributing $18.1 million in grants to 102 organizations nationally to educate residents and the housing industry about the protections provided by the Fair Housing Act. Kim Kendrick, HUD's Assistance Secretary for Fair Housing and Equal Opportunity, says, "No one should be denied the opportunity to live where they want because of how they look, or the religion they practice, or because they have a disability." For a list of all FHIP grantees, in pdf format, click above.

You have a right to know how the federal government spends its money.

10/16: According to a new web site created by OMB Watch: This website, created by OMB Watch, is a free, searchable database of federal government spending. To begin searching, select either the Grants or Contracts tab at the top left side of this page. You can easily switch back and forth as you search. The data on total federal spending was taken directly from the FedSpending.org database. With over $12 trillion in federal spending, this more open and accessible tool for citizens to find out where federal money goes and who gets it is long overdue. We believe this website is a good first step toward providing that access. to go to the web site, click above.

The New Age: Old but Not Frail: A Matter of Heart and Head

10/6: The following is from an Oct. 5th NY Times report: Mary Wittenberg, the 44-year-old president of New York Road Runners, is a fast, strong and experienced runner. But she races best, she says, when she runs just behind Witold Bialokur. He can run 10 kilometers, or 6.2 miles, in less than 44 minutes and he is so smooth and controlled. "He's like a metronome with his pacing," Ms. Wittenberg says. "I am often struggling to keep up with him and it's a good day when I do." While Mr. Bialokur's performance would be the envy of most young men, he is not young. Mr. Bialokur is 71. It is one of the persistent mysteries of aging, researchers say. Why would one person, like Mr. Bialokur, remain so hale and hearty while another, who had seemed just as healthy, start to weaken and slow down, sometimes as early as his 70’s? That, says Tamara Harris, who is chief of the geriatric epidemiology section at the National Institute on Aging, is a central issue that is only now being systematically addressed. The question is why some age well and others do not, often heading along a path that ends up in a medical condition known as frailty. Frailty, Dr. Harris explains, involves exhaustion, weakness, weight loss and a loss of muscle mass and strength. It is, she says, a grim prognosis whose causes were little understood. "It means that some people spend a long time in a period of their life where they have lost function," Dr. Harris says. "People find that very distressing, and there is a tremendous health care cost." Now, though, scientists are surprised to find that, in many cases, a single factor -- undetected cardiovascular disease -- is often a major reason people become frail. They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace. Investigators say that there is a ray of hope in the finding -- if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition. A second finding is just as surprising to skeptical scientists because it seemed to many like a wrongheaded clich? -- you’re only as old as you think you are. Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path. Still, it is a view that can lead to blaming the victim, and some scientists at first resisted it. Now, though, more and more say they have been won over by an accumulating body of evidence. Click above for full article.

Democrats Reviving Social Security Issue

10/6: According to an Oct. 2nd Washington Post article: Social Security has drifted out of the national debate, but Democrats, eyeing the senior vote, are trying to revive the issue -- just in time for the midterm elections. Democratic leaders are advising their party's congressional candidates to focus on what the Republicans might do to Social Security given the chance. "The president hasn't given up yet, even though the American people resoundingly rejected his proposal for private accounts," said House Minority Leader Nancy Pelosi, D-Calif. Politicians from both parties acknowledge Social Security is likely to face insolvency in future years as the population ages, although they don't agree on the solutions. Overhauling the landmark New Deal program to aid seniors was President Bush's postelection goal in 2004. His proposal called for allowing workers under age 55 to divert some Social Security taxes into personal accounts in exchange for lower guaranteed benefits. Democrats, labor and senior groups strongly opposed private accounts. And Republican unease about the program was enough to kill it, a major defeat for the president. But a number of groups are working to keep the issue alive. Social Security advocates are holding dozens of events around the country challenging Republicans to sign a pledge that they will not support efforts to create personal accounts. Americans United, a labor-backed group formed to fight Social Security changes, plans to follow politicians who favor private accounts -- including GOP Sen. Rick Santorum of Pennsylvania -- with campaign workers dressed as gorillas carrying the message, "Don't monkey with our SS." Another group, "For Our Grandchildren," is sending out a competing pledge to candidates asking that all options be considered to save Social Security, said Tim Penny, a former Democratic congressman from Minnesota. "It's always been a reliable issue for the Democrats," said Ross Baker, a political scientist at Rutgers. "The problem is that when the president was trying to sell it it was an issue, but it has receded so much." Still, Democrats believe the phrase "Social Security" will be heard by voters 50 and over, despite the loud debate over terrorism, Iraq and the economy. These voters in 2002 made up almost half of the electorate, according to exit polls. Senior voters have swung back and forth in recent elections, backing Republicans in 2004 and leaning Democratic in current AP-Ipsos polling. To access article, click above.

In wake of changes, seniors urged to revisit Medicare drug plans

10/5: The following is from an Oct. 4th USA Today report: The rollout of Medicare prescription drug plans for 2007 last week was heralded by federal officials as a trifecta of good news: low premiums, more choices and better coverage, particularly in the feared "coverage gap." Health care analysts and consumer advocates have a slightly different view: The lowest premiums, sought by healthy seniors who join the program to avoid future penalties, will rise exponentially. Additional choices mean that beneficiaries in all but two states will have to choose from more than 50 plans. And most of the "gap coverage" will be for generic drugs only. Currently, 94% of beneficiaries in the program face a gap from the time they have paid about $750 until they've paid $3,600. For these and other reasons, millions of seniors and people with disabilities are being urged to re-examine the plan they chose for this year and compare plans again. "The right plan for someone in 2006 might not be the right plan in 2007," says Tricia Neuman of the Kaiser Family Foundation, a health research organization. "The concern is that products are changing, but seniors won't." Medicare officials unveiled details about the program's second year last week, including the number of plans to be offered, premiums, deductibles and types of coverage. They emphasized that average monthly premiums will stay below $24, far less than the $37 originally projected. At the same time, they said, companies are adding new forms of coverage. "Competition is working," said Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. "They are adding plans that people want." Companies began marketing those plans Sunday. Further details, including the drugs covered and the co-payments, will emerge later this month. Enrollment begins Nov. 15 for the year beginning Jan. 1. Click above to access article.

Auditors: CMS Health Records at Risk

10/5: According to an Oct. 3rd Associated Press article: Security weaknesses have left millions of elderly, disabled and poor Americans vulnerable to unauthorized disclosure of their medical and personal records, federal investigators said Tuesday. The Government Accountability Office said it discovered 47 weaknesses in the computer system used by the Centers for Medicare and Medicaid Services to send and receive bills and to communicate with health care providers. The agency oversees health care programs that benefit one in every four Americans. Its massive amount of data is transmitted through a computer network that is privately owned and operated. However, CMS did not always ensure that its contractor followed the agency's security policies and standards, according to the GAO report released Tuesday. "As a result, sensitive, personally identifiable medical data traversing this network are vulnerable to unauthorized disclosure," the federal investigators said. "And these weaknesses could lead to disruptions in CMS operations." Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, said the agency was working to address problems cited in the report but noted the GAO "found no evidence that confidential or sensitive information had actually been compromised." "Security of our beneficiaries' data is paramount and we appreciate GAO's assistance in identifying important opportunities for the contractor to strengthen network security," he said. In the past year, security breaches have led to closer scrutiny of how government agencies maintain sensitive information about the people they serve. The most notable example was the theft of a laptop computer from a Veterans Affairs employee, which contained personal data on about 26.5 million people. The laptop was later recovered. Its contents had not been accessed or copied. But the theft put a scare into many veterans and prompted calls for major changes in how government records with personal information are secured. The network handling Medicare claims transmits extremely personal information, such as a patient's diagnosis, the types of drugs the patient takes, plus the type of treatment facility they visited, including treatment centers for substance abuse or mental illness. In addition, claims data contains personally identifiable information such as Social Security numbers, addresses and dates of birth, the investigators said. The investigators and CMS emphasized that the report focuses solely on the transmission of data. The auditors did not evaluate security controls for the servers used to store patient data. Click above to access article.

Indiana county rejects changes to smoking ban which would have exempted nursing homes from law; For-profit nursing home lobbying groups' arguments rejected

10/4: According to a. Oct.3rd article in the Muncie, Indiana Star Press: Delaware County commissioners on Monday unanimously rejected an amendment that would have exempted nursing homes from the countywide smoking ban that took effect July 15. Commissioners portrayed the amendment as a phony issue trumped up by the Indiana Health Care Association, a trade association representing the state's nursing homes. Commissioner John Brooke called the amendment a "red herring" and said he was "offended that they even tried to pull this smoke screen -- pun intended." IHCA policy and research specialist Robin Shackleford had told commissioners in two previous meetings that federal regulations give residents of nursing homes at the time the ban took effect the right to smoke in designated areas. Nursing homes that fail to follow federal guidelines on patients' rights could lose Medicaid and Medicare funding, Shackleford said. But Brooke and Commissioners Tom Bennington and Larry Crouch quoted James Bergman, co-director of the Smoke-Free Environments Law Project, Ann Arbor, Mich., as saying that IHCA's statements "are not supported by any federal Medicaid or Medicare laws that I am aware of." If this were a serious issue for nursing homes, why did only one local nursing home support the amendment? Brooke asked. To access the full article, click above.

Older Americans Act reauthorized by House and Senate; Goes to Bush for certain signature

10/2: On September 30th, the U.S. Senate by unanimous consent passed the Older Americans Act reauthorization bill, H.R. 6197. The House had unanimously passed the bill on September 28th. Since neither the House nor Senate made any amendments to H.R. 6197, there is no need for a conference committee, and, therefore, the bill goes directly to Bush for a certain signature. According to a House Committee press release: The U.S. House of Representatives on September 28th approved the Older Americans Act Amendments of 2006 (H.R. 6197), a measure reflecting a bipartisan, House-Senate agreement to reauthorize and strengthen services offered under the Older Americans Act, the chief federal law governing the organization and delivery of a number of social services for older Americans. Established in the 1960s primarily to govern social services for seniors, programs under the Older Americans Act have transformed into the first stop for seniors and their families to identify home- and community-based long term care options, as well as programs and services for which they may be eligible. Key to the bipartisan House-Senate agreement -- sponsored by Select Education Subcommittee Chairman Pat Tiberi (R-OH) -- was an accord on allocations made available to states to fund services for seniors. "Today, we've acted to renew and improve the programs that seniors across the country use every day," said Tiberi. "It's the result of months of bipartisan effort and is an example of Congress at its best." The House-Senate agreement promotes the key principles of President Bush's Choices for Independence plan, which emphasizes consumer choice, access to reliable information, and health promotion. It would support community-based efforts to assist low-income and limited-English speaking populations with enrollment in the Medicare prescription drug program and launch Aging and Disabilities Resource Centers in all 50 states and Puerto Rico to create a single point of access to the range of services available to seniors, including the Medicare prescription drug program. Prior to today's announcement, the House passed similar reauthorization legislation, the Senior Independence Act (H.R. 5293), in June. To access a wealth of information about the OAA reauthorization, including links to H.R. 6197 and to related Congressional press releases, analyses, and information about the OAA, go to TCSG?s Reauthorization of the Older Americans Act site by clicking above. Shortly, we will be adding new analyses of the just-passed bill, as well as additional links to related information.

Medicare Insurers to Offer More Options in ?07; But, Premiums May Rise for Many Plans

10/2: According to a NY Times article: Medicare beneficiaries will have access to more options for prescription drug coverage in 2007, with many insurers offering better value and a larger number of medications, the Bush administration said Friday. But the potential for confusion may also increase. The administration said beneficiaries who were satisfied with their current drug coverage would not have to do anything when the six-week open enrollment period begins Nov. 15. Consumer advocates, however, said beneficiaries should carefully review the options because prices have changed, often by significant amounts. Insurers can begin marketing their 2007 options on Sunday [Oct. 1st]. The drug program got off to a chaotic start in January. But the Bush administration, realizing that health care could be a potent issue for Democrats in midterm elections this fall, appears to have solved many of the biggest problems. Many experts had predicted a shakeout in the market for drug coverage, which is offered through dozens of private insurers subsidized by the government. But it did not occur. In most states, Medicare beneficiaries had a choice of slightly more than 40 free-standing drug plans this year. In 2007, every state but Alaska and Hawaii will have more than 50 drug plans, and 23 states will have 55 or more. The number of national drug plans offering coverage in every state will rise to 17 next year, from 9 this year. In New York, 61 drug plans will be available, up from 46 this year. ... But Deane R. Beebe of the Medicare Rights Center, a counseling and advocacy group, said beneficiaries should not be lulled into complacency. "Your drug plan might have worked for you this year, but you can?t assume that it will be affordable or cover the drugs you need next year," Ms. Beebe said. "You should go back to the drawing board to determine whether your current plan or another one would best meet your needs." Congress defined a standard benefit, which includes a significant gap in coverage, also known as a doughnut hole. Medicare officials encouraged insurers to help close the gap in 2007, and many companies responded. For premiums ranging typically from $40 to $50 a month, beneficiaries can enroll in plans that provide extra benefits, including coverage in the gap for generic and sometimes for brand-name drugs. While many companies are in the market, enrollment is concentrated in drug plans offered by just a handful of companies. Two companies, UnitedHealth and Humana, attracted almost half of the people in prescription drug plans this year, but that could change. Humana, which offered the lowest premiums in many states this year, is raising some of its charges in 2007, and other companies have cut their premiums to compete more effectively. Click above for full article. See related news note directly below.

Medicare Releases Data on 2007 Drug Plan Options

10/2: The following is from a Sept. 29th press release from the Dept. of Health & Human Services: Seniors who are satisfied with their current Medicare prescription drug coverage will not have to take any action when the Medicare Open Enrollment period begins November 15th, but those who wish to make a change will find new options with lower costs and more comprehensive coverage available for 2007. They will also find new tools from Medicare to help them make a choice. Surveys consistently show over 80 percent of Medicare beneficiaries are satisfied with their current coverage and drug plans. As a result of the Medicare prescription drug benefit, more than 38 million seniors and people with disabilities now have some form of drug coverage. The monthly premium beneficiaries will pay in 2007 will average $24 if they stay in their current plan -- about the same as in 2006. While some people will see an increase in their current plan premiums, they have the option to switch plans. Nationally, 83 percent of beneficiaries will have access to plans with premiums lower than they are paying this year, and beneficiaries will also have access to plans with premiums of less than $20 a month. Beneficiaries will have more plan options that offer enhanced coverage, including zero deductibles and coverage in the gap for both generics and preferred brand name drugs. Plans are adding drugs to their formularies. Nationwide the average number of drugs included on a plan formulary will increase by approximately 13 percent, and plans will also use utilization management tools at a lower rate. ... "If you're satisfied with your coverage, you do not have to do anything during the Open Enrollment period. If you are considering a change, Medicare has new tools to help," Dr. McClellan said. Across the country, nearly all beneficiaries enrolled in Medicare prescription drug plans will be able to remain in the plan in which they enrolled for 2006 since almost all Part D sponsors are either continuing their current plans in 2007 or streamlining and consolidating their 2006 plans. They will be able to choose from plans that offer enhanced benefits or services, such as coverage in the gap and little or no deductible. Beneficiaries will have a wide range of plans that have zero deductibles, some of which also offer other enhanced benefits. There are also options that cover generics and preferred brand name drugs through the coverage gap for as low as $38.70, and generally for under $50. [It should be noted that elder rights advocates have already reported that premiums from some plans have jumped higher than this press release suggests.] To access the HHS press release, click above. To access information about the national plans, click here. Specific information about the state plans does not appear to be available at this time.

Judge Halts Effort to Recoup Mistaken Medicare Refunds

10/2: According to a Sept. 29th NY Times report: A federal judge on Thursday ordered the Bush administration to halt its effort to collect $50 million from 230,000 Medicare beneficiaries who had received erroneous refunds of premiums paid for prescription drug coverage. He said many of them might qualify for waivers because repayment would cause hardship. The judge, Henry H. Kennedy Jr. of Federal District Court here, said Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, must immediately send a notice to every one of the 230,000 beneficiaries, stating that each has a right under federal law to request such waivers. Federal officials had previously told beneficiaries to return the money by Saturday, Sept. 30. Judge Kennedy said the administration could not enforce that demand unless it first gave beneficiaries an opportunity to seek an exemption. If a beneficiary requests a waiver, the government cannot try to recoup the money until the secretary of health and human services rules on the request, Judge Kennedy said in issuing a preliminary injunction sought by the plaintiffs. The plaintiffs include the Action Alliance of Senior Citizens, based in Philadelphia, and Gray Panthers, a national organization for older Americans. Judge Kennedy said that any money already paid to the government "must be immediately returned to the beneficiaries so that they may decide whether to request waiver." Peter L. Ashkenaz, a spokesman for the Medicare agency, said government lawyers had not decided whether to appeal the decision. Click above to access article.

Federal Medicaid and Medicare laws do not require localities or states to exempt nursing home residents from smoke-free laws

9/29: For a number of months, a lobbying organization for Indiana's for-profit nursing homes has been pressuring Delaware County Commissioners to exempt nursing home residents who are currently smokers from having to adhere to the county's smoke-free law. They have been claiming that federal and state Medicaid and Medicare laws require localities to exempt current residents who are smokers from the smoke-free law. We at TCSG were contacted by Indiana health groups about this Delaware County situation and asked if we would prepare a response to the nursing home lobbyist’s assertions. We researched the issue and concluded that the nursing home lobbyists were incorrect. In fact, the answer is demonstrably clear that federal and state Medicaid and Medicare laws do not require such an exemption. To access a copy of our memorandum on this topic, go to the Smoking Policies in Facilities Serving Older Persons section of our web site by clicking above and scrolling down, or you can access the 3-page memorandum directly, in pdf format, by clicking here. You will also find a wealth of information on the web site about secondhand smoke issues in nursing homes, assisted living facilities, senior centers, and adult day care facilities. For a news report about the Delaware County situation, click here.

Millions of Seniors Facing Medicare 'Doughnut Hole'

9/29: The following is from a Sept. 25th Washington Post article: Millions of older Americans are confronting a temporary break in their Medicare drug coverage this month that will require them to pay the full cost of their prescriptions or face the painful prospect of going without. This is the "doughnut hole" in the new Medicare drug benefit that began in January, and advocates for seniors say there is nothing sweet about it. Some seniors knew nothing of the coverage gap until they were hit with a bigger drug bill, advocates say. "Virtually everyone who calls to say they've been denied coverage, they're shocked," said Robert M. Hayes, president of the Medicare Rights Center, a nonprofit that helps seniors navigate Medicare. "Trying to explain that this is the way the program was created by Congress angers folks who think it makes no sense. Many people feel blindsided." The coverage gap was one of the most contentious elements of the 2003 legislation that created the new benefit. It ends federal payments for a person's drug purchases once an annual spending limit is reached, resuming them only after the beneficiary has spent thousands of dollars out of pocket. Proponents saw the unusual setup as a way to provide some help to all beneficiaries, and substantial help to those with catastrophic drug costs, and yet not break the bank in a federal program that is expected to cost hundreds of billions of dollars over the next decade. Nine months into the program, as more and more seniors reach the threshold that puts them in the gap, many see it as a headache -- or worse. Frances Acanfora, 65, had been paying $58 for a three-month supply of her five medications. But this month the retired school lunchroom aide learned that her next bill would be $1,294. She had entered the doughnut hole. "It's not my fault that I take this medicine," the Brooklyn resident said. "I've got to take it. And they make a limit. That's not fair." After talking to her doctor, Acanfora decided to temporarily stop taking a drug as part of her treatment for breast cancer. She hopes to obtain some free samples of eye drops for her glaucoma. Three other medicines -- for high cholesterol, diabetes and osteoporosis -- cost $506.62, which Acanfora put on her credit card. "I pay a little bit at a time," she said. "What am I going to do? I need it. . . . Sometimes, just to think about it, I cry." Click above to access full article.

State-level guardianship data now available

9/29: The National Center on Elder Abuse (NCEA) has released a new publication entitled, State Level Guardianship Data: An Exploratory Survey. According to NCEA, press accounts have highlighted significant instances of malfeasance and exploitation stemming from guardianships, yet basic data on guardianship are scant. As a result, there is little guidance to courts, policymakers, and practitioners on how to improve the system. This new publication is designed to provide some of that initial and critical data. The data presented in the publication were obtained from state court administrators' offices by the American Bar Association Commission on Law and Aging, which conducted the survey for NCEA. Among the report's conclusions: major investment in court technology, training and standardized definitions is required to secure data for effective guardianship case management, as well as enabling courts, policymakers, and practitioners to move toward strengthening the guardianship system and preventing elder abuse. To read the report, in pdf format, click above.

Legal Needs Surveys of Older Americans: New Georgia Assessment Completed and Online

9/28: We’re delighted to report that a new legal needs of the elderly assessment has been completed in Georgia and is now online on the TCSG Law & Aging web site. This is the second such survey/assessment that has been done; the first was done in Utah in 2004. The following is a description of both the Georgia and Utah assessments. Elderly Legal Assistance Program: Report on the Legal Needs of Seniors in Georgia This September, 2006 report was prepared for the Georgia Division of Aging Services by the Planning and Evaluation Section Quality Assurance Team in collaboration with the Georgia Legal Services Developer, Natalie Thomas. This 23-page report provides an assessment of the legal needs of Georgia's senior population. In the fall of 2005, the Division of Aging Services sent a survey form to 1,596 seniors; the response rate was nearly 30%. The survey was based on a similar survey done in Utah in 2004, and assistance with the Georgia survey was provided by TCSG staff and TCSG Consulting Attorney Jilenne Gunther, who was the co-author of the Utah study. The purpose of the study was to assess (a) the legal needs of Georgia's seniors, (b) their awareness of available legal services, (c) their experiences with and perceptions of lawyers, (d) the barriers seniors have with using lawyers, (e) legal issues that concern seniors, and (f) the legal services that would have the most benefit for them. Planning for the Legal Needs of Utah's Seniors This 2004 survey and report on the legal needs of Utah's older persons was conducted and written by Jilenne Gunther, J.D., M.S.W., Alan Ormsby, J.D., and Nathan Stephens, B.S. The study assesses the legal needs of Utah's seniors, their perception and experiences with attorneys, their awareness of current legal services, and the barriers to obtaining legal assistance. This 34-page study, with charts and graphs, provides excellent data, as well as a fine example of the value of such needs assessments as planning documents and as an essential document in fund-raising efforts for legal services for older persons. The full study, in pdf format, as well as the 6-page, 43-question, survey questionnaire which was used to conduct this assessment is available on the TCSG site. A PowerPoint presentation by Jilenne Gunther titled Assessing the Legal Needs of Seniors describing the study and its findings, is also available on the TCSG site. Congratulations to Natalie Thomas and her colleagues in Georgia for this wonderful assessment. Assessments such as these can be extremely valuable tools in increasing the quantity and quality of legal programs for older Americans. With each new elderly legal needs assessment that is completed, we all are gaining better data for informing policymakers and funders on the local, state and federal levels about the need for and value of legal assistance for older Americans. We at TCSG are very pleased to have been able to work with both Georgia and Utah on these assessments, as well as with other states which are currently working on elderly legal needs assessments. TCSG’s March, 2005 Best Practice Notes newsletter is devoted entirely to the topic of Assessing Legal Needs of Older Persons, for those who want to learn more about this, and can be accessed by clicking here. You can access both the Georgia and Utah studies and the related materials by clicking above and scrolling down.

Forensic Skills Seek to Uncover Elder Abuse

9/28: The following is from a Sept. 27th NY Times report: The elderly man in the emergency room was covered with bruises, some purple and others fading to yellow. Despite signs of dementia, he told the same story over and over: His wife’s burly home health aide had beaten him. But the health aide and the wife insisted he had fallen. Now it was up to the members of Orange County’s Elder Abuse Forensic Center to decide which story was true. As the man lay on a gurney, he was interviewed by a team from the center: a geriatrician, a social worker and an investigator from the sheriff’s office. The bruises on the man’s chest, they determined, were the result of being punched. There were bloody outlines of a shoe on the man’s leg. His clear, consistent story, and cognitive tests, persuaded the prosecutor to charge the aide with a felony. At the center here, public health and law enforcement officials are learning to speak the same language and using the same forensic techniques as those popularized on the three C.S.I. television series to diagnose elder abuse and neglect. For decades, the techniques have been the state-of-the-art approach for investigating child abuse and domestic violence. But elder abuse has lagged far behind, suffering from a lack of financing, research and data. Now change is in the air, and forensic techniques are just one of many new initiatives nationwide to protect the elderly. Geriatricians at the Baylor College of Medicine in Houston, for example, review county autopsy reports looking for suspicious themes. Bank tellers at Wachovia branches nationwide are learning to detect irregular transactions in the accounts of elderly customers. Congress is also expected to consider, before the October recess, the Elder Justice Act of 2006, which would create the first nationwide database on elder abuse, replacing inconsistent or unavailable data. The legislation, which has bipartisan support, also assigns a federal official to coordinate projects and technical assistance and helps replicate programs like Orange County’s. The legislation moved from committee to the full Senate on a unanimous vote within days of a celebrity scandal involving elder abuse accusations against the son of Brooke Astor, 104, the grand dame of New York society. To access the full story, click above.

Employers Chip Away at Retiree Health Benefits

9/27: The following is from a Sept. 26th story in the Los Angeles Times: Just as they are cutting back on pensions, employers are increasingly targeting health benefits as a way to save money, saddling older people with costs that companies used to accept as a routine part of business. Over time, some maintain, growing legions of the elderly will find themselves with thousands of dollars in additional costs -- posing difficult personal choices over care and new pressures on a federal government that already faces a vast, uncovered liability for the old-age needs of the baby boom generation. "Across the board, retirement benefits are on the chopping block," said Daniel D. Doyle, an attorney for former Monsanto Co. employees whose benefits shrank after their division was spun off and filed for bankruptcy protection. "As companies try to restructure and squeeze out shareholder value, they are going to rely more and more on Medicare and other government programs to fill the breach." Retiree health benefits first took a big hit more than a decade ago, when new accounting standards required companies to more clearly disclose those costs -- prompting many employers to trim their offerings. More recently, the benefits are falling victim to rising healthcare expenses and corporate cost cutting. On average, retirees account for 29% of the corporate medical bill for large employers that offer such benefits, according to Hewitt Associates, a benefits consulting firm. And like other medical costs, those for retirees have risen steadily — as much as 10.3% from 2004 to 2005, according to a survey of large private employers by the Kaiser Family Foundation and Hewitt. Retiree medical benefits are now offered by just 1 in 3 large employers, down from 2 in 3 in the late 1980s, according to a study by the Kaiser foundation and the Health Research & Educational Trust. For those that still provide such benefits, past commitments are being scaled back, and even steeper cuts are in store for future retirees. General Motors Corp. last fall announced a plan to save $15 billion in future healthcare liability for its retirees, for the first time charging retirees from hourly jobs a range of out-of-pocket costs for their medical needs. "The double-digit cost pressures have been relentless," said Frank McArdle, head of the Washington research office of Hewitt Associates. "In many years, the annual increases for retiree healthcare have actually been greater than for active employee healthcare." Such realities may provide little comfort to people who thought they earned the benefits when they were working and counted on them for security in old age. Click above to access full story.

In-home care lawsuit settled in West Virginia; Seniors, disabled who were cut off will be restored to program

9/26: The Manchin administration agreed Wednesday [Sept. 20th] to settle a lawsuit over cuts it made to a program for seniors and disabled people. Hundreds of people who were kicked off the program will be immediately put back on. Others who tried to receive services but were denied will be re-evaluated based on less stringent standards. The Aged and Disabled Waiver program paid for homemakers and health professionals to help take care of people in their homes, instead of sending them to more expensive nursing homes. In November, the Manchin administration began applying a more stringent evaluation tool to determine who belongs in the program. Hundreds of people were cut from the program, and at least 647 people appealed their denial. The settlement ends almost a year of uncertainty and fear for seniors and their advocates, said LouEllen Blake, a case manager for the Lewis County Senior Center. "They've been living on pins and needles. This is just the best news possible," she said. Some seniors who were cut from the program ended up in nursing homes. Blake hopes she can bring some of them home now. "I would like to thank Gov. Manchin for the decision. I think he made the right decision. I think he made the human decision," Blake said. Mountain State Justice lawyer Bren Pomponio filed the case on behalf of a mentally-disabled Summers County man, Jackie Fleshman. Pomponio alleged that the state's new evaluation guidelines discriminated against his client and other people with mental disabilities. The first hearing in the case had been scheduled for today in front of Kanawha Circuit Judge Charles King. But pressure had been building for months on the Manchin administration to undo the cuts. It came to a head last week, when lawmakers demanded answers about the program from several high-ranking officials. Legislators were shocked when administration officials refused to answer their questions, on the advice of their attorneys. Earlier this week, Attorney General Darryl McGraw announced he was intervening in the case to protect the interests of seniors and disabled people. Pomponio said he received word Wednesday about the settlement. "It gives us everything we were asking for," he said. The settlement requires the state Bureau of Medical Services to stop using the new eligibility tool, the PAS-2005, and return to using an older tool, the PAS-2000. It says the state will reinstate all people who were cut from the program because of medical evaluations completed after Nov. 1. And it says that anyone who tried to join the program after Nov. 1 but was denied will be given a new evaluation based on the previous standard. Last week, Manchin ordered a review of the Aged and Disabled Waiver program because of constituent complaints, according to a statement from the state Department of Health and Human Resources. DHHR Secretary Martha Walker completed the evaluation Wednesday and decided to return to the old eligibility requirements, according to the statement. "In an attempt to maximize services, we made the eligibility requirements too stringent," said Nancy Atkins, commissioner of the Bureau for Medical Services. The Legislature will be asked for additional money to complete the evaluations, Walker said in her statement. That shouldn't be a problem, said Delegate Don Perdue, D-Wayne. He said the Legislature is willing to add money not just for evaluations, but also to expand the number of people receiving in-home health. "This is something we need to embrace," Perdue said. "In-home care will save us money over the long haul." The settlement heads off a protest that was scheduled for early next month, five weeks before mid-term elections. The loud and persistent protests from constituents got the attention of lawmakers and eventually the governor, Perdue said. Click above to access news report.

Retiree health care could bankrupt governments

9/26: The following is from a Sept. 24th Associated Press report: The bill is coming due for years of generous benefits bestowed upon the nation's public employees, and it's a stunner: hundreds of billions of dollars over the next three decades, threatening some local governments with bankruptcy and all but guaranteeing cuts in services like education and public safety. This staggering burden is coming to light because of new accounting rules issued by the Government Accounting Standards Board. They require public agencies to disclose the future cost of health care and other benefits -- such as dental, vision and life insurance -- promised alongside traditional pensions to the nation's estimated 24.5 million active and retired state and local public employees. Retiree health care costs have been quietly mounting for decades while public agencies have passed out generous retirement benefits during labor negotiations -- often in lieu of salary increases. But government negotiators rarely considered the long-term financial consequences of awarding such perks, according to Brian Whitworth, a retirement benefits specialist with JP Morgan Chase and Co. "A surprising number of public entities didn't even make informal estimates of long-term costs prior to the new accounting rules," Whitworth said. Many cities and state agencies already are struggling to fully fund their pension obligations, but experts say those liabilities pale in comparison to the debt accumulated for other retirement benefits. Last >

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siders the most comprehensive preliminary estimate. It projects the present value of unfunded health care and other non-pension benefits at between $600 billion and $1.3 trillion. By comparison, the debt rating agency Standard and Poors estimates the country's total unfunded public pension debt at around $285 billion. "There's a good chance some government entities are going to go bankrupt," said California Assemblyman Keith Richman, a Republican from Chatsworth. "But the issue isn't just bankruptcy, it's governments dying of a thousand cuts in services. The costs of promises that have been made are going to be astronomical." Union officials say it's not their fault municipalities put themselves in a hole by promising more than they can deliver. "This is a monumental problem and government is going to have to deal with it," said Steve Regenstrief, head of the retirement division at the American Federation of State, County and Municipal Employees. When the new accounting rules take effect in 2008, taxpayers will be able to see for the first time just how much they're paying to provide benefits to active and retired state and local public employees. "When the numbers are produced, they're going to be shocking," said Ronald Snell, director of state services for the National Conference of State Legislatures. To access news report, click above.

Medicare Refund Mixup Part of Larger Tangle

9/25: The following is from a Sept. 25th NY Times article: When Medicare mistakenly sent premium refunds to 230,000 people who had signed up for prescription drug coverage, the Bush administration said the error had resulted from a rare "computer glitch." But government records and interviews with federal officials show it was the latest example of a strained, often dysfunctional relationship between two of the government’s biggest programs. For more than a year, officials who run the two programs, Social Security and Medicare, have struggled to mesh their computer systems so that Medicare premiums are correctly withheld from Social Security checks, and low-income people get the extra help to which they are entitled. The problems are compounded because this information is collected and used by scores of private Medicare drug plans, each with its own procedures and computer systems. Lawmakers worry that similar problems will occur as millions of people sign up for new drug plans starting on Nov. 15. Several recent surveys, including one by J. D. Power & Associates, the market research company, suggest that three-fourths of the people getting drug coverage through Medicare are satisfied with it. But officials predict that many beneficiaries will switch plans to lower their drug costs or get better coverage. Under the 2003 Medicare law, people who sign up for drug coverage can pay premiums once a month on their own, or they can have the money withheld from their Social Security checks, just as basic Medicare premiums have for years been deducted from such checks. Since the drug program began on Jan. 1, hundreds of thousands of beneficiaries have reported problems in getting the government to carry out their instructions to start or stop the withholding of premiums. Drug plans have repeatedly complained to Medicare officials that premiums have not been properly withheld and that beneficiaries have been upset. Medicare officials say Social Security and its computer systems bear much of the responsibility. And Social Security says the data it receives from Medicare is often full of errors and does not match the information it already has. Without a perfect match, Social Security officials say they cannot order the Treasury to change the amount of a person’s Social Security payment. The commissioner of Social Security, Jo Anne B. Barnhart, and the Medicare administrator, Dr. Mark B. McClellan, discussed the problems with the Senate Finance Committee behind closed doors on Sept. 7. After the briefing, lawmakers said they did not fully understand the interaction between the two agencies. "There seems to be greater confusion, not less," Senator Gordon H. Smith, Republican of Oregon, said after listening to the officials' explanations. For full story, click above.

Congress Is Winding Down, but Much Is Left Undone

9/25: According to a Sept. 25th NY Times article: A Congress derided as do-nothing has a week to do something, and the prospects are cloudy. Procrastination, power struggles and partisanship have left Congress with substantial work to finish before breaking for the elections. The fast-approaching recess and the Republican focus on national security legislation make it inevitable that much of the remainder will fall by the wayside. At best, it appears that just 2 of the 11 required spending bills will pass, and not one has been approved so far, forcing a stopgap measure to keep the federal government open. No budget was enacted. A popular package of business and education tax credits is teetering. A lobbying overhaul, once a top priority in view of corruption scandals, is dead. The drive for broad immigration changes has derailed. An offshore oil drilling bill painted as an answer to high gas prices is stalled. Plans to cut the estate tax and raise the minimum wage have floundered, and an important nuclear pact with India sought by the White House is not on track to clear Congress. New problems surfaced over the weekend for the annual military authorization bill. And numerous other initiatives await a planned lame-duck session in mid-November or a future Congress. "It is disappointing where we are, and I think Republicans need to be upfront about this," said Representative Jack Kingston, Republican of Georgia and a member of the House leadership. "We have not accomplished what we need to accomplish." ... While Republicans prefer to blame Democrats for the backlog, intramural fights and sharp differences between House and Senate Republicans have been chief impediments to major legislation. For the full report, click above.

No Donut Hole! web site created to get rid of hole in Medicare prescription drug program; September 22nd is National Donut Hole Day

9/21: September 22nd has been designated National Donut Hole Day. According to a press release from Americans United: Nearly 7 million seniors and disabled Americans will find themselves completely on their own -- forced to pay the full cost of their prescription drugs on top of their costly monthly premiums. Earlier, the Institute for America's Future prepared a troubling analysis which identified September 22nd as the date the average Medicare-eligible American will fall into the Bush-Part D 'donut hole' trap -- a massive gap in coverage for those covered by Part D whose annual drug costs are between $2,250 and $5,100. Seniors who plummet into the 'donut hole' trap have little chance of climbing out before the whole vicious cycle starts all over again next year. Nearly 7 million 'donut hole' victims will quite literally be forced to choose between food and medicine in the coming weeks and months, which as the IAF report noted, will have dire -- even fatal -- health consequences for those who choose to go without their prescriptions. The steady drumbeat of Americans United 'Fix Part D' campaign will crescendo in the week leading up 'National Donut Hole Day' with 22 events in 20 cities around the country conducted by Americans United, the Alliance for Retired Americans, AFSCME and a host of other groups. Americans United affiliates and partners in Iowa, California, Connecticut, Illinois, Maine, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, West Virginia and Wisconsin will be highlighting the troubling September 22nd milestone with "doughnut hole" events outside Members' offices. The events will feature real Part D victims who will tell their horror stories about the enormous health and financial burden they now face thanks to the 'donut hole.' Other affiliates will join in an extraordinary campaign kicked-off by the Campaign for America's Future to crush, smash, pulverize, or eat 69,000 doughnut holes outside Members' offices -- 1 for each of the 100 seniors of the estimated 6.9 million who are expected to fall-in -- to highlight the need to eliminate the 'donut hole' and to call on Congress to Fix Part D NOW! To access the No Donut Hole web site, click above.

Georgia Law Requiring Voters to Show Photo ID Is Thrown Out; Judge Says Some Would Be Disenfranchised; State Plans Appeal; Elderly Woman was Plaintiff in Case; U.S. House is Poised to Pass Similar Law, and NAACP and AARP are Set to Challenge it if Enacted

9/21: According to a Sept. 20th Washington Post report: A state judge yesterday rejected a Georgia law requiring voters to show government-issued photo identification, writing in his decision, "This cannot be." Fulton County Superior Court Judge T. Jackson Bedford Jr. said the law, pushed by Gov. Sonny Perdue (R) to fight voter fraud, violates the state constitution because it disenfranchises citizens who are otherwise qualified to vote. State officials vowed to appeal Bedford's ruling to the Georgia Supreme Court before the Nov. 7 general election. ... The U.S. House is set today to vote on legislation that would require voters in 2008 to present a valid photo identification that "could not have been obtained without proof of citizenship." The bill is part of a package of measures designed to demonstrate a new get-tough attitude on illegal immigration and border security. "There have been enough reports over the years of voter fraud that it is time to have a picture ID to ensure the integrity of our voting process," House Majority Leader John A. Boehner (R-Ohio) said yesterday. Like the Georgia law, the federal legislation would almost certainly be challenged in court. A coalition of interest and civil rights groups, including the NAACP, AARP, and the Mexican American Legal Defense and Educational Fund, denounced the bill yesterday, saying it would disenfranchise hundreds of thousands of minority and elderly voters. Georgia's law was challenged by Rosalind Lake, an elderly black woman who was left partially blind after being nearly electrocuted in her home, is unable to drive and could not easily obtain a voter ID, her attorney said. The lawyer, former governor Roy Barnes, argued that even though the state offered to deliver an ID to Lake's home, it could not do the same for everyone who is similarly challenged. "We have a low voter participation," said Barnes, a Democrat. "We're going to make it more difficult?" ... Bedford's ruling was the latest in a string of court decisions against the Georgia law. Last year, U.S. District Judge Harold L. Murphy issued an injunction against the law, likening it to a segregation-era poll tax because the digital picture ID would cost voters $20. After the Georgia General Assembly revised the law to issue the ID at no cost, Murphy refused to completely lift the injunction, saying the state did not have time to properly educate voters before July primaries. In his ruling, Bedford said the law places too much of a burden on voters, regardless of certain state remedies. Voters could cast ballots without identification, but they would have to return to an elections office within two days to prove their identity or forfeit their vote. "Any attempt by the legislature to require more than what is required by the express language of our Constitution cannot withstand judicial scrutiny," Bedford said. Click above for full reprt.

Lawsuit blocks CMS repayment campaign

9/20: The following is from a Sept. 19th report in The Hill: The Medicare and Social Security agencies' efforts to recoup money erroneously refunded to beneficiaries have been stymied by a new lawsuit. The Centers for Medicare and Medicare Services (CMS) has temporarily halted its campaign to get back the Part D premiums it mistakenly returned to 230,000 beneficiaries this summer. The Center for Medicare Advocacy, on behalf of the Gray Panthers and the Pennsylvania-based Action Alliance of Senior Citizens, has initiated a lawsuit to block CMS from reclaiming the money. The group filed the suit on Friday in federal district court in Washington. The plaintiffs say some beneficiaries are entitled to a "waiver of recovery" exempting them from repayment. CMS did not inform beneficiaries that they might qualify and get to keep the money despite being warned of the threat of a lawsuit, according to the Center for Medicare Advocacy. CMS maintains that the waiver of recovery policy does not apply in these cases. Sen. Jay Rockefeller (D-W.Va.), who has criticized CMS over the refunds, commented, "I hope the agency will move swiftly to notify beneficiaries of their rights under the law." Click above to access the news report. . For a related story in Newsday, click here.

Few Black Churches Get Funds; Small Percentage Participate in Bush's Faith-Based Initiative

9/20: The following is from a Sept. 19th Washington Post report: The Bush administration's faith-based initiative is reaching only a tiny percentage of the nation's black churches, most of which have limited capacity to run social programs, hampering the initiative's promise of empowering those congregations to help the needy, according to a study to be released today. The national survey of 750 black churches by the Joint Center for Political and Economic Studies found that fewer than 3 percent are participating in the program, which funnels at least $2 billion a year in federal social services spending to religious organizations. Black churches in the Northeast and those with self-identified progressive congregations and liberal theologies were most likely to be taking part in the program, a finding that surprised the researchers, who concluded that the White House has not used the program as a political tool as some critics have suspected. "Those people who were most worried can exhale," said Robert M. Franklin, a professor of social ethics at Emory University who worked as a consultant on the survey. "Churches have not been manipulated by Karl Rove. They have not sold out." Despite instances of grants going to political and ideological supporters of President Bush, the survey found that, overall, liberal-leaning churches were more likely to apply for and receive the grants, even though they tend to view the program more skeptically than their conservative counterparts do. "The thing is that the churches that are most likely to actually do social outreach or social ministry are liberal churches, they are not conservative churches," said David A. Bositis, a senior research associate at the center who conducted the study. "Those churches may have significant reservations about the program. But if the money is there, they are going to take it. They are the ones who have the capacity and the infrastructure to get grants and administer them." While many of the churches surveyed had an interest in assisting those in need and frequently offered small-scale programs such as food pantries or used-clothing giveaways, most had neither the money nor the expertise to do more -- or even to seek more resources. Most of the nation's estimated 50,000 black churches are led by pastors who work other jobs full time and have little more than administrative help in running their churches. The survey found that >

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had annual revenue of less than $100,000 and half had revenue of less than $250,000. Only 12 percent reported taking in more than $1 million a year. "The survey reveals for us the breadth of churches in the African American community, and it shows how churches that already have capacity have a leg up on churches that may do some good things" but are not in a position to do them on a larger scale, said Harold Dean Trulear, a professor of religion at Howard University who was an adviser on the study. Click above to access article.

Alliance Between Disability Advocates, Bush Administration Officials Helped Develop Program To Encourage Home Care for Medicaid Beneficiaries

9/19: According to a Sept. 18th Kaiser Network Daily Update: NPR's "Morning Edition" on Friday examined how an "unlikely alliance" between a group of disability advocates and Bush administration officials resulted in a major change to federal funding for long-term care of Medicaid beneficiaries. HHS in July announced plans to award $1.75 billion in grants to states under a five-year program that would allow Medicaid beneficiaries to reside in their homes or in their communities, rather than in nursing homes. Under the program, states for one year will receive a higher rate of federal Medicaid matching funds for beneficiaries whom states move from nursing homes into their own homes or communities. States also can use the funds to make modifications to the homes of Medicaid beneficiaries to allow their continued residence and to provide respites for family caregivers. States must agree to continue to provide Medicaid beneficiaries with home or community care for at least one year after the higher rate of federal Medicaid matching funds ends. HHS said that the program could reduce costs because nursing home care is more expensive than home or community care. According to NPR, the relationship began in 2002 when 200 protestors in wheelchairs blocked traffic at an intersection near the White House and started discussions with Mark McClellan, current CMS administrator and a member of the president's Council of Economic Advisers at the time. Since his appointment to CMS, McClellan met four times annually with Bob Kafka, executive director of the American Disabled for Attendant Programs Today. Although some health care and disability advocates criticize some of the program's provisions, such as one allowing states to change benefits and charge copayments, McClellan said the Money Follows the Person program is the "biggest change in long-term financing in decades" and that his work with ADAPT is one of his proudest accomplishments from his tenure. According to NPR, 30 states have told McClellan that they would like to participate in the program, which began accepting grant applications two weeks ago. The NPR segment includes comments from Kafka and McClellan. To access the Kaiser report, with various related links, click above. AARP pushes for laws to permit medicine purchase from abroad

9/19: The following is from a Sept. 18th Associated Press report: AARP launched a $500,000 ad campaign Sunday in Iowa and other states pushing for Senate action on legislation that would let consumers buy U.S.-made prescription drugs from Canada and other countries. The ads will appear in newspapers and on radio in cities such as Baltimore, Indianapolis, Anchorage and Des Moines. David Certner, legislative policy director for the advocacy group, said the campaign focuses on the home states of senators who have shown some openness to letting people buy U.S.-made medicine shipped abroad. "This is going on right now regardless of the law. People are going outside the country to buy their medicine," he said. "We want to make sure the system is as safe as we can make it." The bill that AARP supports, written by Sen. Byron Dorgan, D-N.D., has bipartisan support from 31 co-sponsors. It would allow consumers to buy U.S.-made prescription drugs from Canada and eventually from other countries such as Australia, Japan and nations within the European Union. AARP officials said the political ads were not developed with November in mind, but they also know that cheaper medicine is a top priority with voters during the elections. The ads urge people to call their senators to co-sponsor the bill. Click above for full article.

Apartment company tells smokers to butt out; Nationwide management firm says it won't take new tenants who light up

918: The following is from a Sept. 15th Charlotte Observer article: Banished from offices, airlines and many hotels, smoking may soon be snuffed out in another place: apartment complexes. This month, a nationwide apartment management company for seniors went completely smoke-free -- a move that's thought to be the industry's first. Virginia-based First Centrum Communities, which has nearly 5,500 units in six states -- including three complexes in Charlotte -- made the switch to protect residents from secondhand smoke that could circulate through heating and air-conditioning systems or permeate through walls. "I honestly haven't heard a single comment yet," said Rob Couch, president of Centrum Management, which will allow all existing smokers to stay, even after their leases expire. "I think you will see more of this (by other management companies). It will be a floor-by-floor or building-by-building basis." Some independent landlords have long refused to rent to smokers, but the big management companies that own or manage sprawling complexes have let tenants puff away. That may be changing, said Tom Wilkes, president of Atlanta-based Post Apartment Property Management, which has 22,000 units nationwide, including Charlotte. Post is considering making parts of its complexes under construction nonsmoking. If that's successful, the company may convert parts of its existing apartment buildings. "We're pondering it," Wilkes said. "Perhaps one day we'll take an entire property nonsmoking." Wilkes said the company would act, in part, for the same health concerns for its residents that prompted First Centrum to change. The movement to curtail public smoking has accelerated in recent years, though legislative efforts have lagged in tobacco-influenced North Carolina, where lawmakers just this year banned smoking in the legislative building. ... This summer, the surgeon general said that secondhand smoke is more dangerous than previously thought and can dramatically increase the risk of heart disease and lung cancer in nonsmokers. That report -- coupled with media stories about nonsmoking policies at businesses such as Westin -- have raised awareness about secondhand smoke. "We've definitely had more calls about it," said Kate Uslan, tobacco control coordinator for the Mecklenburg County Health Department. "People are saying: `My neighbor smokes, and I'm physically sick because of it. I can smell it. I hear it's bad for me.' " Joyce Guin, 75, has refused to rent apartments that smelled like cigarette smoke. She recently moved into University Square, a new First Centrum community in northeast Charlotte. "When I was told about this, I was excited," Guin said about the no-smoking policy. First Centrum's 5,500 units make it a small management company when compared with giants such as Chicago-based Equity Residential, which has roughly 200,000 units and no nonsmoking complexes. But experts say that First Centrum's decision will spur other apartment management companies to act. "No one likes to be first," said Barbara Vassallo, vice president of government affairs for the National Apartment Association. "But this will clearly be market-driven. If they think this will be an amenity, they'll do it." Landlords and management companies also have been hesitant out of concerns it would be illegal to ban smoking, though those fears have abated. Criminal background checks are common at many apartment complexes today, though Wilkes, of Post Apartments, said that initially many management companies were wary of implementing them. A taboo against smoke-free apartments could be broken in a similar way, he said. Said Ken Szymanski, executive director of the Charlotte Apartment Association: "I thought (smoke-free apartments) would have been here already in 2006." Another factor that could encourage more smoke-free units is the savings from cleaning apartments. Thoroughly de-stinking an apartment used by a heavy smoker can cost more than $1,000, Wilkes said, often more than the security deposit. If heavy smokers are segregated into special apartments, management companies could save money if the number of smoke-filled apartments is limited. But Wilkes is curious as to how the ban would be enforced. "One of the difficulties is with a hotel guest that violates the policy, they are gone in a night," Wilkes said. "It will be interesting to see how enforcement will work. There is really no way you can fine someone, unless you have a very carefully worded lease." Click above to access the article.

Lobby groups want drug plan fee dropped

9/15: According to a Sept. 13th Associated Press article: Advocacy groups for older people and the disabled urged lawmakers on Wednesday to let more people enroll in the Medicare drug plan this year without penalty. More than 1 million Medicare beneficiaries would have to pay a penalty if they sign up for the drug program between Nov. 15 and Dec. 31. That fee is assessed because they failed to register during the first open enrollment period for the Part D benefit, which ended May 15. The penalty is equal to 1 percent of the average monthly premium for each month of delay in enrolling. People who enroll later this year basically would have to add 7 percent to their monthly premium -- or about $2.50 -- as long as they participate in the program. Lawmakers in both the House and Senate sponsored legislation to eliminate the penalty as soon as the spring deadline passed. The bills, however, have languished. "Many beneficiaries were unaware or confused about whether or how to enroll in the Part D benefit and should not received a lifetime penalty as a result," said the advocacy groups, including the National Council on Aging, Easter Seals and the Alzheimer's Association. The groups outlined their concerns in a letter to Senate Majority Leader Bill Frist of Tennessee and Sen. Harry Reid of Nevada, the top Democrat. The Bush administration has dismissed the penalty for low-income people who qualify for extra help. But the administration says doing away with the penalty for the remaining pool of Medicare beneficiaries is a decision for Congress. A bill in the Senate that does away with the penalty has 45 co-sponsors but has stalled because of objections. A spokesman for Sen. Tom Coburn, R-Okla., who is one of the lawmakers holding up the bill, said the penalty was minimal and would not affect the poor. ... The penalty applies to those who were eligible for the program during the initial sign-up and did not enroll. The penalty would keep adding up with every month they do not enroll. It does not apply to people who become newly eligible for the program. Sen. Charles Grassley, R-Iowa, sponsored the legislation waiving the penalty because he said it would lead to greater enrollment. "The bigger the pool, the more the risk is spread around, and the better the cost for everyone involved, from beneficiaries to taxpayers," he said. Click above for full article.

Beneficiary Choices in Medicare Part D and Plan Features in 2006

9/15: According to a note from the Kaiser Network Daily Update: The study of the above name, conducted for Pharmaceutical Research and Manufacturers of America (PhRMA) by the Lewin Group, examines the characteristics of the Medicare prescription drug plans chosen by about 18 million beneficiaries, looking at the number of beneficiaries enrolled in each plan. The study finds that beneficiaries who voluntarily enrolled in the drug benefit have disproportionately enrolled in plans with premiums on average $6 less than those of other plans. In addition, the study finds that many beneficiaries have chosen plans with either no deductible or a low deductible and with formularies that offer more drugs than the average plan. Beneficiaries also disproportionately chose plans with few prior authorization and step therapy restrictions. To access the full report, in pdf format, click above.

Congress Squanders Year As Appropriations Remain Unfinished

9/15: The following is from a Sept. 12th OMB Watch analysis: With the beginning of the new fiscal year less than three weeks away, not one of this year's appropriations bills has been signed into law. The Senate shoulders most of the blame for the standstill, having now passed just two of its 12 appropriations bills. Because there is so little time left, Congress will have to finish up its appropriations work in a lame-duck session after the November election. Last week, the Senate passed its version of the Department of Defense spending bill, only the second appropriations bill it passed this session, the first being the Department of Homeland Security spending bill. Clearly, Senate leadership has not considered appropriations bills a priority this session. Instead of appropriations bills, the GOP leadership has brought up the estate tax roll-back on three distinct occasions, as well as attempted to pass two unpopular constitutional amendments. None of these measures passed, while 10 must-pass appropriations bills have received no consideration. The appropriations process this year seemed doomed from the start as the Senate did not schedule enough time in session to finish all its appropriations bills. When it adjourns in October, the Senate will have spent 125 days on the job, the lowest count in at least the last 20 years. The House, on the >

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ations bill except for a divisive Labor-Health and Human Services (Labor-HHS) bill.
The Labor-HHS package was amended in committee to include a raise in the minimum wage that many House conservatives have objected to. Further, House Republicans do not agree on the bill's proper funding totals or funding for some specific programs, with moderate Republicans asking for amendments that would add billions to the Health and Human Services budget. Moderates have also protested the House Appropriations Committee's Labor-HHS proposal that would zero out funding for 56 individual programs. Despite the time needed to iron out good-faith compromises on these issues, House leaders will most likely wait until the last minute before adjournment to take up the Labor-HHS bill making good compromises next to impossible. And with so little work done this far into the budget cycle, Congress will have to hold a lame-duck session after the November election to complete all appropriations bills. In order to avoid a government shut down, Congress will have to pass "continuing resolutions" that temporarily fund federal programs until appropriations bills have been signed into law. This year, all the unfinished appropriations bills will most likely be combined into one large "omnibus" bill. This will allow for far less oversight and scrutiny of specific funding levels and will likely lead to program terminations and cutbacks to funding levels that ordinarily would not pass Congress. Click above to access this analysis.

Bush wants to renew Social Security push after vote

9/14: According to a Sept. 9th Reuters report: President George W. Bush hopes to revive his plan to overhaul the U.S. Social Security retirement program if his Republican party keeps control of the Congress in the November midterm elections, the Wall Street Journal reported on Saturday. Despite polls suggesting Democrats have their best chance in years to regain control of the House of Representatives, Bush told the newspaper in an interview he was confident a power shift was "not going to happen." "I just don't believe it," he said, adding that if Republicans prevail at the polls, next year might be a good time to reintroduce the effort to reshape Social Security because he could "drain the politics out of the issue." Bush was forced to abandoned his 2005 push to add private accounts to the retirement program, in part because of concerns among Republicans that the unpopular plan would jeopardize their chances in this year's elections. Some Democrats have emphasized the Social Security reform plan in their campaign to oust Republican incumbents in November, contending it would inject too much risk into the program and push the government deeper into debt. Bush made Social Security investment accounts a top domestic priority for his second term, arguing such a system would help young people by putting the retirement program on a more sustainable financial footing. Click above to access news report.

Smoke-free living; From cities to apartments, more enforce bans

9/14: The following is from a Sept. 11th Detroit News report: The sign outside the door at Meadowcrest Apartments -- "This is a non-smoking building. Put it out!" -- was more of an admonition than a rule. Smokers in the 83-unit complex always were able to puff in peace in their own apartments or on the grounds in the Southfield complex, just south of 10 Mile. But that changed at Meadowcrest and 14 other Michigan apartment complexes for seniors owned by First Centrum Communities on Sept. 1, when the apartment management company started enforcing its smoke-free policy. "As far as we know, they're the first really large apartment management and ownership firm that has done this," said Jim Bergman, co-director for the Center for Social Gerontology, a nonprofit research and social policy organization in Ann Arbor. "The First Centrum policy is going to be a breakthrough, even in the apartment industry." Now, new renters of any of First Centrum's apartments must sign an addendum to their lease pledging not to smoke in the building or on its grounds. Violation of the agreement can result in eviction. Critics say it's the latest in a series of moves by states, counties, cities and private businesses to quash smokers' rights. Smoke-free advocates say the ban is another step in a healthier direction for the nation, which is finally starting to acknowledge that secondhand smoke is dangerous. ... First Centrum president Rob Couch argues the ban is fair because it grandfathers in current smokers until they leave. "We're not going to war with this thing," Couch said. "But there are some people who are dramatically affected" by secondhand smoke. Ruth Darcy was one of them. The 65-year-old Ann Arbor resident suffers from asthma, which is aggravated by even a whiff of smoke. "I can't have smoke around me at all. If someone lights up near me I quit breathing. I have to run out of the area," she said. In apartments, secondhand smoke can travel through hallways, under doors and through vents, she said. Darcy was part of a group of seniors at First Centrum's Courthouse Square in Ann Arbor that petitioned for a smoke-free building. Until now, apartment complexes had avoided the smoke-free issue, put off by the threat of lawsuits and potential loss of clients. But those perceptions are shifting, Bergman said. Bergman cites a 1992 opinion by then state Attorney General Frank Kelley that finds there is nothing in state or federal law that prevents a landlord from banning smoking at an apartment or condo complex. "Smokers are not a protected class," Bergman said. "They do not have a constitutional right to smoke. That's the real nub of this." Apartments owners are realizing they can institute smoking bans without the worry of lawsuits and at the same time save money and reduce a fire hazard, Bergman said. When the Center for Social Gerontology started listing smoke-free apartments in January 2005, Bergman said there were virtually none to be found in Michigan. Now there are 150 smoke-free companies with more than 400 apartment buildings and more than 4,000 apartment units in the buildings on the list. "This is growing, and it's growing rapidly," Bergman said. "We basically have demolished the fear that this is illegal among landlords." Click above for full story. To go to the Detroit News to see a poll on this issue and to view many letters in response to the story, click here.

North Carolina nursing home eases smoke ban for current residents, but facility to be smoke-free for all future residents, and current smokers must smoke outside

9/14: The following is from a Sept. 7th article in the Raleigh News & Observer: Residents of a nursing home system are smoking again after regulators stamped out a tobacco ban. The Moses Cone Memorial Health System recently outlawed smoking on its property to improve the quality of life for people at its facilities. But a state inspection in mid-August found that the tobacco-free policy did not meet federal regulations. Moses Cone wrongfully discharged three residents because of the new smoking ban, breaking federal rules that govern the industry, said Beverly Speroff, chief of the state's Nursing Home Licensure and Certification Section. Residents of the extended care center argued that the facility was their home and should be exempted from the smoking ban. Many disabled residents said it was difficult to leave the property to smoke. "They had to grant us our rights," said Ruby Watlington, a resident at the center. Debbie Combs-Jones, the executive director for Moses Cone Health System, said no residents were forced to leave because of the smoking ban. "It was their choice," she said, adding that the three residents who left have been invited back. The smoking ban has been relaxed. Residents have been grandfathered into the policy and can light up, but they must remain at least 10 feet away from the building. New residents are prohibited from lighting up. Click above to access the news story. For more on this topic, go to TCSG's Smoking Policies in Facilities Serving Older Persons site at here.

High-Income Medicare Recipients to Pay Surcharge

9/13: The following is from the NY Times: The basic Medicare premium will rise next year to $93.50 a month, an increase of $5 a month, the Bush administration announced Tuesday [Sept. 12th], but for the first time, higher-income beneficiaries will be required to pay a surcharge. The standard premium is lower than expected. In May and again in July, Medicare officials estimated that it would be about $98 a month in 2007. Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said that Medicare spending for doctors' services, while still growing at a brisk pace, had increased less than expected. The premium in question is for Part B of Medicare, a voluntary program that covers doctors’ services, diagnostic tests and outpatient hospital care for 40 million people who are 65 and older or disabled. It shot up 50 percent from 2003 to 2006, when it reached $88.50 a month. Explaining the increase for 2007, Dr. McClellan reported "a modest slowdown in physician spending growth," but "very rapid growth in spending for hospital outpatient services." The surcharge, to be phased in over the three years, is a major change: the first time that high-income beneficiaries will have higher premiums for Medicare coverage. It will ranging from $12.50 to $68.60 a month and is expected to raise $7.7 billion in the first five years and $20.8 billion in the coming decade. Dr. McClellan said the surcharge would have "a very positive impact, making Medicare more sustainable in the long term." He dismissed concerns that the higher premiums would prompt some wealthy people to drop out of Medicare, leaving the program to serve poorer, sicker people. Federal health officials estimate that 1.5 million people -- about 4 percent of those in Part B of Medicare -- will have to pay the new surcharge, based on income. Because of the surcharge, officials estimate, 9,000 people will drop out of Part B in 2007, and 30,000 will drop out in 2009. The new surcharge will apply to individuals with incomes of more than $80,000 and married couples filing joint returns with incomes of more than $160,000. In 2007, the surcharge will be $12.50 a month for a single person with income of $80,000 to $100,000, and the same amount for each member of a couple with combined income of $160,000 to $200,000. Their premiums will total $106 a month. The surcharge rises with income. An individual with income greater than $200,000 and each member of a couple with combined income of more than $400,000 will have to pay a surcharge of $68.60 a month, for a total premium of $162.10. Click above to access article.

Average Medicare Drug Benefit Premium To Remain Same or Decline in 2007, CMS Administrator McClellan Says

9/13: The following is from a Sept. 12th Kaiser Network Daily Update: The average monthly premium for the Medicare prescription drug benefit in 2007 will be the same as or less than the 2006 average premium because of competition among Medicare drug plans and negotiations with pharmaceutical companies, outgoing CMS Administrator Mark McClellan said Monday in a speech at America's Health Insurance Plans' annual conference on Medicaid and Medicare, CongressDaily reports. McClellan said the average monthly premiums will be no more than $24, the same as this year. He added that it is possible the 2007 average premium could be up to one-third lower than the 2006 premium. According to CQ HealthBeat, "The prospect of lower drug coverage premiums next year for at least some Medicare beneficiaries may allow CMS to soften the sting of announcing an expected increase in the monthly premium seniors pay next year for Part B coverage." CMS is expected to announce 2007 Medicare premiums on Tuesday. McClellan said he expects a significant number of beneficiaries to switch prescription drug plans next year as those who enrolled in higher-priced plans in 2006 look to take advantage of the lower premiums being offered in 2007. The enrollment period begins Nov. 15. According to McClellan, about 500,000 low-income Medicare beneficiaries who were automatically enrolled in the drug benefit this year will have to sign up on their own for 2007 coverage. He said those beneficiaries will not be automatically enrolled because they no longer qualify for Medicaid or other programs for which the government automatically enrolls beneficiaries. However, the majority of beneficiaries who were automatically enrolled in 2006 will be automatically enrolled again in 2007, he said. CMS will urge all beneficiaries to enroll by Dec. 8, although the enrollment period will continue until Dec. 31, he said, adding that early enrollment will allow insurers time to process beneficiaries' information. McClellan said insurers who sponsor Medicare drug plans should educate beneficiaries about their enrollment options. He also urged insurers to inform beneficiaries of the so-called "doughnut hole" coverage gap and offer plans with coverage options during the gap. Click above to access the full Kaiser note.

Medicare Costs to Increase for Wealthier Beneficiaries

9/12: The following is from a Sept. 11th NY Times report: Higher-income people will have to pay higher Medicare premiums than other beneficiaries next year, as the government takes a small but significant step to help the financially ailing program remain viable over the long term. The surcharge is a major departure from the traditional arrangement under which seniors have generally paid the same premium. It is expected to affect one million to two million beneficiaries: individuals with incomes exceeding $80,000 and married couples with more than $160,000 of income. For individuals with incomes over $200,000, the premium, now $88.50 a month, is expected to quadruple by 2009. The surcharge was established under a little-noticed provision of the 2003 law that added a prescription drug benefit to Medicare. Supporters of the surcharge say it makes sense for wealthy people to pay more at a time when Medicare costs are soaring. But some Medicare experts worry that wealthy retirees will abandon the program and rely on private insurance instead, leaving poorer, sicker people in Medicare. The premium in question is for Part B of Medicare, a voluntary program that covers doctors' services, diagnostic tests and outpatient hospital care. ... Most beneficiaries now pay the same premium for Part B of Medicare. That amount has been increasing rapidly even without a surcharge. The standard premium has shot up an average of 12 percent a year since 2001, when it was $50 a month. The premium is set each year to cover about 25 percent of projected spending under Part B of Medicare, which has been growing because of increases in the number and complexity of doctors’ services. General tax revenues pay 75 percent of the cost. The Bush administration plans to announce the standard premium for 2007 later this month. In July, Medicare officials estimated that it would be $98.40 a month. The surcharge will be phased in from 2007 to 2009. Here is how it will work: The surcharge for 2007 will be computed by the Social Security Administration, using income data obtained by the Internal Revenue Service from tax returns for 2005. If an individual has modified adjusted gross income of $80,000 to $100,000, the surcharge will be 13.3 percent, which adds about $13 to the monthly premium, for a total of about $111.50. For a single person with income of more than $200,000, the surcharge will be 73.3 percent, or about $72 a month, for a total premium of about $170.50. When the transition is complete in January 2009, according to Medicare actuaries, the total premium for a person with income of $80,000 to $100,000 will be 1.4 times the standard premium. A person with income of $100,000 to 150,000 will pay twice the standard premium. A person with income of $150,000 to $200,000 will pay 2.6 times the standard premium, and a beneficiary with more than $200,000 of income will pay 3.2 times the standard amount. If the basic premium rises 10 percent a year -- a relatively conservative forecast -- the most affluent beneficiaries will be paying premiums of more than $375 a month in 2009. Under current law, the $80,000 threshold and the income brackets will be adjusted each year to keep pace with inflation, as measured by the Consumer Price Index. ... More than 40 million people are in Part B. Medicare officials estimate that 2 percent of them will have to pay a surcharge next year. The Congressional Budget Office says 5 percent of beneficiaries will be affected. The Social Security Administration puts the figure at 4 percent to 5 percent. Most people have their premiums deducted from monthly Social Security checks. Fiscally conservative Republicans supported the surcharge. But so did some Democrats, who saw it as a progressive way to finance Medicare without cutting benefits or raising payroll taxes. Click above for full article.

Editorial: Activism Is in the Eye of the Ideologist

9/12: The following is from a Sept. 11th editorial in the NY Times: Conservatives like to divide judges into liberal “activists” and conservative nonactivists who interpret the law rather than making it. Anyone who follows the courts knows that conservative judges are as activist as liberal judges --just for different causes. A new study of Supreme Court voting patterns confirms this and suggests that the conservative Justices Antonin Scalia and Clarence Thomas are actually more activist than their liberal colleagues. Lori Ringhand, a professor at the University of Kentucky College of Law, examined the voting records of the Supreme Court justices from 1994 to 2005. Because judicial activism is a vague concept, she applied a reasonable, objective standard. In the study, which is forthcoming in Constitutional Commentary, justices were considered to have voted in an activist way when they voted to overturn a federal or state law, or one of the court’s own precedents. The conservative justices were far more willing than the liberals to strike down federal laws -- clearly an activist stance, since they were substituting their own judgment for that of the people’s elected representatives in Congress. Justice Thomas voted to overturn federal laws in 34 cases and Justice Scalia in 31, compared with just 15 for Justice Stephen Breyer. When state laws were at issue, the liberals were more activist. Add up the two categories, and the conservatives and liberals turned out to be roughly equal. But Justices Thomas and Scalia, who are often held out as models of nonactivism, voted to strike down laws in more of these cases than Justice Breyer and Justice Ruth Bader Ginsburg, the court’s two Clinton appointees. By the third measure, overturning the court’s own precedents (for which data were available only up to 2000), the conservatives were far more activist. Justice Thomas voted to overturn precedent 23 times and Justice Scalia 19 times, while the court’s four liberals did so in 10 cases or fewer. Activism is not necessarily a bad thing. The Supreme Court is supposed to strike down laws that are unconstitutional or otherwise flawed. Clearly, all nine justices, from across the political spectrum, believe this, since they all regularly vote to strike down laws. What is wrong is for one side to pretend its judges are not activist, and turn judicial activism into a partisan talking point, when the numbers show a very different story. Click above to access the editorial.

Filling Up With Empty-Nesters: Age-Restricted Housing Increasing in Howard County

9/12: The following is from a Sept. 11th Washington Post article: Since Columbia was built nearly four decades ago, Howard County attracted mostly families with young children looking to escape the high housing prices and headaches of modern city life. But when county officials consider who they most want now, it's empty-nesters like Bernard and Phyllis Nash, a growing portion of the population and one that holds advantages for communities that can lure them. They're over 55, yet perhaps decades from a nursing home. They pay plenty in taxes. And they don't use one of the most expensive local services: schools. To that end, Howard County has rewritten its development rules to benefit from the economics and demographics of an aging society. For decades, suburban communities have focused on managing the impacts of growth by demanding land, impact fees and other concessions from developers to subsidize the roads, water systems and schools that new subdivisions require. In Howard, the focus is shifting toward housing for people like the Nashes -- and on trying to loosen the rules for developers who build homes for them. County rules now mandate that at least 250 of the 1,850 residences that can be built in the county each year be set aside for people age 55 and older. In a county where the wait for building permits can run five years, developers of age-restricted communities can jump to the head of the line, and apply for permission to build more units per acre than are otherwise allowed. The incentives appear to be working. There are 16 age-restricted communities in Howard County, half of them built in the past two years, according to the county's Office of Aging. Twenty-two more are in the works. When schools are overenrolled at 115 percent, as they are in some parts of the county, local regulations freeze development of all except age-restricted communities, said Phyllis Madachy, the Office on Aging administrator. "Rather than hold on to the land and wait for the schools to be lesser enrolled, developers turned that land to the use of senior housing," Madachy said. "The building community turned like a big ship away from single-family homes to active-adult housing." The aging of the baby-boom generation is a focus of economic discussion nationwide, as businesses and governments try to anticipate the retirement of a group of people that redefined life and work at every stage of life. Born from 1946 to 1964, the boomers are generally healthier and wealthier than their parents and grandparents. And there are a lot of them: nearly 80 million nationwide. ... Increasing the tax base is "a nice side benefit" but not the motivating factor behind the county's senior housing push, said Marsha S. McLaughlin, director of the county's Planning and Zoning Department. Instead, the county was alarmed by the swelling ranks of seniors (the state expects the county to have as many seniors as school-age children by 2020) and responding to senior advocates who complained about the lack of homes with first-floor master bedrooms and other features required in age-restricted homes. Developers have recognized the opportunity. "Outside the Sun Belt states, the Washington are>

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f active-adult communities in the country," said Jeff Jenkins, deputy director of the seniors housing council for the National Home Builders Association. "It's become a little bit of a hotbed for active adults." Click above for full article.

OUR VIEW: Smoking ban should apply to all patients

9/11: The following is from a Sept. 8th editorial in the Star Press newspaper in Muncie, Indiana: Delaware County commissioners should snuff out an absurd proposal to allow current residents of nursing homes to continue to smoke. The idea is unhealthy -- for patients and employees -- and could be chaotic for nursing homes. The proposal was advanced at a commissioners' meeting by Robin Shackleford, policy and research specialist for the Indiana Health Care Association (IHCA), a trade group representing the nursing home industry. Her group wants commissioners to amend the local smoking-ban ordinance to allow current residents -- not future residents and not employees -- to smoke in designated areas of nursing homes. The nursing home association apparently thinks a federal policy directive for long-term care facilities should apply to the county's smoking-ban. The directive says, in part: "IF A FACILITY CHANGES ITS policy and prohibits smoking, it must allow current residents who smoke to continue smoking in an area that maintains the quality of life for those residents. ... Residents admitted after the facility changes its policy must be informed of this policy at admission." There are some serious problems with the directive and the IHCA's interpretation: 1. A "facility" is not changing its policy; the policy change on smoking was decided by a government unit, the county commissioners. As far as we know, they don't answer to the feds on this issue. 2. It is hard to understand how allowing nursing home residents to smoke would be "maintaining their quality of life." If anything, it would be relegating them to increased health risks involving heart and lung functions, as well as aggravating conditions such as asthma and emphysema. FOR NURSING HOMES, it would also mean exposing employees to unhealthy amounts of second-hand smoke, as well as creating potential conflicts among patients. If only "current" patients were allowed to continue to smoke, imagine the arguments that would occur once nursing homes admitted future patients who happen to be smokers but, unlike other patients, would not be exempt from the smoking ban. Animosity and jealousies would ensue, and staff members would have to keep the peace. The federal directive goes too far in the direction of being "respectful" and "tolerant" of patients' habits. Most hospitals don't allow patients to smoke and neither should nursing homes. As for the county commissioners, they should tell the IHCA to find some other cause to promote. Click above to access the editorial.

Reactions are mixed to Medicare drug plan; Pharmacists and doctors say not all beneficiaries equal

9/11: According to a Sept. 8yj San Francisco Chronicle report: Pharmacists and physicians view Medicare's prescription drug benefit as a mixed bag for beneficiaries, according to a national survey released Thursday. Most of the pharmacists and doctors interviewed for the Kaiser Family Foundation survey said the new program helps elderly and disabled Medicare patients save money. At the same time though, more than 80 percent of pharmacists reported that some customers have had troubles getting medications. Nearly half of the pharmacists reported customers had to leave stores without their prescriptions because they couldn't afford their share of costs. About 10 percent of doctors said patients suffered health complications because of problems getting their medications under Medicare. "There's general satisfaction and a general sense the law is producing a benefit for most people. But a significant minority of people are experiencing problems," said Drew Altman, chief executive officer of the Kaiser Family Foundation, a health research group in Menlo Park. Altman said the foundation wanted to survey people on the front lines, who have seen results of the of the drug benefit plan that began Jan. 1. The program, administered by private companies, has provided coverage to millions of Medicare beneficiaries who did not have insurance to help pay for medications. The drug program has been fraught with problems and computer glitches, especially in its early weeks. Medicare has resolved most major computer problems and many other difficulties. But consumer and senior advocates still criticize the program for its complexity and for significant gaps in coverage. The foundation conducted the survey of 802 pharmacists and 834 doctors between April and July, after many of the startup problems had diminished, but before many seniors started hitting the most significant coverage gap -- the infamous "doughnut hole." Beneficiaries must pay cash for their drugs after total drug spending reaches $2,250. Coverage kicks in again when drug expenses exceed $5,100. Eighty-six percent of pharmacists and 71 percent of doctors said the benefit is helping people save money. But pharmacists reported frequent and serious problems with the program, known as Medicare Part D. "If there's any trouble anywhere along the line related to the administration of the Part D benefit, where it hits the fan, it's at the pharmacy," said Michael Negrete, vice president of professional affairs for the California Pharmacists Association. Pharmacists spend considerable time advising customers about the benefit, Negrete said. According to the survey, 85 percent of pharmacists and 57 percent of doctors said they have "a lot" or "some" responsibility to help their patients understand the program. Many physicians reported they didn't fully understand which drugs individual plans cover. About 69 percent of the physicians surveyed said they are not very familiar with the plans' formularies, which are the lists of covered medications, and 59 percent said they never or rarely check formularies before prescribing a drug to Medicare patients. More than 90 percent of both physicians and pharmacists said the Medicare drug benefit law is too complicated. The Kaiser Family Foundation is also studying patient opinions about the Medicare drug benefit. In the latest patient survey, conducted in early June, more than 8 in 10 seniors said they were satisfied with the program, while 2 in 10 said they had encountered a major problem. The survey of physicians and pharmacists about the Medicare drug benefit can be found by clicking here. For the news report, click above.

New Kind of Apartment Living Puts Focus on Aging Creatively

9/11: The following is from a Sept. 10th NY Times article: As hairdresser to the stars, Connie Nichols, an 86-year-old retiree (Apt. 225), has been on intimate terms with Olivia de Havilland’s hair, Ethel Merman’s hair, Doris Day’s hair and Natalie Wood’s hair, which she spritzed for her wedding to Robert Wagner. Ms. Nichols’s latest leading lady is her downstairs neighbor, Helen Miller (Apt. 125), who is starring, at 81, in “Bandida,” a new comedy about an old woman who robs a convenience store. The movie was written by Suzanne Knode (Apt. 406), who was inspired to take up screenwriting at 63 after moving into the Burbank Senior Artists Colony, the country’s first apartment community for creative older people -- a sort of "Golden Girls" meets Yaddo. "To expose myself artistically was terrifying, especially at my age" said Ms. Knode, whose past credits include raising two children as a single mother in Boston. "But it was safe here. It was gentle. I wasn't scared." In a city that worships youth, the Colony is the latest spin on late-life living. With the understanding that not everyone wants the old-school model of golf course retirement, the Colony offers artful self-expression: a digital film editing laboratory, a theater, drama classes and artists’ studios open for inspiration 24 hours a day. This is a place where amateurs discovering their inner Picassos in retirement can commune with working pros like Charlie Schridde, a painter in his 70's from the "cowboy impressionist" school who resembles the grizzled trappers of his canvases. His neighbors include Janice Lishon, 90, a former chorus girl from Chicago, and Betty Vincent, 76, a self-described "piano broad" who is still playing jazz (her sideman on the trumpet is a retired gynecologist). "It helps you stay out of trouble," said Ms. Miller, who before "Bandida" had never been in a movie or held a gun, let alone had her hair styled by the creator of Doris Day's French twist in "Pillow Talk." The Colony, which was recognized last month as a model for creative aging by the National Endowment for the Arts, represents a profound shift in thinking about aging. In 2001, a study co-sponsored by George Washington University and the N.E.A. found that people 65 and older who were regularly involved in participatory arts programs reported fewer doctors’ visits and less need for medication and were less prone to depression. "We're thinking beyond the problems of aging to its potential," said Dr. Gene D. Cohen, the director of the Center on Aging, Health and Humanities at the George Washington University Medical Center. "What's emerging is a very talented group of people who are an under-recognized national resource." ... The colony is the brainchild of Tim Carpenter, the founder of More Than Shelter for Seniors, who grew up near Yaddo, the New York artists' community. Mr. Carpenter recruited an advisory board sprinkled with actors to hone the concept and drew an initial core of tenants, ages 55 and older, through local arts organizations. No tryouts or portfolios are required, but the artistic ambitions of residents transcend the flutophone or macaroni-glitter-and-glue crowd. The colony, with a multicolored exterior, is a block from downtown Burbank. Seventy percent of the 141 apartments rent at market rate, from $1,430 to $2,125. Thirty percent are reserved for low-income residents, renting from $500 to $650, with 2,000 people on a waiting list. The complex was built by a private developer, the Meta Housing Corporation, which specializes in housing for older people, and financed in part through federal low-income tax credits and a $3.25 million low-interest loan from the city. The colony provides no assisted-living services, but its arts programs are free, provided by More Than Shelter. Mr. Carpenter and John Huskey, the president of Meta Housing, plan to take the arts colony concept to other cities. Click above for full article.

Congress likely to tackle only modest healthcare measures before Nov. elections; Unlikely to pass HHS appropriations bill

9/6: According to a Sept. 5th The Hill article: After months of heated debates on hot-button healthcare issues, congressional leaders are looking to pass a few lower-profile health bills before the end of the 109th Congress. The politics of healthcare issues typically do not lend themselves to election-year compromises and 2006 has not proved exceptional in this regard. President Bush vetoed the stem-cell-research bill and the GOP leadership in Congress endured the Democrats? sustained assault on Medicare Part D without giving in to demands to amend the law. ... Despite the political hullabaloo surrounding the Medicare drug benefit this year, calls from Democrats and some vulnerable Republicans that changes be made to the program are likely to remain unheeded. But a major drive for another Medicare measure will ramp up in September. The physician lobby is making an aggressive push for legislation to block a 5.1 percent payment cut that will take effect in January if Congress does not act. The American Medical Association (AMA) has been waging its campaign in Washington and in key districts and states all year, and the issue remains at the top of its agenda. During the week of Sept. 11, the AMA has organized a fly-in of doctors from across the country for office visits with lawmakers and staff. The chief obstacle to preventing the cuts, as ever, is the hefty price tag. Although lawmakers almost universally agree that the payment formula that calls for the cuts is flawed, even holding payments at this year?s level for a single year would cost $1.1 billion, according to the Congressional Budget Office. Palatable offsets have so far eluded Congress. ... As usual, the end of the legislative year is approaching and Congress has failed to pass the Labor-HHS-Education appropriations bill, the spending measure that seems the hardest to get through. In spite of optimistic predictions from senior GOP appropriators, the fiscal year appears all but certain to end Sept. 30 without the labor-HHS bill being passed. Congressional and lobbyist sources expect to see an omnibus appropriations bill moved after the elections, at best, and have not ruled out the possibility that Congress will simply adopt a continuing resolution that lasts until January. Click above for full article.

Allen Park Housing Commission adopts smoke-free policy for 60 units of elderly housing; Seventh Michigan Housing Commission to adopt smoke-free policy

9/6: On September 5th, the Allen Park Housing Commission unanimously adopted a smoke-free policy for the Leo Paluch Apartments, which has 60 units for the elderly or disabled. The smoke-free policy will go into effect on October 1, 2006. It's been our pleasure to work with Allen Park Executive Director Theresa Sears and her board in recent months on the development and passage of this policy. The Allen Park smoke-free policy will grandfather current residents who are smokers for as long as they live in their units. This is similar to the policies adopted by the Cadillac, Plymouth, Elk Rapids, Melvindale, and Livonia Housing Commissions. The East Jordan Housing Commission policy grandfathers current residents who are smokers until lease renewal, which is in about one year. The East Jordan policy is similar to the policy adopted by the Sisters of St. Joseph for their 76-unit Dillon Hall apartment building for elders near Kalamazoo; a building that has Section 8 subsidized units. Allen Park, located in Wayne County, is the seventh local Housing Commission in Michigan to adopt a smoke-free policy. With Allen Park's adoption of the smoke-free policy, Michigan has 7 local Housing Commissions with smoke-free policies, covering 9 apartment buildings, with about 880 apartment units. Including Dillon Hall, that brings the total units of smoke-free "affordable housing" up to about 960 units in Michigan. Plus, there are other Section 8 units in private apartment buildings that are smoke-free, but which we haven't identified. Plus, there are 15 apartment buildings in Michigan operated by First Centrum Communities, which adopted a smoke-free policy for all its buildings, effective September 1st; that policy also grandfathers current residents who are smokers. The 15 First Centrum buildings have a total of 1,526 units, and most of these units are also "affordable housing." That's a total of about 2,500 units of affordable housing in Michigan which is either already totally smoke-free or is transitioning to smoke-free status as current smokers move out and are replaced with residents who must abide by the smoke-free policies. All these local Michigan policies have been adopted within the past 17 months because of the serious health threat posed by secondhand smoke that seeps into adjoining units and for fire safety and maintenance reasons. Also, like many private landlords, many of these housing commissions are now viewing smoke-free policies as a positive marketing tool. As these numbers increase, and as more private apartment owners adopt smoke-free policies, we're getting closer and closer to achieving our goal of making smoke-free multi-unit housing the norm in Michigan. To access more information about adopting smoke-free policies in multi-unit housing, click above.

McClellan Resigns as Medicare Chief

9/6: The following is from a NY Times report: Dr. Mark B. McClellan, the administrator of the Medicare and Medicaid programs, resigned as expected today [Sept. 5th], telling his employees that his two and a half years in the post have been immensely rewarding but that he is looking forward to spending more time with his family. The White House had already begun searching for a successor to run the Centers for Medicare and Medicaid Services before Dr. McClellan made his plans official. Leslie V. Norwalk, the deputy administrator, is an obvious candidate to serve as acting administrator, though other officials are also under consideration, said a White House official who spoke on the condition of anonymity because a decision had not been made. The Dallas Morning News reported over the weekend that Dr. McClellan was set to leave. In his message to agency employees today, Dr. McClellan said he expected to depart by early October, after a "transition period." Dr. McClellan is expected to work for a research organization and concentrate on health-care issues. For full article, click above.

Medicare Chief Is Silent on Leaving; McClellan Said To Be Ready to Resign Post Soon

9/5: According to a Sept. 4th Washington Post report: Mark B. McClellan declined yesterday to address a report that he plans to announce his resignation as administrator of the Centers for Medicare and Medicare Services as early as this week. "I'll be happy to talk to you when I have something to say," McClellan said at his Northwest Washington home. The Dallas Morning News reported yesterday that McClellan, 43, will soon step down as the overseer of two of the nation's largest public health insurance programs. McClellan, 43, a Texan, plans to return to academia or the private sector after having served in three key health policy posts since President Bush took office in 2001, the newspaper reported. White House spokesman David Almacy also said he could not confirm the report. "We haven't made any formal announcements about any personnel changes," Almacy said. "If he's going to make an announcement, I guess we're going to have to wait and see." To access the news story, click above.

Livonia Housing Commission adopts smoke-free policy for about 388 units of elderly housing; Sixth Michigan Housing Commission to adopt smoke-free policy

9/1: The Livonia Housing Commission on August 17th adopted a smoke-free policy for all three of its apartment buildings for the elderly. The smoke-free policy will go into effect on January 1, 2007 for Newburgh Village with 120 units, Silver Village with 108 units, and McNamara Towers with 160 units. The total of about 388 apartment units is the largest number of smoke-free units of any local Michigan Housing Commission thus far. The Livonia smoke-free policy will grandfather current residents who are smokers for as long as they live in their units. This is similar to the policies adopted by the Cadillac, Plymouth, Elk Rapids, and Melvindale Housing Commissions. The East Jordan Housing Commission policy grandfathers current residents who are smokers until lease renewal, which is in about one year. The East Jordan policy is similar to the policy adopted by the Sisters of St. Joseph for their 76-unit Dillon Hall apartment building for elders near Kalamazoo; a building that has Section 8 subsidized units. Livonia is the sixth local Housing Commission in Michigan to adopt a smoke-free policy, but it is the first one to have the policy apply to multiple buildings. With Livonia's adoption of the smoke-free policy, Michigan has 6 local Housing Commissions with smoke-free policies, covering 8 apartment buildings, with about 820 apartment units. If you include Dillon Hall, that brings the total units of smoke-free "affordable housing" up to about 900 units in Michigan. Plus, there are certainly other Section 8 units in private apartment buildings that are smoke-free, but which we haven't identified. Plus, there are 15 apartment buildings in Michigan operated by First Centrum Communities, which has adopted a smoke-free policy for all its buildings, effective September 1st; that policy also grandfathers current residents who are smokers. The 15 First Centrum buildings have a total of 1,526 units, and most of these units are also "affordable housing." That's a total of about 2,500 units of smoke-free affordable housing in Michigan. All these local Michigan policies have been adopted within the past 16 months because of the serious health threat posed by secondhand smoke that seeps into adjoining units and for fire safety and maintenance reasons. Also, like many private landlords, many of these housing commissions are now viewing smoke-free policies as a positive marketing tool. Why all the talk of numbers? Because our bottom line goal is to make smoke-free apartments and condominiums the norm in Michigan. As these numbers increase, and as more private apartment owners adopt smoke-free policies, we're getting closer and closer to achieving our goal of making smoke-free multi-unit housing the norm in Michigan. For more information on the Livonia Housing Commission buildings, click above. For more on how to go about adopting a smoke-free apartment policy and learning your rights to smoke-free housing, click here.

New drug program to start for Pennsylvania seniors; Pace Plus Medicare is designed to fill the gaps left in coverage by the Part D federal benefit

9/1: The following is from a Sept. 1st Philadelphia Inquirer report: Beginning today, more than 150,000 senior citizens who participate in Pennsylvania's low-cost pharmaceuticals programs should start bringing their new Medicare drug card when they pick up prescriptions. The reason is the introduction of the program Pace Plus Medicare. It combines the new Medicare benefit, called Part D, and the state's drug programs, Pace and PaceNet. Under Pace Plus Medicare, the federal government provides primary coverage, and Pace and PaceNet fill in the gaps. The combination means Pace Plus Medicare will lower the cost of prescription drugs under Part D coverage by an average of $1,200 a year, said Tom Snedden, the director of Pace and PaceNet. Medicare will pay for some prescription costs that the state previously paid, allowing the state to use part of the savings to lower some drug costs for people in Pace and PaceNet, which jointly enroll about 312,000 people. Under Pace Plus Medicare, no one will pay more than they did under Pace and PaceNet, the state said. PaceNet enrollees who join Pace Plus Medicare will pay a monthly premium to the insurance company that provides their Part D plan. In addition, the $40 monthly deductible for people in PaceNet will drop to no more than $32.59. Pace Plus Medicare will also benefit the approximately 87,000 Pace and PaceNet enrollees who were covered through a comprehensive service called Medicare Advantage. Click above for full article.

Essay: Choosing a "God Squad," When the Mind Has Faded

8/31: The following is an essay by Barron H. Lerner, M.D., in the August 29th NY Times: Would you want your tax dollars to pay for dialysis for a patient with irreversible brain damage? In 1972, when Congress agreed to use Medicare money to finance dialysis for patients with end-stage kidney failure, this question had never come up. But now, new research shows, many patients on dialysis have severe mental impairment. Is it appropriate, or even possible, to refuse to give patients this treatment? Dialysis controversy is nothing new. Disputes erupted in the early 1960?s shortly after Dr. Belding Scribner, a nephrologist in Seattle, developed the first shunt allowing patients to receive continuing dialysis of their blood. By 1962, doctors there had established a committee to decide which end-stage kidney patients should gain access to the few available dialysis machines. Wisely, the committee included nonphysicians: a lawyer, a minister and a homemaker. Still, reporters likened it to a "God squad." The headline of one article was "They Decide Who Shall Live and Who Shall Die." Particularly offensive to critics was choosing candidates based on "good citizenship." As a result, married churchgoers with children lived; single men with criminal records died. Such concerns helped spur legislation to provide for the dialysis of all who qualified medically. By the 1970's, the equipment shortage was over. But there were new problems. For one, the bill's sponsors underestimated the demand for dialysis, now given to more than 300,000 patients a year, at a cost of more than $16 billion. It also became clear that the technology was, in some cases, being used indiscriminately. When patients went into kidney failure, dialysis was reflexively instituted. The fact that some of the patients had advanced Alzheimer's disease, some other type of brain damage or a terminal disease received insufficient scrutiny. Of course, aggressive care is hardly limited to dialysis. Throughout the United States, other potentially lifesaving technologies, like respirators and cancer chemotherapy, have been overused. Click above to access the full essay.

Medicare Takes Steps for Senior Payback of Massive Payment Error by Medicare

8/30: The following is from an Aug. 28th Associated Press report: Elderly and disabled Americans who got erroneous refunds from the federal government last week will get a letter this week instructing them on how to repay the money. About 230,000 Medicare recipients got refunds totaling $50 million because of a computer glitch. The average reimbursement was for $215. The first and easiest step for beneficiaries to repay the money is to write VOID on the face of the check and mail it to the following address: Medicare-Drug Premiums, P.O. Box 9058, Pleasanton, CA 94566-9058. The same address can be used when seniors want to reimburse the money either through a personal check or money order. Officials say the check should be made payable to "Medicare." The check should also include a notation with the beneficiaries' account number. The account number will be cited in the letter that seniors get this week from the Centers for Medicare and Medicaid Services. Also, on Tuesday, the federal government will establish a toll-free telephone line for seniors and the disabled to call between 7 a.m. and 9 p.m. EDT. The number is 1-866-292-8080. Operators will be able to answer whether beneficiaries were affected by the glitch. They also can help people arrange to have the repayments withdrawn from their bank account and transferred electronically to the federal government, though this option will require that seniors provide personal banking information to the operator. Some seniors may have received more than $500. For those who need to pay that money back gradually, people can ask to make up to seven monthly payments. Lawmakers had called on CMS to give seniors plenty of time to give the money back. The same toll-free number should be used for beneficiaries wanting installment plans. Click above to access the full article.

POVERTY REMAINS HIGHER, AND MEDIAN INCOME FOR NON-ELDERLY LOWER, THAN WHEN RECESSION HIT BOTTOM: Poor Performance Unprecedented for Four-Year Recovery Period

8/30: The following is from an Aug. 29th analysis by the Center on Budget and Policy Priorities: Overall median household income rose modestly in 2005, while the poverty rate remained unchanged. For the first time on record, poverty was higher in the fourth year of an economic recovery, and median income was lower, than when the last recession hit bottom and the recovery began. In addition, the 1.1 percent increase in median income in 2005, which was well below the average gain for a recovery year, was driven by a rise in income among elderly households. Median income for non-elderly households (those headed by someone under 65) fell again in 2005, declining by $275, or 0.5 percent. Median income for non-elderly households was $2,000 (or 3.7 percent) lower in 2005 than in 2001. In a related development, the median earnings of both male and female full-time workers declined in 2005. ... Furthermore, overall median income remained $243 below its level in the recession year of 2001, while the poverty rate, at 12.6 percent, remained well above its 11.7 percent rate in 2001. In addition, both the number and the percentage of Americans who lack health insurance climbed again and remained much higher than in 2001. Four million more people were poor, and 5.4 million more were uninsured, than in 2001. The percentage of children who are uninsured rose in 2005 for the first time since 1998. The poor also became poorer. The amount by which the average person who is poor fell below the poverty line ($3,236) in 2005 was the highest on record, as was the share of the poor who fell below half of the poverty line. ... "Four years into an economic recovery, the country has yet to make progress in reducing poverty, raising the typical family’s income, or stemming the rise in the ranks of the uninsured, compared to where we were in the last recession," Center executive director Robert Greenstein said. "It is unprecedented in recoveries of the last 40 years," he noted, "for poverty to be higher, and the typical household’s income lower, four years into a recovery than when the previous recession hit bottom." Greenstein observed that, "These disappointing figures on median income and poverty are the latest evidence that the economic growth of the past few years has had an unusually limited reach. Many middle- and low-income families are not sharing in the gains." In related findings that underscore the unevenness of the current economic recovery, data recently issued by the Commerce Department show that a smaller share of the gains from the current economic recovery are going to workers' wages and salaries, and a larger share are going to corporate profits, than in any other recovery since World War II. Click above for the full CBPP analysis. See news note directly below for a related story.

U.S. Poverty Rate Unchanged Last Year

8/30: The following is from a report in the NY Times: The nation's poverty rate was essentially unchanged last year, the first year it hasn't increased since before President Bush took office. The Census Bureau reported Tuesday [Aug. 29th] that 37 million Americans were living under the poverty line last year -- about 12.6 percent of the population. That's down from 12.7 percent in 2004, but census officials said the change was statistically insignificant. The median household income -- the point at which half make more and half make less -- was $46,300, a slight increase from 2004. However, the number of people without health insurance increased to 46.6 million in 2005. About 45.3 million people were without insurance the year before. The last decline in the poverty rate was in 2000, during the Clinton administration, when it dropped to 11.3 percent. With the poverty rate steady but median household income rising, ''that could represent an increase in inequality'' between the wealthy and the poor, said David Johnson, chief of the Housing and Household Economic Statistics Division of the Census Bureau. The official poverty level is used to decide eligibility for federal health, housing, nutrition and child care benefits. The poverty rate -- the percentage of people living below poverty -- helps shape the debate on the health of the nation's economy. ... Poverty rates didn't skyrocket as some had feared. But they didn't drop much, either, suggesting that many of those who left welfare didn't climb out of poverty. The poverty rate was 13.7 percent in 1996, when about 4.4 million families received welfare payments. About 1.9 million families receive payments today. ''Most of the people who leave welfare for work are leaving for jobs that pay $7 or $8 an hour,'' said Joan Entmacher, vice president of the National Women's Law Center, an advocacy group based in Washington. ''Under the best of circumstances, they are just getting by.'' For full Times article, click above.

Who can afford to be old and sick? Those too 'wealthy' for aid and too poor to pay their own way are legion

8/30: The Raleigh News & Observer published an article of the above title on August 27th, along with a number of related stories on this subject. To access this article and the related ones, click above.

Medicare political ads paid by drug industry

8/29: According to an Aug. 25th Associated Press article: The pharmaceutical industry quietly footed the bill for at least part of a recent multimillion-dollar ad campaign praising lawmakers who support the new Medicare prescription drug benefit, according to political officials. The U.S. Chamber of Commerce claims credit for the ads, although a spokesman refused repeatedly to say whether it had received any funds from the Pharmaceutical Research and Manufacturers of America. Several campaign strategists not involved in the ad campaign said no legal issues were raised by the pharmaceutical industry's involvement. Democrats seized on the disclosure, though, to renew their charge that the program amounts to a Republican-engineered windfall for drug companies. "There's a civics lesson here from the drug companies. They write checks to protect their GOP friends, and then they write the laws to benefit themselves, all the while doctors are writing prescriptions middle-class Americans can't afford," said Bill Burton, spokesman for the House Democratic campaign organization. The commercials, airing in 10 states or congressional districts, generally say the local congressman or senator supports the drug program, and that hundreds of thousands of Medicare beneficiaries have saved money since its inception earlier this year. Under the voluntary program, Medicare beneficiaries purchase prescription drug coverage from among competing plans offered by private insurance companies. Monthly premiums cover a fraction of the overall cost of the benefit, and the federal government covers most of the rest. The insurance companies bargain with drug manufacturers over price, and the cost to consumers has been considerably lower than initially estimated. But in drafting the legislation, Republicans rejected Democratic calls to permit the government to negotiate directly in hopes of pushing down prices further. The officials who described PhRMA's involvement said they did not know whether the industry had given the Chamber money to cover the entire cost of the ads and other elements of an election-year voter mobilization effort, or merely a portion. ... Bill Miller, political director for the Chamber, did not respond to numerous requests for an interview. A spokesman, Eric Wohlschlegel, said, "The Chamber paid for the Medicare ads." But he declined repeatedly to say whether his organization had received any money from PhRMA. In announcing the program earlier this summer, Miller described a $10 million ad campaign but made no mention of PhRMA. The episode is reminiscent of another PhRMA-financed ad campaign, this one in May 2002. At the time, a little-known conservative group, United Seniors Association, announced plans for a multimillion-dollar advertising effort supporting prescription drug legislation that Republicans were drafting. A USA spokesman denied then that PhRMA had picked up the cost. But several political officials said it had, and the drug association confirmed it had made an "unrestricted educational grant" to the seniors' group. The Chamber's current advertising effort has been marred by errors. An ad on behalf of Republican Rep. Steve Chabot of Ohio was pulled from the air after officials realized he had voted against the legislation creating the prescription drug bill. Commercials backing three other Republicans, Michael Fitzpatrick of Pennsylvania, Mike Sodrel of Indiana and Dave Reichert of Washington, were changed after Democrats pointed out they had not been in Congress the year the legislation passed. Click above to access the full article. Also, see related news note directly below.

Origins of the Doughnut Hole: Excess Profits on Prescription Drugs

8/29: A report of the above title was prepared and issued in August by Dean Baker of the Center for Economic and Policy Research. According to a synopsis of the report: Pharmaceutical companies are making billions in excess profits under the new Medicare drug benefit, according to a report by the Center for Economic and Policy Research. In the first year of the Medicare Part D program, Pfizer will make $1.2 billion in excess profits on Lipitor and $585 million on Zoloft; Wyeth will make nearly $1 billion on Protonix; and Merck will make $1.6 billion on Zocor. The report, "The Origins of the Doughnut Hole: Excess Profits on Prescription Drugs," by economist Dean Baker, calculated the difference between the average cost of 20 common drugs used by seniors and the cost when obtained through the Veterans Administration. It found excess profits totaling more than $7 billion in the first year of the program. The study also calculated prices for prescription drugs such as Actonel, Aricept, Celebrex, Fosamax, Nexium, Norvasc, Plavix, Prevacid, Toprol XL, and Xalatan. Thousands of drugs cost more than necessary under the Medicare drug plan because Congress prohibited Medicare from negotiating drug prices directly with the pharmaceutical industry, as is done by the Veterans Administration. In the case of many drugs, the prices paid by insurers participating in the plan are more than twice as high as the prices paid by the Veterans Administration. Millions of seniors and disabled Americans enrolled in Medicare Part D drug plans are discovering the "doughnut hole" -- the $2,850 gap placed into the plan in order to save the government money. The Center for Economic and Policy Research has pointed out that this gap was only necessary because the plan's overall design added significant costs and complexity. "The excess profits from just a small number of drugs account for a very large portion of the doughnut hole," said Baker. "The excess profits for the drug industry as a whole will be close to $50 billion in the first full year of Medicare drug benefit program. This is more than twice the size of the doughnut hole." The full report is available, in pdf format, by clicking above.

HOW TO ASSESS TOMORROW'S INCOME AND POVERTY NUMBERS

8/28: The following is from the Center on Budget and Policy Priorities: Tomorrow, August 29, the Census Bureau will release findings regarding household income and poverty for 2005. It is possible these figures will show that median income increased in 2005 and poverty declined; that is the typical pattern for years well into an economic recovery. And if this is the case, Administration officials likely will hail the figures as good news (and seek to portray them as evidence of the success of Administration policies). But such an assessment would be much too simplistic. To assess the new poverty and income figures entails examining not only the changes that occurred between 2004 and 2005, but also the degree of progress (or lack thereof) in income and poverty during the current economic recovery, and comparing any such progress to the progress made during comparable periods of past recoveries. 2005 marked the fourth year of an economic recovery. History shows that by the fourth year of a recovery, median household income always is well above -- and poverty always is below -- the levels attained when the economy was in recession and the recession hit bottom. This occurred in each one of the previous four recoveries (the recoveries for which both poverty and median household income data are available). In these recoveries, median household income in the fourth year of the recovery was an average of $2,127 in today's dollars -- or 5.5 percent -- above its level in the year when the last recession hit bottom. Poverty was an average of 1.0 percent point lower than its level at the last recession's trough. How will 2005 measure up? It is distinctly possible that the new Census data will show that poverty declined and median income rose in 2005, but that poverty still was higher -- and median income lower -- than in 2001, when the last recession hit bottom. If so, this will be unwelcome news and hardly something to celebrate. It will mark the worst performance in recent decades for poverty and median income during an economic recovery. To access the full analysis, click above.

Medicare to hold nine days' worth of providers' pay; Will carry-over bills into new fiscal year so as to make deficit look less

8/28: The following is from an Aug. 25th Associated Press report: Many health care providers will have to make do next month without a government paycheck or two. The Bush administration says it will not make any Medicare reimbursements to hospitals, doctors and scores of other providers during the final nine days of the current budget year, from Sept. 22 to 30. Congress ordered the hold. The providers taking care of older people and the disabled will get paid in full after the new budget year begins Oct. 1. They should not count on any interest on the amount owed. Dr. Arthur Wise, a plastic surgeon in New York's Long Island, and others are not happy about it. Dr. Wise says the hold is unfair and underhanded. "Obviously, none of our suppliers, our renters or our malpractice insurers are saying, 'Hey, we know you're not going to get paid for nine days of September, so don't bother sending us a check,'" Dr. Wise said. For most hospitals, nursing homes and others, the hold will serve more as a frustration than a financial strain, said Chris Jennings, a health policy analyst who used to work in the Clinton administration. "I think they get frustrated with these games, but I think they'll survive," Mr. Jennings said. "It's just another game, another burden they don't want to bear." By delaying payments, the government moves $5.2 billion in Medicare expenses to next year's budget. "The alternative was to cut reimbursements to providers this year. With this payment shift, we avoid that cut," Senate Finance Committee spokeswoman Jill Kozeny said. A Medicare "holiday" has been approved at least twice before, in the early 1980s, she said. In one of those cases, it was repealed before the holiday could take effect. To access the full story, click above.

Senator Grassley & Elder Rights Advocates Express Concern About Checks Sent Erroneously to Medicare Beneficiaries

8/25: The following is from an Aug. 24th Kaiser Network Daily Update: Senate Finance Committee Chair Chuck Grassley (R-Iowa) on Wednesday sent a letter to CMS Administrator Mark McClellan that raised concerns about a glitch that prompted the agency to send payments erroneously to more than 231,000 Medicare beneficiaries to reimburse them for almost $50 million in prescription drug benefit premiums, the Washington Post reports. According to McClellan, who announced the glitch on Tuesday, affected Medicare beneficiaries also received letters from the Social Security Administration that erroneously said the agency will no longer deduct their monthly prescription drug benefit premiums from their Social Security checks. CMS this week sent those Medicare beneficiaries a second letter, signed by agency chief operating officer John Dyer to inform them of the glitch and notify them that they must return the erroneous reimbursements to the federal government. According to the Post, the letter from Dyer does not provide specific details for how the money should be returned. "We will let you know soon about that process," the letter states, adding, "Again, you do not need to do anything other than set that money aside." In his letter, Grassley writes that CMS should recover the erroneous reimbursements, which average $215 each, in small, "manageable" increments over "as long a period as possible." Grassley adds that some Medicare beneficiaries "may not realize the error that was made and may not have put the money aside." McClellan said that CMS officials believe they can "smoothly" recover the erroneous reimbursements from Medicare beneficiaries. He added, "We're sorry about the inconvenience this error has caused. We want to make sure (beneficiaries know) their coverage is continuing." McClellan said that most of the Medicare beneficiaries affected by the glitch received the erroneous reimbursements by direct deposit, although some received checks. In addition, McClellan said that the glitch -- which occurred when CMS updated SSA about Medicare beneficiary information -- should prove inexpensive to correct "by government standards." Paul Precht, policy coordinator of the Medicare Rights Center, said, "This is part of a larger problem which is still unsolved," adding, "We've been trying and other advocates have been trying for months to get those problems fixed and they're still not." Vicki Gottlich, an attorney with the Center for Medicare Advocacy, said, "It's a mess, and this situation was inevitable." She added, "For the last eight months, we've helped people who have had premiums improperly deducted, or were charged for plans they didn't enroll in. ... This week's glitch is evidence that federal government systems can't support the complexities of Part D. We're particularly concerned that people will conclude they're not entitled to their benefits." Tricia Neuman, a Kaiser Family Foundation vice president and director of the Medicare Policy Project at the foundation, said, "The problem is for people who aren't sure about what's going on there's a risk that they will spend that money ... and now find themselves liable. That can be really scary." To access the Kaiser note, with links to related articles, click above. See related news stories under the Aug. 24th news notes.

AARP Legal Hot Line newsletter has articles of interest

8/25: The Spring, 2006 issue of the AARP Legal Hot Line Quarterly is available online and has a number of articles of interest. Among the articles are the following: "professional Responsibility of Delivering Legal Services Through Technology" by William Hornsby; and "Mediation at a Legal Hotline" by David Mandel. To access the newsletter, in pdf format, click above.

Medicare error sends checks to thousands; The mailing also mistakenly says Medicare will no longer deduct premiums for drug coverage from Social Security checks

8/24: The follwoing is from an Aug. 23rd Associated Press report: About 230,000 Medicare recipients are getting checks that erroneously reimburse them for monthly premiums they have paid for prescription drug coverage this year. The checks, which are sure to leave many beneficiaries confused, average about $215. They are accompanied by a letter that mistakenly tells them the Social Security Administration will no longer deduct monthly premiums for drug coverage from their Social Security check. Medicare officials say they caught the glitch just after checks totaling nearly $50 million were sent out last week. As a result, they began sending a second letter Tuesday instructing people not to cash the checks and assuring them that their prescription drug coverage will continue. "It's very important for people to know their coverage is continuing," said Mark McClellan, administrator for the Centers for Medicare and Medicaid Services. "There's no disruption at all." McClellan said this his agency will make sure that insurers continue to get payment for the beneficiaries caught up in his agency's error. McClellan stressed that the checks beneficiaries get will have to be returned. Also, beneficiaries need to know that the government won't be able to start making monthly deductions again until October. He said the agency will work with beneficiaries who face a money crunch in the fall because they had already cashed the check from the Social Security Administration or because they can't afford to have premiums from a few months deducted from one Social Security check. Click above to access the news story. For a related August 24th NY Times story, click here.

20 Common Nursing Home Pro>


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8/24: The National Senior Citizens Law Center is proud to issue a new publication that zeroes in on common problems in nursing home care and identifies common nursing home practices that are actually illegal. 20 Common Nursing Home Problems?and How to Resolve Them walks the reader through each problem, shows what the law says, and describes how to take positive action. It decodes the law in easy-to-follow language, citing chapter and verse. For each of the 20 problems, the guide offers a clear explanation of the relevant law, along with careful instructions as to how a resident, family member or advocate should proceed. Some of the issues covered in the guide are: When a nursing home must follow the preferences of an individual resident; When physical restraints and feeding tubes are illegal; Why Medicare cannot terminate Part A reimbursement because a resident has ?plateaued?'; How to obtain a Medicaid-certified bed for a resident currently in an uncertified bed; and When a nursing home must readmit a Medicaid-eligible resident after a hospital stay of several weeks -- or even several months. For more info on how to obtain this publication, for $9.95 plus shipping, click above.

Obesity, chronic disease drive Medicare costs up

8/23: According to an Aug. 22nd USA Today report: Obesity and certain chronic conditions were major factors driving virtually all Medicare spending growth for the past 15 years, according to a new analysis of Medicare cost and patient data. The rate of obesity among Medicare patients doubled from 1987 to 2002, and spending on those individuals more than doubled, according to economists Kenneth Thorpe and David Howard. Their study appeared Tuesday on the website of the journal Health Affairs. "What this study tells us is that we need to aggressively put in place interventions to deal with obesity and chronic disease prevalence among the elderly to control spending," said Thorpe, chairman of the Department of Health Policy Management at Emory University. In 1987, 11.7% of the Medicare population was considered obese. That number grew to 22.5% of Medicare enrollees by 2002. Spending on medical care for obese Medicare patients was 9.4% of the federal government program's budget in 1987 but jumped to 24.8% by 2002, according to the analysis. Physicians also are becoming more aggressive in treating patients who have a cluster of cardiovascular-related risk factors such as diabetes, high blood pressure or low levels of "good" cholesterol, the study found. Such treatment patterns are good news for seniors because it means many older men and women are living longer. But more elderly Americans living longer also increases the long-term costs of the Medicare program. Total Medicare expenditures were $336 billion in 2005 and are projected to increase at a rapid clip as the first wave of the 75 million baby boomers reaches retirement age and Medicare eligibility in 2010. In the past, most efforts to slow Medicare spending growth focused on cutting payments to hospitals, physicians and other health care providers. These new research findings suggest policymakers should direct their attention toward programs that encourage healthier lifestyles among seniors and those nearing retirement, Thorpe said. To access the USA Today article, click above.

Smoke-Free Apartments Protect the Health & Rights of Tenants and Landlords; Radio Ads Begin August 21st in Ingham County

8/23: The following is from an Aug. 22nd press release from the Ingham County Health Department and SFELP: "As a result of a smoke-free apartments initiative that began in early 2005, Ingham County and a number of other Michigan counties have seen a dramatic increase in the number of apartment owners who now list their apartments as being totally smoke-free," said Jim Bergman, the director of the Smoke-Free Environments Law Project (SFELP) of The Center for Social Gerontology, Inc., in Ann Arbor. "What was rare is now becoming the norm," he stated. The MISmokeFreeApartments initiative is a joint effort of SFELP, the Ingham County Health Department, and the Michigan Department of Community Health's Tobacco Section. "When the initiative began in early 2005, almost no apartment owners indicated apartment buildings as being smoke-free. Today, that has completely changed, in part because building owners know they have a legal right to create smoke-free space within the property that they own," said Bergman. Beginning August 21st, a radio ad campaign was inaugurated in the Ingham County region and will run through September 9th to raise awareness of smoke-free apartments as a housing alternative. Stations airing the two humorous ads are: WQHH-FM; WVIC-FM; WFMK-FM; WITL-FM; WJIM-FM; and WHZZ-FM. Plus, free placement on the Impact; Michigan State University student radio. The ads ask interested persons to visit MISmokeFreeApartment.org to find out more about smoke-free options for tenants and landlords in Michigan. The website offers free signs, lease amendments, and lists rental units that offer smoke-free housing. The listings include large apartment complexes, as well as single homes with multiple units, duplexes and other multi-unit buildings. The listing includes well over 400 apartment buildings with close to 4,000 units. To go to the MISmokeFreeApartment web site, click above.

EVEN WITH NEW BUDGET PROJECTIONS, BUDGET DETERIORATION FROM 2000-2006 WILL BE THE LARGEST 6-YEAR DETERIORATION IN HALF A CENTURY

8/22: The following is from a Center on Budget & Policy Priorities analysis: The Congressional Budget Office has issued new estimates that show that the budget deficit will be 2.0 percent of the Gross Domestic Product in 2006, down from the 2.8 percent of GDP that CBO had estimated (under Administration policies) earlier this year. Over the last month, the Administration has celebrated the reduction in the size of the estimated 2006 deficit. However, a deficit of 2.0 percent of GDP is no cause for celebration, particularly considering that the budget was in surplus as recently as 2001. Indeed, even taking into account this recent improvement, the deterioration in the nation?s fiscal situation over the last six years is the worst six-year deterioration in a half century. This six-year deterioration from a surplus of 2.4 percent of GDP in 2000 to an estimated deficit of 2.0 percent this year ? a deterioration equal to 4.4 percent of GDP ? is just the latest of several exceptional fiscal deteriorations recorded in recent years. The second and third worst six-year fiscal deteriorations of the last half century concluded in 2004 and 2005, respectively. The last several years also have seen the worst two-year, three-year, four-year, and five-year fiscal deteriorations in the last half century. Click above for the full analysis.

Dublin, California says secondhand smoke makes bad neighbor; Elderly homeowner is catalyst for new law

8/22: Smokers, beware: This bedroom community near San Francisco may soon put you in the same category as rodents, junk cars, vicious dogs and weeds. The Dublin City Council gave preliminary approval this week to an ordinance declaring secondhand tobacco smoke to be a public nuisance, a move designed to make it easier for residents to take neighbors who puff with impunity to court. "We have to legislate civility at times," said Councilwoman Kasie Hildenbrand. Hildenbrand sponsored the measure after hearing from an elderly constituent who complained that polite attempts to persuade the smoker next door to curtail her habit had failed. If the council passes the law as expected on Sept. 5, smoking would not be banned in private homes or backyards in Dublin. Neither would police be asked to issue citations to citizens whose smoking offended neighbors. Instead, the purpose is to give vexed residents a stick to shake at recalcitrant smokers when pleas for courtesy are ignored, according to Hildenbrand. Adding secondhand smoke to the list of nuisances the city recognizes -- a docket that already includes excessively loud music, noxious smells and untended garbage -- would lower the burden of proof on plaintiffs who go to small claims court seeking relief from wafting fumes and up to $7,500 in damages. Dublin already outlaws smoking within 15 feet of public playgrounds, ATM machines and bus stops, as well as in the outdoor seating areas of restaurants and enclosed common areas of condominiums, nursing homes and retirement communities. The city also bans hookah bars, where patrons smoke tobacco through communal water pipes, and medicinal marijuana clubs. While suing to stop someone from smoking on private property might seem excessive, the Dublin resident who inspired the legislation said she and her husband considered moving out of their home of six years because of the yearlong battle with a smoking neighbor. Shirley Wassom, 72, said whenever her neighbor lit up on her patio, the smoke wafted through Wassom's windows. Because she is severely allergic to cigarette smoke, Wassom asked the neighbor to smoke on the far side of the yard, but the woman insisted she had the right to smoke where she pleased. Click above to access full story.

Costly Promises: New York Gets Sobering Look at Its Pensions

8/21: The following is from an August 20th NY Times report: Every year since 1999, New York City has reported that it has all the money it needs to pay for the pensions that have been promised to city workers. With the retirement plans said to be financially sound, state politicians have happily showered city employees with generous pension enhancements ? annual cost-of-living increases, holiday bonus payments, early retirement with full benefits -- that are the envy of private-sector workers, whose pension benefits have eroded. But a close inspection of city pension records shows that the funds committed to the plans may fall well short of the city's promises to hundreds of thousands of current and retired workers. They look fully funded chiefly because the city has been using an unusual pension calculation that does not comply with accepted government accounting rules. Even the city's chief actuary, who helps produce the annual reports, says the official numbers are "meaningless" when it comes to showing the plans' financial health. The chief actuary, Robert C. North, has prepared a little-noticed set of alternative calculations showing that the gap in the pension funds could be as wide as $49 billion. That is nearly the size of the city's entire annual budget and the equivalent of the city's publicly disclosed outstanding debt. The existence of a big gap between the city's future obligations and the resources committed to meet them does not mean the pension funds are about to run out of money. But it does mean that New York City is promising its current employees future benefits it might not be able to provide without big tax increases or major budget cuts. When such a reckoning might occur, if at all, is hard to predict. For more on this story which effects many older persons, click above.

Future renters told they can't smoke in their apartments for health and safety reasons

8/21: The following is from an August 8th Raleigh News-Observer story: With smoking bans in airplanes, workplaces, restaurants and hotels, it seems the only place to sneak a drag these days is in the privacy of one's own home. Well, not anymore. That is, at least, if you want to rent one of the 5,452 apartments managed by First Centrum Communities. Those who sign leases after Sept. 1 in any of the Sterling, Va., company's 49 apartment communities, including three in the Triangle, will agree not to smoke in the apartments. That goes for guests, too. First Centrum thinks it's the first big apartment manager to adopt such a ban. But other kinds of landlords also have been kicking the habit this year. Westin Hotels & Resorts in January banned indoor smoking at all of its hotels in the United States. Marriott's hotels will ban indoor smoking next month. And the Carolina Inn in Chapel Hill said last month that it was going smoke-free, following the lead of several other Triangle hotels. The reasons behind the bans: The number of smokers is decreasing, and nonsmokers are becoming less tolerant of second-hand smoke. In other words, it reeks of good sense. First Centrum said health concerns, fire safety and costly clean-ups led to the ban. "There's a lot of smell of smoke in there," said Rob Couch, president of First Centrum subsidiary Centrum Management. "Sometimes we have to replace the carpet and do two or three coats of paint" when a smoker moves out. That costs about $400 per room, he said. Most First Centrum tenants are elderly, and a few complained about secondhand smoke, Couch said. Their concerns won't be extinguished overnight. Current tenants who smoke won't be held to the new rules; the company will go smoke-free through attrition. "It was the best thing in the long term to just not have that smoking thing be an issue," Couch said. Click above to access news story. For more on this SFELP-initiated development, click here for a press release. Also, see news note directly below.