Protect Your Loved One From Abuse

Millions of elderly and disabled Americans live in nursing, assisted living and other care facilities. 

While patients and their families admit patients to these facility rightly expect these care providers to appropriately and safely care for their patients, unfortunately and too many instances the care that their family member receives not only is disappointing, but actually harmful.

And alarmingly long list of negligence and other liability judgments as well as oversight and enforcement work by the Department of Health and Human Services, States’ department of aging, watchdog agencies, nursing home litigators reveal commonly recurring problems account for many of these tragedies   Problems range from overmedicating residents, or patient abuse or neglect. 

Patients and their families need to recognize the need to carefully select and oversee the care of their family member in these facilities   Many resources are available to help educate family members and friends search as this YouTube video about nursing home abuse recently shared by the Department of Health and Human Services.  

Careful investigation and credentialing at the facilities your love will stay in before and during their stay is an important part of the process.  No matter how good the facility looks in this credentialing, families and caregivers and patient must keep in mind that even the best facilities can experience problems of neglect, unawareness, miscommunication, miss perception and even abuse.  For this reason, families should keep in mind that frequent visits from family members and other visitors familiar with and loyal to the patient at different times can make a huge difference in helping the patient to get the best care possible, identifying potential issues services or quality and detecting more quickly service disruptions or deficiencies, changes in their family members conditions that need attention, signs of abuse or neglect and other concerns.

To learn more about what you and your family can do to be more effective participants in your healthcare and help improve health care for others, follow, share input and resources and get involved in our Project COPE initiative by following and sharing our updates in this ProjectCOPE.blog, on Facebook @ProjectCOPECOALITION or on LinkedIn.

Call To Action: Become a Project COPE Healthcare Hero

Despite an endless stream of well-meaning market and governmental reforms over the past 25 years, the U.S. health care system is in crisis. American patients, their families and other caregivers, their employers, their health benefit programs, their health care providers, the communities and even our federal health care budget increasingly are burdened and overwhelmed by the mounting obstacles to caring for our ill, disabled, and aging citizens within our health care system and the extraordinary expense of maintaining and using that system. 

 As Congress takes up reform again, it is critical that Americans act to protect their own and their families’ health care and control the financial burdens of health care by getting informed, providing clear and consistent direction to Congress and other reformers and taking other actions to empower and care for themselves and their loved ones within our evolving health care system.
©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish licensed to Solutions Law Press, Inc. For information about republication of this or other materials and programs of the author, email the author here. All rights reserved.

Empowering Dying Patients Through Choice

The self-composed obituary of Sonia Todd is a touching reminder of the power and importance of patient choice even for patients facing death.  

The success of our health science and the ever extraordinary miracles it achieves to delay death often dupes Americans into forgetting that life is a process that ultimately leads to death.   Regardless of the ultimate pathway traveled from life to death by any particular person, health care ultimately is mostly about delaying death and hopefully, wringing out as much joy and functionality for the afflicted individual with the minimum of pain and suffering. 

Aging, illness, injury and disability often disempower those afflicted and those who love and care for them.   Eventually, everyone runs out of options to keep living. The realization that this time has come for a patient often is devastating for patients and their families. 

When the fight for life becomes futile, loved ones often don’t know what to do next to help the patient.

When death ultimately can not be avoided, empower the patient by supporting reasonable choices about their death and dying.  Allowing patients to make choices about how to live out their last days or moments, their treatment, and other details of their impending death and to plan and talk about what will happen after their death can empower many patients and their families through the process of death and coping after death.  

About The Author

Recognized by LexisNexis® Martindale-Hubbell® as a “AV-Preeminent” (Top 1%/ the highest) and “Top Rated Lawyer,” with special recognition as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Health Care,” “Labor & Employment,” “Tax: Erisa & Employee Benefits” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is nationally and internationally known for her 29 plus years’ of work as a practicing attorney on health care, health benefit, health policy and regulatory affairs and other health industry concerns as a practicing attorney as well as her lifelong involvement as a health, disability  and retirement and workforce thought leader, management consultant, author, public policy advocate and lecturer.

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management, crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training ;board, medical staff and other governance; compliance and internal controls; strategic planning, process and quality improvement; change management; assess, deter, investigate and address staffing, quality, compliance and other performance; meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

The American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting, former Vice President of the North Texas Health Care Compliance Professionals Association, past Chair of the ABA Health Law Section Managed Care & Insurance Section, past ABA JCEB Council Representative, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance management; outsourcing; internal controls and regulatory compliance; billing and reimbursement; physician, employment, vendor, managed care, government and other contracting; business transactions; grants; tax-exemption and not-for-profit; licensure and accreditation; vendor selection and management; privacy and data security; training; risk and change management; regulatory affairs and public policy and other concerns.

As a core component of her work, Ms. Stamer has worked extensively throughout her career with health care providers, health plans and insurers, managed care organizations, health care clearinghouses, their business associates, employers, banks and other financial institutions, management services organizations, professional associations, medical staffs, accreditation agencies, auditors, technology and other vendors and service providers, and others on legal and operational compliance, risk management and compliance, public policies and regulatory affairs, contracting, payer-provider, provider-provider, vendor, patient, governmental and community relations and matters including extensive involvement advising, representing and defending public and private hospitals and health care systems; physicians, physician organizations and medical staffs; specialty clinics and pharmacies; skilled nursing, home health, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing and management services organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, insurers, self-insured health plans and other payers; and other health industry clients to establish and administer compliance and risk management policies; comply with requirements, investigate and respond to Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD, FTC, SEC, CDC and other public health, Department of Justice and state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry investigation, enforcement including insurance or other liability management and allocation; process and product development, contracting, deployment and defense; evaluation, commenting or seeking modification of regulatory guidance, and other regulatory and public policy advocacy; training and discipline; enforcement, and a host of other related concerns for public and private health care providers, health insurers, health plans, technology and other vendors, employers, and others.and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

Past Chair of the ABA Managed Care & Insurance Interest Group and, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also has extensive health care reimbursement and insurance experience advising and defending health care providers, payers, and others about Medicare, Medicaid, Medicare and Medicaid Advantage, Tri-Care, self-insured group, association, individual and group and other health benefit programs and coverages including but not limited to advising public and private payers about coverage and program design and documentation, advising and defending providers, payers and systems and billing services entities about systems and process design, audits, and other processes; provider credentialing, and contracting; providers and payer billing, reimbursement, claims audits, denials and appeals, coverage coordination, reporting, direct contracting, False Claims Act, Medicare & Medicaid, ERISA, state Prompt Pay, out-of-network and other nonpar insured, and other health care claims, prepayment, post-payment and other coverage, claims denials, appeals, billing and fraud investigations and actions and other reimbursement and payment related investigation, enforcement, litigation and actions.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly-regarded laws, regulations, policies, programs, publications and training programs on HIPAA and other data security, privacy and use, EMR, billing and reimbursement, quality measurement,  privacy and other health , HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other data, technology and systems concerns.  

A former lead consultant to the Government of Bolivia on its Pension Privatization Project with extensive domestic and international public policy and governmental and regulatory affairs experience, Ms. Stamer also is widely recognized for regulatory and policy work, advocacy and outreach on healthcare, education, aging, disability, savings and retirement, workforce, ethics, and other policies. Throughout her adult life and career, Ms. Stamer has provided thought leadership; policy and program design, statutory and regulatory development design and analysis; drafted legislation, proposed regulations and other guidance, position statements and briefs, comments and other critical policy documents; advised, assisted and represented health care providers, health plans and insurers, employers, professional. and trade associations, community and government leaders and others on health care, health, pension and retirement, workers’ compensation, Social Security and other benefit, insurance and financial services, tax, workforce, aging and disability, immigration, privacy and data security and a host of other international and domestic federal, state and local public policy and regulatory  reform and enforcement.      Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting, risk assessments, audits, breach prevention and mitigation and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, DOL, HHS, FTC, Insurance Departments, state attorneys’ general and other federal or state agencies, other business partners.  Her advocacy and regulatory affairs and public policy work, involvement and participation also includes numerous client engagements, as well as as founder and Executive Director of the Coalition for Responsible Health Policy and its PROJECT COPE: the Coalition on Patient Empowerment, adviser to the National Physicians Congress for Healthcare Policy, leadership involvement with the US-Mexico Chamber of Commerce, the Texas Association of Business, the ABA JCEB, Health Law, RPTE, Tax, Labor, TIPS, International Life Sciences, and other Sections and Committees, SHRM Governmental Affairs Committee and a host of other involvements and activities.

A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her thought leadership, experience and advocacy on these and other related concerns by her service in the leadership of the Solutions Law Press, Inc. Coalition for Responsible Health Policy, its PROJECT COPE: Coalition on Patient Empowerment, and a broad range of other professional and civic organizations including North Texas Healthcare Compliance Association, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children (now Warren Center For Children); current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, past Representative and chair of various committees of ABA Joint Committee on Employee Benefits; a ABA Health Law Coordinating Council representative, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposium and chair, faculty member and author, who publishes and speaks extensively on health and managed care industry, human resources, employment and other privacy, data security and other technology, regulatory and operational risk management. She has authored, published and presented s hundreds of publications, programs and workshops on these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, Insurance Thought Leadership and many other prominent publications and speaks and conducts training for a broad range of professional organizations.

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here.

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ All other rights reserved. For information about republication or other use, please contact Ms. Stamer here.

Tell Congress To Vote on Obamacare Reform Starting With House’s Vote Tonight

The US House of Representatives is scheduled to vote again tonight on the revised Majority-leadership lead first step healthcare reform legislation seeking to provide Americans and American business with some initial relief from the soaring premium and health care costs, care access barriers  and regulatory and other burdens that have resulted under the ObamaCare law and regulations.  Every American should call, e-mail or fax the leaders and their Congressperson as soon as possible today and tell them to pass this legislation and get busy passing the next set of reforms with no further delay, the get and stay II formed and involved until it gets it done starting with the House hearing and vote slated tonight starting at 8:30 Eastern.  Get details here.

Health care and its reform is a complex challenge.  Americans and American businesses, health payers,  and States and their healthcare needs are highly diverse. The ambitious but far from successful Obamacare law shows the dangers of well-meaning but unrealistic To try to fix these challenges with a sweeping, one shot fix.  

While passage of this legislative package won’t magically fix these challenges, it will provide quick relief for some of the ObamaCare expense and restrictions and expand the choices that Americans, American business, payers, providers and States while Congress works with American to identify and pursue legislative, regulatory, marketplace and other improvements. 

Everyone Has A Part In Making Healthcare Better

Improving health care, its quality and affordability is everyone’s responsibility and everyone has a role to play.  

Congress can do things to influence who provides care, how health care is accessed, how much it costs and how these costs are paid.  While this can ease or raise barriers to care, patients, their caregivers and their heealth care teams still need help well beyond the power of regulators, payers or others to deliver.  These bureaucratic “saviors” : 

  • Can’t prevent disease, illness or disabilities;
  • Can’t erase the personal disappointment, pain, fear, frustration or struggle of aging, illness, disability or death;
  • Can’t provide all the emotional support and encouragement patients and caregivers need to keep going;
  • Poorly provide the real time help to cover the babysitting, transportation and other help to organize or go the chores of daily living that patients and families need help with because they can’t get it all done; 
  • Support on a day to day basis individuals to eat right, exercise and live healthier; or
  • So many other realities of trying to live well, with or without aging, disease or illness.

We all eventually need this help and all can do something to help.  Step up and pass it along.  Someday it will be your turn!

Congress will never get health care policy right until regular people and health providers and the employers and communities caring for them get informed and involved and no matter what, policy can’t fix healthcare completely.

This is one Policy Debate too important to you, your family and your community to sit out or act on tag lines. Get informed and share your specific ideas and thoughts about the Act and your other input on what our health care system should look like going forward, how these proposals relate and the other reforms you believe Congress should make to build a better healthcare system for today that can survive into the future by joining the discussion in the Solutions Law Press, Inc. Coalition for Responsible Health Care Policy LinkedIn Group

©2017 Cynthia Marcotte Stamer. Nonexclusive license to republish granted to Solutions Law Press, Inc.

House Set To Vote on Phase 1 of Health Care Reform 2017 Thursday

Congress is scheduled to vote on American Health Care Act on Thursday.  See here.

The first package of the reforms Republicans are pursuing to repeal or reform the Obamacare law, the Patient Protection and Affordable Care Act (ACA), the Act focuses on changing the revenue and tax components of the ACA.  Because of super-majority vote requirements in tge Ssnate, Republican leaders say  they intend to pursue through separate,  policy-focused healthcare reforms through separate packages of legislation coupled with regulatory reforms.

When introducing the Act, Speaker Ryan touted the Act as rescuing the US health care system from the ACA driving down costs, encouraging competition, and giving every American access to quality, affordable health insurance. 

Push past the rhetoric and form your own positions by reading the Act and getting other key information here.   While Speaker Ryan says some minor adjustments will be made before the vote, the original language otherwise is expected to pass the House in its original form.

Share your specific ideas and thoughts about the Act and your other input on what our health care system should look like going forward, how these proposals relate and the other reforms you believe Congress should make to build a better healthcare system for today that can survive into the future by joining the discussion in the Solutions Law Press, Inc. Coalition for Responsible Health Care Policy LinkedIn Group. 

Health care Quality: Different Meaning For Care Vs. Coverage

By:  Cynthia Marcotte Stamer, Publisher, Solutions Law Press, Inc.; Executive Director, PROJECT COPE:  Coalition on Patient Empowerment & Coalition for Responsible Healthcare Policy

American patients and their families need to be careful about mindlessly making health care choices for themselves or their family in reliance on healthcare “quality” data or guidance by private health plans and insurers, Medicare, Medicaid, or other government payers, and other public and private entities that allow the cost of care to shade their valuation of the quality of care.

The value of quality data – regardless of its source – in determining the quality and value of a proposed plan of care inherently depends upon how well a patient’s actual circumstance fits the assumptions upon which the quality analysis and conclusions rest.  Different treatment plans often impact differently patients diagnosed with the same condition for a variety of reasons.

Patients and their families making health care decisions for themselves or a loved one generally should use a two step approach when making health care provider or treatment decisions:

Patients and their families attempting to make decisions about the treatment plan for a patient affiliated with a life threatening or major chronic illness rightly should work with their health care provider to critically evaluate the options based first solely on the particular needs of the patient first without regard to cost, and then separately evaluate how cost barriers to securing the best treatment for the patient may require compromises or other tradeoffs.

When working with physicians and other health care providers, patients and their families need to understand the role and proper use of quality data – whether used by health care providers to determine care pathways, medical peer review, licensing boards or other quality assurance agencies enforcing quality standards for health care providers, or payers like Medicare, Medicaid, or other government payers or private insurers, self-insured health plans or other nongovernmental payers.

Because each patient’s medical and other circumstances are unique, very few patients fit cleaning the assumptions built into the clinical or payment pathways used to determine quality for a cost or medical efficacy determination.  In essence, each patient considered individually is an outlier at some level.  While these individual deviations have little material effect on the efficacy of proposed treatments in some instances, disregard of unique characteristics of the physical, emotional, psychosocial or other status of the patient significantly undermines or changes the likely efficacy of treatment. The assessment of the care and treatment needs and options of a patient without regard to cost inherently allows the patient, his family and his treatment team to evaluate the best interests of the patient, taking into account the unique physical, emotional, psychosocial and other realities of that patient.

Because the appropriateness of a proposed treatment plan inherently depends upon how closely the patient’s situation fits the underlying assumptions upon which the conclusions drawn from the quality data rests, patients and their families first should investigate and evaluate the needs of the patient and the care options available for treatment from a purely health care perspective without regard to cost based on the unique situation of that patient.   Review of these assumptions with the patient’s physician and other health care team helps determine not only whether the “standard” treatment fits the patient, but also what the patient and his caregivers need to be prepared to deal with the realize the benefits of the treatment proscribed and the likely effects of compromise or deviation from those expectations.  This analysis not only helps ensure the effectiveness of the plan of treatment but also reduces the risk that the patient will be hurt or his care or recovery undermined by the administration of a treatment plan that doesn’t fit the patient or performances that the patient or those supporting him in his care cannot reliably deliver.

Just as patients and their families should carefully question and evaluate assumptions underlying the quality and efficacy data behind treatment recommendations made by health care providers for the treatment of the patient, they also must carefully evaluate the health care “quality” determinations and decisions made by the public or private health plan that covers the patient.  Patients and families need to resist the urge to mindlessly accept without question the increasingly common practice by of private insurers and Medicare and other government regulators of accusing or suggesting that physicians or other health care providers are engaged in overprescribing, “fraud” or other bad medicine because the health care provider prescribes or delivers care supported by the medical quality literature in light of the needs of the patient which exceeds or deviates from the generic, one size fits all care plan selected by a payer to fit the cost containment goals of the payer.

Patients and their families need to understand that quality decisions by public or private payers for purposes of deciding what and how much treatment a payer will pay for inevitably both minimize the importance of the unique needs of the patient and adjust their notions of quality to fit the budget and profitability standards the of the payer based on the premiums or taxes the payer collects to fund the promised benefits.  These are statistical actuarial questions targeted on the amount of dollars that the payer is willing to spend for the dollars collected.  It is not unusual for a government payer such as Medicare or a private payer to try to limit the care that the insurer pays for to care that is less expensive without regards to the unique needs of a particular patient.  The outlier needs of particular patients have little value and receive little or no consideration in this analysis generally.  Consequently, it is not unusual for a Medicare, Medicaid, a private insurer or health plan or other payer to decline or resist paying for certain treatments that a physician orders in an effort to tailor care to the unique needs of a patient when the needs of the patient don’t fit the assumptions underlying the coverage design of the payer.

At the end of the day, patients and their families concerned about getting the best outcome for the patient should inform themselves and actively work with their physician and other health care providers, their health plans and other sources to familiarize themselves not only with the treatment needs and options of the patient, as well as the underlying assumptions behind the quality and efficacy findings underlying these treatment options.  By evaluating the assumptions required to achieve the reported treatment efficacy, patients and their providers can promote better care decisions and outcomes by helping their provider to anticipate and address the unique care needs of the patient, can better determine when and if to make tradeoffs in care for health care coverage or other cost or nonmedical reasons and can help improve the effectiveness of the care plan by better anticipating and arranging to meet the assumptions required to support the optimal outcome.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

Do you have ideas about how to improve the understandability of medication warnings or research findings for patients or other ideas about how to improve healthcare or health care policy?  Share your ideas in the  PROJECT COPE: Coalition On Patient Empowerment LinkedIn Group.  If you have knowledge, experience or other resources that could help patients, families, communities, or the government better understand or cope with  Asperger’s or other health care conditions, costs of care, or other challenges affecting Americans and the American health care system, we encourage you to get involved and share your insights.

As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever.  Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy  and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through PROJECT COPE: Coalition On Patient Empowerment.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of PROJECT COPE.

The Coalition and its PROJECT COPE arise and run on the belief that health care reform and policy must be patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining PROJECT COPE: Coalition On Patient Empowerment and by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

You also may be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, and/or our HR & Benefits Update electronic publication available here.

You also can get details about how to arrange for your employees or other communities to participate in training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here.

NOTE:  This article is provided for educational purposes.  It is does not provide legal advice, establish any attorney-client relationship or provide or serve as a substitute for legal advice to any individual or organization.  Readers must engage properly qualified legal counsel to secure legal advice about the rules discussed in light of specific circumstances.ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, or (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.  ©2016 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.

Caring For The Caregivers: How To Help

Providing meaningful support of caregivers is a growing, challenging and essential urgent need for the millions of Americans acting as caregivers elderly, disabled, injured or ill family members or friends.

Caregiving is surprisingly common.  More than 51 million Americans or 31% percent of the adult population age 20 to 75 provide informal care to a family member or friend who is ill or disabled.

These caregivers are the lifelines of the people they care for and the predominant and growing long-term care system in the United States.  They are a lifeline for the people they support and our long-term care system.  A study by AARP reveals that at 350 billion dollars, the economic value of non-compensated caregiving exceeds 2006 Exxon Mobile profits.

The many hats the wear includes the traditional family care giving roles of  companion, personal shopper, financial manager, chauffeur, housekeeper, cook, personal care assistant, advocate, counselor and emotional support provider.  Along side these roles, the shift in health care delivery model to outpatient, home-based care means caregivers-most of which have little or no medical background-increasingly find themselves responsible for a host of medical procedures from medication administration to a host of other medical care activities once considered the province of nurses or other licensed health care providers.

While often undertaken out of love, often unavoidable and often rewarding, caregivers often face many challenges. It comes as no surprise that acting as a caregiver can cause emotional and physical stress.

While the caregiving role can be enormously rewarding, it also means a lot of sacrifice.  It may start with just a few hours a week.  Usually the need expands and with each increase, caregivers give up more of their personal lives.   The average family caregiver provides nearly 18 to 20 hours of care a week in addition to holding down a job and managing a family. Second Opinion TV Caregiver BurnoutThe added costs of caring for their family members tends to create added economic strain.  When the caregiver also is a breadwinner, the caregiver also tends to suffer adverse employment consequences. Studies have shown that caregivers of the chronically ill tend to suffer significant income losses and many are forced to switch jobs.

As individuals providing long-term care for a loved one with illness try to do more than they are able to do, tend to develop “caregiver burnout.”  They become  more vulnerable to sickness, anxiety, medical problems and depression.  The resulting  physical, emotional and mental exhaustion and leaves the caregiver vulnerable to illness and can lead to cardiovascular disease, hypertension, stroke, and a compromised immune system.

Caregiver burnout symptoms are similar to those for anxiety and depression and include:

  • Sleep disturbances and fatigue
  • Lost interest in once-pleasurable things
  • Changes in appetite, weight, or both
  • Getting sick more often
  • Withdrawal from social contacts
  • Persistent feelings of worry, hopelessness and sadness
  • Irritability
  • Low self-esteem
  • Overreacting to minor issues
  • Decreased productivity
  • Alcohol or drug abuse

Always stressful and demanding,  the number of caregivers and their burden just keeps growing.  While Americans might thing that the burgeoning baby boom generation would have sufficient political pull to demand government address some of these challenges, so far government action seems to be adding to, rather than improving the crisis.  The cost-driven push by Medicare and other payers to force patients out of hospitals, skilled nursing facilities into home care environments coupled with the sharp rise in home care costs, economic downturns, the dispersion of the family, the activity-charged, over busy and over-extended lives of American families generally and the longer and more functional, while disabled life span of aging baby boomers, and other chronically aged, ill or disabled individuals are just a few of the drivers that complicate these challenges.

As a result, American families acting as caregivers and the families and communities must recognize the need to help caregivers care not only for their loved ones but also for themselves.

Caregivers and those around them  should keep an eye out for caregiver burnout and take appropriate steps to prevent or address it.  The  Caregiver Self-Assessment Questionnaire (PDF)  may be a useful assessment tool to help monitor for caregiver burnout.  However, the goal is to prevent or minimize it by taking appropriate preventive action when possible.  While no panacea, some steps for helping caregivers cope with their responsibility include:

  • Caregivers should ask for and accept help.  Meanwhile, friends and family need to offer help with the anticipation that the caregiver that needs it the most is the one most likely to decline or resist it.
  • Friends and family need to offer and provide, and caregivers need to seek social support.  Family and friends can help by touching base regularly, providing respite care to allow the caregiver a break to go out for a couple of hours, or visit.
  • Caregivers and their support network need to develop a realistic understanding of what the patient needs and the caregiver realistically can provide.  Rather than the caregiver feeling guilty about their own limits or family or friends commenting on what the caregiver isn’t or cannot do, the parties should work together to look for and to coordinate resources to help fill the gaps.
  • Family, friends and others in the community surrounding patients and their caregivers need to keep in mind that what is needed is HELP, not commentary.  Avoid the tendency of talking to the caregiver about what the caregiver needs to do or criticizing what isn’t getting done and focus instead on what actions you can do to help out.   Offer to sit with the patient, run errands, or do other tasks that ease the burden of the caregiver and help look for and obtain other resources.
  • Look and seek help where available.
  • Remember, caregiving typically is a long-term role.  Family and friends need to avoid falling into  the out-of-sight, out-of-mind syndrome.  Stay in the game for the long haul as caregiver’s burnout and ite associated challenges tend to get more significant as time passes.

The resources caregivers need and finding them can be a challenge and tend to vary by patient and caregiver situation, place, financial situation, and a host of other factors.  The following is a starting list of some resources, which Project COPE invites the reader to supplement by sharing their additions through postings in the PROJECT COPE LinkedIn Group:

  • Local assisted living, nursing home and other care providers
  • Employee Assistance Programs (EAPs) health and disability plans and insurers
  • Employers
  • Family, friends, church and other social networks
  • Health care providers
  • Administration on Aging (AOA)
  • AARP Caring for Those You Care About free online seminars on planning for and managing caregiving and other resources
  • AMA (Public Health) Caregiver Self-Assessment Tool to help caregivers determine how they are coping with the challenges and stresses of giving care to a loved one
  • Eldercare Locator operated by the U.S. Administration on Aging, has a nationwide directory of state and area agencies that deal with services for the aging and atoll-free number – 1-800-677-1116 – which operates Monday through Friday, 9:00 a.m. to 8:00 p.m., Eastern time
  • Family Caregiver Alliance  web site includes information, free publications, and an online caregiver support discussion group
  • National Alliance for Caregiving online publications and resources
  • National Council on the Aging and your State Department of Aging and Disabilities
  • National Family Caregivers Association which has information on federal and state assistance programs for older Americans in each community and a  TAKE CARE! – Self Care for the Family Caregiver quarterly newsletter
  • PBS Caregiver’s Handbook (from the 90-minute program Caring for Your Parents) With Eyes Wide Open (information on caregiving, grief, difficult decisions and what may lie beyond death) Frontline, Living Old
  • Second Opinion episodes lime  Depression (Episode 201) End of Life (Episode 313) Dementia (Episode 101)
  • Well Spouse Foundation support groups and other resources to husbands, wives, and partners of chronically ill or disabled individuals
  • Healthy Women publications and other resources

Know of other resources?  Share your ideas in the  PROJECT COPE: Coalition On Patient Empowerment LinkedIn Group.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

If you have knowledge, experience or other resources that could help patients, families, communities, or the government better understand or cope with  Asperger’s or other health care conditions, costs of care, or other challenges affecting Americans and the American health care system, we encourage you to get involved and share your insights.

As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever.  Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy  and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through PROJECT COPE: Coalition On Patient Empowerment.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of PROJECT COPE.

The Coalition and its PROJECT COPE arise and run on the belief that health care reform and policy must be patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining PROJECT COPE: Coalition On Patient Empowerment and by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

You also may be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, and/or our HR & Benefits Update electronic publication available here.

You also can get details about how to arrange for your employees or other communities to participate in training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here.

For Advice, Training & Other Resources

Should your business need legal advice about the taxability of or other requirements on tips, gratuities or other compensation,  assistance assessing or resolving potential past or existing compliance exposures, or monitoring and responding to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, an ABA Joint Committee On Employee Benefits Council representative, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a Fellow in the American College of Employee Benefit Counsel, ABA, and State Bar of Texas, Ms. Stamer has more than 25 years’ experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health plans and insurers about ACA, and a wide range of other plan design, administration, data security and privacy and other compliance risk management policies.  Ms. Stamer also regularly represents clients and works with Congress and state legislatures, EBSA, IRS, EEOC, OCR and other HHS agencies, state insurance and other regulators, and others.   She also publishes and speaks extensively on health and other employee benefit plan and insurance, staffing and human resources, compensation and benefits, technology, public policy, privacy, regulatory and public policy and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at www.cynthiastamer.com or by registering to receive these and other updates here.  Recent examples of these updates include:

NOTE:  This article is provided for educational purposes.  It is does not provide legal advice, establish any attorney-client relationship or provide or serve as a substitute for legal advice to any individual or organization.  Readers must engage properly qualified legal counsel to secure legal advice about the rules discussed in light of specific circumstances.ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, or (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.  ©2015 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.