By Caroline E. Mayer

Determine if you qualify financially

Washington state has prepared a guide to buying long-term care insurance

Don’t buy if the out-of-pocket cost for the coverage would be more than you can afford. Consumer Reports advises people that if their net worth, excluding their home, is below $300,000, long-term care insurance is not a good buy for them.

The National Association of Insurance Commissioners also recommends that consumers spend no more than 5 percent of their income on a long-term care policy.

If you need long-term care but have few financial resources, Medicaid should quickly kick in to pay, although that will probably limit your choices for care.

On the other hand, if you have a lot of resources (some financial advisers put that threshold at $2 million), you may be able to self-insure and pay the costs as they arise, thereby eliminating the need to buy a policy.

Shop around.

Unlike car insurance where you can switch carriers easily, it can be expensive to change long-term care policies because the premiums increase as you age and you lose the investments already made. Comparison shopping is critical.

Some companies and associations (such as alumni groups and AARP) offer group policies with relatively liberal eligibility, making it easier to obtain coverage if the policyholder has any health issues.

However, these policies may have more limited benefits than individually purchased plans.

If you are young or in excellent health, a group plan may also be more expensive; you may end up paying more to subsidize your less healthy peers.

And if you are certain you want LTC insurance, the younger you are, the better. Your annual premiums will be smaller, and you have less chance of being denied for health reasons.

Know what’s covered.

Policies differ greatly so know what you are buying:

• What services are covered?
• How long is the disability period before benefits kick in and what happens if you move from one facility to another?
• How much does the policy pay per day for nursing home care, home-health care and assisted living?
• How long will benefits last?
• Is there an inflation adjustment that anticipates rising medical costs as you age?
• How long are benefits extended (one, three or five years, or indefinitely)?
• Who determines benefit eligibility — your doctor, or the insurance company’s doctor — and on what basis?
• Are preexisting conditions excluded?
• Does the policy cover mental or nervous disorders, alcoholism, drug abuse or self-inflicted injuries?

The National Association of Insurance Commissioners advises consumers to look for policies that include at least one year of nursing home or home health care coverage, including intermediate and custodial care; coverage for Alzheimer’s disease; inflation protection; a guarantee that the policy cannot be terminated because you get older or your health deteriorates; no requirement that the beneficiary has to first be hospitalized to receive benefits and a 30-day cancellation period after purchase.

Check out the insurance company.

Review a carrier’s record with your state insurance commissioner’s office. Find out how long it has been in business its complaint record and history of raising rates. Stick with a company that has an A financial rating.

Also, the National Association of Insurance Commissioners and the American Association for Long-Term Care Insurance have consumer guides on their Web sites.

The Department of Health and Human Services provides extensive information on it’s website, longtermcare.gov.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Researchers share data to tackle Alzheimer’s disease

Researchers who usually keep their findings secret until they are ready to publish their research are freely sharing their data as part of a initiative to find effective Alzheimer’s treatments, writes Gina Kolata in today’s New York Times.

“It was unbelievable,” said Dr. John Q. Trojanowski, an Alzheimer’s researcher at the University of Pennsylvania. “It’s not science the way most of us have practiced it in our careers. But we all realized that we would never get biomarkers unless all of us parked our egos and intellectual-property noses outside the door and agreed that all of our data would be public immediately.”

To learn more:

• Read Kolata’s article: Rare Sharing of Data Leads to Progress on Alzheimer’s.

Seattle family copes with child’s relentless, incurable brain disease

Seattle Times health reporter Carol Ostrom profiles a family with a daughter born with a rare metabolic disorder called Sanfilippo syndrome.

Typically, children with the rare disorder die before their late teens after a relentless degeneration robs them of their cognitive functions, their ability to talk, walk and even chew. There is no treatment.

Ostrom describes the family’s years of uncertainty due to repeated misdiagnoses of their daughter’s condition and their efforts to help researchers find effective treatments.

To learn more:

• Read Ostrom’s article: Local family struggles with Sanfilippo.
• Read the MedlinePlus article on Sanfilippo syndrome.
• Visit the National Institute of Neurological Disorders and Stroke’s webpage on Sanfilippo and related mucopolysaccharidoses syndromes.

Battle for beds in southeast King County

Rob Carson, staff writer for The Tacoma News Tribune, reports on the PR battle over who gets to expand and add hospital beds in southeast King County.
Carson writes:

Tacoma’s giant MultiCare Health System, locked in a struggle with Auburn Regional Medical Center and Valley Medical Center to expand in the rapidly growing area, has pulled out all the stops with its public-relations machine.

The prize?

What’s at stake in the competition is access to thousands of underserved patients who live west of Interstate 5 and north of the Pierce-King county line.

To learn more:

• Read Carson’s article: Battle for Beds: Tacoma’s MultiCare vying for SE King County bed spaces.

Illustration by Zoran Ozetsky

News round up

Vets with PTSD need community services

In an op-ed piece in today’s Seattle Times, David R. Stone, CEO of social services organization Sound Mental Health, says the Veterans Affairs Administration will not be able to provide the help needed by the estimated one in five Iraq and Afghanistan war veterans who will suffer from post-traumatic stress disorder.

“The VA is an institution-based care system and was never intended to meet the needs of 300,000 victims of PTSD. These veterans and their families will be much better served by the national network of outpatient community mental-health providers already in existence . . . .

“It is incumbent upon us to demand that appropriate community-based services be made available to these brave folks who — through no fault of their own — are bringing the war home with them. We owe them that much, and we should not sleep until we pay that debt … so they can sleep better as well.”

To learn more:

• Read Stone’s column: The nation’s duty to vets who bring the war home.
• Visit Sound Mental Health’s website.
• Watch President Obama’s video announcing new relaxed VA PTSD rules.

Credit: “@” Illustration by Zoran Ozetsky.

Spinal tap test for Alzheimer’s disease

Researchers have shown that a spinal fluid test can accurately predict whether a person with memory problems is going to go on to develop Alzheimer’s disease, writes Gina Kolata in today’s New York Times.

Kolata writes:

So the new results also give rise to a difficult question: Should doctors offer, or patients accept, commercially available spinal tap tests to find a disease that is yet untreatable? In the research studies, patients are often not told they may have the disease, but in practice in the real world, many may be told.

To learn more:

• Read Kolata’s article: Spinal-Fluid Test Is Found to Predict Alzheimer’s.

Local Resources:

• Alzheimer’s Association of Washington: www.alzwa.org
• Alzheimer’s Disease Education & Referral Center (NIH site): www.nia.nih.gov/alzheimers
• UW Alzheimer’s Disease Research Center: www.depts.washington.edu/adrcweb

Are hospitals shortchanging staff on overtime pay?

The federal investigators are looking into the pay practices throughout the healthcare industry after finding that many hospitals and nursing homes do not pay the overtime due to nurses and other staff who work more than 40 hours a week, writes New York Times reporter Robert Pear.

Pear writes:

“Hospitals around the country have paid millions of dollars in back wages to settle claims by the government and their employees. And many more hospitals are fighting class-action lawsuits that raise the same issues.”

To enforce the labor rules governing overtime pay, Labor Department has hired 250 new wage-and-hour investigators, Pear writes.

“The Fair Labor Standards Act generally requires that employees be paid at least the federal minimum wage of $7.25 an hour, as well as one-and-a-half times their regular rates of pay for hours worked beyond 40 a week.”

To learn more:

• Read Pear’s article: Pay Practices in Health Care Are Investigated.

Local Resources:

• Washington State Nurses Association: www.wsna.org
• Washington State Healthcare SEIU: www.seiu1199nw.org

Thumbnail Illustration by Zoran Ozetsky.

Health experts interviewed by Washington Post reporter Rob Stein say they are generally pleased with the response of state and federal health agencies to early reports out of Mexico of a new flu virus that was killing an alarming number of young, healthy adults.

“If what was being reported in Mexico played out in the United States and elsewhere, this was a potentially serious epidemic that was getting underway,” Thomas V. Inglesby, deputy director of the Center for Biosecurity at the University of Pittsburgh told Stein. “We had to respond quickly.”

The virus now appears to much less dangerous, allowing health officials to “dial back” their warnings, writes Stein, but experts warn we’re not done with this virus.

“We’re dancing with this virus right now, and no one knows what will be the next step that the virus will take,” Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota told Stein. “All of us have to understand that we are not done with this dance yet — not by a long shot.”

• To learn more read Rob Stein’s piece: Viral Threat Emerged in a Ready World

What is “Socialized Medicine”?

Critics of President Barack Obama’s health-care reform proposals often call his plans “socialized medicine”. But what does that mean?

In the New York Times Economix blog, Princeton economist Uwe Reinhardt argues that the critics are confusing social health insurance and socialism. 

Socialized medicine, he writes, refers to a health system in which the government owns and operates both the financing and delivery of health care.  

Social health insurance is a much broader term covering systems in which individuals contribute to a insurance plan either by taxes or by paying premiums based on their ability to pay, rather than how sick they are.

“In principle, one could have a social insurance with 100 percent private for-profit delivery facilities,” writes Prof. Reinhardt.

Under private commercial insurance such as most of us have here in the U.S., he writes, an individual’s premium generally reflects his or her health status, with the older and sicker paying more.

• To learn more read Prof. Reinhardt’s blog: What is ‘Socialized Medicine’: A Taxonomy of Health Care Systems.

Mixed review for HBO’s four-part documentary “The Alzheimer’s Project”

New York Times television critic Alessandra Stanley gives HBO’s four-part documentary series “The Alzheimer’s Project” a mixed review in today’s paper.

The series is “sober” and “deeply affecting”, she writes, but perhaps too optimistic about the prospects for effective treatments. 

The “collective exuberance” of the filmmakers and the scientists they interview, she writes, “is so persuasive that viewers have to remind themselves that there is as yet no way to prevent the disease or even slow its progress.”

“And that’s a problem. It suggests that “The Alzheimer’s Project” comes with an implicit agenda of morale boosting—and fund-raising—that could compromise a balanced understanding of this frightening and complicated disease.”

The first of the series will be broadcast Sunday night at 9 Seattle time.

• To learn more read Alessandra Stanley’s review: The Disease That Steals Your Self.

Gingko biloba

The study appears in today’s issue of JAMA, the Journal of the American Medical Association

Gingko biloba is one of the most popular herbal products with worldwide annuals sales of over $249 million.

More than 3,000 men and women age 75 or older participated in the study, called the Ginkgo Evaluation of Memory (GEM) trial.

Most of the participants had normal cognitive function, but a subset, 482, had mild cognitive deficits.

The participants were randomly assigned to take either 125-mg of Ginkgo extract twice a day or a placebo.The participants were followed for a median of just over six years.

Neither the researchers or the participants knew who was taking the herb or the placebo.

At the end of the study, the researchers found that participants in each group developed dementia at roughly the same rate: 3.3 per 100 per year among those taking Gingko and 2.9 per 100 per year among those taking the placebo, a difference that was not statistically significant.

Overall, 523 of the study participants developed dementia, 246 (16.1%) in the Gingko group and 277 (17.9%) in the placebo group, again, a difference that was not statistically significant.

The herbal product also had no effect on the rate of progression to dementia in those participants who had mild cognitive impairment at the outset of the study.

In an editorial accompanying the JAMA study, Dr. Lon S. Schneider of the University of Southern California, Los Angeles writes, “The GEM study adds to the substantial body of evidence that Gingko biloba extract as it is generally used does not prevent dementia in individuals with or without cognitive impairment and is not effective for Alzheimer’s disease.” 

The lead author of the study was Dr. Steven T. DeKosky, who was at the University of Pennsylvania at the time of the study and is now at the University of Virginia.

Local Seattle researchers Richard Kronmal, professor of biostatistics, and Annette L. Fitzpatrick, a research associate professor at the University of Washington School of Public Health and Community Medicine were also part of the research team.

To learn more:

• Read the paper and editorial in the journal JAMA (fee or subscription may be required).
• Read the National Center for Complementary and Alternative Medicine page on Gingko.
• Visit the National Library of Medicine’s information page on Gingko.
• Visit the Ginkgo Evaluation of Memory study website, which has information about the study and Gingko biloba.