IN THIS ISSUE

• Referral Services and Anti-Kickback
  by Barbara Mascio
  
• Depression in Late Life: Good News, Bad News by Patricia Bertschler, MA, LPCC
  
• Obituary of an Old Friend
• Independence = Mobility
  by Christie Estok of Life Quest Medical Supply
  
• Resources for Caregivers and Seniors
• Calendar of Events
• Subscribe/Unsubscribe information

Referral Services and the Anti-Kickback

Quality Care Options was recently invterviewed by Burt Schorr, editor of My Home Health Line Newsletter. Mr. Schorr was intriqued with our consumer-driven survey process and how we help seniors and family caregivers link to 'Excellent Elder Care Resources'.

Mr. Schorr's concern was whether or not QCO was in violation of the Safe Harbor Regulations and asked permission for Home Care Attorney, Elizabeth Zink-Pearson, of Pearson & Bernard to review our service agreement. I assured Mr. Schorr that QCO is not a referral service, rather a full elder care service that delivers valued services to seniors, family, service providers of elder care, social workers & discharge planners and employers. Still, he wanted their attorney to review our agreement, which I promptly provided for him.

The readers of Mr. Schorr's paper depend on receiving current and accurate industry news and so researching facts is of great importance. The article Mr. Schorr was writing was centered around warning service providers about paying for referrals.

Why?

There are very strict rulings about paying for a customer when you also receive Medicare and Medicaid payments. A ruling, on the books since 1972, called the Safe Harbor Provisions states, in part, "the federal anti-kickback law's main purpose is to protect patients and the federal health care programs from fraud and abuse by curtailing the corrupting influence of money on health care decisions"... it goes on to say, ... "anyone who knowingly and willfully receives or pays anything of value to influence the referral of federal health care program business, including Medicare and Medicaid, can be held accountable for a felony. Violations of the law are punishable by up to five years in prison, criminal fines up to $25,000, administrative civil money penalties up to $50,000, and exclusion from participation in federal health care programs."

The Department of Health & Human Services Office of Inspector General, the OIG, also investigates referral companies who, according to Vicki Robins, chief of OIG's industry guidance branch, asserts that the OIG is "always concerned when anyone asks for money in exhange for referrals."

So, QCO went under some srutiny. We provided our agreement, our brochure, our surveys, and invited all interested parties to read through the extensive content within our web site.

Does Quality Care Options involve kickbacks, placing our service and you in violation of the Safe Harbor Act? No. In fact, we were the only service featured within the article that actually complied with the law. Attorney Perling's opinion of QCO was based on the fact that service providers that contract with QCO pay a fixed fee that isn't based on the volume or value of services. Another is that any elder care service provider meeting the 90% customer satisfaction rating (from our consumer-driven survey process) is free to participate.

Quality Care Options is growing and we've gone through quite an active year and half of development of our program. We are unique, and quite often misunderstood as being just a 'referral service'.

A referral service serves both the senior and the elder care service provider in this manner:

• Service providers register with the referral service (most are free to register with, others charge)
  
• A senior searching for a service is asked which zip code areas they are searching for a particular service. (some services offer seniors this at no charge, others ask for a fee)
  
• The referral company now emails, phones or faxes all the services within the desired zip code to provide you with this referral. (You are provided the name, phone number and address of the senior)
  
• You and your staff quickly respond - you know if you get there first, you have a higher chance of contracting with the senior)
  
• The senior now receives multiple sales calls from nice people who all say the same thing, "You should choose my company because we are the best"
  
• You contract with the senior
  
• The referral company now sends you a bill. The bill is normally based on the dollar amount you charge the senior.
  
  (Example: An assisted living facility that charges $3,000 per month will typically owe the referral service a fee of $1,500. Their neighbor, the assisted living facility across the street charges $1,500 per month and will owe the same referral service a fee for $750.00 for the same client, same service)
  
  
• The referral company has now completed its job, both to the service provider and to the senior.

Representatives of referral companies normally earn commissions. This can also pose a concern. If a family's income depended on earning a high commission, the temptation may be there to direct a senior to a service that

• a. Charges more
  
• b. Where the staff have a history of 'closing' the sale.

We are proud of our services, proud of our entire program. And relieved to know that finally some of the elder care industry's respected officicals are taking the time to understand just how valuable QCO is, to our seniors and to the businesses that provide the services to our seniors.

Reference: Home Health Line Newspaper, 29 years as home care's national independent newsletter and the industry's leading information source, June 18 2004, Volume XXIX No. 24

Depression in Late Life: Good News, Bad News

The good news is that aging alone does not trigger depression. About 85-90% of people age 65 and older remain happy and well-adjusted (Source: American Association of Geriatric Psychiatry, 1997).

Research shows that depression can increase if one has serious medical conditions (25%), is hospitalized (23%), or is placed in a nursing home (up to 60%) (Geriatric Psychiatry Alliance, 1997). However, if depression is treated, the success rate can be as high as 85% with medication and talk therapy.

The bad news is that depression in late life is rarely diagnosed by health care professionals due in part to a large shortage of physicians trained in geriatric care and to the misperception that depression in late life is a normal part of aging. This age discrimination prevents seniors from receiving care that could greatly improve their quality of life (Source: Report on "Ageism: How Health Care Fails the Elderly," May, 2003).

In an article on health care bias against the elderly in the Cleveland Plain Dealer (May, 2003), "one study found that 75 percent of seniors who kill themselves do so within four weeks of having seen a physician." The article goes on to report that Medicare also discriminates by requiring 50% co-pay for behavioral health services but only 20% co-pay for medical care.

So what can be done? First, learn to watch for symptoms whether you are a caregiver or someone getting up in years. I use the mnemonic, SIG-E-CAPS, to help remember the symptoms when I do depression screenings.

• S - Sleep interruption, can't get to sleep, can't fall asleep, can't stay asleep, sleep too much
  
• I - Lack of interest in activities once meaningful.
  
• G - Excessive guilt
  
• E - Low energy….always tired though blood and other tests come back negative that would attribute to this level of fatigue
  
• C - Inability to concentrate… easily distracted, mind wanders
  
• A - Low or excessive appetite
  
• P - Psychomotor retardation or agitation (either very slow gait with obvious sad looks or easily excitable, nervous, fidgety, can't sit still, rocks in place, etc.)
  
• S - Suicidal thoughts, gestures, or attempts

Second, if a person has had a bout of major depression earlier in life, it is not uncommon to have another episode in later years. Each episode increases the chances of having another, though there may be many years between depressions.

Third, think about the high success rate for treated depressions (remember, 85-90%), and get some help from a counselor who specializes in geriatric behavioral health. Start with a depression screening; the counselor will be able to tell if you need to see a psychiatrist to get on medication. Some people benefit from talk therapy only; others may require medication if they have a medical imbalance.

A depression screening might involve taking a Geriatric Depression Screening (GDS), Mini-Mental Status Exam (MMSE), Draw-a-Clock test, and psychosocial history. Generally this takes less than an hour.

Fourth, stop asking medical doctors to prescribe psychotropics. Many seniors turn to their trusted primary care physician for medication. "Doctor, I'm feeling antsy all the time. Can you give me something for my nerves?"

Medical doctors specialize in our physical care. They do not receive extra schooling in psychotropic medication or in geriatric dosing. It is not uncommon for medical doctors to prescribe the wrong medication for someone suffering from depression.

For example, there is such a thing as an anxious depression. The person looks at first glance like she/he suffers from anxiety, and the doctor prescribes accordingly. However, if the nervousness is a symptom of depression, the medicine is not touching the depression at all and the condition remains. A psychiatrist or gerontologist is the right type of specialist to see.

Lastly, if someone in the family appears to be depressed, this often affects other family members as well. The depressed person can be irritable, sullen, refusing to participate in family events, self-isolating. Family members can worry, try to coax, get exasperated, or even give up on the suffering member. If the depressed person refuses help, get help for yourself. Counselors are creative in offering support and/or community resources to assist you through this challenging problem. Don't look the other way and don't give up. Be part of the 85% success rate in treating this over-looked problem in late life.

Patti Bertschler is a licensed professional clinical counselor and co-author of Truce! Using Elder Mediation to Resolve Conflict among Families, Seniors, and Organizations (now in publication, 2004). She can be reached at Northcoast Conflict Solutions, (440) 262-3700 NCS A Senior Approved Service

Obituary of an Old Friend

We are mourning the loss of a beloved old friend who recently passed away. His name was Common Sense. Common Sense lived a long life but died in the United States from a vicious contagious disease.

He selflessly devoted his life to service in schools, hospitals, homes and factories, helping folks get the jobs done without fanfare and foolishness. For decades, petty rules, frivolous lawsuits, and ludicrous verdicts held no power over Common Sense.

He was credited with cultivating such valued lessons as to know when to come in from the rain, why the early bird gets the worm, and that life isn't always fair. Common Sense lived by a simple and sound financial policy. Don't spend more than you earn. Common Sense also lived by other time-tested strategies like: The adults are in charge and not the kids, and it's okay to come in second or third.

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Independence = Mobility

Today as our population ages, things are changing. Many of our seniors now want to stay in their own homes, independent or assisted living environments for as long as they can. For some people, this may become more difficult as time goes on. And if walking becomes a problem, the next step may be a wheelchair.

Many seniors who have a difficult time walking also have a difficult time self-propelling a manual wheelchair with their arms or legs. When this happens, they are dependent on a caregiver or family member to push them from room to room while they are seated in the wheelchair.

Thankfully, today's technology is bringing us powered mobility. Power wheelchairs are controlled with the simple touch of a joystick, which is attached to the armrest of the chair. Power wheelchairs are run by batteries underneath the seat that you can charge in a simple electrical outlet inside your home.

Most amazingly, with mid-wheel drive systems, the new power wheelchairs can turn with the most impressive performance and small turning radiuses allowing our clients to turn around in some of the tighter spots in their homes, such as kitchens or hallways. This is often impossible in a manual wheelchair. Consumers can now maneuver safely in and around the home and take it with them wherever they go.

With your doctor's approval, Medicare should cover 80% of your power wheelchair. Your supplemental or secondary insurance will cover the remainder. We never ask for any up front fees and we submit all necessary paperwork to your insurance company.

Of course in addition to your doctor's initial order, Medicare and most other insurance companies, such as Medicaid need to know that this equipment is "medically necessary". This means that you must meet their criteria to be eligible. The basic criteria for medical necessity are as follows

• Client is unable to walk functionally.
• Client is not able to self propel themselves in a manual wheelchair.
• Client needs this equipment "inside" their home. It is not only needed for outside use.

At Life Quest Home Medical Equipment we have rehab specialists that will handle all your paperwork to help prove medical necessity. First, we will send a therapist to your home to complete a mobility evaluation report. Then we send this report along with other required forms to your physician to sign. Once the papers are completed and the client has met medical necessity, one of our rehab specialist will visit you, take measurements and assist you in choosing the power wheelchair that will best suit your needs.

For more information or to find out if you qualify, call Life Quest Home Medical Equipment for a free consultation and a catalog so that you can become familiar with the different types of power wheelchairs available.

Christie Estok is our rehab reimbursement specialist and will be happy to answer any questions regarding power mobility. 216-731-1250 ext. 390 or 440-342-4504. Life Quest not only is a supplier for power wheelchairs but they are a full line distributor of most needed home medical equipment.

Manual wheelchairs, Hospital beds, Bath safety aids, Walkers, Canes, Pressure relief cushions and mattresses, Diabetic testing supplies, Oxygen Incontinence products, Lift chairs, Stair Lifts, Ramps, Nutritional supplements, and so much more.

Ten Years of Caring A Senior Approved Service

July 2004 Calendar of Events

Normally we publish each event within our newsletter. We are trying something new here and would love your feedback.

We've had a number of requests from our readers to add more article content. We have done that with this issue and it has taken quite a bit of space.

We are also experimenting with a new calendar format. I am not sold on it yet, but will wait for your input. Email me at Barbara

Our July calendar has events and seminars featured in Ohio, California, Florida and few other states. We normally list the event and then direct you to the calendar for details. This time, we would like to send you directly to the - CALENDAR

Resources

This issue features a Senior Approved Service

DocuPrep DocuPrep provides assistance with the creation of wills, living wills, health care directives (and more) without the high cost of attorney fees.