Moving Grandma: Resources for Loved Ones with Dementia, Alzheimer’s

Over the weekend, my family came together to begin the process of moving my grandmother to a long-term care facility.

She is in the middle stages of vascular dementia, caused by a series of mini-strokes that have cut off blood flow to parts of her brain over the years (with symptoms that aren’t all too different from Alzheimer’s).

We organized and boxed up treasures and junk, and years of papers, magazines, photos and clutter, getting her home ready to list on the market. Right now, we don’t have the luxury of time to sit around and read the notes that my mother wrote home from college in the ‘70s (though, I did skim it and laughed at how she sounded as a teen), or look through the photos of their early lives; we’ll get to that when things are more settled.

Now that we’re to this point, it’s begun to sink in that cognitive diseases are extremely hard to deal with for patients and caregivers. It will take a group effort from my grandmother’s family and friends to help her – and each other – through this emotional time.

I began looking online for resources to help us make informed decisions going forward. The Alzheimer’s Association has a lot of great information, a 24/7 helpline, programs for education and support, access to local support groups and online message boards. Most hospitals around have caregiver support groups, and there are several books available on the topics of caring for those with dementia. The National Institute on Aging also offers a wealth of knowledge about cognitive diseases.

One really interesting thing I’ve found is an online community for friends and family to sign up and see a shared calendar of activities, lists of medications, doctor contact information, a place to share announcements and more.

We are getting to the point that decisions about my grandmother’s future have to be made – typically without her input – which is hard for my parents, aunts and uncles: to make major life choices for the person that gave them life.

But, being prepared ahead of time with proven resources and a bit of organization will be one of the more important things that we are able to do for my grandmother. If you’re in a similar situation, I urge you to do some research and find these answers for your family as well.

What to Expect From Congress in an Election Year

The answer to the query in the headline is “not much,” but that is considered a vast improvement over recent years. Here is the analysis from Bo Harmon, vice president of political affairs for BIPAC.

There are a number of legislative items that members of both parties acknowledge need to be addressed. Implementation of Obamacare. Immigration reform. Tax code and entitlement reform. A long term solution to the debt ceiling crisis. Privacy security. Patent reform. Trade.

With all of these issues, the public increasingly frustrated with gridlock in Washington, and an election coming up where Congress will want to be able to talk about their accomplishments, we should expect to see some major legislative action in 2014, right? Wrong. Well, mostly wrong. There is actually a glimmer of hope that 2014 will produce more than 2013. Though, that’s a bit like saying “we scored zero points last game and expect to do better than that this time.”

The reason that Congress hasn’t accomplished much since 2010 is the same reason we don’t expect to see much more in 2014. With the House in the hands of Republicans and the Senate and White House controlled by Democrats, and each side increasingly responsive to the most ideological polarizing parts of their base, they disagree on how to proceed. Both sides understand the things that need to be addressed, but there is zero consensus on how to do it.

The Obamacare debate is a prime example. Not a single Republican in either chamber voted for original passage though many key features of the legislation were included in previous GOP health care reform bills. Once Republicans took the House in 2010, GOP leadership took the position that repeal of the legislation in total was the only option and have refused to offer or support tweaks or fixes to problems. The Republicans believe “it’s not possible to ‘fix’ something fundamentally incompatible with our ideology.” Politically, they also believe if the legislation fails they will benefit and thus have little political incentive to improve the law. From their perspective, it is BETTER politically to have as many things go wrong with ObamaCare as possible.

This same standoff occurs on issue after issue – taxes, immigration, entitlement reform, etc. But, it is a new year and in our optimistic resolutions, we see some possibility of federal action on a handful of bills. There was a small bright spot in December when a two-year budget compromise passed that would avoid the possibility of a shutdown and eliminated some of the most irrational sequester cuts. This rare bipartisan effort was criticized by many however as small ball for not addressing bigger, long term issues. Even still, it was the best that could be achieved in the current gridlock environment.

The environment is also different than it was in 2013. At that time, Democrats were emboldened by the President’s popularity and felt little need to compromise, believing they had received a mandate from the 2012 elections to do as they wanted. With the President’s approval ratings significantly lower now, the confidence to act as boldly is similarly evaporating. Conversely, Republicans spent 2013 in fear of retribution from the Tea Party. Now, Boehner in the House and McConnell in the Senate have openly broken ranks with the Tea Party and seem almost eager to act in ways that show consensus.   The budget deal and the changed political environment provide the foundation for some compromise legislation to take place on issues that need to be addressed. Small, incremental changes to a handful of issues is possible, likely driven by the middle. We may see some movement on immigration, trade, patent reform, etc; even if more contentious things like tax reform remain unlikely.

While many would like to see more comprehensive solutions and small, incremental changes to immigration or Obamacare implementation may not be at the top of your industry agenda, we are dealing with a situation where NOTHING has been getting done and we need to make an effort to support and reward even baby steps at basic government functionality. Only then will members of Congress have the political courage to attempt larger, more comprehensive changes and take a look at issues that are at the forefront of your industry agenda. It is a shame that we have reached this point where expectations for our Congressional “leaders” is so low but they have demonstrated over the last three years that nothing else can be expected from divided government driven by ideological extremes.

 

Chamber’s Top Legislative Priorities in 2014

Eliminating business personal property tax, allowing employers to screen prospective hires for tobacco use and establishing a work share program are among the top legislative priorities for the Indiana Chamber of Commerce in 2014.

“In many categories of commercial and industrial property tax, Indiana is among the very highest states in the country. That’s largely due to our taxing of machinery and equipment. It’s a remaining black mark on our tax climate – an area where we simply can’t compete,” declares Indiana Chamber President and CEO Kevin Brinegar.

“All of our surrounding states have done away with the tax except for Kentucky, which taxes personal property at a lower rate than Indiana. It’s past time to remove this burden that can greatly hinder business expansion and innovation.”

On the health care front, the Indiana Chamber is seeking to repeal what is termed the smokers’ bill of rights for prospective employees.

“This is an intrusion into the rights of employers in making hiring decisions. Holding smoking up to the same standards as we hold discrimination based upon race, gender, religion and ethnicity seems arbitrary and without justification,” Brinegar offers.

“There are other behaviors (such as substance abuse and having a criminal record) which are also personal choice and over which employers do have discretion in hiring decisions; this reinforces that the state’s protection for smokers is unnecessary and not well founded.”

One policy the Indiana Chamber believes would benefit employers, employees and the state is a work sharing initiative that would allow employers to maintain skilled, stable workforces during temporary economic downturns.

“Employers would be able to reduce hours without layoffs and provide unemployment compensation to partially compensate workers for their lost hours. Then when circumstances improve, employees could return to full-time work status for the company,” Brinegar explains.

“What’s more, a federal grant is available for three years to pay for the cost of the program. It’s a positive scenario for all parties.”

When it comes to K-12 education, Brinegar says the Indiana Chamber will continue to push for the absolute best academic standards for the state.

“That’s the bottom line. We need to improve student learning, meet the essential college- and career-ready requirement and have an appropriate student assessment system. Those elements all currently exist within the Common Core State Standards program, which we continue to fully support.”

Below are the Indiana Chamber’s top legislative priorities. The complete list is also available on the Indiana Chamber web site (www.indianachamber.com).

CIVIL JUSTICE
Support regulating the practice of lawsuit lending, in which a third party provides a plaintiff a cash advance loan while the legal case is pending. In turn, a plaintiff agrees to repay the advance (which is usually at a high interest rate) from the lawsuit proceeds. This practice complicates the legal process by forcing more cases to go to trial because the plaintiffs can’t afford to settle due to their repayment agreement with the lender. In turn, this causes more and more Indiana businesses to pay expensive legal fees. This lending practice is legal in most states, but regulation and transparency do not exist in Indiana.

ECONOMIC DEVELOPMENT
Support a voluntary vehicles miles travelled (VMT) pilot program as a potential replacement for existing fuel taxes. With Indiana’s already insufficient fuel tax revenues for roads/transportation trending down and more fuel efficient and electric/hybrid vehicles on the roads, a new funding mechanism for road maintenance needs to be found. Owners of alternative-fuel vehicles, including electrical vehicles, should pay for the roads they use just like other drivers. Voluntary VMT pilots in other states are currently taking place and Indiana cannot afford to ignore this potential road funding alternative.

Support expanding the patent-derived income tax exemption to the pre-patent phase. This incentive change would allow innovative, high-tech businesses that typically pay high wages to qualify during the earlier patent-pending phase of the (often long) patent application process, thus carrying forward any credit. Many emerging businesses would find this helpful in capitalizing their start-ups and expanding hiring. (Current law states you must have had a patent issued by the federal government before you can apply for the exemption.)

EDUCATION
Support maintaining high-achieving academic standards, such as the Common Core, and allowing the State Board of Education (SBOE) to determine student assessments. Indiana needs standards that improve student learning and meet the college- and career-ready requirement. The testing component of the standards can best be determined by the SBOE.
Support a framework for the future development of publicly-funded preschool initiatives for low-income families. There is critical need for improved preschool opportunities, especially for low-income children whose families may not have the means to provide a high-quality preschool experience or to provide needed learning opportunities in the home. The Indiana Chamber supports publicly-funded preschool programs that are: focused on those families in greatest need, limited to initiatives that maintain parental choice, focused on concrete learning outcomes and integrated with reforms at the elementary school level that will maintain and build upon the gains.

ENERGY/ENVIRONMENT
Support a water policy to stabilize our economic future and effectively compete with other states. A policy/plan is needed in order for the state to effectively manage its significant water resources, as well as to ensure delivery of an adequate, reliable and affordable supply of water.

HEALTH CARE
Support repealing the smokers’ bill of rights for prospective employees from the Indiana Code. The Indiana Chamber believes that all employers should have the right to choose whether or not to screen and/or hire prospective employees who use tobacco products. Since employers are footing most of the bill for health care costs for their employees, they should be able to have some discretion in determining whether new employees use tobacco products or not.

Support reinstating the wellness tax credit. The Indiana Chamber supports this incentive to start a wellness program, which can increase attendance, boost morale and productivity, as well as positively impact health care coverage costs.

LABOR RELATIONS
Support a work sharing program that will allow employers to maintain a skilled stable workforce during temporary downturns. Employers then could reduce hours without layoffs, enabling workers to keep their jobs – which hopefully could be returned to full-time status once economic circumstances improve. Also part of the equation: Unemployment compensation to partially compensate workers for their lost hours.

LOCAL GOVERNMENT    
Support common sense simplification and reforms to local government structures and practices. Creating the option for counties to have a single county commissioner and county councils with legislative and fiscal responsibilities is one that several Indiana counties desire. There should be incentives to reward local government efficiencies and performance in the delivery of services to taxpayers.

TAXATION
Support legislation to reduce the dependence on the taxation of business machinery and equipment. This tax discourages capital investment, places a disproportionate property tax burden on businesses and puts Indiana at a competitive disadvantage with surrounding states that have eliminated it or are moving to do so.

Indiana Medical Device Leaders Wary of Taxes from ACA

Gabrielle Karol of FoxBusiness.com reports on the looming taxes and fallout from the Affordable Care Act that could give some of Indiana's medical device makers big headaches. The Chamber and other business organizations continue to fight this.

In Warsaw, Indiana, known as the “Orthopedic Capital of the World,” the CEOs of medical-device companies are none too pleased with the medical-device tax imposed by ObamaCare.

In this edition of Conference Room, Iconacy CEO Tom Allen and OrthoPediatrics CEO Mark Throdahl tell FBN’s Jeff Flock that the 2.3% excise tax will have a major impact on their businesses.

“This is a tax on sales. We have no profits to pay it from, so the only way to stump up the money to pay a tax of this size is by cutting programs,” says Throdahl, whose company makes orthopedic products for children with fractures or leg or spine deformities.

Throdahl says the tax will prevent his company from growing.

“All of the engineers who surround me – their payroll is equivalent to the tax we’re now paying Washington. So we could double the size of our technical staff were it not for the medical-device tax,” says Throdahl. While Allen’s company is still in the launch phase, so the tax hasn’t yet had a major effect, he says it has hindered his ability to add staff as well.

Given that Warsaw is known for its medical-device companies, the tax could also have a profound effect on both the community and the state of Indiana.

“There are estimates that over 40,000 jobs will be impacted in the medical technology industry by the medical-device tax,” says Throdahl.

Indiana Economic Development Corp. president Eric Doden says the tax is particularly disappointing to the community given the strides made to reduce the tax burden paid by these companies.

“In Indiana, we have had a history of entrepreneurship particularly in this arena. And these are high paying jobs and the thing that sort of disappointed us as a state is that Governor Pence and the State House [have] done an incredible job of lowering taxes and trying to create a better environment for these businesses to start to grow,” says Doden. 

Chamber Members: New ACA Helpline can Help Alleviate Your Health Care Stress

Concern over the Affordable Care Act (ACA) — from its complexity to actual implementation — is something we continue to hear a lot about from the business community. To better assist with those inquiries, we are pleased to introduce a new service exclusively for Indiana Chamber members.

The Indiana Chamber's ACA Helpline is now here to help your organization navigate through the complicated health care reform processes and obligations. This FREE service is similar to the popular HR Helpline; we encourage employers of ALL sizes to use this member benefit.

Mike Ripley, Chamber vice president of health care policy, will be answering your questions. He is a former insurance agency owner and was chairman of the House Insurance Committee as a state representative.

Ripley says while employers are faced with a more reasonable timeline overall due to the employer mandate being delayed until January 2015, there is still plenty that needs to be taken care of between now and then. Virtually all the rest of the employer responsibilities and various levels of compliance remain the same — as other ACA provisions were unchanged.

Among the common questions from employers:

  • Who is considered a full-time employee?
  • What if we offer coverage but our employees don't take it?
  • What is the employer shared responsibility payment?
  • Do we have to provide notice to our employees?
  • How do we know if our coverage is affordable/provides minimum value?
  • Will our company qualify for small business tax credits?

Make your own list of issues and start using the Chamber's ACA Helpline today! Call Mike Ripley at (317) 264-6883 or send an email to mripley@indianachamber.com.

Indiana’s New Medical School Opens

Tried to get in to see your primary care physician lately? It’s possible you’ve found it harder and harder to get a quick turnaround time on an appointment, unless it was scheduled months in advance.

There’s a likely reason for that: a shortage of primary care physicians, plus more patients in the system, equals less time for you to see your doctor. (That’s not to mention what will happen when the full brunt of the Affordable Care Act begins in 2014, forcing huge numbers of new patients to vie for attention from a dwindling number of physicians.)

In 2011, I wrote a story for BizVoice® magazine about Marian University opening the first college of osteopathic medicine in the state – and the first new medical school to open here in more than a century.

The Marian University College of Osteopathic Medicine will open next week and will produce about 150 graduates per year, according to a press release from the school.

While writing that story I found some sobering facts about our looming doctor shortage:

“The American Association of Colleges of Osteopathic Medicine is predicting a shortage of more than 150,000 doctors by 2025 (nationwide).

“Indiana’s statistics are staggering: The state is short 5,000 physicians. By 2020, Indiana will need 2,000 more primary care physicians. Of 92 counties, 57 are medically underserved. The mental health provider shortage is 38%, while the deficiency in primary health care physicians is 30%”

So you can see we have a dire need for more physicians.

Do you know the difference between an osteopathic college and a college of medicine? Here’s a quick run-down of the differences:

  • Doctors who graduate from an osteopathic college earn a DO degree; those who graduate from a college of medicine earn an MD degree
  • DO’s and MD’s are in the same medical board; qualifications are essentially the same
  • It mainly comes down to philosophy. When I spoke to the college’s dean, Dr. Paul Evans, in 2011, he said this about the difference: “The philosophy of osteopathic medicine stresses looking at the patient as a whole and the wellness and prevention aspects of medical care. The bottom line (for both) is to treat the patient”
  • Students in both types of school earn a four-year degree and then begin three to seven years of postdoctoral medical education, residencies and fellowships
  • Osteopathic medicine traditionally graduates more primary care physicians

After that story, I sought out a DO for my primary care physician and am quite happy with the results. Cheers to the new school of osteopathic medicine!

Poll: People Still Looking for Health Care Answers

Our most recent poll question asked for opinions about the Affordable Care Act, Obamacare or whatever you prefer to call the federal health care reform legislation that is going to dramatically impact so many lives in the coming months and years. The responses to the four choices are interesting, as always, but we want to also share some of the comments in the "other" category.

Results:

  • 60%: more questions than answers remain
  • 15%: exchanges will be the solution
  • 13%: other (see below)
  • 8%: "wait and see" is the way to go for 2014
  • 4%: employers will "pay" rather than "play"

Comments:

  • "It's a train wreck regardless of who you are"
  • "A good first step in health care reform"
  • "Part-time will become the norm; exchanges too expensive, i.e.,annual income down"
  • "Repeal; it's a piece of !@#$"

The current question (upper right of the page) deals with the U.S. Supreme Court.

These Numbers May Surprise You

Numbers are fascinating. Lisa Sprinkle, part of our Indiana Chamber accounting team, recently said in a BizReport article for our members that she loved numbers so much that she took extra math classes while in school. I wouldn't go that far. I'm more intrigued by the points people try to make through numbers and statistics rather than trying to solve quadratic equations or whatever it was I struggled with in school.

A few recent unrelated numbers I came across; kudos to Governing magazine for the compilation:

  • 90%: portion of tuition covered by the state for University of South Dakota law school students who agree to work in rural South Dakota counties for five years after they graduate. Similar to other programs for doctors and nurses, South Dakota is the first to goes this route with attorneys
  • 7%: amount by which Nevada's water supply is shrinking every year. Occasional summertime droughts are not the issue here; it's having a long-term water plan for our state (any state) to make sure business and individual water needs are met
  • 260,000: the project nursing shortage by the year 2025. Forty percent of the working registered nurses in the country are age 50 and above. More than 54,000 qualifed applicants were turned away from nursing programs in 2010 due to a lack of teachers

Don’t be Unprepared Because of Health Care Reform Myths

Tracey Gavin of Apex Benefits Group wrote a notable column for Inside INdiana Business recently, pointing out the dangers for employers of not being prepared for fallout of the Affordable Care Act. She lists eight common myths that you need to be aware of:

Those answers could help implement solutions that go beyond compliance, but help minimize the financial impact and even capitalize on strategic opportunities through proper planning and preparation.

Myth No. 1: I don't need to worry about Health Care Reform or make any decisions until January 1, 2014.

Truth: Employers need to plan now. Some need to determine their status as "large employer" under the federal statute. Others need to begin the process of determining full-time status for certain classes or types of employees. Failure to do so can trigger maximum penalties – or worse, fines for non-compliance.

Myth No. 2: It is less expensive to terminate our medical coverage plan and just pay the penalty.

Truth: Aside from the impact on employees, many employers will find that once the penalties and tax consequences are accounted for, there may be little to no savings to terminate their coverage. In fact, some will actually pay more by terminating their plan.

Myth No. 3: An employer may ignore the law the first year or two – since they believe the worst that can happen is they end up paying some sort of penalty around $2000 per employee –minus 30.

Truth: No! A dangerous myth. An employer that is subject to the federal law – and willfully avoids compliance – is subject to a fine of $100 per day, per affected person. An employer with 50 equivalent full-time employees that ignored the law (versus an honest mistakes while trying to comply) could be fined $5000 (or more if dependents are included) per day — until the employer corrects the noncompliance. It is clearly noted in the regulations this fine can be levied at up to $500,000 per employer.

Myth No. 4: After health care reform is implemented, most employers will stop offering medical benefits.

Truth: There may be changes to plan offerings and contribution strategies, but few employers plan to drop coverage, according to a Towers Watson and National Business Coalition on Health survey. The reasons to offer coverage to employees have not changed just because health care reform was passed. For example, attracting and retaining employees remains important part of the business operating efficiently.

Myth No. 5: My carrier and broker will take care of everything.

Truth: Some will. Others may not be able to. An advisor's inability to help employers maintain compliance and quantify the financial risks leaves employers vulnerable to serious fines, penalties, excess costs and tax implications. Employers must be proactive and understand the financial viability of their employee benefits programs and impact to their organization.

Myth No. 6: A simple calculation for "pay or play" will provide our company with an accurate projection of financial risk under PPACA.

Truth: Unfortunately, this myth is perpetuated by the many online – or – "black box" calculators in the marketplace. The truth is employers need to do an analysis that captures all the inter-related and moving parts of PPACA that can impact the financial sustainability of their plan. Cost drivers such as plan design, contributions, migration, and many other factors. To complicate this, scenarios need to be modeled precisely and include projecting how changing one factor can in turn impact all the others.

Myth No. 7: Employers that offer a self-funded plan will have very little compliance costs or issues.

Truth: Self-funded plans do in some ways have more plan design flexibility under health care reform and potentially avoid some tax assessments. However, the majority of regulatory requirements apply to groups irrespective of their plan funding. Regardless of funding status, all employers will need to understand the financial ramifications of health care reform to their business and employees.

Myth No. 8: Employees would be financially advantaged by obtaining coverage through Medicaid or the Exchange.

Truth: Maybe. Certainly most individuals qualifying for Medicaid would be advantaged. Individuals who could qualify for tax subsidy may or may not be financially advantaged when premiums and out-of-pocket expenses are compared to employer-sponsored health coverage. Those whose household income is greater than 400 percent Federal Poverty Level (FPL) would be faced with much greater premiums and out-of-pocket expenses compared to employer-sponsored coverage.

Unions Growing Skeptical of Affordable Care Act

Even though labor has been a major contributor to President Obama during his two election bids, there is a growing skepticism about whether or not the Affordable Care Act — often labeled "Obamacare" — will be a benefit to their members. CBS News reports:

Some labor unions that enthusiastically backed President Barack Obama's health care overhaul are now frustrated and angry, fearful that it will jeopardize benefits for millions of their members.

Union leaders warn that unless the problem is fixed, there could be consequences for Democrats facing re-election next year.

"It makes an untruth out of what the president said — that if you like your insurance, you could keep it," said Joe Hansen, president of the United Food and Commercial Workers International Union. "That is not going to be true for millions of workers now."

The problem lies in the unique multiemployer health plans that cover unionized workers in retail, construction, transportation and other industries with seasonal or temporary employment. Known as Taft-Hartley plans, they are jointly administered by unions and smaller employers that pool resources to offer more than 20 million workers and family members continuous coverage, even during times of unemployment.

The union plans were already more costly to run than traditional single-employer health plans.

But Obama's Affordable Care Act has added to that cost — for the unions' and other plans — by requiring health plans to cover dependents up to age 26, eliminate annual or lifetime coverage limits and extend coverage to people with pre-existing conditions…

Unions backed the health care legislation because they expected it to curb inflation in health coverage, reduce the number of uninsured Americans and level the playing field for companies that were already providing quality benefits. While unions knew there were lingering issues after the law passed, they believed those could be fixed through rulemaking.

But last month, the union representing roofers issued a statement calling for "repeal or complete reform" of the health care law. Kinsey Robinson, president of the United Union of Roofers, Waterproofers and Allied Workers, complained that labor's concerns over the health care law "have not been addressed, or in some instances, totally ignored."