SPRING ISSUE 2015
A Special Supplement to
An evolving landscape
O
n an April afternoon, Mary and Jim Lippold’s backyard epitomizes the return of spring. Early blooming flowers sprinkle in fresh colors while other plants are just starting to break through the soil. Birds and bugs provide a unique ambiance with their constant calls while pesky squirrels and rabbits search for a few bites CNA photos by JAKE WADDINGHAM to eat before being Top, Mary and Jim Lippold enjoy a moment together on chased off. A small a bench by their waterfall and stream that flows into a koi pond in their backyard in Creston. Above, hellebores bloom in the Lippold’s backyard. The Lippolds have plantPlease see ed a wide variety of flowers, shrubs and trees that bloom LIPPOLDS, Page 2C from early spring through late fall.
living
Elder care costs keep climbing; nursing home bill now $91K NEW YORK (AP) — The steep cost of caring for the elderly continues to climb. The median bill for a private room in a nursing home is now $91,250 a year, according to an industry survey out Thursday. The annual “Cost of Care” report from Genworth Financial tracks the staggering rise in expenses for long-term care, a growing financial burden for families, governments and insurers like Genworth. The cost of staying in a nursing home has increased 4 percent every year over the last five years, the report says. Last year, the median bill was $87,600. “Most people don’t realize how expensive this care can be until a parent or family member needs it,” said Joe Caldwell, director of long-term services at the National Council on Aging. “And then it’s a real shock.” The annual report from Genworth, which sells policies to cover longterm care, looks at costs for a variety of services, including adult daycare, and home health aides.
“Cost of Care” report For its report, Genworth surveyed 15,000 nursing homes, assisted living facilities and other providers across the country in January and February. It found wide differences from state to state. The cost of staying in a nursing home has increased 4 percent every year over the last five years, the report says. Last year, the median bill was $87,600. And nursing home bills are rising at the fastest pace, twice the rate of U.S. inflation over the last five years. One year in a nursing home now costs nearly as much as three years of tuition at a private college. For its report, Genworth surveyed 15,000 nursing homes, assisted living facilities and other providers across the country in January and February. It found wide differences from state to state. In Oklahoma, for instance, the median cost for a year in a nursing home came out to $60,225. In Connecticut, it was $158,775. Alaska had the highest costs by far, with one year at $281,415. So, who pays the nursing-home bill? “A lot of people be-
lieve Medicare will step in and cover them, but that’s just not true,” said Bruce Chernoff, president and CEO of The Scan Foundation, a charitable organization. Medicare will cover some short visits for recovery after a surgery, for instance, but not long-term stays. Often enough, experts say senior citizens wind up spending their savings until they hit their last $2,000, and at that point they can turn to Medicaid, the government’s health insurance for the poor, to help cover the bill. As a result, Medicaid pays for more than half of the country’s longterm care bill. Please see CLIMBING COST, Page 4C
Page 2c— Creston News Advertiser — Wednesday, April 29, 2015
LIPPOLDS: Continued from Page 1C
waterfall trickles down into a koi pond where the fish swim lazily below the water’s surface. This refuge is where Mary and Jim spend a majority of their time, working to keep the flower beds clean or enjoying a short escape from reality in their own backyard. “We have a good progression of bloom from April until the first frost,” Jim said. While the work to maintain a large yard is a challenge, Mary and Jim said the key is to allow the landscape to evolve to fit their current lifestyle during their retirement. The Lippold’s backyard oasis has been a working process since they moved to Creston in 1976. It started as all dirt with a steep-sloping backyard. Once the grass
was established, Mary and Jim recognized a potential safety hazard trying to mow their yard. “Everything that is here — or at least 95 percent of everything — we planted,” Jim said. “It has been totally changed. First we just had grass, then we went to the railroad terraces, then we went to the limestone terraces with boulders.”
Changing landscape The flat levels of yard gave Mary better space to establish her flowerbeds. Mary’s father had a passion for plants he passed on to her. Several flowers, hedges and trees are starts from his garden. “I helped my dad a lot, because I like being outside more than inside,” Mary Please see LIPPOLDS, Page 3C CNA photo by JAKE WADDINGHAM
When Mary and Jim Lippold first moved to Creston, their backyard was a steep slope. For safety reasons, they installed terraces to create a flatter yard and give them better platforms for flower beds. The terraces are made out of limestone and a variety of boulders.
CNA photo by JAKE WADDINGHAM
Spring flowers pokes through the soil in one of Mary and Jim Lippold’s flowerbeds in their backyard. Mary got the plant start from her father, who she credits for her passion of gardening and landscape. “Friends You Can Depend On”
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Creston News Advertiser — Wednesday, April 29, 2015 — Page 3c
LIPPOLDS: Continued from Page 2C
said. “All the hedge on the west side were plantings that he had. After dad passed away ... I dug up some plants.” Mary and Jim started out planting a wide variety of annual flowers, switching the layout of their flowerbeds each spring. As they got older, Mary said she started to plant more perennial flowers in her beds and only use annual plants in her flower pots. She also added a few more flowering trees and shrubs that required minimum maintenance. “I am starting to feel like I should get rid of some of my perennials and start putting bushes out,” Mary said. “You kind of evolve as
you age on what you want. First when we first started working with plants, we did annuals, then we went to perennials, and now I am thinking about going more toward bushes and trees. It is all because of the physical upkeep.” Mary and Jim retired from Creston Community School District in 2005. Mary was a computer teacher for the middle school and Jim taught English, speech and theater. Jim takes care of a majority of the trimming for the shrubs. He said he prefers varieties that only require one trim a year and grow thick enough that he is able to create shapes like the boxwood hedges in front of the Lippold’s garden shed. “Our privet hedge has
to be clipped three or four times each season,” Jim said. “I prefer to clip it once and be done.” Mary prefers varieties of bushes that bloom, and that are easy to confine to a certain size and location. Please see LIPPOLDS, Page 4C Mary and Jim Lippold stand among their boxwood hedges outside of their garden shed in their backyard in Creston. Their backyard has evolved through the years to display their love for gardening while still being able to do maintenance work. Jim only has to trim the boxwood hedges once a year. CNA photo by JAKE WADDINGHAM
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Page 4c— Creston News Advertiser — Wednesday, April 29, 2015
LIPPOLDS:
CLIMBING COST:
Continued from Page 4C
Continued from Page 1
They have started to categorize their garden by their retirement date, showing friends and garden enthusiasts how the plant types have changed over the years. Trees have become another staple in the Lippold’s landscape. Jim said the longer term investment in a tree can make it difficult to remove if it is damaged or does not grow well. “If you have the guts to plant a tree, you have to have the guts to cut it down when the time comes,” Jim said. “They are like old friends.”
Maintenance A trick Mary works on each fall is cutting back all her foliage and shrubs to limit the amount of yard waste during the winter. They have a compost pile for some of the clippings, but a majority of the Lippold’s clean up goes to the city’s compost site. “We have been very pleased with the compost site,” Mary said. “That has made it so we can do all of this.” One flower bed requires more than three trips to the compost site. This year, the hours changed, making it more difficult for the Lippolds to complete their spring cleaning in their yard. “It is good that we have that, but we miss that extra day (Thursday) that we had to do it,” Jim said. “We have a compost site here, but no way enough for what we have here.” For weeds, Mary and Jim try to mulch a majority of their flower beds to limit the amount of weeds that
That cost accounts for more than a quarter of Medicaid spending, according to the Kaiser Family Foundation. Genworth and other insurers offer long-term care policies to help people shoulder the financial burden. But people have to be healthy enough to qualify for coverage. Those who take out policies find their insurance bill rises steadily as they age. Caldwell described Genworth’s survey as essentially a marketing pitch. “Of course they want people to see how much it costs CNA photo by JAKE WADDINGHAM to sell long-term care inKoi fish swim in a pond in Mary and Jim Lippold’s backyard in Creston. The Lippolds surance,” he said. “What use natural methods to clean and weed their flower beds to keep the fish and other they’re not telling you is visiting wildlife safe. pop up and to help hold moisture in the soil. They do not use any chemicals to kill the weeds because Mary likes to attract birds and butterflies to her flowerbeds. “A lot of it, she does by hand,” Jim said. Jim is recovering from shoulder surgery, so work-
ing in the flowerbeds and on the landscape has been a good way to stay mobile. For any heavy lifting, the Lippolds rely on good neighbors and friends. “Without them, we wouldn’t be able to keep doing this,” Jim said. “It would have stopped a long time ago.”
that the long-term care coverage is becoming more and more unaffordable for middle-class families.” Mounting costs have also pushed many insurance companies out of the business. Four of the five largest providers have either scaled back their business or stopped offering new policies. The largest provider, Genworth, has struggled under the weight of old policies. Less-intensive care remains much cheaper than staying at a nursing home, according to Genworth’s survey. One year in in an assisted-living facility runs $43,200. A year of visits from an agency’s home health aides runs $45,760.
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Creston News Advertiser — Wednesday, April 29, 2015— Page 5c
US intervenes in whistleblower cases against nursing homes McLEAN, Va. (AP) — The Justice Department said Tuesday that it is stepping into a long-running lawsuit against one of the nation’s largest nursing-home chains, accusing it of systematic Medicare overbilling and sometimes putting frail, dying patients through arduous rehab schedules just to increase revenue. The department is taking control of a whistleblower lawsuit in U.S. District Court in Alexandria against Toledo, Ohio-based HCR ManorCare after a yearslong investigation. The initial accusations against the company were filed by a northern Virginia occupational therapist in 2009. The lawsuit alleges that ManorCare routinely pressured administrators of its nursing homes, assisted living and rehab facilities to meet financial targets by billing for unnecessary care. ManorCare, which also operates under the Heartland and Arden Courts brands, denied wrongdoing and said the dispute revolves around providing care that exceeds government expectations. “The government bases its allegations on retrospective analyses performed by a
The lawsuit was initially filed under the False Claims Act, which allows private citizens to bring lawsuits on behalf of the United States when they have knowledge that the government is being defrauded. The U.S. can then investigate and decide whether it wants to take over the case. ■
few alleged experts who have never cared for, spoken with or even seen the patients in question. Instead, these alleged experts second-guess the hands-on clinical judgment of tens of thousands of experienced, licensed, caring and compassionate doctors, nurses and therapists who actually provided care to our patients,” the company said in a statement issued Tuesday. It declined to comment further. But Jeffrey Downey, attorney for the original whistleblower, occupational therapist Christine Ribik, said the government’s investigation of ManorCare was exhaustive and “uncovered an astonishing amount of really bad facts.” The lawsuit alleges that ManorCare routinely pushed the vast majority of its patients into Medicare’s highest tier of reha-
bilitation services, whether they needed it or not. That allowed the company to increase the amounts it billed. For instance, in 2006, ManorCare billed Medicare at the top reimbursement rate for 39 percent of its patients. That number more than doubled to 80 percent by 2009, according to the lawsuit. The lawsuit describes an 85-year-old patient at a ManorCare facility in Palm Harbor, Florida, whose medical records called for hospice care only, instead being put through 100 days of therapy even though a therapist described him as “medically fragile.” He was put into hospice care only at the end of the 100 days, which marked the length of time that Medicare would cover his therapy treatments. “We strive for a system whereby health
care providers provide reasonable and necessary services without overbilling Medicare for unreasonable and unnecessary services,” said Dana Boente, U.S. Attorney for the Eastern District of Virginia, where the case has been brought. The lawsuit does not specify the amount that investigators believe Medicare was overbilled, but says Medicare paid more than $6 billion to ManorCare’s 281 skilled nursing facilities from January 2006 to May 2012. ManorCare operates skilled nursing facilities in 30 states. It was purchased in 2007 by The Carlyle Group for $6.3 billion. The lawsuit was initially filed under the False Claims Act, which allows private citizens to bring lawsuits on behalf of the United States when they have knowledge that the government is being defrauded. The U.S. can then investigate and decide whether it wants to take over the case. Whistleblowers whose cases are taken over by the government are entitled to collect anywhere from to 15 to 25 percent of any money recovered. The percentage increases slightly if they win a case without the government’s help.
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Page 6c— Creston News Advertiser — Wednesday, April 29, 2015
Finally, Congress OKs bill reshaping Medicare doctors’ fees WASHINGTON (AP) — Conservatives hated that it’s expected to swell federal deficits over the coming decade. Liberals complained that it shortchanged health programs for children and women. But after years of complaints and failed efforts, huge majorities of lawmakers from both parties banded together and Congress approved legislation permanently recasting how Medicare reimburses physicians. Fueling the bill’s overwhelming support was backing from potent interest groups including the American Medical Association and AARP, the lobby for senior citizens. Though AARP tried unsuccessfully to change the bill to ease costs for some Medicare recipients, CEO Jo Ann Jenkins hailed its passage as “momentous” Wednesday and said the measure would help Medicare beneficiaries “rest assured that they’ll be able to keep seeing their physicians each year.” The Senate gave final congressional approval late Tuesday to the $214 billion bipartisan measure, which rewrites how Medicare pays doctors for treating over 50 million elderly people. It also provides extra money for health care programs for children and low-income people, which Democrats coveted, and imposed higher costs on some higher-income Medicare beneficiaries, which Republicans touted as a victory. Most immediately, the bill prevented a 21 percent cut in those physicians’ Medicare fees that would have hit home Wednesday when a federal agency planned to start making payments reflecting that reduction. That would have ensured a flood of complaints from doctors and senior cit-
izens that lawmakers dearly wanted to avoid. “This bipartisan bill will protect health coverage for millions of Americans, and I will be proud to sign it into Obama law,” President Barack Obama said after the Senate vote. Said Senate Majority Leader Mitch McConnell, R-Ky., “Instead of kicking this important Medicare payment issue down the road again, a strong bipartisan majority in Congress voted to finally solve the problem and ensure that seniors on Medicare don’t lose access to their doctors.” The Senate roll call was
92-8, with all eight “no” votes coming from Republicans. Among presidential hopefuls, Sens. Ted Cruz, R-Texas, and Marco Rubio, R-Fla., voted against the bill, while Rand Paul, R-Ky., an ophthalmologist, and Lindsey Graham, R-S.C., supported it. By an overwhelming 39237, the House approved the legislation last month after the compromise was crafted by House Speaker John Boehner Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif. Their joint effort marked an uncharacteristic accord to address a problem that both parties
wanted resolved. For congressional leaders including McConnell, passage provided an opportunity to demonstrate that they and their parties can govern. The bill’s chief feature was its annulling of a 1997 law aimed at slowing the growth of Medicare that has repeatedly threatened deep cuts in reimbursements to physicians and led to threats by doctors to stop treating the program’s beneficiaries. The approved bill would create a new payment system with financial incentives for physicians to bill Medicare patients for their overall care, not individual office visits. Before the measure cleared the Senate, lawmakers banded together and rejected six amendments — three from each party. Approval of any
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changes could have doomed the bill by unraveling the careful compromise between Boehner and Pelosi, but the votes let senators show their opposition to portions of the bill. By 58-42, the chamber rejected an effort by conservatives to force Congress to find enough savings to pay for the entire measure without increasing federal red ink. As written, two-thirds of the bill’s
$214 billion, 10-year price tag was financed by making huge federal deficits larger still. Though $141 billion of the bill’s costs is borne by additional federal red ink, $35 billion comes from higher expenses for Medicare beneficiaries. Most of that would come from raising the medical and prescription drug premiums paid by some upper-income recipients starting in 2018.
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The workout that works for seniors of all ages and mobility levels: resistance training As the name implies, resistance training relies on the use of resistance to build muscle strength. ■
(BPT) — Think you’re too old and frail to work out? Think again! The health benefits of daily exercise are widely known, but seniors facing health and mobility issues may feel working out is beyond their abilities. Sixty-three percent of people 60 and older don’t engage in daily exercise, according to the National Council on Aging’s The United States of Aging Survey. But resistance training can help seniors who fear falling or damaging aging muscles and bones while exercising. For seniors with health issues that might make strenuous exercise difficult, resistance training can be an accessible, healthful option that provides both physical and mental benefits, a new study indicates. “Resistance training also called strength training - is an especially safe, valuable mode of exercise
for seniors,” says Dr. Kevin O’Neil, chief medical officer for Brookdale senior living. “As you age, you lose muscle mass, bone density, strength, balance, coordination and flexibility - all of which can result in higher risk of falls and increased difficulty in performing daily tasks. Resistance training allows seniors to exercise in their own home. They can use items found in their house and they can even exercise while sitting down.” As the name implies, resistance training relies on the use of resistance to build muscle strength. Slow, measured movements are easier and more stable for seniors to perform than the strenuous activity of many types of aerobic exercise. “Smooth, controlled movement gives seniors the benefits of the specific exercise with less risk of injuries or falls,” says Nicholas Swanner, a licensed physical therapist, geriatric clinical specialist and healthcare services manager for Brookdale’s healthcare services division. Before starting any kind
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or using exercise equipment. Some of the exercises included in aquatics, Pilates, tai chi and yoga are types of resistance training, and those activities have the added bonus of social interaction when done in groups,” he says. “Seniors can benefit from any type of resis-
“Seniors can benefit from any type of resistance training as long as it’s done safely and is part of a regular routine. Pushing up and down from a chair, opening and closing a door, lifting a can of soup or a 1-pound weight are all types of resistance exercises that seniors can easily do in their own homes.” — Dr. Kevin O’Neil
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of exercise program, seniors should talk to their doctors. Once they have the go-ahead to begin resistance training, many forms can be beneficial to seniors, Swanner says. “Resistance training can include using resistance bands, lifting weights or objects around your home,
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tance training as long as it’s done safely and is part of a regular routine. Pushing up and down from a chair, opening and closing a door, lifting a can of soup
or a 1-pound weight are all types of resistance exercises that seniors can easily Please see WORKOUTS, Page 8C
Page 8c— Creston News Advertiser — Wednesday, April 29, 2015
WORKOUTS: Continued from Page 7C
do in their own homes.” Swanner recommends that seniors start slow with lower-resistance exercises and listen to their bodies. “As you age, your body changes and this will impact how and what types of exercises you will be able to do safely. There are many ways to modify exercises, routines and individual styles of training to fit a senior’s specific needs.”
Benefits Resistance training offers many benefits for seniors, including improved strength, balance, coordination and posture, better bone density, plus lower risks of heart disease, arthritis, osteoporosis and other chronic illnesses, as well as improved cognitive function and mood. A recent study published in the Journal of the American Medical Directors Association also found
that resistance training can positively affect cognitive abilities of seniors with dementia and Alzheimer’s. Engaging in exercise for 150 min-
utes a week can allow seniors to maximize the health benefits. Seniors can exercise in one 30-minute session three or four days a week if they’re able, or if that
intensity is too strenuous, they can break their workouts into 10-minute intervals throughout the week and still reap the benefits. “We always tell our seniors, ‘start
low and go slow’ when they’re beginning an exercise program,” O’Neil says. “Just 10 minutes a day provides health benefits and can feel much more achievable for seniors. Exercise duration can then be increased as endurance improves.” Resistance exercises should be done two to three days per week for each muscle group with a day of rest in between. This does not mean that other types of exercise, such as aerobic or flexibility exercises, should not be done on rest days. People who exercise daily might do resistance exercises for the upper body on one day and for the lower body on the next day. “Even if a senior has mobility or health issues that hinder aerobic exercise, he or she can still do resistance training,” Swanner says. “Talk to your physician and physical therapist to design a program that’s right for you.”
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