Mid-April 2018 Newsletter
Executive Director's Message
April 16 is National Health Care Decisions Day. We use this opportunity each year to create awareness about the importance of planning ahead for a situation most of us don't want to think about ----     a time when health care decisions need to be made on our behalf, by someone else. We call this process "advance care planning." 
I recently took a look at my own advance directive, and my husband's. We wrote them when we executed wills when our children were small. At the time, our top concern was deciding who would take of our kids if something happened to both of us. With our children nearly grown, I've realized that we need to do a lot more thinking (and talking) about our values and preferences if one of us has a serious illness or injury. We've each selected the other to make decisions if we can't speak for ourselves, but it's been a long time since we really talked about it. Since we're getting older, we have a lot more experience to draw upon. Between us, we've lost three parents or step-parents since we first wrote our advance directives. We know a lot more about what the end-of-life can look like, and also how hard it is to be the person making the decisions. As it happens, experts recommend revisiting advance directives every 10 years, so we are overdue. 
I hope that the advance care planning process can also help raise awareness about hospice services and palliative care. Our member agencies often describe situations where clients enter hospice care only during the very last days of life. By not engaging with hospice providers earlier in their illnesses, these patients miss out on key services that could not only have improved the way they lived during their last months, but also supported their families. 
There are many tools available to support people who want to move forward with advance care planning. The VNAs of Vermont  Start the Conversation  guide can help you talk with your loved ones. The Vermont Ethics Network's  Taking Steps Vermont  program guides you through the process of assigning a health care agent, completing an advance directive and talking with your doctor. 
If being at home as long as possible or dying at home is important to you, Vermont's Advance Directive form includes a question specifically about that. Far from being prescriptive, however, the form includes open-ended questions where you can tell your care team and your loved ones anything you'd like them to know if you should become unable to speak for yourself about your care.
Please take the time this month to start the conversation with someone you love, name a health agent or create an advance directive if you haven't already. Start where you are and take the next step. If you already have these in place, consider reviewing them to be sure they still express your wishes now. 

Jill Mazza Olson
Executive Director
Federal Update
Possible New Medicare Coverage for Home Care
Last week, the Centers for Medicare & Medicaid Services (CMS) announced that  Medicare Advantage  plans may allow home care aid/personal care services as a supplemental benefit beginning in 2019, according to a  final rule  issued Monday. Medicare Advantage plans are administered by private health insurance plans on behalf of Medicare, using a managed care model like an HMO. Home care aid/personal care means helping individuals with "activities of daily living" like bathing and dressing and going to the bathroom. Usually Medicare only allows these services for individuals who also need "skilled" care like nursing and therapy. One of the most challenging realities for people who want to remain independent at home as they get older (and their families) is that long term care is not covered by Medicare. Under this change, Medicare Advantage plans can allow these services under a number of new circumstances, including to "reduce avoidable emergency and healthcare utilization." 
While in 2017,  only 8 percent of eligible Vermonters  were covered by Medicare Advantage plans, this is still a significant development. CMS is acknowledging the critical role these caregivers can play in controlling health care costs and improving care. They are in the home with the patient and can help the patient understand their doctor's instructions and they can alert family and doctors if things aren't going well. 
New Medicare Cards
CMS is removing Social Security Numbers from Medicare cards to prevent fraud, fight identity theft and keep taxpayer dollars safe. (See a photo of the card below.) The new Medicare cards will go out to beneficiaries between April 2018 and April 2019. CMS will mail the new Medicare cards in phases by geographic location. As of this writing, it appears that Vermont cards will not go out until after June, 2018, though CMS has not yet given a firm date.  Learn how  the Centers are currently pacing the mailings.

What We're Reading

The Financial Burden of Health Care Spending: Larger for Medicare Households than for Non-Medicare Households
Henry J. Kaiser Family Foundation

Upcoming Events
April 12, May 10, June 14  | 3 to 4 p.m.
Hosted by VNAs of Vermont

May 1, 15, 29   | 9 a.m. to 5 p.m.
Hosted by VNAs of Vermont
May 9  | 1 to 2:30 p.m.
Hosted by VNAs of Vermont

Upcoming Conferences
J6/JK Home Health and Hospice Medicare Summit 2018:
Maintaining a Healthy Compliance Program
hosted by National Government Services
September 19 & 20 | The Orleans, Las Vegas, NV 
Save the Date! Registration opens in February.
VNAs of Vermont | www.vnavt.com | info@vnavt.org | 802-229-0579