More than 200 San Diegans turned out  Monday to celebrate the groundbreaking of the Jacobs Medical Center,  a new 245 room facility that will house three new specialty hospitals: the Hospital for Cancer Care, the Hospital for Advanced Surgery and the Hospital for Women and Infants.

From left, Dr. David Brenner, Carol Vassiliadis, Joan and Irwin Jacobs, Chancellor Marye Anne Fox

Named for benefactors Joan and Irwin Jacobs, who donated $75 million dollars to the project, the Jacobs Medical Center will have private rooms, interactive technology, and will serve as a bridge between research being carried out at UC San Diego and bedside hospital care.

Lauren Reynolds, President and C.E.O. of At Home Care Solution, the leading provider of in home care across San Diego, served as Master of Ceremonies.  She is an active member of the Alumni Association and graduated from UC San Diego in 1994.

Lauren Reynolds Introducing Guests

“I am so proud of my alma mater,” Reynolds remarked, “…it’s growth and reach, it’s impact on our health care, our economy and quality of life.  And it’s vision for the future, which brings us to this celebration today.”

Lauren Reynolds of At Home Care Solution with the Jacobs

Marye Anne Fox, Chancellor, noted, “in addition to having state of the art equipment and facilities, [The Jacobs Medical Center] has also been designed to be patient-focused.”

The center will utilize wireless health, portable medical records and other innovations.

Dean David Brenner, Vice Chancellor for Health Sciences and the Dean of the School of Medicine remarked that when the center opens in 2016, “We will extend the reach of the Moores Cancer Center to in-patient care, given new hope to people who need it most.”

Cancer is the leading cause of death in San Diego, the goal of the Center is to improve outcomes, reduce recovery times and to draw on the latest medical breakthroughs happening on the UC San Diego campus.

“Care will be highly personalized, delivered with extraordinary precision based on a person’s genotype and unique set of environmental influences”, Brenner added.

Irwin Jacobs and his wife Joan joined Carol Vassiliadis, who donated to a wing of the hospital, Congressman Bob Filner, Mayor Jerry Sanders, Dr. Brenner, and Interim UC San Diego Health System C.E.O. Thomas V. McAfee in shoveling the first ceremonial dig of the project.

Jacobs commented that when he first arrived at UC San Diego in the 1960′s, before he launched Qualcomm, there were only a handful of buildings.  At that time, they were celebrating the construction of the one and only engineering building.  He remarked that the growth on the La Jolla campus is extraordinary and joked that he and his wife plan to be around when the Medical Center bearing their name opens its doors in 2016.

Jacobs Medical Center Quick Facts: Construction Costs $664 Million, 245 beds in private rooms, 10 Stories, 12 Operating Rooms, 18,000 Construction Jobs & 750 Permanent Healthcare Jobs

Are you caring for a loved one, or are you worried about the well being of an elderly family member?

If so, the San Diego Caregiver Coalition invites you to a free event on April 5th in Rancho Bernardo.

Called “Back to the Basics, Caregiving 101″, this three hour morning seminar will give information about basic steps to take when caring for someone else, including advise from an Elder Law Attorney and also a discussion about the myths of hospice.

Speakers include Alejandra Ceja-Aguilar from the Southern Caregiver Resource Center, Attorney Richard Scott from the Elder Care Law Firm and Jennifer Marsh of Elizabeth Hopsice.

Lauren Reynolds, owner/founder of At Home Care Solution will provide opening remarks and will introduce San Diego Council Member Carl DeMaio.

To register, simply call 1-800-827-4277 or go online at www.sharp.com.

Download a flier here: Caregiver Coalition’s Caregiving Conference-RB-Final

At the one day conference, members of the home care industry awarded Assembly Member Mariko Yamada (D-Davis) as Legislator of the Year for her efforts to introduce a cost-effective and reasonable bill that would regulate home care.  Her bill stalled in the Assembly despite its goals to protect seniors, employees and agencies from unscrupulous companies and the underground economy.

Lobby Day was organized by the California Association for Health Services at Home in direct response to two bills that threaten to vastly increase the cost of in home care.

The first is SB411, proposed by Senator Price and co-sponsored by the SEIU, a union that represents service workers.  SB411 would regulate home care, which most responsible home care agency owners support.  The problem with SB411 is that it would cost the cash-strapped California $25 million and would impose excessive regulatory costs onto home care agencies.

For example, under SB411, home care workers would need to be “certified” annually before they could perform non-medical in home care such as meal preparation, assistance with bathing, dressing and safety monitoring.  This is a higher standard of regulation than for workers who currently provide certified nursing assistant services.  Plus, at a cost of $165 per employee, per year, this certification would lead to a “tax” on the average home care business of $20,000 – $50,000 per year, an excessive fee to do business in California.

While the concept of SB411 is good, the bill goes way to far and micromanages and overwhelms the home care owner.  In addition, it would require the names and places of employment of each caregiver be posted publicly online.  This would threaten caregiver privacy and make them easy targets of identity thieves.

When Georgetta, a home care worker for more than 20 years, heard that her name and employer would be publicly posted online, she responded, “That’s not safe,  I don’t want my information available like that.”

Equally troubling is AB889, proposed by Tom Ammiano (D-San Francisco), that would end the personal care exemption for home care workers and would assume an employer is negligent if an employee files a worker’s compensation claim.  This would reverse the efforts California has made to decrease the amount of fraud and waste in the worker’s compensation system. It would also shorten worker’s hours, remove the paid meal times worker’s currently get with unpaid meal times and would increase the cost for seniors.

This bill does the opposite of what it intends.

Mr. Ammiano calls his bill the Domestic Worker’s Bill of Rights, and he is promoting it along with the union the AFL-CIO.   Mr. Ammiano cites wage and hour abuses in the domestic service industry as the need for the regulations.

Most responsible home care agencies agree that there are wage and hour abuses in domestic work, however those abuses tend to happen in private homes with workers who are not appropriately paid and do not have payroll taxes deducted.  Private workers in homes also do not have the protections of worker’s compensation insurance and employee bonding.  Adding new regulations to responsible home care agencies who already abide by the law and have appropriate protections would do nothing to stop the “door to door’ abuses in private homes.   All AB889 would do is add another layer of regulation that would fail to even touch the “underground economy” where payroll taxes are not paid and protections are not in place.

Lauren Reynolds, Owner and founder of At Home Care Solution attended lobby day and had meetings with Assemblymember Ben Hueso (D-Chula Vista), his legislative analyst Maria Garcia and Julie Hopper, a staff member of Senator Mark Wyland, (R-Carlsbad).

Assemblymember Hueso and Garcia had a good understanding of SB411 and were very attentive and polite in hearing the concerns of Reynolds and another home care agency owner.

Julie Hopper also understood the proposed bills and was supportive of the CAHSAH group in their request for help to amend or defeat the bills.

CAHSAH supports regulations of the home care industry, but in the current business and economic climate in California, those regulations need to make financial senses or as the saying goes, the cure will be worse than the disease.

While reputable home care companies, who are members of the California Association for Health Services at Home, support licensing the growing home care industry, they oppose this bill unless two very harmful provisions are amended.

First, SB 411 will require that employers pay for training for their employees, and then pay an annual fee of up to $180 per employee.  This is an exorbitant fee and it’s higher than any other fee we can think of imposed on companies in California.    This added expense to have an “annual” certification will cost the average home care agency an estimated $20,000 to $50,000 per year, an expense that will have to be passed onto consumers who already struggle to be able to afford care to stay in their homes.

Secondly, the bill will require all home care aides to have their names and where they work posted publicly on a website, which invades their privacy and threatens their personal safety.  In addition, it provides a launching pad for identity thieves who will already be able to gather a great deal about the home care workers.

One employee, Georgetta, a former nurse, said “that’s not safe; I don’t want anyone who goes online to know where I am working.”

Home care agency owners and their employees instead want to support licensing, but to have home care workers names and employers not posted publicly.

Also, it’s a waste of time and money to force companies to renew the certification of their employees “annually”.  A much better plan would be to have the certification revocable if there was any crime, similar to what happens with Certified Nursing Assistants and nurses.

On top of those two harmful provisions, SB 411 would cost the state an estimated $25 million dollars, at a time when the state is cutting services and grappling with a massive budget deficit.

A much lower cost option is AB 899.   The California Association for Health Services
at Home is supporting AB 899 by Assemblywoman Mariko Yamada (D-Davis), chair
of the Assembly Committee on Aging and Long Term Care.  It would license home care agencies and would not post employees names and placed of work online.

As the elderly population is expected to double over the next 20 years, costs must be controlled or seniors will be forced to find care in the underground economy, or worse, they’ll end up in nursing homes paid for by Medicaid.  We urge those who are concerned about these issues to contact their State Senator or Assembly member and urge no on SB 411, unless amended until it makes common and economic sense.

In a presentation to home care employers, attorney John Gilliland tried to stress that while major changes may be in store, agencies will be able to adapt.

“This wont put you out of business,” he said, clients will still need help.   A sad, unintended consequence is that the higher costs associated with the changes will force some seniors into skilled nursing homes rather than aging in place at home.

A proposal by the U.S. Labor Department would end an exemption that allows employers to not pay overtime to “companions” who provide care in someone’s private home.   This exemption has allowed longer shifts, such as 12 hour shifts and “live-in”, where the caregiver spends 24 hours in the home, but generally sleeps eight hours a night.

The proposed change would also mandate that caregivers be paid minimum wage, something that’s already law in California.

Gilliland said that there are 17 states across the country which have already eliminated the exemption and companies and clients have adjusted.

For live in care, he said, clients will be given a choice:  Do they want continuity of care with one caregiver for most of the week at a higher rate, or do they want costs lowered by having multiple caregivers in the home working less than 40 hours total?

Archana Acharya, an attorney with Murphy Law Group in Los Angeles, said of the proposed changes, “It’s a grey area right now.”

Hypothetically, in California, here is how the rule change for live in care may play out. Right now families are charged a basic rate for 16 hours of work, provided the caregiver gets 8 hours of sleep, five of those hours uninterrupted. The average rate in San Diego County is $200 – 240 per day for that service.

Under the new plan, if a family wants more continuity of care, for a 24 hour “live-in” shift, they could expect to pay a regular rate for the first 8 hours, time and a half for the second eight hours, and double time for the last four hours, adding up to sixteen hours per day of work.  Eight hours of sleep time could be deducted from the employee’s pay and the client’s costs, if the employee actually got 8 hours of sleep.  The costs to the client would likely be as much as $300 a day.

Another requirement of the proposed rule change is that records must be kept of any interruption of sleep time.   Employees would have to keep a time sheet noting any reason for waking up overnight.  In California, if an employee gets less than five hours of uninterrupted sleep, they must be paid for all 24 hours.    It’s at that point that the costs would skyrocket for clients, and it would probably be less expensive to move into a nursing facility.  Worst case, the client would likely be charged roughly $455 a day. (These are averages only, based on current law and what changes may happen.)

Gilliland points out that these rules would apply not just to home care agencies, but also to so called “registries” which act as a match-making service between clients and caregivers.  And he said the restrictions are so strict that families who hire people directly to care for loved ones will face the same rules.

For example, a family that hires someone to provide “fellowship and protection” would not be able to have that same person cook regular meals, or provide regular showers, or keep a particular schedule of care and still not pay overtime.  The person would not be able to perform housework that benefits other members of the family, for example, vacuuming the home or cleaning the restrooms.  The person would also not be able to do things like blood pressure checks.  Families that hire directly to avoid paying the overtime rules and have the employee provide regular baths or cook regular meals could be subject to lawsuits or claims by the private employee.

Finally, he said even if an employee who provided live-in care only provided “fellowship” and didn’t do any personal care, there is still the chance that the employee would not be exempt from the new federal rules if that employee participated in interstate commerce.  So what does “participating in interstate commerce mean”?  He says if the employee uses gloves purchased from another state, or takes notes on paper that crossed state lines, the employee would no longer be exempt from the regular wage and hour rules, including overtime.

The reality is these changes would affect everyone: caregivers, employers, families who hire privately and registries.   If the changes become law, it will take time and probably a couple of legal tests before a new method of operating care in the home becomes normal.

Gilliland says one things that can be expected is higher administrative costs and also higher recruiting and training costs, as more employers need to hire more caregivers, rather than have a fewer number of caregivers work more hours.

Loren celebrates 100 years

The 100 year old retired veteran and his 97 year old wife celebrated with a luncheon and party at the Encinitas Senior Center, where they have been volunteers and members for over 30 years.

Overwhelmed by all the attention, Loren responded to how he managed to live to 100, “I didn’t drink, smoke, tell dirty jokes or go with the girls who did.”

In response, his wife of 71 years told the crowd, “That’s not true, or you would not have married me.”

The happy couple - Loren and his wife, Edna

Mayor Jerome Stocks presented a proclamation from the City of Encinitas to Loren in honor of his reaching the century milestone.

Loren is King for the Day with Encinitas Mayor Jerome Stocks

The Mayor commented that Loren and his wife had lived in Encinitas for 60 years.  They bought an ocean front lot in Cardiff back in the early 1940′s, paying a whopping $700 dollars for the now multimillion dollar property. (They sold it and moved into central Encinitas years later.)

Loren commented that he wished he’d bought a few of those lots, if he only knew.  But he says, $700 was a lot back then!

At Home Care Solution was happy to provide cake for the celebration, baked by Chef Maria Santana.

The Birthday Cake

Our employee, Aida, says she’s so happy to know the couple.  Happy Birthday Loren!

Loren and Aida, At Home Care Solution Employee

Seniors who live longer generally have some sort of disability or need help at some level of living. Sandy Markwood, CEO of the National Association of Area Agencies on Aging, indicates that the focus needs to be on being able to help these seniors live at home as long as possible as nursing home cost could rise to average $72,000 a year.

Long Term Care at any level, in the home, assisted living or nursing home can add a tremendous cost to seniors and their families.

Government Programs Only Pay For About 16% Of Long Term Care

Government programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home if there is a skilled (medical) need. The Veterans Administration will cover the cost of nursing home care indefinitely if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need.

Medicaid will cover both medical and non-medical related long-term care but in order to qualify for Medicaid a person has to have less than $2,000 in assets and income that is insufficient to pay the cost of care.

Funding Long Term Care with your Life Insurance Policy

Drawing cash from life insurance or changing a life insurance policy should only be done after reviewing with an expert advisor.  Loss of the policy and death benefit could prove to be a detriment.  If, however you have accumulated cash in a life insurance policy and no longer need the coverage you may consider using the cash for long term care or purchasing a LTC rider to your current policy.

New insurance products are being developed to cover both life insurance and long term care insurance. ElderLawAnswers reports:

“A new law makes the purchase of products that combine annuities or insurance policies with long-term care insurance more attractive. These “hybrid” products are gaining in popularity due to a law that went into effect January 1, 2010, making distributions from life insurance and annuities tax-free when used to pay for long-term care. The same law also allows owners of annuities or life insurance policies to exchange their old policies for long-term care insurance or hybrid policies without being taxed.”

Combination sales which include life insurance, annuities and traditional long-term care coverage are becoming popular with insurance companies and may prove a method of financing long term care.  Investigate closely, however to find what exactly will be covered.  Some policies do not cover home care costs or complete costs of nursing homes.

Long Term Care Insurance Funding for All Long Term Care Needs

The first long-term care policies were offered about 40 years ago. These were primarily nursing home-only policies designed to take over when Medicare rehabilitation ran out. They were not the comprehensive benefit policies we see today.

Long Term Care Insurance policies today are greatly diversified in their coverage.  Home care, nursing home costs, adult day care, physical therapy, skilled and non-skilled nursing care are some of the services covered.  Policies vary in price and what they cover.  There is also a very restricted qualification of physical and mental heath to get a policy.  Purchasing a policy at a younger age makes it easier to qualify and also provides cheaper premiums. It is best to consult with a long term care insurance professional about the type of policy that fits your needs and budget.

Veterans Aid and Attendance Pension Benefit

Though not an insurance policy, the VA Pension Benefit should be mentioned as a way to pay for long term care needs.  A veteran or spouse of a veteran who served during a period of war can receive money, up to $2,019 a month, to pay for long term care medical expenses, home health care, and assisted living cost.  A qualified Veteran Consultant can help you determine if you qualify for this benefit.

Pre-Need Burial Insurance

One might ask what Pre-need burial insurance has to do with long term care. The purpose of preneed life insurance is to set aside funds for your funeral, before the need arises.
It is an insurance policy that covers the cost of the predetermined expenses of a funeral, cremation or burial.  It gives the purchaser the opportunity to preplan the services and peace of mind in having it paid for.  This is usually an insurance policy that pays at time of death for these expenses. There are many insurance companies that offer these packages as well as funeral homes.

The saddest cases of long term care needs we hear are:

“Mother can no longer live alone and she has no money to go live in a care facility.”

“ Is there someone that can come help me take care of my wife?  We live on our Social Security and I can not pay what home care costs.”

“Father died last night and we have no money to bury him, what do we do?”

It is important to make the necessary arrangements to cover long term care and end of life costs.  There is no government program that will cover all those needs. The National Care Planning Council at www.longtermcarelink.net strives to educate people about long term care services and encourages the planning that needs to be done to prepare for future costs and needs.

As a consumer advocate in 2008, Lauren confronted auto repair shop owner Arnold Parra about air bags he had supposedly repaired in a used truck.   Lauren asked to speak to him about the airbags, but instead, Parra took off running.

He had good reason to try to get away.

“He has blood on his hands,” said attorney Julie Haus.

She represented the Ellsworth family, whose 18 year old son, Bobby, died in a car crash involving that very truck.  Bobby was a passenger in the truck being driven by his friend, Waylon Blocker.  Waylon fell asleep and crashed.

The airbags should’ve deployed, but they were missing.  All that was in the steering wheel was paper.

Waylon’s family had purchased the truck from Arnold Parra.  Parra paid $3000 for it at an auction of totalled vehicles.  He made some repairs and sold it to Waylon’s parents for $8000.  But Parra didn’t repair the air bags.  He tossed some paper in the steering wheel and then glued it shut. (He always maintained he only did some bumper repair on the truck and never touched the air bags).

The Ellsworth family won a $15 million verdict against Parra, but they never were paid a dime and Parra was not convicted of any crime because there was no law about faking air bag repairs.

Lauren presented that information to Senator Leland Yee, who cited her investigation as one of 3 cases in the U.S. where fatal crashes involved fake air bag repairs.  As a result, Senator Lee sponsored a bill to make faking the repairs a crime.   Lauren welcomes the news that as of January 1st that bill becomes law.  It means that from that point forward,  someone who behaves like Arnold Parra will be doing something not just unethical, but illegal.

Original February 28, 2008 story

Family awarded millions in “fake” air bag case

The overtime exemption dates back to 1974 and it was intended for domestic employees who “provide companionship services for individuals who (because of age or infirmity) are unable to care for themselves…”

The idea was to allow a family or individual to hire a “caregiver” and set a wage for live-in, allowing the family to avoid excessive regulations regarding mandatory breaks, paperwork, etc.   Over the last three decades, the exemption has also been used by third party employers, such as home care agencies, to put caregivers in the home for so called “live-in” shifts.   The caregiver is typically paid for 16 hours of work per day and is given 8 hours of rest. The caregivers take meal breaks in the home and have access to restrooms, a phone, tv, and rest as needed.  However, regular labor codes, such as providing a 15 minute break every five hours of work, are not applicable.

The Labor Department cited a large growth in the home care industry and a growing number of workers employed as caregivers as a reason to re-examine the live-in overtime exemption.

Under the rules proposed December 15^th, home care agencies and registries would no longer be able to use the exemption for live-in workers.   It’s not yet clear if that would mean live-in caregivers would have to be paid minimum wage the first 8 hours, time and a half the second four hours, then double time the next four hours.  If that is true, the cost to seniors and their families would go up by roughly 50 percent per day.   The result could be that families would turn to the underground economy for care and would perhaps hire unscrupulous individuals who are not vetted, trained, or supervised.

Under the proposed new rules, Individuals and families could still use the exemption if they hired privately, however, that use would be narrowed.  For example, they could not hire a “professional” caregiver, or someone who provides care as a vocation.   They’d be able to use the exemption only if they hired a family member, friend, or someone who doesn’t ordinarily earn income from caregiving.

The proposed rule clarifies that only incidental housework could be performed by the live-in caregiver.  Tasks such as cleaning dishes or doing a load of laundry would be okay.  Vacuuming would not be okay.

Other incidental tasks to be allowed would include bathing, dressing, grooming, toileting, driving to appointments, feeding, etc.

It’s also not clear what affect this would have on nannies or babysitters, but the proposal seems to eliminate the exemption to not pay babysitters and nannies overtime.  So a family going out of town for the weekend would be required to pay a nanny overtime if she worked from 6pm on Friday to 8pm on Sunday evening.  Other labor codes would also have to be followed.

The proposal will be open to public comment for 60 days after it is published in the Federal Register.   Click this link to read more about the companionship exemption.

You can read more information about the proposed rules on the Labor Department website.

Post a comment about the proposed rule by clicking here.

At Home Care Solution is a leading provider of home care services including hourly, daily and live-in care.  We offer no-cost, in-home assessments and provide fully screened and trained personal care aides.

Health care reform was proposed as a solution to the rising costs, but Steve Espinoza of the Hospital Association of San Diego and Imperial County warns the road ahead is clouded with fog and haze.

Take Accountable Care Organizations for example.  Espinoza explains them this way, “It’s like a unicorn, everyone knows what it is, but no one has ever seen one.”

Health care reform is a 10 year process, with a watershed year being 2014, assuming the constitutional challenges are met and an individual mandate to buy insurance or face a penalty survives.

Accountable Care Organizations are one part of the plan.  Put simply, ACO’s are a way to reduce costs, by reducing unnecessary tests or procedures.  Those in the organization would share the cost savings and the potential risks of getting less reimbursement for undesirable outcomes.  Another major goal is to reduce hospital readmission rates within a 30 day period for the same diagnosis.

Espinoza likens the idea to a TV Manufacturer, say Sony for example.  Sony uses lots of different vendors for the parts… but it assumes liability for the entire finished product, the TV.  Accountable Care Organizations would work the same way. There would be lots of groups involved, but one over-riding organization that would bear the risk and share the reward.

Organizations would bundle care, like primary care, specialists, home health and hospital care.  Patients would be able to opt out of the ACO if they wished.

The first proposal for Accountable Care Organizations was met with fierce resistance from health care providers.   That outcry over burdensome and unrealistic rules led to another set of rules that providers now feel are more manageable.

But the devil is in the details.  The Health Care Reform bill that was approved in March of 2010 dedicated only 6 pages to Accountable Care Organizations, according to Espinoza.  But the proposed rules now take up 690 pages.  The costs of starting up an ACO have been quoted anywhere from $1.5 million to much higher.

To help provide some guidance, the California Hospital Association in early November put out a 15 page summary.  The first ACO’s are slated to start on April 1, 2012.

There is also a community based plan in the works.  In San Diego County, The Aging & Independence Services department is working on the San Diego Care Transitions Partnership.  This is a partnership that engages hospitals, nursing homes, home health agencies and other care providers across the continuum of care to prevent avoidable hospital re-admissions.   It’s a response to a solicitation for the Community-based Care Transitions Program, mandated by section 3026 of the Affordable Care Act.  AIS is partnering with Scripps, Sharp, Palmomar Pomerado and University of California San Diego Hospitals along with other providers such as home health and home care. The measurable commitment is to reduce the readmission rate for Medicare beneficiaries by 20% between January 1, 2012 and December 31, 2017.

The county is seeking charter members of this partnership.  Here is the partnership agreement for those who would like to be involved. Please click on the following link to download the form.  SanDiego_CoalitionCharter_Final