Medical News: Vitamins and Exercise Key to Fall Prevention - in Geriatrics, General Geriatrics from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

Exercise and vitamin D supplements top the list for primary care interventions to prevent falls in older adults, according to a review that will be the basis for updated U.S. Preventive Services Task Force (USPSTF) recommendations.

Some comprehensive multifactorial fall assessment and management interventions can be considered safe options to reduce falls in older adults in the community as well, Yvonne L. Michael, ScD, SM, of Drexel University School of Public Health in Philadelphia, and colleagues reported in the Dec. 21 issue of the Annals of Internal Medicine.

The update to USPSTF recommendations on primary care interventions for fall prevention is due in draft form for public comment soon.

The approach represents a shift for the Task Force from its traditional model, which focused on specific diseases, well-defined preventive interventions, and evidence for improved health outcomes before making recommendations, noted an accompanying article by the USPSTF Geriatric Workgroup.

"However, applying this model to prevention for very old patients has been problematic," they wrote in Annals.

Many geriatric disorders are multifactorial, while older adults are often excluded from clinical trials; and important outcomes -- such as functional disability and quality of life -- may not be measured and reported in ways that are conducive to evidence synthesis and interpretation, they pointed out.

An accompanying editorial by Mary E. Tinetti, MD, of Yale, applauded the USPSTF's willingness to change to better address the needs of older adults.

"The timing is excellent," she wrote in Annals, noting that Medicare will soon cover annual health risk assessment visits and customized prevention plans.
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U.S. GAO - Medicare: CMS Needs to Collect Consistent Information from Quality Improvement Organizations to Strengthen Its Establishment of Budgets for Quality of Care Reviews

Full Report (PDF, 24 pages) Accessible Text Recommendations (HTML)

Summary

Medicare funds health care services for more than 46 million beneficiaries. The Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--contracts with private organizations known as Quality Improvement Organizations (QIO) to, among other core functions, improve the quality of care for Medicare beneficiaries. CMS contracts with one QIO for each of the 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. One of the QIOs' many responsibilities is to review quality of care concerns, raised by Medicare beneficiaries or others, to determine whether Medicare-financed medical services meet professionally recognized standards of health care. Quality of care reviews may address a range of issues, such as inappropriate treatment or hospital staff not administering medications on time; may involve a variety of health care services and settings; and may include a range of Medicare providers or practitioners. CMS enters into 3-year contracts with QIOs for a range of activities and reviews, including quality of care reviews. For each QIO contract, CMS establishes a budget reflecting the estimated costs of these activities and reviews. For the most recent contracts, which cover August 1, 2008, through July 31, 2011, CMS's budgets for the QIOs totaled about $1.1 billion, with approximately $208 million for all types of reviews, including QIOs' quality of care reviews, as well as some other activities. Questions have been raised about CMS's ability to set budgets appropriately for QIOs' quality of care reviews. A 2006 report by the Institute of Medicine (IOM) and a 2008 internal report commissioned by CMS identified weaknesses in CMS's ability to accurately compare costs across QIOs. Based on reports of wide variation in the costs that QIOs report for conducting these reviews, Congress raised questions about how CMS establishes QIOs' budgets. Ensuring that QIOs' budgets are based on accurate information is particularly important because CMS's contracts with the QIOs are funded from the Medicare Trust Funds, which are primarily used to support inpatient and outpatient health care services for Medicare beneficiaries. QIO contracts are funded from the Medicare Trust Funds in proportions from each that CMS determines to be fair and equitable, and the QIO program is not subject to the same kind of congressional oversight as other CMS programs, which are funded through the annual appropriations process. Policymakers are concerned about the long-term solvency of these Trust Funds and thus their ability to fund health care services for Medicare beneficiaries in the future. Congress raised questions about the information QIOs report to CMS for budgeting purposes and how CMS uses this information. To assist congressional consideration of this matter, this report describes and assesses the information CMS uses to establish the portion of QIOs' budgets for quality of care reviews.

To help establish QIOs' budgets for quality of care reviews for the current contract, the 9th Statement of Work, CMS used information that QIOs are required to provide to the agency about the volume of QIOs' quality of care reviews and the costs associated with conducting these reviews. CMS requires the QIOs to record information about the volume of their quality of care reviews in CMS's Case Review Information System (CRIS) and to record information about their labor costs in CMS's Financial Information and Vouchering System (FIVS). However, CMS has not established clear instructions for how QIOs should record volume and cost information in these systems. We found inconsistencies among some QIOs in the ways they record certain volume and cost information in CRIS and FIVS. As a result, the historical quality of care review volume and cost information CMS obtains is inconsistent across QIOs and CMS cannot be assured that the budgets it establishes for QIOs' quality of care reviews are appropriate.


Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director:	Kathleen M. King
Team:	Government Accountability Office: Health Care
Phone:	No phone on record

Recommendations for Executive Action

Recommendation: To ensure that QIOs consistently record volume and cost information for their quality of care reviews and to help ensure that the budgets CMS establishes for these reviews are appropriate, the Administrator of CMS should develop clear instructions specifying how QIOs should record information about the volume and costs of their quality of care reviews in CRIS and FIVS.

Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

Status: In process

Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

U.S. GAO - Long-Term Care Hospitals: Differences in Their Oversight Compared to Other Types of Hospitals and Nursing Homes

Full Report (PDF, 51 pages) Accessible Text

Summary

This report formally transmits the briefing highlighting differences in the oversight of long-term care hospitals (LTCH), other types of hospitals, and nursing homes. This report is a partial response to a congressional request letter and was used to brief congressional staff on November 29, 2010. We provided a draft of this report to the Department of Health and Human Services (HHS) and to The Joint Commission (TJC)--an accrediting organization that oversees the majority of LTCHs.

FCC’s Performance Management Weaknesses Could Jeopardize Proposed Reforms of the Rural Health Care Program

Telemedicine offers a way to improve health care access for patients in rural areas. The Federal Communications Commission’s (FCC) Rural Health Care Program, established in 1997, provides discounts on rural health care providers’ telecommunications and information services (primary program) and funds broadband infrastructure and services (pilot program). GAO was asked to review (1) how FCC has managed the primary program to meet the needs of rural health care providers, and how well the program has addressed those needs; (2) how FCC’s design and implementation of the pilot program affected participants; and (3) FCC’s performance goals and measures for both the primary program and the pilot program, and how these goals compare with the key characteristics of successful performance goals and measures. GAO reviewed program documents and data, interviewed program staff and relevant stakeholders, and surveyed all 61 pilot program participants with recent participation in the program.

What GAO Recommends

GAO recommends that the FCC Chairman assess rural health care providers’ needs, consult with knowledgeable stakeholders, develop performance goals and measures, and develop and execute sound performance evaluation plans. In its comments, FCC did not agree or disagree with the recommendations, but discussed planned and ongoing actions to address them.

Report Highlights

Full Report

U.S. GAO - Medicaid Outpatient Prescription Drugs: Estimated Changes to Federal Upper Limits Using the Formula under the Patient Protection and Affordable Care Act

GAO-11-141R December 15, 2010 Full Report (PDF, 15 pages)

Spending on prescription drugs in Medicaid--the joint federal-state program that finances medical services for certain low-income adults and children--totaled $15.2 billion in fiscal year 2008. State Medicaid programs do not directly purchase prescription drugs; instead, they reimburse retail pharmacies for covered prescription drugs dispensed to Medicaid beneficiaries. The federal government provides matching funds to state Medicaid programs to help cover a portion of the cost of these reimbursements. For certain outpatient prescription drugs for which there are three or more therapeutically equivalent versions, state Medicaid programs may only receive federal matching funds for reimbursements up to a maximum amount, which is known as a federal upper limit (FUL). FULs were designed as a cost-containment strategy and have historically been calculated as 150 percent of the lowest published price for the therapeutically equivalent versions of a given drug from among the prices published nationally in three drug pricing compendia. The prices from these compendia are list prices suggested by drug manufacturers and do not reflect actual transaction prices. State Medicaid programs have the authority to determine their own reimbursement amounts to retail pharmacies for covered prescription drugs. However, for drugs subject to a FUL, the federal government will only provide matching funds to the extent that a state's annual reimbursements do not exceed the sum of the FULs for all such drugs. Concerns have been raised about FULs calculated based on compendia prices. For example, a 2005 report by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that FULs calculated in this manner were ineffective at controlling spending on these drugs. The 2005 OIG report found that the prices in the three price compendia used to set FULs often greatly exceeded prices in the marketplace. The Deficit Reduction Act of 2005 (DRA) established a FUL formula based on average manufacturer price (AMP) rather than compendia prices. In contrast to compendia prices, AMP represents the average of actual transaction prices paid to manufacturers for a given drug and is typically less than any of a drug's published compendium prices. Drug manufacturers are required to report AMPs to the Centers for Medicare and Medicaid Services (CMS) on a monthly basis. DRA also expanded the list of drugs subject to a FUL from those with three or more therapeutically equivalent versions to include drugs with two or more therapeutically equivalent versions. Congressional interest in controlling prescription drug costs using AMP-based FULs continues. The Patient Protection and Affordable Care Act (PPACA) established a new AMP-based formula for calculating FULs and changed the definition of AMP.8 Under PPACA, FULs are to be calculated as no less than 175 percent of the utilization-weighted average of the most recently reported monthly AMPs for the pharmaceutically and therapeutically equivalent versions of a drug. Congress expressed interest in an early indication of the potential effects of PPACA on FULs and asked us to examine the likely effects of PPACA's AMP-based formula by drawing upon data from 2008 that we gathered for our November 2009 report, including 2008 AMPs that pre-date PPACA's changes to the definition of AMP. This report examines how, for selected drugs, estimated FULs using PPACA's AMP-based formula and 2008 data compare to pre-PPACA FULs and to average retail pharmacy acquisition costs.

We found that for most of the drugs in our sample, using AMP and other data from 2008, FULs based on PPACA's formula were lower than pre-PPACA FULs and higher than average retail pharmacy acquisition costs.
Full Summary

HHS PRESS RELEASE: New Affordable Care Act rules shed light on high health insurance rate hikes

Image via WikipediaNew Affordable Care Act rules shed light on high health insurance rate hikes

New proposed Affordable Care Act regulations announced today by the U.S. Department of Health and Human Services (HHS) will bring new transparency and scrutiny to proposed health insurance rate increases.  These proposed rules allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.

“Year after year, insurance company profits soar, while Americans pay more for less health care coverage,” said Secretary Sebelius. “The Affordable Care Act is bringing unprecedented transparency and oversight to insurance premiums to help reign in the kind of excessive and unreasonable rate increases that have made insurance unaffordable for so many families.”

Health insurance premiums have risen rapidly over the past decade, straining pocketbooks for American families and businesses.  Since 1999, average premiums for family coverage have risen 131 percent. 

The Affordable Care Act has already begun to help states strengthen or create rate review processes.  On August 16, HHS awarded $46 million to 45 states and the District of Columbia to help them improve their oversight of proposed health insurance rate increases. This is part of $250 million that the health reform law makes available to states to take action against insurers seeking unreasonable rate hikes.

Today’s proposed regulations will build on these efforts by requiring insurers in all states to publicly justify any unreasonable rate increases beginning in 2011. In 2011, proposed rate increases of 10 percent or higher will be publicly disclosed and thoroughly reviewed to determine if the rate increase is unreasonable.  After 2011, state-specific thresholds would be set using data and trends that better reflect cost trends particular to each state.  Insurance company’s justifications for unreasonable increases will be posted on HealthCare.gov and the insurance plan’s website.

“The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified,” said Jay Angoff, director of HHS’ Office of Consumer Information and Insurance Oversight.

Under the proposed regulation, states with effective rate review systems would conduct the reviews. If a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them.  Meanwhile, HHS will continue to make resources available to states to strengthen their rate review processes. 

In 2014, the Affordable Care Act empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.

For more information on the regulation, go to: http://www.healthcare.gov/news/factsheets/ratereview.html.  For links to the regulation or other premium review information, go to: www.hhs.gov/ociio/initiative/index.html.

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Vitamin D in the Older Adult: The Vitamin D Conundrum

by Laura A. Stokowski, RN

Vitamin D has received a great deal of attention of late in the scientific and lay literature. Scores of mostly observational studies have investigated the possible role of vitamin D in the prevention of chronic diseases ranging from cancer to cardiovascular disease to autoimmune disorders. No one doubts that vitamin D is essential to the health of older adults; the abundance of vitamin D receptor binding sites throughout the human genome highlight the pleiotropic nature of vitamin D in the human body.^[1] However, this evidence has not consistently translated into proof of clinical benefit, leaving many wondering whether vitamin D supplementation should be recommended for older adults, or if they are fine without it.

The Institute of Medicine (IOM) recently released a new report^[2] that attempts to clear up some of this confusion, at least as far as is possible with current evidence. Dietary Reference Intakes for Calcium and Vitamin D is the product of a comprehensive review of literature and data on the health effects of vitamin D. On the basis of this review, the IOM has revised its 1997 recommendations for dietary intake of vitamin D to maintain the health of North Americans.
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U.S. Government's 2010 Financial Reprot Shows Significant Financia Mangement & Fiscal Chanllenges

Image via WikipediaThe U.S. Government Accountability Office (GAO) cannot render an opinion on the 2010 consolidated financial statements of the federal government, because of widespread material internal control weaknesses, significant uncertainties, and other limitations. 

"Even though significant progress has been made since the enactment of key financial management reforms in the 1990s, our report on the U.S. government's consolidated financial statement illustrates that much work remains to be done to improve federal financial management.  Shortcomings in three areas again prevented us from expressing an opinion on the accrual-based financial statements," said Gene Dodaro, Acting Comptroller General of the United States.

The main obstacles to a GAO opinion were: (1) serious financial management problems at the Department of Defense (DOD) that made its financial statements unauditable, (2) the federal government's inability to adequately account for and reconcile intragovernmental activity and balances between federal agencies, and (3) the federal government's ineffective process for preparing the consolidated financial statements.

In addition GAO was unable to render an opinion on the 2010 Statement of Social Insurance because of significant uncertainties, primarily related to the achievement of projected reductions in Medicare cost growth. The consolidated financial statements discuss these uncertainties, which relate to reductions in physician payment rates and to productivity improvements, and provide an illustrative alternative projection to illustrate the uncertainties. 

Dodaro also cited material weaknesses involving an estimated $125.4 billion in improper payments, information security across government, and tax collection activities. He noted that three major agencies-DOD, the Department of Homeland Security, and the Department of Labor-did not get clean opinions. Nineteen of 24 major agencies did get clean opinions on all their statements.

"Given the federal government's fiscal challenges, it's imperative that Congress, the administration, and federal managers have reliable, useful, and timely financial and performance information. Improved accuracy and transparency in financial reporting are urgently needed," Dodaro said.

Dodaro commended the commitment and professionalism of the Inspectors General across government who are responsible for auditing the annual financial statements of individual federal entities each year.

The fiscal year 2010 Financial Report of the United States Government, which includes financial information from the 24 major federal departments and agencies along with GAO's audit report, is being released today by the Treasury Department. The report is also available on GAO's web site at http://www.gao.gov/financial.html.

Confidentiality Cloaks Medicare Abuse - WSJ.com

By MARK SCHOOFS And MAURICE TAMMAN


Physical therapy, which cost Medicare almost $3.5 billion in 2008, offers a case study in how Medicare polices its payments. Even when Medicare identified providers whose physical-therapy billing raised red flags, it kept paying thousands or even millions of dollars, sometimes for years, The Wall Street Journal found. Among the cases:

•A physical therapist in Brooklyn who billed for so much therapy—more than $2.5 million in 2008 alone—that it would have been virtually impossible for him to have performed it all within state and Medicare guidelines, fraud experts say. Medicare has continued to pay him, shelling out nearly a million dollars through July of this year.

•A second doctor in Florida who pocketed more than $1.8 million from Medicare in 2007, much of it from physical therapy on patients with an extremely rare condition. Even after a Medicare antifraud contractor flagged this doctor, the agency paid him at least $6.7 million over more than two years.

•A Houston doctor whose Medicare billing under her provider number spiked from zero to more than $11.6 million in less than a year. At the time, this doctor was being investigated for misconduct in a company owned by a Nigerian with an alleged history of fraud.

There are plenty of reasons why Medicare often fails to stop questionable payments up front. To protect law-abiding doctors and hospitals—the vast majority—Medicare is required to pay nearly everybody within 30 days. Medicare says it is reluctant to suspend payments to providers who may have made honest mistakes, out of concern that beneficiaries might go without needed treatment. Law-enforcement agencies and Medicare contractors, overwhelmed by the sheer volume of Medicare fraud cases, can't investigate and prosecute them all. Sometimes, prosecutors and investigators ask Medicare to keep paying so as not to tip off targets of an investigation.

But a central problem is that Medicare hasn't fully exploited its most valuable resource: its claims database.
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Employment and Aging: Using Large Scale Data To Ask, “Who Works?” | Aging In Action

by John Davy on December 21, 2010

The so-called Great Recession has changed how Americans view work, and not just due to our 10% unemployment rate. Attacks on social security and pensions, the disappearing social safety net, and the need for many older adults to support younger family members (at a life stage when both had perhaps once expected that support would flow in the opposite direction) has delayed or ended retirement for many Americans. At the same time, job prospects for the long-term unemployed are sufficiently poor—which, as we recently discussed, particularly afflicts older adults—that many are forced into undesired, unfunded retirement.

In our recent article on employment and aging, we discussed why older adults struggle to find work, compared to younger cohorts. This may lead one to ask: what are the factors that lead older adults to search for new work? Clearly, unemployment, the loss of pensions, and the need to support spouses, children and grandchildren all lead individuals to take on new employment. Beyond individual circumstances, however, are there structural factors that influence who works? What can we learn about differences between communities, classes, ethnic groups, and regions in terms of which older adults seek out and take on work?

Full Article

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A Negative Palliative Care Trial? | GeriPal - Geriatrics and Palliative Care Blog

from GeriPal Blog

There has been a lot of good news about palliative care in the last year. Most notably is one well designed randomized control trial (RTC) finding improved survival and quality of life for stage IV lung cancer patients receiving outpatient palliative care consultations. This line of evidence has been particularly important for those of us attempting to grow palliative care programs both in the inpatient and outpatient arena. But, what should we do when the results of a RTC of inpatient palliative care consultations come up negative? Should we ignore these findings, dispute them, or acquiesce? These are the questions that I am grappling with after reading a research letter in the Archives of Internal Medicine by Dr. Steven Pantilat and colleagues.


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Granny and Clyde: When Seniors Scam Seniors - WSJ.com

Image by epSos.de via FlickrBy JASON ZWEIG and MARY PILON

A grim category of crime is on the rise: senior-on-senior financial fraud.

According to regulators and prosecutors, there has been a significant increase recently in the number of cases in which older investors have been taken advantage of by elderly scam artists.

"That's a definite new trend," says Denise Voigt Crawford, the Texas securities commissioner. "We're seeing more cases of older people ripping off other older people. Someone joked that seniors ripping off their peers is becoming 'the new retirement plan.'"

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80% of Suspended 401(k) Matches to be Restored by Mid 2011 - Financial Planning

By Lee Barney, Money Management Executive

Employers are clearly more optimistic about the economy, for another 40% that had suspended 401(k) contributions will resume them by mid 2011, doubling the 40% that already have resumed suspended or reduced matches, the Profit Sharing/401(k) Council of America announced Friday.

Full Article

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Odds Skew Against Investors in Bets on Strangers' Lives - WSJ.com

By MARK MAREMONT And LESLIE SCISM

In the summer of 2005, a firm called Life Partners Holdings Inc. said Marvin Aslett, an Idaho rancher 79 years old, had two to four years to live.

It didn't make this estimate on his behalf but for its customers. The company arranges to buy life-insurance policies from people like Mr. Aslett and sells fractional interests to investors, who collect the death benefits when the insured people die.

The investors in a $2 million policy on Mr. Aslett's life would have made a tidy return had he died as projected. But more than five years later, the rancher, now 84, says he runs on a treadmill, lifts weights and chops wood, adding that all of his grandparents lived well into their 90s.

"I'm healthy as a horse," he says. "There's going to be a lot of disappointed investors."

Life Partners, a fast-growing company in Waco, Texas, has made large fees from its life-insurance transactions while often significantly underestimating the life expectancies
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Allan Sloan - New tax law reveals the mirage of the Social Security trust fund

Image via WikipediaBy Allan Sloan

I used to joke about the government "solving" Social Security's long-term problems by creating Treasury IOUs out of thin air and sticking them in the program's trust fund. My point, of course, was to show that no matter how many Treasury securities there are in the trust fund - currently about $2.6 trillion - the fund is merely an accounting fiction that has no economic value when it comes to protecting Social Security beneficiaries.

Now, with last week's passage of the much-ballyhooed tax deal between President Obama and Republican lawmakers, my sarcastic joke has become public policy. It all has to do with the provision cutting payroll taxes in 2011.
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Betty White voted AP entertainer of the year - Yahoo! News

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By JAKE COYLE, AP Entertainment Writer Jake Coyle, Ap Entertainment Writer – Mon Dec 20, 1:03 pm ET

NEW YORK – What Betty White did in 2010 doesn't usually happen: an 88-year-old actress with more than six decades in Hollywood suddenly became the object of adulation of the Facebook-connected masses, which campaigned for her to host "Saturday Night Live," boosting the show's ratings and helping her set ratings records for her own show.

After a year remarkable for a star of any age, White has been voted the Entertainer of the Year by members of The Associated Press.

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A Shelter From Elder Abuse, Caregiving - AARP Bulletin

by: Sally Abrahms

When Tom* learned his 30-year-old son was moving to America from West Africa to live with him, he was thrilled. For more than 20 years, he had worked two jobs, as a New York City cabdriver and a security guard, so he could support his wife and seven children back home.

What he did not anticipate was having a drunk driver hit his cab, breaking two knees and his back so he was unable to work, as well as a son who refused to get a job. One day, Tom asked his son to turn down the radio. Instead, he stormed over to his dad, broke his cane and locked him in his bedroom.

Walking down the street another day, "I felt someone behind me," recalls Tom. "My son jumped on my back, and grabbed the food in my hand. I fell to the ground. 'One day I will kill you,' he said. I was in an accident and he was supposed to help me. I sacrificed my life for my kids, and this is how my son says thank you? Why did he do this to me?"

It's a question that staff get asked repeatedly by the dozen or so residents, like Tom, who come each year to the Weinberg Center for Elder Abuse Prevention located at the Hebrew Home at Riverdale in the Bronx, N.Y., the nation's first elder abuse shelter in a long-term care facility.

A whole new concept of protection

The concept couldn't come soon enough for the age 65-plus victims of physical, emotional, sexual or financial abuse, most often hurt at the hands of a family member who may also be their caregiver. Among the victims are those with dementia who may not be able to articulate the abuse; their bruises or empty bank accounts speak for themselves.

While Americans are living longer — thus delaying inheritances — unemployment is growing, the economy continues to sour and adult children and their older parents are being forced to move in together.

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The New Health Care Law and Dental Coverage - AARP Bulletin

by: Susan Jaffe

No. The law doesn't require insurers to cover dental care for adults, but there's a good chance that could change when the state insurance exchanges begin operating in 2014. These exchanges will be online marketplaces where consumers can easily compare prices and coverage and find the policy that best fits their needs.

The law says that health insurance plans sold on an exchange have to cover an "essential health benefits" package similar to the typical employer-sponsored health care policy. Nearly half of the employers offering health benefits to their employees this year provide some kind of dental coverage, including 87 percent of employers with 200 or more workers, according to a recent survey.

Although adult dental care is not among some examples of benefits the law says must be covered, consumer advocates say it appears that the U.S. Department of Health and Human Services could include it in the regulations that will detail what essential benefits must be provided.

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Ombudsman's Office snags Santa for awhile » Ventura County Star

Image via WikipediaBy Anne Kallas

Rika Vanriemsdijk, 88, was sitting alone in her room at Ventura Convalescent Hospital when Santa Claus stopped by Friday with some helpers from the Long Term Care Services of Ventura County Ombudsman’s Office.

They were handing out homemade crocheted blankets, little stuffed seals and singing Christmas carols. “They came just in time. I’m here all by myself. I’m not used to being alone. I used to be with my family. I need somebody to come in and just open a window, so I can see out,” Vanriemsdijk said, adding the visit from Santa was exactly what she needed. “If that’s not a blessing, I don’t know what is.”

Operation Senior Santa is a program of the Ombudsman’s Office, which is an “advocate for all seniors who live in nursing homes, board and care and assisted living facilities,” Executive Director Sylvia Taylor-Stein said. “Our mission is to ensure the highest level of care and investigate problems. We are a voice for the residents.”

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Borrowers as Prey, Again - NYTimes.com

Image via CrunchBaseNY Times Editorial - December 19, 2010

The Federal Reserve has been rightly criticized for not protecting borrowers — and the economy — in the years before the financial crisis. Under the law, it had the power and the obligation to curb bad lending. It was warned, by Fed insiders and by consumer advocates, of lender recklessness. It still failed to act.

Now, the Fed has proposed a rule that could undermine an important borrower protection passed by Congress in 2008. Hasn’t anything been learned?

 At issue are reverse mortgages, which let homeowners, starting at age 62, borrow against their home equity without monthly repayments. Instead, fees and interest are added to their balance, with the total repaid later, often by selling the home when the owner dies.

The 2008 law prohibited “cross selling,” in which lenders required reverse-mortgage borrowers to use some of the loan proceeds to buy other financial products, such as annuities or long-term care insurance policies, that in many instances made no sense for the borrowers. The Fed has proposed a much weaker prohibition that would allow lenders to sell financial products to reverse-mortgage borrowers as long as the purchase occurred at least 10 days after the loan was made.
Full Article

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