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It’s a good day when Frank Lee, a retired chef, can slip out to the hardware store, fairly confident that his wife, Robin, is in the hands of reliable help. He struggled to care for her largely on his own. “As Mom’s condition got more difficult to navigate, he was just handling it,” said Jesse Lee, the youngest of the couple’s three adult children. “It was getting harder and harder.”“Something had to change, or they would both perish.”Frank Lee’s search for trustworthy home health aides — an experience that millions of American families face — has often been exhausting and infuriating, but he has persisted. He didn’t entirely trust the care his wife would get in an assisted-living facility.

Persons: Frank Lee, Lee, ”, Jesse Lee, ” Frank Lee’s, — Locations: Palms, Charleston, S.C

☆ What to Know About Home Care Services
▼ + stars: | 2023-12-02 | by ( Reed Abelson | More About Reed Abelson | ) www.nytimes.com time to read: +1 min

And most middle-class people will have to pay for home care themselves if they will need it for the long haul. After a fall or surgery, some older people will need short-term care at home from a nurse or therapist to help them recover. Medicare, the federal insurance program for those 65 and over, typically pays for this kind of home health care. They need a home health aide or personal care assistant, who may not have much, if any, medical training. A wide range of services are available, whether it’s light housekeeping or hiring a private-duty nurse.

Persons: Monica Moreno Organizations: Medicare, Alzheimer’s Association

It was costing us $8,000 out of pocket to have people come into my mom’s house to help her, and that was only eight hours a day. She was in rehab for the maximum number of days that Medicare will cover and couldn’t return home. Because she owned a house, had two rentals, savings and two cars, she had to pay long-term care costs out of her pocket. The state says we still owe close to $20,000 for the year Medicaid paid for her nursing home. It was awful — personally all the time and energy and money to do this for her — and it was great.

Persons: I’m, —, that’s, Bryan Ness Organizations: Medicaid

Margaret Newcomb, 69, a retired French teacher, is desperately trying to protect her retirement savings by caring for her 82-year-old husband, who has severe dementia, at home in Seattle. She used to fear his disease-induced paranoia, but now he’s so frail and confused that he wanders away with no idea of how to find his way home. He gets lost so often that she attaches a tag to his shoelace with her phone number. They ran up $15,000 in medical and credit card debt while she took on the role of caretaker. “I had to do it.”Millions of families are facing such daunting life choices — and potential financial ruin — as the escalating costs of in-home care, assisted-living facilities and nursing homes devour the savings and incomes of older Americans and their relatives.

Persons: Margaret Newcomb, Feylyn Lewis, Sheila Littleton, ”, “ Locations: French, Seattle, England, Nashville, Houston

The suit targeted a large doctors’ group that operates anesthesia practices in several states, claiming the group and the private equity firm advising and financing it were consolidating doctors’ groups in Texas so they could raise prices and increase their profits. The agency brought the civil lawsuit in federal court against U.S. Anesthesia Partners and Welsh, Carson, Anderson & Stowe, a private-equity firm in New York. “These tactics enabled USAP and Welsh Carson to raise prices for anesthesia services — raking in tens of millions of extra dollars for these executives at the expense of Texas patients and businesses,” said Lina M. Kahn, the chair of the F.T.C., in a statement. “The F.T.C. will continue to scrutinize and challenge serial acquisitions, roll-ups and other stealth consolidation schemes that unlawfully undermine fair competition and harm the American public.”

Persons: Anderson, Anderson & Stowe, Welsh Carson, ”, Lina M, Kahn Organizations: Federal Trade Commission, U.S, Anesthesia Partners, Anderson & Locations: Texas, Carson, New York

☆ Insurers Deny Medical Care for the Poor at High Rates, Report Says
▼ + stars: | 2023-07-19 | by ( Reed Abelson | More About Reed Abelson | ) www.nytimes.com time to read: +1 min

Private health insurance companies paid by Medicaid denied millions of requests for care for low-income Americans with little oversight from federal and state authorities, according to a new report by U.S. investigators published Wednesday. Medicaid, the federal-state health insurance program for the poor that covers nearly 87 million people, contracts with companies to reimburse hospitals and doctors for treatment and to manage an individual’s medical care. About three-quarters of people enrolled in Medicaid receive health services through private companies, which are typically paid a fixed amount per patient rather than for each procedure or visit. The report by the inspector general’s office of the U.S. Department of Health and Human Services details how often private insurance plans refused to approve treatment and how states handled the denials. Doctors and hospitals have increasingly complained about what they consider to be endless paperwork and unjustified refusals of care by the insurers when they fail to authorize costly procedures or medicines.

Organizations: Medicaid, U.S, U.S . Department of Health, Services

Historically, doctors’ practices have been relatively small, and owned by doctors themselves. Hospitals and insurance companies have also bought out many independent physicians’ practices. Optum, an arm of the publicly traded UnitedHealth Group, which also owns one of the nation’s largest insurers, employs roughly 70,000 physicians. Private equity is often viewed by physicians as an attractive alternative to having their practice bought by a hospital. “It can be a really good thing, but the private equity firms have to keep their promises and be held accountable,” she said.

Persons: ’, “, ”, Richard Scheffler, Lisa Walkush, Grant Thornton, Michael Kroin Organizations: Physicians, Institute, Petris, . Hospitals, UnitedHealth Group, Growth Partners Locations: U.S, Berkeley, Chicago

☆ Medicare Advantage Plans Offer Few Psychiatrists
▼ + stars: | 2023-07-05 | by ( Reed Abelson | More About Reed Abelson | ) www.nytimes.com time to read: +1 min

People with private Medicare coverage may not be getting the mental health services they need because they cannot find a psychiatrist within their plan’s network, according to a new study. More than half of the counties the researchers studied did not have a single psychiatrist participating in a Medicare Advantage plan, the private-sector counterpart to traditional Medicare. Some 30 million people, just over half of all participants in the federal program, are enrolled in these private plans. The researchers, in an article published on Wednesday in the journal Health Affairs, found that of the plans reviewed, nearly two-thirds were narrow, with fewer than a quarter of available psychiatrists in a plan’s network. The more limited “networks present a frustrating additional barrier in mental health services even when, on paper, there are a sufficient number of providers in a geographic region,” the researchers wrote.

Organizations: Health Affairs

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