have four peers i have to reply to in a discussion 200 words each

1.In the article “Companies Improperly Cut Home Care Hours” by Nina Bernstein, the author discusses several issues related to Medicaid’s policy changes for reimbursement among managed care long-term care insurance plans in New York State.  In 2012, Medicaid began replacing the fee-for-service system with a flat rate reimbursement for each patient enrolled regardless of how many hours of care were provided.  This change created a financial incentive for managed care insurance companies, such as Senior Heath Partners of Healthfirst.  By limiting the provision of services (hours) to clients, Senior Health Partners earned more money by providing less care.  In other words, they profited from unused reimbursement funds.  Furthermore, Senior Health Partners exploited this policy change by systematically reducing hours of home care for disabled and elderly clients without proper notice or legal justification. (Bernstein, 2016, p. 2).  An independent study also found that appeals filed in 2015 disputing home-care reductions from Senior Health Partners accounted for at least 56 percent of the 1,046 fair hearings (administrative law hearings) in New York State. (Bernstein, 2016, p. 2).

As described in Chapter 8 of the textbook, “Pratt’s Long-Term Care”, by Steven Chies, Medicaid is a health care program designed for low income who cannot afford health insurance.  The program is operated by the states under federal guidelines from the Centers for Medicare & Medicaid Services (CMS).  The states are mandated to provide nursing services, home care aide services, and medical equipment and supplies. (Chies, 2021, p. 201).  Overall, home care and community-based services covered by Medicaid has increased as states continue to seek new ways of reducing costs. (Chies, 2021, p. 201).

The issues described above affect Medicaid home care and community-based services in several ways.  First, home care reductions severely impact the Medicaid clients’ access to health care and reduce their quality of life. Some clients are totally dependent on their caregivers for mobility, toileting, meals, etc.  The home care reductions also shift the responsibility of care to friends and family members or force them to pay out-of-pocket for services.  Also, Medicaid clients have limited finances and likely cannot afford legal counsel to assist in disputing the home care reductions.


Bernstein, N. (2016). “Companies improperly cut home-care hours for disabled clients, report says”, Retrieved from

Chies, S. (2021). Pratt’s long-term care: managing across the continuum. Burlington, MA: Jones & Bartlett Learning.

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hi catherine!

Great point about the effect the cuts are having the Medicaid population. They generally do not have the means to afford any kind of extra expense like an attorney or consultant to help dispute the cuts made to their services.  They are already dependent on care givers for their daily activities so just the physical demands of disputing the cuts and going through that process with court would be impossible for them to accomplish on their own.  Also, not everyone in the Medicaid home care pool has family they care rely on to assist in their accommodations.  These individuals are often left at the mercy of the system with only social workers and case managers to help organize all the services they need while helping the patient to maintain their home environment as best they can.  Many of these people end up in long term care facility unnecessarily, simply because they do not have a place to go or anyone to assist them when in the community.  These home care services are vital to many people and allow them to have a quality of life similar to everyone else.  With a few changes, all of these patients could be safely cared for in their home.

2. Based on, Companies Improperly Cut Home Care Hours  and the textbook Chapter 8: Community Based Services, what issues is the author discussing? How do they affect access to home care services and community-based services in general?

The author is discussing in both the “companies improperly cut home care hours” and chapter 8 the affect of companies cutting off hours of home care aides in the home of disabled and aged patients.In the article it explains how important Ms.Negron aide is to both her health care and her family. Senior Health Partners of Health first decided to cut off the hours an aide will be able to assist her throughout the week and this leaves time where Ms.Negron will be completely alone and she cannot adequately help herself. Another issue is that her family can’t provide her with the same care that is required for her.  Another person effected will be her aid who will receive less hours with Ms.Negron and less income. In Chapter 8 it explains that when a patient needs more care and supervision by staff it may be harder to gain some of the services due to it not being cost-effective. Even though home care services are less it can cost the insurance companies a good amount if they are more disabled and need the constant care compared to someone who only needs a aide throughout the week a few hours.

Here is an example of someone reply.

Hello Jasmine,

The issue that the author is discussing is companies cutting home care hours when they either should not be cut or if the patient is unaware of these cutbacks. Ms. Negron is having trouble with her home care services because she is not able to provide care for herself and she does need assistance. I like how you not only stated the issue with Ms. Negron, but her aide as well. Not many people focus on these issues as well. The staffing issue has been a serious issue as well. The aides hours are now getting cut as well. I am curious to know if there is a way that patients can still get the care they need that is more cost effective? For one, I think a major issue is this issue is not being discussed with the patient. The patient did not know that her services were getting cut back until it happened. It is a law that a patient is supposed to be notified when things change in her services. If a patient has an add on to a medical condition or a change of service, then it is fine for the patients status to change, but the patient always has to be made aware.

discussion 2

3. Based on, 5 Big Issues in Senior Living in 2018   and textbook Chapter 7: Senior Housing, identify and discuss significant trends impacting senior housing.

Based on the article “5 Big issues in senior living in 2018” the key issues that are impacting senior housing is an adequate amount of employees. Since the elderly is growing more the ratio of employees to seniors is impacted. Also the rate of pay is attractive to a lot of people so that is also the reason nursing home does not have staff. Another issue is that assisted living staff are getting additional work on top of the work they already do. In some states aides  now have to administer control substances. Also fraud is something that is so common in the long-term care industry, several CEOS are going to jail for white collar crimes against them. In some states cameras are being installed in the rooms of residents at assisted living facilities. For the most part assisted living facilities allow independent living to its residents, they often include wellness programs but do not provide other care options. A new option that is impacting residents is that they have reverse mortgage for seniors that are already homeowners this can allow them to continue to pay for services(Chies,pg177). Also everyone wants option for lower cost senior options because most people cannot afford the options being given, the cost may cause an effective increase of seniors if it is of a reasonable price.

example of someone reply

Hello Jasmine,

I really enjoyed reading your post and I definitely agree on your ideas and the facts that you have stated. There are major key issues that are impacting the elderly. The major issue is staffing. I have experienced a lot of staffing issues in the assisted living that I used to work out. Staffing issues can be caused due to a lot of reasons that people may not understand. I never understood until I actually became their boss. I think that it is sad because a lot of aides do not feel appreciated or do a lot of work to take care of someone but they do not get paid enough for it. Fraud is definitely another big issue because many places are not following protocol or doing what they need to in order to take care of the patient. I remember that I have experienced that as well because my old boss used to want me to commit Medicaid fraud and sign off on sheets for the residents being taken care of even though I do not believe that they have received all the care they were supposed to receive. I think that it is very important for patients to receive the care they need and for all staff and health care facilities to follow the correct protocol. Think about it, if a place was caught for fraud, look how many patients will be left without care due to the place most likely being forced to shut down.

4.According to Chapter 7 of the textbook, “Pratt’s Long-Term Care”, by Steven Chies, the most significant trends impacting senior housing including a demand for more housing options and a desire to improve quality of life.  Moreover, due to the high demand for senior housing, occupancy levels are up to 90% throughout most of the United States. (Chies, 2021, p. 179).

The article, “5 Big Issues in Senior Living in 2018”, further discussing the struggles of recruiting a high-quality workforce for the senior living communities.  In various states, many communities have partnered with community colleges and universities to develop program curriculums that focus on attracting nurses and business administration graduates specializing in healthcare.  Brookdale Senior Living, the largest senior living provider, also has offered a $7,000 student loan reimbursement for nurses interested in healthcare administration. (Anonymous, 2018, p. 1.).

Another major issue impacting senior housing and staffing are states’ changes in regulations and statutes. In some states, aides working at assisted living facilities and skilled nursing facilities will be able to perform more advanced tasks such as administrating routine and controlled substances and helping with medical equipment. Additionally, as of 2018, a new overtime rule remained on hold that could double the salary of workers at facilities that worked more than 40 hours per work. (Anonymous, 2018, p. 2).  This rule was opposed by many senior living facilities.

Fraud had been another major issue involving these communities and their senior executives.  Some of the alleged crimes committed include money laundering and kickback schemes where millions of dollars were misused from investors and healthcare providers.  Residents at senior living facilities have also fallen victim to direct mail solicitations and paying for unnecessary testing. (Anonymous, 2018, p. 4).

The desire to improve quality of life and staffing has increased interest in intergenerational programs. Many communities have partnered with colleges and universities offering residency programs with perks such as boarding in exchange for services such as participating in senior enrichment activities. (Anonymous, 2018, p. 5).

And finally, ride-hailing services, such as Uber and Lyft, have become an increasingly popular way of transporting community residents.  However, a study has also suggested that the car services industry may also have become a means for older adults to supplement their income by also participating in the “gig economy”. (Anonymous, 2018, p. 6).


Anonymous. (2018). “5 Big issues in senior living in 2018”. Retrieved from

Chies, S. (2021). Pratt’s long-term care: managing across the continuum. Burlington, MA: Jones & Bartlett Learning.

Example of someone reply

Hello Catherine,

There are definitely many of issues that impact senior living but this article only stated five of them. The five major issues are staffing, changes in regulations and statuses, fraud, intergenerational programs, transportation and of course costs. These are all issues that impact the senior living and many people do not realize it. The biggest issues that I faced when working in an assisted living is being short staffed, people committing fraud and not being able to get reliable transportation for the patients. I understand that staffing will be an issue but it is important to make sure that your staff is happy as well. It is always important to know that patients come first and the quality of care needs to be consistent and nothing should ever be taken out on the patient but some people do not see it like that. Staff might not feel appreciated for all the hard work they do and they might not get paid enough which leads to issues of patients not being taken care of the proper way. Another issue is fraud, many staff members will check off that they did something when they didn’t or take money. Fraud doesn’t just have to happen with the staff itself but it can happen with anyone in the nursing facility. The last issue is getting a ride. I have experienced first hand that Medicaid is not the best. Medicaid transportation at that is very difficult and makes things very complicated. I feel like something that will be good is definitely uber or lyft. Even though its not always so expensive, they could receive more reliable transportation.


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