The Weston Group, Inc. & Paxxon Healthcare Services, LLC Story

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1 The Weston Group, Inc. & Paxxon Healthcare Services, LLC Story The Weston Group Inc. has been providing rehabilitation services specifically for the geriatric population since the 1980s. Mr. Randall Weston, OT is the owner and operator of The Weston Group, Inc. As a clinician himself, Mr. Weston he has a keen understanding of what it takes to keep the elderly safe in their home environment, decrease falls, reduce hospital admission because of falls and de-condition of the elderly, and decrease admission to nursing homes. With the population aging at a rapid rate the impact is global. Aging affects economic growth, formal and informal social support systems, and the ability of states and communities to provide resources for their older citizens. The United States must recognize the scope of the new demographic reality and adjust current policies accordingly (Reference: Decreasing falls will significantly decrease the cost of care for the elderly and the reductions in reimbursement for those who care for the elderly can be significantly impacted. With the right formula, we can decrease falls, decrease expenses to the United States healthcare system secondary to falls and aging, and improve the care provided to our aging population. Falls are the leading cause of hospital emergency room visits and hospital admissions in the United States. The bad news is that its on the rise! In 2000, falls among older adults cost the United States health care system over $19 billion dollars and $30 billion dollars in With the population aging, without a plan for intervention, both the number of falls and the costs to treat fall injuries are likely to increase. A few additionally alarming statistics related to falls are One in three adults age 65 and older falls each year. Of those who fall, 20% to 30% suffer moderate to severe injuries that make it difficult for them to live independently, and increase their risk of early death. Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes. In 2009, emergency departments treated 2.4 million nonfatal fall injuries among older adults; more than 662,000 of these patients were hospitalized. The question becomes, how much is falling going to cost the American people? In 2000, the total direct medical costs of all fall injuries for individuals 65 and older exceeded $19 billion: $0.2 billion for fatal falls, and $19 billion for nonfatal falls. By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion. Among community-dwelling older adults, fall-related injury is one of the 20 most expensive medical conditions. In 2002, about 22% of community-dwelling seniors reported falling in the previous year. Medicare costs per fall averaged between $9,113 and $13,507. Among community-dwelling seniors treated for fall injuries, 65% of direct medical costs were for inpatient hospitalizations; 10% each for medical office visits and home health care, 8% for hospital outpatient visits, 7% for emergency room visits, and 1% each for prescription drugs and dental visits. About 78% of these costs were reimbursed by Medicare.

2 In a study of people age 72 and older, the average health care cost of a fall injury totaled $19,440, which included hospital, nursing home, emergency room, and home health care but not doctors services. In 2000, the direct medical cost of fatal fall injuries totaled $179 million. About 78% of fall deaths, and 79% of total costs, were due to traumatic brain injuries (TBI) and injuries to the lower extremities. Injuries to internal organs were responsible for 28% of fall deaths and accounted for 29% of costs. Fractures were both the most common and most costly nonfatal injuries. Just over onethird of nonfatal injuries were fractures, but these accounted for 61% of total nonfatal costs or $12 billion. Hospitalizations accounted for nearly two-thirds of the costs of nonfatal fall injuries and emergency department treatment accounted for 20%. On average, the hospitalization cost for a fall injury is $17, Hip fractures are the most frequent type of fall-related fracture. The average hospitalization cost was $18,000; this was 44% of the direct medical costs for hip fractures. A fall on the same level due to slipping, tripping, or stumbling was the most common mechanism of injury (28%). Mean hospitalization cost was 17,483 US dollars (S.D.: 22,426 US dollars) in 2004 US dollars. Femur fracture was the most expensive type of injury (18,638 US dollars, S.D.: 19,990 US dollars). The mean reimbursement cost of an ED visit was 236 US dollars and 412 US dollars for an outpatient clinic visit (ref: Roudsari B et al. (2005). The acute medical care costs of fall-related injuries among the United States older adults. Injury, 36 (11): ). These fall statistics are staggering! The cost to the Medicare system is alarming, and we can agree must be brought under control. The question is how without jeopardizing our elderly? With the implementation of watches over the Medicare System, particularly as it relates to rehabilitation we, as a Nation can provide the needed rehabilitation services for our elderly without breaking the Medicare bank. Best practice results are achieved when there is significant organizational support for falls reduction across departments and disciplines. There should be interdisciplinary collaboration on falls prevention at the time of admission between admitting clinicians having first contact with the patient, including admitting physicians, therapist, and pharmacists, and nurses. The problem of fall-related hip fractures will continue to increase unless effective intervention strategies are developed and implemented to improve fall prevention interventions and expand existing programs. Older adults must take an active role in reducing their risk for falling. Not by cutting benefits, but by putting reforms in place to ensure that Medicare dollars were spent more wisely The Cost of Assisted Living Versus Nursing Home

3 Another advantage of providing rehabilitation services for the elderly is to keep them independent and living at home or within assisted or independent living communities. In 2009, reports show the national average rate for a private room at a nursing home was $219 daily or $79,935 annually; a semi-private room was $198 daily or $72,270 annually. The national average cost in 2009 for one-bedroom apartments or private rooms with private baths in assisted living communities was $3,131 monthly or $37,572 annually. In addition, assisted living communities are paid by the resident. There are no costs to the Medicare/Medicaid system. What are the costs of care in a nursing home versus assisted living versus home health care (certified aide or companion) in New York? Nursing Home Daily Cost of Care in NYC Daily Cost of Care Low High Average Private Room $275 $529 $381 Semi-Private Room $250 $489 $361 This translates to an average of $11,811 per month for a private room or $141,732 per year $11,191 per month for a semi-private room or $134,292 per year Please note: these figures are for New York City (which includes all five boroughs). Manhattan nursing homes are at least 15% higher Assisted Living Monthly Cost of Care in NYC Monthly Cost of Care Low High Average Assisted Living Facility $3,000 $8,205 $4,503 This translates to an average of $54,036 a year. Please note: these figures are for New York City (which includes all 5 boroughs). Manhattan nursing homes are at least 12% higher Home Health Care Hourly Cost of Care Hourly Rate Low High Average Home Health Aide $17 $31 $21

4 This translates to an average of $1,363.5 per month for 5 hours/3 days per week, or $16, per year $3,637 per month for 8 hours/5 days per week, or $43,646 per year $15, per month for 24/7 care, or $183,314 per year (this is not a live-in home health aide but rather multiple shifts/ personnel per day; live in rates are usually half of the multiple shift rate). Private room nursing home rates rose 4.6% to $229 per day or $83,585 per year, while assisted living rose 5.2% on average to $3,293 per month, or $39,516 per year. These increases come on top of increases from 2008 to 2009 when both nursing home and assisted living costs were up 3.3%. Costs for home health aides and adult day services were unchanged in the past year. Home health aide costs remain at an average price of $21 per hour, while adult day services costs are still $67 per day. The highest average daily rates for nursing homes continued to be in Alaska, where rates are now $687 for a private room and $610 for a semi-private room. Costs are lowest in Louisiana, outside the Baton Rouge and Shreveport Metropolitan Statistical Areas (MSA), at an average of $138 per day for a private room. For assisted living, the Washington, D.C., area had the highest average monthly base rate at $5,231, while Arkansas, outside Little Rock MSA, had the lowest average monthly rate of $2,073. Access to health care services in the United States is regarded as unreliable; many people do not receive the appropriate time and care they need. The UNITED STATES health care system, which is already strained, will face an influx of patients in 2014, when 32 million Americans will have health insurance for the first time. All of these issues, and others, make the measurement and development of new strategies and models essential. In conclusion, fall prevention programs have effectively reduced falls in select populations by 30%-50%, using multifaceted approaches that include various combinations of education, exercise, medication assessment, risk factor reduction, therapeutic intervention, and environmental modifications. Such programs need to be expanded to include multiple intervention components tailored for diverse populations of older adults and evaluated for effectiveness. In addition, secondary prevention strategies (e.g., reducing the amount of energy transferred to the hip) are needed to prevent hip fracture when falls occur. The benefits of the

5 elderly remaining in their own homes or living within the safe of an assisted living community are numerous. Having the elderly remain in their homes has a significant impact on the Federal Medicare system.

6 Reference: Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992; 82(7): Carroll NV, Slattum PW, Cox FM. The cost of falls among the community-dwelling elderly. Journal of Managed Care Pharmacy. 2005; 11(4): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed November 30, Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996; 41(5): trial. The Gerontologist 1994; 34(1): Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001; 82(8): Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1): Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME. Health care utilization and costs in a Medicare population by fall status. Medical Care 1998; 36(8): Roudsari BS, Ebel BE, Corso PS, Molinari, NM, Koepsell TD. The acute medical care costs of fall-related injuries among the UNITED STATES older adults. Injury, Int J Care Injured 2005; 36: Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorston K, Chan L. Falls in the Medicare population: incidence, associated factors, and impact on health care. Physical Therapy (4):1-9. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006; 12:290 5.