Medicare Ombudsman Program • Boulder County, Colo.
The Balanced Budget Act of 1997 first introduced managed care as an option nationwide for Medicare beneficiaries. In July 1998, Boulder County developed a Managed Care Ombudsman Program and began to provide 10 hours per week of staff time devoted to helping beneficiaries understand the new Medicare + Choice options.
Numerous calls were received from many community professionals as well as Medicare beneficiaries themselves. However, the highest number of calls came from caregivers, particularly adult children trying to assist parents in planning for Medicare or in solving complicated billing problems.
At that point, the county shifted its focus to create a Medicare Ombudsman Program and increased staff time to 20 hours per week. Staff members were given extensive training in Medicare law before embarking on counseling, educating and advocating for county residents.
Currently two half-time Medicare ombudsmen are assigned to address the needs of Medicare beneficiaries in Boulder County. Ombudsmen work out of a central office in Boulder, but also hold regular office hours at senior centers in cities throughout the county, improving outreach.
There are two primary components to the Medicare Ombudsman program: education and direct services.
Information sessions are presented to large groups in venues where beneficiaries, caregivers and the general public hold regular meetings. When critical and timely information needs to be disseminated immediately, the ombudsmen organize information forums that are publicized through local newspapers, corporate publications, senior center newsletters, and faith communities.
These sessions can also feature presenters from other professional and community sources to assist in getting the best and most accurate information out to the public. The program places particular emphasis on spending time to answer individual questions and assist individuals with complex billing or procedure questions.
Ombudsmen bridge the gap between beneficiaries, service providers and Medicare’s fiscal agents. Program staff contact Medicare directly, resulting in a more complete and timely response. Program staff are skilled advocates for beneficiaries and intervene when necessary to insure that beneficiaries receive the coverage and services to which they are entitled.
The program has been successful in reaching much of the community. It has established partnerships with known and credible community organizations such as senior citizen groups, faith communities, veterans’ organizations, and advocacy groups within ethnic communities.
The program places particular emphasis on serving Hispanic, black, rural, low-income and homebound elders and care-giving families.
Because of these efforts, the number of beneficiaries served by the Medicare Ombudsman Program has increased significantly. In 2000, the program made 63 outreach efforts. After the shift in focus to a Medicare Ombudsman in 2001, outreach efforts were increased to 150. Likewise, in 2000, the program conducted 24 educational presentations, which were attended by a total of 390 people.
In 2001, the program conducted 41 educational presentations, which were attended by a total of 1,186 people, an outreach increase of 238 percent and a presentation attendance increase of 304 percent.
The cost of one full-time staff member is approximately $2,700 in monthly salary and benefits. Additional costs of $3,000 for one staff member include a laptop computer for presentations, access to Web-based information through a local Internet service provider, and a cell phone with local service for a year. The program provided 41 educational seminars in 2001 at a cost of approximately $5,000 for advertising, facility fees, refreshments, etc.
Intergenerational Summer Camp • Baltimore County, Md.
The Baltimore County Department of Aging recognized an important trend developing with today’s senior citizens. Many seniors have become the primary day care providers for their grandchildren, especially in the summer months when children are home from school. This situation created a need in the senior community for the development of organized intergenerational activities wherein seniors could still enjoy their senior center programs and also fulfill their responsibilities as caregivers.
The Baltimore County Department of Aging, in partnership with the Baltimore County Department of Recreation and Parks, the Commission on Arts and Sciences, Senior Citizens, Inc. (a nonprofit organization created to benefit needy seniors), and a grant from the Weinberg Foundation, sponsored a countywide intergenerational summer camp for grandparents and grandchildren.
Housed at four local senior centers around the county, the camp ran from June 25–Aug. 16, 2001, one day a week at each location from 9 a.m.–3 p.m. Both the grandparents and children needed organized activities that would allow them to interact with their peers but allow the grandparents to spend quality time with their grandchildren as well.
The creation of the intergenerational camp solved these problems. Senior citizens were able to still go to their senior centers and bring their grandchildren. They could either be involved in a guided activity along with their grandchild as a part of the camp or they could do their own senior activity at the center knowing that their grandchild was being well-cared for by responsible staff, which consisted of one camp director and an assistant. These employees were hired and trained by the Department of Recreation and Parks and provided supervision, guidance and direction at all four locations.
Attendance fees were minimal to help seniors who were living on fixed incomes. The department wanted everyone to be allowed to participate. The fee for camp was $10 per child. The total attendance for the camp, including seniors and children, was 731 participants for all four locations. The cost for the camp, which included supplies at each location, transportation, special events, administration, and staff salary, was $14,000.
(Hats Off to … was compiled by Joseph Hansen, research assistant. For information regarding the Achievement Award program, please call (202) 661-8834.)
