Friday, April 27, 2007

It's never too late...

When 95-year-old Nola Ochs graduates next month, she will be the world's oldest college graduate. The record Ochs will break, according to Guinness World Records, belongs to Mozelle Richardson, who at age 90 in 2004 received a journalism degree from the University of Oklahoma.  On Thursday, the Kansas Legislature honored Ochs with praise and standing ovations.  Ochs did not plan to break records. She started taking classes at a community college after her husband of 39 years, Vernon, died in 1972. A class here and there over the years, and she was close to having enough hours for an undergraduate degree.  Last fall, Ochs moved the 100 miles from her farm to an apartment at Fort Hays State University to complete the final 30 hours to get a general studies degree with an emphasis on history.
An added joy for Ochs is that her 21-year-old granddaughter, Alexandra Ochs, will graduate with her.
"How many people my age have a chance to hang out with their grandmothers? She's really accepted by the other students," Alexandra said. "They enjoy her, but probably not as much as I do."  With her white hair pulled into a bun, Nola Ochs walks purposely down hallways to classes with her books in a cloth tote bag. Students nod and smile; she is described as witty, charming and down to earth.  "Everybody has accepted me, and I feel just like another student," she said. "The students respect me."

Read more about this remarkable life long learner at Yahoo/AP.

April 27, 2007 | Permalink | TrackBack (0)

Hearings on nursing home care in the US

A big, national spotlight will be on nursing home providers next Wednesday. The chair of the Senate Aging Committee is holding a hearing on the safety and quality of the nursing home industry 20 years after the implementation of the Nursing Home Reform Act, also known as OBRA '87.  Committee Chairman Herb Kohl (D-WI) will preside over the hearing, which will feature testimony from prominent individuals from provider, government, advocacy groups, and other areas. The hearing comes just days after a report found that federal enforcement actions have failed to improve quality at some nursing homes.

Panelists will include: Mary Ousley, former chair of the American Health Care Association; Kathryn Allen, director of health care, U.S. Government Accountability Office; and Alice H. Hedt, executive director of the National Citizen's Coalition for Nursing Home Reform. The hearing will be held at 10:30 EST May 2 in the Dirksen Senate Building.

Source:  McKnight's Long Term Care News

April 27, 2007 in Health Care/Long Term Care | Permalink | TrackBack (0)

Tuesday, April 24, 2007

CMA, NSCLC announce "Justice Partnership"

The Center for Medicare Advocacy and the National Senior Citizens Law Center announce a new affiliation called the "Justice Partnership". The groups are planning a major conference in Washington, DC to focus advocates and policymakers on the challenges facing lower income older people and people with disabilities. The conference will take place this October.

For two decades the Center for Medicare Advocacy and the National Senior Citizens Law Center (NSCLC) have worked together. The two organizations have shared histories, interrelated missions, and have successfully collaborated in significant litigation, projects, and grants to advance the rights of older people and people with disabilities.

The Justice Partnership grows out of a mutual concern that the safety net for older Americans, created over the last several decades, is unraveling. By collaborating more closely, both organizations will strengthen their ability to advance the legal rights of lower-income older people and people with disabilities and to ensure fair access to quality health care. The partnership comes as Michael Kelly takes the helm as NSCLC's new executive director.

Kelly says he is excited about this new affiliation, "Together we will be able to tackle important work for our clients that neither organization could take on alone." Judith Stein, executive director of the Center for Medicare Advocacy agrees. "The Justice Partnership will expand our geographic horizons, our expertise, and our ability to solve the real problems of real people," says Ms. Stein.

In celebration of the National Senior Citizens Law Center's 35th anniversary and the Center for Medicare Advocacy's 21st anniversary, the first major venture of the Justice Partnership will be a national conference about challenges facing lower-income older people.  The conference will be held at the Kaiser Family Foundation in Washington, DC on October 19th. It will assemble advocates, policy-makers, and academicians to examine creative solutions to meet the needs of an aging society.

April 24, 2007 in Medicare | Permalink | TrackBack (0)

SS Trustees' Report released

The Social Security Board of Trustees today released its annual report on the financial health of the Social Security Trust Funds.  The 2007 Trustees Report shows slight improvement in the projected financial status of the Social Security program from last year.             

In the 2007 Annual Report to Congress, the Trustees  announced:            

  • The projected point at which tax revenues will fall below program costs comes in 2017 -- the same as the estimate in last year’s report.              
  • The projected point at which the Trust Funds will be exhausted comes in 2041 -- one year later than the projection in last year’s report.              
  • The projected actuarial deficit over the 75-year long-range period is 1.95 percent of taxable payroll -- .06 percentage point smaller than in last year’s report.              
  • Over the 75-year period, the Trust Funds would require additional revenue equivalent to $4.7 trillion in today’s dollars to pay all scheduled benefits.  This unfunded obligation is about $100 billion higher than the amount estimated last year.    
      • “Social Security provides valuable economic protection to workers and their families.  We owe it to the American public to continue to offer the best possible support for older Americans, people with disabilities and their families in the coming decades,” said Michael J. Astrue, Commissioner of Social Security.  “The Trustees Report is an important tool for those in the legislative and executive branches who will have to make the very difficult decisions about how best to ensure Social Security remains viable for the long term.”             

        Other highlights of the Trustees Report include:

        • Income including interest to the combined Old-Age and Survivors, and Disability Insurance (OASDI) Trust Funds amounted to $745 billion ($626 billion in net contributions, $17 billion from taxation of benefits and $102 billion in interest) in 2006.

        • Total expenditures from the combined OASDI Trust  Funds amounted to $555 billion in 2006.                         

        • The assets of the combined OASDI Trust Funds  increased by about $190 billion in 2006 to a total of $2 trillion

        • During 2006, an estimated 162 million people had  earnings covered by Social Security and paid payroll taxes.      

        • Social Security paid benefits of $546 billion in calendar year 2006.  There were 49 million beneficiaries at the end of the calendar year.

        • The cost of $5.3 billion to administer the  program in 2006 was a very low 1.0 percent of total expenditures. The combined Trust Fund assets earned interest at  an effective annual rate of 5.3 percent.
  • The 2007 Trustees Report is posted at

April 24, 2007 in Medicare, Social Security | Permalink | TrackBack (0)

Monday, April 23, 2007

More creepy elder-monitoring....

Satellite technology could be used to allow families to monitor elderly relatives or those suffering from Alzheimer's, the Government suggested yesterday.  Malcolm Wicks, the science and innovation minister, told MPs that satellites currently monitored the planet in various ways - including the -climate, the Antarctic and crops.  Many motorists now used "satnav" systems - connected to global position satellites - instead of maps to find their way around. The devices are accurate to within a few yards.  "I'm raising this as a question for discussion - are there other uses of satellite technology that could benefit society?" Mr Wicks told The Daily Telegraph.  "For example, we've got an ageing population, with many people frail and many suffering from dementia, including Alzheimer's - how can we get the balance right so that these people have the freedom to live their lives, to go out into the community and go shopping, but also that some might benefit from being monitored so that their families know they are safe and secure?

Source:  The Telegraph (UK),

And here's a follow up story...,,2061561,00.html

April 23, 2007 in Other | Permalink | TrackBack (0)

Sunday, April 22, 2007

Not elder law: Gray is beautiful

Gray_2 Once upon a time, women would curse their gray hair and reach for the dye to cover it up.  Or they'd eventually cave in and drench themselves in that ghastly purplish-blue rinse - the one that turns the shade of the Rocky Mountains at dusk. It was like the mark of the old-age beast.  But with salt falling on their heads like a blizzard, baby boomers are, as usual, opting to do it their way. So long, stigma, hello gray.  It's a fashion statement showing up more and more, even in Hollywood (think of a classy-looking Meryl Streep in "The Devil Wears Prada" or the radiant Helen Mirren at the Oscars).  "Baby boomers aren't afraid. They led the way in coloring hair and now that they are older, they don't hesitate not to color their hair either," says Greg Chavez, owner of J. Gregory Salon, an upscale spot in Colorado Springs, Colo.

Read more:

April 22, 2007 in Other | Permalink | TrackBack (0)

EBRI 60th conference is May 3

EBRI's 60th policy forum, The Impact of PPA, FASB, and GASB on Defined Benefit Pension Plans, will be held in Washington, DC, on Thursday, May 3, 2007." For more information, please contact Alicia Willis at (202) 572-7422; e-mail:, or Jack VanDerhei at (202) 775-6327; e-mail:


April 22, 2007 in Retirement | Permalink | TrackBack (0)

AoA updates aging-related conference information

TOC and abstracts: Journal of Elder Abuse and Neglect

"No Secrets" and Beyond: Recent Elder Abuse Policy in England
Page Range: 1 - 18
DOI: 10.1300/J084v18n01_01

Rachel Filinson

  This paper provides an overview of English elder abuse policy including guidelines developed for adult protection by their Department of Health in 2000, a report released fromtheHouse of Commons Health Committee in 2004 on elder abuse, related policy changes affecting older adults, the mentally incapacitated, and social care regulations, and the launching of public awareness campaigns. In contrast to the U.S., English policy subsumes elder abuse within the larger category of vulnerable adult protection, steers clear of mandatory reporting, emphasizes abuse by formal caregivers rather than domestic violence, relies on a multiagency approach to investigation and intervention, and supports more remedial, less punitive regulatory oversight. doi:10.1300/J084v18n01_01
  Keywords: Elderly abuse, policy, regulation, England

Nursing Home Statutes: Mistreatment Definitions
Page Range: 19 - 39
DOI: 10.1300/J084v18n01_02

Jeanette M. Daly, Gerald J. Jogerst

  Introduction. Forty-nine states and the District of Columbia have adult protective services (APS) related statutes that define adult/elder mistreatment found in domestic settings. Institutional adult/elder mistreatment laws are administered by the nursing home licensing agencies and may contain different or duplicate APS-related mistreatment definitions. The purposes of this paper are to describe and summarize the mistreatment definitions in the nursing home licensure statutes and compare those definitions with the definitions found in the APS-related statutes. Methods. Westlaw and Lexis-Nexis law database systems were used to retrieve all adult protective services statutes and institutional licensure statutes. Each statute's text was reviewed and coded by two researchers. Results. Institutional mistreatment definitions are addressed in 14 of the states and District of Columbia's nursing home statutes. No one state has a list of the 27 different definitions of mistreatment identified in the literature search. The common types of mistreatment described were physical and emotional abuse, neglect, financial and property exploitation, and sexual abuse. Conclusion. Standardized definitions of resident-to-resident and institutional specific types of mistreatment need to be included in nursing home statutes. doi:10.1300/J084v18n01_02
  Keywords: Elder mistreatment, abuse, older women, intimate partner violence, interpersonal abuse

Recommendations for the Elder Abuse, Health, and Justice Fields About Medical Forensic Issues Related to Elder Abuse and Neglect

Page Range: 41 - 81
DOI: 10.1300/J084v18n01_03

Lori Stiegel JD

  Increased interest in pursuing criminal and civil actions against alleged perpetrators of elder abuse and neglect has revealed that efforts to assist victims and hold perpetrators accountable are often hampered by the lack of knowledge about the detection and diagnosis of elder abuse and neglect and by the lack of resources for development of research and assistance in these matters. This report sets forth recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect. The recommendations were developed by a "working group" of experts representing an array of disciplines that address the problem of elder abuse and neglect pursuant to a grant project funded by the National Institute of Justice (NIJ), the research, development, and evaluation agency of the U.S. Department of Justice (DOJ). The project was conducted by the American Bar Association Commission on Law and Aging, with the assistance of the University of California, Irvine School of Medicine. This was the final project report submitted to NIJ; it has been updated to include information about the availability of reports and products from other grant projects that are discussed in the report. doi:10.1300/J084v18n01_03
  Keywords: Elder abuse and neglect, forensic, prosecutors, law enforcement, first responders, adult protective services, health care providers, medical examiners, coroners, researchers, educators, funeral home directors, regulatory agencies for long term care facilities, detection, diagnosis, screening, assessment, multidisciplinary, training

The Prevalence and Incidence of Intimate Partner and Interpersonal Mistreatment in Older Women in Primary Care Offices
Page Range: 83 - 105
DOI: 10.1300/J084v18n01_04

Therese Zink MD, MPH, Bonnie S. Fisher PhD

  Self-report information about mistreatment experiences and perpetrators were collected from a large sample of women over 55 years of age who sought care from Midwestern primary care offices. A significantly larger proportion of women had experienced sexual mistreatment since turning 55 that was perpetrated by an intimate partner than committed by an interpersonal perpetrator. The women experienced significantly more threats, physical mistreatment, and caregiver mistreatment since turning 55, and more threats and caregiver mistreatment within the last year by an interpersonal perpetrator than by an intimate partner. Several women described different types of perpetrators who had threatened or mistreated them. Few women reported the mistreatment to anyone. Implications for elder service providers and advocates are discussed. doi:10.1300/J084v18n01_04
  Keywords: Elder mistreatment, abuse, older women, intimate partner violence, interpersonal abuse

Elder Abuse in Europe: An Overview of Recent Developments
Page Range: 107 - 116
DOI: 10.1300/J084v18n01_05

Bridget Penhale MSc

  Elder abuse is a global phenomenon. Despite recognition and action several decades ago in a number of countries, in many others the phenomena of abuse and neglect have been much more recently identified as in need of attention. This brief will discuss the situation relating to responses to and interventions in elder abuse that have been evolving in a number of countries in the European region, which are at different stages of development. The examples provided will assist in meeting the worldwide challenge that elder abuse presents. doi:10.1300/J084v18n01_05
  Keywords: Elder abuse, neglect, European context, developing responses

April 22, 2007 in Elder Abuse/Guardianship/Conservatorship | Permalink | TrackBack (0)

Stetson launches online LLM in elder law

Stetson University College of Law is offering the nation’s first online LL.M. degree in elder law beginning this fall.  The three-semester, 24-credit program allows students to study online at times that are convenient for their schedules.  The program is directed by Professor Rebecca Morgan, who leads Stetson’s Center for Excellence in Elder Law and holds the Boston Asset Management Faculty Chair in Elder Law, the first elder law chair in the country.  Applicants for admission to the program must have received their first law degree from a U.S. law school or at a law school approved by the appropriate authority in a country other than the United States. Foreign applicants must have received a law degree from a law school approved by the appropriate authority in their respective countries.  To learn more about the program, visit or call 562-7849 or e-mail

April 22, 2007 in Other | Permalink | TrackBack (0)

Wednesday, April 18, 2007

Kenney Hegland (Arizona) co-authors elder care book

Hegland Kenney Hegland (Arizona) and Robert Fleming have recently co-authored a book. Alive and Kicking: Legal Advice for Boomers." First copies are arriving from the warehouse this week.   Seniors and their adult children are the intended audience.  According to Robert Fleming, Professor Hegland "has a unique writing style and an extraordinary command of literary minutiae--making the product wry, witty and (heaven forfend) erudite."  The book is available at

April 18, 2007 in Health Care/Long Term Care | Permalink | TrackBack (0)

Tuesday, April 17, 2007

Medicare D bill would require comparative efficacy studies

A bill expected to go to the Senate floor this week would seek to begin changing that by having the government compare major kinds of medications and treatments provided to more than 43 million Medicare recipients to see how well they work.  The legislation faces an uphill battle because it would also lift the prohibition against the government negotiating lower drug prices for seniors in the Medicare prescription program — a change that President Bush has threatened to veto.  Yet the little-noticed consumer information provisions of the Senate bill could transform the market behavior of millions of patients — with potentially greater cost savings for seniors and taxpayers than merely granting bargaining power to Medicare bureaucrats.  "The stuff on comparative effectiveness is certainly important, and maybe even more important than negotiating authority," said William Vaughan, a senior policy analyst with Consumers Union, publisher of Consumer Reports. "Ninety-nine percent of us respond the same way to different kinds of pills. When we know the facts, we will buy the stuff that works."  The comparison studies are just one way in which the Senate bill differs from a version passed in the House as part of the Democratic majority's initial agenda.

Source:  LA Times

Just how nervous are the drug companies about this bill?  Check out the full page ad in today's major newspapers, such as the one in today's Minneapolis Star Tribune, and you'll get a sense. 

April 17, 2007 in Medicare | Permalink | TrackBack (0)

Monday, April 16, 2007

On Vonnegut and the boomers

Like his friend Joseph Heller, Kurt Vonnegut was a hero to baby boomers -- though he was raised in an earlier time. The president he mourned was Franklin Delano Roosevelt, not John F. Kennedy. His war was the Second World War, not Vietnam.  Nearly 40 when the 1960s began, Vonnegut was less a peer of the young rebels who loved such novels as Cat's Cradle and Slaughterhouse Five, than a wise, eccentric and cranky uncle, scorning the world's madness but rarely failing to get some laughs or challenge some minds.  Vonnegut, who died this week at 84, didn't need Vietnam to figure out that the system didn't work, that the 1950s were a lie and that you shouldn't believe what grown-ups tell you. His absurdist humour, the survival tactic of a former prisoner of war whose mother had committed suicide, proved as useful and as up-to-date to the postwar generation as a Bob Dylan song.  "Growing up when I did, at a time of widespread alienation and disgust, Vonnegut's irreverence was very appealing, and certainly influenced my own views of contemporary life," said novelist Ken Kalfus, 53, a National Book Award finalist last year for A Disorder Peculiar to the Country, a satire of marriage, Sept. 11 and the Iraq war. "His work opened up new space to think about politics and society and also to think about what literature was good for." Norman Mailer, another Second World War veteran who found an audience with younger readers, noted that Vonnegut was "an icon to several generations of young Americans who rushed to read everything he published."

Read more in the Victoria (BC) Times-Colonist,

April 16, 2007 in Other | Permalink | TrackBack (0)

The new Bush Social Security reform plan

President Bush signed an ambitious Social Security plan into law Monday that will allow citizens to bet a third of their payroll taxes on their favorite sports teams.  It's time we gave the American people the chance to make some real money for retirement," Bush said, speaking from the new Office of Social Security and Pari-mutuel Wagering Building. "Some naysayers think the average citizen doesn't know how to handle his own money. When spring training starts next year, it's up to you to prove them wrong."  "It's your money," Bush added. "You earned it. You should be able to bet it on whatever team you want."  Under the new plan, participating citizens will be asked to list their favorite teams on their W-2 forms. At the start of each major sports season, program participants will visit their local Social Security booking offices to review point spreads and sample playoff trees. Citizens' team selections will be subject to approval by their employers, who contribute a percentage of wages to the employee Social Security Earned Benefits Fund, or "pot," under the new system.

Source:  The Onion (of course),

Thanks to WM 2-L Phil Ruce for the tip. 

April 16, 2007 in Social Security | Permalink | TrackBack (0)

Sunday, April 15, 2007

Smoking ban annoys seniors

There is little sympathy from Premier Dalton McGuinty for Ontario smokers forced out into the cold from their long-term care and nursing homes.  One senior has already died after taking a smoking break outside his long-term care home on Manitoulin Island in below-freezing temperatures. The tobacco-industry sponsored group says many seniors have been forced outside in dangerous, icy conditions since the provincewide smoking ban became law last June.  McGuinty says he understands that some long-term care facilities don't have the money to build specially ventilated rooms for smokers.  He says the government had to make some tough choices with its smoking ban, and one of those was to protect workers at nursing homes from second-hand smoke.  Health Minister George Smitherman says the smoking ban also protects the vast majority of seniors living in care who do not smoke.


April 15, 2007 in Discrimination | Permalink | TrackBack (0)

Thursday, April 12, 2007

CCELS Call for Papers

The Canadian Centre for Elder Law Studies has announced a Call for Papers for the Third Annual Canadian Conference on Elder Law, to be held November 9th and 10th, 2007 at the Sheraton Wall Centre, Vancouver, Canada.  The overarching theme for the 2007 Conference is: Moving Forward, Moving Beyond.

We invite individual abstracts, as well as abstracts for a full panel or symposium.  The abstract deadline is MAY 30th, 2007.

This umbrella conference will also feature various other events including the following:

*       Simon Fraser University Ting Forum on Social Justice.  This year's streamed forum will focus on Social Justice Responses to Elder Abuse.

*       The Third Annual 2007 meeting of the World Study Group on Elder Law (November 8th) - an academic forum for scholarly research and networking.

*       The Canadian Federal / Provincial / Territorial Working Group on Seniors' Issues Forum on Elder Abuse (by government invitation only).

*       Gala Dinner - with Michael Valpy, Senior Writer, Globe and Mail.

*       Distinguished Keynote Address by the Right Honourable Beverley McLachlin, P.C., Chief Justice of Canada.

Submissions for this year's Call for Papers should include a completed Submissions Form detailing 1) the title of the proposed paper, 2) an abstract of up to 250 words, and 3) full contact information including firm or organizational affiliation, email address, as well as the fax/telephone number of the presenter.

Again, the deadline for abstract proposals is May 30, 2007; but early expressions of interest are strongly encouraged.

More information will be posted regularly on our website at <>  or by emailing .  Submissions should be Journal length (approximately 15 - 40 pages double-spaced) in Word format with 12-point font.

April 12, 2007 in Other | Permalink | TrackBack (0)

Wednesday, April 11, 2007

Monstrous hike in LTCI premiums for California public employees

Thousands of state and local government workers and retirees will pay more for long-term care policies as California's largest health insurance provider struggles to contain costs.  The California Public Employees' Retirement System has notified 173,000 policyholders that the cost of an average long-term care policy will go up by about a third beginning this summer.  The move comes after trustees of the $4 billion nonprofit agreed last year to raise rates to offset a projected $600 million deficit in the coming decades. The increases will range from 5 percent for younger, healthier individuals to 47 percent for older members.  “Long-term (care) is probably the greatest need you may have,” said Wayne Doyle, a 64-year-old retired firefighter from Redding. “They're putting us in a position of considering dropping out of the program.”


Meanwhile, some 20 states will begin launching--using taxpayer funds--a hard-core sales campaign promoting private LTCI as part of the DRA-authorized Long Term Care Partnerships.  Policies sold as partnership policies don't have to contain cost control provisions.  Say what?

April 11, 2007 in Health Care/Long Term Care | Permalink | TrackBack (0)

Convention on the Rights of Persons with Disabilities

Disable The Convention on the Rights of Persons with Disabilities was opened for signature at the U.N. on March 30, 2007.    It is found at, along with FAQs (such as "What is an international convention?"):

April 11, 2007 in Discrimination | Permalink | TrackBack (0)

Tuesday, April 10, 2007

"Private" Medicare plans are no deal for seniors--or taxpayers

When the federal government implemented the Medicare prescription drug, or Part D, plan in January 2006, the focus was to provide beneficiaries with drug coverage, something previously available only through private supplemental plans. But the government also allowed private insurance companies, approved to sell Part D, to sell their own comprehensive health plans that replace traditional Medicare.  Last winter, when an agent selling private Medicare plans called Perkins' mother, Gertrude Jenkins, who was then living at home, Perkins listened to the agent's spiel.  "They said they could give her a good break if she took the Part D and the medical," he recalled.  His mother, 88, also of Fort Wayne, was taking only a few medications at the time. The $12 monthly cost for Part D "looked really good," Perkins said. Her co-pay for doctors' visits was just $20."So I signed her up," he said. But in October, his mother broke her hip, requiring surgery, hospitalization and rehabilitation. Perkins was then told the hospital could not get the private Medicare company to approve in-hospital rehabilitation, something traditional Medicare covered when she broke her other hip a few years back.
So it was off to a nursing home for rehabilitation. That's when the real shocker came, Perkins said: "There was only one nursing home in Fort Wayne that was in (the company's) network."  It was not the one he wanted to take her to, "but I had no other option," he said.  If he moved her to an out-of-network facility, any one of Allen County's 24 other nursing homes, the out-of-pocket cost for his mother would be $150 per day, or 10 times the cost of the in-network one.  If his mother had kept the traditional plan, Medicare would have paid all costs for the first 20 days in the nursing home, and all but $124 a day after that. Medicare pays part of the cost up to a possible 100 days for a nursing-home resident who comes directly from the hospital."

Source:  North

Ed:  the taxpayer cost-per-patient for private Medicare plans is 20% higher than traditional Medicare. 

April 10, 2007 in Medicare | Permalink | TrackBack (0)

Big part D plans won't cover brand-name drugs in donut hole

The gap in Medicare's prescription drug coverage is looking deeper.  For the second time in two years, a major insurer that covered brand-name drugs in the "doughnut hole" has said it's losing money on the drug plan and pulling it off the market at the end of the year.  As a result, seniors who depend on costly medications to treat chronic or serious illnesses are left to wonder, again, where to turn for comprehensive drug coverage next year.  Of 60 drug plans available in Texas this year, 17 cover generic drugs in the doughnut hole, where seniors typically bear the full cost of prescriptions.

Read more in the Dallas Morning News.

April 10, 2007 in Medicare | Permalink | TrackBack (0)