Thursday, June 17, 2010

My Blog has moved!!

I have moved my LTC Reform blog to Posterous because it is just easier to use.

Go to to subscribe.

Thursday, April 29, 2010

ADAPT Action Update

Link is Twitter posts.

Pics at

More pics at

Joe's take at

"See youuuuu in September.... (got to be old to remember this)

Norman DeLisle, MDRC "With Liberty and Access for All!" GrandCentral: 517-589-4081 MDRC Website: LTC Blog: Recovery:

Wednesday, April 28, 2010

Update on ADAPT Action

Link is the "official" (is anything about ADAPT official?) Action Update.

Oodles of Photos at

Great stuff!

Norman DeLisle, MDRC "With Liberty and Access for All!" GrandCentral: 517-589-4081 MDRC Website: LTC Blog: Recovery:

Monday, April 26, 2010

Latest on ADAPT in DC

Many more pictures of the buildup to today's actions:

More later....

Norman DeLisle, MDRC "With Liberty and Access for All!" GrandCentral: 517-589-4081 MDRC Website: LTC Blog: Recovery:

Sunday, April 25, 2010

National ADAPT at the Gates!

National ADAPT is ready to fight for Choice and Freedom.

Find photos at

Best way to follow is through National Adapt Tweets! at

More as things develop.

Norman DeLisle, MDRC "With Liberty and Access for All!" GrandCentral: 517-589-4081 MDRC Website: LTC Blog: Recovery:

Sunday, April 4, 2010

Lingering Fears, Lingering Problems

Recently, much has been made about what LTC services should be provided to elderly prison inmates, and where those services should be provided. The politics of the issue has focused on persons convicted of sexual offences and violent crimes, though, of course, any ex-inmate committing any criminal offense in any LTC setting will grist for that mill (as compared with someone never convicted of a crime who commits the same crime in an LTC setting).

The financial issue is that LTC services provided in prison must be paid for out of only state tax revenues or "General Funds" (GF). Ex-inmates could be eligible for Medicaid, and that means that our Federal tax dollars, in the form of Medicaid, could be used to provide LTC services. The services would likely be less expensive, too, given the increasing costs of security.

But old inmates are only the beginning of the issue. There will be many more inmates coming out of our prisons (one way or another, all of them), and some of them will require LTC supports at one or more times in their life. There is a very real possibility that the political problem of security will allow a back door method for recreating large institutions.

We need to be thinking through the general issue of personal security in community based LTC. Two principles should be that individuals can live on their own with supports, and that people should never be forced to accept any room mate. Another should be that individuals receiving community-based LTC should be able to choose assistive technology that supports their personal security.

At a higher level, organizations that manage LTC and organizations that provide supports need to include these principles in their work, and everyone who gets LTC needs to consider personal security as part of their LTC planning. 

Or we may see real LTC reform corrupted by all too common fears.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website:
LTC Blog:

Tuesday, March 30, 2010

Comments on Health Reform Goodies

Now that health reform has passed, what can we expect?

In the Near Term:
  • In 90 days, a temporary high risk pool for people with pre-existing conditions. High risk pools only work for people with chronic conditions if the premiums are controlled. Otherwise, the premiums tend to drift up and make the pool not affordable.
  • Parents can cover their kids up to age 26. I think, but am not sure, this adds a year and broadens already existing practice for some carriers.
  • No more life time limits on dollars of coverage.
  • Better coverage of preventive services
  • Better monitoring of carrier use of funds, and better investigation of big rate increases
  • Medicare Donut hole rebate for the near term, and elimination of the donut hole by 2020
  • Expanded Medicare coverage for people exposed to an environmental emergencies
  • Improved care coordination for people who receive both Medicare and Medicaid
  • A 10% tax on tanning services(!)
A couple of other interesting things:
  • Section 2402 and what follows seem to allow home and community based services in a waiver to easily use 300% of SSI as the income limit. This would broaden eligibility for waiver services in many waivers.
  • An interesting project on shared medical decision making
Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website:
LTC Blog:

Thursday, February 4, 2010

#LTCReform: Health Care Reform and Older Americans: Achieving Better Chronic Care at Lower Costs at

Friday, January 22, 2010

Problems at the Core

Joe Lieberman, official photo.

Image via Wikipedia


Both our political parties have

significant structural and functional problems. They each contain a group that believes  the purpose of politics to be ideological warfare, and they each contain a group that believes politics is a tool to serve their interests. Since the groups within each party are not compatible with one another, there is a struggle within each party that mirrors the struggle between parties in oddly complementary and paradoxical ways. 

We might call the two groups Selfish Toadies (ST) and Cultural Fanatics (CF).

There is a cycle of dynamic dominance between the two groups in each party. Currently, the Republican party has seen the rise of more and more ideological cadre, with the STs trying to co-opt the message of the CF's for their own purposes. In the Democratic party, liberals are gradually taking the role of spoilers, again with the STs trying to co-opt the CW message for their own purposes. The Obama administration is largely STs at this point. 

Across parties, the struggle is between CFs in the Republican party and STs in the Democratic party. The current political instability is not just between the parties, but also between the components within each party. Any stability that occurs either within or across parties will be immediately undermined by the other inside "enemy" or the other party. This general instability will not change any time soon, especially with the economy crashing and the growing deterioration of the health care system, local infrastructure, and the fragmentation of allegiances in every part of the political fabric. In a phrase, everyone, in multitudinous and shifting groups, is struggling for the "soul" of “their” party.

The national political system is no longer capable of solving any major problem. The two parties view vetoing effective action by the other as the only predictably useful political strategy, and within the parties, the components view vetoing the other component in the same way. Joe Lieberman is kind of the poster child for this approach to a political career.

As the whip cream on the sundae, the Supreme Court has now allowed a far greater use of corporate funds to promote political agendas than at any time in modern history. Spin and insults are standard competitive tactics used by corporations to undermine competitors. Therefore, we will be spending far more money to create an incompetent political class than we have in the past. 

Needless to say, the extra money  will not produce better political results.

What to do?

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Wednesday, January 20, 2010

New blog post: - To Moscow and Back Again: A Democrat’s Tale about the health care bill

To Moscow and Back Again: A Democrat’s Tale

In 1812, Napoleon invaded Russia, reaching and taking Moscow, but failing to get a Russian surrender and without supplies to stay in Moscow. His armies had expended every last bit of support they had to get into Moscow. When the Russian army pushed back,  Napoleon’s Army started a long, disastrous retreat which destroyed his forces largely through starvation (including cannibalism) and death from exposure.

The resemblance to the Democratic party’s effort to pass a health care bill are uncanny, and the loss of the Senate seat in Massachusetts is the equivalent of arriving in Moscow and finding no food, buildings, or people that could be used to support the “victory”.

It remains to be seen how much of the current health care bill’s provisions will be lost in the new environment (it wasn’t by any standard a great bill up to this point), but one reasonably likely casualty will be the inclusion of the CLASS act, the only part of the bill that had improvement of the LTC system as a goal, and a weak concept at that considering the problems that the American LTC system has.

And that is just the beginning. Right or wrong, supporting the health care bill will be seen as a political liability for much of the country in the 2010 elections. Ben Nelson, who staked his political career on his support for this bill, will now suffer all the same political problems for a significantly weaker bill. I suspect that other Democratic senators who only won their seats  the last time around by moving away from liberalism will face uphill battles.  And of course, there will be significant losses in the Democratic House as well in 2010.

A strategic failure of the first order.  A feasible outcome is a frozen Senate, incapable of actually support President Obama on anything important (look at how weak their support for health care has been with the so called “veto-proof” majority), and a much weaker Democratic House.  And don’t be surprised by signs of cannibalism in the Democratic Party.

There are worse possibilities as far as health care is concerned. However the health care bill turns out, NO ONE will try for significant health care reform in my lifetime. The American health care system will continue to crumble like the infrastructure of Detroit, and when a solution becomes politically feasible again, because of the sheer incompetence of the health care system, the problem to be solved will be far larger and far more intractable than it is now.

The only redeeming feature is the Republican compulsion to play “Russian Roulette” (see how I maintained the metaphor?) with their party’s message.

A very sorry and disappointing state of affairs…..



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Wednesday, January 13, 2010

Aging baby boomers more likely to need drug treatment than older cohorts, study finds - McKnight's Long Term Care News


Illicit drug use by seniors is on the rise. That could lead to a significant increase in the need for drug treatment services for seniors over the next decade, according to a new report.

The baby boom generation has a high rate of lifetime drug use, according to the report from the Substance Abuse and Mental Health Services Administration (SAMHSA). As that population ages, the number of adults using illicit drugs is also likely to rise, SAMHSA predicts……

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Aging baby boomers more likely to need drug treatment than older cohorts, study finds - McKnight's Long Term Care News

Report underscores problems with durable medical equipment Medicare claims process, group says - McKnight's Long Term Care News


A new report from the Department of Health and Human Services Office of Inspector General confirms that the regulatory documentation requirements for durable medical equipment Medicare claims are “confusing, onerous and must be improved,” according to a DME provider group……
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Report underscores problems with durable medical equipment Medicare claims process, group says - McKnight's Long Term Care News

Tuesday, January 12, 2010

Nursing Homes Overuse Antipsychotics

In 2006, a year after the FDA issued mortality warnings about prescribing antipsychotic drugs for the elderly, nearly 30% of nursing home residents received the medication -- despite the fact that a third of them had no indication for the drugs, a study revealed…..

This elevated risk associated with facility-level prescribing was seen for patients with dementia but no psychosis (RR 1.40, 95% CI 1.23 to 1.59), and in residents with neither psychosis nor dementia (RR 1.54, 95% CI 1.24 to 1.91), the researchers reported in the Jan. 11 Archives of Internal Medicine.

An unrelated study, also released today, indicated that office-based physicians were in fact cutting back on prescription of antipsychotics for dementia as a result of FDA warnings……

Sunday, January 10, 2010

Person-Centered Care for Nursing Home Residents: The Culture-Change Movement

In the 1980s, consumer groups exposed substandard care in some U.S. nursing homes, as well as instances of even more dire problems like abuse and neglect. These revelations led the Institute of Medicine to issue a report recommending major regulatory changes and, in 1987, Congress passed a sweeping set of nursing home reforms that required facilities to provide individualized, or "person-centered," care. As a result, some providers began to move away from the institutional model of nursing home care and toward a more homelike environment in which residents could have a say in their day-to-day lives. In 1997, leaders in the industry formed the Pioneer Group to advocate for person-centered care and create a movement for "culture change" in the nation's nursing homes……

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IL: Stricter Controls on the use of Antipsychotic Mediations

Nursing home resident advocates in Illinois are pushing for new, stricter rules on the use of antipsychotic drugs among elderly nursing home residents, in order to prevent misuse of the drugs as a form of chemical restraint in nursing homes.
Illinois Citizens for Better Care, a grassroots organization that fights to improve nursing home care in the state, is pushing for new state laws and regulations that would prevent nursing homes and doctors from using antipsychotic and psychotropic drugs as a form of chemical restraint on the elderly, according to a report by the Chicago Tribune and ProPublica…….

Thursday, January 7, 2010

Alzheimer's Mice Improved by Cell Phone Radiation

Inveterate cell-phone addicts may feel that the devices help them to work smarter and -- surprisingly -- they may be right.

If they're mice, that is.

In mice prone to an animal form of Alzheimer's disease, long-term exposure to electromagnetic radiation typical of cell phones slowed and reversed the course of the illness, according to Gary Arendash, PhD, of the University of South Florida in Tampa, and colleagues.

A similar exposure in normal mice -- for two hours a day over seven to nine months -- improved their cognitive abilities compared with controls, Arendash and colleagues said in the January issue of the Journal of Alzheimer's Disease, which is the research journal of the Alzheimer's Association…..

"This is no call for anyone to self-medicate," Thies said.

And other reactions to the study ranged from "interesting" to "nonsense."

Original Article Link

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Wednesday, January 6, 2010

Music and Alzheimer’s

…..At the Institute for Music and Neurologic Function (IMNF), technology is playing a key part in helping people with Alzheimer's disease reconnect to their memories and their loved ones—if only for immediate periods of time. We call it our “Well-Tuned” program and its impact has been extraordinary.

The technology I mentioned is the iPod, which can be loaded with music that is emotionally significant to the individual with Alzheimer's disease. The music may spur memories thought long gone or stimulate recognition of a loved one that moments earlier was no more than a blank face. It may also help a person with Alzheimer's disease function and transition throughout the day, from energizing them during their waking hours to helping them wind down as bedtime approaches.

The iPod music play list is customized, changing from person to person based on their experiences, cultural backgrounds and frame of reference. As with lovers who grow sentimental when “their song” is played on the radio, the right music stimulates the personal associations that it is connected with, sparking memory and renewed “presence.”…….

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Monday, January 4, 2010

The BIG Picture: Once invincible business models aren't so bulletproof after al

As 2010 dawns, many providers and publishers find themselves limping along. Both have just endured one of the more challenging years on record.

Who would have thought the once bulletproof continuing care retirement community model would be reeling? Erickson Retirement Communities offers a good example of how weird things have become. As fewer and fewer prospects were able to sell their homes (essentially a prerequisite for moving in), occupancy rates tumbled, along with operating revenues. The result: a sell-off of the company in tandem with a Chapter 11 filing.

An assisted living juggernaut—Sunrise Senior Living—is on the brink as well......


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Thursday, December 24, 2009

FDA seeks public comment on ECT

The FDA is asking for comment to determine whether it should reclassify ECT to require "reasonable assurance of the safety and effectiveness" of the mechanical devices used for electroconvulsive therapy. ECT was already in use when the FDA codified mechanical devices, and hence grandfathered under a classification that today would require testing for safety and efficacy. In response to public interest and complaints, the FDA is deciding whether a "premarket approval" is necessary in the "completion of product development." The answer to this will influence whether they downgrade the classification under less stringent rules. Some consider this tantamount to deregulation......

Read more about the current controversy:

Psychiatry Weekly

To comment before Jan. 8, 2010:
Electronic submission:

Written comments:
Division of Dockets Management (HFA-305), Food and Drug Administration, 5630
Fishers Lane, rm. 1061, Rockville, MD 20852.

FOR FURTHER INFORMATION CONTACT: Victor Krauthamer, Center for Devices
and Radiological Health, Food and Drug Administration, 10903 New
Hampshire Ave., W066-1106, Silver Spring, MD 20993, 301-796-2474.

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Friday, December 18, 2009

Cokie and Steven Roberts: A CLASS Act deserves support - Inside Bay Area

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WE ARE the lucky ones. Not only are we blessed with two mothers in their 90s — we are doubly blessed with mothers whose resources cover their care. That's not the norm in America, where the aging population's need for long-term care imposes harsh economic as well as emotional stress on many families. A provision of the health-care bill aims to offer some relief to those families, and we're all for it.

The Community Living Assistance Services and Supports Act, called CLASS, was one of Teddy Kennedy's pet proposals in recent years. It's a simple idea. Workers would voluntarily pay into a fund for at least five years and then be able to draw from it if they become disabled by age or illness.

A daily stipend tied to the degree of disability, to be set by the secretary of Health and Human Services but probably starting at about $75, would go for whatever was needed — someone helping out at home, transportation to senior day care, installation of handicap-friendly devices — allowing many individuals to remain in their communities and out of costly nursing homes.

For people who aren't as lucky as we are, that's often the only choice. Their parents or a disabled relative might need assistance in eating, bathing, dressing or moving from a chair to the bathroom. A small stipend can make all the difference. It can mean an elderly person gets to stay at home with some assistance getting dressed and ……

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Wednesday, December 16, 2009

Long-term care program is fiscally sound

Thanks and a Hat Tip to Patti Dudek…

The Dec. 9 editorial "Health reform's heavy lifting" unfairly criticized the fiscal soundness of the CLASS (Community Living Assistance Services and Supports) Act, an innovative, voluntary, long-term care insurance program in the Senate health-care bill….

A closer look reveals that the proposal has new provisions to assure financial sustainability by reducing premiums, creating a healthier risk pool and new reserve requirements, and providing numerous safeguards to guarantee solvency over a 75-year period -- thanks to an amendment from Sen. Judd Gregg (R-N.H)….

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Friday, December 11, 2009

3 Arrests in Public Guardian's Office

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The Michigan State Police’s investigation into the Arenac County Public Guardian Office, which began in June, has led to three arrests.
A statement from the Ogemaw County Prosecuting Attorney’s Office issued Dec. 9 said over $300,000 worth of misappropriated funds from approximately 50 clients, during the years 1999 to 2009, was uncovered by the MSP investigation.
According to Detective Sergeant David Rivard, of the West Branch State Police Post, public guardian Robert Romps was arrested by the Michigan State Police on Dec. 8, along with Sherilyn Jones, the public guardian Romps replaced who was fired in August while her office was under investigation for criminal activity by the Michigan State Police and being audited by the Michigan Treasury Department. Jones’ mother, Sally Lebeau, was also arrested…….

Monday, December 7, 2009

Brown University provides data on nursing home care in the US. Our goal is to allow researchers to trace relationships between state policies, local market forces and the quality of long-termcare and enable policymakers to craft state and local guidelines that promote high-quality, cost-effective, equitable care for older Americans.Learn More >

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Brown University

Senate preserves long-term care program - The ReporterBusiness: Serving North Penn, Indian Valley and neighboring communities

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The Senate on Friday turned back a Republican effort to eliminate a long-term care insurance program to help seniors and the disabled, saving the plan once championed by the late Sen. Edward M. Kennedy in its health overhaul bill.
But the vote exposed the difficulties Democratic leaders face in persuading their own moderates to remain united behind sweeping legislation they hope to deliver to President Barack Obama. Eleven Democrats voted with Republicans, who warned that the new program would turn into a drain on the federal budget…..

Senate preserves long-term care program - The ReporterBusiness: Serving North Penn, Indian Valley and neighboring communities

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Wednesday, December 2, 2009

People like me --


Last year, I was rushed to the hospital after a severe gastrointestinal infection became septicemia. I was unconscious, inches away from death, but before the doctors would perform their magic they asked my wife, "Are you sure you want us to do this?"
Actually, they said, "Is he full code?" but it meant the same thing.
To my wife, it was clear their uncertainty was due to my physical disabilities. I was born 47 years ago with a congenital neuromuscular delight called spinal muscular atrophy. I've never walked or stood and have very limited use of my hands.
Was my life worth prolonging? Should the hospital provide me with the same measure of medical intervention it would anyone else?
Please! Don't hold my rag-doll body against me!……

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People like me --

Wednesday, November 25, 2009

Uninsured Health Care Workers Pose Public Health Risks |


The U.S. health care workforce’s lack of health coverage raises “important and perhaps alarming issues,” according to an article in the American Journal of Public Health’s December issue.

In some settings — specifically residential care and nursing homes — “almost one third of all workers providing hands-on care to vulnerable adults are uninsured,” the researchers report…….

The authors of the AJPH article argue that their findings raise serious public health and policy issues regarding the quality of the U.S. health care workforce. Of particular concern are “workers transmitting undetected infectious disease because they delay seeking care, and transmitting the flu because they do not receive a flu shot.”……

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Uninsured Health Care Workers Pose Public Health Risks |

2010 Long Term Care Tax Deductibility | NewRetirement Blog


The American Association for Long-Term Care Insurance has just released a new guide that addresses the new 2010 tax deductible items and limits for individuals and business owners purchasing long-term care insurance.   The “Guide To Tax Deductible Long-Term Care Insurance can be found at their website: This guide provides comprehensive information including state by state deductibility rule s and federal tax deductibility rules….

2010 Long Term Care Tax Deductibility | NewRetirement Blog

Info Long-Term Care: Older People's Vision of Long Term Care


Commissioned by the Joseph Rowntreee Foundations Independent Living Committee, the Older People’s Programme (OPP1) and the Centre for Policy on Ageing (CPA) in the UK, this report explores older people’s experiences of living with high support needs. This work focused on those moving to and living in care homes now, and those using other kinds of supported accommodation or living arrangements (e.g. extra care and adult placement schemes)…..
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Info Long-Term Care: Older People's Vision of Long Term Care