Center For Medicare Advocacy Conference Develops Medicare Beneficiary Complaint Process, USA

he Center for Medicare Advocacy, Inc., (the Center), convened a working conference in January 2007 that designed a model for resolving Medicare beneficiaries' complaints about quality of care. Sponsored by the Commonwealth Fund, with assistance from AARP, the conference provided a forum for key stakeholders to discuss concerns and develop a blueprint for change.

Medicare beneficiaries and their advocates are concerned that this current process for resolving beneficiary complaints about quality of care has not been effective in providing fair and timely resolution of complaints. Concerns about the process include an inadequate resolution of beneficiary complaints about poor quality, a lack of information about proper care protocols, and the failure to provide expedited review of denials of care.

Humanizing Dementia Care May Extend Patients' Lives

Through an intensive comparative study of two nursing home units using contrasting approaches to dementia care for elders with severely disturbed behaviors, Central Michigan University professor of anthropology Athena McLean has found that "humanizing" approaches to dementia care may not only extend quality of life for patients, but also their length of life.

In McLean's recently published book, "The Person in Dementia: A Study of Nursing Home Care in the U.S.," she discusses the dramatic contrasts in the outcomes of the two approaches to dementia care: a rigid task-oriented maintenance approach emphasizing disease progression and a flexible person-sustaining approach attentive to elders' communication and individual needs.

McLean found dramatic differences between life quality of the patients at the two nursing units. The patients at the unit that focused on "personhood", or looking beyond physical and reasoning abilities to a person's will and relationship with others, were found to be happier, had an overall improved quality of life and even lived longer. Those at the unit emphasizing disability and pathology tended to have their personal needs ignored, were heavily medicated and often failed to thrive.

Connecting Tags; LTC, fan-the-flame, copower, prosynergy

Treatment For Those In Vegetative State? Participants Invited For MossRehab Study On Impact Of Drug Ambien

Dramatic license is often taken in relating stories of patients who, after a serious brain injury, fall into a vegetative state and then miraculously awaken. In reality there are no proven treatments to help these patients regain consciousness. However, recent reports suggest that three such patients experienced dramatic improvements when given the commonly prescribed sleeping medication zolpidem, commercially known as Ambien.

In order to gather systematic date, the Pennsylvania Department of Health has awarded the Moss Rehabilitation Research Institute at MossRehab, the nationally known rehabilitation hospital a grant to study how often this type of response occurs; whether less dramatic benefits can be seen in larger numbers of patients; and whether it can be determined which individuals are likely to benefit.

Connecting Tags; Recovery, fan-the-flame, copower, prosynergy

Consumer Education Project

Also see http://communitycatalyst.org/index.php?doc_id=32&PHPSESSID=1624dab17ae61987038f51483113f844

Community Catalyst is pleased to announce a new undertaking - the Special Needs Plan Consumer Education Project - which is supported by the Retirement Research Foundation.

Through this project, Community Catalyst will partner with Commonwealth Care Alliance to educate consumers about the opportunities and risks offered by Special Needs Plans (SNPs). The project will also identify and promote SNP best practices while strengthening the consumer voice on state and federal policy issues related to SNPs.

Read on for more background and information about the Special Needs Plan Consumer Education Project...

Background: The Medicare Modernization Act of 2003 did more than add prescription drug coverage to Medicare. It also established a new coverage option for Medicare beneficiaries with serious or chronic illnesses. The Special Needs Plan (SNP) option was created to offer better coordinated care for the most medically vulnerable beneficiaries. SNPs differ from traditional Medicare managed care plans in that they are able to limit enrollment to specific categories of beneficiaries, e.g. those who are living in nursing homes or living in the community but who require a nursing home level of care, those that are dually eligible for Medicare and Medicaid, and people with chronic conditions such as diabetes, mental illness, and HIV/AIDS. SNP benefits and provider networks must be tailored to the needs of the specific population the SNP has chosen to serve.

For people with chronic illnesses, SNPs offer an opportunity to address the shortcomings of the current fee-for-service system. That system is set up to address discrete short-term episodes of illness, but it does less well at providing optimal care for people who need more flexible benefits and integration of acute and long-term care services. At their best -- and if truly integrated at the state and federal level -- SNPs have the potential to offer� comprehensive and coordinated care, resulting in better health outcomes, improved quality of life, and fewer high-cost hospitalizations. Additionally, by reducing avoidable hospitalizations and institutionalization, SNPs may offer a mechanism for moderating state Medicaid expenditures without harming recipients.

At the same time, SNPs present a number of risks and potential problems both for beneficiaries and state Medicaid programs.� Medicare and Medicaid managed care beneficiaries have sometimes experienced unstable provider networks and marketing abuses. Additionally, there are concerns that the capitation mechanism of financing may lead to reductions in service and quality. For state Medicaid programs, lack of coordination between SNPs and Medicaid could result in increased costs rather than savings.�

Connecting Tags; LTC, community-based, Medicaid, Medicare, fan-the-flame, copower, prosynergy

Former nursing home exec gets four months for Medicare fraud

Charles B. Kaiser III, former president of American Healthcare Management, pleaded guilty in January to a misdemeanor charge of making false statements. He was sentenced Friday and ordered to pay $15,000 in fines.

Kaiser already served a year in prison on a misdemeanor charge of failing to report elder abuse in the death of a patient.

Robert Wachter, the company's former chief executive, was sentenced to 18 months in prison for a conspiracy to defraud Medicare and Medicaid by collecting payments for services not provided.

Connecting Tags; LTC, abuse, economics, rights, fan-the-flame, copower, prosynergy

Oversight of Nursing Homes Is Criticized

WASHINGTON, April 21 — Federal health officials impose only minimal penalties on nursing homes repeatedly cited for mistreatment of patients, Congressional investigators say in a new report.

As a result, they said, some nursing homes cycle in and out of compliance with federal standards and pose a continued threat to the health and safety of patients.

“Some of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs,” said the report, to be issued next week by the Government Accountability Office, an investigative arm of Congress.

The Department of Health and Human Services “fails to hold homes with a long history of harming residents accountable for the poor care provided,” the investigators said.

Congress established stringent standards for nursing homes in 1987. In 1998, the G.A.O. reported that “homes can repeatedly harm residents without facing sanctions.” Since then, President Bill Clinton, President Bush and the nursing home industry have announced many initiatives to improve care.

But in its new report, the accountability office says that little seems to have changed at the worst-performing homes. The Bush administration rarely uses its authority to deny payment to homes with a history of compliance problems and typically imposes fines far less than the maximum of $10,000 a day, the report said.

In Michigan, federal investigators found that a nursing home was still open even though it had repeatedly been cited for “poor quality care,” poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

Most-at-risk Nursing Home Residents To Be Tested For "Superbugs"

A Johns Hopkins study of adult patients admitted to The Johns Hopkins Hospital showed that patients who resided in nursing homes or other kinds of long-term care facilities at any time within the last six months were far more likely than other adult patients to carry or be infected with a drug-resistant superbug.

The study, conducted over a four-month period in 2006, was intended to grasp the extent of one of the lesser known hospital superbugs, multidrug-resistant Acinetobacter (MDR-ACIN), and control its spread among the hospital's most vulnerable adult patients. More than 1,600 were screened within 24 hours of admission to any one of five intensive care units where previous infections had been recorded.

Results showed that patients who had been in nursing homes, either admitted to Hopkins directly from a long-term care facility or transferred from home or another community hospital, were 12 times more likely than other patients to be carriers of the bacterium. Rates were even higher, 22 times, among those patients who were wheelchair- or bed-bound because their legs were paralyzed.

Connecting Tags; Medicare, Medicaid, LTC, fan-the-flame, copower, prosynergy

Revolution Health

This site is the brainchild of Steve Case, founder of AOL. It has many of the things you would expect from a health site, but also has "premium services" for $129 a year that includes a personal health advocate (will talk to insurance companies, research rules, etc.)

This is a model like the one in "The Support Economy"

The future for advocacy?

Connecting Tags; advocacy, Medicaid, rights, social production, fan-the-flame, copower, prosynergy

Three Little Words Spell Independence For People With Dementia, UK

The words 'I have dementia' meant Bill Wilson could collect a prescription for his month-old grandson. Using a pocket-sized helpcard carrying this phrase, Mr Wilson was able to take home the medication while the pharmacist called a relative to explain the dosage. From today (April 12) people with dementia across the country can secure this same independence, with the launch of the Alzheimer's Society dementia helpcard.

Designed by people with dementia for people with dementia, the helpcard provides an effective and discrete tool for people to explain their diagnosis when they are out on their own. Carried inside a purse or wallet it includes contact details for a carer, friend or relative.

Connecting Tags; community-based, accessibility, choice, rights, tool, fan-the-flame, copower, prosynergy

Choices For Care (1115 Long-Term Care Medicaid Waiver)

Choices for Care is a Medicaid-funded, long-term care program to pay for care and support for older Vermonters and people with physical disabilities. The program assists people with everyday activities at home, in an enhanced residential care setting, or in a nursing facility.

Support includes hands-on assistance with eating, bathing, toilet use, dressing, and transferring from bed to chair; assistance with tasks such as meal preparation, household chores, and medication management and increasing or maintaining independence.

A second program is for Moderate Needs individuals who need minimal assistance to remain at home. This program offers limited case management, adult day services, and/or homemaker service.

Connecting Tags; LTC, waiver, community-based, choice, fan-the-flame, copower, prosynergy

Federal and State Caregiving Legislation

Federal Legislation Introduced or Enacted in 110th Congress (Coming soon!)

Federal Legislation Introduced or Enacted in 109th Congress

Archived Federal Legislation

plus much more....

Connecting Tags; LTC, community-based, social production, fan-the-flame, copower, prosynergy

Budget Resolution from Michigan Alzheimer's Association

THE STATE BUDGET CRISIS

Whereas, after seven straight years of state budget deficits and four years of budget cuts, we are facing yet another $3 billion shortfall in state revenues for the current and 2007-08 fiscal years; and

Whereas, the Governor has already cut over $3.6 billion from the state’s budget over the past four years, has cut more from the state’s budget than any previous governor, and is operating the state with fewer state employees than we had in 1970; and

Whereas, we have cut major taxes over 32 times in the past decade, our unemployment rate remains one of the highest in the country, our auto industry continues to struggle, and we have now eliminated the Single Business Tax (SBT) with no replacement for the $1.2 billion in revenue generated from this tax;

Whereas, the State of Michigan has baseline responsibilities to public health and the welfare of its citizens that cannot be abolished and while the identification and elimination of unproductive discretionary expenses should be a first priority, it is irresponsible to assume that state government can continue to suffer budget cuts year after year without affecting its constitutional responsibilities;

Therefore be it resolved, that the Alzheimer’s Association calls on the Michigan Legislature to demonstrate bipartisan leadership by raising revenues as necessary to avoid further cuts to Medicaid services and other services provided to seniors and persons with disabilities, including persons with Alzheimer’s disease or related dementias.

European Research Helps People With Dementia To Navigate Their Day

As approximately 1.9 million elderly people in Europe experience a form of dementia. A pan-European research project is seeking to help them 'navigate their day' and improve their quality of life.

The recently launched CogKnow project, funded under the EU's Sixth Framework Programme (FP6), aims to help people to remember, maintain social contact, perform daily life activities and enhance their feelings of safety.

Dr Nugent from the University of Ulster in the UK told CORDIS News: 'We are delighted to be involved in this project which is working towards the development of tangible home-based solutions to support persons with memory loss problems.

'The project is unique in the way that both patients and carers will contribute to the design of the discrete user-friendly technology,' he added.

As the technical coordinator of the project, the role of the university will be to research and prototype assistive technologies to support people with memory loss by providing easily recognisable prompts to help them navigate through their day.

Connecting Tags; LTC, community-based, tech, choice, tool, fan-the-flame, copower, prosynergy

Shift in investment would improve options, save millions

The Ohio General Assembly has a rare opportunity to save millions of dollars while providing high-quality health care to thousands more Ohioans in the manner they prefer by rebalancing its Medicaid funding to provide more home care services.

Most states already are reaping the rewards of such action. But as Ohio now considers its next two-year state budget, it ranks 49th among the states - ahead only of Mississippi - in the percentage of Medicaid funds going to home care. A number of recent, independent studies clearly show the folly of this imbalance.

The most recent study, by the esteemed Scripps Gerontology Center at Miami University, looked at the cost of long-term care for Ohio's elderly - who receive most Medicaid dollars, although home care agencies serve a diverse population, including medically fragile children and the disabled.

Advocacy Groups Seek Elimination Of Medicare Eligibility Waiting Period For Individuals With Disabilities

A number of advocacy groups, such as the Medicare Rights Center, have begun to lobby Congress to revise a law that requires a two-year waiting period to become eligible for Medicare after they begin to receive Social Security disability benefits, USA Today reports. An estimated 400,000 uninsured U.S. residents with disabilities are waiting to become eligible for Medicare, according to a report released on Wednesday. The report, prepared by the center and funded by the Commonwealth Fund, profiles 21 individuals with disabilities who are waiting to become eligible for Medicare. Medicare implemented the waiting period in 1972, when the program expanded to cover individuals with disabilities, to limit the cost and ensure only those with severe and long-term disabilities would qualify for the program.

First-Ever Study Links Strong Voice On The Job To Better Quality Nursing Home Care

In the first study of its kind, researchers found that allowing workers a strong voice on the job improves nursing home care quality. The study, published in this month's Journal of Aging and Health, analyzed data from nursing facilities across California.

"We found that allowing workers to have a voice on the job appears to enhance problem reporting while, especially in stronger union environments, it may reduce the incidence of serious quality violations," said James Swan, PhD, the study's lead author.

One possible reason for these results is that workers who have formed a union are less afraid to speak up on the job, and can negotiate over key factors that improve care such as staffing levels, training, and pay and benefits that help retain qualified caregivers.

CMS Pulls Federal Funding From Wisconsin's SeniorCare Prescription Drug Program

CMS last week rejected a request for a new Medicaid waiver for SeniorCare, a Wisconsin prescription drug program for low-income seniors, the Washington Post reports (Lee, Washington Post, 4/10). In 2005, before the implementation of the Medicare prescription drug benefit, HHS issued a waiver to allow Wisconsin to continue to operate SeniorCare until at least June 30. SeniorCare has no monthly premiums, lower copayments than the Medicare prescription drug benefit and no gaps in coverage.

According to acting CMS Administrator Leslie Norwalk, the agency rejected the request for a new waiver because the state has not provided evidence that SeniorCare reduces costs for the federal government as required.

Connecting Tags; Medicare, Medicaid, economics, waiver, fan-the-flame, copower, prosynergy

Elder residents served notice as homes quit taking Medicaid

FREMONT, Neb. — Residents in assisted living facilities in three Nebraska cities have been served notice after the company operating the homes decided to no longer take Medicaid.

Officials at Assisted Living Concepts say Medicaid longer covers the costs of caring for the residents.

The change means 26 people at homes in Fremont, Wahoo and Blair need to move out by June 30.

"At this point, the Medicaid program pays less than it costs us to take care of folks," said Laurie Bebo, president and chief operating officer of Assisted Living Concepts. "Now the private pay folks are subsidizing the Medicaid folks."

Bebo said people who pay for assisted living care pay 50 percent more than Medicaid residents — about $25 below what it costs to care for a resident each day.

Milwaukee-based Assisted Living Concepts runs 207 facilities in 17 states with 8,300 units. All the facilities nationwide will be affected by the change.

Connecting Tags; LTC, Medicaid, community-based, choice, economics, fan-the-flame, copower, prosynergy

AARP Launches Campaign To Allow Federal Negotiations For Medicare Prescription Drugs; CMS Releases Quality-Care Measures

Summaries of two recent developments related to Medicare appear below:

AARP: AARP on Wednesday asked members to call their senators in support of legislation that would allow the HHS secretary to negotiate prices directly with pharmaceutical companies under the Medicare prescription drug benefit, CQ HealthBeat reports. According to AARP, members have made more than 60,000 calls and sent more than 42,000 e-mails to senators in support of the legislation.

CMS on Tuesday announced the release of 74 measures that the agency will use to determine the quality of physician care, CQ HealthBeat reports.

Connecting Tags; Medicaid, Medicare, fan-the-flame, copower, prosynergy

CMS Issues Final Rule On Bidding For Durable Medical Equipment

CMS on Monday issued a final rule for competitive bidding in Medicare for durable medical equipment, CQ HealthBeat reports. CMS said that the 2008 competitive bidding program will operate in 10 of the largest Metropolitan Statistical Areas and will apply to 10 of the top durable medical equipment, prosthetics, orthotics and supplies product categories, as outlined in the rule. In 2009, the program will expand to an additional 70 MSAs and will continue to expand in future years (Carey, CQ HealthBeat, 4/2). CMS currently pays for durable medical equipment based on a listed price. Under the rule, durable medical equipment companies will submit bids to CMS, which will select suppliers based on cost and volume or on the potential savings for Medicare beneficiaries.

Connecting Tags; Medicaid, Medicare, LTC, AT, economics, fan-the-flame, copower, prosynergy

Homecare Industry Issues A "Call To Arms" Letter Urging Support For The American Association For Homecare

It's time to stand up for homecare and join the American Association for Homecare. That's the central message of an industry "call to arms" letter signed by more than two dozen prominent providers and manufacturers in the homecare sector.

The signatories to the letter reflect the full range of members within the Association in terms of size, types of services and equipment, and broad geographic distribution.

"Several members on the AAHomecare board of directors came up with this idea and message and pushed this effort forward," said Tyler J. Wilson, president of the Association. "While a larger list could have been gathered, we limited the signatories to organizations on our board in order to try to reflect companies in the industry that have demonstrated a very high level of support in terms of Association membership, involvement, and investment of their time advocating for the homecare community."

Connecting Tags; LTC, community-based, rights, choice, fan-the-flame, copower, prosynergy

New federal regulations make it riskier for the elderly to give money to relatives

New government rules restrict how older adults can give away assets and qualify for Medical Assistance coverage of their long-term care costs.

The regulations, designed to hinder the ability of well-off people to make sure their money goes to heirs instead of nursing homes, took effect in Pennsylvania March 5. The arcane rules resulted from a 2005 law passed by Congress, intended as one means of controlling the rising federal and state costs of Medical Assistance, or Medicaid.

The changes published by the state Department of Public Welfare have been little noticed beyond elder law attorneys and nursing home officials, and some of them are concerned that families innocently passing on money as gifts will be forced to regret it later.

Connecting Tags; LTC, Medicaid, economics, fan-the-flame, copower, prosynergy