AARP Report Shows How States Can Help Prevent Abuse Of Older Americans, Identifies Better Ways For Courts To Oversee Guardianships

A new report by AARP's Public Policy Institute (PPI) identifies effective practices for monitoring court-appointed adult guardians, reducing the chances for abuses that occur when oversight is lax.

Conducted with the American Bar Association (ABA) Commission on Law and Aging, the report follows a 2006 AARP survey showing that a large number of state courts around the country fail to assign a monitor to visit vulnerable individuals under guardianship, leaving many Americans open to physical neglect and financial abuse. The 2006 survey also found that, in many jurisdictions, no one verifies the information in guardianship reports.

Coalition Proposes More Training for Home Caregivers

Olympia, WA – A group of advocates for Washington seniors and disabled citizens soon will ask the State Legislature to increase the amount of training that in-home caregivers receive. They say the current training standards are inadequate, and they also want training to be available to family members.

Crap In = Crap Out

"Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs, the report says."

Wow.

3.5 billion dollars a year? I bet it's way more than that.

Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. The committee noted that these are likely underestimates.

Amazing. Almost 2 million a year.

I agree that the numbers likely represent gross underestimates. The problem, as I see it, is not preventable, nor fixable in the current fragmented environment of health care delivery. Breaking down the problem reveals so many in congruent variables that the current delivery of health care is wide open to errors.

Dehydration in the Elderly

I lost this link, so you'll have to trust me on this one:

As people age, the part of their brain that tells whether there is enough water intake begins to malfunction. The brain underestimates the amount of water intake required to prevent dehydration. Thus, the person is always close to dehydration.

The only practical answer is to double the intake of water during the day from the amount that seems right.

Nursing Homes Get Funds To Prevent Pressure Ulcers

ALBANY—The New York State Department of Health has awarded $800,000 to 16 nursing homes to support implementation of an evidence-based best practice shown to significantly reduce pressure ulcers.

Known as “On-Time Quality Improvement for Long Term Care,” the approach to preventing pressure ulcers was developed by the federal Agency for Healthcare Research and Quality (AHRQ).

A pressure ulcer (also called a bedsore) is an area of skin that breaks down when a person stays in one position for too long, putting pressure on the same spot without shifting weight. They occur most often in people who are bedridden or in wheelchairs, even for a short time after surgery or an injury.

“The State Health Department is pleased to work with AHRQ and nursing homes across New York on this important effort to improve the health and well-being of nursing home residents in the state,” said State Health Commissioner Richard F. Daines, M.D. “In addition to creating pain and suffering, pressure ulcers can become infected, causing fever, confusion, weakness and even death. They are also very preventable, and costly to treat.”

Nursing home residents at highest risk for pressure ulcers are those in a coma and others who can’t move around or change position on their own. Among this high-risk population the incidence of pressure ulcers is 14 percent in the state (the U.S. average is 12 percent). Among low-risk patients in New York, the incidence is 2 percent (the same as the national average).

The “On-Time” program uses health information technology (HIT) to collect, analyze and promptly report back to staff the information they need to identify which nursing home residents are at risk for pressure ulcers and to track the results of their efforts to reduce risk. It has been implemented, tested and refined in more than 35 nursing homes across the nation and produced an average decrease of 33 percent in prevalence rates in the nursing homes that implemented the model.

Few Cancer Services Provided To Nursing Home Residents

Elderly nursing home residents receive relatively few cancer care services, including screening, surgical treatment, or hospice care.

Few studies have examined cancer treatment and care among elderly patients residing in nursing homes. Yet as the U.S. population ages, more people will move into nursing homes, many of whom will later be diagnosed with cancer. Cancer risk increases as people age.

Cathy Bradley, Ph.D., of the Virginia Commonwealth University Massey Cancer Center in Richmond and colleagues assessed the cancer care received by elderly nursing home residents who were insured by Medicaid. Using data from the Michigan Tumor Registry and Medicare records, they identified 1,907 nursing home residents diagnosed with cancer. They analyzed the patient data by cancer stage at diagnosis, type of cancer, survival time, and whether the patient received surgery or hospice care, as well as other variables.

Sixty-two percent of the nursing home residents with cancer had late or unstaged disease when they were diagnosed, and almost half died within three months of diagnosis. Among patients with late stage cancer, only 28 percent received hospice care. Patients aged 71 to 75 were three times more likely to have surgery than patients aged 86 and older.

Congress Approves Extension of Mental Health Parity Act

Dec 24, 2007

Congress Wednesday passed legislation extending the Mental Health Parity Act of 1996 until the end of 2008. Included in the Heroes Earnings Assistance and Relief Tax Act of 2007 (H.R. 3997), the extension will prohibit group health plans that provide medical, surgical care and mental health care from imposing coverage limits on mental health coverage that don’t apply to other types of medical treatment, and imposes a $100 fine per day for violations.

The extension does not eliminate a loophole in the 1996 law that allows group health plans to impose higher co-payments, deductibles and coinsurance payments for mental health services. The AHA has long advocated parity for hospital days, outpatient visits, co-pays, deductibles and maximum out-of-pocket costs for in-network services.

Source: AHA News Press Release

Alzheimer's Society Comment On Rights, Risks And Restraints,

Anyone reading this report will draw a sharp intake of breath at some of the appalling examples of restraint, in many cases involving people with dementia.

It is devastating to hear of vulnerable people not being treated with the dignity and respect they deserve.

CSCI's report is right to acknowledge that often there isn't simply one place to lay blame for this abuse, as it is partly a result of an overstretched and under resourced system.

It's all too easy to think that restraint is about belts and shackles. In fact restraint goes far wider: from the thousands of people with dementia being sedated by the inappropriate use of anti psychotic drugs to people being denied access to outdoor space because of a lack of staff in care homes.

Many of the horrendous stories of abuse in the report occurred because of care staff's lack of understanding and training in dementia care. Alzheimer's Society's recent Home from Home report echoed these experiences and we believe mandatory dementia training for staff in all care settings would begin to tackle the huge variation in dementia care.

This report makes tough reading for any involved in or using older people's care services. It should provide a wake up call that we can no longer leave people in the front line of care to cope alone without adequate resources; proper inspection and regulation; and specialist dementia training.

Notes

- The All Party Group in Dementia has announced an inquiry into the overuse of anti psychotic drug treatments in care homes.

- Alzheimer's Society spokespeople are available for comment.

- 700,000 people in the UK have a form of dementia, more than half have Alzheimer's disease. In less than 20 years nearly a million people will be living with dementia. This will soar to 1.7 million people by 2051. 1 in 6 people over 80 have dementia.

- The Alzheimer's Society is the leading care and research charity for people with all forms dementia and their carers. It provides information and education, support for carers, and quality day and home care. It funds medical and scientific research and campaigns for improved health and social services and greater public understanding of dementia.

- The Alzheimer's Society provides a national help line on 0845 3000 336 and website http://www.alzheimers.org.uk

BenefitsCheckUp Has Served Two Million Seniors

BenefitsCheckUp(R), the nation's most comprehensive online benefits screening service for seniors with limited income and resources, served its two millionth senior as of this month.

Historically, no more than half of older Americans who are eligible for these needed programs ever apply for them. For example, 70 percent of those qualified for food stamps have not enrolled in the program and nearly half of those who qualify for supplemental security income (SSI) have not applied. Similarly, there are still as many as 4.2 million who have not enrolled in the extra help available through Medicare prescription drug coverage.

Developed and maintained by The National Council on Aging (NCOA), BenefitsCheckUp® enables seniors with limited income and resources as well as those who care for or serve them to screen for and in some cases apply for federal, state and local benefits programs.

BenefitsCheckUp® includes more than 1,550 public and private benefits programs from all 50 states and the District of Columbia. These programs include health care, prescription drug assistance, heating and energy assistance, legal services, housing assistance, property tax programs and nutrition programs, as well as volunteer and training opportunities and education programs.

Since its inception in 2001, BenefitsCheckUp® has helped two million seniors determine eligibility for these programs and has identified over $5.8 billion in public benefits...

See http://www.ncoa.org/content.cfm?sectionID=305

Serious Nursing Home Citations Increased By 22% Over Six Years, According To Analysis

The number of nursing homes nationwide that were cited for placing residents in "immediate jeopardy" increased by 22% from 2000 to 2006, according to a USA Today analysis of CMS records. The citations are the most serious reprimand inspectors can issue and often follow cases in which residents have been physically or sexually abused or did not receive their medications, USA Today reports. Nursing homes that are cited for immediate jeopardy may be fined or prohibited from accepting new Medicaid beneficiaries, "a major source of their income," USA Today reports.

The analysis found that inspectors in 2006 identified nearly 2,000 violations that jeopardized residents at about 850 of the 16,000 nursing homes across the U.S. Those violations account for about 6% of total violations found in nursing homes. CMS records for 2007, which are incomplete, show that more than 1,300 immediate jeopardy citations have been issued.

Hillary and Harkin Introduce Bill to Force Disclosure of Names of Worst Nursing Homes

As someone with a parent in a nursing home, I am very glad to learn that Hillary Clinton and Tom Harkin (D-IA) have introduced a bill "that would force a federal agency to make public its list of the nation's worst nursing homes."

The U.S. Centers for Medicare and Medicaid Services has compiled a list of 128 nursing homes that have repeatedly fallen in and out of compliance with government health and safety regulations and caused harm to their residents. Those so-called "special-focus facilities" are now subject to more frequent government inspections.

Two weeks ago, the agency released an abbreviated, public version of the list that identified only 52 of the facilities. The agency refused to release the full list of 128 homes, even though it had already provided the full list to nursing home association lobbyists at the American Health Care Association.

Home-Centered Health Care

ike Magee is author of eight books, including Health Politics: Power, Populism and Health. He directs healthcommentary.org, and serves as a member of the National Commission for Quality Long Term Care. We discuss his latest book, Home-Centered Health Care, which argues that the quality of health care can be dramatically improved, and costs contained, by re-building health management around electronic patient records and home-based electronic medical monitoring.

Maryland Appeals Court Ruling Could Broaden Medicaid Eligibility Standards For Elder Care

The Maryland Court of Special Appeals last month ruled that some Medicaid eligibility standards used by the Department of Health and Mental Hygiene were stricter than federal laws allow, and advocates hope the broad standards outlined in the case will be applied universally, the Baltimore Sun reports. The lawsuit was filed by Diane Byus on behalf of her mother, Ida Brown, after Brown was diagnosed with Alzheimer's disease and was unable to receive assistance through the Older Adults Waiver Program, a Medicaid program designed to provide services such as nursing and adult day care.

Maryland limits eligibility in the program to residents older than age 50 who have incomes less than $1,869 a month and require daily care from licensed health care professionals. Although Brown, who also has several chronic conditions, requires daily monitoring, she does not require constant care from a physician or nurse, the Sun reports. Attorneys from the Legal Aid Bureau and AARP argued in the case that state and federal laws limit eligibility to residents who regularly require "health-related care and services," such as those that could be provided in a nursing home, but not necessarily daily by a skilled nurse.

NCQLTC Releases Final Report

By bringing together government and academic leaders, consumer advocates and experts from the front lines, we’re working to lay out real solutions to the pressing questions shaping how an aging generation will live:

Elder care plan defied on 2 fronts

New Hampshire's 10 counties are waiting for a judge to decide if they must follow a new state law that requires them to take over the state's share of long-term care services for poor, frail elders.

The lawsuit won't be heard until mid-winter, but some House members have already crafted an insurance plan - legislation that would remove the counties from the nursing home business, leaving the state with the bill.

The move is the latest development in a complicated debate that's spanned nearly a decade. At issue is how New Hampshire should subsidize elder care for the thousands of poor seniors living in nursing homes or receiving health care services in their communities.

Report on the 2006 AARP National Survey of Reverse Mortgage Shoppers

Results of the first nationally representative survey of reverse mortgage shoppers—older homeowners who have gone through reverse mortgage counseling and either taken out a loan or decided not to do so—are presented in this AARP Public Policy Institute (PPI) Research Report by Donald L. Redfoot of PPI, Ken Scholen of the AARP Foundation, and S. Kathi Brown of AARP Knowledge Management. This survey provides the first detailed look at consumer interest in reverse mortgages, consumer experiences with lenders and counselors, why some consumers decide against these loans, how borrowers use the loan proceeds, and how well reverse mortgages address borrower needs.

The Democratic “Invisible Army of Caregivers”

Senator Hillary Clinton released her awaited ”Long-Term Care Agenda” this past week, joining her fellow lead democratic candidates Barack Obama and John Edwards with a plan for how to deal with the rising needs of seniors and caregivers around the country.

Caregiver Education and Support Programs Provide Positive Impact

White Paper Abstract: According to statistics by the Family Caregiver Alliance, approximately 52 million informal and family caregivers provide care to an adult that is ill or disabled in the United States. The majority of caregivers are 35 to 64 years old, and an estimated 60 percent are also working outside the home. A proactive approach to this growing dilemma through caregiver education and support programs allows employers to provide an invaluable benefit, while increasing employee loyalty and productivity.

Please fill out the registration form below to receive "Caregiver Education and Support Programs Provide Positive Impact" [Note: Incomplete and invalid forms will not be processed.]

Top Holiday gifts for those with Dementia

I'm sure if you have a loved-one with Alzheimers, what to get them as a gift can be difficult. Here are some excellent suggestions.

Top Holiday Gifts For Those With Dementia
By Susan Berg

Over 5 million Americans are living with Alzheimer's disease or a related dementia. Buying a gift for them for the holidays is not difficult if you keep a few things in mind.

First you should know the persons likes and dislikes. Also important is knowing their strengths and weaknesses. In addition consider, when purchasing a gift for someone with dementia, keeping their mind and body active. Also think about a gift that will keep on giving long after Christmas, Chanukah, Kwanza or other celebrated holidays are gone Keep in mind, also, that gift selections should change as Alzheimer's disease or another dementia, progress

Gifts that keep dementia persons' mind active

S.1577 - Patient Safety and Abuse Prevention Act of 2007

A bill to amend titles XVIII and XIX of the Social Security Act to require screening, including national criminal history background checks, of direct patient access employees of skilled nursing facilities, nursing facilities, and other long-term care facilities and providers, and to provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers.

SenseCam Aids Patients with Memory Problems

"A small digital camera developed by Microsoft Research could boost memory in people with dementia and possibly mild forms of Alzheimer's disease. SenseCam is worn around the neck and automatically takes a wide-angle, low-resolution photograph every 30 seconds. It contains an accelerometer to stabilize the image and reduce blurriness, and it can be configured to take pictures in response to changes in movement, temperature, or lighting. An entire day's events can be captured and downloaded onto a PC where software converts the pictures into a short movie displaying the images at up to 10 frames per second, to allow patients to view a day's events in a few minutes to jolt their memory. "Not only does SenseCam allow people to recall memories while they are looking at the images, which in itself is wonderful, but after an initial period of consolidation, it appears to lead to long-term retention of memories over many months, without the need to view the images repeatedly," says neuropsychologist Emma Berry."

Caregiver Candidates

According to an article from AARP, and number of the current political candidates are caregivers themselves.

For example, Hillary Clinton’s mother lives with her in her Washington, DC home, and, Elizabeth Edwards, wife of American Democratic presidential hopeful, John Edwards has aging parents in long term care.

I have no idea how that fact may or may not shape their policies, but, I like seeing how they are real people who face some of the same things we do. Even though they may have more resources than we regular folks have, there is a universal emotional and time impact that caring for an aging parent enacts.

Grassley Seeks Probe On Antipsychotic Use In Nursing Homes

Sen. Chuck Grassley (R-Iowa) in a letter on Tuesday asked HHS Inspector General Daniel Levinson to examine the use of antipsychotics in nursing homes, the possibility of payments to physicians who prescribe the medications and the drugs' cost to Medicare and Medicaid, the Wall Street Journal reports. According to a Journal article published on Tuesday, which Grassley cited in the letter, antipsychotics have become the most expensive class of medications for Medicaid. Nursing homes often administer the medications to dementia patients to quiet their symptoms.

In 2005, Medicaid spent $5.4 billion on atypical antipsychotics, not including rebates that the federal government might receive. Grassley also asked CMS for information about how the agency responds to nursing homes that misuse antipsychotics, a practice he called "disturbing and alarming."

Update on Medicare Therapy Caps and ADA Restoration Act

MS Exceptions Set to Expire on Medicare Therapy Caps
Rehabilitation therapy under Medicare might no longer be affordable for some people living with multiple sclerosis and other conditions. The exceptions process to Medicare's arbitrary reimbursement limits, or therapy caps, on rehabilitation services is set to expire on December 31, 2007.

MS activists have long been determined to eliminate Medicare therapy caps altogether on reimbursement for physical therapy (PT), speech language pathology, and occupational therapy (OT) services. In 2008, the therapy cap reimbursement level is scheduled to be $1,810 for PT and speech therapy, and a separate cap of $1,810 will apply to OT services.

Nursing Homes Often Medicate Residents Without Psychosis

"In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals," largely because nursing homes are "giving these drugs to elderly patients to quiet symptoms of Alzheimer's disease and other forms of dementia" -- conditions for which the drugs are not approved by FDA, the Wall Street Journal reports. According to CMS, 21% of nursing home residents who do not have a diagnosis of psychosis are prescribed antipsychotic drugs. "The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing home industry," the Journal reports.

Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging -- a not-for-profit industry group -- said, "You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable." According to Teigland, her research shows about one-third of dementia patients in nursing homes in New York state are receiving antipsychotics, with some facilities dispensing the drugs at rates as high as 60% to 70% of patients.

Aging is a Business and Economic Issue

Like other CEOs, I’m concerned about stemming “brain drain” amid a mass retirement and experience exodus in Minnesota.But a more immediate economic and competitiveness issue is how to deliver and pay for senior care to assist our current employees who are dealing with their aging parents. Absent innovation, the human and financial costs of a much larger, longer-living senior society will weaken other investments designed to enhance Minnesota’s competitiveness and make this state livable for a lifetime.

If my 86-year-old mother-in-law suffered a significant medical event that required care, I would have the luxury of being able to call upon any number of experts within Ecumen for guidance on what to do next, so she could live as fully and independently as possible.

Kerrey Joins Gingrich On Plan for Elderly Care

WASHINGTON — The Democratic head of the New School and a Republican former House speaker are urging presidential candidates to take up the issue of long-term care for elderly Americans, a problem that they warn will worsen with the retirement of the baby boom generation in the coming decades.

Bob Kerrey, the university president and a former Nebraska senator, joined with Newt Gingrich yesterday to release a 94-page report calling for a federal overhaul of the long-term care system that would be financed with a combination of public and private dollars.

Laguna Honda Settlement Creates Community Services

FOR IMMEDIATE RELEASE
Contact:Barbara Duncan
Director of Communications
Protection & Advocacy, Inc. (CA) c/o NDR
Phone: (510) 267-1256
E-Mail: Barbara.Duncan@pai-ca.org

November 28, 2007
Settlement of San Francisco lawsuit to create new community services for
seniors and adults with disabilities

SAN FRANCISCO, CA-Mitch Katz, San Francisco's director of public health,
announced today that a preliminary settlement has been reached in the civil
rights class action regarding expanded community-based living options for
seniors and people with disabilities in San Francisco (Chambers et al. v.
the City and County of San Francisco). The results will be improved
coordination of care and greatly increased housing options and other
services.
The new program, called "Success at Home" will provide people with "a single
door to independent living," said Katz. "We are very pleased to be taking
this innovative next step."
Mark Chambers, a plaintiff in the lawsuit, who has lived in Laguna Honda
Hospital and Rehabilitation Center since receiving a head injury in 1999,
was delighted to hear that he is about to be given the opportunity "to live
in the world." He hopes to be first in line to qualify for one of the 500
units of accessible housing to be found or modified in San Francisco over
the next five years and made affordable by subsidy from the new program.
Elissa Gershon, lead attorney from the Oakland office of Protection &
Advocacy, Inc., counsel in the lawsuit, said that "San Francisco now stands
to regain its progressive edge in disability rights implementation."

Success at Home
Anne Hinton, director of San Francisco's Department of Aging and Adult
Services, which will jointly manage the program with the San Francisco
Department of Public Health said that "Success at Home puts San Francisco in
the forefront of independent living services." The program enables San
Franciscans with disabilities to receive community-based housing and
services to live in the most integrated setting appropriate instead of in an
institution. Eligible individuals will be assessed for, referred to, and
provided with federally subsidized medical services, subsidized housing,
attendant and nursing care, case management, vocational rehabilitation,
substance abuse treatment, mental health services and assistance with meals.
Hinton said "This new single point of entry will also mean community
transition services will be tailored to individual needs and preferences."
Transition services will be coordinated by an individualized Community
Living Plan. Medi-Cal qualified residents of Laguna Honda Hospital and
Rehabilitation Center, those who have been discharged in the last two years
or are on a waiting list for the facility, and patients at San Francisco
General Hospital will be assessed for services.
Herb Levine, director of the San Francisco Independent Living Resource
Center, the organizational plaintiff in the case, commented that he is
"looking forward to the new collaboration between the City and community
service organizations to achieve independence and community living for
hundreds of seniors and people with disabilities." The settlement sets out a
five year timeline for implementation of the new services.

New directions
Paralleling the introduction of new community services, the Laguna Honda
facility will begin to emphasize short-term rehabilitation as one of its
goals. In addition, several hundred Medi-Cal Home and Community-Based waiver
slots, which will allow people to receive long-term health care in their
homes, will be made available to those who qualify, which should bring
millions of dollars in federal and state Medicaid funding to San Francisco.

Summary
The preliminary settlement of the case is awaiting approval by the Board of
Supervisors, the Health Commission, and the Court. Individual plaintiffs are
six residents of Laguna Honda; organizational plaintiff is the Independent
Living Resource Center of San Francisco. Co-counsel on the case are
Protection & Advocacy, Inc., Disability Rights Education and Defense Fund,
AARP Foundation Litigation, the Bazelon Center for Mental Health Law, and
the law firm of Howrey LLP, pro bono.
###

NATIONAL ADAPT MAILING LIST - Adapt Community Choice Act List
http://www.adapt.org

Upstairs Solutions

Welcome to Upstairs Solutions LTC, your all-in-one resource for comprehensive on-line training and compliance for senior care professionals.

As a provider-owner company, we understand the obstacles that you face and the many staffing needs that you encounter every day. That’s why we’ve developed:

Candidates as Caregivers

As the presidential candidates crisscrossed the early-primary states in recent months, Americans facing the challenges of long-term care might have wondered about the contenders' own experiences with their parents. And more important, how have those experiences helped shape the candidates' policies on the way families provide and receive long-term care?

Universally, the candidates have made the best of the varied situations they've been dealt. And from these encounters have emerged a variety of proposals that range from neighborhood networks to many ways government should or shouldn't help.

Hospitalizations and Deaths Caused by Methicillin-Resistant Staphylococcus aureus, United States, 1999-2005

Hospitalizations related to methicillin-resistant Staphylococcus aureus (MRSA) infections more than doubled, from 127,000 to nearly 280,000, between 1999 and 2005, according to a new study in the December issue of the journal Emerging Infectious Diseases. During that same period, hospitalizations of patients with general staph infections increased 62 percent across the country.

Assisted Living Facilities In-service Curriculum offered Online

I’ve just discoverdd an organization called Care2Learn that offers online in-service training - for assisted living facilities nationwide that was developed for the purpose of educating, training, testing, reporting and tracking continuing education for employees in post-acute healthcare.

Their new assisted living curricula offers 87 in-services....