New Episode Of The Senior Care Podcast By LivHOME Focuses On Caring For Seniors With Dementia

LivHOME, the nation's largest provider of professionally led at-home care for seniors, has released a new episode of The Senior Care Podcast by LivHOME that discusses caring for seniors with dementia.

In Episode 4, LivHOME Chief Professional Officer Steve Barlam describes common caregiving mistakes in working with dementia sufferers, how to identify the causes and precursors to challenging behavior, and explores ways to reduce anxiety among seniors suffering from dementia. Drawing on more than 20 years of geriatric social work experience, Barlam provides advice for caregivers and offers poignant examples based on actual caregiving experience.

The episode is particularly important for caregivers, since about half of Americans age 85 and over suffer from some form of dementia, which includes Alzheimer's disease.

Episode 4 of The Senior Care Podcast by LivHOME can be found at the podcast's homepage (http://www.livhome.com/podcast). Listeners can subscribe to the show via RSS feed, email or through the iTunes store. Episode 4 has a runtime of 14 minutes, 22 seconds.

CMS Proposes Stronger Protections For Beneficiaries Using Durable Medical Equipment, Prosthetics, Orthotics, And Supplies, USA

The Centers for Medicare & Medicaid Services (CMS) on January 25 issued a proposed rule to enhance the enrollment standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. The proposed rule is intended to increase protections for Medicare and its beneficiaries from potentially dishonest or low quality suppliers.

By creating five new standards and strengthening seven of the 21 existing standards that suppliers must meet, the proposed rule would provide Medicare beneficiaries with additional assurance that they are being served by suppliers who meet the highest standards of quality.

"The proposals represent the next step in Medicare's ongoing efforts to ensure its beneficiaries continue to have access to high quality products and services at appropriate prices, while protecting them and the program from unscrupulous suppliers," said CMS Acting Administrator Kerry Weems. "In addition to meeting the enrollment standards, all DMEPOS suppliers are required to obtain accreditation from one of ten accrediting organizations announced in November 2006."

Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias, Second Edition

The Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias consists of three parts (Parts A, B, and C) and many sections, not all of which will be equally useful for all readers. The following guide is designed to help readers find the sections that will be most useful to them.

Part A, "Treatment Recommendations for Patients With Alzheimer's Disease and Other Dementias," is published as a supplement to the American Journal of Psychiatry and contains general and specific treatment recommendations. Section I summarizes the key recommendations of the guideline and codes each recommendation according to the degree of clinical confidence with which the recommendation is made. Section II is a guide to the formulation and implementation of a treatment plan for the individual patient. Section III discusses a range of clinical considerations that could alter the general recommendations discussed in Section II.

Part B, "Background Information and Review of Available Evidence," and Part C, "Future Research Directions," are not included in the American Journal of Psychiatry supplement but are provided with Part A in the complete guideline, which is available online through the American Psychiatric Association (http://www.psych.org) and in print format in

H.R.3088 Long-Term Care Act of 2007

To amend the Internal Revenue Code of 1986 to provide that distributions from an individual retirement plan, a section 401(k) plan, a section 403(b) contract, or a section 457 plan shall not be includible in gross income to the extent used to pay long-term care insurance premiums.

H.R.3001 Community Living Assistance Services and Supports Act

To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes.

H.R.2582 Qualified Long-term Care Fairness Act of 2007

To amend the Internal Revenue Code of 1986 to allow a deduction for qualified long-term care services in computing adjusted gross income.

SENCARE 2008 To Open Big Pic On Health & Life Care For Elderly, Taiwan

Taiwanese AT show:

According to projections from the well-known market survey institute Espicom Business Intelligence, the market of medical equipment, including the assistive device industry, offers incredible potential business opportunity, since it will expand rapidly from US$164.3 billion in 2006 to US$201.6 billion in 2016, with a compound annual growth of (CAGR) 5.2%. And with an increasingly global aging society, market demand for Assistive Devices is emerging to become a gold rush for medical equipment industries.

To help tap into these prospects, TAITRA (Taiwan External Trade Development Council) will organize the second Taiwan Int'l Senior Lifestyle and Health Care Show from May 2-5, 2008 at Hall 3, Taipei World Trade Center. The international fair that targets those of, or serving the gray hair generation, will offer an integrated venue for the medical industry and health care business to stage a comprehensive one-stop platform for global buyers. As a result every major firm in the industry chain will be represented including those in R&D, the manufacturing process, and various service sectors. These concerns will be invited to display the best including products from multifunctional Mobile Assistive Devices to daily life Assistive Devices and peripherals.

Nursing Home Report Card Makes The Grade

A national, Web-based report card on nursing homes is improving some aspects of nursing home care, a new study finds.

The Centers for Medicare & Medicaid Services began publishing the "Nursing Home Compare" report card results on the Web in 2002. The site gives detailed information about the past performance of every Medicare- and Medicaid-certified nursing home in the country.

According to lead investigator Dana Mukamel, Ph.D., the study is the first "to investigate the impact of a report card on quality of nursing home care." Previous such studies have focused on health plans, hospitals or physicians.

U.S.A. Gov Helps Long-Distance Caregivers

USA.gov, the U.S. government’s official web portal, now links to Caring from a Distance, a web site dedicated to the seven million Americans who manage the needs of seniors who live hundreds or thousands of miles away.

A CBS poll found that four in ten who have had the experience of caring for aging parents say issues involving care can be stressful and can lead to disputes among family members.

Caring from a Distance was founded to bring caregivers seeking help needed information and resources at-a-glance. Our goal is to utilize a range of communication and social networking technology to reduce caregiver stress through improved family communication.

For more information, visit cfad.org

Welcome to the National Care Planning Council

The site is surprisingly complete:

The 35 articles below contain over 690 pages of valuable information....

ADAPT testimony at the CCA hearing

From Scott Heinzman:

This lays it out damned well! It is up to each of us to speak out. -s

-------- Original Message --------

Subject:	ADAPT testimony at the CCA hearing
Date:	Mon, 21 Jan 2008 10:15:38 -0600
From:	ADAPT
To:	commchoice-list

Here's the testimony.  The Appendixes are not attached here for reasons of
length.  Appendix one was a list of the MDS numbers for folks wanting out
from all the states represented on the Health Subcommittee.  Appendix 2 was
a summary of testimony given in Nashville TN (printed in Incitement);
Appendix 3 was the list of CCA supporters -- all 700!  We picked up a few
more at the hearing so we're updating that list before we send it out again.

*********

Good Morning.  I am Stephanie Thomas, a National Organizer for the
grassroots disability rights organization ADAPT.  I appreciate the
opportunity to speak to you today.

Over 17 years ago the Americans with Disabilities Act was signed into law.
The disability community celebrated, but as we celebrated we realized that
there were members of our community who were being left behind.  Stuck in
nursing homes and other institutions, they had neither liberty nor pursuit
of happiness; they were virtual prisoners of a system that basically uses
them as a cash crop to draw down dollars for others to enjoy.  Many of the
members of the group I represent, ADAPT, have themselves been trapped in
nursing homes and other institutions and had to fight their way out to live
in the community.  Many of the rest of us see this bleak picture as our
future, a future that haunts us every day.

We have listened to our friends who have lived through being
institutionalized against their will.  They told us of living in an 8' by 8'
room with another person - not of their choosing, being told when to get up,
when to go to bed, what and when to eat.  We have gone to visit them and
been told they can not leave the building, that we cannot go to see them
because we raise up their hopes.  We have heard them explain how "your life
is not your own."  We have heard them say "I would rather die than go back."
I have never in my life heard someone say, "I am looking forward to moving
into a nursing home."  We know of children born with disabilities who have
been forced away from their families into institutional placements because
this was the only "support" option available to their families; children
belong in families, not in institutions.  Being institutionalized by one's
own choice is one thing, being trapped there because you have no
alternatives is something very different.

According to CMS' own numbers, nationally over 300,000 people, in nursing
homes alone, have expressed a preference for home and community services,
yet they are stuck inside - unable to connect with any community options
that might exist.  8,787 are from NJ, 5,762 from GA.[1]   This does not even
count those trapped in other kinds of institutions, and those in the
community scraping by as they wait year after year to move up a waiting
list.  What I want to talk to you about today is a way to give those people
choices, and help the states and Federal government at the same time. Why do
we invest so much to keep people locked away?

In 2005 ADAPT held a hearing in Nashville Tennessee and invited people who
had previously been institutionalized to come and testify.  People flocked
from across the nation to give testimony, and the hearing lasted over six
hours.  You have all been given a DVD which summarizes what was said.  [2]

People continue to have to move out of state - away from family and
friends - to be free. They fight brain washing and intimidation.  They
believe in themselves beyond what all around them believe, in spite of the
doubt and oppression from the current service system.  And these are the
lucky ones.  Those who got out did not "get better" from their disabilities,
they simply got out - and now live in the community with attendant services
and supports.

But I am not here to talk about how awful nursing homes or other
institutions are.  I am here to urge you to take action to give people a
real choice in long term care, to pass Representative Danny Davis and John
Shimkus' bill HR 1621 The Community Choice Act, CCA, and to squarely address
the institutional bias in Medicaid long term care.

Medicaid has helped millions of people with disabilities of all ages; it has
saved people from alms houses and even death.  It has played a vital role in
assisting people to achieve independence, dignity and health.  But it has
done this with its hands tied behind its back.  The glaring problem of
institutional bias grows more pronounced every day as the awareness and
values of our nation change, as the medical and scientific breakthroughs
promise more independence and autonomy for children, adults and seniors with
significant disabilities - yet Medicaid stays so wed to the institutional
mode.  Even Money Follows the Person, an important new demonstration program
funded in the DRA, requires that the person must be in an institution to get
out and receive services.

Our current system is backwards.  The institutional bias has led to a system
wherein the institutional service is mandated, and the community is
optional; where 67% of the Medicaid long term care funds go to the
institutions and just 33% are left for community services, despite the fact
that there are long waiting lists - sometimes as long as 10 years - for
community services.  Ironically, these same community services cost only
about 2/3 of their institutional equivalent.  We could be serving 3 people
for every 2 we are serving now, and doing it more humanely.

Services are fragmented, based on disease categories and age, instead of on
functional need.  If you have a traumatic brain injury at the age of 18 you
may be eligible for extensive support services, but if you have that same
injury six years later you are out of luck.   If you have a spinal cord
injury, a boutique program may cover your needs, but if you have Multiple
Sclerosis and need the exact same tasks done your only option may be Villa
Siesta Nursing Facility.  It makes absolutely no sense, unless you are into
Byzantine policy history, and even then .

We hear about fear of the "woodwork effect," an insulting term that actually
refers to unmet need of real live human beings. We are not cockroaches and
this is not pest control.  Let's look at the reality of this issue:  People
eligible for the Community Choice Act are people who are currently meeting
the income and medical necessity requirements of nursing home or other
institutional services.  They are people with significant disabilities.
Without any services they will eventually endanger their health and wind up
using much more costly medical services: going without eating, staying in
one position for too long, or consistently urinating or defecating on
yourself leads to serious problems like malnutrition, bedsores, and worse.
Getting by with no support services is not an option.  Forcing people to get
by on nothing is not good policy and does not solve the money issue in the
long run.

Many states would like to even the playing field, but when the Federal
Government says you must fund nursing homes -- and if you want you can fund
these other community services, States are going to be darn sure the finite
dollars they get go to covering the mandated programs first -- and community
waiting lists will grow.

We even believe the Community Choice Act would help to improve the services
in nursing homes and other institutions because it would give them real
competition.  If people knew they could go somewhere else, like their own
home, nursing homes and other institutions would have to provide an option
people would freely choose.

Over 700 national state and local organizations have signed on supporting
the Community Choice Act, from the American Medical Association to the
National Council on Independent Living; from the United States Conference of
Catholic Bishops, and Service Employees International Union to the NAACP and
NOW; from the Oglala Sioux Nation to the Christopher and Dana Reeve
Foundation and Not Dead Yet.  I could go on and on, but the list is included
with my written testimony.

WHAT THE COMMUNITY CHOICE ACT, HR 1621, DOES

This bill is based on a very simple concept.  By reforming Title XIX of the
Social Security Act (Medicaid) it takes a huge step toward ending the
institutional bias.  It makes an existing mandated service more flexible, to
meet the needs of those who are currently eligible for its services.  The
Community Choice Act allows individuals eligible for services in a Nursing
Facility, Intermediate Care Facility for the Mentally Retarded (ICF-MR), or
Institutions for Mental Disease (IMD) the opportunity to choose instead a
new alternative, "Community-based Attendant Services and Supports."  It
doesn't force anyone to move out, as some have claimed.  It simply gives
people a choice.

In addition, by providing an enhanced match and grants before October 2011
when the benefit becomes permanent, the Community Choice Act offers states
financial assistance to reform their long term service and support system to
provide services in the most integrated setting.  This is already beginning
to happen but in an ad-hoc, piecemeal basis, and often people must be in
institutions in order to choose community services.

Specifically what does this bill do?

It provides community-based attendant services and supports that include
assistance with:
* activities of daily living (eating, toileting, grooming, dressing,
bathing, transferring),
* instrumental activities of daily living (meal planning and preparation,
managing finances, shopping, household chores, phoning, participating in the
community),
* and health-related functions.

CCA includes hands-on assistance, supervision and/or cueing (like reminding
someone), as well as help to learn, keep and enhance skills to accomplish
such activities.

It requires services be provided in the most integrated setting appropriate
to the needs of the individual.

CCA provides Community-based Attendant Services and Supports that are:
* based on functional need, rather than diagnosis or age;
* provided in home or community settings like -- school, work, recreation or
religious facility;
* selected, managed and controlled by the consumer of the services;
* supplemented with backup and emergency attendant services;
* furnished according to a service plan agreed to by the consumer;
and that include voluntary training on selecting, managing and dismissing
attendants.


This bill allows consumers to choose among various service delivery models
including vouchers, direct cash payments, fiscal agents and agency
providers. All models are required to be consumer controlled and comply with
federal and state labor laws.

For consumers who are not able to direct their own care independently, the
Community Choice Act allows for an individual's representative to be
authorized by the consumer to assist.  A representative might be a friend,
family member, guardian, or advocate.

It allows health-related functions or tasks to be assigned to, delegated to,
or performed by unlicensed personal attendants, according to state laws.

It covers individuals' transition costs from a nursing facility, ICF-MR or
IMD to a home
setting, for example: rent and utility deposits, bedding, basic kitchen
supplies and other
necessities required for the transition.

CCA serves individuals with incomes above the current institutional income
limitation -- if a state chooses to waive this limitation to enhance
employment potential.

In addition, CCA provides for quality assurance programs which promote
consumer control and satisfaction.

The bill also provides a maintenance of effort requirement so that states
can not diminish more enriched programs already being provided.

CCA allows enhanced match (up to 90% Federal funding) for individuals whose
costs exceed 150% of average nursing home costs.  This protects against
discrimination based on severity of disability, so people with more
significant disabilities who require more services can still receive
services on the community.

For the first five years (2007 through 2011) after which the services become
permanent, CCA provides enhanced matches (10% more federal funds each) for
states which:
* begin planning activities for changing their long term care systems,
and/or
* include Community-based Attendant Services and Supports in their Medicaid
State Plan.
And, in the area of systems change:
CCA provides grants for Systems Change Initiatives to help the states
transition from their current institutionally dominated service systems to
ones more focused on community based services and supports, guided by a
Consumer Task Force.

It also calls for national 5 -10 year demonstration project, in 5 states, to
enhance coordination of services for individuals dually eligible for
Medicaid AND Medicare.

CONCLUSION

Ten years ago I and hundreds of other members of the disability community
sat in the audience of this committee for a similar bill called MiCASSA.
Mike Auberger and Justin Dart Jr. among others, testified to this Committee
[several of you were here at that time too] about the urgent need to end the
institutional bias in our long term care system.  At that time the
Congressional Budget Office gave the bill a fiscal note that included costs
for people who are actually not eligible for the bill and services that are
not included in this bill.  Since then, the University of California at San
Francisco has done a statistically valid and peer reviewed re-calculation of
the cost and found it would be $1.4 to $3.7 billion dollars, a fraction of
the original, erroneous CBO scoring.

In those past 10 years there has been a rising frustration as Congress
refuses to act on this critical issue.

For the women on this committee, and the women who staff this committee and
it's members -- take heed.  The vast majority of people in nursing homes are
women over the age of 65, the vast majority of the underpaid direct care
workers are women, and the vast majority of women who are providing long
term care to family and friends for "free" are women.  Is this issue swept
so completely under the rug because of this?  Who can say?  What we can say
is that most of you, men and women alike, will have to face this issue in
the near future from one of these angles - a recipient of personal care
services, a family provider, or through paid service provision.

I faced it when my father-in-law came to live with my husband and me.  A
diabetic who had a stroke, he stubbed his toe and soon had to have first
that leg amputated and then the other.  His eyesight was going and so was
his memory of things like whether he left the stove on.  It would have been
so simple for him to go to a nursing home; "professionals" of various ilks
urged us to do it again and again!  Despite the fact that my husband and I
both have disabilities, we were able to keep him out of a nursing home, and
living with us - with the help of attendant services.  Today however, he
would be on the bottom of an over 40,000-person waiting list and it is
doubtful he would have reached the top before he passed away.  I will face
this again as my quadriplegic husband comes to need even a little more
assistance, as my parents get older and -- hopefully last but not least, as
I too age and need more assistance.

America is aging, and as America grays this issue looms larger and larger.
It is not a question of if we will be dealing with long term care, it is a
question of how we will be dealing with it.  We must pull our heads out of
the sand and face the issue.  Like most monsters under the bed, once we
confront this we will find it is not what we feared.

Long term care insurance may help some people, but for people who are
eligible for the CCA, in other words eligible for Medicaid nursing home and
other institutional services, it is not an option.  They can not afford it,
and frankly the community options such insurance offers are often woefully
short of the need - despite the fact that they often offer much more
expansive and expensive institutional services as a "benefit."

Vouchering the services for everyone is not the solution either.  As my
friend Doris put it "I don't want to have to become a small business, doing
taxes, recruiting workers and all that, just to be able to get out of bed
and take a bath!"  Unlike many who would be eligible for services, Doris
does not have any kind of cognitive disabilities which would make such a
solution even more complex.  And it is a lot easier to cut dollars for
vouchers than to slash services for individuals.  When Senior and disability
advocates have sought vouchers, it has been as part of the system, not the
entire system.  We do not support block grants; we support choice.

Passage of the Community Choice Act would put these service choices in the
hands of the individuals who are affected, not in the hands of a Federal
Bureaucracy which has ratcheted down on spending for Medicaid long term
care, despite the growing need.  We are facing a terrible example of this
ratcheting down right now:  Even as CMS is encouraging states to assist
people who want out of nursing homes or other institutions to move out (a
good thing!), it has bizarrely decided to cut Case Management Services by
almost 70%.  This assistance is vital for people who have lost everything
once they have been institutionalized, who need help getting everything they
need to move out -- from a social security card to an apartment.  This
devastating cut shows the lack of understanding of the reality of people's
lives - the distortion in priorities and understanding of what long term
care is all about.  You need to reverse this terrible decision on Case
Management and reverse the overall institutional bias in Medicaid.  Passing
the Community Choice Act is an important piece in this overall effort.

Thank you for the opportunity to speak today.  I would be happy to answer
any questions.




[1] See appendix for complete list. Or go to
www.cms.hhs.gov/MDSPubQIandResRep/
[2] See the ADAPT website www.adapt.org for a transcript of the entire
hearing, or contact me at adapt@adapt.org.  Excerpts of the testimony are
attached to my written testimony. 

Gay & Gray and Invisible

«Those in their 80s and 90s were forced to endure an era where homosexuality was considered both a mental illness and criminal,» Froelich says. «And for those in long-term health facilities, things may only get worse.»

Elder gays and lesbians are often forced to revert to living closeted lives again in their last years in order to avoid ridicule and sub-standard care in institutional settings.

«By the time they enter a nursing home, they really need a tremendous amount of assistance,» Lisa Krinsky, who directs a pioneering LGBT aging project in Boston, tells Froelich. «So the fear that those (places) may not be respectful, may not attend to you in a timely manner or (may) downright mistreat or abuse you is a fear that many older LGBT folks have.»

Engaging People with Early Stage Alzheimer's Disease in the Work of the Alzheimer Society

This report was the result of research conducted in 2005, motivated by The Alzheimer Society of Canada's desire to identify strategies that promote the active participation of people with early-stage dementia in our organization and our work, particularly policy, research, and service delivery.

Drawing from related literature, the experiences of people with the disease, Alzheimer Society staff, and key informants, this report examines the factors that influence individuals to volunteer and the barriers that may limit their participation.
http://www.alzheimer.ca/docs/EarlyStagesEng.pdf

Advocacy Groups Offer New Plan for Long-Term and Post-Acute Care Delivery System

Three long-term care advocacy organizations--the American Health Care Association (AHCA), the Alliance for Quality Nursing Home Care (AQNHC) and the National Center for Assisted Living (NCAL)--last week unveiled a comprehensive plan designed to create a consumer-oriented system bringing greater private resources into the long-term and post-acute care delivery system.

The proposal emphasizes better coordination of both care and financing, greater private sector involvement, and appropriate personal responsibility. The plan would reorganize the Medicaid long-term care and Medicare post-acute care systems by centralizing and streamlining government services and making more private resources available to pay for care. Read the executive summary.

New Nursing Home Philosophy: Limit Time in Wheelchairs

RALEIGH, N.C. (AP) -- You can see it at most long-term care centers -- residents in wheelchairs lining hallways, just sitting or rolling slowly down the hall.

But a health service director at a Durham center says it's time to stop parking older people in wheelchairs.

Leslie Jarema of The Forest at Duke says in the old-school nursing homes, people are sitting around the nurses' station and asking for help because they are uncomfortable.

The Midwest-based group called GROW, or Get Residents Out of Wheelchairs, has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners. The group, which has asked Jarema to speak about her approach at The Forest at Duke, also tries to get residents to be as active as possible, encouraging walking to meals, going on foot to the bathroom or shower and taking outside walks with family and friends when possible.

Parent Care

We solved the caregiver maze …
So you won’t have to

We help remove obstacles to older parents’ safety and independence even if they’re not local.

Subscribe now and get a detailed report on your folks’ county to help locate and evaluate senior assistance services.

Self-Directed Personnel Assistance Services Program State Plan Option (Cash and Counseling),

Centers for Medicare & Medicaid Services

This is the published rule for comment on Self-Directed Personal Assistance.

The entire January 18, 2008 Federal Register is available at http://tinyurl.com/2wd5n8

Caregivers Find Unexpected Emotional Rewards in Tending for Family Members

Nearly 80% of family caregivers are finding the caregiving experience emotionally rewarding, despite initial negative perceptions of caregiving, according to a nationwide survey by Caring Today magazine.

Published in conjunction with National Family Caregivers Month this past November, the Caring Today survey shows that caregivers have distinctly more positive feelings after caring for a family member than they did as they were about to take on the responsibility. The number of caregivers finding the experience highly rewarding jumped by 50% following the caregiving experience.

White Nursing Home Residents Less Likely Than Blacks To Be Hospitalized, Study Finds

Black nursing home residents are more likely than their white counterparts to be hospitalized for conditions such as dehydration, poor nutrition and bedsores, according to a study to be published in the June issue of the journal Health Services Research, the Washington Post reports. Lead study author Andrea Gruneir and other researchers affiliated with the Brown University Albert Medical School examined data from 2000 on more than 500,000 nursing home residents in 9,000 facilities across the U.S. (Spinner, Washington Post, 1/15).

CMS Proposes Cash Allowance To Let Beneficiaries Hire Personal Care Workers

MS on Monday announced it will accept public comment on a proposal to provide some Medicaid beneficiaries with a cash allowance to hire personal care workers, CQ HealthBeat reports. If their home states elect to adopt a self-directed personal assistance services option in their state plan, beneficiaries would be able to hire and train their own qualified caregiver -- who could be a family member -- to assist with daily activities but not direct medical care.

Democrats seek release of the names of more bad nursing homes

Knowing which nursing homes are bad can be valuable information for a family seeking long-term care for an elderly loved one but concerned about issues like nursing home abuse and neglect. Recently, the Centers for Medicare and Medicaid Services announced the names of 54 nursing homes that had ranked as one of the worst in their state. Proper administration of medication to patients, appropriate assistance with activities of daily life and concern for the prevention of malnutrition and dehydration are examples of what inspectors look for in nursing homes. Inspectors also look for signs of nursing home abuse and neglect such as failure to maintain resident safety and prevent accidents, such as falls, infections, bed sores and other problems elderly people are susceptible to.

The list published by CMS containing the names of 54 nursing homes is actually a sample of 128 "special focus facilities", or homes that were identified as in need of more oversight. CMS says that the rest of the facilities were not identified because during the six months after being titled a "focus facility" they showed improvement. Democratic legislators, however, are demanding that all of the names be released in order to protect nursing home residents. Most nursing homes have around 6-7 deficiencies identified during inspection, but the ones on the list had twice as many or more. Unfortunately, no national standard has been set for the investigations so each state has its own parameters. An Illinois nursing home can be considered in terrible condition, but would not qualify in another state. A bill was recently introduced in the legislature to make it mandatory for CMS to publish all of the names, but the issue of discrepancies between states' standards is an issue that should be addressed by congress.

Waking the Unconscious

A 38 year old male had suffered severe brain damage, slipped into in a deep coma, and a year after receded into a minimally conscious state. The patient was non verbal, was fed and kept alive through tubes in a long term care facility. Six years later, despite the large amount of damage to the cortex, imaging results showed that some parts of the brain were still functioning. This led a team of neurosurgeons to believe that they would be able to improve the patient’s state through manual stimulation of those undamaged parts of his brain. Upon examination at the time of enrollment, the patient was able to move his eyes sideways (but not up and down), and the rest of his body was out of conscious control.

The results were dramatic – within 48 hours post surgery the patient was able to respond to noise stimuli by turning his head towards the source of the voice. Further, he was able to keep his eyes open for a sustained period of time on his own, as well as move his limbs. Within 50 days with continued stimulation, he was able to bring a cup to his mouth, swallow food, thus becoming independent of his feeding tube.

The patient continued to improve after the experimental phase was over, and eventually was able to put together up to six words to express himself vocally. The cost of care for this patient has since reduced significantly, since he is no longer on a feeding tube and can feed himself manually three times a day.

CMS Issues Proposed Rule To Empower Medicaid Beneficiaries To Direct Personal Assistance Services, USA

A proposed rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services delivered by an agency, was announced by the Centers for Medicare & Medicaid Services (CMS).

Through the rule on display today at the Federal Register, CMS requests public comment on how states could allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers rather than working with personnel employed by an agency. Beneficiaries could even hire qualified family members who may already be familiar with the individual's needs to perform personal assistance (not medical) services.

COMMISSION MAKES RECOMMENDATIONS TO IMPROVE LONG-TERM CARE

Old story. but the picture and the site are interesting:

A report issued by the National Commission for Quality Long-Term Care warns of a coming long-term care crisis and includes recommendations to advance long-term care reform in four areas: quality, workforce, technology and finance.

As Home Instead’s The BUZZ continues its look at this report, entitled “Isolation to Integration: Recommendations to Improve Quality in Long-Term Care,” today’s article details recommendations regarding quality. Highlights of the commission’s 26 recommendations include:

· A critical part of long-term care quality is the individual’s quality of life. Giving individuals more choice and control over the services they receive in the settings of their choice will enhance their quality of life;

Program creates jobs and meets senior care needs

Halton is pleased to announce the continued success of a program that is providing jobs to Ontario Works (OW) participants and preparing Halton to meet the needs of a growing seniors population. The highly effective Personal Support Worker (PSW) program, which trains OW participants for careers in the long-term care and home care fields, graduated 23 new PSW's at a ceremony on Friday, January 11 at the Halton Region.

“Graduates of the PSW program will help ensure that Halton is ready to meet the needs of its growing seniors population,” said Regional Chair Gary Carr. “The program is also helping Ontario Works participants gain their financial independence and contribute to the success of Halton’s economy – it’s a win-win situation.”

The PSW program has cost $237,965 with a total savings to date of $1,175,852 based on reductions to social assistance costs. Since OW costs are shared at an 80/20 ratio between the Province and the Region, Halton’s share of the savings has been $235,170. Investments in this worthwhile program pay off in participant outcomes and will continue to result in ongoing reductions to social assistance costs. For more information, please contact Susan Lazzer at 1-866-442-5866 or visit www.halton.ca.

Reversal Of Alzheimer's Symptoms Within Minutes In Human Study

An extraordinary new scientific study, which for the first time documents marked improvement in Alzheimer’s disease within minutes of administration of a therapeutic molecule, has just been published in the Journal of Neuroinflammation.

This new study highlights the importance of certain soluble proteins, called cytokines, in Alzheimer’s disease. The study focuses on one of these cytokines, tumor necrosis factor-alpha(TNF), a critical component of the brain’s immune system. Normally, TNF finely regulates the transmission of neural impulses in the brain. The authors hypothesized that elevated levels of TNF in Alzheimer’s disease interfere with this regulation. To reduce elevated TNF, the authors gave patients an injection of an anti-TNF therapeutic called etanercept. Excess TNF-alpha has been documented in the cerebrospinal fluid of patients with Alzheimer’s.

The new study documents a dramatic and unprecedented therapeutic effect in an Alzheimer’s patient: improvement within minutes following delivery of perispinal etanercept, which is etanercept given by injection in the spine. Etanercept (trade name Enbrel) binds and inactivates excess TNF. Etanercept is FDA approved to treat a number of immune-mediated disorders and is used off label in the study.

The use of anti-TNF therapeutics as a new treatment choice for many diseases, such as rheumatoid arthritis and potentially even Alzheimer’s, was recently chosen as one of the top 10 health stories of 2007 by the Harvard Health Letter.

Kaiser Daily Health Policy Report Highlights Recent Developments In Elder Care

Elder care managers: The Los Angeles Times on Sunday examined how elder care managers are "emerging to bridge the gap between far-off relatives and aging parents who may be overwhelmed by the labyrinth of medical and other services designed to help the aged and infirm survive in their own homes.

Home care: The Minneapolis Star Tribune on Sunday examined how a "shift in focus and in resource allotments needs to happen in the near future to accommodate" the "overwhelming preference for home care" among elderly patients. According to the Star Tribune, despite the recent growth of the home elder care industry, the "infrastructure ... is not yet in place to handle this coming age wave of American retirees."

AARP Seeks U.S. Supreme Court Ruling That EEOC Lacks Authority To Allow Employers To Reduce Health Care Benefits For Medicare-Eligible Retirees

AARP has petitioned the U.S. Supreme Court to review whether the Equal Employment Opportunity Commission had the authority to issue a Dec. 26, 2007, regulation that allows employers to legally eliminate or reduce health benefits for retirees when they reach age 65 and become eligible for Medicare while retaining benefits for retirees under age 65, CQ HealthBeat reports (Reichard, CQ HealthBeat, 1/3).

The ruling allows employers to create two classes of retirees -- those younger than age 65 and those older than 65 -- and offer different benefits to each group. In addition, the ruling allows employers to eliminate or reduce benefits provided to spouses or dependents of retirees older than 65. EEOC proposed the rule in response to a 2000 U.S. Court of Appeals decision that required benefits to be offered at the same level for Medicare-eligible retirees and those younger than 65 (Kaiser Daily Health Policy Report, 1/2). A June 2007 decision by the Third Circuit Court of Appeals found that EEOC has the authority to create the exemption under the Age Discrimination in Employment Act.

CCA hearing set

The House Hearing for the Community Choice Act has been set!

The hearing on CCA and other long term care issues will be held on
Wednesday, January 16, 2008 at 10 am.
The hearing will held by the Health Subcommittee of the House Energy and
Commerce committee. we still don't have the details on what room but we will
let
you know when we get them.

We want a BIG turnout, like we had for the Senate hearing. If you have a
orange shirt, wear it because it showed up very well not only in the hearing
room, but on the internet as well!

This hearing will keep the momentum going for passage of CCA and reform of
the long term services and supports system.

Let's keep pushing MFP and getting it implemented in the states, BUT let's
also focus on passage of CCA! This hearing is the next step.

DEVELOPING A NEW AND BETTER LONG TERM CARE SYSTEM

Note Especially the "Long Term Compact", which provides for a novel funding mechanism to reduce the need for impoverishment before Medicaid eligibility. It is a kind of partnership program.

VNS Initiative Improves Work Life for Home Care Aides, ADLs for Patients

A successful effort to improve quality of life for home care workers and the people they assist is described in HHA Partnering Collaborative Evaluation: Practice/Research Brief, a publication of the U.S. Department of Health & Human Services Office of Assistant Secretary for Policy & Evaluation.

The initiative was launched in 2003 by the Visiting Nurse Service of New York. Its goal is to improve the work life of home care aides and increase support for their patients' improvement in key activities of daily living. Components include:

• Implementation of the "Five Promises" -- a set of field supervision practices designed to promote positive and effective communication among all caregivers while in the patient's home.
  
• Use of an ADL Tool to structure common goal-setting among nurses, patients, and aides in order to improve functional health.
  
• Proactive communication between patient service managers and licensed agency coordinators to cover aide supervision and service delivery issues.
  
• Increase in field support and supervision provided to aides.

In addition, it has changed the culture of health service delivery by moving from a purely professional model toward one of self-care management. In the self-care management model, patients and informal caregivers are active participants in decision-making and goal-setting, and home health aides play a key supportive role.

Elevated Risk Of Cognitive Problems In Elderly Surgical Patients

Patients over the age of 60 who have elective surgeries such as joint replacements, hysterectomies and other non-emergency, inpatient procedures, are at an increased risk for long-term cognitive problems, according to a new study led by Duke University Medical Center researchers.

The study also found that elderly patients who developed these postoperative cognitive problems were more likely to die in the first year after surgery.

Long Term Storage – Fade Out, The End

A very interesting take on LTC and community-based options:

It reminds me way too much, of moving day. That is, moving day to a Long Term Care Facility. The day that our parent or grandparent moves out of their home community and into Long-Term Storage. Dropped off. All looking alike. All gathering dust. Fade out. The end.

Long Term Storage facilities. They all look and act very similar. They are all miles out of town, have a nice long entry driveway through a pastoral setting that ends at a drop-off porte cochere that enters a massive building that houses 50 to 100 residents in a setting that is quite unlike the home these residents have left behind. It is far away from their social network. And, this is really the only option for a lot of people. The only option, by default, is the best option. Also by default, it is the worst....