Medicare's Immediate And Long-term Problems Demand Congressional Attention

"Once again, Medicare's Trustees have rung the alarm bell that the long-term fiscal solvency of the program is in serious trouble. It is critical that lawmakers ensure that Medicare will be a viable safety net for future generations of seniors. Seniors who rely on Medicare now also need Congress to take immediate short-term action to preserve their access to physician care this year.

"Findings from the latest Medicare Trustees report point to the critical need to reform the broken physician payment system. Cutting Medicare physician payments 41 percent over nine years while practice costs increase is penny-wise and pound foolish. Trying to save Medicare money by slashing physician payments will ruin the physician foundation of Medicare for current and future generations of seniors. A startling sixty percent of physicians say this year's cut alone will force them to limit the number of new Medicare patients they can treat. Couple this fact with a physician shortage and the huge influx of baby boomers soon to enter Medicare, and the outlook for Medicare patients' access to care is grim.

"Congress must take immediate action to preserve seniors' access to care as the first cut begins this July - and will total more than 15 percent by the end of 2009. The AMA supports the Save Medicare Act of 2008 (S.2785), which will replace 18 months of cuts with payment updates that better reflect medical practice cost increases. To demonstrate physicians' support for the legislation, nearly 1,000 physicians from across the nation will make a 'House Call' on Congress next week to call for action."

DRA and long-term care for senior Americans with disabilities

Here is the conclusion to her article:

There is no question that this nation needs to look closely at the means by which long-term care for elders with disabilities-indeed, all heath care, for everyone-is financed. Many options for restructuring the financing of long-term care for the elderly are available-including adding a long-term care benefit to Medicare or following the leads of Japan and Germany in creating a separate social insurance program to provide long-term care for older Americans. These will require additional taxes and may involve some general cost-shifting back to consumers who use government-financed health care services. But such cost-shifting should impact everyone, not just the elderly and disabled.

The DRA's solution to a crisis (that at the moment is largely manufactured) entailing the shifting of additional burdens onto groups that already bear most of the tremendous economic and emotional burdens that long-term disabilities implicate should not be considered acceptable. Nor should taxpayers be forced to support the long-term care partnerships, which amount to government sponsored discrimination benefiting a small group of wealthy, non-disabled Americans. The asset-transfer and LTCP provisions of the DRA should be repealed while Congress seeks gender- and ability-neutral solutions to the nation's future financing of long-term care for the millions of seniors who will need it in the coming decades.

A New Internet Based Solution for Caregivers of the Elderly

Tender Tidings, Inc. announced today the launch of a new Internet based solution for caregivers of the elderly. Caregivers will be able to visually monitor their aged loved ones via streaming video from any computer with a high speed Internet connection.

Whether at work, at home, or traveling, caregivers now have the ability to check on their senior loved ones through a convenient, affordable, easy to install wireless camera that can be placed in any room of the senior's home.

Besides the high-quality wireless camera, TenderTidingsSeniors.com offers a collaborative, on-line calendar so family members can keep up with important appointments and events. They also have access to convenient notepads and reminder tools for communicating with in-home caregivers.

TenderTidingsSeniors.com was created by a mother/daughter team: Elaine Osteen, whose mother-in-law with the early stages of dementia lives right around the corner, and Amy Howell, who lives two hours away from her grandmother.

Because so many caregivers share that responsibility with siblings or other family members, the whole family can share one subscription. The main caregiver, or the Guardian, can issue passwords to other trusted friends or family members and each can access the video of their elderly loved whenever it's convenient for them.

Home Guardian Releases Innovative Sensor System To Keep Seniors Safe

Home Guardian, LLC has announced the release of a suite of sensors that non-intrusively monitor the health status of seniors in their homes while enabling professional caregivers to focus on providing needed care. This includes the detection of falls, which constitute the largest cause of injuries for people over age 65 in the United States.

The systems were developed by a team of researchers originally from the University of Virginia's Medical Automation Research Center (MARC) in partnership with two nationally recognized not-for-profit senior care and service providers, The Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD) and the Volunteers of America (VOA) National Services (Alexandria, VA).

Immediate benefits of the sensor systems-as shown in carefully controlled studies done by The Evangelical Lutheran Good Samaritan Society and the Volunteers of America National Services-include:

-- A reduction of the cost of care of nearly 75 percent
-- Increased feelings of safety and security in participants
-- Less job-related stress for caregivers

Health Insurance Boosts Retention in Washington State

Providing health insurance makes consumer-directed home care workers more likely to stay, both on the job and in the field as a whole, according to a study from Washington state.

Evaluation of Interventions to Improve Recruitment and Retention (pdf) reports on a survey to evaluate a series of initiatives instituted by the Home Care Quality Authority (HCQA). The changes were aimed at improving recruitment and retention of the so-called individual providers (IPs) who participate in the state's consumer-directed home care program, many of whom are related to the people they care for.

The most expensive initiative - and the one the researchers expected would have the greatest effect - was subsidized health insurance. To qualify for the insurance, IPs had to have been working for the program at least 86 hours a month for at least three months. In general, though some exceptions were made, they also had to be ineligible for health insurance from any other source.

Researchers at Washington State University surveyed IPs and the consumers who employed them about their experiences from 2004, when the program began, to 2006. Among their findings:

* Average monthly turnover declined a statistically significant amount (from 1.53 percent to 1.27 percent);

Proposed Federal Background Checks on LTC Workers

On March 17, 2008, McNight's Long-Term Care News posted a news article entitled "Senate budget to include $160 million for elder abuse prevention".

It reported: "The [U.S.] Senate has set aside funding in its fiscal year 2009 budget resolution for a national system of background checks to keep those with abusive and criminal histories out of nursing homes and long-term care facilities."
The Senate approved an amendment for the funding last week, but the money, which would total $160 million, will only be available upon the Senate's passage of the Patient Safety and Abuse Prevention Act of 2007 (S. 1577). The act would set up a comprehensive nationwide system of background checks for long-term care workers.

Both the Senate and House passed nonbinding budget resolutions late last week. The two bodies plan to reconcile their plans this spring.

Survey Finds 3 In 5 Caregivers Say Their Children Help Care For Loved Ones With Alzheimer's Disease

Results from the third annual Alzheimer's Foundation of America (AFA) ICAN: Investigating Caregivers' Attitudes and Needs Survey suggest that Alzheimer's disease care is a family affair. Most "sandwich caregivers" - the parents or guardians of children under 21 who also care for an aging parent, other relative or friend with Alzheimer's disease - say their children are assisting with caregiving responsibilities that range from attending doctors' appointments to feeding and dressing their loved ones.

Survey results ound that about three in five caregivers say their children aged 8 to 21 are involved in caring for a loved one with Alzheimer's disease. Of the caregivers who feel they do a good job balancing the care of their loved ones with Alzheimer's disease and children under 21, more than one-third (36%) specifically cited support from children as a contributor to their success.

Among children, ages 8-21, who are involved in caregiving, many are reported as taking on significant tasks:

* About one-third of young adults (ages 18-21) assist with doctors' appointments;

* 42% of young adults assist with transporting loved ones with Alzheimer's disease;

* About one-quarter of young adults and teens (ages 13-17) assist with activities of daily living, such as feeding and dressing;

* Nearly 90% of pre-teens (ages 8-12) visit and entertain a loved one with Alzheimer's disease (please use caution when interpreting results due to small base size);

* Approximately 85% of teens pay visits to the person with the disease.

Brain-damaged woman at center of Wal-Mart suit

JACKSON, Missouri (CNN) -- Debbie Shank breaks down in tears every time she's told that her 18-year-old son, Jeremy, was killed in Iraq.

Even though the 52-year-old mother of three attended her son's funeral -- she continues to ask how he's doing. When her family reminds her that he's dead -- she weeps as if hearing the news for the first time.

Shank suffered severe brain damage after a traffic accident nearly eight years ago that robbed her of much of her short-term memory and left her in a wheelchair and living in a nursing home.

It was the beginning of a series of battles -- both personal and legal -- that loomed for Shank and her family. One of their biggest was with Wal-Mart's health plan.

National Aging in Place Council

education and collaboration to keep your loved ones safe and in their own homes

Rep. Dingell Introduces Legislation That Would Delay Seven New Medicaid Regulations For One Year

House Energy and Commerce Committee Chair John Dingell (D-Mich.) on Thursday introduced a bill (HR 5613) that would postpone seven new Medicaid regulations for one year -- "potentially killing them, depending on who is president by then," CQ Today reports (Wayne, CQ Today, 3/14). The regulations, proposed by the Bush administration, would prohibit states from using federal Medicaid funds to help pay for physician training, place new limits on Medicaid payments to hospitals and nursing homes operated by state and local government, and limit coverage of rehabilitation services for people with disabilities, including those with mental illnesses (Kaiser Daily Health Policy Report, 3/4).

Dingell in a statement said, "The restrictions the administration is imposing on Medicaid are harmful and will undoubtedly put the health of thousands of our most vulnerable children at unnecessary, indefensible risk." Dennis Smith, director of the Center for Medicaid and State Operations at CMS, said the Bush administration does not plan to delay the regulations because of congressional concerns.

2008 AARP Michigan Senate DCH Appropriations memo

Patti's Comments: This budget will just keep folks locked up in nursing homes and institutions as the only places to secure long term care services. The services need to be separated from the place, as most folks prefer to get their services in a home-like setting. Furthermore, we cannot afford to build a nursing home or group home for every person in need of long term care. Please let the folks in Lansing know that this budget is bad public policy for Michigan! Thanks.

2008 AARP Memo.pdf

Keeping Dementia Sufferers In Their Own Homes For As Long As Possible

APH Ltd is using KNX technology as part of a project which is looking to helping dementia sufferers stay in their own homes for as long as possible - a flat within a Sheltered Housing Scheme in Bristol, England, has been converted into a prototype "Smart Home".

APH is a member of the KNX UK Association and was asked to tailor an intelligent design to suit the requirements of the occupant of the flat. KNX smart technology is employed to monitor the occupant's activity and sounds a warning when it thinks there may be a problem. Special sensors have been fitted into the flat that can tell, for example, if the front door is being opened at night. In this particular flat, wireless light switches, motion detectors, speakers and a voice messaging system have been installed. Coercive messages pre-recorded by the occupant's family are then played when appropriate.

New Section On MayoClinic.com For Alzheimer’s Caregivers: How to Cope

In the early stages of Alzheimer’s disease, individuals may still be able to perform the daily tasks necessary to live and function independently. As the disease progresses, these responsibilities increasingly fall to the caregiver.

A new section on MayoClinic.com for Alzheimer’s caregivers provides helpful information on daily routines, communicating with the patient, dealing with family issues, long-term care options and self-care.

The feature offers a number of practical tips that can make providing care easier.

Talking Points about the Community Choice Act

The Community Choice Act levels the playing field and assures choice in the long term “care” system. Right now, institutional “care” is mandated by the federal government. States MUST pay for nursing facility care. The Community Choice Act doesn’t create a new mandate, but it expands the existing mandate so that people who would be eligible for placement in a facility could have the CHOICE to live in the community with supports. The Community Choice Act would require that states have a community-based option for people who would otherwise be placed in an institutional setting. Until we get the Community Choice Act passed, institutional “care” will remain the standard/norm. As other states have run into financial problems, they have cut community based services in order to maintain funding for nursing facilities because the institutions are REQUIRED under federal Medicaid law and community services are not.

Self-Reported Falls and Fall Injuries, MMWR, March 7, 2008

Falls are the leading cause of fatal and nonfatal injuries for persons aged >65 years. National estimates for rates of fatal falls and fall-related injuries treated in emergency departments have been published previously; however, this report presents the first national estimates of the number and proportion of persons experiencing fall-related injuries associated with either restricted activity or doctor visits. The results in this study suggest that in 2006, approximately 1.8 million persons aged >65 years (nearly 5% of all persons in that age group) sustained some type of recent fall-related injury.

Rejections Of Drug Claims For Nursing Home Residents Under Medicare Part D

Some nursing facility administrators and physicians have raised concerns about the increased administrative burden of working across multiple Part D prescription drug plans (PDPs), citing the possibility for adverse resident outcomes and financial burden on facilities when PDPs reject drug claims for residents. We examined data on claims in rejected status for one large long-term care pharmacy as of December 2006. There was considerable variation across PDPs in both rejection rates and reasons for rejection.

Estate Recovery

You have perhaps heard that Michigan passed a form of estate recovery in September of 2007, becoming the last state in the union to do so. Estate recovery is a program through which states attempt to recoup the costs of Medicaid long term care benefits paid out. Although Michigan has passed the necessary legislation to begin estate recovery, it will not be until the program is reviewed and approved by CMS that it is officially implemented.

What is subject to estate recovery? Many commentators say that only probate assets are subject to estate recovery, and conclude that one must only avoid probate in order to avoid estate recovery. But I believe this is misleading for a few reasons. First, annuities purchased or modified after February 6th, 2006 must name the state of Michigan as a remainder beneficiary to the extent of Medicaid benefits received. For all practical purposes, this is estate recovery on a non-probate asset. Second, many common techniques for avoiding probate of real estate can interfere with qualification for Medicaid. So to say that one must only avoid probate in order to avoid estate recovery is not accurate.

An Efficient Response In Primary Care Would Reduce The Use Of Hospitals By Elderly People And Hospitalisation Costs

Researchers from the Department of Preventive Medicine and Public Health from the University of Granada have carried out a study with patients over 60. The main conclusion they have come to is that an efficient response in primary care would reduce hospitalisations in more than 50% of the cases caused by three of the most frequent pathologies in older population: diabetic ketoacidosis, digestive haemorrhage and chronic bronchitis.

The study, carried out by Doctor Isabel Valenzuela López and supervised by Professors Aurora Bueno Cavaillas and José Luis Gastón Morata, has analysed the main reasons for hospitalisations caused by the pathologies that demand an effective response in primary care and how these hospitalisations could be avoided.

The significance of such study is unquestionable, considering that the elderly population represents the highest public health consumption. Furthermore, the percentage of the Spanish population who reaches an elderly age has risen from 26% at the beginning of the 20th century to 86% today.

Alzheimer's Study: Grief Is Heaviest Burden For Caregivers

The hardest part of caring for loved ones with Alzheimer's type disorders is not the everyday practical challenge, but rather the emotional impact of losing the patients' support and companionship as the disease robs them of their faculties, according to new research at the University of Indianapolis.

"You are losing and grieving while you're providing the care, because Charlie isn't Charlie anymore," says Associate Professor Jacquelyn Frank of UIndy's Center for Aging & Community. She says the results point toward new avenues of service that could be provided by community-based support agencies.

Frank gathered responses from more than 400 dementia caregivers around Indiana, most of them spouses and adult children of Alzheimer's patients. She is continuing to analyze data from the survey's 100-plus items, but she was struck immediately by the responses to this open-ended question: "What would you say is the biggest barrier you have faced as a caregiver?"

Drugs for Elderly More Costly, Study Finds

Drugmakers increased prices by an average of 7.4 percent last year for the brand-name medicines most commonly prescribed to the elderly, according to the advocacy group AARP.

The increase far exceeded inflation, continuing a longtime trend.

AARP said prices charged to wholesalers have been slightly higher since the Medicare drug benefit started on Jan. 1, 2006. Since then, the outcry over prices has diminished, with the government picking up much of the tab.

"Unfortunately, many manufacturers have taken the absence of an outcry as a green light to go ahead and raise prices even more," said John Rother, AARP's policy director.

Latest Release Of Web-Based Quality Assurance System Assists Nursing Homes In Improving Resident Care And Quality Of Life

Nursing Home Quality, the national leader in Quality Indicator Survey (QIS) based quality assurance solutions for long-term care providers, announced the release of the latest version of abaqisTM, a web-based quality assurance system designed for use by nursing home providers to identify quality concerns and focus quality improvement efforts.

The QIS is a revised long-term care survey process utilized by the Centers for Medicare & Medicaid Services (CMS) that involves two stages of review. In Stage I, preliminary investigations are conducted through structured resident, family, and staff interviews, resident observations, record reviews, and analysis of Minimum Data Set (MDS) data.

These tasks, in combination with structured facility reviews, yield 162 Quality of Care and Quality of Life Indicators (QCIs) that are compared with defined thresholds to identify Care Areas for further investigation in Stage II of the QIS. The second stage involves in-depth quality investigations using Critical Element Pathways that address assessment, care planning, care provision, and reassessment.

The latest release of the abaqis TM system encompasses all six assessments conducted on site during Stage I of the QIS, with modules for family, staff, and resident interviews, resident observations, and census and admission record reviews. The system comprehensively guides the quality assurance efforts based on QIS concepts and processes, electronically manages the resident file, and even provides analysis of facility data based on national thresholds.

"I believe that the QIS has rendered the survey process more objective and more resident-centered," says Andrew Kramer, M.D., CEO of Nursing Home Quality. "However, the QIS software used in the survey process was developed solely for government surveyor use. The abaqis TM system is an affordable, user-friendly tool designed specifically for nursing home providers, allowing them to replicate the QIS for quality improvement purposes. At the end of the day, this system enables nursing homes to provide better care and quality of life to their residents."

Culture change needed at long-term care facilities

A couple of months ago I wrote about the efforts under way across the country to spread the practices of culture change in nursing facilities. I have continued to explore what this term means through conversations with those kind readers who contacted me with their personal stories as well as professionals engaged in the efforts in their community.

I am motivated in this process of self-education from my personal experience of being with a family member who spent a week in a local nursing facility after a stroke. During that week, we experienced a wild ride of emotions, partly because of medical issues and partly because of our need to quickly learn the “culture” of the facility.

What I mean by this is that we needed to figure out who to talk to for medications, who to talk to for food, who to talk to for an update on medical concerns and who to talk to when we needed an assist for a trip to the bathroom.

We learned about the hierarchy of which staff will respond to a call button and which would not. We learned that sometimes it is easier to just find the snack or transfer someone to a wheelchair by ourselves. We learned how to intrude on personal staff conversations in order to get a response for our family member.

All of this in just a week. I cannot imagine the experience for those of you who have spent months or years in a relationship with a facility on behalf of a family member.

Study Suggests Medicaid-Sponsored Home Care

A recently released study of Medicaid-financed nursing home use over 18 months in 2001 and 2002 finds that in states such as Oregon that have extensive community based long-term care services, Medicaid-covered nursing home stays were shorter than the national average. The numbers suggest that where seniors have alternatives, their nursing home stays are more likely to be for acute care following a hospitalization or for a shorter period at the end of life.

The study, "Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patters of Care, 2001-2002," conducted by Matehematica Policy Research for the Office of Disability, Aging and Long-Term Care Policy for the U.S. Department of Health and Human Services, reports that over half of Medicaid-covered nursing home residents do not become eligible for benefits until after they move to a nursing home, with 29 percent obtaining coverage within six months of moving to the nursing home, 5 percent between six and 12 months, 7 percent between one and two years, and 9 percent after more than two years.

Complex Interventions For Elderly People Can Be Beneficial

According to a meta-analysis published in The Lancet, elderly people can improve physical function and live more independently if provided with complex interventions such as preventive home visits and community-based care after hospital discharge. The study of over 90,000 elderly people also led authors to conclude that well-developed services for the elderly should not be withdrawn.

Elderly people tend to have reduced physical capabilities, which leads to increased dependence on others, a need for hospital and long-term nursing-home care, and premature death. Community-based complex interventions seek to preserve physical function and independence in elderly people. Researchers were interested in assessing the efficacy of interventions such as preventive home visits, care after hospital discharge, fall prevention, and education and counseling in a group setting.

Anna Ortigara on Learning from Direct-Care Workers

“There has been a lot of paternalism about direct-care staff – the notion that they are not really adults,” says Anna Ortigara. “People wonder: Are they really capable of being in a lead role? Can they be trusted to make good decisions? Are they capable of self-direction?”

Instead of these questions, Ortigara believes, we should ask ourselves: “How can we possibly think we are going to improve long term care without involving frontline workers? We need them at the table in order to achieve cultural transformation - and why wouldn’t we want them at the table?”