Community-Acquired Pneumonia In The Elderly: Every Tenth Patient Dies In Western Countries

Community-acquired pneumonia (CAP) represents a public health problem of substantial magnitude, and remains the leading cause of death due to infectious diseases, with an incidence ranging from 1.6 to 10.6 per 1,000 adults per year in Europe.

Owing to demographic changes, elderly patients now represent about 50% of CAP patients in western countries. 

Norman DeLisle, MDRC

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Home Care Nurses Drive More Miles For Their Job Each Week Than The Average UPS Driver, USA

A study released today by the Washington D.C.-based National Association for Home Care and Hospice shows that the nurses, therapists, home care aides and others who serve elderly and disabled patients in their homes drive, on average, more miles annually than many driving professionals including UPS drivers.

"Caring for over seven million patients annually with 428 million visits, these dedicated providers of home care and hospice are feeling the same pain at the pump as other consumers, but they carry the added burden of the Administration's deep cuts into Medicare and Medicaid benefits, says Val J. Halamadaris, President of the National Association for Home Care and Hospice (NAHC*). "These draconian cuts ignored the cost of living increases, chief among these is the rising price of gasoline -- a commodity most essential for these traveling 'road warriors' of mercy. Home care patients are homebound - they are so sick, so chronically ill, they cannot leave their homes without assistance. If nurses do not get in their cars to visit them, there is no way to reach them. What will be precipitated is a full-scale national emergency," added Halamadaris.Norman DeLisle, MDRC
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The What, Why and How of Consistent Assignment

If you ever wanted a quick, clear, jargon-free way to explain consistent assignment to someone else – or if you’re not too sure about it yourself — you might want to check out the new two-page fact sheet (pdf) from the Advancing Excellence in America’s Nursing Homes campaign.

The fact sheet is part of a series that lay out the goals of the campaign. Consistent assignment, which is goal #8, is defined as ensuring that ”residents see the same caregivers (registered nurse, licensed practical nurse or certified nurse aide) or team of caregivers almost every time they are on duty” in order to “build and sustain relationships between individual residents, their families and friends and nurse aides.”

Norman DeLisle, MDRC
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MEDSCAPE Search for Long Term Care

Examples (free access with registration):

• chest, and back.
• The Effectiveness of Vaccine Day and Educational Interventions on Influenza Vaccine Coverage Among Health Care Workers at Long-Term Care FacilitiesA 2-year study in community-based long-term care facilities was conducted to ascertain the reasons for the low influenza vaccine coverage of health care ...
  Journal Article, Am J Public Health, April 2007
• The Evercare Story: Reshaping the Health Care Model, Revolutionizing Long-Term CareLearn how two innovative long-term care nurse practitioners developed a new healthcare model for nursing home residents, ultimately launching a public ...
  Journal Article, Journal for Nurse Practitioners, February 2008
• Optimizing Pain Management in Long-term Care ResidentsPain is common among long-term care residents and is often undertreated. This study presents an overview of assessment and treatment of pain in residents, ...
  Journal Article, Geriatrics Aging, September 2007
• CME/CE Management of Chronic Constipation in an Elderly Patient in Long-term Care: A Case-Based ApproachC.Y. is a 78-year-old woman who lives in a long-term care facility who complains of unsatisfactory defecation. Brooks Cash, MD, FACP, FACG, explores the ...
  Clinical Case, Medscape Gastroenterology, November 2007
• Long-Term Care Insurance "Troubling": U.S. LawmakerMajor U.S. long-term care insurers, including Genworth Financial Inc and Manulife Financial Corp, are being asked about "troubling data" showing a sharp ...
  News, Reuters Health Information, October 2007
• What Is an Average Caseload for an NP in a Long-term Care Setting?Can you describe what an average caseload is for an NP in the long-term care setting? What variables should I consider when determining an appropriate caseload?

Norman DeLisle, MDRC
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Long-Term Care Reform

If the materials are published after July 11, I'll link to them in LTC Reform blog

Event Summary

On July 11, the Brookings Institution’s Engelberg Center for Health Care Reform will host a Hill briefing on Long-Term Care Reform that will focus on opportunities to improve quality of care and address the long-term fiscal challenges of long-term care in the United States. The event will be co-hosted by The New School and the Center for Health Transformation.

Several distinguished panelists will participate in this special briefing, including Senator Ron Wyden, Senator Susan Collins, Representative Jim McCrery, Congressional Budget Office Director Peter Orszag, former Senator Bob Kerrey, former Speaker Newt Gingrich, and other expert panelists representing the policy, academic, advocacy and provider communities. Panelists will address policy options and political prospects for integrating long-term care reforms into broader health reform efforts to achieve improved care while also addressing issues of affordability and sustainability.

After each panel, participants will take audience questions.

Norman DeLisle, MDRC
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Drinking More Water Given As Reason For Improved Health In Elderly Care Home Residents

Residents and staff at a care home for the elderly in Suffolk, UK are convinced that the improvements in residents' health is because they are now drinking more water after a "water club" was introduced last summer.

The residents at charity-run The Martins care home in Bury St Edmunds, Suffolk, were encouraged to increase their water intake when the water club was introduced by care home staff last summer. They were encouraged to drink between 8 and 10 glasses of water a day, they were each given a jug of water in their room and water coolers were installed throughout the home.

A year ago, 88-year-old resident Jean Lavender struggled to walk, but now she goes outside most days for a walk, and feels 20 years younger. She told BBC News that:

"I feel more alert - more cheerful too. I'm not a miserable person, but it's added a sort of zest."

The care home is also seeing fewer falls, significant improvements in health, fewer GP call-outs, reductions in the use of laxatives and urinary infections, less agitation among dementia residents, and residents reporting better quality of sleep.

Wendy Tomlinson, a former nurse who became manager of the home last year, suspected that the low intake of drinking water among the residents was not doing their health any good and with staff devised and introduced the water club. But even she was surprised at the difference it has made.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
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Long-Term Care Financing Solutions: AARP

Earlier we blogged here about the long-term care financing forum at the University of Minnesota. One of the solutions put forward came from AARP. Here are highlights from Enid Kassner, director, Independent Living/Long-Term Care Public Policy Institute. Next we’ll share an approach from the American Association of Homes and Services for the Aging.

AARP’s Goal:

Create an affordable, consumer and caregiver-focused system providing coverage for, and access to, high quality long-term services and supports for independent living.

1. Promote - nationally and in the states - reform of delivery and financing for long-term services and supports.

2. REFOCUS reform debate on providing: long-term services and supports for independent living . . . rather than on “long-term care” or “Medicaid Reform.”

3. Include ALL populations, people with: developmental disabilities and physical disabilities . . . while improving services for seniors.

4. Defin “long-term services and support system” as FOUR separate, but related components:

1. Caregivers
2. Housing
3. Health Care
4. Long-Term and Community-Based Supportive Services

. . . . plus mechanisms to finance each component.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
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High Quality Of Life In Spite Of Very Severe Disease

The authors showed that the quality of life of amyotrophic lateral sclerosis (ALS)patients does not depend on the severity of their physical restrictions. In contrast, it was found that patients who have to be given artificial respiration are more satisfied than patients for whom this is not necessary. Although an outside observer would have expected ALS patients to be depressed, as the disease is so serious, this was only the case for 10% of patients. This means that the proportion of depressive disorders is only slightly greater than in the overall population.

In view of the public discussion on euthanasia and assisted suicide, the authors think it essential that there should be a scientific investigation of the quality of life, as seen by the patient.

Norman DeLisle, MDRC
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Nursing homes to pay for their own sprinklers, CMS says

Image via WikipediaIt is estimated that almost one out of every 11 nursing homes do not contain a sprinkler system, between 20% and 30% do not have automatic sprinklers, and retrofitting will cost facilities roughly $850 million.

The Centers for Medicare and Medicaid Services said Wednesday that, within five years, all nursing homes will require full automatic sprinkler coverage to participate in Medicare. CMS also announced that the full financial burden of these upgrades will rest solely on the facility.

Reacting to the CMS rule, both the American Association of Homes and Services for the Aging and the American Health Care Association have said that they support the requirement, but would like to see some financial assistance to help facilities undertake the endeavor. The organizations support the Nursing Facility Fire-Sprinkler Act of 2007, which would create a framework for issuing low-interest loans to nursing homes.

Norman DeLisle, MDRC
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A Supreme Court Victory for Older Workers

The Supreme Court ruled for older workers Thursday in a closely watched age discrimination case, placing on employers the burden of proving that a layoff or other action that hurts older workers more than others was based not on age but on some other “reasonable factor.”

The 7-to-1 decision overturned a ruling by the federal appeals court in New York, which said employees had the burden of disproving an employer’s defense of reasonableness.

The case was brought by 28 employees who lost their jobs during cutbacks at a federal research laboratory in upstate New York. All but one of the employees who were laid off were at least 40, the age at which protections begin under the federal Age Discrimination in Employment Act.

The issue in the case, while technical, is important for the litigation of age discrimination cases in which an employer’s action or policy that appears neutral on its face has a disparate impact on older workers. David Certner, the chief legislative counsel for AARP, praised the decision and said it would prove “vital to the creation and maintenance of a workplace that is fair and free of age bias.”

Norman DeLisle, MDRC
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The STrains and Drains of Long Term Care

Published in June, 2008 by the Urban Institute, this report discusses the economic burden that Americans take on when they are no longer able to care for themselves as they age.

Norman DeLisle, MDRC
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Study of Elderly Women Shows Health Benefit of Friendship and Family Ties

June 20, 2008 -- Elderly women who maintain close friendships and strong family ties are less likely to develop dementia than women who are less sociable, according to new research funded by the National Institute on Aging.

The latest findings, published in this week's American Journal of Public Health, add to the growing body of evidence suggesting that strong social networks can protect against dementia.

Previous studies have showed that adults who live alone or who have no social ties have a much higher risk for cognitive impairment than those who have more social connections.

Dementia is a decline in cognitive (thinking) function that greatly affects one's day-to-day activities and relationships. Alzheimer's disease is the most common cause of dementia.

Norman DeLisle, MDRC
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'Ten More Good Years' probes LGBT aging issues

Miss Major doesn't seem like the kind of woman to be trifled with. But the longtime activist in the lesbian, gay, bisexual and transgender community who was on the front lines of the 1960s gay rights movement in New York has relocated to Oakland partly for a humbling reason: At age 64, she can't get proper health care in New York.

"I can go in to see a doctor, and him not having any idea what transgender people are ... now have a patient of that ilk here, what are you going to do about it? 'Well, I am going to refer you to another doctor,' and that doesn't really help me," says Miss Major in Michael Jacoby's documentary "Ten More Good Years," which plays Sunday as part of the 32nd San Francisco International LGBT Festival.

The documentary is about the special challenges elderly LGBT people confront, from getting survivor's benefits to sensitive issues of long-term care.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
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Long-Term Care Facilities Across America to Protect Residents with Full Sprinkler Systems

CMS to Publish Final Rule

Long term care facilities such as nursing homes across America will, for the first time, have to protect their residents by installing sprinkler systems throughout their buildings if they wish to continue to serve Medicare and Medicaid beneficiaries, under a new regulation to be issued by the Centers for Medicare & Medicaid Services. Facilities will have a five-year phase-in period to be fully compliant with the new rule.

Approximately three million elderly and disabled Americans reside in the nation’s 16,000 nursing homes, all of which must have comprehensive sprinkler systems in place by 2013. To date, there has never been a multiple-fatality fire in a facility with a sprinkler system that meets the requirements of today’s rule.

“CMS is taking further action to protect the lives of our beneficiaries through a more comprehensive and effective approach to fire safety,” said Kerry Weems, acting administrator of CMS. “In the past, certain older facilities were exempt from having an automatic sprinkler system, but we now will hold all 16,000 nursing homes in the nation to this standard.”

Norman DeLisle, MDRC
"With Liberty and Access for All!"
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Breaking the Cycle of Violence in Long-Term Care

Nursing homes not only can but must change the way they operate, becoming better places to live and work. Only then will they be able to reduce the epidemic of violence that currently plagues them, according to an article in the Journal of Gerontological Nursing, Vol. 34 No. 3.

CNAs often experience “harassment, threats, and assaults” from residents, and the number of those incidents is probably “seriously underestimated,” according to “Policy Recommendations on the Prevention of Violence in Long-Term Care Facilities.” (The article is free to subscribers only; others must pay.)

Those attacks cause emotional distress, which can lead to more confrontations. “Frustrated and fearful, CNAs’ voices might be louder and their movements rougher, causing residents to respond in an aggressive manner,” notes the report. A vicious cycle of abuse can also occur when, “in retaliation, such aggressive behavior results in staff-to-resident abuse.”

Norman DeLisle, MDRC
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CMS TO RATE NURSING HOME QUALITY NEW FIVE-STAR SYSTEM TO BE ADDED TO NURSING HOME COMPARE SITE

The Centers for Medicare & Medicaid Services today announced it will soon launch a ground-breaking ranking system of America’s nursing homes, giving each a “star” rating. CMS is requesting comments on the system designed to provide patients and their families an easy to understand assessment of nursing home quality, making meaningful distinctions between high performing and low performing homes.

The ratings will be posted on the agency’s Nursing Home Compare Web site by the end of this year. A sample screen shot of the proposed star ratings is available at www.cms.hhs.gov/PressContacts/10_PR_fivestar.asp. Medicare Compare can be found at www.medicare.gov.

“More than three million Americans rely on services provided by a nursing home at some point during the year. The new “five-star” rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily,” said Kerry Weems, CMS acting administrator.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
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Antipsychotics and the Elderly

The Food and Drug Administration warned doctors that prescribing a group of antipsychotic drugs to older people suffering from dementia could increase their risk of death.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
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Out of Gas?

Everywhere I go, people are talking about how the high price of gas is affecting home care workers and agencies. Organizations are contacting me and my colleagues for ideas on how to deal with it, so I’d be very interested to hear from people in other parts of the country. How are employers and workers and clients dealing with it? Are any states planning a response to this crisis? If so, what’s being considered?

Four-dollar-a-gallon gasoline exacerbates all recruitment and retention problems, and I fear that it forces workers to make some very difficult choices. Employers are calling workers to offer them cases and having the workers do the gas calculations and say “I can’t afford to take this one.” Home care aides are seeing their co-workers go to other jobs where they don’t have such stressful transportation issues.

Here in Michigan, in the waiver program that funds home care for people who are eligible for nursing home services, I’m hearing that the only time a worker must be paid for transportation is when they’re driving the client, taking them shopping or the doctor or the pharmacy or something like that. People aren’t getting paid for all the driving they have to do just to get to their clients.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

New York Fact Sheet: Caregivers without Health Care

Download the report (pdf 180K)

New York state has been “a national leader” in expanding health care coverage for home care aides and other workers, yet 30 percent of its home care workers lack insurance according to a fact sheet from PHI’s Health Care for Health Care Workers campaign.

Caregivers Without Coverage focuses on home care workers because they are the largest and fastest-growing segment of the state’s direct-care worker population. It explains the conditions contributing to the high rate of uninsurance among direct-care workers, including low wages that make it difficult to afford premiums and copays.

Among the facts it presents:

• One in seven low-income workers in New York City is employed as a home care worker;
• Starting wages for home health aides are just $7.50 - $8 an hour in New York City, though its cost of living is one of the highest in the nation; and
• The statewide median hourly wage for home care workers is $9.74 an hour, compared to $16.91 for all workers.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
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MAPPING CARE OF OLDER PEOPLE

This analysis was sponsored by the Resolution Foundation and carried out by Deloitte & Touche LLP. It describes long-term care in England as a ‘mixed market’, made up of a combination of public and private funding and supply.

There is a widespread expectation that care provision is an integral part of the welfare state, but the reality is that long-term care is now almost entirely provided through private and third sector suppliers, and increasingly, is funded through private means.

The long-term care market does not function as a private market, because a series of intermediary processes such as means and needs testing that distort the interaction between supply and demand. These processes also have an impact on ‘self-funders’ who may face higher prices for similar services as a result of cross-subsidisation.

The analysis identifies key drivers of inefficiency and unfairness across the system, and tests the characteristics of supply, demand, and intermediary processes against indicators of a well-functioning market. This shows that whilst supplier profitability and entry and exit are stable, local markets and intermediary processes can distort outcomes for each individual, even for those who fund their care through private means.

The analysis indicates that the whole of the mixed market needs to be tackled, not just that part funded by the public sector. Innovation will be required by intermediaries, by the financial services sector, the supplier market as well as in the public sector.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Nursing homes, consumers lock horns over arbitration bill at congressional hearing

Providers cried "discrimination" and consumer advocates called for an even tougher stance Tuesday during a congressional hearing on the "Nursing Home Arbitration Act of 2008." House and Senate bills (H.R. 6126 and S. 2838) seek to disallow pre-admission clauses that bind residents to arbitration should a complaint be filed later.

Providers "aggressively oppose efforts to diminish the use of arbitration by American businesses, especially those unfairly targeting long-term care consumers and providers," testified Gavin Gadberry on behalf of the American Health Care Association and the National Center for Assisted Living before members of the House Judiciary Subcommittee on Commercial and Administrative Law. He said troubling anecdotes cited by others at the hearing were the exception rather than the rule in nursing homes.

Among those endorsing the "Fairness" act was AARP board member Dr. William Hall, who said he hoped to work with all parties to expand the bill's reach. AARP hopes that the bill would apply to "all current residents of long-term care facilities, not just those whose pre-dispute arbitration agreements are made, amended, altered, modified, renewed or extended on or after the date of enactment of the bill. The protections provided under this legislation should be available to all current long-term care facility residents."

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
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LTC Blog: http://ltcreform.blogspot.com/
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Lawmakers Discuss Delaying Medicare Durable Medical Equipment Bidding Program

Sens. Debbie Stabenow (D-Mich.) and George Voinovich (R-Ohio) on Friday circulated a letter in the Senate seeking support for legislation that would delay a competitive bidding program in Medicare for durable medical equipment, CongressDaily reports. The program is scheduled to begin on July 1 (Edney, CongressDaily, 6/9). CMS will select DME suppliers to participate in Medicare based on bids they submit. The 2003 Medicare law mandated the program as part of a larger effort to implement competitive bidding.

In 2008, the program will operate in 10 of the largest Metropolitan Statistical Areas and will apply to 10 of the top durable medical equipment, prosthetics, orthotics and supplies product categories. In 2009, the program will expand to an additional 70 MSAs and will continue to expand in future years. The program also will apply to additional product categories in future years. The program likely will result in an average 26% decrease in the prices of medical equipment in the 10 MSAs, according to CMS (Kaiser Daily Health Policy Report, 5/7).


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
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LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Lawmakers hear testimony on nursing home arbitration clauses

WASHINGTON (Legal Newsline)-Federal lawmakers heard Tuesday that binding arbitration clauses in nursing home contracts provide a fair and timely resolution of patient disputes.

Arbitration agreements are "a viable option" for long term care providers and their residents to resolve legal disputes, said attorney Gavin Gadberry, representing the American Health Care Association and the National Center for Assisted Living.

"Arbitration is less adversarial than traditional litigation, produces quicker results and has been determined to be both fair and appropriate by our courts," he told members of the House Judiciary's Subcommittee on Commercial and Administrative Law.

The 12-member panel is considering legislation introduced by committee chair Rep. Linda Sánchez, D-Calif., who said she recently placed her father in a nursing home.

"Unfortunately, this debate is colored by anecdotes and misinformation perpetuated by high-profile trial attorneys who traditionally oppose any effort to bring balance to the personal injury playing field, and who give too little consideration to the harmful consequences on the long term care industry that follow from the high transaction costs of traditional litigation and the resulting financial drain on the system," Gadberry said.

The legislation, outlined in H.R. 6126, would render invalid pre-dispute arbitration agreements between a long-term care facility and a resident or anyone acting on the resident's behalf.

"When legal concerns arise, we believe that fair and timely resolution -the kind that is often the product of arbitration - is in the best interest of both the consumers and their care providers," Gadberry said.

The bill-the Nursing Home Arbitration Act of 2008-is supported by AARP, which represents older Americans.

Dr. William Hall, a member of AARP's board of directors, told the committee that pre-dispute arbitration clauses in nursing home contracts are "harmful" to residents and their families.

"These arbitration clauses force a Hobson's choice --waive the right to seek redress in the courts or get care in another facility, assuming there is one in their area without an arbitration clause," the Rochester, N.Y., geriatrician said.

While the quality of care in nursing homes and other residential care centers has improved since the enactment of federal nursing home quality standards in the Omnibus Budget Reconciliation Act of 1987, he said "much more" needs to be done to improve patient care.

"Many facilities do provide high quality care, but there are also too many facilities that show significant quality deficiencies that can cause harm to residents on their annual inspections," Hall said.

Arbitration clauses, he said, unfairly take away residents' and families' legal options. What's more is that many nursing home admissions are made unexpectedly, after a crisis.

"Clearly, most people seeking nursing home admission are focusing on the quality and range of services available, and are not thinking about possible future disputes," Hall said.

"When they are presented with admissions contracts, they often do not know that an arbitration requirement is buried in the fine print of the multi-page document," he added.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Bright Lighting Could Improve Dementia Symptoms In Elderly

A modest improvement in symptoms of dementia has been associated with the use of bright light in daytime, in an effort to improve their circadian rhythms, according to a study released on June 10, 2008 in JAMA. Additionally, the use of melatonin resulted in improved sleep.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Culture Change in Nursing Homes: How Far Have We Come?

Although The Nursing Home Reform Act, passed in 1987, established residents' rights and quality standards for nursing homes nationwide, serious concerns remain about quality of care and quality of life for nursing home residents. The "culture change" movement is working to radically transform nursing home care, and help facilities transition from institutions to home. This report presents results from the Commonwealth Fund 2007 National Survey of Nursing Homes, fielded to examine the penetration of the culture change movement at the national level and measure the extent to which nursing homes are adopting culture change principles and practicing resident-centered care. Results are mixed, with much room for improvement. The survey highlights important lessons, including the finding that the more a nursing home has adopted culture change principles, the greater the benefits that accrue to it, in terms of staff retention, higher occupancy rates, better competitive position, and improved operational costs.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
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CMS Outlines Rights Of Medicare Hospice Patients

Medicare beneficiaries with terminal illnesses have their right to determine how they receive end-of-life care outlined for the first time in a new regulation soon to be published by the Centers for Medicare & Medicaid Services.

In the first overhaul of regulations governing the hospice industry since 1983, the new Medicare Conditions of Participation (CoP), include explicit language on patient rights that had not existed under the previous regulations.

Although many hospice patients are already active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights.

Specifically, the rule says, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan; the right to effective pain management, the right to refuse treatment and the right to choose his or her own physician.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Nursing home operators lose 93% of appeals: report

The federal government won 66 of 71 appeals cases brought by nursing home providers last year according to a recent report from the Center for Medicare Advocacy. The Centers for Medicare & Medicaid Services won all 18 cases decided on the merits at the Appellate Division; it won 48 of 53 cases at the Civil Remedies Division.

The report author used the findings to call for stricter regulatory oversight of facilities. It is believed to be the first such examination of nursing home appeals findings in citations of poor care, she said.

"The study shows not only that problems in care are serious and that penalties are modest, but also that facilities choose to appeal these enforcement actions throughout he administrative appeals process. Almost always the facilities lose their cases," said report author Toby S. Edelman, a senior policy attorney for the Center for Medicare Advocacy.

She called for an upgrade of the regulatory system, including higher fines for deficiencies. Her analysis, "Nursing Home Decisions of the Department of Health and Human Services' Departmental Appeals Board, 2007," can be found at http://www.medicareadvocacy.org.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Researchers: Nursing home residents attacking each other more often than expected

Nursing home residents are lashing out at each other verbally, physically and in other ways more often than previously believed, according to Cornell University-based researchers.

"Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem," said Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology.

Studies led by Pillemer and professor of medicine Mark S. Lachs, MD, at a large, city-based nursing home discovered 35 different types of physical and verbal abuse between residents. Screaming was the most common form, followed by pushing, punching and fighting.

Researchers also found in another two-week study period that 2.4% of residents said their were on the receiving end of physical aggression, while 7.3% said they had been verbally assaulted.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Joanne Rader: “It’s the Direct-Care Worker, Stupid”

“My passion for working with people with dementia, for making life better for them, has been my major motivating factor. But over time, I keep saying to myself: ‘It’s the direct-care worker, stupid,’” says Joanne Rader. “The only way to make the lives of people with dementia better is to improve the working lives of the direct-care workers. We need to put the things in place that let them provide relationship-based care.”

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Assessment of Primary Care Resources and Supports for Chronic Disease Self-Management (PCRS)

The Primary Care Resources and Supports for Chronic Disease Self-Management (PCRS) is a self-assessment tool for primary care settings interested in improving self-management of chronic illnesses. It is consistent with the Chronic Care Model and specifically supports implementation of the management support component.

The PCRS is designed to help primary care settings evaluate supports for self-management and identify areas and ways in which they could enhance these services. It is intended for use by multidisciplinary patient care teams representing front-line staff, clinicians and administrative personnel who are committed to quality improvement.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

2008 Alzheimer's Disease Facts and Figures

PDF File:

10 million baby boomers will develop Alzheimer's disease.

43 pages.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Settlement Will Allow People with Brain Injuries to Move out of Nursing Facilities

Landmark Settlement for Individuals with Brain Injuries

SPRINGFIELD, Mass.--(BUSINESS WIRE)--Nearly 2000 individuals with brain injuries will be able to move out of nursing facilities and other institutions under a landmark settlement agreement signed today by state officials and attorneys for the plaintiffs.

The settlement resolves a class action lawsuit, Hutchinson v. Patrick, which was filed in US District Court in Springfield last year on behalf of five individuals, the Brain Injury Association of Massachusetts (BIA-MA) and the Stavros Center for Independent Living. The complaint charges that the Commonwealth is violating the Americans with Disabilities Act for failing to provide adequate community services.

"This is a historic moment for persons with brain injuries in Massachusetts, many of whom have been unnecessarily institutionalized in nursing facilities, often for decades," said Steven J. Schwartz of the Center for Public Representation, lead counsel for the plaintiffs. "As a result of the settlement, close to 2000 persons with brain injuries finally will be able to live in integrated settings, nearer to their families and their home communities."

Approximately 8000 people with brain injuries currently reside in nursing and rehabilitative facilities in Massachusetts. At least a quarter of them could successfully transition to integrated community settings if services were available, according to plaintiffs' co-counsel, Richard Johnston, a partner at Wilmer Hale Cutler Pickering Hale and Dorr.

"Today's agreement is a first in the nation for people with brain injuries and will serve as a model for other states," said Arlene Korab, Executive Director of BIA-MA.

The Centers for Disease Control report that 5.3 million Americans are living with disabilities as a result of traumatic brain injuries (TBI) - head injuries caused by external events, such as falls or accidents. Acquired brain injuries (ABI) - caused by internal medical events such as stroke, disease or poisoning - also are significantly prevalent: more than 700,000 Americans suffer new or recurrent strokes every year.

This case and the settlement agreement apply to Medicaid-eligible residents of nursing and rehabilitation facilities who have either kind of brain injury. It is the first lawsuit in the nation that seeks community services for persons with all forms of brain injuries, regardless of the cause.

Under the settlement agreement, which is still subject to court approval, the Commonwealth will create two new waiver programs designed to transition individuals with brain injuries from nursing facilities and other institutions to community residences. The programs must be approved by the federal government, which will pay half the cost of both programs. The first program, called the ABI waiver, will serve up to 300 individuals with acquired brain injuries who currently are living in nursing and rehabilitation facilities. The second, called the Community First Demonstration Project, will offer transitional services and provide community placements to 1600 persons with brain injuries in nursing facilities. The programs will be implemented over several years, but should result in approximately 200-250 persons a year leaving nursing facilities.

"When I first learned about the issues being resolved, I was so happy, I filled up with tears," Catherine Hutchinson, 55, the lead named plaintiff, wrote in a recent email. A mute quadriplegic as a result of a brain-stem stroke in 1996, she lived for more than a decade at the Middleboro Skilled Care Center. "I think about the residents [with brain injury] ... and I know what their empty lives are like," wrote Hutchinson, who recently moved to The Boston Home, a specialized care facility in Dorchester.

The agreement also requires the Commonwealth to create a new system of community services for persons with brain injuries, including new policies and procedures, a new treatment planning process, a new appeal process for individuals and families, and new quality standards for community services. People in nursing facilities will be offered a choice to receive services in the most integrated setting appropriate to their needs, including their own homes and apartments, or shared living arrangements. In addition, the Commonwealth will establish an education and outreach initiative to inform persons with brain injuries and their families about the new waiver programs as well as the benefits of community living.

Korab applauded the courage of the named plaintiffs who "have opened the door for individuals with brain injury to live independently in the community."

The majority of people with brain injuries spend weeks or months in acute care hospitals and rehabilitative facilities. Once the acute treatment ends, these individuals still need some level of assistance with personal care and activities of daily living rehabilitative care. However, due to the lack of community-based options for continued rehabilitative care, most of them have no choice but to be admitted to nursing and rehabilitative facilities to have their basic needs met.

When the lawsuit was filed May 17, 2007, Hutchinson described her decade-long institutionalization as being "in prison for a crime I didn't commit." In a written statement, she added, "We must find a way to allow people like me to live as independently as possible. I should not have to fight the system when each day I must already fight to communicate, to be understood, make choices and express my feelings."

The settlement agreement will provide transitional and community services to Hutchinson, the other named plaintiffs and all class members. "For them, the promise of the Americans with Disabilities Act will become a reality," said Schwartz.

In addition to Hutchinson, originally from Attleboro, the other named plaintiffs are Raymond Puchalski, 59, a Millers Falls resident who has lived for three years at the Kindred/Goddard Hospital's neurobehavioral unit in Stoughton; Glen Jones, 58, of Haverhill, who has resided at the Worcester Skilled Care Center since 1990; and Nathaniel Wilson, 55, of Springfield, who resides at Wingate of Wilbraham. A fifth named plaintiff, Jason Cates of Westfield, died last fall.

A preliminary hearing on the settlement agreement will be scheduled for mid-June before District Court Judge Michael A. Ponsor in Springfield. Judge Ponsor has been asked to set a final fairness hearing on the agreement for July 25, 2008.

Judy R. Roy
Independent Living Resources of Greater Birmingham
206 13th Street S.
Birmingham, AL 35233-1317
Phone 205.251.2223 ext 102
Email bhamilc1@bellsouth.net
There are only four kinds of people in the world: those who have been caregivers; those who are currently caregivers; those who will be caregivers; those who will need caregivers. - Rosalynn Carter

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Divided we fail

The AARP is advocating a platform called Divided We Fail. This platform essentially seeks to remove health care and long-term financial security from being partisan issues, and make them the concern of all legislators and members of Congress.

The AARP had a vendor booth at our local Traverse City Senior Expo last week. They encouraged people to sign their pledge to support those running for office who support the Divided We Fail platform.


DIVIDED WE FAIL PLATFORM
We believe that the opportunity to have access to health care and long-term financial
security is a basic need that all Americans share. We believe it is the foundation for
future generations.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Intestinal Superbug: A Serious Health Care Threat

In recent years, healthcare-associated infections—illnesses you acquire during a stay in a hospital or long-term care facility—have reached epidemic proportions. One of the most widespread and potentially serious of these illnesses is caused by the bacterium Clostridium difficile, often simply called C. diff, which is responsible for tens of thousands of cases of diarrhea and at least 5,000 deaths in the United States each year. And the problem is getting worse. According to a new study, the number of people hospitalized with this intestinal superbug has been growing by more than 10,000 cases a year.

Dr. L. Clifford McDonald, a CDC expert said, "The nature of this infection is changing; it's more severe."

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Older Adults More Likely To Go Into A Nursing Home Just After Death Of Spouse

The chances of older adults being institutionalized, for instance in a nursing home, go up significantly immediately after the death of a spouse, according to new research from Finland.

The study was conducted by Elina Nihtila and Pekka Martikainen, sociology researchers at the University of Helsinki in Finland and was published online in the American Journal of Public Health yesterday, May 29th.

The researchers investigated the risk of an older adult entering long-term institutional care after the death of their spouse, compared with how long they lived after their loss. They also looked at whether level of education or household income had an effect.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/