PHI Launches Nine Elements of Quality Care

from PHI:

For consumers of paid long-term care services, eight out of every ten hours of service are provided not by a nurse or a doctor, but by a direct-care worker—a home health aide, certified nurse aide, or personal care worker.

Therefore, for consumers who rely upon services and support from direct-care staff, PHI has identified the Nine Essential Elements of Quality Care —whether that care is received in the consumer’s home or in a residential setting.

This builds off of PHI’s Nine Essential Elements of a Quality Job, which is a guide to help ensure direct-care workers are able to provide the highest-quality care to all long-term care consumers.

We are interested in hearing your thoughts on the elements of quality care. Does this vision resonate for you? Let us know by commenting below.

Worried governors ask Congress for more federal Medicaid funding

from McKnight's:

The nation's governors have appealed to congressional leaders to boost federal Medicaid funding and change tax provisions to help states through the current economic slowdown. In particular, the governors recommended in a letter sent Monday that Congress increase for at least a two-year period a formula that determines matching payments to state Medicaid programs.

The House Ways and Means Committee will hold a hearing today to explore tax-related options that could be included in an economic stimulus package. The governors' letter to congressional leaders can be found here.

AbleNet's Impulse™ Bluetooth(R) Technology Access For Computers For People With Significant Physical Limitations

from Medical News Today:

AbleNet announces the release of the innovative new Impulse™ Bluetooth® Technology Access product. Impulse is specifically designed for persons with significant physical limitations, allowing them to use any muscle surface (face, jaw, neck, arm, leg, etc.) to control their computer. This device is particularly applicable for persons with degenerative conditions such as ALS, MS and MDA; as well as anyone with physical limitations or paralysis.

"This product leapfrogs anything in the market in terms of flexibility, usability, safety and price," said AbleNet CEO Jen Thalhuber. "Computer access unencumbered by wires and visual limitations is now possible for persons with the most severe physical limitations, as long as they have even faint muscle control somewhere on their body."

"Impulse offers consistent, wireless computer access capability for users who may be using complementary tools including eye-tracking technology," continued Thalhuber. "We expect the price point will be very appealing, especially when coupled with the flexibility and usability improvements. Impulse also has the stylish technology design of a Bluetooth headset, giving the user the same look and comfort other consumers demand and receive."

AbleNet

High Tech and Personal Touch in Chronic Care: Finding a More Sustainable Model

from Brown2020:

Last week I spoke at the On Lok Lifeways Conference on October 22, 2008 in San Francisco, entitled “Sustainable Long Term Care: Ethics, Technology and International Perspectives.” The organizers asked me to draw insights from my experience in developing new models for chronic care as the founder and former CEO of Health Hero Network, and to compare that to what I had learned while traveling in Rwanda with Partners in Health last year. Here is my presentation.

Survey Reveals Long Term Care Key Issue for Voters in Presidential Election

from Market Watch:

Eighty-four percent of
baby boomers say the presidential candidates' positions on long term care
issues and funding will be an important factor in determining how they cast
their vote in November, according to a national survey of more than 800
registered voters ages 45 to 64 sponsored by Genworth Financial, Inc.

Caregivers In A Pickle - Research At American Public Health Association Meeting

from Medical News Today:

People taking care of more than one generation -- such as their
children and parents -- engaged in fewer healthy behaviors, found a
study by researchers from Indiana University and Arizona State
University.


As the U.S. population continues to age, more and more midlife adults
find themselves similarly "sandwiched," leading the research team to
conclude that "encouraging healthy behaviors among caregivers has the
potential to prevent significant illness and premature mortality."

Michigan Hospice and Palliative Care LTC Conference

From MHPC web site:

This conference will explore the regulatory relationships between LTC, Assisted Living, and Hospice. A flyer is out, but was inaccessible. The link is to the registration form on the Michigan Hospice site.

Science forum highlights problems with U.S. health care

from Tennessee Journalist:

Dr. Richard Rose, a private practice doctor specializing in treatment
of infectious diseases, gave a lecture titled "How we got into this
mess" on the problems with the U.S.'s health care system during the UT science forum Friday.

Rose described health care practices in the Unites States from the time of the Neanderthals up to present day.

The discovery that insulin injections treat diabetes changed the face
of medicine, he said. Instead of doctors simply treating acute diseases
with one visit, chronic disease treatment became common practice for
doctors.

"For most of the history of man, 'fee for service' made sense because it was based on episodic care giving," said Rose.

"A system developed around treatment of acute diseases was now translated into treating chronic diseases," Rose said.

It is not effective to provide care for long term treatable diseases
in a health care model based around treating acute problems, he said.

As far as the presidential election goes, Rose feels that neither of
the candidates' plans for reform will have much of an effect on the
problems with health care.

"Their plans are really just tweaks," Rose said. "I'm not basing my decision on their health care plans."

Rose admitted he doesn't have the answers to these problems.

"I just told you how we got here, but I'm not going to tell you how
to get out," Rose said. "I'll leave the solutions up to you."

Ernie Reynolds, advocate extraordinaire!

from Northern Lakes:

We are proud to share that Ernie Reynolds was one of the featured speakers at theMichigan Association of Community Mental Health Boards fall conference. Ernie is a Certified Peer Support Specialist at Northern Lakes and has a great deal of experience with public speaking and advocacy.

Ernie has oftentimes been heard to say that if he can help just one person each day, it was a good day.  This presentation, and the many other presentations he has made in his advocacy career, was extremely effective and helped many, many people – so it must have been a tremendous day for Ernie!

REFORMING LONG TERM CARE SERVICES IN NEW YORK STATE

from Center for Disability Rights:

The traditional model of long term care services emphasizes a medical approach to meeting needs, often involving unnecessary high cost professionals.  The independent living (IL) approach to long term care services vests control of services in the consumer rather than the professional.  Many of the services that are widely perceived as “medical” are simply a part of daily life to a person with disabilities.  The independent living paradigm supports an integrated life in the community, with personal care workers providing needed assistance in tasks ranging from dressing and bathing to managing breathing devices, feeding tubes and catheters.  Tasks that hospitals routinely train family members to perform can also be done in a home setting by other laypersons under the direction of the individual or their family member.  

Improving Palliative Care in Nursing Homes

from Info Long-Term Care:

In August 2006, the Fan Fox and Leslie R. Samuels Foundation (the Foundation) awarded the Center to Advance Palliative Care (CAPC) a planning grant to develop strategies for providing palliative care in nursing home settings. The purpose of the planning grant was three-fold:

1) Assess the need for palliative care in the nursing home setting;
2) Evaluate effective approaches to meeting the need; and
3) Develop a practical strategy for extending palliative care services to nursing home
residents.

This report to the Foundation reviews the needs assessment conducted by project researchers and describes our findings. The need for extending palliative care services to nursing facilities is compelling, and the report includes suggestions for future initiatives in this area.

http://www.capc.org/support-from-capc/capc_publications/nqf-crosswalk.pdf

Women Caring for Women: A New Fact Sheet

from Health Care for health Care Workers:

A new fact sheet from HCHCW, Women Caring for Women
(pdf), examines the unique characteristics that are inherent to the
direct-care workforce because it is dominated by women. Some of the key
facts revealed in this publication:

• Women are 90 percent of the 3.1 million paid, professional caregivers in long-term care.
• Nearly two thirds (65 percent) of long-term care consumers are women.
• Nearly one in three direct-care workers lack health insurance coverage.

Study: Medicaid under funds nursing homes by $4.2 billion, providers call for pay hike

from McKnight's:

Medicaid is underfunding state long-term care efforts by $4.2 billion this year, according to a new analysis of Medicaid financing released Wednesday by the American Health Care Association. 

The funding shortfall, combined with the crippled economy and almost guaranteed state budget cuts next fiscal year, could threaten access to care, said AHCA president Bruce Yarwood. AHCA, along with several other healthcare advocates, have called on Congress to include an increase to states' Federal Medical Assistance Percentage in any stimulus package they may create. 

Hardest hit by the under funding are New York and Illinois, who came up short by $548.1 million and $379.3 million respectively. Ohio, Pennsylvania and New Jersey filled out the top five.

Study: Medicare pay-for-performance penalizes hospitals that treat more elderly patients

from McKnight's:

Hospitals that serve large groups of the elderly, poor, African-American or female patients tend to be ranked lower than hospitals with healthier, younger clientele under the Medicare pay-for-performance program, according to new research from the Duke Clinical Research Institute.

Investigators examined the records of nearly 150,000 Medicare beneficiaries at 449 hospitals around the country who had suffered a heart attack between 2000 and 2006. They evaluated each hospital's performance based on guidelines established by the Centers for Medicare & Medicaid Services and then adjusted the findings to account for patient demographics, such as age, race, income and gender. CMS does not currently factor in these variables when considering performance.

While their initial findings meshed with CMS' ranking, researchers say 16.5% of hospitals treating more elderly and poor patients-when adjusted to account for less-healthy patient demographics-would fall under a different category in Medicare's pay-for-performance program. To reduce the disparity, report authors suggest rewarding hospitals for improvements based on evidence-based treatment, as opposed to rewarding a single score or ranking.

Cuomo has eyes on nursing home industry

from legalNewsline.com:

Hidden cameras in nursing homes have resulted in 26 convictions of
workers accused of endangering patients' health and falsifying records,
New York Attorney General Andrew Cuomo said Tuesday.

Cuomo said
his Medical Fraud Control Unit uses hidden cameras more than any other
similar agency to prosecute mistreatment of patients.

"We trust
health care facilities to provide top level care for our loved ones,"
Cuomo said. "These are unfortunately some caregivers who cut corners
and shirk their duties, leaving patients who cannot help themselves in
dire jeopardy.

"In Western New York, we are quite literally keeping an eye on New York's most vulnerable."

Cuomo's staff put the cameras in the patients' rooms and said it found the following problems:

Florida association releases nursing home preparedness guidelines

from McKnight's:

The Florida Health Care Association last week released the Emergency
Management Guide for Nursing Homes, a new, comprehensive approach to
disaster preparedness for nursing homes.



The new guide includes disaster-specific guidelines to establish an
emergency plan and create procedures for staff training and exercises.
FHCA has also launched a nursing home emergency preparedness website
that highlights these new tools and provides additional resources for
nursing homes. That Web site is www.fhca.org/emerprep/index.php.



The 290-page Emergency Management Guide will be distributed to more
than 500 nursing homes in Florida and to state healthcare associations
across the country. It was developed with assistance from the John A.
Hartford Foundation and the University of South Florida.

Crisis in long-term care: Motion sensors could help seniors stay in their homes longer

from TwinCities.com:

Every morning, motion sensors track Joyce Denning as she rises from bed, goes into the bathroom, opens the refrigerator, moves around the living room and strolls out her apartment door.

A computer checks those movements against the 78-year-old's daily routines and alerts nursing staff when something seems out of the ordinary — like too many trips to the bathroom or restlessness in bed or no motion at all.

The monitoring system has helped Denning remain in her Chisago City apartment for two years — despite a gradual waning of strength in her legs — and avoid moving to an assisted-living or nursing home that would cost more and take away some freedom.

Home Care Costs Rise 5% In The Last Year

from The Long Term Care Review:

The MetLife Mature Market Institute released the results of their 2008 survey on adult day services and home care costs.

They found that the average hourly rate of a Home Health Aide is now $20, up 5% from a year earlier. Companion/homemaker services saw no change and remain $18 per hour. Adult Day Services – programs that provide social, health and therapeutic activities in a group environment – are up 5% and now average $64 per day.

This is more or less in line with an average 5% annual inflationary increase in the long-term care industry for costs over the past 30 years or so. It is one more concrete support for getting inflation protection in a LTCI policy to make sure that you have the funds necessary to pay for care several years down the road if needed.

Culinary, design competitions big hits at nursing home convention

from McKnight's:

Two new spectacles garnered special attention this week at the annual conference of the American Association of Homes and Services for the Aging in Philadelphia: The Chef Challenge and the Last Designer Standing competitions. 

Attendees flocked to the events, which were held on the exhibit hall floor throughout the show, which ended Wednesday. The Chef Challenge was a cook-off between teams of chefs from senior living communities. Two teams faced off each day to make a three-course meal in an hour. They also had to incorporate into their dishes secret ingredients that were disclosed only that day. (Brussels sprouts, pomegranate and striped bass were a few.) Competing were Aramark Senior Living Services, Sodexo Senior Services, Cura Hospitality and Morrison Senior Dining. The Cura team was named the winner Wednesday afternoon.

A few aisles down from the Chef Challenge was the Last Designer Standing, a competition featuring interior design students from nearby Drexel University. The students' task was to create a skilled nursing resident room with a particular resident from St. Ignatius Nursing Home in Philadelphia in mind. Two teams of students competed. 

To see videos of these events, go to www.mcknights.com and click on the "Videos" link near the top. Or go to http://www.mcknights.com/McKnights-Video/section/558/.

Clostridium Difficile Infection in Long-Term Care:

from Smart Brief:

VOORHEES, N.J., Oct. 15 /PRNewswire/ -- Clostridium difficile infection (CDI) is increasingly being seen in older adults, especially among residents of long-term care facilities (LTCFs). This is further complicated by the emergence of a new resistant strain of C. difficile associated with high rates of morbidity and mortality.

Implementing strategies for prevention and control, early diagnosis, and prompt aggressive treatment is critical in managing CDI.

To address the need for current education on CDI, especially among healthcare professionals working in LTCFs, Robert Michael Educational Institute LLC (RMEI) and Postgraduate Institute for Medicine (PIM) are jointly sponsoring a complimentary continuing education teleconference, with ten convenient dates and times available. This teleconference offers continuing education credit for physicians, pharmacists, and registered nurses. This activity is supported by an educational grant from ViroPharma Incorporated.

Faculty for this teleconference include Donald Kaye, MD, Professor of Medicine at Drexel University College of Medicine in Philadelphia, Pennsylvania, and Kurt B. Stevenson, MD, MPH, Associate Professor in Internal Medicine and Associate Director of Clinical Epidemiology at Ohio State University College of Medicine in Columbus, Ohio.

Healthcare professionals can listen to a teleconference by contacting RMEI:

Online: www.RMEI.com/LTCCDItelecon E-mail: LTCCDItelecon@RMEI.com Toll-free Phone: 1-877-547-5642, ext. 333

Nursing Home Chain Files for Bankruptcy; 3rd in Recent Months

from WTIC News Talk 1080:

The operator of four Connecticut nursing homes has filed for bankruptcy protection. Affinity Health Care Management operates homes in Hartford, Enfield, Bloomfield, and Windham . A fifth home in the chain, Crescent Manor of Waterbury, was placed in state receivership earlier this month at the requst of Department of Social Services Commissioner Michael Starkowski.

The bankruptcy filing took place Tuesday in New York state, and Connecticut officials heard about it Wednesday at the same time other creditors did, because of $676,000 in back taxes owed the state.

MDRC Open House and Board Meeting on October 24

Michigan Disability Rights Coalition will hold an Open House from Noon to 3 PM on October 24, 2008, followed by a public Board Meeting at 4 PM on the same day. Our Office location is:

3498 E. Lake Lansing Road, Suite 100
East Lansing, MI 48823

Our phone number is 517-333-2477.

What Effect Will the Financial Crisis have on LTC?

The global financial system believes that we are entering a significant recession, even with the bail-out of the banking system.  I was wondering what impact this might have on long term care in the US. These are a few of the ideas I had. Leave comments if you have others:

• Money for private pay will be reduced, putting more pressure on Medicaid
• Rebuilding nursing homes will be far more difficult, because getting loans to do it or using bonds will be far more difficult
  
• The already tenuous nursing home financial model will be put under additional pressure, as credit will be harder to find
• Michigan's already broken state budget will get worse as the auto industry is put on life-support
• Universal health care, though more necessary than ever, will likely take second place to supporting the financial system

What other ideas do you have? Or what do you think of these?

Governor cuts funding for long term care ombudsman program

from Los Angeles Business:

In a little-publicized line-item veto last month, Gov. Arnold Schwarzenegger eliminated state funding for California’s long-term care ombudsman program.

The $3.8 million cut represents half the funding for ombudsman services. The program investigates elder abuse and other complaints on behalf of 250,000 residents of California’s 1,300 nursing homes and more than 8,000 assisted living facilities.

“We are in a very difficult financial environment, as evidenced this week,” said Sarah Ludeman, spokeswoman for the California Department of Aging, which administers the program. “Each area will try to do the best they can with the money left.”

The cut came days after the federal government issued a report condemning conditions in nursing homes.

Barrett, Walker: Don't depend on Washington for long-term care solutions

from McKnight's: 


Two high-profile private sector leaders entreated long-term care providers Tuesday to take control technological innovation and care delivery by the horns and not wait for the federal government to act.

“You hold the power in your hands. It's not in Washington's hands,” said Craig Barrett, chairman of the board of Intel Corp.

He along with David Walker, former comptroller general of the United States, were the keynote speakers during the general session Tuesday at the annual conference of the American Association of Homes and Services for the Aging in Philadelphia.

Barrett stressed that the Center for Aging Services Technology (CAST), the technology arm of AAHSA, develop a standard for electronic health records because the government has been slow to act on it.



To see a McKnight's interview with Walker, go to the home page of www.mcknights.com.


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/

AAHSA's financing plan has proponents, Minnix says

from McKnight's: 


The American Association of Homes and Services for the Aging's long-term care financing plan has gained traction with lawmakers on both sides of the aisle, as well as consumer groups, said Larry Minnix, president and CEO of the association.

“It's not a red state plan or a blue state plan,” said Minnix during a press conference at AAHSA's annual meeting and exposition this week in Philadelphia. The conference runs through Wednesday.

The plan calls for a national insurance trust which would provide a daily cash benefit for people needing assistance. Minnix noted that AAHSA's plan differs significantly from the plan proposed by the American Health Care Association. The AHCA plan would ask people to purchase a long-term care policy or place funds into long-term care savings vehicles.

“It does some good things, but it doesn't solve the problem,” Minnix said. 


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/

Law Equalizes Coverage For Mental, Physical Care

from Washington Post: 



An estimated 113 million Americans, including hundreds of thousands in the Washington region, will receive better insurance coverage for their mental health and substance abuse problems because of landmark legislation that for the first time requires mental and physical illnesses to be treated equally.

The law is a culmination of a decade of lobbying and negotiating among advocates for the mentally ill, the insurance industry, the business community -- including the U.S. Chamber of Commerce -- and doctors' groups. The change, which was included in the economic rescue package signed by President Bush last week, will take effect Jan. 1, 2010, for most plans. Businesses with 50 or fewer employees would be exempt.

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/

http://www.huffingtonpost.com/stuart-shapiro/presidential-candidates-l_b_133373.html

from Huffington Post: 



The good news is that Americans are living longer than they have previously.
The bad news is that our nation's financial and health-care systems are woefully unprepared for them.

What's worse, neither presidential candidate seems to be giving it much thought.
U.S. Sens. John McCain and Barack Obama may spar over Social Security and tinker around the edges of entitlement programs Americans know best, but neither has a serious plan to stabilize our retirement foundation to provide a true safety net for the elderly.


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/

Person-Directed Dementia Care Assessment Tool: A guide for creating quality of life and successfully refocusing behavior

from Info Long-Term Care: 


This tool was developed by the State of Wisconsin, Department of Health and Family Services, Division of Disability and Elder Services to be used as a guide for identifying the elements involved in implementing a person-directed dementia care.

The nine sections of the tool examine specific areas of focus vital in providing person centred care, emphasizing culture change elements. The goal is to provide as much planning to meet an individual's social and emotional needs.


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/

Great Comment lost in vacation

Greg Pawelski left a great comment on a post on the impact of private equity firms buying nursing homes. But, I was on vacation and didn't get around to looking at comments til today. So here is the Comment in it's entirety:

Greg Pawelski has left a new comment on your post "Private equity firms do not affect nursing home qu...": 

Staffing Cuts and Mounting Patient Care Problems at Manor Care's Pennsylvnia Facilities under Carlyle's Ownership 

A new analysis of federal government data reveals staffing cuts and a surge in violations at ManorCare’s Pennsylvania nursing homes while under Carlyle’s ownership. Average nurse and CNA staffing has actually decreased to just 3.29 hours per resident per day (HPPD) at the 20 Pennsylvania Manor Care nursing homes that have undergone annual surveys since Carlyle acquired the company on December 21, 2007. (1) Nurse staffing was cut by 21.4% to just 3.05 HPPD at Manor Care Health Services – Lansdale, a 170 bed facility in Montgomeryville. (2) In addition, none of the 20 facilities provided the 4.07 hours of care identified by experts in a 2001 study as the threshold below which quality of care is compromised. (3) This staffing data may help to explain a surge in violations of federal health and fire safety standards at these facilities, which increased 31% overall to 202 violations in their post-buyout surveys. (4) 

Government survey records describe the tragic stories behind these violations: 

ManorCare Health Services - York South was cited in January 2008 and again in May for two separate incidents involving a failure to timely notify a physician of a resident’s change in condition. The residents involved in both incidents died. In January, a resident with a history of fainting and at a known risk for falls fell and died several days later as a result of blunt force head trauma sustained in the fall. Incomplete information was faxed to a physician’s closed office, but a physician was not actually called for more than 17 hours after the fall occurred, during which time the resident exhibited symptoms of increased confusion and vomiting. (5) In May, the facility again failed to timely notify a physician after a resident, whose medication carried a known risk of side effects including heart attacks, complained of head and chest pain and had elevated blood pressure. The resident went into fatal cardiac arrest late that night. (6) 

ManorCare Health Services at Mercy Fitzgerald was cited by government inspectors for failing to provide timely assistance to a resident who had amputations of both legs, whose repeated requests for assistance in using the bathroom went unanswered over the course of half an hour. (7) 

Donahoe Manor was cited for failure to follow state law and its own policies requiring an FBI criminal background check for an employee who had been hired more than 9 months earlier, and for hiring a dietary aide who worked on the tray line and delivering carts before his tuberculosis skin test was completed. (8) 

(1) This average is weighted to reflect different homes census level. The staffing data is based on information from “About the Nursing Home–Inspection Results,” Centers for Medicare and Medicaid Services Nursing Home Compare data, downloaded 7/22/2008 and 11/09/2007. Under federal law, nursing homes must be inspected every nine to 15 months. 

(2) Ibid. 

(3) Ibid. 

(4) Ibid. 

(5) MANORCARE HEALTH SERVICES-YORK SOUTH, Incident investigation and a State monitoring visit, 01/09/2008, F-0309. 

(6) MANORCARE HEALTH SERVICES-YORK SOUTH, Medicare/Medicaid Recertification, 

State Licensure, Civil Rights Compliance and Incident investigation survey, 05/22/2008, F-0309. 

(7) MANORCARE HEALTH SERVICES AT MERCY FITZGERALD, M edicare/Medicaid Recertification, State Licensure and Civil Rights Compliance Survey, 01/08/2008, F-0309. 

(8) DONAHOE MANOR, Medicare/Medicaid Recertification Survey and State Licensure Survey, 01/07/08, F-0226, F-0630. 

Posted by Greg Pawelski to LTC Reform at October 6, 2008 9:18 PM

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/

The depth of self-serving arrogance

A recent study of minimally conscious people, using scans to compare the response of normal volunteers and people recovering from PVA,  showed that they feel pain.  Why does such a study merit the wide reach of Medical News Today?

Because, believe it or not, there are actually medical professionals who believe that it is alright to cause untreated pain in patients as long as they have a rhetorical excuse to do so.  In this case, the excuse is that since minimally conscious patients don't report pain in terms that doctors can understand, they must not feel any. Such an assertion is almost academic in its disconnection from the real world.  Unfortunately, medicine is not so disconnected. Such self-serving beliefs cause real suffering for real people.

Vulnerable people can always be treated as non-persons by medicine. But, there is no law of nature requiring medicine to do so. It is truly a shame that we must use all of our technology to force medicine to behave decently.

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/

Duh! of the Week

from Medical News today: 


Patients Who Recover From Coma But Cannot Communicate Feel Pain



Do patients who survive a severe brain injury but fail to recover speech or non-verbal communication perceive pain ? After their remarkable publication where they showed that a patient in a vegetative state in reality was conscious, scientists at the University of Liège (ULg) were able to tackle the very difficult issue of pain perception in coma survivors.

The Coma Science Group of the Cyclotron Research Centre and Neurology Department of the ULg used PET scanning to measure minimally conscious and vegetative patients' brain activation in response to noxious stimulation.

After comparing results obtained in the different patient groups with those in healthy volunteers who could communicate it felt painful they concluded that minimally conscious patients must feel pain despite being unable to tell their environment. Hence, these patients should receive pain-killers, the authors concluded.

This study has major ethical and therapeutical consequences also with regard to end-of-life decisions in these challenging but vulnerable patient populations



See my next post for commentary

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/

Conference to Explore Voting in Long-Term Care Facilities in Virginia

from UVA Today :

October 2, 2008 — The University of Virginia's Institute on Aging will host a conference focusing on the problems and issues of voting by seniors in nursing homes and assisted-living facilities. This conference will be held Friday, Oct. 10, from 9:30 a.m. to 4:30 p.m. in the Caplin Auditorium at the U.Va. School of Law.

The conference will bring together leaders from several fields to review the challenges faced by individuals with cognitive and physical impairments and to recommend policies and procedures that can maximize voter participation while avoiding fraud and exploitation of this vulnerable population. The goal: Find  a way to facilitate voting rights for the elderly in Virginia that can serve as a national model for improving the voting system.

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/

2007 Institution vs Community-Based Medicaid Services,

from Steve Gold:


Each State's FY 2007 Medicaid data, submitted to CMS for reimbursement and
compiled by Thompson/Medstat, provides extremely helpful information to
analyze your State's distribution of its Long Term Care expenditures
between its Institutional versus Community-Based Services.

How a state allocates its Long Term Care expenditures demonstrates its
commitment to provide the elderly and persons with disabilities a choice
between unnecessary institutionalization and living in the community.
Let's repeat - "show us the money" and where a state spends it, and you
can see how much the state respects both the ADA and the Olmstead
decision.  Remember that the Supreme Court in 1999 - eight years ago -told
states to end unnecessary institutionalization!  The following data shows
how much your state respects the ADA and the Olmstead decision.

Nationally, for "all disabilities," 58.3% of the long term care
expenditures went to institutions, i.e, both to nursing homes (for
physically disabled persons of all ages) and to intermediate care
facilities (for persons with MR/DD). 41.7% went for community based
services, i.e., for all MA waivers (i.e., both Aged and Physical
Disabilities and MR/DD), "personal care" option, and home health services
in the community.

As you all know, we live with the historical disability divide - persons
with MR/DD, on one hand, and the elderly and persons with physical
disabilities of all ages, on the other hand.  As unfortunate as the divide
is and as much as it perpetuates divisions in the disability community,
it's what we have.  MA expenditures and analysis follow this divide.

When "all disabilities" are broken down into MR/DD and Aged/PD, a dramatic
difference exists in the above 58.3% institutional vs 41.7% community
national long term care distribution.

For persons receiving MR/DD services, nationally only 36.9% went for
institutions (ICF-MRs) and 63.1% was spent for community-based (waiver)
services.  Thus, significantly less Medicaid funds went to provide
services for persons with MR/DD in institutions than in the community.
In dollars, $12 b was spent on institutions but $20.5 b was spent for
community-based services.

In contrast, for the aged and persons with physical disabilities, 69% was
expended on institutional services and 31% on community-based services.
In dollars, nursing homes received $46.9 b but only $21.1 b was spent for
community-based services.

Why the lopsided distribution based on type of disability?

Let's look at the differences in each State. The following chart provides
two columns - the first for MR/DD and the second for Aged/PD.

How does your State compare?  Advocates should make two comparisons.
First, how is your State doing for each MR/DD and Aged/PD with regards to
leveling the playing fields between institutional and community-based
services?  Second, how is your State doing when you compare MR/DD and
Aged/PD expenditures?

% of Medicaid Long Term Care expenditures for institutional services
versus community services.

                        MR/DD                       Aged/PD
              Institutional/community      Institutional/community
National ...................36.9%/63.1%           69%/31%

Alabama ....................12.2/87.8               86.9/13.1
Alaska ......................0.2/99.8               49.4/50.6
Arizona ......................N/A                   36.0/64.0
Arkansas....................58.0/42.0               74.1/25.9
California..................37.7/62.3               47.9/52.1
Colorado.....................8.1/91.9               65.1/34.9
Connecticut.................34.3/65.7               79.3/20.7
Delaware....................26.3/73.7               86.3/13.7
D. C........................72.5/27.5               65.1/34.9

Florida.....................26.4/73.6               82.5/17.5
Georgia.....................24.4/75.6               76.0/24.0
Hawaii.......................7.9/92.1               82.2/17.8
Idaho.......................50.4/49.6               59.6/40.4
Illinois....................61.9/38.1               75.1/24.9
Indiana.....................43.2/56.8               85.5/14.5

Iowa........................51.1/48.9               73.8/26.2
Kansas......................20.4/79.6               64.8/35.2
Kentucky....................42.0/58.0               81.1/18.9
Louisiana...................53.6/46.4               73.2/26.8
Maine.......................23.5/76.5               73.4/26.6
Maryland....................10.2/89.8               84.1/15.9
Massachusetts...............26.7/73.3               73.6/26.4
Michigan.....................9.7/90.3               81.0/19.0
Minnesota...................16.2/83.8               53.4/46.6
Mississippi................100.0/0.0                97.8/2.2
Missouri....................23.2/76.8               68.9/31.1
Montana.....................13.3/86.7               70.7/29.3
Nebraska................... 31.8/68.2               77.7/22.3
Nevada..................... 25.5/75.4               64.9/35.1
New Hampshire................1.7/98.3               85.6/14.4
New Jersey..................55.1/44.9               79.0/21.0
New Mexico.................. 7.8/92.2               39.3/60.7
New York ...................39.6/60.4               60.7/39.3
North Carolina..............52.3/47.7               57.3/42.7
North Dakota................48.2/51.8               93.7/6.3
Ohio........................48.4/51.6               79.2/20.8
Oklahoma....................32.5/67.5               71.3/28.7
Oregon......................0.0/100.0               43.5/56.5
Pennsylvania................32.4/67.6               87.3/12.7
Rhode Island.................3.5/96.5               87.4/12.6
South Carolina..............44.7/55.3               77.0/23.0
South Dakota................19.6/80.0               88.5/11.5
Tennessee...................28.4/71.6               98.7/1.3
Texas.......................62.3/37.7               55.7/44.3
Utah........................33.3/66.7               89.3/10.7
Vermont......................N/A                    71.5/28.5
Virginia....................40.2/59.8               73.2/26.8

Washington .................22.1/77.9               44.4/55.6
West Virginia...............21.5/78.5               76.6/23.4
Wisconsin ..................23.1/76.9               69.3/30.7
Wyoming ....................18.6/81.4               79.6/20.4

   Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.  To
contact Steve Gold directly, write to stevegoldada@cs.com

--
Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com

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Norman DeLisle
"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/

The Undead

from The Times Online :

Trapped inside their bodies, apparently switched off to the world, but still alive: they are the undead. Or so we thought. Forty per cent of patients in a ‘vegetative state’ are misdiagnosed. Now British scientists are leading the field in trying to put that right.

Kate Bainbridge is a lively 37-year-old former schoolteacher. We are communicating in the conservatory of her parents’ home in south Cambridge. She has expressive eyes and a broad and ready smile, but she can utter only occasional single words with difficulty. She sits in a wheelchair “speaking” with the aid of a letter-board, using her left forefinger to spell out words individually.

Ten years ago, Kate went into a deep coma and was on a ventilator for several weeks. She had suffered severe brain inflammation after contracting a viral infection. When she came out of the coma, she opened her eyes and could breathe naturally, but she was unresponsive to speech and visual stimuli, and appeared to lack all conscious awareness. She was still in this condition four months after falling ill, and was later diagnosed to be in a persistent vegetative state, or PVS: in other words, persistently unaware. But the diagnosis was wrong.

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/

Residents’ Rights Week, Oct. 5-11

from PHI: 

National Residents’ Rights Week, Oct. 5-11, honors residents living in all long-term care facilities, including nursing homes, sub-acute units, assisted living, board and care, and retirement communities.

The week has been designated by NCCNHR: The National Consumer Voice for Quality Long-Term Care so that facilities may celebrate awareness of dignity, respect and the value of each individual resident.

During Residents’ Rights Week, NCCNHR is giving residents from facilities across the country an opportunity to share their ideas of what “home” means to them and how to create that home in a long-term care facility. Submissions will be randomly displayed on the  National Ombudsman Resource Centerwebsite in a new section called “The Residents’ Voice.”

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/

Legislation Would Create Medicare Pilot Program To Expand At-Home Services For Some Beneficiaries With Chronic Conditions

from Medical News Today: 


Sen. Ron Wyden (D-Ore.) and Rep. Edward Markey (D-Mass.) have introduced legislation (S 3613, HR 7114) that would create a three-year Medicare demonstration project in 26 states that aims to expand at-home services for some beneficiaries with multiple chronic health conditions, CQ HealthBeatreports. Eligible beneficiaries would include those who have functional impairments, two or more chronic illnesses and recent use of other health services.

Under the bill, participating physicians or nurse practitioners would collaborate with beneficiaries to develop a comprehensive care plan. The legislation also includes minimum performance standards for health outcomes and would measure the satisfaction level of beneficiaries, caregivers and providers. The bill would require providers to demonstrate savings of at least 5% annually compared to the cost of serving non-participating Medicare beneficiaries with chronic health problems. Providers would be able to keep 80% of the savings as an incentive for participation.


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/

Plan aims to keep nursing home open in Macomb County

from the Detroit Free Press: 


Advocates of a tax-funded nursing home in Macomb County plan a last-minute pitch to commissioners this morning to save the center from closure, saying they can save taxpayers $5 million a year.




The county's Social Services Board, which oversees the administration of the Martha T. Berry Medical Care Facility in Mt. Clemens, will urge commissioners to keep the center open because it cares for more than 200 sick and dying patients who consider it home.
The board says it can cut the center's projected $7-million tax subsidy to $2 million next year and $1 million in 2010.
"The county has a rich tradition of providing 217 beds for the most vulnerable and financially indigent in our community," board Chairman Roger Facione said. "We believe that the mission of the medical center needs to be continued and protected."
At a meeting Tuesday, commissioners are to consider closing the center to chip away at a record $33-million deficit next year.


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/