LTC Reform: 2010

National ADAPT is ready to fight for Choice and Freedom.

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More as things develop.

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/

Sunday, April 4, 2010

Lingering Fears, Lingering Problems

Recently, much has been made about what LTC services should be provided to elderly prison inmates, and where those services should be provided. The politics of the issue has focused on persons convicted of sexual offences and violent crimes, though, of course, any ex-inmate committing any criminal offense in any LTC setting will grist for that mill (as compared with someone never convicted of a crime who commits the same crime in an LTC setting).

The financial issue is that LTC services provided in prison must be paid for out of only state tax revenues or "General Funds" (GF). Ex-inmates could be eligible for Medicaid, and that means that our Federal tax dollars, in the form of Medicaid, could be used to provide LTC services. The services would likely be less expensive, too, given the increasing costs of security.

But old inmates are only the beginning of the issue. There will be many more inmates coming out of our prisons (one way or another, all of them), and some of them will require LTC supports at one or more times in their life. There is a very real possibility that the political problem of security will allow a back door method for recreating large institutions.

We need to be thinking through the general issue of personal security in community based LTC. Two principles should be that individuals can live on their own with supports, and that people should never be forced to accept any room mate. Another should be that individuals receiving community-based LTC should be able to choose assistive technology that supports their personal security.

At a higher level, organizations that manage LTC and organizations that provide supports need to include these principles in their work, and everyone who gets LTC needs to consider personal security as part of their LTC planning.

Or we may see real LTC reform corrupted by all too common fears.

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/

Tuesday, March 30, 2010

Comments on Health Reform Goodies

Now that health reform has passed, what can we expect?

In the Near Term:

In 90 days, a temporary high risk pool for people with pre-existing conditions. High risk pools only work for people with chronic conditions if the premiums are controlled. Otherwise, the premiums tend to drift up and make the pool not affordable.
Parents can cover their kids up to age 26. I think, but am not sure, this adds a year and broadens already existing practice for some carriers.
No more life time limits on dollars of coverage.
Better coverage of preventive services
Better monitoring of carrier use of funds, and better investigation of big rate increases
Medicare Donut hole rebate for the near term, and elimination of the donut hole by 2020
Expanded Medicare coverage for people exposed to an environmental emergencies
Improved care coordination for people who receive both Medicare and Medicaid
A 10% tax on tanning services(!)

A couple of other interesting things:

Section 2402 and what follows seem to allow home and community based services in a waiver to easily use 300% of SSI as the income limit. This would broaden eligibility for waiver services in many waivers.
An interesting project on shared medical decision making

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/

Thursday, February 4, 2010

#LTCReform: Health Care Reform and Older Americans: Achieving Better Chronic Care at Lower Costs at http://bit.ly/9FfQGE

Friday, January 22, 2010

Problems at the Core

Image via Wikipedia

Both our political parties have

BuzzNet Tags: political parties,problems

significant structural and functional problems. They each contain a group that believes the purpose of politics to be ideological warfare, and they each contain a group that believes politics is a tool to serve their interests. Since the groups within each party are not compatible with one another, there is a struggle within each party that mirrors the struggle between parties in oddly complementary and paradoxical ways.

We might call the two groups Selfish Toadies (ST) and Cultural Fanatics (CF).

There is a cycle of dynamic dominance between the two groups in each party. Currently, the Republican party has seen the rise of more and more ideological cadre, with the STs trying to co-opt the message of the CF's for their own purposes. In the Democratic party, liberals are gradually taking the role of spoilers, again with the STs trying to co-opt the CW message for their own purposes. The Obama administration is largely STs at this point.

Across parties, the struggle is between CFs in the Republican party and STs in the Democratic party. The current political instability is not just between the parties, but also between the components within each party. Any stability that occurs either within or across parties will be immediately undermined by the other inside "enemy" or the other party. This general instability will not change any time soon, especially with the economy crashing and the growing deterioration of the health care system, local infrastructure, and the fragmentation of allegiances in every part of the political fabric. In a phrase, everyone, in multitudinous and shifting groups, is struggling for the "soul" of “their” party.

The national political system is no longer capable of solving any major problem. The two parties view vetoing effective action by the other as the only predictably useful political strategy, and within the parties, the components view vetoing the other component in the same way. Joe Lieberman is kind of the poster child for this approach to a political career.

As the whip cream on the sundae, the Supreme Court has now allowed a far greater use of corporate funds to promote political agendas than at any time in modern history. Spin and insults are standard competitive tactics used by corporations to undermine competitors. Therefore, we will be spending far more money to create an incompetent political class than we have in the past.

Needless to say, the extra money will not produce better political results.

What to do?

Wednesday, January 20, 2010

New blog post: http://tinyurl.com/ycz4ss3 - To Moscow and Back Again: A Democrat’s Tale about the health care bill

To Moscow and Back Again: A Democrat’s Tale

In 1812, Napoleon invaded Russia, reaching and taking Moscow, but failing to get a Russian surrender and without supplies to stay in Moscow. His armies had expended every last bit of support they had to get into Moscow. When the Russian army pushed back, Napoleon’s Army started a long, disastrous retreat which destroyed his forces largely through starvation (including cannibalism) and death from exposure.

The resemblance to the Democratic party’s effort to pass a health care bill are uncanny, and the loss of the Senate seat in Massachusetts is the equivalent of arriving in Moscow and finding no food, buildings, or people that could be used to support the “victory”.

It remains to be seen how much of the current health care bill’s provisions will be lost in the new environment (it wasn’t by any standard a great bill up to this point), but one reasonably likely casualty will be the inclusion of the CLASS act, the only part of the bill that had improvement of the LTC system as a goal, and a weak concept at that considering the problems that the American LTC system has.

And that is just the beginning. Right or wrong, supporting the health care bill will be seen as a political liability for much of the country in the 2010 elections. Ben Nelson, who staked his political career on his support for this bill, will now suffer all the same political problems for a significantly weaker bill. I suspect that other Democratic senators who only won their seats the last time around by moving away from liberalism will face uphill battles. And of course, there will be significant losses in the Democratic House as well in 2010.

A strategic failure of the first order. A feasible outcome is a frozen Senate, incapable of actually support President Obama on anything important (look at how weak their support for health care has been with the so called “veto-proof” majority), and a much weaker Democratic House. And don’t be surprised by signs of cannibalism in the Democratic Party.

There are worse possibilities as far as health care is concerned. However the health care bill turns out, NO ONE will try for significant health care reform in my lifetime. The American health care system will continue to crumble like the infrastructure of Detroit, and when a solution becomes politically feasible again, because of the sheer incompetence of the health care system, the problem to be solved will be far larger and far more intractable than it is now.

The only redeeming feature is the Republican compulsion to play “Russian Roulette” (see how I maintained the metaphor?) with their party’s message.

A very sorry and disappointing state of affairs…..

BuzzNet Tags: health care bill,LTC,strategic blunders

Wednesday, January 13, 2010

Aging baby boomers more likely to need drug treatment than older cohorts, study finds - McKnight's Long Term Care News

Illicit drug use by seniors is on the rise. That could lead to a significant increase in the need for drug treatment services for seniors over the next decade, according to a new report.

The baby boom generation has a high rate of lifetime drug use, according to the report from the Substance Abuse and Mental Health Services Administration (SAMHSA). As that population ages, the number of adults using illicit drugs is also likely to rise, SAMHSA predicts……

BuzzNet Tags: LTC,Boomers,drug use

Aging baby boomers more likely to need drug treatment than older cohorts, study finds - McKnight's Long Term Care News

Report underscores problems with durable medical equipment Medicare claims process, group says - McKnight's Long Term Care News

A new report from the Department of Health and Human Services Office of Inspector General confirms that the regulatory documentation requirements for durable medical equipment Medicare claims are “confusing, onerous and must be improved,” according to a DME provider group……
BuzzNet Tags: LTC,DME

Report underscores problems with durable medical equipment Medicare claims process, group says - McKnight's Long Term Care News

Tuesday, January 12, 2010

Nursing Homes Overuse Antipsychotics

In 2006, a year after the FDA issued mortality warnings about prescribing antipsychotic drugs for the elderly, nearly 30% of nursing home residents received the medication -- despite the fact that a third of them had no indication for the drugs, a study revealed…..

This elevated risk associated with facility-level prescribing was seen for patients with dementia but no psychosis (RR 1.40, 95% CI 1.23 to 1.59), and in residents with neither psychosis nor dementia (RR 1.54, 95% CI 1.24 to 1.91), the researchers reported in the Jan. 11 Archives of Internal Medicine.

An unrelated study, also released today, indicated that office-based physicians were in fact cutting back on prescription of antipsychotics for dementia as a result of FDA warnings……

http://www.medpagetoday.com/Geriatrics/Depression/17892

Technorati Tags: LTC,dementia,antipsychotic medications

Sunday, January 10, 2010

Person-Centered Care for Nursing Home Residents: The Culture-Change Movement

In the 1980s, consumer groups exposed substandard care in some U.S. nursing homes, as well as instances of even more dire problems like abuse and neglect. These revelations led the Institute of Medicine to issue a report recommending major regulatory changes and, in 1987, Congress passed a sweeping set of nursing home reforms that required facilities to provide individualized, or "person-centered," care. As a result, some providers began to move away from the institutional model of nursing home care and toward a more homelike environment in which residents could have a say in their day-to-day lives. In 1997, leaders in the industry formed the Pioneer Group to advocate for person-centered care and create a movement for "culture change" in the nation's nursing homes……

http://bit.ly/83etCs

Technorati Tags: LTC,person centered planning

IL: Stricter Controls on the use of Antipsychotic Mediations

Nursing home resident advocates in Illinois are pushing for new, stricter rules on the use of antipsychotic drugs among elderly nursing home residents, in order to prevent misuse of the drugs as a form of chemical restraint in nursing homes.
Illinois Citizens for Better Care, a grassroots organization that fights to improve nursing home care in the state, is pushing for new state laws and regulations that would prevent nursing homes and doctors from using antipsychotic and psychotropic drugs as a form of chemical restraint on the elderly, according to a report by the Chicago Tribune and ProPublica…….

http://bit.ly/5UuH9S

Technorati Tags: LTC,nursing homes,antipsychotic medications

Thursday, January 7, 2010

Alzheimer's Mice Improved by Cell Phone Radiation

Inveterate cell-phone addicts may feel that the devices help them to work smarter and -- surprisingly -- they may be right.

If they're mice, that is.

In mice prone to an animal form of Alzheimer's disease, long-term exposure to electromagnetic radiation typical of cell phones slowed and reversed the course of the illness, according to Gary Arendash, PhD, of the University of South Florida in Tampa, and colleagues.

A similar exposure in normal mice -- for two hours a day over seven to nine months -- improved their cognitive abilities compared with controls, Arendash and colleagues said in the January issue of the Journal of Alzheimer's Disease, which is the research journal of the Alzheimer's Association…..

"This is no call for anyone to self-medicate," Thies said.

And other reactions to the study ranged from "interesting" to "nonsense."

Original Article Link

Technorati Tags: Cell phones,Alzheimer's,mice

Wednesday, January 6, 2010

Music and Alzheimer’s

…..At the Institute for Music and Neurologic Function (IMNF), technology is playing a key part in helping people with Alzheimer's disease reconnect to their memories and their loved ones—if only for immediate periods of time. We call it our “Well-Tuned” program and its impact has been extraordinary.

The technology I mentioned is the iPod, which can be loaded with music that is emotionally significant to the individual with Alzheimer's disease. The music may spur memories thought long gone or stimulate recognition of a loved one that moments earlier was no more than a blank face. It may also help a person with Alzheimer's disease function and transition throughout the day, from energizing them during their waking hours to helping them wind down as bedtime approaches.

The iPod music play list is customized, changing from person to person based on their experiences, cultural backgrounds and frame of reference. As with lovers who grow sentimental when “their song” is played on the radio, the right music stimulates the personal associations that it is connected with, sparking memory and renewed “presence.”…….

http://bit.ly/746TlG

Technorati Tags: LTC,dementia,music,memories

Tuesday, January 5, 2010

New Issue of "Health Affairs" is Out

Some Sample Articles:

Raising The Standard: Palliative Care In Nursing Homes

The Revolving Door Of Rehospitalization From Skilled Nursing Facilities

Diversion, Transition Programs Target Nursing Homes’ Status Quo

Monday, January 4, 2010

The BIG Picture: Once invincible business models aren't so bulletproof after al

As 2010 dawns, many providers and publishers find themselves limping along. Both have just endured one of the more challenging years on record.

Who would have thought the once bulletproof continuing care retirement community model would be reeling? Erickson Retirement Communities offers a good example of how weird things have become. As fewer and fewer prospects were able to sell their homes (essentially a prerequisite for moving in), occupancy rates tumbled, along with operating revenues. The result: a sell-off of the company in tandem with a Chapter 11 filing.

An assisted living juggernaut—Sunrise Senior Living—is on the brink as well......
http://bit.ly/6LLpcP

LTC, economic models