Long-term care fraught with uncertainties for elderly baby boomers

GAINESVILLE, Fla. — The continued decline of the nursing home — once the mainstay care for the frail elderly — and an upsurge in popularity of assisted living will lead to many dramatic changes in long-term care, according to a University of Florida expert and editor of a new book on the subject.
“The American public has expressed a strong distaste for going to a nursing home because it smacks of a hospital-like, institutional way of living and receiving care,” said Stephen Golant, a UF geography professor and expert on elderly housing. “Assisted living has emerged as a highly attractive option for older persons who have experienced some physical or cognitive decline and feel less secure about receiving care in their own home.”
Yet there are few certainties about either the future of assisted living for the elderly or the huge number of baby boomers who stand to be its recipients, Golant said.
“Although baby boomers will constitute a large market, it is unclear what share will have impairments and chronic health problems that make them candidates for assisted living,” he said. “The emergence of an unexpected new medical or rehabilitation breakthrough, such as a cure or the discovery of a disease-controlling drug for Alzheimer’s disease – could result in a substantial decline in the number of elderly Americans who need such 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/

AAHSA’s Long-term Care Solution is in the News… Again

Since my last post, there have been even more AAHSA members getting letters to the editor published about AAHSA’s Long-term Care Solution as a way to alleviate the high costs of providing long-term care. Check these out:

• Today, the Boston Globe published this letter from Elissa Sherman, executive director of MassAging, about an article regarding rising caregiving costs.
• Jim Leich with the Indiana Association of Homes and Services for the Aging had this letter published in the July 6 edition of the South Bend Tribune.

Have you seen a similar story in your paper? Let us know and we can help you draft a letter of your own.

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/

AARP Solutions Forum Convenes Panel To Examine Medicaid Funding Of Long-Term Care

AARP will release a new report and convene a panel of experts to discuss Medicaid funding for long-term care (LTC) for older adults and adults with physical disabilities. The report analyzes the progress states are making shifting public funds and the people who rely on them from nursing homes to home and community based services.

Approximately 10 million older Americans need assistance with every day activities. Overwhelmingly, people (87 percent) prefer to receive this care in their homes or communities rather than in nursing homes. Few Americans have planned for the cost of LTC and by default Medicaid, which has an institutional bias towards nursing home care, is the primary payer.

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/

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
"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/

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
"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/

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!"
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/

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
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/

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/

Voices Institute Graduates - May the Root Thrive!

We just completed another historic and successful step forward for the movement to empower direct care workers and to fix our broken long-term care system!

It is clear that Direct Care Workers want a voice and to have their voices heard to improve the profession and the quality of care and services. It was fitting that direct care workers from 12 states met at a place whose motto is: May the Root Thrive! The 25 leaders from 12 states gathered at the DeKoven Center are the roots of our growing movement! I have no doubt that each and every one of the attendees will ensure that the long-term care care-gap is avoided and direct care workers are empowered by applying the powerful tools we all learned at our five day training program.

The events I witnessed at the Voices Institute Inaugural class reminded me of the gracious, generous and powerful nature of direct care workers and their ability to meet any challenge and thrive: flexibility, ability to solve problems, address crisis situations, balance challenging schedules are the stuff that the daily care-giving experience is made of. And so, all the Voices Institutes leaders gathered and we learned speech making, fundraising, organizational and self empowerment strategies and we all thrived in the intense and challenging environment Bob Hudek designed for us. Thank you Bob Hudek for locating the perfect learning environment and for designing a curriculum that gave us comfort, hope and thought us powerful tools that along with Vera’s empowerment tools will lead us to success.


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/

My Caregiver Magazine

The National Association of Health Care Assistants- NAHCA- used to have a magazine for CNA’s called “CNA TODAY”- it ceased publication a couple years ago. NOW, they introduce a new magazine for ALL direct care workers in the nursing field, titled, “MY CAREGIVER”.

From the MY CAREGIVER web site:

My Caregiver is a quarterly magazine published by the Academy of Certified Health Professionals (ACHP) for and about health care assistants and their role in long term care. It is a special magazine, a publication virtually every person in the long term care industry will want to read.

With a circulation of 10,000, we reach nursing assistants, Directors of Nursing, facility Administrators, nursing home residents, and their families, product manufacturers, policy makers, and other health care associations.

The first issue of My Caregiver debuted March 2008. It evolved from the original CNA Today magazine to focus on health care assistants from diverse settings in long term care. The original magazine, CNA Today, launched June 2001 and was unveiled at the NAGNA National Convention.

Now My Caregiver will prove to be a remarkable resource for information on long term care for all who perform the role or duties of a nursing assistant, regardless of title.

The magazine is published quarterly and costs $15.00/year for non NAHCA members; $10.00/year for members.

NAHCA’s main web site is HERE.

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/

House measure would outlaw nursing home arbitration clauses

Nursing home operators would be unable to subject residents and prospective residents to binding arbitration clauses under a bill introduced Thursday afternoon in the U.S. House. When a companion bill was introduced in the Senate in April, consumer groups enthusiastically praised it and provider advocates roundly criticized it.

"This legislation will not prohibit arbitration. Instead, it will simply ensure that residents have the choice whether to arbitrate a dispute after it has arisen," said bill co-sponsor Rep. Linda Sanchez (D-CA), whose father recently entered a nursing facility.

Sanchez said hosting three recent hearings on the Federal Arbitration Act as the chairwoman of the Subcommittee on Commercial and Administrative Law helped form her opinions on the topic. "The long term care industry is one stark example where businesses draft take-it-or-leave-it admission agreements for prospective residents that include pre-dispute, mandatory arbitration clauses."

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/

Elderly In Long-term Care Setting Suffer Depression More Than Those Cared For At Home

t some point after they were admitted, compared to only a quarter of the home-cared elders.

Jodi Shapuras and Lindsay Egan, undergraduate students in the social work program at ISU, conducted the research at their internships as part of a senior-level field practicum class.

“We are both interested in working with the elderly population in our careers, so we conducted this research to get a better feel for the prevalence of depression in those who need some level of outside care,” said Shapuras of Mitchell, Ind. “As social workers, it is important to understand the mental health issues, such as depression, within the different care settings.”

Shapuras and Egan said they weren’t surprised by their findings.

“We actually hypothesized that the long-term care patients would utilize antidepressants more and would self-report depression more,” said Egan of Terre Haute, Ind. “When an individual moves to a long-term care facility, they undergo a tremendous amount of changes. They are no longer able to live independently and are relying on others for care, and this greatly affects how they feel about themselves and the world around them.”

Shapuras added that in the home-care setting, elders are still residing within a familiar environment.

People First Theatre Troupe dramatizes the stories of persons with intellectual disabilities.

As his wheelchair is pushed through the doors of the nursing home, Michael (Gordie Arsenault) wipes a tear from his eye.

The actor is portraying a man with an intellectual disability who has had an accident.

Michael has fallen off a stepladder and broken his leg.

But that’s not what hurts him the most. Michael has a broken heart. Ever since the accident happened, his sister has wanted him out of her home. She is going to have a baby and can’t take care of him anymore.

The Guardian photo

That is why he is moving into a long-term care facility.

And he’s not happy about it.

“Bingo and no beer, boy this place is going to be hard on the head. The only thing left is solitaire,” says Michael as he listens to the orderly, Ralph (Norman Pickering), listing off house rules.

It’s a scene from a new play by Vian Emery. From Pillar to Post will be performed by the People First Theatre Troupe at The Guild in Charlottetown on April 24.

The play deals with what often happens to persons with intellectual disabilities, following an accident or the death of a parent, when they are placed into long-term care facilities because there’s nowhere else for them to go.

DRA and long-term care for senior Americans with disabilities

Here is the conclusion to her article:

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

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