Wall Street Journal Examines Nursing Home Evictions Of Elderly, Frail Residents

The Wall Street Journal on Thursday examined how U.S.
nursing homes are "forcing out frail and ill residents" in an effort to
"replac[e] them with shorter-term residents likely to bring more
revenue." Federal law allows nursing homes to evict residents for six
reasons: they are healthy enough to return home; they require care not
offered at the nursing home; they risk the health of other residents or
staff; they endanger the safety of other residents or staff; they do
not pay their bills; or the nursing home closes. However, some state
officials and patient advocates say that nursing homes "often go too
far, seeking to evict those who are merely inconvenient or too costly,"
such as residents with dementia or demanding families.

Medicaid
beneficiaries are at greater risk of eviction because Medicaid
reimbursement rates are as little as half of what nursing homes make
from residents who pay their bills out-of-pocket, with private coverage
or through Medicare, according to the Journal. The Journal
reports that Medicaid reimbursement payments to nursing homes in 2007
were $4.4 billion less than the cost of treating beneficiaries.
According to Michael Wiederhorn, a health care analyst for Oppenheimer,
approximately two-thirds of nursing home residents who stay in
facilities more than 90 days depend on Medicaid to pay their bills.

Rising Gas Prices Expose Home Care Fault Line

Are rising gas prices making it harder for you to deliver or receive care? Add your comments at the end of this post.

We all feel the pinch from high gas prices, but for
home care workers it’s more of a punch. As PHI President Steven Dawson
puts it: “The doubling of gas prices over the past few years has been
like a pay cut for many home care workers — particularly those serving
clients in rural areas.

“Policy makers like to believe that home care is cheaper than
nursing homes, but that’s only true because home care workers are paid
less than nursing home workers, often without health benefits,” adds
Dawson. “There’s not much good to say about higher gas prices, except
perhaps that they will now force policy makers to look more closely at
the real costs of shifting toward home-based care, and in response
create realistic reimbursement policies that will offer home care
workers a true livable wage and benefits.”

When PHI’s Michigan State Director Hollis Turnham wrote about the home care gas crisis
in our blog in June, talking about the problems she was already hearing
about, anticipating others, and asking what other people were
experiencing, the response was swift and impassioned. An
employer called rising gas prices “the 500 lb gorilla in the room for
home care agencies.” A home care worker talked about seeing turnover
increase and “looking for something closer to home myself.” The head of
a home care and hospice aide recruitment agency said he planned to do
“something very tangible to address this issue,” though he
wasn’t ready yet to say just what.

Chronic conditions afflict millions of uninsured adults

More than 11 million uninsured adults have at least one chronic
condition, including cardiovascular disease, hypertension, diabetes, or
chronic obstructive pulmonary disease, according to a study in
Tuesday's Annals of Internal Medicine.



These uninsured chronically ill people aged 18 to 64 are less likely
than those with insurance to have visited a doctor in the past 12
months and are more likely to visit the emergency department for
routine care. The study raises doubts about the assumption that many
uninsured U.S. residents are young and healthy, researchers noted. The
long-term care system often bears the burden for untreated chronic
illnesses.



"We have made dramatic advances in treatment of chronic illnesses like
heart disease and high blood pressure," Andrew Wilper, the study's lead
author, said in a statement. "But many Americans are locked out of the
system because they are uninsured and cannot afford this life-saving
care."

A New PHI Initiative

Earn, Keep, Save, MORE is PHI Michigan’s new initiative to improve
the income of all direct-care workers serving Michigan residents using
long-term care supports and services. The initiative focuses on the
federal earned income tax credit (EITC) and new Michigan earned income
tax credit (EITC) beginning in the 2008 tax season.

For tax year 2008, a working family may be entitled to as much as
$4,824 for the federal EITC and as much as $482 in state EITC. In tax
years 2009 and beyond, the Michigan EITC will be 20% of the family’s
federal EITC refund.

In addition to promoting filing for the tax credits, we want to
explain and promote the advantages of using one of the hundreds of free
tax-preparation services located across the state, the volunteer
opportunities at the free tax-preparation sites, the disadvantages of
taking out “loans” from commercial preparers to get a refund “sooner,”
and the tools that low-income families can use to build a stronger
financial future.

PHI Michigan will work intensively with Michigan’s existing regional and state tax assistance coalitions (www.michiganeic.org) and the broad long-term care community to insure that all money belonging to the LTC workforce is claimed.

We will be developing a “tool kit” for use by the broad long-term
care community to promote tax returns that claim all credits and
deductions as a way to increase wages and to connect employers,
consumers, and workers to the local EITC coalitions and the free
preparation sites. These resources include:

Study Finds Higher Costs for Caregivers of Elderly

The out-of-pocket cost of
caring for an aging parent or spouse averages about $5,500 a year,
according to the nation’s first in-depth study of such expenses, a sum
that is more than double previous estimates and more than the average
American household spends annually on health care and entertainment
combined.

Family members responsible for ailing loved
ones provide not only “hands on” care but often reach into their own
pockets to pay for many other expenses of care recipients, including
groceries, household goods, drugs, medical co-payments and
transportation. That nudges the average cost of providing long-distance
care to $8,728 a year.

These caregivers, spending on average 10
percent of their household income, manage the financial burden by
taking out loans, skipping vacations, dipping into savings or ignoring
their own health care.

The Depression Advantage

In The Depression Advantage, Tom Wootton reveals his insight
about the surprising advantages of the depressive state, with the view
that people with mental conditions can lead extraordinary lives.

Tom has developed an entirely new system of representing the
broad spectrum of emotional states experienced by people with mental
conditions. His revolutionary ideas about redefining functionality and
scale provide a powerful set of tools for those looking to turn their
perceived ‘illness’ into a vehicle for a rich, fulfilling and
successful life.

Drawing from historical and literary examples ranging from the
lives of the Saints to Buddhist parables to pop culture heroes like the
X-Men, The Depression Advantage demonstrates that physical,
mental, emotional and spiritual pain can be a catalyst for personal
growth and transcendent understanding.

House Panel Approves Legislation That Would Invalidate Mandatory Binding Arbitration Provisions Of Nursing Home Admission Contracts

The House Judiciary Committee on Wednesday by a 17-10 vote approved a bill (HR 6126) that would ban the use of mandatory arbitration clauses in nursing home contracts, CQ Today reports (Stern, CQ Today,
7/30). The clauses require that people seeking to enter a nursing home
and their family agree to waive their right to take disputes regarding
care at the facility to court and must settle them through arbitration.
According to CongressDaily, Democrats, who largely
support the ban, defeated several amendments from Republicans that
sought to cap lawyers' fees and "to weaken the ban on arbitration.

Medicare Increases Nursing Home Payment Rates, Recalibration Of Rugs To Be Studied Further

Medicare payment rates to nursing homes will increase by $780 million
next year, the Centers for Medicare & Medicaid Services (CMS)
announced.


The boost in payments is the result of a 3.4 percent increase in the
annual market basket calculation of the cost of goods and services
included in a skilled nursing facility stay. The price of the items in
the basket is measured every year and Medicare payments are adjusted
accordingly.


A recalibration of the payment categories, intended to correct a
previous error, which had been proposed for Fiscal Year 2009 has been
delayed while CMS continues to evaluate the data. The proposed rule
announcing the planned recalibration was published in the Federal Register on May 4, 2008.

Living With A Partner Reduces Risk Of Alzheimer's

Living with a spouse or a partner decreases the risk of developing
Alzheimer's and other dementia diseases. This according to a study by
Krister Håkansson, researcher in psychology at Växjö University and
Karolinska Institutet, Sweden. The results were presented for the first
time yesterday at the world's largest dementia conference.


"This is, for me, an overwhelming start," says Mr Håkansson. "It's the
first study I've done in this field, and the results are astounding.
They indicate a very strong correlation between this type of social
factor and the risk of developing dementia."


The new findings are based on data from a Finnish study, which was
unique in that 2,000 people were examined at the age of around 50 and
again twenty-one years later. Normally, dementia researchers only study
late-life individuals. Previous research has shown that an active
lifestyle, both intellectually and socially, can decrease the risk of
developing dementia; since a shared life often entails considerable
social and intellectual stimulation, the point of inquiry of this
present study was whether living with a spouse or a partner can help to
ward off dementia.


The results show that people living with a spouse or a partner in
midlife ran a 50 per cent lower risk of developing dementia than people
living alone, even when controlled for other risk factors, such as age.

Person-Centered Care: Reforming Services and Bringing Older Citizens Back to the Heart of Society

July 23, 2008

› Click here to view webcast.

---

Statements of Committee Members

• Senator Herb Kohl (D-WI), Chairman
• Senator Gordon H. Smith (R-OR), Ranking Member
• Senator Robert P. Casey, Jr. (D-PA), Committee Member
  
  

---

Witness Testimony

William Thomas, MD, Professor, Erickson School of Aging Studies, University of Maryland, Ithaca, NY

Robert Jenkens, Director, Green House Project, NCB Capital Impact, Arlington, VA

Melinda Abrams, M.S., Assistant Vice President, Patient-Centered Primary Care, The Commonwealth Fund, New York, NY

Eric Coleman, MD, MPH, Director, Care Transitions Program, University of Colorado, Aurora, CO

Zoe Holland, Daughter of a former Green House resident, Lincoln, NE

Edna Hess, Shahbaz, Lebanon Valley Brethren Home, Palmyra, PA

Diane White, Ph.D., Senior Research Associate, Institute on Aging, Portland State University, Portland, OR

---

Senators Learn About Person-Centered Care and the DCW-Resident Link

“I can honestly say that I love being a Shahbaz, and so do my fellow
Shahbazim,” Edna Hess told the senators at a July 23 U.S. Senate
Special Committee on Aging hearing.

Hess worked for years as a CNA at the Lebanon Valley Brethren Home
in Palmyra, Pennsylvania, becoming a Shahbaz (the Green House® name for
direct-care workers) when the home converted to the Green House®
model nine months ago. Since then, she told the committee, not a single
Shahbaz has left. “This a big improvement over my facility’s 23 percent
annual turnover rate for nursing assistants, and an even bigger
improvement over the national turnover rate for nursing assistants,
which I understand to be slightly over 70 percent per year.”

“The working life we now enjoy is very
demanding, because we do cooking, cleaning and activities in addition
to nursing care, but it is so much more fulfilling,” Hess added. “We
are now able to do all of the ‘extras’ that we rarely had time for in
the traditional nursing home. We can let an elder linger in a luxurious
whirlpool bath because there is no time pressure to get onto the next
bath. We can sit with the ladies and do manicures, or just chat on the
patio with them while enjoying afternoon iced teas.”

Thoughts and Considerations

Each month I try to provide reviews of various hardware and software
for your reading pleasure and buying knowledge, but many other things
took priority such as moving my office (oh, what an ordeal), defending
our budget (an annual nightmare), and preparing for a big meeting (a
major challenge every other month). Yet, I do want to take this
opportunity to share a variety of observations and reports.

For
example, I want to bring you up to date on our Long Term Care Computer
Quest. On the evening of July 29, Mark Snell and I had our first
meeting with the new computer group at Heisinger Bluffs Independent
Living Facility. They already have one PC in their Computer Room, and
we have placed two G3 iMacs in the assisted living and nursing home
parts of Heisinger which are awaiting Internet connections. We had a
great conversation about how we can help them organize their computer
club, expertise we can provide, and directions they can take.

Our
role will largely be as trainers, advisors and consultants (we need
more volunteers to help with this effort). Two other G3 iMacs have also
been placed at Adams Place nursing home (also awaiting Internet
connections). George Kopp and I picked up four more G3 iMacs from the
Mokane High School (where many were being surplused) which will be
upgraded with new software, and placed in new long term care locations
for resident use (any suggestions?). This is a very worthwhile effort
to help our senior citizens in institutions to stay in touch with their
friends and family which means a lot to them.

Long-term care issue needs attention

This program is central to my freedom and
independence. Without it, I might be forced to surrender myself to a
nursing home. But because federal long-term care policy still heavily
favors institutionalization, countless people with disabilities are
forced to give up their freedom in exchange for assistance.

Those of us using community assistance programs like the one in my state are just a budget cut away from joining them.

For everyone who has been or may be caught in this painful trap, reversing this institutional bias in Medicaid policy is key.

Neither Obama nor McCain list long-term care as an issue on their main Web pages.

Obama does have a nine-page platform addressing disability issues,
in which a small section proclaims his support of a major piece of
proposed legislation that would make it much easier for people to
receive Medicaid-funded assistance in their homes. There is a paragraph
on Obama’s Web site about giving seniors long-term care choices that
are “consistent with their needs, and not biased towards institutional
care.”

McCain’s Web site proposes no specific disability agenda. The only
long-term care discussion I could find was a paragraph that proposes
creating more “pioneering” programs to help seniors receive home
assistance.

Both candidates are giving the issue of long-term care short shrift.

Alleviating The Fear Of Falling

Getting old isn't just about body aches and pains. As we get older, our
risk of falling greatly increases. Old bones don't heal like young
ones, and for senior citizens, falls are a leading cause of death.



But researchers at Tel Aviv University provide hopeful news from an unexpected source. Ritalin,
used for managing Attention Deficit Disorder in hyperactive children,
may have therapeutic benefits for seniors too. Older people who take
methylphenidate (the generic name for Ritalin) may improve their
cognitive abilities and their gait, cutting the risk for serious falls.
This surprising finding was made by Prof. Jeffrey M. Hausdorff, a
lecturer at the Sackler School of Medicine at Tel Aviv University, and
his colleagues, and reported in the Journal of the American Geriatrics Society.



TAU's researchers are the first to investigate the power of Ritalin to
prevent falling in the elderly. After only one dose of Ritalin, seniors
walked with a steadier gait and performed better on a standard
screening test for fall risk, Prof. Hausdorff found.

Federal Standards For Long-Term Care Insurance Policies Needed, Witnesses At House Hearing Say

Witnesses on Thursday at a House Energy and Commerce Oversight and Investigations Subcommittee hearing called on federal lawmakers to require minimum standards for private long-term care insurance policies, CQ HealthBeat reports. Bonnie Burns, a training and policy specialist at California Health Advocates,
said that, because states regulate such policies, the standards offered
differ based on where policyholders live. She said, "It should not
depend on the state a person lives in whether they have a quality
product," adding, "There's a disconnect between those services
available in a community and the way they are described in an insurance
policy, and no two companies have the same definitions."

Some witnesses also raised concerns about large premium increases for long-term care insurance policies. Washington State Insurance Commissioner
Mike Kreidler in written testimony said, "The majority of consumer
complaints my office receives about long-term care insurance are about
the double-digit rate increase they received on products they purchased
in the late '80s and early to mid '90s."

In addition, witnesses
discussed the inconsistencies in denials of claims submitted under
long-term care insurance policies. Burns said that such denials often
appear "completely unpredictable." However, according to Marc Cohen,
president of the long-term care research and consulting firm Life Plans,
a recent survey conducted by the company found that, among 1,500
policyholders who filed claims under long-term care insurance policies,
94% reported no unresolved disagreements with their insurers and that
insurers denied only 4% of those claims (Cooley, CQ HealthBeat, 7/24).

Witnesses At Senate Aging Committee Hearing Call For 'Person-Centered' Care For Elderly

Witnesses on Wednesday at a Senate Committee on Aging hearing on efforts to improve care for the elderly cited the need for a focus on "person-centered" models, CQ HealthBeat reports. During the hearing, Robert Jenkens, director of the Green House Project,
discussed the "Green House model," which he said "reinvents nursing
homes to make them real homes" through a combination of "small houses
with the full range of personal care and clinical services needed by
elders typically served in skilled nursing facilities."

Most
Green House homes have 10 elderly residents and include private and
community areas, Jenkens said, adding, "The design creates a
therapeutic environment, encouraging self-reliance through short
distances and a safe environment for elders." The Green House Project
is a not-for-profit that relies on funds from the Robert Wood Johnson Foundation
and Medicaid reimbursement. Jenkens asked the committee to accelerate
federal reviews of proposed revisions to state Medicaid programs that
would promote the establishment of Green House homes.

Communication Key To Dementia Care

Alzheimer's Society comment: Adults with Alzheimer's disease who are talked to like children are more resistant to care.


This is according to new research presented at the International Conference on Alzheimer's Disease (ICAD).


Good communication skills and regular interaction are vital when caring
for people with dementia. This research shows that speaking to people
with dementia in an adult manner not only enhances their quality of
life but also improves the entire care experience.


Quality care relies on simple principles and even small changes can
vastly improve quality of life for people with dementia. Alzheimer's
Society research is calling for mandatory specialist dementia training
to help empower staff and ensure everyone gets access to a high
standard of care.

Assessing self-neglect in older patients

Scenario: Do physicians have a responsibility to report suspected self-neglect?

Older patients with chronic conditions can, over time, lose the
ability to care for their own basic needs and safety. But how can
physicians maintain respect for a patient's autonomy while assessing
self-neglect?

Response:

Self-neglect is the inability to care for one's own basic needs,
including health, welfare and safety. In two national studies,
self-neglect was cited most often for referrals to adult protective
services, more common than any category of elder mistreatment,
including neglect by others. Older people who do not care for their own
health and well-being adequately typically have functional impairments
and lack necessary support networks; ultimately, they lack the
cognitive capacity for self-protection.

A landmark 1998 study in the Journal of the American Medical Association
revealed that self-neglect is medically significant and is associated
with an increased risk for death. Those who refuse medical care may
suffer higher morbidity from untreated medical conditions. Usually the
person who is neglecting his or her own care is not aware of the need
for assistance, or agrees to get help but then refuses services. The
factors that contribute to self-neglect are still incompletely
understood. But a geriatric medical team at the Baylor University
College of Medicine, Houston, recently developed and published a model
of self-neglect in the American Journal of Public Health, and
researchers are seeking to understand it as a geriatric syndrome rather
than a distinct medical condition. In geriatric medicine, the concept
of a syndrome assumes multiple etiologies and resultant functional
decline.

AAH Favors Tougher Approach To Fighting Fraud, Opposes Delay In Medicare Accreditation Deadline For Durable Medical Equipment

he American Association for Homecare (AAH) opposes the decision by the
agency that oversees Medicare to cancel the accreditation deadline for
durable medical equipment providers in the 70 metropolitan areas
throughout the U.S. designated for Round Two of the Medicare
competitive bidding program.


The Centers for Medicare and Medicaid Services (CMS) announced last
week that it was canceling its January 14, 2009 accreditation deadline
for durable medical equipment (DME) or home medical equipment providers
in the 70 metropolitan areas that were to be included in Round Two of
the recently postponed bidding program.


"The home medical industry has advocated accreditation of homecare
providers for three decades because accreditation helps ensure quality
care for Medicare beneficiaries and can serve as a powerful tool in
preventing fraud," said Tyler J. Wilson, president and CEO of
AAHomecare. "We are surprised that CMS would in the first case argue
against the reforms and the delay enacted by Congress in the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA) by stating
that it would delay accreditation - and then cancel the accreditation
deadlines it had already set for providers in 70 metropolitan areas.
Enactment of MIPPA is no reason to push back accreditation deadlines."

Age-Related Reduction in the Maximal Capacity for Sleep

From Current Biology:

Sleep changes markedly across the life span and complaints about insomnia are prevalent in older people [1].
Whether age-related alterations in sleep are due to modifications in
social factors, circadian physiology, homeostatic drive, or the ability
to sleep remains unresolved. We assessed habitual sleep duration at
home and then quantified daytime sleep propensity, sleep duration, and
sleep structure in an inpatient protocol that included extended sleep
opportunities covering 2/3 of the circadian cycle (12 hr at night and 4
hr in the afternoon) for 3–7 days in 18 older and 35 younger healthy
men and women. At baseline, older subjects had less daytime sleep
propensity than did younger subjects. Total daily sleep duration, which
was initially longer than habitual sleep duration, declined during the
experiment to asymptotic values that were 1.5 hr shorter in older (7.4
± 0.4 SEM, hour) than in younger subjects (8.9 ± 0.4).
Rapid-eye-movement sleep and non-rapid-eye-movement sleep contributed
about equally to this reduction. Thus, in the absence of social and
circadian constraints, both daytime sleep propensity and the maximal
capacity for sleep are reduced in older people. These data have
important implications for understanding age-related insomnia.

ASSISTED LIVING: The Model For Person-Centered Long Term Care

Alexandria, VA - The model for person-centered long term care can be
found in assisted living communities according to testimony submitted
recently to the US Senate Special Committee on Aging.

"Assisted living is a philosophy of care that embraces choice,
independence and the opportunity for seniors to live enriching lives
with dignity, respect and privacy," said Richard Grimes, the President
and CEO of the Assisted Living Federation of America, in testimony on
the need and value of person-centered long term care for American
seniors.

The nation's leading assisted living association told the
Committee that assisted living has become the fastest growing long term
care option in the United States because it puts the individual first.

Nursing Teams In Care Homes Could Reduce Hospital Admissions

Bringing a community nursing and physiotherapy team into residential
care homes for older people improves quality of life and reduces
hospital admissions, according to a new evaluation study's reports
published by the Joseph Rowntree Foundation.


The research, undertaken by the University of the West of England,
Bristol (UWE) and the University of Warwick, found that savings made
through reduced hospital admissions and delayed transfer to nursing
homes offset any potential costs of the scheme. The study suggests that
the overall cost ranged from an added £2.70 a week per resident to a
more likely weekly saving of £36.90.

Memory Problems Tied to Sound Processing Disorder

Mild memory impairment may be associated with a sound processing
disorder called central auditory processing dysfunction, say U.S.
researchers.

People with the disorder have difficulty hearing in
complex situations with competing noise, such as making out what one
person is saying while many people in a group are talking at the same
time.

"Central auditory processing dysfunction is a general term that is
applied to persons whose hearing in quiet settings is normal or near
normal yet who have substantial hearing difficulty in the presence of
auditory stressors such as competing noise and other difficult
listening situations," according to background information in the
study. "Central auditory testing is important in evaluating individuals
with hearing difficulty, because poor central auditory ability, per se,
is not helped by amplification and requires alternative rehabilitation
strategies."

Previous research has found that people with
Alzheimer's disease and other types of dementia have central auditory
processing dysfunction.

This new study by Dr. George A. Gates, of
the University of Washington, Seattle, and colleagues included 313
people, average age 80, taking part in a dementia surveillance program
that began in 1994. Of the participants, 17 had been diagnosed with
dementia, 64 had mild memory impairment, and 232 had no memory problems.

Three
tests were used to assess the participants' central auditory
processing. In one test, nonsense sentences were read over the
background of an interesting narrative. In the other two tests,
separate sentences or numbers were read into each ear simultaneously.

"These
central auditory processing test paradigms evaluate how well an
individual manages competing signals, a task that requires adequate
short-term memory and the ability to shift attention rapidly," the
researchers noted.

See Wikipedia article for more info...

Adding Long-Term Care Benefit to Medicare Is Best Way to Ensure Affordability for Families, Say Health Care Opinion Leaders

Nearly four of five (79%) respondents favor or strongly favor adding
a long-term care benefit to Medicare, financed by a premium, to pay for
care.

More than two-thirds (69%) of respondents to the survey believe it
is very important (41%) or important (28%) that the health reform plans
of the presidential candidates address the quality and financing of
long-term care.

"As our population ages, health care opinion leaders are sounding
the alarm about the significant challenges we will face financing and
improving the quality of long-term care," said Commonwealth Fund
President Karen Davis.

Texas, One Successful Example of Ending Discrimination by Helping People Move Out of Nursing Homes

Information Bulletin # 255 (7/08).



Texas has compiled impressive data regarding its commitment to move people

out of nursing facilities, and its Medicaid expenditures reflect its

efforts.



Between 9/1/2001 and 5/31/2008, Texas implemented its own "Money Follows

the Person," and did not wait for or need the federal program. During

these years, Texas moved 15,626 people out of its nursing homes.



Here are some interesting demographics:



43% or 6,719 people were 64 years old or younger;



53% or 8,282 people were 65 or older.

Of the total, 27% or 4,219 people were 85 years old or older.



67 % or 10,469 people moved from the nursing facility to either live

alone or live with family members or other people.



A breakdown of the 67 % shows that 22% or 3,438 people left the

nursing facility to live alone, and 45 % or 7,032 people moved in with

their families, relatives, or others .



28% or 4,375 people live in assisted living and 5% or 781 people live

in a group homes (adult foster).



Now let's look at how Texas allocated its Medicaid expenditures:



In FY 2001, Texas spent 70.6% of its long-term care Medicaid funds on

nursing homes. In FY 2006, it reduced its nursing home expenditures to

54.6%.





Conversely, in FY 2001, it spent only 29.4% of its long-term MA funds

on waivers and other community-based services. In FY 2006, it spent 45.6%

in the community.



Big surprise. There is a relationship between how a state spends its money

and whether or not people moved out of nursing facilities.



To determine if your state is truly committed to ending unnecessary

institutionalization of people with disabilities in nursing facilities,

and therefore ending discrimination against people with disabilities, look

at how your state allocates its Medicaid "long-term care" expenditures.

Look at the numbers of persons who moved out of nursing facilities and

returned to the community. After the 1999 Supreme Court decision in

Olmstead, many disability and elderly advocates waited to see how their

states would implement the "integration mandate." Well, it's been nine

years!



Disability and older American advocates:



Do you know how many people in your state have been moved out of

nursing facilities and where they moved to? Do you state officials know

this information? Can you or they find out? Since Texas can track this

information, other states probably can and do, too.



In Information Bulletin # 251, we calculated by state the changes in

long-term care expenditures from 1999 thru 2006, and we expect to have the

FY 2007 data available soon.

Relying On Medicaid For Long-Term Care Can Be Risky

I’m constantly surprised by the numbers of people I talk to about
LTCI who have the assets to comfortably pay for a policy but who
ultimately decide to take their chances with the Medicaid system if
they exhaust their assets and still need care.

This mentality
of reliance on government programs to bail people out of tough
financial situations may have worked in the past, but there are ever
increasing signs that it will be very risky business in the future.

We
are already starting to see many facilities who decline participating
in the Medicaid program altogether due to the fact that funds provided
for Medicaid patients are often less than what is needed for providing
their care. And this is before the baby boomer generation begins to
retire and place an even greater strain on the Medicaid coffers in the
years ahead.

Extra Care Housing Enabling More Older People And Those With Dementia And Long-term Conditions To Live In A Home Of Their Own, UK

Health and Care Minister Ivan Lewis today (Monday 21 July) announced
the sites that will benefit from £80million of Government funding to
build extra care housing, enabling more older people and those with
dementia and long-term conditions to live in a home of their own. He
will today be presenting the successful Barnsley extra care housing
scheme with a cheque for £3.8 million together with Sir Michael
Parkinson.


People who are unable to continue to live in their own homes have
traditionally had their choices limited to care homes, creating a
number of problems including couples finding they can no longer live
together.

Let's Make It Affordable to Care

In the midst of all the political rhetoric and debate during this
presidential season, one critical issue seems to have been left out
-America's broken system for long-term care financing.

The current system, therefore, is simply unsustainable. So what is
the solution? The American Association of Homes and Services for the
Aging (AAHSA), of which St. Andrew's is a member, commissioned an
in-depth study to develop a workable plan for future financing of
long-term care. Their recommendation calls for a broad-based
national insurance trust into which all Americans would be enrolled.
Among its features are:

• Low overhead costs.


• The insurance would be financed by premiums, not by general
  tax revenues.


• Individuals could pre-fund their long-term care needs.


• Benefits should be available regardless of setting and
  payable in cash.

Preliminary Long-Term Care Opinion Leader Survey Results

The Commonwealth Fund and Brown University conducted a survey of long-term care leaders.
Over 1100 respondents, including consumer advocates, providers, public
officials, and policy experts, completed the survey between September
2007 and March 2008.

Among the findings, eighty-five percent ranked the workplace as one of
the top three challenges facing long-term care, followed by financing
(66%) and achieving quality (60%). More ranked nursing homes as fair or
poor (53%) than other service types, including hospices (6%). They
favored adopting savings incentives and adding a long-term care benefit
to Medicare. Few had faith in consumer report cards to help people make
informed choices. Read more by downloading the top-level findings.

Nursing Home Transparency and Improvement Act of 2008

A bill to amend title XVIII and XIX of
the Social Security Act to improve the transparency of information on
skilled nursing facilities and nursing facilities and to clarify and
improve the targeting of the enforcement of requirements with respect
to such facilities.

Other Bill Titles (2 more)Hide Other Bill Titles

• Official:
  A bill to amend title XVIII and XIX of the Social Security Act to
  improve the transparency of information on skilled nursing facilities
  and nursing facilities and to clarify and improve the targeting of the
  enforcement of requirements with respect to such facilities. as introduced.
• Short: Nursing Home Transparency and Improvement Act of 2008 as introduced.

2/14/2008--Introduced.
Nursing Home Transparency and Improvement
Act of 2008 - Amends titles XVIII (Medicare) and XIX (Medicaid) of the
Social Security Act to direct skilled nursing facilities (SNFs) and
nursing facilities to make available, upon request, ownership and
affiliated parties
information to the Secretary of Health and Human Services and other
responsible parties. Outlines accountability requirements for such
institutions. Requires specified additional information to appear on
the Department of Health and Human Services Nursing Home Compare
Website. Requires SNFs to separately report expenditures for wages and
benefits for different levels of nursing staff. Directs the Secretary
to develop a standardized form for use by a resident (or a person
acting on the resident's behalf) in filing a complaint about a SNF with
a state survey and certification agency or long-term care ombudsman
program. Requires a state to establish a complaint resolution process.
Directs the Secretary to establish a program for SNFs to report
staffing information based on payroll data. Increases certain civil
monetary penalties for SNF violations. Requires the Comptroller General
to study and report to Congress on:
(1) the financial
status, resident care, and performance of SNFs and nursing facilities
in the Special Focus Facility (or a successor) program of the Centers
for Medicare & Medicaid Services relative to a comparable
sample of facilities outside such program; and
(2) best
practices for, and barriers to, the appointment of temporary management
for SNFs with a record of poor care. Directs the Secretary to provide
for an national independent monitoring program to oversee interstate
and large intrastate chains of SNFs. Requires a SNF administrator to
notify the Secretary and other responsible parties of an impending
closure of the facility. Directs the Secretary to conduct demonstration
projects on culture change and use of information technology in SNFs
and nursing facilities. Provides for dementia management training and
patient abuse prevention training. Directs the Secretary to study and
report to Congress on training for certified nurse aides and
supervisory staff of SNFs and nursing facilities.


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Sponsor

• Sen. Charles Grassley [R, IA]
• and 4 Co-Sponsors
  • Sen. Robert Byrd [D, WV]
  • Sen. Robert Casey [D, PA]
  • Sen. Herbert Kohl [D, WI]
  • Sen. Bill Nelson [D, FL]
  close

Committees

• Senate Finance

Amendments

This bill has no amendments.

Amendments to S.2641

Number	Status	Purpose