IU Study Finds 25% Of Family Caregivers Of Alzheimer's Disease Patients Go To ER Or Are Hospitalized

from Medical News Today:

One quarter of all family caregivers of Alzheimer's disease patients succumb to the stress of providing care to a loved one and become hospital patients themselves, according to an Indiana University study published in the November 2008 issue of the Journal of General Internal Medicine.

Researchers from the Indiana University School of Medicine, the Regenstrief Institute and the Indiana University Center for Aging Research report in a new study that a quarter of family caregivers of Alzheimer's dementia patients had at least one emergency room visit or hospitalization every six months.

While it has long been anecdotally recognized that caring for a family member with Alzheimer's disease is stressful, this work is the first to measure just how stressful providing care is and to examine the impact of this stress on both the physical and mental health of the family caregiver.

The study found that the behavior and functioning of the individual with Alzheimer's dementia, rather than cognitive ability, were the major factors determining whether the caregiver went to the emergency room or was hospitalized.

Assistive Technology and Long Term Care

From Michigan's Long Term Care Commission:

The websites for assistive technology are:

View the Video:  "Imagine the Future of Aging" at:
http://www.agingtech.org/index.aspx

The Lifeshirt: http://www.vivometrics.com/research/clinical_trials/about_the_system/what_is_the_lifeShirt_system.php

The Medicine Cabinet of the Future:
http://www.popsci.com/scitech/article/2005-08/inside-medicine-cabinet-future

Accenture's Online Medicine Cabinet:
http://www.accenture.com/Global/Services/Accenture_Technology_Labs/R_and_I/OnlineMedicineCabinet.htm

Nutritional Diet Calculating Scale:
http://www.toplinedigitalscales.com/catalog.php?action=110&cat_id=1

Glad you asked

from McKnight's:

Long a staple for gauging company performance in a service-based
economy, customer satisfaction surveys now are becoming a standard
data-gathering tool in the long-term care industry as well.



Facility operators have only to consider the various factors pushing
the trend to realize the true importance of feedback from those they
serve: Consumer-directed healthcare is gaining traction, the federal
government is unveiling a “Five Star” rating system for nursing homes
in December, the emphasis on pay-for-performance initiatives is
growing, and trade associations are embracing the concept of “culture
change.”



Some see long-term care's mushrooming interest in resident feedback as part of a natural evolution.

“Awareness of customer satisfaction has become pervasive among the
general public,” says Brad Shiverick, chief quality officer for the
Wausau, WI-based healthcare survey firm My InnerView. “For instance,
after a recent trip I got

Elder Care: Elderly Thrive in Denmark

from Spotlight on Elder Abuse: 

WHAT THE DANES REALLY WANT: The Danes do all they can to enable elders to stay in their own homes. And for those who are too frail, the country's nursing homes are small, homey and delightful.

IN TERMS OF services that elderly people actually want, Denmark – and neighbouring Sweden – are the best places in the world to grow old. Both have strong, cradle-to-grave social programs, and compete with each other – and with their Scandinavian cousins Norway and Finland – to give their citizens the best comprehensive elder care.

Danish and Swedish policies are designed to help people stay at home as long as possible through a variety of home-care services and regular house calls by doctors. In Denmark, regular monitoring of an elderly person's needs begin with a visit by a nurse when an individual turns 75. "That visit has a huge impact," MacAdam observes. "It reassures the individual and also educates the individual."

I am struck by the attitude of proud independence I encounter in many of the seniors I meet in the two countries, how they persist in doing the chores they are able to do. The system supports them where needed, but doesn't take over – not even in nursing homes, where they have kitchenettes so they can make their own toast and tea. "The philosophy is that, no matter how frail, you have a right to be in charge of your life," MacAdam says.

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/

S.3327: Empowered at Home Act of 2008

from OpenCongress:

Empowered at Home Act of 2008 - Amends title XIX (Medicaid) of the Social Security Act (SSA) to revise the income eligibility level for home and community-based (HCBS) services for elderly and disabled individuals. Gives states the option to provide HCBS services under a waiver to eligible individuals whose income does not exceed 300% of the supplemental security income (SSI) benefit rate. Gives states the option to provide HCBS waiver services to individuals for whom such services are likely to prevent, delay, or decrease the likelihood of an individual's need for institutionalized care. Directs the Secretary of Health and Human Services to award assistance grants to states electing to provide HCBS waiver services under Medicaid through the state plan amendment option. Reauthorizes Medicaid transformation grants at increased funding and specifies additional permissible uses to facilitate the provision of HCBS and other long-term care (LTC) services. Directs the Secretary to award grants on a competitive basis to eligible states to conduct an evidence- and community-based health promotion program. Amends the Internal Revenue Code to allow: 
(1) a tax deduction for premiums on qualified LTC insurance contracts; and 
(2) a tax credit for certain caregivers taking care of individuals with LTC needs. Revises requirements for the model regulation and model Act concerning LTC insurance consumer protections and the excise tax for failing to meet requirements for such protections. Amends SSA title XIX, with respect to treatment of the income and resources of HCBS waiver services recipients who would otherwise be institutionalized, to repeal the state option, and thus require, application to such individuals of spousal impoverishment protection requirements. Allows states to elect to exclude up to six months of the average cost of nursing facility services from an individual's assets or resources for purposes of eligibility for HCBS waiver services. Directs the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, to revise certain data reporting forms and systems to ensure uniform and consistent state reporting under this Act. Directs the Comptroller General to study and report to Congress on: 
(1) the provision of home health services under different state Medicaid plans; and 
(2) the extent to which states offer consumer self-direction of such services, or allow for other consumer-oriented policies with respect to them.

Nursing homes advised to report crimes to law enforcement

from The Norman Transcript: (no relation)

Suspected criminal acts committed against residents of long-term
care facilities are to be reported immediately to law enforcement,
according to an advisory letter sent Oct. 27 from the Oklahoma State
Department of Health to all nursing homes in Oklahoma.

The
letter was sent to all nursing facilities, skilled nursing facilities
and intermediate care facilities for persons with mental retardation.
The letter is in response to appeals by A Perfect Cause and the
overwhelming support for action by long-term care residents' families,
the Attorney General's Office, Oklahoma County District Attorney's
Office, YWCA and Long-Term Care Facilities Advisory Board.

Earlier
this year, Wes Bledsoe, citizens' advocate and founder of A Perfect
Cause, discovered major gaps in Oklahoma statutes concerning the
reporting of criminal acts in long-term care facilities to law
enforcement. He contacted the Oklahoma County District Attorney's
office and Attorney General's Office about his concerns after a
41-year-old nursing home resident was raped and sexually assaulted in
August 2007. Upon further investigation it was determined the rape and
assault were never reported to law enforcement, Bledsoe said.

Nursing homes across the U.S. receive bonuses despite violations

from DesMoinesRegister.com:

Nursing homes throughout the country are eligible for hundreds of
millions of dollars in taxpayer-funded bonuses despite past violations
of basic health-and-safety standards.

A Des Moines Register
review of 81 bonus payment programs in 36 states shows that some homes
are collecting quality-of-care bonuses approved by the same federal
agency that considers them to be below-average caregivers.

In addition, more than 60 bonus programs exist to help nursing homes do
what they are legally required to do, such as pay the minimum wage or
install fire sprinklers for resident safety.

The total cost to
taxpayers is unknown, according to the Centers for Medicare and
Medicaid Services, which approves and helps fund each of the
bonus-payment programs now in effect but does not track any of those
payments.

National Family Caregivers Month

from PHI:

November is National Family Caregivers Month, a nationally recognized time to focus attention on the more than 50 million family caregivers who provide 80% of our nation’s long term care services. It is sponsored by the National Family Caregivers Association.

The theme this year is “Speak Up!” and the NFCA has included resources on their website to help you do this, including the top 10 ways to celebrate and a free teleclass on improving communication.

“Family Caregiver Month is an opportunity to look again at the challenge of how we can better meet society’s need for more quality caregiving, both family and formal, both paid and unpaid,” says PHI Director of Policy Research Dr. Dorie Seavey.

“At a time when the family caregiving ‘system’ is increasingly stressed and the poor quality of direct-care jobs results in high rates of turnover, it no longer makes sense to treat family and formal caregiving as two separate worlds. Our actual practices in providing long-term care have outgrown this construct. That is why PHI is calling for a new policy direction that integrates and supports both family and formal paid care under a common agenda.”

PHI resources on this topic:

• Better Jobs Better Care Issue Brief (pdf)
• National Policy Agenda: Consumer direction and family caregiving (pdf)

Aaron Toleos, Online Communications Director
atoleos@phinational.org

St. Paul Pioneer Press Launches Age Wave, a Long-Term Care Blog

from Changing Aging:

St. Paul Pioneer Press reporter Jeremy Olson has launched a new blog called The Age Wave.  Jeremy has received a fellowship from the Kaiser Family Foundation to look at long-term care today and its future and is writing a series of stories for the newspaper.

In writing the series and the blog Olson says he’s taking his late grandmother’s advice:

“Take care of the corners and the middle always takes care of itself.” Sure, she was talking about spreading frosting, but it applies. By examining individual stories and struggles — by highlighting the hidden corners of long-term care in Minnesota — he intends to identify broader solutions.

Poorhouse to Warehouse: Institutional Long-Term Care in the United States

from Publius:

Nursing homes in the United States are a product of American federalism and reflect the complexities and variabilities of that system. Over time, institutional long-term care for frail elders has shifted from local government funding and administration to state-level oversight and support to a shared federal-state concern. The unsystematic American approach produces haphazard results in terms of quality, equity, and efficiency. The graying of the American population will increase the demand for long-term care, resulting in pressure for a more coherent policy response.

Choice Connections provides consulting on nursing home transition

from BattleCreekEnquirer:

When Tami Roussey gets a call asking for help to find new, safer living
arrangements for an aging loved one, chances are that a sense of
urgency already exists.

Roussey has recently opened an independent placement service to
assist families of seniors who can no longer manage without assistance
in their own homes, called Choice Connections. It is a free, one-stop
service that leads the family and the senior through this emotional and
often confusing time as gently and sensitively as possible.

Each
family is provided guidance and counsel on an individual-needs basis.
When it comes to selecting living accommodations for elderly loved
ones, Choice Connections knows that one size does not fit all. They
will work with the family, identifying specific needs, until choices
are narrowed down to the most appropriate solution for each individual.
They will also schedule tours of different facilities and assist
throughout the transition, until a decision is reached that leaves all
family members with a sense of relief and security that their loved one
will be comfortable and well-cared for in their new living arrangement.
Choice Connections remains in contact to ensure that the senior has
found the perfect place to call home.

Local Expert Shares Three Ways to Save 20-50 Percent On Long-Term Care Insurance

from Bignews.biz:

Irvine, CA--Thanks to increased longevity and advances in health care, Americans are facing a new crisis: a growing need for long-term care. Americans spent over $200 billion on long-term care last year, about a tenth of the nation's health care spending and that number will explode as baby boomers age, explains Jesse Slome, executive director of the American Association for Long-Term Care Insurance.

Most insurers offer preferred health discounts that can reduce the yearly cost by 10 percent. Once you qualify for this discount, you never lose it even if your health changes, explains Petchul.

Adding a deductible to your policy -- something most people have for their car, health and home insurance -- can reduce the cost by roughly 20 percent annually. Over 80 percent of long-term care insurance policies purchased today have a 90-day deductible period, states Petchul. Most people have some savings that will cover the cost during this time period or

Evidence-based research delivers new staff retention tools to nursing homes

from Mcknight"s:

Long-term care providers, who frequently suffer employee turnover rates near 100% annually, have three new resources designed to reduce workforce turnover. The new tools, which were announced Monday by the Better Jobs Better Care Coalition, also can help providers find new employees and create a better work environment for the staff they already have, researchers said. 

The tools are the byproduct of four years of investigation, said the director of BJBC, an initiative managed by the Institute for the Future of Aging Services.

"It's no secret that quality in long-term care cannot be achieved without a quality workforce," says Robyn Stone, Ph.D., executive director of IFAS. "These resources make it easy for providers to take lessons from evidence-based research and use them to transform their organizations."

A catalogue of the group's research shows the benefits of job training programs on staff retention, while a short accompanying video highlights real-world examples of the effectiveness of the programs. A "News You Can Use" fact sheet shows providers where to find new pools of potential employees. More information is available at www.bjbc.org.

Policies for Nursing Home Care Dwindling as Home Care Grows

from market Watch:

Last year not one Unum 
group long term care policy was
purchased for nursing home care only, evidence of a dramatic trend
indicating Americans' desire to "age
in place". In Unum's
third annual Landscape of Long Term Care, the company reports a steady
increase in policies with the home care option.

As the leader in the group long term care market, Unum provides an
annual review of sales and claims trends each fall in recognition of
Long Term Care Awareness Month in November.

"We carefully track these trends so we
understand the needs of our customers," said
John Noble, director of long term care products for Unum. "More
people expect to be able to receive care at home, and making that
possible is an important element of long term care coverage."

Of Unum's inforce policies, 93.4 percent are
purchased to cover some type of home care. And nearly 70 percent of Unum's
group customers use their long term care benefits for care that occurs
in the home.

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.