Category Archives: Senior Health

Medicare rates home health agencies

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Star full faceHome Health Agencies Get Medicare’s Star Treatment

By Jordan Rau
KHN

The federal government released on Thursday a new five-star rating system for home health agencies, hoping to bring clarity to a fast-growing but fragmented corner of the medical industry where it’s often difficult to distinguish good from bad.

Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings.

The elderly tend to be less familiar with the reputation of home health agencies than they are with hospitals and other institutions.

The star ratings come as home health agencies play an increasingly important role in caring for the elderly.

Last year 3.4 million Medicare beneficiaries received home health services, with nurses, aides, and physical and occupational therapists treating them in the home.

Medicare spends about $18 billion on the home health benefit, which provides skilled services that must be authorized by a doctor, not housekeeping care that some elderly pay for privately. Continue reading

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A new focus on family caregivers

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A younger man holds an elderly man's handBy Susan Milligan
Stateline

Iraq war veteran Doug Mercer had been home in McAlester, Oklahoma, for just four days when he was in a motorcycle accident that left him broken and brain-damaged.

His wife Michelle became his caregiver after he left the hospital, but nobody there explained how to transport him safely.  A few weeks later, Michelle struggled as she tried to get Doug from the car to his wheelchair, breaking his leg.

“They’re sending you home, and you’re thinking, ‘What?’ Nobody instructs you, and says, ‘This is what’s coming home with you and how to use it,’” she said.

The Mercers’ story was a driving force behind an Oklahoma law that took effect in November that requires hospitals to train a designated family caregiver to tend to the medical needs of a released patient.

As many as 42 million Americans take care of a family member at any given time.

Since then, 12 more states (Arkansas, Colorado, Connecticut, Indiana, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Virginia and West Virginia) have approved similar laws. In Illinois and New York, legislation is awaiting the governor’s signature.

As many as 42 million Americans take care of a family member at any given time. Traditionally, family caregivers provide assistance with bathing, dressing and eating. They shop for groceries and manage finances.

But as the number of elderly Americans with chronic conditions has grown, family caregivers have taken on medical tasks once provided only in hospitals, nursing homes or by home care professionals.

In an AARP survey released in 2012, nearly half of family caregivers said they administered multiple medications, cared for wounds, prepared food for special diets, used monitors or operated specialized medical equipment. Continue reading

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As demand grows, states consider better pay, benefits for home care workers

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And younger man's hand holds an elderly man's handBy Rebecca Beitsch
Stateline

People working in one of the fastest growing professions in America aren’t well paid. Many of them don’t get health or retirement benefits. And federal minimum wage and overtime protections still don’t apply to them.

Despite the low wages and odd hours, 2 million Americans are home care workers, helping to dress, feed, and bathe the elderly and disabled within their homes. They are in high demand: The U.S. population is aging, and more seniors want to stay in their homes instead of moving to nursing homes.

In Washington and Oregon, unions played a role in raising wages for home care workers in those states’ Medicaid programs. 

Some states are trying to improve home care workers’ wages and benefits, aiming to attract and retain more skilled and dedicated workers in a high-turnover industry.

But other states are concerned about adding costs to their Medicaid programs, and some are in court fighting a 2013 U.S. Department of Labor regulation that would apply minimum wage and overtime rules to home care workers, who have long been exempt.

In Washington and Oregon, unions played a role in raising wages for home care workers in those states’ Medicaid programs. Montana and North Dakota used federal stimulus dollars to help fund increases.

And in Maine, Democrats are pushing legislation that would raise the pay of home care workers to $15 an hour from $9 an hour, according to Democratic House Speaker Mark Eves, who is sponsoring the measure.

But Ohio has stripped home care workers of union bargaining rights, and has resisted giving them health benefits, arguing that they can get health care insurance on Affordable Care Act exchanges.

This story was updated to reflect the fact that Connecticut, Iowa, Maryland and Minnesota have signed onto the brief in favor of applying federal minimum wage and overtime rules to home care workers.

Meanwhile, the Department of Labor regulation that would extend overtime and minimum wage protections to home care workers has been tied up in court, with some states (Connecticut, Illinois, Iowa, Maryland, Massachusetts, Minnesota, New Mexico and New York) submitting briefs in favor of the rule but others (Arizona, Georgia, Kansas, Michigan, Nevada, North Dakota, Tennessee, Texas and Wisconsin) in opposition. Continue reading

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Calming dementia patients without powerful drugs

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By Rachel Dornhelm, KQED

Diane Schoenfeld comes every Friday to the Chaparral House nursing home in Berkeley, Calif. to spend time with her aunt, Lillie Manger.

“Hi Aunt Lill!” she says, squatting down next to her aunt’s wheelchair, meeting her at eye level.

Manger is 97. She has straight white hair pulled back in a neat bun today. It’s tied with a green scarf, a stylish reminder of the dancer she used to be.

Diane Schoenfeld, left, shows a family photo to her 97-year-old aunt, Lillie Manger. (Photo by Rachel Dornhelm/KQED)

Diane Schoenfeld, left, shows a family photo to her 97-year-old aunt, Lillie Manger. (Photo by Rachel Dornhelm/KQED)

They go together to the dining room to look over family pictures. Manger needs to be reminded who is in them. Including one of herself. “That’s me?” she asks. “That’s you,” her niece confirms.

“Am I supposed to remember?” says Manger.

Schoenfeld smiles at her encouragingly: “I don’t know if you’re supposed to. It’s OK either way.”

Manger has dementia. Schoenfeld is her “surrogate decision maker” meaning that legally, she is the person who makes decisions about Manger’s health care. Continue reading

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Hunger stalks millions of US seniors

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In sunlit paradise, seniors go hungry

By Sarah Varney
KHN

NAPLES, Fla.— It wasn’t until the Maffuccis found themselves living on cups of coffee, and coffee alone, that they finally called a food pantry for help.

The couple had sold their suburban New Jersey home where they had raised three children and set out to pursue the glossy dream of an easy-going retirement in sunny southwest Florida.

But Mina and Angelo Maffucci quickly ran out of money—overtaken by illness, bad luck and an economic crisis that claimed their Florida dream home to foreclosure. They soon found themselves staring at an empty cupboard.

“You open up the closet and all we had was coffee,” said Angelo Maffucci, 82, who had been a drywall installer in New Jersey. “I never thought we would be down on our hands and knees like that, but it happened fast.”

aging_hunger_newshour_maffucci-family

Angelo and Mina Maffucci pose for a portrait in the kitchen of their son’s apartment, where they’ve been living for about five years — since they lost their house. (Photo: Ariel Min/PBS NewsHour)

While the U.S. economy adds jobs and the financial markets steadily improve, a growing number of seniors are having trouble keeping food on the table.

In 2013, the most recent data available, 9.6 million Americans over the age of 60 —or one of every six older men and women—could not reliably buy or access food at least part of the year, according to an analysis from researchers at the University of Kentucky and the University of Illinois. Continue reading

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Medicaid expansion helps cut rate of older, uninsured adults from 12 to 8 percent

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ACA health reform logoBy Michelle Andrews
KHN

The health law’s expansion of Medicaid coverage to adults with incomes over the poverty line was key to reducing the uninsured rate among 50- to 64-year-olds from nearly 12 to 8 percent in 2014, according to a new analysis.

“Clearly most of the gains in coverage were in Medicaid or non-group coverage,” says study co-author Jane Sung, a senior strategic policy adviser at the AARP Public Policy Institute, which conducted the study with the Urban Institute.

Under the health law, adults with incomes up to 138 percent of the federal poverty level ($16,243 for one person in 2015) are eligible for Medicaid if a state decides to expand coverage. Twenty-seven  states  had done so by the end of 2014.

The study found the uninsured rate for people between age 50 and 64 who live in states that haven’t expanded Medicaid was twice as high—11 percent—as for those who live in states that have done so.

More than 2 million people between 50 and 64 gained coverage between December 2013 and December 2014, according to the study. Continue reading

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Washington state ranked 11th in the nation for senior health

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Washington MapWashington state ranks 11th in the nation for senior health, ahead of Maryland but behind Maine, and up from its 15th-place ranking last year, according to a senior health assessment conducted each year by the UnitedHealth Foundation.

Vermont was rated number 1 in the nation, followed by New Hampshire, Minnesota, Hawaii and Utah. West Virginia. The Oklahoma, Arkansas, Kentucky, Mississippi and Louisiana came in at the bottom of the list.

The rankings, which appear in the foundatio’ns “America’s Health Rankings Senior Report,” are based on 35 measures of health, which include such factors as availability and quality of health care services, health behaviors, community and environmental amenities, and state health care policies.

Among Washington’s Strengths were:

  • Low prevalence of physical inactivity
  • High enrollment in the Supplemental Nutrition Assistance Program
  • Low prevalence of full-mouth tooth extraction

Among the state’s weaknesses were:

  • High prevalence of chronic drinking • Low prescription drug coverage
  • High prevalence of falls

Highlights:

  • In the past year, hip fractures decreased 21% from 6.7 to 5.3 hospitalizations per 1000 Medicare beneficiaries.
  • In the past 2 years, home health care increased 17% from 73.2 to 85.5 home health care workers per 1000 adults aged 75 and older.
  • In the past 2 years, preventable hospitalizations decreased 15% from 46.4 to 39.3 discharges per 1000 Medicare beneficiaries.
  • In the past year, obesity increased 6% from 25.6% to 27.0% of adults aged 65 and older.
  • In the past year, poverty increased 5% from 7.8% to 8.2% of adults aged 65 and older.
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A top-rated nursing home is hard to find in Texas, 10 other states

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Natalie Anne Sealy's headshot.

Natalie Sealy (Photo courtesy of Billie Pender)

LOCKHART, Texas — The call from the nursing home came just before dawn, jolting Martha Sherwood awake.

During the night, fire ants had swarmed over her 85-year-old mother, injecting their stinging venom into Natalie Sealy’s face, arms, hands and chest.

“She was just lying there being eaten alive,” said daughter Billie Pender, who said she and her sister had repeatedly complained about a broken windowsill in their mother’s room at Parkview Nursing and Rehabilitation Center.

In 11 states, 40 percent or more of nursing homes get Medicare’s lowest two lowest rating.

The Sept. 2 attack devastated Sealy, a retired bank teller with dementia. “She went steadily downhill,” dying in late March, said Sherwood, who brought a lawsuit against the home.

Their mother had chosen the for-profit facility two years earlier because it was near her adult children. The family didn’t know that Parkview scored poorly on staffing and other quality measures.

This year, Medicare rates it one star out of a possible five stars — the lowest rating possible — on Nursing Home Compare, which was designed by the federal government to help consumers choose a long-term care facility.

The problem for Sealy’s family and residents of many parts of the country is they have few, if any, higher-rated options if they want their loved ones close by.

In 11 states, 40 percent or more of nursing homes get the two lowest ratings, according to an analysis by the Kaiser Family Foundation.  (Kaiser Health News is an editorially independent program of the foundation.)

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Texas has the highest percentage of one-and two-star homes in the country: 51 percent of its nursing homes are rated “below average,” or “much below average,” on Nursing Home Compare, according to the analysis. Louisiana is close behind at 49 percent, with Oklahoma, Georgia and West Virginia tying for third at 46 percent. Continue reading

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Running out of money is more than just a worry for many seniors, study finds

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clockBy Michelle Andrews
KHN

For many older people and their families, particularly those dealing with conditions such as Alzheimer’s or cancer that often require long-term, pricey medical care, running out of money is a nagging concern.

Families are right to be worried, according to a new study that analyzed data from nearly 1,200 people who died between 2010 and 2012 and who participated in the University of Michigan’s ongoing national Health and Retirement Study.

Among people who were age 85 or older when they died,  one in five had no assets left apart from their homes, and 12 percent had no assets left at all, only income from sources such as Social Security or pensions.

Among people who were age 85 or older when they died,  one in five had no assets left apart from their homes, and 12 percent had no assets left at all, only income from sources such as Social Security or pensions.

The analysis by the Employee Benefit Research Institute found that those who died younger were even worse off.

Among people who died between age 50 and 64, 30 percent were without assets and 37 percent had only their homes. Continue reading

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High morale linked to longer survival among elderly | Reuters

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Smiley_FaceWhether it is cause or effect is unclear, but high morale seems to go along with a longer life, according to a new Scandinavian study.

Among people 85 years and older, those who felt optimistic about life and had something to look forward to lived five years longer on average than their more pessimistic counterparts.

Source: High morale linked to longer survival among elderly | Reuters

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50 years later the US Older Americans Act limps along, relying on local and state agencies to provide services

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A younger man holds an elderly man's handBy Rita Beamish
Stateline

This year marks a half-century since Congress created the Older Americans Act, the major vehicle for delivering social and nutrition services to people over 60.

But there’s little to celebrate on the golden anniversary of the law that helps people age at home.

Federal funding hasn’t kept up with the skyrocketing number of America’s seniors, now the largest elderly population in history.

That’s left states and communities struggling to provide the in-home support, meals, case management and other nonmedical services that help seniors avoid more costly nursing home care and enrolling in taxpayer-funded Medicaid.   Continue reading

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Some dementia can be treated, but my mother waited 10 years for a diagnosis

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Pauline Rabin with granddaughters Emma and Aviva Rabin-Court near the C&O Canal in Great Falls, Md. (Photo courtesy of Roni Rabin).

Pauline Rabin with granddaughters Emma and Aviva Rabin-Court near the C&O Canal in Great Falls, Md. (Photo courtesy of Roni Rabin).

By Roni Caryn Rabin
KHN

When my mother, Pauline, was 70, she lost her sense of balance. She started walking with an odd shuffling gait, taking short steps and barely lifting her feet off the ground. She often took my hand, holding it and squeezing my fingers.

Her decline was precipitous. She fell repeatedly. She stopped driving and she could no longer ride her bike in a straight line along the C& O Canal. The woman who taught me the sidestroke couldn’t even stand in the shallow end of the pool. “I feel like I’m drowning,” she’d say.

A retired psychiatrist, my mother had numerous advantages — education, resources and insurance — but still, getting the right diagnosis took nearly 10 years. Each expert saw the problem through the narrow prism of their own specialty. Surgeons recommended surgery. Neurologists screened for common incurable conditions.

The answer was under their noses, in my mother’s hunches and her family history. But it took a long time before someone connected the dots. My mother was using a walker by the time she was told she had a rare condition that causes gait problems and cognitive loss, and is one of the few treatable forms of dementia.

“This should be one of the first things physicians look for in an older person,” my mother said recently. “You can actually do something about it.” Continue reading

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Standing up to senior falls: local program promotes independence and safety at home

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By Alan Abe, Emergency Medical Services Division
Public Health – Seattle & King County

ems-falls

Do you know someone over 65 who has fallen? Have you reached that age and are concerned about your risk?

Senior falls are all too common, with results that are often serious and sometime even grave.

Nearly 24,000 seniors died nationally in 2012 due to falls, nearly doubling in ten years. And over 2.4 million people – almost four times the population of Seattle – were hospitalized.

What’s driving this toppling trend? More of us are living longer, and as a society, we’re getting older. And with the aging of the baby boomer generation, this trend will continue.  By 2030, the US Census Bureau estimates that there could be about 75 million people over 65 in the United States.

As we age, we tend to collect conditions that make us more vulnerable to falls: diabetes, heart disease, stroke, arthritis and Parkinson’s disease.

So, what can we do about it? We know that 60% of senior falls happen in the home, so if we improve safety and reduce risks there, we can make a big difference.

That’s where King County Emergency Medical Services/Medic One comes in. They have developed the One Step Ahead Fall Prevention Program to help at-risk seniors stay healthy, independent and safe in their homes.

How does the program work? Continue reading

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Doctors In Massachusetts Now Required To Offer End-Of-Life Counseling | CommonHealth

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Map of BostonThe state will review whether hospitals are following the rule and compliance could become an issue in a facility’s licensing review. But the state is not focused on enforcement right now.

via Doctors In Massachusetts Now Required To Offer End-Of-Life Counseling | CommonHealth.

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New Medicaid rule could hinder shift away from nursing homes

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A younger man holds an elderly man's handBy Christine Vestal
Stateline

For more than 30 years, states have been finding new ways to care for aged and disabled Medicaid beneficiaries without confining them to nursing homes.

In fact, the number of people living in skilled nursing facilities has declined significantly over the last decade, despite a marked increase in the ranks of the elderly in the U.S.

Starting this year, a new federal rule will require states to ensure that long-term care alternatives to nursing homes—such as assisted living facilities, continuing care retirement communities, group homes and adult day care—work with residents and their families to develop individual care plans specifying the services and setting each resident wants.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one and to give residents choices about their care.

While nearly everyone supports the concept, states, providers and even some consumer advocates are complaining that the rule could make it difficult for health care providers to fulfill increasing demand for long-term care outside of nursing homes.

Under the rule, for example, elderly people with dementia who enter assisted living facilities should not be subjected to constraints, such as locked exits, unless they are at risk for wandering.

But if they share living space with other residents with dementia who do need to be prevented from wandering, it will be difficult to allow them to leave the building whenever they want without jeopardizing the safety of others.

“The goal was completely laudable,” said Martha Roherty, director of the National Association of States United for Aging and Disabilities, which works to help elders and people with disabilities live in their communities for as long as possible.

“Unfortunately, what’s happened is that it is limiting individuals’ choice of what and where to receive (long-term care) services rather than broadening it, especially as it relates to seniors,” she said. Continue reading

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