The 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.
By Christine Vestal
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.
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
Holly Dawson believes her job is a calling.
She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay.
Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear.
George Grellinger, a former client of hers, has dementia. He recently fell down the back steps of his home. Dawson remains friends and regularly stops in to check on him. To remain living at home, Grellinger had to switch to an aide who is covered by his veterans’ benefits.
“A lot of us are barely home because if we don’t go to work, we don’t get time off. We don’t get paid vacations. And some of us haven’t had raises in years.”
Dawson says she has been a home health aide for 31 years. She has never done it for the money, rather to help people like Grellinger, she says.
But the conditions of home health work are leading many aides to seek better pay and benefits.
On an early September morning, home health workers held a rally in Cleveland. Jasmine Almodovar, 35, chants with the crowd: “We want change and we don’t mean pennies!”
She says she earns $9.50 an hour, which is actually just above average for a home health worker in Ohio.
“We work really long hours, really hard work,” she says. “A lot of us are barely home because if we don’t go to work, we don’t get time off. We don’t get paid vacations. And some of us haven’t had raises in years.”
Almodovar says her last raise was four years ago. She makes about $21,000 a year so she makes too much to qualify for Medicaid, but paying for a plan on Ohio’s federal exchange doesn’t fit in her monthly budget. Continue reading
By Millie Dawson
Health Behavior News Service
Nearly half of Americans age 65 and older, totaling about 18 million people, require help with routine daily activities like bathing, handling medications or meals.
A new study in Milbank Quarterly reveals a growing need for improved services and support for older Americans, their spouses, their children and other “informal caregivers.”
While 51 percent of older Americans in the study reported no difficulty with routine tasks, “29 percent reported receiving help with taking care of themselves or getting around in the previous month,” said co-author Vicki A. Freedman, Ph.D., a research professor with the Institute for Social Research at the University of Michigan.
“Another 20 percent reported that they had difficulty carrying out these activities on their own,” she said.
- Nearly half of Americans age 65 and older require help with routine daily activities such as bathing, meals or taking medications.
- Substantial numbers of older adults living outside of nursing homes experience adverse consequences from unmet care needs.
- There is a growing need for improved community-based services and support for older Americans and their caregivers.
By Stephanie Stephens,
Health Behavior News Service
As many as half to two-thirds of women who’ve undergone hysterectomies or are older than 65 years in the United States report receiving Pap tests for cervical cancer.
This prevalence is surprising in light of the 2003 U.S. Preventive Services Taskforce guidelines recommending that women discontinue Pap testing if they have received a total hysterectomy without a history of cervical cancer and if they are over age 65 years with ongoing and recent normal Pap test results.
Performing these unnecessary tests can result in stress for the patient, increased costs, and inefficient use of both provider and patient time, concludes a new study in the American Journal of Preventive Medicine.
“During this time of health care reform, we could probably use our resources more wisely,” said corresponding author Deanna Kepka, Ph.D., M.P.H., assistant professor at the University of Utah’s College of Nursing and Huntsman Cancer Institute. Continue reading
By Jenni Bergal
Over the years, Illinois Attorney General Lisa Madigan has consistently heard “horror stories” about the abuse or neglect of nursing home residents. Now she is trying to bring such cruelty out of the shadows and into clear view.
Madigan’s office is drafting legislation, likely to be introduced in 2015, which would allow Illinois nursing home residents and their families to place cameras in their rooms to help protect them.
“Residents and family members should have the option, for their own peace of mind, to monitor what is taking place,” said Madigan. “If something goes wrong, you can see what actually happened.”
If the measure is approved, Illinois would join at least four other states—New Mexico, Oklahoma, Texas and Washington—that have laws or regulations allowing residents to maintain cameras in their rooms.
It is time for conversations about death to become a part of life.
That is one of the themes of a 500-page report, titled “Dying In America,” releasedWednesday by the Institute of Medicine.
The report suggests that the first end-of-life conversation could coincide with a cherished American milestone: getting a driver’s license at 16, the first time a person weighs what it means to be an organ donor.
Follow-up conversations with a counselor, nurse or social worker should come at other points early in life, such as turning 18 or getting married.
The idea, according to the IOM, is to “help normalize the advance care planning process by starting it early, to identify a health care agent, and to obtain guidance in the event of a rare catastrophic event.”
The IOM plans to spend the next year holding meetings around the country to spark conversations about the report’s findings and recommendations. “The time is now for our nation to develop a modernized end-of-life care system,” said Dr. Victor Dzau, president of the IOM. Continue reading
By Christine Vestal
August 12, 2014
Providing health care to an aging prison population is a large and growing cost for states. Not only do inmates develop debilitating conditions at a younger age than people who are not incarcerated, but caring for them in the harsh environment of prisons is far more expensive than it is on the outside.
Of the 2.3 million adults in state and federal prisons, about 246,000 are 50 or older, according to the National Institute of Corrections.
“In a couple of years, this is the only thing people are going to be talking about. It’s getting worse by the minute.”
“In a couple of years,” said Donna Strugar-Fritsch, a consultant with Health Management Associates, “this is the only thing people are going to be talking about. It’s getting worse by the minute.”
Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday.
That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act. Continue reading
From the Office of Research on Women’s Health
A stroke, also called a brain attack, occurs when blood flow to the brain suddenly stops. Blocked or damaged vessels are the two major causes of stroke.
During a stroke, brain cells begin to die because oxygen and nutrients cannot reach them. The longer blood flow is cut off to the brain, the greater the damage.
Every minute counts when someone is having a stroke. Immediate treatment can save a person’s life and enhance the chance for a successful recovery.
There are two kinds of stroke: Continue reading
Q. I’m a realtor who’s listing a client’s home. She is on Social Security and is moving into assisted-living housing. Will the proceeds from the sale of her home affect her eligibility for housing, which is based on her income?
A. This is an unusual question because assisted-living facilities typically do not have special eligibility criteria for low-income residents, experts say. Continue reading
Mealtime. Naptime. Bath time. Bedtime. Everything is on a schedule for residents in a traditional nursing home, leaving little flexibility for personal decision making.
But LaVrene Norton is working to change that.
Norton is founder and president of Action Pact, a national consulting firm. It specializes in helping retirement communities and nursing homes train staff and design their facilities to feel and be more like living at home.
Since beginning work on the “household model” in 1984, Norton has helped design hundreds of these communities. Continue reading
Some states are taking steps to ensure that more seniors can get the kind of long-term care they want — without becoming poor to get it.
By Michael Ollove
Three years after the demise of the long-term care piece of the Affordable Care Act, some states are retooling their Medicaid programs to maximize the number of people who can get care at home and minimize the number who have to become poor to receive help.
They also are trying to save state dollars. Medicaid is a joint state-federal program, and long-term care for the elderly is putting an ever greater burden on state budgets: Total Medicaid spending for long-term services rose from $113 billion in 2007 to nearly $140 billion in 2012. Continue reading
The state with the highest marks long-term services and support for the elderly, disabled and their caregivers was Minnesota, followed by Washington, Oregon, Colorado and Alaska.
The lowest ranked states were: Indiana, Tennessee, Mississippi and Alabama, and, coming in last, Kentucky, according to a new report.
The report “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers,” evaluates 26 indicators in five key dimensions that make up the Long-Term Services and Supports (LTSS) system in each state. It was produced by AARP, The Commonwealth Fund and The SCAN Foundation.
Minnesota, Washington, Oregon, Colorado, Alaska, Hawaii, Vermont, and Wisconsin, in this order, ranked the highest across all five dimensions of the scorecard..
These eight states clearly established a level of performance at a higher tier than other states—even other states in the top quartile. But even these top states have ample room to improve.
The cost of long sterm continues to outpace affordability for middle-income families, and private long-term care insurance is not filling the gap. Continue reading
By Michael Ollove
Stateline staff Writer
The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.
A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.
Now, quietly, the proposal is headed toward reconsideration — this time through a regulatory procedure rather than legislation. Continue reading