Health and Disability

from The Irish Times:

THAT'S MEN: Carers involved in long-term or chronic care need to remind themselves that they are choosing to care

IN
A RECENT column, I wrote about the stresses involved in caring for
somebody whose condition is terminal, and also about the stresses
involved in being the person who is cared for.

Subsequently, I
wrote about the tendency of human beings in conflicts to torment
others, and about the importance of personal and moral choices in
avoiding such behaviours.

A reader pointed out that both of
these columns are particularly applicable in cases where a person is
caring for somebody with a chronic illness. The person with a terminal
illness is coming to the end of his or her life. Chronic conditions,
however, can go on for decades. This can be very stressful indeed for
both parties involved in the caring.

Some disturbing news appeared last week in The Wall Street Journal.
The highly respected newspaper found that nursing homes are evicting
long-term, frail residents—many on Medicaid—to make room for short-stay
residents.

This timely information (See more at http://www.mcknights.com/News-report-Illegal-nursing-home-evictions-on-the-rise/article/113572/)
comes as nursing homes are openly courting the short-stay population.
These residents—who typically come for rehabilitation or treatment and
stay for 30 days or less—are on Medicare, which, pays much more per day
to nursing homes than Medicaid.

The industry, which reportedly argued that evictions are not common,
cannot deny it is going out of its way to woo this lucrative group. My
InnerView, a research company that performs many long-term care
surveys, recently published a story called “The Changing Landscape from
long term care to short-term stay: What are your short-stay customers
saying?” It appears on the Web site of Provider magazine, the journal
of the American Health Care Association, the largest association of
nursing homes. (You can see it at www.providermagazine.com.)

The article stresses the need to meet short-term residents’
expectations as a way to enhance facilities’ reputations in their
communities and improve their abilities to attract short-stay
admissions.

“As the trend to shorter stays, more acute patients, and more
admissions and discharges continues to grow, providers’ reliance on
this population for their success becomes ever more important,”
according to the article, which was written by Brad Shiverick, chief
quality officer for My InnerView

This weekend, Democratic leaders endorsed an outline of their
party’s policy platform for delegates to review and ratify during the
party’s upcoming convention in Denver.

The document, Renewing America’s Promise,
is the result of more than 1,600 listening sessions in communities
across the country. It addresses issues ranging from education reform
to climate change. And thanks to the hard work of our staff and AAHSA’s Long-term Care Solution ambassadors,
it also includes a call for our country to make it affordable to care
for older Americans and disabled individuals. Here are two passages
from the outline that reflect this commitment to action:

Empowerment and Support of Older Americans and People with Disabilities.

Seniors and people with disabilities should have access to
quality affordable long-term care services, and those services should
be readily available at home and in the community. Americans should not
be forced to choose between getting care and living independent
and productive lives.

The freedom to "age in place" conveys hope for seniors-a chance to
enjoy the final season of life without being institutionalized and
without burdening family members. As evidenced by exponential growth in
assisted living, independent living and community-based programs,
consumers are driving the long-term care market and they demand
options, autonomy and the freedom to make choices-including choices
that entail risk. Balancing autonomy with safety, however, presents a
serious challenge to assisted-living facilities striving to deliver on
the hope of aging in place for their frail and elderly residents.

Risk abounds

In a community of residents with an average age of 84 who depend on
assistance for many daily tasks, risk abounds. Just consider the
obvious risks in a population where 86% require assistance with
medications, 68% with bathing, 47% with dressing and 25% with eating.
And do not minimize the fact that, on average, half the residents also
suffer from some form of dementia. Falls, elopements, abuse,
medication issues and contagious infections are just a few of the more
common problems that keep both administrators and family members up at
night.

But there is another layer of less obvious risks. Some seniors, who
thought they bought the complete lifetime package, will face the risk
of eviction. Glossy marketing brochures that assured prospective
residents of services to meet all needs of all residents all the time
have faded away leaving only a trail of broken promises.

Jim Moore, a respected assisted living consultant, refers to it as the
"million dollar wake-up call" for assisted-living facilities. He notes
that by adding just 60 minutes of assistance per day for just 40% of
residents, a facility's costs can increase by $123,000 per month.
Unless the facility can cover those expenses with higher prices,
promises are broken. Even in the wake of broken promises, many
residents will resist the need to move along the continuum of care.
Likewise, many administrators who find themselves under constant
pressure to keep the facility full may not pursue a transfer.

The confluence of these factors leads into another equally undesirable
set of risks. Although the phrase "aging in place" conjures up
favorable images for the majority of seniors, the reality may be a
disappointment for them and their family members. Because
assisted-living facilities are not regulated by the federal government,
and only loosely regulated by state government, the level of services
provided from facility to facility varies significantly. In an effort
to minimize operating expenses, many facilities depend heavily on
unlicensed personnel (universal workers) for a majority of resident
care, including the administration of medication. For seniors with
deteriorating health conditions and multiple chronic diseases, lack of
adequate nursing care and nursing supervision can spell disaster. In
fact, most mistakes that result in injuries to residents are typically
rooted in staffing issues.

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.

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.

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."

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:

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.