Health and Disability

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 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 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.

July 23, 2008

› Click here to view webcast.

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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

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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

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“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.”

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.

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.

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.

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 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.