Antipsychotics and the Elderly

The Food and Drug Administration warned doctors that prescribing a group of antipsychotic drugs to older people suffering from dementia could increase their risk of death.

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/
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Out of Gas?

Everywhere I go, people are talking about how the high price of gas is affecting home care workers and agencies. Organizations are contacting me and my colleagues for ideas on how to deal with it, so I’d be very interested to hear from people in other parts of the country. How are employers and workers and clients dealing with it? Are any states planning a response to this crisis? If so, what’s being considered?

Four-dollar-a-gallon gasoline exacerbates all recruitment and retention problems, and I fear that it forces workers to make some very difficult choices. Employers are calling workers to offer them cases and having the workers do the gas calculations and say “I can’t afford to take this one.” Home care aides are seeing their co-workers go to other jobs where they don’t have such stressful transportation issues.

Here in Michigan, in the waiver program that funds home care for people who are eligible for nursing home services, I’m hearing that the only time a worker must be paid for transportation is when they’re driving the client, taking them shopping or the doctor or the pharmacy or something like that. People aren’t getting paid for all the driving they have to do just to get to their clients.

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/
Change: http://prosynergypsc.blogspot.com/

New York Fact Sheet: Caregivers without Health Care

Download the report (pdf 180K)

New York state has been “a national leader” in expanding health care coverage for home care aides and other workers, yet 30 percent of its home care workers lack insurance according to a fact sheet from PHI’s Health Care for Health Care Workers campaign.

Caregivers Without Coverage focuses on home care workers because they are the largest and fastest-growing segment of the state’s direct-care worker population. It explains the conditions contributing to the high rate of uninsurance among direct-care workers, including low wages that make it difficult to afford premiums and copays.

Among the facts it presents:

  • One in seven low-income workers in New York City is employed as a home care worker;
  • Starting wages for home health aides are just $7.50 - $8 an hour in New York City, though its cost of living is one of the highest in the nation; and
  • The statewide median hourly wage for home care workers is $9.74 an hour, compared to $16.91 for all workers.

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/
Change: http://prosynergypsc.blogspot.com/

MAPPING CARE OF OLDER PEOPLE

This analysis was sponsored by the Resolution Foundation and carried out by Deloitte & Touche LLP. It describes long-term care in England as a ‘mixed market’, made up of a combination of public and private funding and supply.

There is a widespread expectation that care provision is an integral part of the welfare state, but the reality is that long-term care is now almost entirely provided through private and third sector suppliers, and increasingly, is funded through private means.

The long-term care market does not function as a private market, because a series of intermediary processes such as means and needs testing that distort the interaction between supply and demand. These processes also have an impact on ‘self-funders’ who may face higher prices for similar services as a result of cross-subsidisation.

The analysis identifies key drivers of inefficiency and unfairness across the system, and tests the characteristics of supply, demand, and intermediary processes against indicators of a well-functioning market. This shows that whilst supplier profitability and entry and exit are stable, local markets and intermediary processes can distort outcomes for each individual, even for those who fund their care through private means.

The analysis indicates that the whole of the mixed market needs to be tackled, not just that part funded by the public sector. Innovation will be required by intermediaries, by the financial services sector, the supplier market as well as in the public sector.

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/
Change: http://prosynergypsc.blogspot.com/

Nursing homes, consumers lock horns over arbitration bill at congressional hearing

Providers cried "discrimination" and consumer advocates called for an even tougher stance Tuesday during a congressional hearing on the "Nursing Home Arbitration Act of 2008." House and Senate bills (H.R. 6126 and S. 2838) seek to disallow pre-admission clauses that bind residents to arbitration should a complaint be filed later.

Providers "aggressively oppose efforts to diminish the use of arbitration by American businesses, especially those unfairly targeting long-term care consumers and providers," testified Gavin Gadberry on behalf of the American Health Care Association and the National Center for Assisted Living before members of the House Judiciary Subcommittee on Commercial and Administrative Law. He said troubling anecdotes cited by others at the hearing were the exception rather than the rule in nursing homes.

Among those endorsing the "Fairness" act was AARP board member Dr. William Hall, who said he hoped to work with all parties to expand the bill's reach. AARP hopes that the bill would apply to "all current residents of long-term care facilities, not just those whose pre-dispute arbitration agreements are made, amended, altered, modified, renewed or extended on or after the date of enactment of the bill. The protections provided under this legislation should be available to all current long-term care facility residents."

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/
Change: http://prosynergypsc.blogspot.com/

Lawmakers Discuss Delaying Medicare Durable Medical Equipment Bidding Program

Sens. Debbie Stabenow (D-Mich.) and George Voinovich (R-Ohio) on Friday circulated a letter in the Senate seeking support for legislation that would delay a competitive bidding program in Medicare for durable medical equipment, CongressDaily reports. The program is scheduled to begin on July 1 (Edney, CongressDaily, 6/9). CMS will select DME suppliers to participate in Medicare based on bids they submit. The 2003 Medicare law mandated the program as part of a larger effort to implement competitive bidding.

In 2008, the program will operate in 10 of the largest Metropolitan Statistical Areas and will apply to 10 of the top durable medical equipment, prosthetics, orthotics and supplies product categories. In 2009, the program will expand to an additional 70 MSAs and will continue to expand in future years. The program also will apply to additional product categories in future years. The program likely will result in an average 26% decrease in the prices of medical equipment in the 10 MSAs, according to CMS (Kaiser Daily Health Policy Report, 5/7).


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/
Change: http://prosynergypsc.blogspot.com/

Lawmakers hear testimony on nursing home arbitration clauses

WASHINGTON (Legal Newsline)-Federal lawmakers heard Tuesday that binding arbitration clauses in nursing home contracts provide a fair and timely resolution of patient disputes.

Arbitration agreements are "a viable option" for long term care providers and their residents to resolve legal disputes, said attorney Gavin Gadberry, representing the American Health Care Association and the National Center for Assisted Living.

"Arbitration is less adversarial than traditional litigation, produces quicker results and has been determined to be both fair and appropriate by our courts," he told members of the House Judiciary's Subcommittee on Commercial and Administrative Law.

The 12-member panel is considering legislation introduced by committee chair Rep. Linda Sánchez, D-Calif., who said she recently placed her father in a nursing home.

"Unfortunately, this debate is colored by anecdotes and misinformation perpetuated by high-profile trial attorneys who traditionally oppose any effort to bring balance to the personal injury playing field, and who give too little consideration to the harmful consequences on the long term care industry that follow from the high transaction costs of traditional litigation and the resulting financial drain on the system," Gadberry said.

The legislation, outlined in H.R. 6126, would render invalid pre-dispute arbitration agreements between a long-term care facility and a resident or anyone acting on the resident's behalf.

"When legal concerns arise, we believe that fair and timely resolution -the kind that is often the product of arbitration - is in the best interest of both the consumers and their care providers," Gadberry said.

The bill-the Nursing Home Arbitration Act of 2008-is supported by AARP, which represents older Americans.

Dr. William Hall, a member of AARP's board of directors, told the committee that pre-dispute arbitration clauses in nursing home contracts are "harmful" to residents and their families.

"These arbitration clauses force a Hobson's choice --waive the right to seek redress in the courts or get care in another facility, assuming there is one in their area without an arbitration clause," the Rochester, N.Y., geriatrician said.

While the quality of care in nursing homes and other residential care centers has improved since the enactment of federal nursing home quality standards in the Omnibus Budget Reconciliation Act of 1987, he said "much more" needs to be done to improve patient care.

"Many facilities do provide high quality care, but there are also too many facilities that show significant quality deficiencies that can cause harm to residents on their annual inspections," Hall said.

Arbitration clauses, he said, unfairly take away residents' and families' legal options. What's more is that many nursing home admissions are made unexpectedly, after a crisis.

"Clearly, most people seeking nursing home admission are focusing on the quality and range of services available, and are not thinking about possible future disputes," Hall said.

"When they are presented with admissions contracts, they often do not know that an arbitration requirement is buried in the fine print of the multi-page document," he added.


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/
Change: http://prosynergypsc.blogspot.com/

Bright Lighting Could Improve Dementia Symptoms In Elderly

A modest improvement in symptoms of dementia has been associated with the use of bright light in daytime, in an effort to improve their circadian rhythms, according to a study released on June 10, 2008 in JAMA. Additionally, the use of melatonin resulted in improved sleep.


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/
Change: http://prosynergypsc.blogspot.com/

Culture Change in Nursing Homes: How Far Have We Come?

Although The Nursing Home Reform Act, passed in 1987, established residents' rights and quality standards for nursing homes nationwide, serious concerns remain about quality of care and quality of life for nursing home residents. The "culture change" movement is working to radically transform nursing home care, and help facilities transition from institutions to home. This report presents results from the Commonwealth Fund 2007 National Survey of Nursing Homes, fielded to examine the penetration of the culture change movement at the national level and measure the extent to which nursing homes are adopting culture change principles and practicing resident-centered care. Results are mixed, with much room for improvement. The survey highlights important lessons, including the finding that the more a nursing home has adopted culture change principles, the greater the benefits that accrue to it, in terms of staff retention, higher occupancy rates, better competitive position, and improved operational costs.

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/
Change: http://prosynergypsc.blogspot.com/

CMS Outlines Rights Of Medicare Hospice Patients

Medicare beneficiaries with terminal illnesses have their right to determine how they receive end-of-life care outlined for the first time in a new regulation soon to be published by the Centers for Medicare & Medicaid Services.

In the first overhaul of regulations governing the hospice industry since 1983, the new Medicare Conditions of Participation (CoP), include explicit language on patient rights that had not existed under the previous regulations.

Although many hospice patients are already active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights.

Specifically, the rule says, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan; the right to effective pain management, the right to refuse treatment and the right to choose his or her own physician.

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/
Change: http://prosynergypsc.blogspot.com/