Health and Disability

The federal government won 66 of 71 appeals cases brought by nursing home providers last year according to a recent report from the Center for Medicare Advocacy. The Centers for Medicare & Medicaid Services won all 18 cases decided on the merits at the Appellate Division; it won 48 of 53 cases at the Civil Remedies Division.

The report author used the findings to call for stricter regulatory oversight of facilities. It is believed to be the first such examination of nursing home appeals findings in citations of poor care, she said.

"The study shows not only that problems in care are serious and that penalties are modest, but also that facilities choose to appeal these enforcement actions throughout he administrative appeals process. Almost always the facilities lose their cases," said report author Toby S. Edelman, a senior policy attorney for the Center for Medicare Advocacy.

She called for an upgrade of the regulatory system, including higher fines for deficiencies. Her analysis, "Nursing Home Decisions of the Department of Health and Human Services' Departmental Appeals Board, 2007," can be found at http://www.medicareadvocacy.org.

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 home residents are lashing out at each other verbally, physically and in other ways more often than previously believed, according to Cornell University-based researchers.

"Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem," said Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology.

Studies led by Pillemer and professor of medicine Mark S. Lachs, MD, at a large, city-based nursing home discovered 35 different types of physical and verbal abuse between residents. Screaming was the most common form, followed by pushing, punching and fighting.

Researchers also found in another two-week study period that 2.4% of residents said their were on the receiving end of physical aggression, while 7.3% said they had been verbally assaulted.

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/

“My passion for working with people with dementia, for making life better for them, has been my major motivating factor. But over time, I keep saying to myself: ‘It’s the direct-care worker, stupid,’” says Joanne Rader. “The only way to make the lives of people with dementia better is to improve the working lives of the direct-care workers. We need to put the things in place that let them provide relationship-based care.”

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/

The Primary Care Resources and Supports for Chronic Disease Self-Management (PCRS) is a self-assessment tool for primary care settings interested in improving self-management of chronic illnesses. It is consistent with the Chronic Care Model and specifically supports implementation of the management support component.

The PCRS is designed to help primary care settings evaluate supports for self-management and identify areas and ways in which they could enhance these services. It is intended for use by multidisciplinary patient care teams representing front-line staff, clinicians and administrative personnel who are committed to quality improvement.

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/

PDF File:

10 million baby boomers will develop Alzheimer's disease.

43 pages.

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/

SPRINGFIELD, Mass.--(BUSINESS WIRE)--Nearly 2000 individuals with brain injuries will be able to move out of nursing facilities and other institutions under a landmark settlement agreement signed today by state officials and attorneys for the plaintiffs.

The settlement resolves a class action lawsuit, Hutchinson v. Patrick, which was filed in US District Court in Springfield last year on behalf of five individuals, the Brain Injury Association of Massachusetts (BIA-MA) and the Stavros Center for Independent Living. The complaint charges that the Commonwealth is violating the Americans with Disabilities Act for failing to provide adequate community services.

"This is a historic moment for persons with brain injuries in Massachusetts, many of whom have been unnecessarily institutionalized in nursing facilities, often for decades," said Steven J. Schwartz of the Center for Public Representation, lead counsel for the plaintiffs. "As a result of the settlement, close to 2000 persons with brain injuries finally will be able to live in integrated settings, nearer to their families and their home communities."

Approximately 8000 people with brain injuries currently reside in nursing and rehabilitative facilities in Massachusetts. At least a quarter of them could successfully transition to integrated community settings if services were available, according to plaintiffs' co-counsel, Richard Johnston, a partner at Wilmer Hale Cutler Pickering Hale and Dorr.

"Today's agreement is a first in the nation for people with brain injuries and will serve as a model for other states," said Arlene Korab, Executive Director of BIA-MA.

The Centers for Disease Control report that 5.3 million Americans are living with disabilities as a result of traumatic brain injuries (TBI) - head injuries caused by external events, such as falls or accidents. Acquired brain injuries (ABI) - caused by internal medical events such as stroke, disease or poisoning - also are significantly prevalent: more than 700,000 Americans suffer new or recurrent strokes every year.

This case and the settlement agreement apply to Medicaid-eligible residents of nursing and rehabilitation facilities who have either kind of brain injury. It is the first lawsuit in the nation that seeks community services for persons with all forms of brain injuries, regardless of the cause.

Under the settlement agreement, which is still subject to court approval, the Commonwealth will create two new waiver programs designed to transition individuals with brain injuries from nursing facilities and other institutions to community residences. The programs must be approved by the federal government, which will pay half the cost of both programs. The first program, called the ABI waiver, will serve up to 300 individuals with acquired brain injuries who currently are living in nursing and rehabilitation facilities. The second, called the Community First Demonstration Project, will offer transitional services and provide community placements to 1600 persons with brain injuries in nursing facilities. The programs will be implemented over several years, but should result in approximately 200-250 persons a year leaving nursing facilities.

"When I first learned about the issues being resolved, I was so happy, I filled up with tears," Catherine Hutchinson, 55, the lead named plaintiff, wrote in a recent email. A mute quadriplegic as a result of a brain-stem stroke in 1996, she lived for more than a decade at the Middleboro Skilled Care Center. "I think about the residents [with brain injury] ... and I know what their empty lives are like," wrote Hutchinson, who recently moved to The Boston Home, a specialized care facility in Dorchester.

The agreement also requires the Commonwealth to create a new system of community services for persons with brain injuries, including new policies and procedures, a new treatment planning process, a new appeal process for individuals and families, and new quality standards for community services. People in nursing facilities will be offered a choice to receive services in the most integrated setting appropriate to their needs, including their own homes and apartments, or shared living arrangements. In addition, the Commonwealth will establish an education and outreach initiative to inform persons with brain injuries and their families about the new waiver programs as well as the benefits of community living.

Korab applauded the courage of the named plaintiffs who "have opened the door for individuals with brain injury to live independently in the community."

The majority of people with brain injuries spend weeks or months in acute care hospitals and rehabilitative facilities. Once the acute treatment ends, these individuals still need some level of assistance with personal care and activities of daily living rehabilitative care. However, due to the lack of community-based options for continued rehabilitative care, most of them have no choice but to be admitted to nursing and rehabilitative facilities to have their basic needs met.

When the lawsuit was filed May 17, 2007, Hutchinson described her decade-long institutionalization as being "in prison for a crime I didn't commit." In a written statement, she added, "We must find a way to allow people like me to live as independently as possible. I should not have to fight the system when each day I must already fight to communicate, to be understood, make choices and express my feelings."

The settlement agreement will provide transitional and community services to Hutchinson, the other named plaintiffs and all class members. "For them, the promise of the Americans with Disabilities Act will become a reality," said Schwartz.

In addition to Hutchinson, originally from Attleboro, the other named plaintiffs are Raymond Puchalski, 59, a Millers Falls resident who has lived for three years at the Kindred/Goddard Hospital's neurobehavioral unit in Stoughton; Glen Jones, 58, of Haverhill, who has resided at the Worcester Skilled Care Center since 1990; and Nathaniel Wilson, 55, of Springfield, who resides at Wingate of Wilbraham. A fifth named plaintiff, Jason Cates of Westfield, died last fall.

A preliminary hearing on the settlement agreement will be scheduled for mid-June before District Court Judge Michael A. Ponsor in Springfield. Judge Ponsor has been asked to set a final fairness hearing on the agreement for July 25, 2008.

Judy R. Roy
Independent Living Resources of Greater Birmingham
206 13th Street S.
Birmingham, AL 35233-1317
Phone 205.251.2223 ext 102
Email bhamilc1@bellsouth.net
There are only four kinds of people in the world: those who have been caregivers; those who are currently caregivers; those who will be caregivers; those who will need caregivers. - Rosalynn Carter

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/

The AARP is advocating a platform called Divided We Fail. This platform essentially seeks to remove health care and long-term financial security from being partisan issues, and make them the concern of all legislators and members of Congress.

The AARP had a vendor booth at our local Traverse City Senior Expo last week. They encouraged people to sign their pledge to support those running for office who support the Divided We Fail platform.

DIVIDED WE FAIL PLATFORM
We believe that the opportunity to have access to health care and long-term financial
security is a basic need that all Americans share. We believe it is the foundation for
future generations.

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/

In recent years, healthcare-associated infections—illnesses you acquire during a stay in a hospital or long-term care facility—have reached epidemic proportions. One of the most widespread and potentially serious of these illnesses is caused by the bacterium Clostridium difficile, often simply called C. diff, which is responsible for tens of thousands of cases of diarrhea and at least 5,000 deaths in the United States each year. And the problem is getting worse. According to a new study, the number of people hospitalized with this intestinal superbug has been growing by more than 10,000 cases a year.

Dr. L. Clifford McDonald, a CDC expert said, "The nature of this infection is changing; it's more severe."

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/

The chances of older adults being institutionalized, for instance in a nursing home, go up significantly immediately after the death of a spouse, according to new research from Finland.

The study was conducted by Elina Nihtila and Pekka Martikainen, sociology researchers at the University of Helsinki in Finland and was published online in the American Journal of Public Health yesterday, May 29th.

The researchers investigated the risk of an older adult entering long-term institutional care after the death of their spouse, compared with how long they lived after their loss. They also looked at whether level of education or household income had an effect.

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/

A dementia care guide that has been helping direct-care workers since 2006 is now better than ever.

Knowledge and Skills Needed for Dementia Care: A Guide for Direct Care Workers in Everyday Language helps direct-care workers determine whether they have the skills they need to deliver person-centered dementia care — and where to go for assistance if they need training. It also helps supervisors, policymakers, and others evaluate dementia care training programs. It was developed by a team of experts and reviewed by many more, including more than 60 home health aides and CNAs.

“Most people who provide hands-on care for individuals with dementia have big, warm, caring hearts,” says Dementia Project Coordinator Micki Horst. ”They want to learn all they can about how best to care for and interact with someone with dementia. We developed this guide to give them a tool for assessing their own competencies.”

The updated version includes useful additions:

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/