Voices Institute Graduates - May the Root Thrive!

We just completed another historic and successful step forward for the movement to empower direct care workers and to fix our broken long-term care system!

It is clear that Direct Care Workers want a voice and to have their voices heard to improve the profession and the quality of care and services. It was fitting that direct care workers from 12 states met at a place whose motto is: May the Root Thrive! The 25 leaders from 12 states gathered at the DeKoven Center are the roots of our growing movement! I have no doubt that each and every one of the attendees will ensure that the long-term care care-gap is avoided and direct care workers are empowered by applying the powerful tools we all learned at our five day training program.

The events I witnessed at the Voices Institute Inaugural class reminded me of the gracious, generous and powerful nature of direct care workers and their ability to meet any challenge and thrive: flexibility, ability to solve problems, address crisis situations, balance challenging schedules are the stuff that the daily care-giving experience is made of. And so, all the Voices Institutes leaders gathered and we learned speech making, fundraising, organizational and self empowerment strategies and we all thrived in the intense and challenging environment Bob Hudek designed for us. Thank you Bob Hudek for locating the perfect learning environment and for designing a curriculum that gave us comfort, hope and thought us powerful tools that along with Vera’s empowerment tools will lead us to success.


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 Caregiver Magazine

The National Association of Health Care Assistants- NAHCA- used to have a magazine for CNA’s called “CNA TODAY”- it ceased publication a couple years ago. NOW, they introduce a new magazine for ALL direct care workers in the nursing field, titled, “MY CAREGIVER”.

From the MY CAREGIVER web site:

My Caregiver is a quarterly magazine published by the Academy of Certified Health Professionals (ACHP) for and about health care assistants and their role in long term care. It is a special magazine, a publication virtually every person in the long term care industry will want to read.

With a circulation of 10,000, we reach nursing assistants, Directors of Nursing, facility Administrators, nursing home residents, and their families, product manufacturers, policy makers, and other health care associations.

The first issue of My Caregiver debuted March 2008. It evolved from the original CNA Today magazine to focus on health care assistants from diverse settings in long term care. The original magazine, CNA Today, launched June 2001 and was unveiled at the NAGNA National Convention.

Now My Caregiver will prove to be a remarkable resource for information on long term care for all who perform the role or duties of a nursing assistant, regardless of title.

The magazine is published quarterly and costs $15.00/year for non NAHCA members; $10.00/year for members.

NAHCA’s main web site is HERE.

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 Health Coverage Crisis in Direct-Care

Download the report (pdf 1.9MB)

Report Shows High Rates of Injury, Inadequate Health Coverage May Result in Caregiver Shortage

As part of National Women’s Health Week, PHI’ Health Care for Health Care Workers Campaign will deliver a sobering report -– Invisible Care Gap: Caregivers without Health Coverage — on the health insurance status of our nation’s caregiving workforce, 90% of which is female. Based on the most recent data from the U.S. Bureau of the Census and Bureau of Labor Statistics, the report reveals that:

  • Nurse aides have the highest rates of workplace injuries and illnesses in the country, making it America’s most dangerous job.
  • Nearly 30% of direct-care workers have no health insurance coverage, twice the rate of the general population.
  • The country’s fastest-growing workforce—jobs providing in-home personal care services—is the least likely to have health coverage.
  • Direct-care wages are so low (median hourly wage of $9.56/hr) that nearly 30% live in or near poverty and few can afford high cost of insurance premiums.
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/

Antipsychotics In Older Adults With Dementia Associated With Serious Adverse Events And Death

Short term courses of antipsychotic medications, when given to older adults with dimentia, are associated with a greater risk of hospitalization and death, according to a report released on May 26, 2008 in the Archives of Internal Medicine, one of the JAMA/Archives journals.

Antipsychotic drugs are used to treat various psychotic disorders -- some conventional examples include haloperidol or loxaprine. The authors point out that a new generation of these drugs has been released, but the effects of short term prescription have not yet been ascertained. "Newer antipsychotic drugs (olanzapine, quetiapine fumarate and risperidone) have been on the market for more than a decade and are commonly used to treat the behavioral and psychological symptoms of dementia," they say. "Antipsychotic drugs are often used for short periods to treat agitation in clinical practice. They are frequently prescribed around the time of nursing home admission." Approximately 17% of nursing home admission begin a regimen of antipsychotic medications, with only 10% on a single prescription. Given this information, they say, it is important to evaluate the effects of short term regimens on patients.

To investigate this issue, Paula A. Rochon, M.D., M.P.H., F.R.C.P.C., of the Institute for Clinical Evaluative Sciences (ICES), Ontario, and colleagues examined older adults living with dementia in the community and in nursing homes between 1997 and 2004. In each setting, three separate groups of equal size were identified, each differing only in their exposure to antipsychotic medications. One group had not received antipsychcotics, one group had been prescribed atypical or newer antipsychotics, and the last group was prescribed conventional psychotics. For older adults in the community, 6,894 were in each group for a total or 20,682 patients. In the older adults with dementia living in nursing homes, each group had 6,853 for a total of 20,559 subjects.

The medical records of each participant were examined, and hospital admissions and death within 30 days of the initiation of therapy were noted as serious adverse events. The team found that, in the general community, those prescribed with nonconventional antipsychotic drugs were more likely to experience adverse events, while those on conventional antipsychotic drugs were even more likely. "Relative to community-dwelling older adults with dementia who did not receive a prescription for antipsychotic drugs, similar older adults who did receive atypical antipsychotic drugs were three times more likely and those who received a conventional antipsychotic drug were almost four times more likely to experience a serious adverse event within 30 days of starting therapy." The authors continue, noting a similar but less pronounced trend in the nursing room group: "Relative to nursing home residents in the control group, individuals in the conventional antipsychotic therapy group were 2.4 times more likely to experience a serious adverse event leading to an acute care hospital admission or death. Those in the atypical antipsychotic group were 1.9 times more likely to experience a serious adverse event during 30 days of follow-up."


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 Places Three-Year Moratorium On Construction Of New Long-Term Care Hospitals

CMS officials this week announced a regulation that places a three-year moratorium on the construction of new long-term care hospitals and limits the effects of payment reductions to existing facilities, CQ HealthBeat reports. According to CQ HealthBeat, admissions criteria among long-term care hospitals and the industry’s “Medicare-fueled growth” had “raised eyebrows among policy makers.”

As a result, several regulatory provisions, including a proposal to reduce base rates and the extension of the so-called 25% rule, were “putting the hurt” on the long-term care hospital industry. The 25% rule reduced payments for care of each patient from a single referring facility above one-quarter of a long-term care hospital’s patient load. According to CQ HealthBeat, the 25% rule addressed hospitals building long-term care facilities within their own facilities to capture higher revenues associated with long-term care. The new regulation implements provisions of a measure signed by President Bush last year regarding Medicare and Medicaid payments and an extension of SCHIP.

The new revisions “ease the impact” of the 25% rule and block the base rate reduction, according to CQ HealthBeat. In addition, the regulation sets policies for implementing the moratorium and determines which facilities will be prohibited from new construction. CMS will be evaluating exemptions on a case-by-case basis, according to Alec Vachon, a Washington, D.C. consultant and former Senate Finance Committee staffer. The regulation will be published in the Federal Register on Thursday (Reichard, CQ HealthBeat, 5/21).

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/

Statement By Mike Leavitt Secretary Of Health And Human Services On Two Medicaid Rules, USA

The Administration has been asked several times the impact of implementing two Medicaid rules when an existing moratorium expires May 25, 2008.

1. Graduate Medical Education -- CMS 2279 -- proposed rule published on May 23, 2007; and

2. Cost limit for Providers Operated by Units of Government and Provisions to Ensure the Integrity of Federal-State Financial Partnership -- CMS 2259-FC -- final rule with comment period, published on May 29, 2007.

In response, Secretary Michael O. Leavitt released the following statement today:

"I reiterate the Administration's willingness to work with Congress and Governors to discuss their concerns before the rules go into effect," Secretary Leavitt said. "We will voluntarily refrain from making these rules effective until August 1, 2008, more than 60 days after the moratorium expires. I invite interested parties to sit down with me and my staff in the coming weeks to ensure that we meet our mutual commitments to protect health care for low-income individuals."

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/

Caregivers For Alzheimer's Patients Record Life Stories With Project StoryKeeper

Project StoryKeeper, a non-profit organization dedicated to preserving family heritage and announced that new findings by the Alzheimer's Association are increasing the need to document the life stories of patients. Caregivers of Alzheimer's patients can get access to Project StoryKeeper's interviewing technology by visiting http://www.storykeeper.org.

"The Alzheimer's Association just announced that one in eight Baby Boomers can expect to develop the disease," said Dennis Stack, Founder of Project StoryKeeper. "That means that more and more family histories - and the richness they hold - will be slipping away if we don't do something now to preserve them. We think Project StoryKeeper is a great way for families and caregivers of all ages to use the latest technology to keep family legacies going strong."

Targeted towards caregivers, Project StoryKeeper's online training program includes questions, interviewing techniques, and recording tips to be used in drawing out the personal histories of senior citizens at home or within elder care settings such as hospices, assisted living facilities, and home care agencies.

Capturing life stories - through technology.

Captured stories can be posted and archived on a private family web page on http://www.lifelenz.com. LifeLenz is a family-centric social network designed to enable families to easily preserve their legacy, stay in touch and communicate in ways not possible before. The tools LifeLenz provides allow for caregivers and family members to share in each other's lives through text, audio, video and photographs.

Easy-to-use online communication tool.

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/

House measure would outlaw nursing home arbitration clauses

Nursing home operators would be unable to subject residents and prospective residents to binding arbitration clauses under a bill introduced Thursday afternoon in the U.S. House. When a companion bill was introduced in the Senate in April, consumer groups enthusiastically praised it and provider advocates roundly criticized it.

"This legislation will not prohibit arbitration. Instead, it will simply ensure that residents have the choice whether to arbitrate a dispute after it has arisen," said bill co-sponsor Rep. Linda Sanchez (D-CA), whose father recently entered a nursing facility.

Sanchez said hosting three recent hearings on the Federal Arbitration Act as the chairwoman of the Subcommittee on Commercial and Administrative Law helped form her opinions on the topic. "The long term care industry is one stark example where businesses draft take-it-or-leave-it admission agreements for prospective residents that include pre-dispute, mandatory arbitration clauses."

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/

Measure to expand long-term care options wins House approval

NASHVILLE (AP) -- A proposal that will allow the state to offer more home and community-based care has passed the House.

The House voted 97-0 to pass the bill championed by Gov. Phil Bredesen and sponsored by Rep. Dennis Ferguson, a Democrat from Harriman.

The Senate must approve some small differences between its version and the House's.

TennCare, the state expanded Medicaid program, currently spends almost all its annual $1.2 billion long-term care budget on nursing homes.

The legislation would begin the process of directing about half of those funds toward home-based care over the next decade.

It also seeks to simplify the process for determining eligibility and for enrolling in home-based care programs.

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/

House Committee Holds Hearing On Concerns About Nursing Home Ownership, Inspections

The House Energy and Commerce Oversight and Investigations Subcommittee on Thursday held a hearing to examine the effects that the "increasingly veiled nature" of nursing home ownership and problems with inspections have had on the quality of care for elderly and disabled residents, CQ HealthBeat reports (Reichard, CQ HealthBeat, 5/15). According to CongressDaily, more than 50% of nursing homes are part of chains, with many of those owned by private equity firms that establish "layered entities" to operate the facilities, "making it difficult" for CMS, states and consumers to determine their owners and operators (Cox, CongressDaily, 5/16).

At the hearing, Lewis Morris, chief counsel to the Inspector General for HHS, said that CMS operates a database called "Pecos" that includes some nursing home ownership information but added that the system does not address the issue adequately. The database includes ownership information on 70% of the nursing homes that participate in Medicare, according to acting CMS Administrator Kerry Weems. He said that CMS seeks to "populate Pecos 100%" and link ownership information to quality data on the Nursing Home Compare Web site but added that the agency must have "usable" ownership information (CQ HealthBeat, 5/15).

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/