Today U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) held a hearing to address the impending severe shortage of health care workers who are adequately trained and prepared to care for older Americans. The committee reviewed key factors that are contributing to the deficiency, such as the lack of geriatric training in the medical education system and the need for federal and state training requirements for direct care workers, such as home health aides and personal care attendants. The panel also heard from family caregivers that enhanced education and training would help them develop the necessary skills to provide the best possible care for an ailing family member. Currently there are over 44 million Americans serving voluntarily as the sole source of care for an older family member or loved one. Chairman Kohl announced his plan to incorporate lessons from today's hearing into legislation to expand, train, and support all sectors of the health care workforce, including doctors, nurses, direct care workers, and family caregivers.

"By the year 2020, it is estimated that the number of older adults in need of care will increase by one-third," said Chairman Kohl. "The United States will not be able to meet the approaching demand for health care and long-term care without a workforce that is prepared for the job. Fortunately, understanding what we need to change is half the battle, and this hearing provides us with that knowledge."

The hearing was the first in which Congress reviewed the Institute of Medicine's (IOM) major recommendations for improving and expanding the skills and preparedness of the health care workforce in their report, "Retooling for an Aging America: Building the Healthcare Workforce," released Monday. Dr. John Rowe, Chairman of the IOM's Committee on the Future Health Care Workforce for Older Americans, focused his testimony on the report's recommendations. Joining him on the first panel was Dr. Robyn Stone, Executive Director of the Institute for the Future of Aging Services at the American Association of Homes and Services for the Aging. Dr. Stone's testimony highlighted the weaknesses and limitations of the current health care system in meeting the needs of aging boomers.

On the second panel, businesswoman and author Martha Stewart testified on the role of family caregivers in providing essential services and support to loved ones. Ms. Stewart shared with the committee her experience as a caregiver for her mother, and how it shaped her decision to establish the Martha Stewart Center for Living, a model clinic for coordinated outpatient geriatric services at Mount Sinai in New York. Dr. Todd Semla, President of the American Geriatrics Society, made the case for using existing law to increase the number of trained geriatricians practicing in the U.S.

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LivHOME, the nation's largest provider of professionally led at-home care for seniors, has released a new episode of The Senior Care Podcast by LivHOME that discusses the challenges of long-distance caregiving and practical ways to close the gap.

In Episode 5, LivHOME Care Manager Sharon Rosenfield discusses the challenges of providing care to senior family members who live apart from their grown children. Long-distance caregiving has become a necessity for many seniors as families find themselves living at greater distances.

During the interview, Rosenfield emphasizes the importance of noticing the little things, such as whether a senior is taking his or her medicine and paying attention to personal hygiene, as a clue to understanding whether it is time to begin providing long-distance care. She discusses ways to make the experience less lonely for seniors and explores the roles a long-distance caregiver must play in emergencies.

For more information, visit livehome.com

Elderly patients who use antipsychotic drugs have a 60 percent increased risk of developing pneumonia compared to non-users. This risk is highest in the first week following prescription and decreases gradually thereafter. These findings are published in Journal of the American Geriatrics Society.

Antipsychotic drugs are frequently used in elderly patients for the treatment of psychosis and behavioral problems associated with dementia and delirium. This study is the first to show that the development of pneumonia is associated with antipsychotic drug use.

"The risk of developing pneumonia is not associated with long-term use, but is the highest shortly after starting the drug," say Drs. Rob van Marum and Wilma Knol, authors of the study. They caution that "all antipsychotic drugs may be associated with pneumonia in elderly patients."

Lobbyists for the long-term care industry on Friday voiced strong objections to the Fairness in Nursing Home Arbitration Act, a new piece of legislation that would prohibit the use of arbitration agreements at the time of a resident's admission to a long-term care facility.

The American Health Care Association and the National Center for Assisted Living argued that arbitration agreements allow nursing home and assisted living facility staff to concentrate on providing care to residents. They help ensure that Medicaid money will go towards improving care instead of paying off legal fees and settlements, the group claims.

But requiring prospective residents to sign pre-admission arbitration agreements intrudes upon their right to “access the civil justice system for redress of their potential claims,” said Sens. Herb Kohl (D-WI) and Mel Martinez (R-FL), who introduced the bill last week. Bruce Yarwood, president and CEO of AHCA, called the bill “misguided.

Nursing home residents and their families increasingly are "giving up their right to sue over disputes about care, including those involving death, as the homes write binding arbitration into their standard contracts," the Wall Street Journal reports. Under arbitration agreements, nursing home residents and their families agree to settle disputes through a third-party arbiter. According to the Journal, "Nursing homes have been among the biggest converts to the practice since a wave of big jury awards in the late 1990s."

The practice has "profound implications" on the nursing home industry, according to the Journal. An industry study released last year found that the average cost of settling cases has declined for nursing homes. At the same time, claims of poor treatment have been increasing, the Journal reports.

Consumer advocates and plaintiffs' lawyers have criticized the arbitration systems for nursing homes, saying that people too often do not understand whether the arbitration clauses are mandatory or that they are waiving their right to sue. Critics say courts should handle such claims. Sens. Mel Martinez (R-Fla.) and Herb Kohl (D-Wis.) on Wednesday introduced legislation that would prohibit nursing homes from requiring patients to sign an arbitration agreement as a term of service. Martinez said, "It is an unfair practice given the unequal bargaining position between someone desperate to find a place for their loved ones and a large corporate entity like a nursing home."

The American Arbitration Association, which is the largest arbitration provider in the nation, generally refuses to handle cases of nursing home arbitration and opposes arbitration requirements in nursing home claims. The American Health Lawyers Association has a similar stance, and other arbitration groups said they only accept the cases when the agreements are in compliance with law. Eric Tuchmann, general counsel for the American Arbitration Association, said that some patients "really are not in an appropriate state of mind to evaluate an agreement like an arbitration clause."

The nursing home industry says arbitration is relatively inexpensive for plaintiffs and defendants, and allows nursing home staff to focus on patient care, instead of litigation (Koppel, Wall Street Journal, 4/11).

Research carried out at the Peninsula Medical School, South West England, has found strong links between neighbourhood deprivation and the physical and intellectual health of older people.

Two studies were conducted, both using data on participants in the English Longitudinal Study of Ageing (ELSA).

The first study investigated over 7,000 individuals aged 52 and older who lived in urban areas across England. The study found that even when individual differences in education and income were taken into account, people who lived in the most deprived areas were significantly more likely to have poorer cognitive function than those living in the least deprived areas. These findings represent a cause for concern because poor cognitive function in older people is closely linked to the risk of developing dementia.

Meanwhile, the second study, which involved 4,148 individuals aged 60 and over, assessed whether mobility disability and neighbourhood deprivation are linked. Over a two-year period, 13.6% of those in the most deprived areas developed problems with mobility compared to 4.0% of those in the least deprived areas. As with the first studies, these figures took into account individual differences in income, education, and health.

“Most of the people that get into this work are women, and they have kids,” says Patti Green of her fellow direct-care workers. “A lot of them are single. They need to earn a decent hourly rate of pay, and they need to have health insurance.”

“That would attract more people, and then if they had the good screening and training we could weed out those that don’t really have a heart for it.”

“They listened to me - I was kind of surprised”
A natural leader, Green has become an expert on the state of direct-care work in America by running what amount to online break rooms for direct-care workers. Nursing Assistant Resources on the Web, the blog she started 10 years ago and now runs with the help of two other direct-care workers, is a trove of free articles, thoughtful blog posts, FAQs, and useful links. And at NursingAssistant@yahoogroups.com, the online community Green launched around the same time and still moderates, 750-plus members engage in a lively exchange of ideas, asking questions, venting frustrations, and offering each other affirmation and support.

A group of Michigan providers convened to address their state’s looming care gap and formed the Kent County Health Field Collaborative (HFC). Its first project: a cooperative, flexible, and resourceful program that would directly address the barriers to sustained employment per the individual staffer.
John Oberlin

In 2004, a number of Michigan providers convened to address their state’s looming care gap and formed the Kent County Health Field Collaborative (HFC). Its first project: a cooperative, flexible, and resourceful program that would directly address the barriers to sustained employment per the individual staffer.

The Opportunity Partnership & Empowerment Network (OPEN) program has been a success and continues to expand its role and coverage area outside of Kent County. During a two-year pilot program, more than 80% of employees utilizing the program maintained their employment. All of these employees were considered at risk of losing their jobs because of inabilities to successfully manage personal challenges and work expectations. Also, two of the five participating employers cut turnover rates in half, while another company reported a drop from an average of 36% to 22%. Among the employers who initially made up the HFC, turnover rates ran as high as 58% before the program.

The program's collaborative structure keeps costs low. Collectively, the provider members, who all share the same problem of staff turnover, pay for one case worker’s salary and any expenses such as supplies and additional project work. Because the HFC is made up of long-term care, acute care, and rehab providers, payments are calculated through a utilization formula.

Andy Farmer sent a message saying that the hotline is live for the current Michigan appropriations process.

The number is

(888) 232-6829!

Click the Title Link and learn about this petition drive to assure every Michigan citizen health insurance. This is our best shot at changing the rules in this critical part of life. The language of the petition covers LTC as well.

The referendum doesn't dictate how health insurance would be provided. That would have to be decided by the Michigan legislature and the Governor (AND US!) if the referendum passes in November.

You can get involved and help reach the goal of 450,000 signatures, too!