Health and Disability

Drugmakers increased prices by an average of 7.4 percent last year for the brand-name medicines most commonly prescribed to the elderly, according to the advocacy group <layer id="clearforesthighlight"><layer onmouseout="javascript:gnosisDocMenu(event,false,false);" onmouseover="javascript:gnosisDocMenu(event,true,true);" class="clfAARP" style="border-bottom: 3px double rgb(0, 254, 254);" id="Organization">AARP</layer></layer>.

The increase far exceeded inflation, continuing a longtime trend.

<layer id="clearforesthighlight"><layer onmouseout="javascript:gnosisDocMenu(event,false,false);" onmouseover="javascript:gnosisDocMenu(event,true,true);" class="clfAARP" style="border-bottom: 3px double rgb(0, 254, 254);" id="Organization">AARP</layer></layer> said prices charged to wholesalers have been slightly higher since the <layer id="clearforesthighlight"><layer onmouseout="javascript:gnosisDocMenu(event,false,false);" onmouseover="javascript:gnosisDocMenu(event,true,true);" class="clfMedicare" style="border-bottom: 3px double rgb(0, 254, 254);" id="Organization">Medicare</layer></layer> drug benefit started on Jan. 1, 2006. Since then, the outcry over prices has diminished, with the government picking up much of the tab.

"Unfortunately, many manufacturers have taken the absence of an outcry as a green light to go ahead and raise prices even more," said <layer id="clearforesthighlight"><layer onmouseout="javascript:gnosisDocMenu(event,false,false);" onmouseover="javascript:gnosisDocMenu(event,true,true);" class="clfJohn_Rother" style="border-bottom: 3px double rgb(43, 254, 0);" id="Person">John Rother</layer></layer>, <layer id="clearforesthighlight"><layer onmouseout="javascript:gnosisDocMenu(event,false,false);" onmouseover="javascript:gnosisDocMenu(event,true,true);" class="clfAARP" style="border-bottom: 3px double rgb(0, 254, 254);" id="Organization">AARP</layer></layer>'s policy director.

Nursing Home Quality, the national leader in Quality Indicator Survey (QIS) based quality assurance solutions for long-term care providers, announced the release of the latest version of abaqisTM, a web-based quality assurance system designed for use by nursing home providers to identify quality concerns and focus quality improvement efforts.

The QIS is a revised long-term care survey process utilized by the Centers for Medicare & Medicaid Services (CMS) that involves two stages of review. In Stage I, preliminary investigations are conducted through structured resident, family, and staff interviews, resident observations, record reviews, and analysis of Minimum Data Set (MDS) data.

These tasks, in combination with structured facility reviews, yield 162 Quality of Care and Quality of Life Indicators (QCIs) that are compared with defined thresholds to identify Care Areas for further investigation in Stage II of the QIS. The second stage involves in-depth quality investigations using Critical Element Pathways that address assessment, care planning, care provision, and reassessment.

The latest release of the abaqis TM system encompasses all six assessments conducted on site during Stage I of the QIS, with modules for family, staff, and resident interviews, resident observations, and census and admission record reviews. The system comprehensively guides the quality assurance efforts based on QIS concepts and processes, electronically manages the resident file, and even provides analysis of facility data based on national thresholds.

"I believe that the QIS has rendered the survey process more objective and more resident-centered," says Andrew Kramer, M.D., CEO of Nursing Home Quality. "However, the QIS software used in the survey process was developed solely for government surveyor use. The abaqis TM system is an affordable, user-friendly tool designed specifically for nursing home providers, allowing them to replicate the QIS for quality improvement purposes. At the end of the day, this system enables nursing homes to provide better care and quality of life to their residents."

A recently released study of Medicaid-financed nursing home use over 18 months in 2001 and 2002 finds that in states such as Oregon that have extensive community based long-term care services, Medicaid-covered nursing home stays were shorter than the national average. The numbers suggest that where seniors have alternatives, their nursing home stays are more likely to be for acute care following a hospitalization or for a shorter period at the end of life.

The study, "Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patters of Care, 2001-2002," conducted by Matehematica Policy Research for the Office of Disability, Aging and Long-Term Care Policy for the U.S. Department of Health and Human Services, reports that over half of Medicaid-covered nursing home residents do not become eligible for benefits until after they move to a nursing home, with 29 percent obtaining coverage within six months of moving to the nursing home, 5 percent between six and 12 months, 7 percent between one and two years, and 9 percent after more than two years.

According to a meta-analysis published in The Lancet, elderly people can improve physical function and live more independently if provided with complex interventions such as preventive home visits and community-based care after hospital discharge. The study of over 90,000 elderly people also led authors to conclude that well-developed services for the elderly should not be withdrawn.

Elderly people tend to have reduced physical capabilities, which leads to increased dependence on others, a need for hospital and long-term nursing-home care, and premature death. Community-based complex interventions seek to preserve physical function and independence in elderly people. Researchers were interested in assessing the efficacy of interventions such as preventive home visits, care after hospital discharge, fall prevention, and education and counseling in a group setting.

“There has been a lot of paternalism about direct-care staff – the notion that they are not really adults,” says Anna Ortigara. “People wonder: Are they really capable of being in a lead role? Can they be trusted to make good decisions? Are they capable of self-direction?”

Instead of these questions, Ortigara believes, we should ask ourselves: “How can we possibly think we are going to improve long term care without involving frontline workers? We need them at the table in order to achieve cultural transformation - and why wouldn’t we want them at the table?”

The Outlook for Spending on Health Care and Long-Term Care (PDF; 515 KB)
Source: Congressional Budget Office
PDF of PowerPoint slides — Presentation to the National Governors Association’s Health and Human Services Committee

The term “long-term care” is revealing. Long-term care is usually about long-term loss: the loss of authority, money, health, and connections to family and community. Our system is based on an expert and medical model of passive consumption and limited choices. And because none of us really want this, we avoid talking about it or planning for it . . .

We need to begin an intergenerational discussion to redefine the issue in radically new - civic - terms . . .

We should talk about how we all age, not just about “the elderly”; about harnessing wisdom and building individual capacity, not just providing more/better services and care. We should talk about health and wellness, not just chronic illness; about taking personal responsibility for our retirement and for the economic health of future generations, not just how we pay the bills for the current troubled system . . .

If you're a direct-care worker or you work with direct-care workers, you might want to help spread the word about the earned income tax credit (EITC). Direct-care workers who file a federal tax return this season could be eligible for thousands of dollars in state and federal credits and refunds, mainly through the federal EITC, which will return up to $4,716 per person to eligible low-income taxpayers. As much as a quarter of all EITC funds go unclaimed each year because so many people don't know they're entitled to them.