Federal Government Encourages States to Make Self-Directed Personal Care an Option for Disabled Medicaid Consumer Who Need Help at Home

Centers for Medicare & Medicaid Services allows state Medicaid programs to offer a "Cash & Counseling" state plan option without first obtaining a federal waiver. This change comes after evaluation found that Cash & Counseling improves quality of life, reduces unmet needs for care, and helps disabled consumers maintain health without costing Medicaid substantially more than traditional services.

Proposed Legislation Strips Nursing Home Residents Of Their Legal Protections, USA

Can Michigan look forward to much the same?

Just four years since the National Healthcare Corporation (NHC) nursing home fires killed 16 residents in Nashville - and in a year when nursing home violations and admission suspensions are at an all time high - Tennessee nursing homes are seeking unprecedented legal protection from residents who are abused or neglected.

The move came two days after Governor Phil Bredesen announced he will fundamentally restructure how long-term care is handled in Tennessee by expanding alternatives to nursing homes.

State Sen. Jim Tracy (R-Shelbyville) and state Rep. Randy Rinks (D-Savannah) introduced the bill last week that would severely restrict the rights of nursing home victims and their families to seek justice no matter how bad the injury they suffer and no matter how bad the conduct of the home. The type of neglect and abuse recently documented in Tennessee nursing homes ranges from maggots in wounds to untreated broken bones to rape.

NHC, which reported more than $500 million in annual gross profits in 2006 and whose CEO Robert G. Adams makes more than $1.3 million a year, is one of the supporters of the legislation. NHC is the same corporation that owned the Nashville nursing home where 16 residents perished in September 2003, and that owns a nursing home in Milan, Tenn. that put residents "at risk of injury or death from a fire," according to a June 20, 2007 inspection report of the Tennessee Department of Health.

The legislation would ensure that:

- Residents would have little to no recourse against nursing homes no matter how bad the conduct of a home.

- Nursing homes can demand that residents sign arbitration agreements in order to live there, making nursing home residents the least protected class in the state.

Older Americans Suffer Serious Access Limitations to Exercise their Right to Vote

The US Senate Special Committee on Aging held a hearing yesterday in Washington, DC, on older Americans and the significant barriers they face in exercising their right to vote.

Jason Karlawish, MD, associate professor of Medicine and Medical Ethics at the University of Pennsylvania School of Medicine, testified before the Committee, citing results from a series of his studies examining voting rights for the elderly.

Karlawish, a member of Penn's Institute on Aging who specializes in older adult health care and related issues, recommends that to help break down the logistical and geographical voting barriers many older Americans face, the United States must develop a model for mobile polling.

"Elderly voters -- especially elderly voters who live in long-term care settings -- are at the mercy of others when it comes to exercising their right to vote," said Karlawish.

"Mobile polling means election officials or equivalent groups visit long-term facilities in their district prior to registration deadlines to encourage and solicit registrations," said Karlawish.

Time for Companies to Offer Long-Term Care Benefits?

Along with Medicare, Social Security, pensions and health care, here's another disaster coming straight at us: long-term health care. Since we're not having much luck solving the other issues, many people and policymakers just prefer to not even think about long-term care -- and that's reflected by the low numbers of people insuring themselves and their family for the very likely visit they will take to a nursing home in old age. Besides, most of us can't afford the coverage or the care itself and are banking on the government to pay for it -- even if we or our loved ones have to spend down their assets first. But Medicaid is already straining and will be unable to absorb the crush of Baby Boomers coming and headed for nursing homes over the next 30 to 40 years.

In a paper entitled Long-term Care Coverage: The Missing Element in the Employee Safety Net the consulting group Milliman suggests that it's time for employers to consider adding long-term care insurance as a benefit -- with some help paying for it.

OIG Solicits Comments on Nursing Facility Compliance Program Guidance

On January 24, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) published a Notice in Federal Register soliciting comments, recommendations and suggestions on how to best revise the nursing facility compliance program guidance. Specifically, the OIG is seeking comments addressing any changes to existing risk areas and introducing new risk areas. Comments must be delivered to the OIG by no later than 5 p.m. on February 25, 2008. The Notice explains how to submit any comments.

OIG Reports on Government-Long Term Care Industry Roundtable

On January 31, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) and the Health Care Compliance Association released a report arising from a recent government-industry roundtable called Driving for Quality in Long-Term Care: A Board of Directors Dashboard. The roundtable was held on December 6, 2007 and provided the long-term care industry with an opportunity to inform the OIG of issues surrounding board of directors' oversight of quality of care.

The report includes written summaries of the discussions that took place in breakout groups designed around the following 3 perspectives on the oversight of quality of care: (i) organizational commitment to quality; (ii) processes related to monitoring and improving quality; and (iii) outcome measures related to quality. In the report, a fourth breakout group also considered the benefits of, and challenges to, developing a Quality of Care Dashboard (i.e., a management tool that may provide a way to access and oversee performance on quality of care issues).

New Episode Of The Senior Care Podcast By LivHOME Focuses On Caring For Seniors With Dementia

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 caring for seniors with dementia.

In Episode 4, LivHOME Chief Professional Officer Steve Barlam describes common caregiving mistakes in working with dementia sufferers, how to identify the causes and precursors to challenging behavior, and explores ways to reduce anxiety among seniors suffering from dementia. Drawing on more than 20 years of geriatric social work experience, Barlam provides advice for caregivers and offers poignant examples based on actual caregiving experience.

The episode is particularly important for caregivers, since about half of Americans age 85 and over suffer from some form of dementia, which includes Alzheimer's disease.

Episode 4 of The Senior Care Podcast by LivHOME can be found at the podcast's homepage (http://www.livhome.com/podcast). Listeners can subscribe to the show via RSS feed, email or through the iTunes store. Episode 4 has a runtime of 14 minutes, 22 seconds.

CMS Proposes Stronger Protections For Beneficiaries Using Durable Medical Equipment, Prosthetics, Orthotics, And Supplies, USA

The Centers for Medicare & Medicaid Services (CMS) on January 25 issued a proposed rule to enhance the enrollment standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. The proposed rule is intended to increase protections for Medicare and its beneficiaries from potentially dishonest or low quality suppliers.

By creating five new standards and strengthening seven of the 21 existing standards that suppliers must meet, the proposed rule would provide Medicare beneficiaries with additional assurance that they are being served by suppliers who meet the highest standards of quality.

"The proposals represent the next step in Medicare's ongoing efforts to ensure its beneficiaries continue to have access to high quality products and services at appropriate prices, while protecting them and the program from unscrupulous suppliers," said CMS Acting Administrator Kerry Weems. "In addition to meeting the enrollment standards, all DMEPOS suppliers are required to obtain accreditation from one of ten accrediting organizations announced in November 2006."

Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias, Second Edition

The Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias consists of three parts (Parts A, B, and C) and many sections, not all of which will be equally useful for all readers. The following guide is designed to help readers find the sections that will be most useful to them.

Part A, "Treatment Recommendations for Patients With Alzheimer's Disease and Other Dementias," is published as a supplement to the American Journal of Psychiatry and contains general and specific treatment recommendations. Section I summarizes the key recommendations of the guideline and codes each recommendation according to the degree of clinical confidence with which the recommendation is made. Section II is a guide to the formulation and implementation of a treatment plan for the individual patient. Section III discusses a range of clinical considerations that could alter the general recommendations discussed in Section II.

Part B, "Background Information and Review of Available Evidence," and Part C, "Future Research Directions," are not included in the American Journal of Psychiatry supplement but are provided with Part A in the complete guideline, which is available online through the American Psychiatric Association (http://www.psych.org) and in print format in

H.R.3088 Long-Term Care Act of 2007

To amend the Internal Revenue Code of 1986 to provide that distributions from an individual retirement plan, a section 401(k) plan, a section 403(b) contract, or a section 457 plan shall not be includible in gross income to the extent used to pay long-term care insurance premiums.