Health and Disability

Sen. Chuck Grassley (R-Iowa) in a letter on Tuesday asked HHS Inspector General Daniel Levinson to examine the use of antipsychotics in nursing homes, the possibility of payments to physicians who prescribe the medications and the drugs' cost to Medicare and Medicaid, the Wall Street Journal reports. According to a Journal article published on Tuesday, which Grassley cited in the letter, antipsychotics have become the most expensive class of medications for Medicaid. Nursing homes often administer the medications to dementia patients to quiet their symptoms.

In 2005, Medicaid spent $5.4 billion on atypical antipsychotics, not including rebates that the federal government might receive. Grassley also asked CMS for information about how the agency responds to nursing homes that misuse antipsychotics, a practice he called "disturbing and alarming."

MS Exceptions Set to Expire on Medicare Therapy Caps
Rehabilitation therapy under Medicare might no longer be affordable for some people living with multiple sclerosis and other conditions. The exceptions process to Medicare's arbitrary reimbursement limits, or therapy caps, on rehabilitation services is set to expire on December 31, 2007.

MS activists have long been determined to eliminate Medicare therapy caps altogether on reimbursement for physical therapy (PT), speech language pathology, and occupational therapy (OT) services. In 2008, the therapy cap reimbursement level is scheduled to be $1,810 for PT and speech therapy, and a separate cap of $1,810 will apply to OT services.

"In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals," largely because nursing homes are "giving these drugs to elderly patients to quiet symptoms of Alzheimer's disease and other forms of dementia" -- conditions for which the drugs are not approved by FDA, the Wall Street Journal reports. According to CMS, 21% of nursing home residents who do not have a diagnosis of psychosis are prescribed antipsychotic drugs. "The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing home industry," the Journal reports.

Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging -- a not-for-profit industry group -- said, "You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable." According to Teigland, her research shows about one-third of dementia patients in nursing homes in New York state are receiving antipsychotics, with some facilities dispensing the drugs at rates as high as 60% to 70% of patients.

Like other CEOs, I’m concerned about stemming “brain drain” amid a mass retirement and experience exodus in Minnesota.But a more immediate economic and competitiveness issue is how to deliver and pay for senior care to assist our current employees who are dealing with their aging parents. Absent innovation, the human and financial costs of a much larger, longer-living senior society will weaken other investments designed to enhance Minnesota’s competitiveness and make this state livable for a lifetime.

If my 86-year-old mother-in-law suffered a significant medical event that required care, I would have the luxury of being able to call upon any number of experts within Ecumen for guidance on what to do next, so she could live as fully and independently as possible.

FOR IMMEDIATE RELEASE
Contact:Barbara Duncan
Director of Communications
Protection & Advocacy, Inc. (CA) c/o NDR
Phone: (510) 267-1256
E-Mail: Barbara.Duncan@pai-ca.org

November 28, 2007
Settlement of San Francisco lawsuit to create new community services for
seniors and adults with disabilities

SAN FRANCISCO, CA-Mitch Katz, San Francisco's director of public health,
announced today that a preliminary settlement has been reached in the civil
rights class action regarding expanded community-based living options for
seniors and people with disabilities in San Francisco (Chambers et al. v.
the City and County of San Francisco). The results will be improved
coordination of care and greatly increased housing options and other
services.
The new program, called "Success at Home" will provide people with "a single
door to independent living," said Katz. "We are very pleased to be taking
this innovative next step."
Mark Chambers, a plaintiff in the lawsuit, who has lived in Laguna Honda
Hospital and Rehabilitation Center since receiving a head injury in 1999,
was delighted to hear that he is about to be given the opportunity "to live
in the world." He hopes to be first in line to qualify for one of the 500
units of accessible housing to be found or modified in San Francisco over
the next five years and made affordable by subsidy from the new program.
Elissa Gershon, lead attorney from the Oakland office of Protection &
Advocacy, Inc., counsel in the lawsuit, said that "San Francisco now stands
to regain its progressive edge in disability rights implementation."

Success at Home
Anne Hinton, director of San Francisco's Department of Aging and Adult
Services, which will jointly manage the program with the San Francisco
Department of Public Health said that "Success at Home puts San Francisco in
the forefront of independent living services." The program enables San
Franciscans with disabilities to receive community-based housing and
services to live in the most integrated setting appropriate instead of in an
institution. Eligible individuals will be assessed for, referred to, and
provided with federally subsidized medical services, subsidized housing,
attendant and nursing care, case management, vocational rehabilitation,
substance abuse treatment, mental health services and assistance with meals.
Hinton said "This new single point of entry will also mean community
transition services will be tailored to individual needs and preferences."
Transition services will be coordinated by an individualized Community
Living Plan. Medi-Cal qualified residents of Laguna Honda Hospital and
Rehabilitation Center, those who have been discharged in the last two years
or are on a waiting list for the facility, and patients at San Francisco
General Hospital will be assessed for services.
Herb Levine, director of the San Francisco Independent Living Resource
Center, the organizational plaintiff in the case, commented that he is
"looking forward to the new collaboration between the City and community
service organizations to achieve independence and community living for
hundreds of seniors and people with disabilities." The settlement sets out a
five year timeline for implementation of the new services.

New directions
Paralleling the introduction of new community services, the Laguna Honda
facility will begin to emphasize short-term rehabilitation as one of its
goals. In addition, several hundred Medi-Cal Home and Community-Based waiver
slots, which will allow people to receive long-term health care in their
homes, will be made available to those who qualify, which should bring
millions of dollars in federal and state Medicaid funding to San Francisco.

Summary
The preliminary settlement of the case is awaiting approval by the Board of
Supervisors, the Health Commission, and the Court. Individual plaintiffs are
six residents of Laguna Honda; organizational plaintiff is the Independent
Living Resource Center of San Francisco. Co-counsel on the case are
Protection & Advocacy, Inc., Disability Rights Education and Defense Fund,
AARP Foundation Litigation, the Bazelon Center for Mental Health Law, and
the law firm of Howrey LLP, pro bono.
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NATIONAL ADAPT MAILING LIST - Adapt Community Choice Act List
http://www.adapt.org

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As the presidential candidates crisscrossed the early-primary states in recent months, Americans facing the challenges of long-term care might have wondered about the contenders' own experiences with their parents. And more important, how have those experiences helped shape the candidates' policies on the way families provide and receive long-term care?

Universally, the candidates have made the best of the varied situations they've been dealt. And from these encounters have emerged a variety of proposals that range from neighborhood networks to many ways government should or shouldn't help.

Hospitalizations related to methicillin-resistant Staphylococcus aureus (MRSA) infections more than doubled, from 127,000 to nearly 280,000, between 1999 and 2005, according to a new study in the December issue of the journal Emerging Infectious Diseases. During that same period, hospitalizations of patients with general staph infections increased 62 percent across the country.

I’ve just discoverdd an organization called Care2Learn that offers online in-service training - for assisted living facilities nationwide that was developed for the purpose of educating, training, testing, reporting and tracking continuing education for employees in post-acute healthcare.

Their new assisted living curricula offers 87 in-services....