New Issue of "Health Affairs" is Out

Some Sample Articles:

Raising The Standard: Palliative Care In Nursing Homes

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/

Card-check and transparency and arbitration acts—Oh my!

The Editors’ Blog

Card-check and transparency and arbitration acts—Oh my!

If you’ve been staying on top of long-term care news, you’ve probably noticed that lawmakers have been busy lately. Lots of bills have been introduced in recent days—some drawing praise, others scorn from provider associations.
Here’s a rundown of some of the bigger ones to keep an eye on in coming weeks and months, and what they mean to you, the long-term care provider....

For More...


Norman DeLisle, MDRC
"With Liberty and Access for All!"
Google Voice: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
NPAgile: http://npagile.blogspot.com

Elder Care: Elderly Thrive in Denmark

from Spotlight on Elder Abuse: 

WHAT THE DANES REALLY WANT: The Danes do all they can to enable elders to stay in their own homes. And for those who are too frail, the country's nursing homes are small, homey and delightful.

IN TERMS OF services that elderly people actually want, Denmark – and neighbouring Sweden – are the best places in the world to grow old. Both have strong, cradle-to-grave social programs, and compete with each other – and with their Scandinavian cousins Norway and Finland – to give their citizens the best comprehensive elder care.

Danish and Swedish policies are designed to help people stay at home as long as possible through a variety of home-care services and regular house calls by doctors. In Denmark, regular monitoring of an elderly person's needs begin with a visit by a nurse when an individual turns 75. "That visit has a huge impact," MacAdam observes. "It reassures the individual and also educates the individual."

I am struck by the attitude of proud independence I encounter in many of the seniors I meet in the two countries, how they persist in doing the chores they are able to do. The system supports them where needed, but doesn't take over – not even in nursing homes, where they have kitchenettes so they can make their own toast and tea. "The philosophy is that, no matter how frail, you have a right to be in charge of your life," MacAdam says.

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/

Barrett, Walker: Don't depend on Washington for long-term care solutions

from McKnight's: 


Two high-profile private sector leaders entreated long-term care providers Tuesday to take control technological innovation and care delivery by the horns and not wait for the federal government to act.

“You hold the power in your hands. It's not in Washington's hands,” said Craig Barrett, chairman of the board of Intel Corp.

He along with David Walker, former comptroller general of the United States, were the keynote speakers during the general session Tuesday at the annual conference of the American Association of Homes and Services for the Aging in Philadelphia.

Barrett stressed that the Center for Aging Services Technology (CAST), the technology arm of AAHSA, develop a standard for electronic health records because the government has been slow to act on it.



To see a McKnight's interview with Walker, go to the home page of www.mcknights.com.

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/

http://www.huffingtonpost.com/stuart-shapiro/presidential-candidates-l_b_133373.html

from Huffington Post: 



The good news is that Americans are living longer than they have previously.
The bad news is that our nation's financial and health-care systems are woefully unprepared for them.

What's worse, neither presidential candidate seems to be giving it much thought.
U.S. Sens. John McCain and Barack Obama may spar over Social Security and tinker around the edges of entitlement programs Americans know best, but neither has a serious plan to stabilize our retirement foundation to provide a true safety net for the elderly.


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/

Great Comment lost in vacation

Greg Pawelski left a great comment on a post on the impact of private equity firms buying nursing homes. But, I was on vacation and didn't get around to looking at comments til today. So here is the Comment in it's entirety:

Greg Pawelski has left a new comment on your post "Private equity firms do not affect nursing home qu...": 

Staffing Cuts and Mounting Patient Care Problems at Manor Care's Pennsylvnia Facilities under Carlyle's Ownership 

A new analysis of federal government data reveals staffing cuts and a surge in violations at ManorCare’s Pennsylvania nursing homes while under Carlyle’s ownership. Average nurse and CNA staffing has actually decreased to just 3.29 hours per resident per day (HPPD) at the 20 Pennsylvania Manor Care nursing homes that have undergone annual surveys since Carlyle acquired the company on December 21, 2007. (1) Nurse staffing was cut by 21.4% to just 3.05 HPPD at Manor Care Health Services –
Lansdale, a 170 bed facility in Montgomeryville. (2) In addition, none of the 20 facilities provided the 4.07 hours of care identified by experts in a 2001 study as the threshold below which quality of care is compromised. (3) This staffing data may help to explain a surge in violations of federal health and fire safety standards at these facilities, which increased 31% overall to 202 violations in their post-buyout surveys. (4) 

Government survey records describe the tragic stories behind these violations: 

ManorCare Health Services - York South was cited in January 2008 and again in May for two separate incidents involving a failure to timely notify a physician of a resident’s change in condition. The residents involved in both incidents died. In January, a resident with a history of fainting and at a known risk for falls fell and died several days later as a result of blunt force head trauma sustained in the fall. Incomplete information was faxed to a physician’s closed office, but a physician was not actually called for more than 17 hours after the fall occurred, during which time the resident exhibited symptoms of increased confusion and vomiting. (5) In May, the facility again failed to timely notify a physician after a resident, whose medication carried a known risk of side effects including heart attacks, complained of head and chest pain and had elevated blood pressure. The resident went into fatal cardiac arrest late that night. (6) 

ManorCare Health Services at Mercy Fitzgerald was cited by government inspectors for failing to provide timely assistance to a resident who had amputations of both legs, whose repeated requests for assistance in using the bathroom went unanswered over the course of half an hour. (7) 

Donahoe Manor was cited for failure to follow state law and its own policies requiring an FBI criminal background check for an employee who had been hired more than 9 months earlier, and for hiring a dietary aide who worked on the tray line and delivering carts before his tuberculosis skin test was completed. (8) 

(1) This average is weighted to reflect different homes census level. The staffing data is based on information from “About the Nursing Home–Inspection Results,” Centers for Medicare and Medicaid Services Nursing Home Compare data, downloaded 7/22/2008 and 11/09/2007. Under federal law, nursing homes must be inspected every nine to 15 months. 

(2) Ibid. 

(3) Ibid. 

(4) Ibid. 

(5) MANORCARE HEALTH SERVICES-YORK SOUTH, Incident investigation and a State monitoring visit, 01/09/2008, F-0309. 

(6) MANORCARE HEALTH SERVICES-YORK SOUTH, Medicare/Medicaid Recertification, 

State Licensure, Civil Rights Compliance and Incident investigation survey, 05/22/2008, F-0309. 

(7) MANORCARE HEALTH SERVICES AT MERCY FITZGERALD, M edicare/Medicaid Recertification, State Licensure and Civil Rights Compliance Survey, 01/08/2008, F-0309. 

(8) DONAHOE MANOR, Medicare/Medicaid Recertification Survey and State Licensure Survey, 01/07/08, F-0226, F-0630. 
Posted by Greg Pawelski to LTC Reform at October 6, 2008 9:18 PM

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/

Duh! of the Week

from Medical News today: 


Patients Who Recover From Coma But Cannot Communicate Feel Pain



Do patients who survive a severe brain injury but fail to recover speech or non-verbal communication perceive pain ? After their remarkable publication where they showed that a patient in a vegetative state in reality was conscious, scientists at the University of Liège (ULg) were able to tackle the very difficult issue of pain perception in coma survivors.

The Coma Science Group of the Cyclotron Research Centre and Neurology Department of the ULg used PET scanning to measure minimally conscious and vegetative patients' brain activation in response to noxious stimulation.

After comparing results obtained in the different patient groups with those in healthy volunteers who could communicate it felt painful they concluded that minimally conscious patients must feel pain despite being unable to tell their environment. Hence, these patients should receive pain-killers, the authors concluded.

This study has major ethical and therapeutical consequences also with regard to end-of-life decisions in these challenging but vulnerable patient populations




See my next post for commentary

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/

Conference to Explore Voting in Long-Term Care Facilities in Virginia

from UVA Today :

October 2, 2008 — The University of Virginia's Institute on Aging will host a conference focusing on the problems and issues of voting by seniors in nursing homes and assisted-living facilities. This conference will be held Friday, Oct. 10, from 9:30 a.m. to 4:30 p.m. in the Caplin Auditorium at the U.Va. School of Law.

The conference will bring together leaders from several fields to review the challenges faced by individuals with cognitive and physical impairments and to recommend policies and procedures that can maximize voter participation while avoiding fraud and exploitation of this vulnerable population. The goal: Find  a way to facilitate voting rights for the elderly in Virginia that can serve as a national model for improving the voting system.

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/

2007 Institution vs Community-Based Medicaid Services,

from Steve Gold:


Each State's FY 2007 Medicaid data, submitted to CMS for reimbursement and
compiled by Thompson/Medstat, provides extremely helpful information to
analyze your State's distribution of its Long Term Care expenditures
between its Institutional versus Community-Based Services.

How a state allocates its Long Term Care expenditures demonstrates its
commitment to provide the elderly and persons with disabilities a choice
between unnecessary institutionalization and living in the community.
Let's repeat - "show us the money" and where a state spends it, and you
can see how much the state respects both the ADA and the Olmstead
decision.  Remember that the Supreme Court in 1999 - eight years ago -told
states to end unnecessary institutionalization!  The following data shows
how much your state respects the ADA and the Olmstead decision.

Nationally, for "all disabilities," 58.3% of the long term care
expenditures went to institutions, i.e, both to nursing homes (for
physically disabled persons of all ages) and to intermediate care
facilities (for persons with MR/DD). 41.7% went for community based
services, i.e., for all MA waivers (i.e., both Aged and Physical
Disabilities and MR/DD), "personal care" option, and home health services
in the community.

As you all know, we live with the historical disability divide - persons
with MR/DD, on one hand, and the elderly and persons with physical
disabilities of all ages, on the other hand.  As unfortunate as the divide
is and as much as it perpetuates divisions in the disability community,
it's what we have.  MA expenditures and analysis follow this divide.

When "all disabilities" are broken down into MR/DD and Aged/PD, a dramatic
difference exists in the above 58.3% institutional vs 41.7% community
national long term care distribution.

For persons receiving MR/DD services, nationally only 36.9% went for
institutions (ICF-MRs) and 63.1% was spent for community-based (waiver)
services.  Thus, significantly less Medicaid funds went to provide
services for persons with MR/DD in institutions than in the community.
In dollars, $12 b was spent on institutions but $20.5 b was spent for
community-based services.

In contrast, for the aged and persons with physical disabilities, 69% was
expended on institutional services and 31% on community-based services.
In dollars, nursing homes received $46.9 b but only $21.1 b was spent for
community-based services.

Why the lopsided distribution based on type of disability?

Let's look at the differences in each State. The following chart provides
two columns - the first for MR/DD and the second for Aged/PD.

How does your State compare?  Advocates should make two comparisons.
First, how is your State doing for each MR/DD and Aged/PD with regards to
leveling the playing fields between institutional and community-based
services?  Second, how is your State doing when you compare MR/DD and
Aged/PD expenditures?

% of Medicaid Long Term Care expenditures for institutional services
versus community services.

                        MR/DD                       Aged/PD
              Institutional/community      Institutional/community
National ...................36.9%/63.1%           69%/31%

Alabama ....................12.2/87.8               86.9/13.1
Alaska ......................0.2/99.8               49.4/50.6
Arizona ......................N/A                   36.0/64.0
Arkansas....................<wbr></wbr>58.0/42.0               74.1/25.9
California..................<wbr></wbr>37.7/62.3               47.9/52.1
Colorado.....................<wbr></wbr>8.1/91.9               65.1/34.9
Connecticut.................<wbr></wbr>34.3/65.7               79.3/20.7
Delaware....................<wbr></wbr>26.3/73.7               86.3/13.7
D. C........................72.5/<wbr></wbr>27.5               65.1/34.9

Florida.....................<wbr></wbr>26.4/73.6               82.5/17.5
Georgia.....................<wbr></wbr>24.4/75.6               76.0/24.0
Hawaii.......................<wbr></wbr>7.9/92.1               82.2/17.8
Idaho.......................<wbr></wbr>50.4/49.6               59.6/40.4
Illinois....................<wbr></wbr>61.9/38.1               75.1/24.9
Indiana.....................<wbr></wbr>43.2/56.8               85.5/14.5

Iowa........................<wbr></wbr>51.1/48.9               73.8/26.2
Kansas......................<wbr></wbr>20.4/79.6               64.8/35.2
Kentucky....................<wbr></wbr>42.0/58.0               81.1/18.9
Louisiana...................<wbr></wbr>53.6/46.4               73.2/26.8
Maine.......................<wbr></wbr>23.5/76.5               73.4/26.6
Maryland....................<wbr></wbr>10.2/89.8               84.1/15.9
Massachusetts...............<wbr></wbr>26.7/73.3               73.6/26.4
Michigan.....................<wbr></wbr>9.7/90.3               81.0/19.0
Minnesota...................<wbr></wbr>16.2/83.8               53.4/46.6
Mississippi................<wbr></wbr>100.0/0.0                97.8/2.2
Missouri....................<wbr></wbr>23.2/76.8               68.9/31.1
Montana.....................<wbr></wbr>13.3/86.7               70.7/29.3
Nebraska................... 31.8/68.2               77.7/22.3
Nevada..................... 25.5/75.4               64.9/35.1
New Hampshire................1.7/<wbr></wbr>98.3               85.6/14.4
New Jersey..................55.1/<wbr></wbr>44.9               79.0/21.0
New Mexico.................. 7.8/92.2               39.3/60.7
New York ...................39.6/60.4               60.7/39.3
North Carolina..............52.3/47.<wbr></wbr>7               57.3/42.7
North Dakota................48.2/51.<wbr></wbr>8               93.7/6.3
Ohio........................<wbr></wbr>48.4/51.6               79.2/20.8
Oklahoma....................<wbr></wbr>32.5/67.5               71.3/28.7
Oregon......................0.<wbr></wbr>0/100.0               43.5/56.5
Pennsylvania................<wbr></wbr>32.4/67.6               87.3/12.7
Rhode Island.................3.5/96.<wbr></wbr>5               87.4/12.6
South Carolina..............44.7/55.<wbr></wbr>3               77.0/23.0
South Dakota................19.6/80.<wbr></wbr>0               88.5/11.5
Tennessee...................<wbr></wbr>28.4/71.6               98.7/1.3
Texas.......................<wbr></wbr>62.3/37.7               55.7/44.3
Utah........................<wbr></wbr>33.3/66.7               89.3/10.7
Vermont......................<wbr></wbr>N/A                    71.5/28.5
Virginia....................<wbr></wbr>40.2/59.8               73.2/26.8

Washington .................22.1/77.9               44.4/55.6
West Virginia...............21.5/<wbr></wbr>78.5               76.6/23.4
Wisconsin ..................23.1/76.9               69.3/30.7
Wyoming ....................18.6/81.4               79.6/20.4

   Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.  To
contact Steve Gold directly, write to stevegoldada@cs.com

--
Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com

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Norman DeLisle
"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/

Residents’ Rights Week, Oct. 5-11

from PHI: 



National Residents’ Rights Week, Oct. 5-11, honors residents living in all long-term care facilities, including nursing homes, sub-acute units, assisted living, board and care, and retirement communities.
The week has been designated by NCCNHR: The National Consumer Voice for Quality Long-Term Care so that facilities may celebrate awareness of dignity, respect and the value of each individual resident.
During Residents’ Rights Week, NCCNHR is giving residents from facilities across the country an opportunity to share their ideas of what “home” means to them and how to create that home in a long-term care facility. Submissions will be randomly displayed on the  National Ombudsman Resource Centerwebsite in a new section called “The Residents’ Voice.”

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/