dementia, transition

#LTCReform: Dementia Turning Points: Is It A Transition? http://bit.ly/cvEGll .

In every journey, whether it is pleasure filled or not, there are forks in the road that require contemplation about how to proceed.  In the tricky world of dementia, there are some defining moments that could be called "turning points" that require a decision in order to move to the next stage.  Have you faced these yet?

Lisa P. Gwyther is a Social Worker and dementia family advocate who outlines 4 key turning points in dementia care that can be very challenging transitions for the person with dementia and their caregiver:

Lingering Fears, Lingering Problems

Recently, much has been made about what LTC services should be provided to elderly prison inmates, and where those services should be provided. The politics of the issue has focused on persons convicted of sexual offences and violent crimes, though, of course, any ex-inmate committing any criminal offense in any LTC setting will grist for that mill (as compared with someone never convicted of a crime who commits the same crime in an LTC setting).


The financial issue is that LTC services provided in prison must be paid for out of only state tax revenues or "General Funds" (GF). Ex-inmates could be eligible for Medicaid, and that means that our Federal tax dollars, in the form of Medicaid, could be used to provide LTC services. The services would likely be less expensive, too, given the increasing costs of security.


But old inmates are only the beginning of the issue. There will be many more inmates coming out of our prisons (one way or another, all of them), and some of them will require LTC supports at one or more times in their life. There is a very real possibility that the political problem of security will allow a back door method for recreating large institutions.


We need to be thinking through the general issue of personal security in community based LTC. Two principles should be that individuals can live on their own with supports, and that people should never be forced to accept any room mate. Another should be that individuals receiving community-based LTC should be able to choose assistive technology that supports their personal security.


At a higher level, organizations that manage LTC and organizations that provide supports need to include these principles in their work, and everyone who gets LTC needs to consider personal security as part of their LTC planning. 


Or we may see real LTC reform corrupted by all too common fears.


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/

Comments on Health Reform Goodies

Now that health reform has passed, what can we expect?


In the Near Term:
  • In 90 days, a temporary high risk pool for people with pre-existing conditions. High risk pools only work for people with chronic conditions if the premiums are controlled. Otherwise, the premiums tend to drift up and make the pool not affordable.
  • Parents can cover their kids up to age 26. I think, but am not sure, this adds a year and broadens already existing practice for some carriers.
  • No more life time limits on dollars of coverage.
  • Better coverage of preventive services
  • Better monitoring of carrier use of funds, and better investigation of big rate increases
  • Medicare Donut hole rebate for the near term, and elimination of the donut hole by 2020
  • Expanded Medicare coverage for people exposed to an environmental emergencies
  • Improved care coordination for people who receive both Medicare and Medicaid
  • A 10% tax on tanning services(!)
A couple of other interesting things:
  • Section 2402 and what follows seem to allow home and community based services in a waiver to easily use 300% of SSI as the income limit. This would broaden eligibility for waiver services in many waivers.
  • An interesting project on shared medical decision making
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/

Problems at the Core

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Both our political parties have

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significant structural and functional problems. They each contain a group that believes  the purpose of politics to be ideological warfare, and they each contain a group that believes politics is a tool to serve their interests. Since the groups within each party are not compatible with one another, there is a struggle within each party that mirrors the struggle between parties in oddly complementary and paradoxical ways. 

We might call the two groups Selfish Toadies (ST) and Cultural Fanatics (CF).

There is a cycle of dynamic dominance between the two groups in each party. Currently, the Republican party has seen the rise of more and more ideological cadre, with the STs trying to co-opt the message of the CF's for their own purposes. In the Democratic party, liberals are gradually taking the role of spoilers, again with the STs trying to co-opt the CW message for their own purposes. The Obama administration is largely STs at this point. 

Across parties, the struggle is between CFs in the Republican party and STs in the Democratic party. The current political instability is not just between the parties, but also between the components within each party. Any stability that occurs either within or across parties will be immediately undermined by the other inside "enemy" or the other party. This general instability will not change any time soon, especially with the economy crashing and the growing deterioration of the health care system, local infrastructure, and the fragmentation of allegiances in every part of the political fabric. In a phrase, everyone, in multitudinous and shifting groups, is struggling for the "soul" of “their” party.

The national political system is no longer capable of solving any major problem. The two parties view vetoing effective action by the other as the only predictably useful political strategy, and within the parties, the components view vetoing the other component in the same way. Joe Lieberman is kind of the poster child for this approach to a political career.

As the whip cream on the sundae, the Supreme Court has now allowed a far greater use of corporate funds to promote political agendas than at any time in modern history. Spin and insults are standard competitive tactics used by corporations to undermine competitors. Therefore, we will be spending far more money to create an incompetent political class than we have in the past. 

Needless to say, the extra money  will not produce better political results.

What to do?