Health and Disability

from The Heritage Foundation:

The Center for Medicare
and Medicaid Services (CMS) published a final Medicaid rule that
permits Medicaid recipients to self–direct their own health care and
supportive services. The rule, Self–Directed Personal Assistance Services Program State Plan Option (Cash and Counseling),
is a great victory for persons with disabilities. Medicaid recipients
in need of long–term care have been given the freedom to control their
own destiny. If states take advantage of it, this change has the
potential to revolutionize the $100 billion long–term care delivery
system under Medicaid.

Self–direction, with the
benefit of counseling, is a dramatic reversal of the traditional model
of long–term care that is based on dependency. Self–direction puts the
individual back in control. This raises expectations and demands
greater personal responsibility on the part of the Medicaid recipient.
But properly understood, that in itself adds value and quality as well
as expands access to services.

John Kemp, an expert on
disability issues, has explained that "control and choice is not just a
theme; they are a tenet of the disability movement."[2]
Experience shows, moreover, that putting the consumer rather than the
provider in control is also cost effective as well as personally
liberating. Says Kemp: "We have been trying to save our government
money for a long time."[3]

from McKnight's:

Advance directive documentation is sharply on the rise in the nation's
nursing homes, according to a recent report from the Institute for the
Future of Aging Services, a research arm of the American Association of
Homes and Services for the Aging.

Nearly 70% of all nursing home residents over the age of 65 have at
least one advance directive document in their records. That is up from
53% in 1996, according to the report.

from Medical News Today:

What will motivate the elderly, the chronically ill and the medicallyunderserved to use interactive information technology systems toactively help manage their own health problems? What barriers haveprevented people in these groups from using such systems more widelythan they have?

The U.S. Agency for Healthcare Research and Quality's (AHRQ) OregonEvidence-based Practice Center (EPC) at Oregon Health & ScienceUniversity searched the scientific literature for answers. The EPC'sreport is the first to identify and catalog the factors that influencethe use of home computer-based health IT systems by the most at-risksubgroups of the population and to review the evidence on healthoutcomes attributable to the use of these technologies. "This reportwill help us make health information technology more available andaccessible to consumers as they use it to become more active in theircare," said AHRQ Director Carolyn M. Clancy, M.D. "I hope the reportwill be useful to clinicians, policymakers, patient advocates andothers who are working to integrate health IT solutions that improvethe quality and safety of health care for all Americans."

Among the study's findings:

- The most effective systems are those that provide routine and timelytailored clinical feedback and advice. Patients prefer systems thatprovide them with information that is specifically tailored for themand is not general in nature.

- Patients prefer systems that send them information on devices that fit into their normal daily routine, such as cell phones.

- The lack of a perceived benefit is the primary barrier to wider useby patients of interactive IT technologies. When patients did notperceive a potential health benefit or did not trust the advice theywere given they were less likely to use the technology.

- Issues of access, ease of use, and convenience of technology systems were also found to be key barriers to wider use.

- The most frequently used health IT functions are online peer group support bulletin boards and disease self-management tools.

- Patients value the anonymity and nonjudgmental nature of interactingwith a computer system, especially those with HIV/AIDS or mentaldisorders.

from Medical news Today:

Thanks to home medical equipment providers, millions of seniors andpeople with disabilities will share Thanksgiving and other holidays inthe comfort of their homes. During November, which is National HomecareMonth, the American Association for Homecare celebrates the thousandsof dedicated professionals who provide cost-effective andconsumer-preferred homecare.

Five Facts about Homecare

1) Among the eight million Americans who depend on homecare formedically required services or equipment are people with chronicobstructive pulmonary disease (COPD), multiple sclerosis, Lou Gehrig'sdisease, spinal cord injuries, congestive heart failure, diabetes, andother conditions.

2) Virtually every type of healthcare short of surgery can be performedin the home. Today Americans benefit from oxygen therapy, wheelchairs,skilled nursing, sleep therapy, infusion therapy, diabetes supplies,hospice, and other medical services, supplies, and equipment at home.

3) The home is the most cost-effective setting for medical care.Home-based care is a key part of the solution to the severe fiscalchallenges facing Medicare and Medicaid and should be an essential partof healthcare reform discussions for federal and state policymakers.

4) Advances in technology for home medical equipment and telemedicine are expanding the clinical effectiveness of homecare.

5) In the event of a pandemic flu, homecare will play a large role in treating the millions of Americans who will require care.

For consumer information and links about homecare, visit www.aahomecare.org/athome.

from Medical News Today:

One quarter of all family caregivers of Alzheimer's disease patientssuccumb to the stress of providing care to a loved one and becomehospital patients themselves, according to an Indiana University studypublished in the November 2008 issue of the Journal of General Internal Medicine.

Researchers from the Indiana University School of Medicine, theRegenstrief Institute and the Indiana University Center for AgingResearch report in a new study that a quarter of family caregivers ofAlzheimer's dementia patients had at least one emergency room visit orhospitalization every six months.

While it has long been anecdotally recognized that caring for a familymember with Alzheimer's disease is stressful, this work is the first tomeasure just how stressful providing care is and to examine the impactof this stress on both the physical and mental health of the familycaregiver.

The study found that the behavior and functioning of the individualwith Alzheimer's dementia, rather than cognitive ability, were themajor factors determining whether the caregiver went to the emergencyroom or was hospitalized.

From Michigan's Long Term Care Commission:

The websites for assistive technology are:

View the Video:  "Imagine the Future of Aging" at:
http://www.agingtech.org/<wbr/>index.aspx

The Lifeshirt: http://www.vivometrics.com/<wbr/>research/clinical_trials/<wbr/>about_the_system/what_is_the_<wbr/>lifeShirt_system.php

The Medicine Cabinet of the Future:
http://www.popsci.com/scitech/<wbr/>article/2005-08/inside-<wbr/>medicine-cabinet-future

Accenture's Online Medicine Cabinet:
http://www.accenture.com/<wbr/>Global/Services/Accenture_<wbr/>Technology_Labs/R_and_I/<wbr/>OnlineMedicineCabinet.htm

Nutritional Diet Calculating Scale:
http://www.<wbr/>toplinedigitalscales.com/<wbr/>catalog.php?action=110&cat_id=<wbr/>1

from McKnight's:

Long a staple for gauging company performance in a service-based
economy, customer satisfaction surveys now are becoming a standard
data-gathering tool in the long-term care industry as well.

Facility operators have only to consider the various factors pushing
the trend to realize the true importance of feedback from those they
serve: Consumer-directed healthcare is gaining traction, the federal
government is unveiling a “Five Star” rating system for nursing homes
in December, the emphasis on pay-for-performance initiatives is
growing, and trade associations are embracing the concept of “culture
change.”

Some see long-term care's mushrooming interest in resident feedback as part of a natural evolution.

“Awareness of customer satisfaction has become pervasive among the
general public,” says Brad Shiverick, chief quality officer for the
Wausau, WI-based healthcare survey firm My InnerView. “For instance,
after a recent trip I got

from OpenCongress:

Empowered at Home Act of 2008 - Amends title XIX (Medicaid) of the Social Security Act (SSA) to revise the income eligibility level for home and community-based (HCBS) services for elderly and disabled individuals. Gives states the option to provide HCBS services under a waiver to eligible individuals whose income does not exceed 300% of the supplemental security income (SSI) benefit rate. Gives states the option to provide HCBS waiver services to individuals for whom such services are likely to prevent, delay, or decrease the likelihood of an individual's need for institutionalized care. Directs the Secretary of Health and Human Services to award assistance grants to states electing to provide HCBS waiver services under Medicaid through the state plan amendment option. Reauthorizes Medicaid transformation grants at increased funding and specifies additional permissible uses to facilitate the provision of HCBS and other long-term care (LTC) services. Directs the Secretary to award grants on a competitive basis to eligible states to conduct an evidence- and community-based health promotion program. Amends the Internal Revenue Code to allow: 
(1) a tax deduction for premiums on qualified LTC insurance contracts; and 
(2) a tax credit for certain caregivers taking care of individuals with LTC needs. Revises requirements for the model regulation and model Act concerning LTC insurance consumer protections and the excise tax for failing to meet requirements for such protections. Amends SSA title XIX, with respect to treatment of the income and resources of HCBS waiver services recipients who would otherwise be institutionalized, to repeal the state option, and thus require, application to such individuals of spousal impoverishment protection requirements. Allows states to elect to exclude up to six months of the average cost of nursing facility services from an individual's assets or resources for purposes of eligibility for HCBS waiver services. Directs the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, to revise certain data reporting forms and systems to ensure uniform and consistent state reporting under this Act. Directs the Comptroller General to study and report to Congress on: 
(1) the provision of home health services under different state Medicaid plans; and 
(2) the extent to which states offer consumer self-direction of such services, or allow for other consumer-oriented policies with respect to them.

from The Norman Transcript: (no relation)

Suspected criminal acts committed against residents of long-term
care facilities are to be reported immediately to law enforcement,
according to an advisory letter sent Oct. 27 from the Oklahoma State
Department of Health to all nursing homes in Oklahoma.

The
letter was sent to all nursing facilities, skilled nursing facilities
and intermediate care facilities for persons with mental retardation.
The letter is in response to appeals by A Perfect Cause and the
overwhelming support for action by long-term care residents' families,
the Attorney General's Office, Oklahoma County District Attorney's
Office, YWCA and Long-Term Care Facilities Advisory Board.

Earlier
this year, Wes Bledsoe, citizens' advocate and founder of A Perfect
Cause, discovered major gaps in Oklahoma statutes concerning the
reporting of criminal acts in long-term care facilities to law
enforcement. He contacted the Oklahoma County District Attorney's
office and Attorney General's Office about his concerns after a
41-year-old nursing home resident was raped and sexually assaulted in
August 2007. Upon further investigation it was determined the rape and
assault were never reported to law enforcement, Bledsoe said.