Health and Disability

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

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....................58.0/42.0 74.1/25.9
California..................37.7/62.3 47.9/52.1
Colorado.....................8.1/91.9 65.1/34.9
Connecticut.................34.3/65.7 79.3/20.7
Delaware....................26.3/73.7 86.3/13.7
D. C........................72.5/27.5 65.1/34.9

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

Iowa........................51.1/48.9 73.8/26.2
Kansas......................20.4/79.6 64.8/35.2
Kentucky....................42.0/58.0 81.1/18.9
Louisiana...................53.6/46.4 73.2/26.8
Maine.......................23.5/76.5 73.4/26.6
Maryland....................10.2/89.8 84.1/15.9
Massachusetts...............26.7/73.3 73.6/26.4
Michigan.....................9.7/90.3 81.0/19.0
Minnesota...................16.2/83.8 53.4/46.6
Mississippi................100.0/0.0 97.8/2.2
Missouri....................23.2/76.8 68.9/31.1
Montana.....................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................1.7/98.3 85.6/14.4
New Jersey..................55.1/44.9 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..............52.3/47.7 57.3/42.7
North Dakota................48.2/51.8 93.7/6.3
Ohio........................48.4/51.6 79.2/20.8
Oklahoma....................32.5/67.5 71.3/28.7
Oregon......................0.0/100.0 43.5/56.5
Pennsylvania................32.4/67.6 87.3/12.7
Rhode Island.................3.5/96.5 87.4/12.6
South Carolina..............44.7/55.3 77.0/23.0
South Dakota................19.6/80.0 88.5/11.5
Tennessee...................28.4/71.6 98.7/1.3
Texas.......................62.3/37.7 55.7/44.3
Utah........................33.3/66.7 89.3/10.7
Vermont......................N/A 71.5/28.5
Virginia....................40.2/59.8 73.2/26.8

Washington .................22.1/77.9 44.4/55.6
West Virginia...............21.5/78.5 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/

The Undead

from The Times Online :

Trapped inside their bodies, apparently switched off to the world, but still alive: they are the undead. Or so we thought. Forty per cent of patients in a ‘vegetative state’ are misdiagnosed. Now British scientists are leading the field in trying to put that right.

Kate Bainbridge is a lively 37-year-old former schoolteacher. We are communicating in the conservatory of her parents’ home in south Cambridge. She has expressive eyes and a broad and ready smile, but she can utter only occasional single words with difficulty. She sits in a wheelchair “speaking” with the aid of a letter-board, using her left forefinger to spell out words individually.

Ten years ago, Kate went into a deep coma and was on a ventilator for several weeks. She had suffered severe brain inflammation after contracting a viral infection. When she came out of the coma, she opened her eyes and could breathe naturally, but she was unresponsive to speech and visual stimuli, and appeared to lack all conscious awareness. She was still in this condition four months after falling ill, and was later diagnosed to be in a persistent vegetative state, or PVS: in other words, persistently unaware. But the diagnosis was wrong.

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/

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/

Legislation Would Create Medicare Pilot Program To Expand At-Home Services For Some Beneficiaries With Chronic Conditions

from Medical News Today:

Sen. Ron Wyden (D-Ore.) and Rep. Edward Markey (D-Mass.) have introduced legislation (S 3613, HR 7114) that would create a three-year Medicare demonstration project in 26 states that aims to expand at-home services for some beneficiaries with multiple chronic health conditions, CQ HealthBeatreports. Eligible beneficiaries would include those who have functional impairments, two or more chronic illnesses and recent use of other health services.

Under the bill, participating physicians or nurse practitioners would collaborate with beneficiaries to develop a comprehensive care plan. The legislation also includes minimum performance standards for health outcomes and would measure the satisfaction level of beneficiaries, caregivers and providers. The bill would require providers to demonstrate savings of at least 5% annually compared to the cost of serving non-participating Medicare beneficiaries with chronic health problems. Providers would be able to keep 80% of the savings as an incentive for participation.

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/

Plan aims to keep nursing home open in Macomb County

from the Detroit Free Press:

Advocates of a tax-funded nursing home in Macomb County plan a last-minute pitch to commissioners this morning to save the center from closure, saying they can save taxpayers $5 million a year.

The county's Social Services Board, which oversees the administration of the Martha T. Berry Medical Care Facility in Mt. Clemens, will urge commissioners to keep the center open because it cares for more than 200 sick and dying patients who consider it home.
The board says it can cut the center's projected $7-million tax subsidy to $2 million next year and $1 million in 2010.
"The county has a rich tradition of providing 217 beds for the most vulnerable and financially indigent in our community," board Chairman Roger Facione said. "We believe that the mission of the medical center needs to be continued and protected."
At a meeting Tuesday, commissioners are to consider closing the center to chip away at a record $33-million deficit next year.

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/

CMS Issues Final Rule To Empower Medicaid Beneficiaries To Direct Personal Assistance Services

from Medical news Today:

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was announced by the Centers for Medicare & Medicaid Services (CMS).

The rule, on display today at the Federal Register, guides states who wish to allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers. Beneficiaries could even hire qualified family members who may already be familiar with the individual's needs to perform personal assistance (not medical) services.

http://www.cms.hhs.gov/

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/

Rough waters: rethinking bathing in long-term care

from McKnight's:

To fully understand how the simple process of bathing affects long-term care facility residents it's important to walk—or more likely slip—in their shoes.

Just think about how this activity, one that able-bodied people require privacy to perform, becomes an exercise in embarrassment once a caregiver enters the picture.

That is why facility operators need to pay even closer attention to how this routine is carried out, and whether it is being done in a manner that minimizes the emotional dread that residents may experience, according to experts.

Thankfully caregivers are becoming increasingly sensitive to the dignity issue, according to bathing and lift equipment vendors.

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/

Medicaid long-term health care costs to soar

from Reuters:

WASHINGTON (Reuters) - Fueled by the needs of a growing elderly population, spending on long-term health care under the Medicaid program will soar in the next 20 years, a report released Monday predicted.

Spending for long-term care for elderly and disabled people under the Medicaid health insurance program for the poor will total $3.7 trillion in the next two decades, according to the report by America's Health Insurance Plans, an industry group.

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/

Violations Reported at 94% of Nursing Homes

from NYTimes:

WASHINGTON — More than 90 percent of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes, federal investigators say in a report issued on Monday.

About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.
Problems included infected bedsores, medication mix-ups, poor nutrition and abuse and neglect of patients.
Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.

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/