Health and Disability

ADAPT begins with training on direct-action and non-violence.

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/
Change: http://prosynergypsc.blogspot.com/

Elderly patients living in impoverished areas are more likely to die after undergoing surgery compared to peers from higher-income ZIP codes, a new study finds.



n fact, all patients regardless of income who underwent treatment at the hospitals in the poorest areas were more likely to die, whereas all patients undergoing surgery in the wealthiest ZIP codes proved less likely to die.

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/
Change: http://prosynergypsc.blogspot.com/

Getting real about retention
This is the fourth in a series of PHI Expert Interviews, which bring you insights from four senior PHI staff. They’re an impressive group — among the nation’s leading experts on long-term care’s direct-care workforce — and collectively they’ve spent decades studying the challenges facing the workforce and how to address them. We think you’ll be interested in what they’ve learned.

When Steven Dawson came out of the workforce development field in 1992 to join Peggy Powell in heading up the Paraprofessional Healthcare Institute, PHI’s sole purpose was to raise funds and provide technical support for Cooperative Home Care Associates. Over time, Steven led PHI into the broader long-term care arena, where its policy and practice experts work with employers and lawmakers to support and stabilize the nation’s direct-care workforce.

Steven has written about the impending direct-care workforce crisis (pdf) and the link between quality jobs for direct-care workers and quality care for long-term care consumers. Through the years, his emphasis has been on creating workplaces that are intentionally re-designed to retain direct-care staff.

“A constantly churning workforce is the enemy of quality care — ask anyone whose mother has had to deal with five different home health aides within a month, or with a blur of CNAs in the nursing home. The industry still manages to attract hundreds of thousands of skilled, caring workers every year, but once hired, these frontline staff are too often treated as if they were invisible. So, of course they leave,” he 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/
Change: http://prosynergypsc.blogspot.com/

from Steve Gold:

Information Bulletin # 259 (9/08).

Throughout the country, Public Housing Authorities have waiting lists for
both their housing vouchers and public housing units.

In many states, people are in nursing homes because they cannot afford to
rent an apartment or housing unit on their limited SSI incomes. Without
either a housing voucher or a public housing units, many people in nursing
facilities will continue to be institutionalized.

The question that has been raised a number of times is whether or not your
Public Housing Authority could target their vouchers and public housing
units to help transition people out of nursing homes and other
institutions?  People have complained that their Public Housing
Authorities, because they have waiting lists for housing vouchers and
public housing units, have not been responsive and have presented a number
of excuses to using their vouchers and housing units to end unnecessary
institutionalization.

Here are a number of points you should be aware of:

1.  Yes, your Pubic Housing Authority can open its waiting list for one
preference category of people - for example, people transitioning out of
institutions.

2.  Yes, it is possible for your Public Housing Authority to establish a
preference for persons transitioning out of institutions, so long as the
preference is not targeted towards people with a specific disability
(e.g., MI, or PD) and the preference is not based on where a person
resides (e.g., one particular institution).  Other than those two, it can
give the preference.

3.  Yes, your Housing Authority's waiting list can be opened indefinitely
for the preference group of people transitioning out of institutions.

4.  A Public Housing Authority can limit the number of applicants who
qualify for any specific preference.

5.  In order for your Public Housing Authority to establish the preference
for both its housing vouchers and housing units for persons transitioning
out of institutions, the Public Housing Authority must prepare a revision
of its administrative plan that states the new preference and complies
with other HUD procedural hoops.

Disability and elderly advocates:

   What are you going to do to ensure that your Public Housing Authority
establishes a preference for persons transitioning out of institutions?

   Advocates have to make sure it does.  This requires a strategy and
some political clout.  Do you have it?

   "Power concedes nothing without a struggle."  Frederick Douglas.

   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
or call 215-627-7100.

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/
Change: http://prosynergypsc.blogspot.com/

from McKnight's

The Senate Finance Committee this week passed the Patient Safety and Abuse Prevention Act (S. 1577), which would establish a nationwide system of background checks for potential long-term care employees, by a unanimous vote.

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/
Change: http://prosynergypsc.blogspot.com/

from Long Term Care Blog:

Saw an interesting article on  pets in Long Term Care (LTC) facilities. Not just traditional birds, cats or dogs.  They actually had a small Kangaroo hoping around free. You can not keep them off the couch either.  He was actually  wearing a diaper because you can not house break a Kangaroo.  It is easy to housebreak a rabbit.   Many clinical studies have shown that petting an animal actually reduces your stress and blood pressure!

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/
Change: http://prosynergypsc.blogspot.com/

The "general intent" of pay-for-performance programs "is to reward doctors for providing better care," but as they gain "momentum, the initiative[s] may be having untoward consequences," Sandeep Jauhar, a New York-based cardiologist and author, writes in a New York Times commentary. "To get an inkling of the potential problems," Jauhar discusses another quality-improvement program: surgical report cards.

The program, which was introduced in the early 1990s, was intended "to improve the quality of cardiac surgery by pointing out deficiencies in hospitals and surgeons; those who did not measure up would be forced to improve," according to Jauhar. However, studies on the program "demonstrated there was a significant amount of 'cherry-picking' of patients in states with mandatory report cards," Jauhar writes. "With surgical report cards, surgeons' numbers improved not only because of better performance but also because dying patients were not getting the operations they needed," he writes, adding, "Pay for performance is likely to have similar repercussions."

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/
Change: http://prosynergypsc.blogspot.com/

from McKnight's:

A year after a news report uncovered resident care and ownership problems at privately held nursing homes, a new report from Harvard Medical School finds the opposite: Quality at nursing homes does not suffer, and, in certain cases, may even improve under private-equity ownership.

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/
Change: http://prosynergypsc.blogspot.com/

Labels, stereotypes, abbreviations, shorthands, and heuristics are bad trade-offs. They speed communication and muddy it at the same time. Worse, once we apply the label, we stop thinking.

Labeling is a particularly dangerous behavior in health care, and yet it is considered proper and necessary behavior. In health care, labeling or stereotyping is called making a diagnosis.

Making a diagnosis implies to both providers and patients that problem is understood. Consider some common diagnoses (or labels) that you see in TV advertisements by pharmaceutical companies selling drugs directly to consumers or by lawyers recruiting clients for class action suits.
• Fibromyalgia (= pain in joints and muscles. The mechanism of disease is a mystery.)
• Mesothelioma (= cancer of the lining of the lungs, often follows exposure to asbestos. How does the asbestos produce the tumor? Your guess is as good as mine.)
• Erectile dysfunction (The "what" is obvious. The "why" is unknown.)

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/
Change: http://prosynergypsc.blogspot.com/

More than $8 million in federal funding aimed at keeping people away from nursing homes started arriving in seven states Tuesday. Most of the money will be used to build hospital-discharge planning processes that emphasize home- and community-based care programs, officials said

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/
Change: http://prosynergypsc.blogspot.com/