Thursday, October 7, 2010

Aging's Challenges Amplified for Gays and Lesbians - NYTimes.com

Gay flagImage via WikipediaBy PAULA SPAN

David and his partner, Paschal, together for more than 20 years, married during the brief period that same-sex marriages were legal in California. They’re in their 60s, in decent health and financial shape. Yet thinking about their future makes David uneasy.

With an eldercare system (if you can call it a system) that depends on younger family members shouldering responsibility for older ones, perhaps any childless and aging couple would share his concerns. But gay men and lesbians face particular challenges, as David pointed out to me in a recent e-mail.

Let him count the ways. “The guys who are 65 and older now generally came of age, and came out, when doing so meant alienation from your family,” David wrote. “Many of the older gays I know are still estranged.” They don’t feel they can rely on younger relatives for help.

David and Paschal (citing privacy concerns, they asked that their full names not be used) expect to have to care for themselves — not because they’re estranged from family members, but because their nieces and nephews live far away. So David is considering other options.

If the couple wanted to retire to Paschal’s home state in the South, where senior housing communities would be much less expensive, “we’d have a hard time finding a life care facility that would accept us as a married couple,” David wrote. “And I doubt the other residents would be too welcoming if we did get in. And church-sponsored places — often a good value for straight folks — are largely not available for open gays.”

A number of researchers have found that, for those reasons, older gay men and lesbians sometimes conceal their sexual orientation when they enter nursing homes or assisted living facilities, effectively recloseting themselves at one of life’s most vulnerable passages.


At older ages, too, a number of the federal policies that protect married couples come into force, leaving gay men and lesbians, even those who marry in their own states, at a comparative financial disadvantage. Paschal’s Social Security benefits, for instance, are considerably greater than David’s, but David won’t be eligible for the spousal and survivor benefits that other widowers receive should something happen to Paschal.
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Nurses Should Play a Larger Role in Healthcare, IOM Says from MedPage Today

By Emily P. Walker, Washington Correspondent, MedPage Today

Expansion of nurses' scope of practice is just one of the ways to meet the growing demands for healthcare services created by the Affordable Care Act (ACA) that are detailed in a new report from the Institute of Medicine (IOM).

"Restrictions on scope of practice, policy- and reimbursement-related limitations, and professional tensions have undermined the nursing profession's ability to provide and improve both general and advanced care," according to the summary from "The Future of Nursing, Leading Change, Advancing Health."

The report, prepared by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the IOM, has four key messages that "informed the recommendations" of a joint committee chaired by former Health and Human Services (HHS) Secretary Donna Shalala:
  • Nurses practice should reflect their educational level.
  • More nurses should pursue higher levels of education through an improved system.
  • Nurses should be "full partners" in the redesign of U.S. healthcare.
  • Better data collection and information infrastructure are needed for planning work force and policy changes.
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Better Outcomes With Combo Therapy in Early RA from MedPage Today

By Nancy Walsh, Staff Writer, MedPage Today

Patients with rheumatoid arthritis who received initial combination therapy with adalimumab (Humira) plus methotrexate for two years had better long-term disease control than those who started on monotherapy, an open-label study showed.

At five years, 35% of patients whose initial treatment included both drugs met the stringent criteria of clinical remission, normal function, and no radiographic progression, compared with 13% of those who received only adalimumab and 14% of those taking methotrexate alone, according to Désirée van der Heijde, MD, PhD, of Leiden University in the Netherlands, and colleagues.

These findings "indicate a window of opportunity to influence the disease course with early, aggressive treatment and suggest that there are consequences associated with delay of combination treatment in patients whose disease activity warrants such therapy," the investigators wrote in a paper published online by the Journal of Rheumatology.

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Agency Acts to Ease Delays of Medications at Nursing Homes - NYTimes.com

The seal of the United States Drug Enforcement...Image via WikipediaBy NATASHA SINGER

The Drug Enforcement Administration has issued a new guideline intended to help ease the delay some nursing home residents face in receiving certain painkillers and anti-anxiety medications.

Physicians may now authorize nurses employed by long-term care facilities to phone in their oral prescriptions for these controlled substances to pharmacies, the agency said in a policy statement published on Wednesday in the Federal Register, the daily publication of changes to government rules.

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HCBS Reductions? What Advocates Can Do

Steve Gold's Information Bulletin # 324  (9/2010)

Has your State threatened to cut back or reduce Medicaid-funded home and community-based services ?  Has your State actually reduced HCBS Medicaid services?  What impact will these reductions have on people remaining in the community?

What can advocates do about these reductions?  What should CMS do? In addition to how the ADA and integration will be impacted if the reductions are implemented, another handle is the Medicaid statute itself?

To receive federal Medicaid funds, a State must have a written state plan that has been submitted to and approved by the Secretary of the U.S. Dept of Health and Human Services.  CMS posts state MA plans and amendments at www.cms.gov/medicaid/stateplans/

State MA plans must be amended to reflect changes in federal policy, Court decisions, and "material changes" in policy, state law, or operation of the program. 42 Code of Federal Regulations ' 430.12.  Proposed State plan amendments must be submitted to the CMS regional office which must "consult with central office staff on questions regarding application of Federal policy." 42 C.F.R ' 430.14.  CMS must make a "determination as to whether State plans (including plan amendments and administrative practice under the plans) originally meet or continue to meet the requirements for approval are based on relevant Federal statutes [including the ADA] and regulations."  42 C.F.R ' 430.15.

Hmmm.  The United States Supreme Court in 1999 in the Olmstead decision found that unnecessary segregation in institutions violated the ADA - sure sounds like a Court decision.  CMS has issued several "Dear State Medicaid Director" letters telling states that their State plans must comply with both the Medicaid and the ADA statutes, and these letters sure look like federal policy. Therefore, when your State proposes reductions in HCBS, advocates must analyze what impact the reductions will have on causing or preventing unnecessary segregation. 

Advocates must ensure that CMS will disapprove the amendments based on Olmstead and its own policy requiring compliance with the ADA.

Advocates for older and younger Americans with disabilities should:

1.  Find out if your Governor has reviewed the proposed amendments, a Medicaid requirement for State plan amendments?

2. Contact your regional CMS officials and obtain copies of documents between your State and CMS regarding the amendment.

3. Unbelievably, there is no requirement for public hearing or even an opportunity for public comment.  Nevertheless, each State has a Medical   Care Advisory Committee that reviews and comments on proposed changes.    Get to them and make your voices heard.

4.  Send your comments to the CMS regional office AND to the Secretary of   HHS.  Tell them how the amendments will impact on people unnecessarily   being institutionalized.

Thanks very much to the National Health Law Program for their invaluable suggestions and observations, many of which are the basis for and incorporated in this Information Bulletin.

Steve Gold, The Disability Odyssey continues

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.


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Ask an Elder Attorney: New Power of Attorney - NYTimes.com

Image representing New York Times as depicted ...Image via CrunchBaseBy CRAIG REAVES

Q. What is done when a power of attorney is left to both siblings jointly but one decides to become uncommunicative and “checks out,” not participating in decision-making, handling estate matters or caring for a parent with dementia? Does the sibling left with shouldering the burden really have to go to court to get the other sibling’s name taken off the power of attorney? — Kcz

A. I think you may have to go to court, but there are two avenues you should pursue first. (click link below)
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When Sleep Apnea Masquerades as Dementia - NYTimes.com

Image representing New York Times as depicted ...Image via CrunchBaseBy PAULA SPAN

The woman who came to see Dr. Ronald Petersen, an Alzheimer’s specialist at the Mayo Clinic, was only in her 60s but complained that she was having trouble concentrating. “Her attention was waning,” Dr. Petersen recalled. “She couldn’t follow a television program or stay focused during a conversation.”

She was probably developing dementia, Dr. Petersen thought as he took her history. But along the way he asked, as he usually does, how she was sleeping. The woman, who lived alone, hadn’t noticed any problems.

Her son, however, had stayed with her the previous night to drive her to the appointment. “She was snoring like a freight train,” he reported.

Aha. Overnight sleep testing determined that the woman had obstructive sleep apnea — nightlong interruptions in breathing that reduce oxygen flow to the brain and prevent deep sleep. The interruptions can happen 10 or more times an hour and are quite common in older adults, exacerbating — or sometimes mimicking — dementia symptoms.

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Monday, October 4, 2010

Women's Institute for a Secure Retirement Fall Updates

Greetings!
We are pleased to share the Fall 2010 Newsletter: Stashing the Cash! Do You Have Too Much? Are There Guarantees?

This issue focuses on providing information on options fFall2010 Newsletteror cash investments. There's a lot of buzz about people putting too much cash for too long into savings or money market funds, where interest rates can't get much lower. Cash is really important for emergency funds, but may not be appropriate for long-term retirement savings. This article will provide some helpful advice on how you should be stashing your cash and where the guaranties are.

Sincerely,
cindy signature
Cindy Hounsell
President
Women's Institute for a Secure Retirement
www.wiserwomen.org
Read/Download Newsletter

Transcendent — This Old Brain

Agatha ChristieImage via WikipediaBy Mike
Transcendent – Friday Quote From Agatha Christie

I have enjoyed greatly the second blooming that comes when you finish the life of the emotions and of personal relations; and suddenly find – at the age of fifty, say – that a whole new life has opened before you, filled with things you can think about, study, or read about…It is as if a fresh sap of ideas and thoughts was rising in you.

I keep hearing a refrain. The baby boomer population is different. Aging ain’t what it used to be.

But what is it then? And what can we do when we have it?
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Facts of the Day | Retirement USA

Crane Paper Company in Dalton produces the pap...Image via Wikipedia39 percent of nonwhite or Hispanic families have a retirement savings account.

46 percent of full-time African American workers participate in a retirement plan at work.

Only 4 out of 30 OECD countries have higher elderly poverty rates than the United States.

3 in 10 full-time Hispanic workers participate in a retirement plan at work.

1 in 5 African-American and Hispanic seniors live below the federal poverty line.

Half of Hispanics age 65 and older have a yearly income of less than $12,181.

Half of African Americans age 65 and older have a yearly income of less than $14,620.

A women who reached age 65 this year can expect to live another 20.4 years.

58% of older women rely on Social Security for more than half of their incomes.

Half of all families with 401(k)-type retirement plans and IRAs have less than $45,000.

1 in 2 private-sector workers do not participate in a retirement plan other than Social Security.

Half of retirees age 65 and older have a yearly income of less than $15,635.

$14,050 is the average Social Security benefit received by retirees this year.

The nation's Retirement Income Deficit is $6.6 Trillion.
More Information on Each of the Facts
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Cops: healthcare employee stole $48,000 from elderly victim | LoHud.com | The Journal News

By James O'Rourke

A New Jersey woman was being held in the Rockland County jail Friday, accused of stealing $48,000 from an 83-year-old woman whom she cared for as a live-in health care provider.

Cicille R. Davis, aka Rosalie A. Davis, 44, of 165 Pierson St. in Orange, was arrested Thursday on suspicion of felony forgery and grand larceny charges, Suffern police Detective Craig Long said. Davis had been hired by the victim's family in July 2009 to provide live-in health care at the victim's home. In March, the family began to notice discrepancies in financial records and became suspicious of Davis. The family dismissed Davis without telling her of their suspicions and contacted authorities.
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Expect doc shortages to worsen in post-reform era: AAMC - Healthcare business news from Modern Healthcare

MIAMI - APRIL 02:  (L-R) James Sikora , Kay Sc...Image by Getty Images via @daylife By Jennifer Lubell
Without increases in residency training, physician shortages post-reform will continue to worsen for both primary and specialty care, the Association of American Medical Colleges is reporting.

The AAMC estimates that there will be a shortage of 45,000 primary-care doctors and 46,000 surgeons and medical specialists over the next decade, driven in part by the healthcare reform law's new coverage expansions and the aging of the population.
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Let's Kick It Off! - Residents' Rights Week

This year's theme aims to educate people about Residents' Rights and improved dining experiences for residents by highlighting residents' concerns and comments on this issue. Residents were encouraged to think about and respond to the following questions:

  • How can dining services be improved to make your meals more enjoyable?

  • What makes your meals and dining experience positive?

  • What is your favorite recipe? Why is it special to you?
Ms. Carolyn Higginbotham, a resident of the Milton Home in South Bend, Indiana, submitted two wonderful recipes for our Residents' Rights Week cookbook (learn more about purchasing the cookbook below). Carolyn also shared that her facility has recently improved meals by adding a salad bar to the regular menu. She says residents can also order al carte and that "this makes the meals and dining much more pleasant." Carolyn also shared that her favorite recipe is homemade noodles served over dressing and mashed potatoes.
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Caregiving Thrives at an Intersection of Faiths

Image representing New York Times as depicted ...Image via CrunchBaseby Jane Gross

Amid the fiery national debate over the limits of religious tolerance — and a veteran myself of the never-ending frustration of family caregivers that aides are often too overwhelmed to do their jobs properly, assigned too many patients and sometimes just plain not cut out for the work — I was touched by their solicitude. Aides of all denominations — Baptist, Roman Catholic, Seventh Day Adventist — tended lovingly to these elderly Jewish men and women, Holocaust survivors among them, although fewer with each passing year.

One would like to think that caring for the elderly universally brings out the best in people, and always transcends religious and cultural barriers. That has been my experience most of the time but, alas, not always. This holiday lifted my heart.

“God created people,’’ Rabbi Hirschhorn reminded me. “God did not create religion. People created religion.’’
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All Cancer Therapies May Impair Memory from MedPage Today

By Ed Susman, Contributing Writer, MedPage Today

Cognitive impairments associated with breast cancer treatment are not limited only to "chemobrain," but may occur with radiation or hormonal therapies as well, a researcher said here.

About 14% of individuals who had undergone therapy for a variety of cancer diagnoses complained of post-therapy memory loss compared with 8% of individuals who had not received cancer treatments (P=0.001),

"Chemobrain is sort of a misnomer, because we observed this memory-loss phenomenon among people who have undergone chemotherapy, radiation therapy or hormonal therapy for treatment of various types of cancer," Jean-Pierre told MedPage Today during a poster session here at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities.
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