Governor Rips Nursing-home Lobby, Says Tax Cut Possible in '12

By Joe Vardon - THE COLUMBUS DISPATCH

In a suburban Cincinnati facility where tooling for engines used by the military is made, Gov. John Kasich unleashed a volley of verbal missiles at Ohio's nursing-home lobby yesterday.

Kasich, whose speech was scheduled as an event to stump for his two-year, $55.6 billion budget proposal, also said that if the state holds the line on spending this year, "we will have a tax cut next year."

The governor declined to disclose the type or amount of tax cut after his speech. He has in the past floated the idea of eliminating Ohio's income tax.

But Kasich was largely focused on the nursing-home lobby, which got his attention with an ad paid for by the Ohio Health Care Association that began airing on Friday.
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Leadership Council of Aging Organizations Consensus Statement on Older Americans Act Reauthorization

Introduction by LCOA on its consensus recommendations:

The Older Americans Act (OAA) is the major federal discretionary funding source for home and community-based services for older adults. Programs supported through the OAA include home-delivered and congregate nutrition services, in-home supportive services, transportation, caregiver support, community service employment, the long-term care ombudsman program, services to prevent the abuse, neglect, and exploitation of older persons, and other supportive services. These programs provide vital support for those older adults who are at significant risk of losing their ability to remain in their own homes and communities, or who need support and protection in long-term care facilities.

In addition, OAA funds resource centers that support the work of the aging services network, these resource centers address a variety of needs, including access to benefits, elder justice, multigenerational service and volunteering, legal services, financial literacy, long-term care ombudsman training, and targeted services to minority and special populations in need.

To develop and implement the wide array of OAA services, a system of federal, state and local agencies and organizations, known as the Aging Network, was established. The core of the Aging Network is the U.S. Administration on Aging (AoA), 56 State and Territorial Agencies on Aging (SUAs), 629 Area Agencies on Aging (AAAs), 246 Title VI Native American and Native Hawaiian aging programs, and more than 30,000 community-based service provider organizations. This critical aging infrastructure is the backbone of our nation’s home and community-based long-term services and supports system offering assistance to older adults. The Aging Network’s activities also benefit other populations such as people with disabilities and caregivers.

Supported by the OAA, the Aging Network has successfully served millions of older adults in the community and in long-term care facilities since 1965, and is positioned to assist the country’s growing aging population to remain healthy, active, and in their communities. With each reauthorization, the OAA has been adapted to meet the changing needs of this growing population, the changing role of family supports, and expanding research and technological advances, often with inadequate funding. Further, the Aging Network and its services have the potential to save the Medicare, Medicaid, and Veterans Administration programs billions of dollars each year by enabling older adults to stay in their homes and communities and out of hospitals and long-term care facilities.

This current reauthorization provides an opportunity to reassess the successes and shortcomings of the OAA’s ability to serve older Americans, particularly those with the greatest social and economic need. In these times of fiscal restraint, the Leadership Council of Aging Organizations (LCAO) offers in this document recommendations for improving the efficiency and effectiveness of the OAA in its delivery of core services and how it interacts and coordinates with other federal programs that serve older adults.

In order to maximize effectiveness, community-based services provided through the Aging Network must be coordinated and integrated with the various federal health care services that older adults receive. In addition, they must work hand in glove with other programs at the state and federal levels such as the Low-Income Energy Assistance Program (LIHEAP), fraud prevention programs, Senior Corps and other programs promoting community service, transportation programs, the State Health Insurance Assistance Program (SHIP), the Adult Protective Services Program and other elder abuse-related programs.

The goal of the following LCAO recommendations is to authorize the AoA, the Assistant Secretary, and the programs and staff across the nation to fulfill their promise by giving them the tools, direction and flexibility to provide the services that the aging population of our nation demands. Our focus is on person and family-centered care with local flexibility to serve the needs of unique communities and sub-populations. LCAO’s recommended improvements do not require major changes to the OAA’s core services or eligibility requirements. LCAO strongly believes that increasing the authorized funding for all titles of the OAA is necessary; however, provision of adequate funding is just one of the ways that we propose to improve and expand services. Additionally, any new programs added to OAA should be given specific authorization levels.

With the population of older individuals expected to grow exponentially in the coming years, the aging network faces incredible challenges associated with the influx of older individuals into OAA programs. The LCAO, which has played a significant leadership role in past reauthorizations, is committed to a reauthorization that will strengthen the OAA for both the older adults currently receiving services and for the boomers who, in 2011, have begun turning 65 years of age.

We urge Congress to update and improve the Older Americans Act, while providing the funding needed for OAA programs to keep older Americans independent and productive, thereby saving federal and state government resources. Therefore, the LCAO makes the following recommendations to strengthen and enhance the OAA.

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Medicine-On-Time Shown To Reduce Likelihood Of Nursing Home Admission By 66 Percent

In a new study published in The American Journal of Geriatric Pharmacotherapy, researchers from the University of South Carolina School of Public Health found that the use of the Medicine-On-Time medication delivery technology reduced the likelihood of nursing home admission by 66 percent.


The study assessed the impact of a medication adherence management program on nursing home admissions. Medicine-On-Time's medication management system helps ensure that medications are taken properly through the use of patient-specific customized packaging.


This study found that the pharmacy-based calendar card dispensing system and coordinating service, which was designed to facilitate medication adherence, can reduce medication management issues, address problems as they arise, and reduce nursing home admissions of community dwelling, nursing home-eligible patients. With nearly 1.5 million residents in nursing homes, the widespread implementation of a medication management system could potentially save the healthcare system billions of dollars per year by avoiding unnecessary nursing home admissions.

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Establishing a Person-Centered Culture in a VA Nursing Home

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by JOHN DAVY

The Veterans Administration has taken up the model of person-centered care, asking administrators throughout its health care system to modify their facilities and train their staff accordingly. Staff from the VA’s newly-renamed Haley’s Cove Community Living Center (HCCLC) in Tampa, Florida recently published a case study on their own shift to the patient-centered model.

HCCLC assigned an ethics committee responsible for providing oversight and education on patient autonomy, and which reviews ethical issues that arise in providing care. The case study provides examples, including a resident asking to stay outside on the patio on sleepless nights. The case study presents how the committee and staff established a plan to encourage the resident’s autonomy without putting him or other residents at risk. Other examples include allowing residents more choice in diet and dining, and providing support for residents who want to dine out.
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What Is Nursing Home Quality and How Is It Measured? - The Commonwealth Fund

Authors: Nicholas G. Castle Ph.D., M.H.A., A.G.S.F., and Jamie C. Ferguson, M.H.A.

Journal: The Gerontologist, August 2010 5(4):426–42

Contact: Nicholas G. Castle, Professor, Graduate School of Public Health, University of Pittsburgh, castlen@pitt.edu

Summary Writers: Jennifer Dunham

The Issue

Numerous indicators are used to assess the quality of nursing home care, and there are many initiatives focused on quality improvement in nursing facilities. Questions remain, however, about the accuracy and effectiveness of these indicators and initiatives. Meanwhile, quality problems remain common.

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What the Study Found

The authors reviewed a range of quality indicators and improvement initiatives, including those used in the Facility Quality Indicators Profile Report, the federal Nursing Home Compare Web site, the Advancing Excellence in America’s Nursing Homes campaign, and deficiency citations issued as part of the Medicare and Medicaid certification process. Their analysis shows that all employ a mixture of structural, process, and outcome measures, "each of which has noted advantages and disadvantages."

Looking ahead, the health care reform law will require nursing homes to disclose ownership and financial information, as well as quality data on a Web site. Additional steps recommended by the authors include integrating nursing homes with the larger system of long-term care, enhancing current quality improvement initiatives, and upgrading the nursing home certification process.

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Conclusions

Improvements in nursing home quality have "likely occurred," the authors conclude, but more improvements are still needed.

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Iowa Senior Care Advocate's Job Plan, Silence Are Questioned | The Des Moines Register | DesMoinesRegister.com

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Written by CLARK KAUFFMAN (ckauffman@dmreg.com)

Iowa's top advocate for seniors in nursing homes wants to have her job performance evaluated by the industry she oversees.

At the same time, the director of the Iowa Department on Aging is telling the state's eight local long-term care ombudsmen that they should not speak out about a recent dramatic cut in the number of state nursing home inspectors.

"That is unconscionable," said John Tapscott, a former state legislator who now advocates for the elderly. "You can't tell our ombudsmen not to speak out on the issues that affect their constituents."

According to federal law, each of the nation's long-term care ombudsmen is to advocate independently for the elderly residents of care facilities - a job that historically has put the ombudsmen at odds with both nursing homes and state regulators.

But new questions are being raised about whether Iowa's ombudsman, Jeanne Yordi, is working independently or advocating effectively for the elderly.

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Related articles:
Seniors' advocate must be independent
Iowa long-term care ombudsman's tie to lawyer questioned

Georgia Woman Certified as World's Oldest Person

Image via CrunchBaseGeorgia's 114-year-old Besse Cooper got a visit from Guinness World Records to certify her as the world's oldest living person.

Surrounded by family, Cooper accepted a plaque during a small ceremony at a Monroe nursing home Thursday morning.

Her son, 75-year-old Sid Cooper, said previously that relatives never imagined she would live to be the world's oldest person.
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Locals Protest Cuts to Medicaid | NevadaAppeal.com

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By Geoff Dornan

Local officials on Wednesday protested human services cuts in the governor's proposed budget they say will cost counties nearly $50 million a year.

The biggest piece reviewed is a change in the Medicaid long-term care funding formula local officials say will cost them $20 million a year.

Medicaid provides long-term care beds for those unable to take care of themselves. The reductions are made by changing the complex formula for determining state funding for those Medicaid recipients in long-term care facilities. Under the current formula, the state, federal money and local governments share the cost of caring for those disabled people.

Charles Duarte, administrator of Health Care Financing and Policy, told a joint Senate/Assembly subcommittee the long-term care change saves the state $37 million over the biennium.

“A county cannot pay more than its budget,” said Mary Walker, lobbyist for Carson, Douglas, Lyon and Storey counties. “We'd be deciding whether to lay off police and firefighters or kick these people out of their beds. That would be a terrible choice.”
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States Turn to Private Insurance Companies for Managed Care - USATODAY.com

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By Phil Galewitz Kaiser Health News

Desperate to rein in rising Medicaid costs, Tennessee last year became the sixth state to require its frailest and costliest patients — the elderly and disabled who need long-term care — to enroll in managed care plans.

At least 10 other states, including Florida, Maryland, New Jersey and Rhode Island, are considering introducing or expanding the use of managed long-term care. The trend is sparking opposition from the nursing home industry and raising some concerns from AARP and other patient advocates.

Traditionally, states pay Medicaid providers, such as doctors and nursing homes, directly for individual services. But many officials say that system makes it hard for them to predict and control Medicaid spending. Under managed care, states pay health insurers a fixed monthly fee for each Medicaid patient. The lump sum is used for all the patient's costs, including physician and nursing home care.

Managed care companies, including UnitedHealthcare and Wellcare Health Plans, say they can save money for states by keeping Medicaid patients who need long-term care at home, whenever possible, rather than in more-expensive nursing homes. They use care coordinators to monitor patients to help ensure they're getting the right care in the most appropriate setting.

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Capitol Weekly: Opinion: California Should Take the Lead in Reducing Long-term Care Costs

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By David Kieffer

For those of us who work in long-term care, California’s budget crisis can be viewed in two ways – as yet another devastating blow to the seniors and people with disabilities we care for – or as an opportunity to get things right. Which of these views turns out to be accurate will depend on the choices we make.

Formulaic cuts to hours or types of services are not the right approach. The necessary search for savings has the potential to help California develop a more forward-looking approach to long-term care, but only if we go about it strategically. We need to use the federal funds available to us and expand the savings we have already achieved by taking more aggressive measures to care for more people at home instead of in more expensive institutions.
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Lobbyists Favored Over Elderly | The Indianapolis Star | indystar.com

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The 2011 version of the Indiana General Assembly has taken on such volatile issues as gun rights, abortion, same-sex marriage and immigration.

This week, lawmakers confront throngs of protesters drawn to the Statehouse by bills dealing with labor unions.

Education reform legislation also has sparked heated debate.

So how is it that a bill aimed at improving Indiana's nursing home care has been deemed too controversial?

It's more likely that the power of the nursing home lobby is the real reason why state Rep. Clyde Kersey's bill to require minimum staffing levels is unlikely to get a hearing before the House Public Health Committee.

The chairman, Rep. Tim Brown, R-Crawfordsville, told The Star's Heather Gillers that it would be pointless to "put people through the struggle of such divisiveness" when consensus on the Terre Haute Democrat's bill is a long shot.

"Dead on arrival" is how an industry spokesperson put it.
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Mather LifeWays Institute on Aging Identifies 10 Senior Living Trends | Aging In Action

by Linda Hollinger-Smith - Aging In Action blog

Mather LifeWays Institute on Aging derived 10 top senior living trends after surveying 600 senior living organizations representing more than 1,000 communities from 15 states. Trends indicate that older adult living communities and care providers must anticipate and cater to the personal needs and interests of residents by offering options beyond the basics and include more comprehensive provision for in-home care.

Trends are identified to allow developers and providers to address opportunities and create innovations to help shape the future of senior living relative to services, programs, amenities, and design. The ultimate goal is to create environments and lifestyles where people want to live, not where they need to live.

Based on survey results, the following are the top 10 emerging senior living trends.

1, Senior living residents are choosing to “age in place.”

2. Health and wellness programs and services are top priorities.

3. Technology will be key to promoting and sustaining independent lifestyles among senior living residents.

4. Resident programs must focus on meaningful activities and intellectual stimulation.

5. Senior living providers will provide services “beyond” their four walls.

6. Long-term care is transforming to support person-directed care and meaningful relationships.

7. Residents are demanding “customized services” driving the need for senior living providers to offer a customer-driven portfolio of services and programs.

8. Language, perceptions, and attitudes of care providers must be updated to reflect changing older adults’ needs and expectations.

9. Senior living industry may become a hotbed for job creation.

10. Above all, consumers want choices and value.
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PowerUp Friday: Culture change “awakenings” « ChangingAging.org

By Dr. Al Power in the Changing Aging blog

Bill asked me to respond to a profile in The New York Times New Old Age blog Tuesday on Sunrise Nursing Home in Two Harbors, Minn, highlighting their work in reducing psychotropic medications in people living with dementia. The resultant “awakenings” of the people coming off the medications has convinced Ecumen, the parent organization, to bring the approach to 15 other nursing homes in the state.

At Sunrise, all 10 people who were taking antipsychotics successfully stopped the medication. This validates several studies (heretofore largely ignored by the medical press), which have shown that, with targeted interventions, the vast majority of people in nursing homes can have their anrtipsychotic drugs removed, with no objective evidence of worsening behavioral distress.

The key for Sunrise was to enlist the entire staff of the home in understanding and learning how to connect with and respond to the needs of the elders–a sort of cross-training in dementia. They also added two staff for this home of 60 elders, costing about $75,000 in annual salaries. But the price of the 10 antipsychotic drugs alone is at least half that annually, not to mention the decreased distress and increased well-being that resulted. A small price to pay indeed.

Kudos to Sunrise for their courageous leap forward, and for getting the word out through the New Old Age blog. It is critical that we educate both the public and long term care providers that there is a clear alternative to “being a zombie in a nursing home,” as Laurel Baxter, the Awakenings project manager, puts it. I have now corresponded with four Times reporters in the past year, one in a personal meeting, but have yet to see this issue seriously addressed in the print version.

In the article, Dr. Mark Lachs of Weill Cornell Medical College made the important observation that these drugs “get perpetualized, like insulin”. I often tell audiences that these drugs are highly addictive–not to the person with dementia, but to the families and care staff.

The article continues to perpetuate some ideas, however, which I believe to be patently false. One is that the medications still have an important role in soothing some people’s distress. While the drugs may be occasionally needed in emergency situations, they will never correct unmet needs, and should never be seen as helping a person attain well-being. The “soothing” is primarily sedation–it is almost never an answer to the real problem.

The other is the notion that these “behaviors” are an inevitable result of brain disease. I believe they are the result of a mismatch between the needs of a changing individual and an environment that is inadequate to meet those needs. As I’ve said before, it’s like expecting a paraplegic to walk, and then sedating him when he gets frustrated that we won’t give him help for his disability.

Last week, Dr. Richard Taylor came to town and reminded us that “I am not dying of a fatal disease; I am living with a chronic disability.” However you choose to classify dementia, this view creates a whole new paradigm for helping each person achieve her or his highest practicable level of well-being. That will never be found in a bottle.

– Dr. Al Power is author of Dementia Beyond Drugs and a weekly contributor to ChangingAging.org


PowerUp Friday: Culture change “awakenings” « ChangingAging.org

Clearing the Fog in Nursing Homes - NYTimes.com

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By PAULA SPAN

“What’s people’s biggest fear? Being a ‘zombie’ in a nursing home,” said Laurel Baxter, the Awakenings project manager.

Any visitor can see what she means. Even in quality nursing homes, some residents sit impassively in wheelchairs or nod off in front of televisions, apparently unable to interact with others or to summon much interest in their lives. Nursing home reformers and regulators have long believed that this disengagement results in part from the overuse of psychotropic medication to quell the troublesome behaviors that can accompany dementia — yelling, wandering, aggression, resisting care. For nearly 25 years, federal law has required that psychotropic drugs (which critics call “chemical restraints”) be used only when necessary to ensure the safety of a resident or those around her.

The drugs can cause serious side effects. Since 2008, the Food and Drug Administration has required a so-called black box warnings on their packaging, cautioning that they pose an increased mortality risk for elderly patients. Nevertheless, a national survey reported that in 2004 about a quarter of nursing home residents were receiving antipsychotic drugs. (Among the antipsychotic drugs most commonly used in nursing homes are Risperdal, Seroquel and Zyprexa.)

Though they may be prescribed less frequently following the F.D.A.’s warnings, these drugs are still overused in long-term care, said Dr. Mark Lachs, chief of geriatrics at Weill Cornell Medical College. And once the pills are prescribed, residents keep taking them. “They get perpetualized, like insulin,” he told me, even though the behaviors they’re meant to soothe may wane anyway as dementia progresses.

“If a place is understaffed, if it takes particularly unruly patients, you can see how it happens,” Dr. Lachs added. “Behavioral interventions are far more time-consuming than giving a pill.”

Nevertheless, Ecumen’s Awakenings project emphasizes nondrug responses. “Medications have a place, but that shouldn’t be the first thing you try,” said Eva Lanigan, director of nursing at the Two Harbors facility.

So the home trained its entire staff (housekeepers, cooks, dining room servers, everyone) in a variety of tools to calm and reassure its 55 residents: exercise, activities, music, massage, aromatherapy. It taught people the kind of conversation known as “redirecting” — listening to elders and responding to them without insisting on facts that those with dementia can’t absorb or won’t recall.

“The hands-on, caring part is the most important,” Ms. Lanigan said. “Sometimes, people just want a hug. You sit and hold their hand.”

At the same time, consulting with a geriatric psychiatrist and a pharmacist, the home began gradually reducing the doses of antipsychotics and antidepressants for patients whose families agreed. Among them: the woman with the mysterious cries.

As Dr. Lachs pointed out, behavioral interventions are labor-intensive. Two Harbors hired an additional nurse to oversee those efforts, and Ms. Lanigan was available to answer staff questions around the clock. Ecumen estimates that introducing the program to a 60-bed nursing home cost an additional $75,000 a year for two full-time employees.

The results startled even the believers, however. Every resident on antipsychotics (about 10) was able to stop taking them, and 30 to 50 percent of those taking antidepressants also did well without them. When drugs still seemed necessary, “we tried to reduce them to the lowest dose possible,” Ms. Lanigan said.
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Nursing Home Med Errors Vary by Form of Drug

By Michael Smith, North American Correspondent, MedPage Today

Residents in nursing and old age homes are four times as likely to get an incorrect dose of medication if it's in liquid rather than pill form, researchers reported.

In a study in 55 British homes, errors included such things as incorrect measurements and not shaking a suspension, according to David Phillip Alldred, PhD, of the University of Leeds in Leeds, England, and colleagues.

Errors also were more likely with inhalers and other drug formulations, compared with pills or tablets dispensed using a monitored dosage system, Alldred and colleagues reported online in BMJ Quality and Safety.

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Immigration Reform: A Key Retirement Issue - The Best Life (usnews.com)

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By Philip Moeller

With Social Security and Medicare programs facing deficit-cutting proposals in the new Congress, seniors and their advocacy groups already have big issues on their plates. Yet a good case can be made that immigration reform is another emerging issue for millions of seniors who need care. The shifting outlook has several components—rising demand for care due to a growing elderly population, a sustained effort to provide elder care in homes rather than institutions, a shrinking work force of Americans, and an economic recovery that will eventually reduce the supply of family members available to provide unpaid care.

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Moving Out of Nursing Home Care; Independent Assisted Living - AARP Bulletin

by: Cynthia Ramnarace | from: AARP Bulletin

For eight years, Thomas Smallwood got around relatively well for a man with no legs. Poor circulation had led Smallwood, 63 at the time, to a difficult choice: his legs or his life. He chose the latter. You don't need legs to be a man, he thought. The man makes the legs.

Smallwood was among as many as 12 percent of nursing home residents — 168,000 out of the 1.4 million — designated "low-need," meaning that the assistance that they do need could conceivably be delivered in their own homes or in assisted living. And according to a recent November 2010 pilot study by researchers at Cornell University, more than half of that low-need population could transition back into the community with the right social supports.

"People just assume that a nursing home is a one-way street," says Rhoda Meador, associate director of outreach and extension at Cornell's College of Human Ecologyand author of the study. "But many practitioners don't accept that."
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Nursing Home Closures Concentrated in Poorest Areas | Brown University News and Events

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A nationwide study of nursing home closures finds that the country has lost 5 percent of its beds, and that closures are twice as likely in the poorest areas than in the richest areas. Researchers say this will mean less access to nursing home care for the people – particularly minorities – who still depend on it.
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Aged Care Bonds Must Be Capped - Australian Nursing Federation

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The Australian Nursing Federation says media reports of aged care residents paying up to $2 million in bonds highlights the urgent need for reforms that ensure equity of access and quality of care.

ANF federal secretary Lee Thomas said the reports allude to the competitive nature of the current system with differing levels of quality and care offered by residential facilities.

"When you hear about some people paying up to $2 million in bonds to secure a place in a residential aged care facility that is reputed to have good staff levels and infrastructure it rings alarm bells. Bonds should be capped to ensure some level of equity."

Ms Thomas said the current review of the aged care system must ensure all older Australians have access to high quality nursing care in accommodation that is comfortable and structurally sound.

"The major concern we have with the recent Productivity Commission report is the fixation on financial matters and the lack of attention to staffing and skills mix.

"While we all recognise the need for adequate funding for bricks and mortar and the need for people to contribute to the cost of their care if they can, we also want a safety net for those who can't afford to pay," Ms Thomas said.

One of the key issues in guaranteeing equity in access and care lies in addressing the staffing and working conditions in the sector, according to the ANF.

"We don't want to end up with a system that provides high quality care for those who can afford to pay and an inferior service for those who can't."

Source:
Australian Nursing Federation

Occupancy and Revenue Gains from Culture Change in Nursing Homes

by Saher Selod

Long-term care communities are undergoing innovative changes in order to improve the quality of life of their residents. “Culture change” is an example of a new practice being implemented in many of the communities around the United States. One of the ways long-term care communities are changing is by moving from a “provider-directed” model (focusing on the institution) to a “person-centered” model where the residents are able to participate in the majority of their daily decisions.
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