Grandma's Vital Signs on Your Phone

by Eric Bogatin

Automated home health monitoring may finally become practical with the HealthTune 360 from Boston LifeLabs. Cambridge, Mass. start-up Boston LifeLabs recently announced a new product for at-home health monitoring, which the company plans to make available within a few weeks in the U.S. pending FDA approval.

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Marki Flannery: Home Health Aides: On the Front Lines of Caregiving

by Marki Flannery

Although home health aides provide assistance with all the "stuff" of daily life, the job of a home health aide cannot and should not be done by just anybody -- contrary to all-too-popular belief. Trained home health aides are highly skilled, compassionate caregivers; every day they man the vital front lines of healthcare for vulnerable seniors and others who are not stable enough to be on their own. These talented aides are the best offense for keeping at-risk individuals out of the hospital and living safely and as comfortably as possible in their own homes.

A good home health aide knows that daily activities -- bathing, dressing, eating, sleeping -- are really barometers of health. Subtle changes may indicate deteriorating health or issues with medication.

• If a patient is eating less or sleeping more than usual, do medications or dosages need adjusting?
• If the patient did not previously need help dressing and now does, has his or her condition degenerated?
• If a patient is refusing to bathe, are there emotional issues that need addressing?

A well-trained home health aide is much more likely to notice changes in a patient's behavior or well-being and act immediately and appropriately.
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Nationwide Poll: Americans Say No To Medicaid Cuts

Coming on the heels of a major research report finding that long term care is paid less on an hourly basis than the national minimum wage, a new nationwide poll shows that 65 percent of Americans would oppose further cuts to funding for long term care.

"As a former governor, I know firsthand the difficult decisions lawmakers face during these tough economic times," stated Governor Mark Parkinson, President & CEO of the American Health Care Association (AHCA). "Despite the nation's fiscal difficulties, the American people are very clear on where they don't want cuts - at the expense of the frail and elderly."

According to the survey results, there is broad concern among likely voters of the impact inadequate funding - specifically Medicaid - has on the nation's seniors. Supporting those concerns, researcher Eljay yesterday release new projections showing that state Medicaid programs underfunded nursing facility care by $5.6 billion in 2010 - on average paying only $7.17 per hour per patient, less than the national minimum wage of $7.25 per hour.

"America's greatest generation deserves a secure health care delivery system," concluded Parkinson. "This poll shows the bottom line fact that Americans recognize the critical importance of stable funding for the care of seniors in our facilities."

The survey was conducted by Zogby International via an interactive poll of 2,067 likely voters from 1/7/11 to 1/10/11 and has a margin of error of +/- 2.2 percentage points.

Top-line results of the survey from Zogby include:

About two-thirds of likely voters (65%) say they oppose policies that resulted in cuts to Medicaid funding for nursing home care for America's poor and elderly. A plurality (40%) say they strongly oppose such cuts to nursing home care.

A strong majority (66%) say they would oppose policies that resulted in additional cuts to Medicare funding for nursing home care for seniors, with 39% saying they strongly oppose such action.

Nearly three-quarters of likely voters (72%) say the Federal Government's role in helping states meet their financial obligations to cover programs such as Medicaid is important, with nearly half (45%) saying it is very important.

Nearly two-thirds (65%) of likely voters say they support extending additional Medicaid funding to state governments in response to state deficits and economic difficulties, with a third (33%) saying they strongly support such action.

To access the full poll results or the analysis from Eljay, A Report on Shortfalls in Medicaid Funding For Nursing Home Care, please visit here.

Source:
American Health Care Association

Health Business Blog » Since When Is a Co-pay The Cure For Fraud?

by David E. Williams

Medicare coverage for home care visits has a checkered history. The original rationale for including home care in Medicare was straightforward and compelling: it’s much cheaper, healthier and pleasant for a patient to be at home receiving skilled care than to stay in a hospital for lack of enough support in the home environment. That logic remains solid. Unfortunately it doesn’t mean Medicare spending has dropped with home care coverage in place. That’s because operators of home care agencies don’t see it as their job to reduce Medicare spending and neither do hospitals. Both want to make as much money as possible under the fee-for-service system. Home care ended up being an additional cost to the system, not a cheaper substitute for the hospital.

There have been various attempts to control home care spending. The latest is a 13-1 recommendation by the Medicare Payment Advisory Commission to impose co-payments to discourage unneeded use of home care services.
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Health Care Facility Inspections to be Cut if Fees Not Raised - Las Vegas Sun

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If a panel of elected officials in Nevada rejects a proposal to increase health care facility licensing fees today as it did in October some state healthcare facilities inspectors will lose their jobs and the health care facility inspections will be greatly reduced, state officials said. The proposed fee increases are exponential in some cases, which has caused sticker shock for the facilities. Their lobbyist argues that the state, not the businesses, should bear the financial weight of protecting the public. "This amounts to what somebody calls a 'sick tax,'" said Charles Perry, president/CEO of the Nevada Health Care Association, the lobbying group for long-term care facilities.
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Seniors May Have to Pay for Medicare Home Health

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By RICARDO ALONSO-ZALDIVAR, Associated Press
Medicare recipients could see a sizable new out-of-pocket charge for home health visits if Congress follows through on a recommendation issued Thursday by its own advisory panel. Until now, home health visits from nurses and other providers have been free of charge to patients. But the Medicare Payment Advisory Commission says a copayment is needed to discourage overuse of a service whose cost to taxpayers is nearing $20 billion a year amid concerns that fraudsters are also taking advantage. The panel did not prescribe an amount, but its staff has suggested the charge be $150 for a series of related visits. Medicare requires copays for many other services, so home health has been the exception, not the rule.
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TIME GOES BY | GRAY MATTERS: Lise's Tribute to Her Father, Saul Friedman

Posted by Ronni Bennett in the Time Goes By blog

As you know, Gray Matters and Reflections columnist, Saul Friedman, died on 24 December 2010. He was beloved by his readers, a great man, a great journalist and teacher, someone we could all do well to emulate.

Saul's funeral was held on Tuesday, 28 December, and his family has made some some of the orations, tributes, remembrances and eulogies available to Time Goes By. Over the coming Saturdays, they will be published here in place of his column.

This is from one of his daughters, Lise Friedman Spiegel. Married for 25 years with three children, she is a licensed clinical psychologist where she lives in Encino, California

- Ronni

---

After Mom informed Dad’s oncologist that Dad had taken a sudden turn for the worse and had but days left, the doctor said he had never seen a case like Dad’s in all his years. No kidding.

No one has seen a case like this and I am not necessarily referring to his cancer. Personally, I keep waiting for Dad to call while he is out chasing down a story.

Many of you know the writer, the speaker, the reporter, the blogger and, of course, the sailor. But, I must express to you what this larger-than-life man, who was NEVER supposed to die, gave me.

There is not enough time for all of those things, but here are some highlights.

First of all, the love for just about anything with four legs, especially dogs. I have never known my father without a dog at his side, on the bed, at the computer, awaiting a treat under the table. Puppies born at the beach in Nags Head and naming a new mutt who we had for 16 years Ringo in 1964.

Dad knew that one of the most moving gifts he gave me a few years ago was a one-month supply of skin medicine ($200) for my debilitated rescued Akita.

It’s no accident that we have four family dogs one of which Mom and Dad had flown first class to California when they could not keep her.

Then, there are the Beatles. Dad came home one day in 1964, when I was six years old and said, “I think these kids are something special. Listen.” You know the rest.

And when Paul McCartney married Heather just a few years ago, Dad called me with condolences.

And when I was a little girl and he thought I was ready to understand it, he took me to a movie theater to see Gone With the Wind. Well, no one since has looked up a staircase like Clark Gable did and that one of my daughters is named Melanie is no accident. It is still my husband’s and my favorite film of all time.

Then there is the love of music, all kinds of music - classical, good rock, folk, bluegrass. We went to concerts and bluegrass festivals and, of course, Dad’s love for singing and playing the guitar shaped so much of my future.

He came to my concerts and recitals and paced because he wanted so much for them to go well. A friend of mine sent me an email yesterday which recalled his tears of pride as I performed solo in Carnegie Recital Hall because she watched him as he listened between bouts of pacing.

And all the while, Dad made sure [my sister] Leslie and I remained aware of the world around us, reading the newspaper, socially conscious and willing to make sacrifices to follow our beliefs.

What other father would make sure their child missed much of 6th grade to work at the Vietnam Moratorium Committee and demonstrate against the war in October and November 1969?

What other father would get a long-term press pass to make sure I could sit in the gallery every day during the Watergate hearings?

And what other father would make sure I was sitting behind Ted Kennedy at the Democratic convention in 1980 when he made one of his finest speeches?

And how many kids can say that they met presidents, went to White House Christmas parties and correspondents’ dinners? I know the answer.

A few stories:

In 1972, Dad took me out of school to hang out with him for the last two weeks of the Nixon-McGovern presidential race. I traveled all over Michigan and some of Canada, for fun, ending up in the Detroit Free Press newsroom to await election results.

It was such a sad time, but a time that I had with him as he worked and taught me how the election process worked and why the obvious man should win. And I was so proud when Nixon put Dad on the infamous White House enemies list which, appropriately, took up residence on our bathroom door.

I was celebrating my 16th birthday and Dad wanted to take me out, just the two of us, to a fine French restaurant in Gerogetown, Lion d’Or. He bought me a dress and shoes and we went.

He said I could order any drink I wanted so, like a big girl, I ordered a scotch on the rocks. At the next table was a senator who Dad went out of his way to introduce me to. I do not remember what I ate, but I so remember how that whole evening made me feel.

Then, at the beginning of 10th grade, he and Mom took me out of school to travel in England, Scotland and Wales for two months because he thought traveling was a better education than sitting in a classroom. I learned British history, a love of horse riding on the Scottish moors and that schooling shouldn’t interfere with one’s education.

Finally, as Dad coped with the effects of his stroke, his esophageal cancer and this last cancer, he showed everyone that each day can be valuable and productive if one has love, especially in the form of my mother, sister and brother-in-law, resilience and an open mind to change which, for a man in his 70s into 80s, was extraordinary.

He showed the African bush to his family for his 80th birthday and just notice the car he and Mom bought last July and drove to New York together six weeks ago.
But that is just what he was and will remain for me: simply extraordinary, full of love, life and adventure no matter what came his way.


TIME GOES BY | GRAY MATTERS: Lise's Tribute to Her Father, Saul Friedman

(A number of Saul Friedman's articles have been posted by Aging and Disability in America
-- Jim)

HomeHealthcare Monitoring Technology Estimated to Be Worth $10 billion

Companies across the world are working to develop innovative solutions for the aging populations of Europe, the United States and Canada. Many of these products and services for baby boomers are designed to enable older adults to live independently during their golden years.

One new report conducted by the Swedish analyst firm Berg Insight has estimates that this emerging market is worth $10 billion in 2010. New devices that utilize wireless technology are also being created for this industry.

"Progress is being made in the adoption of wireless technology among manufacturers of medical monitoring equipment, but there is still a long way to go before remote monitoring becomes a standard practice in the healthcare sector," said senior analyst André Malm, according to HealthcareITNews.com.

He predicted that health-related apps will be released for smartphones in increasing numbers, making mobile health programs (mHealth) more accessible. "The number of apps focusing on chronic disease management is however still relatively low," he explained.

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Medicare Coverage Standards Are Too Strict, Courts Find - NYTimes.com

Image via CrunchBaseby Robert Pear
Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older
Americans are entitled to Medicare coverage of skilled nursing home care and home health care.

Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said.

Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.

The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer’s disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person’s condition is stable and unlikely to improve, the courts said.
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When the Family Needs an Umpire - NYTimes.com

Image via CrunchBaseBy JOSHUA TAPPER

The home care aide didn’t expect her new charge to be particularly cantankerous. After all, she had worked for the elderly woman’s sister for four years, and they’d gotten along well.

But the new relationship was rocky from the start. More than once the aide received confusing calls from the 88-year-old woman late at night. She traveled to the woman’s apartment on the Upper West Side, only to be met with a curt “What’s going on? Why are you here?” The older woman, bedridden and recovering from a broken hip, repeatedly told the caregiver to leave because she didn’t need help.

Frustrated and angry, the aide threatened to quit. That’s when the patient’s family called in Joy Rosenthal, an elder mediator.

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California has paid scores of criminals to care for vulnerable residents - latimes.com

By Evan Halper

Scores of people convicted of crimes such as rape, elder abuse and assault with a deadly weapon are permitted to care for some of California's most vulnerable residents as part of the government's home health aide program.

Data provided by state officials show that at least 210 workers and applicants flagged by investigators as unsuitable to work in the program are nonetheless scheduled to resume or begin employment.

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PHI – Training | Fall Prevention Awareness

Uniquely designed for adult learners, the Fall Prevention Awareness training curriculum helps home health aides reduce falls and minimize injury to their clients by increasing their awareness of the risk factors for common falls and by enhancing their communication skills.

Specifically, participants build on their existing knowledge and skills by strengthening their “observe, record, report” skills and by developing communication skills that help them address with their clients how to reduce the risk of falling.

This curriculum — a joint project between PHI and NCOA — consists of two three-hour in-service trainings. In addition, each session includes optional pre- and post-testing as well as warm-up and closing activities that can add an additional hour to the training. A complete facilitator guide and handouts for all sessions can be downloaded below.

This project was funded by the U.S. Department of Labor Education and Training Administration.

Download:

• Introduction
  Cover, Table of Contents, Introduction (pdf 180 KB)
• Session 1: Recognizing Risk Factors for Falling
  Five activities plus ten handouts (pdf 777 KB)
• Session 2: Enhancing Skills to Address Risk Factors
  Seven activities plus nine handouts (pdf 341 KB)
• Appendix A
  Session 1 Review: Game Materials (pdf 112 KB)
• Appendix B
  Pre/Post-Tests: Sessions 1 and 2 (pdf 63 KB)
• Appendix C
  Workshop Evaluation Form (pdf 1.2 MB)
• Appendix D
  Simulation Scenarios (pdf 88 KB)

Evaluating Employee Turnover in Home and Hospice Care

by Richard Shank

The number of home and community based services for older adults have grown tremendously over the past 20 years. This has occurred because of a continued shift in government expenditure related to these programs and an increasing desire of older adults to age in place in their homes and/or communities. Because of this growth, it is no surprise that questions about staffing quality and professionalization are now occurring related to home-based care. In response, a new study has compared the turnover rates of home care and hospice agencies among their direct care staff.

This study found that both organizational characteristics and factors related to the local economy often drive turnover in home and hospice care. The findings suggest that focusing on these organizational characteristics will improve retention and care quality. This study also provides direct care turnover rates for care providers in North Carolina.
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No Place Like Home - The New Old Age Blog - NYTimes.com

by Paula Span

Mary Wareheim suffers from a long list of health problems. She’s an amputee who uses a wheelchair. She has diabetes, heart disease, high blood pressure and an irregular heartbeat; she takes 11 prescription drugs. At 83, she leaves home infrequently, perhaps twice a year.

Yet she’s been the hospital just once in six years, probably because she’s had excellent medical care and monitoring. Though she’s essentially homebound, doctors come to her, in the Baltimore house she shares with her daughter, son-in-law and a Great Dane named Murphy, through the Johns Hopkins Elder House Call Program.

“My mother would absolutely make excuses not to go to a doctor,” said her daughter Chris Ricko, 49. “Now she doesn’t have an excuse.”

House calls aren’t a new idea, of course. Johns Hopkins has been sending attending physicians and residents out to see frail, elderly patients in their homes for 30 years. (I remember our family doctor coming to see me, black bag in hand, when I had the measles in my long-ago youth, so I wouldn’t infect everyone in his waiting room.)
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Lawmakers Urge Swifter Launch Of Home Health Care Demo

From Medical News Today

Democratic lawmakers are pushing the Obama administration to launch a Medicare home health demonstration project as soon as possible.

"The so-called Independence at Home (IAH) program, included as part of the Democrats' new health reform law, is scheduled to take effect no later than Jan. 1, 2012, but Sen. Ron Wyden (D-Ore.) and Rep. Edward Markey (D-Mass.) warn that waiting that long would threaten the health of one of the country's most vulnerable populations," The Hill reports. "The lawmakers are pressing the Centers for Medicare and Medicaid Services (CMS) to install the program 'sooner rather than later,' with a target launch within six months." The push may also have a political incentive. "With many seniors wary of the Medicare cuts contained in the Democrats' new health reform law, party leaders are eager to prove that those cuts won't harm the quality of care... It was CMS that, leery of potential complications surrounding implementation, had pushed lawmakers to delay the required launch of the IAH program until 2012" (Lillis, 6/29).

Congressional Quarterly: "Under the three-year demonstration project, people with chronic conditions such as Alzheimer's disease would have primary care provided in their home by teams of providers directed by physicians and nurse practitioners. Seniors with chronic conditions account for 85 percent of Medicare spending and often receive disjointed and badly managed care through the current Medicare system, Wyden and Markey said" in a letter to Medicare administrators. "Organizations that contract to participate are held accountable for producing 5 percent savings in the cost of the beneficiaries' care, but at the same time improving the quality of care and satisfying family members and caregivers. In return, the organization gets a share of the savings beyond 5 percent" (Norman, 6/29).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

Lawmakers Urge Swifter Launch Of Home Health Care Demo

Quality of HF Care Not Better Despite Shorter Stays - from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Although hospital length of stay and inhospital mortality are decreasing for older patients with heart failure, that doesn't necessarily mean quality of care is improving, a large observational study showed.

From 1993 to 2006, length of stay and inhospital mortality significantly decreased in the U.S., but postdischarge mortality and 30-day readmission rates increased -- by a relative 49% and 17%, respectively;Journal of the American Medical Association.
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• For heart failure patients, risk of in-hospital death has decreased; readmission rate has increased (physorg.com)
• The Revolving Hospital Door (online.wsj.com)

PHI – Training | Fall Prevention Awareness

Uniquely designed for adult learners, the Fall Prevention Awareness training curriculum helps home health aides reduce falls and minimize injury to their clients by increasing their awareness of the risk factors for common falls and by enhancing their communication skills.

Specifically, participants build on their existing knowledge and skills by strengthening their “observe, record, report” skills and by developing communication skills that help them address with their clients how to reduce the risk of falling.

This curriculum — a joint project between PHI and NCOA — consists of two three-hour in-service trainings. In addition, each session includes optional pre- and post-testing as well as warm-up and closing activities that can add an additional hour to the training. A complete facilitator guide and handouts for all sessions can be downloaded below.

This project was funded by the U.S. Department of Labor Education and Training Administration.

Download:
PHI – Training |  Fall Prevention Awareness

Medicare's Home Health Pay For Performance Demonstration

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from Medical News Today

The Centers for Medicare & Medicaid Services (CMS) announced that it is sharing more than $15 million in savings with 166 home health agencies (HHAs) based on their performance during the first year of the Medicare Home Health Pay for Performance (HHP4P) demonstration.

The 2-year demonstration, which began in January 2008 and ended in December 2009, was undertaken to show the impact of financial incentives on the quality of care provided to home health patients in traditional fee-for-service Medicare and their overall Medicare costs. Savings in the program are being shared with agencies that either maintained high levels of quality or made significant improvements in quality of care.
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TIME GOES BY | GRAY MATTERS: Medicare Home Health Care

by Saul Friedman in Time Goes By Blog

I learned the hard way: The greatest and the most predictable danger for older people is falling. Too often, a broken hip can lead to a deep and irreversible decline in one’s health or well-being if you don’t get the best of help quickly. For me, I was laid temporarily low by a mild concussion.

Fortunately, for those of us who are eligible, Medicare and Medicaid have made some advances in fashioning benefits that will keep patients at home to mend instead of keeping them in a hospital which can be dirty, dangerous and expensive, or sending them to a nursing home, where the pampering, diapering and surroundings can be even more debilitating.

I hope this is not too basic, but in case you’re a caregiver or a potential patient and you don’t know, or haven’t read the 2010 “Medicare and You” manual, under the Medicare law, after a hospitalization of at least three days – say, for an accident, a stroke or for a broken or surgically mended hip – a patient is entitled to up to 20 days of rehabilitation and therapy in a skilled nursing facility at no cost. (After 20 days the cost is more than $133 a day). The skilled nursing facility, I should add, is not a nursing home. But nurses and therapists are available to help you bathe and dress until you’re able to do so for yourself.

A very important (and inexpensive) alternative, when leaving the hospital or the nursing facility or if you simply need medical help getting over a wound or illness is home health care, which Medicare covers and will cost you nothing. This is one of the best Medicare benefits, although too few beneficiaries or caregivers know about it.

I learned something about Medicare Home Health Care just a few days ago after I took a serious fall from the steep brick steps leading into my home, which left me with bruises, a minor concussion and further impairment of my right arm and leg, which had been weakened by a stroke six years ago. For those of you who are wondering, even six years into a stroke, therapy can help.

That meant I needed trained professionals to look after my recovery from the concussion and to provide physical therapy to get me back on my feet. All it took to get part-time home health care was a prescription from a savvy emergency room physician who wrote in his Rx that the care was “medically necessary.”

As the manual says, “a doctor must order it and a Medicare-certified home health agency must provide it.” That’s especially important for in past years, Medicare cracked down on fly-by-night agencies who charged but didn’t deliver adequate care.

The hospital may recommend an agency, but you should use one that is recognized. In my area, the best is the Johns Hopkins Home Health group.

The home health services may include medical social services, making sure you have help in the home, and part-time or intermittent home health aide services such as checking on a bandage or an IV, administering drugs or simply keeping track of your vital signs and the healing of a wound or a surgical site. The manual says that “you must be homebound” to receive such services, but that means you can leave home to visit a doctor, go to religious services or even go to adult day care.

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Home Care Law Blog: Update on Health Care Reform and Home Health - The Ghost of Christmas Future

NAHC has sent out an update to its members on the effects to home health and hospice of the Manager's Amendment that is currently working its way through the Senate. LIke the Ghost of Christmas Future in A Christmas Carol, it paints a pretty bleak picture. (I apologize for the Christmas Carol references, but I thought I would try to distract from the bad news with a Christmas theme.) According to NAHC, the Manager's Amendment will do the following:

Specifically, the amendment makes the following changes to the home health portions of the overall health reform package:
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