Elder Law Prof Blog

How much less do prescription meds cost in UK? inquiring minds want to know

Summary of the data:

Prescription Cost Analysis (PCA) provides details of the number of items and the net ingredient cost of all prescriptions dispensed in the community in England. The drugs dispensed are listed alphabetically within chemical entity by British National Formulary (BNF) therapeutic class.
Summary

In the PDF file, the number of prescription items dispensed for individual preparations, dressings or appliances is rounded to the nearest 100. There are a very large number of preparations/dressings/appliances where only 50 items or less were dispensed in 2006. While accounting for just under 50 per cent of the total number of preparations dispensed, such preparations covered less than 0.02 per cent of the total items dispensed. In order, therefore, to keep the publication to a manageable size, such preparations have been excluded.

The Excel file also excludes data on products where less than 50 prescription items were dispensed and aggregating data for individual products may not produce the actual totals.

The data in the file for prescription numbers, cost and quantity are given to the nearest hundred. However we would recommend that any data extracted for use is presented to the nearest thousand.

Get report.

Then compare US drug costs.

Costs for nursing home increase at average rate of 7%/year since 2004

Via KFF Daily Health Policy Report:

Costs for nursing homes, assisted living facilities and some in-home care services have increased for a fifth consecutive year and might continue to increase as a result of an expected shortage of long-term health care workers, according to a study released on Tuesday by Genworth Financial, the AP/Houston Chronicle reports. For the study, researchers examined data from more than 10,000 nursing homes, assisted living facilities and in-home care providers nationwide.

The study found that private rooms in a nursing home this year on average cost $76,460 annually, or $209 daily, a 17% increase from $65,185 in 2004. In addition, the study found that assisted living facilities this year on average cost $36,090 annually, a 25% increase from $28,763 in 2004. The study also found that Medicare-certified home health aides this year on average cost $38 per hour and that the cost has increased by 7% annually over the past four years. Non-Medicare certified in-home care providers this year on average cost $18 per hour for homemaker services and $19 per hour for home health aide services, about the same as in 2004, the study found.

Buck Stinson, president of the long-term care insurance business at Genworth, said the study indicates that the "expense of just a few years of long-term care in a facility or at home can very quickly wipe out a lifetime of savings." He added that baby boomers "need to do more thinking about their own retirement plan and how they're going to age."

A companion study released by Genworth found that low wages and benefits, as well as a lack of training and career-advancement potential, have led to problems with recruitment and retention of employees in the elder care industry. Stinson cited a need to "recruit close to 200,000 people a year to keep pace with the aging demographic." In addition, the companion study found that adult day health care this year on average cost $15,000 annually, or $59 daily (Alt Powell, AP/Houston Chronicle, 4/29).

The studies are available online. 

                         

ABA posts health care issues legislative updates

2007 Health Decisions Legislative Summary PDF

Surrogate Consent in the Absence of an Advance Directive - January 2008 PDF

Health Care Power of Attorney and Combined Advance Directive Legislation - January 2008  PDF

Center for Elder Justice and Policy publication: 50 State Survey of Family Caregiver Legislation

The Center for Elder Justice and Policy at William Mitchell College of Law has just published a Fifty-State Survey of state legislation authorizing the use of paid time off for care of an adult family member. The survey was authored by 3L Letty Van Ert in behalf of the Alzheimer's Association of Minnesota-North Dakota. Get the survey in PDF or HTML format.

ALCA hosts free Webinar on assisted living and Medicaid

Medicaid now can pay for assisted living care in more than 30 states.  But the rules vary from state to state, and both facilities and residents often have difficulty in navigating the system.

This session will explain common issues in Medicaid payment for assisted living, and discuss advocacy strategies both for indvidual disputes and for advocacy with state Medicaid agencies.

Eric Carlson, attorney from the National Senior Citizens Law Center (and ALCA President) will discuss his on-going research into Medicaid waiver payment for assisted living care, focusing on those issues of most importance to individual residents.  April Forsythe, with the Division of Community and Institutional Services of CMS, will discuss the federal government's role in administering Medicaid payment for assisted living and in monitoring the care provided by certified facilities.  A panelist to be determined will discuss his or her experiences with Medicaid payment for assisted living in a particular state.

You have two options for calling in.  If you think you might want to ask a question, you can call in at (641) 715-3399, code 666-643-442.  Don't use a cell phone, and it would be best if you have the technology to mute your phone when you're listening.

If you expect to listen only, call in as an attendee at (641) 715-3222, code 687-046-683.

The training will start at 3 p.m. Eastern, 2 p.m. Central, 1 p.m. Mountain, and noon Pacific, on Tuesday April 8.

Title:   Affordable Assisted Living? Advocacy Issues in Medicaid Payment for Assisted Living

Date:  Tuesday, April 8, 2008

Time:  3:00 PM - 4:00 PM EDT

Space is limited.
Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/456620183

Marquette hosts symposium on long term care--March 28

Marquette University Law School invites you to:

The Kindness of Strangers: Enhancing Lives Through Long Term Care

The event will be held at the Marquette University Alumni Memorial Union on Friday March 28th.

Speakers and panelists will address challenges facing the U.S. long term care system.  Some issues include resident centered care, making long term care decisions, and the gap between knowledge and practice.

More information and registration materials can be found here:
http://law.marquette.edu/cgi-bin/site.pl?2216&deEvent_eventID=2024&date=03-28-2008

Also, students are eligible for a reduced rate of $20, which includes breakfast and lunch. 

Any questions?  Email chelsie.allan@mu.edu

<mailto:elderlaw@marquette.edu>

Coalition seeks input on Medicaid waivers for AD and dementia

Via the Eldebar listserv:

A grass roots effort has begun in California around the issue of Alzheimer's Disease (AD) and Dementia's not being covered by Medi-Cal due to a carve out from a Waiver and therefore not considered a mental health condition.  This effort has drawn together professionals from all fields associated with this issue; mental health, Alzheimer's Assn, Universities, Department of Aging and the list continues to grow as more people find out about this effort. Our objective is to look at best practices in States where people with Alzheimer’s disease are able to be served through Medicaid when psychiatric or Mental Health services are needed in addition to their medical care.  We are thinking particularly of people who become extremely agitated, anxious or aggressive, and may need more than usual help with combining/dosing and orchestrating psychotropic medications, or even allowing for short term, in-patient medication management in a psychiatric setting.  Are there states where they are successfully paying for and providing this type of crossover care for people who already have a diagnosis of AD, and are not dual diagnosis?

Send your responses directly to Shirley Krohn, Senior Assembly Member, California Senior Legislature at skrohn9520@aol.com   

 

Minn. non-profit to offer LTC resident dental plan

A Minnesota nonprofit group has announced a pilot program that offers dental insurance specifically designed for long-term-care residents and their families.  Care facilities that join will offer the insurance, said Dr. Michael Helgeson, chief executive officer of Apple Tree Dental.  The nonprofit group will refer patients to their regular dentists. If a patient doesn't have a regular dentist, Apple Tree will provide dental care on-site.  The insurance plan was announced Thursday night. The organization will start providing mobile dental service in July to residents of Rochester-area nursing homes, assisted-living facilities and homes for people with special needs, Helgeson said. The insurance will be offered only in the Twin Cities and Rochester area at first, he said.  The dental plan has no deductible and covers fillings, single dentures, crowns, root canals and treatment for gum disease at 100 percent. There are additional costs if the annual maximum of $2,000 is exceeded.  It's less expensive to provide dental insurance than to pay for staff and transportation for one dental visit outside a nursing home, Helgeson said.

Source/more:  Rochester MN Post Bulletin, http://www.postbulletin.com/newsmanager/templates/localnews_story.asp?a=329671&z=2

CMS fingers the worst nursing homes for bedsore and other appalling stuff

Last week the Centers for Medicare & Medicaid Services publicly identified over 4000 nursing homes - more than 25% of facilities nationwide - whose residents are physically restrained, or have pressure sores, or both, in excessive numbers. This should be a call to action to both Congress and the Centers for Medicare & Medicaid Services."What's needed to avoid pressure ulcers and physical restraints is a sufficient number of well-trained certified nurse assistants, accompanied and supervised by a sufficient number of registered nurses," said Senior Policy Attorney Toby S. Edelman with the Center for Medicare Advocacy. "With CMS reporting that more than 90% of nursing homes do not have sufficient staff to meet residents' needs, it is time for Congress to enact legislation mandating comprehensive and meaningful nurse staffing ratios," continued Edelman. "For its part, CMS needs to take stronger enforcement action whenever it finds facilities short-changing their residents and providing them with less care than they need."

Source: Center for Medicare Advocacy.

Get list: http://www.cms.hhs.gov/QualityImprovementOrgs/Downloads/NursingHomeChart.pdf

CA sues to revoke assisted living facility license

The California Department of Social Services has filed a lawsuit to revoke the license of Paragon Gardens, an assisted living facility managed by the Oregon-based Sunwest Management, and to exclude some of the company’s executives from providing care and services to residents of any facility licensed by the Department.  The state’s “more horrific allegations are that a dementia client left the facility unnoticed and was never found, that staff members slept during their shift, that the facility was infested with mice who left dropping in the client’s food and that staff did not understand the meaning of incontinent care and were unable to provide such care.”  Among other deficiencies the State cited insufficient staff in June 2005, November 2005, January 2006, June 2006, and August 2006.  Sunwest Management is one of the largest managers of residential care facilities in the United States, with about 150 facilities in 35 states, including 15 in California.  A private class action lawsuit has also been filed against the management company. 

Source/more: Assisted Living Consumer Alliance, http://www.assistedlivingconsumers.org/legal-library/news/digest.2007-02-12.5511199941

Benefits issues in the campaign? Just the fact, ma'am

Get answers (not spin) to your burning questions on health care, social security, and private pension benefits issues from the Employee Benefits Research Institute.

Half of Chinese urban elderly live alone

Nearly half of all elderly people in China's cities live alone and have inadequate healthcare, state media said Wednesday, citing a recent survey.  An estimated 49.7 percent of city dwellers aged 60 or older lived in "empty nests," Xinhua news agency said, quoting a survey by the government-run China Elderly Work Committee Office.  In the past, care for the elderly was considered a key virtue but greater individualism in recent decades has led to the corrosion of traditional values, analysts say. The survey found that the number of Chinese aged 60 and older in late 2006 was 149 million, or 11.3 percent of the population, imposing a growing welfare burden on China.

"As the country's population is aging, more old people are in need of long-term care," the report said, quoting Guo Haoming, an official with the Chinese Association for Life Care, a Beijing-based volunteer organisation.  Guo said the elderly needed daily care, mental support, emergency aid and hospice care but the development of related industries lagged behind, with the services available far from adequate.

Source: http://afp.google.com/article/ALeqM5jjW_qPtawHGRnIaXdsEbT0fEHbtg

Report says 19 deaths at Illinois VA hospital due to substandard care

Nineteen deaths at the VA Medical Center in Marion, IL were linked to surgical errors or substandard care - a total nearly doubling earlier estimates of 10 patient deaths - in a report made public Monday from an investigation into the medical center's surgical unit.   Of 29 deaths that occurred at the Marion facility during Fiscal Year 2007, the Inspector General's Office of Healthcare Inspections reported that 19 deaths were either the result of surgical error or because patients had received less-than-optimum care. Six physicians have been linked to patient care problems, with two resigning their duties and the remaining four prohibited from performing complex surgeries.  Congressman Jerry Costello described Monday's report as "shocking."   "First and foremost, the families of the (additional) nine veterans who have died due to substandard care need to be notified. The report must be released to the public immediately. Changes must also be made in the management structure of the facility."   Costello said it appears to him that Marion officials made "poor" management decisions and ignored procedures that were already in place.

Source/more:  http://www.southernillinoisan.com/articles/2008/01/29/front_page/doc479faed1ba5f1044656342.txt

Get the full report from the VA.

HHS solicits input on nursing home compliance manual revisions

US DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE OF THE INSPECTOR
    GENERAL, _FEDERAL REGISTER_ NOTICE: ""Solicitation of Information and
    Recommendations for Revising the Compliance Program Guidance for
    Nursing Facilities," (_FR_, Vol. 73, No. 16, .pdf format, p. 4248-4249,
    via HHS OIG.)

This Federal Register notice seeks the input and recommendations of interested parties as OIG revises the compliance program guidance (CPG) for nursing facilities, especially those serving Medicare, Medicaid, and other Federal health care program beneficiaries. The nursing home industry has experienced a number of changes since OIG first published a CPG in this area (65 FR 14289; March 16,
2000). Additionally, the subsequent years of enforcement and compliance activity in the nursing home industry has allowed OIG to address more fully the various risk areas in nursing home compliance. In evaluating the contents of the nursing facility CPG, OIG is soliciting comments, recommendations,
and other suggestions from concerned parties and organizations on how best to revise the nursing facility CPG to address relevant compliance issues. Specifically, OIG seeks comments addressing any changes to existing risk areas and introducing any new risk areas.

DEADLINE Feb. 25, 2008

http://www.oig.hhs.gov/authorities/docs/08/CPG_Nursing_Facility_Solicitation.pdf

Older Americans embrace alternative medicine

More and more older Americans are trying complementary and alternative medicine. Practitioners across the country report an increase in the number of patients ages 50 and up seeking nontraditional treatment, from acupuncture to herbal supplements and chiropractic remedies. The move to nontraditional treatment is encouraged by AARP.  "It's people who are willing to shed the old mantra of what is medical care and what isn't," said Cheryl Matheis, director of health strategy for AARP.   While health experts and aging advocacy groups welcome the trend, they also caution older Americans to keep their traditional doctors in the loop.
"You're the patient, and you need to know what the interaction of different things and different treatments on your body is going to be, or you could end up doing yourself more harm than good," Matheis said.

Source/more:  http://www.stltoday.com/stltoday/business/stories.nsf/story/6DF2CE9EEF555010862573D9000AC556?OpenDocument

UK: Panel report says dementia treatment should be NHS priority

Dementia must be viewed as an urgent priority after years of woeful neglect by the NHS, says the House of Commons Public Accounts Committee (PAC). The disease deserves the same attention accorded to cancer and heart disease, given that so many of us are now set to develop the condition, the MPs said. They compared it to cancer in the 1950s, when fear and mystery surrounded a disease seen as untreatable. Just over 500,000 people in England suffer from dementia. The report from the cross-party committee, which scrutinises public spending , follows one from the National Audit Office which said England lagged behind Europe when it came to diagnosis and access to drugs. The panel, which is led by a Tory MP, says the Department of Health has not given the disease the attention it deserves and so the NHS has failed to deliver on both fronts.

Source/more:  BBC

AARP seeks fulltime senior litigation attorney

Senior Attorney-Litigation (Health/Long-Term Care)

AARP Foundation Litigation provides legal advocacy on behalf of older persons in courts nationwide is seeking an attorney to participate in public interest health and long-term care advocacy.   You will work collaboratively with a team of attorneys in a friendly work environment on AARP amicus briefs and significant impact litigation.  You will bring national recognition to AARP and the AARP Foundation as a leader and expert in health and long-term care law.  This position is located in our Washington, DC office.

Requirements:  Member in good standing with the DC Bar or eligible for admission; 8 years of related legal advocacy experience with at least 5 years complex litigation experience; and experience in health law such as Medicaid, Rx litigation, and long-term care.  Some travel required based on cases/issues.

Qualified candidates are invited to apply on-line at:  www.aarpjobs.com (see AARP Foundation).  We are an Equal Opportunity Employer that values workplace diversity.

Weems says withholding from the public of nursing home problems is not his fault

The acting head of the nation's Medicare and Medicaid programs said Wednesday that he would not have distributed a list of the nation's worst nursing homes to industry lobbyists and trade groups while withholding that information from the public.  "That was not my choice. Things happen in agencies, where individuals for very good reasons take the initiative," said Kerry Weems, acting administrator for the U.S. Centers for Medicare and Medicaid Services, at a breakfast meeting with reporters. said that when he asked agency officials why the list had been given to trade groups, "the answer was that the trade groups can offer specific technical assistance to facilities." He said he did not know who distributed the list, or when it occurred.  "It may have been before my tenure," said Weems, a career employee of the U.S. Department of Health and Human Services who was appointed to his new post by the president in September. "It would not have been my choice."

The agency, which oversees health care for low-income, disabled and elderly Americans, has put together a list of 128 nursing homes around the country that have repeatedly fallen in and out of compliance with government health and safety regulations and caused harm to their residents.  However, it has released the names of only 52 of the facilities to the public and press, while giving the complete list to an industry-funded trade group, the Alliance for Quality Nursing Home Care, as well as lobbyists at the American Health Care Association.  Weems defended the decision to keep the entire list of what are called "special-focus facilities" from public disclosure.

Sen. Tom Harkin, D-Ia., along with Democratic presidential candidate Hillary Clinton, has introduced legislation that would force the agency to release the list to the public.

Source and more:  Des Moines Register, http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20071220/NEWS09/712200376/-1/SPORTS09

Nursing home citations climb by 22%

More nursing homes are being cited for serious violations as inspectors face increasing pressure to crack down on dangerous conditions, a USA TODAY analysis shows.  From 2000 through 2006, the number of citations for putting patients in "immediate jeopardy" increased 22%, according to the records from the U.S. Centers for Medicare and Medicaid Services, which regulates nursing homes. Those citations are the most serious reprimand inspectors can issue and often follow cases in which patients were physically or sexually abused or left without medications.  The increase came as many states stepped up nursing home inspections. Homes that put their patients in immediate jeopardy risk fines or being told they cannot accept new Medicaid patients, a major source of their income.  "It doesn't necessarily mean things are getting worse. It means we're finding more of the problems," said Richard Mollot, executive director of Long Term Care Community Coalition, which advocates for nursing home patients.  Inspectors found nearly 2,000 violations last year that jeopardized patients at nearly 850 of the nation's 16,000 nursing homes, according to the records. They account for about 6% of the total violations uncovered in nursing homes.

Source/more: USA Today, http://www.usatoday.com/news/nation/2007-12-18-nursinghomes_N.htm

KFF Health Policy Picks for December 2007

KFF Health Policy Picks for Dec. include (but are not limited to)

Medicare Part D 2008 Data Spotlights

The Faces of Medicaid II

Nursing Home Quality 20 Years After OBRA

View the full listing of publications at http://www.kaiseredu.org/picks/health_policy_picks.aspx

Uninsured cancer patients will die more quickly...duh

Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.  People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.  The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say _ even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.

Source and more:  Houston Chronicle/AP, http://www.chron.com/disp/story.mpl/ap/fn/5393027.html
The article will eventually be accessible at http://caonline.amcancersoc.org/

CREW sends letter warning about bias of allegedly neutral "Center for LTC Reform"

Citizens for Responsibility and Ethics in Washington (CREW) has sent letters to two national organizations, the National Association of Insurance Commissioners and the National Association of State Medicaid Directors, concerning Stephen Moses and the Center for Long-Term Care Reform and his planned “National Long-Term Care Consciousness Tour.” Moses has spent the past decade posing as an independent expert from a respected think tank that analyzes the need for long-term care insurance, but is in fact serving as a front for the long-term care insurance industry.  According to his website, Mr. Moses has testified as an independent expert on long-term care before two-thirds of the nation’s state legislatures. He has been quoted in stories around the country and has been actively working to create legislation to benefit the industry in states including Kansas and Texas.

Mr. Moses is not, however, actually independent. When he launched the Center for Long-Term Care Reform in 1998, he began actively soliciting the industry for contributions, stating “The long-term care insurance industry -- and LTC providers whose financial survival depends on the growth of private financing -- must take steps to encourage private sector solutions. The Center for Long-Term Financing is uniquely positioned to promote this effort." He also boasted, "the Center increases long-term care insurance sales remarkably" and he has touted his appearance as an impartial expert claiming, "our established credibility as an independent third-party voice allows us to perform in essential roles that no one else can fill for reasons of perceived bias and self-interest."

In January 2008, Mr. Moses will begin a “National Long-Term Care Consciousness Tour.” The tour first focuses on the southeast, then moves to southwestern states, followed by the northeast, the midwest and finally the west coast. Details of the tour are available at http://www.centerltc.com/bullets/latest/727.htm. Mr. Moses has been soliciting corporate and organizational sponsorships to help him make the tour profitable. Part of the purpose of the tour is to make “political contacts with Governors, state legislators, city council members, Congressional representatives, state Insurance Commissioners, Medicaid directors and their staffs toward the end of improving long-term care public policy.” 

By “improving long-term care public policy,” Mr. Moses really means working to increase the number of people purchasing of long-term care insurance. Mr. Moses has blamed government funding of Medicaid for the fact that the long-term care insurance market is not expanding as rapidly as insurers would like.

Read text of CREW's letter:  http://www.citizensforethics.org/files/Roherty%20NASMD.pdf

Many nursing homes medicating patients unnecessarily

Nursing Homes Often Medicate Residents Without Psychosis

In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals," largely because nursing homes are "giving these drugs to elderly patients to quiet symptoms of Alzheimer's disease and other forms of dementia" -- conditions for which the drugs are not approved by FDA, the Wall Street Journal reports. According to CMS, 21% of nursing home residents who do not have a diagnosis of psychosis are prescribed antipsychotic drugs. "The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing home industry," the Journal reports.

Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging -- a not-for-profit industry group -- said, "You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable." According to Teigland, her research shows about one-third of dementia patients in nursing homes in New York state are receiving antipsychotics, with some facilities dispensing the drugs at rates as high as 60% to 70% of patients.

The nursing home industry often uses the drugs to "try to calm dementia patients and to maintain safety and order in their facilities," the Journal reports. The Journal notes that the "economics of elderly care can work in favor of drugs because federal insurance programs reimburse more readily for pills" than for the extra staff that would be needed to care for dementia patients without the use of drugs.

Wall St. Journal via Kaiser Daily Report via Andrea Palumbo (my student)

AARP report on aging in place in KY

Here's an excerpt:

Kentucky AARP Members want to Age in Place

As the population of Kentucky ages, many people will be dealing with the issue of
long-term care. In 2020, there will be nearly 5 million Kentuckians age 65 and older.
This influx of older residents will result in a greater need for long-term care options.
As this survey shows, AARP members age 55 and older in Kentucky want a choice in
where and how they receive long-term care, and they want to stay in their own homes
as they age. Members support the state putting additional funds into home- and
community-based services so that they have at-home options, even if this means the
state reduces funding for nursing homes. The State should consider transferring funds
from unused nursing home beds to home- and community-based care options.
● Eighty-five percent of members support increasing funds for services that help
people stay in their homes as they age. In addition, 87 percent support using
money that would otherwise go to nursing homes for home- and community-based
services. Over half say they would be more likely to vote for a candidate for office
who works to give people choices in their long-term care.
● Kentucky members want to age in their homes. Over nine in ten say it is
important for them to stay at home for as long as possible. Seventy-eight percent
say it is important for them to choose how and where they receive long-term care
services.
● Members are not confident of their ability to pay for long-term care in a
nursing home or with a home health aide. About half of members say that they
are not at all or not very confident that they could afford needed long-term care.

http://assets.aarp.org/rgcenter/il/ky%5Fltc%5F07.pdf

Toolkit for supporting safe staffing ratios in nursing homes

The Long Term Care Community Coalition has developed a toolkit for people to speak out to support safe staffing standards in nursing homes.  The toolkit includes sample letters, brief reports addressing the need for staffing standards and overcoming the challenges, a petition form, and more resources.

PLEASE HELP US GET THE WORD OUT BY LETTING YOUR MEMBERS AND CONSTITUENTS KNOW ABOUT THIS TOOLKIT AND ENCOURAGE THEM TO SPEAK OUT!  THE TOOLKIT CAN BE ACCESSED AT WWW.NURSINGHOME411.ORG. 

In order to improve conditions for nursing home residents and staff we must improve staffing levels.  Over 90% of nursing homes do not have sufficient staff to provide adequate care.  This means that both residents and workers suffer.  Congress is holding hearings now on nursing home quality.  According to today’s article in the NY Times article, “These are the first major hearings on nursing homes since the late 1980s; those led to the Nursing Home Reform Act of 1987.”  More hearings are expected in both the House and the Senate.  Now is the time for us to make a difference!!

WHAT YOU CAN DO:

Send  this message directly to your friends, colleagues, members of your organization, etc… and encourage them to speak out.  Use the toolkit to send a message or collect signatures on the petition.
Make copies of the attached poster and hang in your community – at the library; at your church, temple or mosque; etc… If you have a newsletter put in a notice about the toolkit and the need for people to speak out.

WV representative helps "unveil" long term care legislation

West Virginia's Second District Congresswoman says now is the time to address the needs of nursing homes in this state and across the country.  Congresswoman Shelley Moore Capito says that's why she is backing the Long-Term Care Quality and Modernization Act, which she helped unveil on Capitol Hill on Tuesday afternoon.  "We have an aging population. We need to make sure that the staff is trained. We need to make sure that the medicine is delivered in the highest quality, and we need to make sure that the facilities are modernized for what I think is going to be the big challenge of our aging population," she said in an interview with MetroNews.  The proposed legislation, which has bipartisan support, calls for the creation of a Long-Term Care Quality Advisory Commission that would come up with a national plan for insuring quality service at nursing homes.  The proposal would modernize billing rules to insure they're reflecting changes in technology, ensure access to proper diabetes management in nursing homes and offer incentives to nurses who work in those long-term care homes.

Source:  http://www.wvmetronews.com/index.cfm?func=displayfullstory&storyid=21904

Ed:  the bill was actually introduced more than three months ago.  Search Thomas using "S.1980" for text of bill.  Or read text at GPO. 

Health care costs grow more slowly for elderly than other groups

Health care spending for people under 65 is growing faster than for those over that benchmark age, the government reported Tuesday.  While the growing number of older Americans has been expected to alter patterns of health spending, the impact has been only modest and is expected to remain that way, the Centers for Medicare and Medicaid Services said.  Not surprisingly, per person spending is higher for older people than younger ones  But it has not been growing as fast as costs for working-age people, CMS reported in a paper in the journal Health Affairs.  Among the elderly, the largest decline in spending relative to younger people occurred among those age 85 and older. Spending for this group was 6.9 times higher than spending by the working-age population in 1987, but only 5.7 times higher in 2004.  For those 65 and over health costs were 3.5 times higher than working age people in 1987 and 3.3 times higher in 2004.  As members of the massive post-World War II baby boom turns 65 they will add to the younger end of the elderly population, a group that is relatively less costly for medical care than those 85 and over.

Source/more: http://ap.google.com/article/ALeqM5h_lCYEqH_5B8h20iDJzmkULscFuwD8SNVQ4O0

Read Health Affairs article.

KFF develops interactive presidential candidate health care website

The presidential candidates vary greatly in the extent to which they have discussed health care issues to date. Some have issued detailed proposals or have indicated that proposals are forthcoming. Others have articulated positions on specific health care issues or critiqued the positions and plans of other candidates in response to questions but have not offered their own proposals.  This side-by-side comparison of the candidates' positions on health care was prepared by the Kaiser Family Foundation with the assistance of Health Policy Alternatives, Inc. and is based on information appearing on the candidates' websites as supplemented by information from candidate speeches, the campaign debates and news reports. The sources of information are identified for each candidate's summary (with links to the Internet). The comparison highlights information on the candidates' positions related to access to health care coverage, cost containment, improving the quality of care and financing. Information will be updated regularly as the campaign unfolds.

Check it out at health08.org.

In UK, long term care insurance is becoming less popular

The market for long-term care insurance is declining, the Association of British Insurers (ABI) has said, possibly as policies are becoming more expensive due to people living longer.

Long-term care insurance can cover people to help meet the cost of either being cared for in their own home or in a residential care home and it usually comes into effect when a person fails to accomplish two or three everyday activities, such as feeding or dressing themselves.

Jonathan French, a spokesperson for the ABI, said that consumers might expect the long-term care insurance market to be growing in tandem with the ageing population in Britain; but with policies becoming more expensive as providers add on the cost of people needing longer periods of care, the market is in fact in decline."As with any age-related insurance policy, the older you are the more expensive it will be," Mr French said. "If people did want to look at buying this kind of product, as with a pension, it's best to start as early as possible. If you wait until you have retired to look into this policy, the likelihood is that your premiums are going to be very high."He added: "The insurance industry is looking at this issue very closely. It's our view that if things go on as they are, both in terms of the public sector and the private sector involved in long-term care, it will become an unsustainable problem."Long-term care already costs the state and individuals huge amounts of money. Quite often people have to sell their properties in order to pay for long-term care, and doubtless these were properties which in many cases doubtless the owners wanted to bequeath to their relatives. We are working with the government and other organisations in this field to work out how we can move towards solving this problem."

More:   Craegmoor Healthcare, http://www.craegmoor.co.uk/news/industry/18323893/long-term_care_insurance_less_popular.aspx

Israel: composition of 2008 "health basket" committee criticized

Health Minister Ya'acov Ben-Yizri rejected criticism by the Israel Medical Association of the new members of the committee that will recommend new medications and medical technologies for the 2008 health services basket.   The health funds must provide these drugs and technologies to members who need them, at state expense.  IMA Chairman Dr. Yoram Blachar, a member of the new basket committee, attacked the choice of nominees and called the committee an "impotent" body chosen according to the Treasury's directives.  "These are dark days for the health system," he said, adding that the IMA would consider whether to participate at all in the committee.  Blachar said that seven of the 16 members were state employees who might have a conflict of interest. In the previous committee, only three of 21 received their salaries from the government.  "There is no representative of patients' groups, no social economist, no expert for general ethics matters and no representation of many medical fields, such as family physicians. And there is no hospital director," he noted.

Source/more:  http://www.jpost.com/servlet/Satellite?cid=1192380573246&pagename=JPost%2FJPArticle%2FShowFull

New report discusses health information technology and long term care

Health information technology (HIT) is a powerful tool for improving the quality of long-term care, but it must be implemented to interact with other segments of healthcare in order to be successful, according to a new report by BearingPoint, prepared for the National Commission for Quality Long-Term Care. The Commission is a nonpartisan independent body based in Washington but overseen by The New School in New York. The report examines long-term care within the broader healthcare context, addressing the steps that need to be taken so that information technology can help improve quality of life for all. Due to the shortage of available resources, a strong business case must be made for the adoption of HIT by many differing long-term care stakeholders, and clear incentives for improving efficiency and outcomes for consumers must be provided.  The report concludes that technology in long-term care is much more fragmented than the rest of the healthcare system. It also involves a wider spectrum of issues; provides a wider range of services for seniors; faces greater workforce and financing challenges; and has been slower to adopt technology. To combat these barriers, the report suggests that policymakers and federal healthcare purchasers must understand that the full integration of HIT into long-term care will affect all other healthcare sectors because a disproportionate percentage of health care dollars are spent on the elderly. However, the origins of these expenditures often begin many years earlier. So the role of HIT in improving the health of seniors must focus on people of all ages. A more holistic approach to developing HIT-related solutions is required.

Source/more: PR Newswire, http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/10-04-2007/0004675877&EDATE=

Access the report:   http://www.qualitylongtermcarecommission.org/pdf/BearingPoint_Report_for_NCQLTC.pdf

Grassley wants explanation from LTCI companies about sharp rise in complaints and claim denials

Major U.S. long-term care insurers, including Genworth Financial Inc., and Manulife Financial Corp are being asked about "troubling data" showing a sharp jump for the industry in claims-related complaints, a senior Republican lawmaker said on Monday.  Iowa Sen. Charles Grassley sent letters on Thursday to U.S. insurance providers "to learn more about how effectively the sector is meeting the needs of Americans who have purchased such policies," he said in a statement.  Grassley, the top Republican on the Senate Finance Committee, said he made the request after learning about industry trends from the National Association of Insurance Commissioners (NAIC).  The group reported a 92 percent jump in long-term care complaints nationally from 2001 to 2006 and "a steady increase in the number of complaints regarding claim denials," he said. It also identified a 74 percent increase in claim denial related complaints between 2003 and 2006.  "While this may be explained by the increasing number of people purchasing LTCI (long-term care insurance), the relationship remains unclear," Grassley said in the letter, which also went to Conseco Inc  MetLife Inc Penn Treaty American Corp., Unum Group, Prudential Financial Inc ,and others.  The Senate Finance Committee oversees the federal government's Medicare and Medicaid health care programs. Grassley said in his letter that any increase in rejected long-term care insurance claims could place "a substantial and perhaps unnecessary financial burden ... on Medicaid."

Source/more: Reuters UK, http://uk.reuters.com/article/governmentFilingsNews/idUKN0134070220071001

Older Americans less healthy than their European counterparts...duh

Costly diseases, many of them related to obesity and smoking, are more prevalent among aging Americans than their European peers and add as much as $100 billion to $150 billion a year in treatment costs to the U.S. healthcare tab, a new study says.  The study by researchers at Emory University's Rollins School of Public Health found higher rates of several serious diseases -- including cancer, diabetes and heart disease -- among Americans 50 and older as compared with aging Europeans.  For example, heart disease was diagnosed in nearly twice as many Americans as Europeans 50 and older. More than 16% of American seniors had diagnosed diabetes, compared with about 11% of their European peers. And arthritis and cancer were more than twice as common among Americans as Europeans.

The study published on the Web today by the journal Health Affairs found that Americans were nearly twice as likely as Europeans to be obese (33.1% versus 17.1%), and they also were more likely to be current or former smokers (53% versus 43%).  "We expected to see differences between disease prevalence in the United States and Europe, but the extent of the differences is surprising," said lead author Kenneth Thorpe, a public health professor at Emory and former deputy assistant secretary of the U.S. Department of Health and Human Services.

Source/more:  http://www.latimes.com/business/la-fi-healthspend2oct02,0,7898945.story?coll=la-home-center

 

NS gov't approves plans for long term care in Pictou

The provincial Health Department approved the development of a long-term plan for Pictou County health-care facilities, the local health authority announced Friday.  Healthy 2020 — Pictou County aims to meet the needs of future generations, health authority chairman Murray Hill said. The master plan and program will focus on the Aberdeen Hospital in New Glasgow and the Sutherland Harris Memorial Hospital and addiction service facility in Pictou.  The project involves identifying the types and volumes of programs and services the health authority needs to deliver over the next 10 to 15 years, including staffing details and operational and functional requirements. 

Source: Nova Scotia Chronicle Herald, http://thechronicleherald.ca/NovaScotia/914834.html

New CRS report on family caregiver legislation

Family Caregiving to the Older Population: Legislation Enacted in the 109th Congress and Proposals in the 110th Congress
September 07, 2007
Download Locations: Open CRS (User submitted)

Family caregivers fulfill the majority of the need for long-term care provided to older persons with chronic disabilities in the United States. Among those older Americans receiving long-term care, the overwhelming majority receive some form of informal, or unpaid, care primarily provided by spouses and adult children. Family caregiving encompasses a wide range of activities, including assistance with personal care needs, medication management, and coordination with other health-care professionals. For many, caregiving is a rewarding experience; however, for some, caregiving can lead to emotional and physical strain, as well as financial hardship. As demand for caregiving to the older population is likely to increase, certain demographic factors may limit the number of family caregivers and their capacity to provide care. Although the federal government has established programs and services for family caregivers, policy makers have identified the need for additional federal benefits. This report briefly describes legislation enacted in the 109th Congress and proposals introduced in the 110th Congress that directly assist family caregivers (H.R. 1032, H.R. 1161, H.R. 1369, H.R. 1542, H.R. 1560, H.R. 1807, H.R. 1871, H.R. 1911, H.R. 2244, H.R. 2392, H.R. 3043, S. 614, S. 897, S. 898, S.910, S. 1340, S. 1681). This report will be updated upon significant legislative activity.

Census data show smaller perecentage of "oldest old" reside in nursing homes

Despite the graying of the nation, the percentage of elderly living in nursing homes has declined, according to Census data released today. The downturn reflects the improved health of seniors and more choices of care for the elderly.  About 7.4% of Americans aged 75 and older lived in nursing homes in 2006, compared with 8.1% in 2000 and 10.2% in 1990.  "The upper-income white population has other options than nursing homes," says William Frey, demographer at the Brookings Institution. "They're moving to assisted living or their well-off, baby boomer children are taking care of them in other ways." At-home care and assisted-living facilities have been a fast-growing segment of elder care in the past decade, says Elise Bolda, director of Community Partnerships for Older Adults, a Robert Wood Johnson Foundation program that helps communities develop long-term care and services for the elderly.  More than 1.8 million people live in nursing homes.  The percentage of the oldest age group of seniors living in nursing homes has been dropping. Less than 16% of the 85-plus population was in such facilities in 2006, according to the Census. In 1985, more than 21% in that age group lived in nursing homes, according to the National Nursing Home Survey, a government study.  This is good news, given this is the age group most likely to need the assistance and the fastest-growing group in our population," Bolda says.  The Census data on people who live in "group quarters" — including nursing homes, college dormitories and prisons — provide the first detailed profile of those populations since the 1980 Census.

Source/more:  USA Today, http://www.usatoday.com/printedition/news/20070927/1a_bottomstrip27_dom.art.htm

Full report:

http://www.census.gov/Press-Release/www/releases/archives/american_community_survey_acs/010709.html

Nursing home chains--in it for the money?

The New York Times reports:

Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002. Alice Garcia, with her granddaughter Jacqualynn Hewitt in 1995. Mrs. Garcia, who had Alzheimer’s disease, died in 2003 after a bedsore  became infected at Habana Health Care Center in Tampa, Fla.  The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.  The investors and operators were soon earning millions of dollars a year from their 49 homes.  Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.  “They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.

Sidebar:  The Times examined more than 1,200 nursing homes purchased by large private investment groups since 2000, and more than 14,000 other homes. The analysis compared investor-owned homes against national averages in multiple categories, including complaints received by regulators, health and safety violations cited by regulators, fines levied by state and federal authorities, the performance of homes as reported in a national database known as the Minimum Data Set Repository and the performance of homes as reported in the Online Survey, Certification and Reporting database.

Read the rest:  http://www.nytimes.com/2007/09/23/business/23nursing.html
Thanks to Richard Kaplan for the heads up.

KFF announces Barbara Jordan Fellowships

The Henry J. Kaiser Family Foundation is accepting applications for the 2008 Barbara Jordan Health Policy Scholars Program. This opportunity is for college seniors and recent college graduates who have a strong interest in addressing racial and ethnic health disparities, or who are themselves a member of a population that is adversely affected by racial and ethnic health disparities. The application deadline is 5:00pm ET on December 14, 2007.              

During their nine-week experience, the Scholars work in congressional offices in Washington, D.C., obtaining first-hand experience in the policy-making process. They participate in seminars and site visits to enhance their practical knowledge of health care issues and gain first-hand knowledge of the federal legislative process. Each Scholar also writes and presents a health policy research paper in one of the following areas: Medicaid and the uninsured, Medicare, or HIV/AIDS.

More info at: 

http://www.kff.org/minorityhealth/bjscholars/index.cfm