Elder Law Prof Blog

Legendary wrestler Verne Gagne and a tragic tale of Alzheimer's

Verne Gagne, 82, is a former wrestling champion who has attained folk legend status in Minnesota. And Helmut R. Gutmann, 97, was a former cancer researcher who came to this country after fleeing Hitler's Nazi Germany.  Both have suffered from Alzheimer's-related dementia and had been residing in a Bloomington facility housing people with Alzheimer's and dementia.  In a tragic moment on Jan. 26, Gagne apparently threw Gutmann to the floor. Gutmann was taken to the hospital and died 20 days later.

 

It's not known what precipitated the incident between the two men at the memory loss unit of the Friendship Village retirement community. But according to Gutmann's widow, Betty Gutmann, Gagne picked up the diminutive and frail man and hurled him violently to the floor, breaking his hip.

More on this story in the MInnesota Post.

Pay home health care workers as part of stimulus plan

Interesting post from Health Beat Blog today--here's an excerpt:

Now that the economy is in decline with massive job losses, consider the economic effect of providing well earned money to the 46 million personal care providers (31 million full-time equivalents). Paying minimum wages to family and friends of the disabled for their caretaking time ($7.25 per hour beginning July 2009) would cost about $360 billion per year (46 million health aides x 21 hours per week average per caregiver x 52 weeks/year x $7.25 per hour for wages plus benefits = $364 billion).

A successful model program exists. For people with Medicaid insurance, a pilot project of giving disabled people money to pay for their own caregivers has been a huge success. Investigators at Mathematica Policy Research, Inc. found that, compared with services from traditional home care agencies, Medicaid’s “Cash and Counseling” program gave disabled people and their caregivers improved quality of life and resulted in less use of nursing homes.

These 31 million full-time equivalent paid jobs could be created immediately. This $360 billion spread broadly (average yearly income: about $7,800 for 46 million people) would be what the doctor ordered to immediately help counteract massive job losses throughout most economic sectors. Much of the money would be immediately returned to taxpayers, because paying these health care workers would mean they require less public assistance. The collateral economic benefit of the money these workers would spend for necessities would have an infinitely greater multiplier effect in creating more jobs than lavishing more billions on banks or enacting the $800+ billion proposed stimulus bill. It would address Republican concerns that the stimulus create jobs immediately and Democrat priorities that the money go to help the poor.

Read the full post here:  http://www.healthbeatblog.com/2009/02/pay-health-care-aides-to-jumpstart-the-economy.html

Quick and dirty overview of COBRA...

...prepared for one of our Congresspersons who doesn't understand how it works...

Health Insurance Continuation Coverage Under COBRA

Most Americans with private group health insurance are covered through an employer, coverage that is generally provided to active employees and their families, and may be extended to retirees. A change in an individual?s work or family status can result in loss of coverage. In 1985, Congress enacted legislation to provide temporary access to health insurance for qualified individuals who lose coverage due to such changes. Under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA, P.L. 99-272), an employer with 20 or more employees must provide those employees and their families the option of continuing their coverage under the employer?s group health insurance plan in the case of certain events. The coverage, usually for 18 months, can last up to 36 months, depending on the nature of the triggering event. The employer is not required to pay for this coverage; instead, the beneficiary can be required to pay up to 102% of the premium. Employers who fail to provide the continued health insurance option are subject to penalties. In 1987, the Internal Revenue Service issued proposed regulations providing guidance for employers on COBRA. The regulations were finalized in February 1999 and January 2001. Final regulations regarding COBRA notification requirements were issued by the Department of Labor in May 2004. Some maintain that in requiring employers to provide former employees with the option of continuing their health insurance coverage, COBRA has resulted in extra costs for employers (in the form of increased premiums for employers? group health insurance policies), as well as added administrative burdens. Regardless of costs, others maintain that COBRA should be expanded to include new eligibility categories and longer coverage periods, so that more workers and their families have a source of group health insurance coverage during periods of job or family transitions. They argue that the financial and administrative burdens on employers have been exaggerated. This report provides background information on continuation health insurance under COBRA and on the COBRA population. It will be updated as events warrant.

Link:  http://opencrs.cdt.org/document/R40142
 

New Census report on spending for health care and social assistance programs

Medicaid continued to be the largest source of funding for nursing and residential care facilities in 2007 at $59 billion, according to the U.S. Census Bureau.   These tabulations come from the 2007 Service Annual Survey: Health Care and Social Assistance, which focuses on health care and social assistance providers for individuals, and gives estimates and sources of revenue for businesses with paid employees. Overall, health care and social assistance revenue increased 6.8 percent in 2007 to $1.66 trillion, up from $1.56 trillion in 2006.

Revenue for continuing care retirement communities grew 10.1 percent to $20 billion. These communities include establishments that provide a range of residential and personal care services, including on-site nursing care and assisted-living facilities. Homes for the elderly, which do not include on-site nursing care facilities, saw their revenues increase by 7.1 percent to $14.5 billion.Revenue for hospitals grew 6.5 percent in 2007 to $687 billion. Revenue for physicians’ offices increased 5.6 percent to $346 billion and revenue for dentists’ offices increased 6.5 percent to $94 billion.    

Medicare was the leading source of revenue for kidney dialysis centers, reaching $9.1 billion in 2007, a 10.4 percent increase from 2006.

Revenue for emergency and other relief services decreased 13.2 percent to $6.9 billion in 2007. This is the second year in a row revenues decreased. Revenue has now returned to a level roughly equivalent     to that of 2004.  The Service Annual Survey (SAS) provides data that help to measure America’s current economic performance. Using a sample of about 70,000 service companies, the SAS collects revenue, expenses and e-commerce sales.   The services provided by establishments in this sector are delivered by professional, trained health practitioners or social workers. Excluded from this sector are aerobic classes; amusement, gambling and recreation industries; and nonmedical diet and weight reduction centers. Although these can be viewed as health services, they are not typically delivered by trained health practitioners.

NIH publishes progress report on Alzheimer's disease

The National Institute on Aging (NIA), part of the Federal Government’s National Institutes of Health (NIH) at the U.S. Department of Health and Human Services, has primary responsibility for basic, clinical, behavioral, and social research in Alzheimer’s disease (AD) as well as research aimed at finding ways to prevent and treat AD. The Institute’s AD research program is integral to one of its main goals, which is to enhance the quality of life of older people by expanding knowledge about the aging brain and nervous system. This 2007 Progress Report on Alzheimer’s Disease summarizes recent AD research conducted or supported by NIA and other components of NIH, including:

• National Center for Research Resources
• National Heart, Lung, and Blood Institute
• National Human Genome Research Institute
• National Institute of Biomedical Imaging and Bioengineering
• National Institute of Diabetes and Digestive and Kidney Diseases
• National Institute of Mental Health
• National Institute of Neurological Disorders and Stroke
• National Institute of Nursing Research

Modest AD research efforts also are supported by the National Cancer Institute, National Center for Complementary and Alternative Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, and John E. Fogarty International Center.

In Remembrance
The 2007 Progress Report on Alzheimer’s Disease is dedicated to Robert Katzman, M.D. (1925–2008), an internationally known AD research pioneer who fundamentally changed the way scientists and clinicians thought about the brain disorder we now know as Alzheimer’s disease, and the first to detail its prevalence and severity, in 1976. Dr. Katzman was founding director of the NIA-funded AD Research Center at the University of California San Diego one of the original members of NIA’s National Advisory Council on Aging, and a founder of the Alzheimer’s Association.

Get the report:  http://www.nia.nih.gov/Alzheimers/Publications/ADProgress2007/

GSU seeks attorney to work on health disparity issues

The Georgia State University College of Law seeks an attorney to work as a Health Disparities Fellow  in a community collaboration called the Health Law Partnership (HeLP), under a grant received under the Georgia Health Equity Initiative of the Georgia Dept. of Community Health.  HeLP provides public health legal services and educational programs in a partnership among Georgia State Law, Children's Healthcare of Atlanta, and the Atlanta Legal Aid Society.  See www.healthlawpartnership.org.  The one-year project funded by this grant addresses the adverse impact that socio-economic factors have on the health and well-being of poor and minority children who receive health care services at Children's hospital at Hughes Spalding in downtown Atlanta.   The Fellow will work with GSU faculty, staff, and students; HeLP-affiliated staff and partners; hospital personnel affiliated with Children's hospitals; and academic constituents (faculty and students) affiliated with Emory and Morehouse medical schools.  To apply, visit the GSU job search Web site at http://jobs.gsu.edu and   "Search Postings " under  'Vacancy Number 0600841. " In addition to required application materials, candidates selected for interview will be asked for a legal writing sample; contact information for 3 references; and official law school transcript.   Resume review will begin immediately, and the position is expected to be filled in January 2009.  See also attached position announcement for more information.

Tom Daschle tabbed for HHS Secretary

President-elect Barack Obama Wednesday named former Sen. Tom Daschle to lead the nation's Department of Health and Human Services.  GOP senators say former Sen. Tom Daschle "knows how the Senate works."  Daschle, D-S.D., is one of Obama's first Cabinet picks. If confirmed by the Senate, he will replace HHS Secretary Michael Leavitt in guiding critical, high-profile federal agencies, including the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS) and the National Institutes of Health (NIH). The massive job includes oversight of a department budget that exceeded $707 billion for fiscal year 2008.

Daschle was Senate majority leader under President Clinton. Even before Obama was elected, he had reportedly told confidantes he was most interested in a position at HHS because he thought health care would be one of the most important issues facing the new administration.  His book, "Critical: What We Can Do About the Health Care Crisis," was published in February this year.  "By almost any measure, the situation is grim," he wrote in his book. "We like to boast that we have the highest standard of living in the world, and yet, at the dawn of the twenty-first century, we are the only industrialized nation that does not guarantee necessary health care to all of its citizens. It is stunning and shameful."

Health care group Families USA Wednesday was quick to react to Obama's selection.  "The appointment of Sen. Daschle as secretary of the Health and Human Services Department is the best news possible for those who want to achieve meaningful health care reform," said Families USA executive director Ron Pollack in a statement.

The RNC, however, took a different stance.  "Barack Obama is filling his administration with long-time Washington insiders," said RNC spokesman Alex Conant. "Since losing his Senate seat, Tom Daschle has worked for a major lobbying firm. For voters hoping to see new faces and fewer lobbyist connections in government, Daschle's nomination will be another disappointment."

Source and more:  ABC News, http://abcnews.go.com/Politics/President44/story?id=6199235&page=1

Editor:  What can I say but...well done, Mr. President-elect.

News from NHeLP

NHeLP has issued a new fact sheet that answers the most commonly asked questions about Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.  EPSDT provides early health screenings, preventive care, comprehensive treatment, and health education to children and young adults who are Medicaid beneficiaries.  The fact sheet is located on NHeLP’s website under the “What’s New” section at www.healthlaw.org.

Some farmers take jobs off-site to get health insurance

As in the rest of the nation, the rural United States is facing increasingly expensive health care options. With an aging population of farmers and ranchers, those in the agriculture sector are watching premiums rise and, often, making hard choices about preventative treatment.  Seeking to bring attention to what farmers and ranchers are facing, a recent survey — titled “Health Care in the Heartland: 2007 Health Insurance and Survey of Missouri Farm and Ranch Operators” — was released by the Missouri Rural Crisis Center, a farmer advocacy group.

“A big finding is that farm families are being forced to go off-farm to take a job for the health insurance,” says Tim Gibbons, who has been with the MRCC for three years. “In some cases, they don’t even need the job except for the health benefits.”  While current conditions are difficult for many farm families, the future is also a huge concern. Farmers are “really worried about what could happen in the next 10 years. Will health care insurance be even more expensive? Will the farm be under even more pressure? Will farmers be forced to choose between exorbitant health care coverage and a piece of needed equipment or land?”

Richard Williams, a red Angus rancher from Tipton, Mo., says his situation “is standard around here for self-insured farmers.” Shown Williams’ claims, several Mid-South insurance agents say his situation is also not an outlier for the Delta.  “We’ve got darned high deductibles,” says Williams, whose state has 104,000-plus farm operations — second only to Texas. “There are many farmers whose wives have to go out and get a job just for the insurance — maybe a job with the state, or something.”  With both spouses working on the farm, the Williamses spend about 15 percent of their budget on health care. “That’s give-or-take, of course. Being on a farm, it’s difficult to say exactly what you’ll make.”

Source/more:  Delta Farm Express, http://deltafarmpress.com/news/healthcare-insurance-1024/

Full report:  http://www.inmotionmagazine.com/ra08/090408jwjBriefweb.pdf

Bee Gees can help with CPR. Seriously.

Update:  Dick Kaplan, U.Ill., reports to me: 

My daughter the EMT informs me that CPR can be also performed appropriately to the song, "Another One Bites the Dust" by Queen. For obvious reasons, using the song “Stayin Alive” is better public relations."

Thanks for the tip!

US medics have found the Bee Gees' 1977 disco anthem, Stayin' Alive, provides an ideal beat to follow when performing CPR on a victim of a cardiac arrest.  A University of Illinois medical school study said it contained 103 beats per minute, close to the recommended rate of 100 chest compressions per minute.

Dr David Matlock said many people were put off performing CPR as they were not sure about keeping the correct rhythm.  He said CPR could triple cardiac arrest survival rates when performed properly.  The study by the University of Illinois College of Medicine saw 15 doctors and students performing CPR (cardiopulmonary resuscitation) on mannequins while listening to Stayin' Alive. They were asked to their time chest compressions with the beat.

Five weeks later, they did the same drill without the music, but were told to think of the song while doing compressions.

The average number of compressions the first time was 109 per minute; the second time it was 113 - more than recommended by the American Heart Association, but better than too few, according to Dr Matlock.

"It drove them and motivated them to keep up the rate, which is the most important thing," he told the Associated Press.

Source/more:  BBC, http://news.bbc.co.uk/2/hi/health/7678371.stm