A newsletter of FCA's National Center on Caregiving Family Caregiver Alliance | National Center on Caregiving | Fact Sheets & Publications |  Contact Us Subscribe | View Past Issues July 8, 2009 Volume IX, Number 14 IN THIS ISSUE State Legislation, Policy & Reports Iowa: New Quality Assurance Fee Will Boost Direct-Care Staff Compensation  More... Montana: State Deploys ARRA Funds for Long-Term Care and Senior Services  More... Tennessee: The Adult Care Homes Act Becomes Law  More... Policy Brief Shines Light on Paid Family Leave Programs  More... Federal Legislation, Policy & Reports Senators Introduce Home and Community Balanced Incentives Act of 2009  More... Senior Navigation and Planning Act of 2009 Focuses on End-of-Life Decisions  More... Medicare Nursing Home Guidance Aims to Improve Residents' Quality of Life  More... International News World: With Older Population Likely to Triple by 2050, Global Aging Is "A Slow Burning Fuse"  More... Research Reports & Journal Articles Pew Survey Reveals View of Growing Old Depends on Age  More... Study Shows Nurse Care Managers Can Help Dementia Caregivers  More... A New Patient Care Model Assesses If Elderly Can Live Alone  More... Conferences & Trainings 10th International Conference on Alzheimer's Drug Discovery, September 14-15  More... 2nd UCLA Technology & Aging Conference, October 30  More... Funding, Media & Miscellaneous Hawaii Seeks Proposals for Long-Term Care Commission Policy Research  More... PHI Launches PolicyWorks to Strengthen Direct-Care Workforce  More... NPR Maps Dementia-Driven Wandering  More... U.S. in Need of a "Reality Road Test on Independence" Says Ellen Goodman  More... back to top State Legislation, Policy & Reports Iowa: New Quality Assurance Fee Will Boost Direct-Care Staff Compensation Governor Chet Culver, at the end of May, signed into law Senate File 476 to implement a fund leveraging strategy for Iowa's long-term care delivery system. All for-profit and nonprofit nursing facilities now must pay a quality assurance fee of 3 percent per patient day. Annually, this "granny tax" is expected to generate about $33 million that will be deposited in a state-run Quality Assurance Trust Fund and used to leverage $45 million or more in federal Medicaid matching funds. According to PHI, an advocacy group for the direct-care workforce, at least 35 percent of the new revenue must be used to increase compensation for direct-care workers, such as certified nurse's aides.  Most facilities will see a net revenue gain, but those with a low share of Medicaid bed days will have a net loss. For more information, visit: Iowa General Assembly PHI Montana: State Deploys ARRA Funds to Support Long-Term Care and Senior Services The Montana Department of Public Health and Human Services (DPHHS) reports the American Recovery and Reinvestment Act will increase wages for Montana's direct-care and ancillary service staff in long-term care.  The Legislature, through the Montana Reinvestment Act (H.R. 645), appropriated $16. 3 million, including $4.5 million general funds, to raise provider rates to fund a one-time direct-care worker wage increase for Medicaid services in the Senior and Long Term Care Division. The rate increase, for the 2011 biennium only, goes to nursing facility providers, personal assistance providers and other community-based service providers. The Legislature also designated $3 million for non-Medicaid community aging services through contracts with the Area Agencies on Aging for transportation, congregate meals and meals on wheels, respite care, home chore services, legal assistance, long term care ombudsman and information and referral services. For more information, visit: Montana DPHHS Tennessee: The Adult Care Homes Act Becomes Law During the 2009 legislative session, state lawmakers unanimously approved The Adult Care Homes Act (SR 2275/HB 2282), creating a new housing option for Tennesseans who receive long-term care services but don't want to live in large nursing homes. Governor Phil Bredesen signed the bill into law on July 1, authorizing licensure of small residences operated for two to five people.  Originally the bill would have allowed caregivers to operate adult care homes for anyone who receives long-term care services, but lawmakers decided to limit the new option to ventilator-dependent and brain-damaged Tennesseans. According to Clarksville Online, Senator Lowe Finney and other sponsors of the bill vow to take up legislation in 2010 so those who need less care also may live in adult care homes. For more information, visit: Tennessee Legislature Clarkesville Online Policy Brief Shines Light on Paid Family Leave Programs In June, Boston College Graduate School of Social Work's Sloan Work and Family Research Network released "Paid Family Leave: One Solution to Helping Today's Working Families Meet Their Family Responsibilities at Critical Times." Prepared by Julie Weber, J.D., with support from the Alfred P. Sloan Foundation, this brief gives state legislators and other state policy makers a quick review of paid family leave (PFL), including its importance, why the federal Family and Medical Leave Act is insufficient and what's happening at the state level. It compares three states' PFL laws (California, New Jersey and Washington), looking at compensation, length of benefit, structure and funding. For more information and to download the four-page brief, visit: Work and Family Research Network back to top Federal Legislation, Policy & Reports Senators Introduce Home and Community Balanced Incentives Act of 2009 On June 11, Senators Maria Cantwell (D-WA) and Herbert Kohl (D-WI) introduced the Home and Community Balanced Incentives Act of 2009 (S. 1256).   This bill would amend Title XIX of the Social Security Act to enhance Medicaid matching rates for States to expand home and community-based long-term care and services for Medicaid beneficiaries. Among the bill's provisions are improving case management to help people stay out of nursing homes, allowing for consumer direction, developing a services and information clearinghouse to help people easily learn about their home and community-based options, creating a standardized method for tracking home and community-based services, and collecting data on consumer outcomes. For more information, visit: Thomas  Senior Navigation and Planning Act of 2009 Focuses on End-of-Life Decisions Senator Mark Warner (D-VA) introduced the Senior Navigation and Planning Act of 2009 in mid June (as S. 1251 and S. 1263) to strengthen counseling, support services and care management for patients and families coping with life-limiting illnesses. "This legislation will not deny health care to patients and families that want it," Senator Warner said. "But I firmly believe that any comprehensive health reform should include more information, counseling and resources that will allow patients, their families, their caregivers and others to consider and discuss decisions about when and how long to pursue treatments at the end of life."  Without access to such planning assistance, the result for patients nearing the end of life may be unnecessary tests, treatments and hospitalizations that more informed individuals might not choose. For more information, visit: Thomas Sen. Mark Warner Medicare Nursing Home Guidance Aims to Improve Residents' Quality of Life On June 19, the Centers for Medicare & Medicaid Services (CMS) issued new guidance for nursing home surveyors to sharpen focus on key dimensions of care.  According to CMS Acting Administrator Charlene Frizzera, the revisions are "intended to support efforts underway to transform nursing homes into environments that are more like [residents'] homes through both environmental changes and resident-centered caregiving." Surveyors are asked to look at how nursing homes ensure residents live with dignity, offer choices in care and services, accommodate the environment to each resident's needs and preferences, and create a more homelike environment. For more information, and to download the guidance, visit: CMS back to top International News World: With Older Population Likely to Triple by 2050, Global Aging Is "A Slow Burning Fuse" The U.S. Census Bureau announced on June 23 that the world's 65-and-older population will probably triple by mid-century, from 516 million in 2009 to 1.53 billion in 2050. During the same period, the under-15 population likely will grow by just 6 percent (from 1.83 billion to 1.93 billion).  This latest update from the Census Bureau's International Data Base includes projections by age, including people 100 and older, for 227 countries and areas. A special report from Economist.com on June 25, "A Slow Burning Fuse," written by Barbara Beck, takes a look at the reasons why the world is getting so much older. In the 1970s women across the world gave birth to an average of 4.3 children each, compared to 2.6 globally today and just 1.6 in rich countries. The economic, social and political consequences of this "slow- moving but relentless development," she says, are "scary."  For more information, visit: US Census Bureau Economist.com back to top Research Reports & Journal Articles Pew Survey Reveals View of Growing Old Depends on Age A Pew Research Center survey on Social & Demographic Trends queried a nationally representative sample of 2,969 adults. "Growing Old in America: Expectations vs. Reality," released June 29, finds "Growing old isn't nearly as bad as people think it will be. Nor is it quite as good." When does old age begin? Those between the ages of 18 and 29 said 60, middle-aged respondents put the age nearer 70 and those older than 65 said the average person does not become old before 74. All generations agreed on a handful of markers for old age: failing health, an inability to live independently or drive, and difficulty with stairs. The best thing, by far, about getting old, according to older adults, is being able to spend more time with family members. Three-fourths of adults with a parent over the age of 65 are very satisfied with the relationship with their parent/s; if a parent needs help caring for his or her needs, that share falls to 62 percent. For more information and to download the 151-page report, visit: Pew Research Center Study Shows Nurse Care Managers Can Help Dementia Caregivers An article in the June/July 2009 issue of American Journal of Alzheimer's Disease and Other Dementias, 24 (3), by Janet Specht and four colleagues from the University of Iowa College of Nursing, points to the effectiveness of assistance from nurse care managers in supporting caregivers of persons with dementia who live at home. Caregivers who received assistance were more likely to show improvement, consistent over time, in their stress levels, endurance potential and well-being. The article, "The Effects of a Dementia Nurse Care Manager on Improving Caregiver Outcomes," defines the role of dementia nurse care management and shares the results of the outcomes measurements. For more information, visit: American Journal of Alzheimer's Disease A New Patient Care Model Assesses Elder's Ability to Live Alone Researchers at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center at Houston report they have developed a systematic, interdisciplinary approach to "capacity assessment and intervention" (CAI) for older adults. An Archives of Gerontology and Geriatrics article in press, "Determining If an Older Adult Can Make and Execute Decisions to Live Safely at Home: A Capacity Assessment and Intervention Model," by fourth-year medical student Felicia Skelton and three colleagues, follows one patient through the CAI process and examines two other cases to highlight challenges in capacity assessment. For more information, visit: Archives of Gerontology and Geriatrics Baylor College of Medicine back to top Conferences & Trainings 10th International Conference on Alzheimer's Drug Discovery, September 14-15 The Alzheimer's Drug Discovery Foundation (ADDF) presents the 10th International Conference on Alzheimer's Disease Drug Discovery on September 14 and 15 in Jersey City, NJ. ADDF is a public charity dedicated to accelerating the discovery and development of drugs to prevent, treat and cure Alzheimer's disease and cognitive aging. This conference brings together academic and industry scientists for that purpose. For more information and to register, visit: ADDF 2nd UCLA Technology & Aging Conference, October 30 At this one-day conference academic and industry leaders will discuss how the latest technologies in the medical, consumer and lifestyle fields will help older adults live better, longer lives. Its breakout sessions address two themes: Aging In Place and Aging Healthier Longer. The conference will be held at the Skirball Cultural Center in Los Angeles. For more information and to register, visit: UCLA Center on Aging back to top Funding, Media & Miscellaneous Hawaii Seeks Proposals for Long-Term Care Commission Policy Research The University of Hawaii at Manoa's Social Sciences Public Policy Center (SSPPC) has issued a Request for Proposal, "Assessing Long Term Care and Policy Options for the State of Hawaii." They are seeking a researcher to undertake and to coordinate research to execute a work plan developed by the State of Hawaii Long-Term Care Commission (LTCC). Act 224, Session Laws of Hawaii 2008, established the LTCC to do a two-year comprehensive assessment of the long-care needs of the population, assess the adequacy and challenges of the current long-term care infrastructure, and recommend measures and policies to create a financing system and services structure that meets the future needs of the aging population. Deadline for proposals is July 20. For more information, visit: Public Policy Center PHI Launches PolicyWorks to Strengthen Direct-Care Workforce In June, PHI announced that PolicyWorks, an online strategy center, is up and running to promote national and state policy solutions for the direct-care workforce. Features of the center include Strategic Areas, which provides frameworks for understanding leading policy issues; Workforce Facts, which focuses on the demographics, size and economic impact of the direct-care workforce; Policy Recommendations; a Chart Gallery of key data; a Guide to Accessing Federal Recovery Act Funds; and Health Reform Resource Center, which aims to make sure national change efforts work for direct-care workers. PolicyWorks NPR Maps Dementia-Driven Wandering National Public Radio's Linton Weeks told the stories of three Maine wanderers with dementia in his June 29 program, "The Mysteries of Dementia-Driven Wandering." Their trips had three different outcomes: safe return, disappearance and death. Mr. Weeks explored the impetus to wander from both cultural and medical perspectives and offered strategies for managing wandering behavior, tapping advice from Robert Koester, who wrote Lost Person Behavior and is the former president of the Virginia Search and Rescue Council. Covered in this program, too, were special devices, such as shoes with GPS technology for  wanderers to wear, the MedicAlert+Safe Return initiative of the Alzheimer's Association and states' Silver Alert emergency program to find missing seniors. For more information, visit: NPR U.S. in Need of a "Reality Road Test on Independence" Says Ellen Goodman Nationally syndicated columnist Ellen Goodman wished her readers "Happy Dependence Day" on July 3. "About 34 million Americans provide at least some of the care for frail, aging family members and yet we don't see it as a normal, predictable part of the life cycle," she writes. She refers to Paula Span's book, When the Time Comes, as a welcome "support group in print." Despite 40 books on pregnancy and childbirth, no best-seller  exists entitled "What to Expect When They are Declining" or any "Missing Manual" on "what to do when our parents become too frail or confused to live alone." American child-rearing seems to leave out "the lesson that caregiving continues through the life cycle," she says. "Needing help is not role reversal but joint responsibility."  For more information, visit: Boston Globe back to top To find caregiver support services in your state, visit FCA's Family Care Navigator http://caregiver.org/caregiver/jsp/fcn_content_node.jsp?nodeid=2083 ?2009 Family Caregiver Alliance. All rights reserved. The National Center on Caregiving at Family Caregiver Alliance works to advance the development of high-quality and cost-effective policies and programs for caregivers in every state in the country. The National Center is a central source of information and technical assistance on family caregiving for policymakers, health and service providers, program developers, funders, media and families. For questions or further information about the National Center on Caregiving, contact PolicyDigest@caregiver.org or visit the Family Caregiver Alliance website at www.caregiver.org. To subscribe or unsubscribe to Caregiving PolicyDigest, use the following link: www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=836 Or, contact Family Caregiver Alliance using our toll-free phone number: (800) 445-8106 Your subscription information is used only for the purpose of improving this service and tailoring it to the needs of its audience. Information provided to us will not be shared with any other organization, agency, corporation, entity or third party. Caregiving PolicyDigest is a publication of the National Center on Caregiving at Family Caregiver Alliance, 180 Montgomery Street, Suite 1100, San Francisco, CA 94104.

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