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|A newsletter of FCA's National Center on Caregiving
September 22, 2010
Volume X, Number 17
| IN THIS ISSUE|
State Legislation, Policy & Reports
- New York's Lieutenant Governor Releases Report Advocating Changes To Medicaid More...
- New York Passes First "Bill Of Rights" Law In The Nation For Domestic Workers More...
- Research Brief Explains How California Can Improve Long Term Care Through ACA More...
- Report: Older Adults In California Need More To Survive More...
Federal Legislation, Policy & Reports
- Demonstration Program To Treat Patients With Multiple Chronic Conditions At Home More...
- Demonstration Program Will Cover Hospice and Curative Treatments Concurrently More...
- Field Hearings On Reauthorization Of Older Americans Act More...
- Caregiving In China: An Emerging Issue More...
- Europe's Approach To Paying For Long-Term Care More...
- Five Most Common Challenges Faced By Caregivers More...
- Philippines Aged Population Support System More...
Research Reports & Journal Articles
- Art And Music As Communication Tools For Patients With Alzheimer's More...
- Study Examines Wearable Technologies For Adults With Alzheimer's More...
- Study Finds Link Between Post-Traumatic Stress Disorder And Dementia More...
- Telephone Support Groups For Caregivers Of Veterans With Dementia More...
Conferences & Trainings
- Webinar: Competency Model for Long-Term Care Workers More...
- Web Forum: How Physicians And Hospitals Can Be Accountable Together More...
- Conference Call: Health Reform And Seniors With Vice President Biden More...
Funding, Media & Miscellaneous
- Brave Old World: Multimedia Website Explores Aging In America More...
- Grants For Native American Caregiver Support Program More...
- Six Month Anniversary Of Affordable Care Act More...
New York's Lieutenant Governor Releases Report Advocating Changes To Medicaid|
The Lieutenant Governor of New York, Richard Ravitch, released a report this week about New York's Medicaid program that consumes approximately one-third of the state budget. His report analyzes a number of issues that he suggests lead to fragmentation of services and high costs for the state. For example, New York is rare among major states for allowing the legislature to set Medicaid reimbursement rates each year as part of budget negotiations. In addition, New York has used flexibility in the Medicaid program to start optional programs and receive a federal match for these programs (FMAP); however, it only receives a 50% match from the federal government because of its high average per-capita income. The Lieutenant Governor advocates a number of changes, including consolidating decision-making for Medicaid, advocating for a larger FMAP match, and cost-containment. For more information, visit:
Lieutenant Governor's Report on Controlling Increases in the Cost of New York Medicaid
New York Passes First "Bill Of Rights" Law In The Nation For Domestic WorkersNew York became the first state in the nation to pass a Domestic Workers' Bill of Rights on August 31st (A01470/ S2311-E). The law will provide employment protections to approximately 270,000 domestic workers who are not employed by agencies, including home care workers. Under the law, which takes effect November 29, 2010, home care workers will be entitled to increased overtime pay, at least one day off a week, and three paid days off annually. While this law will protect non-agency home care workers in New York, advocates have suggested that U.S. Labor Secretary Hilda Solis should revise the "companionship exemption" in the Fair Labor Standards Act that exempts home care agencies from having to pay home care workers the federal minimum wage or time-and-a-half for overtime. The Department of Labor is expected to release a proposed rule for comment on this issue in October 2011. For more information, visit:Paraprofessional Healthcare Institute (PHI)
New York Legislature
Research Brief Explains How California Can Improve Long Term Care Through ACA
A recent Scan Foundation brief focused on provisions in the Affordable Care Act (ACA) that California can use to improve how the state provides long-term care. The brief is based on testimony to a state commission and focuses on the CLASS program (voluntary long-term care program) and other provisions that will help caregivers and care recipients. For example, under ACA, revisions to the 1915(i) Medicaid HCBS State Plan Option permit service packages that are targeted to specific populations. California's Department of Health Care Services, Rehabilitation, and Mental Health is currently developing a 1915(i) application to extend Home and Community Based Care (HCBS) to residents with traumatic brain injury. For more information, visit:
Testimony of Scan's Policy Director with Chart Explaining Provisions in ACA
Scan Research Brief
Report: Older Adults In California Need More To Survive
Recently released Census data found that 43.6 million Americans were living below the Federal Poverty Line (FPL) in 2009, which is $22,050 for a family of four. While this figure represents over 14% of Americans living in poverty, a recent policy brief suggests a more accurate way to measure the cost of living. The alternative measure is called the Elder Index and is a county-specific benchmark about the cost of basic needs (food, housing, health care, and transportation). Using this index, the authors explain that older Californians need $21,763 per year (on average) in order to meet basic living expenses, which is more than twice the amount of money ($10,830) suggested by the FPL. This finding has important implications for seniors and their caregivers because many government programs use the FPL both for eligibility criteria and in decision-making about how to target services. The authors report that 60% of the Area Agencies on Aging in California have shifted to using the Elder Index in their strategic plans to keep older adults living in their homes independently. Legislation has also been introduced (AB 2114) to require California's Department of Aging to utilize the Elder Index. For more information, visit:
UCLA Center for Health Policy Research
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Demonstration Program To Treat Patients With Multiple Chronic Conditions At Home|
Medicare enrollees with multiple chronic conditions represent a large expense in the Medicare program. Under a demonstration program created by the Affordable Care Act (ACA), 10,000 Medicare enrollees with multiple chronic conditions and who are unable to perform Activities of Daily Living (ADL's) will receive home visits by doctors. The demonstration, known as "Independence at Home," will allow patients to remain in their homes and may alleviate pressure on caregivers who are often responsible for coordinating patient travel to health care providers. A similar program in Washington D.C. serves approximately 600 patients annually and has reported that the program reduced expected hospitalization of participating patients by almost two-thirds. Healthcare organizations that participate in the demonstration project and that are able to cut treatment costs by 5%, improve health outcomes, and receive positive reviews will be eligible to share in further savings from the demonstration. The program is expected to start in January 2012. For more information, visit:
The Los Angeles Times
Demonstration Program Will Cover Hospice and Curative Treatments Concurrently
A demonstration program in the Affordable Care Act (ACA) will allow patients to enroll in hospice care while also continuing to receive curative treatment. This demonstration represents an important shift since current rules permit Medicare beneficiaries to choose hospice care only if their doctor determines they have less than six months to live and the beneficiary forgoes any further life-prolonging treatments for their disease. The three-year demonstration will operate at 15 nationwide sites and will allow patients to receive both hospice and curative care. The August issue of the New Yorker features an article by Dr. Atul Gawande, "Letting Go," in which he explains the issues of curative vs. hospice care through the stories of several patients and their families. Dr. Gawande also discusses the results of an Aetna program that provides both curative and hospice care (which lowered costs and improved patient outcomes), and the city of La Crosse, Wisconsin, where 85% of residents who died in 1996 had completed an Advanced Directive as a result of a campaign that asked patients and doctors to discuss end-of-life wishes. For more information, visit:
Kaiser Health News
The New Yorker
Field Hearings On Reauthorization Of Older Americans Act
The United States Senate Special Committee on Aging recently held field hearings about the Older Americans Act that is expected to be re-authorized in 2011. One of the witnesses, Dorothy Williams, is a caregiver in Wisconsin and explained how the National Family Caregiver Support Program allowed her to receive respite from caring for her mother who has dementia. The Administration on Aging has a website with information on the upcoming re-authorization and individuals can submit their input through this website. For more information, visit:
U.S. Senate Special Committee on Aging
Administration on Aging Older Americans Act Reauthorization Page
Caregiving In China: An Emerging Issue|
The June special issue of Ageing International (Volume 35, Number 2) features six articles focused on caregiving in China, a country that has the largest aging population in the world. One article suggests China use a three-pronged approach in its approach to dementia care, by building an indigenous "family-based, community-oriented, and social worker-supported" model. Another study focuses on 47 Chinese American caregivers and the authors suggest that while the caregivers exhibited typical caregiver stress, strong belief in Asian values also led to more normal cortisol (stress hormone) patterns, less depressive symptoms and greater self-efficacy. For more information, visit:
Europe's Approach To Paying For Long-Term Care
A recent policy brief analyzes public and private financing of long-term care (LTC) in eight European countries. In "Paying for Long-Term Care," the authors suggest that declining birth rates coupled with people living longer may lead to fewer family caregivers. The authors explain that compared to government spending on other social programs like pension and health care, European governments devote minimal resources for long-term care. According to a report released this week from Alzheimer's Disease International, the worldwide cost of dementia care in 2010 will exceed 1% of global GDP at a cost of $604 billion. For more information, visit:
European Centre for Social Welfare Policy and Research
Alzheimer's Disease International
Five Most Common Challenges Faced By Caregivers
The August edition of British Medical Journal features a qualitative study of the various challenges faced by caregivers. Through one-on-one interviews and focus groups, the authors identify five decision making areas that are consistently challenging for caregivers: accessing dementia related services, care homes, legal/financial matters, non-dementia related health care, and making plans for the care recipient if the caregiver becomes too ill to care for them. Caregivers explained that decision-making was often hampered by active resistance from the care receiver, legal authority is often insufficient and support from professionals was important for navigating the many hurdles in caregiving. To read "Making decisions for people with dementia who lack capacity: qualitative study of family carers in UK" by Dr. Gill Livingston and colleagues, visit:
British Medical Journal
Philippines Aged Population Support System
A recent article in the Manila Bulletin focuses on the estimated seven million older adults in the Philippines and the government infrastructure to support this population. The author explains that Filipino children have traditionally served as caregivers for their parents; however, some parents are not supported by their children and may be referred to state-run elderly centers. The Department of Social Welfare and Development reports that state-run centers served 516 elders in 2009 and have served 27,300 older persons since inception. A government representative explained that the centers only accept elders who are neglected or who have no families. For more information, visit:
Art And Music As Communication Tools For Patients With Alzheimer's|
A recent article in the Summer 2010 issue of Aging Well magazine (Volume 3, Number 3) discussed using music and art to facilitate communication with patients who have Alzheimer's. The author interviews several doctors who share stories of patients who had difficulty communicating, however, the doctors noticed an improvement in communication after patients participated in art and/or music therapy. The article discusses various approaches to using art and music therapy. To read "Unlocking Memory: Art and Music Serve as Keys" by Lindsey Getz, visit:
Study Examines Wearable Technologies For Adults With Alzheimer's
A recent study in the American Journal of Alzheimer's Disease and Other Dementias examines current technology and the state-of-the-art for devices for adults with Alzheimer's. The authors discuss design issues and after a review of current products, conclude that there is room for improvement. A September 10th article in the Toronto Star also examined new technologies, designed with the goal of assisting caregivers, including remote health monitoring systems and GPS bracelets to help track loved ones who wander. It is unclear to what degree these new products will be adopted by caregivers and care receivers, though supporters suggest that technology could enable "remote caregiving" and allow more care recipients to stay in their homes instead of moving into a care facility. For more information, visit:
American Journal of Alzheimer's Disease and Other Dementias
Study Finds Link Between Post-Traumatic Stress Disorder And Dementia
The September issue of the Journal of the American Geriatrics Society (Volume 58, Issue 9) features a study that found that Veterans with post-traumatic stress disorder (PTSD) were twice as likely to develop dementia compared to Veterans without PTSD. The study included 10,481 Veterans aged 65 or older and could have important implications for future Veteran care because of the number of Veterans who have served in Iraq and Afghanistan. In July, the Department of Veteran Affairs announced new rules intended to simplify the process for Veterans to claim service connection for PTSD that is also expected to reduce the amount of time for claims processing. A 2008 Rand Corporation Study interviewed 1,965 Veterans and servicemenbers of the conflicts in Iraq and Afghanistan and found that 14% screened positive for PTSD while 19% reported a probable Traumatic Brain Injury (TBI) during deployment. For more information, visit:
Journal of the American Geriatrics Society
Telephone Support Groups For Caregivers Of Veterans With Dementia
The September issue of the Gerontologist (Volume 50, Issue 5) features a study that evaluates how a caregiver telephone support and education group could reduce costs of care for Veterans with Dementia. The year-long study included 158 spousal caregivers, half of whom received monthly, 1-hour sessions of telephone education and support on care recipient health care. At six months, the patient costs for the caregivers receiving the telephone support/education were $2,768 less than the group that did not receive telephone support/education. However, these costs were not maintained at the one year mark. Each expense was assessed separately and only the nursing home costs reached statistical significance with a savings of $1,057. The authors suggest that future studies could measure if phone support/education groups also have outcomes for the caregiver. To read "The Effects of Telephone Support Groups on Costs of Care for Veterans With Dementia" by Dr. Laura O. Wray and colleagues, visit:
Webinar: Competency Model for Long-Term Care Workers|
The Affordable Care Act (ACA) established training opportunities for people who are interested in health care careers in long-term care, supports and services. The Employment and Training Administration (part of the Department of Labor) has worked in collaboration with subject-matter and technical experts to develop a comprehensive competency model for workers providing long-term care. Presenters for the webinar include Janet Stan, Chief of Workforce System Support at ETA; Henry Claypool, Project Officer with U.S. Department of Health and Human Services, Office on Disability; Steven Edelstein, the National Policy Director at PHI; and Jessica Barker, Associate Director at ANCOR. The webinar is on Monday, September 27, 2010, at 12:00pm Eastern (11:00am/Central, 10:00am/Mountain, 9:00am/Pacific). For more information or to register, visit:
Employment and Training Administration
Web Forum: How Physicians And Hospitals Can Be Accountable Together
A web forum sponsored by the Public Health Institute and Kaiser Permanente Institute for Health Policy will address how to improve physician and hospital collaboration and accountability. Speakers will discuss current thinking on organizational structures and payment reform as well as the roles that various stakeholders can play in the delivery system transformation. Presenters include: Dr. Stephen M. Shortell from the School of Public Health at the University of California, Berkely; Stuart Guterman, Vice President of Payment and System Reform at the Commonwealth Fund and Dr. Francis J. Crosson, Senior Fellow at Kaiser Permanente Institute for Health Policy. The forum is on Monday, September 27, from 6:30pm-8:00pm (ET). For more information or to register, visit:
Kaiser Permanente Institute for Health Policy
Conference Call: Health Reform And Seniors With Vice President Biden
A conference call on Thursday, September 23 will feature Vice President Joe Biden and Health & Human Services Secretary Kathleen Sebelius who will discuss how health reform will affect seniors. The call will address Medicare, prescription drug costs, and the new Patient's Bill of Rights, which takes effect on September 23, 2010. The phone number for the call is 1-888-455-9735 and the call will begin at 11:30am (ET). For more information, visit:
National Council on Aging
Brave Old World: Multimedia Website Explores Aging In America|
A website created by reporters at the Columbia School of Journalism explores the demographic shift in the United States as the aging population increases. The site features stories and images of people aging across the U.S. and includes a video of "Elderland," a fictional town in 2035 where one in five Americans is over 65 and new technology adapts to meet their needs. For more information, visit:
Brave Old World
Grants For Native American Caregiver Support Program
The Administration on Aging recently announced a three-year grant opportunity for the Native American and Native American Caregiver Support Program. Completed grant applications are due by November 30, 2010. The grant is open to "all current Title VI, Part A and Part B grantees, current grantees who wish to leave a consortium, and eligible federally recognized Indian tribal organizations that are not now participating in Title VI, and would like to apply as a new grantee." For more information, visit:
Administration on Aging
Six Month Anniversary Of Affordable Care Act
September 23, 2010 is the six month anniversary of the passage of the Affordable Care Act (ACA). Several of the provisions of the new law take effect on September 23, including the ability of young adults to stay on their parent's health plan until the age of 26, as well as a prohibition on denying coverage for children with pre-existing conditions. (In some cases the implementation date will depend on when the plan was sold to the consumer and/or the "health year.") The Kaiser Health Foundation launched a new website that explains the time-line for various provisions in the bill and the Commonwealth Fund also designed a website with a search engine for finding provisions within the new law. Family Caregiver Alliance prepared a guide earlier this year that explains how provisions in the new bill will benefit family caregivers. For more information, visit:
Commonwealth Fund Health Reform Resource Center
Family Caregiver Alliance "Health Care Reform and Family Caregivers"
Kaiser Health Foundation Timeline Website
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