|Home > Newsletters > Caregiving PolicyDigest > Volume X, Number 19, October 20, 2010
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|A newsletter of FCA's National Center on Caregiving
October 20, 2010
Volume X, Number 19
| IN THIS ISSUE|
State Legislation, Policy & Reports
- Governor Schwarzenegger Vetoes Funding For Programs Serving Caregivers More...
- Report Highlights Impact Of Budget Delays On Nonprofits Who Contract With States More...
- All 50 States Accept Additional Federal Medicaid Money But Most Still Make Cuts More...
- Massachusetts Elected Officials Shadow Direct Care Workers More...
- Property Taxes Popular In Michigan To Support Seniors More...
Federal Legislation, Policy & Reports
- Year Of The Family Caregiver Launches November 17th More...
- Report On Title III Programs Finds Increased Demand For Services More...
- Three Reports Analyze High Medicare Spending For Long-Term Care Beneficiaries More...
- Policy Brief Explains Four Options To Expand Community-Based Care Under ACA More...
- Report Profiles Performance Measures In Fee-For-Service Medicaid More...
- Study Finds Half Of Elderly Participants Taking Inappropriate Medications More...
- International Global Aging Preparedness Index Released More...
- Australians Trust Government The Most To Care For Elderly More...
- Report Analyzes Employment And Caregiving For Women In Europe More...
Research Reports & Journal Articles
- AARP Releases Reports On Medicaid Eligibility Standards And Caregiving In Medicare More...
- Literature Review Of Driving Risk For Patients With Dementia More...
- New Diagnostic Framework For Alzheimer's More...
- Study Finds Differences In End-Of-Life Care Preferences Being Followed More...
Conferences & Trainings
- National Respite Conference, Baltimore, MD October 24-27 More...
- Webinar: "A Place For Everyone: Serving LGBT Older Adults At Your Senior Center" Oct. 21
- Webinar: "Free To Move About Your Community: A Look At Senior Transportation Issues" Oct. 21 More...
- Webinar: "The Impact Of Healthcare Reform On Family Caregivers" More...
Funding, Media & Miscellaneous
- Foundation Support For Analysis Of Affordable Care Act More...
- Friends And Family Diagnose Dementia More...
- Medicare Open Enrollment Period Begins November 15th More...
- $500,000 Grant Improves Hospital Discharge By Investing In Home Health Nurses More...
- New Guides Released To Assist Hospital Staff And Caregivers More...
- $100,000 Prize For Intergenerational Programs More...
- Alzheimer's Study Seeks Participants With Mild Cognitive Impairment More...
Governor Schwarzenegger Vetoes Funding For Programs Serving Caregivers|
After a 100 day delay (the longest yet in California's history), the California legislature passed a state budget on October 8, 2010. Using his veto power to override the state legislature, Governor Schwarzenegger cut funding for several programs that serve caregivers and their care recipients. The Governor cut $6.4 million for Community Based Services programs that generally serve low-income seniors and include the Alzheimer's Day Resource Centers, Brown Bag program, Respite, and Senior Companion. The Governor also ordered a 3.6% across-the-board reduction to the hours assessed for In-Home Supportive Services (IHHS), meaning caregivers will have their hours reduced. For more information, visit:
California's State Budget 2010-11
Scan Foundation Fact Sheet: California's 2010-11 Budget
Report Highlights Impact Of Budget Delays On Nonprofits Who Contract With States
A recently released report by the National Council of Nonprofits draws attention to the precarious budget situations faced by nonprofits that contract with government to provide services. The study highlights five main challenges faced by nonprofits, including budget delays, overly complex contracting and reporting requirements, the full cost of services not being paid for, and reporting procedures and contracts being changed by government half-way through completion. Forty-five percent of nonprofits whose government contracts were changed mid-stream reported laying off employees, which is 14% higher than nonprofits whose contracts were not changed mid-stream. In California, where nonprofits were paid with I.O.U.'s by the state in 2009, a state law prevents nonprofits from being eligible for a late payment penalty if the delayed payment is due to the Budget Act not being enacted. A New York City survey found that 66% of nonprofits had been forced to take out a line of credit due to late payments from government agencies. The authors reference a GAO report which found wildly different reimbursement rates for the same federal program, depending on the state. A nonprofit delivering the services in Wisconsin could be reimbursed up to 14% in overhead costs, in Louisiana, the nonprofit would received no more than 9.4%, and in Maryland, the nonprofit would receive zero reimbursement for overhead costs because the state keeps it. The authors conclude: "The consequences of neglecting this broken contracting system are staggering in scope, undermining the reliability of a "system" that is supposed to deliver vital human services." For more information, visit:National Council of Nonprofits
All 50 States Accept Additional Federal Medicaid Money But Most Still Make Cuts
Health and Human Services Secretary Kathleen Sebelius reported in September that all 50 states have requested and accepted additional federal funding for Medicaid that extends the FMAP increase until June 30, 2011. (Governors were required to officially request the funding from the federal government and some suggested this requirement was implemented to address elected officials who publicly criticized the assistance while also accepting it.) The Kaiser Family Foundation's Annual Medicaid Budget Survey found that even with the increased federal funding, 48 states implemented at least one new policy to control cost in fiscal year 2010. In addition, 20 states implemented benefit restrictions for fiscal year 2010, the largest number since the surveys began in 2001. However, under the American Recovery and Reinvestment Act, states were not allowed to restrict Medicaid eligibility standards beyond what they already had in place in July 2008 and 41 states have plans to or have already expanded or simplified eligibility processes. Eighteen states reported implementing utilization controls and other reductions on long-term care services in FY 2010 to contain costs. In a separate report, the Foundation found that 23 states experienced double-digit growth in enrollment in their Medicaid programs between December 2008 and December 2009. For more information, visit:
Kaiser Family Foundation 50 State Medicaid Budget Survey for FY 2010 and 2011
Kaiser Family Foundation Medicaid Enrollment December 2009 Snapshot
Massachusetts Elected Officials Shadow Direct Care Workers
A state senator and representative in Massachusetts recently spent the day with direct care workers to gain a "hands-on" understanding of the importance of their work. The "Come Care With Me Days" was sponsored by the Paraprofessional Health Institute and was designed to enlighten the public and elected officials on the work of the estimated 60,000 direct care workers in Massachusetts. Elected officials in Iowa and Pennsylvania have also participated in this initiative, designed to call attention to the need for increased training and compensation and a lack of health care benefits for direct care workers. For more information, visit:
Paraprofessional Health Institute
Property Taxes Popular In Michigan To Support Seniors
A recent article in the Detroit Free Press
focused on the popularity of millage (property) taxes to support senior services at the county level. A think tank reviewed 623 ballot proposals in Michigan on a range of issues and found that voters passed every single ballot initiative for senior citizens. Sixty-three of Michigan's 83 counties have a millage, but for counties without a millage, senior centers and programs supporting seniors rely on state and federal money and unpredictable funding from the general fund of local governments. In contrast, in Rochester, Rochester Hills, and Oakland Township, voters approved a millage in 1982 to fund senior programs. This tax funds the Older Person's Commission and the Older Person's Center, a 90,000 square foot center with lap and therapeutic pools, fountains, and recreational activities. The authors explain that a homeowner with a house valued at $200,000 would pay about $25 a year for this tax. In recent August election primaries, 45 millages for senior citizens were renewed and even increased. For more information, visit:
Detroit Free Press
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Year of the Family Caregiver Launches November 17th|
This upcoming November marks the 10th Anniversary of the National Family Caregiver Support Program (NFCSP), a program that has served caregivers throughout the U.S. In recognition of the vital role of caregivers, the Administration on Aging (AOA) has created a new website that celebrates caregivers and allows for submittal of written and video testimonials. In addition, a 10th Anniversary celebration will take place in Washington, DC on November 17th and AOA encourages partners to add their caregiver related events to a calendar on this website. In a recent national survey, 81% of caregivers interviewed said that NFCSP allowed them to care for their loved ones longer and avoid more costly and restrictive placement in an institution. For more information visit:
Administration on Aging
Report On Title III Programs Finds Increased Demand For Services
Title III programs are authorized by the Older Americans Act and provide services to seniors in every state, including home-delivered meals, transportation services, and support for caregivers. The agencies are funded through several sources, and of the 64 agencies that responded to a recent GAO survey, 69% reported that their state funding was reduced for fiscal year 2010. The authors of the report also found state agencies administering these programs are facing increased demand for services and are unable to meet all requests for services. In addition, nearly one in five respondents (19%) reported that they were generally or very unable to serve all seniors who requested home-delivered meals. Respite programs, funded by Title III E, were the most requested service in FY 2009. However, 27% of responding agencies that provide respite reported that they were generally or very unable to meet all requests for respite care. The Older Americans Act is set to be re-authorized in 2011 and the Administration on Aging has a website for input on the reauthorization. Family Caregiver Alliance strongly encourages anybody who uses or administers Title III programs to provide feedback to the Administration on Aging through this website. For more information, visit:
United States Government Accountability Office
Administration on Aging Older Americans Act Reauthorization Page
Three Reports Analyze High Medicare Spending For Long-Term Care Beneficiaries
Kaiser Family Foundation recently released three reports focused on the high use of hospital and other Medicare-covered services for beneficiaries living in nursing homes and other long-term-care facilities. The first report analyzes data from 2006 and found that the 2.2 million Medicare beneficiaries living in a long-term care facility represented approximately six percent of the Medicare population but accounted for 17% of total Medicare spending. The second report uses interviews with family members and clinical staff at long-term care facilities to identify ten primary reasons for high hospital admission rates among long-term care residents. The third report addresses current financial incentives that may encourage skilled nursing facilities to transfer patients to hospitals. For more information, visit:
Kaiser Family Foundation
Policy Brief Explains Four Options To Expand Community-Based Care Under ACA
A recent policy brief by the National Academy of State Health Policy analyzes four options within the Affordable Care Act for states to enhance long-term services and supports (LTSS) through Medicaid Home and Community Based Services. First, the State Balancing Incentive Payments Program will allow eligible states to compete for up to $3 billion in enhanced matching payments in exchange for increasing the percentage of Medicaid LTSS expenditures on home and community based services (HCBS). Second, the Money Follows the Person Rebalancing Demonstration was extended to 2016. Fourteen states sent letters of intent to apply for this demonstration and each of these states received a $200,000 planning grant. Third, the 1915(i) State Plan HCBS encompasses many services, however, only a few states have adopted this option and the authors suggest that few will adopt this option in the near future because of restrictive provisions. Fourth, the Community First Choice Option finances HCBS and would provide states a six percentage point increase in their FMAP rate for Community First Choice Option expenditures. The September/October issue of the Commonwealth Fund's States in Action also provides additional articles about changes to LTSS as well as examples of how three states are shifting to more patient-centered models within facility based care. For more information, visit:
National Academy for State Health Policy
Report Profiles Performance Measures In Fee-For-Service Medicaid
The Center for Health Care Strategies, Inc released a report that examines how nine states have developed performance measurements for their Medicaid fee-in-service (FFS) programs, whose beneficiaries account for approximately 80% of total Medicaid spending. The authors explain that the passage of the Affordable Care Act increases the importance of states having the ability to measure health care quality for current Medicaid beneficiaries as well as the millions more that will become eligible in 2014. For more information, visit:
The Center for Health Care Strategies, Inc
Study Finds Half of Elderly Participants Taking Inappropriate Medications|
A recent study in the September issue (Volume 3, Number 8) of Irish Medical Journal features a study in which 50 participants participated in a brief, ten minute medication review. The mean age of participants was 73, and 88% of patients had some changes made to their medication after the review. Inappropriate medications were detected and changed in 54% of the participants and 70% of participants required cessation of at least one medication. Patients and their caregivers often have to keep track of a number of medications and this study highlights the importance of speaking regularly with a doctor about all prescription and over-the-counter medications. Ninety-six percent of the participants reported that they would like a repeat review. To read "Take Ten Minutes: A Dedicated Ten Minute Medication Review Reduces Polypharmacy in the Elderly" by EK Walsh and colleagues, visit:
Irish Medical Journal
International Global Aging Preparedness Index Released
Three recent stories focused on the oncoming silver tsunami of declining birth rates, an aging population, and underfunded retirement programs. The Center for Strategic and International Studies released an index that measures how well 20 countries are prepared to care for a growing aging population. In their accompanying report, the authors include a reform guide that analyzes the benefits of seven reform strategies, including reducing public pension benefits and increasing immigration. Australia is highlighted for its low-cost, means-tested "floor" of public old-age poverty protection combined with a large, fully-funded, mandatory pension system. The New York Times featured an Op-Ed by the authors about their index. A recent National Public Radio interview featured Ted Fishman, the author of the new book, "Shock of Gray" that highlights the fact that in 2030 more than 1 billion people in the world will be over the age of 50. For more information, visit:
Center for Strategic and International Studies
New York Times
National Public Radio
Australians Trust Government The Most To Care For Elderly
A recent article in the Sydney Morning Herald analyzed results from a survey that found Australians strongly favor government caring for the elderly as compared to friends and relatives. The 2009 survey polled more than 1,400 people on their attitudes and expectations of aged care and 53% responded that the government would be best at delivering care for the elderly, while 16% suggested family and relatives would be best suited. For delivery of services, the most popular option (35%) was for elderly to remain in their homes and be visited by a government care provider. For more information, visit:
Sydney Morning Herald
Report Analyzes Employment And Caregiving For Women In Europe
A recent study used an economic model to study the prevalence of informal caregiving by adult women in Northern, Central, and Southern European countries. The authors begin their report by explaining that Northern European countries are considered to have generous long-term care programs while Southern countries provide only basic benefits for low-income elders. The authors also explain that one theory suggests that higher education levels and stronger labor force attachment may translate to fewer women in Northern countries serving as caregivers because of the higher opportunity costs. The authors find that in Southern countries parent health does have an impact on the daughter's probability of daily care-giving and of their probability of working, and even more significant impacts are found for combinations of low-education working daughters "close to the margin of non-participation, or daughters whose parents suffer from dementia." To read "Caregiving to Elderly Parents and Employment Status of European Mature Women" by Dr. Laura Crespo and colleagues, visit:
Centro de Estudios Monetarios Y Financieros
AARP Releases Reports On Medicaid Eligibility Standards And Caregiving In Medicare|
The Public Policy Institute at AARP recently released two reports with important information for and about caregivers. The first report surveyed state Medicaid financial eligibility standards for nursing home and home and community-based waivers services for older person and adults with disabilities. The report explains differences in how states treat assets and income both before and after qualifying for Medicaid. The second report analyzes data from the National Long-Term Care Survey, a nation-wide survey of Medicare beneficiaries age 65 and older and compares caregiving trends from 1994 to 2004. Women continued to do the majority of caregiving work in 2004, with wives representing 57% of all caregiving spouses and daughters representing almost two-thirds of caregiving children in both 1994 and 2004. For more information, visit:
AARP: Access to Long-Term Services and Supports: A 50-State Survey of Medicaid Financial Eligibility Standards
AARP: Trends in Family Caregiving and Paid Home Care for Older People with Disabilities in the Community: Data from the National Long-Term Care Survey
Literature Review Of Driving Risk For Patients With Dementia
A study featured in the April issue of Neurology (Volume 74, Issue 16) is now available online.
The authors of the study reviewed 422 articles related to dementia and driving to update the 2000 American Academy of Neurology practice parameters on driving and dementia. The authors explain the need for the review by citing research that found that while patients with dementia are higher risk drivers, as many as 76% of patients with mild dementia are able to pass an on-road driving test and can safely drive. The authors conclude that six characteristics are helpful for identifying patients at increased risk for unsafe driving, while two are considered not useful. Family Caregiver Alliance's website features a fact-sheet on dementia and driving that provides suggestions for caregivers and the American Medical Association produced a free guide for doctors that lists laws in each state related to driving and dementia. To read "Practice Parameter Update: Evaluation and Management of Driving Risk in Dementia" by Dr. DJ Iverson and colleagues, visit:
Family Caregiver Alliance "Dementia and Driving"
AMA Physician's Guide to Assessing and Counseling Older Drivers
New Diagnostic Framework For Alzheimer's
The November issue of The Lancet Neurology (Volume 9, Issue 11) features a paper by the International Working Group for New Research Criteria for the Diagnosis of Alzheimer's Disease that addresses recent advances in Alzheimer's diagnosis, including the use of biomarkers. The authors propose a common lexicon as a point of reference for both the clinical and research communities and propose considering Alzheimer's "solely as a clinical and symptomatic entity that encompasses both predementia and dementia phases." To read "Revising the Definition of Alzheimer's Disease: A New Lexicon" by Professor Bruno Duois and colleagues, visit:
The Lancet Neurology
Study Finds Differences In End-Of-Life Care Preferences Being Followed
A report in the September issue of Archives of Internal Medicine (Volume 170, Number 17) focuses on end of life (EOL) care for 71 black and 261 white patients with advanced cancer. The authors attempt to discern why black patients tend to receive more life-prolonging care while white patients are more likely to receive comfort-directed care. While the black and white patients had similar rates of EOL discussions, the authors found several differences, including black patients being less aware of the terminal nature of their disease and white patients being more likely to have Do Not Resuscitate (DNR) orders in place and preferred symptom-directed care as compared to life-prolonging EOL care. However, black patients who had Do Not Resuscitate (DNR) orders were "no less likely than black patients without DNR orders to receive life-prolonging care." To read "Racial Disparities in the Outcomes of Communication on Medical Care Received Near Death" by Dr. Jennifer W. Mack and colleagues, visit:
Archives of Internal Medicine
National Respite Conference, Baltimore, MD October 24-27|
The Maryland Respite Care Coalition, in partnership with the ARCH National Respite Network, will host the National Respite Conference October 24-27, 2010 at the Sheraton Baltimore City Center Hotel in Baltimore, MD. The theme is RESPITE: Create It and is a call for advocates and professionals to showcase the creative ways in which Respite Care is delivered throughout the nation. This conference is intended for everyone who supports family members and caregivers of individuals across the Lifespan. This is an especially exciting year as the new federally funded Lifespan Respite States and the 20th Anniversary of ARCH are celebrated. For more information or to register, visit:
Maryland Respite Care Coalition
Webinar: "A Place For Everyone: Serving LGBT Older Adults at Your Senior Center" Oct. 21
The National Council on Aging, National Institute of Senior Centers, and SAGE will host a webinar on Thursday, October 21, 1:30pm (EST). The webinar will focus on how senior centers can serve lesbian, gay, bisexual and transgender older adults. For more information or to register, visit:
National Council on Aging
Webinar: "Free To Move About Your Community: A Look At Senior Transportation Issues" Oct. 21
The National Council on Aging and the National Center on Senior Transportation will host a webinar on Thursday, Oct. 21 at 1:30PM (ET). The webinar will introduce participants to the National Center on Senior Transportation, provide an overview of senior transportation options available in most communities, and will also provide a sampling of "best-of-the-best" resources and programs in senior transportation. For more information or to register, visit:
National Council on Aging
Webinar: "The Impact of Healthcare Reform On Family Caregivers"
The National Alliance for Caregiving, the National Family Caregivers Association, and Family Caregiver Alliance will present a webinar on November 8th at 10am (Pacific Time) on the impact of the Affordable Care Act (ACA) on family caregivers. Presenters will include Gail Hunt, President and CEO of the National Alliance for Caregiving, Suzanne Mintz, President and CEO of the National Family Caregivers Association, and Kathy Kelly, Executive Director of Family Caregiver Alliance. Family Caregiver Alliance previously released a policy brief about the impact of the new health care law on family caregivers. For more information or to register, visit:
Webinar: The Impact of Healthcare Reform on Family Caregivers
Family Caregiver Alliance Research Brief
Foundation Support For Analysis Of Affordable Care Act|
Health Affairs Grant Watch Blog recently featured a two-part series focused on foundations and how they are providing funding for analysis, education, and planning for changes under the Affordable Care Act. Projects range from the Blue Shield Foundation granting $1.9 million to assist 12 California counties in planning for health care expansion to the Kaiser Family Foundation's animated short video,"Health Reform Hits Main Street," narrated by Cokie Roberts. For more information visit:
How Philanthropy is Helping With Health Reform, Part I
How Philanthropy is Helping With Health Reform, Part II
Friends And Family Diagnose Dementia
A recent article in Bloomberg Businessweek discussed the results of new research that suggests that a person's family and close friends are better able to spot the initial signs of dementia than doctors. The screening is known as Ascertain Dementia 8, and asks questions about a patient's judgment, activity levels, forgetfulness, and overall thinking skills and can be completed in two minutes. The co-author of the study explained that the tool could be used for a faster, less expensive approach instead of testing all Alzheimer's disease patients for disease biomarkers. For more information, visit:
Medicare Open Enrollment Period Begins November 15th
The open enrollment period for Medicare begins on November 15th, and a number of resources are available to assist patients and caregivers in making decisions. A recent New York Times article explains how rates may change for Parts A, B, C, and D, and cautions consumers that premiums for Medicare Advantage plans have been frozen at last year's level, which may lead insurers to cut other services to make up for lost revenue. The National Committee for Quality Insurance recently released its 2010 health insurance plan rankings and its website says it will release rankings for Medicaid and Medicare plans shortly, both rankings will be featured in Consumer Reports. The Associated Press recently reported on a study that found that every state will have at least two prescription drug plans that will cover at least some drugs in the donut hole. Finally, the official Medicare website features a "Plan Finder" to assist consumers in finding an appropriate Medicare plan. For more information visit:
New York Times
National Committee for Quality Insurance
Medicare Plan Finder
$500,000 Grant Improves Hospital Discharge By Investing In Home Health Nurses
A recently announced two-year, grant-funded project in Colorado will invest $500,000 to build a stronger home health care workforce. Home health nurses play an important role in working with patients and their caregivers after they have been discharged from the hospital and this need will increase with a rapidly aging population. The grant will support home health nurses in Colorado through increased training, development of assessment and recruitment tools, establishing an orientation program for new staff, and developing an assessment methodology to evaluate and validate nurse competencies. For more information, visit:
Robert Wood Johnson Foundation
New Guides Released To Assist Hospital Staff And Caregivers
Next Step in Care recently released two helpful guides. The first guide, "Reducing the Stress of Hospitalization for Patients with Dementia and Their Family Caregivers" introduces the reader to the topic from the perspective of a patient with Dementia who is in the Emergency Room. The guide gives practical advice for hospital staff to assist patients and their caregivers. The second guide, "Rehab to Home: Discharge Guide" is available in English, Spanish, Chinese and Russian and is written for family caregivers. The guide provides information about planning for a discharge, including equipment, household adaptations, medication, and how to appeal a discharge plan if a caregiver disagrees with the decision or feels it is unsafe. For more information, visit:
Next Step in Care: "Reducing the Stress of Hospitalization for Patients with Dementia..."
Next Step in Care: "Rehab to Home: Discharge Guide"
$100,000 Prize for Intergenerational Programs
The Eisner Foundation recently announced a $100,000 cash award for organizations and individuals to recognize excellence in uniting multiple generations, especially seniors and youth. The deadline for nominations is January 31, 2011. For more information, visit:
Alzheimer's Study Seeks Participants With Mild Cognitive Impairment|
The National Institute on Aging (NIA) is Seeking Individuals 55 to 90 Years Old Who Are Experiencing Early Stage of Mild Cognitive Impairment (MCI) for Their Study "Imagine a World Without Alzheimer's". ADNI GO, a landmark research study sponsored by the National Institute on Aging (NIA) at the National Institutes of Health (NIH), is examining the sequence and timing of events at the initial onset of mild cognitive symptoms and may help scientists to better identify who is at risk for AD, as well as the effectiveness of potential prevention and treatment strategies. Specifically, researchers are looking for volunteers between the ages of 55 and 90 who may be transitioning from normal cognitive aging to an early stage of mild cognitive impairment (MCI), a condition that may progress to Alzheimer's disease. This two-year, $24 million study focuses for the first time on people experiencing the very earliest complaints of memory problems that affect their daily activities. Several nationwide clinical research sites are participating in the ADNI study. For more information, visit:
Alzheimer's Disease Neuroimaging Initiative
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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 Policy_Digest@caregiver.org or visit the Family Caregiver Alliance website at www.caregiver.org.
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