|Home > Newsletters > Caregiving PolicyDigest > Volume X, Number 21, November 17, 2010
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|A Newsletter of FCA's National Center on Caregiving|
November 17, 2010
Volume X, Number 21
|IN THIS ISSUE|
State Legislation, Policy & Reports
- State Budget Woes Continue More...
- Texas Legislators Suggest Dropping Medicaid More...
- Website Explains How Each State Is Implementing Affordable Care Act More...
- New Report On Medicaid Payment Practices As Program Expands More...
Federal Legislation, Policy & Reports
- Kaiser Family Foundation Advocates For Medicare Beneficiaries More...
- States Will "Draw Down" 94% Of FMAP But Are Worried About July 2011 More...
- Financing Long-Term Care In California More...
- Colombian Clan With Dementia Mutation Part Of Efforts To Cure Alzheimer's More...
- Study Finds Chinese Elderly Need More Support From Children More...
- Alberta Aging Population Policy Framework Released More...
- Ireland Ombudsman Finds 300 Cases Of Nursing Home Care Denied More...
Research Reports & Journal Articles
- Study Provides Unique Qualitative And Quantitative Data On Caregivers More...
- Study Finds Significant, Unique Challenges For Veteran Caregivers More...
- Four Processes In Successful Models Of Care For Older Adults With Multiple Conditions More...
- Report Addresses Differences In CLASS Act And Long-Term Care Insurance More...
Conferences & Trainings
- Webinar: "Caregiving 101: Exploring The Complexities Of Family Caregiving" December 7 More...
- Webinar: "Spirituality And Aging: Working Across Religious Boundaries" November 18 More...
- Webinar: "Vision And Aging: Helping Older Adults See Well For A Lifetime" November 18 More...
- Webinar: "Roadmap For Long-Term Supports And Services: State Innovations And Opportunities" November 22 More...
Funding, Media & Miscellaneous
- Aging Drivers Focus Of Recent Forum In Washington, DC More...
- Caregiver Blogs About Experience To Highlight Need For Paid Sick Days More...
- Tenth Anniversary Of National Family Caregiver Support Program More...
- Web-based Study: Promoting Alzheimer's Caregivers Communicative Skillfulness (PACCS) More...
- Alzheimer's Study Seeks Participants With Mild Cognitive Impairment More...
State Budget Woes Continue|
The Center on Budget and Policy Priorities released a report on November 5 that found 29 states and the District of Columbia have cut services or significantly increased the amounts that people must pay for services. These services include medical, rehabilitative, home care or other services needed by low-income people who are elderly or have disabilities. The weakened economy has increased enrollment in Medicaid in most states, putting additional strain on state budgets. While states received a six-month extension of the increased FMAP funding from the federal government, this additional funding will expire in July 2011. In Arizona, the legislative liaison for the state Medicaid program predicts that the expiration of extra FMAP funding will translate to a $1 billion shortfall in the state's Medicaid program starting July 1, 2011. In California, the state's budget shortfall is now projected at $25 billion, due in part to overly rosy projections by the California legislature in passing the most recent budget, including $3.5 billion in funding from the federal government that is unlikely to materialize. For more information, visit:
Center on Budget and Policy Priorities
Arizona Business Journal
Los Angeles Times
Texas Legislators Suggest Dropping Medicaid
A recent Kaiser Health News
article discussed a suggestion by some Texas state legislators to have Texas drop out of Medicaid. While the legal and practical matters are unclear, Republican representatives (who now have a majority in the Texas House Chamber) say they are motivated by an estimated $25 billion state budget deficit and stringent federal rules about how Medicaid is administered. They also suggest that if Texas drops Medicaid, then low-income people would be able to enroll into state exchanges slated to begin operating in 2014. There are 3.6 million Texans enrolled in Medicaid and seven out of ten Texas nursing home residents rely on Medicaid to pay for their care. Even with restrictive income limits, the biennial bill for Medicaid in Texas is $45 billion (representing 20% of the state budget), of which the federal government pays 60% of the bill. The authors explain that almost a dozen other states (including AL, MS, WA, WY) are also considering either dropping Medicaid or remaking it with only state financing and/or seeking federal waivers to change parts of their Medicaid programs. For more information, visit:Kaiser Health News
Website Explains How Each State Is Implementing Affordable Care Act
The National Academy for State Health Policy (NASHP) has created a website that tracks each state's implementation of the Affordable Care Act. The website is divided by issue areas, including state timelines, workplans, fiscal analyses, implementation websites, and state laws. The executive committee of NASHP identified ten priorities for states in implementing the Affordable Care Act and the website also includes reports on how states are addressing these priorities. For more information, visit:
National Academy for State Health Policy
New Report On Medicaid Payment Practices As Program Expands
A recent report from the Center for Health Care Strategies addresses current Medicaid payment practices in the context of Medicaid growing to become the nation's single largest insurer by 2016, with an estimated 20 million additional beneficiaries. Because the Centers for Medicare and Medicaid have provided somewhat limited guidance, stakeholders have turned to the courts to interpret federal statutory mandates, which can be a cumbersome and time-consuming process. The authors examine several of these court cases and conclude by suggesting that Medicaid will have to become a more sophisticated purchaser of health care (for example, by better leveraging its market position) as the number of beneficiaries increases. A recent USA Today
article profiled some of the nation's largest Medicaid health plans whose leaders hope to expand under the Affordable Care Act. However, many patients and doctors interviewed in the article complained about difficulties finding doctors in their networks, low reimbursement rates and long waits for specialists. For more information, visit:
Center for Health Care Strategies
USA Today "Medicaid Managed Care Programs Grow; So Do Issues"
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Kaiser Family Foundation Advocates For Medicare Beneficiaries|
Drew Altman, PhD, CEO of the Kaiser Family Foundation, authored a recent article with suggestions for the three national commissions charged with lowering the national debt. Dr. Altman suggests that a guiding provision for the commissions should be to not add additional taxes to low-income beneficiaries of Medicare and Medicaid who already spend a high percentage of their income on their health care. He explains that 47% of all elderly and disabled people on Medicare have incomes below twice the federal poverty level (less than $20,800 for an individual and $28,000 for a couple in 2008). In 2006, low-income Medicare beneficiaries spent about 14% of their household budgets on health care, as compared to only 4% for non-elderly households. The Kaiser Family Foundation also recently released its Medicare Chartbook 2010 that features national and state-specific graphs, charts, and demographic data about Medicare. For more information, visit:
Kaiser Family Foundation "The People Behind the Entitlement Debate"
Kaiser Family Foundation "Medicare Chartbook 2010"
States Will "Draw Down" 94% Of FMAP But Are Worried About July 2011
A recent GAO report found that states and the District of Columbia are on pace to "draw down" about 94% of the increased FMAP funding provided by the federal government through the Recovery Act. The authors explain that enrollment growth in Medicaid ranged from 1 to 38% across the states from October 2007 to February 2010, with 22 states and the District experiencing growth between 10 and 20% and 16 states reporting growth of 20% or greater. However, almost every state Medicaid director expressed concern about sustaining their state's Medicaid programs without the increased FMAP funding that expires in July 2011. For more information, visit:
United States Government Accountability Office
Financing Long-Term Care In California
A recent technical brief produced by the Scan Foundation provides an overview of the financing of long-term care in California. The report includes California-specific data; however, many of the issues discussed are applicable to all states. Medicaid pays the largest share of long-term care nationally, funding 40% of care provided in 2008. The authors cite a recent poll in which more than two-thirds of Californians aged 40 and older incorrectly thought that Medicare is the primary payer of long-term care. Medicare does not generally pay for long-term care, but will pay for post-acute care services, including short-term home care or home health care for rehabilitation after a hospital stay. The report explains that approximately 36% of long-term care is paid for through either long-term care policies or "out-of-pocket" expenditures, and that many Americans also receive assistance from friends or family. The Affordable Care Act includes demonstration models to reduce the cost of long-term care and also includes the CLASS program, a voluntary long-term care insurance program that will provide an estimated benefit of $50 per day to pay for long-term care. For more information, visit:
Colombian Clan With Dementia Mutation Part Of Efforts To Cure Alzheimer's|
A recent New York Times article about Alzheimer's research focused on a clan in Colombia in which members tend to inherit a genetic mutation that guarantees they will develop dementia, generally in their forties. A research team consisting of American and Colombian scientists plans to test treatments on Colombians in their late thirties and early forties to see if dementia can be either prevented or significantly delayed. Testing for the project is expected to begin in 2011 or early 2012. For more information, visit:
New York Times
Study Finds Chinese Elderly Need More Support From Children
A recent survey of elderly parents in Guangdong province in southern China found that Chinese parents are receiving less support from their children. The survey was conducted by the Guangdong Academy of Social Sciences' elderly affairs research center and included almost 1,300 participants aged 60 or older in urban areas. Historically, Chinese parents lived with their adult children; however, 62% of survey participants reported living away from their children. Of these "empty nesters," 48% receive weekly visits from their children, while 28% expect a visit once a month, and 24% only have a visit once a year. For more information, visit
Alberta Aging Population Policy Framework Released
The government of Alberta released its "Aging Population Policy Framework" on November 8, based on research completed in 2008 that consulted 100 stakeholder groups and conducted an online survey of 10,000 Albertans. The survey identifies eight strategic policy priorities to address the 650,000 Albertans who will be age 65 or older by 2020. The policy directions include raising awareness about the cost of retirement, providing career services for mature workers, and assisting employers with a "multi-generational workforce." Additional directions include supporting senior drivers and providing affordable transportation when driving is no longer feasible, increasing awareness/prevention of elder abuse, easing access to government services, and building "age friendly" communities. In response to criticism that the report doesn't create new policies or programs, the Minister of Aging explained that the report provides a framework for future planning on how to address this growing population. For more information, visit:
Ireland Ombudsman Finds 300 Cases Of Nursing Home Care Denied
A November 10 article in the Irish Independent highlights a recent report by the Ombudsman of Ireland that is critical of the Department of Health and its decisions about who receives publicly funded nursing home care. The report explains that the Irish government is facing more than 300 legal cases from people who assert they were improperly denied publicly funded home care. According to the article, a source within the Department of Health confirmed that if the Department had to pay for private nursing care in these 300 cases, the cost could be several billion euros. The Department of Health has settled 12 of the cases while none of the other cases have yet come to hearing and judgment in the high court. The Ombudsman, Emily O'Reilly, explained, "You could have two people of similar financial backgrounds lying side by side in a private nursing home. One person was getting the care for free and the other was having to pay for it. There was no equity." For more information, visit:
Study Provides Unique Qualitative And Quantitative Data On Caregivers|
The Families and Work Institute has released a report that analyzes data on caregiving based on the ongoing National Study of the Changing Workforce. The report includes both quantitative data from a random sample in 2008 of 3,502 workers in the U.S. as well as qualitative interviews with 140 caregivers. The authors find that 42% of employed Americans have provided elder care ("special attention or care for a relative or in-law 65-years-old or older helping with things that were difficult or impossible for them to do themselves") in the past five years. Similar to past research, this study also finds that women are more likely to provide family care on a regular basis and spend more time than men providing care (9.1 hours on average per week for women, 6.4 hours for men). Caregiving also creates financial challenges. Of the 38% of respondents who report taking time off or working fewer hours, 48% report losing income during their caregiving leave. In addition, 48% reported that they and/or their spouse helped cover the cost of care for their elder, with 27% perceiving this as somewhat of a burden, and 14% perceiving this as a great burden. In terms of caregiver health, 44% of current and former family caregivers report that caregiving has had a negative impact on the way they take care of themselves. The report includes individual responses from the qualitative interviews. One theme highlighted is that of caregivers having a negative view of the aging process: "An alarming theme that emerged from our interviews is that family caregivers overwhelmingly seem to view aging and receiving elder care as profoundly negative, depressing processes to be avoided if at all possible." For more information, visit:
Families and Work Institute
Study Finds Significant, Unique Challenges For Veteran Caregivers
The National Alliance for Caregiving released a report on November 10 detailing findings from their survey of 462 self-identified family caregivers who provide care to a veteran whose injury, illness, or condition is related to military service. The authors also conducted six focus groups and conducted 45 in-depth telephone interviews. The report compares the results of the survey to past caregiver research and finds that caregivers of veterans face unique caregiving burdens. For example, while 15% of caregivers report that they have been giving care for 10 years or more, 30% of veteran caregivers reported providing care for 10 years or more. Mental illness was the most prevalent illness reported (70%), followed by post traumatic stress disorder, which affected 60% of veteran care recipients. While 57% of caregivers nationally reported "having a choice" in taking on their caregiver role, only 29% of veteran caregivers felt that they had a choice. In this study, 96% of veteran caregivers were women, as compared to only 65% of caregivers nationally. For more information, visit:
National Alliance for Caregiving
National Public Radio"Study Spotlights Challenges Faced By Caregivers Of Veterans"
Four Processes In Successful Models Of Care For Older Adults With Multiple Conditions
The November 3 edition (Vol 304, Number 17) of the Journal of the American Medical Association includes a study that examines all peer-reviewed studies of comprehensive primary care models for older adults with multiple chronic conditions published between 1999 and 2010. Based on this review, the authors identify four processes present in most successful models of primary care for this population of adults with four or more chronic conditions. The processes include a comprehensive patient assessment, creation and implementation of an evidenced-based plan of care that addresses all of the patient's health-related needs, communication and coordination with all care providers, and promotion of the patient's (and their family caregiver's) engagement in their own health care. The authors also cite three models that include these processes, including the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE) model. To read "Comprehensive Primary Care for Older Patients With Multiple Chronic Conditions: 'Nobody Rushes You Through'" by Dr. Chad Boult and Dr. Darryl Wieland, visit:
Journal of the American Medical Association
EurekAlert Summary of Study
Report Addresses Differences In CLASS Act And Long-Term Care Insurance
Professor Richard Kaplan recently authored a report that explains current financing options for people to pay for long-term care and then provides a comparison to the new CLASS Act long-term care provision included in the Affordable Care Act. While family caregivers provide an estimated 80% of long-term care in America, the author points out that "without charge" is not the same as "without cost" because caregivers who stop working to provide care may sacrifice their own retirement planning, including Social Security benefits (calculated based on employment earnings) as well as access to retirement products like 401(k)'s or self-funded Individual Retirement Accounts that have to be funded with employment income. Only 10% of Americans have long-term care insurance and the author cites an AARP study that finds "nine of the top-selling companies in this business (long-term care insurance) terminated their long-term care insurance lines." Recent news articles have also highlighted the impact of insurance companies raising long-term care insurance premiums. With this context, the author explains the program design of CLASS, and its benefits as well as the challenges the Department of Health and Human Services will face in creating this program in a self-sustaining manner. To read "Financing Long-Term Care After Health Care Reform" by Richard Kaplan, visit:
University of Illinois College of Law
New York Times: "When a Safety Net Is Yanked Away" (article about Long-term Care)
Webinar: "Caregiving 101: Exploring The Complexities Of Family Caregiving" December 7|
Family Caregiver Alliance is sponsoring a webinar on Tuesday, December 7, from 11:00am to 12:20pm (PST). Participants attending the webinar will gain a better understanding of the challenges and benefits facing family caregivers. The webinar will offer insight on the characteristics of family caregivers, contributing factors to caregiver stress, emerging issues and barriers that affect family caregivers, and the importance of validating the family caregiver experience. This webinar is useful for staff and volunteers who are interested in gaining a broad understanding of what it means to be a family caregiver. The speaker for the webinar is Donna Schempp, LCSW. For more information or to register, visit:
Family Caregiver Alliance
Webinar: "Spirituality And Aging: Working Across Religious Boundaries" November 18
The American Society on Aging's Forum on Religion, Spirituality and Aging will present a webinar on Thursday, November 18, from 10am to 11:00am (PST) about serving the spiritual needs of older adults using a language of spirituality that is not couched in religious or theological language. Robert Atchley, the former President of the American Society on Aging and a member of the ASA's Board of Directors for 12 years, is the presenter. The webinar is free to ASA members. For more information or to register, visit:
American Society on Aging
"Vision And Aging: Helping Older Adults See Well For A Lifetime" November 18
The National Council on Aging will present a webinar on Thursday, November 18, from 1:30pm to 2:30pm (EST) about what organizations can do to promote senior eye health. The speaker, Neyal Ammary-Risch, MPH, CHES, is the director of the National Eye Health Education Program at the National Eye Institute, part of the National Institutes of Health. Participants will learn about the prevalence of eye disease, including glaucoma, diabetic eye disease, low vision, macular degeneration, dry eye, and cataracts and will also discuss community-based education resources at the National Eye Institute. For more information or to register, please visit:
National Council on Aging
Webinar: "Roadmap for Long-Term Supports and Services: State Innovations And Opportunities" November 22
The Center for Health Care Strategies is sponsoring a webinar on Monday, November 22, from 2:00pm to 3:30pm (EST) that will summarize important considerations for overhauling long-term supports and services in the Medicaid program. Presenters will include Patti Killingsworth, Chief of Long-Term Care for TennCare; Marc Gold, Special Advisor for Policy and Promoting Independence with the Texas Department of Aging and Disability Services; and Mary Sowers, Director of the Division of Community and Institutional Services, Center for Medicare & Medicaid Services Disabled and Elderly Health Programs Group. For more information or to register, visit:
Center for Health Care Strategies
Aging Drivers Focus Of Recent Forum In Washington, DC|
The National Transportation Safety Board (NTSB) hosted its first forum on aging drivers on November 9 and 10 in Washington DC. The Chairman of the NTSB citied the 30 million licensed drivers in the U.S. who are 65 years-old or older as the reasoning for hosting this forum. While highway fatalities have decreased by half among drivers over the age of 80, the assembled researchers explained that there was insufficient data to explain the decline. Dr. Bonnie Dobbs from the University of Alberta explained that illness, not age usually impairs an individual's ability to drive, with men outliving their driving careers by six years and women by seven years. The NTSB encourages the public to submit comments on this topic through its website until November 30, and the forum has been archived for viewing. The American Medical Association has also produced a free guide on state driving laws and dementia for doctors. For more information, visit:
National Transportation Safety Board: "Safety, Mobility, and Aging Drivers"
American Medical Association: Guide to State Laws and Dementia
Washington Post "NTSB Forum Examines Growing Population of Elderly Drivers"
Caregiver Blogs About Experience To Highlight Need For Paid Sick Days
A recent blog posting by Kate Karpilow, Executive Director of the California Center for Research on Women and Families, uses her personal experience as a caregiver to make the case for paid sick days nationwide. While picking up medicine for her mother with congestive heart failure, the author noticed that the pharmacy clerk appeared to have the flu, and when confronted, the clerk admitted that she was sick but did not have paid sick leave because she was a contract worker. While the author ended up going to another clerk, she uses this example to highlight the need for paid sick leave for all employees. For more information, visit:
Tenth Anniversary Of National Family Caregiver Support Program
The Administration on Aging sponsored a celebration of the ten-year anniversary of the National Family Caregiver Support Program on November 17, 2010, from 9am to 12pm (EST) at the Ronald Reagan Building in Washington DC. The Administration on Aging has created a new website that celebrates caregivers by providing an opportunity for them to submit written and/or video testimonials. The website also provides tips on how programs can join in on this yearlong celebration by hosting an event honoring family caregivers and posting events on the online calendar. For more information, visit:
Administration on Aging
Web-based Study: Promoting Alzheimer's Caregivers Communicative Skillfulness (PACCS)|
If you routinely attend medical appointments with a close friend or family member who has been diagnosed with Alzheimer's disease or a related memory disorder OR are responsible for communicating with your loved one's medical providers in a long-term care setting, you may be eligible for a research study. This study will test whether a new educational program can help caregivers to communicate more effectively with their loved one's doctors. Participation in this study takes place over the internet and by phone. Please contact Amanda Gentry at (412) 624-3798 or firstname.lastname@example.org for more information.
Alzheimer's Study Seeks Participants With Mild Cognitive Impairment
The National Institute on Aging is seeking individuals who are experiencing early stages of mild cognitive impairment for their study "Imagine a World Without Alzheimer's." ADNI GO, a landmark research study sponsored by the National Institute on Aging at the National Institutes of Health, 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 Alzheimer's disease, as well as the effectiveness of potential prevention and treatment strategies. Specifically, researchers seek volunteers between the ages of 55 and 90-years-old who may be transitioning from normal cognitive aging to an early stage of mild cognitive impairment, a condition that may progress to Alzheimer's disease. This two-year, 24 million-dollar 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 taking part in the ADNI GO study and are looking for participants. For more information, visit:
|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|
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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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