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|A Newsletter of FCA's National Center on Caregiving|
February 23, 2011
Volume XI, Number 4
| IN THIS ISSUE|
State Legislation, Policy & Reports
- Arizona: State Can Cut Medicaid Rolls In September 2011 More...
- New York: 49 Proposed Strategies To Rein In Medicaid Budget More...
- Increased Cost-Sharing Does Not Save Money And May Worsen Health Care More...
- California: New Report Analyzes Implications Of Budget Cuts On Most Vulnerable More...
- California: Paid Sick Days Legislation Introduced More...
Federal Legislation, Policy & Reports
- Proposed Federal Budgets Are Mixed Bag For Family Caregivers And Elderly More...
- Two Reports On HCBS Waivers And Money Follows The Person More...
- CLASS Program Moves Forward More...
- United Kingdom Lowers Asset Test Threshold For Residential Care More...
- Survey Examines How Customers in UK Encounter Community Services More...
- Canada: Survey Finds One Sibling Does Majority Of Caregiving Work More...
- Hospital In United Kingdom May Use Legal Process To Force Discharges More...
Research Reports & Journal Articles
- Blacks More Likely To Be Readmitted To Hospital Soon After Discharge More...
- Study Analyzes Caregiving Effects On Being Employed More...
- Review Of Research On End-Of-Life Care And Spirituality More...
- Report: 42 Percent Of Employees Lack Paid Sick Days In 2010 More...
Conferences & Trainings
- Conference: Council On Social Work Education, October 27-30, 2011 More...
- Conference: Gerontological Society Of America, November 18-22, 2011 More...
- Conference: National Home And Community Based Services Conference, Sept. 11-14 2011 More...
- Webinar: "Meeting The Needs Of Our Diverse Clients: Why Culture Counts In Health Care" Feb. 24 More...
Funding, Media & Miscellaneous
- Nursing Home Quality And Ownership Focus Of Reports More...
- New Caregiver Quality Of Life Questionnaire Released More...
- Practical Financial Advice For Family Caregivers More...
- Female Informal Family Caregivers Of Veterans With Traumatic Brain Injury More...
Arizona: State Can Cut Medicaid Rolls In September 2011
Governor Jan Brewer requested in January that the federal government allow Arizona to cut 280,000 low-income, childless adults from the state's Medicaid program, and in a February 15 letter, Secretary Sebelius appeared to grant permission for the cuts. State analysts project that eliminating this coverage would translate to savings of $541 million. However, under the Affordable Care Act and in order to receive increased federal funding (FMAP), states are required to maintain Medicaid eligibility standards that were in effect on July 1, 2008, until state Medicaid exchanges take effect in 2014. In Secretary Sebelius' letter, she explains that because the 280,000 beneficiaries are part of a demonstration, Arizona could achieve its goals by not renewing the demonstration in September 2011. The New York Times notes that five other states have similar demonstration waivers. The Center on Budget and Policy Priorities (CBPP) analyzed the potential impact if HHS waived the Maintenance of Effort (MOE) requirements for states, and found that on average, every dollar that a state cuts in its Medicaid program means $1.33 less in federal funding, for a total loss of $2.33. Family caregivers rely on Home and Community Based Services provided through Medicaid and the authors note that waiving the MOE requirements could mean beneficiaries are cut from the programs, eligibility requirements are made stricter, or enrollment caps are implemented. For more information, visit:
Secretary Sebelius letter to Governor Brewer
CBPP: "Repealing Health Reforms Maintenance of Effort Provision..."
California Health Line: "HHS Gives Arizona Go Ahead on Plan To Cut Medicaid Eligibility"
New York Times "Sebelius Clears the Way for Arizona to Shed Adults from Medicaid"
New York: 49 Proposed Strategies To Rein In Medicaid Budget
New York Governor Andrew Cuomo created a panel in 2010 known as the Medicaid Redesign Team to identify cost-savings proposals for the state program. The New York Times
reports that after receiving input from stakeholders including about 3,000 suggestions, the panel identified 49 potential strategies with expected cost savings of $4 billion, a significant amount in a state that spends $54 billion on Medicaid annually. However, advocates are concerned about proposed cuts to services that help disabled patients to remain in their homes by assisting with housekeeping, shopping, cooking, and other activities of daily living. Valerie Bogart, an attorney with Selfhelp Community Services, called the elimination of these services a "penny-wise, pound-foolish," and explained that "Without assistance to shop, clean or do laundry, a frail individual is at much higher risk of falling or other hazard, triggering emergency acute medical care and potentially more extensive long-term care." For more information, read:NY Medicaid Redesign Team "Description of Proposals"
New York Times: "49 Suggestions for Cutting Billions in State's Medicaid Costs"
Increased Cost-Sharing Does Not Save Money And May Worsen Health Care back to top
A recent RWJF analysis of studies of increasing cost-sharing (increasing the patient's share of the cost of their health care) found that it often leads to worse health outcomes and does not always achieve cost savings. The findings are especially relevant for state policymakers who may be considering increasing cost-sharing in Medicaid as a way to save money. In one Rand study, higher cost-sharing led to less patient-initiated care for healthier patients, however, this population already has low medical expenses. The Rand study also found that higher cost-sharing led to patients reducing their use of both appropriate and inappropriate care about equally. For people with chronic conditions that need high amounts of health care, cost-sharing will not necessarily mean a reduction in the amount of care they consume because their treatments are medically necessary. The authors explain that additional studies found that "that low-income people in poor health are more likely to suffer adverse health outcomes, such as increased rates of emergency department (ED) use, hospitalizations, admission to nursing homes, and death, when increased cost-sharing causes them to reduce their use of health care, particularly prescription drugs..." Businessweek
provides a short summary of eight states and their plans to reduce costs through cutting payments to providers, reducing benefits, and restricting eligibility requirements. For more information, visit:
Robert Wood Johnson Foundation: "Cost-sharing: Effects on Spending and Outcomes"
Businessweek "Taking a Scalpel to Medicaid"
California: New Report Analyzes Implications Of Budget Cuts On Most Vulnerable
A recent study interviewed 33 Californians who are consumers of long-term care services to better understand how they rely on these programs. All of the interviewees receive at least Medicare, Medi-Cal, and In-Home Supportive Services (IHSS). The authors find that most of the recipients rely on a patchwork of services to receive the care they need and that all of the interviewees prefer to stay in their homes as compared to institutional care. The authors note that Governor Brown's 2011-12 proposed budget will cut an additional 8.4% (on top of the 3.6% cut from last year) to the In-Home Supportive Services program that these interviewees rely on. Brown's budget will also eliminate hours for domestic and related services for children and for the 48% of adults in IHSS who reside in a "shared living arrangement" with a relative, friend, or other person. The Paraprofessional Healthcare Institute recently noted that these cuts to services could expose the State of California to legal liability based on the landmark Olmstead decision. For more information, visit:
UCLA Center for Health Policy Research: "Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent"
PHI: "Proposed Cuts to California IHSS Could Face Legal Challenges"
California: Paid Sick Days Legislation Introduced
State Assemblywoman Fiona Ma introduced the Healthy Workplaces, Health Families Act on February 14, 2011. The legislation would require employers to provide employees with paid sick days at the rate of one hour per every 30 hours worked. Employees would not be able to use the sick days until after they had been employed for 90 days. The sick days could be used if the employee is ill or if a close relative is ill and requires care. Family caregivers who are employed often face predicaments of balancing their job while maintaining their own health and/or taking their loved ones to doctor's appointments and this situation is exacerbated when employers don't provide paid sick leave. In a 2010 poll about similar federal legislation, 86% of respondents reported favoring legislation that would mandate seven paid sick days per year. For more information, visit:
California Legislature: "AB 400, the Healthy Workplaces, Healthy Families Act"
Public Welfare Foundation: "Paid Sick Days: Attitudes and Experiences"
Paid Sick Days Website
Proposed Federal Budgets Are Mixed Bag For Family Caregivers And Elderly
President Obama released his proposed federal budget for FY 2012 on February 14th with strong support for programs serving family caregivers, including $10 million for the Lifespan Respite Care Program (a $7.5 million increase over current levels) and $23 million for a State Paid Leave Fund, administered by the Department of Labor to assist states in creating state paid leave programs. President Obama's proposed budget also allocates an additional $48 million for Home and Community Based Services including adult day care, transportation services, and minor home modifications. However, the National Council on Aging (NCOA) points out that the President's budget also proposes a 45% cut in the Senior Community Service Employment Program (SCSEP), which would result in the loss of over 55,000 part-time jobs and cuts the Low Income Home Energy Assistance Program (LIHEAP) budget by 50%. NCOA's analysis explains that nearly 40% of people who receive LIHEAP are aged 60 or older. Obama's budget also cuts Community Development Block Grants (CDBG) by $300 million, a program that serves 2.3 million seniors. $120 million is allocated in the President's budget to begin implementation of the CLASS program, a voluntary long-term care insurance program.
Because Congress only passed a "Continuing Resolution" bill to fund the federal government for FY 2011, Congress must also either pass a FY 2011 budget by March 4th or pass an additional continuing resolution bill. On February 19th, the House of Representatives passed a FY 2011 budget with $100 billion in budget cuts that includes some of the same cuts as Obama, including LIHEAP and CDBG. Senior housing programs would be reduced by $551 million. For more information, visit:
Arch National Respite Network and Resource Center: "President Obama Doubles Funding Request for Lifespan Respite Program"
NCOA: "Deep Proposed Budget Cuts Would Weaken Programs Targeted to Low-Income Older Americans"
NCOA: "House Approves Cuts Targeting Seniors"
Direct Care Alliance: "FY 2012 Budget Letter"
NASUAD: Preliminary Analysis of President's 2012 Proposed Budget
Two Reports On HCBS Waivers And Money Follows The Person
The Kaiser Foundation released reports on two programs that serve care recipients and family caregivers. The Money Follows the Person (MFP) program was started in 2006 with a goal of transitioning 38,000 people from institutional care to community care, however, as of July 2010, only 9,000 people have been transitioned out of community care. Affordable housing was cited as a large impediment to transitioning more people. The program was extended under the Affordable Care Act until 2016 and participants are now eligible for MFP after receiving institutional care for only 90 days, whereas previously they had to receive institutional care for at least six months.
The second report analyzed the three main Home and Community Based Services (HCBS) programs, including the 1915 (c) HCBS waiver, Mandatory Home health benefit, and the optional state plan personal care services benefit. All states reported using cost containment strategies in their 1915(c) waivers, including financial and functional eligibility restrictions. As of 2009, there were 139 waivers in 39 states with over 365,000 individuals on waiting lists (221,898 for MR/DD population; 107,563 for aged and aged/disabled populations). The average wait time on the wait list for all waivers was 21 months, and the report provides data and charts with information specific to each state. For more information, visit:
Kaiser Foundation: "Money Follows the Person: A 2010 Snapshot"
Kaiser Foundation: "Medicaid Home and Community-Based Service Programs: Data Update"
Politico: "Home care tripped up by red tape"
CLASS Program Moves Forward
The Department of Health and Human Services is moving forward to design and implement the Community Living Assistance and Support Program (CLASS) that was included in the Affordable Care Act. Secretary Sebelius provided an update on the planning for the program that will be located within the Administration on Aging in a February 7th speech. Sebelius cited the approximately ten million Americans who currently need long-term services and support (expected to rise to 15 million by 2020) and the high costs of long-term care in explaining the need for CLASS. Sebelius explained that while there is flexibility in designing the program, the two priorities are to keep the program self-sufficient (not taxpayer supported) and to not include medical underwriting for applicants. AARP recently released a two-minute video that summarizes the key components of the CLASS program. In addition, a recent report from the Center for Retirement Research analyzed CLASS and three possible average premium amounts ($94, $121, $312) based on different participation scenarios. For more information, visit:
HHS: "Kaiser Family Foundation Briefing on Long-term Care"
AARP: Video on CLASS Program
Center for Retirement Research: "What is 'CLASS'? and Will it Work?"
United Kingdom Lowers Asset Test Threshold For Residential Care
An article in the Telegraph analyzed a recent government decision to not index the asset test for people living in residential care homes, a move that effectively raises the amount that people will have to pay as part of their care. Similar to the Medicaid program in the U.S., there is an asset test in the United Kingdom for people seeking residential long-term care. If a person has savings and assets (including a house) of more than 23,250 pounds (about $38,000), then they have to pay the full cost of care of 500 pounds a week (about $815) until their assets are below the asset test. While the asset test was historically increased every year to account for inflation, the government decided to freeze the asset test, which the author suggests amounts to an effective ten percent cut in the threshold. Governments around the world are struggling to plan for providing and paying for care for the rapidly increasing elderly population, and a recent plan in Australia also suggested including a family home when calculating a person's ability to pay for long-term care. For more information, visit:
Telegraph "Thousands more will have to sell homes for elderly care"
Survey Examines How Customers in UK Encounter Community Services
A recent survey analyzed how people came into contact with The Pension Service (TPS) and the Disability and Carers Service (DCS) in the United Kingdom. Through interviews and focus groups, the authors draw several conclusions, including that customers are often not aware of the financial benefits that are available, a perception among clients and applicants of "having to jump through hoops" to receive a service, and a lack of understanding about how different benefit programs interact with each other. Family caregivers are often forced to navigate long-term care services for their loved ones, and the authors provide suggestions about how to improve service delivery and how to better inform potential clients about services. For more information, visit:
PDCS: "Customers' experiences of contact with the Pension, Disability and Carers Service"
Canada: Survey Finds One Sibling Does Majority Of Caregiving Work
In a recent survey of 383 Canadian caregivers, 41% of caregivers reported that one sibling took all or most of the responsibility for caregiving for parent(s) who needed assistance. The authors titled their summary report the "50-50 Rule," referring to age 50 as the average age when people will find themselves becoming caregivers and the other 50 referring to the need to split caregiving responsibilities with family members. The report provides seven examples of real-life family caregiver/sibling situations with advice on how to address the issues. Primary caregivers in the survey report spending 14 hours a week providing care and proximity to parents was cited as the reason for 25% of caregivers becoming the primary caregiver. For more information, visit:
Home Instead Senior Care: "The 50-50 Rule: Helping Siblings Overcome Family Conflict While Caring for Aging Parents"
Canada.com: "Caring for elderly parent falls primarily to one sibling"
FCA Fact Sheet: "Holding a Family Meeting"
Hospital In United Kingdom May Use Legal Process To Force Discharges
A recent article in the Telegraph highlighted a local health council's decision to use anti-trespass powers to evict elderly patients who refuse to leave the hospital after they have been discharged. A government representative explained that the legal strategy would be used as a last resort and that the government is trying to ensure that there are sufficient beds available in the hospital. However, Michelle Mitchell, the director of AGE UK, suggested that if patients were refusing to leave then there may be issues related to the discharge and care arrangements being offered to the patient. For more information, visit:
The Telegraph "NHS Trust plans to 'evict' elderly bed blockers"
Blacks More Likely To Be Readmitted To Hospital Soon After Discharge
A recent study found that older black people were more likely to be readmitted to the hospital within 30 days than older white people. Using Medicare data, the authors of the study looked at hospital discharges for three common conditions (heart attack, congestive heart failure, and pneumonia) and found that overall, older blacks had 13 percent greater odds of being readmitted to the hospital. Older black patients discharged from hospitals that serve primarily minority patients have a 23% greater chance of hospital readmission than older whites. The authors explain that on average, about 20% of all hospital patients are re-admitted within 30 days and suggest that there is room for improvement in the hospital discharge process. The authors did not explain why there is a difference in readmission rates between older whites and blacks, but speculated that better access to transitional services may lead to lower readmission rates for older whites. Another recent study focused on "preventable readmissions" in California and the authors suggests that lowering hospital stays from preventable readmissions by one day could save $227 million per year. For more information, visit:
JAMA "Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care"
BusinessWeek "Blacks Readmitted to Hospital More Than Whites: Study"
California Discharge Planning Collaborative: "What a Difference a Day Makes..."
FCA: "Hospital Discharge Planning: A Guide for Families and Caregivers"
Study Analyzes Caregiving Effects On Being Employed
A recent working paper examined the relationship between labor force attachment and caregiving in the United States, a topic that has been extensively studied in Europe. The authors explain that previous research had attempted to discern if there is a causal relationship between caregiving and reduced employment- in other words, did caregiving cause people to reduce employment, or were people who were less employed more likely to become caregivers. The authors conclude that there is a modest decrease (two percentage points) in the likelihood of being in the workforce if a person is a caregiver. The authors also provide interesting analysis, for example, caregivers in the study had higher education levels than non caregivers and female caregivers had higher homeownership rates than non caregivers. Becoming a caregiver leads to a three percent reduction in hourly wage for women while men caregivers who recently stopped caregiving see a predicted wage increase of $2.26 per hour ($24.88 for caregivers vs. $22.62 for non caregivers). The authors speculate that if a husband has a wife also providing care, then the husband may increase his work hours to compensate for the wife's reduced income. The 4.5% of the sample who were female caregivers for four years or greater had a 14% reduction in wages, totaling around $3,000 a year in lost income. While the authors did not find a strong relationship between caregiving and reduced Social Security benefits, they explain that 23% of caregivers with both members aged 62 or greater have a sufficiently higher earning spouse, so additional work years does not affect their benefit levels. For more information, visit:
Center for Retirement Research: "Effect of Informal Care on Work, Wages, and Wealth"
Review Of Research On End-Of-Life Care And Spirituality
A recent analysis reviewed research on end-of-life care and spirituality as part of the United Kingdom's End of Life Care Strategy. The authors identified 248 studies that were classified and reviewed by three consultation groups. Five overarching themes were identified, including disciplinary and professional contexts (what sources the disciplines came from); concepts and definitions; spiritual assessment; spiritual interventions; and education and training. The authors provide ten recommendations and also conclude that while the review found a substantial amount of literature relevant to spiritual care at the end of life, there is less material addressing spiritual care in the context of end-of-life care. For more information, visit:
Dept. of Health: "Spiritual Care at the End of Life: A systematic review of the literature"
Report: 42 Percent Of Employees Lack Paid Sick Days In 2010
A recently released fact sheet suggests that statistics on paid sick leave from the U.S. Bureau of Labor Statistics may provide an overly-rosy picture of access to paid sick leave in the U.S. The authors explain that while employees may be "eligible" for paid sick leave, many employees have not been at their jobs long enough to claim paid sick leave. On average, employees have to wait 78 business days (about 3 ? months) before they can access paid sick leave. Occupations like management have high rates of eligibility for paid sick leave and fewer low-tenure workers, leading to an 88% coverage rate for paid sick leave. However, employees in food preparation and serving related occupations have only a 23% coverage rate because fewer employers provide paid sick days in this industry and employee tenure is shorter. The implications of the research are important not only for flu and other outbreak prevention, but also for family caregivers who are also employed and may need sick days for themselves or relatives. During the 111th Congress, Representative DeLauro (D-CT) introduced the Healthy Families Act that would have mandated seven days of Paid Sick Leave for employees to use for their own illnesses or for the care of a relative. For more information, visit:
Institute for Women's Policy Research: "44 Million U.S. Workers Lacked Paid Sick Days in 2010"
FCA: "Summary of Health Families Act"
Conference: Council On Social Work Education, October 27-30, 2011
The Council on Social Work Annual Program Meeting is accepting aging-related proposals for its 57th annual meeting and the Gero-Ed track. The deadline for proposals is February 28th. For more information, visit:
Council on Social Work Education
Conference: Gerontological Society Of America, November 18-22, 2011
The Gerontological Society of America is currently accepting abstracts for its 64th annual scientific meeting. The deadline to submit an abstract is March 15, 2011. For more information, visit:
Gerontological Society of America
Conference: National Home And Community Based Services Conference, Sept. 11-14 2011
The National Association of State Units on Aging, the DC Office on Aging and the Maryland and Virginia Departments of Aging are currently accepting applications for the National HCBS conference. Proposals are due by March 4, 2011. For more information, visit:
National HCBS Conference
Webinar: "Meeting the Needs Of Our Diverse Clients: Why Culture Counts In Health Care" Feb. 24
The National Council on Aging is sponsoring a webinar on February 24th at 1:30pm (EST) focused on understanding cultural diversity within the context of providing aging services. The speaker for the webinar is Marcie Freeman, M.Ed., who is the Director of Outreach and Recruitment for the Institute for Aging Research, Hebrew SeniorLife, an affiliate of Harvard Medical School and is also the Chair of Boston's Multicultural Coalition on Aging. For more information or to register, visit:
National Council on Aging
Nursing Home Quality And Ownership Focus Of Reports
A recent review of research on nursing homes and quality finds that non-profits provide better quality care and suggests that government policies should be changed to ensure that quality of care is not sacrificed for profitability. The authors review data suggesting that for-profits often cut staffing levels to increase profits which results in inferior quality of care. Their recommendations include public sector financing for non-profit facilities, legislating minimum staffing levels, surprise visits by trained inspectors, increased transparency around staffing levels and inspection reports, and a public, Canada-wide report care of care quality measures. Ownership of nursing homes is also a contentious issue in the U.S., where Florida Governor Rick Scott recently forced out the state's long-term care ombudsman after he asked the state's nursing homes to provide information on their ownership. A 2007 New York Times article suggested that some private equity firms buy nursing homes and cut staffing levels, resulting in lower quality of care for residents, and that the complex ownership chains make it difficult for families to sue over negligent care. A 2010 GAO report found that over 1,800 nursing homes were acquired by private equity firms between 1998 and 2008. Quality of care at nursing homes is an important issue for family caregivers who may need to move loved ones to institutional care to receive adequate medical care. For more information, visit:
Institute for Research on Public Policy: "Residential Long-Term Care for Canadian Seniors: Nonprofit, For-Profit or Does It Matter?"
Miami Herald: "State's top elderly advocate removed from job"
New York Times "At Many Homes, More Profit and Less Nursing"
GAO: "Nursing Homes: Complexity of Private Investment Purchases Demonstrates Need for CMS to Improve the Usability and Completeness of Ownership Data"
New Caregiver Quality Of Life Questionnaire Released
A new caregiver assessment tool was recently released in the United Kingdom. The 40-item questionnaire measures quality of life for caregivers in eight areas, including support for caring; caring choice; caring stress; money matters; personal growth; sense of value; ability to care, and caregiver satisfaction. The tool includes a short manual for use, and a scoring mechanism to measure the caregiver's quality of life. For more information, visit:
The Princess Royal Trust for Carers and the School of Sociology and Social Policy at the University of Nottingham: "Adult Carer Quality of Life Questionnaire (AC-QoL)"
Practical Financial Advice For Family Caregivers
A recent New York Times article focused on probate, living trusts, and wills, and legal issues that family caregivers and their relatives should consider in long-term care and estate planning. Probate is the legal process used after a person dies to ensure that the will is legally valid and it creates a public record and people can opt to use a living trust to bypass the probate process. The authors explain that certain assets, including retirement assets, life insurance, and jointly titled bank accounts, brokerage account, and real estate will not go through probate, regardless of what a will or living trust instructs. The authors also cite the example of a family caregiver who is listed jointly on a checking account in order to pay bills for a parent. If the parent dies, the money in the account automatically goes to the co-owner, and if a child attempted to share this money with her/her siblings, then it could be potentially be taxed as a gift. To avoid one child accidentally inheriting a checking account, a bank employee interviewed in the article suggests giving the family caregiver power of attorney instead. For more information, visit:
New York Times: "Efforts to Avoid Probate Can Carry Their Own Risks"
FCA: "Durable Power of Attorney" Fact Sheet
Female Informal Family Caregivers Of Veterans With Traumatic Brain Injury
Participants are needed for a research project examining stress and perceived health of female informal caregivers caring for a Veteran who has experienced a moderate or severe traumatic brain injury within the past six months to ten years. Participants must be at least 18 years of age and able to speak and understand English. Study involves completing a written questionnaire and collecting several saliva samples (to measure stress-related hormones) over a two-day period. Participants will be mailed all study materials to their homes and U.P.S. will pick up completed materials at their doorstep. Participants will be provided a $30 gift card. For more information, please contact Dr. Karen Saban, Health Research Scientist, at Edward Hines, Jr VA Hospital at 708/202-5264 or Karen.Saban@va.gov
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