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|A Newsletter of FCA's National Center on Caregiving|
March 30, 2011
Volume XI, Number 6
|IN THIS ISSUE|
State Legislation, Policy & Reports
Federal Legislation, Policy & Reports
- Kentucky: State Passes Two Laws To Address Guardianship And Elderly Abuse More...
- Massachusetts: State Panel On End-Of-Life Care Releases Report More...
- Connecticut: Proposed Hospice Regulations Create Controversy More...
- Nevada: State Could Be Sued For Reducing Medicaid Reimbursements More...
- California: State Budget Negotiations End With No Results More...
- Federal Budget Impasse For FY 2011 Continues More...
- CLASS Hearings Highlight Need For Improvements To LTC Financing More...
- Battlefield Brain Injuries Discussed At Congressional Hearing More...
Research Reports & Journal Articles
- Canada Politicians Promise $300 Caregiver Tax Credit In Proposed Budgets More...
- Study Focuses On Complexity Of Discharge Planning For Family Caregivers More...
- Alzheimer's Report: Every 69 Seconds, Someone Develops Alzheimer's More...
- Study Examines Intergenerational Family Care For And By Older People In Thailand More...
Conferences & Trainings
- Webinar: "Caregiving: Work With Your Siblings To Keep Your Life, Family and Sanity Intact" More...
- Webinar: "Doing the Best We Can: An Overview of Online and Clinical Resources for Care Providers of Families Struggling with Dementia" More...
- Webinar: Department Of Justice And Olmstead: Current Cases and Decisions, April 7th, 2-3pm (EDT) More...
- Conference: 2011 Aging in America April 26-30, 2011 More...
Funding, Media & Miscellaneous
- Consumer Guide For Long-Term Care Released More...
- Article Addresses Caregivers Struggling With "Impossible" Promises More...
- Technical Brief Explains Origins, Background, And Composition Of The Aging Network More...
- GAO Report Finds Insurers Reverse Themselves When Customers Appeal More...
- Many Families Struggle To Afford Care For Elderly Parents More...
- LGBT Aging Center Announces Portal On Caregiving More...
- If you are interested in having your research study listed in PolicyDigest, please send an email to firstname.lastname@example.org.
Kentucky: State Passes Two Laws To Address Guardianship And Elderly Abuse
Governor Steve Beshear signed two bills earlier this month that address elder abuse and guardianship issues. The first law, House Bill 52, bars people who have been convicted of abuse or neglect of vulnerable older adults from serving as the victim's guardian or power of attorney and also prohibits them from receiving an inheritance from their victims or serving as executor of their estates. A report released this week from the Kentucky Cabinet for Health and Family Services found that adult protection workers determined that abuse and neglect probably occurred in about 18% of investigations involving residents in Kentucky long-term care facilities in fiscal year 2010. The second law, HB 164, adopts the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act, (UAGPPJA) that has already been adopted by 19 states. Guardianship decisions are decided in state court and UAGPPJA creates a uniform set of rules to address legal issues that arise when caregivers/guardians live or travel in states that are different than their loved ones. For more information, visit:
The Courier Journal: Governor Steve Beshear signs 2 bills to protect elderly
Lexington Herald Leader: State finds probable abuse in 18 percent of nursing home investigations
Alzheimer's Association Fact Sheet "Adult Guardianship Jurisdiction"
State of Kentucky: "Elder Abuse in Kentucky"
In 2009, the Massachusetts legislature assigned a panel of experts to "identify best practices for end-of-life care" and "present recommendations for legislative, regulatory, or other policy changes..." The panel released its report on March 14, 2011 and it includes a number of recommendations to improve end-of-life care. The panel's report suggest that the state's health care system does an inadequate job in learning about, documenting, and following patients' wishes around end-of-life care. The authors note that while 70% of Americans would prefer to die at home, in Massachusetts, over 70% of people die in hospitals or nursing homes. The panel's recommendations include implementing a high-visibility public awareness campaign, requiring end-of-life care education in state-financed medical, nursing, and social work programs, and requiring all health insures in Massachusetts to cover hospice care. For more information, visit:
A recent legal analysis of Nevada Governor Brian Sandoval's plan to balance the state's budget by reducing Medicaid reimbursement rates suggests that the reduced rates could violate federal Medicaid laws and expose the state to legal liability. The analysis, conducted for the nursing home industry, suggests that based on past court cases, cutting reimbursement rates based solely on budget reasons is not allowed and may lead to the federal government withholding matching funding. The governor's plan would reduce reimbursement rates by about $20 per day, and the association suggests this will cost the average nursing home about $500,000 per year. The Nevada Hospital Association suggests that if the proposed cuts are enacted, the total loss to hospitals will be $190 million from 2009 to 2013. The administrator of the Nevada Division of Health Care Financing and Policy suggested that the governor decided to cut the reimbursement rates instead of eliminating "optional" Medicaid Services. He suggested that if the nursing homes sue the state and win then Medicaid patients would ultimately be harmed. For more information, visit:
Law Vegas Review Journal: "Groups say cutting state aid to elderly may violate laws"
On March 29th, Governor Jerry Brown announced that negotiations with Republicans on a state budget deal are stopping without a resolution. Governor Brown's proposed state budget included $11.2 billion worth of cuts as part of his strategy to close an estimated $26 billion deficit. To address the remaining $15 billion gap, Brown hoped to convince at least four Republicans to vote for a special election in June to allow voters to decide whether or not to continue temporary car, sales, and income taxes. Citing an "ever-changing list of collateral demands" from Republican lawmakers, Governor Brown ended negotiations. It is unclear how the budget process will move forward, according to the Associated Press, possibilities include gathering signatures for a citizens' initiative on the tax plan, or using an untested legal loophole to allow a simple majority vote of the state legislature on whether or not to put the measure on the ballot. A similar maneuver was used recently in Wisconsin by Republican leaders who removed a bill on collective bargaining from a larger budget bill in order to pass the collective bargaining bill with only a simple majority. In a poll of 2,000 California residents earlier this month, 64% of Democrats, 57% of independents, and 34% of Republicans said a special election was a good idea, which represents a reduction in support since January. When asked about Brown's proposal to use a combination of cuts and tax extensions, 48% of all adults favor the idea while 41% do not. The budget bill that was passed by the legislature and signed by Governor Brown on March 24th includes a number of cuts, including a reduction in Social Security Income/State Supplementary Payments that will result in 8,500 seniors and people with disabilities losing their grants. The budget also includes changes to programs like Adult Day Health Care that will require approval from the federal government. For more information, visit:
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Federal Budget Impasse For FY 2011 Continues
The federal government has not passed a budget for FY 2011 and a Continuing Resolution that currently funds the government is set to expire on April 8th. The Republican controlled House of Representatives, released a budget in February that called for $100 billion worth of cuts to programs. Advocates in the elder community, including the National Council on Aging, have criticized the potential cuts that will be made to programs serving elderly, especially programs that serve low-income elders. According to Meals on Wheels, one in nine seniors is hungry in the U.S. today. A coalition of 38 religious groups started an indefinite hunger fast on March 28th to protest potential cuts to programs serving low-income Americans. For more information, visit:
National Council on Aging "House Approves Cuts Targeting Seniors"
Time: "Hunger strike aims at congressional cuts"
Washington Post: "With "time short," Congress still at impasse on shutdown talks"
USA Today: "Thousands of mayors hit road to help feed hungry seniors"
CLASS Hearings Highlight Need For Improvements To LTC Financing
On March 17th, the Health Subcommittee of the House Energy & Commerce Committee held a hearing on the CLASS program, the voluntary long-term care insurance program that was included in the Affordable Care Act. The chair of the committee, Representative Joe Pitts (R-PA) opened his comments by labeling the program an entitlement while Representative Mike Burgess (R-TX) suggested that the program is mandatory for employers. Under the Affordable Care Act legislation, the program benefits are only allowed to be funded by voluntary premium contributions (not taxes) and the program is voluntary for employers, though if an employer chooses to participate, then an employee would have to choose to opt-out. Three Republican representatives co-sponsored a bill on the same day of the hearing to repeal the CLASS Act.
William Minnix, the Chair of Advance CLASS, a coalition of 270 consumer organizations, explained in his testimony that family caregivers spend an average of $5,500 a year on out-of-pocket caregiving expenses and that long-term care is something that everybody will need while nobody wants to talk about it. He also explained that while he has a private long-term care insurance policy, the premiums on his policy were recently increased by 60%. Minnix discussed the problem with the current de facto "solution" of Medicaid paying for long-term care by sharing the story of a colleague whose mother received a letter informing her that she had moved to #176 on the waiting list for a Medicaid Home and Community Based Services program in her state- a week after she died. Assistant Secretary Kathy Greenlee reiterated her commitment as well as President Obama and Secretary Sebelius' commitment to not start the program unless it could be designed in an actuarially sound, self-sustaining manner. For more information, visit:
U.S. House of Representatives: Energy and Commerce Health Subcommittee
Kaiser Health News "House GOP Targets CLASS Act During Subcommittee Hearing"
Professor Richard Kaplan: "Financing Long-Term Care After Health Care Reform"
Advance CLASS Website
Battlefield Brain Injuries Discussed At Congressional Hearing
Traumatic Brain Injury (TBI) is considered the "signature" wound of the Iraq and Afghanistan wars, and at a hearing on March 15, Army Surgeon General Lt. Eric Schoomaker answered questions about diagnosis of TBI. Schoomaker explained that the standard tool used to measure TBI on the battlefield (Automated Neuropsychological Assessment Metrics- ANAM) fails to identify between 25 and 33 percent of soldiers who have been concussed while including 50% of soldiers who are not concussed. Schoomaker explained that the army is conducting an evaluation between ANAM and another tool, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPact), a tool also used by the National Football League. Vice Admiral Adam Robinson, the Surgeon General of the U.S. Navy, explained that preserving service member's and family member's psychological health is one of the greatest challenges faced today and that base-line resilience of soldiers is challenged by repeated deployments and long engagements. Robinson also explained that the decade of combat operations has led to an increase in the number of service members with TBIs. A series of articles by Propublica has focused on the military's approach to treating soldiers who have experienced TBI and Post Traumatic Stress Disorder (PTSD). The most recent article in the series follows five soldiers who were diagnosed with mild traumatic brain injury after an Iraqi rocket exploded near their trailer in 2009. A senior Army neuropsychologist, in Iraq to evaluate TBI assessment tools, persuaded the five men to enroll in his study, and they became the first documented cases of "pure blast" concussions- defined as mild traumatic brain injuries caused by the force of an explosion, instead of a secondary effect, such as slamming into a wall after an explosion. The article follows one of the men, Iraq veteran Brock Savelkoul, in his difficult recovery. For more information, visit:
NextGov.com: "Battlefield brain-injury assessment tool has high failure rate"
U.S. Armed Services Committee "Military Health System Overview and Defense Health Program Cost Efficiencies" (Note: Discussion of ANAM begins at 99 minutes into hearing)
Propublica: "Aftershock: The Blast That Shook Psycho Platoon"
Canada Politicians Promise $300 Caregiver Tax Credit In Proposed Budgets|
Canadian politicians have introduced competing budget proposals, both with positive policy changes for family caregivers. For example, Liberal Leader Michael Ignatieff has proposed a $1 billion program that would provide a new, six-month family care employment insurance program for the approximately 30,000 Canadians who take time off of work to serve as caregivers for sick family members, as well as a $1,350 family care benefit. In contrast, Canada's Conservative Party has proposed a $300 tax credit for family caregivers in its budget and estimates that 500,000 people would use the credit, for a cost of $160 million a year. Legislation creating tax credits for family caregivers has been introduced at the state and federal levels in the U.S., but have not been enacted. The Wall Street Journal recently featured an article on how family caregivers can claim tax deductions for medical expenses paid for by a caregiver. For more information, visit:
Toronto Star "Budget Promises Tax Credit for Caregivers"
Wall Street Journal "Caregiver Tax Breaks" (U.S.)
FCA Summary of Caregiver Assistance and Relief Act (CARE) of 2010 (U.S.)
Study Focuses On Complexity Of Discharge Planning For Family Caregivers
A recent study focused on discharge planning for older Americans who represent 37% of all hospital discharges. Through her interviews with 13 older adults, 12 family members, and seven health care team members, the author, Dr. Lori Popejoy, identified themes around discharge planning, including "home," "staying independent," "advocating for them," "deciding what to tell," and "changing the plan." She suggests that an improved approach to the hospital discharge process would better incorporate the rights of the patients and families to receive accurate and complete information about the patient's condition and realistic care options, including home care, personal care, and nursing homes. For more information, visit:
Journal of Family Nursing: "Complexity of Family Caregiving and Discharge Planning"
Alzheimer's Report: Every 69 Seconds, Someone Develops Alzheimer's
The Alzheimer's Association recently released a report with data on the impact of Alzheimer's in the U.S. in 2010. According to the report, Alzheimer's is the sixth-leading cause of death in the U.S. and is the only disease in the top ten causes of death that cannot be prevented, cured, or even slowed. While death rates for most major diseases have declined from 2000 to 2008, deaths from Alzheimer's disease have risen 66 percent during the same time period. The impact on the estimated 15 million Alzheimer's and dementia caregivers is also large, with 60% reporting high levels of stress because of the prolonged duration of caregiving and 33% of caregivers reporting symptoms of depression. The financial impact is also large, with caregivers providing 17 billion hours of unpaid care (valued at $202 billion) and paying for $7.9 billion in additional health care costs. The report includes facts and figures for each individual state. For more information, visit:
Alzheimer's Association: 2011 Alzheimer Disease Facts and Figures
USA Today: "Alzheimer's carries heavy toll on 15M unpaid caregivers"
Family Caregiver Alliance Fact Sheet: "Caregiver's Guide to Understanding Dementia"
Study Examines Intergenerational Family Care For And By Older People In Thailand
A recent study examined the role of adult children in providing care for elderly family members in Thailand and also examined the grandparents and their role in providing care for their grandchildren. The authors explain that the family is the most important part of the four pronged "care diamond" that includes the government, market, and voluntary sector. However, reduced fertility and increased migration are both contributing to a reduction in co-residence of elderly parents with their adult children and this has important implications for the future provision of elder care. For more information, visit:
University of Michigan Population Studies Center: "Intergenerational Family Care for and by Older People in Thailand"
Webinar: "Caregiving: Work With Your Siblings To Keep Your Life, Family and Sanity Intact" April 28th, 12:00 to 1:15pm (PDT)
Family Caregiving Alliance is sponsoring a webinar with author and caregiver Francine Russo on working with your siblings to balance the load while caring for parents. Through the webinar, participants will be able to: recognize family dynamics that are affected by caregiving challenges; navigate conflict, guilt and angst from both siblings and parents; and utilize tools and strategies that will help your family find common ground as your parents age. Francine Russo wrote on baby boomer and aging issues for nearly a decade for Time magazine. Her personal family caregiving experience prompted her to write the book, "They're Your Parent's Too! How Siblings Can Survive Their Parents Aging Without Driving Each Other Crazy!" The webinar is on Thursday, April 28th from 12:00 to 1:15pm, Pacific Daylight Time. For more information, or to register, visit:
FCA: "Caregiving: Work with your siblings to keep your life, family and sanity intact!"
"Doing the Best We Can: An Overview Of Online And Clinical Resources For Care Providers Of Families Struggling With Dementia" April 4th, 1pm (CST)
The American Psychological Association and Dr. Joseph Gaugler from the University of Minnesota are presenting a webinar that will explore helpful online and clinical resources for providers of care to families grappling with the challenges of dementia. Activities on the Webinar include an evidence-based synthesis of effective interventions for family caregivers of persons with dementia; a review of online resources for care providers (including APA's Caregivers Briefcase); and an overview of other helpful clinical and online resources for care providers and families with dementia. The webinar is eligible for 1.5 hours of continuing education credits and costs $25. For more information or to register, visit:
American Psychological Association and University of Minnesota
Webinar: Department Of Justice And Olmstead: Current Cases and Decisions, April 7th, 2-3pm (EDT)
The Center for Personal Assistance Services (PAS) is sponsoring a webinar focused on the landmark Olmstead decision in which the United States Supreme Court mandated that people have a right to receive care in the most integrated settings possible under the Americans with Disabilities Act. The presenter for the webinar is Renee Wohlenhaus, the Acting Section Chief for the Disability Rights Section of the Civil Rights Division at the U.S. Department of Justice. Ms. Wohlenhaus will summarize recent cases that the Department has litigated and what the outcomes mean from a legal standpoint. Advanced registration is not required, for more information, visit:
PAS: "The Department of Justice and Olmstead: Current Cases and Decisions" American Society on Aging
Conference: 2011 Aging in America April 26-30, 2011
The Annual Conference of the American Society on Aging (ASA) is being held in San Francisco, California April 26-30, 2011. The conference attracts professionals from diverse disciplines and provides an opportunity for attendees to learn about current trends within the field of aging. The National Center on Caregiving at Family Caregiver Alliance (FCA) will be presenting or facilitating at the following sessions: National Technical Assistance Centers for Caregiving and Respite: Creating Learning Communities on April 27th; Caregivers are Partners in Care: Shifting the Paradigm Towards Consumer and Family Centered Care on April 27th; and Hear from the 2010 Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awardees on April 28th.
FCA's National Center on Caregiving will also be hosting a reception to honor the four recipients of the 2010 Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards on Thursday April 28th at Hotel Nikko, 222 Mason Street, Golden Gate Room (Right across the street from the conference). Starting at 5:30, join us for appetizers, beverages and breathtaking views of the City. For more information and registration, visit:
American Society on Aging
Family Caregiver Alliance National Center on Caregiving
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Consumer Guide For Long-Term Care Released
The National Consumer Voice for Quality Long-Term Care recently released a guide for people with disabilities and older adults that is intended to empower consumers to be self-advocates for quality long-term care. The guide addresses the many issues that have to be considered when navigating long-term care services and support, but is unique because it includes suggestions and recommendations from consumers throughout the guide, for example, in the home section, Julie suggests "Your attendant may not be aware of your care or service plan. Ask the agency to give you something in writing that states exactly what your attendants are expected to do." For more information, visit:
NCVQLTC: "Piecing Together Quality Long-Term Care: A Consumer's Guide to Choices and Advocacy"
Caregivers Struggling With "Impossible" Promises
A recent opinion article by Dr. Pamela Tronetti discussed the guilt felt by family caregivers when they consider making changes to how they provide care to a loved one. Dr. Tronetti works in elder care and discusses common caregiver sentiments, including guilt about moving a loved one into a home or allowing another person to provide care. The article addresses these common feelings and how to address these concerns. For more information, visit:
FloridaToday.com "Caregivers Wrestle with Impossible Promises"
Technical Brief Explains Origins, Background, And Composition Of The Aging Network
A recent brief produced by the Scan Foundation provides a concise summary of the aging network, a collection of federal, state, and local entities working together to provide services and supports to older Americans. The guide is an excellent primer of the history of programs, and laws, including the Older Americans Act. While it focuses on California and includes information on California programs and laws, much of the information is applicable to other states as well. For more information, visit:
The Scan Foundation: The Aging Network
GAO Report Finds Insurers Reverse Themselves When Customers Appeal
As part of the Affordable Care Act, the Government Accountability Office was required to research insurance denials for specific medical services and the outcomes when insurance customers appeal these denials. The authors examine data from six states and found that in four states, 39% to 59% of appeals filed by customers of insurance companies resulted in the insurer reversing its original coverage denial. A similar study, conducted by a trade association for insurance companies, found that coverage denials were reversed about 40% of the time. In addition to hands-on care, family caregivers often work with insurance companies to file claims on behalf of their loved ones. This study indicates that the time spent appealing insurance denials may be a good investment of time if the claim denial is reversed. For more information, visit:
GAO: "Private Health Insurance: Data on Application and Coverage Denials"
Washington Post: "Denied insurance under new health-care law? File an appeal, GAO says"
Many Families Struggle To Afford Care For Elderly Parents
A recent article in the Florida Times Union addresses the rising costs of elder care, a cost that is often paid for by adult children, many of whom also have their own children. Hannah Gavronsky is 91 years old and lives in an assisted living facility that costs $5,000 a month. Her daughter, who owns two jewelry stores, is now paying for the $5,000 monthly cost without help from her other siblings and has turned to hosting gold buying parties at night in order to pay for her mother's care. Robert Morgan, an elder law attorney interviewed in the story, suggested that families confirm that a loved one will be allowed to stay in a nursing home after they have depleted their resources and Medicaid begins paying the cost of the nursing home. For more information, visit:
Florida Times Union "Many struggling financially to provide care for elderly family members"
LGBT Aging Center Announces Portal On Caregiving
The National Resource Center on Lesbian, Gay, Bisexual, Transgender (LGBT) Aging recently announced the launch of a new portal focused on caregiving resources for LGBT caregivers. The portal features a number of resources and guides and while some caregiving issues are universal, there are also issues specific to LGBT caregivers, for example, the Family Medical Leave Act does not cover LGBT family members. The portal includes a number of reports, including a September 2010 report from SAGE about spousal impoverishment policies in Medicaid that tend to be financially beneficial for heterosexual married couples but harmful for gay or lesbian couples and unmarried heterosexual elder couples who live together. For more information, visit:
LGBT Aging Center Caregiving Portal
Family Caregiver Alliance Fact Sheet: "Legal Issues for LGBT Caregivers"
SAGE: "LGBT Older Adults and Long-Term Care Under Medicaid"
|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|
?2011 Family Caregiver Alliance. All rights reserved.
The National Center on Caregiving at Family Caregiver Alliance works to advance the development of high-quality and cost-effective policies and programs for caregivers in every state in the country. The National Center is a central source of information and technical assistance on family caregiving for policymakers, health and service providers, program developers, funders, media and families. For questions or further information about the National Center on Caregiving, contact Policy_Digest@caregiver.org or visit the Family Caregiver Alliance website at www.caregiver.org.
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