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|A Newsletter of FCA's National Center on Caregiving|
April 13, 2011
Volume X, Number 7
| IN THIS ISSUE|
State Legislation, Policy & Reports
- CA: After Stalemate, Governor Considers Options To Address $15.4 Billion Gap More...
- VA: Veteran's Administration Program Gives Virginia Veterans A Consumer Directed Budget More...
- IA: Legislation Would Allow Nursing Home Officials To Review LTC Ombudsman More...
Federal Legislation, Policy & Reports
- Federal Government Avoids Shutdown More...
- GOP Plan Would Make Dramatic Changes To Medicaid and Medicare More...
- Scan Foundation Releases Briefs On CLASS Program More...
- Briefs Address Financial Challenges For Medicare Beneficiaries More...
- Cabinet Approves Bill Creating Long-Term Care Reserve Fund More...
- Canadian Program Recognizes Cultural Differences To Tailor Alzheimer's Care More...
- Workshop Gives Caregivers Perspective Of Living With Alzheimer's More...
Research Reports & Journal Articles
Conferences & Trainings
- Study Focuses On Caregivers Of Alzheimer's Patients More...
- Study Focuses On Lack Of Elderly Participants In Clinical Heart Failure Trials More...
- Study Finds Frailty Is Not Correlated With Adverse Drug Events More...
- Article Focuses On Facilitating Family Meetings In LTC Settings More...
- AARP Research Finds Brand Name Drug Prices Increase Dramatically In Two Years Prior To Facing Generic Competition More...
- Conference: 2011 Aging in America April 26-30, 2011 More...
- Webinar: Focus On Affordable Care Act, Medicaid Expansion, And FMAP, April 14th, 12pm (EDT) More...
- Webinar: "Caregiving: Work With Your Siblings To Keep Your Life, Family and Sanity Intact" April 28th, 12:00 to 1:15pm (PDT) More...
Funding, Media & Miscellaneous
- Federal Government Launches Partnership To Improve Medical Care More...
- Tools To Plan And Document End-of-Life Care Preferences More...
- Lifespan Respite Care Program Grant Announcement More...
- Families USA Guide Addresses Benefits For Caregivers In Affordable Care Act More...
- If you are interested in posting your research study in PolicyDigest, please send an email to firstname.lastname@example.org.
CA: After Stalemate, Governor Considers Options To Address $15.4 Billion Gap |
Governor Brown is considering options to address a $15.4 billion gap in California's state budget after he failed to achieve an agreement with the four Republican lawmakers he needed to put an extension of state taxes on the June ballot. Governor Brown already signed a budget with $11.2 billion in cuts to a number of social service programs in March, with the executive director of Area 1 Agency on Aging, Cynthia Denbo, describing the cuts as a "penny-wise, pound-foolish situation," in which an "avalanche effect" of the cuts will fall on many of the same people. "Everywhere these people turn, he or she is going to find it harder to stay afloat, harder to stay healthy and harder to stay independent."
New America Media contrasted the budget cuts to recommendations contained in California's recently released state Alzheimer's Plan. While the Alzheimer's Plan suggests increasing support for home and community based services to address the estimated 1.2 million elders in California who will have Alzheimer's by 2030, the recently passed budget actually cuts funding for the Adult Day Health Care Programs by more than 50% and relies on federal government approval for restructuring the program. Commenting on the restructuring, Lydia Missaelides, the head of the California Association of Adult Day Services, pointed out that even if the transition to the new Adult Day Health Care program is seamless, the new eligibility rules will mean fewer services being provided. Humboldt Senior Resource Center Executive Director Joyce Hayes explained that she wants people to know that the Adult Day Health Care is more than just a day care program: "What goes on during that day is nursing care, physical therapy, speech therapy, a good nutritious meal, occupational therapy and more."
On April 9, Governor Brown explained that he is considering having the legislature approve the tax extensions and then giving voters an opportunity to vote for or against the extension in July. A leaked February Legislative Analyst Office letter suggested programs to eliminate if taxes aren't extended, including California's Caregiver Resource Centers, Adult Protective Services and the Agency on Aging. In a blog posting about the LAO letter, Kathleen Kelly, Executive Director of Family Caregiver Alliance, noted the state's current investment in supporting family caregivers through the Caregiver Resource Centers is $2.9 million, which works out to 72 cents each for California's four million family caregivers. For more information, visit:
FCA Blog: "Will Community Supports for Family Caregivers Survive?"
Letter from Legislative Analyst Office on Sacramento Bee blog
The Times Standard: " 'An avalanche effect' -- senior advocates worry state cuts will disproportionately hit seniors, dependent adults"
New America Media: "California Budget Cuts at Odds With State's New Alzheimer's Plan"
Scan Foundation Fact Sheet: "California's 2011-2012 Budget: Reductions to Aging and Long-Term Care Programs"
VA: Veteran's Administration Program Gives Virginia Veterans A Consumer Directed Budget
A Veteran Directed Home and Community Based Services (VD-HCBS) program in Virginia's Prince William County was recently profiled on InsideNova.com
. The VA contracts with the AAA to administer the VD-HCBS program and the veteran receives an assessment and care planning assistance from AAA staff and work with the staff member to select a mix of goods and services to meet their needs as well as their family caregiver(s). According to the National Resource Center for Participant-Directed Services, as of January 2011, 15 states have fully operational VA-HCBS programs, seven states are developing provider agreements, and 10 states are in the early stage of VD-HCBS development. Through the program, veterans can hire their own caregivers, including family members. Veterans who want to participate in the program must first be referred to the Area Agency on Aging (AAA) by the Veterans Administration Medical Center in Washington DC. The AAA director explains that this is one of two AAAs in Virginia that offer VD-HCBS. The VA launched a National Caregiver Support line in February 2011 for family caregivers of veterans (1-855-260-3274), as well as a website intended for caregivers of veterans: (http://www.caregiver.va.gov
). The VA is implementing a law passed last spring, the Caregivers and Veterans Omnibus Health Services Act that will provide respite, training, and modest stipends for family caregivers of veterans. For more information, visit:InsideNova.com "0329 Program allows vets to direct own care"
NRCPDS : "Everything You Ever Wanted to Know About Veteran-Directed Home and Community-Based Services Programs" (Map of participating states is on page 31)
RWJF Description of VA-HCBS Partnership Between VA and NRCPDS
Legislation introduced in Iowa would have allowed nursing home officials to review the job performance of the state's long-term care ombudsman. Long-term care ombudsmen in each state are charged with investigating complaints about care received in nursing homes. The version of the bill that passed in the Iowa Senate would create a committee of care providers, industry officials and regulators to review and comment on the ombudsman's investigative procedures as part of the ombudsman's annual review. The Des Moines Register
reports that the bill was authored by Jeanne Yordi, Iowa's current long-term care ombudsman, who explained that the bill would bring Iowa into compliance with federal law. However, the Register suggests that this bill appears to contradict federal law that calls for each state to have a long-term care ombudsman who is independent of the industry he or she is regulating. The chairwoman of the National Association of Local Long-Term Care Ombudsmen suggested that such a committee would "represent an inherent conflict of interest." Yordi suggested that she saw the committee as a tool to bring people together to discuss industry trends and share information with her. An amendment being considered in the Iowa House would remove the language creating the committee and instead instructs the ombudsman to consider the views of the nursing home industry. For more information, visit:
Des Moines Register: "Critics: Bill touted by ombudsman for elderly creates conflict of interest"
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Federal Government Avoids Shutdown
President Obama and Congress were able to avoid a shut-down of the federal government over the FY 2011 budget and details about the agreement are beginning to emerge this week. The budget calls for about $38 billion in cuts to the budget, including a $16 million cut to the Administration on Aging (as compared to the FY 2010 enacted budget), or $124 million less than the President's request, effectively killing the Vice-President's Caregiver Initiative that would have provided about $100 million in additional supports for family caregivers in FY 2011. The Community Service Employment for Older Americans program is cut by $375 million as compared to the FY 2010 enacted budget, which is $150 million less than the President's request. While the FY 2011 budget is near completion, the President and Congress will soon begin work on the FY 2012 budget and Congress must also soon vote on raising the debt ceiling. The President's proposed FY 2012 budget, released in February, includes $10 million for Lifespan Respite, $23 million for a State Paid Leave Program, and an additional $48 million for Home and Community Based services.
For more information, visit:
Washington Post: "Budget deal: Cuts of $38 billion include accounting gimmicks, target Obama priorities"
GOP Plan Would Make Dramatic Changes To Medicaid and Medicare
Representative John Ryan (R-WI), the chairman of the House Budget Committee, released a budget plan last week that would dramatically change Medicare and Medicaid. Ryan suggests making Medicaid into a block grant program whereby states are given a set amount of money to spend on providing health care each year and are given greater flexibility. For Medicare, Ryan's plan suggests a voucher-esque program starting in 2022 that would ask wealthier older Americans to pay a larger share of their Medicare bill, would increase the eligibility age to 67, and would provide beneficiaries with a set amount of money to spend on their own care, which many experts suggest will not keep pace with the rising cost of health care, thus shifting costs to Medicare beneficiaries.
The Center on Budget and Policy Priorities (CBPP) is skeptical, suggesting that 2/3 of the cuts in Ryan's plan would fall on poor Americans and that the $4.3 trillion in budget cuts would be offset by $4.2 trillion in tax cuts that would disproportionately benefit the wealthy. CBPP also projects that if Ryan's plan would have been enacted in 2000, then 29 states would have experienced cuts in federal Medicaid funding of 30% or more by 2009. Thirty-five organizations signed onto a letter to Congress suggesting that block-granting Medicaid would harm older Americans and people with disabilities by removing current federal protections like those that prevent spousal impoverishment in Medicaid. Families USA opposes the plan and highlighted the fact that Medicaid is currently the primary payer for 64% of all nursing home residents and also provides home-based care to millions of seniors and people with disabilities. The New York Times highlighted research that suggests the current Medicare program acts mostly as a welfare program for most Americans who will receive a far higher value of benefits than they have paid for through their Medicare payroll tax deductions. The Times also chides Ryan and other politicians for not asking current baby boomers and older Americans to help pay for changes to this and other government programs (Ryan's Medicare changes wouldn't take effect until 2022). For more information, visit:
Center on Budget and Policy Priorities (Multiple Analyses)
Kaiser Health News: "CBO Outlines 'Key Features' Of Ryan Budget Proposal"
New York Times: "Generational Divide Colors Debate Over Medicare's Future"
NCVQLTC: "Aging Organizations Support Medicaid in Face of Call for Cuts, Block Grant"
Families USA: "House Republicans Propose to Slash Funding For Medicaid, Medicare, and Other Health Coverage Programs"
Scan Foundation Releases Briefs On CLASS Program
The Scan Foundation released a collection of 16 research briefs focused on various aspects of the CLASS program. The briefs are grouped by topics including "The Landscape of Services and Support," "Beneficiary Assessment," "Pathways for Successful Use of a Cash Benefit," "Strategies for Marketing," and "Workforce Readiness." The introductory brief notes that while average life expectancy has increased to 78 years, policies around paying for long-term care in America haven't been revised or updated since the inception of Medicaid and Medicare in 1965. In addition, despite the fact that 70% of Americans will need long-term care at some point in their lives, few adults over the age of 40 are confident in their ability to pay for long-term care. The briefs are written by industry and academic experts and provide additional insight into the need for a program like CLASS as well as the challenges of designing and implementing CLASS. For more information, visit:
Scan Foundation: "CLASS Technical Briefs"
Briefs Address Financial Challenges For Medicare Beneficiaries
The Kaiser Family Foundation released three policy briefs that analyze the income, assets, and out-of-pocket expenses for current and future Medicare beneficiaries.
The first brief, "Health Care on a Budget," finds that Medicare households spent 14.9% of their household budgets on health expenses in 2009, significantly higher than the 4.8% spent by non-Medicare households. In addition, Medicare households whose income places them just above the poverty level spend a greater share of their household budgets on health care than those below the poverty level and highest income households. For example, Medicare households below the poverty level who have members that are also covered by Medicaid spent about 85% lower on out-of-pocket expenses than Medicare households below the poverty level without Medicaid ($493 vs. $3,323).
The second brief, ""How Much Skin in the Game is Enough?" examines Medicare beneficiaries and their share of income going to pay for health care from 1997 to 2006. Out-of-pocket spending rose from 11.9% in 1997 to 16.2% in 2006. One in four Medicare beneficiaries spent 30% or more of their income on health expenses in 2006, and 69% of Medicare beneficiaries spent more than ten percent of their income on health care costs. Average out-of-pocket expenses per Medicare beneficiary was $4,241 in 2006. The authors explain that if previous trends continue, median out-of-pocket spending will reach 26% of income by 2020.
The third brief, "Projecting Income and Assets" addresses the income of Medicare beneficiaries and finds that half of Medicare beneficiaries had incomes of $21,000 or less in 2010 and less than five percent of beneficiaries have incomes of $83,000 or more. Similar to non-Medicare beneficiaries, there are also wealth and income disparities, with higher asset and income levels for white beneficiaries than black and Hispanic beneficiaries. When averaged together (including those without assets), Medicare beneficiaries have almost $360,000 in assets ($40,228 in retirement accounts, $101,834 in home equity, $216,436 in financial assets). However, half of Medicare beneficiaries have a little over $92,000 in total assets ($2,095 in retirement accounts, $60,025 in home equity, and less than $30,287 in financial assets). The authors conclude that asset gaps will continue, with white Medicare beneficiaries projected to have $471,353 in savings by 2030 while black beneficiaries will have $101,148 and Hispanics will have $143,639.
For more information, visit:
Data Spotlights Examine Financial Burden of Health Care on Medicare Beneficiaries
Cabinet Approves Bill Creating Long-Term Care Reserve Fund
The Taiwan government approved a draft law requiring the government to provide almost $34 million for a reserve fund to pay for long-term care. Premier Wu Den-yih explained that the law is the first step to creating long-term care insurance in the future. Under the bill, long-term care is defined as medical or personal assistance for a person who is expected to have a physical or mental disability for longer than six months. Caregivers must be licensed and will be required to take refresher courses every six years. For more information, visit:
China Post: "Cabinet Approves long-term elderly care bill"
Canadian Program Recognizes Cultural Differences To Tailor Alzheimer's Care
A Canadian program serving the Onedia Nation of the Thames in Canada was recently profiled for its approach of tailoring Alzheimer's care. For example, the director of the program, Robin Shawanoo, explains that he conducts memory tests and ask participants to name the similarities between corn and squash, in contrast to colleagues in nearby London, Ontario, who ask participants about differences in a watch and a ruler. Dr. Kristen Jacklin is heading a research project into dementia in Aboriginal communities and explains that Aboriginal communities have " a much more natural perception of the illness and one that is more accepting than mainstream society" and that First Nations communities view dementia as a natural, and often sacred, part of the aging process. In addition to incorporating Aboriginal symbols into dementia tests, Shawanoo also incorporates the culture into treatment and care by working with medicine people, using healing ceremonies and using sage. Shawanoo also suggests the importance of honoring the Aboriginal culture by recognizing not only the individual with Alzheimer's, but also their place within their family and community. For more information, visit:
Edmonton Journal "First Nation taking a cultural slant on treating dementia"
Workshop Gives Caregivers Perspective Of Living With Alzheimer's
A workshop developed by a mental health nurse and drama therapist in the United Kingdom allows professional caregivers to experience some of the symptoms of Alzheimer's disease. During the workshop, "meal time" is simulated by asking participants to wear goggles to limit vision and gloves to limit mobility, while a colleague attempts to spoon-feed the participant quickly. Communication is simulated by asking participants to read the newspaper while colleagues ask questions rapidly and loud noises are played. An estimated 2/3 of adults in care homes in the UK have dementia, and the training has been implemented in nine care homes in the UK run by a health and social care services provider. The Nursing and Midwifery Council announced at the end of 2010 that future nursing students will be required to receive training in cognitive behavior. For more information, visit:
BBC "Initiative helps dementia carers train in empathy"
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Study Focuses On Caregivers Of Alzheimer's Patients
A recent report by the National Alliance for Caregiving focuses on the positive and negative impacts of Alzheimer's disease on family caregivers. While past research has focused exclusively on the negative impacts of Alzheimer's on family caregivers, almost two-thirds of the 1,000 caregivers in this online survey report that caring for their loved ones gives them an opportunity to give back, while 46% of caregivers report feeling that they have a closer personal relationship with their care recipient. However, 61% of caregivers report feeling highly stressed, 40% report feelings of guilt for not doing more, and 39% report feeling angry at themselves for becoming frustrated with their loved one. Nine out of ten family caregivers report that their ability to recognize events and situations led them to suspect dementia or Alzheimer's disease, while only 31% report that a doctor's diagnosis contributed to their thought that Alzheimer's or dementia was present. For more information, visit:
National Alliance for Caregiving "What Made You Think Mom Had Alzheimer's?"
Study Focuses On Lack Of Elderly Participants In Clinical Heart Failure Trials
A recent study examined 251 clinical trials investigating treatments for heart failure and found that 43% of the trials excluded older patients from participating based on 1 or more "poorly justified" exclusion criteria. The findings are troubling because the majority of heart failure cases happen in adults age 65 or older, yet this study suggests people aged 65 or older are often excluded from the clinical trials. Exclusion criteria included age limits, if a person was taking more than one medication, or if a patient had multiple diseases. The lead author explained "The elderly are difficult to include in clinical trials because they have so many ongoing problems...that's why we need specific trials that are designed for older subjects. The science needs to adapt to them."
For more information, visit:
Archives of Internal Medicine: The Persistent Exclusion of Older Patients From Ongoing Clinical Trials Regarding Heart Failure
Routers: "Reliable? Heart studies often exclude the elderly"
Study Finds Frailty Is Not Correlated With Adverse Drug Events
A recent study of 377 mostly male veterans age 65 or older who were taking five or more medications found that frailty in elderly patients is not associated with an increased risk of adverse reactions to medications. The lead author, Dr. Michael Steinman, explains that there is a common and reasonable perception among doctors that older people who need assistance with activities of daily living are more vulnerable to adverse reactions to medications. However, using multivariate analysis, the authors found that adverse drug reaction was most strongly correlated with the number of new medications a patient is taking, not the patient's frailty. The authors conclude "although it is important to consider the unique circumstances of each participant, excessive caution in prescribing to older adults with these geriatric conditions may not be warranted." For more information, visit:
Journal of the American Geriatrics Society: "Geriatric Conditions, Medication Use, and Risk of Adverse Drug Events in a Predominantly Male, Older Veteran Population"
EurkAlert: "Frailty not a factor in adverse drug reactions among seniors, study finds"
Article Focuses On Facilitating Family Meetings In LTC Settings
A recent article in the Annals of Long Term Care provides an excellent guide for doctors and other professionals who are facilitating conversations with families about their loved ones who are receiving care in a long-term care setting. The authors discuss three strategies for holding the meetings, suggest timing considerations and provide a step-by-step process chart to conduct a family meeting. The strategies for holding the meetings are based on past research conducted on successful communication between doctors and families. Next Step In Care also released two guides: "Leaving hospital and going where?" that is designed for family caregivers as well as a similar guide intended for providers. The guides explain rights and responsibilities, provide planning suggestions, and are available in English, Spanish, Chinese and Russian. For more information, visit:
Annals of Long Term Care: "Helping Families in Long-Term Care Facing Complex Decisions: Applying the Evidence about Family Meetings from Other Settings"
Next Step in Care: "For Family Caregivers: Leaving the Hospital and Going Where?"
Next Step in Care: "For Providers: Hospital Discharge Planning-First Steps with Family Caregivers"
AARP Research Finds Brand Name Drug Prices Increase Dramatically In Two Years Prior To Facing Generic Competition
A recent AARP research brief calls into question whether or not competition from generic drugs actually translates into lower prices for consumers. Using a "market basket" of 217 drugs that are widely used by Medicare Part D beneficiaries, the authors analyzed price increases for "brand name" drugs before and after the drugs went "off patent" and faced generic competition. While generic drug prices are on average 85% lower than the price of their brand name counterparts, drug manufacturers can delay their competitor's entry through "pay for delay" agreements with the first generic manufacturer who files for FDA approval, a trend that costs the American public $3.5 billion a year due to delays of price competition.
AARP has monitored drug price increases for this market basket since 2004 and finds that brand name drugs that are facing generic competition dramatically increase their prices in the year or two before the generic drug enters the market. For example, the 15 brand name drugs facing competition in 2010 increased their annual retail prices by 13.7%, which is higher than the 8.3% increase in 2009 for the entire market basket of drugs. Brand name drugs that faced generic competition in 2010 increased their retail prices by 51% from 2004 to 2010 (from $1,842 to $2,610 for a year of therapy). For brand name drugs that faced generic competition prior to 2006, retail prices still rose about 30% (or 5.5% a year) between 2005 and 2009. This trends appears counterintuitive because the brand-name drugs should have lowered prices (not raised) when facing generic competition.
Higher drug prices translate to higher out-of-pocket costs for beneficiaries who pay a percentage of their drug costs (coinsurance) rather than a fixed amount (copayment) and also push more Medicare Part D enrollees into the "doughnut hole" where they must pay all or most of their drug costs each year. The Affordable Care Act has provisions to phase out the coverage gap, but not until 2020. The Kaiser report summarized earlier in this issue of PolicyDigest found that the average out-of-pocket health care expenditures (not just drugs) per Medicare beneficiary was $4,241 in 2006. The AARP report also includes a brief video summary of the report findings. For more information, visit:
AARP Public Policy Institute "Retail Prices for Widely Used Brand Name Drugs Increase Considerably Prior to Generic Competition"
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). Join us for appetizers, beverages and breathtaking views of the City. Everyone is welcome! For more information, visit:
American Society on Aging
Family Caregiver Alliance National Center on Caregiving ASA Page
Webinar: Focus On Affordable Care Act, Medicaid Expansion, And FMAP, April 14th, 12pm (EDT)
A webinar on Thursday, April 14, at 12pm (EDT) will focus on the Affordable Care Act's expansion of Medicaid eligibility to millions of previously-ineligible people. Dr. John Czajka from Mathematica Policy Research will discuss the challenges for states in changing their systems to incorporate the new eligibility rules and to identify newly-enrolled Medicaid enrollees who are worth an increased federal medical assistance percentage (FMAP) to states. Karen Gibson, the Director of Health Care Eligibility and Access with the Minnesota Department of Human Services will speak about her state's experience as an early adopter of the Medicaid expansion. For more information or to register, visit:
Medicaid Eligibility Determination under the ACA: Challenges for States
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!"
Federal Government Launches Partnership To Improve Medical Care
The Obama administration launched a public/private partnership campaign earlier this week, "Partnership for Patients: Better Care, Lower Costs," that is intended to decrease preventable hospital-acquired conditions as well as preventable complications that occur when a patient transitions from one care setting to another. Citing the landmark Institute of Medicine study from 1999 ("To Err is Human"), officials hope to address the estimated 98,000 Americans who die every year from preventable medical errors. While the initiative is designed to improve care, it also has the potential to reduce costs, for example, the one in five Medicare beneficiaries who are readmitted to the hospital within 30 days of discharge is estimated to cost $26 billion every year. Dr. Atul Gawande, a doctor and a health policy expert, wrote a 2007 article in the New Yorker detailing how the use of checklists in hospitals has led to dramatically lower infection rates and lower costs. For example, Dr. Gawande discusses the Keystone Initiative, started in 2004 in hospitals in Michigan where infection rates were higher than the national average. The hospitals began using check-lists in their Intensive Care Units (ICU) and the use of the checklists led to Michigan's infection rates falling so low that its average ICU outperformed 90% of ICU's nationwide, and the hospitals saved an estimated $175 million in costs and more than 1,500 lives. For more information, or to join the Partnership for Patients: Better Care, Lower Costs, visit:
Partnership for Patients: Better Care, Lower Costs
The New Yorker: "The Checklist"
Tools To Plan And Document End-of-Life Care Preferences
A recent article in the Wall Street Journal focused on tools for people to direct what type of care they want to receive at the end-of-life. One program highlighted is the Physician Orders for Life-Sustaining Treatment (Polst), currently used in 14 states while an additional 16 states are developing programs. Polst programs provide paperwork that meet local regulations and also train health-care providers who will discuss end-of-life treatment choices with patients with terminal illnesses or people who would like to define their care preferences. In contrast to an advance directive, the Polst form spells out specific treatment instructions and becomes part of a patient's medical record. Bernard Hammes, chairman of a national task force that develops Polst programs designed a training program called Respecting Choices that has been duplicated throughout the U.S. and internationally. Designed for nurses, social workers, and chaplains at the Gunderson Lutheran Health System in Wisconsin, the program teaches them how to facilitate and document advance care planning conversations with patients and families. Aetna, a health insurance company, began using nurse-care managers in 2004 to work with patients and their families to ensure that advanced directives are in place and followed, and this has correlated with increased utilization of hospice care and reduced health care costs. Randall Krakauer, Aetna's head of Medicare medical management, explains that the insurer does not try to suggest specific end-of-life choices, but when advanced cared preferences are not known, "by default we end up using very aggressive curative therapy which in most cases is not only inappropriate, but would not be the patient's choice." A coalition of health care groups is organizing "National Healthcare Decisions Day" on April 16th. For more information, visit:
Wall Street Journal: "New Efforts to Simplify End-of-Life Care Wishes"
National Healthcare Decisions Day
Family Caregiver Alliance Fact Sheet: "End-of-Life Choices: Holding on and Letting Go"
Lifespan Respite Care Program Grant Announcement
The U.S. Administration on Aging recently announced a grant opportunity for 12 states to receive up to $200,000 per state to plan, establish and expand/enhance Lifespan Respite Care systems in the state. Eligibility for the grants is limited to states that did not receive funding under the program in FY 2009 or FY 2010. President Obama's FY 2012 budget includes $10 million for the Lifespan Respite Care Program, an increase over past years, though the program has never been fully funded at the level authorized by the legislation creating the program. The grant is for three years, and 24 states have already received funding through this program to develop Lifespan Respite Care Programs in their states. For more information, visit:
Administration on Aging Grant Announcement: FY 2011 Lifespan Respite Care Program
ARCH National Respite Network and Resource Center: "FY 2012 Appropriations Request"
Families USA Guide Addresses Benefits For Caregivers In Affordable Care Act
Families USA recently released an 8-page guide intended for consumers that addresses provisions within the Affordable Care Act (ACA) that benefit family caregivers. For example, states will have the option to apply for the State Balancing Incentive Payments Program as well as the Community First Choice Option, both of which allow states to increase home and community based services in Medicaid in exchange for additional federal money. The ACA also includes the Elder Justice Act, Nursing Home Transparency and Improvement Act, and the Patient Safety and Abuse Prevention Act, which will increase the quality of care for care recipients while also providing more information to family caregivers. A companion fact sheet provides similar information in a more concise style. For more information, visit:
Families USA: "The Health Care Law: Good News for Caregivers"
Families USA: "The Affordable Care Act: Provisions that Will Help Caregivers"
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