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|A Newsletter of FCA's National Center on Caregiving|
May 25, 2011
Volume XI, Number 9
|IN THIS ISSUE|
State Legislation, Policy & Reports
- CA: Governor Brown's Updated Budget and Reports On Long-Term Care More...
- CT: Paid Sick Leave Legislation More...
- Florida: Converting Medicaid to Managed Care And More Fees For Beneficiaries More...
- Federal Legislation Would Repeal Maintenance Of Effort For States More...
- Proposed Federal Rule May Limit State's Ability To Cut Medicaid Rates More...
Federal Legislation, Policy & Reports
- Research On Proposed Changes To Medicaid And Medicare More...
- Proposed Rule-Making For Accountable Care Organizations More...
- Results Released From HHS "Community Living" Listening Sessions More...
- Ireland: Respite Service Cuts Stretch Dementia Family Caregivers More...
- OECD Report Addresses Long-Term Care Strategies For 34 Member Countries More...
- Report Suggests National Standards For Social Care System More...
- Europe: Relationship Between Formal and Informal Care More...
Research Reports & Journal Articles
- Study Measures Caregiver Attitudes Towards Dementia Screening More...
- Volunteers Of America: Research Report On Lack of Long-Term Care Planning More...
- Five Of Six NIH Grants Will Not Receive Funding This Year More...
- 83% Of Antipsychotic Prescriptions For Elder Nursing Home Residents Were For "Off-Label" Use More...
Conferences & Trainings
- Webinar: "Making Respite More Effective" June 6th, 3:00pm (Eastern) More...
- Conference: 2011 National Lifespan Respite-Call For Papers Deadline May 29th More...
- Webinar: Community First Choice Option and Balance Incentive Payments Program June 3, 2:00pm (Eastern) More...
- Conference: Caregiving, Disability, Aging, and Technology June 5-8th More...
Funding, Media & Miscellaneous
- Blog Posting Compares U.S. Caregiving Support Vs. Canada More...
- NCOA Campaign: "One Away" Allows Seniors To Share Stories More...
- Geriatricians In Limited Supply, Especially In Rural Areas More...
- Report Provides Update On POLST Programs More...
- Health Care For Direct Care Workers Focus Of Lobbying Campaign More...
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Governor Brown released an updated budget proposal for California based on higher revenues than previously projected. However, the proposed budget still makes cuts to programs serving caregivers, including eliminating the Adult Day Health Care program for 37,000 elder Californians, requiring medical certification for IHSS beneficiaries, and implementing cost-sharing and capping the number of doctor visits in Medi-Cal. Five Adult Day Health Care programs in California have already closed due to the budget uncertainties. The California Association for Adult Day Services sent a letter to CMS on May 11th, urging CMS to exercise caution when deciding whether or not to eliminate the program. The Little Hoover Commission released a report in April outlining how California can improve its fragmented long-term care system that is currently administered by seven different departments in the Health and Human Services Agency. The Scan Foundation also released a background paper with recommendations for a recent hearing by the Assembly Committee on Aging and Long-Term Care. For more information, visit:
California Budget Project: "Governor Releases May Revision: Tax Collections Up, Less Balance, Backloaded Business Tax Breaks"
Oakland Tribune: "Seniors, disabled in budget cross hairs"
California Association for Adult Day Services Letter to CMS
Hoover Commission: "A Long-Term Strategy for Long-Term Care"
Scan Foundation: Background Paper
Connecticut lawmakers are considering legislation that would require companies with 50 or more workers to provide up to five paid sick days a year. Paid sick leave is especially important for family caregivers who may use the time for their own medical needs or for care for a loved one, for example, taking a parent to a doctor appointment. Employees would begin earning the sick days after they have worked at least 520 hours in their jobs. Governor Malloy has joined the conversation and is encouraging state lawmakers to vote for the legislation. The Middletown Press reports that PricewaterhouseCoopers released a report naming San Francisco, a city with paid sick leave, as the third best city for innovation and business among 25 other national and international cities. For more information, visit:
Florida lawmakers passed legislation earlier this month to shift its Medicaid program from a fee-for-service model to a managed care model. The shift would require approval from the federal government and is similar to a pilot conducted in five Florida counties. According to the New York Times, a report on the pilot by Georgetown University found that some HMO's left the pilot program because of low reimbursement rates, leaving beneficiaries in limbo. Critics have also suggested that there was insufficient evidence to analyze if the pilot program improved care while saving money and suggest that Medicaid beneficiaries may have difficulty navigating managed care bureaucracies. Lawmakers also passed legislation to increase cost-sharing for Medicaid beneficiaries, including a mandatory $10 monthly premium except for nursing home residents and a $100 co-pay for using the ER for "routine care." These fees conflict with existing federal Medicaid law and would need to be approved by the federal government. Dr. Peter Viccellio explained to Kaiser Health News that he believes Medicaid recipients use ERs because they are sicker and have fewer doctors willing to see them. "When you add a co-pay you obstruct access to care for both emergency and non-emergency care," he said. "This is not a way to save money, it's a way to punish people for being poor." For more information, visit:
As a condition of accepting additional stimulus funding (increased FMAP) and, later, as part of the Affordable Care Act (ACA), the federal government included Maintenance of Effort provisions for Medicaid. Through these provisions, states are limited from making eligibility requirements stricter for Medicaid and the Children's Health Insurance Program (CHIP). The provision in the ACA was included to ensure that low-income individuals would continue to have access to Medicaid coverage until the state health exchanges become active in January 2014. The increased FMAP from the federal government expires in June and lawmakers have introduced federal legislation to relax the MOE provisions of the Affordable Care Act and allow states to make stricter eligibility requirements for their Medicaid and CHIP programs. Congressional Quarterly cites a Congressional Budget Office report that found the proposed changes would result in 400,000 less people in Medicaid/CHIP in 2013 of which two-thirds are children and that an estimated 300,000 would become and stay uninsured as a result. Families USA also analyzed the state-level impacts of eliminating the MOE and has data for all 50 states. For more information, visit:
Families USA: State-level data on MOE impact
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would change how states analyze the impact of rate cuts to providers in Medicaid programs. State lawmakers facing budget crunches have reduced Medicaid provider rates in the past to achieve balanced budgets. State policymakers are supposed to ensure that rate cuts won't reduce access to covered care and services. However, states have been sued as a result of provider rate reductions by advocates who suggest the cuts reduce access. Despite these lawsuits, a clear legal precedent has not emerged. CMS is proposing a new, standardized, transparent methodology to "definitively measure access to health care and services." CMS explains that it already has the power to approve or deny rate changes and that the proposed rule will be helpful in creating a more standardized, transparent process to gather information for rate change reviews. Several state Medicaid directors interviewed by the New York Times viewed the proposed rule change as a power-grab. For more information, visit:
A number of reports were released to analyze Representative John Ryan's plans to block-grant Medicaid and provide vouchers in Medicare. The Kaiser Commission on Medicaid and the Uninsured found that states would receive $243 billion less every year in federal funding by 2021 if Medicaid block grants were implemented. Kaiser's analysis also finds that by 2021, between 31 and 44 million fewer people would have Medicaid coverage. AARP's analysis examines the pros and cons of a block-grant program, but concludes that block-grants would ultimately prove harmful for states that would shoulder greater costs for Medicaid and may turn to more extreme cuts to services during economic downturns, with negative impacts for Medicaid beneficiaries and their caregivers. Professor Harold Pollack at the University of Chicago analyzed the political context of proposed changes to Medicare and Medicaid, explaining: "The tone and the politics change when things turn to Medicaid and related safety-net services. Dozens of states are making painful cuts right now. The disadvantaged people most directly affected are playing conspicuously small parts in the accompanying political process." A report from Families USA provides data on Medicaid's role in financing long-term care, including serving as the primary payer for an estimated 63.6% of all nursing home residents. The National Senior Citizens Law Center explains eight practical implications of block-granting Medicaid in its report, including the possibility of eliminating current spousal impoverishment protections.
Proposed Rule-Making For Accountable Care Organizations
Accountable Care Organizations (ACOs) were included in the Affordable Care Act and would serve as networks of Medicare providers who work closely together to improve care and care coordination while reducing costs and sharing in the savings. CMS recently released a notice of proposed rule making about the actual administration of ACOs. A recent Congressional Quarterly article interviewed representatives from some of the models for ACOs, including the Cleveland Clinic, the Mayo Clinic, Intermountain Healthcare, and the Geisinger Health System whose representatives raised a number of concerns with the implementation of ACOs. Concerns include financial risks for ACOs if they don't produce savings, though CMS offered two options about the amount of time providers have before they would face financial penalties. Providers will be required to collect 65 measures of quality to ensure that providers don't reduce care in order to save money; however, not all organizations currently collect this data. Officials also suggested that potential future demonstration opportunities in the Affordable Care Act may be more attractive than an ACO for organizations like the Mayo Clinic. For more information, visit:
Commonwealth Fund: "Model ACO Health Centers Skeptical of Proposed Rule"
Kaiser Health News: "ACO is the hottest three-letter word in health care"
Results Released From HHS "Community Living" Listening Sessions
As part of President Obama's "Year of Community Living," (honoring the 10th anniversary of the Olmstead v. L.C. decision), HHS launched the Community Living Initiative to identify strategies to improve services and access for individuals with disabilities and older adults. This initiative included Stakeholder Dialogues and Listening sessions in four states (CA, MA, VA, NC) and HHS released the results of these sessions earlier this month as well as successful strategies and campaigns in these states. The lack of affordable, accessible, and integrated housing was highlighted as a major challenge. Access to services provided through Medicaid waivers was also an issue, with participants suggesting that the current eligibility standards based on diagnostic labels means that people can't access needed services and also contributes to conflicts between groups competing for resources. Adequate training and support for family caregivers as well as direct care providers was also included as a challenge to community living. For more information, visit:
HHS: "Stakeholder Dialogues Summary Report"
Ireland: Respite Service Cuts Stretch Dementia Family Caregivers
Dr. Karena Meehan recently presented on the impact of recent cutbacks to home help services and respite beds for the approximately 40,000 people with dementia in Ireland. She explained to the Irish Times: "All home help services have been cut back enormously and we are now finding it very difficult to get support for people with dementia unless they have physical needs....Some of the first beds to have been slashed were respite beds and without this care, people caring for loved ones with dementia are being stretched to the limit in terms of being able to cope." The National Alzheimer's Association and Western Alzheimer's Foundation have provided grants to families that allow for small respite breaks. The Minister of Health for Ireland also recently released results from a longitudinal study of 8,000 Irish people aged 50 and older. One finding highlights the extensive role of family caregivers: "People with disabilities receive an average of 118 hours of help per month. As the most common primary helper for this group is the care recipient's spouse, this translates into extensive inputs by older adults into the care of other older adults." For more information, visit:
Ireland Times: "Dementia home carers 'stretched to the limit'"
"Fifty Plus in Ireland 2011. First Results from The Irish Longitudinal Study on Ageing"
OECD Report Addresses Long-Term Care Strategies For 34 Member Countries
A recent report from the Organization for Economic Cooperation and Development (OECD) addresses the growing aged population in the 34 member countries (including the U.S.), the implications of this shift, and possible strategies to address it. In OECD member countries, more than one in ten adults 50 years or older provides caregiving (usually unpaid) and almost two-thirds are women. According to the authors, without adequate supports, caregiving, especially high-intensity caregiving, leads to a reduction in the labor supply, higher risks of poverty, and a 20% higher prevalence of mental health issues for caregivers as compared to non-caregivers. The authors outline current strategies in member countries, including improved work/life balance policies, paying family caregivers, providing support services like respite, and better recognition and training for direct care workers. For financing long-term care, the authors suggest that universal LTC coverage would allow for the pooling of risk, though also suggest more precise targeting of benefits to those most in need. The Telegraph analyzed the data on the United Kingdom, which is expected to have the highest long-term care expenditures by 2050 of any of the countries studied. They suggest tat older workers in the UK may need to work longer to help pay for the long-term care bill and that the UK's higher rate of family breakdown (12% of British children in step-families as compared to OECD average of 8%) may translate to fewer people to serve as unpaid family caregivers in the future. For more information, visit:
OECD: "Help Wanted? Providing and Paying for Long-term Care" Telegraph: "OECD: huge elderly care bill threatens family ties"
Report Suggests National Standards For Social Care System
The Law Commission in the United Kingdom released a report earlier this month calling for an overhaul to the system of social supports and services provided in England and Wales. The report suggested creating a legal duty on local councils to protect vulnerable adults from abuse, providing grants for individuals to spend on care homes, and additional support for family caregivers of the elderly. Advocates have suggested in the past that elderly people have had to resort to legal avenues in order to access needed services because local councils are uneven in the level of support provided. While the report does not suggest eligibility frameworks, it does suggest that laws must be clearer about basic entitlements to services and must be consistently applied across local councils. The report also suggests introducing more elements of consumer direction, by letting the care recipient choose for themselves how to spend a "personal budget" on a residential home of their choice. Michelle Mitchell, the Charity Director at Age UK, interviewed by the Telegraph, applauded the report: "The current care system itself is a catastrophe waiting to happen and the legal framework a complicated mess that sometimes local authorities either do not understand, or deliberately choose to ignore." A research brief, also recently released, focuses on policy options for financing of long-term care in the U.K. For more information, visit:
Law Commission "Adult Social Care"
Telegraph: "Law Commission: elderly care must be reformed"
International Longevity Center- UK: "Past Caring? Widening the Debate on Funding Long-Term Care"
Europe: Relationship Between Formal and Informal Care
A working paper from the Center for North South Economic Research uses data from the SHARE longitudinal survey to analyze whether informal caregiving affects demand for paid long-term care services in the home. Using several economic models, the authors find that the probability of receiving informal support increases with age, is higher for individuals living alone and who have disabilities, and that the for people with severe levels of disabilities, there is a higher probability of receiving total formal care. The data also suggests that higher income individuals are more likely to use paid caregivers and rely less on family caregivers. In addition, the probability of an older parent receiving care from a child is related to the age and geographic distance, with the farthest and youngest children being less likely to provide support. The authors conclude: "On the whole, the effect of informal support on formal care is negligible and unresponsive to increasing needs. From a policy point of view, this suggests that incentives for informal support are not likely to strongly affect the European demand for paid long-term home services. The role of informal care as an effective cost-saving alternative to paid LTC probably needs some reconsideration." For more information, visit:
CRENOS: "A Country for Old Men? An Analysis of the Determinants of Long-Term Home Care in Europe"
Study Measures Caregiver Attitudes Towards Dementia Screening
A recent study in the Journal of American Geriatrics examines whether dementia caregivers have different attitudes about screening for dementia as compared to the general public. This topic is especially relevant given the recently updated guidelines for Alzheimer's disease that suggest looking at biomarkers of the disease in clinical trials. The NYT explains that biomarkers are signs that a person may eventually develop the disease (blood pressure and cholesterol are biomarkers for heart disease), however, for Alzheimer's, more research is needed. For example, as high as one-third of people with amyloid plaque in their brains have not developed symptoms of Alzheimer's by the time they die. In addition, because there is no cure for Alzheimer's, an early diagnosis may not be as beneficial. The authors interview 81 participants with dementia caregiving experience and 125 participants without caregiving experience. Caregivers had lower acceptance of dementia screening (53.9% vs. 60.6% for non-caregivers) and also had a higher perceived suffering score (61.6% vs. 55.9%). However, there were not differences between caregivers and non-caregivers in perceived benefits of dementia screening, perceived stigma, or perceived negative effects on independence. Both groups reported that the top three barriers to screening are emotional suffering by the family (86% for caregivers; 75% non-caregivers); loss of driving privileges (75% for caregivers vs. 78% non-caregivers); and becoming depressed (64% caregivers vs. 43% non-caregivers). For more information, visit:
Journal of American Geriatrics: "Caregiver and Noncaregiver Attitudes Toward Dementia Screening" (abstract is free, subscription required for full article)
New York Times: Guidelines Allow Earlier Definition of Alzheimer's
Volunteers Of America: Research Report On Lack of Long-Term Care Planning
Volunteers of America recently released a report that brings together data on the current costof long-term care and American's plans (or lack thereof) for financing their own long-term care. The report incorporates data from an earlier survey of caregivers, for example, 40% of caregiver respondents aged 45-65 were "extremely or very worried" about saving enough for a financially secure retirement, as compared to 34% of the general population. In addition, 46% of caregivers were "extremely or very worried" about having secure health insurance for your family, even with a job loss, whereas only 37% of the general population was "extremely or very worried." For more information, visit:
Volunteers of America: "Boomer Bust 2011: Still Unprepared and Unaware"
Five Of Six NIH Grants Will Not Receive Funding This Year
A recent Associated Press article analyzed funding for the National Institutes of Health, the impending budget showdown, and the need for research on diseases like Alzheimer's. According to a recent report from the Alzheimer's Foundation, NIH spends about $469 million a year on Alzheimer's research and that the National Institute on Aging (NIA) only receives 3.6 cents for every dollar the NIH receives. At a May 11th Congressional hearing, the director of NIH, Dr. Francis Collins, explained that NIH currently turns down five out of six applications it receives, which is a higher rate than last year when one in five grants were funded, or a decade ago, when one in three grants were funded. Presidential candidate Newt Gingrich suggested to the audience at the Alzheimer's Association Advocacy Forum that over the next four decades, Alzheimer's could reach a price tag of $20 trillion and suggested selling U.S. bonds to raise money for research. Advocates asked that Congress appropriate an additional $300 million for the NIA for next year's budget. At the Congressional hearing, Senator Jerry Moran (R-KS) asked the director of NIH about how investments in research pay off, and he responded that NIH-funded research led to the development of cholesterol-fighting statin drugs, that helped lead to a 60% reduction in heart-disease deaths, but only cost Americans, on average, about $3.70 per year. For more information, visit:
Associated Press: "How to square budget cuts, need for aging research"
83% Of Antipsychotic Prescriptions For Elder Nursing Home Residents Were For "Off-Label" Use
An audit by the inspector general of the Department of Health and Human Services found that antipsychotic prescriptions were given to elderly nursing home residents, especially those with dementia, even though the drugs increase the risks of death and are not approved to be used in this manner. According to a medical record review, from January 1 to June 30, 2007, fifty-one percent of Medicare claims for atypical antipsychotic drugs were erroneous, totaling $116 million. The investigation also found that 88% of the Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with the condition specified in the FDA boxed warning (i.e. dementia). According to the report, 14% of the 2.1 million elderly nursing home residents had at least one claim for these types of drugs. The report suggests that CMS collect information on the diagnoses given to Medicare patients in order to analyze whether the drug prescriptions are appropriate. For more information, visit:
HHS: "Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents"
NYT: "Antipsychotic Drugs Called Hazardous for the Elderly"
Webinar: "Making Respite More Effective" June 6th, 3:00pm (Eastern)
The Family Caregiver Alliance/ARCH Technical Assistance Center on Caregiving and Lifespan Respite are sponsoring a webinar on June 6th with Dr. Dale Lund, Professor of Sociology at California State University, San Bernardino. Dr. Lund presented at the National Respite Conference in California on respite time-use and his research suggests that family caregivers' use of respite time is a determining factor in the extent to which the family caregiver benefits from respite. Dr. Lund will provide practice and policy suggestions that can enhance caregivers' use of respite time. He will also discuss how to measure these outcomes related to respite time-use. For more information, or to register for this webinar, visit:
"Making Respite More Effective"
The 14th annual conference will take place November 1-4, in Glendale, Arizona, and is being co-sponsored by the Arizona Caregiver Coalition. The theme this year is diversity, and the conference will feature three tracks, including service delivery innovations, diversity and cultural issues, and network building. In addition to learning up-to-date information on respite, participants will also learn about "connecting the dots" between the Lifespan Respite Care Program and other programs that support caregivers. The Call for Papers deadline to present at the conference is May 29th. For more information, or to submit a paper, visit:
ARCH National Respite Network And Resource Center/Arizona Caregiver Coalition
Webinar: Community First Choice Option and Balance Incentive Payments Program June 3, 2:00pm (Eastern)
The Friday Morning Collaborative, a coalition of national aging and disability organizations, is sponsoring a webinar on Friday, June 3, from 2:00pm to 3:30pm (EDT). The webinar will focus on two programs in the Affordable Care Act. The Community First Choice Option is a new Medicaid state plan option that provides an enhanced FMAP to states in exchange for providing a range of personal attendant services and supports. The Balance Incentive Payments Program is grant program that will provide additional funding to states that shift their Medicaid spending from institutional care to community-based services. Presenters include a representative from the CMS Disabled and Elderly Health Programs; Bruce Darling (Center for Disability Rights-NY State, National ADAPT); Anna Rich (National Senior Citizens Law Center); and Elizabeth Royal (SEIU). For more information or to register, visit:
Community First Choice Option and Balance Incentive Payments Program
Conference: Caregiving, Disability, Aging, and Technology June 5-8th
The Festival of International Conferences on Caregiving, Disability, Aging, and Technology will take place in Toronto, Canada on June 5-8, 2011. The two lead organizations for the conference are March of Dimes Canada and the Toronto Rehabilitation Institute. Conference participants will explore aging issues, including the implications for healthcare systems and service providers, the role of family caregivers, and how technology and new research findings can provide new solutions. For more information or to register, visit:
Caregiving, Disability, Aging, and Technology
Blog Posting Compares U.S. Caregiving Support Vs. Canada
A recent blog posting by Carol Levine in Health Affairs highlights the recent Canadian elections and the two party's platforms to support caregivers. In the recent Canadian elections, both the Liberal party and the Conservative party proposed additional caregiver supports as part of their platforms. The Conservative platform proposed a nonreimbursable $2,000 tax credit, projected to assist 500,000 family caregivers. The Liberal party proposed a six month, paid insurance benefit to allow employees to take time off for caregiving duties as well as $1,350 tax credit. Levine concludes: "What accounts for the higher priority given to family caregivers in Canada? Only a full analysis could answer that question, and the outcome of the election may not result in major changes. Still the fact that this is on the public agenda in a much more visible way than in the U.S. warrants some thoughtful reflection." For more information, visit:
Health Affairs: "The Year Of The Family Caregiver - In What Country?"
NCOA Campaign: "One Away" Allows Seniors To Share Stories
As part of the National Council on Aging's focus on elder economic security, it recently launched a campaign called "One Away." The campaign is intended to call greater attention to the fact that 13 million seniors are one event away from economic disaster. Through the interactive website, 836 seniors have posted personal stories about their challenges surviving on fixed incomes while expenses like health care and food increase. The Web site also features a video with interviews with older adults. To share a story or for more information, visit:
National Council on Aging: "One Away"
Geriatricians In Limited Supply, Especially In Rural Areas
A recent study in the Journal of the American Geriatrics Society uses county-level data on the number of geriatricians, family physicians, and general internists and compares this with U.S. Census data on the number of adults 65 years or older. The authors report that in 2008 there were an average of 1.07 geriatricians per 10,000 elderly residents, 22.17 family physicians and 13.94 general internists per 10,000 older adults. However, there are large differences for urban vs. rural. There were 1.48 geriatricians in the most urban areas but only .80 in the most-rural counties. There were 27.29 general internists per 10,000 older adults in urban counties, but only 3.85 per 10,000 older adults in rural areas. Family physicians are more evenly distributed, with 22.02 per 10,000 older adults in urban areas and 14.27 per 10,000 adults in rural areas. The authors point out that training a sufficient number of geriatricians and dispersing them to rural areas is not a realistic solution, especially since fewer than 320 doctors entered geriatric medicine fellowship training every year from 2004 to 2008. Instead, the authors suggest that non-geriatrician doctors, as well as nurse practitioners and physicians assistants will provide the bulk of the care. They also discuss other models of providing care, including linking specialists at academic health centers to more remote areas. They suggest that Medicare could help with creating new models by providing incentives for geriatrician training, compensating doctors for the complex care necessary for very frail older adults, increasing geriatric education for all residencies, and providing higher payments to medical homes to deliver and integrate complex care for elderly Americans.
Journal of the American Geriatrics Society: "Rural-Urban Distribution of the U.S. Geriatrics Physician Workforce"
USA Today: "Elderly Face Lack of Geriatric Specialists, New Report Warns"
Report Provides Update On POLST Programs
AARP released a report that provides an update on the implementation and adoption of Physician Orders for Life-Sustaining Treatment (POLST) programs in states. The POLST protocol requires a health care professional to discuss available treatment options with seriously ill patients (or their surrogates), and these preferences are then documented on a standardized medical form that the patient keeps with them. POLST programs have been adopted by 10 states by the beginning of 2010 with other states also developing programs. The study examines the experience of 12 states to identify factors that helped or hindered both adoption and meaningful implementation of the program. Well-established statewide end-of-life coalitions or palliative care organizations were helpful with starting POLST development, and a core group of "physician champions" is important to gaining acceptance by health care institutions. POLST proponents identified 40 issues and barriers during implementation, including what elements should be included in the form, decision-making authority for surrogates when a patient lacks decision-making ability, and training and education of doctors both in communication skills for the POLST conversations and the therapeutic impact of interventions like CPR and tube feeding for older chronic care patients. For more information, visit:
AARP: Improving Advanced Illness Care: The Evolution of State POLST Programs
Center for Ethics in Health care, Oregon Health & Sciences University. POLST Web Site
Health Care For Direct Care Workers Focus Of Lobbying Campaign
The New York Times recently reported on a lobbying campaign by nursing home and home care agencies to be exempted from providing health care insurance for their workers. Under the Affordable Care Act, in 2014, companies with more than 50 employees will be required to provide health care for their employees or pay fines. Mark Parkinson, the president of the American Health Care Association, trade group for nursing homes suggests several ideas, including giving nursing homes additional time to comply with provisions in the Affordable Care Act, waiving or reducing penalties for nursing homes, or allowing nursing homes to take tax deductions for the penalties. For home care agencies, a representative suggested exempting home care providers or requiring Medicaid or Medicare to help defray costs. Data from the Paraprofessional Healthcare Institute indicates that 26% of front-line workers in nursing homes are uninsured and 37% of front-line workers in home care agencies are uninsured. The CDC recently released a report on home health care aides using data from 2007. According to the report, 46.9% of home health care aids had annual family incomes of less than $30,000. More than one in ten had a work-related injury in the past year, and the NYT cites Department of Labor data that the injury rate for nursing homes is about twice the rate for all occupations. Aids at home health care agencies were less likely to be offered health insurance benefits (66%) than aides working for hospice care only (94.3%) or mixed agencies (89.2%). For more information, visit:
New York Times: "Nursing Homes Seek Exemptions From Health Law"
National Center for Health Statistics: "An Overview of home health aides: United States, 2007"
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