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|A Newsletter of FCA's National Center on Caregiving|
June 8, 2011
Volume XI, Number 10
State Legislation, Policy & Reports
- Report: Increased State Revenues, But Still Lower Than Pre-Recession Levels More...
- CA: State Assembly Committee On Aging And Long-Term Care Hearing More...
- CA: Adult Day Health Care Future Unclear More...
- CT: Paid Sick Leave For Service Workers Approved More...
Federal Legislation, Policy & Reports
- Older Americans Act Hearing More...
- Caring For An Aging America Act Reintroduced More...
- UK: Campaign To Display Patient Charter On End Of Life Care More...
- Ontario Will Implement System To Find Missing Seniors More...
- Australia: Report On Transition Care Program More...
- UK: Local Councils Face 6% Cuts In Social Care Budgets And Begin To Cut Services More...
Research Reports & Journal Articles
- Article Highlights Importance Of Caregiver Assessment More...
- Report: Caregiving Decision Making For Only Children Vs. Siblings More...
- Report Analyzes Growing Elder Population And Local Responses More...
Conferences & Trainings
- Conference: Consumer Voice 36th Annual Conference & Meeting October 25-28, 2011 More...
- Webinar: SAGE LGBT Technical Resource Center June 16th, 1:30PM (Eastern) More...
- Webinar: Economic Security & Consumer Financial Protections June 16th, 3:00PM (Eastern) More...
Funding, Media & Miscellaneous
- Survey: Aging Drivers Support Mandatory Retesting For Driver's Licenses More...
- Bargaining On Long-Term Care More...
- Self-Neglect Among The Elderly More...
- Report Details Cost And Demographics of Elder Abuse More...
- CLASS Blog And Compilation Of Research More...
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A June report by the National Governor's Association and the National Association of State Budget Officers finds that while state revenues have increased from FY 2011, the additional revenues are still insufficient, with states facing a combined gap of over $75 billion for their FY 2012 budgets. States will only receive $2.8 billion in federal stimulus money in FY 2012, a dramatic reduction from the $51 billion in FY 2011 and $60.7 billion in FY 2010. Medicaid accounted for an estimated 22% of total spending in FY 2010, and state funding on Medicaid is expected to increase by 18.6% for FY 2012 while federal funding decreases by 13% due to the expiration of the higher FMAP funding from the Recovery Act. For more information, visit:
NGA/NASBO: "The Fiscal Survey of States"
New York Times: "Improved Tax Collections Can't Keep Pace With States' Fiscal Needs, Survey Finds"
NM: State Eliminates Match Of Food Stamps For Elderly And Disabled
Approximately 4,000 low-income elderly and disabled New Mexico residents will see their food stamp benefits decline by $9 starting in July due to state budget cuts. The state had previously added $9 for residents who receive the federal minimum monthly benefit of $16 a month to ensure that they received a total of at least $25 a month. However, the legislature did not appropriate funding for this benefit for the upcoming year and it's expected to end on July 1. According to recent data from the USDA, a little more than one in five residents of New Mexico receives food stamp benefits. For more information, visit:
Beaumont Enterprise: "NM plans to stop food stamp supplement for elderly"
IL: "Free Rides For Seniors" Program Reduced
The state of Illinois announced that it will implement stricter financial eligibility rules for the "Free Rides For Seniors" program. In September, only low-income seniors ($27,610 or less for a single person) will still receive free rides on public transportation. For seniors with higher incomes, the program will revert to requiring them to pay reduced fares that are about half the cost of a regular fare. Of the 440,000 seniors currently in the program, only 25,000 seniors are expected to meet the eligibility requirements to continue receiving free rides. This program change is expected to provide $30 million in increased revenues for the three transit authorities. For more information, visit:
Chicago Tribune: "Free rides for most seniors to end Sept. 1"
OR: Project Independence Slated For 50% Reduction
Oregon's Project Independence, a program designed to allow elderly and disabled Oregonians to remain in their homes, is facing a 50% reduction in its budget. Advocates for Project Independence argue that the program costs the state $200 to $250 a month, considerably less expensive than $7,000 a month for institutional care. While Governor John Kitzhaber proposed a $63 million increase in funding for senior programs, the loss of federal stimulus dollars equates to a $197 million reduction in 2011-13 as compared to 2009-2011. State policymakers won't announce the budget until June, however, they are facing a $3.5 billion shortfall and are also considering a 19% rate cut for Medicaid providers. For more information, visit:
The Oregonian: "Lawmakers struggling to avoid cuts to programs serving Oregon's seniors"
Katu: "Program to keep seniors in their homes faces cuts"
A hearing on May 17, 2011 focused on the state's approach (or lack thereof) to providing a high-functioning, supportive long-term care system for Californians. Stuart Drown, Executive Director of the Little Hoover Commission, testified about the commission's recently released report that analyzed the challenges of seven different agencies overseeing 36 different programs serving elderly and disabled Californians. Drown explained that current problems include consumer confusion, a lack of leadership and authority at the state level, and poor data collection limiting the state's ability to target services to those most in need. Dr. Steven Wallace from UCLA's Center for Health Policy Research, shared the results from a focus group with 33 low-income seniors who rely on a patchwork of supportive programs to remain in their homes and who would be severely impacted by program cuts. Karen Keesler, Executive Eirector of the California Association of Public Authorities for IHSS, shredded a safety net during her testimony to demonstrate the impact of repeated cuts to IHSS, MSSP, Medi-Cal, SSI/SSP on Californians. Michelle Evans, the executive director of the Del Oro Caregiver Resource Center, shared examples of caregivers working with her staff, including an 86 year-old man who is a caregiver for his 79 year-old wife with Alzheimer's. Dr. Leslie Hendrickson explained that more coordinated data collection would allow policymakers to see the level of assistance needed by individual clients and to know when clients are receiving multiple services. With this information, policymakers could better project how policy changes will affect those most in need of services. For more information, visit: Hoover Commission: "A Long-Term Strategy for Long-Term Care"
The future of the Adult Day Health Care (ADHC) program in California continues to be unclear and program managers are unsure of how to proceed while the federal government reviews a State Plan Amendment submitted by the state on May 13 to eliminate ADHC as a Medi-Cal optional benefit. ADHC was originally eliminated in January, then revived in a reduced form as an optional federal benefit known as KAFI (Keeping Adults Free From Institutions) with promises of $85 million in state funding for the program. However, Governor Brown's revised May budget only included $25 million, not $85 million. While the legislature has indicated that it will move forward with the original $85 million (which will be matched by $85 million from the federal government), this still represents a 50% cut in funding for the program. Advocates have also questioned suggestions that current ADHC clients will be able to use other community services because many ADHC clients have complex medical needs that may not be well-served or addressed by programs like IHSS. When an ADHC center recently closed, the executive director explained that of the 59 clients served by the program, three went immediately into institutional care, while another 10 need institutional care but had not yet been placed. A federal judge ruled on June 2 that Disability Rights California could file an amended complaint (based on the elimination of ADHC) to a previous lawsuit against the state for changes made to the program in 2009/2010. For more information, visit:
The Connecticut legislature voted earlier this month to approve a bill that would require companies with 50 or more employees to offer paid sick leave. While the law covers the estimated 200,000 to 400,000 service workers who receive an hourly wage, it exempts manufacturing companies, nationally chartered nonprofit organization, day laborers, independent contractors and temporary workers. An employee will be able to earn one hour of paid sick time for every 40 hours worked, however, it is capped at five days a year. Governor Malloy is expected to sign the legislation that will take effect at the beginning of 2012. For more information, visit:
Older Americans Act Hearing
On May 26, the Senate Special Committee on Aging hosted a hearing about the reauthorization of the Older Americans Act. Former first lady Rosalynn Carter testified about her organization's report: "Averting the Caregiving Crisis, Why we Must Act Now." Assistant Secretary Kathy Greenlee explained the difficulties faced by "sandwich caregivers" and the important role of programs funded by the Older Americans Act in allowing people to "age in place." Elizabeth Marshall, a former mayor of York, Pennsylvania testified about the services she receives through her local Area Agency on Aging, including Meals on Wheels. She explained, "The beauty of the Older Americans Act is that it allows you to retain your dignity, health and independence with just a little bit of support. It forms the critical glue that holds together all the other supports I have: my adult children, my friends and neighbors, and my own determination to age in place." For more information, visit:
Senate Special Committee on Aging "Meals, Rides, and Caregivers: What Makes the Older Americans Act so Vital to America's Seniors"
Leadership Council of Aging Organizations: Recommendations for Reauthorization of OAA
Caring For An Aging America Act Reintroduced
The Caring for an Aging America Act (Senate Bill 1095) was reintroduced on May 26,
by Senators Boxer (D-CA), Collins (R-ME), Kohl (D-WI), and Sanders (I-VT) to address the shortage of skilled health care workers to care for a rapidly aging population. If passed, the law would provide health care professionals who specialize in gerontology and geriatrics with access to loan repayment programs in exchange for agreeing to work in underserved areas. The legislation is based on recommendation from the 2008 Institute of Medicine report, "Retooling for an Aging America: Building the Health care Workforce." For more information, visit:
Medical News TODAY: "GSA, AGHE Support Passage Of Eldercare Workforce Legislation"
|UK: Campaign To Display Patient Charter On End Of Life Care
The Royal College of General Practitioners and the Royal College of Nursing recently created a patient charter that contains seven "pledges" intended to make the last few weeks of a person's life as comfortable as possible. The organizations explain that general practitioners are often well-situated to facilitate conversations about end-of-life care and to ensure that patient's wishes are followed. A copy of the one-page charter will be sent to 8,500 General Practitioner offices in England for display in waiting rooms. For more information, visit:
Independent: "End-of-life patient charter is unveiled"
RCGP and RCN: End of Life Care Patient Charter
Ontario Will Implement System To Find Missing Seniors
Premier Dalton McGuinty announced in May that Ontario will create a province-wide system, similar to "Silver Alerts" used in the U.S. to help find missing seniors who suffer from Alzheimer's and other cognitive impairments. It is estimated that 180,000 Ontarians currently have some form of dementia and that number will grow to 250,000 by 2020. The program will be the first of its kind in Canada. For more information, visit:
CBC News: "Ontario to set up system to find missing seniors"
Australia: Report On Transition Care Program
Australia's Institute of Health and Welfare released a report on its Transition Care Program (TCP) activities from July 2008 to June 2009. The program provides care to older Australians for up to12 weeks immediately after their hospital discharge (in their home or in a care facility) with the goal of improving independence and also providing time to consider long-term care arrangements. The program served 12,600 people during 2008/09 and improved their independence from an average score of 76 at the beginning of treatment to a score of 90 at the end (as measured by the Modified Barthel index score). After receiving TCP, half of the recipients returned to the community (35% supported with a community aged care service and 15% with no services), while 19% transferred to residential care, and 22% returned to the hospital. The average length of TCP per participant was seven weeks. For more information, visit:
AIHW: "Older people leaving hospital: a statistical overview of the Transition Care Program in 2008-09"
UK: Local Councils Face 6% Cuts In Social Care Budgets And Begin To Cut Services
A recent article in the Independent addressed the impact at the local levels of the ?1 billion ($1.6 billion) in cuts being made this year as part of the austerity budget. Local councils are adapting by closing care homes, respite centers, and day programs; increasing functional eligibility requirements; and implementing increased cost-sharing with clients. Southern Cross Healthcare, an organization that runs 750 care homes with 31,000 residents, publicly admitted that the reductions have put the firm in "critical financial condition" with a half-yearly loss of ?311 million ($511,346,200). Southern Cross will underpay its rent by 30% over the next four months in an attempt to stay in business. Age UK, a nonprofit, recently released a report which found that of the two million older adults in UK who have care-related needs, 800,000 receive zero formal support from public or private agencies. The organization suggests that the country's current investment of .5% of GDP on care for older people is insufficient and will have to be increased. For more information, visit:
Independent: "Elderly will suffer as cuts force councils to slash care services"
Age UK: "Care in crisis: Causes and Solutions"
Article Highlights Importance Of Caregiver Assessment
The June issue of American Family Physician features an article about caregiving, the importance of assessment to support caregivers, and caregiving challenges specific to cancer, dementia, heart failure, and stroke. The authors cite research that demand for family caregivers is expected to rise by 85% in the next few decades and explain the importance of doctors or their staff assessing caregivers (or making a referral) to ensure caregiver health and safety while linking them with additional support services. The article provides several examples of caregiver assessments and includes research about caregiver interventions, for example, a recent meta-analysis found that psychoeducational and psychotherapeutic interventions had the most consistent effects on all outcome measures. The articles provide a concise listing of online resources for family caregivers and the authors conclude with a summary of public policy issues, including the fact that funding for the National Family Caregiver Support Program ($154 million in 2009) represents approximately one-twentieth of one percent of the value of caregiver contributions. For more information, visit:
American Family Physician "Caregiver Care" (abstract is free, article requires subscription)
FCA: "Caregivers Count Too! A Toolkit to Help Practitioners Assess the Needs of Family Caregivers"
Report: Caregiving Decision Making For Only Children Vs. Siblings
A recent discussion paper from the Institute of Labor analyzed the decision making process for adult children to provide caregiving to a parent and analyzed differences between only children and children with siblings. Using data from 12 European countries on adult children who are 40 years or older, the author's models find that generally speaking, only children are more involved in informal caregiving than children with siblings and that they also provide more hours of care. Sibling decision-making about caregiving is classified as cooperative or noncooperative and the authors find that 71% of the siblings fit better into the noncooperative model. The non-cooperativeness is, on average, 10.5% higher for brother-brother dyads compared to sister-sister dyads, while brother-sister dyads are more cooperative than brother-brother dyads. If these siblings were "pushed" into a cooperative equilibrium, the amount of informal care provided to parents is increased from about 1 hour a week to 1 ? hours a week (a 46% increase), however, this reduces the full-time labor supply by 5.7% and increases the part-time labor supply by 6.7%. Siblings who are more highly educated were less likely to provide informal care, possibly due to different value sets or competing interests. For more information, visit:
IZA: "The Effects of Cooperation: A Structural Model of Siblings' Caregiving Interactions"
Report Analyzes Growing Elder Population And Local Responses
A report from the National Association of Area Agencies on Aging (n4a), analyzes how localities are responding to a growing population of elder Americans. The report, written in conjunction with several other organizations, follows a similar survey and report conducted in 2005. The authors explain that by 2030 more than 70 million Americans (twice the number in 2000) will be 65 and older, comprising nearly one in five Americans. This demographic shift coincides with an economic downturn that has meant budget cuts for many of the programs serving older Americans. Despite the weak economy, many local governments report improved supports for older adults, including an increase in the availability of specialized training for public safety and emergency staff (24% in 2005 to 59% in 2010;) and an increase of in-home support services (71% in 2005 to 77% in 2010). The three top challenges reported by local governments in 2010 were financial/funding shortages, transportation and housing while in 2005, they were housing, financial issues and various health issues. Urban communities (1,000,000+) were far more likely to report an availability of health care services to meet a range of needs than rural communities. The availability of subsidized housing was reduced from 70% in 2005 to 63% in 2010, and property tax relief options for older adults also declined from 72% in 2005 to 54% in 2010. For more information, visit:
n4a:"The Maturing of America: Communities Moving Forward for an Aging Population"
The 36th annual meeting will take place in Grand Rapids, Michigan. Participants will be able to participate in networking with consumers, citizen advocacy groups and other advocates, ombudsmen, researchers, and direct care workers. Trainings and presentations will address every-day advocacy efforts and how to improve care. Pre-conference intensive workshops include a workshop focused on facilitating communication and conflict management between consumers, family members, and professional staff/administrators. Advanced registration rates end July 15, for more information or to register, visit:
Consumer Voice 2011 Conference
SAGE (Services and Advocacy for GLBT Elders) will present a webinar on June 16th that will introduce the audience to some of the unique needs of LGBT older adults. Participants will also learn about services provided by the National Resource Center on LGBT Aging, which was launched by SAGE in partnership with ten other organizations and with funding from the Administration on Aging. For more information or to register, visit:
SAGE LGBT Technical Resource Center
Webinar: Economic Security & Consumer Financial Protections June 16th, 3:00PM (Eastern)
The National Council on Aging is sponsoring a webinar on June 16th about elder financial exploitation. Presenters include Andrew Pizor from the the National Consumer Law Center, Erin Ruebbelk, from the Illinois Attorney General's Office, and Ginny Paulson, from the National Consumer Protection Technical Resource Center. Participants will learn about current trends in scams targeting seniors, how and when to make referrals to help, and will learn about the National Consumer Law Center and National Consumer Protection Technical Resource Center. For more information, visit:
National Council on Aging: "Economic Security & Consumer Financial Protections"
Survey: Aging Drivers Support Mandatory Retesting For Driver's Licenses
Dr. Emmy Betz, a researcher at the University of Colorado School Of Medicine, recently released results from a survey she conducted of 122 elderly people about driving. Of survey participants, 12% reported a car accident in the past year, and 87% said they had at least one medical diagnosis that might increase their risk of a crash. Seventy-one percent of respondents support mandatory, age-based driver retesting after a certain age. In terms of who should have the authority to revoke a driver's license, 68% suggested family members, 53% said doctors, 28% said the state and 26% said the police. In Colorado, if a person requests a medical review for a specific driver, then the driver is allowed to know who made the request. Eighty-nine percent of respondents said they might quit driving if their doctor advised it while only 75% would consider stopping if it was their family's idea. An instructor who teaches an AARP driving class in Grand Junction thought most of his students would object to the testing idea, and suggested that the sample size of the survey was too small. In a recent blog posting in The New Old Age, an adult daughter confessed to sneaking into her mother's garage and damaging the engine to stop her mother from driving. For more information, visit:
University of Colorado: "Study shows older drivers support age-based testing"
Denver Post: "Colorado survey finds aging drivers support mandatory retesting to get license"
New York Times The New Old Age: "My Solution to the Driving Problem: Vandalism"
Bargaining On Long-Term Care
The Wall Street Journal recently featured advice on how to bargain when shopping for long-term care. The author suggests using resources like a map prepared by Genworth Financial to comparison shop on local costs of long-term care. According to Genworth's annual survey of long-term care costs, the cost of in-home care stayed about the same from 2010, but assisted living increased 2.4% to an average of $3,261 per month (for a one-bedroom) and the cost of a shared nursing home room increased 5.7% to $193 per day. Financial advisors interviewed in the story suggested negotiating prices using several strategies, including getting quotes from several organizations and checking to see if there are waiting lists- if they don't have a waiting list, they may be willing to negotiate because they want business. For consumers who are paying out-of-pocket, it may be possible to negotiate for extra amenities like a private room. For home-care services, advisors suggest asking for a discount if competitors offer lower rates and asking for a discount for weekend services if a consumer is already contracting for a high number of hours during the week. For more information, visit:
WSJ: "Driving a Bargain For Long-Term Care"
Self-Neglect Among The Elderly
The Houston Chronicle recently profiled a partnership in 13 Texas counties known as Texas Elder Abuse and Mistreatment Institute (TEAM) that addresses elder self-neglect through clinical care, education, and research. TEAM caseworkers reach out to people where self-neglect has been reported and attempt to connect the seniors with medical assistance, help with housekeeping activities, and financial issues. More than 60% of the 1,500 cases handled each month by Adult Protective Services in the Houston area deal with self-neglect, which may be brought on because of dementia, a stroke, or depression. If a senior is mentally capable, they can refuse assistance, however, if they are not mentally capable, caseworkers can petition the state to appoint a guardian. The partnership is 15 years old and includes Region 6 of Adult Protective Services as well as the University of Texas Health Science Center at Houston and the Baylor College of Medicine. For more information, visit:
Houston Chronicle: "The quiet menace: Self-neglect, the most common mistreatment among Houston's elderly, is a growing threat as baby boomers age"
Report Details Cost And Demographics Of Elder Abuse
The Met-Life Mature Market Institute released a report highlighting the enormous financial losses incurred by victims of elder financial abuse, estimated at $2.9 billion every year. The authors use both an analysis of recent news stories about elder financial abuse as well as a review of recent peer-reviewed articles. In an analysis of 314 news stories (from April 2010 through June 2010), the total amount stolen was greater than $530 million, a low figure because 36% of articles that didn't include a dollar amount lost. Fraud by strangers represented 51% of the articles, while abuse by family, friends and neighbors was 34%, and 12% was from business fraud. Women were about twice as likely as men to be victims, while 60% of the perpetrators of fraud were men. The authors explain that the Elder Justice Act of 2010, enacted as part of the Affordable Care Act, will give new tools to combat elder financial abuse, as will a department dedicated to the issue in the new Consumer Financial Protection Bureau.For more information, visit:
The MetLife Study of Elder Financial Abuse Crimes of Occasion, Desperation, and Predation Against America's Elders
CFPB: "Older Americans and the CFPB"
CLASS Blog And Compilation Of Research
Family Caregiver Alliance staff recently contributed a posting to the Government's Disability Blog about the need for a program like CLASS. Through FCA's national information and referral center, family caregivers are connected to resources in their communities, and one of the most frequently asked questions by caregivers is whether or not they can be compensated for the work they are doing. The blog posting explains how the CLASS program could alleviate some of the financial pressures faced by family caregivers and their loved ones. FCA has also compiled many of the most recent reports on the CLASS program at a central page on the FCA Web site. For more information, visit:
FCA: "Why We Need Why We Need Community Living Assistance Services & Supports (CLASS)"
FCA: "CLASS Round-up" (Collection of Reports and Media Coverage on CLASS)
|To find caregiver support services in your state, visit FCA's Family Care Navigator http://caregiver.org/caregiver/jsp/fcn_content_node.jsp?nodeid=2083|
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The National Center on Caregiving at Family Caregiver Alliance works to advance the development of high-quality and cost-effective policies and programs for caregivers in every state in the country. The National Center is a central source of information and technical assistance on family caregiving for policymakers, health and service providers, program developers, funders, media and families. For questions or further information about the National Center on Caregiving, contact Policy_Digest@caregiver.org or visit the Family Caregiver Alliance website at www.caregiver.org.
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