A legislative panel in Florida rejected a $2.1 million federal grant that would have started the process for Florida to receive an additional $35.7 million in federal Medicaid funding as part of the Money Follows the Person demonstration program. The five-year program is designed to shift Medicaid beneficiaries out of nursing homes and into home and community based settings. While Governor Rick Scott recommended accepting the grant, the GOP-majority commission rejected it. The program was expected to result in approximately 1,700 people transferring from nursing homes back into their homes with supportive services. Florida has also held several meetings recently to gather input about the state Medicaid program's possible transition to a managed care system. The plan, which still needs approval from CMS, would require most of the state's three million Medicaid enrollees (including seniors in nursing homes) to join private health plans after July 1, 2012. The shift is seen as a way to better manage costs, with enrollment growth increasing 50% in the past four years with a cost that now exceeds the education budget at more than $20 billion. However, patients and advocates are skeptical, and a participant from a pilot of the managed care plan discussed her experience with doctors leaving the system, prescriptions not being filled by plans, and her having to change plans repeatedly. For more information, visit:

 

 
FCA Innovations Clearinghouse Tracks Legislation Affecting Caregivers

The Innovations Clearinghouse, administered by the National Center on Caregiving at Family Caregiver Alliance, monitors legislation introduced at state and federal levels that is especially relevant to family caregivers and has been recently updated. Alzheimer's laws were the most frequently introduced type of legislation at the state level in 2011, with focuses on state plans and task forces as well as long-term care facilities that advertise being specially equipped for patients with dementia. Staff levels as well as background checks for nursing homes and home care agencies were introduced in 12 bills, while elder abuse (financial and otherwise) was the focus of seven bills. Changes to Medicaid and HCBS programs were introduced through seven bills, and long-term care insurance rate increases and other issues were addressed by six bills. Family leave was introduced in several bills, and legislation around advanced directives and other types of end-of-life care preferences were included in five bills. For more information, visit

FCA Innovations Clearinghouse 

 
Budget Showdown Continues With August 2nd Deadline

Discussions over the federal deficit and a looming deadline to raise the debt limit by August 3rd continue to dominate the political discourse in Washington DC. Changes to Medicaid and Medicare have been discussed as possible strategies, however, a Kaiser poll conducted in June found that while 45% of Americans would support minor reductions to current levels of Medicare spending, less than one in five (18%) would support major reductions. A report by the Lewin Group analyzed a bill introduced by Senator Corker (R-TN) and Senator McCaskill (D-MO) and co-sponsored by seven Republican senators to cut federal spending. The Commitment to American Prosperity Act would limit federal spending to about 20.8% of GDP and automatically cut across all federal programs for any year when spending is projected to go higher than 20.8%. The Lewin analysis found that if enacted, the legislation would cut $4.2 trillion out of the federal budget between 2013 and 2021, with $1.3 trillion cut from Social Security, $859 billion from Medicare, and $575 billion less in federal Medicaid funding to the states. The authors estimate the cuts would force 3.8 million people into poverty, of which 2.1 million are seniors, representing a 44% increase for this age group. For more information, visit:

Kaiser Health Tracking Poll -- June 2011 

Salt Lake Tribune: "Report: Proposed federal cuts proposal would harm elderly, children, poor" 

 
Report Profiles 16 Medicare Beneficiaries, Most Are Close To Financial Edge

 
A recent report from the Kaiser Foundation profiled 16 Medicare beneficiaries and their financial situations. The authors explain that the detailed profiles may be helpful for policymakers in Washington, DC who are considering possible changes to Medicare and Medicaid that could increase costs to enrollees. Half of the individuals/couples profiled have incomes below twice the poverty level (under $22,000 for an individual), which is the same proportion of the total Medicare population. The people interviewed use a variety of strategies to make ends meet with limited or fixed incomes, including incurring credit card debt for regular expenses, prematurely dipping into nest eggs, and relying on money from adult children. Several themes emerged, including barely making ends meet, Medicare playing an important role in ensuring access to health care yet people still postponing medical care, especially if there are out-of-pocket costs, and debt, minimal savings, and concerns about the future as the norm for most of the couples profiled. In addition to the report, there is a 10 minute documentary, as well as an archive of a webcast from June that examined current policy options being considered for Medicare. The Agency for Healthcare Research and Quality (AHRQ) released data in June that roughly one of every six Americans aged 18 to 64 report using more than 10% of their total family income to pay for health insurance premiums and out-of-pocket medical expenses in 2007. For more information, visit:

Kaiser "Living Close to the Edge: Financial Challenges and Tradeoffs for People on Medicare" 

Kaiser Video "Making Ends Meet: The Medicare Generation" 

Kaiser Briefing "The Role of Medicare and Beneficiaries in the Deficit-Reduction Debate" 

AHRQ "Who Paid More Than 10 Percent of Their Family Income for Medical Expenses?"

 

 

Study: Multidisciplinary, Integrated Care Approach Improves Care

A recent study in the Netherlands used a multidisciplinary integrated care approach for 340 residents with physical or cognitive disabilities living in 10 residential care facilities near Amsterdam. About 10% of seniors aged 75 or older live in residential care facilities in the Netherlands, and more than 70% of residents have multiple chronic diseases and related disabilities. As part of the study, trained nurse-assistants conducted functional assessments every three months; discussion of priorities and outcomes with the family physician, patient and family members were held, and monthly meetings with the patient's health care team (including nurse assistant, family physician, psychologist and geriatrician) were conducted. The authors report that while functional ability, number of hospital admissions and health-related quality of life remained comparable (between the control group and study group), the model "resulted in substantially higher quality of care for elderly people in residential care facilities," mortality decreased, and patients were more positive about the quality of their care. For more information, visit:

EurekAlert: "Multidisciplinary integrated care for seniors gives better quality care" 

CDC Releases Data Snapshot: ADL's For People Aged 80 And Older

  
The Center for Disease Control Morbidity and Mortality Weekly Report recently featured data on the percentages of people aged 80 and older who need assistance with activities of daily living (ADL's). Women were more likely than men to need assistance with personal care activities (14.8% vs. 10.2%). Of these activities, women were more likely than men to need assistance with bathing/showering (12.1% vs. 8.1%), dressing (9.1% vs. 7%), and eating (3.9% vs. 2.4%). The estimates are based on household interviews from a sample of the non-institutionalized U.S. population, and therefore excludes adults living in assisted living facilities, nursing homes for the elderly, hospitals for the chronically ill, or correctional facilities. For more information, visit:

CDC: "QuickStats: Percentage of Noninstitutionalized Adults Aged ≥80 Years Who Need Help with Personal Care, by Sex --- United States, 2008-2009"   

Conference Focuses On Research Linking PTSD With Dementia, Heart Disease

Research conducted at the San Francisco Veterans Affairs Medical Center was presented in June at the fourth annual "Brain at War" conference. Researchers have found that combat veterans with post-traumatic stress disorder (PTSD) are twice as likely to have dementia and two to three times as likely to develop cardiac problems as compared to veterans without PTSD. Dr. Michael Weiner, director of the Center for Imaging of Neurodegenerative Diseases at the Veterans Affairs Medical Center, explained that this could lead to a large increase in the number of veterans who develop Alzheimer's disease in the next 10 to 20 years. While there isn't a cure for Alzheimer's, researchers hope that by understanding how combat affects the brain, they can work towards improvements. For example, the hippocampus, devoted to short-term memory and learning new things, is significantly smaller in veterans with PTSD and researchers want to determine if this smaller section can grow as a result of therapy and treatment for stress. It is estimated that as high as 20% (about 400,000) of the two million soldiers who served in Iraq and Afghanistan have developed or are at risk of developing PTSD. A Veterans Administration Web Site features a searchable map of PTSD programs throughout the country, and the National Center for PTSD, administered by the VA, is working to advance the clinical care and social welfare for American's Veterans through research on PTSD. The Center also co-designed a downloadable Phone App, "PTSD Coach" to connect veterans with information, resources, and tools to use to manage living with PTSD. For more information, visit:

San Francisco Chronicle: "Brains of vets with PTSD can change as they age"   

VA PTSD Program Locator  

National Center for PTSD 

Report: Shift From "Long-Term Care" To "Active Ageing"

A recent report from the European Centre for Social Welfare Policy and Research analyzes shifting from a passive approach of "long-term care" and "prevention" to a more empowering approach of "Active Ageing." The authors focus on Austria and note that long-term care is increasing being recognized as a central social and health policy field of action in Europe. Successful development of the approach will require better integration between health and social systems, more coordination between formal and informal care sectors, and the development of "harmonized and transparent quality standards, funding flows and management structures." The author analyzes Austria and its approach to improving long-term care, including the introduction of a non-means tested long-term care allowance in 1993. While Austria has made considerable progress, similar to other countries, the "coordination cooperation between the social and acute medical care sector remains a problem area..." Citing data that 80 to 85% of vulnerable older adults are currently cared for at home by a family member, the author cautions that surveys show the majority of Austrians do not want to be live-in caregivers, but also suggests that "frequent decisions for permanent nursing home admission" are problematic. Report recommendations include a stronger focus on supporting older caregivers who face higher health risks because of their caregiving, better coordinated networks of appropriate care at the right time and in the right setting, and overall better coordination among supportive systems. For more information, visit:

European Centre: "Active Ageing and Prevention in the Context of Long-Term Care"  

Report: Aging Tsunami Or Opportunity To Try New Strategies? 

  

Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards

Applications are now available for the fourth annual Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards. The awards are given in three categories, Creative Expression, Diverse & Multicultural Communities, and Policy & Advocacy. Each of the three award recipients receive a $20,000 award, and applications are invited from non-profits, government agencies, and universities. The application deadline is August 15th, 2011. For more information or to view the application, visit:

FCA: "Rosalinde Gilbert Awards Application"

HHS Announces Up To $500 Million In Funding Through Partnership For Patients

The U.S. Department of Health and Human Services recently announced that the CMS Innovation Center will make available up to $500 million in funding to help hospitals, health care provider organizations and others stop preventable injuries and complications due to health care acquired conditions and unnecessary readmissions. The Partnership for Patients was announced earlier this year as a public-private initiative aimed at reducing harm in hospital settings by 40% while reducing hospital readmissions by 20% over a three year period. To achieve these goals, the funding will pay for "Hospital Engagement Contractors" to design programs to teach and support hospitals in making care safe, conduct trainings for hospitals and care providers, provide technical assistance, and establish and track systems to monitor hospital progress in improving quality. For more information, visit:

HHS: "Up to $500 million in Affordable Care Act funding will help health providers improve care"