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|A Newsletter of FCA's National Center on Caregiving|
July 20, 2011
Volume XI, Number 13
State Legislation, Policy & Reports
- Medicaid Cuts In TX, CA, MA, SC, WA May Place More Strain On Caregivers More...
- IN: Advocate- Pay Family Caregivers Through CHOICE And Medicaid More...
- FL: Report Suggests Focusing On "Compound Caregivers" More...
- IA: Direct Care Professionals Turnover Will Cost $126 Million in 2011 More...
- CA: Future Of Adult Day Health Care Program Up To Governor Brown More...
- CA: Scan Foundation Releases Budget Analysis, Impact More...
Federal Legislation, Policy & Reports
- Gang Of Six Budget Deficit Proposal Would Eliminate CLASS More...
- VA Caregiver Program Releases Stipend Payments To Almost 200 Caregivers More...
- Study: Some Variation In Medicaid Spending Correlates To Primary Care Access More...
- Study Of Oregon's Medicaid Program Finds Health And Financial Benefits More...
- Scotland: Government Considers Reducing Free Personal Care For Elderly More...
- UK: Commission Recommends Individuals Pay First $56,164 of LTC Bill More...
- Canada: Health-Care System Not Equipped For Multiple Chronic Conditions More...
- Zimbabwe: Bill On The Elderly Will Be Introduced More...
Research Reports & Journal Articles
- AARP Report: U.S. Caregivers Provided $450 Billion In "Free" Care In 2009 More...
- Report: ER's Should Provide Better Care For Patients With Cognitive Issues More...
- Report: Minority Elders May Have Less Access To HCBS More...
- Study: Targeted Outreach To Connect People With HCBS Lowered Costs More...
- Study: Black Resident's Higher Rate Of Bed Sores May Correlate To Low Staffing Levels More...
- Study: Family Caregivers For Older Hip-Fracture Patients Need Early Assessments More...
Conferences & Trainings
- Webinar: NASW Standards for Social Work Practice With Family Caregivers of Older Adults, July 29th More...
- Webinar: Marketing to Family Caregivers: Moving Beyond Awareness July 26th More...
- Conference: The Many Faces of Respite, November 1-3, 2011 More...
- Conference: National Home and Community-Based Services Conference Sept. 11-14 More...
- Conference: Consumer Voice 36th Annual Conference & Meeting October 25-28, 2011 More...
Funding, Media & Miscellaneous
- Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards More...
- Rules Impacting LGBT Caregivers Slowly Improving & Two New Fact Sheets More...
- Med Schools Consider Communication Skills As Part Of Admissions Criteria More...
- Caregiver Support Groups Frequently Asked Questions Answered More...
- Hospice Worker Produces Film On End-Of-Life Questions, Will Air On PBS More...
- HealthAgenda Blog Addresses Potential Fraud In Hospice Use More...
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An article by the Associated Press examines how states are reducing or eliminating HCBS programs in Medicaid and how these cuts may eventually lead to more seniors receiving costlier institutional care. The programs, considered optional under Medicaid, are often targets when budgets are tight. Texas underfunded Medicaid by $5 billion in its recent budget which will likely impact seniors and the disabled. California's Adult Day Health Care program had its funding eliminated in the recent budget, though Governor Brown is considering legislation that would continue the program with 50% less funding. In Massachusetts, Governor Patrick proposed cutting 2/3 of the funding for the state's adult day care program that serves 5,200 participants while Washington State reduced the number of hours it will pay for professional caregivers who work with the disabled. Anita Bradberry, executive director of the Texas Association for Home Care & Hospice, Inc, explains "Just because you cut the budget doesn't mean their needs go away." Senator Tom Harkin (D-IA) and Representative Cathy McMorris Rodgers (R-WA) co-authored a blog posting about state cuts to "optional" programs and suggested that updating Medicaid would help to fulfill the integration mandate of the Americans with Disabilities Act instead of putting elderly and disabled residents into nursing homes unnecessarily. For more information, visit:
Sacramento Bee/Associated Press: "State cuts could put more seniors in nursing homes"
The Hill Blog: "Modernize Medicaid to better support people with disabilities"
An Op-Ed on July 3 in the Evansville Courier and Press, written by an elder law attorney who is also the president of SWIRCA and More (an Area Agency on Aging), suggests that state leaders in Indiana should consider allowing family caregivers to be paid through the state's CHOICE program or through its Medicaid Waiver. The author, Randall K. Craig, explains that the goal of CHOICE (Community and Home Options to Institutional Care for the Elderly and Disabled) is to allow people to age in their own home. Both CHOICE and the state's Medicaid waiver program will pay for in-home caregiving by professional caregivers, though Craig suggests that funding is limited. Craig explains that while the population of people aged 65 or older is expected to grow by 90% by 2030, the projected growth in personal care assistance jobs is only 25%, a mis-match in supply and demand that will lead to higher costs for in-home care. Craig suggests that participants in CHOICE and Medicaid waiver programs should be allowed to hire responsible relatives- already an option in other states, and more cost-efficient than institutional care. For more information, visit:
A recent white paper from the Florida Center for Inclusive Communities examines a group of caregivers who may be overlooked- "Compound Caregivers." The author, Dr. Elizabeth Perkins, defines compound caregivers as "a parent who is already providing considerable caregiving responsibilities to their son/daughter with intellectual disabilities (ID), who subsequently becomes a caregiver for an additional family member." The authors analyzes Florida's system of supports for compound caregivers. Florida's Agency for Persons with Disabilities (APD) serves approximately 35,000 individuals with intellectual and developmental disabilities, however, 19,000 people are also on the waiting list, grouped by level of need. Perkins explains that unpublished data found that 28% of caregivers whose sons/daughters were on the DD HCBS waitlist are compound caregivers, thus increasing the possibility of caregivers stress and burnout. She advocates including compound caregivers (aged 50+) in the third and fourth categories of Florida's ADP waitlist and duplicating this throughout all 50 states in waiting lists for similar programs. She explains that the value of respite is diminished for compound caregivers if they are only receiving respite from caregiving for one care recipient while still providing care for another. She suggests modifying eligibility rules in the National Family Caregiver Support program to also include compound caregivers and increasing funding for the Lifespan Respite Care Act, a program that has been under-funded since it was started. For more information, visit:
A report by the Iowa Direct Care Workforce Initiative estimates that each turnover of a direct care worker in Iowa costs $3,749 in direct expenses for the employer. Costs include staff time and expenses associated with covering the work during the vacancy, recruiting, hiring, screening, testing, and background checks, and training/orientation costs for new hires. The authors explain that there are also indirect costs that are more difficult to quantify, including lower productivity by departing and remaining workers, reduced quality of services because of lack of continuity, increased errors, lost clients and damaged community image, and decreased employee morale. If indirect costs are included, each turnover costs a total of $6,793. The authors suggest in addition to higher wages and better benefits, the development of a knowledgeable and well-trained workforce will allow workers to succeed in this field and reduce turnover. The authors also expect that Iowa's new credentialing system for direct care workers will reduce turnover. The Eldercare Workforce Alliance, a national coalition of 28 organizations, released a letter on July 18th, urging U.S. Secretary of Labor, Hilda Solis, to revise the "companionship exemption" in the Fair Labor Standards Act so that direct care workers would benefit from minimum wage and overtime protections. For more information, visit:
The state budget passed by California eliminated the Adult Day Health Care program, however, state legislators kept $85 million in funding to create a reduced version of the program. In signing the state budget, Governor Brown vetoed language that instructed the state to use this money to create a similar program with 50% less funding. In his veto, Brown noted that other state programs may assist those who will be affected by the potential closure of some of the 300 programs throughout the state; though advocates have suggested that other programs like In Home Supportive Services are inadequate substitutes for the trained medical professionals at Adult Day Health Care programs. The director of the Department of Health Care Services announced on July 14th that the program's elimination will be delayed by one month (to October 2011) while the department makes transition plans for the 37,000 people who rely on the program. Legislation requiring the state to submit an application to CMS for a replacement program (KAFI- Keeping Adults Free From Institutions) was sent to the Governor last week and he has until July 27th to sign it or veto it. A hearing on a lawsuit seeking an injunction against the elimination of the program is scheduled for July 26th, and the U.S. Department of Justice has filed a "Statement of Interest" with the court because of potential violations of the ADA. For more information, visit:
The Scan Foundation released its analysis of California's state budget and the program reductions/eliminations that will impact seniors, the disabled, and family caregivers. Participants in California's In Home Supportive Services will now need a doctor's written certification that personal care services are necessary to prevent out-of-home care. A pilot project for medication management is expected to produce $140 million in general fund savings by preventing unnecessary hospital and nursing home admissions that are a result of medications not being taken as prescribed. If this does not save $140 million, an across-the-board reduction in authorized hours for IHSS recipients will take place on October 1, 2012. The Multipurpose Senior Service Program, which provides case management for seniors 65 or older who are Medi-Cal eligible, had its funding cut by $2.5 million. A number of cost-sharing mechanisms were implemented in Medi-Cal, including a maximum annual cap for hearing aids, a limit of seven doctor visits per year (pending CMS approval), restrictions on supplemental nutrition products, $5 co-pays for physician, clinic, and dental services, and a $50 co-payment for ER services, and $100 a day co-payment for hospital stays (capped at $200). The budget is based on tax receipts increasing, however, if they do not, additional cuts will be triggered in January 2012, including a 20% cut in IHSS service hours, elimination of IHSS local anti-fraud efforts, and extension of co-payments and provider cuts to all Medi-Cal managed care plans. For more information, visit:
Policymakers in Washington, DC have not yet reached an agreement on how to address the budget situation, however, a proposal released yesterday by the "Gang of Six" would eliminate the CLASS (Community Living Assistance Services and Supports) program. Despite benefits being paid for through voluntary participant contributions (not taxpayer dollars), the program was included as part of the group's proposal to shrink the deficit. CLASS was enacted as part of the Affordable Care Act in an attempt to improve the nation's approach to providing and financing long-term care which 2/3 of Americans will need at some point in their lives. Through CLASS, people who become disabled would receive a daily cash benefit of at least $50 and they could use the money to pay for long-term care services and supports, including paying a family member or friend to provide care. For more information, visit:
McKnight's Long-Term Care News & Assisted Living: "Providers outraged: 'Gang of Six' spending proposal would eliminate CLASS Act"
Kaiser Health News: "Gang Of Six Deficit Plan: Executive Summary"
VA Caregiver Program Releases Stipend Payments To Almost 200 Caregivers
The Department of Veterans Affairs announced earlier this month that it was sending out $430,000 in stipend payments to almost 200 family caregivers of veterans. Family caregivers will receive anaverage of $1,600 in monthly stipend payments. The caregivers who received the stipends already completed their caregiving training under the VA's new caregiver program that was created to help family caregivers of veterans who were seriously injured in the line of duty on or after September 11, 2001. Nearly 1,250 applications for the program have been received since it began accepting applications in May 2011. The VA also has a toll-free National Caregiver Support line (855-260-3274), staffed by licensed clinical social workers. In addition, the "Aid and Attendance benefit" offered by the VA, was profiled in the Wall Street Journal last year. For more information, visit:
VA: "VA Issuing First Payments to Caregivers"
Wall Street Journal: "War: One Thing It's Good For"
Study: Some Variation In Medicaid Spending Correlates To Primary Care Access
A study in the July issues of Health Affairs analyzed Medicaid spending across states from 2001-2005 for inpatient hospital services, outpatient services, and prescription drugs and found wide variation in spending. Spending per-beneficiary in the ten highest-spending states was $1,650 greater than the national average, with 72% of this due to the greater number of services received.
The mid-Atlantic region (NJ, NY, PA) had the most expensive care due to high service volume, and to a lesser extent high prices. The South Central region (AL, AR, KY, LA, MS, OK, TN, TX) had the
least expensive care. The authors explain that the number of primary care physicians in specific areas was correlated with reduced rates of admissions for diabetes, lung disease, and adult asthma,and suggest that increasing access to these providers could be helpful for managing common chronic conditions while decreasing spending. Washington state is cited as the best example for lowering Medicaid spending through reduced acute care spending (18% below the national average) and increased access to primary care providers (outpatient visits and prescription fills were 15% above the national average). The study also found that higher numbers of hospital beds and specialists were correlated with higher number of hospital admissions. For more information, visit:
Health Affairs: "Differences In The Volume Of Services And In Prices Drive Big Variations In Medicaid Spending Among US States And Regions" (abstract is free)
Study Of Oregon's Medicaid Program Finds Health And Financial Benefits
A recent working paper from the National Bureau of Economic Research analyzed data on Oregon's Medicaid program and a lottery in 2008 that was used to triage who could apply for Medicaid. The New York Times explains that the study is considered unique because prior to this study, it was difficult to compare people who had insurance with those who did not. Because people were randomly selected to have Medicaid or not have it, researchers were better able to isolate the effects of having Medicaid coverage. Data from the first year of the collection indicates that the 6,000 people with Medicaid coverage were 35% more likely to visit a clinic or see a doctor, 15% more likely to use prescription drugs, and 30% more likely to be admitted to a hospital than the 6,000 without Medicaid. Those with Medicaid were 25% less likely to have an unpaid bill sent to a collection agency and 40% less likely to borrow money or not pay other bills due to medical bills. For more information, visit:
NBER: "The Oregon Health Insurance Experiment: Evidence from the First Year" (Abstract is free)
New York Times: "First Study of Its Kind Shows Benefits of Providing Medical Insurance to Poor"
Scotland: Government Considers Reducing Free Personal Care For Elderly
The Scottish Government is considering reducing or changing its free personal and nursing care program for people aged 65 and older. The benefit was started in 2002, however, costs have nearly doubled since the program began. One possible strategy is to end universal entitlement and concentrate on services for the poorest 20% of society. Another option includes only providing five
hours of home care per week at no cost and requiring any additional hours to be paid for by the care recipient. For more information, visit:
The Scotsman: "Free care for Scots elderly is set to be axed"
UK: Commission Recommends Individuals Pay First $56,164 of LTC Bill
A government commission recommended a new approach to funding elder and disabled care in England that calls for individuals to pay the first ?35,000 ($56,164) of their care. The goal behind the cap is to allow older adults to age in their homes instead of having to sell them to pay for care, however, it also comes with a price-tag of an additional ?2 billion ($3.2 billion) a year for the
government. The commission suggested that the government could introduce a tax that would pay specifically for this care, and also suggested that targeting the tax to pensioners would be fairer to
other taxpayers, though this suggestion was condemned by advocates for older adults. In addition to the care, residents of care homes would still have to pay ?10,000 ($16,047) for food, heating,
and accommodation. The largest social care provider in England, Southern Cross, announced earlier this month that it will go out of business, leaving 33,000 older adults in 752 care homes
scrambling to find services, and increasing pressure on the government to create a more sustainable system for providing long-term care. For more information, visit:
The Telegraph: "?80,000 care fees for middle-class pensioners"
The Independent: "Southern Cross collapse leaves elderly care in limbo"
Canada: Health-Care System Not Equipped For Multiple Chronic Conditions
The Globe and Mail recently focused on Canada's lack of services other than hospitals to serve its growing elderly population, many of whom have multiple, chronic medical conditions. This lack of services can contribute to elderly patients using hospital beds that they may not need because there aren't other options, for example, in Toronto, it's estimated that one in every ten acute-care beds is occupied by a patient with nowhere else to go. A 2009 study suggests that 1.7 million hospital days a year are for patients who no longer need acute care. Several organizations are attempting to improve options for long-term care and to better coordinate services. For example, St. Joseph's, a health system profiled in the article, has restructured its operations to also provide home care, long-term care, complex continuing care, rehabilitation, hospice, and traditional acute care. The Fraser Health Authority in British Columbia started partnering primary care
doctors with home health workers to better connect acute and community care services. Another study referenced by the article found that home services (housecleaning, cooking, etc) provided to the elderly in British Columbia resulted in health-care bills that were $3,500 lower than those who did not receive assistance. For more information, visit:
The Globe and Mail "Integrating health care necessary for an aging population"
Zimbabwe: Bill On The Elderly Will Be Introduced
The government in Zimbabwe is drafting new legislation that will require the government to provide assistance to people who are 65 years and older. The Minister of Labour and Social Welfare, Paurina Mpariwa, explained that the government needs to substantially increase it support for older adults, especially the most vulnerable. She suggested that the Bill on the Elderly is being introduced because leaders realized that family members who could have been caregivers may already be dead because of the HIV and AIDS pandemic. She also suggested that there will be a system to classify who is most in need of assistance. For more information, visit:
The Herald "Bill for the Elderly on cards"
AARP Report: U.S. Caregivers Provided $450 Billion In "Free" Care In 2009
AARP released its 2011 update of Valuing the Invaluable: The Growing Contributions and Costs of Family Caregiving. The authors find that the nation's 42.1 million family caregivers provided an
estimated $450 billion in care in 2009, a $75 billion increase from 2007. The authors explain that the "average" U.S. caregivers is a woman, 49 years old, who works outside the home while also
providing almost 20 hours of care to her mother for almost five years. The majority of caregivers are female (65%), and more than 80% are caring for a relative or friend who is age 50 or older. The $450 billion amount was calculated based on an hourly wage of $11.16 an hour and 18.4 hours of care provided per week. Family caregivers are identified as the "hidden patients" who need
support and care to address the many negative health, psychological, and financial challenges brought on by caregiving. While the field of family caregiving has made progress, the authors explain that a number of inexpensive policy changes could be implemented to better support the nation's caregivers. The report includes data on the amount of "free" care provided in each state. For
more information, visit:
AARP: "Valuing the Invaluable"
Report: ER's Should Provide Better Care For Patients With Cognitive Issues
A recent research review in the July issue of the Journal of Advanced Nursing examines the experience of older adults with cognitive impairments in visiting hospital emergency departments. The authors examine 15 studies published between 1994 and 2009 on patients from the US, Canada, Australia, Italy, New Zealand, and Israel, and find a lack of research on how these patients are assessed, treated, or supported during their visits. They find that delirium is the most common cognitive impairment, but is poorly recognized, difficult to identify, and oven overlooked by
physicians. They explain that there is debate about whether or not screening/detecting cognitive impairments should be done in ER's, who should do the assessments, and what provider obligations are after the assessment. They provide three recommendations, including improving the knowledge of healthcare professionals about cognitive impairment so that they can provide effective interventions, involving family caregivers to ensure that quality improvements are appropriate for the patient's needs, and they also suggest that a better screening tool, more appropriate for ER
use, is needed. For more information, visit:
EurkAlert: "Emergency departments need to do more to support older adults with cognitive impairment"
Journal of Advanced Nursing: "Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: a scoping and integrative review" (Abstract is free)
Report: Minority Elders May Have Less Access To HCBS
A study in the July issues of Health Affairs uses data from the Minimum Data Set on the US nursing home population from 1999 to 2008 to analyze use of home and community based services (HCBS). The authors explain that despite a policy shift to allow people to age in their own homes with the support of HCBS, the number of minority elders living in nursing homes actually increased from 1999 to 2008. The numbers of elderly Hispanics grew by 54.9% during this time frame, elderly Asians increased 54.1%, and elderly black residents increased 10.8%. In contrast, the number of elderly whites in nursing homes decreased by 10.2%. The increase of nursing home residents corresponded to larger total elder minority populations during the same time frame. The number of Hispanic elders increased 58.2%, Asian elders increased 64.2%, and black elders increased 16.2%, while white elders increased 6.7%. The authors speculate that changing family structures for minority populations may have led to less availability of family-based care options. While it appears that minorities now have greater access to formal long-term care, because nursing homes are perceived as "the last resort," this improved access may actually just be "a shifting of disparities, with minorities still underrepresented in preferred sites of care." They conclude that white elders may have more choices of care and may be better able to afford community options like assisted living, and also note that when minority elders do use nursing homes, they tend to be at lower-quality facilities. For more information, visit:
Health Affairs: "Growth of Racial and Ethnic Minorities in US Nursing Homes Driven By Demographics and Possible Disparities in Options" (abstract is free)
Study: Targeted Outreach To Connect People With HCBS Lowered Costs
A recent study of the Arkansas Community Connector Program finds that using community health workers to connect people at risk of nursing home placement with Medicaid Home and Community Based Services (HCBS) actually reduced spending per participant by 23.8% on average. The authors explain that some experts suggest HCBS programs may not be cost effective due to a "woodwork effect" theory of people enrolling in HCBS who wouldn't otherwise use institutional care- thus driving up costs. This study appears to disprove that theory. The three-year program used community workers to conduct targeted outreach to people in three counties at risk of nursing home placement in the near term to connect them with HCBS services. The authors compare the intervention group of 919 Medicaid recipients with a statistically matched group of 944 Medicaid recipients from five nearby counties. While both groups experienced growth in per-participant spending during the three-year period (19.3% for study group, over 30% for comparison group), the study group's increase was tied to increased HCBS while the largest driver of the comparison group's increase was more spending on nursing home services. The Community Connector Program ultimately achieved a net savings (after paying the program costs) of $2.619 million for the Medicaid program, a return on investment of $2.92 per dollar invested in the program. For more information, visit:
Health Affairs: "Medicaid Savings Resulted When Community Health Workers Matched Those With Needs To Home And Community Care" (abstract and article are free)
Study: Black Resident's Higher Rate Of Bed Sores May Correlate To Low Staffing Levels
A study in the July issue of the Journal of the American Medical Association examines data on the rate of pressure ulcers (bed sores) for 2.1 million white and 346,808 black residents of 12,473
nursing homes from 2003 to 2008. While there was an overall reduction in bed sores during this period, a large racial disparity was still present and the authors conclude that it is due in part to
where residents receive care. The pressure ulcer rate for black residents in 2003 was 16.8% and the rate for white residents was 11.4%. In 2008, the rate for black residents decreased to 14.6%
and 9.6% for white residents. In nursing homes with the highest percentage of black residents, residents of both races were at least 30% more likely to develop bed sores than residents in nursing
homes with few or no black residents. Dr. Yue Li, one of the authors, noted that nursing homes with higher concentrations of black residents generally have lower staffing levels of registered
nurses and nursing assistants, and tend to be larger for-profit and urban facilities. For more information, visit:
Journal of the American Medical Association: "Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents" (abstract is free)
Study: Family Caregivers For Older Hip-Fracture Patients Need Early Assessments
A study in the July issue of Journal of Advanced Nursing examined the experience of 135 family caregivers for older patients who had hip-fractures. Data on quality of life for the caregivers was
collected at one, three, six, and twelve months after discharge. While caregiver scores for role performance-related scales (bodily pain, social function, role limitations due to emotional
problems or physical problems) improved, their scores for general health and mental health were "significantly lower" at 12 months as compared to one month after discharge. The authors explain
that the health-related quality of life scores were positively related to the caregiver's perceived availability of social support. They conclude that home care nurses should develop interventions
early after discharge to assess and improve family caregivers' health perception, mental health, and social support. For more information, visit:
Journal of Advanced Nursing "Trends in health outcomes for family caregivers of hip-fractured elders during the first 12 months after discharge." (abstract is free)
The Technical Assistance Centers for Caregiver Programs & Lifespan Respite at Family Caregiver Alliance is sponsoring a webinar on July 29th with Dr. Sandra Edmonds Crew, who will review the 12 standards that were released in 2010. The standards were designed by the National Association of Social Workers in partnership with the AARP Foundation, the Administration on Aging, and Family Caregiver Alliance with funding from the John A. Hartford Foundation. Dr. Crew, who helped create the standards, will review each of the 12 standards and discuss the significance of each standard through case studies and discuss how social workers will utilize the standards when working with family caregivers of older adults. Dr. Crewe, a professor at Howard University, is the Associate Dean for Academic and Student Advancement and is also the Director of the Multidisciplinary Center for Gerontology at Howard. For more information or to register, visit:
Webinar: NASW Standards for Social Work Practice with Family Caregivers of Older Adults
ARCH National Respite Network and Resource Center is sponsoring a webinar on July 26th at 3pm (EST) on marketing respite to family caregivers. Alicia Blater, who is the North Carolina Lifespan
Respite Project Director has 10+ years experience in public relations and marketing and will present on effective marketing for respite. She will discuss the benefits and barriers that target
audiences may be experiencing when they hear messages about caregiver services. The webinar will be most useful for Lifespan Respite Grantees and their partners. For more information or to
ARCH National Respite Network and Resource Center: "Marketing to Family Caregivers: Moving Beyond Awareness"
Conference: The Many Faces of Respite, November 1-3, 2011
The 2011 National Lifespan Respite Conference and Grantee Meeting will take place on November 1-3 in Phoenix, Arizona. This year's conference is sponsored by the Arizona Caregiver Coalition in
collaboration with the ARCH National Respite Network. Early registration ends September 17, for more information, or to register, visit:
ARCH National Respite Network/Arizona Caregiver Coalition "The Many Faces of Respite"
Conference: National Home and Community-Based Services Conference Sept. 11-14
The National HCBS conference will take place on September 11-14th, in Washington DC. The agenda is now available and the conference contains a number of workshops on programs serving aging and disabled communities. Topics include collaborations between the aging and disabled systems, prioritizing access when demand exceeds capacity, best practices in family caregiving, Money Follows the Person, and many more. For more information or to register, visit:
National Association of States United for Aging and Disabilities HCBS Conference
Conference: Consumer Voice 36th Annual Conference & Meeting October 25-28, 2011
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 August 1st, for more information or toregister, visit:
Consumer Voice 2011 Conference
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"
Rules Impacting LGBT Caregivers Slowly Improving & Two New Fact Sheets
An article in the July/August issue of Aging Today discusses recent policy changes that have improved the lives of LGBT elders. Daniel Redman, an attorney with the Elder Law Project of the
National Center for Lesbian Rights (NCLR) explains that spousal impoverishment protections in Medicaid don't apply to same-sex partners, which can have negative financial impacts for LGBT
caregivers. Massachusetts implemented spousal impoverishment protections in Medicaid in 2008 for same-sex couples and HHS announced in June that other states could also extend some spousal impoverishment protections to same-sex couples. Redman also addresses an Obama administration announcement from January 2011 that requires all medical facilities receiving Medicaid or Medicare funding to allow patients to choose their own visitors. In addition, HUD guidelines updated this year clarify that "gender identity discrimination" must be treated as gender discrimination under the Fair Housing Act. President Obama announced on Tuesday that he supports the repeal of the Defense of Marriage Act which currently excludes same-sex partners from 1,100 federal rights, benefits, and privileges.
Two New Fact Sheets For LGBT Caregivers
Family Caregiver Alliance recently released two updated fact sheets for LGBT caregivers. The first fact sheet, Special Concerns of LGBT Caregivers, provides solutions for many common issues faced by LGBT caregivers and care recipients. The second fact sheet, Legal Issues for LGBT Caregivers provides a short overview of some of the legal documents that LGBT caregivers should complete. For more information, visit:
Aging Today "Improving LGBT Lives, One Law at a Time"
FCA Fact Sheet: Special Concerns of LGBT Caregivers
FCA Fact Sheet: Legal Issues for LGBT Caregivers
Med Schools Consider Communication Skills As Part Of Admissions Criteria
A recent article in the New York Times focused on eight medical schools in the U.S. that have begun requiring communications skills tests from potential applicants. Virginia Tech Carilion, the
newest medical school in the country, is profiled for its process of nine brief interviews that require applicants to demonstrate they have social and communication skills to navigate a medical
field that is shifting to a team approach. Candidates come to the school on a Saturday in March and are lined up with their backs to the doors of 26 interview rooms. They are given two minutes to
read a summary of an ethical challenge, and are then asked to discuss the challenge for eight minutes with an interviewer and to repeat this process eight more times. Sample questions include
whether giving patients unproven alternative remedies is ethical, and whether insurance co-pays for medical visits are appropriate. During the interview, graders are attempting to analyze the
applicant's ability to listen, communicate, and work on a team where people may disagree. The Times suggests that schools are prioritizing good communication because of research that finds poor communication among doctors, patients, and nurses is to blame for a large number of preventable deaths. For more information, visit:
New York Times:" New for Aspiring Doctors, the People Skills Test"
Caregiver Support Groups Frequently Asked Questions Answered
A recent article in the Herald Tribune by Paula Faulk, who directs a Caregiver Resource Center and Adult Day Service Program in Florida, explains the benefits of caregiver support groups and
answers frequently asked questions. Faulk explains that in support groups, two rules are paramount: confidentiality and one person speaks at a time. New people will typically tell the group some information about themselves and their caregiving situation, and group members ask questions about their challenges. Faulk explains that these groups allow caregivers to learn from other members, speak without being judged, and be seen as a person separate from their care recipient. As trust between group members increases, they will help hold each accountable and encourage each other to identify options, build confidence, and take action. Faulk concludes by explaining that men are joining support groups in greater numbers and encourages readers to find disease-specific support groups. For more information, visit:
Herald Tribune: "Support groups a lifesaver for caregivers"
Hospice Worker Produces Film On End-Of-Life Questions, Will Air On PBS
The New Old Age Blog recently profiled two friends who produced a movie entitled "Consider the Conversation: A Documentary on a Taboo Subject" that addresses end-of-life questions. Michael
Bernhagen, one of the producers, started working at a hospice after his mother passed away with advanced vascular dementia without any doctors suggesting hospice care for his mother. In the movie, Bernhagen interviews 40 patients, chaplains, ministers, doctors, nurses, authors, and researchers. His friend, Terry Kaldhusdal, did the camera work and is a fourth-grade teacher whose brother passed away of pancreatic cancer at the age of 53. The two friends made the movie on a budget of $43,000 and a year of their unpaid work. It has already aired on West Virginia, California, Colorado, Illinois, Michigan and New Hampshire public television and is scheduled to air in additional states during the summer and fall. For more information, visit:
The New Old Age: "End-of-life Care: A Portrait"
Consider the Conversation Web Site & PBS Schedule
HealthAgenda Blog Addresses Potential Fraud In Hospice Use
Two recent posts on the healthAGEnda blog analyzed recent media attention to hospices and whether or not fraud is a growing problem in Medicare funded hospice use. Chris Langston provides a brief primer on hospices, for example, 90% of hospice care is not delivered at a hospice, rather, services are delivered at home (55%), a nursing home (26%), or a hospital (10%). Over 80% of hospice clients are over 65, thus Medicare is a large funder, but Medicare regulations require patients to forgo curative treatment and their doctor must certify that they have six months or less to live. Langston explains that there isn't much data on quality of care in hospices, but that the median number of days people receive hospice care is only 16. Only 37% of people who received hospice care in 2007 received 30 or more days of service. Referencing the overuse of hospice leading to rising costs, he suggests that the overall increase of Medicare beneficiaries receiving hospice care is a good thing (23% received hospice care in 2000, while it increased to 40% in 2008), and may actually be less costly than other healthcare. The second cost driver is length-of-stay, and while most stays are too short to truly benefit from hospice, there has been growth in a small number of people receiving hospice for long periods of time, especially at for-profit agencies, and for conditions like Alzheimer's disease. In his second post, Langston suggests lengthening the expected life requirement to nine months and highlights a concurrent demonstration in the Affordable Care Act that will allow people to receive curative and hospice care simultaneously. He explains that CMS has begun requiring a more formal recertification for patients who live beyond six months. For more information, visit:
HealthAGEnda: "Throwing the Baby Out With the Bathwater?"
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