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:

 

 
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"    

 

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)  

  

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