State Assemblymember Mariko Yamada, the Chair of the Assembly Committee on Aging & Long-Term Care, held a news conference last week calling on Governor Brown's administration to delay the elimination of Adult Day Health Care as a Medi-Cal benefit until March 31, 2012.  The benefit is currently slated to end on December 1, 2011, though a lawsuit has been filed to stop the elimination.  At a hearing on August 16, Toby Douglas, the Director of the Department of Health Care Services, defended the administration's transition plans for 37,000 current enrollees and explained that the majority of people would be served by managed care.  Assemblymember Holly Mitchell represents Los Angels which has a large number of Adult Day Health Care Centers and suggested during the hearing "...the reality is, there will be no place for these people to go...the reality is, X number of people simply will not be served."  A hearing on the transition is scheduled for the Senate's Budget Sub-Committee for September 2, at 1pm.  A hearing on a lawsuit over the elimination is scheduled for November.  For more information, visit:

 

New York Times: "Republican Staff Member, Steeped in Tax Law, Is Chosen to Lead Deficit Panel Staff" 

CBPP: "Raising Medicare's Eligibility Age Would Increase Overall Health Spending and Shift Costs to Seniors, States, and Employers" 

 
Long-Term Care Fundamentals: Medicaid Waivers And Medicaid HCBS

The Scan Foundation released two briefs earlier this month.  The first brief, "What is a Medicaid Waiver?" provides an overview of the state application process for a waiver (to CMS), the different types of waivers, and also explains the Medicaid waivers currently operating in California.  The second brief, "Medicaid-Funded Home and Community-Based Services" provides an overview of HCBS, with a focus on California.  Because the programs have evolved over time in California, they are administered by several different state agencies and consumers must meet eligibility requirements and be approved by each program individually.  In addition, the authors explain that Medicaid's bias towards institutional care means that HCBS programs are more likely to be cut during lean budget years.  Scan also released a Data brief with a color-coded map of the U.S. that shows the percent each state spends on institutional care vs. HCBS.  For more information, visit:

Scan Foundation: "What is a Medicaid Waiver? Long-Term Care Fundamentals" 

Scan Foundation: "Medicaid-Funded Home- and Community-Based Services" 

Scan Foundation: "Medicaid HCBS Spending" 

 
Two Research Reports Focus On Improving Care For Dual Eligibles

Two recent reports focus on people who are eligible for Medicare and Medicaid and the challenges in improving the quality, coordination, and cost of care for this population.  The Kaiser Foundation brief summarizes initial proposals from 15 states that were recently given contracts by CMS to better coordinate care for dual eligibles.  The authors analyze a number of aspects within the plans, including service delivery models, target populations, proposed enrollment, benefit packages, financing arrangements, and beneficiary protections.  The brief includes a one page analysis of each state's initial proposal, and final design proposals will be due to CMS by April 2012.  

The report by the National Senior Citizens Law Center focuses on four areas of Medicare and Medicaid where the programs intersect and gaps occur.  These include durable medical equipment, prescription drugs, skilled nursing services, and language access.  The authors provide suggestions that they believe could be implemented without broad system overhauls, including: revising authorization procedures for both programs around medical equipment; better transfer of data between the two programs to prevent gaps in prescription drug coverage; collecting and using data on language preferences; improving transition policies (especially for Medicaid beneficiaries who become eligible for Medicare); and better enforcement of existing laws around language services in both programs and especially in rehabilitation services in skilled nursing facilities.  For more information, visit:    

Kaiser Foundation: "Proposed Models to Integrate Medicare and Medicaid Benefits for Dual Eligibles: A Look at the 15 State Design Contracts Funded By CMS" 

National Senior Citizens Law Center: "Medicare and Medicaid Alignment: Challenges and Opportunities for Serving Dual Eligibles"

 

 
Medicaid: States Shifting Medicaid Programs To Managed Care

Kaiser Health News analyzed the politics, finances, and consumer impact as at least 20 states shift to managed care for their Medicaid programs.  Texas is profiled for a recent shift to managed care in the Rio Grande Valley.  While Texas state lawmakers had originally banned Medicaid managed-care from several Texas counties in 2003 (at the urging of doctors and hospitals), this was recently reversed in light of budget difficulties, a New Yorker article that focused on high Medicaid costs in McAllen (older and disabled Medicaid patients costs $15,311 a year on average) and an 18-month lobbying campaign by insurers.  The authors suggest one issue that may have to be addressed by managed care companies is the area's average spending on home care and related long-term care services; at $4,791 per patient, it is twice the state's average.  For more information, visit:  

Kaiser Health News/Washington Post: " Insurers See Growing Risks As Well As Revenues In Medicaid Managed Care"   

 

Study: Caregiving Experience Different For Women Vs. Men; Spouses Vs. Children

A working paper that will be featured in a forthcoming issue of Family Relations examines how men, women, spouses, and children experience caregiving and how risk factors are different for these groups.  Based on the results, the author suggests that agencies should tailor their services to the different types of caregivers. The authors measure negative caregiving, positive caregiving, care recipient problem behavior, caregiver involvement, reciprocal help from care recipient, availability of other caregivers, family conflict, support from friends or relatives, and caregiver demographics.  Female and adult-child caregivers generally reported having more negative experiences than male and spouse caregivers, with wife caregivers the least likely to report positive experiences.  Care recipient's problem behavior was the most important risk factor for wife caregivers having a negative experience, whereas positive experience was correlated with reciprocal help from care recipients, suggesting that caregivers need recognition and care from their care recipients. The author explains: "For family practitioners, the unique risk factors found in this study underscore the need to use adaptive interventions (Collins, Murphy, & Bierman, 2004) in helping caregivers, because while some risk factors are universal, others are not. Thus, when designing adaptive interventions to help caregivers, family practitioners and caregivers can start with common factors and then move on to unique ones."  For more information, visit:

Bowling Green State University, The Center for Family and Demographic Research: "Negative and Positive Caregiving Experiences: A Closer Look at the Intersection of Gender and Relationships."  

Study: Out-Of-Pocket Expenses For Cancer Care Average $1,266 A Month

  
A recent study used a nationwide survey of people with insurance to examine their out-of-pocket costs for their cancer treatments for breast, lung, or colorectal cancer.   The study included 127 patients with a mean age of 65 years old, all of whom had health care insurance while 83% had prescription drug coverage.  Seventy-three percent of participants had household income of less than $40,000 and 45% reported a significant or catastrophic financial burden due to out-of-pocket expenses.  Out-of-pocket expenses totaled $1,266 a month and prescription medication represented the largest expense at $523 a month.  In response, 47% of participants reported using all or part of their savings, 30% did not fill prescriptions, 20% took less medication than prescribed, and 40% borrowed money to pay for prescriptions.  Patients experiencing greater financial burden also reported lower levels of satisfaction with their cancer care.  For more information, visit:

Kaiser Health News: "A Need For Health Care Reform: Cancer Care Costs And The Patient Perspective" 

American Medical News: "Oncologists confront "financial toxicity" of cancer care"

ASCO 2011 Meeting Abstracts: "Impact of out-of-pocket expenses on cancer care"    

Study: Long Distance Caregivers Have Special Needs

A study released earlier this summer analyzed issues that are unique to long-distance caregivers (estimated at 14 million people by 2012) and the challenges that they can present to health care professional as well as family members who live locally.  In the interviews with 14 distance caregivers (all of the care recipients had cancer), several common themes emerged, including a lack of feeling of control and lack of knowledge. In addition, distance caregivers are unsure about when to visit and some are constrained from traveling by young children and financial constraints.  While many distance caregivers sought information online, they wanted more information from health care professionals and felt a need to stay connected by hearing regular updates.  In addition, when a parent of an adult child is ill, they may withhold information out of a sense of wanting to protect their adult children.  The author speculates that technology devices like Skype may help improve communication between local and long-distance caregivers, patients, and health care professionals For more information, visit:

Oncology Nursing Forum: "Lack of Communication and Control: Experiences of Distance Caregivers of Parents With Advanced Cancer" (article is free)  

Oncology Nursing Society Podcast Interview with Lead Author Dr. Polly Mazanec   

AHRQ: Nursing Home Survey On Patient Safety Culture Released

AHRQ recently released results from a survey of 226 nursing homes and 16,515 nursing home staff that measures the culture of resident safety in nursing homes from a staff perspective.  The survey measures 12 areas of patient safety culture.  Of the participating nursing homes, 48% are for profit.  The areas of strength include the overall perception of resident safety (average 86% positive response), and feedback and communication about incidents (average 84% positive response).  Areas for improvement include non-punitive responses to mistakes (average 51% positive response), and sufficient staffing to handle the workload, meet resident's needs, and keep residents safe (52% positive response).   

The report compares responses to questions about patient safety, whether or not an employee would tell a friend it is a safe nursing home, and overall safety ratings.  Non-profit/government nursing homes and smaller nursing homes (49 or fewer beds) had the highest ratings for patient safety culture, highest rating of respondents who would tell friends this is a safe nursing home, and the highest percentage of respondents who gave their nursing homes an overall rating of "excellent" or "very good."   

Administrators/Managers and Physicians gave the highest positive responses across patient safety culture composites (79% positive) while Nursing Assistants/Aides gave the lowest (63% positive), with similar gaps between whether or not a person would make a referral for friends and overall ratings on resident safety of "Excellent" or "Very Good."  There were also differences in respondent's views on patient safety based on whether or not the respondent had direct interaction with residents; those with direct interaction were more negative than those who do not interact directly with residents.  Respondents who worked day shifts also gave higher ratings as compared to those who worked night shifts.   For more information, visit:

AHRQ: "Nursing Home Survey on Patient Safety Culture: 2011 User Comparative Database Report" 

16 Days Left To Apply: Rosalinde Gilbert Innovations In Alzheimer's Disease Caregiving Legacy Awards

The application deadline for the fourth annual Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards is September 16th. 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 September 16, 2011. For more information or to view the application, visit:

FCA: "Rosalinde Gilbert Awards Application"

NCOA: Grants To Implement Benefits Enrollment Systems

The National Council on Aging is funding 5-10 grants of $50,000 to $100,000 for the implementation of significant innovations that improve benefits enrollment systems and community-based assistance for seniors and adults with disabilities.  The grant is for 12 months and the deadline is October 31. For more information or to apply, visit:

NCOA: Grants To Implement Benefits Enrollment Systems

If you or a loved one suffer with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) and the symptoms they bring - shortness of breath, fatigue, chest pain and more - consider participating in this research study of an investigational medication.By participating, you may help researchers learn more about this disease and evaluate the effectiveness and safety of an investigational medication. What's more, you may receive study-related care, monitoring and medication at no-cost to you.  Take the online study questionnaire now to see if you may qualify.  Go to www.phclinicalstudy.com today for more information.

Study: Metastatic Renal Cell Carcinoma Patients Taking Torisel 

Stevens, Blair & Company is conducting surveys on patients (or their family caregivers) who are currently taking Torisel or whom have taken it in the past year.  The telephone interviews take 60 minutes and participants will be paid $100.  The study is not promotional, participants will not be quoted in any way, and all information and identity will be kept confidential.  For more information, call: 1-800-482-6660.  

Stevens, Blair & Company