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|A Newsletter of FCA's National Center on Caregiving|
January 11, 2012
Volume XII, Number 1
State Legislation, Policy & Reports
- CT: "Insurance Capital Of The World" Drops Managed Care In Medicaid More...
- CT: Advocates Sue State Over Medicaid Application Delays More...
- ME: Governor's Proposed Budget Eliminates Medicaid Funding For Assisted Living More...
- CA: Governor's Proposed Budget Eliminates Caregiver Resource Centers More...
- NJ: Law Implementing POLST Enacted More...
- WI: Budget Cap On Family Care Lifted, Possibly Due To Federal Pressure More...
Federal Legislation, Policy & Reports
- HHS Announces Quality Measures For Medicaid-Eligible Adults More...
- NASUAD Survey On AAA's Using Participant Experience Surveys More...
- Senator Sanders Will Introduce Reauthorization Of Older Americans Act More...
- National Plan To Address Alzheimer's Disease Draft Framework Released More...
- Comment Period Open For Ending The Companionship Exemption More...
- Q&A About UK's Long-Term Care System And Proposals To Fix It More...
Research Reports & Journal Articles
- Report Released On The Aging Services Network More...
- 2010 Census: Largest Increase In People Aged 65; More Older Males Than Females More...
- Evidence Of Effectiveness Of Quality Improvement Interventions For End Of Life Care More...
- Study: Heart Attack Risk Increase 21% After Losing A Loved One More...
- Report: Medicaid And The Elderly More...
Conferences & Trainings
- Aging in America Conference 2012 Conference More...
- Webinar: The Role Of Geriatric Social Workers: Jan 25, 1:00-2:30PM (EST) More...
- Webinar: Building Partnerships To Promote Activity And Engagement For Older Adults, Jan 26, 1:30-2:30pm (EST) More...
- Webinar: Top Ten Scams Impacting Older Adults, How To Avoid Being A Victim, Jan 12, 1:30-2:30PM (EST) More...
- $10,000 Award For Senior Transportation Services More...
Funding, Media & Miscellaneous
- Article Addresses "In Sickness And In Health" As A Caregiver More...
- Blog Questions Politics Of America's Fragmented Long-Term Care System More...
- Hospitals Help Nurses With Compassion Fatigue More...
- Blog: Do Doctors Chose Differently For Their Own End-Of-Life Care Choices? More...
- New Guide Helps LGBT Elders Navigate Long-Term Care Options in California More...
- Brochure: 10 Things You Should Know About Aging With Dignity And Independence More...
- Clinical Trial Recruiting Stroke Patients More...
- University Of Washington Study: (LIFT) Life Improvement Following Traumatic Brain Injury More...
- Lewey Body Dementia Association Survey More...
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Kaiser Health News reports that as of January 1, the state of Connecticut is bucking a national trend of Medicaid managed care and is dropping private health plans from its Medicaid program. Oklahoma made a similar move in 2005 and according to the state Medicaid director, quality and member satisfaction are high while cost per member has grown at an average annual rate of 1.2% for the past five years. Health advocates in Connecticut applauded the decision, citing low spending on health care, access issues, and a 2009 report that the state overpaid insurers by $50 million a year. Doctors interviewed in the story cited difficulty with multiple rules in different plans, payment delays, and problems with specialist referrals. While base reimbursements will stay the same, doctors will be eligible for bonuses of up to $25,000 a year for improving quality and coordination of care. For more information, visit:
Kaiser Health News: "Connecticut Drops Insurers From Medicaid"
The Connecticut Mirror reports that legal aid attorneys have filed a class action lawsuit against the Department of Social Services (DSS) for not processing Medicaid applications within the timeframe mandated by federal law. The lawsuit suggests that almost 5,000 people have filed Medicaid applications and have had to wait longer than the 45 day time period allowed by federal time limits. The lawsuit seeks an injunction against the state to address the backlog of applications. In response, a DSS spokesperson said the agency has been dealing with double-digit percentage staffing losses in the past decade while Medicaid applications rose 19.5% and SNAP applications increased 81%. A spokesperson for nursing homes in the state explained that eligibility decisions for nursing home residents can often take six months or longer. For more information, visit:
The Portland Press Herald reports that Maine Governor LePage's proposed budget would cut MaineCare funding for residents of assisted living facilities. The proposal would save the state about $60 million, but would also mean the loss of $100 million in matching federal Medicaid dollars. The proposal appears to be based both on budget strains and on a federal review that found some of the services currently provided at assisted living facilities in Maine don't qualify for federal reimbursement. According to the Morning Sentinel, 4,291 residents would potentially be impacted by the elimination. In a facility in Winthrop, half the beds are reserved for nursing home residents and half are for assisted living residents. Twenty of the 24 residents in the assisted living section have their care paid for by Medicaid. For more information, visit:
California Governor Jerry Brown released his proposed FY 2012-13 budget this week which calls for $4.2 billion in spending reductions, including large cuts to programs serving family caregivers. Funding for the 11 Caregiver Resource Centers would be eliminated (note: Family Caregiver Alliance is 1 of the 11 Centers). In California's IHSS program, "domestic and related services" (housework, shopping and meal preparation) would be eliminated for 245,000 IHSS participants (about 60% of the total IHSS population) for a savings of $163.8 million. The proposed budget would also implement a 20% across-the-board cut in IHSS in April 2012. The 20% cut was originally included in the 2011-12 budget agreement, but a court injunction has prevented the state from implementing it. For more information, visit:
Northjersey.com reports that New Jersey joined more than 30 other states to implement the Physician's Orders for Life Sustaining Treatment (POLST) after a law was enacted in December. The POLST program began in Oregon in the 1990's, and the POLST paradigm form is a voluntary medical order form that is completed by a medical professional to document (and follow) a patient's preferences for end-of-life care. In New Jersey, the commissioner of Health and Senior Services will now appoint a 21-member panel to make recommendations on implementation of the new law. For more information, visit:
The Journal Sentinel reports that Wisconsin Governor Scott Walker announced on December 28, 2011 that the state would remove enrollment caps on the Family Care Program in Wisconsin. According to the Journal Sentinel, Governor Walker made no mention of an order from CMS sent two weeks earlier that required the state to lift the cap. Family Care is currently available in 57 of the state's 72 counties and Walker's plan (which would require approval of the legislature) would expand access to the remaining 15 counties. There are currently 43,000 people in the program, with 6,600 people on a wait list (an increase of 853 since the cap), though a deputy secretary for the Department of Health Services said not all people on the waiting list are eligible for Family Care. For more information, visit:
HHS Announces Quality Measures For Medicaid-Eligible Adults
HHS announced earlier this month that it has identified 24 core quality measures for Medicaid-eligible adults. The Affordable Care Act directed HHS to identify the measures and HHS partnered with AHRQ to examine 1,000 measures and ultimately publish 51 measures for public comment, and this list was then reduced to 24 measures. Public commentary raised questions about if the measures would be applied to managed care and fee-for-service, and HHS explained that the core set would be used across all systems, with additional guidance provided. Comments also focused on the need for measures that "address a range of disabilities present among Medicaid beneficiaries and those receiving home and community-based services." In its response, HHS explained that the subcommittee did not indentify existing measures that also met scientific soundness criteria, but that new measure development will be prioritized as part of the Medicaid Adult Quality Measures Program. For more information, visit:
Federal Register: "Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults"
FCA Blog: "Formalizing 'Person and Family-Centered' Care in Healthcare"
Commonwealth Fund: "Measures Aim to Boost Quality of Care for Adults in Medicaid"
NASUAD Survey On AAA's Using Participant Experience Surveys
NASUAD recently released results from an ongoing survey of state agencies on aging and whether or not they conduct participant experience surveys. The introduction notes that measuring quality in HCBS for the elderly and disabled is difficult and that AHRQ has only identified one measurement (readmission or admission to the hospital). The current report includes responses from 22 states as well as copies of survey instruments. The report will be updated as more responses are received. For more information, visit:
NASUAD: "Participant Experience Survey" (Note: Large file may be slow to load)
Senator Sanders Will Introduce Reauthorization Of Older Americans Act
Senator Bernie Sanders (I-VT), Chairman of the Senate Subcommittee on Primary Health and Aging, announced that he will introduce legislation reauthorizing the Older Americans Act later this month. A press release noted the importance of programs providing meals, home-care, coordinating of long-term care, job training and legal services when one in five older Americans survives on an average income of $7,500 a year. The proposed legislation would change how the cost-of-living is calculated for the elderly, strengthen the meals programs with a 50% increase in funding, and make changes to job training and the long-term care ombudsman program. For more information, visit the links below, and see the December report on the Aging Services Network featured in the "Research Section" of this issue.
Press Release: "Chairman Sanders to Introduce Older Americans Act Reauthorization"
Leadership Council of Aging Organizations: "Consensus Recommendations for OAA Reauthorization"
National Plan To Address Alzheimer's Disease Draft Framework Released
The draft framework includes five goals in order to prevent and effectively treat Alzheimer's by 2025. The plan calls for a summit in May 2012 sponsored by the National Institute on Aging that will provide expert input and identify milestones in slowing progression, delaying onset, and preventing Alzheimer's, and the proceedings will be open to the public. Goal 3 of the plan calls for better training for caregivers, better identification and support of caregivers, and more assistance with planning for long-term care before it is actually needed as well as maintaining the dignity, safety, and rights of people with Alzheimer's. The Alzheimer's Association has created a website for people to provide feedback on the plan to HHS. For more information, visit:
HHS: "Draft Framework for the National Plan to Address Alzheimer's Disease"
Alzheimer's Association: "Your Input"
Comment Period Open For Ending The Companionship Exemption
The Department of Labor announced a notice of proposed rule making in December that would end the companionship exemption for home care workers. The policy change has been somewhat controversial, with some home care agencies concerned about the move while advocates for direct care workers applaud the move. Perspectives from both sides are provided below. The Department of Labor is now accepting comments until February 27, 2012. For more information, or to submit a comment, visit:
"Application of the Fair Labor Standards Act to Domestic Service"
PHI President Steven Dawson Addresses Business Owners' Concerns About the DOL's Proposed Rule on the Companionship Exemption
President Obama supports labor law change threatening America's seniors
|Q&A About UK's Long-Term Care System And Proposals To Fix It
A recent question and answer column in the Telegraph gives readers insight into policy issues that aging leaders have been grappling with for the past several years in the United Kingdom. Advocates recently presented a proposal that nobody should have to pay more than ?35,000 over their lifetime for their long-term care. Under the current system, people with less than L 13,000 receive free care, those with L13,000 to L23,250 have to contribute to costs, and those with more than L23,250 (which generally includes the home, except when there is a spouse, partner, or relative living there) do not qualify for any home care. For more information, visit:
The Telegraph: "Long-term care: why the system is close to breaking point"
Report Released On The Aging Services Network
In December, the National Health Policy Forum released an update to a background paper that was originally published in 2008. The authors note in the introduction that the aging services network's ability to sustain current capacity and possibly expand depend on the ability to attract and retain additional resources, a challenging proposition given budget constraints at all levels of government. The network consists of 56 state agencies on aging, 629 area agencies on aging, 246 Indian Tribal and Native Hawaiian organizations, nearly 20,000 service provider organizations, and thousands of volunteers. The Older Americans Act, which created the foundation for the aging services network, includes seven titles, with Title III comprising the largest component and representing 70% of the Act's FY 2011 appropriation. The authors note that while there is not much evaluation information available for the National Family Caregiver Support Program, the Administration on Aging is currently completing a national evaluation. For more information, visit:
NHPF: "The Aging Services Network: Serving A Vulnerable and Growing Elderly Population in Tough Economic Times"
FCA Blog: "The Aging Services Network: Ready to Assist Family Caregivers"
2010 Census: Largest Increase In People Aged 65; More Older Males Than Females
A Census brief released in November provides data on the growth of the number of Americans aged 65 and older. The authors note that the 2010 Census found more people aged 65 years and older than in any previous census. The population of people aged 65 and older increased from 2000 to 2010 at a rate of 15.1%, which is larger than the total U.S. population growth of 9.7%. Males had a more rapid growth in the older population than females, and the largest growth rate was for males aged 85-94 years old (46.5%). Females in the same age group increased 22.9%. The largest growth for women was for females aged 65 to 69 years old at 28.2%. For more information, visit:
U.S. Census: The Older Population: 2010
Evidence Of Effectiveness Of Quality Improvement Interventions For End Of Life Care
AHRQ is accepting comments on a draft paper (until January 24, 2012) that reviews the evidence on the effectiveness of quality improvement interventions for end-of-life care. The authors examine 93 studies and find that "Of the 22 studies targeting continuity, coordination of care, and transitions, 33% evaluating quality of life as an outcome, 67% evaluating patient satisfaction, and 46% evaluating healthcare utilization found a statistically significant improvement with the intervention." "For communication and decision making, only 22% of studies addressing patient or family satisfaction found a statistically significant improvement, compared to 73% for healthcare utilizations." The authors note there is room for improvement and that future research should improve recruitment and retention to ensure a sufficient sample size, better development and description of interventions, and better selection and standardization of outcome measures and tools. For more information or to submit comments, visit:
Study: Heart Attack Risk Increase 21% After Losing A Loved One
A study published in Circulation interviewed 1,985 patients who had suffered heart attacks during a five-year period (1989-1994). Patients were asked about possible trigger events, and 13.6% had experienced the loss of a significant person in the prior six months. The incidence rate of heart attacks was elevated 21.1% within 24 hours of the death of a significant person and declined steadily each subsequent day. The authors conclude that people with already high cardiovascular risk may be specially vulnerable. For more information, visit:
Circulation: "Risk of Acute Myocardial Infarction after Death of a Significant Person in One's Life: The Determinants of MI Onset Study" (Abstract is free- Study may be free )
EurekAlert: "Heart attack risk rises after loss of loved one"
Report: Medicaid And The Elderly
A working paper from the National Bureau of Economic Research provides an overview of the eligibility channels for people over the age of 65 to qualify for Medicaid. The authors compare the categorically needy (described as mostly life-long poor individuals) vs. the medically needy (people who might have earned substantial amounts but have become impoverished). The report includes charts for the 50 states on State SSI supplements, 2009 income and asset limits, estate recovery percentages, and eligibility criteria for Medicaid waivers. The report is free for subscribers, corporate associates of the NBER, journalists, employees of the U.S. federal government with a ".gov" domain name or to residents of "nearly any developing country or transition economy," for all others, it is $5 to download. For more information, visit:
NBER: "Medicaid and the Elderly"
The 2012 Aging in America conference, sponsored by the American Society on Aging, will take place March 28-April 1, 2012 in Washington, DC, and the event typically attracts 3,000+ attendees. Family Caregiver Alliance will host several sessions, including "Family Caregivers: Policy Perspectives and Media Musings," as well as a reception to honor the 2011 Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards. For more information, visit:
Family Caregivers: Policy Perspectives and Media Musings
The 2011 Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards: A Reception Honoring the Award Recipients
Aging in America 2012
A webinar sponsored by the National Association of Social Workers will address the role of geriatric social workers in helping older adults and their families. Forrest Hong, PhD, LCSW, is the presenter and will discuss the challenges faced by aging parents and their adult children. Note: The webinar is only open to NASW Specialty Practice Section members. For more information, visit
Older Adults Adjusting to New Life Challenges: How Social Workers Help Specialty Practice Sections Webinar
Webinar: Building Partnerships To Promote Activity And Engagement For Older Adults, Jan 26, 1:30-2:30pm (EST)
The National Council on Aging is sponsoring a webinar focused on partnerships that promote physical and social activity. Chris Fordyce, MD, a geriatrician and the Medical Director of the Healthy Aging Program at Group Health, Seattle, will present on how health care systems, government agencies, research groups, and community organizations can partner to enhance each other's work. For more information or to register, visit:
NCOA: "Prescription for Life: Building Community Partnerships to Promote Physical Activity and Social Engagement for Older Adults"
Webinar: Top Ten Scams Impacting Older Adults, How To Avoid Being A Victim, Jan 12, 1:30-2:30PM (EST)
A webinar sponsored by the Pennsylvania SeniorLaw Helpline and the Center for Advocacy for the Rights and Interests of the Elderly will focus on the most typical types of scams targeted to seniors and what to do if you become the victim of a scam or fraud. For more information, visit:
Scams, Schemes, and Frauds
$10,000 Award For Senior Transportation Services
The Beverly Foundation, through its STAR Awards program, will award up to eighteen senior transportation services awards of $10,000. The application is available starting January 15, and closes January 29. Applicants are eligible if they deliver transportation to senior passengers; have been in operation at least three years, know how to report transportation data; and demonstrate "an ability to identify good practices in delivering transportation services to senior passengers." Non-profits are eligible for the cash award while for-profit transportation services will be eligible for a non-cash award. For more information, visit:
Beverly Foundation: STAR Awards Program
Article Addresses "In Sickness And In Health" As A Caregiver
A recent profile in the Washington Post Magazine of a caregiver, Page Melton, whose husband, Robert Melton, suffered brain damage after a stroke, addresses how Page Melton addressed the "In Sickness and Health" vows of their marriage. Robert Melton suffered a brain injury after a heart attack and collapse in September 2003. While he came home for some time, experts suggested a routine would be helpful for Robert and Page eventually chose for Robert to live at an assisted living facility in 2004. Page became an advocate and testified to the Virginia legislature about the need for a brain-injury waiver in Medicaid that would enable more people to remain in their homes. In 2008, Page reconnected with an old classmate, Allan D. Ivie IV, at a college reunion, and eventually a romance began to develop. In June of 2010, Ivie proposed to Page, who struggled with the idea of a new marriage and moving her family from Richmond to St. Louis. To read the rest of the story, visit:
Washington Post: "A family learns the true meaning of the vow 'in sickness and in health'"
Blog Questions Politics Of America's Fragmented Long-Term Care System
A recent posting on the Nieman Foundation for Journalism blog (Harvard University) suggests that America's fragmented long-term care services and supports are in part due to broader political movements to privatize services like Medicaid, Medicare, and assisted living. Larry Polivka, a Scholar in Residence at the Claude Pepper Foundation at FSU, explains: "This initiative is designed to diminish the public sector and privatize as many traditional government functions as possible at the federal, state, and local levels -- contracting out these functions to private, usually proprietary firms, including many very large corporations. (General Electric, for instance, bought out a nursing home chain with 186 facilities for $1.5 billion dollars in 2006.)" Polivka suggests that the increased numbers of caregivers will mean more people will be affected by the caregiving experience, and "come to understand the existential meaning of caregiver loneliness and the fundamental vulnerability of everyone. More of us are also likely to perceive the injustice of caregiver abandonment, which has already become all too common." For more information, visit:
Nieman Watchdog Blog: "The long-term care challenge isn't just a fiscal problem, it's a test of our nation's character"
Hospitals Help Nurses With Compassion Fatigue
The Wall Street Journal reports that several hospitals have begun offering programming to address "compassion fatigue" in nurses. An oncology nurse in St. Louis explains that staying compassionate and keeping morale high can be difficult, especially when patients or family members aren't satisfied with the care they receive. A 2008 study found that 27% of registered nurses who weren't working cited burnout or stressful work environments as the reasons. At the hospital in St. Louis, a survey of 150 staffers found that the symptoms were common enough to warrant an intervention, and after a successful pilot, a stress management course is now available to all staffers. The course includes a checklist of symptoms to watch out for, antidotes to compassion fatigue, and physical stress reduction techniques. For more information, visit:
Wall Street Journal: "When Nurses Catch Compassion Fatigue, Patients Suffer"
FCA Fact Sheet: Taking Care of You
Blog: Do Doctors Chose Differently For Their Own End-Of-Life Care Choices?
The New Old Age highlighted a blog posting called "How Doctors Die" written by Dr. Ken Murray. Murray wrote the post as part of a three part series, and he contends that based on anecdotal evidence, doctors are less likely to chose aggressive end-of-life care because they know it is futile. After the blog was posted, a reader sent him a 2008 study that appears to support his thesis. More than 800 physicians who had graduated from Johns Hopkins University between 1948 and 1964 (and were now in their late 60's and 70's) were polled about their preferences for end-of-life treatment. The majority of doctors said they would decline CPR, feeding tubes, and other common interventions if they suffered irreversible brain damage that wasn't terminal but left them unable to speak or recognize people. For more information, visit:
The New York Times New Old Age Blog: "When Doctors Face Death"
FCA Fact Sheet: "End-of-Life Decision-Making"
New Guide Helps LGBT Elders Navigate Long-Term Care Options in California
A new guide provides LGBT elders in California with information on navigating long-term care, including special considerations for LGBT couples. The authors note in the introduction that "Contrary to the widely-believed "myth of gay affluence," LGBT people-and elders in particular-are more likely to be poor than their straight peers." The guide provides information on eligibility and relationship recognition, IHSS, rights around discrimination-free care, finding LGBT-welcoming services, LGBT veterans rights, and life-planning documents. For more information, visit:
NAVIGATING THE SYSTEM: A Know-Your-Rights Guide for Lesbian, Gay, Bisexual, and Transgender Elders in California
FCA Fact Sheet: "Special Concerns of LGBT Caregivers"
Brochure: 10 Things You Should Know About Aging With Dignity And Independence
A new brochure from the Scan Foundation highlights ten things that Americans may not know about aging with dignity (i.e. Medicare does not pay for long-term care) and also provides five strategies for addressing these ten issues. The brochure is five pages and is intended for a consumer audience. For more information, visit:
Scan Foundation: "10 Things You Should Know About Aging With Dignity And Independence"
Clinical Trial Recruiting Stroke Patients
This clinical research study is testing the safety and therapeutic potential of a new stem cell therapy. In animal studies, measurable improvements in use of limbs were shown. Study patients will undergo periodic exams for two years. Study-related costs will be covered. You may be eligible if you:
- suffered an ischemic stroke within the past six months to three years;
have arm or leg weakness;
- are 18-75 years old;
- have no history of seizures;
- had only one stroke.
Trial locations: Palo Alto, CA and Pittsburgh, PA. For more information, visit:
University Of Washington Study: (LIFT) Life Improvement Following Traumatic Brain Injury
After a Traumatic Brain Injury (TBI), many people experience symptoms including low mood, poor energy, loss of interest in usual activities, and changes in appetite and sleep. The LIFT study uses a particular approach to education and counseling, called Cognitive Behavioral Therapy (CBT). LIFT Researchers hope to find out if CBT can help people with a TBI get back to activities they enjoy, develop positive mental habits, and improve overall quality of life. Participants may receive 12 sessions of CBT over the telephone and will be paid up to $100 for their time and participation. For questions about LIFT please contact Kenneth Marshall at (206) 543-4213 or 1-866-577-1925 or visit:
Lewey Body Dementia Association Survey
The Lewey Body Dementia Association (LBDA) is conducting a survey to assess if there are differences in how grief is experienced by caregivers for individuals with Lewy bodies, Alzheimer's disease, Parkinson's disease with and without dementia, and frontotemporal degeneration. The survey will also assess the well-being and quality of life for caregivers of individuals diagnosed with the neurodegenerative diseases. Internet access is required to participate in the study, and LBDA needs 500 caregivers who are currently providing care for each different disease that is being studied. For more information, or to participate, visit:
Neurodegenerative Disease Caregiver Study
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