ElderWeb

Kenneth M. Langa, MD, PhD led a team from the University of Michigan studied the differences in home care services used by people who lived alone and those who lived with others in 1993 and 995. They investigated whether the large growth in paid home care services that took place during the early to mid-1990s was targeted to individuals with higher levels of disability and lower levels of social support, groups which historically have been more likely to use paid home care services and are at higher risk for nursing home admission. The researchers concluded that the large increase in formal home care services provided during the period of their study went disproportionately to those with greater social support, and that home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children. The report is published in the February issue of Medical Care.

The British Medical Journal reports that a majority exists within the Scottish parliament in favor of providing free personal care for older Scots. This action came in response to a report from the Royal Commission on Long Term Care for the Elderly which recommended making personal services free to all. It has been estimated that it will cost ?110m ($165m) a year to pay for the improved package of care in Scotland. The personal services the Commission recommended covering include:

Personal toilet (washing, bathing, skin care, personal presentation, dressing and undressing and skin care)

Eating and drinking (as opposed to obtaining and preparing food and drink)

Managing urinary and bowel functions (including maintaining continence and managing incontinence)

Managing problems associated with immobility

Management of prescribed treatment (e.g. administration and monitoring medication)

Behavior management and ensuring personal safety (for example, for those with cognitive impairment - minimizing stress and risk)

The Department of Health and Hospitals is holding a meeting to receive input and recommendations toward developing a comprehensive strategy to provide more community-based services to people with disabilities and to those requiring long-term care. The meeting is set for Thursday, January 25 in Baton Rouge.

People with interests in elderly affairs, mental health, developmental disabilities/mental retardation, physical disabilities and substance abuse are invited to attend this planning meeting. According to Raymond Jetson, DHH's advisor for special populations, the meeting continues the department's commitment toward making more integrated community-based services a priority. "This is the first step in reaffirming our vision for meeting the future needs of people with disabilities and those who are aging," he said. "The reality is that the state's fiscal problems mean that we will continue to see the overall level of spending on health care decline. This fact reinforces our mission to seek more efficient and effective ways to provide care and services in community-based settings."

He said the department's working vision for the elderly and people with disabilities will be on the DHH website beginning January 25. For people without Internet access, libraries offer this service. Interested persons can also write to Jetson at P.O. Box 629, Baton Rouge, LA 70821-0629 and send him their comments and questions.

"I encourage people to review and comment on this statement," Jetson said. "The website will allow for people to provide input even if they do not attend the meeting. These comments will then be used to help us develop a comprehensive strategy to move forward."

Attorney General Mike Fisher announced that his Bureau of Consumer Protection has obtained a nearly $400,000 judgment against a Pittsburgh home care company and its owner, who were accused of selling non-medical in-home services to more than 90 elderly Pennsylvanians even though they had no ability or intention of providing the services.

"These defendants are permanently barred from having any business dealings with older Pennsylvanians," Fisher said. "The judgment forever bans them from advertising or selling any goods or services to Pennsylvania residents age 60 or older. In addition, they are required to pay nearly $400,000 in consumer restitution, civil penalties and investigation costs."

Fisher said the judgment was obtained against Amfed Homecare Corp., 100 Wise Hill Rd., Fox Chapel, and its president, William Livorio. The defendants were sued by Fisher's Office in February 2000 for numerous violations of Pennsylvania's Consumer Protection Law.

Iowa is set to receive more than $300 million in federal money to expand home- and community-based services for the elderly, according to Governor Tom Vilsack. The money is intended to keep older Iowans in their own homes longer, saving money in the long run by limiting the use of expensive nursing-home care. The money also would open new options for disabled adults, who often end up in nursing homes.

The state knew it would receive about $95 million in federal money. Additional payments were uncertain, however, because federal officials were working to close a loophole that allowed Iowa and 18 other states to get the Medicaid money. New federal rules mean that Iowa will receive the full amount it had been seeking, totaling more than $300 million, Vilsack announced at his weekly news conference. He said a challenge to the new rules was unlikely.

The $300 million will be placed in the state's new 'senior Living Trust." The money will help Iowa expand in-home and assisted-living options that are cheaper than nursing-home care. The grant program allows funding consideration for conversion of nursing facility beds to affordable assisted living units, and for development of Home and Community Based Services such as adult day care, respite care services, child care for children with special needs, and safe shelter for victims of dependent adult abuse. It is anticipated that $20,000,000 will be available for these grants for capital or one-time expenditures, including expenses for start-up, training and operation losses associated with the first year of development. Eligible applicants include licensed nursing facilities and other providers of long-term care services.

?With the proper investment of these new resources, our comprehensive ?Senior Living Trust? long-term care system will become the model for the rest of the nation. We will be able to create a system that is consumer directed based on the principles of independence, quality, dignity, privacy, and personal choice,? Vilsack said.

The state could then save about $73 million in annual Medicaid costs by 2004, Vilsack said. Iowa received its first payment - $95 million - this month. Officials estimate that Iowa would receive $112 million in 2001, $106 million in 2002 and $24 million in 2003.

The Office of Inspector General of the Health Care Financing Administration (OIG-HCFA) investigated claims that home health agency (HHA) placements have become more problematic since reimbursement was reduced with the implementation of the Interim Payment System (IPS). They say that their data shows a 25% decrease in HHAs from 1997 to 1999, which some of them attribute to IPS. The report says that 85% of discharge planners reported no problems in placing patients, 9% report problems with 5% or more of their placements and the rest report they have problems with placements less than 5% of the time.

In spite of these findings, which they categorize as insignificant problems, the OIG made some disturbing observations. They report that there appears to be a drop in home health care staffing in some areas. About one quarter of discharge planners report home health staffing shortages in their area have contributed to delays in placement, which they most commonly attribute to IPS. They explain that because of low reimbursement, they believe that HHAs have cut back on staffing or have closed. These discharge planners say that the remaining staff have been unable to provide care for everyone who needs home care in their area. Other discharge planners cite labor market forces when asked about the cause of staff shortages. These discharge planners say that, in some areas, nurses and home health aides are simply in short supply.

They also report that during the placement process, home health agencies are now looking more carefully at whether patients meet Medicare homebound and skilled need eligibility requirements, which may be a result of recent enforcement activities by the OIG-HCFA. Some discharge planners suggest agencies are using information on medical condition and service needs to screen certain patients. On the occasions when there are placement delays, discharge planners most commonly cite problems with patients needing IV antibiotics or expensive drugs. They also cite delays in placing patients who have decubitus ulcers or who need other wound care, as well as those who need rehabilitation. On average, about a third of those who cite delays due to medical conditions attribute these delays directly to the interim payment system.

The Prime Minister and the other Canadian Ministers met in Ottawa September 11 and issued a "Health Communique." In it, they promised that the federal government would work with provinces and territories to improve Canadian health care. Among other things, they stressed they are committed to strengthened investment in home care and community care as critical components of a more fully integrated health system. They also promised that in order to ensure Canadians continue to have access to new, appropriate and cost-effective drugs, they will work together and mandate their Health Ministers to develop strategies for assessing the cost-effectiveness of prescription drugs, and will create a common intergovernmental advisory process to assess drugs for potential inclusion in government drug plans.

Governor Carnahan created a Caregiver Background Information service through an executive order to assist Missouri citizens in making more informed healthcare and daycare choices for family members. This webpage provides general information and links about the various services available to the public to check the backgrounds of caregivers that serve children, the elderly and persons with disabilities.

Families face difficult decisions when selecting a person to care for a family member. One of the fears these families face is that the caregiver they hire has a history of abuse. This service allows families to receive background information on potential caregivers. While this service is not intended to be a foolproof way to avoid abusive situations, the service does give families valuable information to determine if a caregiver has a history of abuse or neglect.

The Florida Department of Elder Affairs has prepared two disaster preparedness guides for older Floridians. They are "2000 Disaster Preparedness Guide for Elders" and the "What Should You Do If A Hurricane Threatens Your Community?" brochure. These guides are designed to help consumers plan for the possibility of a hurricane in the impending hurricane season, and deal with things like developing an escape plan, making a decision to evacuate, and what to do with the family pet.

The Miami Herald reports that the waiting list for services to help the elderly remain independent and in their homes is growing. Lat year the state used money from the Lawton Chiles Tobacco Endowment Fund to nearly eliminate the waiting list for community care for the elderly. The money represented a hefty increase for the programs, which many felt were underfunded for years. But the lists for community care and home care for the elderly are growing again, and more than 1,600 seniors in Broward and more than 1,900 in Miami-Dade await services today and some South Florida seniors have been waiting nearly a year for help.

Although the aid these seniors seek, such as house-cleaning or assistance with bathing, could mean the difference between living independently or moving to an assisted living facility or nursing home. In the past, elder advocates have tracked the waiting list as an indicator of unmet needs among the state's seniors. In the coming months, the state's Department of Elder Affairs plans to replace the traditional wait list with a new list that state officials say will eliminate redundancies and rank people according to need.

But the bulk of the funding increases is for Medicaid waiver programs, which focus on lower-income seniors. The division helps about 2,500 people a year. To take care of the current waiting list, Stephen Ferrante, interim director of the division, estimates he'd need $2 million more a year from the state.

Australia is mobilizing a "Grey Army." Federal Minister for Aged Care Bronwyn Bishop saluted mature-aged Australian workers at the launch of the Grey Army in Sydney. This army is an umbrella organization providing corporate identity for about 2,000 service providers across the nation. It is made up of displaced older workers who do work in the homes of older Australians, including maintenance, household chores and other tasks.

MSNBC recently published an article which describes how Geriatric Care Managers (GCMs) can help older people remain independent in their own homes. The article describes the GCM practice of Sharon Miles, of Albuquerque, New Mexico, and the value Sharon and other members of the National Association of Professional Geriatric Care Managers bring to long term care.

72,000 home care workers in Los Angeles County received news that Governor Gray Davis agreed to meet their demands for a pay raise to $7.50 per hour plus health insurance, and $1 per hour increases in each of the next four years. But the increase won?t be final unless the county Board of Supervisors agrees to chip in more money for the matching fund program, which they indicate they are unwilling to do. Los Angeles County home care workers account for more than half the home care workers in the state. The majority of home care workers in Los Angeles County are African American, or Latino or Asian immigrants, and most are women. Until last year, they earned minimum wage.

The Canadian National Advisory Council on Aging has issued its recommendations for home care in Canada. They recommend:

Home care be considered an integral part of publicly funded health services.

Canada Health and Social Transfer (CHST) funding recognize the demographic differences in current and future demand for home care services amongst provinces.

Federal, provincial and territorial governments collaborate to develop a set of national home care objectives.

Public administration with a single payer be one of the objectives of a national home care system.

Portability of home care services be one of the objectives of a national home care system.

Reports on the Canadian health care system include measurements of home care expenditures, services and outcomes against a set of national home care objectives.

Federal and provincial governments continue to investigate the most effective and efficient delivery mechanisms for home care services.

Provincial governments adopt a set of nationally comparable standards for the training and compensation of professional home care workers.

The federal government act as a role model by providing a comprehensive set of home care services to Canadians for whom it has primary health care responsibility, e.g. Aboriginal people and veterans.

A section with a special emphasis on home care be maintained within Health Canada to ensure a strong federal presence in home care policy development.

The federal government explore extending Employment Insurance coverage to workers who leave work temporarily to provide informal care.

The federal government act as a model employer by incorporating a comprehensive and flexible set of provisions for adult caregiving in labour agreements with its employees.

The federal government devote additional funding to enhance research on the effectiveness and efficiency of different home care delivery models.

The Financial Times reports that plans to allow councils to "lend" elderly people the cost of their long-term residential care, secured against the value of their homes, are being drawn up by ministers. Councils would meet the cost of the care then claim the money back from the person's estate. Ministers are also planning to allow three months of state-funded residential treatment before people would be forced to use the assets from their home to pay for the cost of care. Ministers hope this "property disregard" will act as an incentive to the elderly to give up National Health Service beds because they know they would not be charged for short-term care of up to three months.

Round-the-clock nursing home care costs about £330 a week and accommodation can be £200. Under plans to be set out in the white paper "Quality, Choice, Fairness - better services for the elderly" the government will meet the nursing costs of treatment but not the residential or "hotel" component of their care. Alan Milburn, the health secretary, has been negotiating the cost of this policy with the Treasury.

The Audit Commission issued a report, "Charging With Care," found wide variations in what people are charged for home help services and in how councils manage charges. It found charging policies in some areas leave some people with less to live on than the income support level appropriate for people of their age. The report also shows how financial arrangements can create incentives for managers to move people into residential homes when they could remain in their own homes.

More than 500,000 people receive home care throughout England and Wales, and 420,000 of them are over 65. These services range from help with shopping and cleaning to personal care services like bathing and dressing. Councils charge users for these services, and the income from charging enables many councils to improve services for the most vulnerable. However, there is no consistency from council to council on charging policy. Charges for similar users in different parts of the country vary from nothing to over £100 per week for the same level of service. About two-thirds of councils exempt those on the lowest incomes from charges, but 30% charge against income support, and some take up to 90% of the attendance allowance, the main disability benefit many older people receive. The Audit Commission also reported that users may be prematurely admitted to residential care because of the perverse financial incentives created by the systems of charges.

The Audit Commission previously issued reports on equipment services and mental health services for older people.

Results of the Canadian Home Care Study are available from the National Association for Home Care (NAHC). This study, "The Comparative Cost Analysis of Home Care and Residential Care Services," examined the utilization and cost of services provided to people who received care at home as compared to those who received care in a residential setting. The results were stratified by the level of care needed to try to make comparisons more meaningful.

Overall, costs for community-based care averaged $8,900 a year, while residential care averaged $30,000 a year. The difference in costs varied with the level of care needed, so that home care represented about 40% of residential care costs for those with lower care needs, but 75% of residential care costs for those with more acute needs. The cost of home care as compared to residential care is highest for clients whose needs are changing, and for clients who die while under care.

Partially in response to this study, Canadian Health Minister Allan Rock proposed an expanded national home care program in a letter to officials in the nation's 10 provinces.

The American Council of Life Insurance released results of a study into the costs of long term care and the benefits of long term care insurance. To illustrate the needs most often ignored by consumers, they investigated the costs of long term care services OTHER than nursing homes. They reported that by 2030, when the last of the baby boom generation reaches age 65, total national spending for non-nursing home long term care costs will be $193 billion, quadruple what it is today. Out-of-pocket costs for these services are projected to climb by 369% to $112 billion.

The ACLI report also pointed out that the Congressional Budget Office had concluded that long term care insurance could save the government about $40 billion in Medicaid costs. The ACLI also projected that the government would further benefit by another $8 billion in tax revenues if the 31% of family caregivers who now quit their jobs to care for elderly relatives were able to continue working.

- submitted by Cathy Weslock

In the City of Wyoming, Michigan, seniors are benefiting from a service called Stepping Stones. Stepping Stones is a new innovative program for homebound seniors utilizing Recreation Therapy. This is the first program of its kind for a municipality. A Certified Therapeutic Recreation Specialist (CTRS) uses Recreation Therapy to help seniors overcome obstacles to that they can return to active lifestyles. The therapy enables individuals to develop a range of skills including physical mobility, problem solving, safety and judgment, and social skills.

Developed in collaboration with Grand Valley State University, with funding from the Kent County Senior Millage, this model program has allowed seniors to be discharged from the program back into the community, where they are now active. The program is ideal for individuals suffering from an acute onset of illness or disability. Referrals for this program come from local hospitals, senior centers, and rehabilitation centers.

Since neither Medicare nor Medicaid cover Recreation Therapy outside of a nursing home or hospital setting, the clients are asked for a donation to help cover costs. However, no individual will be turned down for inability to donate funds. This homebound program is a great compliment to Physical and Occupation Therapy typically offered in the home.

U.S. HomeCare Corp, a $50 million company, has been foreclosed on by its lenders, lead by Chase Manhattan Bank. The home health agency operates 14 sites in Connecticut, New York and Pennsylvania. The failure is blamed on reduced Medicare reimbursement and the $1.8 million settlement of a Medicaid fraud investigation. The company had considered bankruptcy, but decided that nothing would be left of the company after emerging from Chapter 11.

The UK Emergency Bed Service said there was not a single intensive care bed available in all of London several days this winter. The shortage meant that doctors had to make decisions about who got a bed and who would be transferred, sometimes to hospitals many miles away. People over age 75 filled 290 of the 500 intensive care beds in January, and part of the bed shortage was due to the fact that these older people could not be sent home until social services assessed their home conditions, which sometimes took several weeks.

London's senior officials are determined that the same thing should not happen again this winter, and a team, comprised of medical experts and lay people, has been set up to look at the entire chain of events. There is also hope that a new infusion of £2 billion to the budget of the National Health Service will help solve the problem.

Another study published in the British Medical Journal documents an attempt to quantify the value of preventative home visits to elderly patients in reducing later need for hospitalizations or other medical care. Researchers concluded they could find no evidence that these preventative visits made any difference in later medical care needs.

The American Health Care Association (AHCA), a trade association of for-profit nursing homes and long term care facilities, has issued a report on the nursing shortage in long term care. They refer to studies that show a significant discrepancy between pay rates for nursing staff in acute care (hospital) and long term care settings, and attribute the difference largely to the fact that most nursing home care is paid for by Medicaid and Medicare.

They estimate that the cost to increase nurse staffing to levels proposed by some pending regulations and legislation would cost an additional $3 billion to over $15 billion over current staffing levels, at the same time that facilities are unable to find sufficient staff to even meet current minimum requirements.

HR 1436, Nurse Reinvestment Act of 2001 has been introduced by Rep Lois Capps, and is co-sponsored by 84 other representatives. Among other things, the bill proposes to address the nursing shortage by increasing the federal Medicaid match to help pay for nurse training programs, establishing a "National Nurse Service Corps," that would pay for the nursing education of candidates who commit to working in a nursing facility or other health care facility with staff shortages, and establishing federal grants to allow nursing facility employees to pursue gerontology degrees or certificates.

The American Nurses Association (ANA) has identified ten nursing-sensitive indicators of quality of care in non-acute care settings like long term care and home care. They are hoping to explore the relationship of nurse staffing and quality of patient care as they further develop these indicators. They are looking at pain management, consistency of communication, staff mix, client satisfaction, prevention of tobacco use, cardiovascular prevention, caregiver activity, identification of primary caregiver, psychosocial interaction, and activities of daily living.