On May 28, 2014, Not Dead Yet, the Center for Disability Rights and 11 other New York based disability organizations submitted public comments on the New York State Medicaid Delivery System Reform Incentive Payment Program (DSRIP). The comment letter called upon New York officials to eliminate one of the proposed projects, which they allege would fund Medicaid providers to save money by steering people to choose death over living with disability.

New York requested public comments because it is offering grants to Medicaid “safety net” providers with a high proportion of Medicaid patients to reduce unnecessary hospitalizations. Among the 44 potential programs for grant applicants to consider are three palliative care projects.

One of these projects is entitled “Conversation Ready,” and promotes advance care planning as a means of reducing hospitalizations. For this to be effective, the comment letter states that people on Medicaid would apparently be encouraged to refuse life-sustaining treatment as part of their advance care plan.

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The Charleston Post & Courier published a letter from Neah Kelly about legislation to allow video cameras in nursing homes to protect resident and prevent waste and fraud. See letter below:

“The S.C. Senate Medical Affairs Committee’s recent 7-7 vote on legislation to allow residents of nursing homes to install electronic monitoring systems demonstrates a need for more critical analysis of the subject. The news has been inundated with reports on alleged neglect of nursing home residents throughout the nation. No one can argue there is a need to ensure better care and treatment of our elderly.

Many abuse cases that have been in the media were exposed through the use of video cameras that had been placed by family members trying to confirm the safety of their loved ones. This has resulted in residents and family members pressing for more legislation to allow the use of video cameras.

The issue has sparked much discussion and brought with it a multitude of principled questions, which must be discussed when creating and implementing a new policy.

We must not forget that these are places residents call their home, where all their private and personal moments take place.

This should be a place of peace, comfort and security, but some are living out their final days in a desperate torture unable to speak up for themselves.

Those who support the use of electronic monitoring believe that it will end or significantly reduce the instances of cruelty and negligence in facilities and thereby improve the residents’ quality of life and well-being. The use of video surveillance could also eliminate suspicion of any wrongdoing on behalf of the facility.

Those who are opposed to residents’ use of cameras in the nursing home often stress concern that retaining staff will be more difficult, given the scrutiny of electronic monitoring. Another concern is how to maintain the privacy rights of the staff and residents.

These ethical and privacy concerns need to be evaluated against the weighty cost of abuse and neglect. Currently, there are no federal laws that directly address this issue.

Under the Federal Residents Rights regulation, 483.10, residents have the right to self-determination, dignified existence and communication with persons inside and outside the nursing home, and nursing homes must protect and promote these rights.

Texas and New Mexico are the first two states to enact legislation to permit the installation of cameras by nursing home residents. Neither statute allows for covert monitoring.

Until we can be assured that our loved ones placed in care facilities are being properly cared for, the dispute over the use of video cameras is not going away. Nor should it.

Video cameras cannot take the place of proper training and care on behalf of the staff, but they can add to a resident’s sense of security. Protecting the rights of the resident should be of the utmost importance.

The residents have the right to safety, privacy and dignity. According to the Administration on Aging, there annually are more than two million reported cases of elder abuse, neglect or exploitation in the U.S.

It is believed that for every reported case of elder mistreatment or negligence, up to five cases do not get reported. Unfortunately elder abuse happens, but we can all act to protect seniors.

Do not let Senate bill 662 stay undecided. Call for reform, for action. Be a voice. Be an advocate.”

Gene Uzawa Dorio, M.D., is a housecall geriatric physician on staff at Henry Mayo Newhall Memorial Hospital and has been engaged as an advocate in many community activities. He wrote a Commentary for SCVNews.com.  Below are excerpts of that article:

“As a geriatric physician, I have visited patients in nursing homes for more than a quarter of a century. (Personally, I have vowed to make sure this stop is not on my bucket list.) Why do so many of my elder senior patients already know about the care rendered at these facilities? Easy. They see their parents, spouses, family members and friends arrive there, never to leave. From a physician’s perspective in our country, hospitals admit the patient, make a diagnosis, start treatment, then triage them out as quickly as possible to save money. Because home care, assisted-living facilities and board-and-care homes are not capable or legally allowed to continue this care, patients have no choice but to go to a nursing home.

Here are the problems:

* Once a patient is admitted to a SNF, continuity of care is lost. Only one doctor sees the patient, and that is once a month. You will not see a neurologist, orthopedist, gastroenterologist, pulmonologist, nor any other specialist once you are admitted, as they do not go to nursing homes. Any ensuing medical problem or complication can easily be missed.

* Nursing homes are underfunded. Not only do they have to jump through the medical and legal hoops of state and federal regulations; they also must budget based upon low Medicare-Medicaid-insurance reimbursement. Sometimes the level and quality of care is minimal.

 

Tracy Deckman, who works for Senior Dental Services, contacted us to inform us that Senior Dental Services brings dental care to nursing homes at no additional cost to the resident or facility. Their website is www.elderlydental.com.  According to the U.S. Surgeon General, 70% of long-term care residents are not provided with acceptable dental care.

Unlike years ago, 50-75% of all nursing home residents today keep their own teeth into their senior years. A study conducted by the American Academy of Periodontology concluded, “people with gum disease are at double the risk of developing cardiac disease and stroke in comparison to those with healthy gums.

Furthermore, long-term care facilities lack the time, staff, or other resources needed to provide oral hygiene.  However, Senior Dental Services is dedicated to providing a solution to the lack of oral hygiene care and improving the quality of life for LTC residents.

 

The Republic reported that Florida lawmakers, after granting immunity to nursing home owners who systematically neglect and abuse residents, ended the session by killing an omnibus health bill that would have expanded the powers of nurse practitioners and promoted the use of telemedicine.  Proponents said both measures would reduce health care costs and address a critical shortage of primary care physicians in the state.

Several hospitals around the state have had success with telemedicine in recent years, helping patients in rural areas connect to specialists or getting multiple consultations conducted simultaneously for acute emergency cases.  But the powerful Florida Medical Association opposed the telemedicine provision and warned that nurse practitioners should not have powers to prescribe controlled substances without a doctor’s supervision in a state that has been a hotbed for pill mills.

 

The Washington Post recently reported on the premium payment rates for private insurers based on testimony before Congress.  House Republicans summoned a half-dozen health insurance executives to a hearing but insurers refused to go along with the plan to criticize ObamaCare, and surprised Republican critics of the law by undercutting some of their arguments against it. Insurers, appearing before a panel of the Energy and Commerce Committee, testified that the law had not led to a government takeover of their industry, as some Republicans had predicted. Indeed, several insurers said their stock prices had increased in the last few years.

Top health insurance companies also told members of Congress that more than 80 percent of people who’ve signed up under the president’s new health care law have gone on to pay their premiums — a necessary step for the enrollment figures touted by the Obama administration to hold up.

Aetna reported payment rates in “the low- to mid-80 percent range;” Wellpoint said the rate was as high as 90 percent for those whose premium had come due; the Blue Cross and Blue Shield Association said 80 to 85 percent; and the Health Care Service Corporation, which sells Blue Cross Blue Shield plans in five states, pegged the rate at 83 percent or above. The figures were in line with what individual insurers have said on earnings calls with analysts and elsewhere in recent weeks. These figures are the latest sign that the health care law has defied its critics and is working.

 

McKnights wrote on the findings of a study in Health Affairs which indicates that nursing homes are sending residents with dementia to the hospital more often than is needed during their last year of life. Two-thirds of the patients reviewed in the study had at least one potentially avoidable hospital stay during their final year.  The study examined data from 2000 to 2008 and tracked over 12,000 individuals to find these patterns. The information highlights the need to have advanced care planning in place for individuals with dementia long before death.

 Ken Myers is a father of three and passionate about great care. He’s always looking for ways to help families find the support they need to live fuller, richer lives. Find out more about expert care by checking out @go_nannies on Twitter.  Ken explains GoNannies below:

About GoNannies: Business and Benefits
You can never be too careful when it comes to choosing the right person to provide care for your relatives. Although some of the elderly are capable of maintaining themselves, others may require greater assistance. Care can be provided in a variety of ways to help those that are advancing in years. GoNannies.com can help you find the right person for to fit your requirements.

Available Services

GoNannies.com is more than just a nanny service. It is a company that provides care to the human element regardless of age. Whether you need help with your child, elderly parent or simply need someone to assist you throughout the day; you can find the help you need. Some of the services provided include:
• Child Nannies
• Senior Care
• Housekeeping
• Personal Assistants
• In-house Chefs
• Domestic Care

Child Nannies – Experienced and versatile staff wait to care for your child. Handpick those individuals you want to interview in order to find the right person for your family dynamic.

Senior Care – There is a wide range of care that a senior could need. This could range from general help around the house to full physical assistance. Qualified professionals are available to help with every contingency.

Housekeeping – Whether you need help around the house or want to provide a method for your aging parents to relax, professional housekeepers can be of a great benefit.

Personal Assistants – For those that seem too busy to breathe most days, a personal assistant can help keep family and career balanced. Sometimes an extra pair of hands is all you’ll need in order to maintain or even improve your lifestyle.

In-House Chefs – For those that wish they had the time to provide healthier home-cooked meals, an in-house personal chef could provide nutrition as opposed to take-out.

Domestic Care – Having a household manager could be greatly beneficial in order to maintain schedules and plan various events. How often have you forgotten to make doctor’s appointments while pushing through your busy day?
Benefits of GoNannies

When choosing the right agency, you want to know that you’re making the right decision. You want to feel assured that your needs are being addressed. You want to benefit from services such as:
• Free background checks
• Live support
• Secured job postings
• Complete hiring tools

Free Background Checks – Background checks can provide a great deal of information about a potential candidate. Why settle for putting your faith in the word of someone you’ve never met?

Live Support – Regardless of your care-giving needs, GoNannies provides live support to answer any questions you may have concerning the process of finding and maintaining in-house help.

Secured Job Postings – With extensive privacy policy settings, listing your specific job doesn’t have to feel like you’re putting your information out there for the world to see. There is far more security in place at GoNannies than most alternative classified ad systems.

Complete Hiring Tools – GoNannies provides you with everything you’ll need in a hiring kit in order to help you find the most qualified individual for your requirements. Forms, interview guidelines, expert consultations and more are available.

Ann Murray contacted us to let us know about an exciting new super food.  Ambronite is a real food super meal on a mission to make healthy eating as easy as 1-2-3.  They have created the world’s first real food super meal that fulfills 100% of daily nutrition recommendations, avoids soy powder, and has no fake flavors. Ambronite tastes like oats and fresh nuts with a hint of Nordic herbs and berries. Ambronite has already raised tens of thousands of dollars in global pre-orders and launched yesterday with a creative Indiegogo crowdfunding campaign.

To create this super meal, a Finnish “food tech” team asked a bold question: What real food ingredients would be included in the “perfect” meal and how can we source those foods, combine them in right proportions for daily nutrition, and make them tasty?  The result is Ambronite, a revolutionary drinkable meal.  See video here.

 

 

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Last Friday, Congressmen Earl Blumenauer (OR-03) and Chris Smith (NJ-04) introduced HR 4543, the PACE Pilot Act, a bipartisan and budget neutral bill that would allow The Program of All-Inclusive Care for the Elderly (PACE) programs greater flexibilities to expand their successful model to care for people under age 55 who have special health risks.  This is great news for people who do not want to go to a nursing home. 

PACE integrates Medicare and Medicaid benefits for members of our society who have some of the most serious and costly health care problems. The program seeks to keep people living in the community rather than in long-term care institutions. Currently, PACE is only available to individuals age 55 or older and who are certified by their state as being eligible for a nursing home level of care.

Expansion of these programs will offer younger individuals with disabilities this same integrated, community-based option that supports their independence and quality of life.

“PACE has been a huge success,” said Blumenauer. “What we have realized is that there is a group of people out there who currently don’t qualify for PACE because of the age requirement, but would otherwise greatly benefit from the program due to serious medical conditions. This bill allows us to see how we can bring them into the fold efficiently and affordably.”

“PACE continues to provide patient centric care to many of the frailest members in our society, while enabling them to live in their homes and stay in their communities,” said Smith. “We know that all PACE participants are eligible for nursing home care, yet 90 percent continue to live at home. By removing the nursing home level of care requirement, we can help ensure that people have greater access to preventative services and treatments, thereby helping them maintain their quality of life.” 

Currently, a total of 103 PACE sites in 31 states serve about 56,000 enrollees nationwide. A number of research studies show that beneficiaries enrolled in PACE had fewer hospitalizations and nursing home admissions, and lower mortality than similar beneficiaries who were not enrolled in PACE.