Original Story: chicago.suntimes.com
Blocking traffic along Michigan Avenue on the Magnificent Mile, chanting and waving signs, hundreds of protesters gathered Monday to rail against Gov. Bruce Rauner’s proposed budget cuts, which they say will be devastating to Illinois’ poorest and most vulnerable citizens.
One particular budget item attracted dozens of protesters in their 70s and 80s. It would affect senior citizens who depend on the Community Care Program, which provides state money to pay for home care for seniors.
And Patricia Drennan wasn’t having any of it.
“A lot of us old ladies don’t have kids that live here that can take us to the doctor and come in and run the vacuum cleaner and get us to the grocery store and all that,” said Drennan, 82, who lives alone in the North Center neighborhood.
The program, she said, helps seniors live independently and keeps them out out nursing homes, an expense that would be much greater to taxpayers.
Drennan feared a plan by Rauner that would implement new qualifying restrictions that would make it harder for seniors to gain access to the program. Livonia senior care provides highly skilled nurses ready to serve even the most advanced medical needs.
About 30 protesters held hands and blocked Michigan Avenue just north of the Michigan Avenue Bridge for nearly 20 minutes at about 11:30 a.m. before police escorted the group off the roadway.
Sister Gwen Farry, 81, with the Sisters of Charity of the Blessed Virgin Mary, was among the group of traffic blockers who expected to receive citations from police.
“This is a moral issue,” said Farry, of St. Thomas the Apostle Catholic Church in Hyde Park. “I’ve made phone calls and signed online petitions but wanted to do more to protest the cuts that will affect the most vulnerable in our state.” Plymouth MI elder care services provides medical and non-medical support for catastrophic care patients.
Protesters called for wealthy corporations and residents in Illinois to pay more taxes.
Critics say Rauner is using potential cuts to state social service programs as leverage to gain support for fighting unions.
A statement issued by a Rauner spokeswoman after the protest read: “The administration has taken a series of management steps to responsibly manage the state’s finances, because Speaker Madigan, Senate President Cullerton and the legislators Madigan controls overspent taxpayer money causing a $4 billion deficit. The governor has tried to negotiate on critical reforms to free up resources to help the most vulnerable and pass a balanced budget, but unfortunately, the Speaker continues to block those reforms at the expense of the most vulnerable and the middle class.” A Livonia elder care provider is following this story closely.
The protest was organized by a number of activist groups, including Jane Addams Senior Caucus and Fair Economy Illinois.
Showing posts with label Elder Care. Show all posts
Showing posts with label Elder Care. Show all posts
05 September 2014
MEDICARE STAR RATINGS ALLOW NURSING HOMES TO GAME THE SYSTEM
Original Story, NYTimes.com
CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes. A Milwaukee Nursing Home Lawyer is familiar with these types of facilities.
What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.
But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes. A Nashville Nursing Home Litigation Attorney has experience representing clients in nursing home negligence cases.
The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.
The ratings also do not take into account entire sets of potentially negative information, including fines and other enforcement actions by state, rather than federal, authorities, as well as complaints filed by consumers with state agencies. Last year, the State of California, for example, fined Rosewood $100,000 — the highest penalty possible — for causing the 2006 death of a woman who was given an overdose of a powerful blood thinner.
From 2009 to 2013, California fielded 102 consumer complaints and reports of problems at Rosewood, according to a state website. California Advocates for Nursing Home Reform, which also tracks complaints, put the number even higher, at 164, which it says is twice the state average. Nursing home officials are appealing the state fine and point out that only a small fraction of the complaints at Rosewood, which has about 110 beds, have ever been substantiated. While that may be true, the sheer number could be a sign of trouble, industry experts say.
In interviews conducted during a recent visit, a half dozen current and former residents, including some who had lived in other homes, said they did not believe that the home merited a five-star rating. “If I fell down, they’d pick me up, but that’s about it,” said Michael McFadden, 76, who has lived at Rosewood for several years.
John L. Sorensen, the chief executive of North American Health Care, the chain that operates Rosewood, said the quality of the home was excellent. “I would put my parent there,” he said.
Rosewood struggles with many of the same challenges faced by other nursing homes around the country, offering a window into the rating system’s flaws, The Times found. Many residents live three to a room, and there is often a scarcity of basic supplies like washcloths, as well as a shortage of quality staff, according to interviews with current and former patients, their families and statements from former employees.
Lawsuits From Families
Rosewood has also been the subject of about a dozen lawsuits in recent years from patients and their families claiming substandard care.
“It looks nice when you walk in,” said Bonnie Nathan, who said she placed her mother in Rosewood in 2010 mainly because of its five-star rating. She is now suing the home because she claims that workers there failed to treat her mother, Janet Zagon, for a respiratory condition that led to her death. “But I really didn’t have a sense of where patients were going to be cared for,” Ms. Nathan said.
Mr. Sorensen said that his nursing home was not at fault and that even excellent homes occasionally make mistakes.
“While we have had a few problems, they’re pretty minor compared to the overall accomplishments and tremendous customer satisfaction that’s being provided,” he said. The many lawsuits against Rosewood could be attributed to a “very litigious marketplace” in the Sacramento area, he said, and not to poor quality at the nursing home.
Receiving a high star rating has never been more important to nursing homes. When nurses and doctors discharge patients from hospitals, they often use the ratings in referral decisions, and insurers consider them when setting up preferred networks. The ratings are also often a first stop for investors and lenders, who consult them to decide whether a nursing home company is a safe bet.
“This whole program has walked into parts of our industry that we never expected,” said Steven Littlehale, executive vice president and chief clinical officer at PointRight, one of a handful of consulting firms that advise nursing homes on how to improve their ratings.
Widespread acceptance of the ratings is leading to their use beyond the elder-care industry. Beginning this year, Medicare plans to introduce similar five-star ratings for hospitals, dialysis centers and home-health-care agencies.
Federal officials say that while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better.
“We have seen improvements,” said Dr. Patrick Conway, the chief medical officer at the Centers for Medicare and Medicaid Services. As evidence, he pointed to a decrease in the use of physical restraints by nursing homes and in the number of homes reporting bedsores among patients at a high risk of developing them.
But some nursing homes are not truly improving. Instead, they have learned how to game the rating system, according to interviews with current and former nursing home employees, lawyers and patient advocacy groups.
Nationally, the proportion of homes with above-average ratings has risen steadily. In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did.
The Times analysis shows that even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data. Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics. The same homes do not fare as well on the sole criterion that is based on an independent review. More than 95 percent of the homes on the watch list received one or two stars for the health inspection, which is conducted by state workers.
“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” said Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy, a nonprofit organization that helps patients. “It seems implausible.”
‘False Sense of Security’
The seed of Medicare’s five-star rating system was planted in 2007, when during a congressional hearing, Senator Ron Wyden, Democrat of Oregon, asked why it was easier to shop for washing machines than it was to select a nursing home. Medicare officials set up the rating system in 2009, a move that was applauded by consumer groups, who hoped that more transparency would lead to greater accountability.
The nursing home industry, which lobbied against the ratings, later largely embraced them. An industry trade group, the American Health Care Association, offers members a free service that helps companies track their star rating; it says the rising scores are evidence that quality is improving.
Some advocates say the rating system is the best resource available. “I think it’s imperfect, but it’s by far the most valuable tool for people,” said Richard J. Mollot, executive director of the Long Term Care Community Coalition.
Other patients’ groups consider the ratings so inflated that they no longer support their use and have found them helpful only in weeding out the worst-performing homes.
“They’ve given a false sense of security to the public,” Carole Herman, president of the Foundation Aiding the Elderly, a Sacramento patients’ rights group, said.
One of the simplest ways to inflate a score, according to interviews with academics and groups that monitor the process, is through the staffing measure. Nursing homes get an extra star on their overall rating if they score a four- or five-star rating on staff levels.
In 2009, only 39 percent of nursing homes had a four- or five-star rating for staff levels. By 2013, 52 percent did.
The staff rating is based on a form that a home completes once a year, at the time of the annual inspection. Homes often know when an inspection will occur, and many of them have learned to add workers in the period leading up to it.
The inspection period is so crucial that in 2010, an administrator at a home on Long Island described it as “our Super Bowl” and explained that staff levels would drop once the inspection was completed. “The staffing hours will be a little high for this week but will drop the following week,” David Fielding, the administrator of the home, the Medford Multicare Center for Living, wrote in an email, which was excerpted in a lawsuit filed this year against the home by the New York State attorney general.
Since 2008, more than a dozen employees at the Medford home have been convicted on charges of patient neglect and falsification of records. In June, nine more were indicted on a range of charges related to the death of a 72-year-old woman, Aurelia Rios. Medford nonetheless holds a three-star, or average, rating from Medicare and a four-star rating for its health inspection, and state health workers reported no deficiencies during the home’s most recent health inspection last August.
A provision of the Affordable Care Act of 2010 requires Medicare to use payroll data to verify the accuracy of staff levels, but the agency has not begun to follow the requirement. The agency said it was still working on the verification system and hoped to have it running soon.
The other major part of the ratings that is not checked by Medicare, the so-called quality measures, is also susceptible to manipulation. The score in this area is based on data collected by the home about every patient, such as whether bedridden or wheelchair patients are developing bedsores and how many residents experience serious falls.
Nursing homes receive an extra star on their overall rating if they get five stars in this area. The number of nursing homes with five stars in quality measures has increased significantly since the beginning of the program, to 29 percent in 2013 from 11 percent in 2009.
“They need to spot-audit those, but they haven’t done it,” said Charlene Harrington, a professor emeritus at the University of California, San Francisco, School of Nursing, who is an expert on nursing home staffing.
Federal officials acknowledged that the quality measures rating needed improvement and said they were testing an auditing program that they hoped to expand nationally. The agency also plans to consider additional metrics, such as the number of residents being given antipsychotic drugs.
Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, the nursing home trade group, says the ratings have had a positive effect on the industry. “I think it’s helped move us all along in the right direction,” he said, adding that any suggestion that facilities were manipulating their ratings was far-fetched. “I have not seen any evidence of that or heard any evidence of it,” he said.
A Five-Star Pursuit
Few have pursued top ratings with more zeal than North American Health Care, which operates Rosewood and 34 other nursing homes scattered across California and three other Western states. Each of the chain’s nursing homes has a five-star rating, and the company maintains a team of more than 30 nurses who conduct mock inspections to ensure the homes perform well. In recent years, the chain has awarded $50,000 bonuses to nursing home administrators who achieve or maintain a five-star rating.
“It’s everything to us,” Mr. Sorensen, the chief executive of North American, said. “If you create a product that people can trust and admire, the profits that you hope for — they follow as a result of excellence.”
Despite the chain’s exemplary performance in the Medicare ratings, Rosewood is not the only one of its homes to have had problems that are not reflected in the score. State inspectors concluded that staff at another home, Chatsworth Park Health Care Center in Los Angeles, neglected in 2010 and 2011 to properly care for a man with Parkinson’s disease who developed malnutrition and extensive bedsores, which typically occur because of substandard care, and later died.
At another of the chain’s nursing homes, the Grand Terrace Care Center near San Bernardino, Calif., the staff failed in 2010 to properly care for a woman with diabetes and other conditions. The coroner ruled that her death was due in part to a urinary tract infection and bedsores that had become so bad, they had developed gangrene and were infested with maggots, according to a state report about the case.
In 2010, when both episodes took place, Chatsworth carried an overall rating of three stars, and Grand Terrace was rated four stars. Both now hold five-star ratings.
Mr. Sorensen said his staff disputed the facts in these cases, and he maintained that the residents received good care.
Neither case shows up on the Medicare website. Until recently, California often refused to cite nursing homes for federal-level violations, the only type that counts toward a star rating. State workers are responsible for enforcing both state and federal laws governing nursing homes. A spokesman for the California Department of Public Health said the state was now doing so.
Dr. Conway, of the Centers for Medicare and Medicaid Services, said his agency worked hard to make sure states were enforcing federal law but acknowledged that there had been problems. “We are aware of some issues with states,” he said, adding that the federal website warned consumers that state actions were not listed there. Still, he said, “the goal would be not to have that gap.”
North American is also under investigation by the office of the inspector general for the federal Health and Human Services Department. Mr. Sorensen declined to say what the investigation entailed, and a spokesman for the inspector general’s office would not comment. It is not publicly known whether the investigation relates to care.
Ed Dudensing, a Sacramento lawyer who has represented several clients against the chain’s homes, including Rosewood, said he had deposed more than 30 current and former employees of North American Health Care in recent years. Based on those interviews, he said, “I strongly disagree with the suggestion that its nursing homes are five-star quality.”
Mr. Sorensen said the lawsuits against Rosewood were without merit. “We’re in this business because we want to do the right thing for our patients,” he said. “That is our agenda.”
In 2012, nearly all of North American Health Care’s nursing homes held four- or five-star ratings for staff levels, an outcome that Mr. Sorensen attributed to the company’s investment in quality workers.
Nevertheless, an analysis by The Times of 2012 staffing data reported by North American’s nursing homes in California shows that the company consistently reported higher levels of staffing to Medicare than it reported to Medi-Cal, California’s health care program for the poor, which audits the data.
The chain’s 29 homes in California reported staff levels to the federal government that were on average 23 percent higher than what they reported to the state in 2012, the most recent year for which state data were available. Statewide, California nursing homes reported levels to Medicare that were 15 percent higher than what they reported to Medi-Cal.
Mr. Sorensen said the state and federal staff data could not be compared because some employees, like the director of nursing and other supervisory positions, were not counted by the state but were counted at the federal level. He said the disparity could also be a result of different reporting periods and month-to-month variations in staff and patient levels.
A spokesman for the California Office of Statewide Health Planning and Development said that supervisory positions like the director of nursing were included in state staff data and that the main reason for the disparity was probably that the federal data accounted only for the two weeks preceding the annual survey, while the state data reflected the whole year.
Ms. Harrington, who sits on the technical advisory board for Medicare’s rating system and has served as an expert witness on behalf of plaintiffs suing nursing homes, said the disparity showed that the chain’s homes were probably adding people before the annual inspection. “They’re inflating their staffing,” she said.
Even as North American’s nursing homes were reporting high levels of staffing to Medicare, executives were focusing on keeping labor costs low, according to interviews with former employees and records made available in connection with lawsuits.
In 2011, for example, the nursing home administrator at Rosewood eliminated six full-time jobs and cut back on staff hours just days after the annual inspection was completed, according to emails the chain provided to plaintiff lawyers in a pending lawsuit against Rosewood. Ms. Harrington described such cuts as “substantial.” The home received a four-star rating in staffing that year.
Kyle Dahl, Rosewood’s administrator at the time, said in an interview that the staff reductions had been made to prepare for expected cuts to Medicare and Medi-Cal. But he acknowledged that consultant nurses were often brought in before the annual inspection to prepare the home. Their presence also had the effect of keeping staff levels higher than usual. Mr. Dahl likened the annual inspection to a visit from one’s mother-in-law. “You might throw an extra vacuum over the carpet to make sure everything looks good,” he said. “People could potentially staff up during that time period.”
For some families, however, all that effort did not translate to high-quality care, and they said they wished they had better options. Elizabeth Chandler and her husband, Ken, placed his mother in Rosewood in 2011 to recover from a broken femur. Ms. Chandler said she had been impressed that Rosewood had a top rating, “like a hotel.”
Mr. Chandler’s mother died after experiencing serious falls at the home, and the family is suing Rosewood. Ms. Chandler said she felt misled by the rating system.
“You don’t know where to look to get accurate information,” she said. “I can go and find a preschool for my child better than I can find a skilled nursing facility for my loved one.”
CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes. A Milwaukee Nursing Home Lawyer is familiar with these types of facilities.
What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.
But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes. A Nashville Nursing Home Litigation Attorney has experience representing clients in nursing home negligence cases.
The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.
The ratings also do not take into account entire sets of potentially negative information, including fines and other enforcement actions by state, rather than federal, authorities, as well as complaints filed by consumers with state agencies. Last year, the State of California, for example, fined Rosewood $100,000 — the highest penalty possible — for causing the 2006 death of a woman who was given an overdose of a powerful blood thinner.
From 2009 to 2013, California fielded 102 consumer complaints and reports of problems at Rosewood, according to a state website. California Advocates for Nursing Home Reform, which also tracks complaints, put the number even higher, at 164, which it says is twice the state average. Nursing home officials are appealing the state fine and point out that only a small fraction of the complaints at Rosewood, which has about 110 beds, have ever been substantiated. While that may be true, the sheer number could be a sign of trouble, industry experts say.
In interviews conducted during a recent visit, a half dozen current and former residents, including some who had lived in other homes, said they did not believe that the home merited a five-star rating. “If I fell down, they’d pick me up, but that’s about it,” said Michael McFadden, 76, who has lived at Rosewood for several years.
John L. Sorensen, the chief executive of North American Health Care, the chain that operates Rosewood, said the quality of the home was excellent. “I would put my parent there,” he said.
Rosewood struggles with many of the same challenges faced by other nursing homes around the country, offering a window into the rating system’s flaws, The Times found. Many residents live three to a room, and there is often a scarcity of basic supplies like washcloths, as well as a shortage of quality staff, according to interviews with current and former patients, their families and statements from former employees.
Lawsuits From Families
Rosewood has also been the subject of about a dozen lawsuits in recent years from patients and their families claiming substandard care.
“It looks nice when you walk in,” said Bonnie Nathan, who said she placed her mother in Rosewood in 2010 mainly because of its five-star rating. She is now suing the home because she claims that workers there failed to treat her mother, Janet Zagon, for a respiratory condition that led to her death. “But I really didn’t have a sense of where patients were going to be cared for,” Ms. Nathan said.
Mr. Sorensen said that his nursing home was not at fault and that even excellent homes occasionally make mistakes.
“While we have had a few problems, they’re pretty minor compared to the overall accomplishments and tremendous customer satisfaction that’s being provided,” he said. The many lawsuits against Rosewood could be attributed to a “very litigious marketplace” in the Sacramento area, he said, and not to poor quality at the nursing home.
Receiving a high star rating has never been more important to nursing homes. When nurses and doctors discharge patients from hospitals, they often use the ratings in referral decisions, and insurers consider them when setting up preferred networks. The ratings are also often a first stop for investors and lenders, who consult them to decide whether a nursing home company is a safe bet.
“This whole program has walked into parts of our industry that we never expected,” said Steven Littlehale, executive vice president and chief clinical officer at PointRight, one of a handful of consulting firms that advise nursing homes on how to improve their ratings.
Widespread acceptance of the ratings is leading to their use beyond the elder-care industry. Beginning this year, Medicare plans to introduce similar five-star ratings for hospitals, dialysis centers and home-health-care agencies.
Federal officials say that while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better.
“We have seen improvements,” said Dr. Patrick Conway, the chief medical officer at the Centers for Medicare and Medicaid Services. As evidence, he pointed to a decrease in the use of physical restraints by nursing homes and in the number of homes reporting bedsores among patients at a high risk of developing them.
But some nursing homes are not truly improving. Instead, they have learned how to game the rating system, according to interviews with current and former nursing home employees, lawyers and patient advocacy groups.
Nationally, the proportion of homes with above-average ratings has risen steadily. In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did.
The Times analysis shows that even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data. Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics. The same homes do not fare as well on the sole criterion that is based on an independent review. More than 95 percent of the homes on the watch list received one or two stars for the health inspection, which is conducted by state workers.
“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” said Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy, a nonprofit organization that helps patients. “It seems implausible.”
‘False Sense of Security’
The seed of Medicare’s five-star rating system was planted in 2007, when during a congressional hearing, Senator Ron Wyden, Democrat of Oregon, asked why it was easier to shop for washing machines than it was to select a nursing home. Medicare officials set up the rating system in 2009, a move that was applauded by consumer groups, who hoped that more transparency would lead to greater accountability.
The nursing home industry, which lobbied against the ratings, later largely embraced them. An industry trade group, the American Health Care Association, offers members a free service that helps companies track their star rating; it says the rising scores are evidence that quality is improving.
Some advocates say the rating system is the best resource available. “I think it’s imperfect, but it’s by far the most valuable tool for people,” said Richard J. Mollot, executive director of the Long Term Care Community Coalition.
Other patients’ groups consider the ratings so inflated that they no longer support their use and have found them helpful only in weeding out the worst-performing homes.
“They’ve given a false sense of security to the public,” Carole Herman, president of the Foundation Aiding the Elderly, a Sacramento patients’ rights group, said.
One of the simplest ways to inflate a score, according to interviews with academics and groups that monitor the process, is through the staffing measure. Nursing homes get an extra star on their overall rating if they score a four- or five-star rating on staff levels.
In 2009, only 39 percent of nursing homes had a four- or five-star rating for staff levels. By 2013, 52 percent did.
The staff rating is based on a form that a home completes once a year, at the time of the annual inspection. Homes often know when an inspection will occur, and many of them have learned to add workers in the period leading up to it.
The inspection period is so crucial that in 2010, an administrator at a home on Long Island described it as “our Super Bowl” and explained that staff levels would drop once the inspection was completed. “The staffing hours will be a little high for this week but will drop the following week,” David Fielding, the administrator of the home, the Medford Multicare Center for Living, wrote in an email, which was excerpted in a lawsuit filed this year against the home by the New York State attorney general.
Since 2008, more than a dozen employees at the Medford home have been convicted on charges of patient neglect and falsification of records. In June, nine more were indicted on a range of charges related to the death of a 72-year-old woman, Aurelia Rios. Medford nonetheless holds a three-star, or average, rating from Medicare and a four-star rating for its health inspection, and state health workers reported no deficiencies during the home’s most recent health inspection last August.
A provision of the Affordable Care Act of 2010 requires Medicare to use payroll data to verify the accuracy of staff levels, but the agency has not begun to follow the requirement. The agency said it was still working on the verification system and hoped to have it running soon.
The other major part of the ratings that is not checked by Medicare, the so-called quality measures, is also susceptible to manipulation. The score in this area is based on data collected by the home about every patient, such as whether bedridden or wheelchair patients are developing bedsores and how many residents experience serious falls.
Nursing homes receive an extra star on their overall rating if they get five stars in this area. The number of nursing homes with five stars in quality measures has increased significantly since the beginning of the program, to 29 percent in 2013 from 11 percent in 2009.
“They need to spot-audit those, but they haven’t done it,” said Charlene Harrington, a professor emeritus at the University of California, San Francisco, School of Nursing, who is an expert on nursing home staffing.
Federal officials acknowledged that the quality measures rating needed improvement and said they were testing an auditing program that they hoped to expand nationally. The agency also plans to consider additional metrics, such as the number of residents being given antipsychotic drugs.
Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, the nursing home trade group, says the ratings have had a positive effect on the industry. “I think it’s helped move us all along in the right direction,” he said, adding that any suggestion that facilities were manipulating their ratings was far-fetched. “I have not seen any evidence of that or heard any evidence of it,” he said.
A Five-Star Pursuit
Few have pursued top ratings with more zeal than North American Health Care, which operates Rosewood and 34 other nursing homes scattered across California and three other Western states. Each of the chain’s nursing homes has a five-star rating, and the company maintains a team of more than 30 nurses who conduct mock inspections to ensure the homes perform well. In recent years, the chain has awarded $50,000 bonuses to nursing home administrators who achieve or maintain a five-star rating.
“It’s everything to us,” Mr. Sorensen, the chief executive of North American, said. “If you create a product that people can trust and admire, the profits that you hope for — they follow as a result of excellence.”
Despite the chain’s exemplary performance in the Medicare ratings, Rosewood is not the only one of its homes to have had problems that are not reflected in the score. State inspectors concluded that staff at another home, Chatsworth Park Health Care Center in Los Angeles, neglected in 2010 and 2011 to properly care for a man with Parkinson’s disease who developed malnutrition and extensive bedsores, which typically occur because of substandard care, and later died.
At another of the chain’s nursing homes, the Grand Terrace Care Center near San Bernardino, Calif., the staff failed in 2010 to properly care for a woman with diabetes and other conditions. The coroner ruled that her death was due in part to a urinary tract infection and bedsores that had become so bad, they had developed gangrene and were infested with maggots, according to a state report about the case.
In 2010, when both episodes took place, Chatsworth carried an overall rating of three stars, and Grand Terrace was rated four stars. Both now hold five-star ratings.
Mr. Sorensen said his staff disputed the facts in these cases, and he maintained that the residents received good care.
Neither case shows up on the Medicare website. Until recently, California often refused to cite nursing homes for federal-level violations, the only type that counts toward a star rating. State workers are responsible for enforcing both state and federal laws governing nursing homes. A spokesman for the California Department of Public Health said the state was now doing so.
Dr. Conway, of the Centers for Medicare and Medicaid Services, said his agency worked hard to make sure states were enforcing federal law but acknowledged that there had been problems. “We are aware of some issues with states,” he said, adding that the federal website warned consumers that state actions were not listed there. Still, he said, “the goal would be not to have that gap.”
North American is also under investigation by the office of the inspector general for the federal Health and Human Services Department. Mr. Sorensen declined to say what the investigation entailed, and a spokesman for the inspector general’s office would not comment. It is not publicly known whether the investigation relates to care.
Ed Dudensing, a Sacramento lawyer who has represented several clients against the chain’s homes, including Rosewood, said he had deposed more than 30 current and former employees of North American Health Care in recent years. Based on those interviews, he said, “I strongly disagree with the suggestion that its nursing homes are five-star quality.”
Mr. Sorensen said the lawsuits against Rosewood were without merit. “We’re in this business because we want to do the right thing for our patients,” he said. “That is our agenda.”
In 2012, nearly all of North American Health Care’s nursing homes held four- or five-star ratings for staff levels, an outcome that Mr. Sorensen attributed to the company’s investment in quality workers.
Nevertheless, an analysis by The Times of 2012 staffing data reported by North American’s nursing homes in California shows that the company consistently reported higher levels of staffing to Medicare than it reported to Medi-Cal, California’s health care program for the poor, which audits the data.
The chain’s 29 homes in California reported staff levels to the federal government that were on average 23 percent higher than what they reported to the state in 2012, the most recent year for which state data were available. Statewide, California nursing homes reported levels to Medicare that were 15 percent higher than what they reported to Medi-Cal.
Mr. Sorensen said the state and federal staff data could not be compared because some employees, like the director of nursing and other supervisory positions, were not counted by the state but were counted at the federal level. He said the disparity could also be a result of different reporting periods and month-to-month variations in staff and patient levels.
A spokesman for the California Office of Statewide Health Planning and Development said that supervisory positions like the director of nursing were included in state staff data and that the main reason for the disparity was probably that the federal data accounted only for the two weeks preceding the annual survey, while the state data reflected the whole year.
Ms. Harrington, who sits on the technical advisory board for Medicare’s rating system and has served as an expert witness on behalf of plaintiffs suing nursing homes, said the disparity showed that the chain’s homes were probably adding people before the annual inspection. “They’re inflating their staffing,” she said.
Even as North American’s nursing homes were reporting high levels of staffing to Medicare, executives were focusing on keeping labor costs low, according to interviews with former employees and records made available in connection with lawsuits.
In 2011, for example, the nursing home administrator at Rosewood eliminated six full-time jobs and cut back on staff hours just days after the annual inspection was completed, according to emails the chain provided to plaintiff lawyers in a pending lawsuit against Rosewood. Ms. Harrington described such cuts as “substantial.” The home received a four-star rating in staffing that year.
Kyle Dahl, Rosewood’s administrator at the time, said in an interview that the staff reductions had been made to prepare for expected cuts to Medicare and Medi-Cal. But he acknowledged that consultant nurses were often brought in before the annual inspection to prepare the home. Their presence also had the effect of keeping staff levels higher than usual. Mr. Dahl likened the annual inspection to a visit from one’s mother-in-law. “You might throw an extra vacuum over the carpet to make sure everything looks good,” he said. “People could potentially staff up during that time period.”
For some families, however, all that effort did not translate to high-quality care, and they said they wished they had better options. Elizabeth Chandler and her husband, Ken, placed his mother in Rosewood in 2011 to recover from a broken femur. Ms. Chandler said she had been impressed that Rosewood had a top rating, “like a hotel.”
Mr. Chandler’s mother died after experiencing serious falls at the home, and the family is suing Rosewood. Ms. Chandler said she felt misled by the rating system.
“You don’t know where to look to get accurate information,” she said. “I can go and find a preschool for my child better than I can find a skilled nursing facility for my loved one.”
24 October 2010
New Crop of Elderly Outsmart Their Predecessors
Scientific American
A Swedish study finds that 70-year-olds in 2000 did better on intelligence tests than 70-year-olds had done in 1971.
If 50 is the new 40 and 60 is the new 50, what’s the new 70? Well, it seems safe to at least say that 70 isn’t what it used to be. And that’s good. Because a new study finds that 70-year-olds did better on intelligence tests than 70 year olds used to do. In Sweden, anyway. The research was published in the journal Neurology. [Simona Sacuiu et al, Secular changes in cognitive predictors of dementia and mortality in 70-year-olds]
The study compared a group of people born in 1901 and 1902 and tested in 1971 with another group born in 1930 and tested in 2000. And the newer crop of 70 years old performed far better than the previous generation did.
The researchers say the newer seniors had numerous advantages. They had better pre and postnatal care than their predecessors. They also had better nutrition, a higher quality education, and better treatment of high blood pressure and cholesterol. And, the researchers say, today’s high-tech life also helps keep you sharp. Because all of those factors come into play in many other parts of the world, there’s reason to be optimistic that it’s not just old Swedes who are smarter.
If 50 is the new 40 and 60 is the new 50, what’s the new 70? Well, it seems safe to at least say that 70 isn’t what it used to be. And that’s good. Because a new study finds that 70-year-olds did better on intelligence tests than 70 year olds used to do. In Sweden, anyway. The research was published in the journal Neurology. [Simona Sacuiu et al, Secular changes in cognitive predictors of dementia and mortality in 70-year-olds]
The study compared a group of people born in 1901 and 1902 and tested in 1971 with another group born in 1930 and tested in 2000. And the newer crop of 70 years old performed far better than the previous generation did.
The researchers say the newer seniors had numerous advantages. They had better pre and postnatal care than their predecessors. They also had better nutrition, a higher quality education, and better treatment of high blood pressure and cholesterol. And, the researchers say, today’s high-tech life also helps keep you sharp. Because all of those factors come into play in many other parts of the world, there’s reason to be optimistic that it’s not just old Swedes who are smarter.
28 July 2010
Health Law Augurs Transfer of Funds from Old to Young
The Wall Street Journal
Mark Baumann, a 44-year-old uninsured diabetic, sees in the Obama administration's health-care law a future with stable coverage to pay for his insulin shots and blood tests. Currently unable to meet costs such as Anthem health insurance quotes, he will rely on reform measures to meet his medical needs.
That's likely to come indirectly at the expense of his mother's generous health-care plan.
Humana Inc., Mary Baumann's insurer, intends to pare her "Medicare Advantage" plan to make up for the smaller government payments it will soon receive as a result of the new law, leaving her with higher costs or fewer services. On the table are beefed-up co-payments and premiums, as well as the loss of perks such as her free membership at a health club.
Across the country, dozens of private insurers that run similar Medicare plans are preparing to pare dental, vision and certain prescription-drug coverage starting next year, according to consultants who have helped them assemble annual bids.
Although some planned cuts might not materialize given Congress's history of tabling unpopular measures, the law represents the tip of a broader change. Most Americans know the overhaul is designed to cover the uninsured, a decades-long goal of Democrats. But it also represents a change in how the government spreads its social safety net underneath Americans. Already, it's creating tensions that are a harbinger of debates to come.
Since the creation of Social Security and Medicare, younger workers have funded programs for the elderly. It's a compact in which workers paid for retirees with the understanding that they'd be looked after by the generation behind them.
The health overhaul diverges by tapping a program for the elderly to help provide insurance to 32 million Americans of younger generations. Nearly half the funding for the law is supposed to come from paying lower fees to hospitals, insurers and other health-care providers that participate in Medicare, the federal insurance program for Americans age 65 and older, as well as younger disabled people.
The 44 million Americans on Medicare won't see changes to their guaranteed benefits under the law. But of those, 11.3 million on Medicare Advantage plans, a public-private hybrid of the type used by Ms. Baumann, who is 79, are likely to begin seeing extra benefits go away as soon as next year. Medicare Advantage cuts are slated to pay for 15% of the health-care law's tab.
The trims mark the leading edge of a spending shift that could broaden as lawmakers grapple with a deficit expected to hit $1.47 trillion this year. Left unchanged, Medicare and Social Security will consume half of all federal spending by 2035, up from about one third today, according to the Congressional Budget Office.
A White House-sponsored commission that is examining ways to reduce the budget deficit is considering how to tackle Social Security, too. Even AARP, the seniors group, recently embraced the prospect, noting that to keep Social Security viable, Congress "needs to make some small adjustments." AARP supported the health-care overhaul.
Prominent lawmakers in both parties have suggested restrictions on future Social Security benefits, such as a higher retirement age for younger workers and financial means testing to determine who gets benefits.
"We badly need to, over time and very gradually, reallocate resources from the elderly to younger families and their children," said Isabel Sawhill, senior fellow at the liberal-leaning Brookings Institution.
The White House says the health law doesn't take from seniors to help younger generations, but instead eliminates overpayments to private companies, particularly insurers that run Medicare plans like Ms. Baumann's. By lowering payments to health providers, the new law extends the life of Medicare's trust fund by 12 years, according to an actuarial report from Medicare's umbrella agency.
"I'm sure that some of those additional benefits have been nice," Nancy-Ann DeParle, who runs the White House's Office of Health Reform, says of Medicare Advantage plans. "But I think what we have to look at here is what's fair and what's important for the strength of the Medicare program long term."
Stuart Butler, a vice president at the conservative Heritage Foundation, says the White House is misrepresenting the benefits that accrue from Medicare payment cuts. "It uses it to create a new entitlement for a separate group of people rather than strengthening" the program, he says. Moreover, such cuts alone don't pay for the law.
The law will spend $938 billion over a decade, mostly to expand coverage to lower-income Americans. To finance that, there will be $455 billion coming from cuts in government payments to health-care providers that serve patients on Medicare and two other federal programs. The hardest hit—to the tune of $136 billion—will be private insurance companies that run Medicare Advantage plans.
Most of the rest will be funded by new levies, including taxes on health-care companies, a higher Medicare payroll tax for wealthy Americans and a tax on high-value insurance plans. Critics of the law say its total cost is likely higher than advertised.
Some older Americans are irate, including some of Ms. Baumann's gym-mates. One has joined the tea-party movement, in part to protest the cuts. Democrats are worried about the political pressure from seniors, who vote in large numbers, especially in midterm elections, and represent a political force that is disproportionate to their numbers.
The party has played up the perks for seniors included in the law. Among other things, it closes a gap in Medicare prescription-drug coverage and makes preventive services free for enrollees.
Ms. Baumann has few medical needs except two daily blood-pressure medications and dental work, but she is torn about the changes. She credits the gym membership with helping her overcome her husband's death in 1994. She couldn't afford it on her fixed annual income of $17,000 and has voiced that concern at meetings of Humana's local consumer advisory board, of which she is a member.
"I think there's other cuts we could make besides our age group," she says. But she wants her son to get insured.
The Congressional Budget Office says on average, Medicare Advantage enrollees will get $68 less a month in benefits by 2019 because of the law. The payment cuts to Medicare Advantage begin in 2012.
John Gorman, a consultant who helped insurers prepare bids, says his clients are planning to raise non-essential emergency room co-pays to $500 from $200. They're pushing enrollees toward generic drugs and charging more for optometrist visits.
Ms. Baumann and her late husband, Donald, raised six children around New Orleans. Donald Baumann worked as a switchman for the phone company and earned $40,000 a year when he retired in 1982. Ms. Baumann stayed home to raise their children and later sold cosmetics at an Estee Lauder counter.
Donald Baumann's health plan from BlueCross BlueShield of Louisiana kept their costs low. When their youngest child, Mark, was diagnosed with Type 1 diabetes at 16, the insurance covered his two-week hospital stay.
After college, Mark Baumann bounced between jobs in Chicago selling hotel rooms to corporate groups. The hotels offered patchy insurance. In 2008, shortly after Mr. Baumann moved back to Louisiana to be closer to his family, he lost his $44,000-a-year sales job at a New Orleans Best Western.
"I thought I'd be employed within a month," Mr. Baumann said one afternoon as he sat on his mother's couch petting his Chihuahua, Peanut. He didn't worry about housing since he lived in his mother's one-story home, perched eight feet above ground to protect against flooding from nearby Lake Pontchartrain. He limited discretionary spending to splurges such as $150 in plants for their garden.
Mr. Baumann began stretching the time between daily blood sugar tests to make his supply of testing strips, which cost $1.20 each, last longer. He skipped three annual blood tests. Last summer, he went to a low-cost clinic and accepted three vials of free insulin that had been partially consumed. In the fall, an intense side pain landed him in the emergency room, resulting in an $8,000 bill. The facility waived it after he wrote a letter saying he couldn't pay.
Cobra, the federal insurance program for people between jobs, was too costly. Louisiana turned him down for Medicaid, saying he didn't qualify because his unemployment benefits—$3,096 over three months—put him over the income limit.
Under the health law, that will change by 2014. If Mr. Baumann is earning under $43,320 a year then, he'd qualify for a health insurance tax credit. If unemployed, he has a better chance than now of qualifying for Medicaid, the federal-state insurance program for the poor.
Mr. Baumann's unemployment benefits recently lapsed, and he's now leaning on $200 a month of food stamps. He got a break last month, when his local health clinic told him he qualified for the state's low-income care program, which paid for a CT scan and other tests to diagnose bouts of fainting. The program will defray his medical costs until he finds a job, but still leaves him without insurance.
Ms. Baumann has one of the best government insurance deals the country offers. Since 2003, she has been enrolled in a Humana Gold Plus HMO. The plan is part of an experiment Congress started decades ago to make Michigan Medicare plans more efficient by paying private insurers to administer coverage. In rural areas, private insurers didn't rush into the market, prompting Congress in 2003 to raise the rate it paid.
The government now pays private insurers an average of 9% more to operate the plans than it costs to run traditional Medicare, according to the Medicare Payment Advisory Commission. Insurers must spend most of that overpayment on enrollees.
As a result, Ms. Baumann's plan covers her "Silver Sneakers" gym membership, worth $54 a month, at Franco's health club and spa. The plan includes $10 a month worth of sunscreen, vitamins, laxatives and other products. She pays no premium beyond what seniors pay for traditional Medicare.
Humana, which administers Medicare Advantage plans to 1.75 million seniors, is trying to pare 15% of its overall costs, in part to offset lower expected government payments.
"There's no question that either premiums go up or either benefits go down over the long term," said Michael B. McCallister, Humana's president and CEO. "Everything is on the table."
Word of cuts has Ms. Baumann's gym mates in a huff.
"With the president being younger, my biggest concern is that we don't mean anything," said Sandy Reed, a 61-year-old who has a Medicare Advantage plan because she qualifies as disabled. "We're disposable."
One recent morning, Ms. Baumann and her son drove her 1999 Lexus SUV 35 miles to the Louisiana State University Bogalusa Medical Center. It sells insulin for at least 50% less than a traditional pharmacy. Ms. Baumann lent her son $100 to buy it.
He ducked his head into the pharmacy window, underneath a burned-out light bulb, and a woman handed him a paper bag with 100 syringes and three vials of insulin for $83.
Back in the car, he lamented his finances. "Maybe I shouldn't have bought all those plants," he said.
The next morning, Ms. Baumann walked past the waterfall in the lobby of her health club. She brought Mr. Baumann as a guest so he could lift weights. The facility has two pools, waterslides, a Starbucks counter and a grill which sells quesadillas and avocado mint smoothies.
After Ms. Baumann's "Dancin' to the Oldies" class, some of the women fretted that the free memberships they get through Humana could go away.
"Most of these older people don't like change," Ms. Baumann said. "But they have to get used to it. There will be change."
That's likely to come indirectly at the expense of his mother's generous health-care plan.
Humana Inc., Mary Baumann's insurer, intends to pare her "Medicare Advantage" plan to make up for the smaller government payments it will soon receive as a result of the new law, leaving her with higher costs or fewer services. On the table are beefed-up co-payments and premiums, as well as the loss of perks such as her free membership at a health club.
Across the country, dozens of private insurers that run similar Medicare plans are preparing to pare dental, vision and certain prescription-drug coverage starting next year, according to consultants who have helped them assemble annual bids.
Although some planned cuts might not materialize given Congress's history of tabling unpopular measures, the law represents the tip of a broader change. Most Americans know the overhaul is designed to cover the uninsured, a decades-long goal of Democrats. But it also represents a change in how the government spreads its social safety net underneath Americans. Already, it's creating tensions that are a harbinger of debates to come.
Since the creation of Social Security and Medicare, younger workers have funded programs for the elderly. It's a compact in which workers paid for retirees with the understanding that they'd be looked after by the generation behind them.
The health overhaul diverges by tapping a program for the elderly to help provide insurance to 32 million Americans of younger generations. Nearly half the funding for the law is supposed to come from paying lower fees to hospitals, insurers and other health-care providers that participate in Medicare, the federal insurance program for Americans age 65 and older, as well as younger disabled people.
The 44 million Americans on Medicare won't see changes to their guaranteed benefits under the law. But of those, 11.3 million on Medicare Advantage plans, a public-private hybrid of the type used by Ms. Baumann, who is 79, are likely to begin seeing extra benefits go away as soon as next year. Medicare Advantage cuts are slated to pay for 15% of the health-care law's tab.
The trims mark the leading edge of a spending shift that could broaden as lawmakers grapple with a deficit expected to hit $1.47 trillion this year. Left unchanged, Medicare and Social Security will consume half of all federal spending by 2035, up from about one third today, according to the Congressional Budget Office.
A White House-sponsored commission that is examining ways to reduce the budget deficit is considering how to tackle Social Security, too. Even AARP, the seniors group, recently embraced the prospect, noting that to keep Social Security viable, Congress "needs to make some small adjustments." AARP supported the health-care overhaul.
Prominent lawmakers in both parties have suggested restrictions on future Social Security benefits, such as a higher retirement age for younger workers and financial means testing to determine who gets benefits.
"We badly need to, over time and very gradually, reallocate resources from the elderly to younger families and their children," said Isabel Sawhill, senior fellow at the liberal-leaning Brookings Institution.
The White House says the health law doesn't take from seniors to help younger generations, but instead eliminates overpayments to private companies, particularly insurers that run Medicare plans like Ms. Baumann's. By lowering payments to health providers, the new law extends the life of Medicare's trust fund by 12 years, according to an actuarial report from Medicare's umbrella agency.
"I'm sure that some of those additional benefits have been nice," Nancy-Ann DeParle, who runs the White House's Office of Health Reform, says of Medicare Advantage plans. "But I think what we have to look at here is what's fair and what's important for the strength of the Medicare program long term."
Stuart Butler, a vice president at the conservative Heritage Foundation, says the White House is misrepresenting the benefits that accrue from Medicare payment cuts. "It uses it to create a new entitlement for a separate group of people rather than strengthening" the program, he says. Moreover, such cuts alone don't pay for the law.
The law will spend $938 billion over a decade, mostly to expand coverage to lower-income Americans. To finance that, there will be $455 billion coming from cuts in government payments to health-care providers that serve patients on Medicare and two other federal programs. The hardest hit—to the tune of $136 billion—will be private insurance companies that run Medicare Advantage plans.
Most of the rest will be funded by new levies, including taxes on health-care companies, a higher Medicare payroll tax for wealthy Americans and a tax on high-value insurance plans. Critics of the law say its total cost is likely higher than advertised.
Some older Americans are irate, including some of Ms. Baumann's gym-mates. One has joined the tea-party movement, in part to protest the cuts. Democrats are worried about the political pressure from seniors, who vote in large numbers, especially in midterm elections, and represent a political force that is disproportionate to their numbers.
The party has played up the perks for seniors included in the law. Among other things, it closes a gap in Medicare prescription-drug coverage and makes preventive services free for enrollees.
Ms. Baumann has few medical needs except two daily blood-pressure medications and dental work, but she is torn about the changes. She credits the gym membership with helping her overcome her husband's death in 1994. She couldn't afford it on her fixed annual income of $17,000 and has voiced that concern at meetings of Humana's local consumer advisory board, of which she is a member.
"I think there's other cuts we could make besides our age group," she says. But she wants her son to get insured.
The Congressional Budget Office says on average, Medicare Advantage enrollees will get $68 less a month in benefits by 2019 because of the law. The payment cuts to Medicare Advantage begin in 2012.
John Gorman, a consultant who helped insurers prepare bids, says his clients are planning to raise non-essential emergency room co-pays to $500 from $200. They're pushing enrollees toward generic drugs and charging more for optometrist visits.
Ms. Baumann and her late husband, Donald, raised six children around New Orleans. Donald Baumann worked as a switchman for the phone company and earned $40,000 a year when he retired in 1982. Ms. Baumann stayed home to raise their children and later sold cosmetics at an Estee Lauder counter.
Donald Baumann's health plan from BlueCross BlueShield of Louisiana kept their costs low. When their youngest child, Mark, was diagnosed with Type 1 diabetes at 16, the insurance covered his two-week hospital stay.
After college, Mark Baumann bounced between jobs in Chicago selling hotel rooms to corporate groups. The hotels offered patchy insurance. In 2008, shortly after Mr. Baumann moved back to Louisiana to be closer to his family, he lost his $44,000-a-year sales job at a New Orleans Best Western.
"I thought I'd be employed within a month," Mr. Baumann said one afternoon as he sat on his mother's couch petting his Chihuahua, Peanut. He didn't worry about housing since he lived in his mother's one-story home, perched eight feet above ground to protect against flooding from nearby Lake Pontchartrain. He limited discretionary spending to splurges such as $150 in plants for their garden.
Mr. Baumann began stretching the time between daily blood sugar tests to make his supply of testing strips, which cost $1.20 each, last longer. He skipped three annual blood tests. Last summer, he went to a low-cost clinic and accepted three vials of free insulin that had been partially consumed. In the fall, an intense side pain landed him in the emergency room, resulting in an $8,000 bill. The facility waived it after he wrote a letter saying he couldn't pay.
Cobra, the federal insurance program for people between jobs, was too costly. Louisiana turned him down for Medicaid, saying he didn't qualify because his unemployment benefits—$3,096 over three months—put him over the income limit.
Under the health law, that will change by 2014. If Mr. Baumann is earning under $43,320 a year then, he'd qualify for a health insurance tax credit. If unemployed, he has a better chance than now of qualifying for Medicaid, the federal-state insurance program for the poor.
Mr. Baumann's unemployment benefits recently lapsed, and he's now leaning on $200 a month of food stamps. He got a break last month, when his local health clinic told him he qualified for the state's low-income care program, which paid for a CT scan and other tests to diagnose bouts of fainting. The program will defray his medical costs until he finds a job, but still leaves him without insurance.
Ms. Baumann has one of the best government insurance deals the country offers. Since 2003, she has been enrolled in a Humana Gold Plus HMO. The plan is part of an experiment Congress started decades ago to make Michigan Medicare plans more efficient by paying private insurers to administer coverage. In rural areas, private insurers didn't rush into the market, prompting Congress in 2003 to raise the rate it paid.
The government now pays private insurers an average of 9% more to operate the plans than it costs to run traditional Medicare, according to the Medicare Payment Advisory Commission. Insurers must spend most of that overpayment on enrollees.
As a result, Ms. Baumann's plan covers her "Silver Sneakers" gym membership, worth $54 a month, at Franco's health club and spa. The plan includes $10 a month worth of sunscreen, vitamins, laxatives and other products. She pays no premium beyond what seniors pay for traditional Medicare.
Humana, which administers Medicare Advantage plans to 1.75 million seniors, is trying to pare 15% of its overall costs, in part to offset lower expected government payments.
"There's no question that either premiums go up or either benefits go down over the long term," said Michael B. McCallister, Humana's president and CEO. "Everything is on the table."
Word of cuts has Ms. Baumann's gym mates in a huff.
"With the president being younger, my biggest concern is that we don't mean anything," said Sandy Reed, a 61-year-old who has a Medicare Advantage plan because she qualifies as disabled. "We're disposable."
One recent morning, Ms. Baumann and her son drove her 1999 Lexus SUV 35 miles to the Louisiana State University Bogalusa Medical Center. It sells insulin for at least 50% less than a traditional pharmacy. Ms. Baumann lent her son $100 to buy it.
He ducked his head into the pharmacy window, underneath a burned-out light bulb, and a woman handed him a paper bag with 100 syringes and three vials of insulin for $83.
Back in the car, he lamented his finances. "Maybe I shouldn't have bought all those plants," he said.
The next morning, Ms. Baumann walked past the waterfall in the lobby of her health club. She brought Mr. Baumann as a guest so he could lift weights. The facility has two pools, waterslides, a Starbucks counter and a grill which sells quesadillas and avocado mint smoothies.
After Ms. Baumann's "Dancin' to the Oldies" class, some of the women fretted that the free memberships they get through Humana could go away.
"Most of these older people don't like change," Ms. Baumann said. "But they have to get used to it. There will be change."
04 May 2010
Kansas Man Leading the Charge to Change Senior Care
Morning Sun
Steve Shields is on a mission to change the way we take care of our parents and grandparents. Shields, an international expert on nursing homes, is president and CEO of Meadowlark Hills in Manhattan, one of the nation’s most innovative retirement communities.
“Our approach really is pretty simple. It’s to get residents involved in making their own decisions – to take control of their own lives,” Shields said.
Shields is the final speaker in this year’s Sunflower Foundation Advocacy in Health Speaker Series. He will speak at 3:30 p.m. on Wednesday, May 5, at the Oread Hotel in Lawrence. The event is free and open to the public.
Shields will emphasize the importance of nonprofits working together to help change systems of care and Raleigh retirement communitues. “In this time of increasingly scarce resources, we can’t lose our passion and our imagination for creating change,” Shields said. “Now, more than ever, we need to be strong advocates for the people we serve, and we need to help them become more effective advocates for themselves.”
“Steve was selected to present as part of our Advocacy in Health Speaker Series because of his success in changing long-held beliefs and improving lives,” said Billie Hall, president and CEO of the Sunflower Foundation.
“Sometimes ‘advocacy’ is seen as only happening through direct contact with legislators and local officials, and that’s important. But sometimes advocacy involves pushing for regulatory change – and just getting people to work together in different ways,” she said. “Steve is an excellent example of someone who helped bring about needed change by advocating within a system.”
As a pioneer in eldercare reform, Shields has helped transform traditional nursing homes and retirement facilities into the “Household” model of senior care in Michigan as well as in more than 40 other states and 10 countries. He co-authored In Pursuit of the Sunbeam: A Practical Guide to Transformation from Institution to Household and The Household Model Business Case. He is also a faculty member at the Kansas State University Center on Aging, where he teaches leadership in long term care.
This is the Sunflower Foundation’s second year to feature nationally known speakers as part of its advocacy initiative, which is designed to provide education and training opportunities for nonprofit leaders in Kansas who want to become more involved in public policy.
22 April 2010
Let's Talk about Long-Term Care
Atlanta Post
Emotions can run high when the topic of conversation turns to the care of an elderly loved one. In my life, the care of my grandmother is the center of our family discussion. The conversation generally relates to one of the following questions: How are we going to take care of her? Who will volunteer his or her time? When am I going to be asked to help? What am I supposed to do? Why am I always the back-up person?
These are real questions that families must answer while managing relatives’ failing health, living arrangements and financial obligations. These issues and a host of unforeseen circumstances can devastate a family’s wealth and strain the relationships within the family. As an increasing number of clients shared their challenges in covering the care of aging relatives, I decided to incorporate long term care insurance in my financial analysis.
Long term care is an insurance policy designed to alleviate some of the costs associated with nursing home and home health care for individuals unable to care for themselves. Most policies provide coverage for a specified number of years, though some offer lifetime coverage. Policy premiums vary widely depending upon the age of the insured, conditions and services covered, length of coverage and location. A great website to review costs in your area is genworthfinancial.com.
In addition to determining how to finance coverage, families must decide what type of care their relative needs. Raleigh assisted living facilities, similar to children’s day care centers, are a viable option for individuals capable of routine travel. Assisted living facilities allow residents regular access to medical attention, prepared meals and organized activities, while maintaining much of their autonomy. Individuals who decide to care for his relative himself may realize some tax benefits and should consult a tax advisor when weighing this option.
To learn more about elder care options in your community visit eldercare.gov. For assistance with a broad range of issues, one should consider contacting a lawyer specializing in elder care. In the meantime, review your financial situation. Can you afford to start putting some extra money aside now for yourself or for the needs of a parent?
08 April 2010
Making the Most of Old Age
The Washington Post
Adopting healthful habits can significantly alter the course of aging, even if you don't start until you are middle-aged or older, growing research suggests.
As more people live into their 80s, 90s and beyond, researchers are increasingly asking what it takes not just to survive but also to thrive in later years. Here is Consumer Reports' guide to successful aging.
Exercise your brain.
Your brain needs a workout just as much as your arms and legs. Education and an active work life when you are younger can help ward off dementia later, perhaps by building a cognitive reserve so that small losses in function are not as noticeable. It may be equally important to stay mentally engaged after retirement. A study of about 500 men and women 75 and older published in the journal Neurology in 2009 found that they could delay cognitive decline by participating in mentally stimulating activities such as reading, writing and doing puzzles.
Strong social ties can also help.
Harvard researchers followed 16,638 adults 50 and older for six years. Those who volunteered the most and had lots of connections to family and friends were least likely to show declines in memory tests. In North Carolina, seek Raleigh retirement communities for increased social bonds.
Keep eyes and ears sharp.
Vision and hearing tests by specialists should be a regular part of your anti-aging plan. Sight-threatening diseases that are more common with age, including cataracts, glaucoma and macular degeneration, can be controlled or halted if caught early. Hearing loss, the third most common chronic condition in older Americans, can contribute to cognitive decline, depression and social isolation, and can even signal an increased risk of other health problems such as Type 2 diabetes or stroke.
To reduce your risk of eye disease, avoid tobacco smoke, wear sunglasses, maintain a healthy weight and control high blood pressure and blood sugar levels. To reduce the risk of hearing loss, consider using earplugs in situations noisy enough that you have to raise your voice to be heard.
Stay young at heart.
Undiagnosed vascular disease -- clogged arteries in the heart, brain or legs -- may lead to disability not only by triggering heart attacks and strokes but also by causing frailty, weakness and unplanned weight loss, according to findings from the Cardiovascular Health Study, which was funded by the National Heart, Lung, and Blood Institute and involved about 4,700 people 65 and older. So work with your doctor to keep blood pressure, blood sugar and cholesterol levels under control even as you get into your 70s and beyond.
Guard your gut.
People turning 60 now may actually face a higher risk of disability than those who reached that age a decade or two ago, possibly because more people today are overweight. So if you are in your 40s, 50s or 60s, you should be especially vigilant against creeping weight gain.
Strengthen your back.
Back pain is the nation's second-leading cause of disability, trailing only arthritis. Being able to stand straight and remain free of crippling lower-back pain in later years depends on maintaining the strength of the bones in your spine as well as the muscles that support them. Exercises that work muscles in the back and abdomen, such as abdominal curls and trunk extensions, may also help prevent spinal fractures. And activities such as Pilates and yoga can help ease back pain. In Michigan, seek counseling from a Wayne County back treatment center.
Protect hips and knees.
Exercise is also a key to helping prevent or alleviate arthritis and joint pain. Resistance training doing calisthenics or using elastic bands, free weights or weight machines strengthens the muscles. That, in turn, protects the joints and makes them more stable.
Stay steady on your feet.
The fear of falling often causes anxiety, and with good reason: About 30 percent of people older than 65 and half of those 80 and older have fallen at some point. Build strong legs by doing strength exercises two to three times weekly.
Sleep well, age well.
"The idea that people need and want less sleep as they get older is a myth," says Harrison Bloom, a physician who is a senior associate with the International Longevity Center USA in New York. But it is true that the type of sleep they get often changes. "People may not sleep as deeply as they did when they were young, and they may awaken more frequently," Bloom says. That disturbed sleep increases the risk of conditions such as cardiovascular disease, depression and hypertension.
Health conditions that impair sleep, such as sleep apnea, are often independent problems that respond to sleep apnea treatment Dearborn. Your physician should periodically question both you and your bed partner about your sleep habits at routine exams, referring you to a specialist if warranted.
As more people live into their 80s, 90s and beyond, researchers are increasingly asking what it takes not just to survive but also to thrive in later years. Here is Consumer Reports' guide to successful aging.
Exercise your brain.
Your brain needs a workout just as much as your arms and legs. Education and an active work life when you are younger can help ward off dementia later, perhaps by building a cognitive reserve so that small losses in function are not as noticeable. It may be equally important to stay mentally engaged after retirement. A study of about 500 men and women 75 and older published in the journal Neurology in 2009 found that they could delay cognitive decline by participating in mentally stimulating activities such as reading, writing and doing puzzles.
Strong social ties can also help.
Harvard researchers followed 16,638 adults 50 and older for six years. Those who volunteered the most and had lots of connections to family and friends were least likely to show declines in memory tests. In North Carolina, seek Raleigh retirement communities for increased social bonds.
Keep eyes and ears sharp.
Vision and hearing tests by specialists should be a regular part of your anti-aging plan. Sight-threatening diseases that are more common with age, including cataracts, glaucoma and macular degeneration, can be controlled or halted if caught early. Hearing loss, the third most common chronic condition in older Americans, can contribute to cognitive decline, depression and social isolation, and can even signal an increased risk of other health problems such as Type 2 diabetes or stroke.
To reduce your risk of eye disease, avoid tobacco smoke, wear sunglasses, maintain a healthy weight and control high blood pressure and blood sugar levels. To reduce the risk of hearing loss, consider using earplugs in situations noisy enough that you have to raise your voice to be heard.
Stay young at heart.
Undiagnosed vascular disease -- clogged arteries in the heart, brain or legs -- may lead to disability not only by triggering heart attacks and strokes but also by causing frailty, weakness and unplanned weight loss, according to findings from the Cardiovascular Health Study, which was funded by the National Heart, Lung, and Blood Institute and involved about 4,700 people 65 and older. So work with your doctor to keep blood pressure, blood sugar and cholesterol levels under control even as you get into your 70s and beyond.
Guard your gut.
People turning 60 now may actually face a higher risk of disability than those who reached that age a decade or two ago, possibly because more people today are overweight. So if you are in your 40s, 50s or 60s, you should be especially vigilant against creeping weight gain.
Strengthen your back.
Back pain is the nation's second-leading cause of disability, trailing only arthritis. Being able to stand straight and remain free of crippling lower-back pain in later years depends on maintaining the strength of the bones in your spine as well as the muscles that support them. Exercises that work muscles in the back and abdomen, such as abdominal curls and trunk extensions, may also help prevent spinal fractures. And activities such as Pilates and yoga can help ease back pain. In Michigan, seek counseling from a Wayne County back treatment center.
Protect hips and knees.
Exercise is also a key to helping prevent or alleviate arthritis and joint pain. Resistance training doing calisthenics or using elastic bands, free weights or weight machines strengthens the muscles. That, in turn, protects the joints and makes them more stable.
Stay steady on your feet.
The fear of falling often causes anxiety, and with good reason: About 30 percent of people older than 65 and half of those 80 and older have fallen at some point. Build strong legs by doing strength exercises two to three times weekly.
Sleep well, age well.
"The idea that people need and want less sleep as they get older is a myth," says Harrison Bloom, a physician who is a senior associate with the International Longevity Center USA in New York. But it is true that the type of sleep they get often changes. "People may not sleep as deeply as they did when they were young, and they may awaken more frequently," Bloom says. That disturbed sleep increases the risk of conditions such as cardiovascular disease, depression and hypertension.
Health conditions that impair sleep, such as sleep apnea, are often independent problems that respond to sleep apnea treatment Dearborn. Your physician should periodically question both you and your bed partner about your sleep habits at routine exams, referring you to a specialist if warranted.
Copyright 2010. Consumers Union of United States Inc.
For further guidance, go to ConsumerReportsHealth.org. More-detailed information -- including CR's ratings of prescription drugs, conditions, treatments, doctors, hospitals and healthy-living products -- is available to subscribers to that site.
22 March 2010
Need for Elder Care Services Ready to Explode
Gaylord Herald Times
LANSING — At a press conference in Lansing on Tuesday, the Aging Services of Michigan will release its 2010 Annual Long Term Care report, “A Decade in Review,” focusing on long-term elder care issues.
The association is issuing a call for action on the state level to change public policies that are detrimental to the care of seniors, family caregivers and nonprofit care providers.
The association is issuing a call for action on the state level to change public policies that are detrimental to the care of seniors, family caregivers and nonprofit care providers.
According to the Aging Services of Michigan, which represents nonprofit organizations providing community and home-based services for the elderly, there will be an explosion in the need for such services in the coming years.
Among the issues reported in the review is the estimation that Alzheimer’s disease will affect 180,000 Michigan elders in 2010, with an additional 200,000 people affected by from some form of dementia. The number of adults 65 and older will represent 20 percent of the population by 2030; the number of adults 85 and older, the fastest growing age group in the nation, will double by 2050. Michigan is not prepared for the increase in the aging population.
“Michigan’s long-term care system is under assault and has been for a long time,” said David Herbel, president and CEO of Aging Services of Michigan. “The need for Michigan senior care is increasing, while funding and state support is eroding.”
Women have traditionally been the caregivers of aging relatives, but economic factors over the last few decades have forced more and more women into the workforce as a necessity for family survival. The decreased funding and increasing need for care providers as the aging population grows will put an additional burden on middle class families already struggling.
The report was initially released in the first of a series of regional meetings with Aging Services of Michigan’s nonprofit member organizations. It was held at the Otsego Memorial Hospital (OMH) in Gaylord March 4. OMH’s McReynolds Hall skilled nursing facility, which provides short and long-term care, is a member.
For a copy of the 2010 Annual Long Term Care Report, visit the Aging Services of Michigan’s Web site at www.AgingMI.org.
Among the issues reported in the review is the estimation that Alzheimer’s disease will affect 180,000 Michigan elders in 2010, with an additional 200,000 people affected by from some form of dementia. The number of adults 65 and older will represent 20 percent of the population by 2030; the number of adults 85 and older, the fastest growing age group in the nation, will double by 2050. Michigan is not prepared for the increase in the aging population.
“Michigan’s long-term care system is under assault and has been for a long time,” said David Herbel, president and CEO of Aging Services of Michigan. “The need for Michigan senior care is increasing, while funding and state support is eroding.”
Women have traditionally been the caregivers of aging relatives, but economic factors over the last few decades have forced more and more women into the workforce as a necessity for family survival. The decreased funding and increasing need for care providers as the aging population grows will put an additional burden on middle class families already struggling.
The report was initially released in the first of a series of regional meetings with Aging Services of Michigan’s nonprofit member organizations. It was held at the Otsego Memorial Hospital (OMH) in Gaylord March 4. OMH’s McReynolds Hall skilled nursing facility, which provides short and long-term care, is a member.
For a copy of the 2010 Annual Long Term Care Report, visit the Aging Services of Michigan’s Web site at www.AgingMI.org.
08 February 2010
Care Providers Look to Montessori Techniques for Treating Dementia
Public News Service
LANSING, Mich. - Elder care providers across Michigan and the nation are turning to more-specialized and individualized care for dementia patients, based on methods used in Montessori pre-schools to maintain cognitive ability. Meanwhile, families caring for elders at home are losing state resources.
Deedre Vriesman is a program manager for The Woods at Maple Creek, a non-profit, live-in facility run by Lutheran Social Services. She says the mantra for dementia care used to be "clean, safe and dry," but one of the latest techniques includes the learning approach used with pre-schoolers.
"It's the same methods that you use for children who are in Montessori-based schools; very hands on, sorting tasks, feeding tasks, smelling different things, using reminiscence. That's all built in to make it a meaningful event that makes sense to the person, so it's more familiar."
The high price of elder care facilities forces many families to keep a loved one at home for a much longer time, says Vriesman. Before cuts to funding, those families could count on help from the state to find resources, she adds.
"They had a program called the Single Point of Entry. A family member could call and say 'my grandma needs a placement, here's the type of things that I'm seeing with her.' Then, they could help you sort through, 'okay, based on that, these are the programs that could help.' Because, it is overwhelming."
More than 180,000 Michigan senior citizens are diagnosed with dementia. That represents a six-percent increase in the last decade. Vriesman says state money is no longer available to help families find resources for dementia patients, and the drugs to treat dementia are often expensive with limited results. Advocates say the most effective treatment focuses on maintaining cognitive ability and life enrichment using the skills a patient has retained.
Deedre Vriesman is a program manager for The Woods at Maple Creek, a non-profit, live-in facility run by Lutheran Social Services. She says the mantra for dementia care used to be "clean, safe and dry," but one of the latest techniques includes the learning approach used with pre-schoolers.
"It's the same methods that you use for children who are in Montessori-based schools; very hands on, sorting tasks, feeding tasks, smelling different things, using reminiscence. That's all built in to make it a meaningful event that makes sense to the person, so it's more familiar."
The high price of elder care facilities forces many families to keep a loved one at home for a much longer time, says Vriesman. Before cuts to funding, those families could count on help from the state to find resources, she adds.
"They had a program called the Single Point of Entry. A family member could call and say 'my grandma needs a placement, here's the type of things that I'm seeing with her.' Then, they could help you sort through, 'okay, based on that, these are the programs that could help.' Because, it is overwhelming."
More than 180,000 Michigan senior citizens are diagnosed with dementia. That represents a six-percent increase in the last decade. Vriesman says state money is no longer available to help families find resources for dementia patients, and the drugs to treat dementia are often expensive with limited results. Advocates say the most effective treatment focuses on maintaining cognitive ability and life enrichment using the skills a patient has retained.
02 December 2009
Don't Wait Too Long To Talk About Elder Care
Indy Star
Through nearly 20 years working with the elderly, I've learned something profound. Most people don't fear dying -- they fear the aging process.
According to recent AARP survey, baby boomers are three times more worried about a having a major illness (48 percent) or winding up in a nursing home (48 percent) than about dying (17 percent). They're most concerned about becoming a financial, emotional or physical burden on their families.
The AARP also reports that 89 percent of survey respondents older than 50 want to stay in their own homes, surrounded by their lifetime possessions and comforting memories, for as long as possible. Over the past decade I've witnessed a growing trend to enable and accommodate seniors to stay in their own homes, rather than move into assisted-living facilities or nursing homes. Because there are so many questions around and fears about living situations for the elderly, I encourage my clients to plan well for the inevitable future.
In 2006, life expectancy at birth for the total population reached a record high of 78.1 years, according to the Centers for Disease Control and Prevention. Thanks to modern medicine and personal attention to living healthier lifestyles, today we can expect to live a lot longer than previous generations. What we can't expect or take for granted is quality of life.
Diseases of the heart and cancer still account for nearly half of all deaths for those older than 65. Progressive diseases such as diabetes, respiratory illnesses and Alzheimer's also are becoming more prevalent contributors to mortality. This means our parents may struggle for years with a debilitating illness.
I encourage my elderly clients and their family members to have open, honest dialogues about lifestyle expectations -- and to talk about it early and often. Yes, it can be scary and uncomfortable at first. But it's much worse to wait for a health crisis and then try to assume what your loved one wants. I've seen this unfortunate situation time and time again.
Some questions you should discuss include: How and where does your loved one want to live when they need assistance at home? If they can stay in their home with home health-care nursing, aide or companion assistance, will there be adequate insurance or savings to pay for these services? How much does home care cost compared to assisted living? Would your loved one rather stay with you or another family member?
If you're just too uncomfortable initiating or having the discussion with your parent, suggest having the discussion facilitated by a family friend or a clergyman. Another great resource is a geriatric care adviser. Usually a registered nurse, this professional helps seniors and their families through the complexities of aging; this can include everything from organizing medical information to coordinating care in a crisis. Also, be sure to talk to a financial planner about finances as well as long-term care and life insurance programs.
Since 1980, deaths from Alzheimer's disease have doubled with projected diagnoses expected to climb to 42.3 million by 2020. It's as good a time as any to start a conversation with your aging parent to help them -- and you -- face fears straight on and gain a little peace of mind about the future.
According to recent AARP survey, baby boomers are three times more worried about a having a major illness (48 percent) or winding up in a nursing home (48 percent) than about dying (17 percent). They're most concerned about becoming a financial, emotional or physical burden on their families.
The AARP also reports that 89 percent of survey respondents older than 50 want to stay in their own homes, surrounded by their lifetime possessions and comforting memories, for as long as possible. Over the past decade I've witnessed a growing trend to enable and accommodate seniors to stay in their own homes, rather than move into assisted-living facilities or nursing homes. Because there are so many questions around and fears about living situations for the elderly, I encourage my clients to plan well for the inevitable future.
In 2006, life expectancy at birth for the total population reached a record high of 78.1 years, according to the Centers for Disease Control and Prevention. Thanks to modern medicine and personal attention to living healthier lifestyles, today we can expect to live a lot longer than previous generations. What we can't expect or take for granted is quality of life.
Diseases of the heart and cancer still account for nearly half of all deaths for those older than 65. Progressive diseases such as diabetes, respiratory illnesses and Alzheimer's also are becoming more prevalent contributors to mortality. This means our parents may struggle for years with a debilitating illness.
I encourage my elderly clients and their family members to have open, honest dialogues about lifestyle expectations -- and to talk about it early and often. Yes, it can be scary and uncomfortable at first. But it's much worse to wait for a health crisis and then try to assume what your loved one wants. I've seen this unfortunate situation time and time again.
Some questions you should discuss include: How and where does your loved one want to live when they need assistance at home? If they can stay in their home with home health-care nursing, aide or companion assistance, will there be adequate insurance or savings to pay for these services? How much does home care cost compared to assisted living? Would your loved one rather stay with you or another family member?
If you're just too uncomfortable initiating or having the discussion with your parent, suggest having the discussion facilitated by a family friend or a clergyman. Another great resource is a geriatric care adviser. Usually a registered nurse, this professional helps seniors and their families through the complexities of aging; this can include everything from organizing medical information to coordinating care in a crisis. Also, be sure to talk to a financial planner about finances as well as long-term care and life insurance programs.
Since 1980, deaths from Alzheimer's disease have doubled with projected diagnoses expected to climb to 42.3 million by 2020. It's as good a time as any to start a conversation with your aging parent to help them -- and you -- face fears straight on and gain a little peace of mind about the future.
17 November 2009
Virtual Office Visits A Great Boon To Seniors
Washington Post
Above, Juanita Wood transmits her blood pressure readings to a clinic at her retirement community. where she lives. Her husband, Arthur, seen in the mirror, uses a similar device, though he also keeps a written tally.
Every morning at 10 a.m. sharp, Juanita Wood, 87, taps "okay" on a screen to start up a device that takes her blood pressure and transmits the information to her medical clinic. At 10:30 a.m., her husband, Arthur, 91, touch-starts his own device, neatly lined up next to hers. The machine calculates his blood pressure and weight and sends them off, along with a blood sugar count that he enters by hand.
The Woods, of Catonsville, Md., are participants in one of several pilot projects that home health-care providers, retirement communities and others are conducting to see if high-tech but simple devices can help doctors closely monitor aging patients at home in a way that will help control problems before they escalate and cut back on the need for costly long-term care and hospital admissions -- especially repeat hospital visits for chronic conditions.
Although proponents of health-care reform tout its potential for improving efficiency, often missing from the national debate are specific examples of how changes in the system might improve patient outcomes and reduce costs. These pilot projects are exploring some easy-to-use technology that might make a difference to patients and doctors.
"This helps us detect harbingers of a bad event for patients," said William Russell, vice president and regional medical director for Baltimore County-based Erickson Retirement Communities, which is running the pilot program in which the Woods are participating. "Early detection systems are important because more often than not, elderly patients do not come out of hospital stays with a better outcome."
Preventing problems
Seniors and others with chronic health problems such as diabetes, congestive heart failure and high blood pressure often wind up in hospital emergency rooms after forgetting to take their medication or when their condition deteriorates at home without anyone noticing. When that deterioration is severe enough, patients can be forced to move out of their homes into assisted living or nursing facilities, a costly and emotionally wrenching transition. The hope is that by closely monitoring patients at home, some of these events can be avoided or managed better.
Medicare spends more than $12 billion a year on "potentially preventable" repeat hospital admissions, according to the Medicare Payment Advisory Commission, an independent agency that advises Congress. And that number, according to the commission, is likely to grow, given that the Census Bureau projects that by 2025 there will be nearly 64 million Americans older than age 65, an increase of more than a third over today's total.
The pilot projects are not designed to have doctors diagnose illnesses remotely or to substitute for hands-on care. Instead, they are intended to allow elderly or infirm patients to get ahead of changes in their chronic conditions that could tip them into a medical emergency.
Juanita Wood, a retired secretary, had some fainting incidents possibly related to blood pressure problems. She hopes that keeping track of her blood pressure and transmitting the readings to her clinic in real time will help her avoid future episodes.
So every morning she straps on a blood pressure cuff attached to her monitoring machine, presses a button to start it up and waits for the cuff to inflate. Her pressure is recorded and then transmitted to the clinic at Erickson's Charlestown community, where the Woods live.
Arthur Wood, a retired architect, takes his blood pressure and weighs himself. Because he is a diabetic, he also is learning how to register his blood sugar levels, using a separate finger-prick device and then manually entering those numbers into his touch-screen unit. The Woods send in their info every morning, and employees at their clinic monitor the readings and alert them if something seems amiss, hopefully before anything major goes wrong.
The monitors that the Woods use are only one of the devices being tested in the pilot programs. Others are simple scales, to monitor sudden weight gain, which is a warning sign for those with congestive heart failure. There are also motion sensors placed under a bed, to make sure a person has gotten up in the morning, and wall sensors that can tell whether a person is moving around the house normally.
The Woods' devices feature a smallish computer screen that comes awake when a patient taps it, displaying his or her personal information. The device is set to blink with a blue light at the same time every morning to prompt patients to do their monitoring. There's no log-in or complex system for the device, and each machine is programmed to deal with one patient's specific medical issues.
The devices are built by Intel, which has been working to develop technology to bolster home health-care services. Last spring Intel and General Electric Healthcare announced they would jointly commit $250 million to develop wireless products to connect the patient to the physician.
The companies are focusing on such products because of research showing that "more than 80 percent of health-care spending focuses on patients with one or more chronic diseases," according to Louis Burns, vice president and general manager of the Intel Digital Health Group.
A matter of money
Right now, the biggest impediment to high-tech monitoring is that Medicare and private insurers generally do not reimburse for it. And the devices can be expensive. As part of a pilot project, Juanita and Arthur Wood get their devices for free; normally patients of a Raleigh retirement community, for example, would have to pay about $100 a month to rent them.
Also, insurance plans typically do not reimburse doctors for treating patients based on data sent remotely, only for face-to-face care. Some patient advocates also worry that electronically conveyed data might be substituted for direct medical care, which the organizers of the pilot projects say is not the goal.
Instead, they say, the devices will allow doctors to accumulate data on a patient over time; this information can then be used in a face-to-face visit with the patient.
This approach allows the doctor to "spend more time with patients so they are able to plumb the depth of the patient's problem," Russell said.
And if the digitally sent data show that something may be going wrong, medical professionals can step in immediately rather than wait for the patient's next routine appointment. "We set up thresholds, and anything above or below that, then the doctors get notified," explained Kelley Gurley, project manager for the Erickson study. "If the blood sugar is low, the patient would receive a call [from the clinic] that says, 'Please call your doctor,' " she said.
The device itself also is programmed to remind patients, in a friendly computer voice, about their arthritis medication and food consumption if a reading falls outside the parameters set by their doctors. In addition, a "Learn More" prompt on the touch-screen is linked to informational videos related to the data he or she has transmitted. If, for example, a blood pressure reading is high, the machine offers the patient the option of watching a short video in which a doctor explains how to bring the pressure down, such as by sitting down and relaxing for 30 minutes.
The device that the Woods use is known as the Intel Health Guide. Other companies, including General Electric, have their own home health monitoring systems. GE QuietCare is a sensor system most often used in assisted living and similar facilities to track patient activity.
Eric Dishman, general manager of Intel's Research and Innovation Group, said these devices perform an increasingly important function: "You just can't crank out enough medical students to solve our personnel shortage in this country. You need to rely on other means, especially technology, to bridge that gap." There is a productive future in store for students seeking a bachelor's degree in medical technology.
At their home one recent morning, Arthur and Juanita Wood were reminded by the flashing lights on their machines to start their monitoring process. The prompts were delivered by a female voice, which Arthur Wood noted was "sweet," but added, jokingly, "But I love it when she says goodbye." Because then it means he's done for the day.
The Woods, of Catonsville, Md., are participants in one of several pilot projects that home health-care providers, retirement communities and others are conducting to see if high-tech but simple devices can help doctors closely monitor aging patients at home in a way that will help control problems before they escalate and cut back on the need for costly long-term care and hospital admissions -- especially repeat hospital visits for chronic conditions.
Although proponents of health-care reform tout its potential for improving efficiency, often missing from the national debate are specific examples of how changes in the system might improve patient outcomes and reduce costs. These pilot projects are exploring some easy-to-use technology that might make a difference to patients and doctors.
"This helps us detect harbingers of a bad event for patients," said William Russell, vice president and regional medical director for Baltimore County-based Erickson Retirement Communities, which is running the pilot program in which the Woods are participating. "Early detection systems are important because more often than not, elderly patients do not come out of hospital stays with a better outcome."
Preventing problems
Seniors and others with chronic health problems such as diabetes, congestive heart failure and high blood pressure often wind up in hospital emergency rooms after forgetting to take their medication or when their condition deteriorates at home without anyone noticing. When that deterioration is severe enough, patients can be forced to move out of their homes into assisted living or nursing facilities, a costly and emotionally wrenching transition. The hope is that by closely monitoring patients at home, some of these events can be avoided or managed better.
Medicare spends more than $12 billion a year on "potentially preventable" repeat hospital admissions, according to the Medicare Payment Advisory Commission, an independent agency that advises Congress. And that number, according to the commission, is likely to grow, given that the Census Bureau projects that by 2025 there will be nearly 64 million Americans older than age 65, an increase of more than a third over today's total.
The pilot projects are not designed to have doctors diagnose illnesses remotely or to substitute for hands-on care. Instead, they are intended to allow elderly or infirm patients to get ahead of changes in their chronic conditions that could tip them into a medical emergency.
Juanita Wood, a retired secretary, had some fainting incidents possibly related to blood pressure problems. She hopes that keeping track of her blood pressure and transmitting the readings to her clinic in real time will help her avoid future episodes.
So every morning she straps on a blood pressure cuff attached to her monitoring machine, presses a button to start it up and waits for the cuff to inflate. Her pressure is recorded and then transmitted to the clinic at Erickson's Charlestown community, where the Woods live.
Arthur Wood, a retired architect, takes his blood pressure and weighs himself. Because he is a diabetic, he also is learning how to register his blood sugar levels, using a separate finger-prick device and then manually entering those numbers into his touch-screen unit. The Woods send in their info every morning, and employees at their clinic monitor the readings and alert them if something seems amiss, hopefully before anything major goes wrong.
The monitors that the Woods use are only one of the devices being tested in the pilot programs. Others are simple scales, to monitor sudden weight gain, which is a warning sign for those with congestive heart failure. There are also motion sensors placed under a bed, to make sure a person has gotten up in the morning, and wall sensors that can tell whether a person is moving around the house normally.
The Woods' devices feature a smallish computer screen that comes awake when a patient taps it, displaying his or her personal information. The device is set to blink with a blue light at the same time every morning to prompt patients to do their monitoring. There's no log-in or complex system for the device, and each machine is programmed to deal with one patient's specific medical issues.
The devices are built by Intel, which has been working to develop technology to bolster home health-care services. Last spring Intel and General Electric Healthcare announced they would jointly commit $250 million to develop wireless products to connect the patient to the physician.
The companies are focusing on such products because of research showing that "more than 80 percent of health-care spending focuses on patients with one or more chronic diseases," according to Louis Burns, vice president and general manager of the Intel Digital Health Group.
A matter of money
Right now, the biggest impediment to high-tech monitoring is that Medicare and private insurers generally do not reimburse for it. And the devices can be expensive. As part of a pilot project, Juanita and Arthur Wood get their devices for free; normally patients of a Raleigh retirement community, for example, would have to pay about $100 a month to rent them.
Also, insurance plans typically do not reimburse doctors for treating patients based on data sent remotely, only for face-to-face care. Some patient advocates also worry that electronically conveyed data might be substituted for direct medical care, which the organizers of the pilot projects say is not the goal.
Instead, they say, the devices will allow doctors to accumulate data on a patient over time; this information can then be used in a face-to-face visit with the patient.
This approach allows the doctor to "spend more time with patients so they are able to plumb the depth of the patient's problem," Russell said.
And if the digitally sent data show that something may be going wrong, medical professionals can step in immediately rather than wait for the patient's next routine appointment. "We set up thresholds, and anything above or below that, then the doctors get notified," explained Kelley Gurley, project manager for the Erickson study. "If the blood sugar is low, the patient would receive a call [from the clinic] that says, 'Please call your doctor,' " she said.
The device itself also is programmed to remind patients, in a friendly computer voice, about their arthritis medication and food consumption if a reading falls outside the parameters set by their doctors. In addition, a "Learn More" prompt on the touch-screen is linked to informational videos related to the data he or she has transmitted. If, for example, a blood pressure reading is high, the machine offers the patient the option of watching a short video in which a doctor explains how to bring the pressure down, such as by sitting down and relaxing for 30 minutes.
The device that the Woods use is known as the Intel Health Guide. Other companies, including General Electric, have their own home health monitoring systems. GE QuietCare is a sensor system most often used in assisted living and similar facilities to track patient activity.
Eric Dishman, general manager of Intel's Research and Innovation Group, said these devices perform an increasingly important function: "You just can't crank out enough medical students to solve our personnel shortage in this country. You need to rely on other means, especially technology, to bridge that gap." There is a productive future in store for students seeking a bachelor's degree in medical technology.
At their home one recent morning, Arthur and Juanita Wood were reminded by the flashing lights on their machines to start their monitoring process. The prompts were delivered by a female voice, which Arthur Wood noted was "sweet," but added, jokingly, "But I love it when she says goodbye." Because then it means he's done for the day.
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