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Social workers deserve a boost

Posted by admin Tue, 26 Aug 2008 16:43:05 GMT

August 23, 2008 Baltimore Sun
I remember the response many years ago when I told an aunt I was entering social work school: “Why do you want to spend your life giving out ‘home relief’ checks” (“It’s time for the givers to receive,” Commentary, Aug. 19)?

Social work has come a long way from the days when social workers were almost solely identified with “welfare” and the distribution of “checks.”

These days, professionally trained (and licensed) social workers are common in social services as diverse as foster care, adoption, geriatric care, substance abuse and community mental health facilities.

And anyone who has ever dealt with the myriad complications associated with establishing support services for an elderly family member about to be released from an institution (hospital, nursing home, etc.), or a home-bound relative needing assistance, to name only a few scenarios, realizes the valuable role played by social work professionals.

 

Sen. Barbara A. Mikulski’s Social Work Reinvestment Act, which seeks to keep the social work profession strong and vibrant, will benefit not only the profession but the millions of recipients of our services.

It deserves to be funded. Howard Altstein

Baltimore

The writer is a professor at the University of Maryland School of Social Work.

 

Nursing Home Task Force Says, 'The System Is Broken and Can't Be Fixed'

Posted by admin Tue, 26 Aug 2008 16:41:51 GMT

NASHVILLE, Tenn., Aug 25, 2008 /PRNewswire via COMTEX/—A national task force from the American Association of Homes and Services for the Aging (AAHSA) recently reported that the current survey and certification processes used to evaluate long-term care facilities nationwide is broken and beyond repair.
After a thorough investigation into survey and certification protocol across the country, the task force concluded in its final report, “Broken and Beyond Repair: Recommendations to Reform the Survey and Certification System,” that an independent, broad-based national panel of experts should be convened to re-examine the oversight process for nursing homes.
The report’s 31 recommendations address short-term and long-term solutions, including improved communication to surveyors and providers about new requirements and changes to the survey process, standardized job descriptions for surveyors, more efficient use of survey resources, and flexibility to adapt to culture change. The task force’s overarching recommendation is that an independent commission, such as the Institute of Medicine, re-examine the survey and certification process to “create a common vision for how our nation should care for its frailest citizens and to recommend a new oversight model for ensuring that this vision becomes reality in every nursing home today.”
This report hits home in Tennessee, where the trend of increased admission suspensions continues for the second consecutive year, with 16 facilities forced to remit significant fines and suspend new patient admissions so far in 2008, following 29 in 2007. This comes as a result of violations reported under the current survey system.
Co-chair of the 20-member task force and CEO of Hebrew Health Care in West Hartford, Conn. Bonnie Gauthier acknowledged that, “Our short-term suggestions alone won’t bring the system back to the intent of OBRA 87-achieving optimal, quality-based, resident-centered care-but they will tide the system over until broad systemic change can occur.” Immediate changes needed, according to the report, include better public reporting of survey results, joint education of providers and surveyors, and greater overall consistency in the process.
TNAHSA, Tennessee’s AAHSA affiliate, works closely with the Department of Health in an ongoing effort to provide updated and accurate information to licensed providers of long-term care services, according to TNAHSA Executive Director Carrie Ermshar.
“Because the Centers for Medicare and Medicaid Services play a significant role in the certification process, the solution must address procedures at the state and federal levels,” said Ermshar. “We have encouraged enhanced training for Tennessee Department of Health licensure surveyors and we are seeing tremendous efforts to improve communications between surveyors and facilities. We have a great team of providers, lawmakers and surveyors in Tennessee and we all share the common goal of providing excellent patient care.”
To inform its conclusions, the report includes a digest of interviews with survey agency representatives from seven states and a catalog of surveyor job descriptions from numerous states.
Timothy L. Veno, president and CEO of the Kentucky Association of Homes and Services for the Aging (KAHSA) and a co-chair of the task force, said that, “The frustration of good providers has reached a boiling point.” Veno added, “We have to help shape a better system of consumer protection for residents.”
Larry Minnix, AAHSA’s president and CEO, said the task force captured the demoralization of providers who feel caught in a vicious circle. “We have to break the cycle of fear that paralyzes us all: consumers fear nursing homes, nursing homes fear the state, states fear the federal government, the federal government fears Congress and Congress fears voters,” Minnix said. “This system is broken and can’t be fixed. A system based on consistency, fairness and accuracy will help us move toward the day when there are two types of nursing homes: the excellent and the non-existent.”
Copies of the report are available on AAHSA’s Web site at http://www.aahsa.org/advocacy/nursing_homes/documents/SCTF_Report_FINAL.pdf .
About TNAHSA
TNAHSA represents skilled nursing facilities, assisted living facilities, senior housing services and various agencies serving senior adults throughout Tennessee. An affiliate of the American Association of Homes and Services for the Aging (AAHSA), TNAHSA provides leadership, advocacy, education and communication services. For more information about TNAHSA, please visit www.tnahsa.org or call 615-256-1800.
SOURCE Tennessee Association of Homes and Services for the Aging

Who Are You Calling Old? Labels Change as Americans Live Longer, But Age Still Plays a Role in Election

Posted by admin Tue, 26 Aug 2008 16:39:11 GMT

By JUNE KRONHOLZ
August 26, 2008; Wall Street Journal, Page A15

In 1996, Bob Dole, the Republican Party’s presidential nominee, battled criticism that, at 73 years old, he was too old to be president. Now 85, Mr. Dole is working “pretty much every day” at a Washington law firm, says the firm’s spokesman.
Click to see full chart.
Age is certain to be an issue in this election, too. Republican Sen. John McCain, who turns 72 this week, would be the oldest man elected president should he win. Democratic Sen. Barack Obama, at 47, would be the fourth-youngest.

But in a country that is rapidly aging while staying healthy longer, what does old age mean, and how much should it matter?

The average U.S. life expectancy is now age 78, up 30 years since 1900 and up 10 years since 1950, according to the Census Bureau. Geriatricians now talk of those younger than 80 as the “young old,” and of those younger than 65 as the “near old.”

U.S. businesses still seem wary of older people. The Corporate Library, a business-research firm, says that seven of the largest 500 public companies, including News Corp. - owner of Dow Jones & Co., publisher of The Wall Street Journal - have chief executives who are 72 or older. Some corporate recruiters warn about the memories, energy levels and technological savvy of older executives.

 CAST YOUR VOTE
Would you rather have a president who’s relatively old or relatively young?By that standard, businessman Warren Buffet, one-quarter of U.S. senators and four Supreme Court justices are over the over-72 hill.

In corporate America, “there’s a code word—how much ‘runway’ does a guy have” left in his career, said Hal Reiter, chairman of Herbert Mines Associates, which recruits executives for the retail industry. An executive in his 60s probably has five to seven years left on his runway, Mr. Reiter said.

Some who study aging say such fears are misplaced. A 45-year-old and a 75-year-old “absolutely” have the same mental capacity, and energy is a function of health rather than aging, said Neil Resnick, chief of geriatric medicine at the University of Pittsburgh.

“Aging has such a small impact on how we function that it is of minimal importance” compared with experience, personality and the advisers a president or chief executive surrounds himself with, Dr. Resnick added.

Geriatricians say most people begin losing organ function - which means they start aging - somewhere between 18 and 30. After that, the heart, kidneys and other organs lose about 1% of their function each year. The world record for a 75-year-old marathon runner is about 50% longer than the world record for a runner who is 50 years younger.

But organs have from four to six times more capacity than most people need. That excess capacity is why we can run marathons or endure other extraordinary mental or physical challenges.
See an interactive graphic weighing the candidates’ ages.
Brain function declines at the same rate as other organs, and especially affects how fast older people can retrieve information—the explanation for that maddening “senior moment.”

Our genes influence how much and how fast we decline: They account for about 30% of longevity and perhaps half of age-related changes in the brain, said John Rowe, a physician and former Aetna Inc. chairman who now heads a MacArthur Foundation research program on aging.

But life experience and accumulated wisdom can help offset normal brain decline and compensate for slowed retrieval time. “The great benefit of aging is ‘been there, done that and learned from it,’ ” said David Reuben, head of geriatric medicine at the University of California at Los Angeles. Mathematicians do their best work in their 20s; orchestra conductors and diplomats peak in their 60s or 70s, he added.

On the other hand, Robert Butler, who founded the government’s National Institute on Aging and now heads the International Longevity Center research group, credits judgment over experience when it comes to making sound decisions. He points to Abraham Lincoln, who was 52 and had just 10 years of government experience before becoming president.

Dr. Butler added, though, that brain cells can continue to “flourish” and grow in people in their 80s. Vocabularies expand as people age; older brains develop unconscious work-arounds to diminish the effects of slowed retrieval speed.

Despite Sen. McCain’s admitted aversion to technology, there is no research that shows older people are less willing to take up new ideas. “If he’s averse to technology now, he probably always was,” said Dr. Resnick.

UCLA’s Dr. Reuben insists that commentators are asking the wrong question when they focus on age: It isn’t how old, but how healthy the candidates are.

Almost everyone knows a 75-year-old who sky-dives, hikes the Grand Canyon or runs a family business. Census Bureau data suggest that Americans generally are staving off disability to the very end of life: Those at age 65 can expect that half their remaining years will be disability free.

About one in eight men age 70 or older is working, and among those who aren’t, poor health is one of the less-important reasons. Even though age-discrimination laws often prevent mandatory retirement, twice as many say they were “forced” to retire for one reason or other as those who said they were sidelined by illness.

But most people also know someone who died in his or her 50s from a heart attack or cancer. The risks of disease and the effects of a lifetime of exposure to sun, pollution, cigarettes and other life shorteners catch up with us as we age.

The percentage of people with Alzheimer’s disease doubles every five years after age 65, and while heart-related deaths are down in the past four decades, cancer deaths are rising.

The backdrop for all this is an over-65 population that will double to 80 million in 30 years as the tidal wave of baby boomers sweeps through. One in five people will be older than 65, up from one in eight now, and Dr. Rowe predicts a future in which as many Americans push walkers as strollers.

Longer life will have a huge effect on everything from immigration policy to public transit to housing. Where will we find all the home health aides, how do we get 85-year-olds off the highways and what is to become of those four-bedroom houses?

Retirement at age 65 made sense when most workers poured steel, plowed fields and mined coal. Today’s workers - still vital and healthy, for the most part - want nothing to do with lowering their Social Security-benefits age.

An aging society also may affect elections, although that is less clear. Researchers who study prejudice say that Americans are more biased against the elderly than against any other group, including those identified by their race or sexual orientation. Even the elderly are biased against the elderly.

Voters ages 65 and older account for more than one-quarter of the electorate and vote at higher rates than other age groups. In presidential elections, young voters “always go for the new face,” said Robert Binstock, a professor of aging at Case Western Reserve University in Cleveland, but older voters vote much like everyone else.

That means that, even in an aging society, Sen. McCain can’t count on the oldster vote, even as Sen. Obama is relying on the youth vote. Being older is one thing; it could be that voting for an older president is another.

 

Cost of Caring for Aging Parents Could Be Next Financial Crisis

Posted by admin Tue, 26 Aug 2008 16:36:20 GMT

 

NAPLES, Fla., Aug. 26 /PRNewswire/—Many people find themselves responsible for paying for the care of their parents as they age. But according to a just-released survey, these adult children of aging parents, known as family caregivers, are vastly unprepared. The survey found:

—63% of caregivers have no plan as to how they will pay for their parents’ care over the next five years.

—62% say the cost of caring for a parent has impacted their ability to plan for their own financial future.

“With an estimated 34 million Americans providing care for older family members, the survey’s results indicate a financial crisis in the making,” says Joe Buckheit, Publisher of AgingCare, a website and online forum for family caregivers.

“Medicare only covers long-term care for a short time, and only under strict rules. Medi-gap insurance helps, but does not cover all costs. The burden of paying for long-term care often rests with the family,” Buckheit says. “The caregivers’ lack of planning is impacting their own financial future.”

Long-term care costs are not the only expenses caregivers bear. “Family members responsible for ailing loved ones provide not only hands-on care but often reach into their own pockets to pay for many daily expenses, including groceries, household goods, drugs, medical co-payments and transportation,” says Buckheit. “Americans who are already strapped for cash by the rising price of gas and food are unable to afford these additional expenses.” The survey found:

—34% spend $300 or more per month out of their own pocket for caregiving expenses.

—54% have sacrificed spending money on themselves to pay for care of their parents.

Work Issues

Making matters worse, caring for aging parents often impacts adult children at their workplace as well. The survey found:

- 43% have had to take time off work due to caregiving responsibilities. - 48% say they are earning less money at work as a result of caregiving. —25% have been fired or had to quit their job as a result of caregiving.

Physical and Emotional Toll

Despite potentially making less money and doling out more, more than half of the caregivers surveyed are spending what equates to a full-time work week - 40 hours or more - on caregiving duties—many in addition to their full-time careers outside the home.

- 53% of caregivers provide care 40 or more hours per week. - 37% provide care more than 80 hours per week. - 21% say they never get a break from caregiving. - 36% get a break of 5 hours or less a week.

The survey indicates that today’s caregivers face a triple financial threat: unplanned-for caregiving expenses, less money for their own needs and reduced time in the workplace.

Drug error rate low for assisted living patients

Posted by admin Tue, 26 Aug 2008 16:31:10 GMT

NEW YORK (Reuters Health) – Potentially harmful medication administration errors are very rare in assisted living settings, the result of a study of 12 facilities in three states suggests.

Assisted living facilities are a less expensive alternative to skilled nursing facilities, offering residents more independence and a homier environment. Medication errors are a concern in these settings, lead investigator Dr. Heather M. Young of Oregon Health and Science University in Ashland and her colleagues say, because aides with no licensing or professional training are typically charged with distributing drugs to residents.

To investigate the prevalence of medication errors, the researchers observed 29 unlicensed assistive personnel giving out medications to 510 assisted living residents at facilities in New Jersey, Oregon and Washington. They watched 56 “medication passes,” including both day and night shifts, for a total of 4,866 observations.

Young and her team observed 1,373 errors, for an error rate of 28.2 percent. But 70.8 percent of the errors were time-related, meaning a patient didn’t get a drug within an hour of the scheduled dosing time. Once time was removed from the analysis, the error rate was 8.2 percent.

Other causes of errors included wrong dose (12.9 percent), skipped dose (11.1 percent), extra dose (3.5 percent), unauthorized drug (1.5 percent) and wrong drug (0.2 percent),Young’s team reports in the Journal of the American Geriatrics Society. Only three of the errors observed had potential clinical significance, according to the researchers, and none of the errors were considered “highly likely to cause harm.”

None of the time-related errors involved giving medications for which timing was crucial, such as insulin. Because medication is typically given out to assisted living residents twice a day at a standardized time, the researchers say, “a high number of wrong-time errors is not surprising, and given the lack of clinical significance of the errors observed, is probably not a meaningful indicator of quality.”

The researchers did find that errors were more likely to occur with riskier medications, like insulin or the blood thinning drug warfarin, which are typically given to patients “in less stable and predictable conditions.”

They suggest that prioritizing the administration of high-risk drugs, as well as the care of patients with more complex health issues, could help prevent serous medication errors and improve the quality of care.

SOURCE: Journal of the American Geriatrics Society, July 2008.

"Nana” Technologies© to be Featured at AARP’s National Event & Expo

Posted by admin Tue, 26 Aug 2008 16:30:26 GMT

The newest technologies for seniors, as well as a preview of “sci-fi” technologies for the future will be featured during special events at the “Life@50+”| AARP’s National Event and Expo, September 4-6, 2008 at the Washington, DC Convention Center.

The events, to be conducted as part of Technology Pavilion activities, will include a “Nana” Technology booth with samples of current products, as well as companies exhibiting additional technologies throughout the Exposition Hall.  In addition Andrew Carle, who coined the term “Nana” Technology to describe technologies for older adults, will provide a daily presentation for attendees and the media discussing issues of “global aging”, the critical shortage of family and professional caregivers, and the role such technologies will play in meeting the needs of aging Baby Boomers.  

Technologies scheduled for display or review, include:

·        Radio frequency tagging devices that can locate lost keys, purses, or provide the location of a car in the parking lot.

·        “E-mailboxes” that allow seniors to participate in receiving and sending emails, photos, and cards on the world wide web – without the need of a computer.

·        “Brain Trainers” that can delay or address age related cognitive impairment.

·        Home “Health & Wellness” systems that can discreetly monitor for unusual activity, including falls, and provide alerts to family or professional staff. 

·        Lifestyle products, including mailbox alerts, senior friendly cell phones, and voice activated assistive devices.

·        Future technologies to be reviewed by Carle include a “smart shirt” that can administer CPR, a GPS “tracking” shoe for individuals with Alzheimer’s who may become lost, a “personal assistance” robot, and a “Magic Medicine Cabinet” capable of communicating with users to prevent medication errors, monitor vital signs, and schedule an appointment with a physician.

Carle is President of Carle Consulting and a national expert on senior housing, care, and technology.  His work has been featured in or on USA TODAY, UPI, The Washington Post, Business 2.0, National Public Radio, Fox Morning News, Agency France Presse, and the Australian Broadcast Corporation, among others.  He additionally serves as an Assistant Professor and Director of the Program in Senior Housing Administration at George Mason University in Fairfax, Virginia.  He will present on the Technology Pavilion stage at 4:30 pm on September 4th, then at 12:30 pm September 5th and 6th.

Older Adults Reluctant to Question Surgical Treatment

Posted by admin Thu, 21 Aug 2008 12:51:38 GMT

FRIDAY, Aug. 15 (HealthDay News)—Older patients and surgeons don’t communicate effectively when discussing surgical treatment options, even though the decision to have surgery can be particularly difficult and confusing for seniors, says an Indiana University School of Medicine study.
 
The researchers recorded patient-surgeon consultations and later interviewed the patients about their concerns and whether they discussed those worries with the surgeon. The study found that older patients raised only about half of their concerns when talking with the surgeon.
“Unexpressed concerns are challenging, because they can lead to different expectations and understanding of the problems patients are concerned about and treatment recommendations that are poorly tailored to patient needs,” study author Richard M. Frankel, a professor of medicine, said in a university news release.
If concerns aren’t expressed, “physicians will have little chance to correct or modify them. Unfortunately, unexpressed concerns may contribute to breakdowns in communication which are frustrating for both physicians and patients,” he added.
Most (84 percent) of the concerns expressed by older adults in the study were related to the surgery itself. Other major concerns included: quality of life after surgery; the post-surgery care facility; and the timing of the surgery.
Only 16 percent of concerns were related to the surgeons, including doubts about competency and the perception that surgeons tend to promote surgery as the only real treatment option.
While surgeons generally respond well to concerns raised by patients, the study found that patients may be highly selective about which concerns they mention.
“Knowing that older adults frequently don’t voice all their concerns should help surgeons create opportunities for patients who are reluctant to bring them up,” Frankel said.
The study was published in the July issue of The Journal of Bone and Joint Surgery

Insurance gap leads some elderly to forgo medicine

Posted by admin Thu, 21 Aug 2008 12:50:32 GMT

By KEVIN FREKING, Associated Press Writer
WASHINGTON – Many people in Medicare with diabetes, high blood pressure and other chronic conditions stop taking their medicine when faced with picking up the entire cost of their prescriptions, researchers say.
 
About 3.4 million older and disabled people hit a gap, known as the doughnut hole, in their Medicare drug coverage in 2007. When that happened, they had to pay the entire costs of their medicine until they spent $3,850 out of pocket. Then, insurance coverage would kick in again.

About 15 percent of those hitting the coverage gap stopped their treatment regimen. That rate varied depending upon illness. For example, about 10 percent of diabetes patients stopped buying the medicine, as did 16 percent of patients with high blood pressure and 18 percent of patients with osteoporosis.

The drug benefit, which began in 2006, has come in under budget. Most participants report they are satisfied with the program. But many lawmakers and health analysts say improvements could be made.

“If a new president and Congress consider changes to the drug benefit, it will be important to keep in mind that the coverage gap has consequences for some patients with serious health conditions,” said Drew Altman, the chief executive officer and president of the Kaiser Family Foundation. The foundation conducted the study with researchers at Georgetown University and the University of Chicago.

The Republican-led Congress in 2003 crafted the doughnut hole as a way to make the drug benefit more affordable for the federal government.

The researchers based their findings on pharmacy claims data provided by IMS Health, a company specializing in collecting health care data. They excluded people who get extra help in paying for their drug coverage because of their income; they do not pay the full cost of medicine even when in the doughnut hole.

When looking at spending by people who did not receive the extra help, researchers could determine when they hit the coverage gap, which began at $2,400 in total drug spending. They also could determine when they passed through the gap and catastrophic coverage kicked in.

The researchers focused their analysis on eight categories of drugs. Those least likely to stop taking their medicine were Alzheimer’s patients, at 8 percent. Those most likely, at 20 percent, were patients taking medicine for heartburn, ulcers and acid reflux disease, 20 percent.

Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the coverage gap kicks in after participants have saved about $1,600 on their drug costs, on average. He also noted that many plans offer some coverage when beneficiaries hit the doughnut hole. Those plans cost at little as $28.70 a month, and are available in every state for less than $50 a month.

“We urge beneficiaries to choose wisely when selecting their drug coverage,” Nelligan said. “Again, we emphasize that any changes to the coverage gap would need to come from Congress.”

The share of Medicare recipients who reached the doughnut hole varied widely by region. About one-third in Arkansas and seven states in the Northern Plains hit the coverage gap in 2007, but only 12 percent in Nevada did.

Researchers said such regional differences may occur because of physicians’ prescribing patterns as well as overall health of the population. A separate factor may be enrollment in Medicare Advantage plans. Such plans offer comprehensive health coverage on top of the drug benefit. Regions where Medicare Advantage plans were most prevalent had fewer enrollees hit the coverage gap, which could reflect stronger management of drug use.

Democratic lawmakers have led efforts to let the government use its purchasing power to negotiate cheaper drug prices. They say the savings could be used to reduce the coverage gap, though the Congressional Budget Office projected that the legislation would not lead to any significant savings.

About 5 percent of the people who hit the Medicare coverage gap switched to another medication, most often a generic drug, while 1 percent reduced the number of medications they were taking in a particular class of drugs, the report said.

_

On the Net:

Kaiser Family Foundation: http://www.kff.org

 

Aging department's book for boomers' plan for retirement

Posted by admin Thu, 21 Aug 2008 12:45:48 GMT

Publication available a numerous outlets
By Pat van den Beemt

Baltimore County Department of Aging has released “Planning for Your Future,” for baby boomers thinking about retirement and long-term planning.
The book, now available in all senior centers and county libraries, includes valuable information on retirement planning, health insurance, reverse mortgages and long-term care options.

The publication, produced by the Baltimore County Department of Aging in cooperation with Patuxent Publishing Co. and Stella Maris, provides a useful tool for baby boomers thinking about long-term care options for themselves or a loved one. To receive a copy, visit your local senior center, library or call Jessica Fish at 410-887-2002 to have a copy mailed to you.

 
 

Events Just Like These at www.proaging.com

Posted by admin Thu, 21 Aug 2008 12:43:53 GMT

“Eating Disorders and the Elderly”

Presented by:  Dr. Steven Crawford, MD

 

Dr. Steven Crawford is uniquely qualified for his role at the Center for Eating Disorders, where he has filled leadership roles for 15 years.  Dr.  Crawford’s experience with eating disorders stretches all over Baltimore, from Sinai to Mercy Hospitals, University of Maryland Medical Center to St. Joseph’s Medical Center.  He sees his specific role at the Center for Eating Disorders as “helping to knit the whole eating disorder program together so that every patient who comes in has a master treatment plan which maps out the individuals’ goals.”

 

When:  August 27th 11:30-1:00pm

Lunch 11:30-12:00

 

Where:  Brighton Gardens of Pikesville
1840 Reisterstown Road 21208
 

Please RSVP: Jessica Wagner, Director of Community Relations 

410-580-0892 by August 20th

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