ProAging Information Network

Erickson School Executive Education

www.erickson.umbc.edu/execed

<

http://www.erickson.umbc.edu/execed%20or%20call%20443-543-5624> or call

443-543-5624 to register.

ProAging/IAC Meeting - How Is The Economy Effecting Our Service To Seniors?

 

Date: Thursday December 04, 2008

Time: 2-4ish

Location: Woodlands Retirement Community

4320 Forest Hill Drive

Fairfax, VA 20030

Source: http://news.yahoo.com/s/hsn/20081126/hl_hsn/athirdofmedicareclientsunfamiliarwithbenefits;_ylt=AsMU1E_BceEjz2Gtz3QB2T4_cbYF

, Nov. 25 (HealthDay News) – How well a person on Medicare understands the program’s benefits affects their access to health care, a new study says.

The report, published in the Journal of the American Geriatrics Society, found that a third of the surveyed Medicare beneficiaries from across the United States considered themselves as being unfamiliar or very unfamiliar with their program’s benefits.

The lack of understanding was widespread across demographic groups although blacks, Hispanics, enrollees in Medicare managed care plans, beneficiaries with lower incomes and less formal education tended to be less familiar than other groups.

"Beneficiaries’ understanding of their health benefits ultimately may affect the quality and outcomes of their care. Well designed educational interventions or policies simplifying Medicare benefit programs could have a significant effect on beneficiaries’ abilities to get needed care," principal author Robert O. Morgan, a professor of Management, Policy and Community Health at the University of Texas School of Public Health, said in a news release issued by the journal’s publisher.

 

Source: http://www.wjla.com/news/stories/1108/573154.html

Doctor Gives D.C. Nursing Home Failing Grade 

           

 WASHINGTON - There is a warning out about the care, or lack thereof, loved ones may receive at a local nursing home.

An emergency room doctor tells ABC 7/NewsChannel 8 reporter Stephen Tschida he routinely sees patients from the Grant Park Care Center nursing home facility in NE on the verge of death because of neglect.

"She would have died; she was dying," said Carolyn Long of her relative at the nursing home. On a number of occasions they had to take her to the hospital; I believe it might have been dehydration at one point in time."

Carolyn has since removed her aunt from the Grant Park facility, but an emergency room doctor who treats patients from nursing homes in the D.C. Area says the patients he frequently sees form the Grant Park facility are in critical condition.

"They are coming in with acute kidney problems. They are coming in with severe pneumonias. They are coming in with, you know, malnutrition," said Jerry Kasunic, D.C. Long-term care Ombudsman. "They have been malnourished and they’ve been just flat out neglected while in the nursing home."

As a result, ABC 7/NewsChannel 8 obtained inspection reports from the D.C. Department of Health that were done in February and May of 2008. The reports detail an abundance of deficiencies at the care facility such as, "nurse failed to notify physician of resident dehydration, resident with weight changes and of anemia."

As a result, Kasunic, says his staff "has actually filed over 100 complaints with the Department of Health," calling Grant Park one, if not, the worst he’s seen.

"The neglect and abuse we have seen there is unattended wound care [and] dehydration that has led to malnutrition," added Kasunic.

Sandra Durham, executive director at Grant Park, issued the following statement:

"The staff are committed to a culture of continuous quality improvement" and "the center hired a new director of nursing and a compliance officer."

Meanwhile, the night before we spoke with him, Doctor Kasunic said he treated a man from Grant Park on the brink of death.

"The cause was merely dehydration… he clearly was not receiving any kind of fluids and he was a non-verbal patient, so he couldn’t say I would like a glass of water," said Doctor Kasunic.

Both Doctor Kasunic and the inspector for the D.C. Department of Health agree the city’s health department needs to get more aggressive with policing nursing homes. However, a request for a comment on Grant Park from the director of the D.C. Health Department was not returned.

Read entire article at http://www.nytimes.com/2008/11/26/business/26senior.html?ref=business



By TERRY PRISTIN, The New York Times



Published: November 25, 2008

The credit crisis is battering the two largest publicly traded operators of housing for the elderly. One of them, Sunrise Senior Living, is trying to stave off bankruptcy. The other, Brookdale Senior Living, is considered likely to resolve its short-term problems, but it faces a mountain of debt in the next few years.

Both companies, behemoths in a largely fragmented industry, say they are taking steps to reduce costs but have pledged to refrain from cuts that could impinge on the care they offer their residents. Brookdale manages 51,847 units of retirement and assisted-living housing, and Sunrise has 50,235 units.

Once the bellwether of the assisted-living industry, Sunrise Senior Living, based in McLean, Va., has violated certain covenants imposed by its lenders on leverage ratios and has a deadline of Jan. 31 to restructure its line of credit. One analyst, Jerry L. Doctrow, a managing director at Stifel Nicolaus & Company, said Sunrise might need to raise as much as $300 million next year.

Sunrise’s new chief executive, Mark S. Ordan, a former gourmet-grocery executive who specializes in trying to rescue troubled companies, said he did not expect to wait until Jan. 31 to work things out with the lenders. “We should have an arrangement with the banks long before that,” Mr. Ordan said.

Mr. Ordan’s predecessor, Paul J. Klaassen, who founded Sunrise in 1981 with his wife, Teresa, stepped down this month. The Klaassens, who are still heavily involved in Sunrise, are regarded as pioneers in assisted living, which provides frail elderly people with an alternative to the hospital-like setting of a nursing home. But the couple’s reputation was tarnished in recent years as Sunrise became mired in accounting problems and other governance matters that drew the attention of the Securities and Exchange Commission and forced the company to restate years’ worth of earnings.

The company also stumbled when it expanded into Germany and branched into new areas, including developing age-restricted condominiums and acquiring a hospice company that was later accused of fraud in billing Medicare. “They have made a number of ill-advised investments,” Mr. Doctrow said.

Sunrise recently suffered a blow when a real estate investment trust, Health Care REIT, backed out of a $643.5 million deal to acquire a 90 percent stake in 29 properties in which Sunrise has a minority stake, citing the stalemate in the capital markets. Sunrise was to realize at least $41 million from the deal.

On Nov. 28, 2007, Sunrise’s shares closed at $32.16. But since Nov. 12, it has been trading below $1, closing at 53 cents on Tuesday.

Founded in 1986, Brookdale grew rapidly at the height of the real estate cycle by acquiring rival companies, doubling the size of its portfolio. To finance these purchases, Brookdale, now based in Nashville, took on short-term mortgages secured by its existing assets, and has about $1.6 billion in debt due by the end of 2012, according to Green Street Advisors, a research company in Newport Beach, Calif.

Brookdale, the developer of the Hallmark at Battery Park City, a 14-story retirement and assisted-living home in Lower Manhattan, is expected to cut its dividend to meet near-term obligations. The company is also reducing corporate overhead costs, trying to sell some of its unencumbered real estate and increasing the availability of services like therapy and home health care, for which the company can charge fees not included in its basic rate.

Bill Sheriff, Brookdale’s chief executive, said that in recent weeks, residents had urged him to forgo renovations to keep the company from raising monthly fees, which can run as high as $10,000. “Do everything you can to control costs,” he quoted them as saying.

Brookdale’s shares, which traded for $35.16 on Dec. 10, closed at $3.76 on Tuesday.

Though the two companies are close in size and cater to the same upscale segment of the market, they have different business models. Brookdale owns or leases most of its homes, while Sunrise is primarily a management company that develops centers and then sells them to other companies while retaining a minority stake. The average monthly fee, including housing, meals and some services, at Sunrise-operated centers is $5,000.

Nearly three-quarters of Sunrise’s units are dedicated to assisted living, aimed at people who need help with daily activities. A majority of Brookdale’s units are either stand-alone retirement homes — where communal meals are available but the population is less frail — or so-called continuing-care retirement communities, where residents initially live independently but contract in advance for assisted living and nursing care on the premises.

 

Winners of the 2008 Livable Communities Awards from AARP and NAHB Anticipate Trend, Lead Movement toward User-Friendly Homes

www.aarp.org/homedesign.

The poll was conducted August 29–September 8th, 2008 by Opinion Research Corporation using CARAVAN®, a weekly national telephone survey. Interviews were conducted with 1,273 respondents age 45 to 64 using a stratified, random-digit dialing sample of U.S. telephone households. All responses were subsequently weighted by age, gender, ethnicity, and region to be nationally representative of the U.S. population 18+. The margin of error is +/- 6%.

#####

NS2008-175

ABOUT AARP: AARP is a nonprofit, nonpartisan membership organization that helps people 50+ have independence, choice and control in ways that are beneficial and affordable to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for 50+ Americans and the world’s largest-circulation magazine with over 33 million readers; AARP Bulletin, the go-to news source for AARP’s 39 million members and Americans 50+; AARP Segunda Juventud, the only bilingual U.S. publication dedicated exclusively to the 50+ Hispanic community; and our website, AARP.org. AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. We have staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

ABOUT NAHB: The National Association of Home Builders is a Washington, D.C.-based trade association representing more than 235,000 members involved in home building, remodeling, multifamily construction, property management, subcontracting, design, housing finance, building product manufacturing and other aspects of residential and light commercial construction. Known as "the voice of the housing industry," NAHB is affiliated with more than 800 state and local home builders associations around the country. NAHB’s builder members will construct 80 percent of the nearly 1 million new housing units projected for 2008.

On November 7, the DC Office on Aging issued a request for proposals (RFP) for Aging in Place Challenge Mini-Grants.  These grants will provide approximately $300,000 for innovative grassroots projects that help District residents age in place. A wide range of nonprofit models, including “Villages,” are eligible.  The program will support approximately 15-20 projects with mini-grants of $15,000 - $20,000.  Groups receiving funds must match their grants dollar for dollar.  Proposals will be due December 19.   Only District-based initiatives are eligible.

 To learn more, please call Aurora Delespin Jones at the DC Office on Aging at 202-727-6405.

New chief of geriatric medicine

St. Agnes Hospital names Richardson to post

http://www.explorebaltimorecounty.com/community/5090/health-notes/

St. Agnes Hospital appointed Dr. James Richardson as chief of geriatric medicine.

He specializes in the diagnosis and treatment of dementia, frailty, frequent falls and other syndromes connected with aging.

In addition to publishing more than 40 scientific articles and book chapters on geriatric topics, Richardson regularly contributes to Generations, a monthly newspaper for seniors. He is a Fellow of the American Geriatrics Society, the American College of Preventive Medicine and the American Academy of Family Practice.

Richardson graduated from the University of Maryland, Baltimore County and the University of Maryland School of Medicine, where he completed a residency in family medicine.

He resides in Ellicott City with his wife and sons.

 

Wednesday, November 19, 2008

http://www.foxnews.com/story/0,2933,454328,00.html

Nursing-home residents have sexual needs too. And now researchers are finding ways to educate staff on the taboo topic and provide accommodations for the elderly to shack up under some privacy.

"Most staff have the same mindset many of us do, which is ‘I don’t want to think about my parents having sex, let alone my grandparents,’" Gayle Doll, who directs Kansas State University’s Center on Aging, told LiveScience.

The researchers suggest educating staff about sexuality and making sex in nursing homes less hush-hush.

In the long run, they hope federal guidelines will help all nursing homes deal with sexuality in a positive way, especially as baby boomers age and bring their 1950s and 1960s attitudes about sex with them to the facilities.

• Click here to visit FOXNews.com’s Natural Science Center.

The research, whose details were announced Tuesday, was presented in October at the American Association of Homes and Services for the Aging conference.

RelatedStories

‘Second Life’ Affair Leads to Real-Life Divorce Craigslist to Require Phone Number, Credit Card for ‘Erotic Services’ Ads Study: Looks Count for Female Candidates, but Not Male Ones Researchers Find ‘Transsexual Gene’ Fungi Caught Having Sex in Humans "By law, you can’t always lock a room, but you can offer residents some privacy," Doll said. The semi-private rooms that are typical in nursing homes pose a problem for residents who want to engage in sexual activity, either alone or with a partner, Doll added.

In fact, past research has shown that men and women continue to participate in sexual intercourse and "solo activities" well into their 70s and 80s.

Let’s talk about sex

The researchers’ suggestions come from studies about sexuality in three Kansas nursing homes.

In the study, Majka Jankowiak and Laci Cornelison, research assistants at the Center on Aging, surveyed the staff before and after a workshop on sexuality that they had presented.

Rather than telling nursing-home staff what to do, the researchers used the workshop to get staff talking about sex and asking questions.

The surveys, as well as anecdotal feedback from the participants, showed a marked change in attitudes.

"They really felt this was a topic that they needed to be educated on," Jankowiak said. "Part of it is that American society is not supportive of older people and sex. It’s been a taboo, and it’s an even bigger taboo in nursing homes."

Jankowiak added, "After the presentation, the participants felt more confident talking about it and dealing with sexual expression of residents."

Such shifting attitudes ended up having a positive effect on a married couple who had moved into a nursing home room with two hospital beds.

One spouse had to have a leg elevated, but it was on the same side as the partner’s bed. The positioning made it tricky for them to hold hands.

Some staff members didn’t see the importance of allowing the couple intimacy and said the problem couldn’t be fixed.

"But someone who had been to our presentation encouraged everyone to move the furniture," Cornelison said.

Safety first

Sex in nursing homes brings up some safety issues. For instance, HIV and other sexually transmitted diseases can be concerns for a generation that may not have the same awareness that younger people do today, the researchers say.

Also, adult children may have concerns about their parents’ safety or how a new relationship will affect the family or their inheritance. The researchers are developing materials to help family members deal with these questions.

"What they fear is exploitation or that the role the parent played will go away," Doll said.

In addition, Alzheimer’s and dementia raise questions about the ability to consent, and these conditions also may spur sexual behavior that’s inappropriate.

"Even though we advocate for residents’ rights, there are things that are inappropriate," Doll said. "But staff must be able handle this without residents feeling embarrassed. Inappropriate behavior can just come from people needing relationships, not necessarily sexual ones."

 

http://newoldage.blogs.nytimes.com/2008/11/20/unenforced-filial-responsibility-laws/?hp

By Jane Gross

Are children legally responsible for their parents’ care? (Susan Farley for The New York Times)At the end of my mother’s life, for six months, a year at most, Medicaid paid for her care in a nursing home. She was broke by then, after living on a pittance since she was widowed at 58, using the proceeds from her house to pay for six years of assisted living and part of her nursing home stay and never seeing a penny from a long-term care insurance policy that cost a bundle but covered none of what she needed. She had given my brother and me no up-front money to hasten her eligibility for Medicaid and died with $26 to her name and nothing to leave to her children. The good news was we didn’t even have to put her will in probate.

I share that so everyone will know that my mother wasn’t the elderly equivalent of a welfare queen. She played by the rules and earned a government handout the old fashioned way, and I never felt a second of guilt that Medicaid was footing the bill for her last miserable months on earth. That said, I sometimes wondered why adult children weren’t legally responsible for their parents’ financial support, assuming they had money in the bank. Don’t get me wrong; I didn’t want to pay for her $14,000-a-month (yes, $14,000) nursing home bill. But I could have, if truth be told, at least for a while.

So it fascinated me to learn that in 30 states, (PDF of 30-state list) adult children are legally responsible, at least on paper, to pay for necessities like food, clothing, shelter and medical attention for indigent parents. These statutes, known as filial responsibility laws, are modeled on the Elizabethan Poor Laws of 1601, which made blood relatives the primary source of support for family members, the elderly included. Public assistance was available only as a last resort.

The American colonies had similar laws to England’s — and they were enforced — until the advent of the New Deal, which created the Social Security system, intended to provide 45 percent of a worker’s pre-retirement wages. That would keep mom and dad afloat in the good old days. Civil or criminal cases seeking assistance or reimbursment from adult children all but stopped. But, even more significant to the quiet passing of filial responsibility was the introduction of Medicaid, in 1965, a pillar of the Great Society, which had eligibility requirements that seemed at odds with the existing state laws, even though courts had upheld their constitutionality.

Since Medicaid is an entitlement, not a program everyone pays into like Social Security or Medicare, the Federal government defines eligibility. And Federal law prohibits state Medicaid programs from looking at the finances of anyone other than the applicant or the applicant’s spouse. When the elderly exhaust their assets, individually or as a couple, the government steps in and pays for their long-term care. Adult children are not part of the Medicaid eligibility equation.

But Medicaid is in big trouble — cutting here, squeezing there — and will be inundated when baby boomers reach old age. The staggering cost of long-term care and the explosion in the number of people who will need it has prompted a second look at filial responsibility laws as a way to deal with the impending crisis. The National Center for Policy Analysis, a conservative policy group, identified contributions from adult children as one solution to increasing expenditures and insufficient revenues in a 2005 issue brief. A few law journal articles followed, most recently one earlier this year in The Elder Law Journal.

The more temperate arguments about holding adult children responsible take into account the competing demands on their savings, if they have any, including college tuition and impending retirement. Also, most proponents of enforcing filial responsibility laws would exempt those who were abandoned in childhood and see to it that one sibling doesn’t get stuck while the others skip town.

Among the most thought provoking ideas in the journal articles are these from Allison E. Ross, in “Taking Care of Our Caretakers: Using Filial Responsibility Laws to Support the Elderly Beyond the Government’s Assistance.’’ Would enforcing these laws encourage families to plan for the costs associated with the end of life, as they do for the costs at the beginning? Would the transfer of assets from parent to child as an inheritance protection plan stop if the children would then have to spend that money on their parents? And would the quality of life for the institutionalized elderly improve if adult children supplemented rather than replaced the government’s support? That’s what most of us do informally anyhow.

From Jane: I have replied directly to some of the comments below but also wanted to offer a general clarification. It was not my intent to suggest that filial responsibility laws were fair, wise or likely, in this day and age, to ever be enforced again. I simply was interested, personally and intellectually, in exploring whether such laws existed now or ever had and, if so, whether there was any movement, however limited or far-fetched, to revisit the question under current conditions vis a vis Medicaid.