Medicare to Launch New Caregiver Website

The Centers for Medicare & Medicaid will launch a new website for caregivers on Wednesday, September 18, called Ask Medicare. You can sign up here for a live webcast at 12:00pm ET to learn more. (Thanks to the Minding Your Elders blog for sharing information about the new site.)

Hospital-Based Palliative Care on the Rise in California

A brief item from Friday's San Jose Business Journal about the rise in hospital-based palliative care:

Hospital-based palliate care programs, which have a goal of helping patients with serious diseases live more comfortably, are quickly growing in popularity, according to a report released Thursday by the Oakland-based California HealthCare Foundation.

More than 90 percent of California’s 111 programs surveyed by the foundation were started since 2000, with 64 percent started since 2004.

Medicare Hospice Protection Act of 2008

Ten members of Congress have introduced the Medicare Hospice Protection Act of 2008 which would delay a new Centers for Medicare & Medicaid Services (CMS) rule from going into effect for one year. The National Hospice and Palliative Care Organization (NHPCO) and their advocacy arm, The Alliance for Care at the End of Life, have argued the rule change would effectively cut hospice Medicare reimbursement rates. See more information on NHPCO's website.

Discussing Racial and Ethnic Differences in Health Care

A few items appeared this week touching on racial and ethnic differences in health care. We are focused on diversity at HFA, as we prepare for our 2009 teleconference on Diversity and End-of-Life Care.

First, the New Health Dialog Blog discussed a study that appeared in the September 10 issue of the Journal of the American Medical Association, "Student Body Racial and Ethnic Composition and Diversity-Related Outcomes in US Medical Schools". The authors conclude "attending medical schools with high levels of racial and ethnic diversity may better prepare white medical students to care for minority patients." Analyzing over 20,000 web-based surveys from students graduated from 118 medical schools, the authors commented:

. . . white students attending more racially diverse medical schools rated themselves as better prepared than students at less diverse schools to care for racial and ethnic minority patients and had stronger attitudes about inadequate access to health care. . . . The associations of student body diversity appeared to be mediated by more positive interaction and perspective sharing among individuals from different backgrounds within medical schools. The association of student body diversity with white students' self-rated cultural competence was only observed when students perceived a more positive climate for interracial interaction and exchange of diverse perspectives.

Second, Pallimed reviewed a recent study from the Journal of Clinical Oncology on the racial and ethnic differences in advance care planning.

They found that Black and Hispanic patients were less likely to have an advance directive than white patients (and in this case much less likely: 80% vs 50%), were more religious, and were more likely to endorse life-prolonging treatment wishes even if had only a few days to live. Dishearteningly, only 30% of patients had had any sort of discussion with their physicians regarding end of life care - this finding did not differ between groups. Fewer Black and Hispanic patients acknowledged they were terminally ill compared to white patients, however such acknowledgment was associated with increased advance care planning in all groups. The really interesting finding is that differences in advance care planning persisted even after adjusting for demographic factors (age, education level, etc.), terminal illness awareness, religiosity, and preference for life-prolonging therapy when dying. Suggesting, that is, that these differences are either deeply cultural (and thus not as impacted by demographics, illness understanding, etc.) and/or related to how/the frequency with which clinicians bring up advance care planning with patients from different ethnic groups.

And last, the Oregon Center for Applied Science (ORCAS) is conducting surveys for a study funded by the National Institutes of Health. It is seeking people who identify as a racial or ethnic minority to receive $275 for using a new Family Caregiving Support program and completing four online surveys.

Eligible participants must:

* Care for an aging relative or friend with advanced illness or in need of assistance with daily tasks like bathing, eating, dressing, walking, etc.

* Have an email address and access to a computer with a high-speed Internet connection.

* Read and understand English.

Only one person per household may participate in this study.

Visit the survey site here.

More on Falls and the Elderly

Learning more about fall prevention is key component to caring for an aging family member and supporting their quality of life.

First, Jane Gross at the New Old Age Blog, discusses the serious risk of falls for the elderly.

. . .Each year, nearly one-third of older adults experience a fall, and 20 to 30 percent of them wind up with moderate to severe injuries, ranging from broken teeth to broken hips. In 2005, the C.D.C. reports, 1.8 million elderly patients were treated in emergency rooms for non-fatal falls, and 15,800 died of their injuries.

Some 20 to 40 percent of those suffering a hip fracture will die within a year, researchers estimate, but even lesser injuries can precipitate a cascade of medical problems, the onset of severe disability, and the end of independent living and the beginning of round-the clock care.

She notes that there are many efforts underway to study prevention programs.

Meanwhile, Sarah Henry at Caring Currents wrote a post yesterday about the importance of geriatric care. She refers to a New Yorker article about a geriatrician who institutes a number of measures to prevent falls for his patient, after noting her high risk for a fall.

Palliative Care Provides Savings for Hospitals

A recent study reported in the Achives of Internal Medicine said that hospitals using palliative care teams save an average of $300 per patient per day. This post from the New Health Dialog Blog provided excellent coverage of the study:

The paper in the Sept. 8th edition of the Archives of Internal Medicine by Dr. Sean Morrison of the Mt Sinai Hospital and the Center to Advance Palliative Care and colleagues matched palliative care patients to "usual care" patients. The palliative care patients who were discharged alive had an adjusted net savings of $1,696 in direct costs per admission, or $279 per day. Amongst those who died, the adjusted net savings were higher, $4,908 per admission, and $374 per day. The savings came from reductions in laboratory work, intensive care cost (and for the patients who died, pharmaceuticals.) The team checked to make sure that the savings could be attributed to palliative care, not to a clinical course of action already determined before the palliative care team got involved with the case.

Gorilla Mother, Human Grief

Elizabeth Uppman

In a German zoo, a gorilla named Gana is having trouble letting go.

Gana’s baby, Claudio, died some weeks ago, presumably of a heart defect. I say “presumably” because nobody knows for sure what he died of—Gana won’t relinquish his body to the zookeepers. She carries it around with her, strokes his hair, shakes him slightly as if to wake him.

Gana made the news because she appears to be grieving, and because grieving is supposed to be a human activity. Zoo visitors watch her and weep.

Perhaps they see in her an echo of their own losses, of times when they, too, have delayed their understanding of certain brutal facts.

For weeks after my 3-year-old son died, I woke up frantic every the morning because I didn’t know who was taking care of him. I knew Gabriel was gone; I knew I wouldn’t find him in his bed by the window. But I couldn’t fix in my mind the understanding of what gone meant. The thought that he had disappeared—vanished—evaporated, like a splash of water on a hot sidewalk—was too big for me.

So I unconsciously defined “gone” as “somewhere else.” But where? And with whom? Were they nice? Did they have all his medicines? Did they rub his head when they gave him his bath? It always took me a few groggy minutes to remember that gone meant dead, and that dead meant Gabriel no longer needed anybody to take care of him.

Over time, researchers say, gorilla mothers like Gana become less and less attached to the bodies of their babies, until finally they abandon them. We can only guess what’s going on in their heads, but it looks like a slow realization: the baby is never going to wake up again. Something like that happened for me, too, over a period of months and years. The true meaning of gone sunk in deeper and deeper, until one day I woke up, not frantic, but knowing.

It’s a good thing, of course, to rejoin the world where people think and act clearly and deliberately. Still, once in awhile I miss those days, when in the confused moments between sleep and waking I could still believe that Gabriel was alive.

Elizabeth Uppman

Medicare Announces Webcast for Caregivers

The Centers for Medicare & Medicaid (CMS) announced a webcast on "Connecting Caregivers to Medicare Resources." The webcast will air next Thursday, September 18, 2008 from 12–1pm ET. Caregivers will be able to:

• Learn about new online resources for caregivers


• Post questions to CMS Acting Administrator Kerry Weems and a panel of experts online


• Sign up for the Ask Medicare bi–monthly e–newsletter

For more information or to register, see this site.

HFA's Book Living With Grief: Alzheimer's Disease Gets Noticed

The psychiatric blog, Dr. Jeff's and Dr. Tanya's Blog, recently featured a post "Eight great books on understanding Alzheimer's." HFA's 2004 book Living With Grief: Alzheimer's Disease topped the list. View the table of contents and then order the book here.

Lawsuit Filed to Stop New CMS Rule on Hospice Reimbursement Rates

On Friday, September 5, the National Hospice and Palliative Care Organization (NHPCO) filed a lawsuit asking for an immediate injunction to prevent a Centers for Medicare & Medicaid Services'(CMS)rule that changes Medicare reimbursement rates for hospice.

View the latest proposed wage index for FY2009 here.
View NHPCO's response to the proposed rule here.

CMS Holding Next Home Health, Hospice and Durable Medical Equipment Open Door Forum

From the Medicare Update blog:

The Centers for Medicare & Medicaid Services (CMS) will hold the next Home Health, Hospice & DME Open Door Forum at 2:00 p.m. (ET) on September 17, 2008.

There are 2 ways to participate in the Open Door Forum. To participate by telephone, one must dial 1-800-837-1935 and reference conference ID 58369938. To participate in person, RSVP and security clearance is required. One must RSVP by 2:00 p.m. (ET) on September 15, 2008 to HOMEHEALTH_HOSPICE_DMEODF-L@cms.hhs.gov, and include your name, organization, phone number, and the words “Home Health” in the subject line. The Open Door Forum will take place at the Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C.

Beginning 2 hours after the Open Door Forum, CMS will also make an audio recording available. To access the audio recording, one must dial 1-800-642-1687 and enter the conference ID. The recording will expire after 3 business days.

Aging Population Creates Space for More Eldercare Services

Two articles from newspapers in Minneapolis-St. Paul and Dallas discussed different eldercare services this week. Taken together they highlight how the growth in the elderly population in the United States is creating changes in how eldercare services are being offered, and how new business models are being created to perform these services.

The first article, from The Dallas Morning News, discusses home care agencies and in particular, the growth of franchises offering home care services.

Some 11,000 licensed home-care businesses served 7.6 million people last year, according to the American Association of Homes and Services for the Aging. And in-home aides are projected to be the second fastest-growing job over the next decade – the government forecasts a 50 percent increase, from 767,000 to 1.2 million jobs.

Though "mom and pop" businesses have dominated home care, entrepreneurs have propelled the recent growth by opening franchises to capitalize on the expected doubling of the older population by 2030.

Next, this article from the Star-Tribune focused on a company started by four nurses that provides eldercare assessments as well as managing ongoing care.

Two partners spend two hours or more on an assessment, Buelow said, speaking both to the senior and to family members. They spend 10 to 15 hours writing a report, which details a family's options for meeting a parent's needs.

The partners will conduct family meetings, sometimes including out-of-state siblings joining in on cellular phones, to go over the assessment and present the options . . .

Profile of Four Hospice Social Workers

This nice article from a local paper, The Phoenix (PA) profiles four hospice social workers and describes how their professional and personal backgrounds steered them to hospice work.

Jackie McIntyre, Peggy Graf, Jeniffer Flamish and Vickilyn Zazo-Nagy understand clearly that death should be seen as a part of life. They are all social workers at Life Choice Hospice and, while none of them entered this field expecting to work in the specialty of hospice, they all believe they have found their ideal profession and see it as an honor to be with patients at the end of their lives.

Hospice Therapy Dogs Visit Patients

This article from The Bolingbrook Sun describes the role of hospice therapy dogs in calming patients and providing a friendly vistor.

Patty Kaplan, a registered nurse, founded Paws 4 Therapy Inc. with the hopes that the program could assist the patients in acute care. She is the director of the program at Edward.

By 2007, the hospital had one of the largest animal-assisted therapy programs in the country. More than 100 dog and handler teams visit patients daily at bedside.

"I think the biggest thing is that it serves as a diversion from their illness," she said. "It's calming, and for those patients that are lonely it may be the only visitors they get."

"It's a piece of home."

Alzheimer's Foundation of America to Display 'Quilt to Remember' in Washington, DC This Week

The AFA Quilt to Remember will be displayed today through September 6 at the AARP Life at 50+ National Event and Expo, Washington Convention Center, Washington, DC.

AFA announced the AFA Quilt to Remember project in late 2005, and the collection now includes more than 100 panels. By coincidence, the 100th quilt was received just in time for Mother’s Day and pays tribute to a mom, Virginia Loepker of Jasper, IN.; intricately sewn by Phyllis Boor of Elkhart, IN, the panel features a three-dimensional yellow sunflower to denote her mom’s love for flowers.

The goals of the heartfelt initiative include educating the public about the disease and “speaking for those who can no longer speak for themselves,” Hall said.

Not Enough Facilities to Handle Dementia Patients in Maine

This article from the Bangor Daily News addresses the need for more facilities to handle dementia patients in the state of Maine.

Rick Erb, executive director of the Maine Health Care Association, which represents nursing homes in Maine, confirmed in a recent interview that the shortage of places for Mainers with difficult behavior has been a serious problem for several years and is likely to get worse as the population ages. Only three Maine nursing homes offer specialized long-term psychiatric units, he said, with higher levels of trained staff to handle aggressive patients and locked units to prevent residents from wandering. None of the three is north of Waterville or west of Gorham.

Erb said it’s up to the state to fund more of these high-level programs for Mainers with dementia.

“But right now, there is no movement toward creating more special units to deal with these psychological issues,” he said.

According to Diana Scully, director of the Office of Elder Services at the Maine Department of Health and Human Services, the state is well aware of the problem.

“There are long waiting lists” for admission to the three nursing homes with specialized psychiatric units, she said in a recent interview. “It’s hard for the existing facilities to address the need.”

But looking ahead, she said, state officials have yet to tackle the problem of ensuring that appropriate — and expensive — nursing home care is available for Maine baby boomers who develop difficult behavior related to dementia. Instead, the current focus is on increasing space for aging individuals in less-restrictive settings such as assisted living programs and boarding homes, as well as developing community-based support for families caring for their elderly relatives at home.

Scully acknowledged that it is not enough. “There will be more Alzheimer’s and other age-related dementias. We know we are going to need more options as people age,” she said.

Until those options are developed, waiting lists will continue to grow and hospitals will bear the burden.