Monday, March 31, 2008
Mary Boland, 91, can consider herself fortunate. In 2006, the chronically ill former teacher from Cincinnati had a narrow brush with death when she came down with pneumonia. Within minutes, Boland's personal physician, Gregg Warshaw, was called.
"She was weak, confused and breathing abnormally," Warshaw recalls. "Her blood oxygen level was low, and she was suffering a low-grade fever."
In the elderly, pneumonia is often fatal. But instead of rushing Boland to the nearest hospital, as many family doctors might have done, Warshaw, a geriatrician, stabilized the condition and put his patient on antibiotics.
"Luckily, the pneumonia wasn't grave enough to warrant hospitalization," Warshaw says.
Geriatricians have provided specialized care to the elderly for decades, and until recently their numbers have been growing. But despite countless attempts to convince the medical profession and the public of their worth, the number of practicing geriatricians in the United States -- about 7,000 -- is falling seriously behind needed levels.
While the U.S. population age 55 and older is growing rapidly, according to a 2005 census report, the number of medical school grads going into geriatrics has been slow to keep up.
According to one estimate, the nation's teaching hospitals are producing one or two geriatricians for every nine cardiologists or orthopedic surgeons.
Read Entire Story Here
Sunday, March 30, 2008
But caring for the poor among them is a different story - particularly when a patient becomes unable to make his or her own decisions.
To take care of them, Florida, like many states, has a public guardianship system - a government entity that works through the courts to appoint guardians for those without the means to pay for their own.
But it's a skeleton entity, and only about half of Florida's 67 counties are covered. And even in those, there's a waiting list of seniors - 254 people, according to the most recent figures from the Statewide Public Guardianship Office. That was up from 225 in the office's 2007 annual report and 132 people waiting in 2006.
Even then, that might just be a fraction of the problem — the state public guardian estimated in 2004 that 5,000 to 10,000 people who needed its services weren't getting them. That population of endangered adults is expected to rise as more baby boomers age and head here for retirement.
Terry Hammond, a Texas attorney who also serves as executive director of the Pennsylvania-based National Guardianship Association, estimated fewer than 25 states have a public guardian program at all. Florida is ahead of those without one, he said, but barely. Without broad legislative support, it amounts to an unfunded mandate that raises equal protection concerns, he said.
Hammond said he knew of only one other state, New Mexico, with a waiting list for public guardians.
"The question ultimately is, 'What are we willing to pay in human cost to save money for the budget?"' Hammond said. "And if the government isn't willing to spend money on people who need assistance, what is the purpose of that government?"
A guardian is essentially a surrogate decision-maker, appointed by a judge after someone is found incompetent to care for him or herself. To qualify for public help, a person must have limited means and no family or friends willing or able to provide care.
"It's really the office of last resort for the most vulnerable of the vulnerable," said Michelle Hollister, executive director of the SPGO. "They're incapacitated, they have no money and they're basically alone."
Florida does have its success stories.
In 2006, a 69-year-old from Immokalee was suffering potentially fatal septic shock while his wife was out of the country. An emergency guardian was appointed, approved treatment and the man recovered.
A 63-year-old woman with dementia and mild retardation was saved from an abusive caregiver after an Adult Protective Services investigator found her hiding in some bushes. She was appointed a public caregiver and placed in a safe home.
But cases must be referred into the system, and that only happens if someone thinks an individual is exhibiting signs of incapacity. Because the state's wards are by definition alone, the first call often isn't made.
Florida's public guardian system is also chronically underfunded, relying on a county-by-county melange of charities, partnerships and sheer good will.
Some, like the Guardianship Program of Dade County, are almost entirely funded by the county. Others, like the Fifth Circuit Public Guardian Corp., which serves Marion County, rely heavily on the United Way, despite being a "public" agency.
The localities with waiting lists can't simply accept an additional ward or two, because state law limits how many people each guardian can have.
The SPGO is asking for a $1.3 million increase over its roughly $2.3 million budget this year, which would enable it to care for an extra 150 people. It isn't even trying to get the estimated $24 million it would take annually to serve everyone who needs help.
The most severe cases can be taken on by Adult Protective Services, but there are real effects of the waiting list limbo. Perhaps the most tangible is higher public health care costs, because hospitals must keep some patients until the system can accept them.
"As long as we know that they're taken care of," said Andrea Wolfkill, a case manager in Marion County. "If they're in a facility, I don't move as quickly — if they're in a hospital. They've had people two or three months because they don't have a guardian."
That problem — and expense — prompted Martin Memorial Health Systems in Stuart to initiate its own public guardian program for Martin County. Linda Hake, a senior attorney for the hospital who now oversees the program, said she had been trying since 1999 to start a public entity. It opened in 2006, with no county funding.
"Trying to find guardians for people who have no money is impossible," Hake said. "And those are the people that need them, because they're the ones typically that don't have the family resources. They're estranged from their family, they're alcoholics."
Saturday, March 29, 2008
We found the following article useful in that it depicts many of the same philosophies we hold regarding senior and elder care in a home setting.
By Kay Brookshire, email@example.com
Monday, March 17, 2008
A nursing home in Jefferson County and a Knoxville architectural firm are in the forefront of a reform movement aimed at taking long-term care out of institutionalized settings.
Jefferson County Nursing Home is adding three long-term care facilities slightly larger than traditional homes, each with private bedrooms and baths arranged around a hearth room, and a large dining table where residents and staff can gather for meals. The homes are designed to offer elders vibrant communities, with sun-filled rooms and a garden to explore, rather than institutions with long halls and sterile environments.Read the Entire Article Here
What makes a Green House?
- Architecture: Resembles nearby housing, ranging from single-family homes to high-rise apartment buildings. Private bedrooms and bathrooms, open hearth, dining and kitchen areas, ceiling lifts and fenced yard. Materials and design emphasize home-like setting.
- Staffing: caregivers provide personal care, meal planning and preparation, light housekeeping, and laundry. A guide serves as a coach and supervisor and might serve one or more homes. Nurses enter and work in the homes much like they would in a home health care setting.
- Interior design: Residents may bring some of their own furniture and accessories. A large dining table seats staff and residents together for meals. Bedrooms open to the central hearth area.
- Size: Intentionally small, housing 6-10 people in 6,000-7,000 square feet.
- Lifestyle: Less scheduled, more privacy and more control of their daily activities than a traditional setting.
- Relationships: Social interaction is key, and friendship between caregivers and residents is encouraged. Families, children, pets and volunteers are welcome guests.
Monday, March 24, 2008
Residents pessimistic about health care in state
The number of people age 65 and older in Hawaii is expected to grow by 86 percent between now and 2030.
So says a survey by AARP Hawaii, which urges prompt action to avoid a crisis in long-term care for seniors.
"If nothing is done in the very near future, like right now, to begin addressing these issues in a substantive, systematic way, we're going to find ourselves with an essentially insolvable problem," said Bruce Bottorff, AARP Hawaii associate state director.
AARP Hawaii is urging the Legislature to pass Senate Bill 3255 with $250,000 to create a commission that would determine resources needed to meet long-term care policy goals.
Read Full Story Here
Sunday, March 23, 2008
NORWALK — A retired racing greyhound’s life took a fortunate turn when she was adopted by the Norwalk Memorial Home last month.
Lexi, the 2-year-old greyhound, was actually adopted by more than 50 residents of the skilled-nursing facility at 272 Benedict Ave., according to Johnna Young and Nancy Nickoli, spokeswomen for Fisher-Titus Medical Center.
There are 54 long-term residents at the facility and many of whom have become ”enthralled” with the rescue dog since her arrival.
When Nickoli, director of the volunteers and activities at the nursing home, began searching for a replacement therapy dog for one that had died last year, she began familiarizing herself with greyhounds, she said.
Kelso House Adult Foster Care is in Northern Michigan, and this time of year can bring some pretty extreme weather conditions to our area. For example, the past two days saw temperatures around -20 degrees Fahrenheit — NOT counting the wind chill. And it WAS windy.
To add to these conditions, the electric power was knocked out for about 2 hours last night. This was right during dinner, so out come the candles. Northern Michigan Adult Foster Care Tip Number One: keep plenty of candles around. Know where a working flashlight is, and know where to find matches or a lighter for just such emergencies.
We have a gas furnace - but, it needs electricity for the thermostat to even kick the furnace on. We finished our dinner by candlelight, then all stayed in one room and wrapped up for the duration. Northern Michgan Adult Foster Care Tip Number Two: have plenty of extra blankets on hand - comforters and feather beds are the best.
Ailie and my wife curled up on the large sofa together with two large blankets over them to stay good and warm, and I got under the feather bed on a smaller sofa and read a book by candlelight.
Kelso House Adult Foster Care is well-insulated and the heat conserved well. It has crossed my mind a few times to have a back up generator. This is not a bad idea. On the other hand, we have been here for over 8 years now, and the electricity has never been out for more than a few hours. This time was no exception. Ailie had actually fallen asleep, when the lights popped back on and the smoke alarms started beeping around 9 pm and roused us all.
Even when the electricity is fully operational, keeping elderly clients warm in rough winter weather is of primary concern. A blanket is kept over them at all times - even while watching television on the cushy sofa. At night, the temperature always drops a little more, and keeping our clients warm in bed is very important. Northern Michigan Adult Foster Care Tip Number Three: Ailie’s bed is equipped with a heated mattress pad, which we keep at a low heat during the night, and she reports that this keeps her very warm and cozy.
Remember that your clients may not always voice their needs to you. You must always be thinking of their needs and asking them if they need such things as blankets while they are sitting on the sofa, for instance. Better yet - just bring it to them, and they will most likely use it once they see it in front of them.
In Northern Michigan, just when you think winter is letting up - that’s when it always can catch you off guard. Be prepared - stock up on batteries - know where to find flashlights and lighters and matches. Keep heavy blanket and comforters handy. And always try to anticipate your aged clients’ needs before they need to ask.
Hoping the rest of YOUR winter is safe and warm,
Kelso House - a Northern Michigan Adult Foster Care Home for the Aged.
Cambridge - The seniors at Cadbury Commons now have a new skill to master: laughing out loud for one minute a day — every day. Even if there’s nothing at all to laugh about.
Last week, retired psychology professor Freda Rebelsky stopped by the independent and assisted-living facility to educate the residents about how to be happier.
I picked up a recent post from a site called bloglongtermcare.com. The author addresses the often prickly subject of procrastination. Specifically — children waiting and avoiding discussion of what to do about aging parents who are becoming increasingly unable to live on their own.
A highly regarded book on just this subject is available from Amazon and many other online sources. It is called, The Parent Care Conversation. Read amazon customer reviews.
“In late 2007, after a single perfunctory committee meeting, the Michigan House of Representatives passed a series of four bills which, if approved by the Senate and signed into law by Gov. Jennifer Granholm, will have a very negative effect on the health insurance market in the state.”
. . . and later in his article he writes:
“Health care giant Blue Cross Blue Shield (BCBS) has long enjoyed tax-exempt status in Michigan, as the result of a 1938 deal BCBS made with the state to be the “insurer of last resort” for otherwise uninsurable consumers. This means, for tax purposes, that the carrier was treated as a non-profit corporation, while actually operating as a for-profit business.”
To read Jeff’s entire article, go to his blog-entry page.
Besides being a self-described “combat journalist,” Mr. Emanuel is a Research Fellow for Health Care Policy at the Heartland Institute (a free-market public policy organization) - and - the Managing Editor of Health Care News.
Blue Cross / Blue Shield of Michigan is trying to push a controversial insurance bill through the Michigan state legislature. Michigan attorney general Mike Cox is adamantly opposed to the bill, and he recently wrote an editorial expressing his opinion and his reasons. Here is that editorial. Please take the time to weigh in on this serious topic — the new bill could adversely affect Michigan’s elderly population and hamper the efforts of Senior Care Providers, Assisted Living Facilities, Adult Foster Care Homes, and Nursing Homes, to keep their clients in good health.
Published January 13, 2008 [ From Ingham County Community News ]
Blue Cross plan is bad for Michigan
by Mike Cox — Attorney General for State of Michigan
Michigan citizens could see dramatic changes to their health insurance rates and coverage if the legislature approves a package of bills being pushed by Blue Cross. If signed into law, House bills 5282-5285 will cause subscribers, especially the old, sick and most vulnerable, to pay much more for coverage or lose their insurance altogether, while fattening Blue Cross’ already profitable bottom line.
The Blues were created in 1939 and given a social mission; specifically, to be the “insurer of last resort.” As a result, Blue Cross was also made tax-exempt. By their own admission, this tax-exempt status benefits the Blues by at least $82 million each year.
And Blue Cross has done well. Their share of the commercial health insurance market in Michigan is 70 percent. Their surplus has more than doubled in the last five years, to more than $2.8 billion, the highest in history. Blue Cross makes more than a million dollars a day in profits.
Salaries are on the rise, too. According to data filed with state regulators, Blue Cross paid its top ten officers $11.5 million in salary and compensation in 2006 — that’s a 42 percent increase since just 2004.
Guess what else has been going up? Rates. Individuals seeking health insurance have seen their rates skyrocket by 79 percent since 2003. And for those folks who have converted from group policies, their insurance rates have shot up even more — a 92 percent increase since 2003.
Not surprisingly, these massive rate hikes mean that more and more Michigan citizens and families can’t afford insurance. The number of uninsured in Michigan has gone up 8 percent since 2001. And the number of people on Medicaid has ballooned by 38 percent in that same time period. The result: One out of every four Michigan citizens is either uninsured or on Medicaid.
But Blue Cross says that it is heading for a “death spiral.” So the Blues are pushing a package of bills that will do the following:
# Deny coverage of pre-existing conditions for 12 months, a doubling of denial time;
# Charge new customers with chronic diseases such as diabetes up to 80% more;
# Charge new customers with serious illnesses such as cancer up to 250% more;
# Enable the Blues to triple their margins for administrative expenses and profits; and
# Eliminate oversight by the Attorney General and the Governor’s Office of Financial and Insurance Services (OFIS).
Oversight is crucial. This year, Blue Cross sought a 50 percent hike on the premiums that seniors pay for Medigap insurance. I intervened, saving more than 215,000 Michigan seniors $97.5 million initially, and over $69 million per year after that.
These bills would also eliminate the Governor’s ability to provide oversight of rates, by eliminating the ability of the Commissioner of OFIS to set rates. As a result, all state oversight — the ability to intervene and fight for lower rates — for any of Blue Cross’s future rate hikes would, for all practical purposes, be wiped out.
These bills seriously jeopardize Blue Cross’ social mission to care for the oldest and sickest in Michigan, and they destroy the Attorney General’s mission to protect them. I call upon citizens to contact their state legislators and urge Blue Cross stay true to its traditional — and legally required — mission “to secure for al of the people of this state … the opportunity for access to health care services at a fair and reasonable price.”
Mike Cox is Michigan attorney general.
Drug coverage - by number of drugs covered - from the four largest Medicare providers have been slashed by an average of 30% from 2007. AARP MedicareRx Preferred, AARP MedicareRx Saver, Humana PDP Standard, and Humana PDP Enhanced have all lowered the number of prescription drugs they will cover for seniors. In the case of AARP MedicarRx, for example, the number has dropped from 3,763 in 2007 to 2,627 different drugs covered for the current year. Of the top ten prescription drug providers, all but two have decreased the total number of covered drugs under Medicare Part D.Seniors and their care providers need to carefully review the changes in policies and their medications to avoid costly shocks at the prescription booth.
A reason for some of the drops is the Center for Medicare-Medicaid Services (CMS) decision to eliminate coverage for drugs either not approved by the FDA, or drugs approved prior to 1962 - when approval was based upon safety but not efficacy. According to CMS policy, drugs approved in the period 1938-1962 which have since been determined to be “less than effective,” should not be covered by Part D plans.
The Official U.S. Government Website for People with Medicare offers a Formulary Finder, organized by state. The Finder allows you to find plans in your state that match your required drug list:
The Michigan Department of Human Services has advised the following:
How Do I Choose An Adult Foster Care Home Or A Home For The Aged?
There are many types of AFC and HFA homes. Before making a decision, it is strongly recommended that you visit the home, talk with the residents , consider the neighborhood and question the provider. The agencies listed below may help you in the selection process:
The numbers and addresses are in your local telephone directory.
When selecting an AFC or a HFA home, it is important that you clearly understand the services to be provided and the cost of those services.
If you are in the Grand Traverse / Benzie / Leelanau regions of northern Michigan, you may find help with placement through The Alliance. The Alliance was featured in a recent article in the Traverse City Record-Eagle:
Published: November 04, 2007 09:46 am
Choosing the right living situation takes research and time
BY AL PARKER
Special to the Record-Eagle
TRAVERSE CITY — For a time after her stroke, it looked as if life might go back to normal for Annabelle Boersma.Always independent and active, the elderly woman spent two months in an assisted living facility for rehabilitation, then came back home to live alone — with her children checking in on her.But after another hospitalization and another return home, Boersma realized that things had to change.“She said she knew when she walked in the house she could never be home alone again,” said Judy Galligan, Boersma’s daughter. “She was frightened.”Historically, older adults have lived on their own, moved in with their children or headed to a nursing home.Today’s senior citizens, however, face an expanding array of housing choices. New programs, services and technology are helping people stay in their homes longer, while a growing number of nursing homes and retirement communities offer in-home services ranging from housekeeping to telemedicine. Meanwhile, the number of assisted-living facilities and continuing-care retirement communities across the nation has grown steadily over the past decade.With all these choices and services, the search for just the right fit can be time-consuming, frustrating, confusing — and overwhelming.But for residents of Grand Traverse, Leelanau, Benzie, Kalkaska, Antrim and Wexford counties, The Alliance can help.“Our mission is to preserve the dignity and independence of the people our clients cherish most, the family,” explained the program’s founder Connie Hintsala. “We help by providing updated information on each home or facility in the area. We’ll come to the family’s home, discuss their needs and offer suggestions, based on their financial situation.”
The service is free to the families, with funding coming from the homes and facilities that Hintsala enrolls in the program.
“We do the footwork on the homes, gather information and photographs and place them into a portfolio,” explained Hintsala. “We continuously update their information by working closely with each home.”
With help from The Alliance, Boersma, 87, chose Country Pleasures, a small group home on six acres run by Deb Banton and her husband, Wayne. Even then, however, it was a difficult adjustment.
“It was a very big adjustment because she gave up her car and everything; she was driving right up until her stroke,” said Galligan, who visits weekly and often takes Boersma for day and overnight outings. “It was debilitating for all of us because she had been so independent.”
Banton said initial reactions vary from resident to resident.
“Sometimes they’re very angry. They feel they’re being forced to move in,” she said. “We get a great variety, from very upset to ‘I don’t want to do this but I have to.’”
For families who are considering making such a choice for their loved one, she recommends talking it out first, then bringing the loved one for a visit.
“I find it’s better if the family is honest with them and open and at least tries to talk to them,” she said.
After placing a loved one in a new housing arrangement, families should visit often, especially at first, she said. To ease the transition, Banton makes extra time for chats with new residents and encourages other residents to share their experiences there. She also offers plenty of activities, including scenic drives around the area with a stop for $1 sundaes at McDonald’s.
After about two weeks, “it’s like, ‘OK, this isn’t as bad as I thought it was going to be,’” she said.
Finding the right fit was crucial for Galligan. So was letting her mother call the shots.
“It’s not a decision that’s easy to make all at once and I can see why,” Galligan said. “This is the last stage in (her) life because there is no moving from here.”
Banton, whose home offers everything from medication set-up and other basic assistance to end-of-life care, likes to interview potential clients and sometimes rejects those she feels won’t get along in the family-like setting.
“I’ve turned down people that the first time I met them I thought, ‘This isn’t going to work,’” she said. “That’s very important in a small home because they really are like a family.”
But even if one housing situation isn’t right, there are plenty of others. In northern Michigan, the housing options for seniors include:
Retirement Centers: Apartments for independent living that often provide meals (which may or may not be included in the monthly rent), light housekeeping, social activities and transportation.
Assisted Living: Units that provide various levels of care, social programs, meals, laundry, housekeeping, transportation, medication dispensing and monitoring, assistance with daily living tasks. Hospice and respite care are sometimes available.
Adult Foster Care: Semi-private to private bedrooms with various levels of care, social programs, meals, laundry, housekeeping, transportation, medication dispensing and assistance with daily living. Respite and hospice care are sometimes available.
“Low-income senior apartments and nursing homes are also available in the region,” said Hintsala. “But low-income senior apartments often have waiting lists of two to eight months and costs are linked to income.”
Hintsala estimated that there are about 70 assisted living and adult foster care homes in the Traverse City region.
“We look for a home based on their needs,” explained Hintsala. “For example, if the parent is very social, we would suggest a home with a more social program, not reclusive. We don’t push families, but help guide them in their choices.”
While many of her clients are referred to The Alliance by doctors, lawyers or social workers, no referral is required. More than 200 families have taken advantage of Hintsala’s program, which also helps provide advice on and interpret insurance and other means of paying for housing.
For more information on The Alliance, call (231) 263-4040.
Record-Eagle staff writer Marta Hepler Drahos contributed to this story.
The Michigan Department of Human Services has published the following definitions of Adult Foster Care and Home for the Aged:
|Who Needs Foster Care |
Out of home and non-nursing home options include Adult Foster Care and a Home for the Aged.
Adult Foster Care (AFC) homes are residential settings that provide 24-hour personal care, protection, and supervision for individuals who are developmentally disabled, mentally ill, physically handicapped or aged who cannot live alone but who do not need continuous nursing care.
A Home for the Aged (HFA) provides 24 hour room, board, and supervised personal care to:
Note: HFA is restricted to providing care to persons who are 60 years of age or older
If you are uncertain about the level of care needed by the individual seeking adult foster care or a home for the aged, check with the individual’s doctor or the Adult Services Unit of your local Department of Human Services (DHS) for assistance.
Both AFC Homes and HFA provide care to persons who are or have:
Statutory Authority -
(originally posted - 30 December 2007)
Winter is fully upon us in northern Michigan — snow and ice present hazards that can lead to slips and falls by a senior client or your older loved one. From the National Center for Injury Prevention and Control:
“ Among people 65 years and older, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma. Each year in the United States, nearly one third of older adults experience a fall.
In 2003, more than 13,700 people 65 years or older died of fall-related injuries. Another 1.8 million were treated in emergency departments for nonfatal injuries related to falls. The total direct cost for falls among older adults in 2000 was about $19 billion. Given the growing population of this age group, this cost is expected to reach $43.8 billion by 2020.”
And this: “From 1988 to 2000, the unintentional fall death rates for both men and women increased significantly (p<.01, test for linear trend). In 2000, rates for men were 20% higher than rates for women.
(Data: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2002.)
There are things you can do to help prevent such accidents. The following is from the guide, “What YOU Can do to Prevent a Fall,” published through the Center for Disease Control and Prevention.
What You Can Do to Prevent Falls
Many falls can be prevented. By making some changes, you can lower the chances that an elderly person may fall.
Four things YOU can do to prevent falls:
1. Begin a regular exercise program
2. Have your health care provider review your medicines
3. Have your vision checked
4. Make your home safer
1. Begin a regular exercise program
Exercise is one of the most important ways to lower your chances of falling. It makes you stronger and helps you feel better. Exercises that improve balance and coordination (like Tai Chi) are the most helpful. Lack of exercise leads to weakness and increases your chances of falling. Ask your doctor or health care provider about the best type of exercise program for you.
2. Have your health care provider review your medicines
Have your doctor or pharmacist review all the medicines you take, even over-the-counter medicines. As you get older, the way medicines work in your body can change. Some medicines, or combinations of medicines, can make you sleepy or dizzy and can cause you to fall.
3. Have your vision checked
Have your eyes checked by an eye doctor at least once a year. You may be wearing the wrong glasses or have a condition like glaucoma or cataracts that limits your vision. Poor vision can increase your chances of falling.
4. Make your home safer
About half of all falls happen at home. To make your home safer:
Remove things you can trip over (like papers, books, clothes, and shoes) from stairs and places where you walk.
Remove small throw rugs or use double-sided tape to keep the rugs from slipping.
Keep items you use often in cabinets you can reach easily without using a step stool.
Have grab bars put in next to your toilet and in the tub or shower.
Use non-slip mats in the bathtub and on shower floors.
Improve the lighting in your home. As you get older, you need brighter lights to see well. Hang light-weight curtains or shades to reduce glare.
Have handrails and lights put in on all staircases.
Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers.