[News article] Seniors moving to homecare based services face more hospital risk

Seniors moving to homecare based services face more hospital risk.

From the 8 January 2014 ScienceDaily article

… Aging-in-Place House Plans by Nicolleli Architects. [not an endorsement]

Seniors want greater access to home- and community-based long-term care services. Medicaid policymakers have been happy to oblige with new programs to help people move out of expensive nursing homes and into cheaper community or home care. It seems like a “win-win” to fulfill seniors’ wishes while also saving Medicaid programs money, but a new study of such transitions in seven states finds that the practice resulted in a 40 percent greater risk of “potentially preventable” hospitalizations among seniors dually eligible for Medicaid and Medicare.

“We are trying to move people into the community and I think that is a really great goal, but we aren’t necessarily providing the medical support services that are needed in the community,” said Andrea Wysocki, a postdoctoral scholar in the Brown University School of Public Health and lead author of the study published online in the Journal of the American Geriatrics Society. “One of the policy issues is how do we care for not only the long-term care needs when we move someone into home- and community-based settings but also how do we support their medical needs as well?”

Wysocki said her finding of a higher potentially preventable hospitalization risk for seniors who transitioned to community- or home-based care suggests that some medical needs are not as well addressed in community settings as they are in nursing homes. More vigilant and effective treatment for chronic, already-diagnosed ailments such as chronic obstructive pulmonary disease could prevent some of the hospitalizations that occur.

There are two likely reasons why care in home and community settings is not as effective in preventing hospitalizations, Wysocki said.

[One]Nursing homes provide round-the-clock care by trained nurses and doctors, but workers with much less medical training provide community- and home-care services.

[Two] In addition, while Medicaid pays for long-term care, Medicare pays for medical care, meaning that Medicaid programs do not have a built-in financial incentive to prevent hospitalizations. Home- and community-based care is less expensive for Medicaid regardless of the medical outcome.

Read the entire article here

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[Hospital Newsletter Article] The New Nursing Home

 

Believe I’ve reblogged on this concept within the past two years…
Yes, this model is a bit pricy, but can we afford not to move in this direction?

Excerpts from the Fall 2003 article at Proto – Dispatches from the Frontiers of Medicine (Massachusetts General Hospital)

At the vanguard of innovation in the nursing home industry, the three-year-old Leonard Florence Center for Living exemplifies a new model of long-term care known as the Green House, and nothing about it seems institutional. Each of the five upper floors constitutes two separate “households” with private rooms for 10 residents. The normally dominant nurse’s station has been eliminated and instead there are common areas in each household—a living room furnished with comfortable sofas and chairs around a fireplace, an open kitchen and a communal dining table where residents often eat together. Cooking, housekeeping and even laundry are handled by two certified nursing aides known as shahbazim—derived from Persian, it means “nurturing of elders”—who also care for residents. Traditional nursing homes, in contrast, have clear demarcations separating housekeepers, kitchen workers, nurses and aides, who follow rigid schedules for serving meals or dispensing medications.

At Leonard Florence, Mehlhop can sleep, bathe, eat and roam around whenever she wants. The environment is calm and cheery, with none of the physical restraints found in most nursing homes or the alarms that sound if residents get up from a wheelchair, for example. (Instead, patients wear ankle bracelets that help the staff keep tabs on them and will disable the elevator if a patient tries to leave.)

Leonard Florence is far from the only nursing facility striving to create a homelike atmosphere and improve residents’ quality of life. Building a new Green House or undertaking a major physical renovation can be part of the strategy, but other nursing homes are primarily working to transform how they’re run, embracing a movement known simply as “culture change” that entails shifting away from the emphasis on efficiency and economies of scale that characterizes most nursing homes. Culture change typically requires an operational reorganization to give staff members more autonomy and to let residents have a say in even the smallest details of their lives. “It’s about not looking at residents as a task, but rather as who they are as individuals,”

…

Yet building a new, small nursing home that can handle only a relative handful of residents is an expensive proposition. “If it weren’t for the price tag, everyone would be doing it,” says Barry Berman, chief executive officer of the Chelsea Jewish Foundation, which owns the Leonard Florence Center. The home cost $36 million to build, with some two-thirds of the money coming from private donations and government programs. Most traditional nursing homes cost less than half that much, but the Leonard Florence Center is over twice the size of a traditional nursing home and was the first Green House to be built in an urban area. Its multistory construction is also a departure from the usual single-level, ranch-style homes that are typical of Green House centers. The payoff, however, has been the residents’ lower hospitalization and readmission rates. The center has also received high scores for resident and family satisfaction, which Berman describes as “off the charts.” The foundation is now undertaking a $13 million renovation of a 30-year-old, 120-bed skilled nursing facility across town from Leonard Florence. “We’re bringing in as many elements of the Green House as we can and doing our best to retrofit a traditional nursing home,” says Adam Berman, chief operating officer of the nonprofit.

The Green House model is receiving increased academic scrutiny, and early studies have shown positive trends in quality of life for residents, greater family satisfaction, and a lower incidence of rehospitalization, bedsores, depression and other health problems. According to the Green House Project, 83% of Green Houses received a rating of four out of five stars or better on the Centers for Medicare & Medicaid Services’ five-star quality rating system, compared to 42% of nursing homes nationally. But the data are early. “The jury’s still out on whether Green Houses or other small homes achieve equal or better clinical outcomes than traditional models, and whether they’re financially sustainable—factors that may ultimately matter a lot more than the humanistic components in terms of their future growth…

…

Studies of the model’s effectiveness have found a higher quality of care, reduced staff turnover and lower rates of infections for residents….

…

As  encouraging as such stories may be, however, there are questions about how far relatively small-scale efforts can go to reform a giant industry. In a 2010 study by Susan Miller, a professor of health services, practice and policy at Brown University School of Public Health, leadership issues, higher costs and regulatory problems were cited by long-term-care leaders as the most common barriers to implementing culture change. Yet many experts believe those obstacles can be overcome. For example, a campaign called Advancing Excellence in America’s Nursing Homes provides an array of do-it-yourself resources and networks of advisors to help improve clinical outcomes. More than 9,000 nursing homes have participated since the campaign’s launch in 2006. Meanwhile, federal regulators have adjusted some rules to encourage and reward culture change—for example, rather than checking that a nursing home has regular meal schedules, making sure that residents are well fed. And proponents point to studies showing that nursing homes committed to culture change may benefit financially. A study by Pioneer Network, for example, found that from 2004 to 2008, facilities undergoing culture change achieved higher occupancy rates and increased revenue.

…

Related Resource

• Nursing Home Compare (Medicare.gov)

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[Repost] Long Term Care — Five Things Physicians and Patients Should Question

I am especially grateful for #4.

From the ABIM fact sheet

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New Yorker Article on New Models of Long-term Elder Care

Your local library might subscribe to this. Call ahead and ask for a reference librarian!

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As Our Parents Age So Do We

If you can locate a copy of The New Yorker May 20, 2013 article The Sense of An Ending by Rebecca Mead, it’s well worth reading because of its focus on new models of providing care to fragile elders with dementia illnesses in nursing homes. The article extensively describes the Beatitudes Campus in Arizona, but it also mentions The Green House Projectand the Pioneer Network. The Beatitudes model and The Green House Project  share many approaches.

So I was excited during dinner with friends last month when one of the people at the table, a neurologist, mentioned The New Yorker article, saying how excited he was to learn about new models that completely change the way we deliver care  to fragile elders, especially those with memory impairments. After he spoke at length about the article — which I had not read yet — I shared information and my…

View original post 147 more words

November is Long-Term Care Awareness Month

English: Nursing and Residential Care Home, Withington This is Clyde Court, on Lapwing Lane. (Photo credit: Wikipedia)

 

From a recent USA.gov email

 

When planning ahead in these uncertain financial times, it’s important to think about long-term care for yourself and your loved ones. Long-term care (LTC) is a range of services and supports you may need to meet your health or personal needs over a long period of time. These services might include emergency response systems, senior centers, assisted living, nursing homes, transportation services, and many more.

Most long-term care assists people with activities of daily living like dressing, bathing and using the bathroom. Other common long-term care services include helping with housework, cooking, shopping, or even managing money. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. And it’s not just for seniors—if you have a significant health challenge, you may need long-term care at any age.

While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the care you may need. Generally, Medicare doesn’t pay for long-term care, but only for a medically necessary skilled nursing facility or home health care. Long-term care insurance may be an option to help you and your family prepare ahead of time for the potential need for long-term care. There are a variety of plans available that vary in cost depending on what services you want covered and the age you begin coverage. Before you choose a plan you should take into account where and what kind of care you might need.

Be sure to take some time this month to check out your options and plan ahead, so you can rest assured that you and your family get the care you need. And if you’re a caregiver now for a family member with health challenges, find more resources and support from USA.gov.

 

Related resources

 

• National Clearinghouse for Long Term Care Information 
• Guide to Long Term Care Insurance (USA.gov)
• Caregiver’s Resources (USA.gov)

 

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Top Ten Myths of Medicare

 

From the Full Text Report abstract

Top Ten Myths of Medicare

August 26, 2012

Top Ten Myths of Medicare
Source: Social Science Research Network

In the context of changing demographics, the increasing cost of health care services, and continuing federal budgetary pressures, Medicare has become one of the most controversial federal programs. To facilitate an informed debate about the future of this important public initiative, this article examines and debunks the following ten myths surrounding Medicare: (1) there is one Medicare program, (2) Medicare is going bankrupt, (3) Medicare is government health care, (4) Medicare covers all medical cost for its beneficiaries, (5) Medicare pays for long-term care expenses, (6) the program is immune to budgetary reduction, (7) it wastes much of its money on futile care, (8) Medicare is less efficient than private health insurance, (9) Medicare is not means-tested, and (10) increased longevity will sink Medicare.

 

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Residential Care Facilities: A Key Sector in the Spectrum of Long-term Care Providers in the United States

 

From the US National Center for Health Statistics Data Brief (Number 78, December 2011)

Key findings

Data from the 2010 National Survey of Residential Care Facilities

• In 2010, residential care facilities (RCFs) totaled 31,100, with 971,900 beds nationwide.
• About one-half of RCFs were small facilities with 4–10 beds. The remainder comprised medium facilities with 11–25 beds (16%), large facilities with 26–100 beds (28%), and extra large facilities with more than 100 beds (7%).
• One-tenth of all RCF residents lived in small RCFs and about that percentage (9%) lived in medium facilities, while the majority resided in large (52%) or extra large (29%) RCFs.
• About 4 in 10 RCFs had one or more residents who had some or all of their long-term care services paid by Medicaid.
• Larger RCFs were more likely than small RCFs to be chain-affiliated and to provide occupational therapy, physical therapy, social services counseling, and case management.

Residential care facilities (RCFs)—such as assisted living facilities and personal care homes—provide housing and supportive services to persons who cannot live independently but generally do not require the skilled level of care provided by nursing homes. RCFs are not federally regulated, and state approaches to RCF regulation vary widely (1). The ability to provide a comprehensive picture of the long-term care (LTC) industry has been hampered by the lack of data on RCFs (2,3). Previous estimates of the size of the RCF sector varied depending on how RCFs were defined (4,5). Using data from the first nationally representative survey of RCFs …

Read the entire press release

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