Category Archive

On Wednesday, the House Committee on Energy and Commerce is expected to mark up H.R. 6357, the Protecting Records, Optimizing Treatment and Easing Communication through Healthcare Technology Act of 2008.

The measure, also known as the PRO(TECH) Act, was introduced by Rep. John D. Dingell (D-Mich), who said he introduced the measure in an effort to give “the federal government a leadership roll in developing communication standards that allow for the electronic communication between providers, health insurers and others.” Dingell said the bill would “extend federal privacy laws” to reduce the number of new entities able to stockpile electronic health information, while making the U.S. healthcare system more efficient.

According to the representative, would encourage a nationwide adoption of a health information technology (HIT) infrastructure as well as encourage members of the health care community, such as doctors, hospitals, insurers, to utilize electronic exchange of health information.

H.R. 6357 also would make the Office of the National Coordinator for Health Information Technology (ONCHIT) a permanent entity at the U.S. Department of Health and Human Services (HHS).

Finally, Dingell’s bill would push for the use of an electronic health record by each person in the United States by 2014.

“Your grocery store automatically knows what brand of chips you bought last year, but your cardiologist doesn’t automatically know what prescriptions your family doctor prescribed for you yesterday.” Dingell said. “That’s problematic for healthcare quality and costs.”

Another way to ensure that long-term care financing reform is included in the platforms of the Democratic and Republican parties is to contact the members of the parties’ respective platform committees.

The members of both committees are listed below. If you are connected to these individuals, please consider sharing your version of the AAHSA platform statements with them by Aug. 1. If you’re affiliated with a not-for-profit organization, it’s important to identify yourself as an individual and not a representative of the organization that you serve.

Republican Platform Committee:

• Republican National Committee Chairman Mike Duncan
• Committee Chair U.S. Representative Kevin McCarthy
• Committee Co-Chair U.S. Senator Richard Burr

Democratic Platform Drafting Committee:

• U.S. Representative Tammy Baldwin
• State Representative Dan Blue of North Carolina
• Maryland Lt. Governor Anthony Brown
• Columbus Mayor Michael Coleman
• U.S. Representative Rosa DeLauro
• DNC Secretary Alice Germond
• Michigan Governor Jennifer Granholm
• Donna Harris-Aiken, a National Education Association Policy Advisor
• Platform Policy Advisor Heather Higginbottom
• Platform Policy Advisor Chris Jennings
• Florida Tallahassee Commissioner Allan Katz
• AFL-CIO Policy Director Thea Lee
• UFCW Local 1428 President Connie Leyva
• U.S. Representative Patrick Murphy
• Speaker Emeritus of the California State Assembly Fabian Nunez
• Obama for America Foreign Policy Advisor Susan Rice
• U.S. Representative Linda Sanchez
• Youth Representative Giancarlo Sopo of Florida
• Ron His Horse is Thunder, Chairman of the Standing Rock Sioux Tribe of North Dakota.

Democratic Platform Standing Committee:

Chairs

• Patricia Madrid
• Judith McHale
• Deval Patrick, Governor

Members

• Danny Abraham
• Elizabeth Frawley Bagley
• Tom Buffenbarger
• Rev. Tony Campolo
• John Chiang, State Controller
• Ingrid Duran
• Maria Elena Durazo
• Peter Groff, State Senator
• Kamala Harris, District Attorney
• Marjorie Hill
• Voncille Trotter Hines
• Joseph P. Hoar, General, USMC, Ret.
• Chuck Hoskin, State Representative
• Nancy Keenan
• Denise King
• Mark Macarro
• Edward McElroy
• Chris Owens
• Douglas Palmer, Mayor
• Diego Sanchez
• Ricardo Sanchez, General, USA, Ret.
• Smita Shah
• Lillian Tamayo
• Patricia Todd, State Representative
• Reginald Weaver

“I hadn’t been pregnant in 20 years, but this was planned just as my previous pregnancies had been. “

No, this recent Newsweek story isn’t about raising children. It’s about another life-changing event: caring for aging parents.

In the article, Anne Kennedy Rickover compares her experiences moving her parents more than 1,000 miles away from her childhood home in Philadelphia to Topeka, Kan., to childbirth.  The author writes how the “lamaze classes,” or help from a friend working with the elderly, helped her parents find physicians and other services. She asked friends in similar situations about their experiences. But like many new parents, she says that they didn’t have concrete advice. They were just “stumbling along without any real answers.”

What’s her conclusion? That like raising children, caring for aging parents should be considered a treasured part of the life cycle. And in it, she writes, she was “shown again the foolishness of my conceits, the infinitely greater sweetness and richness of life, the poignant beginning and ending of yet another cycle.”

On Tuesday, the Fairness in Nursing Home Arbitration Act (H.R.6126) was approved with a 5-to-4 vote by the House Judiciary Subcommittee on Commercial Law and Administrative Law. The bill would invalidate pre-dispute arbitration agreements between a long-term care facility and a resident or client.

“Long-term care advocates oppose the legislation, arguing that arbitration agreements allow them to channel limited Medicare and Medicaid resources to providing quality care instead of funding lengthy court trials,” McKnight’s reports.

Later today, the Senate Judiciary Committee is expected to mark up its version of the bill, S. 2838.

Congress today voted to override President Bush’s veto of the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), legislation that would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates.

The House approved the override with a vote of 383 to 41, while the Senate results were 70 to 26. The Senate, which previously rejected a cloture motion, reached the veto-proof majority of 60 votes last week after Sen. Edward Kennedy (D-Mass.), who is recovering from a brain tumor, returned for a second attempt at cloture.

Before the second cloture vote, Sens. Harry Reid (D-Nev.) and Mitch McConnell (R-Ky.) agreed that if the motion passed, the bill as a whole would be considered approved. The House approved the bill with a veto-proof majority on June 24.

Explaining his veto, President Bush said in a statement that while he is not opposed to the “primary objective” of preventing reductions in physician payments, he said that the bill’s proposed cuts to Medicare’s privately run insurance plans, known as Medicare Advantage, were essentially “taking choices away from seniors to pay physicians.” The president described the bill as “fiscally irresponsible,” and said “it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem.”

However, at AAHSA we believe the bill will ultimately protect the elderly by helping to, as Rep. Rahm Immanuel (D-Ill.) said before today’s vote, “preserve the doctor and senior patient relationship.”

Larry Minnix, AAHSA’s president and CEO, said, “Thanks to Congress’ decision today, millions of Medicare beneficiaries will continue to receive the physical and occupational therapy they need without fear their care will be rationed or capped.”

photo by Craig Collins-Young

On Friday, AAHSA CEO Larry Minnix was among several legislators, researchers and policy experts invited to speak at a Capitol Hill briefing on long-term care reform sponsored by the Brookings Institution.

Minnix participated in a panel on long-term care financing that was moderated by Peter Orszag, the director of the Congressional Budget Office. During his remarks, Minnix discussed AAHSA’s Long-term Care Solution as a viable way to make it affordable to care in our country.  A webcast of the event will be available soon.


photo by Craig Collins-Young

With a vote of 69 to 30, the U.S. Senate on Wednesday approved a cloture motion for H.R. 6331. According to The Hill, Sens. Harry Reid (D-Nev.) and Mitch McConnell (R-Ky.) agreed that if the cloture motion passed, the bill as a whole would be considered approved.

Sen. Edward Kennedy (D-Mass.), recovering from surgery on a malignant brain tumor, was able to return for the vote. The Hill quoted Kennedy as saying, “I return to the Senate today to keep a promise to our senior citizens – and that’s to protect Medicare.”

Kennedy’s presence was important as the previous cloture motion failed by one vote.

The bill, which would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates, now heads to President Bush.

The U.S. Senate today is expected to once again consider a cloture motion for H.R. 6331, the Medicare Improvement for Patients and Providers Act of 2008. The bill, which failed to reach cloture by one vote on Jun. 26, needs 60 supporters to proceed.

The bill would extend the Medicare therapy caps exceptions process for 18 months as well as place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates which will begin this month.

Senate GOP members say their main area of contention is how the bill would be funded.

Responding to Republican requests to amend to measure, Senate Majority Leader Harry Reid (D-Nev) on Tuesday said that “75 percent of the Republicans in the House voted for it. And it seems a little unusual to me that this bill, they want to change it now.” Reid added that “every day that it’s not passed, seniors are being affected, doctors are being affected, and veterans are being affected.” Reid said, “If we don’t get 60 votes, the Republicans are going to have to live with that.”

We’ll update you as soon as Congress moves forward.

For those consumers that are a bit more technically inclined, the ability to visit with a physician just got a little easier. On Tuesday, TalktoaDoc.org launched its Web site, which offers “the ability to talk to local physicians online through text, voice or video,” HealthcareITNews reports.

The company says that while other “advice sites require patients to pay a yearly membership fee and a high flat fee up front before they can even talk to a doctor,” TalktoaDoc.org will provide the first minute on consultation for free, with each additional minute costing $2.98.

Each of the online physicians, who are available beyond normal office hours, will be required to be “licensed in the state in which the patient is located.” In addition, each doctor will carry medical malpractice insurance.

Last month, HealthcareITNews reported that American Well launched its Online Healthcare Marketplace, which also allows health care providers to offer consumers “real-time consultations online or by phone.”

Roy Schoenberg M.D., CEO of American Well Systems, said that technology is helping to “bring healthcare to people’s homes, changing the rules of engagement and the convenience that goes with them.”

The launching of the two online services trends with the California HealthCare Foundation’s recent findings that roughly three out of four consumers would like online interaction with a health care provider.

For the latest on the development, evaluation and adoption of emerging technologies that will transform the aging experience, be sure to visit AAHSA’s Center for Aging Services Technologies (CAST) Web site.

A few weeks ago, I blogged about a USA Today story on rising bankruptcy rates among the elderly. Today, the paper featured an article with much broader implications: the impact of rising prices on the lives of elderly people living on fixed incomes.

Across the country, seniors are cutting back and seeking out programs and services to help them save money on everything from food to home repairs. Take some of the stories heard at one San Diego food bank. Jannie Hicks, 75, is eating more canned vegetables to compensate for the rising costs of fresh produce.  To save money on gas, Hicks only drives to the grocery store, church and the food bank. Phone calls have replaced regular visits to her friends. Carmen Gonzalez, another senior at the food bank, slashed her grocery bill to just $50 a month. She survives by making tamales and enchiladas with cheese instead of meat.

There are statistics behind these stories. In a recent survey, AARP found that 59% of Americans over 65 reported having more trouble paying for food, gas and medicine. Researchers believe that’s why a growing number of older people are headed to places like credit-counseling centers to find help.

What about Social Security? Well, amount individuals receive is indexed with inflation, but some argue that this isn’t enough because they have a disproportionate need for some goods, like medications. According to the Centers for Medicare & Medicaid Services, premiums for Medicare and its newer drug coverage, as well as the money needed for co-pays, deductibles and any other related costs, eat up 26% of a typical Social Security check.

Other factors, like giving adult financial help, lowering home equity and of course, the high costs of long-term care are affecting the economic strain these seniors are feeling.

While there is no quick fix to this problem, what our country can do to help these individuals is support federal programs, like Section 202 affordable housing, that can help these individuals ensure that their basic needs are fulfilled while avoiding premature, and costly, institutional care. That’s a smart investment.

On Monday, the Bush administration announced that it would give Congress more time to deliberate on the proposed cut to physician payments by the Centers for Medicare and Medicaid Service (CMS). Originally scheduled to take effect today, CMS spokesman Jeff Nelligan said the agency “will not be making any payments on the 10.6 percent reduction until July 15, at the earliest.”

However, at a meeting with therapy provider groups late yesterday afternoon, the agency’s deputy administrator, Herb Kuhn, advised that the administrative payment relief CMS is providing for physicians does not extend to the Medicare therapy caps exceptions process.

This means that any outpatient therapy claims submitted as of today will begin to count against a beneficiary’s allowance of $1,810 per year for speech and physical therapy combined and another $1,810 for occupational therapy. Therapy provided in a hospital outpatient setting does not count against the caps.

Furthermore, CMS will count any therapy a beneficiary may have received since January 1, 2008 against the cap. This means that many beneficiaries will already have exceeded their annual cap, even though they obtained an exception from the cap at the time they received their therapy.

Kuhn suggested that therapy providers could hold claims and not submit them to CMS for the next 10 days, by which time we can hope that Congress will have reconvened and passed an extension of the therapy caps exceptions process.

At AAHSA, we’re encouraging our members to Contact Congress. You may also call the U.S. Capitol at (202) 224-3121 (not a toll-free call) and ask to be connected to your legislators.

He may not be David Letterman, but Eric Schubert with Ecumen’s Changing Aging Blog can sure put together a top 10 list…and today’s topic is an important one: why our country must change the way we finance long-term care. Take a look:

1.  The Age Wave is Unprecendented:  About 10 million Americans need long-term care today.  (Note: Long-term care is an array of services, from home care to assisted living, not simply nursing home care.)  By 2020, 12 million older Americans will need long-term care.

2.  Americans Want More Choice:  People want more choices than ever in how they live and receive care.  The nursing home isn’t a place they want to choose. Guess what?  Many states rely on institutional nursing homes for long-term care.   To pay for choices that today’s consumer desires, we have to have new ways to pay for care.

3.  The Costs are Unsustainable: According to the independent, non-partisan Government Accounting Office (GAO), Medicare, Medicaid  (which pays nearly half of all long-term care expenditures)and Social Security will nearly double as a share of the economy by 2035.  Today long-term care alone costs federal and state governments $116.8 billion every year.  We’ve been able to sustain these entitlements because of a low-depression era birth rates and a large postwar workforce.  No more.  Absent substantive change, Medicaid, Medicare and Social Security will overwhelm the rest of the Federal budget.

4.  America’s Savings Rate is Deplorable:  Americans are horrible savers.  In fact, 2005 and 2006 marked the first time since the Great Depression that American’s charted a negative savings rate in back-to-back years.  By 2030, many retirees will not have enough income and assets to cover basic expenditures or any expenses related to aging services.

5.  Business Production is Taking a Hit:  According to the Metlife Mature Market Institute and National Alliance for Caregiving, American businesses lose as much as $33.6 billion in annual revenue because of employees’ need to care for their loved ones.  That is approximately $2,110 per full-time employee who is also a caregiver.

6.  Busting State Budgets:  On average, state governments spend 18% of their budgets on Medicaid, which pays for all most half of all long-term care costs.  These costs are only rising and if left unchecked will crowd out all other spending.

7.  Americans are Clueless as to What Care Costs:  In 2006, according to AARP study, only 8 percent of Americans over 45 could estimate the average monthly cost of what care costs within 20 percent of its actual cost.  In an Ecumen study of baby boomers, nearly a third of boomers think that they will use Medicare to pay for their long-term care costs.  Sorry . . . . Medicare won’t pay for costs such as memory care and assisted living.

8.  Long-Term Care Insurance isn’t the Whole Answer.  Only one in five Americans can afford the long-term care insurance policy needed to meet their long-term needs.  And even if everyone purchased the best private coverage he or she could afford, Medicaid costs still would triple by 2045.

9.  A Worker Shortage:  According to the U.S. Department of Health and Human Services, the next four decades will see a need for more than 4 million care professionals in the U.S.  Who will pay their salaries?  We need to change the financing system to attract great professionals to this profession for the long-term. 

10.  Voters Want Change:  The vast majority of Americans say that our health care system is broken and they desire a well-coordinated, integrated, cradle-to-grave system.  To have such a system, long-term care/aging services must be part of the solution.  According to a 2007 national poll by Genworth and the Mellman Group, voters want long-term care/aging services to be part of national health care reform.  Nearly 8 in 10 voters (78%) stated that the presidential candidates should make this part of their health care proposals.

Here is my addition to the list.

11. It is unaffordable to care: Most Americans have been or will be caregivers, providing support for an elderly or disabled relative or friend. These individuals assume enormous emotional and logistical burdens to care.  A recent National Alliance for Caregiving survey found that caregivers spend more than $5,531 per year to pay for loved ones’ food, transportation and medicine. That’s more than most spend on their own health care. Long-term care insurance is a partial solution for one in five Americans who qualify. But what about the rest of us?  We have to spend down life savings to go on welfare through Medicaid or live with unmet needs. These personal problems are compounded by the crazy and inadequate ways long-term care is financed.  Simply put, it’s time to make it affordable to care.

I know there has to be more than 11 items on this list. Let us know your reasons.

Yesterday, the U.S. Senate rejected a cloture motion on H.R. 6331, a bill that would extend the Medicare therapy caps exceptions process for 18 months. The bill also would place a moratorium on a 10.6 percent cut to Medicare’s physician payment rates which begin on July 1. The motioned failed 58-40, with Sens. John McCain (R-Ariz.) and Edward M. Kennedy (D-Mass.) not voting.

However, the bill is expected to be addressed after Congress returns from its July 4th recess, as Majority Leader Harry Reid (D-Nev.), following a procedural rule, changed his vote to the winning “no” side, allowing the bill to be brought up at a later time, Congressional Quarterly explains.

According to updated Centers for Disease Control and Prevention (CDC) data, in 2007 roughly 23 percent, or 12.2 million, of those aged 60 and over in the U.S. had diabetes. The agency also estimated that about 536,000 new cases appeared among that age group. Over all, 23.6 million Americans live with diabetes, and researchers say the new numbers represent a 15 percent increase from a 2005 report that found about 21 million living with the disease.

The CDC points out that diabetes, which is associated with high levels of blood glucose due to irregular insulin production, is “the seventh leading cause of death in the country and can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.”

For seniors, diabetes can be particularly detrimental. The CDC reports that in 2004, heart disease contributed to 68 percent of diabetes-related deaths among people

aged 65 years or older. Stroke contributed to about 16 of diabetes-related death for that same age group. The agency also notes that people aged 60 or older with diabetes “are 2 to 3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, do housework, or use a mobility aid compared with persons without diabetes in the same age group.”

The data did have some encouraging news. Over a two year period, the number of people with diabetes that did not know they had the disease decreased from 30 percent to 25 percent, the agency said.

Ann Albright, Ph.D., director of the CDC’s division of diabetes translation, said that while it is “concerning to know that we have more people developing diabetes,” it is good to find that “more people are aware that they have diabetes.” Albright added, “That is an indication that our efforts to increase awareness are working, and more importantly, that more people are better prepared to manage this disease and its complications.”

However, according to the Diabetes Prevention Program, a research study focused on examining the effects of diet and exercise on the prevention or delay of type 2 diabetes, lifestyle intervention reduced the risk of developing diabetes by 71 percent among adults aged 60 years or older.

For more information and tips on prevention, visit the CDC’s Diabetes Web site.

Nursing homes made the front page of today’s Wall Street Journal, but the story wasn’t a scathing expose or a blurb on a new regulation. Rather, this article took an honest look at the possibilities, as well as the challenges, that face nursing homes as they strive to put the “home” in nursing home.

The story’s protagonist was a man named Bill Thomas.  Thomas is a 48-year old physician who is known for developing the Green House  care model.  Unlike other nursing homes, elders in Green Houses live among 10 to 12 of their peers in small, homelike accommodations.  The first Green House was built seven year ago in Tupelo, Miss. Today, there are currently 41 houses in 10 states.

Thanks to the Robert Wood Johnson Foundation, that number may soon be going up. The Foundation recently pledged $15 million dollars over five years to NCB Capital Impact, a not-for-profit organization that is offering technical assistance help to any party interested in operating a Green House.

Money aside, building a Green House isn’t without its challenges. Take regulatory issues.  Nursing homes are some of the most highly-regulated institutions around. There are “life safety” rules intended to keep residents safe, “physical plant” standards that deal with building codes along with health-care rules, food preparation guidelines and general quality of life standards.  Some nursing-home executives argue such rules can make it difficult, if not impossible, to establish a Green House’s homelike environment.

Plus, the concept often faces resistance from nursing home administrators and staff who’ve grown accustomed to the traditional model. I saw this resistance first hand during a screening of Almost Home, a documentary about culture change. In it, a head nurse complained that these kinds of models make it “so much harder” to do everyday tasks like distribute medications or serve meals.

So what is AAHSA’s take? We support the organizations that are  implementing Green House model, but we don’t think there’s a “one size” fits all approach to transforming America’s nursing homes. Eliminating designated meal times, having consistent staffing and making minor modifications to a home’s physical structure can all promote better nursing home care. In fact, our web site features whole section devoted to tips and tools that can help our members offer nursing home residents the services they need in a place they can truly call home.

Congressional Quarterly is reporting that Senate negotiators have brokered a deal on a bill that would block the scheduled 10.6 percent cut to Medicare physician reimbursements, but that would not be vetoed by President Bush. According to Sen. Debbie Stabenow (D-Mich.), several concessions were made to Republicans on the issue of Medicare Advantage funding.

Sen. Orrin G. Hatch (R-Utah) “confirmed that a key part of the compromise dropped restrictions on private fee-for-service plans, a subset of the Medicare Advantage plans,” CQ adds.

The U.S. House of Representatives today voted with a two-thirds majority to approve H.R. 6331, legislation that would, among a plethora of amendments, place an 18-month moratorium on a scheduled 10.6-percent cut to physician reimbursements from the Centers for Medicare and Medicaid Services (CMS). The measure would also provide a 1.1 percent increase to Medicare physician reimbursements in 2009.

Based on Sen. Max Baucus’ (D-Mont.) last Medicare bill, the House measure removes some of the beneficiary enhancements that the Baucus bill contained. Of primary concern to us at AAHSA is the 18 month extension of the Medicare therapy caps exceptions process contained in the bill and the fact that it allows for the full 2009 market basket update for nursing homes and home health agencies in 2009.

We are strongly supporting the legislation, in view of the impending July 1 reimposition of Medicare therapy caps.

The House voted on the bill under suspension of the rules, which is a procedure designed to prohibit amendments and to require a two-thirds majority for passage.

Recently, researchers from the Alzheimer’s Association found that one in eight baby boomers will be diagnosed with Alzheimer’s disease in their lifetime. But that’s the only number that’s causing concern about this disease. The others, however, can be calculated in dollars and cents.

Sunday’s Wall Street Journal featured an article about the financial implications that come with caring for a loved one with Alzheimer’s. Take Theresa Kraus. When her mother got the disease, she figured that her Mom’s resources, along with savings, would easily cover the costs of her health care. Then reality set in. The cost of round-the-clock care and additional household, utility and other healthcare expenses left Theresa thousands of dollars in debt. She even had to max out her daughter’s college savings account to cover those costs.

Earlier this month, a Dallas Morning News  article also highlighted how three families were handling the financial issues that come with an Alzheimer’s diagnosis.  For many, that diagnosis led them to sell their homes, ask family members for financial help or apply for public assistance.

These stories beg a question our country must consider: How can we ensure that individuals with this disease receive the services they need them at a price they can afford?

That’s what our Long-term Care Solution is all about. This plan proposes a national insurance trust whose premiums provide cash benefits to individuals when they need long-term care. When people are well, they would pay premiums like they do for car or health insurance. When they needed help, they would receive cash benefits to hire an aide, pay a family member who misses work to help them or order groceries to be delivered. Based on sound financial principles, this plan would give them more choice and control over their lives while making it affordable to care for them.

For now, there are resources that can help. The Alzheimer’s Association developed an online tip sheet that offers readers tips for managing their financial matters effectively while tackling this disease. The National Institute on Aging also published a legal and financial planning guide for people with Alzheimer’s disease and their family members to use. Feel free to share any other resources you’d recommend with us.

On Wednesday, the Centers for Medicare & Medicaid Services (CMS) announced that it plans to launch a “five star” ranking system for nursing homes not unlike the way hotels and restaurants are rated. The new system will be part of the agency’s Nursing Home Compare Web site.

According to CMS Acting Administrator Kerry Weems, “The new ‘five-star’ rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily.”

While many in the nursing-home field support a system to rate the quality of a provider, one area of concern about Mr. Weems’ plan is that it is based on inconsistent data taken from state surveys of homes. State surveyors are often underfunded and undermotivated. A GAO report issued in May reflects this fact, finding “approximately 70 percent of federal comparative surveys identified state surveys missing at least one deficiency at the lowest level of noncompliance, and in all but five states the number of state surveys with such missed deficiencies was greater than 40 percent.”

At AAHSA, we believe a rating system that helps consumers identify both high and low performing nursing homes is essential. Consumers deserve nothing less than a reliable seal of approval for the best nursing homes in America.

To be reliable, it’s important that a rating system be based on four essential pillars: resident and family satisfaction, staffing based on resident needs that measures nursing hours and staff satisfaction, clinical quality outcomes, and public oversight. Each of these pillars needs to be based on up-to-date and valid data.

We’re already working with CMS and other stakeholders on the Advancing Excellence in America’s Nursing Homes campaign to strengthen all four of these pillars, enhance quality in nursing homes and increase the public’s trust. We believe there should be two types of nursing homes: the excellent and the non-existent.

A new study by the Harvard School of Public Health and the Universidad Autonoma de Madrid suggests coffee might be a relevant subject when discussing the future of aging. The study, which was published in the Annals of Internal Medicine, found that after accounting for various risk factors, such as smoking and diet, coffee consumers were “less likely to die,” mainly because coffee may decrease the risk of cardiovascular disease (CVD).

According to the researchers, compared with non-consumers, women who imbibed “two to three cups of caffeinated coffee per day” were shown to have “a 25 percent lower risk of death from heart disease during the follow-up period,” and an “18 percent lower risk of death caused by something other than cancer or heart disease.” The research team found no significant connection to either an increase or decrease in death for male coffee drinkers.

As for regular or decaf, Medical News Today reports that “there appeared to be no difference in the link to death rates between caffeinated and decaffeinated coffee, they both appeared to have the same link with lower death rates compared with people who did not drink any coffee at all.”

Still, the study team did not recommend a change in drinking habits. Esther Lopez-Garcia, Ph.D., the study’s lead author, said, “More research is necessary to be able to recommend consuming coffee on a health basis.” Dr. Lopez-Garcia added, “Our study is not enough to make such a statement.”

Sen. Charles Grassley (R-Iowa) on Wednesday introduced the Preserving Access to Medicare Act of 2008, legislation intended to postpone a scheduled 10.6 percent reduction to Medicare physician payments. Sen. Grassley said the cuts would likely affect seniors’ access to physicians.

Under Grassley’s bill, a 0.5 percent physician update would be provided for the rest of 2008. That percentage would increase to 1.1 percent for 2009. To help pay for the plan, the bill would cut over the next five years roughly $12.5 billion from privately run Medicare Advantage plans.

The measure also offers incentive payments to healthcare professionals for using a qualified e-prescribing system. Rural home health agencies would see a five percent home health add-on payment for 2009, and starting Jan. 1, certain skilled nursing facilities would be included as originating sites for the telehealth services initiative.

Sen. Grassley said that unlike similar legislation introduced by Sen. Max Baucus (D-Mont.), his bill was far more likely to be signed into law because it “does not make large, unwarranted cuts to Medicare Advantage.” The Baucus bill, the Patients and Providers Act of 2008 (S. 3101), would cut roughly $13 billion from the private Medicare Advantage plans.

On Monday, Kaiser Permanente, the nation’s largest nonprofit health maintenance organization, announced that it will team with Microsoft Corp. to begin a pilot program that will connect Kaiser’s My Health Manager and Microsoft’s HealthVault, two consumer-controlled personal health record (PHR) platforms.

According to the New York Times, if the pilot program is successful, the new product “will be offered to Kaiser’s 8.7 million members in nine states and the District of Columbia.”

Currently, nearly 2 million users of the Kaiser PHR are able to access clinical information and health management tools, including the ability to order prescription refills and to schedule appointments online. However, Kaiser says linking with Microsoft’s system will offer users an even wider array of “health and wellness management applications.”

HealthVault allows patients to store all of their health information, “from prescriptions to X-rays and lab reports,” the San Jose Mercury News explains. Although many of the major insurers, including Kaiser, Aetna and WellPoint, offer their own online databases, Microsoft’s HealthVault enables users to cull all their data in one independent location. The company explains it as being more of a “hub of a network of Web sites, personal health devices, and other services.”

Peter Neupert, corporate vice president of Microsoft’s Health Solutions Group, said, “As the universe of online health applications continues to grow, people will learn how technology can empower them and their trusted providers to make the most informed decisions about their health and care.”

But while the electronic health management tools are meant to make accessing information easier for both health-care professionals and patients, some experts are concerned about privacy issues because, according to the Cleveland Plain Dealer, information aggregation and sharing sites are not covered by the Health Insurance Portability and Accountability Act, or HIPAA, a regulation that govern medical information privacy.

Kaiser and Microsoft have responded to privacy concerns by explaining that their tools and Web sites “adhere to federal standards for data exchange and include advanced safeguards to protect members’ personal information,” Reuters points out.

When the GAO says something, people listen. That’s why it’s no surprise that their latest report on nursing home quality improvement made the The New York Times.  The reports features a variety of suggestions to make sure America’s nursing homes improve. But there’s one important suggestion missing: tracking staffing. After all, they are the best proxy to quality we have. That’s why AAHSA CEO Larry Minnix wrote a letter to Times in response:

To the Editor:

Sure, hiring a new worker or instituting a training program won’t solve this problem, but it could make the life of a vulnerable person a little better. And that’s what it’s all about.

When I think of the New England Journal of Medicine, my first thought isn’t long-term care. New medication for a disease? Yes. A study linking my favorite food with some kind of unpleasant health condition? Possible. But long-term care? Not so much.

That’s why I was surprised to see this article about LTC and the 2008 election in this month’s issue. In it, Dr. David Stevenson analyzes a variety economic, social and political factors that all come down to one conclusion: long-term care is here to stay, and candidates for political office have to start talking about it. Steveson said it best here:

“If the upcoming election truly is about creating sustainable change, then presenting an efficient and humane plan for the reform of long-term care should be viewed as an important test of the candidates’ vision for our country. ^”  

Then it came to me: like a new medication or research study, our long-term care crisis isn’t a stagnant situation. It’s dynamic and our politicians, like medicial researchers, must discover how can we can make  long-term care affordable in America.

I think investigating AAHSA’s Long-term Care Solution would be a good start. Do you have any suggsetions to share?

That’s what happening to long-term care and services costs. Genworth Financial released their annual “Cost of Care” report today and as predicated, the cost of growing old in our country keep going up. Here are the highlights:

The average annual cost for a private room in a nursing home is$76,460, or $209 per day. That’s a 17 percent increase since 2004.

The elderly person typically spends 2- 1/2 years in a nursing home. That means that person, their loved ones and/or the governemtn would pay $190,000 for their care.

Assisted living costs rose 25 percent. Now, it costs an average of $36,090 each year to live in assisted living community.

Care costs are up even if you stay at home. The cost for a Medicare-certified home health aide to visit you rose to an average $38 an hour, up at a 7 percent since 2004.

Of course, these costs do vary by region. Check out this map to see how elders in your area fare. Here in DC, nursing homes cost $216 a day. I know I’m not prepared to pay for that for myself or a loved one.  Are you?

The way we finance long-term care isn’t just a problem for older people. It affects all of us, including 20-somethings like me. That’s why our association is looking to get younger people’s opinion on caregiving and how our country pays for it.

Here are the five questions we’re asking young people (for now, that’s my mostly my friends) that I’d like any younger readers to take a moment to consider:

1. Do you worry about how you and your parents will pay for the care your older loved ones may need in the future?

2. Are you worried about how our country will cover the baby boomers’ health care costs as they age?

3. Do you worry about how you will pay for own health care when you get older?

4. Do you worry about how you would pay for care and assistance if you had
a major accident or illness?

and finally

5. Which of these four situations concerns you the most?

If you know a young person who’d be willing to share their insights, pass along the survey to them. Their responses will help us move our forward our plan to make affordable to care a little faster.

There’s no question that states feel the impact of our growing aging population. Especially those who need Medicaid money to pay for their long-term care. Last year, the care those people needed cost federal and state Medicaid program $100 billion dollars. You can’t blame states for looking for solutions. But is promoting long-term care insurance the right one?

This article from today’s Wall Street Journal investigates how 14 states like California and New York are working with insurance companies to encourage their older residents to purchase private long-term care insurance. And more than a dozen others are planning similar campaigns. 

Right now, millions of seniors are recieving these materials and may be considering purchasing a policy. I can’t help but wonder if this is best way for states to help the majority of their senior citizens. Citizens who can’t afford to pay for a policy and could easily qualify for the program.

 Or folks like 92-year-old  Rudolph Heyd. He could afford a policy, but his insurance company suddenly stopped paying benefits for his nursing home care. Why? According  to the Journal, “despite his diagnoses and letters indicating otherwise from his attending physician, the insurance company deemed Heyd cognitively intact.”  That meant this former grain farmer had to start paying out of pocket for his expensive care.

Instead of  selling, I think states should consider “buying” something else: our solution for long-term care financing.  A solution that would help all people who need long-term care, regardless of income,  receive the services they need while allieviating the burden on state Medicaid programs at the same time. Sounds like a smart investment to me.

I don’t claim to know much about long-term care financing, but two Florida lawmakers are proposing the most interesting idea I’ve ever heard about the topic.

What’s their plan? To put a dollar tax on all strip club admissions in the state and give the money to low-income nursing home residents who receive Medicaid for their personal expenses (like haircuts and movie tickets).

Call me old-fashioned, but I’m not sure I’d want to tell my Grandma that a strip club’s profits paid for her weekly perm.  There’s got to be a better way to pay for Mom’s manicure or Uncle Frank’s favorite food than this. A way that isn’t dependent on ticket sales or schedules. A way that gives these individuals a sense of choice when it come to how and where their money is spent.

Luckily, AAHSA has a plan that would do just that. And I know I’d be happy to share with the elderly people I love.

Thanks to advances in medicine and scientific discoveries, millions of Americans with AIDS are living longer than ever before.

That leaves just one question: How can  providers help these individuals face their unique health challenges as they age?

An article considering this very question made the front page of yesterday’s New York Times.  The article investigates how housing and health care providers across New York City are tackling these challenges while keeping in mind the needs and preferences of the people they serve. These include people like Jeff, a 56-year old who struggles with AIDS-induced osteoporsis and Parkinson’s Disease simultaneously. Or another who, in addition to several AIDS-related hospitalization, has had several heart attacks and triple-bypass surgery.

The article also features insights from medical experts at the Rivington House. This AAHSA member is one of the country’s only nursing homes exclusively for AIDS patients. There, support groups and drug trials bring hope that individuals with AIDS can age with more dignity and independence, but the stressors of today make it difficult to see the promise tomorrow may hold.

From bakers to bankers, it seems like Americans working in all types of professions are concerned about caring for their aging loved ones. And the people running for president are no exception.

This article in December’s AARP Bulletin offers an inside look into these individuals’ caregiving experiences, and how it has influenced their work for their elderly constiuents and those who care for them.

Take Arkansas’ Governor Mike Huckabee. His mother, who sold her home so she could afford assisted living, was mere months away from exhausting her resources while living in a nursing home. That experience, Huckabee says, inspired him to support  Project IndependentChoices, an innovative program where “you can live in a facility or with a relative, and the state would reimburse [the family member] for the cost of care.”

Then there’s Senator Hillary Clinton (D-N.Y.) Clinton’s mother, Dorothy, wanted to stay in her own home for as long as possible, but she was having difficulty getting around. ““She (told us) couldn’t always be asking people to take her places. ” Clinton says,  I think that was what really convinced her that she should come and live with us.”

That experience was part of Clinton’s inspiration for developing a long-term care platform that includes, among other policies, tax-credits for caregivers whose family members live with them.

But it’s not just about parents. Sen. Christopher Dodd’s (D-Conn.) brother moved in with his family after suffering a stroke. Together, Dodd tells the Bulletin, “we decided that it was the best option.” That experience must have inspired for his plan, which promises a ““A Secure, Dignified Retirement for Every Senior.”

Democrat, Republican or somewhere in-between, caregiving will affect us all where we live, including the White House.

That’s the first thought I had when I read about Hillary Clinton’s proposed plan for long-term care.

Politics aside, Clinton is the first presidential candidate to address this important issue outside of an interview or a nursing home visit. And I respect her for doing it. Her plan tackles issues that all of us face, like caring for an aging loved one or preparing for our own care needs, regardless of partisanship. My only hope is that more candidates will follow her lead and develop plans of their own. After all, aren’t politicians known for their making plans? (keeping promises, well that’s for another post…)

Congratulations to Morningside Ministries of San Antonio, for some wonderful media coverage in the San Antonio Express-News about their advances in design for the aging.  Though senior-friendly design and home-like environments are old news to most people working in aging services, we have a ways to go before the media and the public understand  that living in a senior housing community doesn’t mean living in a hospital. Every story like this one helps break down old stereotypes  of what growing old means for where you live and how you think. We like to see all the coverage like this that’s out there.

What are you doing to tell your story through the media?

In my letters to you, I usually tell the stories of how AAHSA members are working hard to create the future of aging services. Today is different. This letter is about how AAHSA member organizations are showing, and telling, their story in a new way.

Eliza Bryant Village began in 1896 as the first nursing home for Cleveland’s African-American seniors. Today, the organizations continueto live that mission under the leadership of their CEO Harvey Shankman. He and his dedicated staff work hard to ensure that residents like Mary Lou Williams can enjoy her daily walk and the “good food” in the dining room. But there I go storytelling again. Watch and hear from Mary Lou herself.

Take seven minutes out of your day and YouTube with Harvey (http://www.youtube.com/watch?v=OJ5CQiUOzns).

In our increasingly complex media world, YouTube is a fantastic way for non-profit providers of aging services to tell how you live your story. Let me know if you already have a “YouTube story” of your own to share.

Larry

AAHSA’s vision for long-term care is a “healthy, affordable and ethical” system of aging services. Today, those three criteria are far from reality. Few would argue that health care in general, and aging services in particular, reflects well-defined, healthy outcomes. Nor do I know any expert who