Category Archive

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.

CMS didn’t just announce their nursing home rating system initiative on Wednesday. They also released a fire safety rule that come with a hefty price tag. By 2013, CMS will require all nursing homes to have full automatic sprinkler coverage in their facilities. If a home can’t comply, they will be unable to participate in Medicare.

These changes don’t come cheap. According to a McKnight’s Long-Term Care News article, retrofitting the thousands of homes that to install or improve their sprinkler systems will cost approximately $850 million. And CMS wants each facility to foot their own bill.

There’s no question that making sprinkler systems in nursing homes mandatory in nursing homes is the right thing to do. But the government provide grants or loans that can help nursing homes pay for these expensive systems. The Nursing Facility Fire Safety Act of 2007 proposes a framework for providing low-interest loans to nursing homes that needed financial assistance with this expense. When it comes to fire safety in nursing homes, we at AAHSA believe that the best thing policy makers could do is encourage passage of this bill or other legislation to promote fire safety in nursing homes.

When most people think of Congressional meetings, they picture policy debates or panel discussions, not computerized “brain fitness” games  or “smart” canes.

But those are just some of the products our Center for Aging Services Technologies (CAST) and the Senate’s Special Committee on Aging and Medical Technology Caucus set up in a Senate office building last week. The reasons? To give a “hands-on” look at how public policy could unleash technology’s potential to transform the way we age.

Take Honor Hacker. She’s a former teacher who now lives in a community where automatic sensors are installed to monitor her health without interrupting her routine and games help keep her memory strong.  She even told members of Congress about the growing “brain game” rivalry between her and her sister, a retired nun. That’s certainly sounds like a strong competition to me!

Experts also testified about how a law the Senate’s considering could help more seniors like Honor benefit from technology now and in the future.  It would bring together the experts and use their knowledge to develop a plan for taking aging-services technology to the next level.

 I don’t know about you, but passing that law means I may get a prescription to play video games in 60 years, I’m all for it!

…or at least their new program to promote person-centered care for low-income seniors. The program is called Putting People First. It’s a simple, but powerful, name for a type of public policy will soon make it “across the pond.”

The program, which will start in April 2008, will allow seniors or a person of their choosing to set up a bank account for funds associated with their care costs.  After the person is means-tested, the government will pay money into the account and allow the seniors or loved ones to use for the care and services that meet the older adults’ needs.

While the program is similar to “Cash and Counseling” initiatives in several states, there is little movement among policy makers to take it nationwide. 

Government officials said that they developed the plan based on British baby boomers’ desire for choice as they age.  Those same boomers liked The Beatles and The Stones before the “British Invasion” hit the states. Why would American boomers not want the same kind of “invasion” in their health care?

Remember the New York Times story about private equity nursing homes? Well, members of Congress didn’t take it lightly. In fact, they held two hearings about the issue addressed in it last week.

At a Ways and Means Health Subcomittee hearing, scrutiny was the name of the game. Chairman Pete Stark (D-Calif.) even called for a Government Accountability Office report on nursing home ownership’s impact on the critical elements of quality: adequate staffing and transparency. And none of nursing-home-chain owners were there to argue against it.

Then came an analysis on the Senate side. That’s where the support comes in.  Don’t get me wrong, there was some scrutiny, but Committee members also talked about the work nursing homes were already doing to make their facilities more transparent and accountable to the public.

That work includes participating in the Advancing Excellence in America’s Nursing Homes., which hundreds of AAHSA members are doing now.  Sen.  Charles Grassley (R-Iowa) even said it was “vital” that more nursing homes participate in the campaign.

The Committee also hear from Denise Zabel. She’s an AAHSA member, and the  daughter of a nursing home resident, who spoke about her experiences on “both sides” of the situation.

Whether you scrutnize or support nursing homes, the real question is, will any of this analysis create solutions?

As a communications professional, seeing a front page story in The New York Times only means two things: it’s time to celebrate or fight a fire. Unfortunately, this story meant I had to get out the ladder and hose.

 The story is true, but leaves readers questioning the quality and integrity of all nursing homes, not just those mentioned in the article.  And it also begs for suggestions about how we can make sure that there only excellent and non-existent nursing homes in America.

That’s why AAHSA’s CEO Larry Minnix responded with a letter that does both. Take a read. It may not be front-page news, but it certainly shows how telling your side of the story can make the media take notice.

The fragmented care system in the US, particularly with respect to payment, has often been cited by field experts as one of the hindrances to a better quality healthcare, while single payer systems, similar to those available in Europe, are seen as conducive to “investing” in programs that reduce the cost of care and generally improve the quality of care for the majority of care recipients, including preventive health programs and technologies.  This comparison is sometimes perceived as advocating single payer healthcare system.  I have recently come across this very interesting article that offers a more balanced multi-faceted comparison between the US and the European healthcare systems, which I thought of sharing with the readers of this blog; enjoy!

- Majd Alwan

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 says what we have today is affordable. Many countries spend far less and have better outcomes. Public outcries related to health care scandals have questioned health care’s ethical underpinnings. And now, Congress and the IRS have their sights focused on not-for-profit ethical behavior and accountability.

Recently, I met with a leading consumer advocate about the state of nursing home care in general and the future of aging services in particular. I asked her what AAHSA’s and the nonprofit role should be in getting beyond where we are today. She said she believes our responsibility is two-fold: continue to create a vision of what the continuum can be for older people in our society and create trust in our work. A provocative perspective succinctly stated.

I submit for your consideration that the vision so badly needed in our field and the trust so hard to earn begins and ends with ethics.

Oh, I’m sure most of us could say with confidence that we are corporately ethical. Our intentions have been noble and honorable for generations. But without a disciplined process of ethical reflection as organized as our processes for financial analysis, it is easy to drift ethically. Ethical lapses lead to crises of trust reflected in headlines that are etched in the public’s mind for decades.

What do ethical lapses look like and how do moral imperatives manifest themselves in difficult times? Let’s use a couple of human resources (HR) examples from real situations. I use human resources because AAHSA’s Ethics Commission, under the leadership of Audrey Weiner from the Jewish Home and Hospital Life Care System in New York, will soon publish a Quality First white paper entitled Our Moral Imperative: Creating an Ethical Workplace. It has guidelines for human resources ethics. It should become part of your corporate ethics tool kit and library, along with corporate compliance, codes of ethical conduct and social accountability material - examples of which AAHSA has available for our members.

In fact, AAHSA’s annual meeting in Orlando this fall is themed “Living Your Story” with daily themes of “A Life of Conscience,” “A Life of Community,” “A Life of Integrity” and “A Life of Legacy” - driven by the AAHSA Ethics Commission’s work.

Back to the human resources lapses and imperatives. Years ago, I visited a colleague’s facility to share solutions to common problems. My organization faced a much higher food service cost per meal than others I compared with. The colleague’s facility had a particularly low-cost program, with labor costs less than half of my facility’s costs. I asked the food service director his secret. He smiled and replied, “It’s simple. Our community has lots of immigrants who need work, so I don’t have to pay more than minimum and I don’t have to offer vacation and other benefits. And if they don’t like it, I can replace them immediately.” Stunning! I wonder: was that an HR policy sanctioned by the board? Did the board even know? Was this an ethical lapse under the board’s radar or corporate intent?

Contrast that with the ethical imperative loudly stated in the actions of Boston member Mary Immaculate Health Care, whose CEO is Barbara Grant. Mary Immaculate experienced a river flood that could have been an even worse disaster. Fire and rescue, local hospitals and nursing homes all responded nobly and quickly, resulting in no injury, no loss of life as the facility succumbed to the river. Perhaps most inspiring was the employee response. Employees on site stayed, others came in to help. All followed their residents to various facilities that took them in. Immediately post evacuation, with a now uncertain future for the facility, the board of Mary Immaculate reassured the staff that no employee would miss a paycheck! A moral imperative, from their perspective.

Our ethical imperative is the leadership dynamic of transformation needed in long-term care. Recently retired CEO Dick Lamden from Wexner Heritage Village in Ohio testified at a state legislative hearing in which conflict about a public policy objective was apparent. Dick’s recommendation to this committee contrasted significantly with the profit sector’s recommendation. After discussion, a prominent elected official stated that he trusted Dick’s recommendation because of Wexner’s history of quality and doing the right things for the right reasons. Unanimous approval.

The Kendal organization in Pennsylvania calls it “One Common Interest” on the cover of its 2006 annual report, which quotes John Woodman, who, in 1763, said:

“Here we face the prospect of one common interest from which our own is inseparable, that to turn all the treasures we possess into the channel of universal love becomes the business of our lives…”

Yes, we have an ethical imperative. It begins with corporate leadership, including the board. It should pervade all aspects of our work. It should encompass all groups of people with whom we have relationships. It is the key to transformational leadership to change a broken system of inadequate quality, despite the resources thrown at it and the competition for them. Ethical thinking is the foundation for change. And it needs to happen every day, in every community.

Larry

William L. Minnix, Jr., D.Min.
AAHSA President and CEO

P.S. Be sure to watch for the September/October issue of AAHSA’s FutureAge magazine, where you’ll find articles that profile members who take ethics and quality to heart, examine the characteristics of a just society, look at what determines an ethical corporate culture and more.

The Good Lord didn’t make a more loyal AAHSA member or more credible elder advocate than Shirley Barnes from Minneapolis. On July 31, I asked all of you to flood your Congressman and Senators during their August recess at home about your concerns — even outrage — about freezes on Medicare cost–of–living increases, about the continuing problem with therapy caps, about user fees, about a broken Medicaid system, about inadequate housing funding, and the need for technology planning.

We asked you to flood your elected officials with appointments to meet with your boards, residents and staff about the effects of some of the Congressional actions or a predicted veto of the State Children’s Health Insurance Program (SCHIP) bill, which contains provisions for Medicare and nursing home payment. We also asked you to flood them with thanks for their interest and concern.

Typical of her leadership, Shirley Barnes contacted Congressman Keith Ellison (D–Minn.) even before we asked. The Congressman’s staff met with Shirley’s staff and residents at the Boulevard and sent a letter of thanks. He said,

“The feedback I received has given me a better perspective of how the legislative proposals in Congress affect Minnesotans. The residents of the Boulevard and their personal situations will remain with me as I cast my votes for health care and senior issues in the U.S. House of Representatives.”

Yes, we must change the perspectives of an elected official. And yes we must help them make it personal. If you watch much political discussion on television these days, you can see and hear how politicians can lose perspective on the personal problems families face every day.

Let the August flood continue. Make it personal about how Medicare and Medicaid freezes impact employees who may not get a raise and the quality of care that your residents and clients receive. Make it personal about how a veto of an SCHIP bill will jeopardize the health of your employees’ children. Tell them how user fees take away money from direct care services. Help them understand how badly seniors need affordable housing.

Shirley Barnes knew what to do. Don’t take no for an answer about a visit, a response to a letter or a petition from residents, families or employees. Don’t let them say no to a letter from your board.

Flood them with perspective and the reality about people and real situations. We have tools and contact to help you flood their offices with your perspective on the personal problems that your residents, clients and staff face. And let us know what you’re doing.

Larry

William L. Minnix, Jr., D.Min.
AAHSA President and CEO

Contact Congress on SCHIP, appropriations and housing.