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Military Caregivers Aid Injured Warriors, but Little Is Known About Their Needs
Military Caregivers Aid Injured Warriors, but Little Is Known About Their Needs
Source: RAND Corporation
Spouses, family members and others who provide informal care to U.S. military members after they return home from conflict often toil long hours with little support, putting them at risk for physical, emotional and financial harm, according to a new RAND Corporation report.
Researchers estimate there are between 275,000 and 1 million women and men who are providing care or have provided care for military members or veterans who served in Iraq or Afghanistan. Caregivers include spouses, children and parents of military members and veterans.
Despite the serious challenges faced by this group, there is no national strategy for supporting military caregivers, even as the nation prepares to end more than a decade of war fighting.
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Military caregivers tend to differ from civilian informal caregivers in several ways. Military caregivers are younger and tend to live with the individual they care for, relative to civilian caregivers who tend to be older adults caring for elderly parents, often with age-associated illnesses like Alzheimer’s disease. Military caregivers must navigate multiple systems of health care and benefit providers for individuals who often face complex injuries and illnesses. The typical military caregiver is a younger woman with dependent-age children.Caregivers help provide a broad assortment of aid, assisting with the normal activities of daily life such as bathing, dressing and eating, serving as mental health counselors, advocating for better treatment, and even overseeing a family’s legal and financial needs.
In addition to general physical strain, caregivers may experience a greater incidence of disease and other health problems than the general population. Prior research on the general caregiver population found that they are at greater risk for coronary heart disease, hypertension, compromised immune function and reduced sleep. It also found that they suffer disproportionately from mental health problems and experience emotional distress associated with caregiving. However, studies on how these conditions compare in the military caregiver population are lacking.
Home Alone: Family Caregivers Providing Complex Chronic Care
Home Alone: Family Caregivers Providing Complex Chronic Care
Source: AARP Public Policy Institute
his study challenges the common perception of family caregiving as a set of personal care and household chores that most adults already do or can easily master. Family caregivers have traditionally provided assistance with bathing, dressing, eating, and household tasks such as shopping and managing finances. While these remain critically important to the well-being of care recipients, the role of family caregivers has dramatically expanded to include performing medical/nursing tasks of the kind and complexity once only provided in hospitals.
Home Economics: The Invisible and Unregulated World of Domestic Work
Home Economics: The Invisible and Unregulated World of Domestic Work
Source: National Domestic Workers Alliance (Center for Urban Economic Development (CUED) of the University of Illinois at Chicago)
From Summary:
Domestic workers are critical to the US economy. They help families meet many of the most basic physical, emotional, and social needs of the young and the old. They help to raise those who are learning to be fully contributing members of our society. They provide care and company for those whose working days are done, and who deserve ease and comfort in their older years. While their contributions may go unnoticed and uncalculated by measures of productivity, domestic workers free the time and attention of millions of other workers, allowing them to engage in the widest range of socially productive pursuits with undistracted focus and commitment. The lives of these workers would be infinitely more complex and burdened absent the labor of the domestic workers who enter their homes each day. Household labor, paid and unpaid, is indeed the work that makes all other work possible.
Despite their central role in the economy, domestic workers are often employed in substandard jobs. Working behind closed doors, beyond the reach of personnel policies, and often without employment contracts, they are subject to the whims of their employers. Some employers are terrific, generous, and understanding. Others, unfortunately, are demanding, exploitative, and abusive. Domestic workers often face issues in their work environment alone, without the benefit of co-workers who could lend a sympathetic ear.
The social isolation of domestic work is compounded by limited federal and state labor protections for this workforce. Many of the laws and policies that govern pay and conditions in the workplace simply do not apply to domestic workers. And even when domestic workers are protected by law, they have little power to assert their rights.
Domestic workers’ vulnerability to exploitation and abuse is deeply rooted in historical, social, and economic trends. Domestic work is largely women’s work. It carries the long legacy of the devaluation of women’s labor in the household. Domestic work in the US also carries the legacy of slavery with its divisions of labor along lines of both race and gender. The women who perform domestic work today are, in substantial measure, immigrant workers, many of whom are undocumented, and women of racial and ethnic minorities. These workers enter the labor force bearing multiple disadvantages.
Home Economics: The Invisible and Unregulated World of Domestic Work presents the results of the first national survey of domestic workers in the US. It breaks new ground by providing an empirically based and representative picture of domestic employment in 21st century America. We asked a sample of domestic workers a standardized set of questions focusing in four aspects of the industry:
- pay rates, benefits, and their impact on the lives of workers and their families;
- employment arrangements and employers’ compliance with employment agreements;
- workplace conditions, on-the-job injuries, and access to health care;
- abuse at work and the ability to remedy substandard conditions.
We surveyed 2,086 nannies, caregivers, and housecleaners in 14 metropolitan areas. The survey was conducted in nine languages. Domestic workers from 71 countries were interviewed. The study employed a participatory methodology in which 190 domestic workers and organizers from 34 community organizations collaborated in survey design, the fielding of the survey, and the preliminary analysis of the data.
Inappropriate Payments to Skilled Nursing Facilities Cost Medicare More Than a Billion Dollars in 2009
Inappropriate Payments to Skilled Nursing Facilities Cost Medicare More Than a Billion Dollars in 2009
Source: U.S. Department of Health and Human Services, Office of Inspector General
Summary
WHY WE DID THIS STUDY
In recent years, the Office of Inspector General has identified a number of problems with billing by skilled nursing facilities (SNF), including the submission of inaccurate, medically unnecessary, and fraudulent claims. Further, the Medicare Payment Advisory Commission has raised concerns about SNFs’ improperly billing for therapy to obtain additional Medicare payments. In fiscal year (FY) 2012, Medicare paid $32.2 billion for SNF services.
HOW WE DID THIS STUDY
We based this study on a medical record review of a stratified random sample of SNF claims from 2009. The reviewers determined whether the information reported by the SNFs on the Minimum Data Set (MDS) was supported by and consistent with the medical record. The MDS is a standardized tool that SNFs use to assess each beneficiary. SNFs use the information on the MDS to classify beneficiaries into resource utilization groups (RUG). The RUGs determine how much Medicare pays the SNFs.
WHAT WE FOUND
SNFs billed one-quarter of all claims in error in 2009, resulting in $1.5 billion in inappropriate Medicare payments. The majority of the claims in error were upcoded; many of these claims were for ultrahigh therapy. The remaining claims in error were downcoded or did not meet Medicare coverage requirements. In addition, SNFs misreported information on the MDS for 47 percent of claims. SNFs commonly misreported therapy, which largely determines the RUG and the amount that Medicare pays the SNF.
WHAT WE RECOMMEND
We recognize that CMS has recently made several significant changes to SNF payments. However, more needs to be done to reduce inappropriate payments to SNFs. We recommend that CMS: (1) increase and expand reviews of SNF claims, (2) use its Fraud Prevention System to identify SNFs that are billing for higher paying RUGs, (3) monitor compliance with new therapy assessments, (4) change the current method for determining how much therapy is needed to ensure appropriate payments, (5) improve the accuracy of MDS items, and (6) follow up on the SNFs that billed in error. CMS concurred with all six recommendations.
Criminal Convictions for Nurse Aides With Substantiated Findings of Abuse, Neglect, and Misappropriation
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
The Patient Protection and Affordable Care Act mandates that OIG submit a report to Congress evaluating the Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term-Care Facilities and Providers not later than 180 days after the program’s completion. This memorandum report provides baseline information for the mandated report on the extent to which nurse aides with substantiated findings of abuse, neglect, and/or misappropriation had previous criminal convictions that could have been detected through background checks and the nature of those convictions.
HOW WE DID THIS STUDY
In September 2011, we requested from each State’s nurse aide registry a roster of all nurse aides who received a substantiated finding of abuse, neglect, and/or misappropriation of property during 2010. For each nurse aide on these rosters, we requested criminal history record information from the Federal Bureau of Investigation. We recorded convictions from each positively matched individual’s criminal history.
WHAT WE FOUND
Nineteen percent of nurse aides with substantiated findings had at least one conviction in their criminal history records prior to their substantiated finding. Among these nurse aides, the most common conviction (53 percent) was for crimes against property (e.g., burglary, shoplifting, and writing bad checks). We also determined whether nurse aides with each type of substantiated finding were more likely to have certain types of convictions. We found that nurse aides with substantiated findings of either abuse or neglect were 3.2 times more likely to have a conviction of crime against persons than nurse aides with substantiated findings of misappropriation, and nurse aides with substantiated findings of misappropriation were 1.6 times more likely to have a conviction of crime against property than nurse aides with substantiated findings of abuse or neglect.
WHAT WE CONCLUDED
CMS may wish to provide the information in this memorandum report to States that participate in the background check program as well as to the Long Term Care Criminal Convictions Workgroup. We plan to use this baseline information in the mandated report to assess the extent to which the background check program may reduce the number of incidents of neglect, abuse, and misappropriation of resident property.
Family Caregivers Online
Source: Pew Internet & American Life Project
Thirty percent of U.S. adults help a loved one with personal needs or household chores, managing finances, arranging for outside services, or visiting regularly to see how they are doing. Most are caring for an adult, such as a parent or spouse, but a small group cares for a child living with a disability or long-term health issue. The population breaks down as follows:
24% of U.S. adults care for an adult3% of U.S. adults care for a child with significant health issues
3% of U.S. adults care for both an adult and a child
70% of U.S. adults do not currently provide care to a loved one
Eight in ten caregivers (79%) have access to the internet. Of those, 88% look online for health information, outpacing other internet users on every health topic included in our survey, from looking up certain treatments to hospital ratings to end-of-life decisions.
American Time Use Survey — 2011 Results
American Time Use Survey — 2011 Results
Source: Bureau of Labor Statistics
In 2011, 16 percent of the U.S. civilian noninstitutional population age 15 and over were eldercare providers, the U.S. Bureau of Labor Statistics reported today. This and other information about eldercare providers and the time they spent providing care were collected for the first time in the 2011 American Time Use Survey (ATUS). This release also includes the average amount of time per day in 2011 that individuals spent in various activities, such as working, household activities, childcare, and leisure and sports activities. For a further description of ATUS data, concepts, and methodology, see the Technical Note.
Aging Today: Family Caregiving & the Older Worker – Fact Sheet
Aging Today: Family Caregiving & the Older Worker – Fact Sheet
- According to a 2004 AARP survey, “35% of Boomers have been or are responsible for the care of their elderly parent, up nine points since 1998.”
- A 2008 study from the Sloan Center on Aging & Work of couples and careers “reveals that one in two older workers (those aged 50 and above) have a dependent child in the household and one in five of these workers have an adult child in the household.”
- According to a 2011 analysis of American Community Survey data, “more than one-third (36%) of the 915,000 grandparents ages 60 and older who are caring for their grandchildren were in the labor force in 2010.”
Complexity in Non-Pharmacological Caregiving Activities at the End of Life: An International Qualitative Study
BackgroundIn late-stage palliative cancer care, relief of distress and optimized well-being become primary treatment goals. Great strides have been made in improving and researching pharmacological treatments for symptom relief; however, little systematic knowledge exists about the range of non-pharmacological caregiving activities (NPCAs) staff use in the last days of a patient’s life.Methods and FindingsWithin a European Commission Seventh Framework Programme project to optimize research and clinical care in the last days of life for patients with cancer, OPCARE9, we used a free-listing technique to identify the variety of NPCAs performed in the last days of life. Palliative care staff at 16 units in nine countries listed in detail NPCAs they performed over several weeks. In total, 914 statements were analyzed in relation to (a) the character of the statement and (b) the recipient of the NPCA. A substantial portion of NPCAs addressed bodily care and contact with patients and family members, with refraining from bodily care also described as a purposeful caregiving activity. Several forms for communication were described; information and advice was at one end of a continuum, and communicating through nonverbal presence and bodily contact at the other. Rituals surrounding death and dying included not only spiritual/religious issues, but also more subtle existential, legal, and professional rituals. An unexpected and hitherto under-researched area of focus was on creating an aesthetic, safe, and pleasing environment, both at home and in institutional care settings.ConclusionsBased on these data, we argue that palliative care in the last days of life is multifaceted, with physical, psychological, social, spiritual, and existential care interwoven in caregiving activities. Providing for fundamental human needs close to death appears complex and sophisticated; it is necessary to better distinguish nuances in such caregiving to acknowledge, respect, and further develop end-of-life care.
AU — Disability, Ageing and Carers, Australia: Disability and Long Term Health Conditions, 2009
Disability, Ageing and Carers, Australia: Disability and Long Term Health Conditions, 2009 (cat. no. 4433.0) presents a suite of data cubes examining the relationship between disability and long term health conditions. The tables include broad level information on the numbers of people with long term health conditions in each of the States of Australia (ACT and NT are not included). They also include information on some of the most common long term health conditions, the degree to which these restrict people with disability and the causes underlying main conditions.
Several tables provide detailed information on five impairment groups – sensory, intellectual, physical, psychological and head injury (an impairment is where there is loss or abnormality in body structure or the way in which the body or mind work). Impairment groups are examined with relation to living arrangements and to the restrictions particular impairments place on daily living (personal care, schooling and employment). There is also information on the need for, and receipt of, assistance in relation to impairment groups.
Several tables provide information on specific age groups – children (0-14 years), working age adults (15-64 years) and people aged 65 years and over.
Residential Care Facilities: A Key Sector in the Spectrum of Long-term Care Providers in the United States
Key Findings
- 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.
Community Living Assistance Services and Supports Program: 2011 Report to Congress
On October 14, 2011, the Secretary of Health and Human Services (HHS) informed Congress that HHS had not identified a Community Living Assistance Services and Supports (CLASS) program benefit plan that is both actuarially sound for the next 75 years and consistent with the requirements of Title VIII of the Patient Protection and Affordable Care Act of 2010 (the CLASS Act). Following this announcement, HHS suspended program implementation activities.Effective January 1, 2011, the CLASS Act established the CLASS program as a federally administered, voluntary insurance program to help working adults cover some costs of long-term-care services and supports. The CLASS Act requires the HHS Office of Inspector General (OIG) to submit an annual report to the Secretary and Congress on the overall progress of the CLASS program and the existence of waste, fraud, and abuse in the program. Each report must include findings in four areas: providing cash benefits; determining eligibility; providing quality assurance and protecting against waste, fraud, and abuse; and recouping unpaid and accrued benefits.
We reviewed progress in the development of the CLASS program from March 23, 2010, when the CLASS Act was enacted, through October 14, 2011, when program activities were suspended. This review focuses primarily on the Administration on Aging’s (AoA) activities in the four areas specified in the CLASS Act’s OIG annual reporting requirement after January 2011, when AoA became responsible for developing the program. We obtained data about AoA’s progress from interviews with AoA senior management, a questionnaire completed by AoA staff, and documents provided by AoA to support interview and questionnaire responses.AoA focused most of its efforts on developing at least three actuarially sound benefit plan alternatives, as required by the CLASS Act. The CLASS Act requires the Secretary to designate one of these benefit plan alternatives as the CLASS Independence Benefit Plan by October 1, 2012. As stated above, the Secretary informed Congress of the status of the benefit plan on October 14, 2011.The Secretary has not designated a viable benefit plan. Therefore, we have no recommendations regarding program progress or the existence of waste, fraud, and abuse. OIG will determine the most appropriate way to meet OIG’s CLASS Act reporting requirements in future years based on the program’s status. AoA had no comments on the report.
2011 Market Survey of Long-Term Care Costs
2011 Market Survey of Long-Term Care Costs
Source: MetLife Mature Market Institute
Key Findings
- The national average daily rate for a private room in a nursing home rose 4.4% from $229 in 2010 to $239 in 2011.
- The national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.
- The national average daily rate for adult day services rose 4.5% from $67 in 2010 to $70 in 2011.
- The national average hourly rates for home health aides ($21) and homemakers ($19) were unchanged from 2010.
+ Full Report (PDF)
Living Arrangements of the Elderly in China
Living Arrangements of the Elderly in China
Source: RAND Corporation
Recent increases in Chinese elderly living alone or only with a spouse has raised concerns about elderly support, especially when public support is inadequate. However, using rich information from the China Health and Retirement Longitudinal Study, this paper finds that the increasing trend in living alone is accompanied with a rise in living close to each other. This type of living arrangement solves the conflicts between privacy/independence and family support. This is confirmed in further investigation: children living close by visit their parents more frequently. It also finds that children who live far away provide a larger amount of net transfers to their parents, a result consistent with responsibility sharing among siblings. Having more children is associated with living with a child or having a child nearby, while investing more in a child’s schooling is associated with greater net transfers to parents.
+ Full Document (PDF)
Children with Disabilities & Sexual Abuse Fact Sheet
Children with Disabilities & Sexual Abuse Fact Sheet (PDF)
Source: California Child Abuse Training and Technical Assistance Centers
Perpetrators are likely to be male, either family or extended family, or caregivers in an institutional/home setting such as schools, afterschool programs and other service delivery locations. In fact, professional or paraprofessionals providing in-home services have also been identified as perpetrators of sexual abuse.
Victims tend to be female, although a significant number are male. There are some characteristics of the child victims that seems to increase risk of abuse, including medical needs, caregivers unable to comfort the child, a child’s conduct that is frustrating to the caregiver are some where increased physical abuse has been identified.
Children with intellectual and/or developmentally disabilities are at a higher risk for sexual abuse than others, estimates ranging from 4-10 times the rate.
Data on Prevalence of Abuse shows that Children with Disabilities are:
- 1.7 times more likely to be abused than children without disabilities (Westat, 1991)
- 3.4 times more likely to be abused than children without disabilities (Boystown, 2001)
- Children with disabilities become adults with disabilities where abuse rates continue at higher rates.
- Adults with disabilities are equally as likely to be abuse victims as the generic population (Nosek, 1999)
- The extent of the abuse is “much worse” for women with disabilities (personal care indignities & abandonment)
- Increased rates of abuse by both men and women with disabilities from 31-83% For women with mental retardation & other intellectual disabilities rates from 40-90%
Caregiving Costs U.S. Economy $25.2 Billion in Lost Productivity
Caregiving Costs U.S. Economy $25.2 Billion in Lost Productivity
Source: Gallup
Working American caregivers — those who work at least 15 hours per week and help care for an aging family member, relative, or friend — report that their caregiving obligations significantly affect their work life.
The majority of caregivers say that caregiving has at least some impact on their performance at work. Based on a five-point scale, where five is a great impact and one is no impact, 10% of caregivers choose five and 44% pick somewhere between two and four.
Additionally, 24% of caregivers say that providing care to an aging family member, relative, or friend keeps them from being able to work more.
Most caregivers also report missing entire workdays as a result of their caregiving responsibilities. Thirty-six percent report missing one to five days per year because of caregiving duties, while 30% say they missed six or more days in the past year.
Overall, caregivers reporting missing an average of 6.6 workdays per year. With approximately 17% of the American full-time workforce acting as caregivers, this amounts to a combined 126 million missed workdays each year. This absenteeism costs the U.S. economy an estimated $25.2 billion in lost productivity per year. Including caregivers who work part time in the equation would cause absenteeism costs to climb even higher.
See also: More Than One in Six American Workers Also Act as Caregivers
