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Archive for the ‘caregiving’ Category

America’s Long-Term Care Crisis: Challenges in Financing and Delivery

April 10, 2014 Comments off

America’s Long-Term Care Crisis: Challenges in Financing and Delivery
Source: Bipartisan Policy Center

An estimated 12 million Americans are currently in need of long-term services and supports (LTSS)—defined as institutional or home-based assistance with activities of daily living such as bathing, dressing, or medication management—including both seniors and persons under age 65 living with physical or cognitive limitations. In the next two decades, the U.S. health care system will face a tidal wave of aging baby boomers. This, among many other factors, will create an unsustainable demand for LTSS in the coming years.

Fewer family caregivers, increasingly limited personal financial resources, and growing strains on federal, state, and family budgets will further complicate efforts to organize and finance services. Although there is tremendous variation in what is, or will be, needed, fully 70 percent of people who reach the age of 65 will require some form of LTSS at some point in their lives. The number of Americans needing LTSS at any one time is expected to more than double from 12 million today to 27 million by 2050. Indeed, the demand for LTSS will substantially outpace the rate of growth in the U.S. economy over the next decade and drive significant growth in Medicaid spending.

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Canada — The economic costs of care to family/friend caregivers: A synthesis of findings

March 5, 2014 Comments off

The economic costs of care to family/friend caregivers: A synthesis of findings (PDF)
Source: University of Alberta

Findings reported here are based on a synthesis of results from a three-year program of research (2010-2013) on the economic costs of care directed by Dr. Janet Fast at the University of Alberta. Embedded within this interdisciplinary research program were five projects led by co-investigators Dr. Janet Fast (University of Alberta), Dr. Norah Keating (University of Alberta), Dr. Donna Lero (University of Guelph), and Dr. Karen Duncan (University of Manitoba). This synthesis report integrates findings from five projects that:

  • Provided a framework and literature review of the economic costs of care to caregivers
  • Examined Canadians’ caregiving trajectories across the life course and risk factors for experiencing care-related employment consequences
  • Estimated the monetary costs of eldercare-related labour market accommodations,
  • Documented the prevalence, correlates, and social and economic consequences of care- related out-of-pocket expenses, and
  • Documented the availability, accessibility and effectiveness of workplace supports for Canadian caregivers.

Guide to Patient and Family Engagement in Hospital Quality and Safety

January 13, 2014 Comments off

Guide to Patient and Family Engagement in Hospital Quality and Safety
Source: Agency for Healthcare Research and Quality

Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality. To promote stronger engagement, Agency for Healthcare Research and Quality developed the Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Long-Term Care Services in the United States: 2013 Overview

December 16, 2013 Comments off

Long-Term Care Services in the United States: 2013 Overview (PDF)
Source: National Center for Health Statistics

Long-term care services include a broad range of services that meet the needs of frail older people and other adults with functional limitations. Long-Term care services provided by paid, regulated providers are a significant component of personal health care spending in the United States. This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Data presented in this report are drawn from five sources: NCHS surveys of adult day services centers and residential care communities, and administrative records obtained from the Centers for Medicare & Medicaid Services on home health agencies, hospices, and nursing homes. This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Service users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.

Choosing Home for Someone Else: Guardian Decisions on Long-Term Services and Supports

October 14, 2013 Comments off

Choosing Home for Someone Else: Guardian Decisions on Long-Term Services and Supports
Source: AARP Public Policy Institute

Guardians are responsible for society’s most vulnerable at-risk adults. One of their most important decisions is where the incapacitated person will live: in a personal residence, the community or a nursing facility. Their choices are limited by the options available particularly as budget cutbacks have impacted home and community based services. At the same time, guardians’ consent may be necessary to make long-term services and supports function as they should.

This report presents findings from an in-depth study of how professional guardians make this decision which goes to the core of the individual’s quality of life.

UK — Independent report: Peer support networks and dementia advisers: evaluation

October 10, 2013 Comments off

Independent report: Peer support networks and dementia advisers: evaluation
Source: Department of Health

This report, commissioned by the Department of Health, provides evidence on the importance of post diagnostic support for people with dementia and their carers, and the role that dementia advisers and peer support networks can provide in this.

Important messages from the report are:

  • people with dementia and carers saw dementia advisers and peer support networks as having a positive impact on their wellbeing and quality of life
  • demonstrator sites provided evidence of both dementia advisers and peer support networks filling a gap in service provision that often occurs after diagnosis but before
  • there is a need for more intensive support
  • both initiatives were seen as having resource saving implications for the local health and social care economy

State Legislative Enactments Supporting Relatives, Kinship Care Providers and Grandparents 2007 – 2012

October 4, 2013 Comments off

State Legislative Enactments Supporting Relatives, Kinship Care Providers and Grandparents 2007 – 2012
Source: National Conference of State Legislatures

A number of states have enacted legislation to expand support for grandparent and relative caregivers. The chart below reflects legislation enacted between 2007 and 2012. The categories identified include easing of licensure requirements, waivers and variances; expanded definition of relative;relative placement preference; school enrollment and medical consent; payment, reimbursement, subsidies; supporting relative adoption; studies, commissions and task forces; and, miscellaneous.

Unpaid Eldercare in the United States-—2011-2012 Summary

September 19, 2013 Comments off

Unpaid Eldercare in the United States-—2011-2012 Summary
Source: Bureau of Labor Statistics

Sixteen percent of the U.S. civilian noninstitutional population age 15 and over (39.6 million people) provide unpaid eldercare, the U.S. Bureau of Labor Statistics reported today. Nearly one-fourth of eldercare providers engage in unpaid eldercare on a given day, spending an average of 3.2 hours providing this care. These estimates are averages for the 2-year period of 2011-12; combining the 2 years of data facilitates a more in-depth analysis of eldercare.

Eldercare providers are defined as individuals who provide unpaid care to someone age 65 or older who needs help because of a condition related to aging. This care can be provided to household or nonhousehold members, as well as persons living in retirement homes or assisted care facilities. Eldercare can involve a range of care activities, such as assisting with grooming, preparing meals, and providing transportation. Eldercare also can involve providing companionship or being available to assist when help is needed, and thus it can be associated with nearly any activity.

The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers

August 26, 2013 Comments off

The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers
Source: AARP

Understanding the effects of the relative size of the Baby Boom compared to preceding and succeeding age groups is essential to anticipating the demand for long-term services and supports (LTSS) and the potential availability of family care in the future.

This paper uses a “caregiver support ratio” to document the declining availability of family caregivers to provide LTSS between 1990 and 2050. It defines a “caregiver support ratio” as the number of potential caregivers age 45-64 for each person age 80 and older. It documents the dramatic widening of the care gap nationally and in all 50 states and the District of Columbia, as Baby Boomers age into their 80’s, beginning in 2026. The report also highlights sociodemographic trends that may influence the future supply of family support for the frail older population.

Consumer Choices and Continuity of Care in Managed Long-Term Services and Supports: Emerging Practices and Lessons

August 21, 2013 Comments off

Consumer Choices and Continuity of Care in Managed Long-Term Services and Supports: Emerging Practices and Lessons
Source: AARP Public Policy Institute

Increasing numbers of states are transitioning their Medicaid long-term services and supports (LTSS) systems from fee-for-service models to managed care models, raising concerns among stakeholders that services will be disrupted and consumer choices diminished.

Recent managed care transitions in Kansas, New York and Wisconsin were studied. The authors found that little changed for consumers during the transition period, and services were not disrupted. The findings are limited to the transition period studied. Longer range impact on consumers of managed LTSS is unknown and should be monitored closely.

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status

August 19, 2013 Comments off

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status
Source: Preventing Chronic Disease (CDC)

We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%–25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care.

A Platform for Aging in Place: The Increasing Potential of High-speed Internet Connectivity

July 30, 2013 Comments off

A Platform for Aging in Place: The Increasing Potential of High-speed Internet Connectivity
Source: AARP Public Policy Institute

Information and communication services, delivered over a high-speed Internet connection, increase the potential for older adults to live independently, safely, and comfortably in their own homes. And yet, few older adults have a fast Internet connection at home.

Some of the most promising Internet-based services and applications involve virtual visits with clinicians and family caregivers, automation of routine home activities, and in-home monitoring for older adults with limitations in activities of daily living. This report presents an overview of these services. It also offers recommendations urging policymakers to ensure that affordable high-speed connectivity is available to all citizens and promoted as an aging-in-place solution.

Dignity, Death, and Dilemma: A Study of Washington Hospices and Physician-Assisted Death

July 22, 2013 Comments off

Dignity, Death, and Dilemma: A Study of Washington Hospices and Physician-Assisted Death
Source: Oregon State University

The extensive literature in biomedical ethics on physician-assisted death has represented the debate to involve three parties with significant interests. First, there are arguments regarding the legitimacy of terminally patients seeking to exercise an expanded right of self-determination. Furthermore, questions have been posed regarding the compatibility of a patient request for physician-assisted death with the professional ethics of medicine and of pharmacy, and of the ethics of individual practitioners who may or may not collaborate with this request for a prescription to end the patient’s life. Third, discussion has address the role of the state, which requires assurance in public policy of both patient decision-making capacity and professional accountability to warrant rescinding paternalistic laws that prohibit or restrict patient rights at the end-of-life.

Family Caregivers are Wired for Health

June 20, 2013 Comments off

Family Caregivers are Wired for Health

Source: Pew Internet & American Life Project

Nearly four in ten U.S. adults (39%) are caring for an adult or child with significant health issues, according to a new Pew Research Center survey. That is up from 30% of U.S. adults in 2010. Caring for a loved one is an activity that cuts across most demographic groups, but is especially prevalent among adults ages 30 to 64, a group traditionally still in the workforce.

Caregivers are heavy technology users and are much more likely than other adults to take part in a wide range of health-related activities.

Military Caregivers Aid Injured Warriors, but Little Is Known About Their Needs

March 8, 2013 Comments off

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.

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

January 16, 2013 Comments off

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

November 28, 2012 Comments off

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

November 15, 2012 Comments off

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

October 9, 2012 Comments off

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

July 12, 2012 Comments off

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 adult

3% 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.

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