Low-income Californians who are elderly and disabled were less likely to go to the emergency room or be hospitalized after their in-home caregivers participated in an intensive training program, according to a report. Under a pilot program, nearly 6,000 aides in Los Angeles, San Bernardino and Contra Costa counties were trained in CPR and first…
The quality of your relationship with your parent will make the difference
If you are a card-carrying member of the Sandwich Generation — working outside of the home, caring for your family (which may include young children or “boomerangers”) and for an older parent, as well — your children could be a big help in taking some of the burden off your shoulders. As an added bonus, they could have a memorable experience with their grandparents by becoming important members of your caregiving team.
The operative word here, however, is could. And the relationship both you and your children have with your parent is an important factor in whether they should be.
Read the entire article here: http://www.nextavenue.org/when-should-you-grandparent-caregiving/
Traxx Mobility Systems manufactures and sell the Titan 500, a freestanding overhead patient lift for home health care. It allows a single caregiver, often a family member, to safely transfer a loved one between the bed and a wheelchair or other assistive device. It protects both the caregiver and the patient from injuries associated with manual transfers or traditional floor-based patient lifts.
Modern Medical Devices Allow For Primary Care At Home
For those living with physical disabilities or chronic disease, the independence that home health care affords is priceless. Home health aides can supplement and provide respite for family caregivers allowing the patient to remain in the comfort of their own home.
Homes are currently being built with many convenient options as part of the design process. Retro-fitting homes to increase accessibility has become more cost effective with new technology. The equipment needed has even been redesigned to work more efficiently in the home. Many new products are on the market that increase accessibility to the home while remaining more cost effective than an extended stay at a long term care facility.
Traxx Mobility Systems manufactures the Titan 500, a freestanding overhead patient lift designed for home health care. Overhead lifting is the preferred method of transfers in any healthcare setting, from hospitals to nursing homes. It provides a more comfortable and dignified lift experience for the patient while protecting the caregiver from the stress and strain of manual transfers and floor-based lifts. While ceiling lifts have been available in the home for some time, it has not been a viable option for most people. It is fairly cost prohibitive for most people and not always an option for those renting or looking to sell their home or downsize at some point in the near future.
The Titan 500 replaces the traditional floor-based lift, often referred to as a Hoyer. The tight spaces and carpet can make the floor-based lift a difficult choice for home health care. Technically, it requires two caregivers to safely transfer a patient, one to move the lift and another to spot the patient should the lift encounter any obstacles on the floor during a transfer. The physical task of moving the lift along the floor with the weight of a patient can be too much for a family caregiver.
The Titan 500 features a freestanding frame along with a rechargeable electric lift motor. The frame spans the bed and allows room for a wheelchair or other assistive device. The electric motor does all the heavy lifting, no hydraulic pump to deal with like the hoyer. Once the patient is up in the air, the caregiver can gently glide them across the overhead beam with little effort. Once in place, the caregiver can lower the patient safely with the press of a button.
The Titan 500 is an ideal solution for those who wish to remain in their home and avoid the high costs of nursing homes or a full home ceiling lift system. The freestanding frame does not attach to the structure in any way and can be completely dismantled and moved to another location. The system is quick to assemble, easy to operate and simple to maintain.
Hoarding is not usually one of the issues caregivers often think about when dealing with the elderly. Yet hoarding poses significant risks to the elderly as well as to the community, and it may very well impede the work of the caregiver unnecessarily.
Hoarding is defined as the keeping of possessions that do not pose a use or benefit to the person and that interfere with daily living. Studies, such as one reported in the International Journal of Geriatric Psychiatry, have found that compulsive hoarding is not something that begins during the elderly years; it is something that starts early on in life and simply progresses with each decade that a person ages. This is why by the time hoarders are in their elderly years, the hoarding may be severe and even compulsive, yet the hoarding tendencies have been there all along.
Read the whole article here: http://www.seniorsmatter.com/senior-living/caregivers-guide-hoarding-among-elderly/
Study: Elderly’s Family Caregivers Need Help, Too
(Original published by Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.)
Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones, reported a study released Tuesday.
Nearly 18 million people care for a relative who is 65 or older and needs help, yet “the need to recognize and support caregivers is among the most significant challenges” facing the nation’s swelling elderly population, their families and society, according to the report from the National Academies of Science, Engineering, and Medicine. Describing family caregiving as “a critical issue of public policy,” a committee of experts in health care and aging said the next presidential administration in 2017 should direct a national strategy to develop ways to support caregivers, including economically.
According to the report, people who help elderly family members with three or more personal tasks a day devote 253 hours a month to caregiving — almost the equivalent of two full-time jobs.
Five years is the median duration that family members care for older adults with high needs, the report said.
For some Americans who accept that responsibility, that can mean taking a less demanding job, foregoing promotions or dropping out of the workforce.
Lost wages and benefits average $303,880 over the lifetimes of people 50 and older who stop working to care for a parent, according to a study cited in the report. That’s not all: A lower earnings history also means reduced Social Security payments for caregivers when they become eligible.
A possible fix for that problem, proposed by researchers in 2009, is to provide caregivers with a Social Security credit for a defined level of deemed wages during a specified time period, the report said.
Leave programs do exist for some workers shouldering caregiving duties, but many lack such job protections.
The federal Family and Medical Leave Act doesn’t cover 40 percent of the workforce. It allows eligible employees to take 12 weeks of unpaid time off to care for certain family members, but the law only applies to those who work federal, state and local governments and private companies with more than 50 employees. But ineligible family relationships for leave include sons- and daughters-in-law, stepchildren, grandchildren, siblings, nieces and nephews. Many workers can’t afford to give up their incomes for 12 weeks.
In 2011, 17 percent of caregivers didn’t take leave because they feared losing their jobs, according to a national survey cited in the report.
The report recommends that family caregivers receive status as a protected class under existing job discrimination laws and that employers get guidance and training on ways to support workers caring for family members.
Beyond the economic costs of caregiving, the report notes that the social and physical toll of caregiving should get more attention than it does.
“If their needs are not recognized and addressed, family caregivers risk burnout from the prolonged distress and physical demands of caregiving, and the nation will bear the costs,” the report said.
Instead of delivering “patient-centered” care, health care providers should adopt “family-centered” models that include checking with caregivers to ensure they are healthy and capable of filling the role. The report also recommended wellness visits, counseling sessions and better training for caregivers who must understand increasingly complicated medical instructions.
Dealing with feeding and drainage tubes, catheters and other complicated medical devices causes stress, and the study’s authors noted that caregivers report “learning by trial and error and fearing that they will make a life-threatening mistake.”
The study was funded by 13 private foundations, the Department of Veterans Affairs, and an anonymous donor that requested the National Academies undertake the research in 2014.
The responsibility of caregiving for a family member can be overwhelming. The mental and physical stress of caregiving in addition to the everyday stress of holding a job and raising your own family can be too much for some. Healthcare providers can work with families to prepare them for these challenges as well as offer resources to help alleviate some of those issues.
Traxx Mobility Systems manufactures the Titan 500, a freestanding overhead patient lift system for home health care. It allows a single caregiver, often a family member or part-time aide, transfer a patient from the bed to wheelchair and back again without the stress and strain of traditional floor-based lifts.
Older adults who are confined to wheelchairs don’t have to give up on exercise. The American College of Sports Medicine recommends 150 minutes of exercise weekly for all adults. Traditionally, that recommendation has referred to 30 minutes of moderate-intensity exercise at least 5 days per week. The current statement, however, states that 10-minute bouts of exercise are sufficient for cardiovascular benefits and may be easier for a senior with limited mobility to achieve. Endurance training, strength training, flexibility and balance exercises can all be effectively executed from a wheelchair.
Read entire article here: http://www.livestrong.com/article/112463-exercises-seniors-wheelchairs/
“Since January 2015, (Senior Health Partners) and at least two other (home health care companies) have been systematically cutting the hours of home care for their disabled clients, typically without proper notice or legal justification. By law, only a change in a client’s medical condition or circumstance is supposed to allow a reduction.”
Read the full New York Times article here: http://www.nytimes.com/2016/07/21/nyregion/insurance-groups-in-new-york-improperly-cut-home-care-hours.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=nygeo-promo-region®ion=nygeo-promo-region&WT.nav=nygeo-promo-region&_r=0
Traxx Mobility Systems manufactures and sells the Titan 500, a freestanding overhead patient lift for home health care. It allows a single caregiver to safely transfer a patient without fear of injury.
In her long career as a psychiatrist, Dr. Phyllis Harrison-Ross has been described by friends and colleagues as practical and calm. But two other traits, humor and patience, went right out the window when she decided to downsize.
“You ask yourself what you want to keep, and the answer is ‘everything,’ ” said Dr. Harrison-Ross, who turns 80 next month. “It’s an emotional roller coaster that takes a toll on you. It’s very tiring.
“I thought I could get down to the bare essence of things myself,” she said. “But that proved to be very difficult, much more than I had expected.”
Her solution: Dr. Harrison-Ross hired a senior move manager.
Read full story here: http://www.nytimes.com/2016/07/24/realestate/helping-the-elderly-downsize.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=mini-moth®ion=top-stories-below&WT.nav=top-stories-below&_r=0&mtrref=www.linkedin.com
Family Caregivers and Home Health Aides struggle with floor-based lifts in the home. Older homes can present many problems for those who rely on caregivers for help with activities of daily living. A freestanding overhead patient lift can overcome many of the barriers to accessibility in the home.
Room size is often the cause of much stress and strain when relying on a floor-based patient lift. A traditional lift needs quite a bit of room for a caregiver to manoeuvre once the patient is in the lift. Many modern beds do not allow access for the lift to fit under the bed. The Titan 500 can work with just about any bed. It spans the bed leaving room for wheelchair access. The freestanding frame remains in place while the caregiver gently glides the patient across the overhead beam.
The Titan 500 is freestanding and does not attach to the structure. We have three lengths of overhead beam to accommodate any size bed or bedroom. It can be lowered and moved to another room, or be completely dismantled and taken to another location. It can also be fitted with casters to provide an easier move within larger structures like group or personal care homes.
The stress and strain of transferring a patient in a floor-based lift on carpet is avoided using an overhead lift. The rechargeable electric lift motor does all the heavy lifting while the caregiver can simply and gently push or pull the patient into place. The caregiver has plenty of room to work and the bedroom furniture can often stay in place.
The Titan 500 is extremely efficient and is rated to lift up to 500 pounds. The frame is made of lightweight, but heavy-duty, aluminum which makes it easy to move and maintain. A complete overhead lift system, the Titan 500 includes the frame, motor, spreader bar, remote control, battery charger, a universal sling (4 sizes) and free shipping within the continental US.
We have been proudly manufacturing and selling the Titan 500, designed by service-disabled veteran Guido Capaldi, in Michigan since 2008.
By Sarah Varney, originally published in Kaiser Health News (khn.org), a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.
DENVER — Inside a senior center here, nestled along a bustling commercial strip, Vivian Malveaux scans her bingo card for a winning number. Her 81-year-old eyes are warm, lively and occasionally set adrift by the dementia plundering her mind.
Dozens of elderly men and women — some in wheelchairs, others whose hands tremble involuntarily — gather excitedly around the game tables. After bingo, there is more entertainment and activities: Yahtzee, tile-painting, beading.
But this is no linoleum-floored community center reeking of bleach. Instead, it’s one of eight vanguard centers owned by InnovAge, a company based in Denver with ambitious plans. With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep older and disabled Americans out of nursing homes.
Until recently, only nonprofits were allowed to run programs like these. But a year ago, the government flipped the switch, opening the program to for-profit companies as well, ending one of the last remaining holdouts to commercialism in health care. The hope is that the profit motive will expand the services faster.
Hanging over all the promise, though, is the question of whether for-profit companies are well-suited to this line of work, long the province of nonprofit do-gooders. Critics point out that the business of caring for poor and frail people is marred with abuse. Already, new ideas for lowering the cost of the program have started circulating. In Silicon Valley, for example, some eager entrepreneurs are pushing plans that call for a higher reliance on video calls instead of in-person doctor visits.
The business appeal is simple: A baby boom-propelled surge in government health care spending is coming. Medicare enrollment is expected to grow by 30 million people in the next two decades, and many of those people are potential future clients. Adding to the allure are hefty profit margins for programs like these — as high as 15 percent, compared with an average of 2 percent among nursing homes — and geographic monopolies that are all but guaranteed by state Medicaid agencies to ensure the solvency of providers.
The goal of the program, known as PACE, or the Program of All-Inclusive Care for the Elderly, is to help frail, older Americans live longer and more happily in their own homes, by providing comprehensive medical care and intensive social support. It also promises to save Medicare and Medicaid millions of dollars by keeping those people out of nursing homes.
For decades, though, the program has failed to catch on, with only 40,000 people enrolled as of January of this year.
“PACE is still a secret in the minds of the public,” Andy Slavitt, Medicare’s acting administrator, said at the National PACE Association meeting in April. The challenge, he said, was to make PACE “a clear part of the solution.”
Several private equity firms, venture capitalists and Silicon Valley entrepreneurs have jumped into the niche. F-Prime Capital Partners, a former Fidelity Biosciences group, provided seed funding for a PACE-related startup, as have well-regarded angel investors like Amir Dan Rubin, the former Stanford Health Care president, and Michael Zubkoff, a Dartmouth health care economist.
And no company has moved with more tenacity than InnovAge. Last year, the company overcame protests from watchdog groups to convert from a nonprofit organization to a for-profit business in Colorado. And in May, InnovAge received $196 million in backing — the largest investment in a PACE business since the rule change was made — from Welsh, Carson, Anderson & Stowe, a private equity firm with $10 billion in assets under management.
“For years we were pariahs, and no one wanted anything to do with us,” said Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, a nonprofit group that advocates for people with disabilities, many of whom are eligible for PACE.
“Now that there’s money involved,” Reiskin said, “everyone is all interested.”
Even the program’s supporters acknowledge that the movement needs fresh momentum. But they worry that commercial operators will tarnish their image in the same way many for-profits eroded trust in hospice care and nursing homes.
Three decades ago, after Congress authorized Medicare to pay for hospice care, commercial operators displaced the religious and community groups that had championed the movement. As recently as 2014, government inspectors found that for-profit hospice companies cherry-picked patients and stinted on care.
In addition, elderly patients with dementia and chronic ailments have frequently been targets of abuse and neglect at nursing homes, something advocates for the elderly say is correlated with the increased commercialization of that industry.
“I’m not wild about every knucklehead running around trying to do PACE,” said Thomas Scully, former Medicare administrator under President George W. Bush. “I would rather keep it below the radar.”
Not Quite Able
Early last year, Malveaux was drowning. She lived alone in a tidy red-brick home in a leafy Denver neighborhood that she paid for by working shifts at a Samsonite luggage factory, now closed.
Laundry piled up. Bills went unpaid. Doors were left unlocked. Pans sometimes burned on the stove as her memory failed.
“I had lost my mind,” she recalled, sitting on her couch in a pink velour robe. “I couldn’t keep up my house.”
For Americans who find themselves in this situation, the next stop is often a traditional nursing home. Malveaux’s son took her instead to visit an InnovAge day center.
The $9 million building south of downtown Denver is designed to calm people with dementia. It has subdued lighting and winding hallways that encircle the first floor like a running track and discourage “exit-seeking behaviors,” where patients search for ways out of a building.
For the frightened Malveaux, it seemed like paradise: a flower garden, a beauty salon and day trips to casinos and candy factories. And, most importantly, it had a team of doctors, nurses, psychiatrists, dentists, physical therapists, nutritionists, home health aides and social workers whose purpose was to help her live safely in her beloved brick home.
After joining the center in June 2015, Malveaux began seeing a psychiatrist and went on medication for depression. A social worker coached her grandson, Jermaine Malveaux, on how to care for someone with dementia. Three days a week, an InnovAge van picks up Malveaux at home and takes her to the center to share lunch with other older adults and try her luck at bingo and ceramics.
“I make friends easily,” she said with a smile. “And the guys flirt with me.”
The InnovAge center, like other PACE facilities, is inspired by Britain’s much-lauded Day Hospitals, outpatient health care facilities that arose in the 1950s that became a hub of daily life for many older people. In the United States, the earliest incarnation of PACE was started in San Francisco in 1971 by a group of Asian and Italian immigrant families seeking alternatives to the American nursing home.
Federal health officials allowed the group, called On Lok — Cantonese for “peaceful, happy abode” — to test what was then a novel and prophetic approach to health care financing. Instead of physicians billing Medicare each time they treated a patient, the government would pay a fixed amount to the center for each member. On Lok would assume the financial risk, similar to an insurance company. In 1990, Medicare officially sanctioned the model.
In exchange for a capped monthly payment from Medicare and Medicaid, PACE staff members arrange and pay for all of a patient’s doctors’ visits, medications, rehabilitation and hospitalizations. At the same time, they are supposed to pay attention to the patient’s daily needs — meals, bathing, housekeeping and transportation to day centers, where older people can ward off isolation and cognitive decline by socializing. (Studies have found that the intensive caretaking reduces costly hospital stays.)
Comparing the cost effectiveness of PACE against nursing homes is difficult, partly because state Medicaid agencies pay a variety of rates. But all the states are required to keep their rates below what they would pay for nursing home care. In Colorado, for example, that amounts to 7 percent less per patient.
On average, Medicare and Medicaid pay PACE providers $76,728 a person a year, about $5,500 less than the average cost of a nursing home. And the money going to PACE covers the all of the person’s health and social needs, unlike nursing home care, which doesn’t include hospitalizations and other expensive medical care.
The flat government payment pushes the organizations to invest in maintaining a patient’s health and safety to avoid big hospital bills. Dentistry — excluded from traditional Medicare coverage — is a crucial focus: Programs invest heavily to fix broken teeth and dentures to avoid costly infections or poor nutrition that can cause cascading health problems.
Providers are also generous with rehabilitation, setting few limits on training sessions that strengthen injured muscles and sturdy patients against falls.
“If you’re neglecting these patients, the odds they’ll call an ambulance and go to the hospital and spend a week there because they’re really sick is pretty high, and that all comes out of the payment,” said Bob Kocher, a former senior health care adviser to President Barack Obama.
Profits are in no way guaranteed, though. The centers still face major financial risk — it just takes a few patients with serious medical conditions to upend the books.
Dan Gray, a PACE financing consultant at Continuum Development Services, said too many trips to the emergency room or an expensive hospital stay can flip fortunes. One organization he advises had $300,000 in hospital medical claims in a month that he refers to as “Black August.”
“I had a nervous twitch,” he said.
High-Tech vs. High-Touch
In January, at the health care industry’s leading matchmaking event, the J.P. Morgan Healthcare Conference in San Francisco, word quickly spread that PACE programs could save states and the federal government up to 20 percent a patient. And suddenly, the program became one of the hottest topics of discussion.
“Every other conversation was, ‘What do you think we should do with PACE?’” said Bill Pomeranz, a managing director at Cain Brothers, who helped finance the nation’s first PACE program in the 1970s.
The message appeared to travel down Highway 101 as well, to the heart of the technology industry. At least eight startups have circulated PACE-related pitches to Silicon Valley venture capital firms, hoping to tap into new capital and create technology-enabled versions of the program.
The interest of the tech industry is so far only nascent. But the possibility that Silicon Valley, notoriously aggressive and extremely deep-pocketed, could play a significant role in PACE underscores the changes that may lie ahead.
Building a center requires medical offices, rehabilitation equipment, food service and fleets of handicapped-accessible vans. On average, it takes up to $12 million just to get it off the ground. That is a lot of money for most nonprofits but relatively little in the technology world. Opening new centers may become less of a hurdle.
The tech industry and nonprofit world are driven by different impulses. The early centers were closely tied to local cultures, making them difficult to replicate. An aversion to aggressive marketing among the center’s leaders didn’t help, either. Tech likes to move as fast as possible.
“PACE reminds me of religious orthodoxy,” said Mr. Pomeranz, who said he had affection for the program. The movement’s leaders come from the world of public health and have a “social work mentality,” he added.
The pitches circulating among investors envision technology-enabled programs that would rely, in part, on video visits and sensors. Some studies have found that telemedicine can help patients better control certain chronic conditions and reduce health care spending. But those technologies are largely untested in geriatric care.
“The entrepreneurs coming into this space all believe there are much lower-cost ways to check on patients every day than driving them all to one building,” said Mr. Kocher, who is now a partner at the venture capital firm Venrock, which invests in health care companies.
These sorts of pitches, while promising, have not been universally welcomed. They’ve even been used as evidence that opening PACE up to for-profit companies might lead to unwanted consequences.
Veteran PACE providers, for example, are skeptical of virtual medicine’s benefits to seniors, especially those with dementia.
“Socialization goes a long way to improve the health of the participants we serve,” said Kelly Hopkins, president of Trinity Health PACE, a nonprofit health system that operates PACE centers in eight states. “It’s naïve to think you can do it virtually.”
Supporters of the change say the necessary safeguards are in place. The for-profit centers were approved, to little fanfare, after the Department of Health and Human Services submitted the results of a pilot study to Congress in June 2015. The demonstration project, in Pennsylvania, showed no difference in quality of care and costs between nonprofit PACE providers and a for-profit allowed to operate there.
The Centers for Medicare and Medicaid Services has vowed to closely track the performance of all PACE operators by measuring emergency room use, falls and vaccination rates, among other metrics. The National PACE Association, a policy and lobbying group, is also considering peer-reviewed accreditation to help safeguard the program. Oversight is now largely left to state Medicaid agencies.
Maureen Hewitt, InnovAge’s chief executive, said, “At the end of the day, we’re held to the same quality and care standards.”
Dr. Si France, a founder of WelbeHealth, an early-stage company based in Menlo Park, Calif., says startups can use technology to improve clinical communication, help caregivers make treatment decisions and monitor patients at home or in a hospital. But he insists even a high-tech PACE program cannot veer from its origins.
“It’s not a way to get rich or generate outsize returns,” said Dr. France, the former chief executive of GoHealth, a chain of urgent care centers acquired by TPG Capital, a private equity firm. “We think this is an arena for missionaries, not mercenaries.”
Will Money Change Things?
Families enrolled in InnovAge’s PACE program in Denver appeared to be unaware of its conversion into a for-profit enterprise. The company did not announce the change directly to its participants, but notified a patient advisory group.
Kathy Baron, 68, who lives in subsidized senior housing, was left disabled by breast cancer and debilitating nerve pain. Her daughter, Leah van Zelm, struggled to take care of her. So Baron, fearful she would be deemed unfit to stay in her apartment, signed up for InnovAge’s program.
“I would rather be dead than go into a nursing home,” Baron said.
She says InnovAge has been generous with services, echoing interviews with other patients. Each week, an InnovAge housekeeper changes the sheets on her bed, launders her clothes and cleans her apartment, a service provided to those unable to tidy their own homes. The few times her requests for special equipment or services were denied, Baron appealed and won.
But she worries new investors will skimp on what outsiders might view as unwarranted services. The company’s commercials, promising “Life on Your Terms” and voiced by the actress Susan Sarandon, have reinforced those concerns.
It’s a concern echoed by Malveaux’s family. “Anytime you involve money,” said Malveaux’s grandson Jermaine, “there’s always the concern for greed, especially with the elderly.”
At least in the near future, the number of companies getting into PACE programs will be limited. Most states currently cap enrollment in PACE centers. And each state — as Colorado did, opening the window for InnovAge — likely needs to amend its law to allow the for-profit companies. So far, it appears only California has done so.
Yet there is a growing realization among longtime PACE providers that new competition looms.
In a newsletter to the generally placid PACE community, one adviser warned that providers who failed to become bigger would face new entrants who “will find a way to meet the needs of persons in your community.”
Those needs will only grow as the adult children of baby boomers face difficult decisions about how to care for their parents.
In the meantime, for people like Van Zelm, the anxiety that once pervaded her daily life has diminished.
“When she’s stable,” Van Zelm said of her mother, “my daily life stress is reduced.”