A Shift From Nursing Homes to Managed Care at Home

Faced with soaring health care costs and shrinking Medicare andMedicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions.

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Dr. Fredrick Sherman at Harlem PACE with Edna Blandon. “My spirits would drop if I went to a nursing home,” she said.

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The rapid expansion of this new type of care comes at a time when health care experts argue that for many aged patients, the nursing home model is no longer financially viable or medically justified.

In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medical outcomes.

The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. In New York City, a program run by a division of CenterLight Health System, formerly known as the Beth Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

“It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care,” said Jason A. Helgerson, the Medicaid director for New York State. “That meant we were institutionalizing service for people, many of whom didn’t need 24-hour nursing care. If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it’s a lower cost to taxpayers.”

The recent influx of adult day-care centers and other managed care plans for the frail elderly is being driven by financial constraints as President Obama and Congressional leaders seek hundreds of billions of dollars in savings in Medicare and Medicaid. Nursing homes, which tend to rely heavily on Medicare and Medicaid dollars, are facing enormous financial pressure — Mr. Obama’s proposed budget includes a $56 billion Medicare cut over 10 years achieved by restricting payments to nursing homes and other long-term care providers.

Nationally, the number of nursing homes has declined by nearly 350 in the past six years, according to the American Health Care Association. In New York, the number of nursing homes declined to 634 this January from 649 in October 2007, and the number of beds to 116,514 from 119,691.

Over the next three years, New York State plans to shift 70,000 to 80,000 people who need more than 120 days of Medicaid-reimbursed long-term care services and are not in nursing homes into managed care models, Mr. Helgerson said.

The move away from nursing homes was highlighted on Thursday when Cardinal Timothy M. Dolan announced that the Archdiocese of New York, one of the state’s largest providers of nursing home care, is selling two of its seven nursing homes and opening or planning to open seven new adult day-care centers over the next three years.

“Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably,” Cardinal Dolan said in a statement before he opened a 250-patient program at Saint Vincent de Paul Catholic Healthcare Center in the South Bronx.

These new adult day-care centers, known around the nation by the acronym PACE — Program of All-Inclusive Care for the Elderly — provide almost all the services a nursing home might, including periodic examinations by doctors and nurses, daytime social activities like sing-alongs and lectures, physical and occupational therapy and two or three daily meals. All the participants are considered eligible for nursing homes because they cannot perform two or more essential activities on their own like bathing, dressing and going to the toilet. But they get to sleep in their own beds at night, often with a home health care aide or relative nearby.

The nonprofit groups that operate them receive a fixed monthly fee for each participant and manage their entire care, including visits to specialists, hospitalizations, home care and even placement in a nursing home. Because Medicare and Medicaid pay set fees instead of paying for specific procedures, center operators are motivated to provide preventive care to avoid costly hospitalizations or nursing home care.

Some elderly people, however, spurn PACE programs because under managed care, they would have to switch their physicians to those at the PACE center or in its network. Most elderly people want to live out their lives at home, a desire evident in interviews in the PACE center the archdiocese opened in 2009 in Harlem, which has a staff of three doctors and is visited regularly by a dentist, a podiatrist and a psychiatrist.

Todd Heisler/The New York Times

Rick Leeds, who teaches yoga and other wellness programs at the ArchCare PACE Center in Harlem, gives a massage to Edna Blandon, who goes to the center three times a week.

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Edna Blandon, 74, a diabetic weakened on her left side by a stroke who relies on a wheelchair, is transported by specialized van to the Harlem PACE center three days a week and appreciates that it provides not only a home care attendant but sends a nurse every two weeks to change pills in her pillbox and load a 14-day supply of insulin into syringes that she will inject.

“My spirits would drop if I went to a nursing home,” she said. “I love the fact that I can go home at night. There’s no place like home. I can sit down, look at the TV and go to bed when I want.”

James Harper, 70, a retired bank employee who spent 10 months at the archdiocese’s Kateri Residence, a nursing home on the Upper West Side, after a stroke paralyzed his right side, enjoys yoga breathing classes and discussions about black history. Yet he gets to spend nights and weekends with his wife, Albertene, and daughter, Traci, both of whom work during the day and are not around to care for him.

“This way I’m around people,” he said.

Dr. Fredrick T. Sherman, the Harlem PACE medical director, said that a 2009 study showed that PACE programs reduce lengths of stays in hospitals and delay assignments to nursing homes.

The archdiocese, whose new centers will serve a total of 1,500 people, receives an average of $4,000 a month from Medicaid for each participant and $3,300 from Medicare. By comparison, said Scott LaRue, the chief executive of ArchCare, the archdiocesan health care network, a month of nursing home care can cost the government $9,000.

Ultimately, the archdiocese hopes that half of its elderly clients will be served in community settings rather than in nursing homes, which currently serve about 90 percent of the archdiocese’s clients. For-profit companies have not yet moved into the managed care market, in part because of uncertainties about reimbursement formulas and the risks of taking on a nursing home population.

The PACE population tends to be younger than that at nursing homes, which raises the question of whether many PACE clients would really need nursing homes without PACE. Dr. Sherman replies to such skepticism by saying that his clients “need that level of service — the question is where they’re going to get it.”

Without PACE, he said, “they’re going to end up in nursing homes.”

Robert Pear and Christopher Reeve contributed reporting.

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New Graduates – Heed My Advice

Remember when we were all children and our aunts and uncles and grandparents would all ask us, “What do you want to be when you grow up?” Most of the adults followed the question with an ambiguous statement: “You can be anything you want to be.” This is not entirely false, but to a child, this statement sounds like there’s some magic occupation wand that you stand in front of when you’re older; declare you want to be a superhero, and then POOF! You’re a crime fighting cyborg impervious to bullets and rockets.

 

Maybe my ambitions as a child were somewhat different from yours, but the point here is that when we’re told we can be whatever we want to be, the adults conveniently leave out all it takes to achieve our goals, all the hard work involved, and the fact that as we mature, our personalities may lead to different roads in the career path. Very few can say they followed their ambitions as a child and became what we told adults we wanted to be.

 

I’ll spoil my story for you; I’m not a crime fighting cyborg.

 

But, you’ve made it this far, completed all the educational requirements, got your degree and now you’re faced with another challenge: the job interview. YIKES!

 

It can be tough to predict the questions you’ll hear during the job interview, but in the healthcare field, there are a lot of likely questions that are typically geared towards new graduates you can prepare yourself for.

 

  1. Landing the job interview.

Frequently, new graduates experience tremendous difficulty in even being considered for a job. When facilities obtain your resume, they quickly recognize that you’re a new graduate and they’ll put your resume to the side in favor of someone who has experience. It’s prudent to make yourself known on a more proactive level, and maintain persistency. On a weekly basis, plan a route to visit facilities in person to drop off your resume instead of emailing it. Ask the receptionist who you need to speak with at the facility to discuss employment opportunities, and if that person is unavailable, revisit the facility the following week and ask to speak with that person again. You’ll be turned away quite often, but don’t be discouraged; eventually the right people will take notice of your persistency.

 

  1. Facility concerns.

The bottom line is: all facilities are worried about longevity. How long will they be able to retain you as an employee? Usually, healthcare facilities are not open to the idea of accepted a new graduate because of concern about spending valuable resources to train personnel that may result in wasted effort once you’ve been exposed to the true nature of the job and decide that this isn’t what you had expected. Make it known in your interview that you have a ‘never quit’ attitude, that you’re eager to fulfill the employers’ expectations of a model employee, and that you can easily adapt to changes in your environment.

 

  1. What made you decide to pursue healthcare?

This is a question commonly asked, and the most common answer is: “I like helping people.” While this isn’t the wrong answer, there’s probably a better one, or at least a more euphemistic one. As a new graduate, there are hundreds of others with the same credentials giving the same answer for the same position. What makes you stand out? Dig down and find out what really made you want this particular career. There’s something unique to you personally that encouraged this endeavor. Tell the story in as much detail as possible.

 

  1. What do you know about the facility?

Any employer is always impressed when the interviewees knows a bit about the company. Do your homework. Find out how long the facility has been open for, how many beds there are, how many units, and the track record of the facility during state reviews.

 

  1. Educational background.

This isn’t necessarily something that you should spend too much time on, but it’s important to discuss what challenges you experienced in school, and the steps you took to overcome these challenges. This will show your discipline, something every employer wants to see.

 

  1. Make yourself available.

Healthcare is a 24 hour job, and if you lay down the law and limit what shifts you’ll be willing to work, the facility will have no interest in you. At the same time, you don’t want to appear too desperate by telling them you’re available “whenever”. Tell them your preferences, but make it known that you’re anxious to take on the challenges of any hour and that you’re in an ideal position personally to offer flexibility with scheduling.

 

 

The first job you’re offered may not be exactly what you had in mind when you started going to school, but the most important aspect of your professional profile that you’re currently missing is experience. By all means, you shouldn’t jump at the first opportunity either. Make sure you feel comfortable with what you’ve already been exposed to with the facility. Once you’ve gained at least a year of experience, many doors will open up to you and you’ll be well on your way towards following the career path you initially had in mind.

 

Sincerely,

 

Jesse Rose

Can A Nurse Be In Two Places At Once?

THIS NURSE WAS EXPECTED TO PROTECT A PATIENT AND RESPOND TO A CODE.

A 92-year-old woman with heart failure, pulmonary fibrosis, anemia, and other problems came to the emergency department with viral pneumonia. Once her condition stabilized, she was transferred to the cardiac care unit (CCU).

Still in the CCU 2 days later, the patient got out of bed, even though both side rails were up, the footboard was on the bed, and the nurses had warned her to stay in bed. The nurses’ notes indicated that she was confused.

The next day, reports on the patient’s mental status varied. At 8:30 a.m., her physician assessed her and didn’t find her condition serious enough to order restraints. At 12:30 and 2:00 p.m., the nurse documented that the patient thought she was at home. When the nurse checked her at 3:20 p.m., however, she was alert and oriented. Thirty minutes later, she was on the floor. Her right hip was fractured.

The patient underwent an open hip reduction and internal fixation and was discharged 10 days later. Using a walker, she was able to walk with assistance. After three follow-up examinations, the fracture had healed and the patient didn’t have pain.

Seven months after her admission to the hospital, the patient was readmitted for numerous disorders, including sepsis, renal failure, and acute pulmonary edema. She died 9 days later. Her children sued the hospital, the physician, and the nurse for negligence regarding their mother’s fall.

In court, the testimony revealed that the nurse had been assigned exclusively to this patient. However, after she had checked the patient at 3:20 p.m., a code was called on another patient. Hospital policy also required her to respond to the code, so she left her patient for 30 minutes.

A jury found in favor of the plaintiffs and awarded them $555,000 in damages. Although the defendants appealed, the appeals court upheld the decision but reduced the amount to $500,000.

The lesson? Nurses are vulnerable even when they follow the rules. By adhering to the facility’s policy, this nurse was drawn into a no-win situation.

 

Credits: This article was referenced from http://www.nso.com/nursing-resources/article/25.jsp

Best Nursing Homes: The U.S. News Honor Roll – US News and World Report

The 18 nursing homes listed alphabetically below make up the 2011 Honor Roll. They were the only homes, out of more than 15,500 in the latest U.S. News Best Nursing Homes rankings, to receive four straight quarters of perfect five-star ratings from the federal Centers for Medicare and Medicaid Services in health inspections, nurse staffing, and quality of care, the three areas in which CMS evaluates these facilities.

Nursing Homes Honor Roll

Alzheimer’s Resource Center of Connecticut Plantsville, Conn.

Bethany Skilled Nursing Facility Framingham, Mass.

Charles A. Dean Memorial Hospital Greenville, Maine

Dakota  Alpha Mandan, N.D.

Jeanne Jugan Residence Newark, Del.

Lourdes Health Care Center Wilton, Conn.

Mary Health of the Sick Convalescent and Nursing Hospital Newbury Park, Calif.

Matulaitis Nursing Home Putnam, Conn.

Miners’ Colfax Medical Center Raton, N.M.

Orzac Center for Extended Care and Rehabilitation Valley Stream, N.Y.

Peconic Landing at Southold Greenport, N.Y.

Rady Children’s Hospital Bernardy Center San Diego, Calif.

Riverview Lutheran Care Center Spokane, Wash.

South Mountain Restoration Center South Mountain, Pa.

SSM Depaul Health Center Bridgeton, Mo.

Westchester Meadows Valhalla, N.Y.

Westview Nursing Care and Rehabilitation Dayville, Conn.

Wibaux County Nursing Home Wibaux, Mont.

via Best Nursing Homes: The U.S. News Honor Roll – US News and World Report.

Baby Boomers are Doing More Than Simply Aging Gracefully

The baby boom generation continues to demand more out of life while maintaining a youthful outlook that defies growing old. According to a new poll conducted by the Associated Press and LifeGoesStrong.com, people born during the period spanning nearly two decades, between 1947 and 1965, believe that “you are as young as you feel” and they plan to keep on working and living instead of opting for passive retirement.

Among those boomers interviewed, a surprising number plan to work until they are at least 65, or even 70, just as long as their employment doesn’t require heavy physical strength, as a decline in strength seems to be a major concern. Otherwise, they have few worries about physical ailments overall. In fact, about 75 percent considered themselves to be middle-aged or younger in their sixties, with the average age at which they considered themselves old was 70.

The baby boomer generation engages in more exercise and eats healthier, in addition to drinking and smoking less than their parents did, which has gone a long way to preserve health, and prolong stamina. In addition, getting adequate sleep and downing more water has contributed to better health for this generation of positive thinkers.

The findings suggest that even after reaching advanced years, baby boomers are determined to hold on to their youth, because they have a lot of living to do. And, live is just what they can do, because in addition to better health, this generation has enjoyed more than their fair share of prosperity with soaring house values attained, pensions achieved, and plenty of time on their hands.

Of course, improvements in healthcare have played a major role in the ability of the boomers to keep living large. Finding themselves free of job and career obligations, many have the time and means to travel, and can also spoil their grandchildren like never before among generations past… read more through link.

via Baby Boomers are Doing More Than Simply Aging Gracefully.

New Jersey cracks down on police steroid abuse | Reuters

(Reuters) – New Jersey on Thursday unveiled reforms to crack down on steroid abuse by police, including random drug testing.

The new rules follow lawsuits claiming excessive force by officers in the throes of steroid rage filed against New Jersey police, according to a report released by New Jersey Attorney General Paula Dow.

The report was the result of a six-month investigation into allegations that a doctor illegally supplied police and firefighters with anabolic steroids, human growth hormones and other muscle-building drugs. Dr. Joseph Colao, now deceased, may have illegally prescribed steroids to 248 public safety officials, mostly police and firefighters, the report concluded.

“It is important that we strengthen oversight, regulation and investigation in order to discourage the improper use of steroids throughout New Jersey’s law enforcement community and ensure the public’s confidence,” Dow said in a statement.

Her recommended reforms include allowing police departments to randomly test officers if there is a “reasonable suspicion” they are abusing steroids, investigating doctors who improperly prescribe them and adding more oversight to the officers’ state-funded prescription drug plans.

The attorney general’s recommendations come at the same time that the New Jersey legislature is considering three bills aimed at eliminating steroid abuse by police.

New Jersey may be the first state to propose laws aimed at curbing steroid use among policeman, the National Council of State Legislatures said earlier this year. Most states are concentrating on steroid use among athletes.

Deputy Speaker of the House John McKeon said steroid abuse is a national problem because there are several cases of doctors tricking police into thinking they need steroids and other types of growth hormones.

“They’re charlatans trying to tell them they need anti-aging medicine,” McKeon said. “In reality, only about one in 100,000 people are appropriately prescribed these things.”

New Jersey’s Police Benevolent Association, one of the state’s largest police unions, told Reuters it supports the random drug testing.

“We’re supportive of testing because we don’t want anything illegally prescribed in the hands of any law enforcement officer,” PBA spokesman Jim Ryan said.

Ryan said the PBA’s concern is the rising cost associated with the random tests. A standard drug test for an officer costs a police department roughly $35 and but the new steroid test would cost $250. Police departments are already dealing with tough budget cuts and the new measure is an additional burden that could lead to layoffs, he said.

McKeon noted the random drug testing is not mandatory as local police departments reserve the right to not implement it if they cannot afford it.

(Editing by Barbara Goldberg and Greg McCune)

via New Jersey cracks down on police steroid abuse | Reuters.

Top 10 Health Care Reform Jokes – Best Political Jokes About Health Reform

Top 10 Health Care Reform Jokes – Best Political Jokes About Health Reform.