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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Todd Heisler/The New York Times

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.

Local Civil Registry

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.

Health Buzz: U.S. News Releases Best Hospitals Rankings – US News and World Report

U.S. News Releases Annual Best Hospitals Rankings

Today, U.S. News released its 22nd annual Best Hospitals rankings, singling out 720 hospitals out of about 5,000 nationwide. Just 17 earned spots on the Honor Roll—which signifies the highest level of medical excellence—with Johns Hopkins Hospital in Baltimore topping the list. The rankings also identify the Best Hospitals in 94 of the largest U.S. metropolitan areas, a major expansion that covers nearly twice as many cities as in the past. This year’s rankings include additional new features, such as the Most Connected Hospitals, or those with the most advanced electronic medical records system. And for the first time, U.S. News has named top doctors at many hospitals, part of a larger upcoming project: Next Tuesday, it will release U.S. News Top Doctors, a directory of nearly 30,000 excellent physicians searchable by location and hospital affiliation, as well as across a wide range of specialties and subspecialties.

Best Hospitals 2011-12: the Honor Roll

A Visual Tour of the Best Hospitals 2011-12

Best Hospitals 2011-12: the Methodology

Our intent when we published the first Best Hospitals annual rankings in 1990 was to help people who find themselves in need of unusually skilled inpatient care, and that mission hasn’t changed in Year 22. The Best Hospitals rankings judge medical centers on their competence in exactly such high-stakes situations. For example, a hospital ranked in cardiology and heart surgery—one of 16 specialties in which centers were evaluated—likely has the expertise and experience to replace a faulty heart valve in a man in his 90s. Most hospitals would decline to perform major surgery on elderly patients, as they should if they aren’t up to speed on the special techniques and precautions required and don’t see many such patients. A ranked hospital in gastroenterology can probably offer the most appropriate care to a patient whose inflammatory bowel disease flares up. At hospitals ranked in neurology and neurosurgery, surgeons face more spinal tumors in a couple of weeks than most community hospitals see in a year.

By contrast, other hospital ratings and rankings for the most part examine how well hospitals treat relatively unthreatening conditions or perform fairly routine procedures, such as hernia repair and uncomplicated heart bypass surgery. The majority of hospital patients need such ordinary care, so for them that approach to evaluating hospitals works fine. But it falls short for patients who are especially at risk because of age, physical condition, infirmities, or the challenging nature of the surgery or other care they need.

A good way to determine how well a hospital deals with a medical challenge is to evaluate its performance across a range of challenges within the specialty. U.S. News ranks hospitals in 16 different specialties, from cancer to urology. This year, only 140 of the 4,825 hospitals that we evaluated performed well enough to rank in even one specialty. And of the 140, just 17 qualified for a spot on the Honor Roll by ranking at or near the top in six or more specialties. [Read more: Best Hospitals 2011-12: the Methodology.]

How to Find the Best Hospital Near You

How We Identified More Than 100 Most Connected Hospitals

We live in a digital age. We use electronic systems to connect with others, to entertain ourselves, and to compare the quality of myriad goods and services, including—as users of U.S. News know—hospital care.

Yet inside the walls of many hospitals, doctors and nurses still rely on reams of paper charts and antiquated systems to track patient health, order tests and treatments, and perform other essential duties. While many of these professionals provide quality medical care, they do so without the use of a suite of technologies broadly known as electronic medical records, or EMRs, that could make patients safer and their care more efficient.

By contrast, a relatively small number of hospitals have readily embraced EMRs and use them to connect healthcare providers to one another and to the information each needs to do his or her job.

An even smaller subset of those hospitals also succeed in delivering the superior care that U.S. News recognizes in its Best Hospitals. U.S. News developed Most Connected Hospitals to highlight that group of institutions, which are both digitally forward and clinically excellent.

via Health Buzz: U.S. News Releases Best Hospitals Rankings – 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.

Medical News: When Medicaid Paid Better, Kids Had More Dental Visits – in Public Health & Policy, Medicaid from MedPage Today

When dentists were reimbursed more for preventive visits, kids on Medicaid ended up in their chairs more often, likely because the increased compensation made them more willing to accept those patients, a government researcher said.

Still, the level of care for children with public insurance didn’t quite match that of those on private plans, according to Sandra Decker, PhD, of the National Center for Health Statistics in Hyattsville, Md.

More Medicaid children saw a dentist over six-month periods in 2000 and 2008 if the reimbursement was $30 rather than $20, Decker found.

But in the latter year, children and adolescents covered by Medicaid were less likely to have seen a dentist in the previous six months than were those covered by private insurance (55% versus 68%), Decker reported in the July 13 issue of the Journal of the American Medical Association.

“The results of this study support the claim that low Medicaid payment rates are associated with children and adolescents receiving less dental care than children covered by private insurance,” she wrote.

Although Medicaid removes many financial barriers to receiving dental care for children and adolescents, patients can’t access care if dentists decline to participate in Medicaid because of low payment levels or for other reasons, Decker wrote.

So Decker assessed data on Medicaid dental fees in 2000 and 2008 for 42 states plus the District of Columbia and merged them with data from the National Health Interview Survey on 33,657 children and adolescents, ages 2 to 17, from 2000-2001 and 2008-2009.

She found that on average, Medicaid dental payment levels didn’t change significantly in inflation-adjusted terms between those two time points.

The mean state Medicaid prophylaxis fee for children was $28.95 in 2000-2001 and $29.98 in 2008-2009.

In five states plus the District of Columbia, however, payments increased at least 50%.

In 2008-2009, more children and adolescents covered by Medicaid had seen a dentist in the past six months than did uninsured children (55% versus 27%).

Yet fewer children on Medicaid were seen compared with those covered by private insurance (68%).

In regression analyses, those who were covered by Medicaid or the Children’s Health Insurance Program (CHIP) were about 13 percentage points less likely than kids with private insurance to have seen a dentist, and uninsured children were about 40 percentage points less likely.

But Decker also found that changes in state Medicaid dental payment fees between 2000 and 2008 were positively associated with use of dental care among children and adolescents covered by Medicaid.

For example, a $10 increase in Medicaid prophylaxis payment level — from $20 to $30 — was associated with a 3.92-percentage-point increase in the chance that a child or adolescent covered by Medicaid had seen a dentist, she found.

“This study found that changes in state Medicaid dental fees between 2000 and 2008 were positively associated with changes in use of dental care among children covered by Medicaid,” Decker wrote. “As future expansions in Medicaid eligibility and insurance coverage more generally are contemplated and possibly implemented, more attention to the effects of provider payment policies on access to care, quality of care, and health outcomes may be warranted.”

She noted that the study was limited because the state Medicaid fees for child dental prophylaxis had to be estimated, and because data on variations in private insurance reimbursement rates were unavailable.

via Medical News: When Medicaid Paid Better, Kids Had More Dental Visits – in Public Health & Policy, Medicaid from MedPage Today.

Medicare is too generous. Seniors take advantage. – Medicare and More

Medicare does not require seniors to pay enough of their health care costs. Seniors go to the doctor too much.  Medicare supplement insurance makes these problems worse and contributes to out-of-control Medicare spending. These are the conclusions in a recent opinion piece in the Wall Street Journal titled, “Why Medicare Patients See the Doctor Too Much”.The authors also say the “Obamacare” changes to Medicare, which provide more free preventive care services to seniors, are bad because  they “further insulate seniors from costs and will drive up spending even more”.According to the authors:Medicare utilization is roughly 50% higher than private health-insurance utilization, even after adjusting for age and medical conditions. In other words, given two patients with similar health-care needs — one a Medicare beneficiary over age 65, the other an individual under 65 who has private health insurance — the senior will use nearly 50% more care.In the opinion of the authors, the answer to Medicare’s problems is:Since private health insurers are much better at controlling utilization and reducing fraud, why not turn to the private sector to resolve Medicare‘s excessive utilization? That’s what House Budget Committee Chairman Paul Ryan was trying to do with his premium-support model that would eventually shift Medicare beneficiaries into private health plans.The authors favor more choices for seniors, such as high-deductible health insurance options and plans that are more like those in the under-65 health insurance market. But the authors don’t mention that these high-deductible plans are designed for young, healthy people who are betting they won’t get sick and have to pay that $3,000 or $5,000 deductible before their insurance kicks in. That’s probably a good bet for a 30-year old. But what about a 70-year old?What are the chances a 70-year old will need to spend several thousand dollars on medical services each year? And what are the chances a senior will put off care because he has to pay 100% of the cost until he meets his deductible? Is it a good idea for seniors to put off care because they can’t afford it – or are too cheap to pay co-pays and deductibles? Is this a choice we want seniors to make? And is this good public health policy, or will it lead to sicker seniors and bigger medical bills for seniors and Medicare?

via Medicare is too generous. Seniors take advantage. – Medicare and More.

Puppy Love: Pet Owners Are Happier, Healthier – FoxNews.com

Pets are good sources of social and emotional support for everyone, not just people facing health challenges, new research suggests.

“We observed evidence that pet owners fared better, both in terms of well-being outcomes and individual differences, than nonowners on several dimensions,” study researcher Allen McConnell, of Miami University in Ohio, said in a statement. “Specifically, pet owners had greater self-esteem, were more physically fit, tended to be less lonely, were more conscientious, were more extroverted, tended to be less fearful and tended to be less preoccupied than nonowners.” [America’s Favorite Pets]

Pet ownership has been on the rise the last few decades. A study in 2006 by the American Pet Products Manufacturers Association determined that about two-thirds of American households (71.1 million) have at least one pet. In comparison, 56 percent of households had a pet in 1988, the first year the survey was conducted.

McConnell’s group conducted several studies of pet owners.

First they surveyed 217 people, determining differences between pet owners and nonowners in terms of well-being, personality type and attachment style. They found that pet owners were happier, healthier and better adjusted than were nonowners.

The researchers then studied 56 dog owners, finding that pet owners who thought their dogs increased their feelings of belonging, self-esteem and meaningful existence had greater well-being than those who didn’t perceive that their pet fulfilled their social needs.

They then asked 96 pet owners who were undergraduates to remember and write about a time they were excluded. They were then asked to either write about their favorite pet, their favorite friend or to draw a map of their college campus. Both writing about a pet or a friend reduced the feelings of rejection brought forth by thinking about being excluded. Surprisingly, both pets and friends staved off the feelings of rejection equally.

All in all, the researchers found that even healthy people benefit from pets. Pet owners are just as close to key people in their lives as to their animals, which serve as important sources of social and emotional support.

“The present work presents considerable evidence that pets benefit the lives of their owners, both psychologically and physically, by serving as an important source of social support,” the researchers wrote in the paper, published online by the Journal of Personality and Social Psychology. “Whereas past work has focused primarily on pet owners facing significant health challenges… the present study establishes that there are many positive consequences for everyday people.”

via Puppy Love: Pet Owners Are Happier, Healthier – FoxNews.com.

Cancer deaths more in men than women – The Times of India

A new study has found that overall cancer mortality rates are higher for men than women in the United States.

Michael B. Cook, an investigator in the division of cancer epidemiology and genetics at the National Cancer Institute, and colleagues used U.S. vital rates and survival data from the SEER database for 36 cancers by gender and age to assess whether cancer mortality rates and cancer survival differed by gender.

“Men are more likely to die from cancer than women,” said Cook of their findings.

“We found this to be true for a majority of specific types of cancer, he added.

For many cancers, men have poorer survival than women but the differences are slight. It is difficult to assign any singular root cause, but influences include differences in behaviour of the tumour, cancer screening among people without symptoms, presence of other illnesses and health care seeking behaviours.

“Our research suggests that the main factor driving the greater frequency of cancer deaths in men is the greater frequency of cancer diagnosis, rather than poorer survival once the cancer occurs,” said Cook.

“If we can identify the causes of these gender differences in cancer incidence then we can take preventative actions to reduce the cancer burden in both men and women, added Cook.

The study has been published in Cancer Epidemiology, Biomarkers and Prevention.

via Cancer deaths more in men than women – The Times of India.

Everything is Bigger in Texas- Including the Babies! – Technorati Technorati Women

I’ve been told everything is big in Texas. One new mother helped prove that point on Friday when she gave birth to a 16 pound, 1 oz. baby boy. A world record? Well no. According to the Guinness Book of World Records, the largest newborn was a 23 pound, 12oz. baby born in Canada in 1879. But this newborn will most certainly hold the record for the hospital he was born in, Good Shepherd Medical Center in Longview, and possibly even the great state of Texas. The state of Texas is busy combing the records now. And since Texas is into being bigger than anyone else, it certainly couldn’t have happened to a better state. Or a nicer couple.

His name is JaMichael Brown. An unusual name, but his parents names are Janet and Michael. That’s kind of sweet. You probably need to write that name down and remember it, because 18 years from now, I’m betting we hear it again when colleges start drafting for football players.

His parents, Janet Johnson and Michael Brown had admittedly been expecting a large baby. Janet had some issues with gestational diabetes which is known to cause larger babies. The doctors had told them to expect a larger baby, but everyone was surprised at JaMichael’s actual size at birth. He was a good 4 pounds larger than what they had expected. JaMichael wasn’t fooling around.

Not only did he top 16 pounds, but he is nearly 2 feet long, with a full head of hair. He is about the size of a 3 to 6 month old. In fact, so large that the hospital did not have diapers to fit him available in the nursery. Fortunately for his mom, he was born as a scheduled cesarean. I had two girls naturally and the largest was 7 lbs. and I felt like I was delivering a volkswagen. So bless the doctor that made the call on the cesarean. I’m sure she is glad about that too.

via Everything is Bigger in Texas- Including the Babies! – Technorati Technorati Women.

NYS Nursing


There are three distinct licenses within the nursing profession in New York State: Registered Professional Nurse, Licensed Practical Nurse and Nurse Practitioner.

A Registered Professional Nurse (RN) may:

diagnose and treat a patient’s unique responses to diagnosed health problems;

perform health assessments to identify new symptoms of possibly undiagnosed conditions or complications

teach and counsel patients about maintenance of health and prevention of illness or complications;

execute medical regimens as prescribed by licensed physicians, dentists, nurse practitioners, physician assistants, and podiatrists, and,

contribute as members of an interdisciplinary health care team and as consultants on health related committees to plan and implement the health care needs of consumers.

A Licensed Practical Nurse (LPN) provides skilled nursing care tasks and procedures under the direction of an RN, physician, or other authorized health care provider.

A Nurse Practitioner (NP) is an RN who has earned a separate license as an NP through additional education and experience in a distinct specialty area of practice. Nurse practitioners may diagnose, treat, and prescribe for a patient’s condition that falls within their specialty area of practice. This is done in collaboration with a licensed physician qualified in the specialty involved and in accordance with an approved written practice agreement and protocols. Nurse Practitioners are autonomous and do not practice under the supervision of the collaborating physician. (Nurse practitioner specialty areas: Acute Care; Adult Health; College Health; Community Health; Family Health; Gerontology; Holistic Nursing; Neonatology; Obstetrics and Gynecology; Oncology; Palliative Care; Pediatrics; Perinatology; Psychiatry; School Health; Women’s Health)

Read more about the nursing profession.

via NYS Nursing.