More than 30 years ago, when the psychiatrist Dr. Peter Rabins and the psychologist Nancy Mace began working with dementia patients and their families at Johns Hopkins Hospital, they had to write and mimeograph (younger readers: look it up) small pamphlets to explain to them what was going on and what was to come.
It’s hard to remember how different things were. If you had stopped 20 people at random on the streets of Baltimore in 1981, I asked Dr. Rabins recently, how many would have known what Alzheimer’s disease was?
“If you asked 20 random doctors and nurses at Johns Hopkins, I don’t think any would have known,” he said.
In 1981, nothing had been published for a general readership. The Alzheimer’s Association was a little over a year old. Scientists had determined that dementia was a disease, not part of normal aging, and that it was caused by changes in the brain, not hardened arteries. “But that information was just barely starting to trickle out,” Dr. Rabins said.
As people from other cities started asking the Hopkins staff to mail copies of their pamphlets, Dr. Rabins and Ms. Mace decided they needed a publisher. They approached 10, five of whom said there was no market for such a book and five of whom never responded. The Johns Hopkins University Press finally agreed to take on the project.
“There was an interesting concatenation: family groups forming, six or seven research centers across the country making diagnoses, baby boomers starting to write about this mysterious condition affecting their parents, and that’s when the book came out,” he said. “It met a need.”
Full Article
Tuesday, January 31, 2012
Thursday, January 19, 2012
Many Seniors Leave Hospital Without Their Regular Meds - Quality Health
While hospitals can be lifesavers, especially for the elderly, an alarming number of older patients fail to continue taking their regular medications after they return home—particularly if they spent time in intensive care. Why? Mainly because they neglect to renew their prescriptions.
Researchers at Toronto's St. Michael's Hospital examined data on almost 400,000 people living in Ontario between 1997 and 2009. They were all over the age of 66 and were regularly taking one of five medications commonly used to treat chronic conditions-statins for lowering cholesterol, anti-clotting drugs, thyroid replacement hormones, respiratory inhalers, and drugs that suppress gastric acid. During that time, slightly fewer than half of the study participants were hospitalized for unspecified conditions, and less than 10 percent of those were admitted to the ICU. What the researchers found is that admittance to a hospital resulted in patients being less likely to renew a long-term prescription. Almost one-fifth of patients did not renew their medications after discharge. Being admitted to the ICU carried an even higher risk-almost one-quarter of ICU patients failed to renew medications after discharge.
Why do so many seniors neglect their medications once discharged from the hospital, particularly if they were in the ICU? The study's lead researcher, Dr. Chaim Bell, said in a statement that the reason may be that ICUs are focused on treating acute illnesses, not chronic conditions. It's not uncommon for a long-term medication to be temporarily discontinued as the critical-care staff deals with a more pressing problem. Regular prescriptions "may later be forgotten or overlooked upon discharge," Bell said. He also noted that ICU patients are typically sent to a regular hospital bed once the emergency is over, and this handoff presents another opportunity for miscommunication and error.
The problem with seniors forgetting to take long-term medications is that the diseases for which the medications are intended are still present and causing damage. Patients who suspend their prescriptions are at increased risk of being readmitted to the hospital. That's why it's a good idea for senior citizens to keep a record of all prescriptions in one handy place. If one medication is temporarily suspended, the patient can review the list with his or her doctor upon discharge and make sure there are fresh prescriptions for everything needed.
Full Article
Researchers at Toronto's St. Michael's Hospital examined data on almost 400,000 people living in Ontario between 1997 and 2009. They were all over the age of 66 and were regularly taking one of five medications commonly used to treat chronic conditions-statins for lowering cholesterol, anti-clotting drugs, thyroid replacement hormones, respiratory inhalers, and drugs that suppress gastric acid. During that time, slightly fewer than half of the study participants were hospitalized for unspecified conditions, and less than 10 percent of those were admitted to the ICU. What the researchers found is that admittance to a hospital resulted in patients being less likely to renew a long-term prescription. Almost one-fifth of patients did not renew their medications after discharge. Being admitted to the ICU carried an even higher risk-almost one-quarter of ICU patients failed to renew medications after discharge.
Why do so many seniors neglect their medications once discharged from the hospital, particularly if they were in the ICU? The study's lead researcher, Dr. Chaim Bell, said in a statement that the reason may be that ICUs are focused on treating acute illnesses, not chronic conditions. It's not uncommon for a long-term medication to be temporarily discontinued as the critical-care staff deals with a more pressing problem. Regular prescriptions "may later be forgotten or overlooked upon discharge," Bell said. He also noted that ICU patients are typically sent to a regular hospital bed once the emergency is over, and this handoff presents another opportunity for miscommunication and error.
The problem with seniors forgetting to take long-term medications is that the diseases for which the medications are intended are still present and causing damage. Patients who suspend their prescriptions are at increased risk of being readmitted to the hospital. That's why it's a good idea for senior citizens to keep a record of all prescriptions in one handy place. If one medication is temporarily suspended, the patient can review the list with his or her doctor upon discharge and make sure there are fresh prescriptions for everything needed.
Full Article
Tuesday, January 17, 2012
"Right-sizing" nursing homes - The Connecticut Mirror
State officials are developing a plan to dramatically reshape the state's long-term care system, just as demand for it is expected to skyrocket.
The effort -- referred to as "right-sizing" the system -- is aimed at allowing more seniors and people with disabilities to live in community settings rather than institutions.
If it goes as officials hope, nearly one in four nursing home beds in the state won't be needed within the next two decades -- at least according to projections being used by state officials. They're planning to award millions of dollars in federal grant money to nursing homes looking to diversify their business models.
Those leading the effort say it's about creating choice, removing the barriers that make it harder to get Medicaid-funded long-term care at home than in an institution.
"We're designing a system that will someday support us," Dawn Lambert told a roomful of people helping to design the effort, including state agency officials, home health care and nursing home industry leaders, long-term care recipients and advocates for seniors, people with disabilities and mental illnesses.
Lambert is project director for Money Follows the Person, a federal-state initiative to help people in institutions move into home- or community-based settings and rebalance the long-term care system.
Doing so requires transforming not just the care system, but the infrastructure of a state sorely lacking affordable, accessible housing and transportation options. There will be a need for community supports to help people avoid being isolated at home, and a major increase in home care workers, who are already in short supply.
The shift will also require a more subtle change in the way care is thought of, those behind the effort say, from a sometimes-paternalistic model that treats people as patients in the care of an institution to one that emphasizes independence, choice and the right to take risks, including getting less care than professionals might advise. While many nursing home residents are seniors, the changes will also affect people with disabilities and mental illnesses, some of whom live in nursing homes.
Many longtime advocates for rebalancing the system say they're cautiously optimistic, saying previous resistance seems to have subsided, and policy changes are starting to reflect a move toward expanding home- and community-based care. Gov. Dannel P. Malloy's administration has already announced plans to expand Money Follows the Person, and Malloy issued a controversial executive order establishing a path for home care workers in state-funded programs to gain collective bargaining rights, citing the expected increase in demand for personal care attendants.
"I don't think we have any choice," AARP Connecticut State Director Brenda Kelley said. "The services that we currently have are not what people want. They're not what people need, and we can't afford it."
The nursing home industry is participating in the planning process, and leaders have acknowledged that a shift toward more home care is inevitable. The industry understands that an overreliance on institutional care, mixed with the looming demographic trends, will lead the state to a long-term care system that's unaffordable, said Matthew V. Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes.
Full Article
The effort -- referred to as "right-sizing" the system -- is aimed at allowing more seniors and people with disabilities to live in community settings rather than institutions.
If it goes as officials hope, nearly one in four nursing home beds in the state won't be needed within the next two decades -- at least according to projections being used by state officials. They're planning to award millions of dollars in federal grant money to nursing homes looking to diversify their business models.
Those leading the effort say it's about creating choice, removing the barriers that make it harder to get Medicaid-funded long-term care at home than in an institution.
"We're designing a system that will someday support us," Dawn Lambert told a roomful of people helping to design the effort, including state agency officials, home health care and nursing home industry leaders, long-term care recipients and advocates for seniors, people with disabilities and mental illnesses.
Lambert is project director for Money Follows the Person, a federal-state initiative to help people in institutions move into home- or community-based settings and rebalance the long-term care system.
Doing so requires transforming not just the care system, but the infrastructure of a state sorely lacking affordable, accessible housing and transportation options. There will be a need for community supports to help people avoid being isolated at home, and a major increase in home care workers, who are already in short supply.
The shift will also require a more subtle change in the way care is thought of, those behind the effort say, from a sometimes-paternalistic model that treats people as patients in the care of an institution to one that emphasizes independence, choice and the right to take risks, including getting less care than professionals might advise. While many nursing home residents are seniors, the changes will also affect people with disabilities and mental illnesses, some of whom live in nursing homes.
Many longtime advocates for rebalancing the system say they're cautiously optimistic, saying previous resistance seems to have subsided, and policy changes are starting to reflect a move toward expanding home- and community-based care. Gov. Dannel P. Malloy's administration has already announced plans to expand Money Follows the Person, and Malloy issued a controversial executive order establishing a path for home care workers in state-funded programs to gain collective bargaining rights, citing the expected increase in demand for personal care attendants.
"I don't think we have any choice," AARP Connecticut State Director Brenda Kelley said. "The services that we currently have are not what people want. They're not what people need, and we can't afford it."
The nursing home industry is participating in the planning process, and leaders have acknowledged that a shift toward more home care is inevitable. The industry understands that an overreliance on institutional care, mixed with the looming demographic trends, will lead the state to a long-term care system that's unaffordable, said Matthew V. Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes.
Full Article
Monday, January 16, 2012
Tax Tips: Assisted-living costs in your home - Hometown Annapolis
The cost of assisted-living (should it ever become necessary) is always a primary concern when planning for retirement. We all need to be mindful of the cost of continuing care facilities in our general locale but, in most cases; it would be preferable to stay in the comfort of our own home if at all possible.
If home care becomes a viable option one day for you or a family member, you need to be aware of some key tax considerations that apply to so-called "household employees"- such as the pesky Nanny Tax.
Based on IRS's definition, household employees also include "private nurses" or "health aides" who provide services in your home. The definition also goes on to include babysitters, cleaners, caretakers, drivers, housekeepers, maids, yard workers and of course, nannies.
How the Nanny Tax works: If a caregiver (or another household employee) is paid more than $1,700 in 2011 you are required to pay the Nanny Tax. (The threshold level will rise to $1,800 in 2012.)
This means you will need to pay and withhold Social Security and Medicare (FICA) taxes, and also pay federal unemployment taxes on each household employee. These taxes are generally paid once a year at tax time with a Schedule H form that you must attach to your tax return.
Some notable exceptions: A continuing care worker will not be considered your employee if he or she is hired through an agency and the agency has control over (a) who does the job and (b) how the job is done.
Full Article
If home care becomes a viable option one day for you or a family member, you need to be aware of some key tax considerations that apply to so-called "household employees"- such as the pesky Nanny Tax.
Based on IRS's definition, household employees also include "private nurses" or "health aides" who provide services in your home. The definition also goes on to include babysitters, cleaners, caretakers, drivers, housekeepers, maids, yard workers and of course, nannies.
How the Nanny Tax works: If a caregiver (or another household employee) is paid more than $1,700 in 2011 you are required to pay the Nanny Tax. (The threshold level will rise to $1,800 in 2012.)
This means you will need to pay and withhold Social Security and Medicare (FICA) taxes, and also pay federal unemployment taxes on each household employee. These taxes are generally paid once a year at tax time with a Schedule H form that you must attach to your tax return.
Some notable exceptions: A continuing care worker will not be considered your employee if he or she is hired through an agency and the agency has control over (a) who does the job and (b) how the job is done.
Full Article
Thursday, January 5, 2012
2012 Medicare debate is all about the baby boomers - The Richmond Register
Washington — Baby boomers take note: Medicare as your parents have known it is headed for big changes no matter who wins the White House in 2012. You may not like it, but you might have to accept it.
Dial down the partisan rhetoric and surprising similarities emerge from competing policy prescriptions by President Barack Obama and leading Republicans such as Wisconsin Rep. Paul Ryan.
Limit the overall growth of Medicare spending? It’s in both approaches.
Squeeze more money from upper-income retirees and some in the middle-class? Ditto.
Raise the eligibility age? That too, if the deal is right.
With more than 1.5 million baby boomers a year signing up for Medicare, the program’s future is one of the most important economic issues for anyone now 50 or older. Health care costs are the most unpredictable part of retirement, and Medicare remains an exceptional deal for retirees, who can reap benefits worth far more than the payroll taxes they paid in during their careers.
Full Article
Dial down the partisan rhetoric and surprising similarities emerge from competing policy prescriptions by President Barack Obama and leading Republicans such as Wisconsin Rep. Paul Ryan.
Limit the overall growth of Medicare spending? It’s in both approaches.
Squeeze more money from upper-income retirees and some in the middle-class? Ditto.
Raise the eligibility age? That too, if the deal is right.
With more than 1.5 million baby boomers a year signing up for Medicare, the program’s future is one of the most important economic issues for anyone now 50 or older. Health care costs are the most unpredictable part of retirement, and Medicare remains an exceptional deal for retirees, who can reap benefits worth far more than the payroll taxes they paid in during their careers.
Full Article
Wednesday, January 4, 2012
The Unspoken Diagnosis: Old Age - The New York Times
Dr. Alexander K. Smith is a brave man.
It has taken physicians a very long time to accept the need to level with patients and their families when they have terminal illnesses and death is near — and we know that many times those kinds of honest, exploratory conversations still don’t take place.
Now Dr. Smith, a palliative care specialist at the University of California, San Francisco, who also practices at the San Francisco Veterans Affairs Medical Center, and two co-authors are urging another change, one they acknowledge would “radically alter” the way health care professionals communicate with their very old patients.
In a recent article in The New England Journal of Medicine, they suggested offering to discuss “overall prognosis,” doctorspeak for probable life expectancy and the likelihood of death, with patients who don’t have terminal illnesses. The researchers favor broaching the subject with anyone who has a life expectancy of less than 10 years or has reached age 85.
“Advanced age itself is the greatest predictor of poor prognosis,” Dr. Smith told me in an interview.
By age 85, the article points out, the average remaining life expectancy for Americans is six years. An 85-year-old has a 75 percent chance of living another three years, but only a one in four chance of surviving for 10. Which category a particular old person falls into has much to do with the medical problems he or she has, or doesn’t have, and with his or her ability to function.
When the odds are that they have only a few remaining years, should doctors discuss that with them?
Dr. Smith and his co-authors, Dr. Brie Williams and Dr. Bernard Lo — a geriatrician and an internist, respectively — vote yes. “This is about empowering patients to make informed choices and encouraging individual decision-making,” he said.
Full Article
It has taken physicians a very long time to accept the need to level with patients and their families when they have terminal illnesses and death is near — and we know that many times those kinds of honest, exploratory conversations still don’t take place.
Now Dr. Smith, a palliative care specialist at the University of California, San Francisco, who also practices at the San Francisco Veterans Affairs Medical Center, and two co-authors are urging another change, one they acknowledge would “radically alter” the way health care professionals communicate with their very old patients.
In a recent article in The New England Journal of Medicine, they suggested offering to discuss “overall prognosis,” doctorspeak for probable life expectancy and the likelihood of death, with patients who don’t have terminal illnesses. The researchers favor broaching the subject with anyone who has a life expectancy of less than 10 years or has reached age 85.
“Advanced age itself is the greatest predictor of poor prognosis,” Dr. Smith told me in an interview.
By age 85, the article points out, the average remaining life expectancy for Americans is six years. An 85-year-old has a 75 percent chance of living another three years, but only a one in four chance of surviving for 10. Which category a particular old person falls into has much to do with the medical problems he or she has, or doesn’t have, and with his or her ability to function.
When the odds are that they have only a few remaining years, should doctors discuss that with them?
Dr. Smith and his co-authors, Dr. Brie Williams and Dr. Bernard Lo — a geriatrician and an internist, respectively — vote yes. “This is about empowering patients to make informed choices and encouraging individual decision-making,” he said.
Full Article
Monday, January 2, 2012
Senior housing become big business across region, nation Senior housing become big business across region, nation - Pittsburgh Tribune-Review
Construction of new senior citizen housing -- including independent-living and assisted-living communities -- is growing in Western Pennsylvania and nationwide, despite the national slowdown on new housing development, experts say.
The total value of senior housing deals in the July-September period was greater than the combined total in the previous two full years, according to the National Investment Center for the Seniors Housing & Care Industry, based in Maryland. It said 380 properties valued at $5.2 billion were completed, primarily by real estate investment trusts that specialize in housing for the elderly.
In the Pittsburgh region, developers say production of senior citizens complexes often consists of 50 units or fewer, and that larger complexes with more than 100 units are no longer being built.
Developer William Gatti of Trek Development in Pittsburgh developed four senior citizen communities this year, involving a combined 120 units and costing about $20 million. One of the four was the 24-unit Kittanning Cottages in Kittanning. Others are in Pittsburgh's Hill District and in Punxsutawney and Blairsville.
Gatti plans four more communities in 2012, with a combined 150 units. They will be in Gibsonia, Ridgeway, Somerset and Braddock.
"Obtaining financing for senior citizen housing is not easy but it is better than for other housing developments," he said. He has used a federal tax credit program to help fund these affordable-housing complexes, which are not subsidized.
Bob and Ruth Lind are typical of seniors who gave up their homes to move into senior citizen housing. They decided this year to sell their seven-room, three-bedroom home in Somerset and become residents of the Village of St. Barnabas in Gibsonia.
"I got tired of taking care of a large yard and at 84, I decided it was time to enjoy living in a community where those maintenance matters were taken care of," said Bob Lind, former publisher of the Somerset Daily American newspaper.
Full Article
The total value of senior housing deals in the July-September period was greater than the combined total in the previous two full years, according to the National Investment Center for the Seniors Housing & Care Industry, based in Maryland. It said 380 properties valued at $5.2 billion were completed, primarily by real estate investment trusts that specialize in housing for the elderly.
In the Pittsburgh region, developers say production of senior citizens complexes often consists of 50 units or fewer, and that larger complexes with more than 100 units are no longer being built.
Developer William Gatti of Trek Development in Pittsburgh developed four senior citizen communities this year, involving a combined 120 units and costing about $20 million. One of the four was the 24-unit Kittanning Cottages in Kittanning. Others are in Pittsburgh's Hill District and in Punxsutawney and Blairsville.
Gatti plans four more communities in 2012, with a combined 150 units. They will be in Gibsonia, Ridgeway, Somerset and Braddock.
"Obtaining financing for senior citizen housing is not easy but it is better than for other housing developments," he said. He has used a federal tax credit program to help fund these affordable-housing complexes, which are not subsidized.
Bob and Ruth Lind are typical of seniors who gave up their homes to move into senior citizen housing. They decided this year to sell their seven-room, three-bedroom home in Somerset and become residents of the Village of St. Barnabas in Gibsonia.
"I got tired of taking care of a large yard and at 84, I decided it was time to enjoy living in a community where those maintenance matters were taken care of," said Bob Lind, former publisher of the Somerset Daily American newspaper.
Full Article
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