As November 8 elections approach, Washington State voters are facing an important question. “In the midst of a state and federal budget crisis, can we afford more rigorous qualifications and testing for our caregivers?” The initiative, I-1163, proposes to spend extra millions to ensure that seniors and others in need of long-term care are receiving proper and sufficient treatment, but some argue that the measure is far too costly and unnecessary. They feel that since the Legislature has to find $2 billion in budget cuts, there may be better financial decisions out there than the proposed initiative.

Washington State currently requires that all long-term caregivers undergo criminal background checks and 34 hours of training in most cases. I-1163 says this isn’t nearly enough to guarantee the safety of our elderly and disabled: it would make the necessary training a minimum of 75 hours, and would make background testing more thorough. The initiative would apply to paid long-term care workers in most situations–excluding some types of care, such as that provided by registered nurses–in nursing homes, assisted living facilities, adult boarding homes, and patients’ homes. It should be noted that family members who are providing care for a family member in need will not be subject to the same requirements, and that the standards will only be applied to new workers. Existing caregivers will not need to retrain.

The initiative was formed by the Service Employees International Union (SEIU), who proposed a similar initiative, I-1029, in 2008. It passed by a wide margin, but has been delayed in being enacted due to budget cuts. If this new initiative passes, a two-thirds majority in the House and Senate would be necessary to delay implementation. A survey in August showed that 77% of state voters supported the measure, even though it will cost the state about $32 million over the next two years. Opponents point out that there is no proposed source of revenue for this increase in spending–no taxation is written into the initiative.

“Candidly, that’s why the Legislature and I have delayed it,” said Governor Christine Gregoire. “Not because we don’t support the policy, we just don’t have the financial wherewithal to pay for it right now. We’ve had to prioritize.”

Ballots for the election will be mailed out next week, and must be postmarked by November 8 to be counted.

Haverford, Pennsylvania’s Quadrangle Continuing Care Retirement Community is facing a lawsuit over the negligent and abusive care of a dementia patient. The woman complained of mistreatment, but nursing home officials played off the claims as part of her dementia. The woman’s daughter, Mary French, installed a secret video camera in a clock radio in Mary’s mother’s room. The camera caught verbal and physical abuse against the 79-year-old by nursing home staff, leading Mary to sue the nursing home staff and facility for negligence.

“I just want them to take responsibility for what they did,” she said. She and her husband, Paul French, reside in Havertown.

Three employees of Quadrangle were arrested earlier this year in connection with abuse charges of French’s mother. They have all pleaded not guilty and are awaiting trial in November. The state has revoked Quadrangle’s care license, but is allowing it to stay open during appeals.

Quadrangle is owned by Sunrise Senior Living Inc., based in McLean, Virginia. The company owns about 300 senior living facilities, and is reported to be taking the lawsuit and allegations of abuse quite seriously. However, they have not yet commented publicly on the arrests and charges. French’s attorneys say this is not the first such incident reported in connection with Quadrangle Continuing Care.

The results of a Care Quality Commission inspection in the United Kingdom will be published officially next week, but initial findings are already alarming. Out of 100 hospitals, 49 neglected to meet nutritional standards, and 17 raised serious concerns about the care of their senior patients. Worcestershire Acute Hospitals, for one, had a ward in which some elderly patients had not been given a drink for at least ten hours. In some cases, the dehydration of patients was so advanced that doctors put them on IV drips.

“Water and food are not treatments – they are a basic human right,” said Patient’s Association chief executive Katherine Murphy. “Helping patients with food and water is not a ‘try to do’, it is a fundamental part of essential care.”

At Sandwell Hospital, inspectors found that staff did not keep track of which patients had eaten or how much fluid they were getting. There were other malnutrition concerns. Understaffing may be a problem: one nurse from Sandwell said, “Sometimes I am the only staff member to feed on the ward. How can I feed all these people?”

Among the most shocking findings is that some hospitals were issuing Do Not Resuscitate orders into the files of patients without receiving such an order from the patient or patient’s families.

There were only 45 hospitals inspected that raised absolutely no concerns about the care and respect of older patients. Sandwell and one other hospital, Alexandra, were the only two hospitals to raise severe concerns about elder care.

Many seniors would greatly prefer to stay in the homes they’ve made their own over the years, rather than relocate to a nursing home. But most of our own homes just aren’t built for senior living. Whether they have poor lighting, steep stairs, cramped bathrooms with no room for assistance modifications, or all of these things and more, the comfort of a lived-in house is sometimes trumped by its dangerous qualities. These homes are often referred to as “Peter Pan” houses–made for people who will never grow old. The decision to remain in a home that’s potentially hazardous for its aging resident(s) depends on many factors.

One of them is the amount of care needed. Are they fine on their own, as long as they have phone access in case of emergency? Do they just need someone to come by now and then, perhaps to bring them groceries or help them with chores and personal care? Those people might be fine in their Peter Pan homes, with perhaps a few modifications to stairways and bathrooms to increase mobility and independence. However, if the person needs help in a significant number of their daily activities, the expenses of live-in care may be too great, and the absence of a caregiver may increase danger.

Healthcare costs for people who choose to remain at home are also a concern. Medicare doesn’t cover in-home costs, and while Medicaid might provide assistance, it’s primarily concerned with nursing home residents. Getting approval for Medicaid coverage requires state and federal approval. It also means seniors have to “spend down.” John Pynoos, professor of gerontology policy and planning at the University of Southern California, clarified the term on NPR:

“That means that you can’t have too much money in the bank, but … the house is not counted as an asset. [Medicaid] force[s] you to use your resources first. And when you get down to a low level, then you’re eligible for the program.” He explains that this is a dangerous predicament because it drains the financial resources seniors had been saving for other purposes, and then makes them dependent on the program.

There are 71 million Americans aged 65 years or older–that means 20% of the population are senior citizens. The decision to remain in a less-than-ideal but familiar house or transition into assisted living is a difficult but important one to make. Modifications may be necessary to make a senior’s current home livable for their later years, but if the cost and standard of living are acceptable, it may remain the preferred option for some.

Researchers at Harvard University and Dartmouth Medical School have found that almost 20% of nursing home residents with advanced dementia, like Alzheimer’s, were transferred to other care facilities or hospitals in the months before they died. The treatment resulting from these transfers often included harsh measures that may have extended their suffering. While adequate care for these patients does become difficult as they enter the end stages of their disease, the people who conducted this study believe the real reasons for the transfers may be monetary. If a nursing home takes back a patient following a short period of hospitalization, Medicare pays the home around three times the typical amount for care.

The author of the study, Dr. Joan Teno of Brown University, suspects this is a possibility. “I think that’s unfortunately a factor in what’s happening here. [...] A lot of this care just feels like in and out, in and out. You really have to question, is the health care system doing a good job or not.”

The research showed that the number of transfers varied quite a bit from state to state, supporting the concern over financial motivation. While Alaska had just 2% of these types of transfers, Louisiana had over 37%. Many hospitalizations were due to simple issues like urinary tract infections or dehydration, and these conditions are most often treatable within the capabilities of nursing homes. Patients were also at an increased likelihood to be fed via a tube, experience a serious bedsore, or be admitted to hospice late (fewer than four days before death).

“This is a population where the burdens of hospitalization often outweigh the possible benefits,” said Teno. “These patients actually do better when they stay in a nursing home.”

The study was published in the September 29 issue of the New England Journal of Medicine. Teno recommends that families who are concerned about the care of their loved ones with dementia can request a “do not hospitalize” order. That way, care options will have to be discussed with the family before any action is taken.

President Obama’s plan to reduce spending resulted in a proposal last week of a $320 billion cut to Medicare and Medicaid over about a decade. The cuts affect many areas of senior care, such as nursing homes, pharmaceutical providers, and in-home care. But one specific niche of spending cuts is aimed at nursing homes with high annual hospital admission rates: such homes would risk losing up to 3% of their Medicare payment, and future spending cuts could extend to Medicaid coverage, too.

About 40% of American nursing home residents are admitted to the hospital every year. Often these visits aren’t for medical emergencies, but simply because nursing homes are short-staffed. Patients are often discharged before being adequately treated, and have to return to the hospital soon after–about 14% of nursing home patients are subjected to this back-and-forth.  The 3% cut would be extremely costly to nursing homes if approved, forcing them to boost the quality of the care at their facilities. However, even this modification would not protect the homes, because Obama has also proposed about $32 billion in cuts to care for nursing home residents who’ve been discharged from the hospital.

Dr. Stuart Shapiro is the president and CEO of the Pennsylvania Health Care Association and Center for Assisted Living Management. He is greatly concerned about the extent of the proposed cuts. “The message is clear,” he writes in Pennsylvania’s Morning Call. “Any further federal or state cuts to Medicare or Medicaid threaten an already fragile long-term care system with unthinkable and tragic results. Further cuts would place quality of care at risk, and very soon limit access to people who need nursing home care.”

Nursing homes will have to weigh the financial implications of hospital readmission and post-hospital care, looking for a balance that allows them to remain financially stable while maintaining quality.

Americans are working into their senior years more than ever in the 21st century. About half of workers plan to keep at least a part-time job after they retire, and nearly a third say they will be retiring after the age of 70 or will never retire.

“I don’t know how many people, unless they are extremely affluent, can afford to retire at 55, or even 65,” says Eileen Felske, 57, who cares for her elderly father. “Given the economy today, unless you were in a profession making a quarter of a million dollars a year, not too many can say ‘I’m confident enough to stop working.’ It’s not an age issue; it’s just what we are living through.”

Older Americans are needing to work later in their lives to support themselves. Since there’s been no cost of living increase in Social Security, the state of the economy has made what used to be enough to retire on no longer sufficient. People are also living longer in modern times, and with longer lives come more years of expenses–specifically more medical costs. However, aside from financial need, some middle-aged and senior citizens continue working for personal reasons.

Germaine Alhes, 76, has worked in the same hospital since she was 18 years old, and says she no longer has a monetary reason to continue employment.

“I enjoy the work,” she said. “It’s hard to imagine people who go to work and don’t like what they’re doing. The people (at the hospital) are like my second family [...] I enjoy the patient care and am thankful I can still do it. When you think about retiring, you get kind of teary eyed. [...] It’s been your whole life.”

We posted this infographic to another site of ours, but since different readers frequent this blog as well, we thought it would be great to add this infographic here too.  This is a super fun read for anyone getting a bit nostalgic.  It’s all about famous dogs and starts off with Rin Tin Tin.  What I didn’t know was that Rin Tin Tin was the first ever famous dog character in TV and film.  I guess it makes sense given the timing.  It shows that the minute film and television entered the scene, so did star dogs!  Check it out:

Click to Enlarge
Dog Beds by PawDigs.com

Researchers recently spent time reviewing the data from the National Institutes of Health-AARP Diet and Health Study, and concluded that people who eat whole grains and have a diet rich in fiber, have a reduced risk of dying at an early age. Fiber has been associated with good heart health for some time, and the Food and Drug Administration even allows companies to make heart disease health claims for fiber rich foods like psyllium, barley, and oats. Additionally the 2010 USDA Dietary Guidelines for Americans encourages consuming fiber-rich fruits, vegetables and whole grains. The recent fiber findings were published in the Archives of Internal Medicine, and it helps support the fact that seniors can benefit from fiber rich diets.

More specifically the researchers found that diets which are high in fiber were linked with having a lower risk of death from all causes, including death from cardiovascular disease, respiratory diseases, and infectious diseases in women and men. Eating fiber was also linked to a lower death risk from cancer for men, but what was surprising is that the same correlation was not seen in women. However the researchers do not have a great understanding as to why this same association was not found to be true with women. The bottom line is that seniors should analyze how much fiber they have in their diet, as it is recommended to have 14 grams of fiber per 1,000 calories. Some of the popular fiber rich foods that seniors can consider eating include berries, beans, whole grains, sweet peas, greens, nuts, and squash. Another way for seniors to ensure they get enough fiber for the day is by using products like Metamucil, which allows you to get 7 grams of soluble fiber per day from psyllium husk by mixing it in water.

Most people in the United States who keep up with college sports are familiar with the University of Kansas basketball team, which is thought to be one of the most successful and prestigious programs in the history of college basketball, as illustrated by their 3 NCAA Tournament champions. The Kansas Jayhawks men’s basketball team have also won various conference championships and appeared in the NCAA Tournament dozens of time. Their program started in 1898 after Dr. James Naismith arrived, who is the man credited with inventing the sport of basketball in 1891. In an effort to keep up with a long history of excellence in men’s basketball, the university decided to implement some changes to ensure that the athletes on the team did a better job attending their classes. This is because professors do not typically take attendance, and the university wants to ensure that these students go to class and get a solid education while playing basketball for the school, since many are there as part of a scholarship.

Historically the university has hired other students to help them monitor student athletes, however this plan did not work well, as it was easy for the basketball players to still cheat and not attend class. This is where senior citizens come into the picture, who were hired by the university to keep better tabs on the athletes, and so far it looks to be paying off. It is much tougher to talk your way out of attending class to a senior citizen or trying to bribe them with tickets, which makes the players feel more accountable and therefore they do a better job attending class. This is one of the first times that a university has tried such a technique, so it will be interesting to see how this plays out over time.