By Emily P. Walker, Washington Correspondent, MedPage Today
Published: August 16, 2011

The researchers expected that seniors, when faced with mounting out-of-pocket costs, would switch to cheaper generics. In fact, that was one of the main arguments behind the coverage back when Medicare’s drug benefit was created in 2006. If seniors saw how much drugs cost, they’d be more thrifty consumers and seek out cheaper drugs, some reasoned.

But the current study shows that hasn’t been the case.

Rather than seeking cheaper alternatives to prolong entry into the doughnut hole, some seniors just stop taking their prescriptions once they reach the coverage gap or alter their dosing regimen to make their medication last longer.

The Affordable Care Act (ACA) will eliminate the doughnut hole by 2020 and until then, the law takes measures to help seniors defray the costs of the coverage gap.

For example, in 2010, many seniors received $250 checks in the mail, and this year 900,000 Medicare beneficiaries have already received a 50% discount on prescription drugs while in the doughnut hole.

But until the doughnut hole is truly closed in 2020 “beneficiaries may still be at risk of decreased drug utilization and adverse clinical consequences,” the authors wrote.

“In contrast to blunt cost-sharing approaches such as the coverage gap feature, more nuanced, clinically informed insurance strategies that specifically promote the use of drugs with high benefit and low cost may hold the most promise for governments and insurers seeking to improve the health of their citizens while reining in drug costs,” they concluded.

One alternative strategy, the authors wrote, would be to encourage the use of generic drugs from the outset in order to forestall entry into the coverage gap.

The study was funded through grants from the National Institute on Aging, the National Institute of Mental Health, the National Heart, Lung, and Blood Institute, Robert Wood Johnson Foundation, and CVS Caremark.

The study authors reported a number of conflicts of interest, including that lead study author is a consultant for a company that contracts with the Centers for Medicare and Medicaid Services; another author is a consultant to United Healthcare, which sells Part D plans, and receives research funding from CVS Caremark, Aetna, and Express Scripts, which all have Part D business. Another author worked at CVS Caremark during the study, and CVS Caremark provided funding and data for the study.

 Primary source: PLoS Medicine
Source reference:
Polinski JM, et al “Changes in drug utilization during a gap in insurance coverage: An examination of the Medicare Part D coverage gap” PLoS Med2011; 8(8): e1001075

Help family caregivers through holidays

Give family caregivers a gift this holiday season by inviting them to participate in one of the upcoming “Home for the Holidays” webinars. This hour-long informational session provides family caregivers with information on how to help their senior loved ones manage holiday travel, family gatherings, seasonal depression and other issues that can occur during this busy time of year. The webinar will be offered on:

Tuesday, November 15 at noon Central Time

Click the following link to register for this date and time: https://www3.gotomeeting.com/register/316436230

• Monday, December 5 at 7 p.m. Central Time

Click the following link to register for this date and time:

https://www3.gotomeeting.com/register/321591990

The “Home for the Holidays” webinar is the next installment in the Caring for Your Parents: Education for the Family Caregiver^SM support series and is moderated by the Home Instead Senior Care^® network, hosted by the American Society on Aging (ASA) and co-sponsored by the National Family Caregivers Association (NFCA) and the National Alliance for Caregiving (NAC).

The Caring for Your Parents: Education for the Family Caregiver support series is another way Home Instead Senior Care^® businesses across the country are building trust in communities and supporting clients and their families.  

Why Seniors are Moving from Institution Back Home

After living for three years in a nursing home following a stroke, Gail, 78, went through his life savings paying for the nursing home and eventually qualified for Medicaid. He had always wanted to and intended to move back home, but his condition required that he stay in the nursing home. His ex-wife, Sue, and a social worker at the nursing home informed him about a program called “Money Follows the Person” (MFP), which supports efforts to move institutionalized individuals back home.

In 2009, MFP enabled Gail to move into Sue’s house because she is his main care provider. The program allotted $1,500 for home services, modifications to the home in the form of ramps and a handicap accessible bathroom, 16 hours of personal care services each month, and attendance at adult day care each day. Gail’s health has remained steady, he is able to enjoy more of a routine life, and he is able to get the care he needs at home while surrounded by friends and family.

The U.S. Congress authorized the MFP as part of the Deficit Reduction Act of 2005. MFP was designed to assist states in rebalancing their long-term care systems and help Medicaid enrollees transition out of institutions and back to their communities.

Since 2008 when the first senior moved back home through the MFP program, an increasing number of states have been making stories like Gail’s a reality for seniors and others with disabilities. As of February 2011, 43 states and the District of Columbia participate in the “Money Follows the Person Rebalancing Demonstration Program.”  The significance of this program for seniors is found in its intention for establishing a strong foundation of person-centered, consumer-directed, and community-based services. Seniors are receiving the services they need in an environment that is more comfortable for their recovery and/or daily living. Ultimately, the service model is no longer provider-driven and institution-based, but rather it is more conducive to successful living because of the personalized approach. (Centers for Medicare and Medicaid Services).

More recently, with the passing of the Affordable Care Act in March of 2010, the MFP received a boost in funding and a time extension through September 30, 2016. Additionally, the MFP program expanded the eligibility requirements to include anyone who is in an institution for more than 90 consecutive days. The old restriction was anyone who had been institutionalized for six months to two years. The longer an individual has been institutionalized the more likely they are to have relinquished a community residence and it is often more challenging for them to again establish a community residence. Individuals who have been institutionalized for a shorter period of time may still have a home to which they still have access. 

States have their own methods for identifying appropriate candidates for the MFP program. Once identified, the individual has access to the designated funds for their case for a period of twelve months and receives assistance in achieving the needed transition services.

After the program is complete, the continuity of care in each state will vary. Generally, MFP participants may be able to access existing waivers. Participants will continue to be served through these waivers as long as they continue to meet the eligibility criteria.  Therefore, there will not be a lapse in services for MFP demonstration participants. Check with your state on the plans the Medicaid office has in place for the post-demonstration period.
 
Challenges that Affect the Program
While each state handles their grant money from the MFP program differently, each is working to gain foothold in providing opportunities for their institutionalized citizens to regain status as community members. Implementing a MFP program involves comprehensive and extensive planning at the state level as well as collaboration with Centers for Medicare and Medicaid Services. The two main challenges to the success of the program continue to be available housing and accessibility of community service providers.

Housing – The number of residential units available for Medicaid dependents is limited in any case, and states recognize the squeeze that the MFP program places on this issue. More and more states have launched a concerted effort in conjunction with other government agencies such as the U.S. Department of Housing and Urban Development (HUD) to increase their chances of creating and locating safe and affordable housing arrangements.

Examples of what states are doing specifically to address this problem include: Ohio has a housing specialist under the MFP umbrella whose job it is to build partnerships with housing officials. Michigan has 26 housing coordinators throughout the state who identify housing opportunities for MFP recipients (www.kff.org).

Community services – Already stretched thin, service providers who can provide Medicaid supported home- and community-based services (HCBS) are difficult to find. MFP aligns more individuals with service providers, but without enough service providers, the MFP program recipients may not have access to these services. States are working hard to develop HCBS services using MFP dollars because community services are typically more cost-effective compared to institutional care when measured on a per-person basis.

Examples of the most commonly expanded services that states are employing are: case management to coordinate transition; help with home modifications; and one-time housing expenses such as security deposits, use of assistive technology, and transportation (Kaiser Family Foundation). North Dakota has developed a 24-hour back-up nursing service.

All of these efforts are to create more opportunity for community-based service providers that will support the long-term care of seniors and people with disabilities in their homes by providing the care they need.

Successes for Seniors Now and Long-Term
Each year, the numbers of participants transitioning increases as solutions to barriers are identified and significant technical assistance helps states meet transition goals. As of December 2010, almost 12,000 individuals returned to the community as a result of these demonstration programs, with a reinstitutionalization rate of only about 3–4 percent.

The infrastructure that is creating avenues to affordable housing and HCBS continues to be strengthened through plans customized at the state level to provide support for seniors even after MFP is slated to end. This infrastructure is required if states plan to successfully extend the opportunity of transitioning institutionalized individuals for the long-term.

According to the Kaiser Family Foundation, “MFP is likely to continue to help states reorient their long-term services and support systems toward more community-based care. This program in conjunction with other ACA Medicaid policy options has the potential to expand Medicaid home and community-based services for many more seniors and persons with disabilities who desire to live in the community.” Kaiser Family Foundation expects this trend to extend beyond the life of the MFP program demonstration and have a positive long-term impact for seniors.

Resources:
To find out if you are eligible and to apply for MFP, contact the Department of Social Services or related Medicaid office in your state. To get to your state’s official website, most states follow the website address pattern of www.insertnameofyourstate.gov, i.e. www.colorado.gov.

Centers for Medicare and Medicaid Services:
www.cms.gov 

October is National Breast Cancer Awareness Month

Breast cancer is the second most common cancer in American women behind skin cancer.  Seniors are at an increased risk to develop breast cancer, so take time during National Breast Cancer Awareness Month this October to learn more about this deadly disease.  Here are a few facts regarding seniors and breast cancer, provided by the National Breast Cancer Awareness Month website (www.nbcam.org).

• The risk of developing breast cancer increases as a woman grows older, but the risk increases significantly for women age 60 and older.
• Breast cancer is not common in women younger than age 35, but it can occur.
• There is some evidence to suggest young African-American women are at greater risk for breast cancer than young Caucasian women.
• Medicare covers mammography screening every year for female Medicare .  Eligible women and their doctors may not know about this important benefit, so be sure to share this information with your female clients and their families. A series of publications regarding this benefit are available in English and Spanish.
• For more information about Medicare coverage, contact the Medicare toll-free hotline at (800) MEDICARE or the Medicare Web site, www.medicare.gov.

Join the effort to detect Alzheimer’s early

The Home Instead Senior Care^® network has joined the Alzheimer’s Early Detection Alliance (AEDA) in a nationwide effort to educate people about the warning signs of Alzheimer’s disease and the importance of early detection.  The AEDA is a group of corporations, nonprofits and government entities under the leadership of the Alzheimer’s Association dedicated to making a difference in the fight against Alzheimer’s disease.

There is no cure for Alzheimer’s disease and no way to prevent it. Early detection allows those living with the disease – and their families – time to plan for the future. The Alzheimer’s Association created the following list of warning signs for Alzheimer’s disease and related dementias. Every individual may experience one or more of these symptoms in varying degrees:

1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

If you notice any of these signs in your senior clients, contact the client’s family members immediately.

To learn more about the 10 signs of Alzheimer’s disease, contact the Alzheimer’s Association at www.alz.org/10signs or 877-IS IT ALZ (877.474.8259).

Older adults should guard against over-medication and talk with their doctor about the best ways to manage their health.  Companionship is one.

Q.    As a healthy 75-year-old, I’ve managed without much medication all of my life. My children are always trying to get me to ask my doctors about the newest medications on the market. I think less is more. Am I being unreasonable?  

It’s important to check with your doctor first about any medications you should be on. Never stop taking a medication or reduce your dosage without first consulting your physician.

The Harvard Health Letter points out that with a disciplined lifestyle, seven of the most common senior conditions can be managed without medications. If you’re interested in learning how to continue to keep your meds to a minimum, here’s how. If you’re thinking of incorporating any of these, please discuss first with your doctor:

Arthritis: There’s a good chance that losing weight will make arthritis less painful. Combine weight loss with exercise and you may have less pain and more mobility.

Cholesterol: Your LDL level may drop by 5 percent or so if you keep foods high in saturated fat off the menu. Additional soluble fiber may reduce LDL levels as well. So can margarines fortified with sterols.

Cognitive decline: Memory training and other “brain exercises” seem to help healthy older people stay sharp.

Depression: Studies have shown that regular physical activity can have a potent antidepressant effect.

Diabetes: Regular physical activity is a powerful brake on blood sugar levels as well, because exercised muscle becomes more receptive to the insulin that helps it pull sugar in from the bloodstream.

High blood pressure: Losing weight, getting more exercise, and eating less sodium all lower blood pressure.

Osteoporosis: Weight-bearing exercise puts stress on bones, and bone tissue reacts by getting stronger and denser, fending off osteoporotic processes. Extra vitamin D and calcium top the list of dietary recommendations.

Also, don’t discount the importance of companionship to staying healthy. Make sure that you get out often and socialize with friends. You can make a new friend by hiring a CAREGiverSM from Home Instead Senior Care®. The company’s CAREGivers are often seniors like you who could share many of your hobbies and interests.

For more information about the Harvard newsletter, log on to

www.health.harvard.edu/health

The Loneliness Factor

Loneliness – it’s one of the most serious obstacles to good nutrition that your senior loved one could face. In the United States, approximately 40 percent of the population age 75 and older – 6.7 million people – lives alone, according to the U.S. Census Bureau. These seniors face significant socialization challenges, particularly when it comes to lack of shared mealtime experiences.

“Who likes to eat alone?  Nobody,” says Sandy Markwood, Chief Executive Officer (CEO) of the National Association of Area Agencies on Aging (n4a) – who served as expert source for the Home Instead Senior Care^® network’s Craving Companionship^SM program. “Meals are not just a matter of sustenance, but a social outlet,” said Markwood, whose members coordinate the popular home-delivered meals program, also known as “Meals On Wheels^®.”

“It’s how we come together as a family or a community. When you’re isolated from that opportunity it’s indicative of bigger challenges that person could be facing.”

The far-reaching impact of loneliness prompted the Home Instead Senior Carenetwork to conduct a first-of-its-kind study* to measure mealtime routines, challenges and preferences of seniors age 75 plus who live by themselves in their own homes or apartments. 

This comprehensive study, which involved 600 interviews, provides evidence that increased opportunities for seniors to share meals with others will promote nutritional and emotional well-being. Key findings include:

• Two of five seniors who live alone have at least four warning signs of poor nutritional health.
• One in five seniors says he or she sometimes or most of the time feels lonely when eating alone.
• Seventy-six percent of these seniors eat alone most of the time.
• The biggest mealtime challenge for older people who live alone is lack of the shared family experience, including lack of companionship. 
• Mealtimes last nearly twice as long when seniors who live alone share meals with others compared with when they eat alone.
• A majority of seniors who live alone say they eat more nutritiously and the food actually tastes better when eating with others.
• More than three-fourths of seniors say they wish their families shared more meals together.
• The most common obstacle preventing these seniors from sharing more meals with others is that their family and friends don’t have enough time.  

As a result of this study, the Home Instead Senior Care network launched the Craving Companionship program to encourage extended families to bring back the family meal for the benefit of their seniors, especially those who live alone.

For more information, visit www.mealsandcompanionship.com. The program includes a variety of resources such as recipes and tips to help family caregivers make the most of mealtimes.

*The Home Instead Senior Care network completed 600 telephone interviews with seniors age 75 and older in the U.S. who live alone in their own homes or apartments. The sampling error is +/-4.0% at a 95% confidence level.   

Sharing your heart also entails learning as much as you can about each client. So use the Labor Day holiday as an opportunity to learn more about your client.

Questions you can ask your client:

What was your first job?
What did you like or dislike about it?
How do you feel about no longer working?
What did your parents do for jobs?
How did their line of work influence yours?
These are just a few ideas. Use your creativity and knowledge of your client to guide the conversation.

We’d love to hear from you, how you spent the holiday getting to know your client better.

Related articles:

Labor Day (greetingcarduniverse.com)

We hope this was helpful. If you have any questions or if you know of a senior who could benefit from our vast array of home care services in Sonoma County, please call us at 707-586-1516 or email us. We accept most long term care insurance as payment and have a full time staff of trained and certified home care personnel covering Sonoma Country !

10 Senior Mealtime Challenges 

Research conducted for the Home Instead Senior Care^® network reveals 10 mealtime challenges for older adults. The following percentages refer to the number of seniors who believe these are challenges for older people who live alone. After each are tips for how to make the most of mealtimes for older adults who live alone, from the Home Instead Senior Care network and Sandy Markwood of the National Association of Area Agencies on Aging.

1. 1.     Lack of companionship during mealtimes (62 percent) Tip: If you can’t be there to dine with a loved one regularly, look for alterative options such as friends and neighbors. Check out special activities at churches and senior centers as well as the local Area Agency on Aging and Home Instead Senior Care resources.  
2. 2.     Cooking for one (60 percent) Tip: Freeze most any type of leftovers including sliced and seeded fruit by placing it in plastic containers or freezer bags. Buy your senior healthier low-sodium dinners for one.
3.      Eating nutritious meals (56 percent) Tip: Buy fresh, when possible, or frozen foods including fruits and vegetables. Frequent affordable farmer’s markets in season. Your older loved one may enjoy perusing the racks of produce.  If your senior is able, help plant a garden.
4.    Grocery shopping for one (56 percent) Tip: Transportation can be a big issue for seniors. Contact the local Area Agency on Aging and Home Instead Senior Care business, or encourage your loved one to engage neighborhood support systems when possible.
5.     Eating three meals a day (49 percent) Tip: So many seniors are on prescription medications that must be taken with or without food. Coordinate the food plan with the medication plan. “Remember, Dad, to take this pill when you’re eating oatmeal for breakfast.”
6.  High expense of cooking for one (45 percent) Tip: Encourage shared meals when possible – your older loved one will get the benefit of reduced costs of meals as well as companionship. Check out your local senior center, which often offers affordable meals for older adults, as well as the home-delivered meals program, also known as “Meals On Wheels^®.”
7.   Relying too much on convenience food (43 percent) Tip: Encourage your older adult to meet with a nutritionist or talk with the doctor to learn how to read labels. So many older adults don’t know the foods that are good and bad for them.
8.  Loss of appetite (41 percent) Tip: Help older adults make mealtimes an event, which can make dining more appealing. Pull out a favorite recipe, help that older adult prepare a meal, get out the good dishes and decorate the table with real or artificial flowers.
9.    Eating too much food (38 percent) Tip: The bigger issue is eating too much of the wrong types of food. If you’re helping an older loved one with a shopping list or grocery shopping, encourage healthier choices.

10.  Eating too little food (35 percent) Tip: Plan a trip to a favorite restaurant for a special dish. If lack of food is an ongoing problem, check with your senior’s doctor to learn about supplemental products that could ensure an older adult is getting the proper nutrition.

For more information about the National Association of Area Agencies on Aging, go to www.n4a.org. Learn about the Home Instead Senior Care network’s Craving Companionship^SM program at www.mealsandcompanionship.com.

The Elder Care Radio Show – August 2011

KSRO 1350 AM Fridays – 12:30 – 1:00 p.m.

KNEW 910 AM Saturdays – 8:30 – 9:00 a.m

Do older adults disengage as they get older? It may seem that way if it’s hard to get Mom to go out and do things like she used to.  Experts explore the topic of QUALITY OF LIFE in August.  We’ll discuss the importance of helping people connect with a sense of purpose and meaning – even, and especially, when there are health issues or cognitive impairments that compete for “attention.” I hope you will give yourself a 30-minute break each week to tune in to the live show or to a podcast. Take good care, Kira Reginato

Nina Herndon, MA, CMC
Care Manager and Principal of Sage Eldercare Solutions
What can quality of life (QOL) mean if you’re limited physically or mentally?  Nina will share stories of clients who are non verbal, have Alzheimer’s, have physical challenges, and have found interests adapted to them that have returned QOL to them. Learn to build a quality of life plan and/or a therapeutic activity kit for your loved one.

Julie Ann Anderson, Owner
Home Instead Senior Care
What can quality of life mean if you’re living alone?  Julie Ann will fascinate you as she explains their LifeCatching Program, a way to record personal histories to share with others.  She will entice you to enter the Craving Companionship Recipe Contest, too.
 

  Dr. Michael Fraga, Neuropsychologist
Neuropsychological Associates
What can quality of life mean if you have a brain injury, whether from a bicycle accident, stroke or disease?  Dr. Fraga will tell us about his amazing work with patients and the improvements they make to increase their quality of life and regain independence.
 
  

Dorothy McReynolds, Admissions Director
Golden Living Center, Petaluma
What can quality of life mean if you’re in a facility?  What can you expect from an excellent facility?  Dorothy will tell you how their staff goes the extra mile in their “Life’s Simple Pleasures Program.”
Special guest, Diana Gruhl, MSW, will talk about her Elder Active Program.
 
THE ELDER CARE RADIO SHOW THANKS ITS SPONSORS:
SearchSeniorLiving.Com • Dr. Michael A. Fraga, Neuropsychologist • Brookdale Senior Living •
Arcadia Home Care and Staffing • Golden Living Centers • Home Instead Senior Care • Institute on Aging •
Jewish Home of San Francisco • Lifeline Personal Response and Support Services • Dr. Thomas Yatteau, Concierge Medicine • Reliable Caregivers