Alternative 2 Nursing Home Cite

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Tonquita DavisNovember 19, 2008Chapter 12 AssignmentDesign mgmt

Multiple choice

1. nTrue falseCritical thinkingKinkySpontaneousCajoles

Hi-tech home help. (NURSE RESIDENTIAL CARE), 2007 Jul 9(7): 294 CINAHL with Full TextTfelecare systems are sensordevices placed in a per-.son's home to monitor theirhealth and wel!t)eingand to reduceaccidents.

As such,they can provideadtiitional supportto enable vulnerableolder people,or those with longtermconditions,such as diabetesor high blood pressure,tt> live anindependent life athome, thus reducing

the need for emergencyor unexpected admissions tohospital.

telecare devices, which actas sensors in the home, alsohave a role to play. The sensorscan turn lights on and off toensure that elderly people donot have to walk around in [hedark if they need to get out ofbed during the night. They can

also raise the alarm if the persondoes not come back to bedafter a specified time, so thatiHssistance can be summoned,if needed.and social needs, in adtlitionto patients with chi'onicheart disease, chronic obstrut-[ive pulmonary disorder and


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type 2 diabetes.

Averwater, N., & Burchfield, D. (2005, April). Technology. No place like home: telemonitoring can improve homecare. hfm (Healthcare Financial Management), 59(4), 46. Retrieved November 23, 2008, from CINAHL with FullText database.

patients in this market, These patients typically have the financial resources topay for services themselves. Marketing campaigns can promote the homehealth agency's telemonitoring capability by offering the service for an attractivetelemonitoring actually allows them tovisit more patients and would be unlikely to affecttheir overall compensation.By facilitating daily monitoringof patient status, telemonitoring can help these agen>cies improve care delivery, and by requiring fewerpatient visits by nurses, it can help reduce an agency'snurse salary and mileage expense. A short list of thearrangement to a single home health firmprovided that firm increase its orders for new equipmentin accordance with an agreed-upcn schedule.

In-home monitoring helps VAs manage their health: program reduces ED visits, hospitalization. (2008, February).

Hospital Home Health, Retrieved November 19, 2008, from CINAHL with Full Text database.Independence through telecare.Authors: Nazarko L Independence through telecare.L 2007 Sep; 9(9): 414-6 (14 ref) NURSE RESIDENTIAL CARECINAHL with Full TextComputerized technology and the internethave made little impact on the day-to-daycare in a person's home or in care homes.This is now changing, and the Departmentof Health (DH) is encouraging primary caretrusts CO invest in telecare (DH, 2005).

people in their own homesare helping many peopleto maintain independence.Linda Nazarko introducesTelecare devices can be used to monitor theenvironment, the person's activity withinthe environment, and the state of a person'shealth. These devices can be used to preventproblems, monitor health or to enablethe person to obtain specialist advice andtreatment without leaving home.

Telehealth is the use of technology to

monitor and diagnose people at home.The person remains at home, and technologyis u.sed to monitor and managean existing condition such as diabetes(Curry et al, 2003) or to diagnose a newcondition (Fragasso et ai, 2006).Sophisticated lifestyle monitors can be combinedwith a range of sensors to build upa picture of a person's normal activities.These might include what time the person


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gets up, how long the person spends inthe bathroom, what time tbe person goes

activity monitors can beused to reduce the risk of falls by turningon lights and by alerting monitors of possiblepnjhlems. Fails detectors can be worn

by people ai risk (jf falls. The devices detectthe impact and also the angle of the fall. Itthen sets off an alen to inform the personthat it is railing for help. The person cancancel the call urallow the device to alertihe monitor.Healthcare monitors can be used to monitora pcrso[i"s health- These monitors enablepeople to screen various aspects of healthincluding blood sugar, oxygen saturationlevels, cardiac rhythm and blood pressure.The monitors work with a range of sensorsthat are tailored to a person's medical

conditions.There are several types of activity monitors.These devices can either be passive infrareddetectors (PIR detectors) or pressure sensors.The PIR devices can be used to alertmonitors if a person has been still for sometime.

Swann, J. (2007, November). Telecare: Looking to the future.International Journal of Therapy & Rehabilitation,14(11), 512-517. Retrieved November 20, 2008, from Health Source: Nursing/Academic Edition database.

Sensors target one particular aspect of activity, e.g.falling, movement in a doorway and occupancy of

a bed or chair{Figure 2a). Alternatively, sensorscan monitor a specific area, such as pressure or passiveinfrared (PIR) sensors which detect movement.Other examples include flood detectors (Figuiv 2b),extreme temperature sensors, carbon monoxidemonitors, automatic lighting when getting out of bedand epilepsy sensors.Telecare systems are useful for a range of people

(Table 2)but may particularly benefit those withdementia or cognitive problems, especially peoplewho may wander, are at risk of falling or haverecently been discharged from hospital.Sensors can detect when a fall or an

episode of incontinence occurs.bed. In these circumstances, it is essential for providers

Bendekovits, R. (2002, January). Telemedicine in home care.. Orthopaedic Nursing, 21(1), 102. RetrievedNovember 20, 2008, from Health Source: Nursing/Academic Edition database.

The nursing shortageand changes in reimbursement have


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impacted the traditional data collectionvisits in the home care setting.daily coverage instead of a fixed numberof visits per week. In addition, staffmembers are able to schedule visitswhile still empowering patientsto be independent in their care.Telemedicine should be viewed asToday'shealth care addresses prevention andwellness on one end of the spectrumand management of chronic illnessaccording to patient needs and thusmake visits when appropriate ratherthan according to a schedule.an adjunct, not a replacement for thenurse. With the reality of a nursingshortage, use of telemedicine reducesWithin a few minutes, a device cancollect daily health indicators such as

heart rate, blood pressure, oxygensaturation, temperature, weight, bloodglucose, lung function, and prothrombintime.provide holistic, comprehensive care.Through digital imagery, the orthopaedicnurse will be able to providecare without leaving the office. Advantagesof the video visits includepatients. Nurses can humanize technology,using it as another patientcare tool.Rita Bendekovits,

MSN, RN, ONC, CRRN

U innprove patient outcomes and resourceutilization. The nursing shortageand changes in reimbursement haveimpacted the traditional data collectionvisits in the home care setting. Today'shealth care addresses prevention andwellness on one end of the spectrumand management of chronic illness on

the other, yet the majority of careneeded is in the vast middle.More and more health care will beprovided in the home or as community-based care. Cost containment isstill an important issue, and the use oftechnology to provide care at a distancewill become an Importantadvantage.


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Daily monitoring can increase thequality of life for patients and preventcostly readmissions to the hospital oremergency room. Application capabilitiesinclude tracking and trendingpatient data and recording and viev^ngnurse or physician notes. Parametersare set by the physician and the systemalarms to notify the nurse whenparameters are not within normal limits,allowing immediate intervention.contact are important, but they can beoffset by making visits that are necessarywhile still empowering patientsto be independent in their care.Telemedicine should be viewed asan adjunct, not a replacement for thenurse. With the reality of a nursingshortage, use of telemedicine reducesnursing visits while still providing

daily care for a patient. Daily knowledgehelps the nurse treat the patientbetter, improving quality of life andoutcomes for the patient.Jerant, A. (1999, September 15). Home Telemedicine: Merging the Old and New Ways..American Family

Physician, p. 1096. Retrieved November 20, 2008, from Health Source: Nursing/Academic Edition database.

Telemedicine systems are sensor devices placed in a person's home to monitor their health and well beingand to reduce accidents. As such, they can provide additional support to enable vulnerable older people,or those with long-term conditions, such as diabetes or high blood pressure, t live an independent life at home, thusreducing the need for emergency or unexpected admissions to hospital.

'The use ofmonitoringdevices in thehome has the

potentiai tocreate majortheir own health. Sf> a personwith diabetes can have theirblood sugar monitored fromhome - meaningless unexpected oremergency trips to

hospital.'theSupportThe 12 millionprogrammeannounced by thegovernmentaimst


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dispensed and thenumber of emergency hospitalbed days and admissions. It isefficiently.lelecare devices, which actas sensors in the home, alsohave a role to play. The sensorscan turn lights on and off toensure that elderly people donot have to walk around in [hedark if they need to get out ofbed during the night. They canalso raise the alarm if the persondoes not come back to bedafter a specified time, so thatiHssistance can be summoned,if needed.

ConfidenceAs part of the government'sprogramme, the pilot sites inKent, Newham and Cornwalla way to give patients greaterconfiiience and security in tbeirown homes. Such additionalconfidence may prove particularlyimportant for those whohave recently returned homeafter a stay in hospital and whoare worried about their abilityto cope on their own.The pilot projects will alsobe subject to a major independentevaluation through the

Department of Health's PolicyResearch Programme. This evaluationwill highlight the majorlessons to be learnt from thesesites, as well as enabling thegovernment to determine thebest options for implementingEden AlternativeAlternatives to nursing home placementThe Aging ProcessHow to choose a nursing homeHome Care Base ServicesNursing homes are often thought of as the only option when seeking long term care services. However, there are

alternatives available that may provide a more appropriate level of care and promote independent living.Alternatives to nursing homes include in-home careand retirement communities, as well as:

Independent living apartments. Independent living apartments are ideal for seniors who do not needpersonal or medical care but who would like to live with other seniors who share similar interests. In mostindependent living facilities seniors can take advantage of planned community events, field trips, shoppingexcursions and on-premise projects. These apartments are not licensed or regulated.

Adult homes. Adult homes are licensed and regulated for temporary or long-term residence by adultsunable to live independently. They usually include supervision, personal care, housekeeping, and threemeals a day.
http://var/www/apps/conversion/tmp/scratch_4/homecare.cfmhttp://var/www/apps/conversion/tmp/scratch_4/homecare.cfmhttp://var/www/apps/conversion/tmp/scratch_4/highlandsatpittsford.cfmhttp://var/www/apps/conversion/tmp/scratch_4/homecare.cfmhttp://var/www/apps/conversion/tmp/scratch_4/highlandsatpittsford.cfm


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Enriched housing. Enriched housing is similar to adult homes, with the exception that seniors live inindependent housing units. They offer a minimum of one meal per day and are licensed by the StateDepartment of Health.

Family-type homes. Family-type homes offer long-term residential care, housekeeping, and supervisionfor four or fewer adults unrelated to the operator. The department of Social Services oversees theiroperations.

Assisted living program (ALP). An excellent alternative to nursing homes for seniors who need help withtheir daily routines, but who do not need 24-hour care. Room, board, case management, and skilled nursingservices come from an outside agency. This program accepts Medicaid, Supplemental Security Income(SSI), and home relief recipients.

Continuing care retirement communities. Continuing care communities offer a continuum of livingoptions, from independent living, enriched living, assisted living, and skilled nursing home, all on onecampus. Residents can move from one level of care to the next as needs change. Transitions to differentlevels of care are easier because people are able to remain in familiar surroundings. In addition, spouseswho age at different paces may also remain near each other.The Highlands at Pittsford is Strong Health'scontinuing care retirement community, offering independent living in cottage and apartment homes,enriched living in Laurelwood, and skilled nursing at The Living Center.

Nursing home (or skilled nursing facility).Nursing homes offer 24-hour a day care for those who can nolonger live independently. In nursing homes, trained medical professionals provide specialized care to

seniors with severe illnesses or injuries. Specially trained staff assist residents with daily activities such asbathing, eating, laundry and housekeeping. They may specialize in short-term or acute nursing care,intermediate care or long-term skilled nursing care

Homemaker and Companion AgenciesHomemaker and companion agencies provide individuals to aid elderly and disabled individuals with general tasks.Homemakers provide assistance with routine household activities, such as cooking and cleaning. Companionsprovide assistance during trips and outings and may prepare and serve meals. By law, homemakers and companionsmay not provide hands-on personal care to a client, such as assistance in bathing or undergarment changing. Theymay not dispense medications.Homemaker and companion agencies must be registered by the state of Florida and include their registration numberin public advertisements. Some individual homemakers and companions are employees of agencies. Some arecontracted agents. Individual homemakers and companions are required to undergo criminal history checks.Complaints against the agencies may be investigated by the state of Florida, but the individuals are not licensed orinspected by the state.Continuing-Care Retirement Communities (CCRCs)Continuing Care Retirement Communities, also called Life-Care Communities, offer different levels of care basedon the needs of the individual or couple. The care level ranges from an independent living apartment or house toskilled nursing in an affiliated nursing home. CCRC residents are guaranteed care for the rest of their lives. TheCCRC residents move from one setting to another based on their needs but continue to remain a part of their CCRCcommunity. Many Continuing Care Retirement Communities have an entrance fee prior to admission as well as amonthly charge. AHCA licenses and inspects the nursing facilities, assisted living facilities, or home health agenciesthat may be part of a CCRC. The Department of Financial Services regulates the CCRC contracts.Licensed Nurse RegistriesNurse registries act as employment agencies between an individual patient and nurses, nursing assistants, homehealth aides, companions and homemakers for services in the patient's home. Each individual health care worker iscontracted with the registry. Nurse registries provide nursing care services, but they are not licensed to providephysical therapy or other therapy services or medical equipment services. Unlike home health agencies, licensed

nurse registries are not required to carry liability insurance. As the name implies, all licensed nurse registries mustbe licensed by the state of Florida and must include the nurse registry license number in public advertisements.Home Health AgenciesHome health agencies deliver health and medical services and medical supplies through visits to private homes,assisted living facilities (ALFs), and adult family care homes. Some of the services include nursing care, physicaltherapy, occupational therapy, respiratory therapy, speech therapy, home health aide services, and nutritionalguidance. Medical supplies are restricted to drugs and biologicals prescribed by a physician. Along with services inthe home, an agency can also provide staffing services in nursing homes and hospitals. Home health agencies arerequired to be licensed and inspected by the state of Florida.
http://services/seniors/Caring/highlandsatpittsford.cfmhttp://services/seniors/Caring/highlandsatpittsford.cfmhttp://var/www/apps/conversion/tmp/scratch_4/laurelwood.cfmhttp://var/www/apps/conversion/tmp/scratch_4/laurelwood.cfmhttp://www.highlandsatpittsford.org/livingcenter.htmlhttp://www.highlandsatpittsford.org/livingcenter.htmlhttp://services/seniors/Caring/highlandsatpittsford.cfmhttp://var/www/apps/conversion/tmp/scratch_4/laurelwood.cfmhttp://www.highlandsatpittsford.org/livingcenter.html


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Adult Day Care CentersAdult day care provides a protective setting that is as noninstitutional as possible. Adult day care centers offertherapeutic programs of health services and social activities such as leisure activities, self-care training, rest,nutritional services, and respite care for a portion of a day. Some nursing homes provide adult day care services.Adult day care centers are required to be licensed and inspected by the state of Florida.Adult Family-Care HomesAn adult family-care home provides a full-time, family-type living arrangement in a private home for up to five agedor disabled people who are not related to the owner. The owner lives in the same house as the residents and provideshousing, meals, and personal services; however, services vary. Adult family care homes are required to be licensedand inspected by the state of Florida.Assisted Living FacilitiesAn assisted living facility (ALF) provides housing, meals, and personal services. ALF services vary greatly in thetypes of residents served. For example, some accept residents who need assistance in bathing, others do not. AllALFs are required to be licensed and inspected by the state of Florida. Some ALFs are specially licensed to provideextended congregate care (ECC). This allows the ALF to care for residents as they become frailer in order for theresident to age in place. Some ALFs are specifically licensed to provide limited nursing services and/or limitedmental health services.HospiceHospice services emphasize comfort measures rather than aggressive curative treatment. Hospice provides acoordinated program of professional services, including pain control and counseling for patients who have a

prognosis of six-months or less to live. Counseling and support for the family members and friends of the terminallyill patient are also provided. Hospice services are predominately provided in the patient's home. However, theservices are also available in ALFs and nursing homes. Hospice providers are required to be licensed and inspectedby the state of Florida.Nursing HomesA nursing home provides nursing care, personal care, and custodial care to people who are ill or physically infirm.This is the type of facility that you will find listings for in this Guide. Nursing homes are freestanding, which meansthat they are not part of a hospital. Some nursing homes are part of a continuing care retirement community (CCRC)and are governed through special contracts. All nursing homes listed in this Guide are licensed and regularlyinspected by AHCA.Skilled Nursing UnitsSkilled Nursing Units (SNUs) are based in hospitals. They typically provide only short term care and rehabilitationservices. Some SNUs are located inside the hospital, and some are located in a separate building. The skilled nursing

unit is licensed as part of the hospital. They are regularly inspected by AHCA.Home and Community CareA person who is ill or disabled may be able to get help from a variety of home services that might make moving intoa nursing home unnecessary. Home services include Meals on Wheels programs, friendly visiting and shopperservices, and adult day care. These programs are found in most communities.If you are considering home care, discuss this option with family members to learn if they are able to help provideyour care or help arrange for other care providers to come to your home. Some nursing homes may provide respitecare and admit a person in need of care for a short period of time to give the home care givers a break.Depending on the case, Medicare, private insurance, and Medicaid may pay some home care costs that are related tomedical care.Subsidized Senior Housing (Non-Medical)There are Federal and State programs that help pay for housing for older people with low to moderate incomes.Some of these subsidized facilities offer assistance to residents who need help with certain tasks, such as shopping

and laundry. Residents generally live independently in an apartment within the senior housing complex.Assisted Living (Non-Medical Senior Housing)If you only need help with a small number of tasks, such as cooking and laundry, or reminders to take medications,assisted living facilities maybe an option worth considering. "Assisted living" is a general term for livingarrangements in which some services are available to residents who still live independently with in the assistedliving complex. In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees forthe services that they require.Board and Care HomesBoard and Care homes are group living arrangements designed to meet the needs of people who cannot liveindependently, but do not require nursing home services. These homes offer a wider range of services than


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independent living options. Most provide help with some of the activities of daily living, including eating, walking,bathing, and toileting. In some cases, private long-term care insurance and medical assistance programs will helppay for this type of living arrangement. Keep in mind that many of these homes do not get payment from Medicareor Medicaid and are not strictly monitored.Continuing Care Retirement Communities (CCRCS)CCRCs are housing communities that provide different levels of care based on the residents' needs from independentliving apartments to skilled nursing care in an affiliated nursing home. Residents move from one setting to anotherbased on their needs, but continue to remain a part of their CCRC community. Be sure to check the record of theCCRC's nursing home. Your CCRC contract usually will require you to use it. Many CCRCs require a largepayment prior to admission and also charge monthly fees. For this reason, many CCRCs may be too expensive forolder people with modest incomes.Summary of OptionsThe options discussed above may work for people who require less than skilled care, or who require skilled care foronly brief periods of time. Many people with long-term skilled care needs require a level and amount of care thatcannot be easily handled outside of a nursing home.

Assisted Living Facilities. An assisted living facility is a primarily residential setting whichoffers some supportive services for people who are able to live fairly independently but needsome assistance with medications, activities of daily living, or meals. An assisted living facilityis not primarily medical (it may or may not have professional nursing staff) and it provides less

intensive nursing and medical supportive services than a nursing home. It may be a good optionfor someone who may not be safe or comfortable living alone, even with in-home services, butwho does not yet need nursing home care.

Other Services. In addition to the specific alternatives to nursing home care setout above, there are a number of services which may help an individual stay in herhome. Such services include Meals on Wheels, a program which delivers

prepared meals to the homes of home-bound disabled persons; companion orchore services; Personal Emergency Response System electronic devices forhelp should the person fall or have a medical emergency.

Home care allows the elderly or disabled person to remain in his or her home in the community and builds upon,rather than replaces, care by relatives. It enables patients to be discharged from hospitals and avoid unneededinstitutionalization - often at less expense to the taxpayer.The average annual cost for a home-care client is $12,000, as compared with an average annual cost of $14,600 at ahealth-related facility or $29,500 at a skilled nursing facility.Home care is not intended to replace nursing-home care where that is needed, but it can provide a valuable, viableoption for some hospital patients ready for discharge. CAROL RAPHAEL, Assistant Deputy, Administrator Officeof Home Care Services, Human Resources Administration, New York, Nov. 12, 1982

A substantial number of people are accused of becoming qualified for Medicaid nursing home beds only becausethey artificially spend down their mother's or father's money or "hide" their assets with creative accounting. In orderto be eligible for Medicaid, you have to be poor, otherwise you'd have to pay private rates which are currently $35-45,000 a year. If we could reduce the number of people who are in fact artificially spending down their parent'smoney in order to qualify for a Medicaid nursing home, then these persons might be more inclined to look forcheaper alternatives given that the cost is coming out of their own pockets. Assuming that scenario, assisted livingfacilities would gain greater credibility and money because they would be a less expensive alternative.There are many aspects that are attractive but one of them is that they are increasingly providing care for physicallyand mentally frail older persons but in an environment that more closely resembles a hotel or an inn as opposed to ahospital or nursing home. Residents have their own rooms or their own little suites. They have much more freedomto come and go as they wish and they have more say in the types and frequency in which they receive services.


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They're treated less like patients and more like residents. In general, these facilities are able to deal with an olderperson's frailty in a much more home-like or humane-type setting than a nursing home.Assisted living is an attempt to give people who are frail a chance to live their own lives according to their own rulesas much as possible," says Whitney Redding, a spokeswoman with the Assisted Living Federation of America(ALFA),which represents more than 7,000 for-profit and nonprofit communities across the country.Assisted living centers cost about a third less than living in a nursing home, but they're not a cheap livingarrangement. The average cost of a private room or studio in an assisted living center in 2004 averaged $2,100 to$2,900 a month according to a review by Health Policy Tracking Services. The centers -- some of which cater topeople with Alzheimer's disease and other forms of dementia -- may also offer a range of housekeeping,transportation, personal services, and social activities. Summerville at Creekside Lodge, for example, hosts bingo aswell as health-oriented exercise classes and blood pressure screenings. And there are recreation rooms to watchtravel videos and play games or music -- something that the Vandenbergs particularly enjoy. "My husband playspool practically every day," Altave Vandenberg says.About 38 percent of all assisted living communities also offer some type of nursing service, which costs more,Redding says. But most assisted-living communities stress independent lifestyles.

There's no question that assisted living is an attractive group housing alternative, and the book will argue that there'sa strong possibility assisted living can replace nursing homes for the majority of frail elders if: we don't over-regulate them; we're careful to insure that the public has a stronger and more informed understanding of what thisalternative is about; the private sector can, to some extent, police themselves through private accreditation programs

as opposed to creating a heavy regulatory environment; and if assisted living facilities don't attempt to bite off morethan they can chew.These facilities probably won't ever be used by more than a minority of the population because of the attractivenessof home care, but nonetheless, it's an alternative that should be nurtured and supported as a long-term shelter andcare alternative for older persons who become physically or mentally frail.Advocates for senior citizens are looking for ways to attract more workers and they're also looking for alternatives tonursing homes. One such alternative is senior foster care. The system works much like foster care for kids. A familyis paid to care for up to five seniors in their home.

This new version of a nursing home is catching on. About 50 families in Olmsted County provide senior foster care.There is training required and homes must meet specific safety guidelines. The program is less expensive than anursing home would be. On average, senior foster care in Olmsted County costs $300 to $500 a month less thannursing home care.

That vignette, excerpted from the website of the Center for Health Care Strategies Inc., highlights

a basic fact of life in America: that many older and disabled adults live in nursing homes simply

because no other alternatives are available to them. The bias toward institutional care is rooted in

the foundation of Medicaid, which for years has devoted the bulk of its long-term care budget

almost exclusively to services in nursing homes and other such facilities. As a result, the $214 billion

program continues to pay for care for nearly two of every three nursing home residents.

But a confluence of factorsconsumer preference, the high cost of institutional care and court

decisions, most notably the U. S. Supreme Courts 1999 ruling inL.C. & E.W. vs. Olmstead, which

held that disabled people must be cared for in the community if they wish, assuming that such a

setting is appropriate to their needs and that the state in which they live can afford itis slowly but

surely eroding the bias. In FY 1990, for example, 90 percent of Medicaid long-term care dollars

were allocated to institutional care (nursing homes and intermediate care facilities for the mentallyretarded) and 10 percent to home and community-based services. By 2001, the gap had narrowed,

to 71 percent and 29 percent respectively. Since 1993, nursing home occupancy rates nationally

have also declined.

To encourage the trendand save money for Medicaid in the bargainstates are experiment-

ing with a variety of programs that provide services and supports at home or in the community, so

that frail elders and people with disabilities can avoid institutional care for as long as possible. Two

of the latest vehicles: nursing home transition grants, which let states shift residents from nursing


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homes into the community or divert unnecessary placements by intervening during hospital dis-

charge planning, and nursing home conversion grants and loans, which help the homes transform

themselves into assisted living facilities or offer alternatives such as respite care and adult day care.

Betty Ann Shaughnessys move, for instance, was facilitated by a $100,000 Olmsteadplanning

grant, awarded by the center as part of a larger seven-state, $700,000 program funded by the

RobertWood Johnson Foundation. According to the centers summary, the project confirmed forUtah officials that a lack of accessible, affordable housing is the greatest barrier to transition for

those currently residing in nursing homes or in swing-bed hospitals, or facilities that are allowed

to redefine acute-care beds as long-term care beds as need dictates. As of last January,it reported, the

states Division of Health Care Financing had helped 30 people move out of nursing homes into

more integrated community settings.

The high cost of nursing homes and the desire of folks to live in the community have also

prompted the federal Centers for Medicare and Medicaid Services (CMS) to channel money into

the nursing home transition grant program, according to Mary Fran Laverdure, a CMS health

insurance specialist. Since its inception in 1998, the program has awarded funds to a total of 27

states and over time, both the size of the grants and the number of grantees have grown, from

$160,000-175,000 to each of 4 states in year one to $550-800,000 to each of 11states this year.COVER STORY

1

Though most people in nursing

homes would like to be someplace

else, in-home and community care

options are few. States are changing

that by diverting patients or

letting homes offer other services.

BEHAVIORAL HEALTH NEWS 2

More patients with depression are

turning to their primary care

physicians, who often arent trained

to diagnose and treat the disease. A

look at Colorados efforts to help.

HIGHLIGHTS

3

FL Medicaid Rx drug decision

Insurance costs NM HIFA

waiver MS malpractice session

List of questionable docs AL

plan for abused women Studies

on women and exercise OH,

NYC smoking bans Drug abuse

survey Kids and marijuana

ER drug visits IL assisted living

facility licenses.

TRACKING TRENDS 7

Despite a return of double-digit

increases, health insurance has been


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largely a back-burner issue this year.

FYI

8

Police in Minneapolis are receiving

comprehensive training on dealing

with mentally ill in everydaysituations and tense confrontations.

Page 2

5

S

TATE

H

EALTH

N

OTES

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EPTEMBER

23, 2002

[Nursing Home Care, p.6]

NEW JERSEY: COMMUNITY CHOICE

One of the first and largest of the CMS-

sponsored programs is New JerseysCommu-

nity Choice. Started in March 1998 by the

Department of Health and Senior Services

with a small infusion of state funds, the pro-

gram provides nursing home residents and

hospital patients with information on in-home

services, housing alternatives and community

resources. In the past, nursing home admis-

sion was a one-way ticket, explained Rebecca

McMillen, the programs coordinator. We

didnt want that to continue.

Through June of this year, more than

4,000 people have made the move from nurs-

ing homes back into the community, said

McMillen. The majority of those who did so

were elderly, and most went back to their

own homes or families though some went to

senior housing projects. In order to make sure

none of the states 350 nursing homes are ex-

cluded, the program employs 29 counselors

and 60 preadmission screening nurses to help

guideresidents through the transition process.

The federal support has enabled the pro-

gram to grow. In 1999, Community Choice

received a $500,000 grant from CMS, en-


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abling it to hire three project specialists to

help with marketing, identifying barriers and

assuring quality of care. With a renewed grant

of $600,000 this year, it will expand its fo-

cus to help younger people with disabilities

move back into the community.Though the program is widely seen as a

success, not everyone has been happy with

it. At first, McMillen said, the nursing home

industry perceived [us] as an enemy. Toease

tensions, the counselors did presentations on

the program to nursing home staffs, explain-

ing that the purpose was not to empty beds

but rather to give people who didnt belong

in the home more choices.

Addressing the nursing home transition

program in general, Janice Zalen, director ofspecial programs for the American Health

Care Association, which represents 12,000

providers of assisted living and nursing, resi-

dential and subacute care, said the industrys

biggest concern isntthe downsizing of nurs-

ing facilities. We believe that people should

live in the least-restrictive setting. Whatsob-

jectionable, she said, is the counselors wan-

dering in and looking for people to talk to

because, after all, they are in peoples homes.

It would be better if such decisions could be

Nursing Home Care, from p. 1

Conference Slate

Third International Conference on Family

Care: Empowerment Through Innovation.Oct.

12-14. Arlington, Virginia. Hosted by the

National Alliance for Caregiving, conference

topics include family care around the world;

eldercare; care for people with mental illness

and disabilities; grandparents caring for grand-

children; and caregiving by young people.

For additional information, call (301) 718-8444.

Surviving Adversity: A Critical Access Hos-

pital Conference. Oct. 9-11, Kansas City,

Missouri. Sponsored by the National Rural

Health Association, the meeting will feature

discussions on recruitment and retention;

benchmarking for success; and financing, in-


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cluding maximizing reimbursement and fa-

cility/equipment replacement. Questions?

Goto http://www.NRHArural.org or call the

association at (816) 756-3140.

24

thAnnual Meeting of the Society for Medi-

cal Decision Making. Oct. 19-23, Baltimore.

Jointly sponsored by the Society and the

George Washington University Medical Cen-

ter, the meetingstheme will be genomics and

decision making, with a panel discussion on

the impact of the genomics revolution on

diagnostic testing and therapy decisions. For

information, call (202) 994-8929 or go to

http://www.smdm.org

In PrintIn Our Hands: How Hospital Leaders Can

Build a Thriving Workforce. Prepared by the

American Hospital AssociationsCommission

on Workforce for Hospitals and Health Sys-

tems, the report is aimed at helping hospitals

deal with current and coming health care

workforce shortages. Its five key themes: fos-

tering meaningful work; improving work-

place partnerships; broadening the base of

health care workers; collaborating with oth-

ers; and building societal support. For de-tails, go to http://www.asahp.org/newsacross

theprofessions.htm

The Medicare Payment Advisory Commit-

tee has released two reports to Congress:Medi-

care Payment to Advanced Practice Nurse and

Physician Assistants andMedicare Coverage of

Nonphysician Practitioners, including surgi-

cal technologists, mental health service pro-

vides and clinical pharmacists. For additional

information, go to http://www.medpac.gov

Barriers to Medicaid Enrollment for Seniors:Findings from 10 Focus Groups with Low-In-

come Seniors. Published by the Henry J. Kai-

ser Family Foundation, the report is an effort

to understand why low-income elderly who

are eligible for Medicaid do not enroll. In

addition to describing seniors experiences

with the health care system and how well


15/23

programs like Medicaid are working for them,

it offers a list of strategies for removing the

barriers and increasing enrollment. Toobtain

a copy of the report, (publication #4029),

go to http://www.kff.org

On TapeHeart-to-Heart: Improving Care for the

Dying Through Public Policy.Produced by the

Midwest Bioethics Center and Last Acts,the

two-part audio series is directed at the infor-

mation needs of state policymakers. PartI fo-

cuses on painmanagement,exploring barriers

doctors face in easing pain and identifying po-

tential policy solutions. Part II describes the

achievements of public officials in three state

a legislator, an attorney general and a cabinet

officerin providing leadership in the area.Order copies by calling (800) 989-9455

SAVE THE DATE!!

NCSLs Sixth Annual Health Conference

will take place Nov. 17-19 in New Or-

leans. Among concurrent sessions: the state

of emergency rooms; cancer screening pro-

grams; state environmental health services;

the link between chronic disease and the

environment; the dentist shortage; path-

ways to prevention; childhood obesity;

challenges to treating mental health andsubstance abuse; prescription drug costs

and coverage; Medicaid costs and cover-

age; long-term care costs; nursing home li-

ability; health insurance affordability; and

more. For details, visit http://www.

ncsl.org/programs/ health/health.htm or

call Joanne Stroud at (303) 364-7700.

Page 3

6

S

TATE

H

EALTH

N

OTES

- S

EPTEMBER

23, 2002


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ADVISORY BOARD

Rep. Charlie Brown, Indiana

Rep. Dianne White Delisi, Texas

Kurt DeWeese, Speakers staff, Illinois

Rep. Susan Gerard, Arizona

Rep. Peter Ginaitt, Rhode IslandDel. Marilyn Goldwater, Maryland

John Kasprak, Senior Attorney,

Connecticut Legislature

Sen. William Martin, North Carolina

Sen. Sandy Praeger, Kansas

Sen. John J.H. Schwarz, Michigan

RESEARCH & EDITORIAL STAFF

Dick Merritt

Forum Director

Linda Demkovich

EditorAnna C. Spencer

Assistant Editor

Contributors: Donna Folkemer, Wendy Fox-Grage,

Shelly Gehshan,Tim Henderson, Johanna Keely, Kala

Ladenheim, Jordan Lewis, Greg Martin, Anna B.

Scanlon,Tara Straw

Published biweekly (24 issues/yr.) by

the FORUM FOR STATE HEALTH

POLICY LEADERSHIP, an

information and research center at the

National Conference of State Legislatures

in Washington, DC.

For more information about Forum

projects, visit our web site at:

www.ncsl.org/programs/health/forum

HEALTH POLICY TRACKING SERVICE

M. Lee Dixon

HPTS Director

Staff: Deirdre Byrne, Allison Colker, James Cox,

Eileen Crean, Teresa Floridi, Patrick Johnson, Lillian

MacEachern, Rachel Morgan, Stephanie Norris,

Carla Plaza, Rachel Tanner

EDITORIAL INQUIRIES

Linda Demkovich, Editor

Tel: 202-624-5400 Fax: 202-737-1069

email: [email protected]

CUSTOMER SERVICE & SUBSCRIPTIONS

NCSL, 1560 Broadway, #700, Denver, CO 80202

Tel: 303-830-2200 Fax: 303-863-8003


17/23

Nursing Home Care, from p. 5

made prior to the residents placement in

the institution.

Since the establishment of Community

Choice and the implementation of an assisted

living Medicaid waiver program, New Jerseyhas experienced a slight decline of several

thousand Medicaid nursing home residents,

said McMillen. The number of nursing home

beds hasnt dwindled, however, because the

aging population continues to grow.

As for anticipated cost savings, We are

trying to gather that information, she said,

though a back-of-the-envelope calculation

looks like this: The Medicaid nursing home

per diem is between $3,000-$3,500 per resi-

dent per month compared to $1,800 for as-sisted living facilities. That means moving an

individual could net savings of $1,200-

$1,700. And as McMillen observed, there is

even more potential for savings because most

people whove benefited from Community

Choice have moved back into their own

homes, not into assisted living. The programs

focus, though, has been on improving qual-

ity of life, not cost savings, McMillen in-

sisted. Dignity, choice and options are what

we are all about.

An evaluation of Community Choice by

Rutgers Universitys Center for State Health

Policy will be released soon. Indeed, CMS

requires all state grantees to build in a strong

evaluation component, and an initial compara-

tive analysis of the 12 FY 2001 grantees by the

Research Triangle Institute is due to be com-

pleted this month; over the lifetime of the

grants, the institute will prepare a series of

reports, which will then be published on the

agencys website. In addition, the MedStat

Group, a subcontractor to the institute, is pre-

paring case studies on several of the programs.

Though the evaluation is still in the

works, 1,300 people are supposed to be

transitioned or diverted for the FY 2001

grantees alone, CMS Laverdure said. Because

of tight budgets, however, some states were


18/23

reluctant to target a [specific] number, which

means the numbers who benefit from the

grants could exceed the preliminary estimate.

NEBRASKA: MAKING CONVERTS

With much the same goals in mind, three

states in the MidwestIowa, Nebraska andNorth Dakotahave initiated nursing home

conversion programs, offering grants and/or

low-cost loans that allow the facilities to make

a transformation to assisted living or to pro-

vide other alternatives, like respite care and

adult day care. Unlike transition grants, con-

version grants are solely state-financed, and

homes voluntarily apply for the funds. The

option serves a real need, especially in rural

areas where itshard to support free-standing

assisted living because of a dearth of resi-dents and workers, observed Lyn Bentley,

senior policy director at the National Center

for Assisted Living.

The Legislatures decision

to create the program in

the economic boom years

of the 1990s was

fortuitous.

In Nebraskawhich has had the most

experience and the most success of the three

statesthe Legislature created the NursingFacility Conversion Cash Fund in 1998 as a

follow-up to a 1996 Department of Health

study on the state of the stateslong-term care

system. Targeted to low-density rural areas, the

goal was to give nursing home owners finan-

cial incentives to incorporate assisted living and

adult day care into their existing business in

order to maximize their cost-effectiveness.

To qualify for the fundsa maximum

grant of $52,000 per assisted living unit, up

to a total of $1.1 millionowners agreed toreserve 40 percent of the newly constructed

units for Medicaid-eligible residents, reduce

licensed nursing home beds by at least the

number of assisted living units created and

run as an assisted living facility for 10 years.

In addition, applicants were required to come

up with a 20 percent match, which dissuaded


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a number of facilities from applying for the

funds. The money could be used for start-up

costs, construction, training expenses and

first-year operating losses.

Over the life of the programthe last of

threerounds of applications closed more thana year agothe state awarded $52.5 million

to rural homes to convert wings or entire fa-

cilities. According to Medicaid Director Bob

Seiffert, that has resulted in a total of 74

project conversions, yielding 967 new assisted

living units, 16 respite care suites and 27

adult day care programs. (Once an applica-

tion has been submitted, it takes about 18

months between design and completion,

which means construction on the last of the

projects should wrap up bythe end of this year.)From a financial standpoint, the program

appears to have met the Legislatures objec-

tive of reducing the cost of care for Medic-

aid-eligible residents. The state projects $5.5

million in savings to Medicaid, said Seiffert,

taking into account the $31 per patient day

differential between nursing home ($68) and

assisted living ($37) costs.

In addition, nursing home occupancy

has dropped 12.5 percent over the time of

the program, though he noted that several

other factorsmany more assisted living fa-

cilities in urban areas of the state, for instance,

and other services under the states broader

Medicaid home and community-based ser-

vices waiveralso contributed to the decline.

From a consumer satisfaction standpoint,

on the other hand, the conversion program

certainly doesnt meet all the need, Seiffert

admitted. There are, he estimated, 25 to 35

communities that could have benefited from

it but that for one reason or another chose

not to apply. Still, he said, it goes a long

way in offering residents of some rural areas

an otherwise unavailable luxuryof assisted

living. Call it luck or call it what you will,

but the Legislatures decision to create the

program in the economic boom years of the

1990s was fortuitous. Given todays devas-


20/23

tating deficit, its highly unlikely wed be

able to get it off the ground. Timing, as they

say, is everything.

WFG

Before deciding on a nursing home, you may want to consider other options. ome people have an aversion tonursing homes and want to try out almost anything else before they go into one. Others do not necessarily need the

24-hour, total supervisory care of a nursing home. Even for someone who cannot live independently and needs a highlevel of care, however, there are lternatives, and it makes good sense to understand and evaluate them.Alternatives will vary widely depending on whether you live in a city, a suburb or a rural area. Generally, people inrural areas have fewer options than those in cities or suburbs. Some of the alternatives to nursing homes may includethe followingCOMMUNITY SERVICESThese can include transportationservices, telephone reassuranceprograms, home maintenanceand repair services, senior centers,Meals on Wheels programsand home observation programs.

ADULT DAY SERVICESThese programs offer all-day,morning, afternoon and sometimesevening care for seniors.HOMEMAKING AND PERSONAL CARE SERVICESThese provide assistance withhomemaking (such as cookingand cleaning) and personal care(such as dressing and bathing).SUBSIDIZED, NONMEDICAL SENIOR HOUSINGSome federal and state programssubsidize housing for low-tomoderateincome seniorsoffering assistance with

shopping, laundry and cleaning. Usually,residents live in independentapartments within a largercomplex.HOME HEALTH CARESemi-skilled and skilled servicesare available, for a few hours aday or 24 hours a day, for peoplewho need medical care athome.ASSISTED LIVING FACILITIESGenerally unsubsidized, assistedliving facilities charge a regular

monthly rent, with fees chargedfor any special services. Assistancemay include help withtasks like cooking, laundry orremembering medications.BOARD AND CARE HOMESThese group-living arrangementsprovide some care services aswell as opportunities for socialization.They often provide help


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with some daily activities, likeeating, walking, bathing andother general personal caretasks. The homes are usuallynot covered by Medicare orMedicaid, and often they arenot strictly monitored by Stateor Federal agencies. Under somecircumstances, they may becovered by private long-termcare insurance or other medicalassistance programs.During the past 10 to 15 years, an increasing number of elderly persons began living in settings that are neithertraditional home settings nor traditional nursing homes. There has been a proliferation of facility-like residentialalternatives to nursing homes. These settings go by various names including assisted living facilities, continuing carefacilities, retirement communities, staged living communities, age-limited communities, etc. For simplicity in thisarticle we will refer to all these types of living arrangements as elderly groupIn February 2006, another lawsuit accused the state of Connecticut of forcing psychiatric patients into nursinghomes when community living would provide more suitable alternatives. Connecticut Lt. Gov. Kevin Sullivan ischampioning efforts to make sure that individuals with mental illnesses are placed in community-based care rather

than nursing homes. Nursing home beds are far more costly than home or community care, Sullivan notes. Thesituation that prompted the lawsuit is "wrong as a matter of law and as a matter of smart public policy," he says."Nursing homes do not provide effective care and recovery for the nongeriatric mental health patients who aretrapped there." And it shouldn't take a lawsuit to make Connecticut do the "right thing," Sullivan adds.Many family members, unfamiliar with the full range of aging services available, assume that nursing homeplacement is the only alternative when an older person is unable to manage their own care at home. While that issometimes the right solution, a good assessment process could ensure no better alternative exists before that decisionis made.

Types of Aging Services AvailableThere is a wide range of services and housing options available for older persons. The brief descriptions will assistyou in determining what degree of care or type of service you or your loved ones need.

Senior Housing/Independent LivingYou may want to think about senior housing if you want to live on your own, but don't want to have all the choresthat go along with having a home. It's also a great option for people who want to live in a community with otherseniors.

Depending on the community you choose, you can rent an apartment either at the market rate or if your income levelapplies, a lower rate. They are often specially designed with things like railings in bathrooms or power outlets higherup on the wall. They may also offer a 24-hour emergency call service if residents need help right away. Some placesmay also offer different kinds of services to the people who live there like meals, transportation, social activities andother programs. Search for Not-for-Profit Aging Service Providers

Continuing Care Retirement Communities (CCRCs) are multilevel continuums that bring various levels of caretogether, often on one campus, so that residents can stay in the same community as their needs change. CCRCs offertheir residents a contract that generally secures living accommodations and services. There are three common typesof contracts: 1) unlimited nursing care for little or no substantial increase in the usual monthly payments; 2)specified amount of nursing care beyond which the resident is responsible for payment; 3) residents pay full dailyrates for all long term nursing care required.Search for Not-for-Profit Aging Service Providers

Assisted Living Residences combine apartment-like living with a variety of support services including meals,
http://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1


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assistance with personal care, housekeeping, laundry, social and recreational programs, oversight of residents selfadministration of medication, 24-hour security, and on-site staff to respond to emergencies. In Massachusetts,Assisted Living Residences are regulated by the Executive Office of Elder Affairs. Most assisted living residencesare paid for privately, while some accept payment for eligible residents through Medicaids Group Adult Foster Careprogram. Some long-term care insurance policies also pay for assisted living.Search for Not-for-Profit AgingService Providers

Rest Homes / Residential Care Facilities provide housing, meals, 24-hour supervision, social and recreationalprograms, administration of medications, and personal care to individuals who do not routinely require nursing ormedical care. In Massachusetts, residential care facilities are licensed and regulated by theDepartment of PublicHealth. Public assistance through the Supplemental Security Income (SSI) program and Emergency Aid to Elderly,Disabled and Children (EAEDC) is available at some residential care facilities for individuals who cannot afford topay for their care privately. In addition, some long-term care insurance policies may pay for residential care. Searchfor Not-for-Profit Aging Service Providers.

Nursing homes, Nursing homes offer round-the-clock care if someone is too sick to live on their own, or if they needto recover after having an illness or operation. Some people stay for a short time in a nursing home and then gohome. Other people may be sicker and need more care for longer. Some nursing homes have special units for

residents with dementia or Alzheimer s disease. In Massachusetts nursing homes are licensed by the Department ofPublic Health. Some residents or their families pay for nursing home care out of their own private funds or withprivate long-term care insurance. Others, who have limited finances or who spend-down their finances on theircare become eligible for Medicaid. Medicare covers some nursing home care in limited circumstances following ahospitalization. Search for Not-for-Profit Aging Service Providers.

Like most people, you probably want to stay in your home for as long as possible. But you may also need help andsupport to stay there. That's where Home and Community-based services (HCBS) can help you. HCBS providerscan offer everything from help with the chores to health care services, or even just someone to call and check in onyou. Also, if you are taking care of a family member or friend, these services can give you the help and support thatyou need as well.

While there are many different services available, not every community has them.The Executive Office of ElderAffairsor your localAging Service Access Pointcan provide you with more information.

Adult Day Care: Provides a variety of health, social and related support services in asafe setting during the day. Some day care programs are designed especially for peoplewith Alzheimer's disease. Care Managers: Helps people figure out what services are needed and what services.Together, managers and their clients come up with a care plan that best fits anindividual's lifestyle and arranges the services. Congregate Meal Programs: Offer free or low-cost meals in group settings (often in a

senior center or senior housing). Financial Counseling Programs: Help an individual balance a checkbook, file taxesand pay bills. They also help with Medicaid, Medicare or other insurance forms. Friendly Visiting: Provides volunteers who will come to visit and talk in a person'shome. Home Health Care Services: Includes part-time nursing services, personal care, helpwith chores, medical supplies or equipment and different kinds of therapies (physical,occupational, and speech) to help a person recover from an illness or surgery.
http://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://www.mass.gov/dph/http://www.mass.gov/dph/http://www.mass.gov/dph/http://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://www.mass.gov/dph/http://www.mass.gov/dph/http://custom/providers/?pageid=3288&showTitle=1http://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://www.800ageinfo.com/map/http://www.800ageinfo.com/map/http://www.800ageinfo.com/map/http://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://www.mass.gov/dph/http://www.mass.gov/dph/http://custom/providers/?pageid=3288&showTitle=1http://custom/providers/?pageid=3288&showTitle=1http://www.mass.gov/dph/http://www.mass.gov/dph/http://custom/providers/?pageid=3288&showTitle=1http://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eeldershttp://www.800ageinfo.com/map/


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Homemaker or Chore Services: Helps with different chores around the house, such ascleaning, preparing meals or doing laundry. They also help with harder tasks such aswashing floors, windows and walls and shoveling snow. Hospice Care: Provides comfort, nursing care and other services, such as griefcounseling, to people who are dying (and their families). Hospice care is provided in your

home, in a nursing facility or in a free-standing hospice. Home-Delivered Meals: Bring meals in to individuals if they cannot prepare them ontheir own. Personal Care Services: Provide help with things like bathing and dressing. Respite Care: Gives families a break from caring for older people who are unable tocare for themselves. Respite care can take place in the older person's or caregiver's home. Transportation Services: Helps people get to and from shopping centers, doctor'sappointments, senior centers and other places.

Documents

Alternative 2 Nursing Home Cite