Bathing Disability In Elderly Strong Predictor Of Long-Term Admission To Nursing Homes

Researchers at Yale School of Medicine have found that persistent bathing disability among the elderly can increase the risk of long-term nursing home admission by 77 percent, but interventions aimed at prevention and remediation could reduce the need for these long-term care services.



The results are published in the August issue of Gerontology: Medical Sciences. Disability in bathing-the need for personal assistance to wash and dry one's whole body-is highly prevalent in older persons and is a strong predictor of morbidity and mortality. It is also the primary reason why older persons receive nursing aide assistance in the home.



Thomas Gill, M.D., professor of medicine and epidemiology and public health at Yale School of Medicine and colleagues conducted a longitudinal study of 754 community-living residents of New Haven aged 70 and older. These participants were non-disabled in four essential activities of daily living. They were followed with monthly telephone interviews for over six years to determine the occurrence of persistent (present for at least two consecutive months) disability in bathing and the time to the first long-term nursing home admission, defined as longer than three months.



Gill and his co-authors found that 15 percent of study participants had a long-term nursing home admission. At least one episode of persistent bathing disability occurred among 52.2 percent of participants with a long-term nursing home admission and 32.8 percent without a long-term admission. The occurrence of persistent bathing disability increased the risk of long-term nursing home admission by 77 percent. This elevation in risk accounted for several other factors including the occurrence of persistent disability in other essential activities of daily living, and was not observed for short-term nursing home admissions.
"The results show that the occurrence of persistent bathing disability is strongly associated with the risk of long-term nursing home admissions," said Gill, who is the recipient of a MERIT award from the National Institute on Aging. "Interventions directed at the prevention and remediation of bathing disability have the potential to reduce the burden and expense of long-term care services. Identifying potentially modifiable risk factors for bathing disability should be a high research priority."



The results are part of the ongoing Yale Precipitating Events Project (PEP), which seeks to better understand how older persons manage day-to-day activities and remain independent at home. Titled "Epidemiology of Disability and Recovery in Older Persons," the PEP study includes 754 participants age 70 or older from the Greater New Haven area.



Other authors on the study include Yale researchers Heather G. Allore and Ling Han.



The research was supported by grants from the National Institute on Aging.



Citation: J. Gerontol. Med. Sci., Vol. 61A, No. 8 (August, 2006)



# # #



Yale News Releases are available via the World Wide Web at yale/opa

For further information please go to:
Yale University

NHS Central Lancashire Pioneers New Home Health Monitoring Technology For Chronically Ill Patients

NHS Central Lancashire's community matrons have introduced an innovative remote patient care management tool to help chronically ill patients in Preston monitor and manage their health at home and remain independent for longer.


The technology is currently being piloted with 40 patients with chronic obstructive pulmonary disease (COPD) - a serious and incapacitating condition which affects over 3.7 million people in the UK and typically causes acute shortness of breath and susceptibility to lung infections. If successful, NHS Central Lancashire aims to expand the programme to help patients with other chronic illnesses such as diabetes, hypertension and heart failure across central Lancashire.


The Intel Health Guide was designed and developed by Intel to address the challenges of chronic conditions for patients, their families and the healthcare professionals responsible for their care. The device, currently available in the US and UK through GE Healthcare, allows patients to measure their vital signs such as blood pressure, pulse and weight, and respond to questions about their diseases on a daily basis, with all data reviewed by the community matron team. The technology, which also includes a videoconferencing capability enabling patients to talk with community matrons, allows the care team to assess the patient for signs that their condition is worsening. The hope is that early recognition and treatment of a change in symptoms will reduce the need for admissions to hospital. The technology also helps patients to manage their own condition, look out for particular symptoms and take medication at the right time.


Anne Walton, NHS Central Lancashire's community matron locality lead, said: "I am very excited to be leading on this project. My team and I have been working very hard to get this pilot up and running and we are getting lots of positive feedback from patients.


"This new technology allows patients to take a more active role in their own care and to learn more about their own condition. This will hopefully teach them how to spot signs of symptoms so they can act sooner to avoid being admitted to hospital.


"If this pilot is deemed a success it will potentially open up a new way of working for community matrons and other services, helping to improve the existing quality service we provide to our patients."


Jackie Vella, Preston Breatheasy Group's chair, said: "I personally think this new technology is fantastic and is a real step forward. I think it will be well received by patients. I know if I was offered it I would jump at the opportunity to be involved in this pioneering pilot."


The pilot - which started in June 2010 - will run for 12 months across Preston and will be evaluated at regular intervals to assess how the technology is helping improve patients' quality of life, their general satisfaction with the equipment and the opinion of carers.















Joe Rafferty, NHS Central Lancashire's chief executive, said: "This pilot fits with our pledge to ensure that the people of central Lancashire are treated using the most appropriate technology. We know that people would much rather receive care and treatment at home rather than have to make frequent trips to hospital. It is a win/win situation for our chronically ill patients and community matrons."


Richard Rees-Davies, GE Healthcare's Home Health UK general manager, said: "The increasing cost and burden of chronic disease is a huge problem in the UK and one which is only likely to intensify. This is where new health technologies like the IntelO Health Guide can make a real difference by extending care from the hospital to the home. In particular it will help to improve access, increase quality and reduce the cost of healthcare bringing benefits to patients, health practitioners and the health service.


"The trial with NHS Central Lancashire is an extension of our alliance with Intel to drive new models of care including more personalised care at home. Our experience with the IntelO Health Guide in the US shows that it can have a positive impact on many types of chronic disease. At NHS Central Lancashire we have also seen the benefits of collaboration working with the health trust to ensure the effective roll-out of the technology."


Case Study



Dennis Winder, 68, from Fulwood, Preston has had COPD for the past 25 years.



"My illness is getting progressively worse year on year," he said. "There are things I could do a year ago which I cannot do today. It is a very restrictive illness and can stop me from doing the things I love. I can't play in the park with my grandchildren or go out socialising down the pub as much I used to. I love my garden but I have to rely on my wife Stella to mow the lawn as I get short of breath pushing the lawn mower.



"I try not to let it interfere with my life too much. Life is for living. It's Stella who suffers most. She is the one who keeps me going. I don't know what I would do without her at times.


"The equipment is brilliant and very easy to use. It keeps me in constant contact with the community matron team while not being intrusive. If the matrons think there is a problem they give me a call to check I am ok. There was an occasion the other week when my measurements went up and John, my community matron, was round my house in no time to check on me.



"I find the educational videos are useful and I feel that I now have more contact with the matrons, even though it is not always face-to-face. It gives me and Stella peace of mind to know we are not alone and help is as hand."



Stella, 66, added: "In the past I have had to keep a close eye on Dennis and I felt it was my decision as to when to get in touch with the community matrons. I felt that I didn't want to be a nuisance to them and so quite often left it too late to get in touch. This would result in Dennis having to be admitted to hospital.



"This new system is a great relief to me as it is shares the decisions with the professionals. This way Dennis is treated sooner and before things get worse.



"I have also found that I am learning a lot about Dennis' condition too. Looking at his vital signs every day I can see the trends, which can indicate his symptoms are changing and can ensure action is taken.



"This technology is amazing and I am looking forward to seeing what the future holds."

Dementia Load On Carers Lessened By Computerized COACH

An artificial intelligence coaching system has been developed that will help carers of older adults with moderate dementia. The COACH system (Cognitive Orthosis for Assisting aCtivities in the Home), described in the open access journal BMC Geriatrics, uses a camera and computer to deliver interactive advice - lessening the workload on often-overburdened carers.



Alex Mihailidis led a team of researchers from the University of Toronto, Canada, who tested the COACH's ability to help a group of six older adults with dementia remember how to wash their hands. Mihailidis said, "COACH employs various computer vision and artificial intelligence techniques to autonomously provide the user with verbal and/or visual reminders as necessary during their activities of daily living".



When COACH was used, the participants with moderate dementia showed an increase in the number of handwashing steps they were able to complete without assistance from the caregiver as well as a decrease in the number of times they required assistance from the caregiver during the activity.



COACH uses a camera to monitor the care recipient's progress and delivers relevant advice, either through speakers or on a television screen. According to the authors, "To be useful to both a person with dementia and their caregivers, a coaching device must be automatic and not require feedback like button presses, as this cannot reasonably be expected of the target audience or their overworked caregivers. Cognitive assistance should be personalized and appropriate to the deficits in question. Finally, assistance should only be given when needed to minimize confusion and keep the user as involved in the task as possible".



When the COACH system believes that a mistake has been made, a pre-recorded prompt is played. COACH gives the relevant advice, sometimes accompanied by an illustrative video, recorded from the point of view of the person doing the task. The authors found that of the five test subjects with moderate dementia, four were independent of human caregivers while the device was used. The other subject with moderate dementia notably and consistently failed to use soap, even when she received the correct prompts.







Notes


1. The COACH prompting system to assist older adults with dementia through handwashing: An efficacy study

Alex Mihailidis, Jennifer N Boger, Tammy Craig and Jesse Hoey

BMC Geriatrics (in press)


Article available at journal website: biomedcentral/bmcgeriatr/


All articles are available free of charge, according to BioMed Central's open access policy.



2. BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of health care in older people. BMC Geriatrics (ISSN 1471-2318) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE and Google Scholar.



3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

Hospital At-Home Programs Provide Similar Patient Outcomes

For select patients, hospital at home treatment produces similar outcomes to inpatient care at similar or lower costs, found a study by researchers from the United Kingdom and Italy to be published in CMAJ cmaj.ca/press/pg175.pdf.



Hospital at home programs are popular alternatives to hospital stays given the demand for acute care beds and the need to cut costs.



The study, a systematic review and meta-analysis, sought to determine whether patients receiving at home care compared with in-patient hospital care have better or equivalent health outcomes. It looked at trials of patients 70 years of age or older with chronic pulmonary disease (COPD), stroke patients and older patients with acute medical conditions.



"Patients allocated to hospital at home had a significantly reduced risk of death at 6 months follow up," state Dr. Sasha Shepperd and coauthors. "This reduction was not significant at 3 months, possibly reflecting the lower number of events by that time point." They note patient satisfaction was high for treatment at home.



However, mortality rates were lower at 3 months for patients in hospital stroke care units compared with hospital at home care.



"Our findings do not mean that hospital care is hazardous," cautions Dr. Shepperd who led the team of researchers. "More work needs to be done to determine if there are particular types of patients who benefit from hospital at home care. This is especially important, as the level of treatment available to a person at home, and the ways of delivering care in both the home and the hospital, change."



Professor Mike Clarke, another member of the research team, from the UK Cochrane Centre, adds "We are also cautious because we had to rely on data from trials that have been published, and we were not able to find any unpublished trials. It may be that other research has taken place and that the trials we identified are not representative of all those that have been done. However, our findings still represent the most complete analysis yet of this topic and provide important knowledge for patients, doctors and policy makers."



The study was conducted by researchers from University of Oxford; University Hospital Aintree Hospitals NHS Trust; University College, London; King's & St. Thomas' School of Medicine; University of Leicester; and University of Torino, Italy.



In a related commentary cmaj.ca/press/pg156.pdf, Dr. Bruce Leff of Johns Hopkins University School of Medicine writes: "We must incorporate hospital at home into the continuum of care without it becoming yet another siloed health care delivery model." He suggests hospital at home could operate as one element in a portfolio of options to keep select patients out of hospital and to help patients' transition from hospital.

$1.9m To Improve Care For Thalidomide Survivors In Wales

First Minister Carwyn Jones announced on Friday ??1.9million for the Thalidomide Trust to improve the care and support for thalidomide survivors in Wales.


The funding which will be available from April will be distributed amongst survivors to help meet their health needs and minimise any further deterioration of their condition.


This funding will be in addition to ??20million announced by the Department of Health last month for the Thalidomide Trust for a pilot scheme to support thalidomiders, as they refer to themselves.


Between 1958 and 1961, the drug, thalidomide, was used by expectant mothers to control symptoms of morning sickness. Tragically, this led to many babies being born with often severe physical disabilities. There are 31 thalidomiders in Wales.


The First Minister, who will meet thalidomide survivors in Gorseinon, Swansea today, said: "I believe that addressing the ongoing needs of thalidomiders rests with the UK Government as it authorised the use of thalidomide. While survivors in Wales will have access to a share of the funding announced by the Department of Health, I wanted to provide additional funding to ensure that people affected by thalidomide in Wales receive the care and support they need.


"I am pleased that the UK Government has expressed its sincere regret and deep sympathy for the injury and suffering endured by all those affected
when expectant mothers took the drug between 1958 and 1961.


"The funding I am announcing today will help thalidomiders manage the continuing and increasing health needs as they get older.


"We will be working with the Thalidomide Trust on how this funding will be distributed to maximise the benefits for individuals."


Nick Dobrik, representative of the National Advisory Group for the Thalidomide Trust and leading campaigner, said: "On behalf of the thalidomide community, we would like to thank the Welsh Assembly Government for its speed and generosity in contributing to helping thalidomiders maintain their independence."


Source
Welsh Assembly Government

Patients With Medical Homes Receive Better Primary Care At No More Cost

A one-year evaluation at Group Health Cooperative is the first to demonstrate the measurable benefit to both patients and staff when a primary care practice adopts a "patient-centered medical home" model. This model gives patients more time with doctors, more preventive care, and improved collaboration among caregivers. The September 2009 American Journal of Managed Care will publish the results - which include significantly fewer emergency room visits and hospitalizations.



Much national attention is focused on the medical home model as a way to improve health outcomes, control costs, and help solve the U.S. shortage of primary care (from generalists). A medical home provides expanded primary care that is personalized, focuses on prevention, actively involves patients in making decisions about their care, and helps coordinate all their care and get their health needs met.



The new study provides some of the nation's first empirical evidence of the benefits of this new type of care. It compared a random sample of the 9,200 patients at Group Health's medical home to a control group. At one year, patients at the medical home:
Had 29 percent fewer emergency room visits, 11 percent fewer hospitalizations that primary care can prevent, and 6 percent fewer in-person visits


Reported higher ratings on six scales of patient experience


Used 94 percent more e-mail, 12 percent more phone, and more group visits and self-management support workshops Received better health care, including needed screening tests, management of their chronic illnesses, and monitoring of their medications

"A medical home is like an old-style family doctor's office, but with a whole team of professionals," explained evaluation leader Robert J. Reid, MD, PhD, an associate investigator at Group Health Center for Health Studies and Group Health's associate medical director for preventive care. "Together, they make the most of modern knowledge and technology - including e-mail and electronic medical records - to give patients excellent care and reach out to help them stay healthy."



Now 25 medical home projects are active in 17 states. Still, to date, much enthusiasm for the medical home has been based on qualitative observation. This evaluation provides more quantitative evidence.



Only 10 percent of the medical home doctors, nurses, and staff felt "burned out" or emotionally exhausted, vs. 30 percent of controls. Reducing burnout is key to improving health care. "Many primary care providers work so hard, they feel like they're on a hamster wheel," Dr. Reid said. They often also earn much less than specialists, particularly outside such systems as Group Health, which pay doctors a salary to care for a group of patients, not "fee for service" (more money for more tests and treatments). The shortage of U.S. primary care providers is a crisis, he added. Most U.S. medical students choose to specialize, and primary care physicians retire earlier than specialists do.
















Group Health put much thought - and resources - into improving primary care in the medical home pilot. Each primary care doctor (family physician or general internist) was responsible for fewer patients: 1,800 instead of 2,300. That left time for outreach, coordination, daily "team huddles," and longer office visits: 30 vs. 20 minutes. But it also meant investing $16 more per patient over the year in extra staffing: for 72 percent more clinical pharmacists, 44 percent more physician assistants, 18 percent more medical assistants, 17 percent more registered nurses, and 15 percent more primary doctors. On average, patients at the medical home used $37 more specialty care, perhaps because the enhanced primary care detected previously hidden health problems.



"Our evaluation showed these costs were recouped within the year," Dr. Reid said. The main reason was emergency room savings of $54 per patient in the course of the year. "These findings are important because they provide a 'proof-of-concept' that investments in a medical home can achieve relatively rapid returns across a range of key outcomes." Impressed by the return on investment, Group Health is expanding the medical home model from its Factoria medical center in Bellevue, WA, to all 26 of its medical centers.



"Patients fortunate enough to have health care centered on their needs and delivered by Group Health have already seen the future," said Paul Grundy, MD, MPH, president of the Patient Centered Primary Care Collaborative. "This work is a new model that can help address our nation's need for better access to primary care."



Group Health Cooperative funded the medical home pilot and evaluation. Dr. Reid's co-authors are Paul Fishman, PhD; Onchee Yu, MS; Tyler R. Ross, MA; James T. Tufano, MHA, PhD; Michael P. Soman, MD, MPH; and Eric B. Larson, MD, MPH.

Dementia Care Event: Considerations And Innovative Alternatives, UK

World renowned dementia care expert David Sheard is hosting a one day event on Dementia Care Innovation at Richmond Villages Northampton on Thursday 4th December. The meeting will cover best practice based on person-centred care, introduce a new alternative in dementia care and establish a focus group to develop ideas to meet future challenges.


David Sheard, director of Dementia Care Matters, is a training consultant with the Alzheimer's Society and will present throughout the event. Richmond Villages will be launching a free training and support initiative for carers in the community. This initiative, called 'Yesterday, Today and Tomorrow', is for anyone who is a volunteer carer who would appreciate a greater insight and understanding of dementia. In addition, it is hoped that a support group will be set up to combat the feeling of isolation that many carers feel due to the lack of socialisation that their role can bring.


The meeting is open to Specialist Dementia Care Practitioners, Referrers and Fund Holders, Societies and Groups, GPs and Carers.


The Programme


09.00 Registration

09.30 Welcome and Introduction. An outline of purpose and content of the day 'Educational and state of the art dementia care'

09.45 'Being. An approach to life and dementia'. David Sheard

11.00 Coffee

11.20 What does person-centred dementia care look, sound and feel like. David Sheard

12.30 Escorted tour of Richmond Northampton

13.00 Lunch

14.00 Lessons learnt/transferable learning from supported living for people experiencing a dementia. David Sheard

14.45 Launch of Richmond Villages' new approach to dementia care and introduction of focus groups

15.30 Guest speaker Sheena Wylie of Barchester's Memory Lane

16.00 Summary and Q&A

16.30 Tea and close


The meeting will be held at:

Richmond Northampton

Bridge Meadow Way

Grange Park

Northampton NN4 5EB


For more information and confirmation of meeting attendance, please email nicola.harrisrichmond-villages or call 0845 607 6405.


Further information

David Sheard

David Sheard is director of Dementia Care Matters, an independent consultancy and training team specialising in developing Dementia Care services for old people with organisations and their staff. He is also a training consultant with the Alzheimer's Society and a visiting Senior Fellow with the Division of Health and Social Care, University of Surrey, dementiacarematters


Richmond Villages


Richmond Villages is a UK retirement village pioneer offering three types of accommodation: independent village apartments, 'assisted living' in hotel-style serviced apartments, plus a small nursing home. Each village has nurses and carers within the care centre, in addition to its own on-site registered domiciliary care team, which attends to those living in the village and serviced apartments.


At Richmond Northampton there are a number of serviced apartments designed to help couples stay together where one partner is suffering from a dementia, or for individuals who have a dementia but do not want to enter residential care.


Richmond Villages currently has four operating villages: Northampton, Painswick in Gloucestershire, Coventry and Nantwich, Cheshire. Construction is close to completion at a fifth site, Letcombe Regis in Oxfordshire, richmond-villages.


Dementia


- It is estimated that there are 700,000 people in the UK with dementia. By 2020, that figure is set to rise to 1 million.

- Dementia affects 1 in 20 people over the age of 65 and 1 in 5 over the age of 80.

- Dementia costs the UK economy ??17 billion a year.



Source

Paula Cole/Tracey Bretherton

LawsonClarke PR

lawsonclarke

Vital Funding Guidance For Adult Children With Elderly Parents Needing Care, UK

You've brought up children, put them through education and now you're
approaching retirement. It's time to think about relaxing??¦. but can you,
if you have elderly parents?


One in five British adults have elderly parents who require care and
assistance and one in four of those aged over 65 will require some form
of Long Term Care. In, fact almost everyone in the UK will either need
care or become a carer - according to health think-tank, The King's Fund
and others, including Age Concern and Help the Aged.


Denial and ill preparation


Despite this, however, most adult children are in denial about their
parents ever needing care. Care homes are a subject that's just too
taboo for them and/or their parents to even think about. So, when mum
does suddenly have a fall or stroke, or her dementia has reached the
stage where she can't safely live at home, where do they turn? The
present system of paying for care is governed by a labyrinth of
legislation guidance and rulings dating back to 1948 - and is rife with
inconsistencies when determining who pays for what. People are simply
ill prepared for what to expect - many missing out on funding or support
they could get if they were in the know.


For both adult children and their parents, moving into a care home can be
an incredibly emotional and stressful time. On the one hand, there will
be the wanting of the best care possible for mum, on the other hand may
be the feeling of guilt for not being able to provide it themselves. And
then there's the money. Mum wanted to leave her house to her children,
but it looks like it's going to be swept away in a torrent care fees!


Specialised, experienced advice available now from NHFA


Families should be encouraged to seek advice. Funding long-term care is
a complex area and, as the OFT and others have reported, advice and
information at this difficult time is not readily available. Even when
you might think all is sorted out, circumstances can change and so does
the funding. A specialist care fees adviser such as NHFA Care Fees
Advice can give expert guidance on all these issues - making the whole
process for the whole family that much easier and successful.
Be prepared. Don't let care costs leave a legacy of decimated family
assets. For further information and NHFA contact details go to the
comprehensive feature article on the Care Directions
website.





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Long Term Care Community Praises Senator Gordon Smith For His Leadership, Vision For Long Term Care In America

The American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL), the nation's largest long term health care association, alongside the Oregon Health Care Association (OHCA), today recognized Senator Gordon Smith (R-OR) for his legislative advocacy on behalf of the millions of the nation's frail, elderly, and disabled, and the men and women who care for them each day.


Senators Smith and Blanche Lincoln (D-AR) recently co-sponsored the Long Term Care Quality & Modernization Act, which is being touted widely by long term care health officials as the most comprehensive piece of legislation in recent history. The legislation would totally reform long term care as we know it today.


"Our nation's seniors and caregivers throughout the long term care community owe a debt of gratitude to Senator Gordon Smith for what he has done and for what he is doing to ensure quality care for those who need it most," said Bruce Yarwood, President and CEO of AHCA. "His efforts demonstrate what effective lawmaking in America is all about-not only does he represent his constituents in Oregon and the people of the United States well, but he does so in a bipartisan way that gets results. That's what the citizens of Oregon and the United States want, and that is what they are getting in Senator Gordon Smith."


Senator Smith has been outspoken on the importance of economic stability in the nursing home sector in order to meet growing government and consumer demands for quality care. His comments linking economic stability with improved care quality have been echoed by providers and government officials alike; moreover, recent government reports have substantiated those comments and shown measurable progress in key areas of quality care.


"Proposed cuts to Medicaid starting in 2007, and potential cuts to Medicare in this Congressional session, threaten these quality improvements," said Yarwood. "Senator Smith has taken the time to truly understand these complex issues, and has stood up for stable funding and the sustained quality improvements we're seeing here in Oregon," remarked Steve Fogg, President of the Oregon Health Care Association (OHCA). Yarwood agreed saying, "The millions of America's frail, elderly, and disabled citizens and their families nationwide-including more than 15,000 Oregonians being cared for in long term care facilities across the state-truly have a friend in Senator Gordon Smith.


The American Health Care Association and the National Center For Assisted Living are the nation's leading long term care organizations. AHCA/NCAL and their membership are committed to performance excellence and Quality First, a covenant for healthy, affordable and ethical long term care. AHCA/NCAL represent nearly 11,000 non-profit and proprietary facilities dedicated to continuous improvement in the delivery of professional and compassionate care provided daily by millions of caring employees to more than 1.5 million of our nation's frail, elderly and disabled citizens who live in nursing facilities, assisted living residences, subacute centers and homes for persons with mental retardation and developmental disabilities.



American Health Care Association

Home Health Payment Rates Will Increase 2.8 Percent for 2006, USA

CMS announced a 2.8 percent increase in Medicare payment rates to home health agencies for 2006. Medicare pays home health agencies through a prospective payment system (PPS), which pays at higher rates to care for those beneficiaries with greater needs.



CMS said rural home health agencies will see an estimated 3.4 percent increase and urban agencies will see a 2.5 percent increase in payments. This will add approximately $370 million in reimbursements for 2006. Home health payment rates are updated annually by either the full home health market basket percentage, or by the home health market basket percentage as adjusted by Congress. CMS establishes the home health market basket index, which measures inflation in the prices of an appropriate mix of goods and services included in home health services. For calendar year 2006, the home health market basket percentage is 3.6. However, the Medicare Modernization Act of 2003 requires updates for 2005 and 2006 to equal the applicable home health market basket percentage increase minus 0.8 percent.



CMS is adopting the revised Metropolitan Statistical Area (MSA) definitions as announced by the Office of Management and Budget (OMB) in their July 6, 2003, OMB Bulletin. CMS uses MSAs to set payment adjustments to reflect variation in costs across the U.S. In implementing the new MSA designations, CMS will allow for a one-year transition with a 50-50 blend, consisting of 50 percent of the new MSA designations' wage index and 50 percent of the previous MSA designations' wage index.



CMS is also updating the fixed dollar loss (FDL) ratio, which is used in the calculation of outlier payments, updating the FDL ratio from 0.70 to 0.65 for 2006, thereby qualifying more episodes for outlier payments.


American Association for Homecare

625 Slaters Lane, Suite 200

Alexandria

VA 2314

USA

For more information, please call AAHomecare at (703) 836-6263.
aahomecare.

California's Disabled Elderly Are Barely Holding On

The network of public services that supports California's low-income, disabled elderly is fragile, affecting the ability of these vulnerable residents to live independent lives in their own homes, according to a new study from the UCLA Center for Health Policy Research.



This policy note reports the first findings from a yearlong effort to follow the lives and challenges encountered by several dozen representative older Californians in Los Angeles, San Diego, San Francisco and Santa Clara who are enrolled in Medicare and Medi-Cal and who receive in-home and community care.



The documentary project comes as California lawmakers consider additional cuts to a network of services that help seniors remain "safely in their homes" - the stated goal of these public programs and the way in which an overwhelming number of Americans say they want to age.



The policy note, "Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent," shows seniors struggling to live functional lives in the face of already reduced caregiving hours. For example:



Caring for the caregivers



Sara cares for her disabled son and husband, whose heart disease, diabetes, incontinence and limited mobility require 24-hour care. There's help from In-Home Supportive Services (IHSS) and other family members, but Sara is the primary caregiver. Now, her back is acting up. She's been delaying seeing a doctor to take care of her own needs - who will care for her family if she's hospitalized?



Delicate balance



Paralyzed by polio, Mary breathes with the help of a ventilator and gets around in a wheelchair. She needs help to dress, bathe, use the toilet and eat. She's created an elaborate system to meet her needs, using maximum IHSS hours of support and offering room and board to another caregiver in return for care. Mary's happy with her life and rates her health as "excellent," but she knows that even a small change in the delicate balance of her care system will send her to a nursing home.



His choice



Incapacitated by stroke and diabetes and confined to a wheelchair, Jack spent time in a nursing home a couple of years ago, and he's not in a hurry to go back. In the nursing home, he felt unsafe and more isolated than he does in his own house with support from IHSS. Jack's a realist. He knows a nursing home may be in his future again, but he wants to choose when and where he'll go.



According to the researchers, all participants in the study are aware that the networks of care they've cobbled together could easily unravel, and most say they'd rather "make do" by eating less often, letting their homes become less safe or allowing their medical conditions to worsen than give up their independence and go to a nursing home - the likely scenario if they lose the in-home services they now rely upon.
















"These seniors are using every sort of innovation and self-deprivation to make do," said Steven P. Wallace, the study's senior author and associate director of the UCLA Center for Health Policy Research. "They have nowhere to turn if their fragile care systems are further undermined.



"Policymakers need to see the faces of these vulnerable Californians as they crunch the numbers in budget discussions," Wallace added. "Further cuts are an assault on their independence. Slashing in-home and community care will also increase total health care costs as these seniors increasingly use emergency room care, are hospitalized or enter institutions - under conditions that could have been prevented."



Budget cuts looming



California, which is home to the largest number of older adults in the country, has several programs funded by federal, state and local dollars to assist low-income adults with disabilities. Proponents of these programs say that while such care isn't perfect, it is far less expensive and more humane than the alternative - placing seniors in publicly financed nursing homes.



Yet, IHSS program-hours were trimmed by 3.6 percent in January 2011, and they face further across-the-board cuts of 8.4 percent, plus additional targeted reductions in the governor's proposed budget. Adult day health care centers are slated for elimination, and supplemental security income cash benefits are to be reduced for single low-income aged and disabled individuals.



All the older adults in the study receive IHSS support, ranging from 20 hours of in-home help each month to the maximum of 283 hours per month. Most need help with household tasks, such as cleaning and cooking, and personal tasks like getting dressed or taking medications. Many require help getting in and out of bed, bathing and using the toilet. Some who might benefit from adult day health care or other supportive programs are unable to participate because of limited mobility or lack of transportation.



"California's current system to support old and young adults with disabilities at home operates in silos and is not person-centered," said Bruce Chernof, M.D., president and CEO of the SCAN Foundation, which is funding the study. "The Brown administration has an important opportunity to design a more stable, integrated, efficient and person-centered system that can meet the needs of these vulnerable residents throughout the state."

New And Enhanced VA Benefits Provided To Caregivers Of Veterans

The Department of Veterans Affairs (VA) is launching the first of a series of new and enhanced services supporting family caregivers of seriously ill and injured Veterans. In May 2010, President Obama signed the Caregivers and Veterans Omnibus Health Services Act of 2010 legislation authorizing VA to establish a wide range of new services to support certain caregivers of eligible Post 9/11 Veterans.


"Caregivers make tremendous sacrifices every day to help Veterans of all eras who served this nation," said Secretary of Veterans Affairs Eric K. Shinseki. "They are critical partners with VA in the recovery and comfort of ill and injured Veterans, and they deserve our continued training, support and gratitude."


"DAV is happy to hear that caregivers of Veterans are getting additional support and services to care for our Nation's heroes and unprecedented new services for our most recent severely ill and injured," said David W. Gorman, executive director of the Washington Headquarters of the Disabled American Veterans. "We understand there are challenges to implementing the new law; including ensuring that critically ill and injured Veterans of all eras are similarly supported."


In addition to the new benefits and services for eligible Veterans who were disabled in the line of duty since Sept. 11, 2001 (Post 9/11 Veterans), VA will also begin providing enhanced benefits and services to caregivers of Veterans of all eras who are already enrolled in VA care, including:


- Access to VA's toll-free Caregiver Support Line: 1-855-260-3274

- Expanded education and training on caring for Veterans at home,

- Other support services such as counseling and support groups and referral services; and

- An enhanced website for caregivers.


Some of the new benefits of the Caregivers and Veterans Omnibus Health Services Act are restricted by law to the caregivers of the most seriously ill and injured Post 9/11 Veterans. Those additional benefits include:


- A monthly stipend,

- Health care coverage,

- Travel expenses, including lodging and per diem while accompanying Veterans undergoing care,

- Respite care; and

- Mental health services and counseling.


VA will take the opportunity to report to Congress in the future on the feasibility of expanding the enhanced services to family caregivers of Veterans of all eras.


While some of these enhanced benefits are available now, many of the other significant newly-enacted benefits will require the issuance of regulations. These additional benefits include monthly stipends, pay for travel costs, medical coverage, training, counseling and respite care designed to prevent institutionalization of Veterans whenever possible. The law requires detailed regulations for determining eligibility, designating and approving caregivers, and providing stipends and health care coverage to primary family caregivers. The complex process required to implement these regulations will provide Veterans, caregivers and the general public the opportunity to provide comments before those regulations are finalized.


"VA has supported caregivers of Veterans of all eras for almost eight decades," said Deborah Amdur of VA's Care Management and Social Work Service, "and we know from our experience and research that Veterans are best served when they can live their lives as independently as possible surrounded by caring family and friends."


Each VA medical center has designated caregiver support coordinators who will assist eligible Veterans and caregivers in understanding and applying for the new benefits. VA also has a htCaregiver Support Web page, which will provide general information once final regulations are published.

Death By Dementia

A growing number of older adults are dying from dementia. In an editorial in the October 15, 2009 issue of the New England Journal of Medicine, Greg Sachs, M.D., professor of medicine and director of the Division of General Internal Medicine and Geriatrics at the Indiana University School of Medicine and a Regenstrief Institute investigator, notes that end-of-life care for most older adults with dementia has not changed in decades and urges that these individuals be provided far greater access to palliative care, the management of pain and other symptoms.



Dr. Sachs believes that more research on palliative care for patients with dementia is needed to update public policy and get lawmakers and insurance companies to recognize the need to support and fund care which will improve the overall health of older adults who can no longer speak for themselves.



"Since individuals with advanced dementia cannot report their symptoms, these symptoms often are untreated, leaving them vulnerable to pain, difficulty breathing and various other conditions. We shouldn't allow these people to suffer. We should be providing palliative care to make them more comfortable in the time they have left," said Dr. Sachs, who is a geriatrician and medical ethicist.



While it is not easy, caregivers and medical personnel should attempt to pick up on nonverbal clues of pain, such as the individual holding the body in a certain way to avoid a painful posture, or exhibiting swollen, tender joints, he said. These observations, reported by a caregiver or found on medical examination, may help the physician make the patient more comfortable, and help identify underlying conditions.



Palliative care involves a team-oriented approach to pain management and medical treatment, as well as emotional support tailored to the patient's needs. Palliative care focuses on relieving symptoms such as pain, shortness of breath, fatigue, nausea, loss of appetite and difficulty sleeping. Hospice care provides palliative care but palliative care can be administered regardless of prognosis along with medical treatment and does not hasten death.



Dr. Sachs' editorial accompanies a Harvard University observational study of 323 patients with advanced dementia residing in 22 nursing homes which found that while few suffered a sentinel event such as a stroke or a heart attack, the survival of patients with advanced dementia was usually less than a year, especially following the occurrence of pneumonia, episodes of fever, or eating problems.



Dr. Sachs leads the Indiana Palliative Excellence in Alzheimer Care Efforts (IN-PEACE) Program which is studying the feasibility of incorporating an outpatient palliative care program for patients with dementia into the primary care setting, where most older adults receive their medical care. The program, supported by a grant from the National Palliative Care Research Center, provides improved symptom management, enhanced family support, and assistance with difficult decision making.

Common Anti-psychotic Drugs Bad For Alzheimer's Patients, New Study Finds

A new UK study has found that anti-psychotic drugs, such as (Melleril), chlorpromazine (Largactil), haloperidol (Serenace), trifluoperazine (Stelazine) and risperidone (Risperdal), are bad for patients with Alzheimer's disease - the drugs were found to make their condition worse.


The researchers, from Kings College London and the Universities of Oxford and Newcastle, found that neuroleptics undermined Alzheimer's patients' verbal skills, and offered most patients with mild symptoms of disturbed behavior no long-term benefit. In fact, they found that a deterioration in verbal skills happened within six months of taking the medications. Neuroleptics are drugs used for treating schizophrenia as well as some other serious mental illnesses.


In this study, researchers looked at 165 Alzheimer's patients from four different nursing homes in Oxfordshire, Newcastle, Edinburgh and London. Approximately 60% of UK Alzheimer's patients are given medications to control their often aggressive behavior. There are indications that neuroleptics may also up the death rates of Alzheimer's patients.


You can read about this study in the Public Library of Science Medicine.


All the 165 patients had started on neuroleptics and had been on them for three months before the study started. Half of them continued on them for another 12 months while the others were switched to a placebo.


"It is very clear that even over a six-month period of treatment, there is no benefit from neuroleptics in treating the behavior in people with Alzheimer's disease when the symptoms are mild. For people with more severe behavioral symptoms, balancing the potential benefits against adverse effects is more difficult," said team leader Professor Clive Ballard.


Many experts are saying that in light of this study neuroleptics should only be used long-term for dementia patients who have severe behavioral problems, after other treatments have failed.


Neil Hunt, Chief Executive of the Alzheimer's Society (UK), wrote -


"The overprescribing of antipsychotics to people with dementia is robbing people of their quality of life and is a serious breach of human rights. Paul Burstow MP's report illustrates the scale and severity of the important issue.


Inappropriate use of antipsychotics in people with dementia can cause devastating side effects, such as excessive sedation, parkinsonism symptoms, accelerated cognitive decline and an increased risk of stroke. This abuse has got to stop.


Antipsychotics have got to stop being a quick fix. There are over 700,000 people with dementia in the UK and more than half of these will experience behavioral symptoms. Alzheimer's Society research has shown that basic dementia training can help staff deal with behavioral symptoms and reduce the use of antipsychotics drugs by 50 per cent."


"A Randomised, Blinded, Placebo-Controlled Trial in Dementia Patients Continuing or Stopping Neuroleptics (The DART-AD Trial)"

Clive Ballard, Marisa Margallo Lana, Megan Theodoulou, Simon Douglas, Rupert McShane, Robin Jacoby, Katja Kossakowski, Ly-Mee Yu, Edmund Juszczak, on behalf of the Investigators DART AD

PLoS Med 5(4): e76 doi:10.1371/journal.pmed.0050076

Click here to read the research article online


Written by -


View drug information on Risperdal Oral Formulation.

Keeping Childless Seniors Out Of Nursing Homes

Older Americans without children have a much lower risk of being admitted to a nursing home if they live in a state that spends more on home- and community-based services (HCBS), according to an article published in the latest issue of the Journal of Gerontology: Social Sciences (Vol. 62B, No. 3).



A team of researchers, headed by Naoko Muramatsu of the University of Illinois at Chicago, sought to determine if variations in state spending had an effect on nursing home admissions, and whether a senior's family status also played a role. Although the association was not statistically significant older people with living children, they found that doubling state HCBS expenditures per person over age 65 would reduce the risk of nursing home admission among childless seniors by 35 percent.



Citing previous research, the authors found that some states spend as little as $35 per person each year on HCBS for seniors, while other states spend more than $1,300 annually.






Support for the project was provided the National Institute on Aging.



The Journal of Gerontology: Social Sciences is a refereed publication of The Gerontological Society of America, the national organization of professionals in the field of aging.



The article abstract is available online at
psychsoc.gerontologyjournals/cgi/content/abstract/62/3/S169.



Contact: Todd Kluss


The Gerontological Society of America

Economic Study Finds DME Competitive Bidding Program Will Reduce Competition, USA

A new economic study finds that the competitive bidding program for durable medical equipment (DME) being rolled out by the Centers for Medicare and Medicaid Services (CMS) would lead to reduced competition, lower quality of care, and higher costs.


Two Robert Morris University professors, Brian O'Roark, PhD and Stephen Foreman, PhD, conducted the study, which was released this week by the Pennsylvania Association of Medical Suppliers (PAMS).


"The limits on competition that CMS is proposing to implement will have great potential to produce higher prices and lower service quality," Foreman stated. "The franchise bidding process that CMS is implementing is at odds with everything that we know about markets, efficiency and incentives. We should be encouraging added competition in the market, not limiting it. Limits on competition like those proposed by CMS rarely, if ever, make consumers better off."


PAMS hosted a press conference on Monday at the United Cerebral Palsy of Pittsburgh, and the study has generated significant press coverage in the Pennsylvania media. Congressman Jason Altmire (D-Pa.) included comments in the PAMS press release. (See press release and study at pamsonline and press Pittsburgh Post-Gazette article at post-gazette/pg/08050/858499-28.stm).


John Shirvinsky, PAMS executive director, commented, "We have been gratified by the positive and accurate coverage that this important story has been receiving in the media. The study is so far proving to be a great boon in helping reporters to better understand the flawed nature of CMS's competitive bidding program for DME. We hope that Congress and CMS will heed the warnings of the study's authors about the high potential for negative and unintended consequences from competitive bidding and put this anti-competitive scheme on hold - at least until these impacts can be fully analyzed."


During the press conference, Foreman posed several questions, summarized below:


- Why target the DME industry since it's a tiny, slow-growing slice of the Medicare budget?


- Why destroy a functioning market since DME providers already compete on the basis of quality of service and patient access while the government sets prices?


- What happens when there are only a few DME suppliers left since market concentration is a bad idea on virtually every level - price, service, quality, innovation?


- Why haven't we learned from other industries that concentration is bad since healthcare sectors defined by concentration are characterized by high price increases, poor consumer satisfaction, and very high profits?


"This economic study underscores the potential harm of this Medicare bidding program and the urgency of a thorough reassessment by both Congress and the administration," said Alan Landauer, chairman of the American Association for Homecare and CEO of Landauer Metropolitan, a homecare provider based in Harrison, New York.



American Association for Homecare

ResCare Acquires Texas Home Care Services

ResCare, Inc. (NASDAQ: RSCR) the nation's leading provider of residential, training, educational and support services for people with disabilities and special needs, announced the acquisition of Select Health Care Services, a home health care agency located in Baytown, Texas, serving 30 counties in the Houston area. Select Health Care offers programs for adult and pediatric patients that include companion care, skilled nursing, physical, occupational and speech therapy. Select Home Care revenues are primarily through Medicaid waiver payments and licensed, Medicare-certified, personal assistant services with approximately 5% coming from private duty home health services. Annual revenue is estimated to be $7 million.


Ralph G. Gronefeld, Jr., ResCare president and chief executive officer, said, "The acquisition of Select Health Care Services expands our home care offerings in Texas and fits perfectly into our ResCare HomeCare operations nationwide. We welcome the employees of Select Health Care Services, and we look forward to working closely with them to further enhance the services offered to the people served in Houston and the surrounding areas."


ResCare, with 30+ years of experience helping people reach their highest level of independence, is one of the largest providers of home care to the elderly and those with disabilities. It also offers residential and support services to people with intellectual and developmental disabilities and provides education, vocational training and job placement for people of all ages and skill levels. Based in Louisville, Kentucky, ResCare and its 42,000 dedicated employees serve daily more than 65,000 people in 37 states, Washington, D.C., Puerto Rico and in a growing number of international locations. For more information about ResCare, please visit the Company's website at rescare.


From time to time, ResCare makes forward-looking statements in its public disclosures, including statements relating to expected financial results, revenues that might be expected from new or acquired programs and facilities, its development and acquisition activities, reimbursement under federal and state programs, financing plans, compliance with debt covenants and other risk factors, and various trends favoring privatization of government programs. In ResCare's filings under the federal securities laws, including its annual, periodic and current reports, the Company identifies important factors that could cause its actual results to differ materially from those anticipated in forward-looking statements. Please refer to the discussion of those factors in the Company's filed reports. Statements related to expected financial results are as of this date only, and ResCare does not assume any responsibility to update these statements.

rescare

Blacks Receive Hospice Care At Lower Rate Than Whites

Blacks receive hospice care at a disproportionately lower rate than whites in part because of cost, health insurance status and cultural factors, the AP/Florida Times-Union reports.

According to a 2005 survey by the National Hospice and Palliative Care Organization, 82.2% of people receiving hospice care were white and 7.5% were black, compared with the entire U.S. population, which is 75% white and 12% black, according to the Census Bureau. The California HealthCare Foundation in March released a study that suggested minorities and immigrants view hospice care as a way for health care providers to refuse "the medical care [minority patients] have been fighting to get," the AP/Times-Union reports.

John Radulovic, vice president of communications for the NHPCO, said, "Some people think that if a doctor wants them to stay home and not come into the hospital, that the medical system isn't truly concerned about them."

According to the AP/Times-Union, the hospice industry is "reaching out to blacks and the growing Hispanic population." Some hospices are looking to churches and faith-based community settings as an avenue to educate minority populations about the benefits of hospice care. Hospices also are trying to hire more minority workers.

David Stone, executive director of the Alabama Hospice Organization, said, "When you're dealing with someone at such a vulnerable time, it's understandable that you'd want someone you feel you have a connection with" (Thomas, AP/Florida Times-Union, 7/15).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Elderly US Nursing Home Residents Whose Care Is Funded By Medicaid Receive Limited Cancer Care

Elderly nursing home residents whose care is funded by Medicaid, a state-administered scheme in the US that pays for healthcare for people with low incomes, receive limited cancer services, with only a small proportion undergoing surgery, chemotherapy or radiotherapy, warns a study.


Approximately one in 10 people living in elderly nursing homes have cancer, but very little research has previously looked at this group. Researchers, led by Cathy Bradley, from Virginia Commonwealth University in Richmond, Virginia, USA, used the Michigan Tumor Registry and Medicaid records to identify elderly nursing home residents diagnosed with cancer between 1 January 1997 and 31 December, 2000, and who were receiving state-funded care. They found 1907 patients and compared their cancer care with other Michigan residents living in the community who were diagnosed with cancer during the same period.


The results showed than nearly two-thirds (62%) of the Medicaid-insured nursing home residents diagnosed with cancer had late or unstaged disease - cancer for which not enough information is available to indicate the stage or severity, which is an important factor in guiding cancer management. The commonest cancers were colon/rectum (17%), lung (15%), breast (14%) and prostate (10%).


The researchers noted that late and unstaged cancer was far more common in nursing home patients than in older elderly cancer patients living in Michigan. This may be partly explained by their greater frailty, which previous research has shown may make cancer screening such as mammography more stressful, but they suggested: "It is also possible that nursing homes are challenged in their ability to provide day-to-day care. Therefore, cancer-related services may receive a low priority."


The study showed that the nursing home residents received limited treatment for their cancer. Only 22% had surgery related to their cancer, with the majority of this being for women with breast cancer. Fewer than one in ten (6%) received chemotherapy and/or radiation.


Cancer spread, age and race affected the likelihood of having surgery. Patients with local-stage disease were most likely to have surgery. Those who were younger (aged 71-75 years) were nearly three times more likely to have surgery for their cancer than older nursing home residents (86 years and older). African American patients were only half as likely to receive surgery compared to white patients.


Mortality was high, with nearly half of the nursing home residents (48%) dying within three months of being diagnosed with cancer. The average survival after diagnosis was only nine months. Only about one-quarter (28%) of people with distant-stage cancer received hospice care. The researchers considered this was low, particularly as hospice use can achieve appropriate pain management and increase satisfaction with end-of-life care.















Information on patient or family preferences for treatment was not available, Dr Bradley and her colleagues acknowledged, and their study looked only at Medicaid-funding nursing home residents in Michigan, so was not representative of all people living in nursing homes. But they concluded: "Very few cancer services are provided to Medicaid-insured nursing home patients, despite the fact that many of these patients likely experienced cancer-related symptoms and marked physical decline before diagnosis and death."


In an accompany editorial, Noreen Aziz and Keith Bellizzi, from the Office of Cancer Survivorship at the National Cancer Institute, commented: "The fact that Medicaid-insured nursing home patients ??¦ had a preponderance of late and unstaged disease, high mortality within a few months of diagnosis, low hospice utilization, and little cancer-directed treatment is of concern."


Looking at how the low level of cancer care for Medicaid-funding elderly nursing home residents could be improved, the study authors suggested: "Guidelines for the recognition and treatment of cancer in frail elderly patients are needed and should be communicated to health care professionals, patients and care givers."


Aziz and Bellizzi agreed that standards, guidelines or best practices for cancer care were needed, particularly in the elderly, adding: "It is time that we enhance efforts to achieve clarity regarding the experiences of cancer-related care in our elderly cancer survivors."


Absence of Cancer Diagnosis and Treatment in Elderly Medicaid-Insured Nursing Home Residents

Cathy J. Bradley, Jan P. Clement, Chunchieh Lin

J Natl Cancer Inst 2008, 100: 21-31


Older Survivors and Cancer Care

Noreen M. Aziz, Keith Bellizzi

J Natl Cancer Inst 2008 100: 4-5


Cancer Research Summaries are overviews of important cancer research findings that have been reported in leading cancer publications. The Cancer Research Summaries are provided by the Cancer Meda Service (CMS) in collaboration with Nature Clinical Practice Oncology.

This summary is provided by the Cancer Media Service which is operated by The European School of Oncology.


cancerworld/mediaservice

Nurses, Doctors Arrested But Insurers Get A Seat At The Table

5 More Caregivers Arrested at Baucus Finance Committee on "Florence Nightingale Day Protests" for Guaranteed, Single-Payer Healthcare


Registered nurses, physicians and healthcare activists delivered an emphatic protest before the Senate Finance Committee for its failure to open discussion on healthcare reform to nurses, doctors and other advocates of single-payer, guaranteed healthcare for all, while continuing to provide a red carpet to big insurance companies and other healthcare industry interests.


Five were arrested -- two RNs, members of the National Nurses Organizing Committee/California Nurses Association, two physicians, members of Physicians for a National Health Program, and a patient activist with PNHP and Health Care Now - after vocally challenging the committee for what they called a stacked process against real debate.


Marking the anniversary of the birth of Florence Nightingale, some 40 other RNs staged a silent protest - standing before the committee in red nursing scrubs and turning their backs to show signs reading "Nurses Say: Patients First. Stop AHIP. Pass Single-Payer." AHIP, America's Health Insurance Plans, is the private insurance industry lobby arm that is given a regular voice by the Committee, chaired by Sen. Max Baucus, which is in the forefront of discussion on a health plan.


"What a disgrace that RNs and physicians are shut out and arrested while the insurance industry is given a seat at the table. We would expect that from the Bush administration, not in the time of the Obama administration," said NNOC/CNA Executive Director Rose Ann DeMoro. "The Baucus Committee can arrest nurses, but they cannot silence the voices of RNs who will continue to speak from their hearts on behalf of their patients who want and deserve real reform."


Standing up in the audience and speaking before she was arrested, Sue Cannon, RN, said, "don't guarantee drug profits, guarantee healthcare. We're entrusted to care for our patients, and we can't do that without single-payer, guaranteed healthcare. We need no more Blue Crosses and double crosses."


"In honor of Florence Nightingale, patients need access to healthcare. We need to protect our patients, we need single-payer now," said NNOC/CNA Board member DeAnn McEwen, RN.


It was the second consecutive week of protests and arrests at the Finance Committee. Eight were arrested last week for speaking out on behalf of single-payer/guaranteed healthcare.


Tuesday morning's protest was also the kickoff of two national days of actions by RNs from across the U.S., coinciding with National Nurses Week. Upcoming event:



Wednesday, May 13: RN Day of Action

Conference on RN Ratios, Rights, and Representation:

9 a.m. - 12 noon, Washington Court Hotel, 525 New Jersey Ave NW

Source
California Nurses Association

The National Alliance On Mental Illness Applauds New Report On Caregiving

The National Alliance
on Mental Illness (NAMI) praises a new report, Caregiving in the U.S.
2009, which offers a revealing portrait of the nearly one-in-three
American adults who serve as a family caregiver.



The study is based on interviews with 1,480 caregivers chosen at
random and offers a national profile of people caring for adults, the
elderly and children with special needs. It follows similar studies
conducted in 2004 and 1997, but for the first time, caregivers for
children, as well as those caring for adults over the age of 18, were
surveyed.



The report echoes the findings of NAMI's own depression survey and
schizophrenia survey, which include the perspective of caregivers for
people living with these serious mental illnesses. All these reports
suggest that caregivers face daily stresses that can impact their own
health and other relationships. For example, NAMI's depression
survey, released in November, found that while almost one-half (48
percent) of caregivers for people with depression have been diagnosed
with depression themselves, only about 25 percent were engaged in
treatment at the time of the survey.



"We know from our own studies that caregivers make significant
sacrifices to care for their loved ones living with mental illness,"
said Michael Fitzpatrick, NAMI executive director. "The findings of
this new report will help us anticipate the needs of caregivers so
that we can improve NAMI's education and support programs."



NAMI offers a variety of peer education and support programs,
including those specifically for caregivers.



Family-to-Family is a free, twelve-week course for family caregivers
of individuals with severe mental illnesses. The course is taught by
trained family members and more than 115,000 family members have
graduated from this national program. The course is also available in
Spanish.



NAMI Basics is an education program for parents and other caregivers
of children and adolescents living with mental illnesses. The course
is taught by trained teachers who are the parent or other caregivers
of individuals who developed the symptoms of mental illness prior to
the age of 13 years.



Source
The National Alliance on Mental Illness

Nursing Home Alternative Challenges Traditional System

The Robert Wood Johnson Foundation and Bill Thomas, a former nursing home physician, have been working to overhaul the nation's nursing home system by promoting "smaller, home-like facilities," the Wall Street Journal reports. RWJF has invested $15 million over five years to encourage the construction of "Green Houses" -- a concept developed by Thomas in which facilities house 10 to 12 residents. There are currently 41 Green Houses in 10 states, and the foundation has set the goal of building Green Houses in all 50 states.

Jane Isaacs Lowe, head of RWJF's Vulnerable Populations portfolio, said, "We want to transform a broken system of care." According to the Journal, "The foundation's undertaking represents the most ambitious effort to date to turn a nice idea into a serious challenger to the nation's system of 16,000 nursing homes."

The Journal reports that to supporters of the Green House model, it is "nothing less than a revolution that could overthrow what they see as the rigid, impersonal, at times degrading life the elderly can experience at large institutions." However, despite funding from RWJF to build more houses, "obstacles remain," according to the Journal. Barriers to constructing more Green Houses include "a thicket of elder-care regulations," the need for "enormous capital" to build new homes, "stiff resistance from many parts of the existing nursing home system" and lower overhead at larger facilities.

Michael Martin -- vice president of Riverside Health System, which owns several traditional nursing homes -- said that Green Houses "will absolutely provide a quality of life unsurpassed," but "they don't work financially."

RWJF "officials acknowledge they don't know whether Green Houses are a viable economic model," but "they've decided not to wait for an answer" and could provide more funding in the future, the Journal reports. Thomas Hamilton, who oversees nursing home quality and regulatory issues for CMS, said, "Robert Wood Johnson is making an important investment to try to make sure there is a sufficient cadre of early adopters of the Green House model -- and research to make sure the model is actually working," adding that CMS is trying to encourage nursing homes to create more "patient-centered" models (Lagnado, Wall Street Journal, 6/24).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

New Law Requires Child Care Agencies To Post Consumer Safety Information, Kentucky USA

A new law requiring the state's licensed child care centers to educate parents and caregivers about the Consumer Product Safety Commission (CPSC) has taken effect, the Cabinet for Health and Family Services (CHFS) announced.


The law requires day care centers to prominently display information about the CPSC and its Web site so that parents and caregivers can stay up-to-date on the agency's information pertaining to child safety. In addition, the law requires the cabinet to notify all child care centers of the existence of the CPSC upon licensure and at all re-licensure surveys. CHFS will also notify all certified family child-care home operators of the existence of the CPSC, but in-home providers will not be required to post information.


"The Consumer Product Safety Commission is a wonderful agency dedicated to consumer safety and is a particularly useful resource for parents," said CHFS Inspector General Sadiqa N. Reynolds. "With this new law, more parents and caregivers will be made aware of the CPSC's existence and will be able to take advantage of its regular updates and useful information."


The Office of Inspector General (OIG) is responsible for licensing and regulating all child care facilities in the state, including investigating complaints against child day care programs, residential child caring facilities and child-placing agencies.


"Child safety is our number one priority in monitoring these facilities," said LaShana Harris, director of the OIG's Division of Regulated Child Care. "The more resources providers and parents have available to them, the better prepared they'll be to care for children. Making sure they are aware of the CPSC is one more thing we can do to help ensure health, safety and welfare at these facilities."


The CPSC is charged with protecting the public from unreasonable risks, such as fire, electrical, chemical or mechanical hazards, from thousands of types of consumer products under the agency's jurisdiction. The agency's work deals with various products including toys, cribs, power tools, cigarette lighters and household chemicals. The agency sends out updated consumer safety information, such as information on product and toy recalls, on a regular basis.


For more information about the Consumer Product Safety Commission, visit cpsc. Additional information on consumer product safety can be found on the Kentucky Department for Public Health's Web site.


Source
Kentucky Department for Public Health

Minster Brady Welcomes Report On Implementation Of The Home Care Package Scheme, Ireland

Minister Brady welcomed the launch of a report of the National Economic and Social Forum (NESF) entitled "Implementation of the Home Care Package Scheme".


The Minister highlighted that "a main feature of Government policy in recent years has been to develop services to allow older people to remain living at home and in their communities for as long as possible". Where this is not feasible Older People should have access to quality, affordable long-term residential care.


The Minister pointed out that, "unprecedented levels of investment had been provided to develop community based provision for older people over 2006-8, with just over €200m additional base funding made available to the HSE to develop such services nationally. These included the new Home Care Package (HCP) Initiative introduced in 2006, and the expansion of existing Home-Help, Meals-on-Wheels and Day/Respite services around the country".


The Minister noted that the NESF report on the €120 million a year Home Care Package programme, which focused on this initiative primarily from a policy point of view, acknowledges that this was a well thought out policy and that many older people in receipt of the packages are happy with the service. She accepts that there are lessons to be learned from implementation of the initiative but also stressed that this major initiative is only 3 years old and the HSE has been building up the service since that time. Implementation of Home Care Packages will have to be refined to ensure improved delivery in the most effective and efficient manner possible, in line with resource availability. She said that calls for expansion of the service would be particularly difficult, given overall economic and financial constraints.


The Department had already been working with the HSE to evaluate and review implementation of this initiative and, in line with commitments in Towards 2016, commissioned an independent evaluation earlier this year. This is now almost completed and is expected to be formally submitted to the Minister for Health and Children by PA Consulting very shortly, with a view to implementing its recommendations from early next year. It is anticipated that these will include recommendations around standardised access to and operation of the Scheme.


The Department of Health and Children is also considering the Consultation Paper launched earlier this year by the Law Reform Commission, entitled "Legal Aspects of Carers". This report considers the legal issues around home care provision and makes a number of recommendations in the area of Standards and Regulations. It also recommends giving a function to the Health Information and Quality Authority (HIQA) in this area. Any changes of this nature will require primary legislation and detailed consultation with the stakeholders concerned.


Minister Brady indicated that "the need for better regulation for home based care has been recognised for some time and well accepted by the Department and the HSE. The various issues now being reinforced resonate beyond just Home Care Packages into the broader area of mainstream home care service." The HSE has been working with private providers over the last year and has drafted a voluntary code of Quality Standards for Home Care. These voluntary Standards cover, amongst other things, vetting and training and will be considered by the Department with a view to adoption as policy within the next year in tandem with considering the overall legislative framework required.

Source
Department of Health and Children, Ireland

Palliative Care Research To Benefit From $1.5 Million Award

The American Cancer Society and the National Palliative Care Research Center (NPCRC) are awarding $1.5 million in research grants to researchers at eleven institutions for studies aimed at reducing suffering for seriously ill patients and their family caregivers. The studies will be conducted over the next two years. The NPCRC, in collaboration with the American Cancer Society, has directed over $5 million towards supporting 38 palliative care research projects since starting this initiative three years ago.



"The physical and emotional symptoms that accompany chronic and serious illness like cancer cause so much suffering and yet have rarely been the focus of medical research or research funding" noted NPCRC Director R. Sean Morrison, M.D., who is also professor of Palliative Care, Geriatrics and Medicine at Mount Sinai School of Medicine. "It is my belief that if we are truly going to improve the quality of life for adults and children with chronic illness, then we need to focus our energies equally on disease specific treatments and on the physical, psychological, and emotional symptoms that accompany chronic illness and cause so much distress and suffering. Supporting evidenced-based research is a critical first step in the right direction," he noted.



Palliative care focuses on relieving suffering and supporting the best possible quality of life for adults and children living with serious illness. It is a field comprised of doctors, nurses, social workers, and other specialists who care for patients with chronic illnesses, functional impairment, and a high burden of family caregiving responsibilities. It is provided at the same time as all other appropriate medical treatments.



The collaborative initiative between the American Cancer Society and the National Palliative Care Research Center is designed to support clinician investigators conducting patient-oriented research in palliative care in hopes of bringing more funding from federal agencies, which have supported some research in palliative care, but for whom it is not a priority area. Pilot data results are typically needed before a federal agency will consider funding a research project. "It is encouraging to see the high caliber and innovative applications being submitted by professionals interested in conducting research in palliative care," said Ronit Elk, Ph.D., cancer control and prevention research program director in the extramural grants of the American Cancer Society. "This request for application (RFA) provides clinicians and researchers an opportunity to answer important questions they had long wanted to investigate, but without this unique funding opportunity had been unable to."



"The American Cancer Society, in its initiative with the NPCRC, is making significant contributions towards reducing suffering caused by cancer and other serious illnesses," said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. "We strongly encourage other disease-specific organizations to follow suit and designate research dollars to further support research scientists who will advance the field of palliative care."
















The 2009 Grantees:



NPCRC Pilot Project Support Grant Recipients



Harvard Medical School - Jennifer W. Mack, M.D., MPH, an assistant professor of pediatrics at Dana-Farber Cancer Institute /Children's Hospital Boston, will examine the interplay between hope, prognosis communication, and end-of-life decision-making in the pediatric oncology setting to find ways to improve how physicians communicate prognosis and support parents' hopes for their child's end-of-life period. Ultimately, this work will help parents of children with advanced cancer make meaningful, value-driven decisions for their children's lives and care.



Northeastern Ohio Universities College of Medicine - Kyle R. Allen, D.O., professor of internal medicine and family medicine, and chief of the division of geriatric medicine and medical director of the Post Acute Senior Services Service Line at Summa Health System in Akron, Ohio, will conduct a randomized pilot study along with his co-investigator, Steven Radwany, M.D., medical director of hospice and palliative care at Summa Health System to determine the feasibility of a fully powered study to test the effectiveness of an in-home interdisciplinary palliative care case management intervention in improving a global measure of quality palliative care for consumers of Ohio's community-based long-term care Medicaid waiver program, PASSPORT.



American Cancer Society Pilot Project Support Grant Recipients



University of North Carolina, Chapel Hill - Edwin B. Fisher, Ph.D., a professor in the department of health behavior and health education in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Dr. Fisher's research will describe how different types of support, including nondirective (cooperative) and directive (prescriptive) support may play key roles in quality of life among patients with advanced cancer or who are receiving palliative care. This will also lead to research to develop interventions that will improve quality of life for patients with advanced cancer and to develop guides or other resources that will help their friends, family, and clinical teams to be more effective in providing them social support.



University of Oklahoma Health Sciences Center - Marianne Matzo, Ph.D., a professor and the Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing at The University of Oklahoma Health Sciences Center College of Nursing in Oklahoma City, Oklahoma, will focus on developing and pilot testing a coached communication intervention for sexual health promotion in women with recurring ovarian cancer (OVCA). This is a significant research area because it is an important concern of hospice patients which has not been well studied. This study will pave the way toward a larger, interventional study of palliative care patients and their sexual health.



University of California, San Francisco - Michael Rabow, M.D., an associate professor of clinical medicine in the division of general internal medicine at the University of California, San Francisco, will evaluate the clinical efficacy, family caregiver outcomes, and health care utilization impacts of a surgical oncologic/palliative care co-management model for patients with bladder cancer to determine an intervention able to decrease suffering and improve well-being among bladder cancer patients and families. Elucidating the benefits of concurrent disease and symptom care may provide an innovative model that is broadly useful in the outpatient care of patients with other life-threatening cancers.



Harvard Medical School - Jennifer Temel, M.D., an assistant professor of medicine at Harvard Medical School and an attending physician in thoracic oncology at Massachusetts General Hospital, will conduct a study to encourage oncology clinicians to discuss and document their patient's goals of care and end-of-life care wishes. The intervention will involve an electronic reminder, sent via email, which contains pertinent information about the patients' disease and prognosis and resources to assist the clinician with the conversation.



Northwestern University, Feinberg School of Medicine - Jamie H. Von Roenn, M.D., a professor of medicine at Northwestern University, Feinberg School of Medicine, is a medical oncologist and expert in palliative medicine. She is Medical Director of the Palliative Care and Home Hospice Program at Northwestern Memorial Hospital and a full member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, will conduct a randomized study to examine the effects of a tailored physical therapy program on patients with advanced cancer newly hospitalized on the inpatient oncology unit for acute care. Such rehabilitation might maintain or improve these patients' physical function, compared to patients who receive the usual care.



NPCRC Junior Faculty Career Development Award Recipients



Harvard Medical School - Jane L. Givens, M.D., MCSE, an instructor of medicine within the division of gerontology at Beth Israel Deaconess Medical Center and Hebrew SeniorLife Institute for Aging Research will conduct one of the first detailed studies of family members of nursing home residents with advanced dementia to promote understanding of the mental health burdens facing over 4 million US families whose loved ones are experiencing the end-stage of dementia in nursing homes, and set the foundation for future research aimed at developing strategies to lessen that burden.



Brown University - Ramona Rhodes, M.D., MPH, an assistant professor of medicine within the division of geriatrics at Lifespan/Rhode Island Hospital, Alpert Medical School, Brown University will conduct a study to improve hospice care for minorities. Specifically, she will describe and examine hospice-level variability associated with African Americans' perceptions of the quality of hospice services as well as identify processes of care and interventions that have resulted in improved quality of care for African Americans, through a nationwide survey of hospice providers.



San Diego Hospice and Palliative Care - Scott A. Irwin, M.D., Ph.D., is an assistant clinical professor of psychiatry at University of California, San Diego, a diplomate of the American Board of Psychiatry and Neurology and is the Director of Psychiatry Programs at the Institute for Palliative Medicine at San Diego Hospice. Dr. Irwin will assess the feasibility of conducting a randomized, controlled, safety and efficacy trial of rapidly treating major depressive episodes with methylphenidate monotherapy in patients receiving hospice care. This trial will lay the groundwork for future multi-site randomized controlled trials in patients receiving hospice care and their caregivers, which are lacking for many psychiatric interventions used in this population.



University of California, San Francisco - Alexander K. Smith, M.D., MPH, is an assistant professor of medicine. Dr. Smith will conduct a study using a nationally representative survey linked with Medicare Data to describe the characteristics of elderly patients seen in the emergency department in the last 6 months of life and will use direct observation and survey methodology to examine communication about goals of care among a diverse group of seriously ill elders, their family caregivers, and emergency department providers.



"We are truly enthusiastic over the large number of qualified and promising investigators that have applied for the pilot project support grants and junior faculty career development awards over the past three years," said Dr. Diane E. Meier, Chair of the NPCRC's Scientific Advisory Board, Director of the Center to Advance Palliative Care, and the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine. "Based on the progress and achievements of the current NPCRC and American Cancer Society grantees, we now look forward to opening more doors for additional investigators to advance the scientific field of palliative care."



Further details about the NPCRC and ACS 2009 Grantees and their research projects are available at npcrc/grantees/.

SCOTUS To Hear Case On Home Care Workers' Wages, Overtime

The Supreme Court on April 16 plans to hear oral arguments in a case that could determine whether federal minimum wage and overtime laws apply to home care workers, the New York Times reports. In the case, Evelyn Coke, a 73-year-old immigrant from Jamaica, filed a lawsuit against New York-based Long Island Care at Home to challenge Department of Labor regulations that exempt home care workers from the laws. The Supreme Court agreed to hear the case after the U.S. 2nd Circuit Court of Appeals overturned the regulations, which the court said conflicted with the congressional intent. Congress in 1974 amended the Fair Labor Standards Act to extend federal minimum wage and overtime laws to household workers but exempted baby sitters and "companions" for the elderly and those with illnesses. In 1975, DOL proposed regulations to implement the revisions to the law that exempted home care workers. In a brief, Long Island Care argued that the regulations were consistent with congressional intent because some lawmakers had raised concerns about the need to reduce costs. According to the brief, "The need to restrain costs in the case of third-party employees has only become more acute as agencies provide an increasing amount of needed care." However, attorney Craig Becker, who represents Coke, said, "In its exemption for baby sitters and companions Congress had in mind the quintessential neighbor-to-neighbor relations," adding, "Increasingly this is not a casual form of work akin to baby-sitting but a full-time regular type of employment." The case applies only to home health care workers employed by agencies.

Implications
The "stakes" in the case are "considerable," with the number of home care workers expected to increase to almost two million by 2014, the Times reports. The Service Employees International Union supports the lawsuit because a victory for Coke could lead to increased wages for hundreds of thousands of home care workers, and AARP plans to file a brief on behalf of Coke to argue that the increased wages would reduce turnover among home care workers and prevent a shortage. The federal government and the administration of New York Mayor Michael Bloomberg oppose the lawsuit because of concerns that a victory for Coke would increase Medicare and Medicaid costs and could limit access to home care workers for the elderly and those with illnesses. In a brief, the Bloomberg administration and the New York State Association of Counties wrote, "In the worst cases, some clients, especially those with high hour needs, might no longer be able to be serviced in their homes and might have to be institutionalized." MaryAnn Osborne, vice president of Long Island Care, said that a victory for Coke could force the company to close. She said, "This would be horrendous for the entire industry, because the reimbursement rate we get won't cover that type of money" (Greenhouse, New York Times, 3/25).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Cost Of Caring For Elderly Parent Affecting Retirement For Baby Boomers

Health care costs are "astronomical" for many elderly people who are cared for by their adult children, "compromising the retirement of baby boomers who were expecting inheritances rather than the shock of depleted savings," the New York Times reports. More than 15 million adult children nationwide are providing care for their elderly parents, including paying part or all of their housing, medical supplies and incidental expenses, surveys show. According to the Times, adult children with the highest expenses are those supervising care long distance, those who hire in-home help and those whose parents have too many assets to qualify for Medicaid "but not enough to pay for what could be a decade of frailty and dependence." An AARP survey released last month found that most U.S. residents are unaware of the costs of providing long-term care and believe costs will be covered under Medicare. However, "Medicare is of almost no help, since it covers only acute episodes like a heart attack, cancer or repair of a broken hip," rather than the long-term, low-tech care most elderly people need, the Times reports. A survey conducted in 2004 by the National Alliance for Caregiving found that half of adult children in the U.S. contribute to their parents' care. The average monthly expenditure by adult children was $200, according to the survey. Respondents who reported caring for their parents for at least 40 hours per week spent an average of $324 a month. Gail Hunt, president of NAC, said those figures were based on "quick, top-of-the-head estimates." In addition, many out-of-pocket costs like clothing, home repair and telephone bills "go unnoticed," according to the Times (Gross, New York Times, 12/30/06).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Wisconsin Joint Committee Approves Proposal To Expand Family Care To Additional Counties

The Joint Finance Committee of the Wisconsin Legislature on Thursday voted 15-1 to approve a proposal that would allocate $80.6 million over the next two years to fund an expansion of Family Care, a state program that provides long-term care to elderly and disabled residents, the AP/Janesville Gazette reports. Under the proposal, part of the fiscal year 2007-2009 state budget proposed by Gov. Jim Doyle (D), the program, which currently covers about 10,500 state residents in seven counties, would expand to additional counties. The program seeks to provide long-term care at home or in the community, rather than in nursing homes or other institutions, to help reduce costs.

The proposal would allow the state Department of Health and Family Services to expand the program to any county (Richmond, AP/Janesville Gazette, 5/25). However, the committee would have the authority to suspend proposed expansions of the program to ensure they would result in reduced costs, a level of oversight that Doyle had proposed to eliminate (Marley, Milwaukee Journal-Sentinel, 5/24).

In addition, DHFS would have to provide documentation of consent from counties in which the department proposes to expand the program (AP/Janesville Gazette, 5/25). The proposal would finance the expansion of the program with $20.1 million in state funds, $20.6 million in federal funds and $39.9 million in county funds. The proposal requires approval by the full state Legislature and Doyle (Milwaukee Journal-Sentinel, 5/24).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.