CLASS Act is gone but long-term care problem remains
The ill-fated CLASS Act is gone.
What’s not gone is the problem of how to provide long-term care to the millions of disabled and/or elderly people who need it – numbers that will only grow as the baby boomers age.
What, if anything, does the Affordable Care Act do to address the problem?
What questions do you have about health reform and how to cover it?
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
The health reform law did not solve the long-term care problem. Not today’s problem, not the growing problem of the future. Even the most ardent backers of the CLASS Act (Community Living Assistance and Services and Supports), which was part of the health care law, did not see it as a complete answer. CLASS was designed to ameliorate, but not eliminate, long-term care costs, which can easily run $70,000 or more a year. Had CLASS been implemented, it would have given families who chose to participate about $18,000 (the finances were never finalized) a year that could pay a piece of a nursing home bill, or for assistance at home, or to build or a wheelchair ramp or accessible-bathroom etc to enable someone to stay at home.
But CLASS sank in an actuarial/legal/political swamp.
Is there anything else in the ACA to help family caregivers?
The law does have dozens of provisions that – depending on how well they are funded and implemented, how widely they are adopted and, quite frankly, how well some of the new care models turn out to work in the real world - can at least nibble around the edges of the long-term care needs.
New models of care
Some of you have started reporting on hospital readmissions. If we’re going to keep older people out of that revolving hospital door, they are going to need to be taken care of – well – outside the hospital. And that’s where a lot of the new models step in – community health teams to support primary care practices, the independence at home act, medication reconciliation programs, transition teams etc. A part of the legislation called “rebalancing” addresses some of the requirements and obstacles that up until now have led states to put institutional/nursing home care ahead of home and community based services.
The AARP just put out a report on how health reform addresses aspects of long-term care and family caregivers. It’s just nine pages, and some of the programs are going into effect this fall, or early next year. There are lots of good local angles for stories there. (The SCAN Foundation is also a good resource on these issues, and I wrote a while back about some of the relevant care models here.) We tend to think of the elderly when we think about long-term care but remember families of the disabled, whether adults or children, and some of people with serious mental disabilities also have these needs.
The report from the AARP Public Policy Institute by Lynn Feinberg and Allison Reamy notes that the health reform law explicitly includes both individuals and their caregivers in shared decision making an in quality assessment. What the family thinks and experiences matters; the family is a partner in care. The law includes family caregivers in some of the programs to improve caregiver training. The AARP report notes, in fact, that “The law explicitly mentions the term ‘caregiver’ 46 times and ‘family caregiver’ 11 times.”
Graham to lead AHCJ’s resources on aging
Veteran health care journalist Judith Graham will be AHCJ’s topic leader in building new resources for journalists covering aging.
Judith Graham
Graham, who was at the Chicago Tribune for 14 years, will write tip sheets and background briefs, recognize important reporting on the issue, ask other journalists to share their experience on the topic and she will curate lists of resources for journalists.
She will encourage and review suggestions from AHCJ members on what resources they need to cover this increasingly important beat.
We’ve asked Graham to introduce herself:
I’m a long-time journalist who started writing about health care finance and policy in the mid-1980s when this was a new beat, with only a handful of reporters tracking it closely across the country. Over dozens of years, I’ve reported on Medicare, Medicaid, long-term care, chronic care, patient safety, public health, efforts to improve health care quality, end of life care, and the business of health care, among other topics.
Understanding aging is both a personal and professional passion of mine. On the personal front, my mother had multiple sclerosis for 63 years and very early in life, I came to understand how the health care system fails people with long-term chronic illnesses. As a caregiver, I dealt for years with problems that frail, older people experience – finding transportation to medical appointments, uncoordinated medical care, securing reliable home health assistance, debilitating isolation, dealing with insurance hassles, and more.
For the past year, I’ve authored a monthly column on aging for the Tribune Co. newspapers, which was distributed widely across the country. Also, I’ve hosted more than half a dozen hour-long Web chats on aging issues and written extensively about these topics on my blog, Triage (now discontinued), and in the news pages of the Chicago Tribune, where I was a senior health and medicine reporter until recently.
Please feel free to contact me via email (judith@healthjournalism.org) with questions or suggestions about how to improve this site. I’m eager to make it as useful to you as possible.
Resource is a fact book on older Americans
The latest version of “Profile of Older Americans: 2010,” published by the HHS Administration on Aging is available.
AHCJ member Eileen Beal, an independent journalist based in Cleveland, recommends the resource as “a great little booklet of facts and data on older Americans: health, income status, marriage status, etc.” She says it is something that reporters interested in Medicare/Medicaid and senior health care issues will want to have.
AHCJ members: What resources have you come across that your fellow journalists will find useful? Let us know in the comments below.
Members’ investigations prompt bills in Wash.
Filed under: Government, Health journalism, Health policy, Member news, Nursing, Pharmaceuticals
Three health-related bills moving through the Washington legislature came about as a result of articles reported by AHCJ members at The Seattle Times and InvestigateWest.
One bill is part of a “proposed overhaul of laws on long-term care of elderly adults” that was prompted by “Seniors for Sale,” a series by Seattle Times reporter and AHCJ member Mike Berens that detailed problems in the state’s adult family homes.
Another bill, unanimously approved by the state senate, will push a state agency to create standards on how to handle chemotherapy drugs. It was prompted by reporting from AHCJ member Carol Smith of InvestigateWest, a nonprofit journalism organization, that revealed that nurses who handle those drugs are exposed to health problems.
A related bill, intended to identify potential links between occupational exposures and cancer outcomes, also was unanimously approved by the senate. It would “require that a cancer patient’s occupation be reported to the registry, and that if the patient is retired, the patient’s primary occupation before retirement be reported,” InvestigateWest reports.
45 nursing homes added to CMS program to improve care
On Jan. 20, the Centers for Medicare & Medicaid Services released the most recent list of nursing homes in its Special Focus Facility Initiative. These are homes that have a history of serious quality issues and are in a special program to improve their quality of care.
The initiative is intended to address nursing homes that cycle in and out of compliance. Homes in this program are visited by survey teams twice as frequently as other nursing homes. This list includes nursing homes added to the SFF initiative and updates the status of homes already in the program.
As far as we can tell, CMS only released the information as a PDF, making it more difficult to search, but AHCJ has posted the list as a series of web pages and has made them available to download as Excel spreadsheets.
The list of nursing homes recently added to the program includes 45 facilities in 24 states. You also can check on the status of homes that have been taking part in the program, including the 62 that have shown improvement, the 49 that have not, the 31 that recently graduated from the program and the four that are no longer participating in Medicare and Medicaid.
Slim guide:
Covering the Health of Local Nursing Homes
This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
Other resources
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
Brokers place seniors in homes without screening
Filed under: Conflicts of interest, Hospitals, Hot Health Headline
The Seattle Times‘ Michael Berens takes a deep look at the industry of “free” elder placement services that began in Seattle and has spread nationwide. The rapidly growing companies offer to help families desperate to find a place for an ailing relative and don’t charge anything. The catch? They only place seniors in facilities that are willing to pay for the referrals.
In addition, most placement companies do not screen homes for past violations. As a result, many have referred seniors to facilities with documented histories of substandard care, including fatal neglect.
In 143 cases over the past three years, seniors were victimized after companies placed them in adult family homes, or other long-term- care facilities, that had a record of serious violations, a Times analysis of Department of Social and Health Services documents reveals.
For the proprietors, such referrals don’t come cheap.
At stake are commissions worth thousands of dollars for every senior. To fill an empty bed, adult-home owners pay placement agencies the equivalent of one month’s rent, on average about $3,500. Large placement companies adopt strict quotas on employees to maintain speed and volume.
Berens tells the tale of one broker “trolling” the parking lot of a rehabilitation center in a search for referrals and about the owner of several adult family homes who was inundated with faxes containing private information about seniors looking for care.
Many such organizations really do have the patients’ best interests at heart, as Berens points out, but he doesn’t shy away from the fact that others are motivated only by profits. Compounding the problem is the lack of oversight and regulation of the process.
Berens previously reported on deaths in adult homes that indicated neglect or abuse but were not reported to the state or investigated.
Slim guide:
Covering the Health of Local Nursing Homes
This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
Other resources
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
Dementia patients overwhelm Scottish system
Filed under: Europe, Health journalism, Hospitals
The (Edinburgh) Scotsman’s Adam Morris won the Guild of Health Writers’ “Best Regional Health Feature” award for his investigation into how an overwhelmed local health system was failing its growing population of dementia patients. Here’s the overview of his example-laden piece:
The growing strain which caring for an ever-increasing number of patients with dementia has placed on the region’s hospitals has led to a series of complaints from families and watchdogs.
They paint a picture of often hard-pressed staff struggling to cope with the challenges of caring for their confused and vulnerable patients, while those with dementia are frequently “left to rot” with precious little stimulation beyond the visits of family and friends.
Related
For more European health news, see AHCJ’s Covering Europe initiative.
Using public records to track elder abuse
Filed under: Health journalism, Health policy, Hot Health Headline, Public records
The Lexington Herald-Leader’s new series, Voiceless & Vulnerable, looks at nursing home abuse in the state. In the investigation (how they did it), the reporters focused on the eight serious nursing home complaints (about 7.5 percent of the total) from between 2006 and 2009 which the state attorney general has taken an unusually long time to resolve. They’ve been pending for an average of 19 months, and officials say each unresolved case can be blamed on unique factors and not on systemic issues.
In addition, investigators’ high case loads, staffing shortages and coordination with other law enforcement agencies have slowed some investigations, said (Shelley Johnson, spokeswoman for the state AG). Other factors include high turnover of nursing home staff and difficulty finding witnesses.
Overall, few such cases are prosecuted, and the ones that do go to court don’t often result in heavy sentences.
In addition to a discussion of how other states are fighting elder abuse (sidebar), the Herald-Leader package also includes graphics about the investigation process and how to report abuse, and a searchable database of serious nursing home complaints.
Old, frail fall through the cracks in Wash. system
In a series of articles, Seattle Times reporter Michael J. Berens looks at Washington’s adult family homes - legally sanctioned facilities in which the state licenses “homeowners to provide spare bedrooms and care for the old or frail who might otherwise have to live in nursing homes.”
These private residences — called adult family homes — were marketed as opportunities for seniors to live in cozy settings and familiar neighborhoods, close to family and friends, with more freedom and superior care.
The owners were given freedom, as well. To encourage this new industry, the state imposed few regulations — no requirements for a minimum level of employees or even, for many years, liability insurance.
Through interviews with more than 250 people, documents obtained through public-records requests and analysis of computer databases and disciplinary actions, Berens found that “thousands of vulnerable adults have been exploited by profiteers or harmed by amateur caregivers” in the state’s 2,843 adult homes.
The Times uncovered accounts of elderly victims who were imprisoned in their rooms, roped into their beds at night, strapped to chairs during the day so they wouldn’t wander off, drugged into submission or left without proper medical treatment for weeks.
In part two of the project, Berens reports on one home that was cited for numerous serious violations but remained in business. Part three will be published on Tuesday.
More information about how the series was reported and a list of other people involved in the project is included in the “About the series” sidebar.
The Times posted a searchable database of the state’s adult family homes.
Slim guide:
Covering the Health of Local Nursing Homes
Check out AHCJ’s latest volume in its ongoing Slim Guide series. This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
Other resources
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
Drug data could inform stories about elder care
The 2007 National Home and Hospice Care Survey (NHHCS ) Medication Public-Use File and Documentation are now available for downloading.
One group of researchers used earlier NHHCS data to “examine changes in hospice services over time, as they were collected during the period from 1992 to 2000, paralleling the period of substantial growth in hospice use and spending.”
With recent studies and news about the increase in use of antipsychotics in the elderly, this data might be useful in reporting such stories and documenting the increase, as well as stories about how treatments have changed.
The 2007 NHHCS Medication Public-Use Data File is supported by SAS, SPSS, and STATA input statements. The documentation includes three PDF files: technical notes, a data dictionary, and a PDF file that provides drug name codes, drug estimates and rates, and drug characteristics.
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