Kaiser Health News reports:

In the healthcare world, skilled nursing facilities are often a stop for elderly patients transitioning home from the hospital, but an emerging “hospital at home” model could eliminate that stop by keeping some chronically ill patients at home the whole time.
Kaiser Health News reports:

“Hospital at home” programs fundamentally refashion care for chronically ill patients who have acute medical problems — testing traditional notions of how services should be delivered when people become seriously ill. Only a handful of such initiatives exist, including the Albuquerque program, run by Presbyterian Healthcare Services, and programs in Portland, Ore., Honolulu, Boise, Idaho, and New Orleans offered through the Veterans Health Administration.
But the concept – which has been adopted in Australia, England, Israel and Canada — is getting attention here with increased pressure from the national health overhaul to improve the quality of medical care and lower costs. Hospital at home programs do both, according to research led by Dr. Bruce Leff, the director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore who pioneered the concept.
In a study of three experimental hospital at home programs published in 2005 in the Annals of Internal Medicine, Leff demonstrated that patient outcomes were similar or better, satisfaction was higher and costs were 32 percent less than for traditional hospitalizations.
“It’s a very successful model and in five years, I think it’s going to be very common. But we’re still in the early adoption phase,” said Mark McClelland, an assistant professor at the Center for Health Care Quality at George Washington University.

Despite McClelland’s expectations, this isn’t a model that health care providers are seeing a lot of—so far, at least, says Greg Crist, vice president of public affairs at the American Health Care Association.
“We’d be hard pressed to see much of a market there because of the complexity of the patients,” Crist says, although he acknowledged there is demand for such a model.
Hospital-at-home models can’t offer the efficiency a skilled nursing center can in terms of having multiple staff available to help residents at various points of need, he says. Additionally, a patient receiving these services at home may eventually need certain medical equipment that’s immediately available at a facility, but would take time to obtain in a home setting.
“Around-the-clock care is very expensive, and even though there are Americans who can afford that, we don’t see that being replicated on a massive scale,” he says.
Read the full Kaiser Health News article.
Written by Alyssa Gerace

Money Follows the Person Program

Funding to help older adults access long-term services and supports at home

The Department of Health and Human Services has announced $25 million in funding to help states strengthen their ability to help seniors and people with disabilities access home and community-based long-term services and supports. Funding will support Aging and Disability Resource Centers in nearly every state. Meanwhile, a new Mathematica Research report shows that the Money Follows the Person Program is 36% below its state target for moving low-income elderly and disabled people from long-term care facilities into the community.

$25 million available to give older adults better access to long-term services and

The Department of Health and Human Services is making $25 million available to give older adults better access to long-term services and supports in their homes and communities.
Aging and Disability Resources Centers will benefit from the funding in the next one to three years under the Affordable Care Act, says HHS Secretary Kathleen Sebelius. The funding will help the centers make it easier for people to learn about and access services available in their area, from home care and social supports for daily living to nursing home care.
“We are pleased to make it easier for Americans to get the care and support they need where they need it,” said Secretary Sebelius. “This opportunity, supported by the new health care law, will help states continue to improve their long-term service and support systems.”
The Veterans’ Health Administration (VHA) is making another $27 million of funding available for similar services to veterans.
The initiative, called the Aging and Disability Resource Center Program, is established through a partnership between the newly-formed Administration for Community Living (ACL), the Centers for Medicare & Medicaid Services, and the Department of Veterans Affairs’ VHA.
State agencies will be better able to administer and coordinate state and federal long-term service and support (LTSS) programs for seniors with the help of the ADRC program, says HHS.
About eight states will compete to participate in accelerating the development of “single entry point models” in the next couple of years. These “one-stop shop” programs will provide one-on-one counseling to consumers weighing their LTSS options.
“Options counseling is an important tool that can provide custom-tailored advice about all the services available in a person’s community, reducing unnecessary time and energy spent searching for answers in a variety of places,” said Kathy Greenlee, ACL’s administrator and assistant secretary of aging.
ACL will provide funding for up to 40 states in the next year to support current ADRC efforts, in addition to whichever eight states are selected to accelerate program development. This will help them develop a “sustainable infrastructure that is critical to ensuring ongoing coordinated access to services,” says HHS.
Written by Alyssa Gerace

What to Say When a Senior Says, “I Just Want to Die.”

By Anne-Marie Botek, April 25, 2012

Text Size: -+

 

It's a statement that caregivers hear all too often from their elderly loved ones: "I can't handle this anymore—I just want to die."
How are you supposed to respond to such a declaration?
Furthermore, how are you supposed to personally cope with the fact that the care you're providing doesn't seem to be enough?
Margaret Sherlock, M.A., Clinical Director of the Behavioral Health Program & Assessment Program Services at the Visiting Nurse Service of New York (VNSNY), offers some advice for caregivers dealing with this difficult situation:

1. Don't ignore it: Sherlock says that the painful emotions surrounding the topic of death can sometimes make caregivers "allergic" to having honest, open dialogues with their elderly loved ones. If your loved one keeps saying that their life is no longer worth living, or that they would be better off dead, Sherlock says that you can help by asking questions to get them thinking about ways they might be able to cope with their situation. Queries like, "Why do you feel that way?" and "What would you like to be different?" can help a senior focus on the facts of a situation, instead of getting caught up in their feelings of pain and helplessness. If your loved one is suffering from Alzheimer's or another form of dementia, they may not respond to these questions. In this case, a caregiver should address the issue of incessant suicidal comments by attempting to distract the senior from their gloomy train of thought by changing the subject to something more pleasant.
2. Set limits: While it's important to know when to talk to your loved one about their feelings, Sherlock emphasizes that it's also vital to know when to stop talking about them. She suggests setting aside some time each day to discuss the tough stuff. That way, difficult dialogues don't pop up out of the blue, which can be emotionally draining. If your loved one tries bringing up the topic ahead of schedule, you can gently remind them that you both agreed to set aside time later on to talk about that issue.
3. Be realistic: As a caregiver, you may feel hesitant about acknowledging that your loved one is near death, but they may be well aware of their condition and want to talk about it. "People with suicidal thoughts want relief from their psychological distress and a caregiver can provide comfort by engaging in mater-of-fact conversations," Sherlock says. While it may be painful, having end-of-life discussions with your terminally ill loved one can help them process their feelings as well as allowing you to make sure that their last wishes are carried out in the way they want them to be.
4. Look out for signs of depression: As always, it's important for a caregiver to be vigilant when it comes to monitoring their loved one for symptoms of depression. Persistent lamentations about wanting to die could be a sign that your loved one is suffering from this mental disorder. According to Sherlock, common symptoms of depression can include: constant feelings of sadness and anxiety, loss of interest in activities that they used to enjoy, sleeping too much or too little, loss of energy, irritability, and loss of appetite.

Sherlock also stresses the importance of taking time for yourself, particularly when you're dealing with a loved one who keeps saying they want to die. A caregiver can become so overwhelmed by their loved one's constant air of doom and gloom that they may end up becoming depressed themselves. She suggests recruiting other family members, or a respite care provider to help you get some time away from your caregiving duties.

Comunity based services VS Nursing Home Care

Most people who use LTS prefer to receive services in the community rather than in a nursing facility, and this desire becomes more prevalent as age increases.
75% of individuals age 45 to 54, and 83% of individuals age 55 to 64 strongly agree or somewhat agree that they wish to remain in their current homes as long as possible; 92% of individuals age 65 to 74 and nearly all (95%) individuals age 75 and over want to do so.14
Among elder and disabled MassHealth members living in the community, as well as among those who are not MassHealth members, there is a desire for more access to home and community-based supports. The ability of elders and people with disabilities to choose community over institutional care is affected by the availability of community options.15
Increasing numbers of Massachusetts elders and people with disabilities receive community-based LTS through MassHealth and through discretionary programs administered by state agencies.16
Approximately 130,000 elders receive services in the community through the Executive Office of Elder Affairs (EOEA) and approximately 100,000 individuals with disabilities receive community services through the Department of Developmental Services (DDS, formerly the Department of Mental Retardation), the Department of Mental Health (DMH), the Massachusetts Rehabilitation Commission (MRC), the Massachusetts Commission for the Blind (MCB), and the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH).17 Another 30,000 children receive early intervention community-based supports through the Department of Public Health.
Community-based services funded through MassHealth have shown significant increased participation rates over the last decade. The PCA program has more than doubled its participants over the last ten years; in the last five years both Group and Adult Foster Care and Adult Day Health have increased participants by more than a third.
13 Ibid.
14 Bayer, A. & Harper, L. (2000). Fixing to Stay: A National Survey on Housing and Home Modification Issues Research Report. Washington, DC: AARP. Retrieved from assets.aarp.org/rgcenter/il/home_mod.pdf
15 Commonwealth of Massachusetts, The Community First Olmstead Plan (2008). Boston, MA: Author. Retrieved from www.mass.gov/Eeohhs2/docs/press_release_docs/080912_comm_living_options.pdf
16 Massachusetts Executive Office of Health and Human Services and Massachusetts Executive Office of Elder Affairs. Boston, MA.
17 This number does not include individuals in MRC vocational rehabilitation programs or individuals receiving ASL interpreter or CART referral services.


Massachusetts Long Term Care Policy

Massachusetts has a lengthy history of supporting the long-term care needs of elders and people
 with disabilities across the lifespan. The Patrick Administration’s
 long-term care policy is community first
, an approach that emphasizes maximizing
 independence in home and community
settings while assuring access to needed
 institutional care. This fact sheet provides
 a snapshot of the current state of long-term
 care supports (LTS) in the Commonwealth,
 including information about the populations
 who use LTS, projected changes in the
 demand for and cost of these services,
 and trends in utilization and payer mix.
 Data in this arena is unevenly available
 across populations and service components.
To the extent possible, population-based and
 relevant national indicators are used.
The fact sheet and additional qualifying
 information about data sources and supporting
 research documents can be found at www.mass.gov/hhs/communityfirst.

  Executive Office ofHealth and Human Services

Plan multigenerational developments

The days of designing and developing retirement communities that segregate older citizens from the rest of the population might be over now that baby boomers are storming into their twilight years, according to architects who say boomers will “do retirement” on their own terms, in a location of their choosing.

About 10,000 boomers are turning 65 each day and will continue to do so until 2030, according to U.S. Census data. But as of 2007, a scant 6% of Medicare enrollees aged 65 or older lived in community housing with services or any sort of long-term care facility, with most remaining in a traditional community, according to a 2012 Center for Housing Policy study.

Meanwhile, an overwhelming majority of retiring baby boomers have no plans to move, according to a recently released MetLife Mature Market Institute study, and this attitude might impact where senior housing developers locate their communities.

Only 11% of MetLife survey respondents said they had plans to enter an active adult community, but 83% said they had no plans to move from their current home. AARP has previously released studies showing 90% of retirees indicating a strong desire to remain in their homes and communities, and this could be a key indicator of the need for designing developments with multiple generations in mind.

Rather than having segregated housing for the nation’s seniors, architects need to plan multigenerational developments, and developers must build with more than one demographic in mind, says Dave Stolte, vice president of senior housing at Encino, Calif.-headquartered NAI Capital.

“If you can get the kids to move into a neighborhood where they can be around their parents, and their kids can have their grandparents around—these would be communities with much more utility, where people can age in place. That’s the key,” Stolte says. “Instead of a separate community, seniors can be included into the community.”

There aren’t too many current examples of well-planned, comprehensively thought out multigenerational communities, Stolte concedes, but he says many senior living developers are realizing that “lifestyle” is a more important concept than “shelter.”

What’s key is incorporating lifestyle into a planned community, with proximity to churches, hospitals, shopping, entertainment, and close to adult children who might become their parents’ caretakers.

“People aren’t wanting to be segregated or seen as a senior,” says Greg Irwin, the president and principal of Irwin Partners Architects. “They want to be a part of all life—not just their own age demographic.”

A large percentage of older Americans remain in their homes because they don’t want to enter an age-specific community, where they’re around lots of people who are similar to them in age only, Irwin says, adding that the future of senior housing development involves finding ways to accommodate seniors’ needs and interests while keeping them a part of the overall community.

“You’re seeing a trend right now to go into a more urban environment and create more opportunity for people,” he says. “We’re seeing an increase in developers asking about how to incorporate senior accommodations into community designs.”

Despite not having current examples to showcase, Irwin says he’s hearing a lot of talk about what it means to blend senior living into a multigenerational community. His firm is currently “working with concepts and ideas on projects,” but isn’t far enough along yet to name any specific projects.

Coming soon, articles on the rise in multigenerational housing, an intergenerational development currently in the works in Massachusetts, and the design of hospitality-style retirement accommodations.

Written by Alyssa Gerace