Dementia Patients Still Getting Dangerous Antipsychotic Drugs In Nursing Homes

More than one out of every five nursing home residents is still being given powerful antipsychotic drugs despite a growing consensus that they are inappropriate and often dangerous. These drugs frequently are given to “calm” dementia patients even though many are approved only for the treatment of diseases such as schizophrenia.

Despite a federal initiative, a $2.2 billion legal settlement by a major drugmaker earlier this month, and the support of many nursing home and consumer organizations, it has been extremely difficult to reduce the overuse of these drugs.

End Medicaid’s Institutional Bias for Long-Term Care

If, like millions of Americans, you need personal assistance and run out of money, you may be eligible for long-term care under Medicaid. But in order to get those safety net benefits, you may have no choice but to move into a nursing home.

This is true even though most people prefer to stay at home and most of the institutions themselves would rather be providing more lucrative post-acute care and rehabilitation. It is true even though policymakers have been trying for decades to “rebalance” Medicaid long-term care so the frail elderly and people with disabilities have access to benefits no matter where they get care. And it is true even though the Supreme Court ruled in 1999—14 years ago—that people with disabilities had the legal right to care in community settings whenever possible.

Nursing Home Use by Medicaid Seniors is Plunging

 

Take a look at this table, which AARP’s Don Redfoot posted earlier this week:

6-26-2013 graph for don

It is a remarkable story: Long-stay nursing home care by seniors enrolled in Medicaid has been plummeting for 15 years.

It is not clear exactly why, but there are probably several reasons. First, state Medicaid programs have been shifting care from nursing facilities to home and community-based settings–a step that seniors themselves favor and one that may save money in the long-run. While Medicaid still spends more total dollars on nursing home care than on home care, Don’s chart shows  that  nursing facility use by Medicaid-eligible seniors has fallen by nearly one-third, from 1.4 million in 1995 to just over 1 million in 2010.

The CPR Death at Glenwood Gardens: What Really Happened and Five Lessons You Should Learn

By now you know the story—or at least think you do: A nursing home nurse sees an 87-year-old resident in cardiac arrest and calls 9-11. Despite desperate pleas of the call center operator, the nurse refuses to do CPR and the resident dies.

Except most of the story isn’t true. Lorraine Bayless lived at a Bakersfield (CA) continuing care community called Glenwood Gardens, but in independent living, not in its skilled nursing facility. She did not die of a heart attack but of a stroke, according to the death certificate signed by her personal physician. CPR may have saved her, but it is very unlikely.

What Ever Happened to the Long-Term Care Commission?

Nearly two months ago, Congress created a commission to recommend reforms to the current long-term care system. So what has happened since? Not much.

Leaders of Congress have appointed members to serve on the panel but President Obama—who has three of 15 picks– has not yet made his choices. The commission can’t select a chairman, find a staff, or set an agenda until he does, so for now the effort remains on hold.

Sources say the delay is mostly bureaucratic—it often takes the White House time to review background checks and run candidates through the usual political traps. 

More People are Dying at Home and in Hospice, But They are Also Getting More Intense Hospital Care

More people over 65 are dying in hospice care and fewer are dying in hospitals. But this good news is tempered by a very different story. People are also being hospitalized more frequently in the last three months of their lives, are more likely to spend time in intensive care units, and are often receiving hospice care for just a few days before they die.

In a new study in the Journal of the American Medical Association (JAMA), Joan Teno and colleagues painted a nuanced picture of end-of-life care in the U.S.  A key finding: Simply knowing where someone dies may not say much about the care she received at the end of life.  

A Right Way and Wrong Way to Confront Elder Abuse

Elder abuse is a serious and growing problem we know too little about and, worse, too often ignore. It comes in many forms—physical, financial, and emotional. Yet, even as society focuses on addressing child abuse, it has fallen far behind when it comes to responding to elder abuse. Here are a couple of examples of the right way, and the wrong way, to confront this problem:

How Teamwork Across the Health System Can Keep Seniors Out of the Hospital

Broad-based, integrated, community-wide initiatives can help keep seniors out of the hospital, says an important new study from the Journal of the American Medical Association.

The study, done by a team led by Dr. Joanne Lynn of the Altarum Institute’s Center on Elder Care and Advanced Illness is new evidence that by working together, hospitals, physicians, social workers, nursing homes, home health agencies, and community organizations can help seniors reduce both initial hospitalizations and readmissions. This suggests that such teamwork can improve the quality of care for elders with chronic disease.

Do You Really Want to Give Away Your Assets to Become Eligible for Medicaid Long-Term Care?

A new insurance company survey of financial advisers reports that four-in-ten have clients who ask about giving away their assets so they can become eligible for Medicaid long-term care.  Oddly, though not surprisingly, the same advisers report their clients say that a key goal of their long-term care planning is “maintaining control.”

The online survey, by Nationwide Financial, questioned a small, self-selected sample of advisers, so the results may not be representative. And remember, this survey did not report that 40 percent of clients want to spend-down, only that 40 percent of advisers had clients who asked about it.

How Senior Communities Can Connect with Their Neighbors

Too often, we stash our elders away in institutional residential care facilities. And, sadly, even many active seniors choose to separate themselves from the broader world, opting for what they see as the safety and security of gated communities.  

This week, I spent a couple of days in Rochester, N.Y., where the St John’s Living Community has developed two alternatives to this world of hidden elders. One is a new independent living community that is explicitly opening itself up to the surrounding neighborhood. The second: Two 10-bed nursing homes that have been built in the midst of a middle-class subdivision, as fully integrated into the neighborhood as the private homes that surround it.