ElderWeb

The Alabama Legislature recently approved SB418 that changed the name of the Alabama Commission on Aging to the Alabama Department of Senior Services. This was done with the support of the Governor's office, Area Agencies on Aging and legislators. With this new name, the state's older citizens and other interested persons can more easily identify them as the state's focal point for aging services.

Act No. 2000-795, HB170 was signed by the Governor and became effective August 1, 2000. The companion bill was S-187 (Butler). This bill amends the Alabama Medicare Supplement Policy Minimum Standards Act and adopts the Alabama Long-Term Care Insurance Policy Minimum Standards Act, so as to make Alabama law substantially similar to the uniform standards developed by the National Association of Insurance Commissioners and required by the Federal Health Care Financing Authority.

The Alabama Public Health Department held an unusual public forum with leaders of the Alabama long-term care industry, to discuss regulation of assisted living in the state. The Health Department argues it has neither the money nor the authority to regulate the assisted-living industry, nor the patience to listen to the nursing home industry say that it's unfair to regulate nursing homes while not regulating assisted living. After efforts to write new laws failed in the last days of this year's legislative session, the Health Department invited dozens of leaders and thinkers to this forum. They say that it was not a legal hearing, just a public negotiation.

After that forum, the state released its proposed new assisted living regulations. Officials estimate that as many as half of the patients in standard assisted-living homes wouldn't be eligible to remain there under the new rules. At least 20 new state inspectors would be hired to inspect hundreds of assisted living homes statewide. The estimated $750,000 cost of those inspections would be paid from an emergency appropriation approved by Siegelman.

The stumbling block centers on whether dementia-care assisted-living homes would be subject to broader state control. The nursing home industry wants such facilities under Certificate of Need (CON) restrictions because they often compete for the same patients. Assisted-living leaders agree some control of growth is needed, but contend the CON is too politicized and doesn't guarantee a higher quality of care.

In a review of 32 studies of activity and mood among the elderly, investigators found that regular exercise, particularly strength training, boosted study participants' moods. The results were remarkably consistent across the studies, according to a report in the Journal of Aging and Physical Activity, in research led by Shawn M. Arent of Arizona State University in Tempe. Researchers found that the combination of aerobic exercise and strength training elevated mood to a greater extent than did aerobic exercise alone. The authors note that there is much to be learned about the optimal intensity, frequency and duration of strengthening exercises for the elderly, particularly those in poorer health. The combination of aerobics and strength training may be the most beneficial activity plan for the elderly, but researchers note that research in this area is "severely lacking."

Arizona Health Care Cost Containment System Administration (AHCCCSA) proposes to revise fee-for-service (FFS) payment rates for long term care nursing facilities and home and community based services (HCBS) for dates of service on and after October 1, 2000. Under this proposal, nursing homes in Arizona will see an increase of about 5% in their reimbursement rates, and Home and Community Based Services (HCBS) providers will see an increase of about 8.8%. Payment rates and ratios are available for review at AHCCCSA, and written comments should be sent to the following address and received no later than 5:00 p.m. on September 29, 2000:

Michael Veit, Contracts and Purchasing Administrator, Arizona Health Care Cost Containment System, 701 E. Jefferson Street, Phoenix, Arizona 85034

State Senators Chris Cummiskey (D-Phoenix) and Tom Freestone (R-Mesa) asked Governor Jane Hull to call the Legislature into special session to address the crisis of skyrocketing prescription drug prices faced by many of Arizona's seniors. This crisis is expected to worsen on January 1, 2001 when four more HMOs leave the Medicare HMO market in rural Arizona, taking much needed prescription drug coverage with them. It is estimated that upwards of 200,000 Arizona seniors will be left without coverage by the end of the year.

Cummiskey and Freestone have proposed a two-stage plan to make prescription drugs more accessible for Arizona?s seniors. The first stage involves creating prescription purchasing coalitions that will benefit all seniors, regardless of income. The free market styled purchasing coalitions will take advantage of group purchasing to negotiate bulk rates using the same benefit management companies that negotiate lower rates for HMOs.

The second stage provides direct support to the neediest seniors through direct subsidies. Seniors with incomes below the federal poverty level, about $8,300 for an unmarried senior, would receive a 100% subsidy for the price of their prescriptions. Additional relief will be provided for seniors with incomes up to 250% of the federal poverty level, almost $20,900 for an unmarried senior, through subsidies ranging from 25% to 75% of the cost of prescription medication depending on the person?s income.

Both parts of the plan have won wide support from such groups as the American Association of Retired Persons (AARP) and the Arizona Silver Haired Legislature.

Arkansas HB1635 has been enrolled as Act 1230, The Arkansas Assisted Living Act. This bill creates a new type of facility in the state, to be called assisted living facilities, for people who need nursing home care, but who do not require 24-hour nursing. The Department of Human Services is instructed to create a rules and regulations to license such facilities. The Department is also instructed to apply for a waiver of the Medicaid rules to allow residents who qualify for Medicaid to be covered in assisted living facilities, in addition to nursing homes. The bill also allows residential care facilities to convert to assisted living facilities.

The Arkansas Legislature will hold a "Silver Haired Legislative Session" on August 30. The Silver Haired Legislative Session (SHLS) is a mock legislature of senior delegates that has convened every two years since 1978. In 2000, it will take place on August 30 in the House Chamber at the State Capitol. The session is held with the permission of the Arkansas General Assembly and is sponsored by the Division of Aging and Adult Services and the Arkansas Area Agencies on Aging.

The legislation passed by the SHLS brings the issues and concerns of older Arkansans to the attention of the Arkansas General Assembly and to the public. Many of the bills proposed in the SHLS have become actual Arkansas law. Seniors participating in the SHLS learn about the legislative process and become more effective advocates for all older citizens.

Any resident of Arkansas who is 60 years of age or older, and is not an employee of the DHS Division of Aging and Adult Services or an Area Agency on Aging, may serve as an SHLS delegate. One candidate from each county will be elected to the Silver Haired Legislature, and three repeat delegates will be appointed by each Area Agency on Aging.

The Medi-Cal Policy Institute has issed a new report, "Understanding Medi-Cal Long Term Care." It answers questions like:
- What is Medi-Cal?
- Who is eligible for Medi-Cal long-term care?
- How is long-term care funded and administered?
- Which services are covered by Medi-Cal?
- What policy issues lie ahead?

The state of California has unveiled a new state website, and as a part of that new site they have posted an online directory to licensed nursing homes, residential care facilities, home and community based services, adult day care, and other services for older Californians. The searches provide names, addresses, phone numbers, and information about the licensure status of the facility.

Governor Gray Davis announced a new initiative to pay premiums of approximately 40,000 elderly and disabled Californians who faced disruption of their health care when nine Medicare+Choice HMOs in California implemented price increases on January 1, 2001. Last fall, nine Medicare+Choice HMOs in California and others nationwide announced plans to increase premiums to cover rising costs of health services. These increases affected beneficiaries who are eligible for both the state's Medi-Cal program and the federal Medicare program. By ending enrollment in their plans these individuals would have returned to a fee-for-service health care plan. These plans are more costly to the beneficiaries and the state.

Under the new program, California will pay the premiums for these individuals, effective January 1. The state is paying the HMOs directly, eliminating the need for individuals to make a payment each month. The payments are comprised of 50 percent General Funds and 50 percent federal matching funds. Initial annual cost projections for the program are $8 million in the current fiscal year and $17 million in subsequent years.

The Sacramento Bee reported that the state of California is suing Susan Gollas for $120,000 to recoup the cost of caring for her father, Sadao Yorita. Susan placed him in a nursing home when she was no longer able to care for him at home. She found that he qualified for Medi-Cal, since he didn't have the resources to pay for his own care. However, Gollas said she wasn't aware that she would have to pay back the state when her father applied for Medi-Cal. She said she will be forced to sell the 20-acre family farm she inherited from him and now works with her husband, Mario, and their three children.

Many people are unaware that federal law requires states to pursue repayment of nursing home costs from the estates of Medicaid recipients. The program in California collected about $40 million last year from more than 2,400 estates. County welfare offices give Medi-Cal applicants for long-term care printed information explaining that the costs will eventually be recovered, but the regulations are complex and advocates say an estate planner or attorney may be needed to help some understand the consequences. Some of those who are surprised the most have very modest estates, and may not have the education or resources to get professional help.

One thing the article did not mention is that the Federal guidelines provide that states should not recover costs if they cause "undue hardship," for example in the event that the estate is the only income-producing asset for the surviving family. It specifically mentions family farms as an example. Hopefully, Ms. Gollas will retain professional help to protect her family farm, but this story illustrates the fact that many people are unaware of all the consequences of relying on Medicaid for nursing home costs.

Governor Gray Davis of California signed AB 1731, a bill which will increase nursing home oversight and enforcement. As a part of the bill, nursing home staffing requirements will also be increased. Existing law provides that the minimum number of actual nursing hours per patient required in a skilled nursing facility shall be 3.2 hours.

This bill would declare the intent of the Legislature to increase the minimum number of direct care nursing hours per patient day in skilled nursing facilities. The bill would require the department to determine the need, and provide recommendations, for any increase in the minimum number of nursing hours per patient day and perform designated analysis. The bill would require the department, on or before May 1, 2001, to prepare a report on its analysis and recommendations and submit the report to the Legislature.

California SB2111 has been passed by the legislature. It will add agents and company representatives to the working group responsible for helping state insurance regulators come up with the content and format for the state's annual LTC rate stability guide. The bill would also allow insurers to focus consumers' attention on rate increases affecting California LTC policies, rather than on increases affecting policies sold throughout the United States.

Current law requires insurers to report and the consumer guide to include summaries of coverage of any policy sold in any state for the last ten years. The bill's author, Senator Joseph Dunn, believes this voluminous amount of information is of little use to California consumers since they can only purchase those policies which are sold in California. Dunn believes the bill makes it clear that the rate guide is intended to have two sections: a rate comparison section of all policies sold in any state in the last ten years, and a policy comparison section comparing policies available for purchase in California.

The California legislature has enacted a new law consolidating several previous law related to advanced healthcare directives. Advanced directives are used to allow people to influence decisions about how they will be cared for in the event they become unable to make their wishes known directly.

The new allows people to appoint another person to be their health care "agent." This person, called an "attorney-in-fact", will have legal authority to make decisions about their medical care if they become unable to make these decisions for themselves. The law also allows people to document their health care wishes in the Advance Health Care Directive form, for example, a desire not to receive treatment that only prolongs the dying process in the event of a terminal illness.

The Advance Health Care Directive is now the legally recognized format for a living will in California, replacing the Natural Death Act Declaration. The Advance Health Care Directive is more comprehensive than a living will, which only states a desire not to receive life-sustaining treatment if the person is terminally ill or permanently unconscious. The Advance Health Care Directive can be used to state the person's desires about their health care in any situation in which they are unable to make your own decisions.

The Advance Health Care Directive has also replaced the Durable Power of Attorney for Health Care (or "DPAHC") as the legally recognized document for appointing a health care agent in California. Previously executed Durable Powers of Attorney for Health Care or Natural Death Act Declarations will remain valid unless replaced with the new Advance Health Care Directive.

The California Legislature has enrolled AB 2107, which requires that all insurers, brokers, agents, and others engaged in the business of insurance owe a policyholder or a prospective policyholder a duty of honesty, and a duty of good faith and fair dealing.

The bill stipulates that if a life agent offers to sell to an elder any life insurance or annuity product, they must advise the client writing that the sale or liquidation of financial assets to fund the purchase of this product may have tax consequences, early withdrawal penalties, or other costs or penalties as a result of the sale or liquidation, and that the elder or elder's agent may wish to consult independent legal or financial advice before selling or liquidating any assets and prior to the purchase of any new products.

A life agent who offers for sale or sells a financial product to an elder on the basis of the product's treatment under the Medi-Cal program may not negligently misrepresent the treatment of any asset under the statutes and rules and regulations of the Medi-Cal program, as it pertains to the determination of the elder's eligibility for any program of public assistance. A life agent who offers for sale or sells any financial product on the basis of its treatment under the Medi-Cal program shall provide, in writing, a specified disclosure that indicates it is not necessary to expend all of their savings before applying for Medi-Cal, and outlines the financial eligibility rules for Medi-Cal.

The bill also clarifies that "Financial abuse" of an elder or dependent adult occurs when a person or entity takes, secretes, appropriates, or retains, or assists in taking, secreting, appropriating, or retaining real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud.

This bill underwent substantial revisions in response to concerns expressed by the insurance industry and other professionals. The original version of this bill would have forbidden lawyers to sell annuities to their clients, or to receive compensation for referring clients to insurance agents or brokers, and would have restricted agents? ability to recommend that older customers sell assets to pay for LTC arrangements. If the original version had been enacted, agents would be allowed to make LTC recommendations involving asset sales only if they held Series 7 licenses from the National Association of Securities Dealers and were certified financial planners or certified financial analysts, according to the bill text.

In the final week before they recessed, the California Legislature sent AB 1731 to the governor. This bill is intended to increase nursing home oversight and consumer protection measures in the state. The bill addresses several areas:

Fines for class "AA" citations of long-term care facilities are increased to $25,000 to $100,000 per incidence.

Additional protections for residents are established in the event that a facility changes ownership or enters receivership, by restricting the ability of new owners to transfer or move residents, and allowing the State increased latitude in setting up a temporary manager. It also provides for additional facility inspections if there are changes in key personnel, like the administrator or director of nursing.

The Department of Health Services (DHS) is instructed to investigate and implement higher minimum nursing hours requirements for nursing homes.

DHS is instructed to create a consumer information service system to provide updated and accurate information to the general public and consumers regarding long-term care facilities in their communities, including an on-line inquiry system accessible through a statewide toll-free telephone number and the Internet, with long-term health care facility profiles, a history of all citations and complaints for the last two full survey cycles, and ownership information.

The bill provides that if a long-term health care facility is sanctioned for violation of state or federal requirements, they must provide written notification of the action to each resident, the resident's responsible party and legal representative, and all applicants for admission to the facility.

The California Citizens for Nursing Home Reform opposed the bill as it was introduced, but some of their concerns were addressed in amendments to the final bill.

House members from the San Francisco Bay area of California -- Fortney Pete Stark, Anna G. Eshoo, Tom Lantos, Barbara Lee, Zoe Lofgren, George Miller, Nancy Pelosi, Ellen O. Tauscher, and Lynn C. Woolsey -- asked the minority staff of the Committee on Government Reform to investigate the conditions in nursing homes in the Bay Area. There are 288 nursing homes in the Bay Area that accept residents covered by Medicaid or Medicare. These homes serve approximately 22,000 residents. This is the first report to evaluate their compliance with federal nursing home standards.

The report found that there are serious deficiencies in many Bay Area nursing homes. Only 18 nursing homes in the Bay Area were in full or substantial compliance with federal standards during their most recent annual inspection. In contrast, 119 nursing homes in the Bay Area -- more than one out of every three -- had violations that caused actual harm to residents or placed them at risk of death or serious injury.

Researchers have found that people with a genetic high risk for Alzheimer's disease had to use more of their brains to perform memory tasks than those at normal risk. Thirty subjects aged 47 to 82 with normal age-appropriate memory performance were tested, and those with higher brain exertion demonstrated noticeable decline in their verbal recall abilities two years after initial testing. The results add to other evidence that physical changes to the brain begin years before dementia. The study was lead by Gary W. Small, director of the Center on Aging at the University of California at Los Angeles, and appears in the New England Journal of Medicine (NEJM).

California Governor Gray Davis signed the state's 2000 budget, which includes $270 million for programs which target the elderly and disabled. Among other things, the budget includes:

$319.9 million to help elderly persons remain at home and lead independent lives and to improve the quality of nursing home and in-home care. Approximately 52,800 more low-income seniors will receive no-cost Medi-Cal, so they can spend less of their resources on health care costs and better afford to remain at home. Nursing home workers funded by Medi-Cal will receive wage and benefit increases. Increased oversight and incentives will improve the quality of nursing home care.
$221.6 million to further supplement the Aging With Dignity Initiative by improving the quality of provider services and strengthening provider recruitment and retention.

The Department of Aging will over see some of this spending, including:

$14.8 million for one-time challenge grants to fund innovative models that provide more options to seniors and younger, functionally impaired adults in need of long-term care assistance to remain in their own homes and communities.

$1 million to establish a Senior Housing Information and Support Center to provide information to seniors and their families concerning home modification and assisted technology alternatives that will allow seniors to live more independently or with their families.

$1 million for a statewide Senior Wellness Education Campaign to educate seniors, their families, and health professionals on healthy aging practices, with information about community-based and in-home care alternatives to institutional care.

$1.3 million in funding for the Health Insurance Counseling and Advocacy Program (HICAP) to increase the state-funded portion of this program to more than $4.7 million.

Bladder control problems that cause older women to rush to the bathroom at night may increase their risk of falls and fractures, researchers report. Researchers, led by Dr. Jeanette S. Brown of the University of California, San Francisco, found evidence that weekly or more frequent incontinence independently boosts an older woman's risk of falls and bone breaks. In a study of more than 6,000 women aged 72 and older, those with frequent urinary incontinence were about 25% more likely than women without the condition to suffer a fall. They had a one-third greater risk of fractures not involving the spine.

Specifically women with "urge incontinence" carried a higher risk of falls and fractures. People with this condition feel an overwhelming need to empty their bladders, but often cannot make it to the bathroom. Weakened pelvic muscles, bladder dysfunction, and certain medications may underlie the problem.

In an editorial, the Journal said that this study made a "compelling argument for urge incontinence as an additional risk factor for fall-related occurrences...Vigorous study should be devoted to combining drug therapies for incontinence with injury-prevention strategies like strength and balance training."

Medicare recipients can now use any California pharmacy that accepts Medi-Cal and receive prescriptions at the Medi-Cal rate plus a 15 cent processing fee for each prescription, in a new program that went into effect on February 1, 2000. Senate Bill 393 enables Medicare recipients to obtain their prescription drugs at a cost no higher than Medi-Cal rates.

When a Medicare beneficiary has a prescription filled, he or she should present the pharmacy staff with the Medicare card. If the doctor phones the prescription in, ask the doctor to notify the pharmacy that the patient is a Medicare recipient. Beneficiaries should ask their regular pharmacies to put a note on their record stating that they are a Medicare recipient so that they will be charged the Medi-Cal rate for future prescriptions.

The Los Angeles Times reports on a growing problem in the Los Angeles area. Elderly people are being evicted from low-income housing projects financed by the Department of Housing and Urban Development (HUD). The problems are erupting in rental properties where the former owner defaulted on HUD-backed loans and HUD has assumed the title. HUD is evicting the residents and attempting to re-sell the property, and putting elderly tenants on the street as a result. One example is the pending eviction of 70-year-old Evelyn Eberhardt. She was in the hospital after undergoing two major cancer surgeries last summer when she was told she had 30 days to move out of the two-bedroom, rent-stabilized unit she has lived in for 10 years.

The Senior Worker Advocate Office, formerly known as the California Task Force for Employment of Older Workers, has pledged to improve employment and training opportunities for senior workers forty and over and to raise public awareness of the issues and problems that confront senior workers. The office works directly with the public and the private sector to afford all senior workers in California access to employment-related resources.

The Web site include information for both employers and senior workers about rights and responsibilities, benefits, training, and job search.

When an elderly person suddenly slips and falls, it may be called an accident and blamed on old age. But researchers in California suggest such falls could in fact be the result of disorders of the inner ear. Dr. Gail Ishiyama, a neurologist at the University of California, Los Angeles, says her research indicates that some falls can be traced to Meniere's disease and related disturbances of the inner ear, and to call these falls "accidental" could result in the patient's receiving the wrong sort of treatment while the real cause remains untreated.

72,000 home care workers in Los Angeles County received news that Governor Gray Davis agreed to meet their demands for a pay raise to $7.50 per hour plus health insurance, and $1 per hour increases in each of the next four years. But the increase won?t be final unless the county Board of Supervisors agrees to chip in more money for the matching fund program, which they indicate they are unwilling to do. Los Angeles County home care workers account for more than half the home care workers in the state. The majority of home care workers in Los Angeles County are African American, or Latino or Asian immigrants, and most are women. Until last year, they earned minimum wage.

California Assembly Bill AB 2107 was introduced on February 22, and has been referred to the Insurance Committee. The bill would only permit a licensed life agent who has a National Association of Securities Dealers Series 7 license and who is either a certified financial planner or certified financial analyst to advise an elder or his or her agent to purchase long-term care planning with the proceeds from the sale of assets. The bill would only permit those life agents to sell or offer for sale to an elder or his or her agent any financial product on the basis of the product's treatment under Medi-Cal. It would also prohibit a lawyer from selling an annuity to an elder with whom the lawyer has or has had an attorney-client relationship.

One in seven nursing homes in Colorado's Second Congressional District had violations severe enough to harm residents or put them at risk of death or serious injury, according to a report released by Congressman Mark Udall (D-CO). Of the area's 27 nursing homes, 70% of them violated some federal standard during recent inspections. According to the report, these violations include improper treatment of bedsores, failure to provide sanitary living conditions, improper use of restraints, administering wrong medications or failure to provide medications to residents and inadequate staffing.

"Frankly, I was shocked and disturbed by the findings in this report. Nursing home residents have a right to quality and compassionate care. Regrettably, many seniors are not receiving the care that they and their families expect and that federal law requires," Udall said at a press conference in Northglenn where he released the 21-page report.

Udall asked the minority staff of the Committee on Government Reform to investigate the conditions in nursing homes in the Second District, which includes all of Boulder, Clear Creek and Gilpin Counties and northern Jefferson and western Adams Counties. The staff reviewed reports by state inspectors, who check nursing homes that receive Medicare or Medicaid funding to see if they comply with federal standards for health, safety and treatment of patients. These inspections were conducted from February 1999 to February 2000, the most recent information available for each of the 27 nursing homes in the area.

To address the situation, Udall announced that he would cosponsor legislation to protect seniors in nursing home care. H.R. 4949, The Nursing Home Quality Protection Act, would impose tougher sanctions, increase funding and increase public disclosure of nursing home conditions.

HR 4949 is now sitting in committee, and it looks like it is unlikely to pass before Congress recesses later this month.

Connecticut's Legislative Program Review and Investigations Committee has recommended that minimum nursing hours required in nursing homes be raised from 1.9 to 2.75 hours per patient per day. They estimate that this increase will cost about $13.7 million for residents covered by Medicaid, half of which would be paid by the state and half by the federal government. The committee noted that many nursing homes are having trouble finding and retaining staff, which may make it difficult for facilities to reach these staffing levels. To counter this problem, they suggest a two year phase in period to allow facilities time to find ways to deal with the staffing problems. The Connecticut Department of Labor provided information used by the committee to conclude that the turnover rate among staff in Connecticut nursing homes was 43% in 1998 and 46% in 1999, but concluded that these high turnover rates would be reduced by raising the minimum ratios in nursing facilities to reduce job burnout by making the work environment less stressful. SB 1173, which would mandate the increase in the minimum staffing hours, has been raised and referred to the Joint Committee on the Program Review and Investigations Committee.

Andrew Julien of The Hartford Courant reports that physicians in Connecticut are becoming reluctant to provide care to low-income nursing home patients. The problem is that the doctors only receive 80% of the regular Medicare payment for that visit. Generally, physicians receive the other 20% as a co-payment from the patient, but when the patient is on Medicaid, which most nursing home residents are, doctors are not allowed to bill the patient. The state used to make up the difference, but quit doing so two years ago.

A low dose of estrogen was as effective in reducing bone turnover as higher doses when given to a group of healthy women 65 years and older, according to a study published in the December issue of the Journal of Clinical Endocrinology and Metabolism. This is the first controlled clinical trial to directly compare the effects of different doses of estrogen on bone turnover in older women.

Bone turnover refers to the bone remodeling cycle in which new bone is formed as older bone is dissolved. Osteoporosis develops when more bone is dissolved than is formed, weakening the bones and making them prone to fracture. The risk for developing osteoporosis increases with age.

Decreases in bone turnover among the women who took 0.25 mg of estradiol, a form of estrogen, was quite similar to the decrease among the women who took 1.0 mg of estradiol, according to lead author Karen Prestwood, M.D., of the University of Connecticut (UCONN). The 1.0 mg estrogen dose that women conventionally are prescribed as part of estrogen replacement therapy (ERT) to treat symptoms of menopause, reduce bone turnover, and treat osteoporosis, sometimes results in side effects such as breast tenderness, fluid retention, headaches, and bloating. The group taking 0.25 mg estradiol had no more side effects than the placebo group, according to the study, conducted at UCONN?s Claude D. Pepper Older Americans Independence Center.

Yale researchers have designed a cost-saving program that helps prevent older patients from declining physically and mentally while hospitalized. The problem of functional and mental decline is increasingly important since patients aged 65 and older account for more than 48% of all hospital days, said Sharon Inouye, M.D., associate professor of internal medicine and geriatrics at Yale School of Medicine. She is principal investigator of the study published in the December issue of the Journal of the American Geriatric Society about the new Hospital Elder Life Program.

The Hospital Elder Life Program involves entire hospital units, provides skilled staff and trained volunteers to implement interventions for all patients, and targets interventions to specific risk factors. Under the program, patients 70 and older are screened on admission for six delirium risk factors: cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment. Targeted interventions for these risk factors are implemented by an interdisciplinary team, which includes a geriatric nurse specialist, elder life specialists, trained volunteers and a geriatrician. All work closely with the primary nurses. Other experts provide consultation at twice-weekly interdisciplinary rounds.

To date, 1,507 patients have been enrolled during 1,716 hospital admissions. The overall intervention adherence rate was 90% for at least partial adherence with all interventions during 37,131 patient days.

Patients In Program vs Not In Program Who Declined 2%+ While in Hospital:

Decline Measured by: Mini-Mental State Examination (MMSE) 8% vs 26%
Decline Measured by: Activities of Daily Living (ADL) 14% vs 33%

Preliminary, unpublished results show that the program reduces overall hospital costs by $1,500 per patient. Start up costs for the program include the equivalent of 1.7 fulltime paid staff and equipment costs estimated to be about $3,000 for one or two hospital units totaling 35 to 70 beds. The figure includes an optional computer expense of $1,500 for patient enrollment, volunteer assignments, and tracking of adherence and program outcomes. The program is effective for delirium prevention and insomnia. Other benefits include providing cost effective care, gaining recognition as a center of excellence, enhancing patient satisfaction, improving community outreach, and serving as an educational site for acute geriatric care.

Co-authors of the paper include Sidney Bogardus, M.D., assistant professor of internal medicine and geriatrics and medical director of the Adler Geriatrics Assessment Center; Dorothy Baker, research scientist in the Department of Epidemiology and Public Health (EPH); Linda Leo-Summers, programmer-analyst, EPH, and Leo Cooney, M.D., professor and section chief, general internal medicine. The study was funded by the National Institute on Aging, The Commonwealth Fund, the Retirement Research Foundation, the Community Foundation for Greater New Haven and the Yale New Haven Hospital Auxiliary.

Older patients hospitalized with pneumonia for an increasingly shorter length of time are more likely to be re-admitted or discharged to a nursing home, a study by a Yale researcher and collaborators shows. This is important because the length of hospital stays is declining nationwide. Pneumonia among older patients is responsible for more than 600,000 hospitalizations nationally and $9 billion in health care costs every year. About 10% of patients older than 64 who are hospitalized with pneumonia die while hospitalized. Many more die within a month of being discharged. Of those patients who do survive, about 12% require placement in a long-term care or rehabilitation facility.

Meehan and his co-researchers looked at patients over 65 who were discharged from Connecticut hospitals between Oct. 1, 1991 to Sept. 30, 1997, after being treated for pneumonia. In that six-year period, the average length of stay for these patients dropped by about 4 days. They found that the mortality rates during the patients' hospital stays declined, because they were there for a much briefer period of time, but:

* The percentage of patients transferred to long term care facilities increased from 30% to 43%.

* The rate of mortality within 30 days after discharge increased from 7% to 9%.

* Re-admissions to the hospital for pneumonia within 30 days of discharge increased from 3% to 4%.

The mean adjusted costs associated with hospitalization for pneumonia declined steadily over the five year period from $9,228 to $6,897. The next study they plan will look at the total cost to the healthcare system when you factor in rates of re-admission and transfer to long term care facilities.

The principal investigator of the study was Mark Metersky, M.D., of the University of Connecticut School of Medicine. Co-authors included Michael Fine, M.D., of the University of Pittsburgh School of Medicine; and Janet Tate, MPH, and Marcia Petrillo, MA, of Qualidigm, a quality improvement organization based in Middletown. Metersky and Meehan also are affiliated with Qualidigm.

Thomas Gill, M.D., associate professor of medicine and geriatrics at the Yale School of Medicine led a study of the causes of falls in older adults published in the December issue of the journal Medical Care. Falls are common among the elderly and often lead to loss of independence or even death. The rate of falls among persons 65 and older is about 30%, and among persons 80 or older, 50%. Of those who do fall, about 10% sustain a serious injury, such as a fracture, joint dislocation, or severe head injury. Falls and fall related injuries also are associated with pain, loss of confidence, functional decline, and placement in a nursing home.

Gill reports that they found very little evidence to link falls to home hazards, and also said the significance of the results is that money spent making homes of the elderly safer probably could be better utilized. A co-author of the study, Mary Tinetti, M.D., professor in the Departments of Internal Medicine, Geriatrics, and Epidemiology and Public Health, completed a study about six years ago showing that a multi-component program targeting primarily muscle weakness, poor balance, vision loss, proper footwear, and monitoring medications, among other precautions, was most effective in preventing falls by the elderly.

Gill and his co-researchers evaluated 1,088 New Haven residents 72 and older and performed home safety assessments to determine whether 13 potential trip or slip hazards were present. These included hazards such as loose throw rugs, obstructed pathways, and slippery bathtubs. They then contacted participants each month for three years asking if they had fallen, and, if they had, what were the circumstances.

The Hartford Financial Services Group, Inc., the MIT Age Lab and Connecticut Community Care, Inc., have developed a guide to Alzheimer's Disease, Dementia and Driving as a tool to help individuals and caregivers determine when it is time to stop driving. The guide points out that many older adults who don't have dementia can assess their driving without family intervention and make gradual changes to the way they drive as they are impacted by problems with eyesight or slower reaction times. It's different for those with Alzheimer's Disease and other dementias. The progression of this disease is usually gradual and somewhat unpredictable. It affects cognitive functions critical to driving, such as judgment, reaction time and problem-solving abilities. It can also cause physical and sensory problems that increase driving risk. With dementia, an individual's capacity to assess his or her driving abilities may also diminish. People with dementia are especially likely to minimize the complexity of driving and overestimate their abilities. As driving and assessment skills decline, the risk of serious loss or injury increases. Caregivers must assume the responsibility for monitoring and regulating the driving of the person with dementia, and this guide is a resource to help them do so.

A study published in the Journal of Gerontology by William T. Gallo of the Yale University School of Public Health reports that negative mental and physical health effects of involuntary job loss are significant for older workers. The researchers noted that workers in the United States save heavily in the years preceding retirement, often relying primarily on personal savings amassed in this period to finance the costs of retirement. Because of that, late-stage job loss has important consequences for the well-being of dislocated U.S. workers. Further supporting their findings, the study indicated that re-employment of the displaced workers was associated with improvements in both physical functioning and mental health.

The Florida Legislature is considering budget changes for Medicaid long term care programs. Among the changes requested by the Agency for Health Care Administration is a new program incorporating competitive bidding or capitation into the program used to reimburse nursing homes for Medicaid services, which is projected to provide $23 million in savings. Other reductions in spending include the elimination of the "Intermediate" category of nursing home service and the transfer of residents in this program to assisted living facilities, and an additional $23 million to buy more community services to allow elder Floridians to stay in their own homes.

To reduce the spiraling cost of the Medicaid budget, eligibility for Medicaid for people age 65 or older would be limited to those with incomes of no more than 87.5% of the Federal Poverty Guidelines, down from the current cap at 100% of the poverty level. The state would also no longer pay the Medicare Part B deductibles and coinsurance for people who are eligible for both Medicare and Medicaid, and they plan to create a restricted drug formulary to limit the prescription medications which would be covered by Medicaid.

The Florida Agency for Health Care Administration announced that they have published a new guidebook online, called Understanding Prescription Drug Costs. The guide contains information for everyone who needs prescription drugs - whether or not they have health insurance to cover those costs. The purpose of this brochure is to help consumers know what cost-saving options there are and what questions to ask. They point out that the best sources of information to help save money on prescription drugs are physicians, pharmacists, and the customer service or employee benefits office of your health insurance plan. The brochure is a new addition to the extensive information about drugs available on FloridaHealthStat.com, the official source of consumer healthcare information from Florida government health and human service agencies.

Governor Jeb Bush of Florida has proposed a series of initiatives designed to make Florida an "Elder-Friendly" state. Among other things, the governor proposes dedicating $46 million in new funding to improve the quality of nursing home care, $52.4 million to expand community-based options in long-term care for elders, $2.5 million to increase Medicaid fees for home health agencies, and $30 million to fund a new program to assist low-income elders in obtaining needed prescription drugs.

He also is encouraging communities and businesses to attain an "Elder-Ready" brand from the state which will greatly improve the livability of a community for elders. An elder-ready community has: easy access to drug stores, reliable transportation to medical care, pedestrian-friendly traffic lights and walkways, adequate lighting in public places, call boxes to enhance safety, zoning for elder-friendly housing, adequate health providers with gerontological training and much more.

In addition, Governor Bush indicated he is in favor of addressing the cost of litigation of long term care facilities, and noted that 30 assisted living facilities have been notified that they are at risk of losing their licenses because they do not carry liability coverage due to the cost or lack of availability of such insurance.

Insure.com reports that 15 Palm Beach County, Fla., residents went to court on Jan. 22, 2001, charging Prudential Insurance Co. with fraud and racketeering and seeking $1 billion in damages. They are charging Prudential with questionable sales tactics targeted at elderly residents, including a "vanishing premium" scheme, in which an agent claims a life insurance policy's cash value will perform so well that the buyer can stop paying premiums within a certain number of years, and avoiding the term "insurance" to sell cash value life insurance policies as "personal pension plans." The plaintiffs in the case all opted out of a class action lawsuit against Prudential that the company settled in 1996 for more than $2 billion.

In a November 1st memorandum to Florida Lt. Governor Brogan's task force, Northeast Florida Area Agency on Aging Executive Director Annette Kjeer said that in Jacksonville, eight of the largest of 37 participating ALFs were withdrawing from the Assisted Living Waiver program, and the remaining ALFs in the program are too small to handle what is approximat