March 26, 2015

Surgery Standard Scrutinized for Elderly Patients

At the American Academy of Hospice and Palliative Medicine conference earlier this month, Dr. Perla Macip spoke at a talk entitled "The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?" In recent years, a number of doctors and other medical professionals have questioned the thirty day mortality standard as a measure of success, particularly when it comes to elderly patients. Some go as far as argue that the standard of thirty days alive after surgery may undermine appropriate care for seniors.

Example of the Thirty Day Standard

One of Dr. Macip's patients, "Mrs. S." was a 94 year old patient who prior to surgery was fit and still lived in her own home. She consented to a valve replacement surgery and told physicians that her main goal was to return home. During the surgery, Mrs. S. sustained cardiopulmonary arrest and needed resuscitation. A series of complications followed, including an irregular heartbeat, fluid in her lungs, kidney damage, and pneumonia. Then, Mrs. S. had a stroke and was moved in and out of the intensive care unit, off and on a ventilator.

After two weeks in the hospital, Mrs. S. become depressed and stopped eating. Her geriatricians recommended discussing "goals of care" in order to determine whether she wanted to continue such aggressive treatment, but surgeons were optimistic that she would recover. As a result, Mrs. S. was not consulted about palliative care until Day 30, when she was septic and had multiple organ failure. She died the next day, 31 days after surgery.

Thirty Day Mortality Standard

For most surgeons, Mrs. S.'s case would be seen as a success because thirty day mortality is considered the normal standard for surgical quality. Several states require public reporting of thirty day mortality rates after certain surgeries, and even Medicare uses risk-adjusted thirty day mortality measures. However, some experts believe pressures for better thirty day statistics can cause more harm than good, discouraging surgery for patients who could benefit in addition to sentencing others to long stays in hospitals and nursing homes.

At other conferences, doctors have admitted that they could not operate on a person because it would hurt their thirty day mortality statistics. The debate is particularly urgent for seniors and elderly patients who are more likely to undergo surgery and to have complications. Surgeons may decline to operate on high-risk patients because of fears that their deaths could hurt the thirty day results.

Effects on Elderly Patients

Not only may surgeons decline to operate on elderly patients, even if the patient understands the risks, but the thirty day rule has other potential ramifications for seniors. When things go wrong in surgery, surgical teams are more concerned about their thirty day metrics than things like palliative care, hospice, or even try to override advance directives. One doctor admitted that ""Surgeons are reluctant to withdraw life support before 30 days, and less reluctant after 30 days." However, many older patients and their families have different ideas about what is worth sustaining and would rather appreciate an honest discussion before the month passes.

March 24, 2015

Tokyo's Elderly Turned Away with Nursing Home Cuts

As the elderly population in Tokyo booms, waitlists for nursing homes are becoming exceedingly long. There has been a scramble for free beds in these facilities, and yet the nursing homes in the city are starting to cut back. The problem is an extreme shortage of workers for these homes and impending cuts in government aid.

Growing Problem in Tokyo

In the city's northern Adachi ward, as many as 4,000 elderly residents are on a waitlist to get into a nursing home. There is a nursing home in the ward with thirty percent of their beds available, but no one is allowed to use them because the facility is too short staffed. This problem is not restricted simply to a couple of wards in Tokyo.

Right now, over one quarter of Japan's total population is older than 65, and Tokyo is expected to have the biggest rise in elderly residents of any city in the nation. However, two decades of deflation in the country's economy and rising debt is forcing Japan's legislators to cut budgeting for its nation's nursing homes.

The nursing homes in Tokyo were started by land owners and are run as family businesses. Japan has unique care coverage for its elderly; long-term care is only paid about ten percent out of pocket with the rest subsidized by the government. Unfortunately, facilities that are eligible for aid from the government have prices that cannot be raised. These nursing homes also cannot close down without government approval, even if the facility is losing money.

Less Aid for Homes

The Japanese government is set to reduce reimbursements for long-term care by a little over two percent in April. Japan's cost to care for the elderly is expected to more than double to 19.8 trillion yen ($167 billion) in 2025 from 2012, with the government covering around half. In an effort to retain staff for its homes, the Japan health ministry has said that it will pay an extra 12,000 yen per month per worker for wages and will pay an even higher premium to facilities that hire workers with additional qualifications.

However, the shortage of spots in nursing homes has also put additional pressure on working children to care for their ailing parents. "Many families in cities don't have the capacity to care for the elderly at home," said Masahide Tanaka, chairman of general affairs at the Tokyo Council of Social Welfare. "It will add burden to family members and may lead to a rise in people exiting from the workforce to care for the elderly at home, elderly abuse and neglect."

Studies have shown that about 490,000 Japanese workers quit or changed jobs in order to care for older relatives between 2007 and 2012. By the year 2025, Japan will need 2.5 million caregivers for its elderly and the country's health ministry forecasts that it will be short 300,000 workers by then. Some government officials are hoping that the cuts will force smaller nursing homes to merge and operate more efficiently, and eventually raise salaries to attract workers.

March 19, 2015

Medical Identity Theft Increases as More Health Data Goes Digital

Last year, medical identity theft increased 22% as more U.S. patient health data becomes electronic. While it is easier for doctors and other medical professionals to readily access patient data, the process is also making it easier for cyber criminals to hack into doctors' offices, hospitals, and insurance companies for personal information.

Medical Identity Theft

In 2014, more than 500,000 people were victimized by medical identity theft frauds and hacks. Those who gained access to the data then proceeded to use it for insurance fraud, free medical care, and other health-related illegal activities. According to the Ponemon Institute, resolving each incident of fraud costs around $13,500 in expenses. In almost twenty percent of the cases, the victims found additional or erroneous medical information added to their records by an imposter. Things like positive drug tests and other damaging information cost some victims job opportunities and caused other significant issues.

As healthcare hacking continues, the number of victims of medical identity theft are expected to rise. Already this year, insurance company Anthem, Inc. had their systems hacked and as many as 80 million clients had their medical information stolen. Medical data has become an incredibly popular target for cyber criminals because it will sell ten times as fast on the black market.

Electronic Medical Files

The Ponemon Institute saw an increase in the number of medical identity theft cases after the use of electronic medical records became more commonplace in 2012. In many cases of medical identity theft, a person's medical history and records can be purchased for around $50 to $100. This is usually purchased by a person who does not have medical insurance and needs care. The records almost always include the name, social security number, birthdate, and other important medical information that is needed to get treated by a medical professional.

The bill from the fraudulent care is then sent to the victim's insurance company, and the victim is on the hook for any unpaid expenses, deductibles, or services that were not covered by the insurance. In other cases, the criminals set up a fraudulent company and bill the insurance companies for services that were never provided to the person with the stolen identity.

Cost of Medical Identity Theft

Not only does it cost thousands of dollars per case to settle issues of medical identity theft, but on average it takes around 200 hours to resolve each case. Another issue is that the healthcare industry is less savvy about how to deal with cyber criminals, unlike the financial industry that has been fighting identity thieves for years. "The industry is aware of cyber threats and vulnerabilities but it is a little bit newer to them compared to retail or financial services." As a result, researchers agree that medical identity theft will continue to increase in frequency as well as severity as more companies and medical care facilities place their clients' and patients' medical records in digital form.

March 17, 2015

Long-Term Care Insurance Sees Increases in Price

According to the Long Term Care Consumer Price Index, the overall costs for long-term care insurance coverage increased 8.6% compared to the costs last year. Researchers found that these costs affected both men and women at varying age levels that are currently paying for or are interested in purchasing long-term care insurance for possibly future needs.

Increased Costs for Long-Term Care Insurance

The American Association for Long-Term Care Insurance group has estimated that a healthy 55 year old man can expect to pay $1,060 per year for $164,000 in long-term care insurance benefits. This amount is fifteen percent higher than the 2014 cost of $925. However, the 2014 figure was a fifteen percent decline from 2013, which means that for healthy middle age men the annual premium has stayed steady between 2013 and 2015.

Women began seeing an increase in their long-term care coverage in 2013 after reports were released that showed that women are more at risk of needing some type of long-term care. For a healthy 55 year old woman, the annual cost of a long-term care policy is $1,390 for the same amount of coverage ($164,000). This is a thirteen percent increase over the 2014 figure of $1,225 per year and has resulted in lawsuits against insurance companies for gender discriminating policies.

Consumers Buying Less Policies

These prices are for new policies that are being issued to seniors or people nearing retirement for long-term care insurance. However, some insurance companies have been increasing the rates on existing policies for years. This is because the companies have been hit particularly hard by low interest rates and higher than expected future claims. One glaring examples of this is the insurer Genworth Financial, that raised its premiums on some policies by as much as fifty percent in 2012.

The higher premiums on long-term care insurance policies mean that seniors are purchasing fewer policies for long-term care coverage and those that do buy policies are paying for less protection. This was backed by an industry-wide survey in July 2014 that found that sales of three year policies increased from 23.6% in 2007 to 35.3% in 2013. For the same time period, sales of five year policies dropped from 18.9% to 13.5%. In addition, the sales of more expensive policies that offer lifetime coverage for long-term care decreased from 5.7% to just 3.6%.

Glaring Price Disparities

For a new policy this year, a married couple that were both sixty years old would pay $2,170 annually for a total of $328,000 in long-term care coverage. Just last year, that number was only $1,980. By adding on inflation to their policy that would garner them $730,000 in coverage by the time that the couple was eighty years old, the couple would pay an additional $1,760 for a total of $3,930.

The price disparity for inflation protection is particularly glaring. Right now, a typical sixty year old man could buy a $200,000 long-term care insurance policy with no inflation protection for about $1,300 a year, but the same policy with five percent inflation protection would cost him almost three times as much, nearly $3,700.

March 12, 2015

One "Genius" Perspective on the Elder Care Crisis

The 2014 MacArthur "Genius Grant" recipient, Ai-Jen Poo, is the co-director of the Caring across Generations Campaign and author of the book, "The Age of Dignity: Preparing for the Elder Boom in a Changing America." While it is common to hear of our aging population as a retirement crisis or the "silver tsunami," Ms. Poo writes that getting older is not a crisis - it is a blessing.

Elder Care Imbalance

Caring across Generations is a nonprofit organization working to transform elder care throughout the country with a mix of nationwide policy advocacy, social media, and other channels. It is spreading the word about the looming crisis in elder care and ways that our country can avoid it.

There are currently 79 million seniors living in America today, and although the Bureau of Labor Statistics has claimed that personal care aides and home health aides are some of the fastest growing professions if the rate of growth does not by 2050, there will be about three times more families in need of elder care providers than workers prepared to do the work. Ms. Poo's suggestion is to create millions of jobs that will support elder care needs. She claims that this can be done by making elder care professional, highly valued, and trained.

Training Care Workers

Ms. Poo claims that training elder care workers can save families and society an enormous amount of time and money. "As people live longer, there are issues about managing chronic illnesses and hospital admissions. Training family and paid caregivers can reduce the costly aspects of our medical delivery system. What better prevention than quality health care? At the front end, training is an investment that creates cost savings and efficiencies in the long term."

One of the biggest problems is that Medicare does not currently pay for custodial care at home or in nursing home facilities. However, seventy percent of seniors over the age of 65 years will need some kind of help with daily living activities before they die. Ms. Poo has stated that Medicare reimbursement structures are not aligned with the current needs of elders today. The program is not thinking about the quality of life, which will affect Medicare in the long run.

Family Responsibilities

In her book, Ms. Poo stated that families have their own responsibility to prepare for their members' future care needs. She encouraged family members to sit down and discuss two major questions: First, what is our family's plan for meeting our future caregiving needs? This includes whether we can afford the care we want. Second, what joys could getting older and caring for one another bring? However, at the same time, it is important to remember that it is unrealistic to expect a family to fully absorb the responsibility of caring for an aging loved one.

For one thing, some families there may be a physical distance issue. Another issue for families dealing with care is the sandwich generation of working-aged adults caring for children and aging parents at the same time. There is also a lot to manage when it comes to care, which is why the profession of geriatric care managers is growing. "In the 21st century reality, it's untenable for many families to go it alone."

March 10, 2015

Americans Feeling Better About Retirement Crisis

In a report released last week by the National Institute on Retirement Security (NIRI), fewer Americans are concerned that they will not have enough money to live on in their retirement. While 86% of Americans agree that the country is in the midst of a retirement crisis, a number that increases to 92% for millennials, more people are taking control of their retirement savings and feeling better about their living expenses once they stop working.

Results of the Report

Every two years, NIRI polls thousands of Americans to see how they feel about their financial security for retirement. They also poll people about their views on government policies and legislation that could help those reaching retirement age. Compared to the results in 2013, the overall percentage of people concerned about their retirement outlook fell from 85% down to 74%. In addition, more people polled expect the money in their pension plans to be there when they retire at 84%, up from 79% in 2013.

The report also showed that Americans view the best option for retirement security to be defined benefit pension plans, even though the option is quickly disappearing from the employment scene. A total of 78% of people polled believe that a loss of pensions makes it harder to be financially secure in retirement, and more than half of those polled now strongly agreed that "those with pensions are more likely to have a secure retirement than those who do not."

Retirement Saving Concerns

One of the biggest worries of those polled for the NIRI report was healthcare costs in retirement. In total, 86% of Baby Boomers cited the rising costs of long-term care as a major factor in making preparation for retirement harder. Coming in second place were salaries not keeping up with wages, with 80% of those polled citing it as a cause of concern. Fewer pensions and longevity were also concerns for the Baby Boomer generation; however, the millennials polled did not cite longevity as a concern.

Policymaking and Retirement Savings

Americans polled also did not see legislators or policymakers helping anytime soon. According to 87% of people polled, the nation's leadership does not understand how difficult it is to prepare for retirement. A significant number of people also feel that policymakers need to do more to help Americans achieve secure retirement savings. However, the report also showed that people are open to alternative ideas. For example, state-sponsored low-risk automatic enrollment retirement plans for those without retirement plans at work was judged a good idea by 71% of those polled, and 75% said that they would consider joining such a plan if it was offered.

One interesting note from the survey comes from the questions on Social Security. When asked, only 42% of respondents replied that it was a good idea to delay taking Social Security, even if it meant tapping savings, in order to get greater benefits from the program. Many people do not seem to understand the massive difference in cash flow that delaying Social Security retirement benefits can make during retirement.

March 5, 2015

Tips for Saving on Prescription Drugs

The cost of prescription drugs is one of the biggest issues for seniors in America today. Not only are the prices of these necessary medications skyrocketing, but many insurers try to get out of paying for most or all of the cost. One of the most common excuses given by insurance companies is that the drug is not being used for its prescribed purpose, even if it is treating some other condition. However, for seniors that are stuck paying for expensive prescription drugs on their own, there are some tips that can help lower the cost of your necessary medications.

Buy generic brands

Whenever possible, try to purchase the generic brand of your prescription drugs. Even if your doctor is prescribing the brand name, ask if a generic is available. The generic brands of drugs work just as well as the name brand types, but they cost a mere fraction of the price. In addition, the co-pays on generic medications are typically smaller than for the brand name drugs.

Ask for free samples

Most of your doctors will have samples of the brand name drugs that they prescribe in their office. These samples come from the pharmaceutical companies, and while they may not cover your entire need it can help reduce the amount that you pay for.

Buy larger doses in tablet form

One way to save money on prescription drugs is to ask for a larger dosage in tablet form. If the drug does come in this way, you can pay less for a reduced number of high dosage pills. Then, you can cut the pills into the size that reflects your accurate dosage for each medication. Most drug stores sell inexpensive pill cutters for this very purpose. However, you should check with your doctor beforehand that your particular drugs can be cut.

Coupons

You can go onto Google or another search engine and type in the name of your drug with "coupon" to see if discounts are available. Discounts can be as high as seventy percent on websites like internetdrugcoupons.com.

Compare prices

Big box stores compete to fill your prescriptions, so you can save money by shopping around for the best price. This is particularly useful if you need an over-the-counter or nonprescription medication.

Consider mail-order pharmacies

The prices from mail-order pharmacies are typically cheaper than filling them the normal way. However, you should thoroughly check out reputation of the company before getting any prescriptions filled. Canadian mail-order pharmacies have been usually very good about filling prescriptions, but mail-order companies from other countries have had issues with sending what is needed.

Call customer service at the pharmaceutical company

Many pharmaceutical companies will send out free samples or offer discounts if you call their customer service. This applies especially for low-income or fixed income individuals who might not have the money to pay for the full cost. Some customer service departments will even appeal to an insurance company on your behalf to cover the cost of the drug.

March 2, 2015

Managing Health Care Costs with Crowdfunding

While some say that it takes a village to raise a child, others are now saying that it takes a crowd to pay for rising medical costs. As more caregivers are expected to pay for their loved one's medical costs out of pocket, they are turning to the internet and crowdfunding websites for help. Certain crowdfunding websites are now dedicated portions of their sites specifically for health care expenses or specific diseases that need treatment.

Crowdfunding Websites

Crowdfunding, also known as crowdsourcing, uses a page on the internet to talk about the issue at hand and raise money for costs. It relies on friends, family, and strangers alike to donate money to the particular cause. Websites like YouCaring.com, GiveForward.com, GoFundMe.com, and Fundly.com are all examples of websites where people can go online and ask for help.

For example, GiveForward.com has raised over $149 million since its inception in 2008. Most of the money raised on the site has gone towards unexpected medical expenses. Donations have been asked for medical expenses, the cost of funerals, out-of-pocket expenses, and even nursing home care. The organization's co-founder said that "No one should have to go through a difficult illness alone, and giving someone the opportunity to help is a big gift."

How to Ask for Help

The operators of crowdfunding websites have noted that some types of requests garner more response than others. For example, unusual expenses or illnesses tend to get more of a response than generic medical care. Crowdfunding is usually more successful with extraordinary circumstances, and the infinite dragging on of expenses is not something that typically gathers support.

Experts say that building a large network is critical in raising money for senior health care costs through crowdsourcing. Try using emails and other social media websites like Facebook and Twitter to gather support. Having friends and family spread the word helps a lot, too. "Usually, 80 percent of the people who contribute are people you know rather than strangers. The key is getting people with big, active networks involved."

In addition, people do not always donate the first time that you ask. It can take three or four times of asking, and persistence is vital. Having a three or four percent return on your "asks" is considered a good rate for these types of websites. Asking for smaller donations is also a better tactic than asking for large sums of money, and most crowdfunding websites will allow donations to start at as little as one dollar.

Why Crowdfunding Works

High out-of-pocket expenses can quickly deplete a caretaker's financial resources. According to a survey done by the Commonwealth Fund, 87% of people ages 65 and older have at least one chronic illness. In addition, seniors in the United States have much more difficulty paying for their medical expenses than the elderly in other countries.

In a society that is so closely tied to the internet, crowdfunding websites can cast a wide virtual net for help. As Americans shift from communities where everyone helped take care of a sick elder, technology can pull from all areas of the country. As one expert put it, "Technology is breaking down solid walls with virtual windows, and it can virtually recreate the family."

February 26, 2015

Chinese Elite Fighting for Palliative Care

Families of China's political elite and senior Communist Party leaders are now fighting for a more unusual cause: the right for their seniors to die with dignity. Failure to take every measure possible to keep these people alive is considered shameful and is often confused with euthanasia in China. As a result, the elite are given every possible treatment to prolong their lives, despite it not being their final wishes.

New Group Efforts

Children and grandchildren of some of China's highest ranking officials have come together to discuss the issue of dying with dignity. Many recall family members that spent their final days strapped to machines and tubes instead of living out that time peacefully at home. The group's goal is to help patients in China say no to certain types of medical interventions and instead seek palliative care.

For the last nine years the group has promoted the use of living wills in China, and recently the group has provided the funds to train medical professionals on how to give end-of-life support to the terminally ill. The group is supported by medical experts, social celebrities, and from the family members of the political elite.

China and Issues with Death

According to an article published by the Asia Pacific Journal of Health Management in 2013, patients in China are encouraged to believe that scientific medicine can cure all diseases. "Some Chinese people do not like saying words like death or dying as they believe it will then happen." Across China, end-of-life discussions are becoming more crucial because over 200 million citizens are currently over the age of sixty. In addition, more than three million new cases of cancer are purported every year.

Ordinary Chinese citizens face a very different issue then the political elite: hospital bills quickly surpass their life savings, forcing them to go home and die in discomfort without professional care. "What we do now is, if you have money we resuscitate and torment you until you die, and if you don't have money you simply wait to die," said the president of the Beijing Living Will Promotion Association. "Neither is right. Both are inhumane, and they can't reflect your dignity."

Developing Death with Dignity

Natural death has not been a choice for many of the country's top political leaders. One leader's child recounted that ""It's a political issue, because my father was a political figure . . . so his life and death were decided by the party." Unfortunately, many Chinese health professionals lack the training to provide pain control and palliative care. The World Health Organization defines palliative care as an approach meant to improve the quality of life for terminally ill patients by treating the pain and using other psychosocial methods; however, it is not meant to either hasten or postpone death.

In China, the Communist Party may pick up the hospital bill after a senior official dies as part of their job benefits. Palliative care has the ability to redistribute resources in the Chinese overburdened healthcare system because spending millions of yuan on one official is money that ordinary people do not have access to.

February 23, 2015

Government to Change How It Rates Nursing Homes

The federal government announced on Thursday that it was changing the way that it rates nursing homes, adjusting the curve that it uses to measure the quality of the communities to make it more difficult to earn four and five star ratings. Using the new guidelines, officials said that many nursing homes' ratings will likely fall, but the information will not be made public until February 20.

Current Ratings System

Currently, nursing homes are rated on a one to five star scale on the website, Nursing Home Compare a widely used federal website that evaluates more than 15,000 facilities across the country. Unfortunately, the system relies heavily upon unverified information that resulted in notoriously poor nursing homes receiving top marks. Two of the three major criteria used in the current ratings system, staffing levels and quality measure statistics, were self-reported by the nursing homes and not audited by the federal government.

Last October, the government announced that nursing homes would be required to start submitting their staffing levels quarterly through a system that could verify its claims through payroll data. It also announced that it would initiate a nationwide auditing program geared towards checking quality measure statistics.

Changes to the System

Under the new system, the Centers for Medicaid and Medicare Services (CMS) expanded and strengthened its NHC-5 Star Quality Rating System. It did so by reevaluating and introducing the following revisions to the program:

Adding Two Quality Measures
These measures refer to the use of antipsychotic medication in nursing homes. One quality measure focuses on the use of these medications for short-stay residents without diagnoses of schizophrenia, Huntington's disease, or Tourette syndrome. The second quality measure looks at the continued use of these medications for long-term nursing home residents that do not have these conditions.

Raising Performance Expectations
This change broadly raised the standards for nursing homes to achieve a high rating on all publicly reported measures in the Quality Measures category.

Adjusting Staffing Algorithms
This change is focused on more accurately reflecting the staffing levels at the nursing homes. Under the new changes, nursing homes must earn four stars on either the individual registered nurse or the staffing categories to receive four stars in the Overall staffing rating. In addition, a facility cannot have less than a three star rating on any of those criteria.

Expanding Target Surveys
The final change institutes specialized, on-site surveys of nursing homes by the State Survey Agencies. They assess the adequacy of the resident assessments and the accuracy of the information reported to CMS that is used in the quality measures for the ratings system. A pilot study was done in five states in 2014 that will be available to the public on February 23.

Response to the Changes

Federal officials have stated that the purpose for the revisions is to rebalance the ratings by raising the bar for nursing homes to achieve a high score in the quality measures areas. Representatives for the nursing homes have responded that they are worried that the changes will send the wrong message to the consumers. However, officials have contended that the changes would be explained fully on the website and that the public would be cautioned not to draw conclusions just because a nursing home's star rating declined.

February 19, 2015

Elderly Man Charged with Killing Nursing Home Roommate Dies

An 89 year old man who was charged in the killing of his 86 year old roommate at a Buffalo, New York nursing home facility has died. Chester Rusek, 89, passed away in the Erie County Medical Center, where he was being treated for multiple medical issues. He was charged with manslaughter in the November 2012 killing of his roommate in the assisted care facility, Salvatore Trusello, 86.

The authorities stated that Mr. Rusek used a two pound magnet to beat Mr. Trusello to death as he laid in his bed at the senior living community in Tonawanda. Mr. Trusello survived the initial attack but died one month later due to his injuries. Mr. Rusek told police at the time of the attack that he believed that Mr. Trusello was stealing from him. Mr. Rusek's attorney has stated that once a death certificate is filed, the prosecutors plan to dismiss the charges.

Violence in Nursing Homes

Mr. Rusek and Trusello's incident is not an isolated case of senior violence in nursing homes. In October 2013, two men in the Beacon Rehabilitation and Nursing Center in the Rockaways shared a room and had a disagreement about the curtain divider. It exploded into violence where one resident, Thomas Yarnavick, 66, took a piece of his wheelchair and severely beat his 71 year old roommate. The roommate died a short time later at the hospital.

In another case, a Houston nursing home resident is facing capital murder charges for killing two people in his room at a nursing home. Guillermo Correa, 56, did not get along with his roommates: Antonio Acosta, 77, and Primitivo Lopez, 51. In April 2014, an argument escalated to violence, and Mr. Correa beat his two roommates to death.

Examples go on and on of increasing levels of senior violence in nursing homes. While most nursing home abuse and neglect is focused on the caregivers, oftentimes the residents are the most violent.

Resident to Resident Mistreatment

Studies have been done that focus on the causes, effects, and rates of resident to resident violence in nursing homes. In a presentation by the New York Presbyterian Health Care System, "negative and aggressive physical, sexual, or verbal interactions between long term care residents that would likely be construed as unwelcome by the recipient in a community setting, and that have high potential to cause physical or psychological distress."

One major issue in studying and fixing resident on resident violence is that the information is difficult to gather. Some of the major issues are that the events happen constantly, the rates of cognitive impairment are substantial, and dementia produces false positives and negatives.

Another study of resident to resident violence focused on various triggers that seniors in nursing homes have. The study found that two categories of triggers emerged from the work: active triggers and passive triggers. Active triggers included the actions of other residents that were intrusive, like wandering into another resident's room, taking a resident's belongings, etc. Passive triggers included the internal and external environment of the residents. For example, factors such as boredom, competition for attention and communication difficulties all contributed to passive triggers. The study found that there is still a lot of work to be done in examining and minimizing resident on resident violence in nursing homes.

February 16, 2015

Choosing an End Game for Dementia

A number of elderly people create an advance directive that states that they do not wish to have life-saving measures performed in the case of a medical emergency. But now, more seniors are adding a new provision to their advance directives that state that if they develop a certain level or form of dementia or Alzheimer's disease they do not want any type of nutrition or hydration. It has started a quiet debate among medical professionals over whether seniors who develop dementia can use this method to hasten the end of their lives in an advance directive.

Use of an Advance Directive for Dementia

The measure at issue is called "voluntarily stopping eating or drinking," otherwise known as VSED, and it is a common end-of-life strategy for elders dying of a terminal illness. However, only a handful of people have incorporated the strategy into their advance directive as it pertains to dementia and Alzheimer's disease.

The number of elderly suffering from dementia has seen a fairly significant increase in recent years with the Baby Boomer generation reaching the age where dementia can affect them and their parents. As of now, over thirty percent of seniors over the age of 85 are affected by Alzheimer's or another form of dementia. "People in their 50s and 60s frequently say: 'I don't want to be in that situation. I don't want to put my family in that situation and people will increasingly voice those views to others, sometimes in a formal way through advance directives."

Even in states that allow physicians to prescribe lethal amounts of drugs to someone with a terminal disease, the law requires that the patient be mentally competent and able to ingest the drugs themselves. This means that patients with dementia are unable to die with dignity, even though multiple studies have shown that VSED is a comfortable way to die.

Issues with Dementia and Advance Directives

Although experts agree that dementia is a terminal disease, it presents unique obstacles for seniors who wish to choose how they wish to die. Generally, dementia kills slowly over years, and there is no specific point where there is "the plug" to pull. With dementia, there is no life-sustaining treatment that can be withheld.

The main issue with using VSED for patients with dementia is whether it should be allowed for seniors who later do not remember or understand why they wanted to exit in this way. Even medical professionals in support of the method admit that the patients, their families, and their doctors will face a lot of controversy if they try to cut off food and water to a person with dementia.

Moreover, the issue of using VSED with a patient that is suffering from dementia has been untested in court. The Hastings Center Report recently wrote an article where two advocates of the procedure argued that food and water should not be withdrawn until severe dementia has eroded the patient's quality of life and "the self has withered." In addition, several states have strict laws that make it difficult to withdraw food and water, even if it is in an advance directive.

February 13, 2015

A New Way to Approach Long-Term Care Insurance

According to a new article published by Financial Planning, "How to Fix LTC Insurance" claims that the best way to make long-term care insurance accessible to more seniors, as well as affordable, is to integrate the use of short-term elimination periods. The Director of Research at the Pinnacle Advisory Group is claiming that the use of this often avoided measure may be the key for more seniors to be able to use long-term care insurance for their medical needs.

Purpose of LTC Insurance

Originally, the purpose of long-term care insurance was to guard against the "high-impact but lower-probability risk of needing long-term care assistance at an advanced age." When this insurance was introduced, the thought was that a small number of seniors would need long-term care, but those who did would face incredibly high medical costs.

However, due to advances in medicine and medical technology, the life expectancy of the elderly has increased dramatically and the chances of needing long-term healthcare are also higher. Researchers estimate that the risk of a person at age sixty needing long-term care in their lifetime is as high as fifty percent, and the chances of a fifty year old woman needing this level of care is as high as 65%.

That being said, research has also suggested that the costs of long-term care may be less than what was originally anticipated. According to the American Association of Long-Term Care Insurance, around 75% of nursing home stays last no longer than three years. What this means is that instead of long-term care being a "high-impact but lower-probability risk" it is actually a "low-impact but higher-probability risk."

Proposed Solution for LTC Insurance

The solution proposed by Financial Planning is to dramatically lengthen the elimination period for long-term care insurance. Right now, around ninety percent of long-term care insurance policies are sold with a 90-day elimination period. This means that the senior pays for the first ninety days of care on his own, and the insurance covers the rest. However, ninety days does not achieve the intended purpose, which is to carve out high-frequency small claims because insurance companies still consider a year or two is a "small" claim whereas a large claim might be five years of care or more.

By lengthening the elimination periods to as much as two or three years, with benefits covering up to five to ten years of care afterward, would make long-term care insurance a much more effective policy. "With an elimination period that high, even the average stay in a nursing home will fall within the deductible period; the actual probability of ever having a material claim against the long-term-care insurance would fall dramatically. That's good, as it means the cost of coverage could fall significantly, while policies could simultaneously have richer benefits (after the elimination period) and do a better job of insuring against extreme events when they occur."

The article admits that it would also force consumers and insurers to rethink other parts of the long-term care equation. For example, policies with a longer elimination period attached would need financial underwriting or "some other process that will reduce the risk that consumers might buy untenably long elimination periods."

February 10, 2015

How the Elderly Can Stay Independent Longer

Most of the questions surrounding elder care revolve around who will take care of that senior or determining where that senior will reside. However, a more important question that the elderly should be asking is how can they take care of themselves for as long as possible without becoming dependent on the assistance of someone else. The Centers for Disease Control (CDC) and other organizations have put together a list of tips for keeping seniors active and independent longer as they age.

Improve Your Fitness Level

According to the CDC, falls are the leading cause of injury among seniors ages 65 and older. Consequently, falls are also one of the biggest threats to independent living for the elderly. In fact, in 2013 over 2.5 million seniors were treated in emergency rooms for injuries related to falls and 20,000 people died as a result.

Increasing your fitness level as a senior can help to prevent falls and lowers the chances of injury if you do happen to trip. In addition, increasing you level of exercise has other benefits like preventing certain chronic illnesses that could jeopardize your independence, such as diabetes, congestive heart failure, certain cancers, and even Alzheimer's. In fact, some experts have gone as far as saying that regular exercise is the single best thing, physically and emotionally, that an elderly person can do for themselves in their twilight years.

Expand Your Social Connections

A strong social network can also aid in keeping seniors independent longer. It keeps the elderly engaged physically and mentally with others, making them happier overall. Thankfully, with the advent of certain technology and social media websites, expanding your social connections as a senior is easier than ever.

Research has found that elderly people in social isolation is as bad for you as smoking up to fifteen cigarettes per day and can even be worse for a person than being sedentary or obese. In order to stay independent, tend to your current friendships and try to cultivate new ones. Signing up for classes, meeting with neighbors, or joining a club can all help expand social connections.

Arrange for Extra Help

Staying independent longer does not necessarily mean that you have to do everything on your own. If you need some help around the house, yard work completed, or some meals delivered to your home it can all be easily arranged through your children or on the internet. Companies such as TaskRabbit have been created solely to provide seniors with extra help for things like running errands, cleaning the gutters, or shoveling a driveway.

Rethink Your Living Situation

Downsizing your living situation can be one of the best things that a senior can do to stay independent longer. Moving to a place like a condominium where you do not need to take care of yard work and have certain amenities provided for you can help you stay out on your own. Hosted independent living, assisted living communities, or a retirement village are all other options that can still give you a sense of living independently. If you do not want to move from your current home, consider making modifications that will make it easier to get around.

February 5, 2015

Nursing Homes Filing for Guardianship to Collect Debts

Few people are aware that a nursing home has the power to file for guardianship over its residents. Because guardianship cases are difficult to gain access to or track through the court system the rate at which this occurs is difficult to ascertain. However, research is emerging that shows that this practice is becoming routine for nursing home facilities that have issues with financing the care of their long-term residents.

Nursing Home Guardianship Research

Researchers at Hunter College completed a review of New York state guardianship court data and conducted interviews with seniors that have shown that nursing homes are commonly filing for guardianship over their patients when long-term care costs become an issue. This practice is underscoring the increased power that nursing home facilities have over their residents and their families in regards to the financing of long-term care.

In a random sample of 700 guardianship cases filed in Manhattan alone over the last decade, more than twelve percent were brought by nursing homes to take guardianship over their residents. While some of these cases may have had legitimate purposes such as family feuds, suspected embezzlement, or absence of help to obtain Medicaid coverage, those who know about the guardianship process agree that the majority of these cases were probably used as a means of bill collection.

Why Nursing Homes File for Guardianship

Nursing home facilities primarily use guardianship petitions as a way to collect on unpaid bills or to force the settlement of bill disputes with residents. It is universally agreed upon that this was not the intent of the state legislature when the guardianship statute was enacted in 1993, known as Article 81 of the Mental Hygiene Law, and at least one judge has ruled that the process is an abuse of the law because the nursing homes had brought the petitions solely for the purpose of being paid.

Even if the petition is ultimately unsuccessful, filing for guardianship can force the families of nursing home patients into costly court battles. It is meant as a strategic move to intimidate the families, and as a result most families agree to settle any bill disputes that they have with the facilities in exchange for dropping the guardianship lawsuit.

Purpose of Guardianship

The purpose of a guardianship proceeding is to transfer a person's legal right to make decisions for themselves to another person appointed by the court. The guardianship act is aimed at helping people who are unable to manage their affairs on their own because of incapacity and need the court to intervene on their behalf. In legal terms, a guardian supplants both a power of attorney and a healthcare proxy.

Typically, the guardian is an attorney appointed by the court who is paid with the ward's money. However, nursing homes have made the argument that a representative of their facility should act as guardian because using guardianship to secure payment for long-term care is better than suing their own incapacitated resident who cannot respond to the lawsuit.