March 12, 2007 - Vol 1, Issue 10
Geriatric Mental Health Funding Included In Senate Budget Resolution
We are delighted to share with you that the Senate budget resolution includes an additional $2 million for geriatric mental health services and $200,000 for a mental health training program in nursing homes!
Unfortunately, the additional funding was not included in the Assembly budget. Therefore, in your meetings/conversations with Assemblypersons, please urge them to support the additional funding in the final budget negotiations.
Don’t forget to thank your Senator.
Below are the letters we sent to the Assembly and Senate committee leadership earlier this week.
- Assembly Committee on Mental Health - Assemblymember Rivera
- Assembly Committee on Aging - Assemblymember Englebright
- Senate Committee on Aging - Senator Golden
- Senate Committee on Mental Health & Developmental Disabilities - Senator Morahan
------------------------------------------------------------------
Status of OMH Geriatric Mental Health Demos
The Office of Mental Health is still evaluating the proposals it has received in response to the Geriatric Mental Health Request for Proposals. OMH hopes to have the evaluation process complete within the next couple of weeks. Once the evaluation process is completed each applicant will receive a letter regarding the status of their proposal.
------------------------------------------------------------------
GMHA Upcoming Events
March 22, 2007 – Best Practices: Building a Workforce of Older Adults hosted by the Geriatric Mental Health Alliance of New York and the Brookdale Center for Healthy Aging and Longevity of Hunter College. Presenters are:
- Claire Haaga Altman, Executive Director, ReServe, Inc.,
- Janice Jones, Board Chair, Mental Health Empowerment Project
- Gajtana Simonovski, Retired & Senior Volunteer Program (RSVP) of the Community Service Society
The time is 3:00 - 5:00PM at the Hunter College School of Social Work – Auditorium, 129 East 79th Street, NYC, (Between Lexington and Park Avenues). Please make a registration by emailing yhsin@mhaofnyc.org or calling (212) 614-6356. The event is free but pre-registration is required. Please click here for additional planned presentations.
May 31, 2007 - Save the Date: 1st Annual Geriatric Mental Health Alliance Conference. Please join fellow Alliance members from around the state for our first annual conference entitled “Geriatric Mental Health: Challenges and Opportunities Across the Horizon” on May 31, 2007 from 10:00-4:00pm at the Hotel Pennsylvania. Steve Bartels, MD, MS, Professor of Psychiatry, Dartmouth Medical School, will be the keynote speaker. Dr. Bartels served as a consultant to the President's New Freedom Commission on Mental Health's Subcommittee on Older Adults, and he is a past president of the American Association for Geriatric Psychiatry. More details to follow.
------------------------------------------------------------------
Upcoming Events
April 11, 2007 – Taking a Closer Look: Reflections on Living with Early Stage Memory Loss - The Alzheimer’s Association – New York City Chapter is hosting a symposium for people with early stage Alzheimer’s disease and other dementias, family members and professionals from 9:00am-3:30pm at The Roosevelt Hotel, 45 East 45th Street, New York, NY. Please see the brochure for more information.
April 13, 2007 – Health Promotion and Culturally Appropriate Clinical Care sponsored by The Consortium of New York Geriatric Education Centers. The event focuses on focuses on clinical care of elders and their families in the context of cultural and gender diversity. For more information, please view the flyer. Michael Friedman, Alliance Chairman, is the keynote speaker.
April 19, 2007 – Optimizing Medicare Opportunities: Increasing Mental Health Services for Seniors sponsored by The Westchester Co Geriatric Mental Health and the presenter is Derek Jansen, Ph.D., MPH, Practice Management Alternatives, LLC. The program will be from 8:30am until 12pm at St. Vincent’s Hospital, 275 North Street, Harrison, NY. Please see the flyer for more information.
April 27, 2007 – OPEN HOUSE: NYSPA Division on Addictions will be holding an Open House from 6-9 PM at the Torch Club in Manhattan. It is open to all psychologists involved in the field of addictive disorders. The event is designed to allow the AddicDiv to keep psychologists informed about current issues connected to addiction in New York State and to hear feedback from the field about how the Division can best serve the needs of psychologists working in the field of addiction. Please see the Save the Date flyer.
June 19th and 20th - Save the Date: The 11th Annual “Aging Concerns Unite Us” Conference at the Albany Crowne Plaza, State and Lodge Street, Albany, NY. For more information, please email gabe@nysaaaa.org or visit the NYSAAAA website.
------------------------------------------------------------------
Report on Aging and Health in America
Press Release
March 8, 2007
Eighty Percent of Older Americans Live With a Chronic Disease, New Report Finds
CHICAGO, March 8, 2007 – Eighty percent of Americans aged 65 and older live with at least one chronic disease that could lead to premature death and disability, but these adults can lower their risk by adopting healthier behaviors and getting recommended screenings, according to a new report released today by the Centers for Disease Control and Prevention (CDC) and The Merck Company Foundation.
The report, The State of Aging and Health in America 2007, presents the most current data available on 15 key health indicators for older adults. These indicators address health status (physically unhealthy days, frequent mental distress, oral health and disability); health behaviors (physical inactivity, nutrition, obesity and smoking); preventive care and screening (flu vaccine, pneumonia vaccine, mammography, colorectal cancer screening, up-to- date preventive screening, and cholesterol); and injuries (hip fracture hospitalizations) for older Americans.
The report also documents the progress made in meeting the national Healthy People 2010 objectives for these indicators. The “State-by-State Report Card” provides similar information for each of the 50 states and the District of Columbia. The State of Aging and Health in America 2007 follows a similar report released in 2004.
“This report presents a reason for optimism coupled with a clear need for action,” said Janet Collins, Ph.D., director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. “Getting older in America does not mean having to live with disease and disability. It is never too late to initiate healthy behaviors. Public health has a critical role to play in providing older Americans with support needed to ensure that their added years are healthy years.”
Nearly 95 percent of health care expenditures are spent on treating chronic health conditions among older adults, according to the report, which was issued at the 2007 Joint Conference of the American Society on Aging and the National Council on Aging. Two demographic trends – aging baby boomers and increasing racial and ethnic diversity among older adults – will add to the challenges of addressing chronic diseases, the report concluded.
By 2030, the number of older Americans is estimated to reach 71 million, or roughly 20 percent of the U.S. population. As America’s older adult population becomes more racially and ethnically diverse, existing health disparities for racial and ethnic populations whose health lags behind that of non- minority populations will likely increase unless such disparities are more actively addressed. By 2030, it is estimated that U.S. health care spending is projected to increase by 25 percent due to the aging of the U.S. population.
The report provides bold “Calls to Action” on critical issues for older adults, including oral health, environmental changes to facilitate physical activity, and increasing the use of potentially life-saving preventive services such as adult immunization and screening to detect chronic diseases early, in their most treatable stages. The report also includes a “Spotlight” on preventing falls, the leading cause of injury-related deaths and most common cause of non- fatal injuries among older adults. Emerging public health opportunities such as promoting cognitive health and facilitating the communication of preferences at the end of life are also addressed.
"The State of Aging and Health in America 2007 presents important information and key prevention strategies that can help Americans of all ages promote healthier, active aging, and we are pleased that The Merck Company Foundation sponsored this report,” said Richard Murray, M.D., vice president, External Scientific Affairs, U.S. Human Health, Merck & Co., Inc. “Encouraging the adoption of healthy lifestyles and engaging older adults as critical partners in improving health will be essential to addressing the challenges of population aging in the 21st century."
According to the report, the United States has met national targets for four indicators measured by Healthy People 2010 objectives: current smoking, mammogram within the past two years, colorectal cancer screening, and cholesterol checked within the past five years. However, there is much progress to be made on other fronts, such as for flu and pneumonia vaccinations and reducing hospitalizations for hip fractures, particularly among women. There is considerable variation among the states for each indicator. While the vast majority of states have met national targets for cholesterol screening, current smoking, mammography, and colorectal cancer screening, no states have met targets related to physical activity, eating fruits and vegetables daily, and flu and pneumonia vaccines. Twenty-one states and the District of Columbia have met the target on oral health. However, only three states – Colorado, Hawaii, and New Mexico - have met the target for obesity, indicating there is much work to be done in this area.
A searchable online version of the report, supported and developed by CDC, is available at www.cdc.gov/aging. An electronic version of the report in pdf format is posted on the CDC’s website here: The State of Aging and Health in America 2007 Report
------------------------------------------------------------------
In the News
For Some, Service is a Lifesaver
March 6, 2007
By Desiree Cooper
Free Press Columnist
Senior citizens with mental illness have big hurdles to overcome: lack of access to mental health care, lack of access to jobs, lack of social or family support.
From years of being called "crazy" or even "possessed," they also may have acquired antisocial behaviors that have more to do with shame than their underlying illness: aggression, poor personal hygiene, inappropriate social behavior. Some never claw out of the bind. Others are lucky to find a helping hand like Detroit's Adult Well-Being Services.
Mental health supervisor Shirley Payne has been working at AWBS for five years. "When I first came here, many of our consumers had been in institutions most of their lives and had been on harsh, psychotropic drugs," she said. "Because of the stigma, their families put them away and forgot about them."
Payne runs a day program that helps seniors recreate the feeling of family and shed the shame of their illnesses. "Sometimes you can see that something is missing," said Payne, whose program serves about 80 seniors. "It's the substance of them; their personhood. We try to wake that up."
A chance at new life
Gene Golles 54, received one such wake-up call last fall. Suffering from severe depression for most of his life, Golles held down a job at a Westland Italian restaurant for 20 years. But as he aged, his depression, coupled with alcoholism, became disabling.
He was living in an adult foster care facility when he became physically ill. During his three-month hospitalization, the home closed. Fortunately, a friend took him in. It was then that Golles suffered another depressive episode.
I sat by myself," he said. "I couldn't talk to anyone, I wouldn't eat. It's almost as if I didn't have the will to live."
The friend referred him to AWBS. Golles attends the program daily.
"There are people here to encourage me," Golles said. "It's like night and day."
Deborah Chapman, 58, relied on alcohol to dull the shame of her schizophrenia, and to become the life of the party.
"They saw a pretender and a drunk," said Chapman, a widow and mother of three. "It's taken me 40 years to understand that I have a mental illness and that's not going to change. Now I love who I am." For the lucky few, a helping hand
According to the Geriatric Mental Health Foundation, depression affects 15% of all adults 65 and older and 25% of those with chronic illnesses like arthritis, heart disease and Alzheimer's disease. The suicide rate among older adults is higher than in any other age group.
For the lucky ones, programs like AWBS are their only hope.
"We teach that they can be proactive in their own lives," Payne said. "They are not alone."
--------------------------------------------------------------------------
Elderly Care Costs Rising, Require Prevention, Study Says
From Kaiser Daily Health Policy Report,
March 9, 2007
The cost of caring for aging U.S. residents by 2030 will add 25% to the nation's overall health care costs unless those residents actively work to stay healthy and preventive services are provided to help them, according to a CDC report released Thursday, Reuters reports. The report, titled "The State of Aging and Health in America 2007" and funded by Merck's charitable foundation, found that 80% of U.S. residents age 65 or older have at least one chronic condition that could lead to early death or disability.
The report also found that the cost of caring for older U.S. residents is three to five times greater than the cost of caring for younger adults, indicating the increased need for preventive health care directed toward elderly U.S. residents, researchers said (Steenhuysen, Reuters, 3/8). According to the report, the U.S. is meeting federal benchmarks for the care of elderly residents in four of 11 categories. Those four categories include smoking cessation, mammogram screening, colorectal screening and cholesterol monitoring. The U.S. does not meet goals for improved oral health, physical activity promotion, flu and pneumonia vaccination, and hip fracture prevention. Thirty-nine percent of elderly whites, 29% of elderly Hispanics and 24% of elderly blacks say their health is very good or excellent (Ritter, Chicago Sun-Times, 3/9). The report also found that across the 50 states, Hawaii provided the best health care for its elderly residents, ranking highest in overall health, mental health and disability, and it had the lowest percentage of obese elderly residents. West Virginia ranked the worst for overall health, oral health and disability in its elderly residents. Kentucky had the highest number of elderly residents with mental health problems. Louisiana reported the highest levels of obesity, with 25% of its elderly residents considered obese.
Comments
Lynda Anderson, a chronic disease and aging expert at CDC, said, "You have some regions that are doing extremely well in a lot of areas and others that are struggling to get these services to older adults." She added, "There are certainly areas that we need to really pay attention to." Bill Benson, a health care benefits and policy analyst who advised CDC on the report, said, "We are going to see an increase in health care costs, but the goal has to be to restrain the rate of increase. Prevention is the key to that." Richard Murray, a vice president at Merck, said, "We have the opportunity for prevention. We need to be serious about it" (Steenhuysen, Reuters, 3/8). James Firman, president of the National Council on Aging, said the report "confronts brutal facts for all of us" (Chicago Sun-Times, 3/9).
The report is available online.
--------------------------------------------------------------------------
Study Reveals Depressed Elderly Risk Early Death
March 11, 2007
Depression in elderly people is causing early mortality, a University of Liverpool study has found.
In a project involving more than 300 elderly people who had been discharged from hospital, 17% were found to have previously undiagnosed depression and of that figure, 7% died within two years of leaving hospital.
The study also showed that 41% of elderly people who have depression are often later re-admitted to hospital with other illnesses, possibly a result of not receiving appropriate treatment for their depression. The participants, all aged over 75, were interviewed regularly over a two-year period following discharge from hospital. Factors including physical illness, breathing capacity and social activity were found to impact on the prevalence of depression and consequently the likelihood of re-admission to medical care and early death.
Professor Ken Wilson, from the University's School of Population, Community and Behavioural Sciences, said: "The project has shown that depression is common in older people with physical ill health, recently discharged from medical care. It is often undiagnosed and both patients and doctors confuse it with other illnesses or general signs of ageing. This can have detrimental impact on life expectancy and likelihood of going back into hospital."
Depression is still a relatively 'new' disease in terms of treatments and services available to sufferers and many older people are still unaware of the symptoms. Often they will visit their doctor presuming they have a physical illness when they are actually showing signs of depression and will not receive appropriate treatment as a result."
The research team hope that their findings will impact on health care policy with the introduction of a pilot project to identify patients at high risk of depression when they are in hospital. Professor Wilson added: "We hope that future research we have planned will inform new approaches to health care for the elderly with serious illnesses so their chance of survival in the community after leaving hospital is maximised."
The research has been published in the International Journal of Geriatric Psychiatry.
--------------------------------------------------------------------------
New Options (and Risks) in Home Care for Elderly
March 1, 2007
New York Times
By JANE GROSS
Dr. Diane E. Meier, a geriatrician at Mount Sinai Medical Center in New York, is an expert on end-of-life care. So when her elderly parents needed long-term help at home with bathing, dressing and cooking after her father's stroke, she knew where to find assistance. It was not through agencies in Manhattan that provide home health aides who are bonded, insured and certified. A year of custodial care from such an agency would cost her family $150,000, and in short order exhaust its savings because aides are not covered by government assistance unless patients are poor or fresh from a hospital stay.
Instead Dr. Meier turned to ''a little list'' of aides from the so-called gray market, an over-the-back- fence network of women. They are usually untrained, unscreened and unsupervised, but more affordable without an agency's fee, less constrained by regulations and hired through personal recommendation.
With 4.2 million Americans currently over 85 -- a number expected to grow to 5.9 million by 2014 and then accelerate with the baby boom generation -- the exploding need for long-term care is remaking the home-care industry, driving more of it underground.
Gray-market hiring, fraught with risks, is a solution that middle-class families are turning to as they face the crushing burden of indefinite home-care expenses. But it is hardly the only one, as businesses rush to meet the needs of these families, the fastest- growing segment of the marketplace, who are intent on keeping their loved ones out of nursing homes.
Traditional agencies like the Visiting Nurse Service, founded to serve the poor with all manner of home health care, are opening divisions geared toward clients who must pay their own way. At VNS, 15 percent of clients now pay out of pocket, an 11 percent increase over last year, and aides trained in wound care and vital signs are also learning to interact with doormen, use espresso machines or escort a client to the opera.
At the same time, upscale agencies providing trained aides are proliferating solely for the private-pay market, as are national chains with more modest services -- and more reasonable prices. These franchises are intended for today's consumer of home health care who need simple companionship, reminders to take medication, an escort to doctors' appointments and help preparing meals.
The largest of these chains, Home Instead, opened in 1994 with six franchises and now has 722. Their 37,000 part-time workers tend to the needs of 43,000 elderly clients. The advantage is a lower hourly fee -- say, $15 an hour for nonmedical needs vs. $20 an hour for a trained agency aide -- and the disadvantage a scramble to find more skilled help as a patient's health declines.
Policy experts worry that the new home health care businesses could put profit above quality. ''Consumers are always in jeopardy when there's an opportunity to make a lot of money,'' said Val J. Halamandaris, president of the National Association of Home Care, who 40 years ago was chief counsel to the Senate Committee on Aging. ''Sometimes it works out beautifully, and sometimes it doesn't. But nobody's policing it; that's for sure.''
Gray-market hiring, which Dr. Meier says most of her patients choose, is largely a financial decision to avoid the fees of home-care agencies, where perhaps $9 of the $20 hourly fee goes to the aide. In a gray- market arrangement, the aide might get $12, a 33 percent increase -- although sometimes without benefits, worker's compensation or Social Security -- leaving a family able to afford additional hours. Many who have hired by word-of-mouth, without criminal background checks, and paid directly cite the loyalty of employees and their ability to work unfettered by regulations. Some agencies, for example, prohibit their aides from lifting a patient who has fallen without calling 911 or getting approval from a supervisor. That rule protects a client from being moved improperly, the aide from injury and an agency from liability. But some families shudder at the prospect of a loved one lying on the floor.
Many families worry more about temperament than tasks. Dr. Meier, and most of her patients say that entrusting someone with intimate care is less a reasoned decision than an intuition about character. ''You can teach someone how to turn a bed-bound person,'' Dr. Meier said, ''but you can't teach the milk of human kindness.''
Others say they chose gray-market employees if family members insisted upon someone of the same race. That is why Michael Elsas, president of Cooperative Home Care Associates in the Bronx, a worker-owned agency, turned to what he called ''the German au pair network,'' rather than his own better- trained aides, for his mother. But as her Parkinson's disease progressed, Mr. Elsas said, the au pairs were not up to the task. He hired two aides from his agency, keeping one of the German women to placate his mother.
''The cost quadrupled,'' Mr. Elsas said, to $1,400 a week, from $350.
Referrals from corporate employee-assistance plans and also coverage under long-term care insurance are fueling the growth of the full-service agencies. Senior Bridge, for example, has expanded from New York City to 18 suburban and Sun Belt locations. And House Works in Boston, a boutique agency with fewer than 700 clients, has seen its gross revenue grow in six years to $9 million, from $590,000. According to the American Association of Long-Term Care Insurance, a trade group for agents, more than one-third of the $63.3 billion in benefits paid in 2006 went toward home care. But policies differ in whether they cover only certified aides or a broader menu including gray-market employees or companions. And state insurance officials worry about the pressure to deny benefits as more policyholders, now in their 50s and 60s, begin to make claims.
The demand for home care aides throughout the industry is expected to outstrip supply. The Bureau of Labor Statistics counted 663,280 such aides in 2005, up from 577,530 in 1999, a tally that does not include gray-market workers. But the Census Bureau reports a stagnant number of women with little education, ages 25 to 54, the traditional labor pool for this occupation, just as the 85-and-over population is soaring.
Innovators in the field are looking for ways to reduce turnover, estimated at 40 percent to 100 percent a year by various agencies. This so-called churn results in an inexperienced and uncommitted work force.
The Service Employees International Union has been at the cutting edge of creating a more stable pool of workers. In New York, Local 1199 unionized 60,000 home-care employees. Unionized aides, many of them former welfare recipients, get a full array of benefits, rare in this industry, and opportunities to master English, study nursing or learn computer skills.
One of the union's newest offerings is a sort of consciousness-raising group, focusing on self- esteem and a sense of community among otherwise isolated workers. Last month, 13 aides from an agency in Queens shared their gripes with a facilitator. Many had been summoned from clients' homes just moments before the workshop. This sort of administrative confusion was typical, they said, and along with wages, which average $9.34 an hour nationwide, is their main complaint. But aides also said clients criticized their broken English, refused to eat their ethnic food, touched them inappropriately or assumed they would steal.
The Visiting Nurse Service is raising its pay scale to $10 an hour by 2008. Compensation will be tied to seniority, which VNS hopes will reduce turnover, and to the completion of specialty training in areas like Alzheimer's disease, which will provide career ladders for aides.
By all accounts, there is only one training program in the country for gray-market aides, at the Schmieding Center for Senior Health and Education at the University of Arkansas. There, Dr. Larry Wright, a geriatrician, designed a 119-hour curriculum for independent contractors, most enrolled by private employers. The course costs only $275, thanks to the subsidy of a benefactor.
Dr. Wright makes a case for buttressing the independent work force.
''If I saw agencies doing fantastic work, it would be one thing,'' said Dr. Wright, who says most agencies do little more than criminal background checks. ''But there's not much value added and significant cost.''
Even the best-trained agency aides wind up improvising in the privacy of a client's home. It may be against the rules to escort patients in a private vehicle or use their credit cards when shopping. But Mr. Elsas, of Cooperative Home Care Associates, has no doubt it happens.
''The system depends on the good judgment and integrity of workers who may be making $7 an hour,'' he said. ''What's wrong with that picture?''
One effort to instill good judgment is a peer- mentoring program at Mr. Elsas's agency where senior aides make in-home visits to newcomers. But a home setting precludes the oversight found in nursing homes, tightened after the scandals of the 1970s. Setting national standards for agency employees, independent contractors and even family caretakers is one goal of a conference in March at the International Longevity Center in New York. Sheila Baker, a geriatric social worker who has hired gray-market help for her mother, prefers informal oversight. At Mount Sinai's geriatric clinic, for example, aides escorting patients to medical appointments are always asked to leave the room long enough for the elderly person to speak freely about the arrangement. And at Ms. Baker's mother's apartment, even with a gray-market aide who was once a physician in the Philippines, Ms. Baker and her sister, a nurse, make unannounced visits.
Larry Minnix, head of the American Association of Homes and Services for the Aging, advocates national standards to prevent a repeat of the nursing home scandals in the home-care arena. And he speaks from personal experience.
Before they died, Mr. Minnix's in-laws were cared for at home by one beloved aide hired from the gray market. That aide, in turn, hired friends for additional help. One, who did yard work, had a criminal record.
Another, with a family of nine, ran up exorbitant grocery bills because she was taking most of the food home. But his in-laws, Mr. Minnix said, were dependent on the original aide and fearful of changing the arrangement.
''This could happen to anyone,'' he said. ''And it's something the country doesn't know what to do about yet.''
No comments:
Post a Comment