Multi-Specialty Teams Help Seniors Manage Diabetes (Part 1 of 2)

A multi-disciplinary medical team of pharmacists, podiatrists, optometrists, ophthalmologists, dentists and dental hygienists best assist seniors in managing their diabetes by addressing medication, foot health, vision impairments, dental loss, and heart conditions, researchers at the U.S. Centers for the Disease Control (CDC) and Prevention and the U.S. National Institutes of Health (NIH) say.

While most of the aforementioned categories of physicians may not have time to take on these different aspects of diabetes outside of their specialties, they may be able to ask questions and provide their senior patients with advice during regular visits, check-ups and exams, the National Diabetes Education Program’s (NDEP) Pharmacy, Podiatry, Optometry and Dental Professionals Work Group of CDC and NIH say.

The joint-federal agency working group releases their annual reference guide titled Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists and Dental Professionals to train medical professionals to converse with aging diabetics about treating their condition with insulin, drugs, proper diet, exercise and sleep.

The booklet’s recommendations on how to diagnose and manage pre-diabetes and diabetes are based on clinical work and research by the medical professional trade organization American Diabetes Association (ADA). It and other specialty-based literature and materials are available at ndep.nih.gov.

Affected professionals also include primary care, family practice or internal medicine physicians, physician assistants, endocrinologists, certified diabetes educators, nurses, nurse practitioners, registered dietitians, cardiovascular specialists, renologists, neurologists, psychologists, psychiatrists and social workers.

Certified diabetes educators are trained healthcare providers who can counsel and train diabetics about their condition by setting behavioral goals and discussing health issues. A diabetes educator is usually a nurse, dietitian or pharmacist certified to guide and instruct patients about diabetes and self-care.

Diabetes Prevalence and Impact

Deemed severe, common, expensive but able to be controlled, diabetes is considered the sixth leading cause of death in the country and impacts at least 21 million individuals with at least 6.2 million undiagnosed. It costs the nation nearly $200 billion in direct and indirect expenses.

Nationally, diabetes ranks first among all long-term, deadly diseases as the cause of lower limb amputation that is not connected to trauma, first as the cause of acquired blindness and first as the cause of kidney disease ending up in dialysis.

The condition also contributes significantly to heart disease, being its number one cause of death in the country. At least 65 percent of senior diabetics die from heart failure.

Meanwhile, the prevalence of diabetes increases. Federal research shows it has more than tripled in the last 25 years from 5.8 million to the current 21 million, and in some states, over 25 percent of adults are diabetic. Projections will continue to be high. By the year 2050, the number of diabetics is expected to reach 39 million.

With current trends, one out of every three individuals nationwide will contract diabetes in his or his adulthood and may find his or her life span reduced by 10 to 15 years.

There are three forms of diabetes, type 1, type 2 and gestational diabetes. Federal research shows that, as of 2005, about two-thirds of adults nationwide were obese with the body mass index (BMI) of over 25, contributing to the onset of diabetes in this segment of the population.

In fact, the incidence of obesity has jumped by 61 percent since 1991, leaving more than 60 percent of adults overweight. A high body mass index and obesity pose the greatest risks to individuals for developing diabetes.

Type 1 is defined an autoimmune disease that is characterized by the destruction of insulin-producing beta cells. This version of diabetes can take place at any age but most especially in childhood or young adulthood.

Type 1 diabetes patients can develop ketoacidosis, a diabetic complication in which the body releases excess blood acids also known as ketones. Diabetics must take insulin daily whether by injection, insulin pump or inhalation.

Additionally, type 1 diabetics must test their blood sugar several times every day, follow a customized meal plan and take part in physical exercise.

Type 2 diabetes is connected to insulin resistance. The pancreas produces insulin but it is not recognized or used by other body tissues. Patients of this form of diabetes are treated with insulin, drugs or both. Otherwise, the condition can be controlled with an individualized food plan and physical exercise.

The development of type 2 diabetes is multifactorial, with insulin resistance, sedentary lifestyle, advancing age and obesity contributing to this increase.

This version of diabetes hits nearly 10 percent of the country’s population of young adults and double of the senior segment with a high incidence among those who are obese and physically inactive.

Still, the number of type 2 diabetics among children and teens is increasing, a n important concern as the number and intensity of complications grow with age.

Type 2 diabetes affects African Americans, Hispanics, Native Americans, Alaska Natives, Hawaiians or other Pacific Islanders and they are all two times as likely to have the condition as whites of the same age group. Some sectors of the Native American population suffer the highest rates of diabetes in the world.

The third form, gestational diabetes, involves glucose intolerance in women at the time of pregnancy. Gestational diabetes is most likely to take place among African Americans, Hispanics and Native Americans. It also occurs in obese women with a family history of diabetes.

At the time of pregnancy, mothers are treated to have their blood glucose levels stabilized so as to not affect their infants. Afterward, five to 10 percent of gestational diabetics are discovered to have type 2 diabetes. Indeed, women with gestational diabetes harbor a 20 percent to 50 percent risk of contracting diabetes over the next five to 10 years.

Other forms diabetes stem from genetics such as “maturity-onset diabetes of youth,” surgery, drugs, malnourishment, infections and other illnesses. They make up 1 percent to 5 percent of such cases.

Prevention Tools

About 54 million individuals aged 40 to 74 years of age — an age group that makes up 40.1 percent of the country’s population — suffer from pre-diabetes, which endangers them into developing type 2 diabetes.

Without action, pre-diabetics can advance to type 2 by a rate of 10 percent higher every year. They also have a higher risk of heart disease and stroke.

Pre-diabetes, “a condition in which blood glucose levels are higher than” what is considered healthy “but not in the diabetes range,” is described as “impaired fasting glucose (IFG) of 100 to 125 mg/dL or impaired glucose tolerance (IGT) diagnosed by a post 75-gram glucose challenge of 140 to 200 mg/DL.”

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of NIH can assist patients and providers in determining whether they are at risk for pre-diabetes. Federal research identifies three types of prevention: primary prevention to keep diabetes from occurring and secondary prevention to prevent complications in those who are already stricken with diabetes (e.g., prevention of foot disease).

Still, a third version, called tertiary prevention, means avoiding worsening complications such as an amputation from injury to a diseased foot or death.

These three levels of prevention occur because of the high financial and non-financial costs of diabetes. Federal research shows that more than 4,100 individuals per day are diagnosed with diabetes. As a result, 55 lose their sight, 120 undergo renal failure and 230 lose a limb to amputation — daily.

To test for diabetes, medical professionals will perform finger sticks or forms of laboratory testing. To qualify to conduct laboratory testing, professionals must be registered with the Centers for Medicare and Medicaid Services (CMS) under the Clinical Laboratory Improvement Amendment (CLIA) of the law governing the policy and procedures of the federal agency.

The amendment sets quality standards for accuracy, reliability and timeliness of test results no matter what types of tests are performed. Three classes of tests and certification have been set and the categories depend on the level of difficulty and effort of the method used.

It has set up rules for each category of testing calling for quality control and documentation processes. Some states have added more requirements for different laboratory sites or medical professionals. For more information, professionals are asked to consult their state agency and the CMS website at http://www.cms.gov/clia/.

To help those who already have diabetes, the guide, Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists and Dental Professionals, provides detail on the type of drugs that best manage blood sugar, including insulin, as well as blood pressure and cholesterol.

The booklet concentrates on diabetes-related complications affecting foot health, vision, oral care and medication therapy issues. Using clinical graphics, including patient education posters to be hung in a medical office, and four specialty-based prevention brochures, it aims to encourage interdisciplinary medical team work to treat diabetes and make appropriate patient referrals.

Additionally, another booklet, the Working Together Medications Supplement, instructs on how to understand and properly use medications meant to control diabetes and can be used to organize team care. Package inserts or another guide titled the Physicians’ Desk Reference include prescribing information.

The Working Together Medications Supplement guide provides insights for professionals and senior patients on such issues as:

–The different types of insulin and the appropriate times to administer them so as to not conflict with a scheduled procedure;

–The most common symptoms of medication use to help a medical specialist to pinpoint a problem and make an appropriate referral to another specialist;

–Reduction of adverse interactions of drugs prescribed by different specialists;

–Avoidance of accidental overdosing or underdosing by generating awareness of medication names, strengths and dosages, and;

–Making the most of each visit, check-up or exam to teach patients about how to correctly use prescribed drugs and to receive drug use counseling from a primary care physician or pharmacist.

Physicians, specialists and other medical professionals can access the reference guides, which are all free, at the Centers for Disease Control and Prevention’s continuing education website, http://www2a.cdc.gov/TCEOnline/ and fill out an evaluation form and post-test.

Taken together, the guides are meant to help professionals identify the different type of diabetes and to prevent complications; to practice key messages to senior patients about diabetes; to articulate the most pressing concerns about drug therapy, foot health, vision and oral care for diabetics, and; to interpret the outcomes of the Diabetes Prevention Program (DPP).

According to the American Diabetes Association Standards of Medical Care, Diabetes Care reference guide, professionals are required to train senior patients to pay attention to their hemoglobin A1C, a test that shows their average blood glucose over three months (the goal is an A1C of less than 7 or 150 mg/dL), a blood pressure reading at less than 130/80 mm Hg, and a cholesterol count of less than 100 mg/dL.

With such training, senior patients are expected to practice sound self-management habits. They can maintain a customized, healthy meal plan with the help of the dietitian, participate in physical exercise, avoid cigarette smoking with guidance from a certified diabetes educator, and take prescribed drugs properly with counseling from a pharmacist.

Social workers can help coordinate government services for patients, especially seniors, and mental health professionals can assist them with depression and other mental illness issues as they pertain to diabetes.

Resources geared at assisting them can be found at the NDEP’s Better Diabetes Care Web site at http://www.betterdiabetescare.nih.gov/WHATpatientcentereddimensions.htm.

Finding the Time

Pharmacists, podiatrists, optometrists, dentists and dental hygienists may not find time to look at a senior patient’s medications, feet, eyes or teeth, especially if each category of physician feels entrenched in his or her specialty, members of the joint CDC-NIH work group say.

However, specialists are capable of sending direct messages to their senior patients about health problems or issues they have noticed. Instead of opening a statement with wording such as, “You should see someone about that … ,“ a specialist could tell his or her patient that, “I recommend that you … “

For example, a pharmacist does not need to be a podiatrist, an optometrist or ophthalmologist or a dentist or dental hygienist or perform an exam to determine when a senior patient presents with a problem that warrants the attention of another category of specialist, the workgroup members say.

A minute is all that is needed, for example for a pharmacist, to view a senior patient’s foot, mouth or eye to ask some questions about medications, supplies or cigarette use, they say.

By merely mentioning the problem a pharmacist, for instance, may have identified, he or she reinforces the need for prevention once he or she examines the issue before referring the patient to another specialist-colleague, goes the argument of the workgroup.

A pharmacist, podiatrist, optometrist, ophthalmologist, dentist or dental hygienist can support comprehensive diabetic care by going beyond his or her specialty to point out potential issues and then make a referral with an “I recommend … “ statement.

CDC-NIH workgroup members say patients will be grateful to specialists for taking their health and well-being into consideration, setting up a referral system and adopting a comprehensive team-care approach with their professional peers.

Foot Health

Besides podiatrists and as part of a comprehensive diabetes care team, pharmacists, optometrists, ophthalmologists, dentists and dental hygienists and other specialists ought to watch their senior patients for the most common diabetes-related foot issues: neuropathy, vasculopathy, dermatological conditions and musculoskeletal problems.

To assess for peripheral sensory neuropathy or the loss of sensation in the feet, specialists should check for the senior patient’s experience of tingling, burning, numbness or sensation of bugs, crawling on the skin of the feet. Podiatrists seek to detect this foot condition by using an instrument known as the Semmes-Weinstein 5.07 (10 gram) monofilament.

Senior diabetics with neuropathy are nearly two times more likely to suffer from ulcers in the feet than their peers without this condition. For senior diabetics with both neuropathy and foot deformity, the danger of cultivating ulcers is 12 times greater. Still, furthermore, senior diabetics with a history of foot disease, including previous amputations or ulcers, face a worsening risk of up to at least 36 times greater.

The demographics most at risk for lower-extremity ulcers and amputations are members of the male gender, non-Hispanics, African Americans, seniors and diabetics of at least 10 years, having past cigarette use and having a history of poor blood sugar control or heart, eye and kidney complications.

A comprehensive foot exam for diabetics includes evaluating “pulses, sensation, foot biomechanics,” which is defined as foot structure and function, and nails. NDEP medical literature titled Feet Can Last A Lifetime describes how to use this monofilament to conduct a complete foot exam and can be accessed at ndep.nih.gov.

Vasculopathy represents the cramping of calf muscles when walking, also known as “charley horse”, which leads to several rest periods bet. The cramping stems from insufficient blood in the area below the knee, caused by the blocking of the arteries, which commonly happens in the lower extremities of senior diabetics.

Nighttime severe cramping and toe aches are known as rest pain and is treated by walking or allowing the feet to hang over the side of the bed. This particular symptom means there is an end-stage blood vessel disorder and tissue ischemia, all of which comes before the onset of diabetic gangrene.

Neuropathy is cited by clinical research as being most responsible for ulceration and related foot complications. However, an inadequate blood supply can also lead to bad ulcer healing and, thus, amputation. Both neuropathy and not enough blood should be factored into a complete diabetic foot exam and care.

Dermatological conditions are exemplified by feet corns and callouses, also hyperkeratotic lesions, which are the result of “elevated mechanical pressure and shearing of the skin.” These conditions come before the “breakdown of skin” and cause “blisters or ulcers.”

Additionally, “surface lacerations and heel fissures or maceration (softening by wetness)” can all result in infection. “Corns, callouses, toenail deformity and bleeding under the nail” may be symptoms of neuropathy. “Fungus infections of skin or nails” become secondary infections that must be treated immediately.

“Musculoskeletal symptoms” in diabetic feet may emerge with “muscle-tendon imbalances” because of motor neuropathy. Such deformities include the hammertoes, bunions, high-arched foot or flatfoot, which raises the possibility for irritation of the foot in the shoe.

A patient’s style of life and his or her family history can determine the status of foot health. Senior diabetics who smoke are four times more likely than smokers without diabetes to acquire lower-extremity vascular disease.

Consuming foods high in fat and sodium and remaining physically inactive can lead to insufficient long-term control of blood glucose and place the patient at risk for diseases of the peripheral nervous system and blood vessels.

Additionally, a family history of illnesses of the blood vessels in the brain and coronary artery disease may mean a greater risk of lower-extremity arterial complications. Foot types or shapes may make a patient more vulnerable to biomechanical deformities that could end in skin breakdown.

Senior patients with neuropathy are highly likely to acquire degenerative arthropathy, also known as Charcot foot, that targets the joints and results in a red, swollen and deformed foot that can be taken for cellulitis. A Charcot foot usually means little to no pain and may progress over weeks to months before a specialist discovers it in a patient.

Radiological imagery may reveal a collapse of joint structure and can be taken for osteomyelitis. Therapy for Charcot foot is a light cast, in the absence of any swelling, and special shoes to correct changed biomechanics. If Charcot foot is not treated, the senior patient’s feet can degenerate into greater deformity, ulcers and, in the end, amputation.

Podiatrists and specialists in general should watch for senior patients who complain that their shoes don’t fit or wear slippers or shoes with portions cut out to adapt to changes in foot shape or limping.

The American Diabetes Association (ADA) and the American Podiatric Medical Association (APMA) take into consideration two forms of risk for developing diabetic foot complications: high risk and low risk.

The symptoms of high risk for developing foot disease include a “loss of protective sensation, absent pedal pulses, foot deformity, a history of foot ulcers and prior amputation.” By sharp contrast, for low risk, none of these symptoms exist.

To prevent low-risk senior patients from advancing to high risk, both professional trade associations, the ADA and the APMA, ask specialists to urge them to control their A1C, or hemoglobin blood sugar levels, blood pressure readings and cholesterol count and to quit smoking for those using cigarettes.

To assist high-risk senior patients, both organizations ask specialists to help patients guard against developing ulcers through self-management training, foot care and using the proper footwear. Light trauma “such as stubbing a toe or stepping on a sharp object” is the event most likely to lead to acquiring ulcers.

As a result, specialists are asked to stress to senior patients and their families the need to take the initiative to clear out walking areas, especially near the bed and the route to the bathroom, and to use night lights to enable a senior patient to see in the dark.

Additionally, high-risk senior patients must know who and when to call about their foot health issues. Same-day emergency calls to a primary care physician or podiatrist will likely be about a puncture wound, ulcer, redness or new foot pain. For less urgent issues such as patients with callouses or thick or ingrown nails, a podiatrist should be phoned and visited within a matter of days.

Nearly 20 percent of senior diabetics who visit their primary care physicians or specialists for check-ups or exams will present a foot health issue. With each visit, their doctors must ask their senior patients to take off their socks and shoes and check both feet for problems.

The likelihood of developing foot ulcers among diabetics is 15 percent. Worse still, the probability of diabetics with kidney complications and undergoing dialysis at risk for foot complications is higher but is treatable.

A podiatrist or other specialists are asked to pose senior diabetics the following questions when probing for foot care problems:

Whether they know how diabetes affects their feet, that diabetes puts them at risk for ulcers, which can result in amputations, and that foot care can prevent this;

Whether they have had a comprehensive foot exam in the past year and, in particular, one by a podiatrist, and a foot inspection by a primary care doctor, and;

How do they care for their feet daily and if their care regimen includes looking and touching for cuts, bruises, puncture wounds, corns or callouses, redness or pus; cleaning the feet’s skin and nails daily; drying in between toes; checking the insides of shoes for materials before wearing them and avoiding walking barefoot at all times.

Specialists can also refer senior diabetic patients to foot care literature from NDEP in English and Spanish at ndep.nih.gov.

Assistive Technology, Home Modifications Boost Senior Mental, Physical Functionalities (Part Three)

“One of the ladies [I provide services for] has arthritis,” she said. “She lives in [a senior independent living facility]. In that place, there is [a] senior facility [that contains] bars [to prevent falls]. [Other places say] ‘We don’t [carry] bars, grab bars.’

“[In] every [senior long-term care facility and assisted living center I visited in the past], [I see chairs with] one or two arms or two legs. I have some problems [like getting] chairs with arms.

“[When I talk to some seniors in long-term care, I will get comments like, ‘The] kids are too busy. I tell my wife to get me [a] chair [with particular features to accommodate my illness and disability’]. How many [assisted living facilities or senior long-term care centers] don’t have a table? They put [so many objects] on it [that it no longer functions as a table for mealtimes].”

Eckhouse established her business using her master’s degree training in gerontology from 2000, her work in senior long-term care and rehabilitation services, her 30 years of experience as an occupational therapist and later her certification as an “aging in place” specialist in 2008. Her thesis project for her master’s degree at Northeastern Illinois University was “Internet-based Resources on Information for Successful Aging and Independent Living.” Her website is at http://www.MyElderSpace.com.

A member of the Chicago chapter of ASA and the AARP, Eckhouse networks locally with the Senior Lawyers Committee of the Chicago Bar Association, Senior Services Division of the City of Chicago Providers Council, CJE SeniorLife and Covenant Methodist Homes to learn about the latest trends, research and practices in senior long-term care and home care to inform her commercial services.

“[With our current] health (care) system, you [may have, for example,] one week of [emergency room medical center or hospital care or] housing and three or four [weeks of] rehabilitation,” Eckhouse said. “You are lucky [to have] two weeks [of adequate transition time in between categories of care].”

As do most local companies, ElderSpace staff must consider the material, designs and regulations under which private family residences built after World War II were constructed to determine home improvement plans.

“[In the] post-World War II [era,] [there was a brand of] emerging housing [that they created to accommodate new middle city and suburban families throughout the country],” Eckhouse said. “[The] standards never changed. Cabinets and door knobs used [a particular material and design].”

Part of the counseling to homeowners and some of the products used for transforming homes include assistive technology such as computers, tablets and Skype, she said.

For example, if seniors living at home or in a long-term care facility need to take five or six bottles of medicine and they are forgetful, a specially-built machine may be set to help them remember to take them on time, in the correct dosage and with the right frequency.

“We call [on] assistant technology [to enable seniors to perform basic daily life functions],” Eckhouse said. “There are different ways that technology can help. Some technology is to help people [with tasks on a step-by-step basis] and others are sensors. [In either case,] technology is for communication.”

Still, she said, the difficulty of working with technology is learning the rules and laws governing use and implementation.

“With technology, it is complicated,” Eckhouse said. “The definitions aren’t the same. The government passes laws [on the definitions and regulations]. You are working with documents, namely electronic paperwork, and working with patients to try to implement [those machines or equipment].”

Read This Story From the Beginning: Part One

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Assistive Technology, Home Modifications Boost Senior Mental, Physical Functionalities (Part Two)

Loeb-Aronin praised another collaborator, Sherri Snelling, California-based CEO and founder of the Caregiving Club, executive producer of the “Handle With Care” TV show and newsletter editor, for bringing in a caregiving component to the intergenerational program activities. Snelling’s website is at http://www.caregivingclub.com.

At the workshop, all professors and cognition, gerontology and geriatrics experts demonstrated how a variety of intergenerational activities around the country improved self-sufficiency, health care, mental and physical functioning and access to technology. The panelists shared “mind-building activities” and Internet-based content.

“[At] Pace and Case universities, [I and a team of instructors developed products to assist seniors with] loss of memory,” Loeb-Aronin said. “[The] computers and tablets [were used] with programs for recognition. [These programs] sensitized college instructors in [the] senior center [when they are working] with tablets [to address seniors with] memory disorders.”

“I [work on these projects with a team of] collaborators. [I get] advice and help from visitors and advisors [at my centers and universities]. Sometimes, there is an agency or group [that sponsors, leads or funds our work].”

Eckhouse said she started ElderSpace in July 2006 to assess the houses of seniors and enhance their living space at affordable rates to enable them to continue their lives at home and in their neighborhoods.

“[We encourage] planning, saving and aging in place,” she said. “[Most people don’t say] ‘I’m thinking of talking to [a] planner.’ Most people don’t want to plan. [They remain in] denial and worry. Don’t wait for a crisis [to occur to take action].”

Assessments focus on the mental and physical functions of a senior in his or her home, problem areas in his or her quality of life and health care and high-risk spots for injuries or falls in houses. Eckhouse said the assessments take into account whether there is sufficient lighting, safe and usable bathrooms, availability and use of house keys and accessibility of faucets and appliances in the kitchen as a whole.

She added that, after assessments, she offers modifications, adaptations, occupation therapy and products to the homes of her elderly customers using universal design and a specialized team of architects, engineers and construction workers.

“Home modification goals [are] safety, independence and functionality,” she said. “ElderSpace [provides] village members with communities and multi-generational housing. [We] retrofit space and create transportation and walking areas and visibility programs.”

She said ElderSpace helps Baby Boomers or seniors at different stages of rendering their homes more livable whether they are recovering from illness or accidents, coping with disability, remodeling or planning ahead for their houses and health care.

Aside assisting with planning changes to the house and staying at home, the company will also provide products, services and counseling on physical accommodations for Alzheimer’s and dementia patients, accident and fall prevention, assistive technology and contractor referrals.

Changes can take the form, for example, of placing studs in walls for future grab bars, widening doors with offset hinges to avoid hands getting caught in door jambs, lowering the height of counters, cabinets, and toilets, providing solid office chairs, modifying lighting, adding lighting and ultra-sense faucets, placing walkers at the top and bottom of stairs to prevent falls and removing barriers.

“Escalators, stairs and even revolving doors [are] products,” Eckhouse said. “[When I went to visit] Lurie [Children’s hospital in downtown Chicago,] everything [went] up. [I saw a] two-story escalator.”

Eckhouse explained that many of her company’s ideas for in-home accommodations come from the structural features she finds missing as well as the ones present in many medical centers and senior long-term care facilities.

Continued: Part Three

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Assistive Technology, Home Modifications Boost Senior Mental, Physical Functionalities (Part One)

Both assistive technology and modifications to one’s private home can connect seniors to the digital world, improve their intellect and knowledge base and enable to perform daily life tasks, a computer science expert and a gerontologist said on a panel at an annual conference on aging.

Felice Eckhouse, a gerontologist, occupational therapist, aging in place specialist certified by the National Association of Home Builders and founder/president of ElderSpace, Inc., a company started to assess and improve home environments to empower seniors to safely age in place in Chicago, and Dr. Gene Loeb-Aronin, founder/director of the Center for Technology and Cognitive Health of Older Persons in west suburban Wheaton, Ill. and the Center for Community Informatics in north suburban Wheeling, Ill., made their observations during their poster panel presentation titled “Are We Ready to Age in Place?” at the Aging in America conference by the American Society on Aging (ASA).

The presentation was also alternately called “Connecting Elders With Social Computer Networking via Intergenerational Community-Based Programs.”

“We invent terms because they sound pretty [such as] ‘aging in place,’” Loeb-Aronin said. “The problem is not re-defined. [There are different] pieces of the puzzle. Another problem [has to do with] doing enough [to promote successful aging in place and quality senior long-term care]. You look around. How many people are aging?

“Personally, it does not matter [which] neighborhood [seniors live in, how they obtain health care and what government services they participate in]. People are [not] writing about this but we don’t know how to implement [the technical resources needed to] to support home care.

Eckhouse said there are varying perspectives on age and this will color how prepared the industry and government are for the rise in the number of seniors.

“What [is life going to be like at age] 50, 60 and 70?” she said. “We’re in [the] middle [of a senior care revolution and transformation of the aging in place movement]. [Age] 75 [is the] beginning of the old and old-old. There are not that many [members of this age group]. [It depends on how you look at it.] [Either] no one’s old [or] everyone is old.”

Loeb-Aronin explained that both of his centers use volunteers to teach and initiate seniors in urban and suburban communities around the country to use information technology to hone their cognitive skills and become more knowledgeable about the world around them.

“[Our programs are meant to resolve] aging needs and [to promote] brain health,” he said. “[We want to help seniors attach names to] faces and [preserve their] memories.

“Volunteers help seniors [get] connected with people all over the world. [These aging] issues are all over the world. I lived in Australia [for a time]. I followed these organizations. I’ve got a lot of content.”

Editor of the Journal of Community Informatics and reviewer of the Journal of Informing Sciences and Merlot, Loeb-Aronin uses his educational background, research on learning, psychology and aging, instruction and travels to different countries and memberships in global organizations to enhance learning and development, create curriculum and technologies and write journal articles on aging and technology subjects. One of his websites include http://www.seniorslivewell.blogspot.com.

Locally, Loeb-Aronin sits on the planning committee on ASA’s Chicago Roundtable of bimonthly meetings of geriatric professionals at Rush Presbyterian St. Luke’s University Medical Center in Chicago. He is also affiliated with Roosevelt University in its campuses in Chicago and northwest suburban Schaumburg, Ill.

Aside from their poster session on aging in place, Loeb-Aronin participated in a 90-minute workshop at the conference titled “Intergenerational Activities and Community Involvement: A Winning Plan for Quality Senior Living.”

He co-hosted the workshop with Dr. T.J. McCallum, associate professor of psychology of Case Western Reserve University in Cleveland, Ohio, Dr. Jean Coppola, associate professor at Pace University, Dr. Kristin Bodiford, program director of the initiative Creating Aging-friendly Communities, Dr. Robert Winningham, associate professor and division chair of the Department of Psychology at Western Oregon University, gerontology professor and expert on cognition.

Continued: Part Two

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part Three)

Both researchers said that each of the 50 states they studied protects seniors from physical abuse, financial or material exploitation and neglect but definitions vary. Forty-four states carried emotional or psychological abuse provisions or laws. Forty states had laws or provisions on self-neglect. Thirty-seven states addressed sexual abuse. Thirteen states protected against abandonment. Ten states – Alaska, California, Hawaii, Louisiana, New York, Pennsylvania, Rhode Island, Utah, Washington, and Wyoming – defined all seven NCEA categories of abuse.

For example, Virginia identifies adult abuse as “the willful infliction of physical pain, injury or mental anguish or unreasonable confinement of an adult,” combining both physical and emotional or psychological abuse. Hawaii defines psychological abuse as “the infliction of mental or emotional distress by use of threats, insults, harassment, humiliation, provocation, intimidation, or other means that profoundly confuse or frighten a vulnerable adult.”

For independently-defined abuse, no state, Jirik and Sanders said, had independent definitions of all seven NCEA categories of abuse. This held for six states on physical abuse; 46 states on financial or material exploitation; 46 states on neglect; nine states on emotional or psychological abuse; 16 states on self-neglect; 17 states on sexual abuse, and eight states on abandonment.

For age definitions, sixteen states specified ages 60 and older; six states, ages 65 and older; Hawaii, ages 62 and older; 14 states specified two ages for persons under its elder abuse law, age 18 and older and ages 60, 62 or 65 and older. Four states – Maryland, Mississippi, North Dakota, and West Virginia – had no specified age for a defined population. The remaining states defined the age of requirement as 18 years and older.

Jirik and Sanders pointed to a lack of consistency among the 50 states on training requirements under their elder abuse and neglect laws with some provisions being detailed while others were vague. Thirty-two states did not define any training requirements for investigators of senior abuse or the categories of professionals to be involved, although training could be at an administrative or department level or regulated in a different law or code. The remaining 19 states specified training for investigators of elder/dependent adult abuse and the type of professionals required.

Read This Article From the Beginning: Part One

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part Two)

In recent years, both said, state laws on elder abuse and neglect have expanded. In particular, more states are requiring mandatory reporting of incidents. In 2000, researchers found that seven states did not demand reporting of elder abuse and neglect cases, a figure that has now dropped to three states.

States have greatly expanded the categories of abuse prosecuted. In 2001, researchers found abandonment to be addressed in 10 state laws, a number which has grown to 13 states. In that same time period, 42 state laws included emotional abuse in its categories and this has extended to 44 states.

Still, by comparison, Jirik’s and Sanders’ research paints a grimmer picture: abuse definitions vary from state to state; only eight states have specific elder abuse laws, namely, Connecticut, Illinois, Massachusetts, Ohio, Oregon, Pennsylvania, Rhode Island and Wisconsin.

Few states, they said, protect against all seven categories of elder abuse as defined by the National Council on Elder Abuse (NCEA) under the U.S. Administration on Aging, and have specific laws on mandatory reporting and penalties for failure to report, specifically, California, Pennsylvania, Rhode Island, Utah, Washington and Wyoming. Many types of abuse are not independently defined but described in general. While state laws share particular concepts, they all differ in the details and the methods in which they are carried out, making scientific comparison difficult, they said.

In fact, Jirik and Sanders reported, many of the professionals central to the study reported feeling unable to intervene on behalf of seniors in trouble, have had to grapple with the self-determination and mental competency levels of their victims, found difficulty understanding and applying the laws of their state, did not succeed in having the cases they report accepted for investigation and found it hard to partner with under-resourced and under-trained investigative agencies.

To embark on their study, both researchers examined elder laws in state university libraries or government websites, focusing on state laws germane to home-based community services (HBCS) instead of senior long-term care facilities. Jirik performed the coding for the laws and reviewed them with Sanders. Both discussed the outcomes with two other elder abuse researchers, sampled particular states and phoned their elder abuse program directors to confirm their findings.

Concentrating on 2011 and 2012 state laws, Jirik and Sanders made records of statute numbers and titles, the type of victims covered, elder abuse cases versus dependent adult abuse cases, definitions of elder abuse, comparisons to the categories defined by the NCEA, mandatory reporting requirements and penalties, investigative agencies, provisions of consent and professional training.

This mode of collection was based on two well-known attempts at elder abuse law analysis: the 2000 articles titled “Statute Definitions of Elder Abuse” by J. M. Daly and G. Jogerst and “Adult Protection Service Laws: A Comparison of State Statutes from Definition to Case Closure” by L. Roby and R. Sullivan.

NCEA defines the following seven terms of elder abuse and neglect as follows: physical abuse as “acts of violence, physical punishment, inappropriate use of drugs;” emotional or psychological abuse as “threats, humiliation, harassment and isolation;” financial of material exploitation as “misusing or stealing money or possessions;” sexual abuse as “unwanted touching, including all types of sexual assault or battery;” neglect as “failure or refusal to provide elder with necessities such as food or medicine;” self-neglect as “failure or refusal of an elder to provide himself or herself with necessities;” and abandonment as “desertion of an elder by person who has assumed responsibility for [an] elder.”

Aside from finding that only eight states had elder or dependent adult abuse laws, Jirik and Sanders found that 14 state laws protect both dependent adults and elders from abuse with California’s “Elder Abuse and Dependent Adult Civil Protection Act” being a prime example. Twenty-nine states have dependent adult abuse laws that include seniors under certain conditions such as New Jersey’s “Adult Protective Services Act” for victims aged 18 and older, mentally or physically disabled persons and victims of abuse, neglect or exploitation.

For mandatory reporting, both researchers found three states – Colorado, New York state and North Dakota – did not specify mandatory reporting. Six states – Delaware, Indiana, North Carolina, Rhode Island, Utah, and Wyoming – had a universal mandatory reporting requirement. Thirty-one states required a specific class of professionals to report incidents. The remaining 11 had a universal reporting requirement with a list of specific professionals.

For penalties for failure to report, Jirik and Sanders found that 42 states have penalties, which include classifying the negligence as a misdemeanor, applying a fine of a $500 maximum and imposing a six-month jail term. Six states – Delaware, Indiana, Maryland, New Jersey, North Carolina, and Ohio – did not specify a penalty for professionals who failed to report. Three states – Colorado, New York state and North Dakota – have neither a mandatory reporting law nor penalties.

Continued: Part Three

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part One)

Nationwide, public and private sector laws and policies to elder abuse and neglect are fragmented and do not sufficiently address a problem that, if left under-addressed, may grow overtime with the number of seniors in the country’s population, two social work authors of a state law and policy research study on the subject said during their panel at a conference on aging.

Stacey Jirik, BSW, with the DuPage County Senior Services in Illinois and Sara Sanders, Ph.D, MSW, associate professor and Hartford faculty scholar, undergraduate social work program director at the University of Iowa and gerontology and end-of-life care expert, recommended more unified strategies when they discussed their 50-state study of federal and state senior abuse and neglect laws and policies, titled “Elder Abuse in the United States: An Analysis of Elder Abuse Policy and State Elder Abuse Statutes.”

Urging social workers, case managers, state directors of federal Area Agencies on Aging (AAA), registered nurses, home health care workers, elder abuse investigators and academicians to relate their professional experiences with elder abuse and neglect, Jirik and Sanders compared notes about laws and policies of the different states conference attendees hailed from.

During the panel, participants identified their state and the most effective solutions, greatest challenges, funding, attempts at advocacy, training, elder abuse and dependent adult abuse laws, mandatory reporting and penalties confronting elder abuse and neglect.

As the population continues to age, both social work experts said, the specter of elder abuse and neglect will loom larger. Their study, which encompasses legal statutes and policies across the country, found that between 1 to 27 percent of seniors are abused and that, for every case that is reported, 14 are not.

Meanwhile, the two panelists said, the U.S. Census 2010 found seniors make up 13 percent of the nation’s population or 40.3 million people. Government estimates project that, by the year 2030, one of every five persons in the nation will be aged 65 and older. This is, in large part, due to the medical and technological advancements that increase the life span for aging Baby Boomers.

Many researchers believe that senior abuse and neglect law and policy are in the same state that the issue of child abuse had 30 years ago and that the subject of domestic violence had 15 years ago, both said. Some have described the problem of elder abuse as a “patchwork quilt” of so many factors making an influence independently, making for disparate solutions to the problem.

Jirik and Sanders concluded that, over the decades, senior abuse has not received the same level and degree of “attention from professionals or the public” that child abuse and domestic violence have been given.

Both explained that elder abuse is not well-addressed because of the lack of societal value placed on older adults. With respect to detecting, treating and reporting elder abuse and neglect, physicians have not been involved in the overall effort because it has not been incorporated into their medical training, they said.

The public’s ageist attitudes and lack of awareness and an aging victim’s fear of retaliation contribute to inaction, they added. And resources needed to combat elder abuse at the federal, state and local level are limited when compared with that afforded child abuse and domestic violence.

By contrast, they said, government, business and nonprofit efforts are most effective against elder abuse and neglect when the victims of abuse are actively engaged in the fight, a wealth of research exists on the subject and there is a great deal of media attention.

Both social work experts recommended that policymakers and care professionals achieve greater uniformity among state laws in terms of the number of categories of elder abuse and protective remedies enacted and used, including for seniors not covered by dependent adult abuse laws.

They also called for more research on federal and state laws and policies to analyze and interpret such factors as the connection between the wording or length of laws and the types of elder abuse reports, the type of reports accepted or the overall outcome of senior abuse cases. They asked panel participants to deepen their understanding of how the federal and state laws and policies work and to articulate their “positive and negative aspects.”

Jirik and Sanders urged participants to become advocates against senior abuse and make its victims a priority, fighting against accompanying social stigma, a lack of funding for intervention programs and the pervasive ageism that leads to public apathy or inaction.

Continued: Part Two

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Chicago Hospital Makes The Case For Connecting Social Work With Senior Care (Part Two)

The Centers for Medicare and Medicaid and the Agency for Healthcare Research and Quality (AHRQ) created a tool to report such patient experiences. Patients can visit CMS’ website at http://www.medicare.gov, to compare Medicare programs and hospital providers, Rosenberg said.

He added that CAHPS involves a 27-item questionnaire by mail or phone. The survey is administered several weeks after an aging patient is discharged from the hospital. There must be staff communication, response and medical compliance with federal and state regulations in order to carry out the survey project.

CAHPS is tied to good marketing and Medicare compliance, Rosenberg said. And there is a 2 percent penalty for facilities that do not report patient experience through the surveys. Visitors to the Medicare website can check out senior long-term care facilities, medical facilities and home-based community care sites by zipcode.

Under CMS in the year 2015, Rush medical center will spend $815 million to improve care and patient satisfaction. This will be taken from what Medicare would pay on these patients, he said.

“Social workers can have impact,” Rosenberg said. “Re-direction [translates into a] savings in Medicare.

“[There are many] new emerging and untested approaches. [They involve the] AHRQ and PCMH core attributes. [Care is] patient-centered, comprehensive [and] coordinated. [The result for the patient is] superb access to care.

“[We] must have social insurance that considers the whole person in the context of the person’s larger environment. Social work [is] an obvious fit. [He or she is the] care coordinator of behavioral health, self-management and capitation.”

The physicians, nurses and other practitioners involved are paid per member per month for senior care, he said. They are also paid per member per year as well as per month to provide pediatric care.

“[The concept keeps an] ACOs core principles,” Rosenberg said. “[It is all based on] patient-centered primary care, pay reform and [the use of] care coordinators. [This is] different from HMOs. [There is] no patient lock-in. ACOs have to work to keep their patients from leaving.”

He added that the Medicare Shared Savings and Program (MSSP) rewards them for lowering costs while delivering care.

“[The] social work [model] fits exactly with PCMHs,” Rosenberg said. “Other payors [can be used.] [This is an] underexplored option. [There is] current interest in transitional care of care coordination. [The medical care teams will] need utilization review data. Insurers want to see that interventions decrease expenses.”

Robyn Golden, MSW, LCSW, director of health and aging at Rush University Medical Center and a panelist, agreed, stating that the different tasks performed by social workers are transferrable skills needed to round out a transition of care effort for aging patients.

“[The] physical wrap-around [continuum of medical care] and PCMH (Patient-Centered Medical Homes) encourage healthy homes,” Golden said. “[The] role for social workers [is] in [the] augmentation [of] the patient’s primary and specialty care encounter. [They] address gaps, provide compensatory help and assess patients’ psychological health. [They are also] educational providers.

“This resource is controlled to PCMH success. [This leads to] true improvement [of] income [and] health. [The] team [includes a] master of social work [degree, training and experience]. [This is] wraparound medical care addressed by non-medical needs. [It] increases premium care clinician awareness and proactivity. [It] follows the principle of patient empowerment and self- determination.”

She said social workers use motivational interviewing strategies, assessment, [medical] plans of care and reasons for referral to start and shape PCMHs and ACOs. They take into account patient safety, identified values and preferences as the “social determinants of health.”

For Rush medical center in particular, the outcomes of its transitional care model are that social workers proved themselves to be indispensable because they possessed and fostered a profound understanding of medical assistance language at an appropriate educational and training level, Golden said.

This was the result of using better-educated and trained social work discharge planners in 2007 and implementing an Avoidable Readmissions Penalty Charge (ARPC) in 2011.

“[It is about] building interventions and biophysical assets around the social dimension,” she said. “[The master’s degree program at colleges and universities provides] preparatory [training] for social workers.”

Golden explained that the social workers coordinate medical teams of care on a pre-discharge basis with two days of post-discharge activity and 30 days of follow-up. “We talk to patients and caregivers and work with the community,” she said.

CPTs allow for reimbursement are particularly meaningful for Rush’s PCMHs because social workers, otherwise in a traditional medical arrangement and setting, would not be allowed to bill under federal law as this would the preserve of hospitals and their physicians.

To enable medical care service category definition and billing, Golden said two new CPT codes have been introduced by CMS and the AMA: for care transitions and patients. They are Care Transitions CPT codes. Two new codes have also been developed for modes of medical complexity or high health complications among aging patients.

“What [about] the future and [new] codes?” she said. “The ACA (Affordable Care Act) [will influence] complex chronic care and coordination services. [You] can charge one. The Rush Generations program [offer patients a comprehensive continuum of geriatric care for seniors].”

The Rush Generations program is a comprehensive program of a continuum of senior care created by the medical center to offer senior affinity, cross-referenced membership, an identified payor mix and overhead and operating costs.

“What’s next for social work?,” Golden said. “[The field contains the] social determinants of health. [It connects medical] care [with] social work. It [connects] competencies to social determinants of health. Professionals need to do [a] better job of defining [the title].

“[In the future, there will be] advocacy. We need to speak for ourselves. [There will be improved] payment models, [more] CPT codes and [models of care] for chronic care [illness].”

Read This Story From the Beginning: Part One

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Chicago Hospital Makes The Case For Connecting Social Work With Senior Care (Part One)

Marrying social work with senior long-term and hospital care will require studying the organization and function of medical programs, health care and economic consequences and outpatient follow-up, four aging healthcare experts at a conference on aging.

Four panelists at their presentation titled “Current and Emerging Sustainability Avenues for Social Work in Health Care” during the Aging in America conference by the American Society on Aging said that it is necessary to connect social work to senior care in general and that this will involve much examination and planning before execution.

“[There is a] business case [to be made about connecting social work with senior long-term care and health care at] Rush [Presbyterian St. Luke’s] Hospital [Medical Center in Chicago’s lower West Side],” said Robert Mapes, director of program and community support at AgeOptions in the city, and a panelist.

“[This means] identifying clinical and economic outcomes, comparing quality and cost outcomes for reduced hospital readmissions and Emergency Department (ED) visits [as well as] for appropriate outpatient follow‐up and isolating essential program elements [to] create efficiencies.

“[This means also] making [the business] case for improving quality and reducing cost to position as ‘compelling solution for the payer community’: private purchasers, insurers, public payers and providers; get consumer to ask for [the] program, and; need to know they should expect transitional care.”

Mapes explained that separating the costs of providing health care to seniors from the medical contributions or value of such care results in a solid business case to be made to investors. He said it is crucial to measure or weigh the costs of hiring and firing staff, overhead and multiple stakeholder perspectives.

This calls for data collection, analysis and interpretation. Contributions to measure include 30-day re-admissions for aging patients, emergency room utilizations, nursing home placement, patient satisfaction, health disparities and the role of social work.

For data use, Mapes said social workers, utilization review nurses and data analysts must use a single database. They should study the rules and regulations of social services with staff, stakeholders and supervisors each separately and develop an understanding of the material.

“[You should ask, ‘are we on the] right track? Priorities [may have] shifted,” he said. [If you notice any] trends [in the manner in which social service is delivered or in the medical conditions of patients, you will see] red flags.”

Mapes said that there are many positive outcomes of performing this data activity and some
“tried-and-true methods” of examining and interpreting senior care data. Social workers, utilization review nurses and data analysts can successfully obtain funding from private organizations to support their work because of its nature and value.

To secure such funding, medical facilities must have cultivated a proof of concept (POC) theory of their work, he said. The proof is the full execution or demonstration of a particular method or idea to show its effectiveness and potential for being used.

“Proof of concept data [is important],” Mapes said. “It gives your effort] greater exposure [to possible influential supporters such as other medical facilities, nonprofits or government agencies.]”

However, there are negative outcomes to this activity, he added.

“[The] requirements [call for the use and expenses of] significant resources,” Mapes said. “[You must have] grantwriting relations [with personnel who have the qualifications, the time, energy and resources to write grant proposals for funding.]

“[Certain aspects of the data analysis and interpretation activity may be] inconsistent. [This makes room, unfortunately, for] mission drift [or creep]. When funding cuts [are implemented], so [are cuts to the] program. [This is, unfortunately, at the expense of] FTEs [full-time employees.]”

Additionally, he said that writing grants to obtain funding from government agencies and private foundations to support data generation and analysis takes a great deal of time, which may dampen social workers, nurses and analysts’ efforts if they do not locate a grant writer for the task.

“Grant[writing] is time consuming,” Mapes said. “[But] hospitals and clinics [need it and engage in it nonetheless to carry out their duties in] inpatient social work, case management, transitional care and outpatient social work.”

Both federal agencies, the Centers for Medicare and Medicaid (CMS) and the Administration on Aging (AoA), provide funding for such research by making it available through the states. In particular, the state of Illinois is a recipient of the CMS Transitions grant with support from the multi-organizational Illinois Transitional Care Consortium (ITCC). Their funds and technical assistance, he said, “strengthen the role of Aging and Disability Resource Centers (ADRCs) in implementing evidence‐based care transition models.” The Medicaid Waiver program and Older Americans Act both regulate federal funding for these grants, enabling community-based care for disabled patients.

Ultimately, the research work of social workers, nurses and data analysts engage seniors, people with disabilities and caregivers in transitioning from one form of care to another – namely, from care in the medical hospital to that of a skilled nursing facility, rehabilitation center, nursing home or hospice care.

“We want to try to meet you where you are,” Mapes said to listening other medical facility leaders and managers outside of Rush medical center at the presentation. “Our hope is to show you models of participation that will encourage you to join in and begin this work, no matter your organization’s stage.”

After analyzing and interpreting the research conclusively, medical facilities form Patient-Centered Medical Homes (PCMAs), a program of primary care emphasizing care coordination and communication among care providers and their patients.”

These “medical homes” are meant to lead to higher quality care for the patients and lower costs for the providers. To operate these medical homes, Mapes said facilities must create Account Care Organizations (ACOs), which are teams of doctors, hospitals, and other health care providers to provide coordinated care to Medicare patients.

Specifically, he added, PCMAs and ACOs work well for providing psychotherapy and physical wrap-around services to seniors.

“We don’t see social workers integrated into clinics anyway,” he said. “Some physicians will take a cut in bottom line and invest [in the medical facility they work for]. They believe in the quality of care. Hospitals can use a different pot of money.”

Gayle Shier, program coordinator for Rush Health and Aging at Rush University Medical Center and a panelist, said more social workers should be engaged in this effort.

“[We] need more social workers,” Shier said. “[We have a total of] 20 social workers. One doctor said, ‘I’m embarrassed we don’t have [more] social workers.’ That’s the best way to get to nurses. [The] hard work they do can go to nurses.”

Mapes said medical facilities can develop partnerships with their private and public funders and supporters to form an aging healthcare network working “within hospital walls.” This would mean patient care integration with inpatient learning and greater access to a patient’s electronic medical record for community-based care transitions.

With this, Rush medical center and other participating facilities may develop new Current Procedural Terminology (CPT) codes already started and maintained by the Centers for Medicare and Medicaid and the American Medical Association (AMA).

After the delivery of care to senior patients and their families, Walter Rosenberg, M.S.W., program coordinator for Health and Aging at Rush University Medical Center and another panelist, said Medicare’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) implements a complete set of ongoing surveys that ask patients to recall and evaluate the social aspects of their health care experience.

“Social work is quality care,” Rosenberg said. “Going by [a person’s] medical needs makes patients feel truly cared for.”

He explained that Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) is linked to “value-based purchasing” while Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGAHPS) is tied to reimbursement.

Continued: Part Two

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Tying Aging in Place to Disability Advocacy Is In the Cards for Senior Long-Term Care (Part Two)

A White House conference for the first time addressed elder abuse. Greenlee said participants talked about financial exploitation and several government agencies such as her own and the Institute of Medicine (IOM) and businesses attended.

“Cognitive impairment is at [the] root of [the] problem,” she said. “It knows no age. It is prevalent in people who are older [but it could be brought on by] traumatic brain injury.”

Laura L. Carstensen, Ph.D., professor of psychology at Stanford University’s Center for Longevity, said connecting aging to disabilities will require changing the conversation about the human life span to focus on seniors rather than just youth.

“Long life in the 21st century,” Carstensen said. “[There is such] complacency [in the use of that phrase]: [we are] familiar with [the] terms. We forget the unprecedented time. In a blink of an eye, we [have] doubled [the human] life span.”

She said that, because of 18 or 20 outliers and through human evolution, life became more extended.

In the 1800s, Carstensen said, a person could only expect to live to his or her 30s. In 1900, the life expectancy expanded to age 47. By the end of the 1900s, it reached age 77. In the new millennium, the average human life span extends to age 78. Additionally, the nation’s fertility rates dropped by half, overtime.

Meanwhile, she added that, in the 20th century, seniors made up four percent of the country’s population. Currently, seniors make up 13 percent of the nation’s population. By 2030, seniors are projected to make up 20 percent.

“The changes in odds of surviving [are dramatic],” Carstensen said. “[The changes in age distribution are] everywhere. [Social] pyramids are being re-shaped. This means babies for the first time can grow older. It is not discussed [in terms of] older people but [in terms of] babies.”

She said, in terms of the survival rates of infants and children, the distant past held high mortality rates. In the 1800s, about 20 percent of the nation’s population died before age 5 and many more died before the age of 12. The percentage of maternal deaths were also high. Science, technology and the study of disease reversed the trends of high infant, child and maternal mortality.

“Garbage collection has [as] much to do with longevity as medicine,” Carstensen said. “[So does] lower fertility rates, an investment in [infants and children], [the end of] exploitive [child labor], more schools [that] charted nutritional needs of your children and food for life programs to prevent pellagra, rickets and gout.”

Most technological and medical advances were aimed at youth, she said.

“We did things to support young life,” Carstensen said. “We [made] advances in technology and medicine. But [our] ancestors did not try to relate [to] aging professionals. [The] actuaries are terrified.

“Humans are creatures of culture. [Around the world, there are] more populations of people [around the age of] 60 than [there are aged] 15. [All of] these things were built for young people.

Trains and hotels are for younger people. Speed, agility and facility [are affiliated with the] young. We only recently lived in [a] world that focused on aging. We need [to make] changes to [the] culture. Science and technology got us where we are today.”

She explained that the national conversation about the human life span should be changed to focus on aging.

“We need [to talk about] Alzheimer’s disease, congestive heart failure and osteoporosis,” Carstensen said. “We need to know what good deaths look like after long, satisfying lives. We need to look at long-term planning, 40 to 60 years out. We need to think [about] lifelong investments to help those over 65.

“[The youth] of today [will be the] centenarians of [the] 22nd century. They are here. It is [our] duty to take them through [the next] decades of life. Aging is not the problem. We must improve aging for all of the population or we will all fail. Societies [must] not only be saved but improved. Aging is inevitable. How we age does not. In the end, it will be about aging. It will be about long life. And it will be our story to tell.”

Read This Article From the Beginning: Part One

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.