Government, Business Must Partner to Boost Healthy Aging Via Environmental Protection (Part One)

A multi-prong strategy of solutions by government agencies, businesses and nonprofits would promote healthful and successful aging for seniors and protect the environment at the same time, Environmental Protection Agency (EPA) representatives and pesticide control and neurological disease experts said an aging conference.

During a panel titled “Safer Chemicals, Healthier Aging: A Prescription for Positive Change” at the “Aging in America” conference in downtown Chicago by the American Society on Aging, four environmental protection advocates said seniors, government agencies, long-term care and healthcare industry leaders, businesses, investors, insurance companies, elected officials and community leaders must each play a role in a larger, long-running initiative to link a sound environment to healthy aging.

The panel featured Kathy Sykes, senior advisor for aging and sustainability in the EPA’s Office of Research and Development; Ted Schettler, science director of science and environment programming of the Collaborative on Health and Environment; Medha Chandra, PhD, international campaign coordinator of Pesticide Action Network North America and Jackie Christensen, state director and board member of the Parkinson’s Action Network/National Parkinson Foundation in Minnesota.

Research by the Collaborative on Health and Environment (CHE) — a California-based international partnership of 4,500 groups in 50 states and 79 countries, founded in 2002 and aimed at leading and guiding a scientific and public conversation on the impact of environmental pollution on human health — found that environmental pollution is directly tied to chronic illness.

Chronic illness is becoming more prevalent in seniors and is developing at younger ages among individuals in general than in previous decades. In turn, those stricken with such illnesses as diabetes, obesity and heart disease are at risk for mental health and neurological conditions such as dementia, Alzheimer’s and Parkinson’s diseases.

Meanwhile, researchers argued, the number of those aged 65 and over will double in the next few decades to more than 71 million, increasing the number of people at risk for illnesses influenced by environmental pollution.

Already, the Collaborative reported that tomorrow’s seniors are already at risk for poor health. Specifically, about two-thirds of the nation’s adults are overweight or obese. About 40 percent of adults are diabetic or pre-diabetic, which constitutes double the percentage two decades ago. Over five million people in the country have been diagnosed with Alzheimer’s disease with the risk increasing with age.

Further, the Collaborative found that changes in how food is produced, processed and distributed leads to more digestion of calorie-rich, nutrient-poor food. Suburban development and greater use of personal and family vehicles translated into decreased physical exercise, less public space, more displacement of animals and plants from their natural habitats and reduced air quality.

With respect to aging, more seniors are living alone and are more likely to be poor and socially, psychologically and emotionally isolated as their children, grandchildren, relatives and friends live in other locales or die, and as an overall consequence of their isolation are more prone to lower quality of health, than those who live with others. Socioeconomic stress and social isolation are greatly influential in health status, disease risk and life span, Collaborative researchers said.

The increased incidence of disease and environmental pollution comes at a high cost to the public. Researchers report that chronic disease nationwide costs $1.8 trillion annually. Average health care costs per person are $5,000 to $6,000 a year, which doubles with diabetes. Annual costs for Alzheimer’s disease are well over $180 billion and between $13 billion to $28.5 billion a year for Parkinson’s disease.

Part Two: Connections to Air Quality

This article was originally published Feb. 18, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Illinois Medicare Watchdog Group Pledges To Reach Out to More Non-English Speakers, Disabled Individuals, Indigents (Part 4)

In addition to the deaf, hard-of-hearing and visually-impaired, MMW coalition advocates say it is important to reach seniors with limited English proficiency (LEP) with healthcare information using “unique outreach methods” and “effective strategies.”

During her own panel, “Reaching Limited English Proficiency (LEP) Older Adults with Health Care Outreach,” Erin Weir, MSW, manager of healthcare access of Age Options, said individuals with limited English, especially seniors, are less like to seek medical care, even if they are insured.

Weir said, according to a research report by the Kaiser Family Foundation in August 2012 titled “Overview of Health Coverage for Individuals with Limited English Proficiency,” they are more likely to report negative health care experiences. The report can be accessed at the foundation’s website at http://www.kff.org/uninsured/upload/8343.pdf.

“[They are] more likely to be uninsured and [have] negative experiences,” she said. “They need health literacy, [especially with] the Affordable Care Act. A lot of health information is difficult for even people with degrees.”

The foundation reports further that individuals, especially seniors, with limited English are more likely to be uninsured than adults who speak standard American English. About 50 percent of limited English adults are uninsured, which is three times the rate of uninsured English speakers. These adults are more likely to have less high school education than English-proficient adults, it states. Children who have limited English proficiency or have a parent suffering likewise are twice as likely to be uninsured, the foundation reveals in its research.

Additionally, according to a report by the Coalition of Limited English-Speaking Elderly in June 2012 titled “A Profile of Limited English Speaking Older Adults in metropolitan Chicago,” one-third of limited-English seniors in Chicago have a disability, Weir added. The coalition also demonstrates that more than half of limited English adults in Chicago have not completed high school.

A September 2005 article in the Journal of General Internal Medicine found that limited-English adults are more likely to report difficulties understanding medical situations. The article can be accessed at the National Library of Medicine website at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490205.

“[Seniors with] LEP have it hard,” she said. “You can imagine how hard it is. A person goes to a hospital and is told that an interpreter will be there and they don’t [show up]. That’s devastating. They may never go to [that] hospital again.”

Healthcare materials, Weir explained, can be hard to understand even for native English speakers. Those who do not read or understand English may have more difficulty and need more help navigating healthcare applications and systems.

She said limited-English demographics need unique outreach methods because of their challenges to health literacy must be overcome, there is a possibility that their negative experiences may block access to care, their culture, beliefs, values, roles of families, communities and individuals and the prioritization of their needs must be examined and their trust in health institutions must be restored.

“Trust is a major factor,” Weir said. “Many LEP [adults] have a lot of negative experiences. [The] blind have reason to distrust government and associations. We need to win their trust back again.”

To regain the trust of the disabled and those speaking limited English, coalition advocates must listen to the needs, fears and perceived barriers of the members of their communities whether by creating or participating in forums that enable this, she said. Weir explained that responding to identified needs ensures that the message of advocates is received as important and valuable. This leads to trust on the part of the underserved.

Weir said that advocates must work with key stakeholders already trusted in their communities. She pointed to a partnership formed between the MMW coalition and the Coalition of Limited English Speaking Elderly in Chicago. She advised that advocates must reach out to highly utilized locations such as community centers or churches and partner with them rather than using them as a site for field work.

“We tried to listen,” Weir said of AgeOptions and its efforts to reach out to adults with limited English and their communities. “You will never get [their] trust if you talk first. What are they afraid of? What don’t they trust? What do they need?”

She added that building trust takes time. Partnerships must benefit both parties — the advocates and key stakeholding groups in the communities, Weir said. Advocates must also be prepared to hold up their end of the bargain when entering with and executing relationships with such community groups, she said.

“We have great partnerships,” she said of AgeOptions. “You may have community centers. Don’t call them to ask to use their site. You may have a partnership [with them]. When you [have] materials, talk to [your] partners. Use them as stakeholders.”

Weir counsels advocacy groups to be honest and accurate when conducting outreach to limited English and disabled communities. She said “deceptive/incorrect information” will breach any trust sought for.

“You focus on teaching them that issue [that’s most important to them],” Weir said. [You] not only give information out [but you also] take back trust.”

She added that it is important to learn what is and what is not culturally appropriate in both oral and written communication. The most knowledgeable stakeholders, she said, use methods and tools that work and learn how to avoid offending those they serve.

They use plain English language in all of their communication materials, she said. They translate all written materials and know when to perform an appropriate translation of language and when to conduct a literal translation.

“Don’t be offensive or [your message] won’t be received,” she said. “[Make sure that it is] simple and plainly done [when addressing key] health issues. Make it easy to comprehend.”

Weir held up as an example an initiative by the Coalition of Limited English Speaking Elderly to reach out to 50 ethnic groups and to produce and distribute materials in Korean, Arabic, Indian and Spanish languages. AgeOptions itself worked with 13 agencies in 13 different languages to spread Medicare materials.

The MMW coalition, she said, prides itself on distinguishing between providing culturally appropriate translations and translating word for word in delivering its content.

Advocacy groups should also designate and identify individuals that their limited-English and disabled clients must contact to follow up with questions or obtain further assistance, Weir said. This must be done before engaging in outreach, she added.

They should also determine what methods will be used to assist limited-English clients and reveal these in their materials, she said. Advocates must also decide whether they will use bilingual staff or in-person or telephone interpretation services for their clients.

“Use community stakeholding groups that use language to rewrite in their languages of origin,” Weir said. “Know who you will tell to call. It is dangerous to offer things [that are] not there. Decide [if you will use bilingual staff or an interpretation service].”

Read this series from the beginning:
Part 1: Watchdog Group Pledges to Reach Out to Community Members
Part 2: Serving Hard of Hearing/Deaf Communities
Part 3: Serving Blind, Low Vision Individuals

This article was originally published Feb. 8, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Illinois Medicare Watchdog Group Pledges To Reach Out to More Non-English Speakers, Disabled Individuals, Indigents (Part 3)

Aside from the deaf, visually-impaired seniors and individuals in general must also be served to enable them to gain access to Medicare and other government benefits.

Kim S. Liddell, information and referral advocate for the Progress Center for Independent Living, an outfit aimed at serving disabled individuals in Blue Island, Ill., a south suburb of

Chicago, said those with limited vision are impacted in every aspect of their lives by their disability and obtaining Medicare and other benefits is no small feat.

Liddell made these comments during her panel titled “Working with Blind/Low Vision Individuals to Improve Access to Benefits.”

“Support is needed in their everyday challenges,” Liddell said, “ It comes in [various] forms. Life is not simple. It’s not cut and dried. There is something about vision loss that can affect people on a day-to-day basis. We are trying to see how people are receiving support for Medicare and services. Software and technology is out there to help on tax and information on computers.”

She explained that vision loss falls into gray areas, stating that there are many levels of vision loss. Some of her center’s clients can read Braille, others can’t and still some can use audio information. Additionally, magnifiers and CCTDs can serve as assistive technology for vision-impaired individuals as well as a screen reader to empower them to hear human speech.

“Screen readers can be installed that provide speech,” Liddell said. “It provides access to [government benefit] programs. We held a focus group [to learn] how a community accesses information. Many [of our clients] are [on] Medicare and [are] visually impaired.”

At the focus group meeting, she learned that the webpages that her clients access to obtain information on Medicare and other benefits contain too much information, leaving them befuddled about how to choose what is relevant to them.

“We asked a few select sets of questions,” Liddell said. “It was interesting to find the feedback about chasing information. [The clients would say that they would find] information on a link. They went to the page. They had to click on another link. The webpages [were] vast. Where does one start?”

In their comments, she said, participants in the focus group said that they wanted accommodation on the Medicare summary statement online and basic information about what Medicare covers and what they might be expected to pay in the way of premiums.

“[There are basic] qualifications for [the right] materials [to be used],” Liddell said. “[There] needs to be a good contrast. [There must be] use of [the] screen reader. [For the] audio files, [there was] not a loud enough volume. And you don’t want to read all topics. You want to read the ones you want.”

“I have an issue for the blind community. We can read [most of the materials] in Adobe Acrobat reader. I went to [the] Social Security website. I found a PDF that was not accessible. When you take a document to scan, you convert it to PDF. It is important to have a scan.”

When faced with a lack of accommodation in government benefits information materials online, Liddell said it is important for the center to reach out to such organizations as the Lighthouse for the Blind that can make documents accessible to the blind or those of low vision.

“ [After examination of the documents, our client group staff] said the documents [could be] opened,” she said.

“They said they had a blind/low vision individual [on staff] to improve access to benefits. [They] told me about Adobe Reader. The blind community told us, ‘If you are going to [use the] screen reader, please tell us.’ The advisory group [we attended on the subject was] about seeing the need [for such assistance] for [the] visually impaired. Now we see the areas that need to be worked on. I think it is important to provide a quick reference in Braille and audio CD format [for the government benefits information online.]”

Liddell explained that her goal is to serve Illinois’ Senior Health Insurance Program (SHIP) counselors by providing accommodation to the visually-impaired communities on Medicare and other government benefit information.

“I want to serve SHIP [and] let them know about [the] visually impaired and how to use PDF formats,” she said. “They have language. They should have choices. A lot of things are good for visually-impaired SHIP counselors [who] don’t know anything about [this]. This is what I like to promote.”

Part 4: Serving Individuals with Limited English Proficiency (LEP)

This article was originally published Feb. 8, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Illinois Medicare Watchdog Group Pledges To Reach Out to More Non-English Speakers, Disabled Individuals, Indigents (Part 2)

In particular, the MMW coalition is seeking to provide more services to the hard-of-hearing and deaf communities, she explained.

“We tell how we reach certain groups.” Gerdes said. “We had JulieAnn Chavez, [former Make Medicare Work project coordinator for the Progress Center for Independent Living and the volunteer management coordinator/Medicare benefits specialist for the state of Arkansas]. She said [some of the members of the] deaf [community] are not getting Medicare benefits. There was misinformation. They did not know what to do.”

She referred to research by the Hearing Loss Association of America (HLA) and the National Institute on Deafness and Other Communication Disorders (NIDOCD) finding that over 30 million individuals nationwide suffer some level of hearing loss. Specifically, this means one in 10 persons, including 1 in 3 over the age of 65, and 1 in 14 aged 29 to 40 already have hearing loss.

Research from the HLA and NIDOCD further demonstrated that, among seniors, hearing loss is the third most dominant but treatable condition. Roughly 95 percent could be treated with hearing aids but only 22 percent actually use them, data showed.

In studying the hearing-impaired, Gerdes said she learned that there were different levels of hearing loss: mild hearing loss, moderate hearing loss, severe hearing loss and profound hearing loss. Descriptions for the levels of hearing loss can be found at the Centers for Disease Control’s website at http://www.cdc.gov/NCBDDD/hearingloss/types.html.

With mild hearing loss, a sufferer hears some speech sounds but soft sounds are hard to hear. Under moderate hearing loss, a person may hear almost no speech when another person speaks at a normal level. Severe hearing loss means a person will hear no speech when a person is talking at a normal level and only some sounds. Profound hearing loss consists of not hearing any speech but only very loud sounds.

In studying and reaching out to the hard-of-hearing and deaf communities, Gerdes found many felt left out of the social services continuum, were acutely aware of their isolation and experienced anxiety over this, found their needs not being met by mainstream outreach, and discovered programmatic information delivered in group presentations to be inaccessible. At meetings and hearings aimed at serving them or through e-mail correspondence or mobile phone texts, some reported growing up deaf, developing deafness in later life or being hard-of-hearing.

“They said they could not get information from written materials,” she said, citing limited speech, reading skills and a lack of language interpreters or usable formats for potential deaf clients. “They go to workshops and sat in the back and were afraid to ask questions. They were tight-knit. Some grew up deaf. The type of materials [were] varied for need. Some can’t speak

English. They cannot gain access to material. Some of the vocabulary [in the material they do access] may be overwhelming. Some [of their] texts had monikers or unique names.”

As a result of the coalition’s discoveries about the deaf community, its service providers felt unprepared and under-resourced to address their needs, Gerdes explained. Namely, communication with the deaf would be difficult.

The typical outreach and counseling methods used on other disadvantaged, disabled or underserved populations would not work on them. Many caseworkers, social workers and other certified white-collar professionals were not familiar enough with assistive technology to serve the deaf and most materials are not available in accessible formats.

“One-on-one counseling was more effective,” Gerdes said. “[There were] challenges [for the] deaf [and] for several providers. They don’t know how to approach [the] deaf. [The] typical outreach, counseling and use of doctors [would] not work. TTY [telephone typewriter] is a thing of the past. A lot of [members of the deaf community] lack video relay service or VRS.

“What would happen if a deaf person came in [our offices]? They would panic. How to use video relay or VRI? How to communicate with client? You can get them to write down questions. It’s not rude.”

The best approach she said was for the MMW coalition to develop a Deaf Work Group. Created in 2009 by the coalition to reach out to members of the deaf and hard-of-hearing communities, the work group consisted of diverse deaf, hard-of-hearing and hearing professionals in education, law, social services, advocacy and religion.

“We created [the] MWW Deaf Work Group,” Gerdes said. “JulieAnn worked with [the] deaf community. [We were seeking to learn] how can we reach the deaf community in an effective way. [This means using] accessible formats. That does not mean taking out flyers. You will get into translational issues. You can’t do it word for word. We came up with videos in sign language [and other media formats]. [The] materials come from trusted sources.]”

Aside from learning about accessibility and trust, Gerdes said that the coalition also discovered that visuals worked best in reaching out to the deaf.

“The CMS [Centers for Medicare and Medicaid] posted [our materials] on video. There, we bonded,” she said. “JulieAnn placed [our materials] on [a] Facebook page. Success came from that. You’d be surprised. You see a flyer and it’s all words. If you are not used to working with [the] deaf, you may make mistakes.”

Gerdes said the coalition also found that, in serving the deaf and hard-of-hearing communities overall, it pays to utilize best policy and advocacy practices such as maintaining a physical presence to establish credibility, collaborating with stakeholding partners and staff fluent in American Sign Language (ASL) – which does not translate word for word – advertising that

accommodations will be provided, and using materials in ASL or languages other than standard American English.

Additionally, she said entities serving the deaf and hard-of-hearing communities must connect with their local Aging and Disability Resource Network, the Center for Independent Living resources and their state’s Commissions Office of Deafness for resources.

Eventually, the MMW Deaf Work Group created a MMW Universal Toolkit to assist groups throughout the state that do not serve deaf or hard-of-hearing communities. The toolkit consists of descriptions of the different levels of hearing loss, tips for those working with the deaf or hard-of-hearing, details about the types of technologies available to assist their clients and information about planning disabled-accessible meetings and events.

“We talked about the toolkit,” Gerdes said. “Some agencies did not have it. It was important to create a toolkit. It was straightforward, not difficult or daunting. The agencies can use them.”

She added that the MMW coalition worked with DeafMd to translate Medicare factsheets to ASL and post them to the network’s website at http://www.Deafmd.org.

“We created Medicare factsheets and we translated [them] into sign language,” Gerdes said. “We worked with [U.S. Rep.] Jan Schakowsky (D-Ill.). We created official videos in sign language. They are videos on the basics of Medicare. We heard they had difficulty in communicating language. We are working on glossary for ASL interpreters since there are no standard signs for Medicare terms.”

The Medicare videos are available on YouTube and received 16,000 hits or views, she added.

“There was a lot of feedback on what is a good resource,” Gerdes said, citing the Center for Independent Living at http://www.ilru.org/html/publications/directory/index.html, ADA National Network, http://adata.org, the National Association of the Deaf (NAD), http://www.nad.org, Communication Access Real-Time Translation (CART) at http://www.jan.wvu.edu/soar/hearing/commgroup.html and Registry of Interpreters for the Deaf (Sign Language Interpreters) at http://www.rid.org as her best examples.

“These can be used for the deaf, [individuals studying English as a Second Language] ESL, [people with] low vision or [the] blind. It is not just communication for the deaf. When we are advertising, we always include accommodation. If you put these out there, people will come.”

Part 3: Serving Blind, Low Vision Individuals

This article was originally published Feb. 8, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Illinois Medicare Watchdog Group Pledges To Reach Out to More Non-English Speakers, Disabled Individuals, Indigents (Part 1)

With the difficulties involved, a suburban Illinois Medicare and benefits watchdog group plans to reach out to more disabled persons, limited English speakers, mentally ill patients, hearing- and vision-impaired individuals, welfare recipients and those new to Medicare, three health insurance and benefits information leaders said at a conference on the aging.

The Make Medicare Work Coalition, a suburban Illinois-based coalition of more than 300 nonprofits, faith-based initiatives, federal, state, county and city agencies and academic, policy and research groups — impacting 800-plus individuals throughout the state — pledges to provide higher quality information about Medicare, Medicaid, Social Security and other benefits to clients, respond to changes in policy or client circumstances, assist clients with challenging problems and give them more confidence in their future life prospects.

Built in 2005 to address a then-newly-created Medicare Part D’s impact on state residents and funded and supported by the Chicago Community Trust, Michael Reese Health Trust, Retirement Research Foundation and the National Council on Aging, the MMW coalition thus far touts its greatest policy accomplishments as pushing legislation to revise the Illinois Cares Rx program, the first bill in the nation to convert persons in Disabilities Advocacy Program (DAP) to Illinois Cares Rx, expansion of the health benefits to workers with disabilities and patient assistance programs.

Three leaders in the coalition made the promise during their panel, “Coalition Building to Reach Underserved Populations with Accessible Information and Outreach,” during the American Society on Aging’s annual conference titled “Aging in America” at the Hyatt Regency Hotel in downtown Chicago.

The MMW coalition’s promise is in response to an annual member feedback survey to measure client satisfaction and Medicare information communication efforts outcomes.

During her own panel titled “Aging and Disability Partnerships: Aging and Disability Partnerships: Reaching Deaf and Hard-of-Hearing Consumers,” Georgia Gerdes, a healthcare choices specialist with AgeOptions, an entity formed to inform senior customers about their lifestyle and benefit choices and headquartered in Oak Park, a western suburb of Chicago, and a member of the MMW coalition, said that 81 percent of their clients received the surveys and other materials by e-mail, reaching 10,500 people in the process.

Of the thousands who responded to the survey, 94 percent wanted more quality information about Medicare and other benefits; 76 percent wanted greater responses to changes in policy or in their own living circumstances and newer information; 73 percent wanted assistance with difficult problems; 73 percent wanted more people reached; and 69 percent wanted MMW

coalition staff to provide them with greater confidence and re-assurance that their problems will be resolved and their quality of life improved, Gerdes said.

“[We serve] older adults and people with disabilities,” she said. “Our people at one point were under fire [to justify our programs in the midst of budget cuts]. We brought client stories and advocacy on their behalf [during government agency meetings and hearings]. [For our surveys and other correspondence], we had 850 people on our e-mail list to organizations statewide. Many of us are team agencies and members of the disabled [community]. [Our members are] across the board. We are a very diverse group.”

In nearly 10 years, the coalition has forged partnerships with the Area Agencies on Aging (AAA) for suburban Cook County in the areas north and west of Chicago proper in Illinois, the state agencies of the Senior Health Insurance Program (SHIP), the Illinois Department of Aging (IDOA) and Illinois Department of Healthcare and Family Services (IHFS) and the federal agencies of the Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration (SSA).

Pivotal topics in their hearings and meetings included the new rules of the Affordable Care Act, she said.

“We take information, translate it and [give it] back to [the] community,” Gerdes said. “We try to reach people who will be on Medicare soon. We help seniors on Social Security benefits. We advocate for laws and policies. We target and assist underserved groups.”

Most of the coalition’s materials and services appear on the AgeOptions website at http://www.ageoptions.org/whatwedo/MMW.cfm and http://www.makemedicarework.org. These include Medicare Part D open enrollment period charts and resources, toolkits for Medicare and employer coverage, resources for the uninsured or underinsured and the hearing-impaired, webinar recordings and coalition bulletins and topical briefs.

“They want to be informed — free communications, bulletins and alerts, topical briefs, toolkits and fact sheets,” Gerdes said of the coalition’s clients. “[We] make it easy. We provide monthly conference calls. Each agency works with us. Issues on healthcare for seniors tend to be the same. Our materials are used by these groups.”

She added that many coalition nonprofit or agency members are pleased with the campaign information and use it to inform their own work with the disadvantaged and disabled.

“We ask members to tell us how we are doing,” Gerdes said. “[About] 95 percent allow [us] to provide [them] information. Our materials allow them to [work with their stakeholding clients] with confidence.”

Part 2: Serving Hard of Hearing/Deaf Communities

This article was originally published Feb. 8, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Industry Execs: Despite Research, Debate, Caregiving Needs More Support

While the field has garnered much research and debate, especially in the face of budget cuts to Medicare, Medicaid and Social Security, caregiving is largely under-resourced and under-funded, national industry experts say.

During a panel at the American Society on Aging’s annual conference titled Aging in America in mid-March at the Hyatt Regency Hotel in downtown Chicago, four company executives informed participants that government and the industry have a long way to go toward providing caregivers with the support they need to enable the elderly to age in place.

Gail Sheehy, author of the book Passages in Caregiving and journalist, said an ecosystem of caregiving has evolved over the decades as a result of a multidisciplinary, multi-industry effort to attend to the needs of families providing care to their loved ones at home.

Citing the latest statistics about family caregivers, Sheehy said 50 percent of caregivers work full-time with the age of such providers averaging 18 years in a $220 billion market. The cost to families is $20,000 a month, she added.

Sheehy explained that this breaks down into $25 an hour for a caregiver and giving an aide $12 an hour. Often, payment means paying for an eight-hour work day when all a caregiver needs is two hours’ worth of senior care.

She cited one study that served as a great knowledge base for industry leaders in which senior patients were observed for five years to learn about the challenges of caregiving facing their families. Researchers found that one-third of families lost income in carrying out their caregiving duties and maintaining full-time jobs. An average of $5,000 followed out-of-pocket care costs for sick seniors.

In the study, caregivers averaged in age in their late 40s to 50s. They can’t work and are getting ill. “That is an enormous cost to our culture,” Sheehy said. Caregivers contributed $450 in lost wages, which is paid into the economy from commercial largesse.

“It is fair to call it an ecosystem of caregiving,” she said. “It is very difficult to find resources to this category of health care.” As the Baby Boomers age and the ecosystem of caregiving expands, all technology will be adapted toward serving them, Sheehy added.

Sherwin Sheik, founder and CEO of CareLinx, an online clearinghouse for linking families to home healthcare professionals, says he is seeking to ease families’ search for competent care for seniors.

“We’re empowering families to easily find caregivers,” Sheik said, exhibiting at a booth in the Hyatt Regency Hotel on Wacker Drive and after presenting on a panel about caregiving. “We saw what they go through when they cannot get help from agencies.

“[There must be] a middle ground between [the high costs of providing home care] of $20,000 a month to $807,000 total. [And these figures don’t represent] the net for a year and there is no guarantee of safety.] They are exposed to risk,” he added.

“Families come to our site,” Sheik said. “They punch in a zipcode, plug in information and do a search. We help families [find caregivers in their local areas]. We save them $10,000 a year in costs.”

“It helps families not go to job boards,” he said. “They hire directly. For example, families go to the site and may need to find females experienced with dementia who can work Mondays through Fridays from noon to 8 p.m. And a person might need to speak Cantonese.”

“The problem is so large when you look at home care agencies,” he said. “We have agency-affiliated caregivers. Agencies need to recruit the staff. They can go through our staff. All the candidates are there [on the website].”

Sheik is able to connect federal Medicare and Medicaid policy with his work. “We saw CMS (The Centers for Medicare and Medicaid) cut funding and resources for skilled nursing [facilities],” he said. “[This means] more skilled nursing services will be offered and provided in the home. It will affect readmissions to the hospitals.

“Private caregivers will be expected to provide more hours of care for the same dollar. Reimbursements will be cut. The government will not save the day.”

“They [the private sector] want to do it but are not comfortable to do it,” he said. “It will be angels and strategic money [that will ultimately meet the demand for senior long-term care and home health care.] They will invest after they’ve seen a homerun.”

Meanwhile, Sheik said he plans to further develop his online network slowly without overextending capital and resources.

“I’m consciously doing a slow rollout,” he said. “I could not scale if I put out a big check. We know we can manage needs but it will happen slowly.”

Jeff Shoemate, vice president of innovation and business development of United Healthcare Group, said,of the 75 million customers his company serves worldwide with 6,000 hospitals, 247,000 healthcare professionals nationally and 20 years of clinical data for nearly 100 million insured individuals, nine million are senior citizens. He explained that his company is working to more fully serve caregivers and their elderly relatives.

“It’s healthcare-centric,” he said. “It is all about healthcare. Everyone goes through different states [of health]. You are in a steady state. You are normal and steady, managing health events, eventually dealing with caretaking. UHG is particularly relevant in direct health transitions when caregiving needs peak. In each of these transitions, caregiving becomes important. As caregivers get drawn in, we can help. It is as underserved as any other facet of health care.”

Shoemate said families are spending “real money,” $5,000 a year to be exact on senior long-term care. If an individual or a couple are making $50,000 a year, he said that this figure does not translate into money “well-spent.” He explained that senior long-term care is still in the process of being fully developed and fine-tuned as an industry to deal with the high cost of care and other issues.

“It’s hard to find all of these solutions,” he said. “We are in the middle of it. We have employees – calling into our lines [to ask questions or raise issues about] Medicare. [Much of the different industrial components of senior long-term care] are not organized. We have a big space. It needs to be scaled. We’ve talked to industry experts. We are aggregators. We provide not only advice but the right assortment of level of quality health care and customer service. We are in the midst of it now.”

Hal Chapel, co-founder and CEO of Lotsa Helping Hands, an online network based in Wellesley Hills, Massachusetts of volunteer caregivers, said this service empowers caregivers dealing with physical or emotional exhaustion and emergencies.

“We bring together caregiver communities,” Chapel said. “Caregivers tap into this initiative. We have the honor of benefitting them every day. The great thing is people in the community are volunteers. They are religious leaders, etc. They ask, ‘What can I do to help?’

“[Caregiving needs] are unpredictable. Managing help is a full-time job. It can create a new caregiving community within 60 seconds. Other communities have resources or features include message boards, research, photo galleries, well wishes and lists, “ he added.

He said Lotsa Helping Hands was started as a form of caregiving ecosystem, an industry term used to which would include “consumers, customers, nonprofits, resellers, products, services and suppliers.”

“Each business affects and is affected by the others,” Chapel said. “Each must be adaptable and flexible to survive. There must be relationships not only with one organization and other members of the ecosystem but they have their own relationships.”

He added that he is pleased that investors are stepping up to the plate to finance such caregiving endeavors.

“They are putting venture capital into this ecosystem space,” he said. “People are talking about it now. They are huge in Chicago, Maryland, Kentucky and Ohio.”

Shoemate said strong leadership is crucial to taking on the daunting task of financing and developing of senior long-term care nationally, most especially its infrastructure.

“Leaders become extremely important,” he said. “They may change overtime. Apple, [at one time], was the leader [in the information technology industry]. Microsoft took over. Google was a leader. Microsoft took over. United Healthcare Group wants to set the tone and set the pace for [the growth of senior care and caregiving] so that we are not flailing about, guessing what [the industry] should look like.”

Businesses are responsible for most idea creation in the nation, Shoemate explained, and their ideas will drive part of the innovation in senior long-term care and caregiving.

“The small startups create most jobs,” he said. “There must be a link between creators and businesses. Less than 50 percent of startups stay up. Creators are thought of as universities [in that they are responsible for research and development]. They must be a link between businesses and creators.”

To stay viable, Shoemate added, new and small businesses specializing in senior care must attract and retain large commercial customers and investors.

“New enterprises need large company customers,” he said. “Venture funds improve products. Large companies get faster time to [bring their companies] to market. They do experiments with [products or services] with lower risk.”

Shoemate added that industry leaders are converging in different regions of the country to discuss, plan and carry out the expansion of senior care.

“Leaders are coming together to cooperate and collaborate regionally,” he said. “Connecticut, New Jersey and New York all have good models of family care coalitions. [In their coalitions], there are hundreds of members of nonprofits in the tri-state area and they get information [about senior care and caregiving] in one place.

“Caregivers are getting certification. They are giving back to their community and making money. Someday, Boomers will become seniors themselves.”

Still, industry leaders are put off by the frustrations and barriers of growing senior care, Shoemate added.

“We have a huge opportunity,” he said. “We are frustrated that it took [so long] for the hockey drill to get to the hockey stations. We discern different signals for the noise for both consumers and businesses. Larger companies are slow to show full commitment [to the growth of senior care and caregiving].

The sheer abundance of choices causes delays in the development of the industry, Shoemate said.

“The industry is in its adolescence,” he said. “It has had a successful childhood and wide acceptance of a nod to pay attention to caregivers. But which solution [should we adopt]? There is so much out there. How do we figure it out?”

This article was originally published September 2013 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

California Based Online Network Fetes One Year of Linking Families to Caregivers

The idea came to Sherwin Sheik after seeing his family struggle to coordinate home health care for a blind, quadriplegic sister suffering from multiple sclerosis and a Lou Gehrig’s disease-stricken uncle needing around-the-clock care.

Why not build a website and resource center easing a family’s search for credentialed and reputable caregivers?

Why allow families to endure what his own went through in reaching out and seeking care?

A year later, CareLinx, a California-based online platform dedicated to connecting to families to caregivers, toasts an anniversary of making the quest for quality home care less daunting for over 100,000 households.

Founder and CEO Sheik was pleased to count himself among the 100-plus entrepreneurs who showcased their product and service lines to support senior home health care at the five-day American Society on Aging’s annual conference titled 2013 Aging in America in mid-March in downtown Chicago this year.

“What I needed to provide was [an easy resource for finding and tracking caregivers],” Sheik said, exhibiting at a booth in the Hyatt Regency Hotel on Wacker Drive and after presenting on a panel about caregiving.

“It’s not just providing services. It’s also about serving as an educating team and determining how to help families. Our site offers FAQs and accepts feedback online. [We developed the site after] figuring out the commonalities in medical issues such as Lou Gehrig’s disease and multiple sclerosis versus just providing services for an elderly person who is frail.”

Sheik, who said that he has worked in health care for 13 years, explained that he started CareLinx in Los Angeles while working as a healthcare analyst and investor. His career includes serving as equity derivative trader with Merrill Lynch in London and working in corporate and research and development finance at Amgen, Inc.

His family faced a number of hurdles in securing care for his sister and uncle. His mother lived in San Francisco while his sister lived in Los Angeles. His mother traveled often to handle his sister’s care. His aunt paid $85,000 to find care on the private market. Problems such as theft by caregivers arose.

Two years ago, he quit his job to launch CareLinx full-time. Sheik hired information technology engineers and programmers and communicated to his hires how his business model would work. His team raised $2 million in financing. The goal was to design an accessible, safe and risk-free clearinghouse of licensed, bonded and insured home health care workers.

“It’s interesting,” Sheik said. “I have connections with FCA [Family Caregiver Alliance]. We are tackling ALS [Lou Gehrig’s disease]. We are active in the [caregiving] community. In terms of background, I did not reinvent the wheel. I [approached the caregiver groups, nonprofits and government agencies] and said, ‘We want to leverage your expertise. I’m smart with partnerships to provide the solution.”

The network is meant as an alternative to traditional agencies, which can charge families in excess of 75 percent of caregiver salaries, he said. Sheik added that, through his network, families save 40 percent in searching costs and caregivers earn 25 percent more for their work.

As visitors browse the site, they find profiles of caregivers in their immediate area. Customers complete a survey and the company contacts them to guide them in choosing a caregiver based on their care needs and budget.

“At first, we did not know the caregivers and the families,” he said. “We asked the families, ‘How did you go about [searching for care]?’ They said they would go to the job boards or to agencies to hire caregivers.”

Families have access to background checks of caregivers conducted by the company. The company handles insurance coverage, paperwork and taxes.

Some visitors can also post jobs free of charge for caregivers to apply. Caregivers set their own hourly rates and salaries, which the two parties negotiate. The company states that the hourly rates are lower and greater flexibility exists for families to locate and secure caregivers.

If customers have chosen caregivers and like the service, they pay a 15 percent service fee and can opt to upgrade their membership levels and fees for greater access to an entire system of background checks, references, the caregivers by e-mail and interviews.

Caregivers log in their hours on the website’s tracking tool. Weekly invoices are sent to the customer for approval. Then, the company charges the customers’ credit or debit cards and deposit caregivers’ earnings in their bank accounts.

Sheik talks to professional caregivers who are eventually listed on his site, especially registered nurses or skilled nursing professionals. He performs the marketing and sales for the company. He confers with his company partners and they share suggestions on how to improve the site to meet a growing demand for services of this type.

Sheik is able to connect federal benefits and entitlement policy with his work. “The reason I started this is [in part] because I saw cutbacks for care,” he said. “I see better outcomes at home. I saw my own family struggle with care for my sister and uncle. I built my solution around what families need. We got a roundtable to help families find affordable healthcare.

“I gave up a lot to start this. [I had to ask myself: Do I want to make more money or do I want to make a difference?”

Asked why private investors and federal policymakers do not support a fuller development of senior long-term care and home health care industries to meet caregiving demand and spur economic growth, Sheik said that a lack of overall leadership and encouragement are factors.

“It is a lack of knowledge and education among the venture capitalists and the public,” he said. “People are afraid of making a bet in the space. The information technology specialists say it is [the responsibility of the healthcare industry]. The healthcare industry says it is [the responsibility of the information technology industry]. The venture capitalists don’t want to touch it.

“They don’t comprehend that this is a new industry and they see the demand. I act as an educator. This is a problem and there are opportunities. The problem is that five to ten years will be up and the venture capitalists will jump when the pain is numbed.”

He said that the effort toward developing long-term care and home health care begins with educating the public and investors.

“The hardest part is educating people,” Sheik said. “Everyone sees the issues. It’s not like these problems will be resolved overnight or we will be solving serious issues instantly. This is how long it will take.”

This article was originally published September 2013 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

MediPreneurs: Geriatric Long-Term Care Nursing

In this MediPreneurs profile, PharmPsych.com decided to feature Sherrie Dornberger, RN, GDCN, CADDCT, CDP, CDONA, FACDONA, executive director of the National Association of Directors of Nursing Administration/Long-Term Care, Inc. (NADONA) based in Cincinnati, Ohio, who has served in this capacity since 2011 after being its president from January 2005 to January 2012.

Dornberger, 58, is a lifelong New Jersey native and a geriatric/senior long-term care nurse by training. She has been director of nursing administration (DON) of Pitman Manor, one of the United Methodist homes of New Jersey. Dornberger worked in their Pitman, N.J. facilities in Gloucester County from 1975 to 2003. She worked there as a geriatric long-term care nurse for 28 years since 1975 until she became too ill to perform physical nursing work in 2002.

While preparing to enter a master’s degree program in nursing administration this year and despite her physical disability, Dornberger wants to help set national standards of practice of geriatric long-term care nursing and to attract and guide more young nurses into her field.

The following is an Aug. 29, 2014 phone exchange between PharmPsych.com and Dornberger from her long-time home in Mullica Hill, N.J.:

1. The last time I spoke with you, I was interviewing you for a story on intellectual development of seniors in assisted living and long-term care. This was the summer of 2011. In that time, you served as president of National Association of Directors of Nursing Administration/Long-Term Care (LTC)/. Now, in 2014, you are executive director of NADONA/LTC. Tell me the difference between the two roles for the organization in terms of your leadership and wanting to improve the field of nursing across the country.

The president is an elected position while the executive director is appointed by the board. When I was president, I was acting in charge of the board. I led the mission statement and goals for NADONA. The board sets the goals to get from point A to point B. I hire and fire staff. I’m [also] in management.

I have been with NADONA for 25 years. I relied on NADONA as DON (director of nursing administration) when I needed someone to listen to me. Some days, we all need that. I want NADONA to be the organization that people turn to when they need help. They don’t want to hear [certain remarks] when they are dealing with different families or employees. They just want someone to listen.

I always called on my colleagues to help me. It’s important for leaders and DONs to stick with each other. No one knows what you go through each day except your colleagues . Unlike your colleagues, your spouse wants to fix it for you. You don’t want to hear what you did or did not do, according to your spouse, unless they too are a nursing Administrator/DON in long term care, but you want to hear that you did a good job.

2.What is your mission or vision for the field of nursing? In particular, what is it for nursing in gerontology, geriatric medicine or senior long-term care? What do you want to accomplish as an executive director that you did not as president? In the time that we last spoke in 2011, what has changed in the field of nursing, particularly in senior care? Has the picture improved in the last three years? If so, what? What else needs to improve in your view? The nursing shortage, especially in terms of senior care? The immigration process for some nurses? The quality of care in the long-term care facilities? The quality of home health care? How has the Great Recession affected all of this in your view?

I would like to have NADONA develop a standard of practice and, actually, I can now brag that this is happening at this time. A standard of practice for Nursing Administrators/Nurse Executives is being developed by a hardworking NADONA committee. I would like to increase the number of nursing administrators we have certified. If I had a choice to hire the certified DON or master’s-degree-prepared nurse, I would hire the certified nursing administrator/DON. A person can have a master’s degree in anything. He or she could have a master’s degree in basket weaving for all I know. Nursing administrators I know care for and are serious about caring for the elderly. They will step up their education to care for them more effectively.

The other thing is that I would like to recruit more young nurses into the field because the average age of a nurse is 57 years. We really need to recruit fresh blood. But geriatric care is the flavor of the month. The White House and the AARP were involved along with Susan Reinhard, (senior vice president of the public policy institute and chief strategist for the Center to Champion Nursing in America at AARP) in the White House Conference on Aging. We are getting support and bringing [the field and issues to the] attention of young nurses. Two registered nurses in long-term care [with NADONA] will approach the National Student Nurses Association and we will be going to the next conference to bring guidance and to recruit more into the profession. If we’re invited, we’ll go.

[The National Student Nurses Association] has a great website. I used to be an executive director of the New Jersey group. Nursing students have a place in my heart. I love their energy. i I love their attitude. There are a lot of nursing schools in New Jersey, currently somewhere around 44.

One of the things that has affected us is the talk of [Medicare/Medicaid] reimbursement. Insurance is paying for less because a lot of people are losing jobs. People don’t have coverage. If you’re dealing with a person putting his or her parents in long-term care, they don’t understand Medicare A, B and C or D. They don’t understand skilled nursing care. People think you don’t need anything other than Medicare. They [seniors] are in the hospitals because the they get caught in the revolving door of care, from home care to the ER to rehab and post acute care, needing more help or getting ill along the revolving door, and they land back in the hospital again, using up precious Medicare coverage. All of these healthcare stops cost the patient/resident lots of money without the proper coverage. Emergency room care and ambulance are no longer totally covered. [It can cost] $20,000 for emergency room care.

A lot of anguished families or loved ones didn’t think Medicare would not pay for everything. A lot of facilities are hit by Medicare cuts and [costly] transportation back and forth. Because of the Recession and Medicare cuts, it has forced [the hand of] the profession — not the industry because you deal with humans, not paperwork.

The facilities who are doing a good job get the concept of transitional care nursing. They (the transitional care nurse) go to the hospital. They make sure of the hospital or medical climate and evaluate the beds, linens and specialized tube feeding that the resident being admitted to their facility needs. [In some cases,] you [as a patient] don’t get the proper equipment needed when admitted if that facility does not have it in stock at the time of admission. [The facility staff can say that they] don’t have specific tube feeding equipment ordered by the specialist. The job of the transitional care nurse would be to assure the equipment is ready and available when the resident is admitted to the facility. Therefore, there is no break in treatment. The same high quality of care may continue to be administered for the benefit of the resident.

We in LTC have been avoiding unnecessary admissions as much as possible. People get better care because of that. The hospitals have gotten their nurses to be more geriatric-care savvy through training and education. The LTC facilities are getting more geriatric nurse practitioners on board,which is also helping with unnecessary admissions to the hospitals.The entire team working together as one (i.e: doctor, nurse practitioner, nurses, aides, rehab, dietary, activities and social service) to excel for the residents’ needs, makes for a high-quality, highly caring professional team who can work wonders!

Now we are in the electronic age. We used to have government hospitals perform beta [imaging of patients]. Now we do [more accurate imaging of patients], print out paperwork or take photos [of the patient] in the LTC facilities. The digital age has gotten us better and more efficient. [We now] have computers and ask more questions. [We] do better, more timely assessments.The savvy facilities have all the equipment hooked up to check blood sugar, BPs, temps and INRs, and it is downloaded into the special software as it is taken .Nurses now don’t [have to make a special effort. To document everything individually, the computer gives printouts, alerts you of abnormal readings, and will give you a printout of the last weeks, months of readings that you can send over to a doctor’s or nurse practitioner’s office for further orders, if needed. It’s all set up. It is ready to go.It’s a good thing and saves lots of time for the nurse documenting these numbers. There are also fewer chances for error as the machines are downloading the information. It takes the clerical errors away!

We are using music therapy and iPods to help us with [nursing home] residents who have Alzheimer’s and dementia. [When we] play music, we can decrease the need for drugs because the [residents] appear happier when there is music in their lives. Not just with pet therapy but with music therapy and aroma therapy all used, facilities have been able to reduce the need for a large number of residents to have their psychoactive medicines decreased or discontinued!!. I know how it feels laying in bed [all day] as I was hospitalized for one year.You don’t hear the music, just sounds of machines and the overhead call system in the hospital or the nurses on the call system looking for one another. You also don’t feel “good” touches. The only time you are touched is to have a procedure done to you and most of those procedures hurt!. [When we hear nice music,] we remember the happy feelings we get from the songs, and therefore get in a better place. Music is so intertwined in our daily lives and, just because we are hospitalized or in a LTC facility, we should not have to give that up.

Dan Cohen, [MSW, founder and executive director of Music and Memory, a nonprofit organization promoting the use of digital music in senior care], is doing a good job with his website, musicandmemory.org. He is doing excellent work. He’s getting iPods and ITune [songs] sold to him at cheap [rates] if the facilities need them.

[I remember one elderly male resident in the nursing home] who used to do back up for [jazz legend] Duke Ellington [and benefitted from the use of the iPods and ITune songs]. I cry when I see this video.It’s phenomenal! [This same resident who used to sing with Ellington] is now leading the [nursing home’s music] small therapy group. [Before the use of the iPods and iTune songs,] he was sitting in a fetal position.

Dan has done wonderful work. It’s things like that, that excite me about LTC nursing. In the 1970s, we used to put them [senior patients] in the Geri [geriatric clinical] chairs and expect them to walk eight hours later in the day with no exercise or a chance to walk until someone thought about attempting to walk them to the bed, bathroom, activity, or just a short walk down the hall. We didn’t know any better at that time. We’ve come a long way, baby! LTC is doing some very exciting things!

3. You have worked in different capacities throughout your nursing career. According to your Linkedln profile, you have worked as director of nursing, registered nurse and GCNC. What does GCNC stand for? You may have worked in hospitals as well as medical settings with senior citizens as your patients.

I am certified to teach nursing aides as a CNA Instructor [ certified nurses aides in the state of] New Jersey. I am certified to [provide] clinical instructions and classroom and skills teaching of [certified] nursing aides.

I’d like to see more standardization among the requirements for certified nurses aides. Each state has its own laws and regulations and [this affects reciprocity]. Hours [of study, testing and certification] are different from state to state. For instance, if a state requires 120 hours of required study/ clinical and, with having the three states of Pennsylvania, Delaware and New Jersey close, all with different requirements. Nurse aides move from place to place. It’s hard to get the certification needed for another state, if that particular state they are moving to requires more hours than the state they received their certification from, making reciprocity extremely difficult in many cases.

As far as continuing education for registered nurses, I really feel [the states] should change the hours required to be consistent from state to state. Some states have continuing nursing education required, while others do not. I’d like [that], if you’ve been out of school 20 years, and I don’t care who you are — you need training to keep up on. Many nurses don’t take [the training, study and certifications] unless they are required. It helps everyone involved [from] patients to facilities when nurses are trained. No matter the number of hours, whether that is 50, 100 or 120 education never harmed anyone.

[You must] stay up on what is happening in your profession!

4. What is it that inspired you to enter the field of nursing? Were you inspired by a member of a family or friends? If so, how and why? In particular, why did you choose to enter the nursing specialty of long-term care, geriatrics or gerontology, of all specialties? Did you feel compelled to make a difference in the way seniors were cared for?

At first, I wanted to be a mechanic but Mom said good girls don’t hang out in places [like mechanic’s shops].

I worked in the hospitals. I did not like [it] as I did not like just “pushing pills” and hanging IVs, and that is what I felt like took most of my time while working in acute care. It paid the bills, but did not make me happy at the end of the day I loved long-term care as I thoroughly enjoyed getting to know both the resident and their family. [As a child], I lived across the street from an elderly woman. I’ve been infatuated with the elderly since I was young. The lady was as close to me as my grandparents. When I saw her, I felt as though I was visiting my grandparents. She taught me lots about life, and helped me know that it was the elderly I wanted to work with “when I grew up.”

I applied for a job in a nursing home because of my grandparents and the lady. I love geriatrics. I like to get to know the residents in my facility. I knew one [elderly person] who once worked in vaudeville. She would act all the time. She was blind and her husband deaf. They were married for 65 years and put on a show daily for the staff. She had a little “ditty” she would say all of the time. It goes like this: “The Bee, she is a busy soul. She has no time for birth control. That’s why you see, in days like these, you see so many “sons of bees.” She celebrated her 65th anniversary with her husband with a party [at the nursing home].

I worked in Pitman Manor [nursing home] in Pitman, N.J. from 1975 to 2003. It was so good that I stayed until I was ill and could no longer work there due to physical limitations. I actually was admitted to my own facility after a long acute care admission where I was in an 18-day coma to get rehab, wound care and pain control and was discharged after seven months.

I was president of NADONA at this time, but looking back on things, I now see that God had a bigger plan for me. I always loved assisting my colleagues, and when NADONA was in need of an Executive Director, the board knew that NADONA was my passion, and when I applied they graciously accepted. As Executive Director of NADONA, I now have the ability to assist nurse executives on a daily basis, making me incredibly happy! I was totally content [working for Pitman Manor] and I would have never left there. But, as I said God had other plans for me, and now I can say with a huge smile, I am so glad he did!

I want to make a difference in long-term care, and working with NADONA. I am getting to do just that!

In the last few years, [in the nursing field, we have had more] online classes popping up. They’ve opened up a lot of nursing [course] availability. [It costs] a little less money to take the classes online. The average age of the nursing instructor is 65 and there are not enough nurses going into the teaching nursing students. Because of this, schools are limited to the number of nursing students that can be accepted to the programs. Thus, we are graduating fewer nurses than we need for our future needs. Recently, through many efforts, the number of applicants to nursing schools and for higher degrees, have increased significantly, which is wonderful. Utilizing online education will also assist with getting more nurses educated. If we stick to the brick-and-mortar schooling only, we will go back to the 1970s with the numbers we can accept into the programs and the number of nurses we graduate! In New Jersey, we would always say, “The Garden State GROWS great nurses.” We still do, even online!

Magnet-status hospitals are driving nurses to get higher degrees. For a hospital to be considered magnet, one of the many requirements of the American Nursing Credentialing Center states that a hospital has to have a certain percentage of the hospital with staffed, degreed personnel. They make it a requirement for a certain number of nurses to have a bachelor’s or master’s degree. The newly-hired nurses have to have nursing degrees. Back in the 1970s, diploma nursing degrees were most prevalent. Now those diploma schools have either closed or merged with an associate degree or bachelor degree nursing program to survive.

The good majority of today’s registered nurses have bachelor’s degrees. It’s easier now [to obtain these degrees] because of the increased number of nursing schools, on-line education and taking a class here and one there to get the preliminary credits out of the way. Some colleges are also giving portfolio credits for your life’s work. It has added to the leadership as we know it. Nurses now have the ability to apply for nursing jobs in– besides LTC — home health care, the American Red Cross, hospices, doctor offices, sports teams, same-day surgeries, missions overseas, nursing teaching, and the pharmacies.

It’s good and bad that there are so many different type jobs available to a nurse. Unfortunately, job stability have produced people who don’t care, the way I feel they should care for the resident or patient they are caring for, but [are in] nursing. Typically, they will not stay in one place too long, especially with hands-on care. It will take some time but [eventually] they will get weeded out of hand on care, and do something where they can collect their check and use their degree but do not need to show the compassion most nurses need to have to be successful!

5. You were a native of New Jersey, correct? Did you study there? Did you graduate? What degrees did you obtain? What skills did you learn?

I grew up in Deptford, New Jersey, a small town. I went to the county college [ in Gloucester County] and took classes nursing] over two years. I’m obtaining my master’s degree in nursing administration now, I will study online as I am [disabled] in a wheelchair and still live in Mullica Hill, N.J. — eight miles from Deptford, N.J. where I grew up.

I had a daughter, a great career and did not move far, and I loved my house. My daughter [is going to] medical school to become a doctor of osteopathic medicine. Apart from medicine and family, she pitches softball and holds NCAA records. [Many of her] friends — [also in athletics] — got hurt from not exercising and training. [She will] graduate in 2015. My husband helps take care of me, the household and my therapy dog, a Labrador named “Star”.

6. You once worked for the American Red Cross. What were you able to achieve in that capacity?

I volunteered with the American Red Cross. I was nominated SAF Volunteer of the Year [in 2006 and 2008 with the Gloucester County Red Cross in Sewell, N.J.]. I worked with them in training volunteers and doing military cases. If a person is stationed and has a family at home, I assisted with working with their commanding officer to get them home for the emergency. The motto for the ARC is “get to know us before you need us.”

7.In scouring the Internet, I found that you write extensively about nursing issue. The issues you cover include medication, medical procedures, long-term care, home care, pain management, safety, hospice care and vaccines. Is it important to you to instruct and advise nursing students and young graduates about proper medical setting processes and procedures?

It’s McKnight [Long-Term Service News]. I always try to share what I know. Some people are afraid just to ask. They all might have the same questions. I get questions from McKnight or [people] asked me [questions] as a mentor for NADONA.

I figure: why not share the information if you have it, along with answering the question?I try to give other resources, such as websites, articles, and product locations people can go to and find out more information about the topic of the question for the month. It goes to others. For NADONA, I represent the Board on Advancing Excellence. I [especially] enjoyed working with the tool kits for infection control and MRSA.

I assisted with writing a new chapter on MRSA [infection control for nursing instruction publication] for APIC in LTC. I loved being an infection control nurse too.

People don’t think enough about germs. [For example, when people go shopping,] they put perishable goods [in an area of a shopping cart where a child may have put his or her feet or buttocks as they sit in the built-in area near the push bar of the cart. If the child has had a soiled diaper, I am sure there is E.Coli all over the area you just laid your lettuce or fresh soft bread. ] Then they wonder why they get sick with diarrhea. Anti-bacterial soap is not the end all, be all. Good hand washing and alcohol gel certainly helps!

8. Have you ever taught in nursing school? If so, where? If not, why not? In the time that I have last spoken to you, do you see enough nurses teaching in the nursing schools or colleges? Do you see enough nurses serving in leadership and management roles such as Director of Nursing? If so, why or why not? Is it part of your mission to assist in increasing the number of professors in the nursing schools and nurses as leadership and management roles across the country?

I have not taught in nursing school. I have instructed CNAs [certified nursing assistants] and mentored [students] in nursing school. In my facility [Pitman Manor], I knew a lot of students. My facility had [relationships] with three nursing schools [who came through for clinical training]. I tried showing them what’s good about long-term care.

Long term care seems to be the story of the week if a paper needs something negative to write about. I can tell you a lot happens in acute care too. If anyone was admitted for a long time, you would see that it’s not all roses. Mistakes happen. Medications are delivered later or not at all, and some staff may speak gruffly. [The media and established society keeps] picking on long-term care. [Our facilities nationally] are never clean enough, never good enough and never fast enough [with medical service].

It kills me to see negative stories about [long-term care]. We [the geriatric long-term care specialty] have made a difference in recent years. Then they [the media] come out with [something] negative about LTC. We have 90- year-old [nursing home residents] who are active, swinging, exercising, into the arts, making PowerPoint presentations, [doing] needlework and [putting out] the facility newsletter. They [the residents] do a lot of good that [the public does not pick up on.].

[We want and need] some positive media. NADONA along with many other organizations are is trying to do an image campaign.Nurses typically nurture and care. Yet they are strong and are who people lean on in their time of need or illness. [The organization is drawing from an analogy to an acorn growing into an oak tree in its campaign.] An acorn [sapling) tree] can grow up to be a mighty oak. You don’t do it on your own. You need nurturing, support, and tender loving care. [The rules set as standards by the government] are rigid. [Geriatric long-term care nursing, nursing homes and the long term care continuum form] the most regulated industry in the country, surpassing nuclear waste.

9. What advice would you give college graduates entering the field of nursing and your professional peers in terms of their approach to their day-to-day nursing work, especially in long-term care, geriatrics or gerontology?

I would tell them that it is an exciting field. Think outside of the box. Get certified. Your choices for certification are many, including Nursing Administration, Diabetes, Assisted Living, Dementia Practitioner, infection Control or MDS coordination [Minimum data set coordination, which is a comprehensive assessment required for all residents who reside in facilities who receive Medicare and Medicaid payments] through a specialty nursing organization.

Education is the way to go. If you want to be a leader [in your field], education is fundamental for doing [it]. I encourage all nurses to join a specialty organization. You can’t do all of this alone, It takes a village. All [of us] need mentors, and we all need people to listen to us and feel needed and wanted.

Pick someone who inspires you and go for it. When someone says [something] to compliment you, it can make you feel great. We all need to feel needed, [including] nurses. You know the famous line: “You may no longer remember what someone was wearing or what they looked liked but, years later, you will remember how they made you feel. It is sooooo true!

Pick someone you want to be like. You don’t have to follow everything [he or she does]; it is nice to be a trailblazer, make a difference to one person at a time and make your own footprints in the sand!

NOTE: (PharmPsych.com offers up MediPreneurs, a news series featuring medical professionals and allied health employees of all specialties, especially the field of pharmacy. MediPreneurs are leaders and managers in a variety of medical fields who often use their talents to start their private practices or businesses or challenge themselves to transform and improve community health as board members, group founders, mentors or college professors. Our MediPreneurs series seeks to draw on and explore the expertise and experience of these medical heroes and put them in the public spotlight, one professional at a time.)

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

Long Term Care Consulting Improves Patient Outcomes, Reduces Costs

Long-term care consulting by pharmacists and physicians for patients and their families about the most relevant categories of care needed, the variety of healthcare services open to them and the use of prescription drugs improves the results of such decisions and practices and reins in costs, medical experts say.

Pharmacists, primary care, family practice and internal medicine physicians and specialists such as geriatricians and gerontologists who serve as consultants in or for senior long-term care and short-term care facilities on behalf of patients achieve success in treating them and ensuring their recovery while hemming in medical expenses.

Federal research from the Census Bureau and the U.S. Commerce, Health and Human Services and Labor departments shows that senior long-term and short-term care makes up 20 percent of the entire healthcare industry, which, in turn, serves as the top employer in the nation because of the burgeoning need for such services.

Senior Patient Demographics, Care

The need is growing as seniors now comprise 14.5 percent of the nation’s population or one in seven Americans. The Census Bureau finds that the oldest Baby Boomers turn 70 this year and that, each year, 10,000 members of this generation (born between the years 1946 and 1964) have been turning age 65 starting in 2011 until 2030.

As they age, members of this group require a range of healthcare services, participation in the most relevant categories of care to their set of circumstances and greater use of prescription drugs.

The most relevant categories of senior long-term and short-term care include assisted living, congregate care, continuing care retirement communities (CCRCs), home health care, hospice, nursing homes, post-palliative/surgical care, senior independent living and skilled nursing facilities (SNFs).

At the same time, older seniors — namely members of the Silent Generation (birthyears 1927 to 1945) and the final tier of the Silent Majority Generation (birthyears 1908 to 1926) — too, will need more care.

The Centers for Disease Control finds that, by the year 2050, about 27 million patients will need such medical attention, an increase from 15 million in the year 2000.

Increasingly responding to these needs are patient-centered medical teams of short-term and long-term care pharmacists, primary care, family practice and internal medicine physicians and medical specialists such as cardiologists, endocrinologists, gastroenterologists, hematologists, hepatologists, nutritionists or dietitians, occupational, physical and speech therapists, oncologists, podiatrists, psychiatrists, psychologists, radiologists and renologists.

In carrying out their policies, these white-collar-level medical professionals are supported by an ancillary staff of physician assistants, nurse practitioners, registered nurses, licensed practical nurses, biomedical equipment technicians, certified medical assistants and nursing assistants.

Whether senior patients are electing to “age in place” or stay at home to recover or to move into assisted living facilities — a category of care growing faster than nursing homes, or other forms of long-term care than in decades past — pharmacists, physicians and specialists make key decisions and resolve issues for patients and their families about the type of care administered, the services offered and medications.

For example, long-term and short-term care pharmacists are offering home infusion services and specialty products such as those that treat cancers for seniors who choose to stay at home.
Some 1,200 independent long-term care pharmacies will serve patients in short-term and long-term care facilities in a manner comparable to the relations between independent community pharmacies and the chain drugstores.

In fact, as evidenced by the creation of such advocacy groups of wholesalers that cater to long-term care pharmacies as the Senior Care Pharmacy Coalition in Washington, D.C. in 2014, such pharmacies lobby for the same core issues as independent community pharmacies such as PBM (pharmacy benefit managers) do like reimbursements, federal regulations concerning compounding and overlapping U.S. Centers for Medicare and Medicaid Services (CMS) guidances.

According to the Centers for Medicare and Medicaid, more than 15,000 skilled nursing facilities, namely nursing homes certified to accept Medicare payments, operate nationally. About 70 percent are for-profit but the remainder are run by charities or community health services.

Meanwhile, the country claims at least 7,000 assisted-living, independent living and memory-care facilities while 45,000 such institutions fall into the remaining categories of senior short-term and long-term care around the nation.

As in previous decades, senior patients in independent living facilities are still likely to visit their local-area pharmacies or a doctor’s office. By contrast, however, long-term care pharmacies are the chief source of prescription drugs for patients in skilled nursing facilities, assisted-living facilities and similar categories of senior care.

Role of Long-Term Care Consultants

As most of the residents of nursing homes and other long-term care facilities suffer from cognitive impairment and multiple physical illnesses and, in some cases, co-occurring mental disorders, federal, state, county and city regulations and medical policies are in place to manage their care to ensure accountability and transparency.

The American Society of Consultant Pharmacists, a white-collar professional trade organization based in Alexandria, Va. of 8,000 pharmacists and some pharmacy students, says long-term care pharmacies recruit and retain the consultant pharmacists who are needed to review the prescription drug routines of a patient of a long-term care facility every month. As third-party pharmacists, they monitor whether the drugs are prescribed for good reasons.

Consultant pharmacists, primary care, family practice and internal medicine physicians, medical specialists and ancillary staff examine a patient’s drug regimen to evaluate factors such as the correct form and administration of medicines, drug interactions, lab checks and the use of medical cocktails.

They also act as educators and advisors to senior long-term and short-term care facilities, often serve on their boards or committees and carry out in-house services every three to four months on a particular category of chronic illness or regulatory subject.

Consultant pharmacists confirm, challenge and change the original drug choices made by primary care, family practice and internal medicine physicians, medical specialists and ancillary staff.

More specifically, the variety of physicians and medical paraprofessional staff who also make decisions beside the consultant pharmacists about patient medications and the drug formularies used by the long-term and short-term care facilities — as well as the categories of care and healthcare services needed — are the prescribing physicians, nurse practitioners, registered nurses and licensed practical nurses, the medical director and the pharmacy and therapeutic committee members.

The matrix of roles typically runs as follows: prescribing physicians or nurse practitioners identify the original prescriptions required for each patient; registered nurses and licensed practical nurses acknowledge symptoms calling for a particular therapeutic treatment choice, and; the medical director of the senior long-term care or short-term care facility and the pharmacy and therapeutic committee members create the drug formularies used.

LTC Pharmacies

With more of the healthcare industry heading for a pay-for-performance mode of operation, long-term care pharmacies are becoming more essential to greater patient outcomes.

Aside from reviewing, educating and advising on the drugs and therapies used for the facilities’ patients, designated long-term care pharmacies carry out the following tasks: managing formularies; drug utilization review and training for staff; medication packaging; drug-delivery formulations and compounding, and; managing reports, forms and ordering supplies.

In particular, industry leaders say unit-dose packaging helps patients access their medicines and stick with a drug regimen.

Additionally, long-term care pharmacies handle drug records, drug orders and emergency medicines, perform holistic medical reviews and they prepare drugs in unit doses or carry out compliance packaging.

Pharmacies and consultant pharmacists also conduct quality assurance with respect to the danger of drug overuse or the incompatibility of drugs, especially when senior patients are prescribed medical cocktails due to their various illnesses. Many of the drugs are narcotic pain drugs, antibiotics and psychotropic medications.

Industry research shows the increase of the use of the following classifications of medicines on the rise in use by senior long-term care and short-term care facilities: HIV medication, 13 percent increase; immune globulin therapy, 71 percent increase; hepatitis C treatments, 25 percent increase; multiple sclerosis medications, 13 percent increase, and; inflammatory conditions, 37 percent increase.

Indeed, as of 2015, researchers say the increase in the use of hepatitis C treatments in a greater market outside of senior long-term care and short-term care was 289 percent.

Generics share the same percentage of the drug market as long-term care facilities — 85 percent. Still, newer drugs are taking effect.

The array of drugs used in nursing homes and other long-term care facilities has stretched to include more treatments of chronic illnesses such as cancer, HIV infection, heart disease, multiple sclerosis, inflammatory conditions, diabetes and hepatitis C.

To pay for these medicines, about 57 percent of senior patients in long-term care and some short-term care settings have Medicare, Medicaid and dual-eligible status for those who have both. It is this same percentage that has no access to the nearly 800 Medicare Part D prescription drug benefit plans today.

Instead, they can only take advantage of the 231 Medicare Part D “benchmark plans,” a particular sector of Part D benefit plans that is meant to be affordable.

By comparison, 29 percent hold private insurance while the rest are private insurance patients. This cohort is privy to the 800 Medicare Part D plans available.

However, the benchmark plans require more rules with respect to the facilities’ formularies and authorizations. In intensive healthcare settings such as skilled nursing facilities, post-palliative or post-surgical care or hospices, physicians and medical specialists are required to only offer medicines under those benchmark plans to hem in costs.

Cost Savings

The work of long-term care pharmacies and the facilities helps to lower health care costs among senior patients in part by cutting down on hospitalizations and emergency room visits.
The Henry J. Kaiser Family Foundation reports that scaling back on both among Medicare participants in long-term and short-term care would cut costs by $2.1 billion in 2011.

Savings stem from the high expenses of acute care, the danger of drug errors and hospital-induced infections that can take place at a hospital stay, especially among the sickest patients.

Research from sources other than the Kaiser Family Foundation found a 33 percent decrease in hospitalizations would save Medicare $1 billion a year. This finding leads to pressure on long-term and short-term care facilities from the Centers for Medicare and Medicaid Services to cut back on patient returns to skilled nursing facilities and nursing rehabilitation facilities.

The CMS averages the number of hospitalizations among Medicare and Medicaid participants receiving Medicare skilled nursing facility care or Medicaid nursing home care that could have been prevented to be 45 percent, judging that billions of dollars in care could have been saved and asking facilities to coordinate care earlier to avoid hospitalizations and high costs.

As a result, long-term care pharmacies and their consultant pharmacists are paying close attention to senior long-term care and short-term care facilities and their patients stricken with chronic illnesses such as heart disease, diabetes or chronic obstructive pulmonary disease (COPD) to provide reviews of their drug regimens and educate and advise the leadership and management staff of those centers.

Researchers say a short-term nursing home with 100 beds may average a stay of 20 days, translating into a turnover enabling 150 patients monthly to return home and receive home health care.

They say such patients benefit from the outcomes data, safety and clinical research that CMS and the long-term care pharmacies and their consultant pharmacists generate, making for an improved transfer of information for an enhanced patient care plan to mitigate the risk of adverse events.

SOURCES:

Bell, Christina, MD; Blanchette, Lanoie, MD, MPH; Michiko Inaba, MD; Wendy Iwasaki, PharmD; Kojima, Gotaro, MD; Lubimir, Karen, MD; Masaki, Kamal, MD, and; Tamura, Bruce, MD. Reducing Cost by Reducing Polypharmacy: The Polypharmacy Outcomes Project. J American Medical Director Association. 13(9): 818.e11-818.e15. https://www.ncbi.nlm.nih.gov/pubmed/?term=Kojima%20G%5BAuthor%5D&cauthor=true&cauthor_uid=22959733. Published online Sept. 5, 2012.

Devinney, Jennifer, RPh, PharmD, Chief Clinical Officer for Grane Rx. An Interdisciplinary Approach to Long-Term Care Pharmacies. http://www.granerx.com/an-interdisciplinary-approach-to-long-term-care-pharmacies/ Accessed Nov. 29, 2016.

Shelley, Suzanne, Contributing Editor. Targeting the Gatekeepers in Long-Term Care: The ‘age in place’ trend creates challenges for market access to seniors. American Society of Consultant Pharmacists journal. Nov. 7, 2016.