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.

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

Connecting supporters of aging in place with advocacy for the disabled is the wave of the future for senior long-term care, government agency chiefs said in a keynote speech at a conference on aging.

It will take all the different segments of the senior long-term care industry and supporters of aging in place to ally aging and disabilities, said Kathy Greenlee, U.S. Assistant Secretary for Aging and Administrator of the Administration for Community Living (ACL) of the U.S. Administration on Aging (AoA).

Greenlee made the prediction during the second of a two-part presentation, titled “Aging and Disability, the Alliance of the Future: Long Life in the 21st Century,” at the American Society on Aging’s “Aging in America” conference in downtown Chicago.

“If you are advocating for [the] disabled, [continue to] do it,” she said. “If ACA [the Affordable Care Act] is your middle name, stay that way. If you are passionate about helping people with intellectual disabilities, please stay [that way].”

Joining aging and disabilities advocacy, Greenlee said, means connecting the treatment of chronic disease, caregiving, the high cost of health care, home-based community care (HCBCs), palliative and hospice care.

“[There must be] an alliance of the [issues of the] elderly and the disabled,” she said. “[We must] align programs that support care and [meet] needs. [This means embracing new] challenges, transferring medicine to management of care, changing state government [policy], creating new conversations and [fostering] new changes in communities.”

Greenlee said policymakers and stakeholders should determine what role Medicare and Medicaid can play and how the provisions of the Older Americans Act and the American Disabilities Act can be interpreted and reconciled to support this alliance.

“The healthcare system [can work with] home [health] care,” she said. “[The Area Agencies on Aging can work] with Medicare. [There might be a comparison between what] charity gives [in terms of funding and technical assistance to this alliance] versus [the contribution of] Medicare vendors. [It is a] huge conversation. [You would have to discuss, too] Parkinson’s, paralysis and diabetes.]”

Greenlee mentioned as a potential example of alliance building, the late actor/filmmaker and disabilities crusader Christopher Reeve, who founded and chaired in 1999 his own national nonprofit, the Christopher and Dana Reeve Foundation, and created the Paralysis Resource Center, which offers resources on spinal cord injury, paralysis and mobility-related disabilities and entered a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to make information and other forms of assistance readily available to those who need most. Reeve, who was stricken with a spinal cord injury after a horse-racing competition in 1995, died of a heart attack in 2004.

She prescribed similar partnerships with government agencies, nonprofits and foundations.

“We have HHS and HUD,” Greenlee said. “[They] think we don’t do housing but HHS does. HUD [addresses] senior housing. [Meanwhile] people [are] screaming in [different] states, ‘We have no one to talk to about housing [and seniors].’”

She also added that the role of caregivers in allying aging and disabilities raises questions.

“[Caregivers are in the] workforce,” Greenlee said. “Who will provide care? How can we support direct care? How do we train? How do we [introduce] geriatrics? [The] role of family of caregivers is essential. What is [the] future of caregivers and seniors? We can work on [this] together. It is unleashed potential.”

Gerard Van Spaendonck, general manager and the senior vice president of Philips Healthcare in Boston, the global home monitoring and home health care medical devices solutions segment of the company, said technology will play a role in caregiving.

“Getting older does not mean we get less productive, less active [and] less well,” Van Spaendonck said. “Families [are] changing their roles in health care. Private policies and changing standards of age [are affecting] families, friends and broader communities. You can’t help getting older but you don’t need to get old.”

He said companies like his merge wireless communication and telephones so that seniors can engage with loved ones, friends, government agencies, nonprofits and businesses outside of their homes. Philips’ own line of products include Lifeline Go Safe to help with falls, assisted GPS, WiFi entries, intelligent bread crumbs and two-way voice communication.

“Some seniors stay connected [because they are] frightened. [They are] falling, the streets [are becoming less] safe [and] they are getting lost [when suffering from dementia]. This does not mean [social] isolation but innovation. New technology [can] improve lives. [It will] help seniors live in their own homes.”

Greenlee said policymakers and stakeholders should be encouraged to think unconventionally in order to link aging and disabilities.

“[There is] common space [to] work on these issues,” she said. “Just because [something] does not have [the word] ‘aging’ in its title does not mean it’s not [about] aging.”

Greenlee also said that elder abuse should also be part of the conversation.

“Ask yourself questions,” she said. “ Are the people I serve abused? Do I know who they are?”

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.