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News Roundup: August 19, 2016

Graying voters wield great power

Published by Republican American
By Joseph Stango
August 19, 2016

Gray power is growing in the United States. Because of their burgeoning numbers, senior citizens — those 65 and older — have a unique opportunity this election cycle to play a pivotal role in electing a president, members of Congress and state legislators. Yet many people, including candidates, discount senior citizens' knowledge and abilities.

In 2012, seniors represented 16 percent of the electorate. By 2014, they comprised 24 percent — and more than 10,000 baby boomers turn 65 daily.

Senior citizens commonly are referred to as the "third rail" of politics, not because of their numbers, but because of the percentage of seniors who vote. In the last four election cycles, more than 60 percent cast ballots. Given the stakes in this year's election, it shouldn't surprise anyone to see that number climb to 70 percent.

Despite these facts, politicians mistakenly believe seniors to be politically obtuse and thinking they care for only two issues: Medicare and Social Security. In reality, seniors have other, more pressing concerns on their minds.

According to recent polling data, a majority of seniors believe the country is heading in the wrong economic direction. They believe a strong economy would be best for them, particularly because interest rates have been too low for the past eight years for them to enhance their savings income.

They also realize that because entitlements are large parts of the federal and state budgets, a robust economy is necessary to continue to pay the benefits they receive. Otherwise, their services are in jeopardy — as has been the case in Connecticut the past few years.

Moreover, "Bring the Vote Home," which collects seniors' opinions on national issues, reports that 80 percent of respondents believe lawmakers should not cut home-care services. Seniors want to live out their lives in their communities rather than in institutional care. They will do what they can to prevent such a fate.

Showing a more erudite grasp for detail, almost 60 percent of seniors in the same poll objected to President Obama's 2017 budget proposal calling for the re-imposition of a $100 copayment for home-health patients. Seniors understood this co-payment, considered by some to be small, could push many seniors into more expensive institutional settings.

The data show many seniors are in crisis mode. They are concerned about the economy and national security. Above all, they don't think candidates are paying enough attention to them and the issues they care about.

But seniors are in the driver's seat. They have the numbers, and they show up at the polls — making them the most influential of all voting blocs. Candidates had better not take senior votes for granted.

Most of these seniors are not of the World War II generation, who were willing to play the political hand that was dealt to them. Today's seniors are politically astute, have a grasp of the issues facing our country, and are more active than their predecessors. And they are hell-bent on maintaining their independence as they grow older.

Politicians who play the entitlement "fear" card will find it won't work in this election cycle.

Joseph Stango of Southbury is the founder of Dora's Hope (www.dorashope.org). He considered running as a Republican in the U.S. 5th House District election this year.

Independence At Home Demo Saves Millions During First Two Years

Published by Inside Health Policy
By Michelle M. Stein
August 19, 2016

CMS and lawmakers touted the Independence at Home Demonstration for saving millions two years in a row, although more than half of the second year's savings will go toward incentive payments. CMS also said the participating practices improved quality from the first performance year in at least two of the six quality measures for the demo.

The demonstration provides primary care services in the homes of chronically ill Medicare beneficiaries. It was originally part of the Affordable Care Act, and last year lawmakers extended the demonstration for two more years. Sens. Ron Wyden (D-OR) and Ed Markey (D-MA), who helped create the demonstration, praised the program and Markey dubbed it a “multi-million dollar success.” Rep. Michael Burgess (R-TX), also said he was pleased the program is continuing to show its value.

“Now in its second year, Independence at Home is clearly a success story of health care done right,” Wyden said. “This data shows that giving quality care to seniors at home not only provides better care for those with serious chronic illnesses, but also holds down health costs."

In the first year of the program, the Independence at Home demonstration saved $25 million, CMS said last year, and nine of the 17 participating practices received incentive payments. On Tuesday, CMS announced that the 15 practices that participated in the demonstration's second year saved more than $10 million. CMS said that while multiple factors likely contributed to a decrease in savings during the second year of the demo, the most important factor is that CMS changed the way it analyzed the savings for the second performance year to improve the comparability between the treatment group -- the Independence at Home beneficiaries -- and comparison group beneficiaries...

Elderly Patients In The Hospital Need To Keep Moving

Published by Kaiser Health News
By Anna Gorman
August 19, 2016

BIRMINGHAM, Ala. — Thelma Atkins ended up in the University of Alabama at Birmingham (UAB) Hospital-Highlands after a neighbor in her senior living center ran over her feet with a motorized scooter.

Terri Middlebrooks, a nurse at the hospital, tried to figure out how active the 92-year-old Atkins was before the incident. “Are you up and moving at home?” she asked.

“I can manage, but I have to have help sometimes,” Atkins replied.

Atkins said she uses a walker to visit friends and to get to the communal dining room. But she’s also fallen a few times in recent years.

“Don’t quit walking here,” Middlebrooks told her. “It’s the most important thing you can do. … This bed is not your friend.”

This KHN story also ran in Modern Healthcare. It can be republished for free (details).
Middlebrooks is the coordinator of a unit designed to address the challenges specific to caring for the elderly. She told her new patient that throughout her stay, one of the main goals would be to keep her active.

The medical center’s effort to get older patients up and moving while they are in the hospital is far from typical. Despite a growing body of research that shows staying in bed can be harmful to seniors, many hospitals still don’t put a high priority on making them walk.

At UAB Hospital-Highlands’ 26-bed geriatric unit, known as the Acute Care for Elders unit, or ACE, patients are encouraged to start moving as soon as they arrive. The unit is one of a few hundred around the U.S. that is attempting to provide better and more tailored care to geriatric patients.

The hospital opened the unit in 2008 with the recognition that the elderly population was growing and that many older patients didn’t fare well in the hospital. ACE units are based on the idea that if the unique needs of seniors are met, they will have better outcomes and their care will be less costly.

Research has shown that the units shorten patients’ stays in the hospital, reduce their likelihood of returning too soon after discharge and make it less likely they will be sent to a nursing home.

In addition to employing specially trained staff who work together as a team, the Alabama unit has special handrails attached to the walls, low-glare lighting and non-skid floors. Every room has a walker and plenty of space to move around. Volunteers walk with patients, and therapists work with them on maintaining their strength.

Staff members try to disabuse patients of the idea that they are there to rest. “People walk in the door of a hospital and think it’s OK to stay in a bed. It’s not,” said Middlebrooks.

Andres Viles, a nurse coordinator, said nurses at other hospitals are often so busy administering medications and tending to wounds that they don’t make time to walk with their charges. The emphasis on patient mobility is “a culture change” for most hospitals, he said.

At UAB Hospital-Highlands, that shift took a lot of education. Staff members in the new unit attended workshops that included role playing and sensitivity training. The hospital also trained “geriatric scholars,” who became advocates for addressing the particular physical and cognitive needs of seniors.

The Affordable Care Act explains some of the reluctance by staff at many hospitals to get patients moving, experts say. Under the law, hospitals are penalized for preventable problems, including falls. Researchers believe that hospital staffers, to ensure their patients don’t fall, often leave them in their beds.

“We are doing an awful lot to prevent falls, but there is a cost,” said Heidi Wald, an associate professor at the University of Colorado School of Medicine. “The cost is decreased mobility.”

Researchers said there are other explanations for the failure of hospitals to get elderly patients moving. They may not have enough staff, for example, or they may fear lawsuits.

Families won’t sue if their mom gets weaker in the hospital, but they may if she falls, said Cynthia Brown, director of the Division of Gerontology, Geriatrics and Palliative Care at the UAB School of Medicine.

“Why would the hospital want to put themselves at risk for litigation or the CMS [Centers for Medicare and Medicaid Services] coming back and biting them?” she said.

Brown added that hospital staffers around the country generally do not consider walking with patients to be as important as their other duties. “It is just one more thing on a list of a whole lot of things,” she said. “Often times, walking falls to the bottom.”

It’s also harder for patients to walk around if they are attached to IV lines or oxygen tanks, or if they take drugs that make them sleepy. Such medication or equipment is not always necessary.

The very layout of hospitals and the way they operate makes it too easy for patients to remain stationary. They can control their televisions by raising a finger, and they typically get their food in bed.

On average, hospitalized older patients spend just 43 minutes a day standing or walking, according to a study by Brown published in the Journal of the American Geriatrics Society. They are in bed more than 80 percent of their hospital stay, she found.

The impact of remaining so sedentary in the hospital can be devastating for older patients: It is puts them at greater risk for blood clots, pressure ulcers and confusion.

Immobility can also reduce patients’ ability to take care of themselves when they go home — a difficulty that persists a month after their discharge, according to Brown. And it puts them at higher risk of readmission to the hospital, according to research.

Immobility hurts older patients more than younger ones, in part because the elderly are generally weaker, have less bone density and are at higher risk of falling. Ironically, keeping a patient in bed, which is often intended to prevent falls in the hospital, can increase their risk of falling after they are discharged, experts said.


Willie Mae Rich exercises with nurse Andres Viles, who helps keep elderly patients both mentally and physically active during their time in the Birmingham hospital. (Hal Yeager for KHN)
Instead of returning home to their normal lives, patients who can’t walk when they leave the hospital are more likely to go into nursing homes, said Seth Landefeld, chairman of the Department of Medicine at the UAB School of Medicine.

“They don’t bounce back,” Landefeld said. “The pneumonia is better, but Aunt Mary is not walking and talking the same as before.”

Landefeld said hospitals frequently take the “smart bomb” approach to illness. “We blow away the disease, but we leave a lot of collateral damage,” he said.

Making sure hospitalized patients spend sufficient time out of their beds can save money, keep them mobile after they return home and improve their overall health. Researchers in Texas found that increasing the number of steps elderly patients took on their first and last days in the hospital reduced their risk of dying over the following two years. A study of pneumonia patients of all ages showed that walking early in their hospital stay shortened its duration, saving an average of $1,000 per patient.

The hospital hosts a twice-weekly session called “Move and Groove,” designed to get older patients dancing. At a recent session, a music therapist played the piano as the patients held tambourines or bells and moved their feet to the beat. All of the patients used walkers. A few had oxygen tanks and most wore bracelets indicating they were at risk of falling.

Occupational therapist Linda Pilkerton said she doesn’t give patients a choice of whether to participate.

“We don’t ask them if they want to do an x-ray or if they want a CT scan,” she said. “This is ordered by the doctor. If they don’t get up and move, they start the death spiral.”

After Atkins was admitted to the unit following the scooter mishap, Middlebrooks told her it would only take two days of lying in bed to lose muscle mass. “And if you lose muscle mass, you get weaker and you’re more apt to fall,” the nurse explained, adding that Atkins had done enough of that.

Atkins, who has a pacemaker and has had hip and hernia surgeries, said she has lived alone a long time and doesn’t want to end up in a nursing home. As she pushed her walker down the hospital corridor, she acknowledged that she’s gotten weaker as she’s gotten older and that her arthritis makes it more difficult to shower and dress by herself.

But she said she’s determined to keep walking — at home and in the hospital.

“I don’t want to lose more independence,” she said. “I’ve already lost a lot of it.”

But even if patients spend a lot of time out of bed while they are in the hospital, it does not guarantee they will recover.

Willie Mae Rich, 86, came to the Alabama hospital this spring because her doctor was concerned about her heart. Rich knew her bones wouldn’t withstand a fall, so she worried about walking around too much.

“I’ll break up like peppermint candy,” she said.

But the hospital staff didn’t give her a choice. They urged her to eat meals while sitting in a chair, get herself dressed and get up as often as possible.

“The more time you spend out of this bed, the healthier you’ll be,” Viles told her.

Despite staying active in the hospital, Rich, a great-grandmother, became more sedentary over the next several weeks. Her daughter, Debra Rich-Horn, said her mother continued to walk when she first came home, but soon she could barely get out of bed.

Queze Ferguson, 75, listens to music therapist Angela Howard sing and play the guitar. Ferguson was hospitalized in the geriatric unit of the University of Alabama Hospital, Birmingham. (Hal Yeager for KHN)
Queze Ferguson, 75, listens to music therapist Angela Howard sing and play the guitar. Ferguson was hospitalized in the geriatric unit of UAB Hospital-Highlands. (Hal Yeager for KHN)

In May, she passed away.

“Her heart was already at a bad stage,” Rich-Horn said. “By the time [the hospital] got her, it was too late.”

NEW STUDY FINDS HOMEBOUND, ELDERLY PATIENTS MISSING OUT ON IN-HOME CARE

Published by UVA Today
By Jane Kelly
August 19, 2016

The saying goes that “what is old is new again.” Many elderly Americans are hoping that proves true.

According to Forbes Magazine, house calls made up 40 percent of U.S doctors’ patient encounters in the 1940s before that figure started to drop off in the 1960s.

A new study involving the University of Virginia finds that older, frail Americans – up to 4 million of them – live at home, but are not getting the health care they need. Aaron Yao, an assistant professor in the Department of Public Health Sciences in UVA’s School of Medicine, said bringing back the house call can greatly help this population.

“We don’t have enough home-based medical care,” Yao said. “In the good ol’ days, doctors always go to patients, but as the technology is getting more advanced, and medicine gets more specialized, our health care is more hospital and office-centered.”

Yao and his colleagues analyzed 2012 and 2013 Medicare payment data to track home visits around the country. They found that geographical location plays a large role in whether or not a patient can be seen in his or her home. Most live more than 30 miles from care providers, putting them out of reach from doctors and nurse practitioners who typically do not travel that distance to see patients.

The new study also highlights another problem: the United States is facing a huge shortage of doctors who make home visits. Yao said less than 1 percent of primary care physicians routinely make house calls.

According to the study, published this month in Health Affairs, a major health policy journal, “About 5,000 primary care providers made 1.7 million home visits to Medicare fee-for-service beneficiaries in 2013, accounting for 70 percent of all home-based medical visits. Nine percent of these providers performed 44 percent of visits.”

The current fragmented model of health care does not serve the full scope of needs of homebound Americans, which results in large expenditures because of hospitalizations and visits to the emergency department, Yao said.

With the U.S. continuing to age, caring for patients in their homes will save money because it prevents people from ending up in the emergency room or the hospital, he said. “If I am old and have problems, but I have my symptoms controlled, then I probably won’t need to call 911. From the society’s perspective, it actually saves a lot of money.”

The study found that the homebound elderly account for more than half of the costliest 5 percent of patients. But pushing for more home-based medical care is not just cost-effective, “it’s also about quality of life,” Yao said.

So how can patients receive care in their homes? Yao recommends they look for home-based medical care providers in their communities, and ask their current doctors to help find in-home care. He also suggested doctors consider adding home-care visits to their schedule, even if for just one day a week or month.

“It’s a more patient-centered model,” he said, adding that health care professionals who do this have huge job satisfaction. “They love their jobs,” he said.