Focusing on statistics from Minnesota, researchers from Indiana University School of Medicine and the Regenstrief Institute report on the inadequacy of quality of care indicators for nursing home residents with behavioral and psychological systems related to dementia in a study published in the November 2011 issue of the Journal of the American Medical Directors Association.

“Measuring quality of care is complicated, but we really need to do a better job,” says Arif Nazir, M.D., assistant professor of medicine at the IU School of Medicine and the study’s first author. A geriatrician, Dr. Nazir serves as the president of the Indiana Medical Directors Association. Medical directors are physicians who provide care to those residing in nursing homes and other long-term care facilities. “We are a society that looks to scores for everything from cars to hotels, but for nursing homes, scorecards aren’t the endgame.”

The 80-and-above age group is the fastest growing segment of the U.S. population. One out of every five individuals in this age group is in a nursing home or will require nursing home placement in the future, the majority due to dementia.

Poor ratings may cause facilities with the most experience with dementia to be overlooked or rejected by those seeking placement for a family member who needs these services. A low score is given, for example, for worsening of behavioral and psychological symptoms associated with cognitive impairment. However, this decline is due to the natural progression of the disease, and not necessarily because quality of care is poor according to the study.

“Since quality measures for dementia behaviors are not appropriately evaluated, that throws the entire rating system off,” Dr. Nazir said. “A facility with a large number of cognitively impaired residents and with staff members who are trained to help them will receive a lower score than a facility with fewer cognitively impaired residents. The scoring system for nursing homes doesn’t accurately evaluate the quality of care provided to individuals with dementia, and it needs to be changed.”

In addition to looking at scorecards, he suggests families also investigate the patient-to-staff ratio; whether prompt quality medical care is available to residents when needed; cleanliness of the facility; and proximity to family members who may visit. He also recommends consulting the checklist on the U.S. government website http://www.medicare.gov/NHCompare for other considerations before making a nursing home placement decision.

He strongly counsels against using only the one-to-five-star ratings (indicating much below average to much above average) on the federal and state websites to make a placement decision.

Nursing homes’ quality indicators are used for regulation and facility quality improvement as well as public reporting. “Our study stresses the importance of having nursing home quality indicators tailored to the special needs of dementia residents, including the quality of their lives as well as their physical needs,” said study co-author and sociologist Greg Arling, Ph.D., associate professor of medicine at the IU School of Medicine, Regenstrief Institute investigator and IU Center for Aging Research center scientist.

“The federal nursing home quality reporting system is currently being revised. It will be interesting to see how these revisions impact the way degree of cognitive impairment and specialized Alzherimer’s units are rated,” Dr. Arling said.

Those are the key findings of a study of two group living care homes in the Netherlands, published in the September issue of the Journal of Clinical Nursing.

“It’s estimated that 80 million people worldwide will suffer from dementia by 2040″ says Ezra van Zadelhoff from Maastricht University. “Up until now, traditional care for people with dementia has mostly been provided in large nursing homes.

“However, a number of countries are increasingly providing care in small group homes, which offer a more domestic environment focusing on normal daily life. These include group living concepts in the Netherlands, Sweden, Germany and Japan.

“Our study focused on two group living units that had been established for approximately 30 months, each providing care for ten residents with dementia. Both were located in the grounds of a traditional large-scale, non-profit making nursing home in an urban area in southern Netherlands.”

The units both centre around a communal living room and kitchen. Eight residents have a private bedroom with their own furniture, 12 share a bedroom with someone else and the units are both decorated to create a homely feel.

All residents require 24-hour care and this is provided by nine nursing staff (7.2 full-time equivalents) aged from 20 to 60 years, with experience in geriatric care. Nursing staff work with the residents to perform household tasks like washing, cleaning and preparing meals in the kitchen and organise activities like walking, exercises and singing.

A multidisciplinary team – nursing home physician, psychologist, physiotherapist and occupational therapist – are involved as required. Both units adhere to a ‘home for life’ principle, with residents staying there until the end of their lives.

The research team carried out 32 hours of observation over eight days and carried out in-depth interviews with five residents, four family members and four staff.

The key headline findings and observations included:

Residents felt at home and most gathered in the living room during the day to talk, drink coffee or read. Everyday activities provided stability and clarity. People were also able to get involved in familiar activities, like laying the table or washing-up, and this helped them to maintain their identity and feel more at home.

“I can go to my room when I like. But I don’t often do so, I prefer to stay in the living room with others.”

“I always do the washing here. I always did this at home as well.”

Family members were able to get more involved in the group home than they could do in a nursing home. They were treated as members, rather than visitors, had a key and tended to visit more regularly, often helping with personal care and chores. Some family members found this level of involvement more difficult than others and this could lead to tension. But most were happy to visit, get involved in everyday activities at the home and take their relatives to medical appointments, church or the hairdresser, as required.

“It is like being at home. For the visitors this is far more pleasant.”

“My mother is at home here. In the traditional unit there were many people who did not know each other. Here she knows everybody.”

Nurses built good relationships with the residents and were able to provide individual care tailored to their needs. However, this could make them feel more emotionally attached and compromise their clinical or professional distance. In most cases they were able to work with family members to provide aspects of personal care, but in some cases there were disagreements about who should be responsible for some care.

“As a staff member I feel that there is more engagement compared with regular care. When something is the matter with a resident I feel more involved, more close.”

“People get on well with each other, experience the group as a household, we live as a family.”

“The findings of our study indicate that the key to providing person-centred care for people with dementia is to enable people to be themselves and live in an environment where they and their families can get involved in normal daily activities” says Ezra van Zadelhoff.

“However the model is not without its problems. Nursing staff get more involved with residents and this can conflict with their clinical and professional distance. And the families in our study varied in how much they wanted to get involved in the care provided by the home, which sometimes led to tension.”

The study, which focused on nursing homes in New Mexico, found that when a facility had between 51 and 75 percent of its health care personnel with direct patient care vaccinated, the chances of a flu outbreak in that facility went down by 87 percent.

“The Centers for Disease Control and Prevention have long recommended that health care personnel in nursing homes get vaccinated against the flu, but we didn’t know just how much help these recommendations might be in reducing flu outbreaks among residents,” said Aaron Wendelboe of the University of Oklahoma, the lead author of the study. “We found strong evidence to support the CDC’s recommendation that to protect residents of nursing homes, health care personnel should be vaccinated annually.”

In association with the New Mexico Department of Health, Wendelboe and his team surveyed influenza rates at the state’s 75 long-term care facilities during the 2006-2007 and 2007-2008 flu seasons. They then looked for correlations between vaccination rates at each facility and whether there was an influenza outbreak.

While increased vaccination of direct care healthcare workers was associated with fewer flu outbreaks, the study found that vaccination rates among residents did not discourage outbreaks. In fact, higher resident vaccination was correlated with a higher probability of an outbreak. That result was unexpected and hard to explain, the researchers say. “While the explanation is likely multi-factorial, we suspect a large factor is that facilities with high resident vaccination rates may over-rely on the direct protection bestowed by vaccinating the residents and under-value the indirect protection bestowed by vaccinating employees,” Wendelboe and his team write.

Despite recommendations by the CDC and the Society for Healthcare Epidemiology of America, vaccination rates among U.S. healthcare workers still hover under 65 percent.

“That vaccinating health care personnel provided more protection to residents than vaccinating residents themselves underscores the importance of these recommendations,” Wendelboe said.

The authors investigated the extent of the effects that can be achieved by strength (resistance) training in elderly persons and which intensities of exercise are useful and possible in persons older than 60 years. They found that regular strength (resistance) training increased muscle strength, reduced muscular atrophy, and that tendons and bones adapt too. These successes in turn had a preventive effect in terms of avoiding falls and injuries. Greater intensities of training yielded greater effects than moderate and low intensities. In order to increase muscle mass, an intensity of 60-85% of the one-repetition-maximum is required. In order to increase rapidly available muscle force, higher intensities (>85%) are required. The optimum amount of exercise for healthy elderly persons is 3 to 4 training units per week.

In the coming decades, the importance of maintaining the ability to work and to make a living will increase, as will the need for independence in everyday life and leisure activities. The increase in the retirement age to 67 years from 2012 means that one in three adults of working age will be older than 50 by 2020, and by 2050, the proportion of people older than 60 in Germany’s population will rise to an estimated 40%. Currently, the proportion of elderly persons who practice strength (resistance) training is about 10-15%.

This policy note reports the first findings from a yearlong effort to follow the lives and challenges encountered by several dozen representative older Californians in Los Angeles, San Diego, San Francisco and Santa Clara who are enrolled in Medicare and Medi-Cal and who receive in-home and community care.

The documentary project comes as California lawmakers consider additional cuts to a network of services that help seniors remain “safely in their homes” — the stated goal of these public programs and the way in which an overwhelming number of Americans say they want to age.

The policy note, “Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent,” shows seniors struggling to live functional lives in the face of already reduced caregiving hours. For example:

Caring for the caregivers

Sara cares for her disabled son and husband, whose heart disease, diabetes, incontinence and limited mobility require 24-hour care. There’s help from In-Home Supportive Services (IHSS) and other family members, but Sara is the primary caregiver. Now, her back is acting up. She’s been delaying seeing a doctor to take care of her own needs — who will care for her family if she’s hospitalized?

Delicate balance

Paralyzed by polio, Mary breathes with the help of a ventilator and gets around in a wheelchair. She needs help to dress, bathe, use the toilet and eat. She’s created an elaborate system to meet her needs, using maximum IHSS hours of support and offering room and board to another caregiver in return for care. Mary’s happy with her life and rates her health as “excellent,” but she knows that even a small change in the delicate balance of her care system will send her to a nursing home.

His choice

Incapacitated by stroke and diabetes and confined to a wheelchair, Jack spent time in a nursing home a couple of years ago, and he’s not in a hurry to go back. In the nursing home, he felt unsafe and more isolated than he does in his own house with support from IHSS. Jack’s a realist. He knows a nursing home may be in his future again, but he wants to choose when and where he’ll go.

According to the researchers, all participants in the study are aware that the networks of care they’ve cobbled together could easily unravel, and most say they’d rather “make do” by eating less often, letting their homes become less safe or allowing their medical conditions to worsen than give up their independence and go to a nursing home — the likely scenario if they lose the in-home services they now rely upon.

“These seniors are using every sort of innovation and self-deprivation to make do,” said Steven P. Wallace, the study’s senior author and associate director of the UCLA Center for Health Policy Research. “They have nowhere to turn if their fragile care systems are further undermined.

“Policymakers need to see the faces of these vulnerable Californians as they crunch the numbers in budget discussions,” Wallace added. “Further cuts are an assault on their independence. Slashing in-home and community care will also increase total health care costs as these seniors increasingly use emergency room care, are hospitalized or enter institutions — under conditions that could have been prevented.”

Budget cuts looming

California, which is home to the largest number of older adults in the country, has several programs funded by federal, state and local dollars to assist low-income adults with disabilities. Proponents of these programs say that while such care isn’t perfect, it is far less expensive and more humane than the alternative — placing seniors in publicly financed nursing homes.

Yet, IHSS program-hours were trimmed by 3.6 percent in January 2011, and they face further across-the-board cuts of 8.4 percent, plus additional targeted reductions in the governor’s proposed budget. Adult day health care centers are slated for elimination, and supplemental security income cash benefits are to be reduced for single low-income aged and disabled individuals.

All the older adults in the study receive IHSS support, ranging from 20 hours of in-home help each month to the maximum of 283 hours per month. Most need help with household tasks, such as cleaning and cooking, and personal tasks like getting dressed or taking medications. Many require help getting in and out of bed, bathing and using the toilet. Some who might benefit from adult day health care or other supportive programs are unable to participate because of limited mobility or lack of transportation.

“California’s current system to support old and young adults with disabilities at home operates in silos and is not person-centered,” said Bruce Chernof, M.D., president and CEO of the SCAN Foundation, which is funding the study. “The Brown administration has an important opportunity to design a more stable, integrated, efficient and person-centered system that can meet the needs of these vulnerable residents throughout the state.”

via Aging safely at home? California’s disabled elderly are barely holding on.

In the study, researchers, using data from the 2007 California Health Interview Survey, found that even though 91 percent of California seniors reported seeing a doctor in the past year, a fall was rarely the reason for the visit. In fact, less than half (46.6 percent) of seniors who had fallen more than once reported a fall as the reason for a doctor’s appointment.

Those who did not seek medical help were less likely to engage in activities that might prevent future falls — only about 31 percent did two or more follow-up activities to prevent falls. In contrast, 73 percent of seniors who did seek medical care after a fall engaged in two or more follow-up activities.

“Following up with a doctor after a fall is critical to senior health,” said UCLA Center for Health Policy Research associate director Steven P. Wallace, lead author of the policy brief. “The safeguards we discuss are some of the best ways of preventing additional falls and the disastrous health consequences associated with falls.”

Falls among the elderly are a widespread problem. More than half a million older Californians (565,000) fell more than once in 2007 — about 100,000 more than reported multiple falls in 2003, according to the California Department of Public Health and the Office of Statewide Planning and Development.

Falls are directly linked to declining health among older Americans: More than 1,400 California seniors died due to injuries from falls in 2007, and approximately 67,000 more were hospitalized.

National guidelines issued by the American Geriatrics Society and other organizations recommend the following activities for reducing the risk of falling among older adults with a history of falls: (1) an evaluation by a health professional with counseling on how to reduce falls, (2) a review of medications, (3) home modifications, (4) exercise and/or (5) physical therapy, and (6) using a cane or walker if needed.

The study’s authors recommended a number of ways to encourage seniors and health care providers alike to prevent multiple falls, including:

• Train first responders – The authors cite a Nevada County, Calif. program that provided emergency medical technicians and paramedics with an assessment and referral form for seniors who call 9-1-1 when they fall but decline to be taken to the emergency room.
• Educate/incentivize health providers – Boost efforts to increase awareness among health care professionals of relatively new billing codes that help track a patient at risk of falls (ICD-9 diagnosis code V15.88 and CPT-II treatment code 1100F). Specifically, the codes are used when a patient has more than two falls in a year or one fall with injuries. In addition, physicians who participate in Medicare’s Physician Quality Reporting Initiative can earn a 1.5 percent quality-of-care bonus if they report specified quality measures that include falls screening.
• Involve the community – Fostering broad-based community coalitions is the most effective way to raise awareness of the problem of senior falls and to advocate for policies to reduce the risk of falls. Supporting and expanding these efforts can reduce the rates of falls among seniors, improving the quality of life of older adults in California while reducing medical care costs.

Read full article via Science Daily

This means the NHS will either be well-placed to cope with the impending financial squeeze on public services due to the recession, or will struggle because the slow build-up to the expected cuts means it is unable to swing into action quickly enough.

Read full story via University of Leeds.

Elderly woman with carer31 of the UK’s leading dementia scientists have signed an open letter calling on the government to use today’s 21st July ministerial summit on dementia research to end “years of underfunding”. They are calling for a threefold increase in investment into efforts to find new treatments, preventions and cures for Alzheimer’s and other dementias.

The Alzheimer’s Research Trust coordinated campaign has the backing of two other charities: the Alzheimer’s Society and Parkinson’s Disease Society. The letter warns that the UK’s “key weakness is lack of funding, not lack of talent”.

Read full story via University of Leeds.

Read full article via SeniorHousing News

Read full story via Winchester Star

Winchester Star.

Read full article via: Building Design & Construction.

Fleetwood Enterprises, Inc. Files Voluntary Petitions for Chapter 11 Protection; Motor Home, Housing Businesses Will Continue Operations – Mar 10, 2009.

Read full press release here:

Read full article here: Senior Housing News

Read full article here: Leesburg Today

Lutheran senior housing partnership provides model for expanding ministries and revenues.

Sandpoint, ID, February 12, 2009 –(PR.com)– http://www.ecumen.org – Churches, such as First Lutheran Church in Sandpoint, Idaho, and their senior housing development partner Ecumen, see aging as an opportunity to help people live better and expand ministries. The two recently collaborated on Luther Park at Sandpoint, a new senior housing community that opened in December 2008.

“We saw a greater purpose for the vacant land adjacent to our church than simply selling it to the highest bidder,” said Pastor Olson. “We wanted to build upon the Great Commandment of loving your neighbor as yourself and the Great Commission of spreading Jesus’ word and work. That led to our congregational vision of creating this community that will keep seniors vitally engaged in our church, will nurture multi-generational relationships, and will help us realize new revenue streams that will support and help us to expand our ministry.”

Ecumen, affiliated with the Evangelical Lutheran Church in America (ELCA) and one of the country’s largest non-profit senior housing, services and development companies, led development of Luther Park of Sandpoint and now manages it for First Lutheran Church, which owns Luther Park.

Read full press release here …. PR.com.

Lisa got the idea for the detox and many of her recipes from the Hallelujah Diet. She was turned on to the group by her mother who recently died of cancer.

Detox Diet | WSPA.

Families can get insurance to help protect the assets of relatives in assisted living facilities through the Chubb Group of Insurance Companies.

Under Chubb’s Masterpiece® assisted living care option, policyholders can help protect the assets of parents or grandparents in an assisted living facility, children or siblings living indefinitely in a mental health care facility or any relative who requires continuous and indefinite residential care.

“Moving loved ones into an assisted living facility is a difficult decision that can expose them to new risks, such as theft and damage of personal belongings, identity fraud and personal liability,” said Peter Spicer, communications manager for Chubb Personal Insurance.

According to U.S. Census figures, about 6.5 million older people need assistance with daily living activities. That number is expected to double by 2020.

And according to a nationwide survey of more than 1,000 people conducted by Opinion Research Corp., 62 percent of respondents are very concerned that a relative living in an assisted living facility or nursing home could become a victim of theft. Sixty-seven percent are very concerned the family member could become a victim of a scam or identity theft, and 51 percent are very concerned that he or she could become involved in a physical or verbal altercation.

“It’s never easy to entrust the care of loved ones to an assisted living facility,” Spicer said. “Our new option gives families peace of mind by offering coverage for loss to their relative’s property and asset protection from liability exposures.”

Read full press release here…

But today, a variety of financial options are available through a number of sources offering more flexibility and access to resources when it is most needed. Here are a few good options to consider.

To learn about additional financial resources that may suit your needs, download our complete Financial Options Guide here, including a Senior Living Expense Worksheet. You may be surprised to find how home maintenance and outside services add up compared to senior living options.

ElderLife Financial Services

Sunrise Senior Living is pleased to share that it has a relationship with ElderLife Financial Services, offering prospective and current residents and their families a loan to bridge the gap in funding short-term and long-term senior living costs. People waiting for the sale of a home or for veterans’ benefits to start among others may benefit from an ElderLife loan.

In its simplest form, ElderLife Access allows seniors to:

* Borrow only what is needed each month

* Structure a loan like a line of credit

* Have more affordable monthly payments when funds are not readily available

* Move into a senior living community without selling their home or using the home as security for a loan

* Access care as soon as it’s needed

* Have up to six family members or responsible parties together on one loan

Read full article…Financial Options.

You’re not alone. According to data compiled by the National Association of Home Builders 50+ Council, more than a 100,000 units targeting the over-55 seniors market were built in 2008. And although these units tend to be roomy — the average home in an active senior community has two bedrooms and about 2,000 square feet, the Council noted — they don’t have the extra all-purpose room or storage space that the old family home had.

And that is a problem, particularly for women who are downsizing. A Canadian study done by a company that specializes in staging homes for sale, reported that while 32 percent of males ranked storage space as the “most important,” aspect of a new home, 54 percent for females did.

“The new place may have a small storage locker but it will probably not have an attic or extra large garage for storage,” points out Bruce Klotzman of Our Attic Storage, “so the decision to downsize sometimes means facing another, more emotional decision for seniors — disposing of some precious family heirlooms.”

Read full article herer:  Seniors Moving to New Home Face Storage Problems.