Category Archives: Assisted Living

Neglect Unchecked

Source: Kaiser Health News, 2018-2019

This Kaiser Health News series examines the reasons that long-term care facilities, their owners and the government fail to protect residents.

Though nursing homes are among the most heavily regulated types of medical providers, they remain dangerous places for frail residents. Four of 10 were cited for harming a patient or putting them in jeopardy over a three-year period.

Assisted living facilities have notably less oversight than nursing homes, even though they increasingly care for elderly people who are so frail that they might otherwise be in a nursing home.

This Kaiser Health News series examines the reasons that nursing homes, their owners and the government fail to protect residents.

Articles include:
Nursing Home Fines Drop As Trump Administration Heeds Industry Complaints
By Jordan Rau, Kaiser Health News, March 15, 2019
Inspectors are citing nursing facilities for violating health and safety more often than during the Obama administration. But the average fine is nearly a third lower than it was before President Donald Trump took office.

Assisted Living’s Breakneck Growth Leaves Safety Of Dementia Patients Behind
By Jordan Rau, Kaiser Health News, December 17, 2018
An analysis of inspection records in California, Florida and Texas shows significant numbers of violations related to assisted living residents with dementia.

1,400 Nursing Homes Get Lower Medicare Ratings Because Of Staffing Concerns
By Jordan Rau and Elizabeth Lucas, Kaiser Health News, July 30, 2018
Medicare said those homes either lacked a registered nurse for “a high number of days” over three months, provided data the government couldn’t verify or didn’t supply their payroll data at all.

‘Like A Ghost Town’: Erratic Nursing Home Staffing Revealed Through New Records
By Jordan Rau, Kaiser Health News, July 13, 2018
Daily nursing home payroll records just released by the federal government show the number of nurses and aides dips far below average on some days and consistently plummets on weekends.

60 Caregiver Issues

Source: PHI, 2017

In 2017, PHI began identifying the most pressing policy issues facing direct care workers. Our research, unique industry expertise, and partnerships with state and national leaders aptly position us to address a worsening concern: direct care workers are walking away from this sector at a time when we need critical supports to age in our homes and communities. In turn, families and the agencies that serve them are left with few options.

Recognizing a growing workforce shortage among our nation’s home care aides, nursing aides, and personal care aides, as well as the need to provide quality care to a rapidly growing population of older people and people with disabilities, PHI launched a national campaign: 60 Caregiver Issues.

Over the course of two years, PHI will release a new issue every 2-3 weeks, inspiring policy makers and long-term care leaders to pinpoint what needs to be done to remedy this shortage and create a vibrant, sustainable system of long-term care.

Underpaid, unpaid, unseen, unheard and unhappy? Care work in the context of constraint

Source: Donna Baines, Sara Charlesworth, Tamara Daly, Journal of Industrial Relations (JIR), Vol. 58 no. 4, September 2016
(subscription required)

From the abstract:
Care work – in its paid and unpaid forms – spans the private, public and non-profit sectors in addition to being an essential underpinning of home and community life (Duffy et al., 2015). Due to its close association with gendered expectations of elastic, uncomplaining work undertaken by women across the continuum of home, community and residential places, care work continues to be undervalued in numerous ways (Baines, 2004; England, 2005; Folbre, 2008). Indeed, care workers often work in conditions in which they are underpaid, unpaid, unseen, unheard and unhappy (Daly and Szebehely, 2012; Palmer and Eveline, 2012). These conditions are related to government austerity models; how care work is regulated within employment relations; state, market and private roles providing and funding care; and how care work organisation is shifting in the context of austerity strategies, policies of constraint, continued high demand, decreased union density and increasing standardisation.

These conditions and the women who work within them and around them are the focus of this Special Issue: Care Work in the Context of Constraint. The Special Issue draws together international researchers and scholars in a close investigation of the complexity of care work in the era of austerity policies.
Government bodies that fund care work have been under increasing pressure to cut costs, expand accountability and contribute to austerity agendas (Brennan et al., 2012; Cunningham et al., 2014; Grimshaw and Rubery, 2012). This impacts at the level of care organisations in the form of decreased financial resources and increased obligations to provide documentary and statistical evidence of the care provided to service users…..

2016 Genworth Cost of Care Survey

Source: Genworth Financial, 2016

The Genworth Cost of Care Survey has been the foundation for long term care planning since 2004. Knowing the costs of different types of care – whether the care is provided at home or in a facility – can help you plan for these expenses. The 2016 survey, conducted by Carescout®, one of the most comprehensive of its kind, covering 440 regions across the U.S. and based on data collected from more than 15,000 completed surveys.

Monthly Costs: National Median (2016)
Home Health Care
Homemaker Services – 2016 Cost – $3,813
Home Health Aide – 2016 Cost – $3,861

Adult Day Health Care
Adult Day Health Care – 2016 Cost – $1,473

Assisted Living Facility
Assisted Living Facility – 2016 Cost – $3,628

Nursing Home Care
Semi-Private Room – 2016 Cost – $6,844

Private Room – 2016 Cost – $7,698

Raise the floor: Quality nursing home care depends on quality jobs

Source: Paraprofessional Healthcare Institute (PHI), April 2016

From the abstract:
Outlines the case for improving jobs for certified nursing assistants, a workforce totaling 650,000 people that allows nursing home residents to live with dignity and as much independence as possible. The report argues that the low quality of nursing assistant jobs — which are characterized by low pay, poor benefits, erratic scheduling, and little advancement opportunity — has an adverse effect on the quality of nursing home care. It suggests numerous ways to improve these jobs, thereby improving care for nursing home residents across the country.

America’s Growing Senior Population: Assessing the Dimensions of the Demographic Challenge

Source: Bipartisan Policy Center, Health and Housing Task Force, Background Paper, September 2015

From the summary:
….In April 2014, BPC also launched the Long-Term Care Initiative to develop policy recommendations to improve financing mechanisms and delivery of long-term services and supports, including better integration across the Medicaid and Medicare programs. In May 2015, BPC‘s Prevention Task Force released policy recommendations focusing on opportunities to better integrate non-clinical health and social-service interventions with the delivery system as a means to help prevent costly and debilitating consequences of chronic disease.

Building upon past and ongoing BPC projects, the task force will focus its work in the following areas:
– Identifying cost-effective ways to modify U.S. homes and communities to make independent living for seniors safe and viable.
– Increasing the supply of affordable housing for seniors, particularly housing with supportive services.
– Identifying barriers to the integration of acute care and home- and community-based services in the Medicare and Medicaid programs and exploring how to scale up successful models of care so that seniors can remain at home or in the community.
– Highlighting best practices for integrating housing and health drawn from a range of politically diverse states and localities.
– Identifying opportunities for further programmatic collaboration between the U.S. Department of Housing and Urban Development and U.S. Department of Health and Human Services to improve outcomes and promote greater efficiencies.

Fulfilling these objectives first requires an understanding of the dimensions of the demographic challenge the nation faces. The following pages attempt to provide some of this context.

Medicaid and Long-Term Services and Supports: A Primer

Source: Erica L. Reaves and MaryBeth Musumeci, Kaiser Family Foundation, May 2015

From the introduction:
Medicaid is the nation’s major publicly-financed health insurance program, covering the acute and long-term services and supports (LTSS) needs of millions of low-income Americans of all ages. With limited coverage under Medicare and few affordable options in the private insurance market, Medicaid will continue to be the primary payer for a range of institutional and community-based LTSS for persons needing assistance with daily self-care tasks. Advances in assistive and medical technology that allow persons with disabilities to be more independent and to live longer, together with the aging of the “Baby Boomers,” will likely result in an unprecedented need for LTSS over the coming decades. To reduce unmet need and curb public health care spending growth, state and federal policymakers will be challenged to find more efficient ways to provide high quality, person-centered LTSS across service settings. This primer describes LTSS delivery and financing in the U.S., highlighting covered services and supports, types of care providers and care settings, beneficiary subpopulations, costs and financing models, quality improvement efforts, and recent LTSS reform initiatives.

Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

Source: U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3148-04R, 2015

Healthcare and social service workers face significant risks of job-related violence and it is OSHA’s mission to help employers address these serious hazards. This publication updates OSHA’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers. OSHA’s violence prevention guidelines are based on industry best practices and feedback from stakeholders, and provide recommendations for developing policies and procedures to eliminate or reduce workplace violence in a range of healthcare and social service settings.

These guidelines reflect the variations that exist in different settings and incorporate the latest and most effective ways to reduce the risk of violence in the workplace. Workplace setting determines not only the types of hazards that exist, but also the measures that will be available and appropriate to reduce or eliminate workplace violence hazards.

For the purpose of these guidelines, we have identified five different settings:
■ Hospital settings represent large institutional medical facilities;
■ Residential Treatment settings include institutional facilities such as nursing homes, and other long-term care facilities;
■ Non-residential Treatment/Service settings include small neighborhood clinics and mental health centers;
■ Community Care settings include community-based residential facilities and group homes; and
■ Field work settings include home healthcare workers or social workers who make home visits.

Indeed, these guidelines are intended to cover a broad spectrum of workers, including those in: psychiatric facilities, hospital emergency departments, community mental health clinics, drug abuse treatment centers, pharmacies, community-care centers, and long-term care facilities. Healthcare and social service workers covered by these guidelines include: registered nurses, nurses’ aides, therapists, technicians, home healthcare workers, social workers, emergency medical care personnel, physicians, pharmacists, physicians’ assistants, nurse practitioners, and other support staff who come in contact with clients with known histories of violence. Employers should use these guidelines to develop appropriate workplace violence prevention programs, engaging workers to ensure their perspective is recognized and their needs are incorporated into the program….

Special Issue: 2015 White House Conference on Aging

Source: Gerontologist, Volume 55 Issue 2 April 2015
(subscription required)

From the introduction:
The White House Conference on Aging (WHCoA), held once every decade since the 1960s, offers a unique opportunity to shape the national landscape for policies affecting older Americans. Although some have debated the impact of past WHCoAs on public policy developments in the field of aging, there is consensus that the 1961, 1971, and 1981 conferences were catalysts for the establishment of many key programs representing the aging policy of the United States today—including Medicare and Medicaid, the Older Americans Act nutrition program, the Supplemental Security Income program, the National Institute on Aging, Social Security reform, expansion of home care coverage under Medicare, and the Older Americans Act. The 1995 and 2005 conferences primarily focused on reaffirming support for existing federal social programs, notably Medicare and Medicaid. Although few new initiatives were proposed, these more recent conferences highlighted a new vision of national aging policy. Framed on the concepts of aging as a lifelong process embracing all generations and recognition of the growing diversity of the older population and its vast reserves of talent and experience, the 1995 and 2005 WHCoAs featured significant involvement of grassroots stakeholders, with more than 800 preconference events in 2005.
The Gerontological Society of America (GSA) always has had a special relationship with the WHCoA. GSA played an active role in many previous conferences; its members and staff were involved in numerous preparatory events and follow-up reports. In 2005, thanks to GSA-led cross-country forums, focus groups, and subsequent white paper recommendations, civic engagement was included as a key WHCoA theme. In that spirit, The Gerontologist committed to developing a Special Issue preparing for the 2015 WHCoA…..

Articles include:
The Neoliberal Political Economy and Erosion of Retirement Security
Larry Polivka and Baozhen Luo

Age-Friendly Community Initiatives: Conceptual Issues and Key Questions
Emily A. Greenfield, Mia Oberlink, Andrew E. Scharlach, Margaret B. Neal, and Philip B. Stafford

Public Health Imperative of the 21st Century: Innovations in Palliative Care Systems, Services, and Supports to Improve Health and Well-Being of Older Americans
Mary Beth Morrissey, Keela Herr, and Carol Levine

Workplace-Based Health and Wellness Programs: The Intersection of Aging, Work, and Health
Marcie Pitt-Catsouphes, Jacquelyn Boone James, and Christina Matz-Costa

Creating a Comprehensive Care System for Frail Elders in “Age Boom” America
Joanne Lynn and Anne Montgomery

Re-Imagining Long-Term Services and Supports: Towards Livable Environments, Service Capacity, and Enhanced Community Integration, Choice, and Quality of Life for Seniors
Rosalie A. Kane and Lois J. Cutler

A New Long-Term Care Manifesto
Robert L. Kane

Improving Policies for Caregiver Respite Services
Miriam S. Rose, Linda S. Noelker, and Jill Kagan

Informal Caregiving and Its Impact on Health: A Reappraisal From Population-Based Studies
David L. Roth, Lisa Fredman, and William E. Haley