“Grandma, is it time for you to die?” Is this subject inevitable ? Yes.  Controversial?  It depends.  This is a topic for family to discuss.  However now with the new health care bill it seems that the government will be involved in these discussions.  This is a mixed bag.  Please weigh in with your thoughts on the subject.

Doctors see benefit in end-of-life controversy

Physicians say it’s brought needed attention to often overlooked service

 By Jessica Marcy

 KHN

 The paragraphs, buried deep in the 1,000-page House health reform bill, appear innocuous, but they have ignited a firestorm among critics predicting government-sponsored euthanasia.

The controversy, over proposed Medicare funding of end-of-life counseling, has come to epitomize some of people’s deepest fears about the government’s role in health care.

Yet physicians who work with patients on end-of-life planning say that while they are surprised and upset about criticism of the proposal, it has brought needed attention to what they view as a long under-funded and overlooked service. Jon Radulovic, vice president for communications at the National Hospice and Palliative Care Organization, says the debate dispute “is providing the end-of-life care community with an opportunity to talk about what good care is and the services that are available.”

Section 1233 of the House bill would reimburse physicians for advance care planning consultations with any Medicare beneficiary, but it does not mandate the completion of any advance care directive or living will. The provision, advocates say, would pay for doctors to have those conversations while a patient is healthy and communicative rather than in the middle of a health crisis.

‘Death panel’ rumors
Much of the furor has centered on claims that the provision would give rise to ‘death panels’ and euthanasia, which experts have dismissed. But critics also have raised concerns about the vagueness and complexity of the language in the bill, asserting that it could be open to a wide interpretation and encourage government to play an excessive role in end-of-life issues.

Sen. Chuck Grassley, R-Iowa, the top Republican on the Finance Committee, vowed the panel would not include such a provision in its much anticipated health care reform package. “I don’t have any problem with things like living wills,” he said. “But they ought to be done within the family. We should not have a government program that determines if you’re going to pull the plug on grandma.”

Dr. Ted Epperly, president of theAmericanAcademyof Family Physicians, often has advance end-of-life conversations in his work as a family physician and geriatrician inBoise,Idaho. He says the discussions can protect patients from having costly procedures done against their will.

He describes such conversations as sensitive and time-consuming since they delve into the “nitty gritty” details: whether patients want to use ventilators to breathe, defibrillation to restart their hearts or feeding tubes for nourishment. He says the discussions are best done with a trusted physician who has developed a relationship with the patients. Family members are also sometimes involved, he says.

Patients’ end-of-life wishes
To start such a conversation, Dr. Diane E. Meier, an internist and director of the Center to Advance Palliative Care in New York City, says she asks her patients what they would want if they were hit by truck and in a coma or a situation where they were not expected to recover sufficiently to be aware of their surroundings. Some say they would want everything possible done to prolong life, But roughly nine out of 10 of her patients say they would want care to be focused on their comfort — not sustaining life — if their brain was not functioning, according to Meier.

Dr. Gene Rudd, an ob-gyn and senior vice president of the Christian Medical & Dental Associations, said such conversations are part of good health care and should be encouraged. However, he worries that the provision could require that physicians use standardized language to counsel patients.

“It’s nothing novel here,” he said. “The novelty is the government then may be deciding that it can say what ought to be said in those sessions, not the fact that they ought to have these sessions and these discussions. It’s standard care.”

Still, health professionals say, these discussions are too rare. That’s largely because Medicare doesn’t explicitly pay for the service, discouraging doctors from taking the time to talk with patients about the issues. Private insurance companies often base their own payment policies on Medicare’s.

Currently, physicians generally classify the conversations under a funding code covering counseling and discussion of issues such as marital problems and depression associated with a job loss, Epperly says.

Medicare typically pays $92.33 for a 40 minute consultation, which Epperly says “drastically underpays for the complexity and the importance of this discussion,” adding that the creation of a new code — as called for in the House bill — would better value its importance.

‘Act of charity’
Under the current payment system, Epperly notes, doctors could see five patients or complete a more lucrative procedure in the time it would take them to have an in-depth end-of-life consultation.

Meier, who also works as a professor of geriatrics and internal medicine at Mount Sinai School of Medicine, agrees: “It’s time consuming, it takes skills and it is so poorly paid that it is basically an act of charity … Physicians who are in a fee-for service environment legitimately cannot really afford to have” such conversations.”

“In my view, (the House bill) is a small and mostly symbolic effort to redress that imbalance of which physician services get paid for and which don’t,” she says.

In addition to the payment issues, doctors often don’t have such conversations because of time constraints and the sensitive nature of such talks. The shortage of primary care doctors has also contributed to the problem, experts say.

According to Epperly, as a result, only one out of five patients who should have such a consultation actually does.

Both opponents and proponents of the legislation acknowledge that it could produce significant savings. Studies show that 25 percent of the Medicare budget is spent on people during their final year of life — with 40 percent of that spent in the final month.

Opponents worry that the cost savings might give doctors incentives to discourage treatment when they talk with their patients. The non-profit policy group Americans United for Life posted the following statement on its Web site: “The provisions that address end-of-life issues must be amended to leave no room for an interpretation that would pressure healthcare providers to make decisions based on cost rather than best medical care.”

Proponents say several studies show that having such conversations not only saves money but improves quality of care.

Researchers found patients with advanced cancer who had end-of-life care conversations with physicians had significantly lower health care costs in their final week of life while higher costs were associated with worse quality of care, according to a 2009 study published in the Archives of Internal Medicine.

In addition, hospice has been shown to improve quality of life and reduce costs during the end of life. Patients using hospice care save Medicare close to $2,400 per beneficiary, researchers fromDukeUniversityconcluded in a 2007 study. Meanwhile, research has found that hospice patients lived an average of 29 days longer than similar patients who did not enroll in hospice, according to a 2007 study in the Journal of Pain and Symptom Management.

Congress has waded into this issue before. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established the Hospice Education Consult, which provides Medicare coverage for a one-time hospice consultation that examines end-of-life care.

However, in order for that consultation to qualify for payment, the patient must be diagnosed with a terminal illness and have a prognosis of six months or less to live. Also, the act did not create a unique funding code.

High-tech beds to help the elderly and infirm

By Patrick May

pmay@mercurynews.com

Posted: 01/08/2012 04:38:00 PM PST

Updated: 01/09/2012 05:30:00 AM PST
First, we had the smartphone.

Then the smart meter.

Now, coming soon to an elder-care facility near you, it’s the “smart bed.”

Using gee-whiz software and a small but powerful sensor embedded in a thin pad beneath the mattress, the two Apple (AAPL) alums behind Campbell-based startup BAM Labs have created a device to monitor patients’ vital signs and movements without a single wire or electrode.

Launched in October, the Touch-free Life Care System (or TLC — get it?) is already being used in scores of beds in seven facilities, offering real-time remote monitoring of the bedridden. Its creators, who say they’ve exported their “Apple DNA” into the user-friendly product, claim that patient falls and bed sores have plummeted in the retirement homes where the smart beds are being used.

The ah-ha moment came in 2001.

“My wife gave birth to twins at 28 weeks,” said CEO Rich Rifredi, who worked as a product marketing manager at Apple alongside Steve Young, now BAM’s chief technology officer. “My son came home attached to a monitor by a bunch of wires. At 2 a.m., a wire came off and set off the alarm and we panicked. The monitor looked like it had been designed by cavemen. I told Steve: ‘We can do better.’ ”

Fast-forward to 2006, when the BAM team turned their focus from

babies to the residential-senior market. As Young put it, “10,000 people are turning 65 every day. Who’s going to take care of them? We are, using these sorts of tools.”

With Young’s Apple-tested code-writing talents in tow, the two men eventually came up with the smart-bed concept: Embedded into a thin air-filled pad slipped beneath the bed’s mattress, a rubber-wrapped biometric sensor the size of a saltine cracker “reads” the air movement and actually measures heart beat, respiration and other vital signs by monitoring a patient’s chest movements. A small “plug computer” attached to the sensor sends the data to BAM’s servers in the cloud, then wirelessly forward the readings to the caregivers’ PCs, iPod touches and other mobile devices they carry on their rounds.

“Instead of having patients hooked up to wires, and having alarms go off in the middle of the night or having nurses forget to turn the patient at the required times, the data is constantly streamed to the mobile device in the nurse’s hand,” said Young the other day, giving a demonstration of the technology. “The caregivers like it because they now have a tool with them at all times that helps keep them focused. And they no longer have to wake up the patient to check vital signs, either; the smart bed does it for them.”

At The Terraces, an upscale retirement center inLos Gatoswhere six of the smart beds were installed several months ago, director of nursing Agnes Toribio said the BAM device is a godsend for staff who must regularly turn incapacitated patients every few hours to avoid bed sores. And avoiding bed sores, which experts say can costs thousands of non-reimbursable dollars to treat, improves the lives of people living out their last years.

“We’ve never had anything like this to help us make sure the residents are turned as required,” said Toribio. “The staff knows what they’re supposed to do, but you have to account for human forgetfulness sometimes. As a result, I’ve actually seen my patients’ skin improve over time because they’re just not developing bed sores like before.”

BAM, which stands for “body and motion,” employs 12 people, a quarter of them Apple alumni. Its advisers include Silicon Valleytech executives as well as sleep experts and researchers from leading university hospitals around the country. BAM, which has also placed beds in elder-care facilities in Marin and Sacramento, has received angel funding from such valley luminaries as eBay (EBAY) founder Pierre Omidyar and the startup prides itself on “doing something good for the world,” said Young, adding that the smart bed is a “hospital-grade instrument at a consumer-electronics price.”

A company spokesman said the beds can be leased for under $2,000 a year, which includes access to the monitor, pad and application services.

“The magic,” said Young, “is in the software,” which BAM engineers continue to improve. Future applications may include a car-seat-sized mat. Young would not go into detail, other than mentioning that driving problems “like DUI and falling asleep at the wheel” might somehow be addressed by BAM’s technology.

Besides watching vital signs, the device protects patients’ dignity, say its creators, by eliminating the morale-busting need to tangle them up in a web of electrical wires. And the smart bed also helps caregivers know immediately when someone has moved in bed, possibly indicating a risky attempt to get up. That problem is especially acute for dementia patients.

“We’ve prevented many falls using the device,” said Toribio. “We have some patients who move a lot even though they’re too frail to do so safely.

“We told one patient about the smart bed,” she said. “She’s stopped trying to get out of bed because now she knows someone’s keeping an eye on her all the time.”

Marc Siegel

4 drugs cause most emergency room visits in elderly

By Anahad O’Connor

New York Times

Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people older than 65 in theUnited States, a new study shows.

Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.

Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just below them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.

All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention.

“We weren’t so surprised at the particular drugs that were involved,” Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”

Every year, about 100,000 people in theUnited Statesolder than 65 are taken to hospitals for adverse reactions to medications. About two-thirds end up there because of accidental overdoses, or because the amount of medication prescribed for them had a more powerful effect than intended.

As Americans live longer and take more medications — 40 percent of people older than 65 take five to nine medications — hospitalizations for accidental overdoses and adverse side effects are likely to increase, experts say.

In the latest study, published in The New England Journal of Medicine, Budnitz and his colleagues combed through data collected from 2007 to 2009 at 58 hospitals. The hospitals were all participating in a CDC surveillance project run looking at adverse drug events.

A common denominator among the drugs topping the list is that they can be difficult to use. Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock. Warfarin, meanwhile, is the classic example of a drug with a narrow margin between therapeutic and toxic doses, requiring regular blood monitoring, and it can interact with many other drugs and foods.

“These are medicines that are critical,” Budnitz said, “but because they cause so many of these harms, it’s important that they’re managed appropriately.”

One thing that stood out in the data, the researchers noted, was that none of the four drugs identified as frequent culprits are typically among the types of drugs labeled “high risk” for older adults by major health care groups. The medications that are usually designated high risk or “potentially inappropriate” are commonly used over-the-counter drugs like Benadryl, as well as Demerol and other powerful narcotic painkillers. Yet those drugs accounted for only about 8 percent of their emergency hospitalizations.

“I think the bottom line for patients is that they should tell all their doctors that they’re on these medications,” Budnitz said, “and they should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.”

Big Drug Hikes in Some 2012 Medicare Plans

By Philip Moeller | US News

Medicare beneficiaries have until only December 7 to make choices for their 2012 insurance plans. The good news for 2012 is that Medicare premiums will be lower for many people. The bad news is that some insurers have changed how they charge for certain prescription drugs. Even plans with lower premiums may not have lower out-of-pocket costs, depending on the specific prescription drugs needed by a plan participant.

On the premium front, Part B premiums for basic Medicare are rising by only $3.50 a month for many people already on Medicare. The resulting $99.90 monthly premium will represent an actual decrease for people who began receiving Medicare in the past two years. They’ve already been paying higher premiums.

Average premiums for Medicare Advantage plans and subscription drug plans (Part D of Medicare) will also be lower in 2012 than this year. And drug subsidies mandated by the health reform law are raising government payments for drugs that Medicare beneficiaries must buy when they are in the drug-plan coverage gap known as the “donut hole.” This insurance gap will be reached in 2012 when payments for covered drugs total $2,930 and will end when out-of-pocket costs exceed $4,700. (For details on the donut hole, see pages 88 and 89 of the 2012 Medicare & You handbook.)

Avalere Health, a Washington-based consulting firm, studied the 2012 drug plans of the largest Part D insurers. It found that most plans will be covering fewer drugs in 2012 than this year. Also, some plans are raising co-pays on their drugs. Many also are making more use of drug-pricing tiers in their plans, and have added drugs to higher-price tiers.

These changes make it difficult to generalize about 2012 drug costs for Medicare beneficiaries. But consumers should not assume that their current drug plan will continue to be their best choice, said Bonnie Washington, senior vice president at Avalere. “What our analysis has shown is that if you look at premium alone, the monthly premium has gone down,” she said, “but the cost-sharing for particular drugs may be going up.”

Fortunately, if you know the prescription drugs you will need to take in 2012, the government’s Medicare Plan Finder will calculate out-of-pocket costs for drug plans,Washington noted.

Washingtonwalked through the Plan Finder with U.S. News, using a hypothetical Medicare participant inChevy Chase,Md., who takes two prescription drugs: Cimzia for rheumatoid arthritis and Cozaar for high blood pressure. Cimzia is an expensive drug that is placed in the top pricing tier of many drug plans, she said. Cozaar has a generic equivalent, but the branded version was retained for this price comparison. Based on these two drugs alone, there was more than a $1,000 difference in projected 2012 out-of-pocket costs for the 10 cheapest plans out of more than 30 available in Chevy Chase. Plans with the lowest premiums did not always have the lowest out-of-pocket costs.

“There is more than $1,000-a-year difference in just these 10 cheapest plans,”Washingtonsaid, and urged consumers to use the Plan Finder to compare plan costs. “You can’t assume that your plan’s coverage is going to be the same next year as it was last year,” she said. To help make comparisons easier, the Plan Finder lets users click on a “2011″ cost option once it has calculated projected plan costs for 2012.

At least three large health plans have developed discount prescription pricing agreements with leading pharmacy chains. Humana has a deal with Wal-Mart,Aetnawith CVS Caremark, and Coventry Health Care with Wal-Mart, Target, and Walgreens. In reviewing drug plans from these insurers,Washingtonsaid, consumers should check to see if Plan Finder cost projections can be lowered by picking a partner pharmacy.

Lastly, she noted, the Plan Finder is only useful in projecting prices for the specific drugs already being prescribed. Many Medicare beneficiaries will wind up taking newly prescribed drugs in 2012.

Once a year there is an opportunity to change Medicare Plans.  The Open Enrollment dates are earlier this year October 15 – December 8, 2011.  Coverage begins January 1, 2012.

You or your elder parent can join, switch or drop a Medicare Advantage Plan any time IN CERTAIN situations, i.e., if you move out of your plan’s service area, or if you have Medicaid, you qualify for extra help or live in an institution

Keep current with the new “Blue Button” on www.mymedicare.gov to access Medicare claims and other personal health information

ELDERCARE LOCATOR

Connecting you to community resources

1-800-677-1116

Assistive Technology

• What is Assistive Technology?
• What are the Benefits of Assistive Technology?
• How Can I Tell if Assistive Technology is Right for Me?
• Case Study
• How Can I Pay for Assistive Technology?
• Where Can I Learn More About Assistive Technology?

What is Assistive Technology?

Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”

Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.

Just as older people may have many different types of disabilities, many different categories of assistive devices and services are available to help overcome those disabilities. These include the following:

• Adaptive switches. Modified switches that seniors can use to adjust air conditioners, computers, telephone answering machines, power wheelchairs, and other types of equipment. These switches might be activated by the tongue or the voice.
• Communication equipment. Anything that enables a person to send and receive messages, such as a telephone amplifier.
• Computer access. Special software that helps a senior access the Internet, for example, or basic hardware, such as a modified keyboard or mouse, that makes the computer more user friendly.
• Education. Audio books or Braille writing tools for the blind come under this category, along with resources that allow people to get additional vocational training.
• Home modifications. Construction or remodeling work, such as building a ramp for wheelchair access, that allows a senior to overcome physical barriers and live more comfortably with a disability or recover from an accident or injury.
• Tools for independent living. Anything that empowers the elderly to enjoy the normal activities of daily living without assistance from others, such as a handicapped-accessible bathroom with grab bars in the bathtub.
• Job-related items. Any device or process that a person needs to do his or her job better or easier. Examples might include a special type of chair or pillow for someone who works at a desk or a back brace for someone who does physical labor.
• Mobility aids. Any piece of equipment that helps a senior get around more easily, such as a power wheelchair, wheelchair lift, or stair elevator.
• Orthotic or prosthetic equipment. A device that compensates for a missing or disabled body part. This could range from orthopedic shoe inserts for someone who has fallen arches to an artificial arm for someone whose limb has been amputated.
• Recreational assistance. New methods and tools to enable people who have disabilities to enjoy a wide range of fun activities. Examples include swimming lessons provided by recreational therapists or specially equipped skis for seniors who have lost a limb as a result of accident or illness.
• Seating aids. Any modifications to regular chairs, wheelchairs, or motor scooters that help a person stay upright or get up and down unaided or that help to reduce pressure on the skin. This could be something as simple as an extra pillow or as complex as a motorized seat.
• Sensory enhancements. Anything that makes it easier for those who are partially or fully blind or deaf to better appreciate the world around them. For instance, a telecaption decoder for a TV set would be an assistive device for a senior who is hard of hearing.
• Therapy. Equipment or processes that help someone recover as much as possible from an illness or injury. Therapy might involve a combination of services and technology, such as having a physical therapist use a special massage unit to restore a wider range of motion to stiff muscles.
• Transportation assistance. Devices for elderly individuals that make it easier for them to get into and out of their cars or trucks and drive more safely, such as adjustable mirrors, seats, and steering wheels. Services that help the elderly maintain and register their vehicles, such as a drive-up window at the department of motor vehicles, would also fall into this category.

What are the Benefits of Assistive Technology?

For many seniors, assistive technology makes the difference between being able to live independently and having to get long-term nursing or home-health care. For others, assistive technology is critical to the ability to perform simple activities of daily living, such as bathing and going to the bathroom.

According to a 1993 study conducted by the National Council on Disability, 80 percent of the elderly persons who used assistive technology were able to reduce their dependence on others. In addition, half of those surveyed reduced their dependence on paid helpers, and half were able to avoid entering nursing homes. Assistive technology can also reduce the costs of care for the elderly and their families. Although families may need to make monthly payments for some pieces of equipment, for many, this cost is much less than the cost of home-health or nursing-home care.

How Can I Tell if Assistive Technology is Right for Me?

Seniors must carefully evaluate their needs before deciding to purchase assistive technology. Using assistive technology may change the mix of services that a senior requires or may affect the way that those services are provided. For this reason, the process of needs assessment and planning is important.

Usually, needs assessment has the most value when it is done by a team working with the senior in the place where the assistive technology will be used. For example, an elderly person who has trouble communicating or is hard of hearing should consult with his or her doctor, an audiology specialist, a speech-language therapist, and family and friends. Together, these people can identify the problem precisely and determine a course of action to solve the problem.

By performing the needs assessment, defining goals, and determining what would help the senior communicate more easily in the home, the team can decide what assistive technology tools are appropriate. After that, the team can help select the most effective devices available at the lowest cost. A professional member of the team, such as the audiology specialist, can also arrange for any training that the senior and his or her family may require to use the equipment needed.

The following case study shows how conducting a needs assessment and working with a team improved the quality of life for one elderly woman and her family:

Case Study

At the age of 66, Christina did not feel old. After her divorce, she became more active than ever in her church and began doing all the things she had been wanting to do for years. She moved into her daughter Kelly’s house to save money and enjoyed her garden there in the backyard. The only thing that slowed her down was that her hearing and vision were beginning to go. She could no longer appreciate music the way she used to or see well enough to read for more than a few minutes without getting a headache. At the same time, Christina’s medical condition was beginning to affect her life at home. Kelly’s children complained that Christina turned the television set up so loud that they could not concentrate on their homework.

Although Christina was in good health otherwise, the hearing and vision problems eventually got so bad that she went to her doctors for a checkup. Her ophthalmologist told her that she had cataracts and would need operations to have them removed from her eyes. The audiologist said that she would need to get a hearing aid. Both doctors also said that she would require rehabilitative services.

Fortunately, Christina was still able to take charge of the situation and find a solution as quickly as possible. While waiting to get her eye operations done, she had her doctors set up a needs assessment team to explore other options she could pursue to make life easier both before and after her surgery. Christina worked closely with the ophthalmologist and audiologist and had physical and recreational therapists come to the house. They spent a full week analyzing Christina’s condition and her home environment. Then, they looked at alternatives that would allow Christina to remain as active as possible, while still addressing her family’s concerns.

The results were wonderful. Together, the team helped Christina get a good hearing aid that enabled her to hear well again. A special magnification device and telecaption decoder on the TV meant that she could watch television without having to bother the children. More assistive technology enabled her to talk on the telephone and use the computer as easily as ever before. In the end, the operations to remove Christina’s cataracts were successful, and she could see better than before, but she still used the magnifying screens and telecaption devices for convenience. Combined with her new hearing aid, each item convinced Christina that assistive technology can make a big difference indeed.

When considering all the options of assistive technology, it is often useful to look at the issue in terms of high-tech and low-tech solutions. Seniors must also remember to plan ahead and think about how their needs might change over time. High-tech devices tend to be more expensive but may be able to assist with many different needs. Low-tech equipment is usually cheaper but less adaptable for multiple purposes. Before buying any expensive piece of assistive technology, such as a computer, be sure to find out if it can be upgraded as improvements are introduced. Whether you are conducting a needs assessment or trying to make a decision after such an assessment, it is always a good idea to ask the following questions about assistive technology:

• Does a more advanced device meet more than one of my needs?
• Does the manufacturer of the assistive technology have a preview policy that will let me try out a device and return it for credit if it does not work as expected?
• How are my needs likely to change over the next six months? How about over the next six years or longer?
• How up-to-date is this piece of assistive equipment? Is it likely to become obsolete in the immediate future?
• What are the tasks that I need help with, and how often do I need help with these tasks?
• What types of assistive technology are available to meet my needs?
• What, if any, types of assistive technology have I used before, and how did that equipment work?
• What type of assistive technology will give me the greatest personal independence?
• Will I always need help with this task? If so, can I adjust this device and continue to use it as my condition changes?

How Can I Pay for Assistive Technology?

Right now, no single private insurance plan or public program will pay for all types of assistive technology under any circumstances. However, Medicare Part B will cover up to 80 percent of the cost of assistive technology if the items being purchased meet the definition of “durable medical equipment.” This is defined as devices that are “primarily and customarily used to serve a medical purpose, and generally are not useful to a person in the absence of illness or injury.” To find out if Medicare will cover the cost of a particular piece of assistive technology, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048). You can also find answers to your questions by visiting http://www.Medicare.gov.

Depending on where you live, the state-run Medicaid program may pay for some assistive technology. Keep in mind, though, that even when Medicaid does cover part of the cost, the benefits usually do not provide the amount of financial aid needed to buy an expensive piece of equipment, such as a power wheelchair. To find out more about Medicaid in your State call the toll free number for your State. A list of toll free numbers can be reached through the following website:

• http://www.cms.hhs.gov/medicaid/allStateContacts.asp

Seniors who are eligible for veterans’ benefits should definitely look into whether they can receive assistance from the Department of Veterans Affairs (DVA). Many people consider the DVA to have a model payment system for assistive technology because the agency has a structure in place to pay for the large volume of equipment that it buys. The DVA also invests in training people in how to use assistive devices. For more information about DVA benefits for assistive technology, call the VA Health Benefits Service Center toll-free at 1-877-222-VETS or visit the department’s website at:

• http://www1.va.gov/health/index.asp

Private health insurance and out-of-pocket payment are two other options for purchasing assistive technology. Out-of-pocket payment is just that; you buy the assistive technology yourself. This is affordable for small, simple items, such as modified eating utensils, but most seniors find that they need financial aid for more costly equipment. The problem is that private health insurance often does not cover the full price of expensive devices, such as power wheelchairs and motor scooters.

Subsidy programs provide some types of assistive technology at a reduced cost or for free. Many businesses and not-for-profit groups have set up subsidy programs that include discounts, grants, or rebates to get consumers to try a specific product. The idea is that by offering this benefit, the program sponsors can encourage seniors and people with disabilities to use an item that they otherwise might not consider. Obviously, elderly people should be careful about participating in subsidy programs that are run by businesses with commercial interests in the product or service because of the potential for fraud.

Where Can I Learn More About Assistive Technology?

Most states have at least one agency that deals specifically with assistive technology issues. The Assistive Technology Act (Tech Act) provides funds to states for the development of statewide consumer information and training programs. A listing of state tech act programs is available at:

• Abledata

Some area agencies on aging (AAA) have programs or link to services that assist older people obtain low-cost assistive technology. You can call the Eldercare Locator at 1-800-677-1116 or visit the website http://www.eldercare.gov to locate your local AAA. In addition local civic groups, religious and veterans’ organizations, and senior centers may be able to refer you to assistive technology resources.

The following resources provide information on assistive technology products and services.

Disability.gov
http://www.disability.gov
This site is designed to serve as a “one-stop” electronic link to an enormous range of useful information to people with disabilities and their families.

ABLEDATA
http://www.abledata.com
800/227-0216 or 301/608-8998
TTY 301/608-8912

ABLEDATA is a federally funded project whose primary mission is to provide information on assistive technology and rehabilitation equipment available from domestic and international sources to consumers, organizations, professionals, and caregivers within theUnited States.

Solutions: Assistive Technology for People with Hidden Disabilities
http://www.ndipat.org/uploads/resources/425/microsoft-word—solutions-book.pdf
This resource guide provides information on adapted devices for people who have memory problems.

First GPS-Enabled Walking Shoes Help Caregivers Track Alzheimer’s Patients

By Rebecca Boyle popsic.com

GPS Shoes The new walking shoes will have a GPS receiver embedded in the sole. GTX Corp.

New shoes with built-in GPS devices will go on sale this month to help track dementia patients who wander off and get lost. Caretakers can download a smartphone app that allows them to track the person wearing the shoes, which could help patients with Alzheimer’s disease stay in their homes and live autonomously for longer periods.

Caretakers or family members can even map out a “safe zone” in which their Alzheimer’s patient is free to walk without sparking worry. When the person wanders out of the safe zone, the GPS shoes will trigger an alert.

The shoes are finally going on sale two years after GTX Corp., maker of miniaturized GPS person-finder technology, announced their plans. The company said last week that the first shipment of 3,000 shoes has been distributed to the footwear company Aetrex Worldwide, which manufactures comfort shoes and orthotics. MedicAlert Foundation, which makes those eye-shapd engraved medical bracelets and operates a 24/7 emergency hotline, will provide location-based emergency services.

Walking Shoes With GPS: Designed for the elderly.  GTX Corp.

GPS tracking of dementia patients is not a new idea, but it’s difficult to ensure that a patient is always wearing the right watch or gadget that will allow them to be tracked. Some Alzheimer’s patients become paranoid and confused by new jewelry or clothing and remove them, according to Andrew Carle, a professor at George Mason University’s College of Health and Human Services, who advised the project and discussed it with the AFP. The shoes could be a simpler way to track them — odds are better that a patient won’t walk out the door without his or her shoes, at least in the early stages of the disease when wandering is a problem. The shoes look like any other senior-specific walking shoe, with a small lip that juts out near the heel.

About 5.4 million Americans suffer from Alzheimer’s, a number that is expected to nearly quadruple in the next 40 years, according to the Alzheimer’s Association. Many states have Silver Alert notifications to help search for wandering senior citizens, but time is of the essence — up to half of wandering seniors suffer serious injury or death within 24 hours — so GPS would be much quicker. The shoes were originally conceived for runners and children, according to the AFP, but GTX changed their plans when Carle advised them on the need for tracking Alzheimer’s patients.

GPS shoes marketed for Alzheimer’s patients: Will they save lives?

By

Ryan Jaslow  CBS News

GTX Corp. GPS shoe

(Credit: GTX Corp.)

(CBS) Move over medical ID bracelets. A Los Angeles-based company has developed shoes with a GPS tracking system for dementia sufferers.

PICTURES: Alzheimer’s disease: 7 things that raise your risk

GTX Corp. has developed 3,000 pairs which will be sold online and at select retailers by Aetrex Worldwide, the AFP reported. The $300 shoes contain a GPS system in the heel that lets family members track the location of the wearer.

Family members can also establish a safe zone which will set off an alert if a family member steps out of it, Katie Lindendoll, CBS The Early Show’s tech expert , said in a segment.

Who can the shoes help?

This shoe could be especially beneficial for people in the earliest stages of Alzheimer’s, according to Dr. Andrew Carle, director of the senior housing administration atGeorgeMasonUniversity’sCollegeofHealth and Human Services, who served as an advisor to the project.

“They might be living in their home but they’re confused,” Carle told the AFP. “They go for a walk and they can get lost for days.” Carle said some studies show up to 60 percent of Alzheimer’s sufferers will wander and become lost – and half of those who are not found within 24 hours might die.

This isn’t the first device to ensure Alzheimer’s patients safety. There are bracelets and pendants that contain address information in case a person wanders, and some are equipped with tracking devices. But sometimes sufferers rip those off since the disease triggers paranoia, so they might dislike the unfamiliar object. Shoes on the other hand might not be so unfamiliar.

Nearly 6 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. By 2050, that number might rise to 21 million.

WebMD has more on Alzheimer’s

Social Security recipients to get 3.6 percent more

By STEPHEN OHLEMACHER – Associated Press | AP – 

WASHINGTON (AP) — Some 55 million Social Security recipients will get a 3.6 percent increase in benefits next year, their first raise since 2009, the government announced Wednesday.

The increase, which starts in January, is tied to a measure of inflation released Wednesday morning.

About 8 million people who receive Supplemental Security Income will also receive the 3.6 percent cost-of-living adjustment, or COLA, meaning the announcement will affect about one in fiveU.S.residents.

There was no COLA in 2010 or 2011 because inflation was too low. Those were the first two years without a COLA since automatic increases were adopted in 1975. However, Social Security recipients did receive a one-time $250 payment from the economic stimulus package passed in 2009.

Monthly Social Security payments average $1,082, or about $13,000 a year. A 3.6 percent increase will amount to about $39 a month, or just over $467 a year, on average.

Advocates for seniors said the raise will provide a much-needed boost to the millions of retirees and disabled people who have seen retirement accounts dwindle and home values drop during the economic downturn. Economists say the increase should provide a modest boost to consumer spending, which should help the economy.

Still, many seniors feel like they have been falling behind.

Nancy Altman, co-chair of the Strengthen Social Security Campaign, said she is pleased Social Security recipients will get a raise next year. But, she added, “The COLA is still not enough to keep up with health care costs.”

“Despite the absence of a Social Security COLA, over the last two years out-of-pocket health care costs rose 14.1 percent for seniors and people with disabilities, effectively reducing the value of Social Security benefits,” Altman said.

Most retirees rely on Social Security for a majority of their income, according to the Social Security Administration. Many rely on it for more than 90 percent of their income.

“For many of our seniors, the creeping costs of medical care, food and housing have forced them to stretch their limited incomes to the breaking point,” said Rep. Xavier Becerra ofCalifornia, the top Democrat on the House Social Security subcommittee. “And after two years without any cost-of-living increases, our seniors are getting some much-needed relief.”

Some of the increase in January will be lost to higher Medicare premiums, which are deducted from Social Security payments. Medicare Part B premiums for 2012 are expected to be announced next week, and the trustees who oversee the program are projecting an increase.

The amount of wages subject to Social Security taxes will also go up next year. This year, the first $106,800 in wages is subject to Social Security payroll taxes. Next year, the limit will increase to $110,100, the Social Security Administration said.

Of the 161 million workers who will pay Social Security taxes next year, about 10 million will get a tax increase from the change, the agency said.

Workers pay a 6.2 percent Social Security tax on wages, which is matched by employers. For 2011, the tax rate for workers was reduced to 4.2 percent. The tax cut is scheduled to expire at the end of the year, though President Barack Obama wants to expand it and extend it for another year.

Several economists said the Social Security increase should provide a modest boost in consumer spending next year. However, David Wyss, former chief economist at Standard & Poor’s, noted that most analysts have already factored the COLA into their growth estimates for next year.

“The COLA will help the economy a bit,” Wyss said. “At least, it is moving in the right direction. But it is not a game-changer.”

Federal law requires the program to base annual payment increases on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). Officials compare inflation in the third quarter of each year — the months of July, August and September — with the same months in the previous year.

If consumer prices increase from year to year, Social Security recipients automatically get higher payments, starting the following January. If price changes are negative, the payments stay unchanged.

Social Security payments increased by 5.8 percent in 2009, the largest increase in 27 years, after energy prices spiked in 2008. But energy prices quickly dropped and home prices became soft in markets across the country, contributing to lower inflation in the past two years.

As a result, Social Security recipients got an increase that was far larger than actual overall inflation.

However, they can’t get another increase until consumer prices exceed the levels measured in 2008. Wednesday’s announcement shows that prices have exceeded those measured in 2008, said Polina Vlasenko, an economist at the American Institute for Economic Research, based in Great Barrington, Mass.

Wednesday’s COLA announcement comes as a special joint committee of Congress weighs options to reduce the federal government’s $1.3 trillion budget deficit. In talks this summer, Obama floated the idea of adopting a new measure of inflation to calculate the COLA, one that would reduce the annual increases.

Advocates for seniors mounted an aggressive campaign against the proposal, and it was scrapped. But it could resurface in the ongoing talks.

“The relief expressed by many should serve as a reminder about how important the COLA is — the difference between filling a prescription, cutting back on food or turning the heat up during a cold spell,” said Eric Kingson, co-director of Social Security Works, an advocacy group. “It also should remind those politicians who are talking about cutting all future COLAs that they are playing with fire, the lives of fellow Americans and their own political futures.”

___

Associated Press reporters Chris Rugaber and Martin Crutsinger contributed to this report.

Elder abuse is a problem that will likely grow.  Everyone should learn more about this.  This report from the National Institute of Justice explains the topic but also points out how little we know.  If you have ideas, feed back, questions or suggestions let us know. The Keys Please would like to hear from you.  Thank you.

U.S.Department of Justice, Office of Justice Programs National Institute of Justice The Research, Development, and Evaluation Agency of theU.S.Department of Justice

Elder Abuse as a Criminal Problem

Elder abuse and neglect is an understudied problem in theUnited States. Historically viewed as a social rather than a criminal problem, most States did not establish adult protective services units until the mid-1980s.

Full extent of elder abuse uncertain. Criminal justice researchers have generally paid little attention to elder abuse until recently. No uniform reporting system exists, and the available national incidence and prevalence data from administrative records are unreliable due to varying State definitions and reporting mechanisms. A 2007 nationally representative study of over 7,000 community residing elders estimated that approximately one in ten elders reported experiencing at least one form of elder mistreatment in the past year. See Extent of Elder Abuse for more from this study.

Research still is needed to determine the prevalence elder abuse, neglect and exploitation among elders with dementia and those residing in residential facilities, to identify risk factors for victimization, and to evaluate the efficacy of interventions.

No forensic guidelines. The lack of research on the forensic aspects of elder mistreatment is of particular concern to criminal justice practitioners. At present, the medical community cannot easily distinguish between those types of injuries that indicate abuse or neglect and those that are the natural effects of illness or aging. Few experts are available to testify in court and limited data exist to bolster cases brought into the system.

Extent of financial exploitation unknown. In addition, little is known about the financial exploitation of seniors in the United States, as these crimes are difficult to detect, definitions vary, and no national reporting mechanism now exists. Such cases are often not reported. [2] Adding to the problem, some victims of financial exploitation may be unaware of being exploited owing to cognitive disabilities or dementia. Likewise, dependence on the perpetrator for care or shelter, fear of retaliation, or fear of the loss of independence if their exploitation should become known keeps many elders from reporting financial abuse.

Identifying Elder Abuse

NIJ’s Elder Mistreatment research program — supported in part by the U.S. Department of Justice’s Elder Justice and Nursing Home Initiative — has produced significant data on the following issues:

Bruising in the Geriatric Population

Documenting normal bruising patterns in this population is the first step toward differentiating accidental from suspicious bruising. An NIJ-funded study found that:

• Accidental bruises occur in a predictable pattern.
• Most accidental large bruises are on the extremities.
• The initial color and appearance of bruises changes over time and is less predictable than previously thought.
• Individuals who are on medications known to make bruising more severe and those with compromised functional ability are more likely to have multiple bruises. [1]

The second step in differentiating accidental from suspicious bruising is to document bruises in elderly individuals who are confirmed victims of elder mistreatment. A follow-up study funded by NIJ found that:

• Sixty percent of examined bruises were inflicted, 14 percent were accidental and 26 percent were of unknown causes.  Most participants from the study of non-abused elders (71 percent) could not identify the cause of any of their bruises.
• A majority of abused elders (56 percent) had a large bruise (>5 cm), which is much higher than the percent of non-abused elders from the previous study with a large bruise (7 percent).
• Abused older adults were more likely than non-abused elders to have bruises on the head, neck or torso. [2]

Determining Abuse as a Cause of Elder Death

An NIJ-funded study examined how medical examiners make determinations in cases of suspicious elder deaths and found that they rarely can differentiate symptoms of illness from signs of abuse in elderly decedents. As a result, signs of abuse that are commonly recognized in younger decedents are missed in elders, and abuse is rarely seen as a cause of death. These findings call for additional research on both the decisionmaking practices of medical examiners and the forensic markers of elder mistreatment. They also highlight the need for medical examiners to receive additional training on this issue. [3]

Potential Markers for Elder Mistreatment

Researchers in Arkansasidentified specific characteristics within four categories of markers that investigators can look for to determine whether elder mistreatment is occurring or has occurred — see table Potential Markers for Elder Mistreatment. [4]

This study is ongoing; the researchers hope to:

• Determine whether the Arkansas Long-Term Care Reporting law has actually made a difference in quality of care.
• Further elucidate markers.
• Development of an adaptive investigative model for coroners and medical examiners.

Notes

[1] Mosqueda, L., K. Burnight, and S. Liao. Bruising in the Geriatric Population (pdf, 22 pages). Final report to the National Institute of Justice, June 2006, NCJ 214649.

[2] Wiglesworth A., R. Austin, M. Corona, and L. Mosqueda. Bruising as a Forensic Marker of Physical Elder Abuse (pdf, 27 pages) . Final Report to the National Institute of Justice, February 2009, NCJ 226457.

[3] Dyer, C.B., L. Sanchez, L. Kim, J. Burnett, S. Mitchell, B. Reilley, S. Pickens, M. Mehta. Factors That Impact the Determination by Medical Examiners of Elder Mistreatment as a Cause of Death in Older People (pdf, 74 pages ). Final report to the Office for Victims of Crime, July 2008, NCJ 223288.

[4] Lindbloom, E., J. Brandt, C. Hawes, C. Phillips, D. Zimmerman, J. Robinson, B. Bowers, and P. McFeeley. Role of Forensic Science in Identification of Mistreatment Deaths in Long-Term Care Facilities (pdf, 96 pages) . Final report to the National Institute of Justice, January 2005, NCJ 209334.

Date Modified: May 18, 2009

 
Perpetrators of Elder Abuse

The National Research Council defines elder abuse and mistreatment as:

1. intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder, or
2. failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.”

NIJ has funded two studies that identify characteristics of those caregivers who perpetrate elder mistreatment. 

In a court-based study of abused women in Rhode Island over the age of 50, researchers reviewed court records — cases in which the perpetrator has been prosecuted for a crime — and found that: [1]

• Nearly half of the suspects had a prior criminal history on record in the state.
• Over a quarter had a prior court case for domestic violence.
• Two in ten had a prior record for a drug- or alcohol-related event.
• Fourteen percent had a prior case for a crime against person (non-domestic).
• Sixteen percent had been sentenced to prison for a prior charge.

In a telephone survey of nearly 6,000 elderly individuals, victims of elder physical mistreatment reported that: [2]

• A majority (57 percent) of perpetrators of physical abuse were partners or spouses.
• Half of perpetrators were using drugs or alcohol at the time of the mistreatment.
• Three in ten perpetrators had a history of mental illness.
• Over a third of perpetrators were unemployed.
• Four in ten perpetrators were socially isolated

Notes

[1] Klein, A., T. Tobin, A. Salomon, and J. Dubois. A Statewide Profile of Abuse of Older Women and the Criminal Justice Response (pdf, 94 pages), Final Grant Report to the National Institute of Justice, March 2008, NCJ 222459.

[2] Acierno R., M. Hernandez-Tejada, W. Muzzy, K. Steve. National Elder Mistreatment Study (pdf, 183 pages), NCJ 226456, March 2008, Grant Report.

Addressing Elder Mistreatment

Some jurisdictions have developed innovative approaches to improve system response to elder mistreatment, such as special elder abuse prosecution units, elder fatality review teams, and the expansion and improvement of statutes that mandate abuse reporting for vulnerable adults. Although these approaches show promise, they are in the nascent stages of their development and have not been rigorously evaluated.

For example, researchers have examined implementation of the Arkansaslaw giving county medical examiners the authority to investigate deaths occurring in long-term care facilities (LCF). [1] They conducted focus group interviews with medical examiners, coroners, and geriatricians from 27 States to determine their involvement in investigations into the deaths of LCF residents. Although Lindbloom’s findings suggest that the Arkansas law had a positive impact on attention to elder mistreatment and the quality of care of LCF residents in Pulaski county, whether care has improved State-wide is not clear because of differences in implementation.

Researchers in Arkansasidentified specific characteristics within four categories of markers that investigators can look for to determine whether elder mistreatment is occurring or has occurred—see Potential Markers for Mistreatment [2].

The second phase of this study concluded in 2007. The resulting data indicates that the Arkansas Long-Term Care Reporting law, which mandated that all deaths that occur in nursing homes in Arkansasbe officially investigated, has not made a difference in quality of care in the state. The project also revealed additional factors associated with higher level of mistreatment suspicion, including family dissatisfaction with care; minority race; tube feeding; the presence of a severe pressure sore or recent ostomy. [2]

The Office for Victims of Crime (OVC) teamed up with the American Bar Association to produce a replication manual to aid elder abuse fatality teams in reviewing the causes of elder deaths and enhancing the response of community agencies to elder victims of abuse.

Notes

[1] A brief description of the Arkansas law and how it came about can be found in the research report Role of Forensic Science in Identification of Mistreatment Deaths in Long-Term Care Facilities. A final report submitted to the National Institute of Justice, January 2005, NCJ 209334.

[2] Lindbloom, E., J. Brandt, C. Hawes, C. Phillips, D. Zimmerman, J. Robinson, B. Bowers, and P. McFeeley. “Role of Forensic Science in Identification of Mistreatment Deaths in Long-Term Care Facilities.” Final report submitted to the National Institute of Justice, January 2005, NCJ 209334.

[3] Lindbloom, E., R. Kruse; J. Brand; M. Malcolm; A. Hough, Jr.; D. Zimmerman and J. Robinson. “Mandatory Reporting of Nursing Home Deaths: Markers for Mistreatment, Effect on Care Quality, and Generalizability Final Report (pdf, 98 pages).” Final report submitted to the National Institute of Justice, March 2008, NCJ 221893

Financial Exploitation of the Elderly

No national reporting mechanism exists for tracking the financial exploitation of elders. According to a 1998 study by the NationalCenteron Elder Abuse, financial abuse accounted for about 12 percent of all elder abuse reported nationally in 1993 and 1994 and 30.2 percent of substantiated elder abuse reports submitted to Adult Protective Services in 1996 after excluding reports of self-neglect. [1] A 2000 survey of the National Association of Adult Protective Services Administrators conducted for the National Center on Elder Abuse found that financial exploitation comprised 13 percent of the mistreatment allegations investigated. Many experts in the field, however, believe that the level of elder exploitation may well exceed what has been reported to authorities and documented by researchers. [2]

Notes

[1] National Center on Elder Abuse. “The National Elder Abuse Incidence Study.” Final report to the Administration on Children and Families and Administration on Aging, U.S. Department of Health and Human Services, Grant No. 90–AM–0660, 1998.
23(4): Summer 2002.Washington,DC: American Bar Association.

[2] Teaster, P.B. A Response to the Abuse of Vulnerable Adults: The 2000 Survey of State Adult Protective Service (pdf, 85 pages).Washington,DC:NationalCenter on Elder

Sexual Abuse of the Elderly

Sexual abuse is one of the most understudied aspects of elder mistreatment. An NIJ-sponsored study that examined elder sexual abuse found that: [1]

•Elderly sexual assault victims were not routinely evaluated to assess the psychological effects of an assault.

•The older the victim, the less likelihood that the offender would be convicted of sexual abuse.

•Perpetrators were more likely to be charged with a crime if victims exhibited signs of physical trauma.

•Victims in assisted living situations faced a lower likelihood than those living independently that charges would be brought and the assailant found guilty.

Next section: Publications on Elder Abuse.

Note

[1] Burgess, A.W., and N.P. Hanrahan. “Identifying Forensic Markers in Elder Sexual Abuse.”  Final report to the National Institute of Justice, Grant No. 2001–IJ–CX–K015.

Date Created: November 8, 2007

For more information and additional reports see the site for National Institute for Justice   http://www.nij.gov/welcome.html  Thank you – The Keys Please