Archive for March, 2014

What providers should do to improve long-term care for frail older people?

iStock_000019409019MediumThe NHS’s greatest success has become its most daunting challenge: people are living longer but increasingly with one or more conditions, a demographic change that drives up both demand and costs. As a result, the current model of care for our most vulnerable members of society is at a tipping point and is no longer fit for purpose.

In the latest report by the Deloitte Centre for Health Solutions, we estimate that the NHS and social care spend on over-65s living with at least one long-term condition is at least £30bn a year. However, this is spent largely on expensive acute intervention and residential care rather than on prevention, self-management, early intervention and helping people live well and independently for longer.

We examined the scale of this challenge and outlined a series of actions that health and social care providers and commissioners should consider. Some of these are already being piloted, but there is a strong case to be made for these to be expedited immediately.

In the short-term
Commissioners should look at levers such as:
• Focusing on offering joint personal budgets for the health and social care of all frail over 75s, while supporting them with care navigators to get best value out of these budgets. These should be reviewed annually.
• Adopting new funding models to provide the right care in the right long term care settings at the right time. This should include moving from volume to outcome, value-based payment models.
• Developing incentives to encourage providers to adopt technology to support the delivery of care and improve the interface between providers and patients, particularly between hospitals and care homes and general practices and people’s homes.

In the meantime
Health and social care providers should look at some of the following options:
• Notwithstanding the issues with, expediting the inter-operability of data systems to allow multiple patients and providers to share data in real-time. Shared patient records are particularly essential for frail older people. At the same time, primary care practices should work with social care providers to offer annual health checks to patients aged 75 and over. They should also establish an electronic patient registry and track treatments and complications.
• Reviewing place of care and workforce capacity and capability. Geriatricians should come out of the hospital setting to assess and intervene in the community, and GPs should be reaching into hospitals to seek training in frailty management and providing appropriate care.
• Ensuring staff receive relevant training on the impact of ageing on health, and are certified to their level of competence in managing conditions associated with aging. A key concern raised in our report was that those who spend the most time caring for frail older people are typically those with the lowest skills and levels of pay.
• Increasing the input of primary community district nurses and other health professionals to manage older people who are frail. Currently there is no supply large enough to meet this demand, suggesting that in 2014-15 all staff will need to be more agile, accessing data and information on the move and spending more time with patients. Mobile technology has a key role to play in enabling this and delaying or preventing the need for more expensive institutional care.

These are by no means all the answers to the challenges facing the care system, and implementing these, particularly when the complex and varied needs of older, vulnerable people are taken into account, will be challenging. But the increasing numbers of frail older people aren’t in a position to wait for policymakers to take five to ten years to develop the more integrated health and social care system that successive governments have agreed is the desired model of care. There are good ideas being trialled, but the time has come for these to be examined and rolled out more widely.



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Kiplinger’s Personal Finance Review

Long term care insurance will remain relevant and it is because of the fact that people are living much longer and therefore they will need the help of this coverage. Around 70% of people turning 65 and those who are older will need long term care and those who are in the age bracket of 18-64 will also require any form of long term care. These numbers tell us only one thing, almost everyone of us will require this type of care and getting coverage is the most efficient way to deal with its cost. Here’s a video that can help you with your ltc planning and for more helpful videos just visit this website.

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Can Caregiving Cause Depression? One Study Says Not Really

stress1-300x200Stress and depression usually result from caregiving, but one study says otherwise. Peter Vitaliano, a professor of Psychiatry and Psychology at the University of Washington, found that genes, family, and mental health history are the main influencers of stress and depression among caregivers, and not necessarily the act of providing care to another person.

The study was conducted among 1,228 female caregiving and non-caregiving twins. Results of the study show that those who didn’t experience depression before have slimmer chances of falling into it due to caregiving. Meanwhile, those who have been depressed in the past are more likely to go through it again because of caregiving.

20% of caregivers are found to be mildly to severely depressed, while only 2% to 3% of non-caregivers are found to be going through depression. Though this shows a significant difference, the depression rate should be more than 20% to safely conclude that caregiving can actually cause depression.

Meanwhile, Peter also found that the participants’ skills in coping with stress are influenced by how their parents reacted to distress such as job loss. Furthermore, the study found that social support and financial resources also influence the way a person reacts to stress.

How to Handle Caregiver Depression and Stress
Caregiving can result to depression and stress. However, the results of Peter’s study prove that there are other factors why caregivers experience these conditions. If you are a caregiver, here are ways on how you can prevent and cope with stress and depression:

  • Take care of your health. This seems so basic, yet a lot of caregivers tend to neglect their wellbeing. Maintain a healthy lifestyle by eating the right kind of food, getting enough hours of sleep, and doing exercise.
  • Participate in a support group. Though caregivers are strong, they still can’t do everything. That’s why support groups are very essential for caregivers. Through this circle, they can get caregiving advice, share stories, and gain friends.
  • Spend time with friends and loved ones. It’s important for caregivers to remember that there’s life outside caregiving. Aside from boosting your social well-being by spending time with your family and friends, this also helps you unwind and regain your energy.
  • Don’t forget to relax. Remember that you have personal needs to fulfill. Every once in a while, take a moment to unwind. Relaxation doesn’t necessarily mean going on vacation. Sometimes, all it takes is a few minutes of alone time.
  • Keep a positive outlook. Based on the findings of Peter’s study, we can say that maintaining a positive perspective avoids, or at the very least, lessens stress and depression among the elderly. As you go through your responsibilities, find ways on how you can make it fulfilling. Though it can be difficult, it can be a rewarding experience for caregivers like you.


Image Credit: Flickr


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Continuing Care Retirement Communities are Not Isolating Settings

P_154_092811110348Continuing care retirement communities don’t create the same problem of isolation as skilled nursing facilities, according to new guidance on a recently finalized Medicaid regulation.

In January, the Centers for Medicare & Medicaid Services issued a final rule on home- and community-based services. This rule mandated person-centered care for Medicaid beneficiaries receiving HCBS, and it defined which settings would be eligible to participate in an HCBS program. These settings should be integrated into the community and provide residents with full access to the community, the rule stated.

Nursing centers were specifically excluded as a viable HCBS setting in the final rule. Continuing care retirement communities — which often include skilled nursing services — are a different story, according to a memorandum released Thursday.

In part because CCRCs include independent living residents as well as those receiving home- and community-based services, they “do not raise the same concerns about isolation” as similar settings, such as group homes that are co-located on the same campus, the guidance document stated.

The memorandum was part of a “compliance toolkit.” Other documents included assessment questions for whether a particular setting meets HCBS criteria, and a schematic illustration of the process for receiving an HCBS Medicaid waiver under the more stringent guidelines now in place.

Visit their website to get updated with the latest news in the long term care industry.


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Free AARP LTC Calculator



With the way the cost of care is rising and with myriad of options available today, families find it a bit difficult to find high quality but affordable care. However, families can finally find the most appropriate type of long term care for their loved ones by means of this long term care calculator. Through this, they can learn the estimate cost of ltc in their respective areas. Visit their website now to use this free ltc calculator.

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AALTCI’s Free Guide



Are you one of those people who are planning to buy long term care insurance? AALTCI offers free 2-minute guide that can help you reduce the cost of your ltci coverage. Visit their website now to learn about different savings and discount option that can cut your long term care insurance premiums for up to 50%.

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Dying with Dignity: LGBT Couples’ Need to Plan for All Possible Futures

gay_flag-300x196It seems appropriate in a column titled “For Graceful Aging” that we should discuss “Dying with Dignity”: What are our options when aging successfully, healthfully, and happily is no longer possible?

Granted, we are opening a topic that many consider taboo.  But just as with all other aspects of aging gracefully and successfully, discussion and planning smooth the road ahead, so this may well be a discussion you want to have between you and your partner.  On the other hand, you may also  want to include several other people who are important in your life in the conversation.  So, where does the discussion begin?

First, understand that assisted suicide, sometimes referred to as “aid in dying,” is illegal in all but four states: Washington, Oregon, Montana, and Vermont.  Very few countries permit the practice.  New Jersey is one of the latest states to consider some form of legalized assisted suicide.  Jack Kevorkian famously, or infamously, went to jail in 1999 after helping an estimated 130 people in their efforts to end their lives.

Second, you may want to have this be part of a larger conversation between you and your spouse/partner and other loved ones.  That conversation should include legal documents, medical care planning, financial and long term care insurance issues, discussions about living arrangements and accommodations, quality of life, and many “what if” topics: What if you are incapacitated?  What if you have Alzheimer’s, ALS, cancer, paralysis?  What if you can’t take care of yourself or each other?  What if you can no longer stay together?

What is your threshold quality of life?  What is your partner’s?  How bad does it have to be before you would want it to end?  All are difficult questions.  All are important considerations.

According to LGBT Elder Initiative (LGBTEI) member Michael Clark, a nurse who served on the ethics committee of a university-affiliated teaching hospital for 20 years, “The two main issues faced by patients and their loved ones are symptom management, including pain, and quality of life.”  Clark says, “I think that the issue is best framed as promoting comfort and dignity to people with terminal illness who have the capacity to express their preferences related to the care that they receive at the end of life.”

Along with these most difficult discussions and decisions, talk to each other about your plans for successful aging.  Where do you want to live in retirement?  Do you want to age in-place?  Is a continuing-care or assisted-living community desirable?  Are they even options?  When should you file an application for subsidized senior housing?

Should you have long-term-care insurance?  How will you pay for hospitalizations or in-home care?  What will be the financial position for the surviving partner when one passes away?

These questions and many others are part of important discussions that should take place — now.  These conversations are difficult, emotional, and critically necessary BEFORE you get sick, BEFORE a catastrophe occurs, BEFORE decisions are required in a turbulent environment.

For same-sex couples, dealing with these issues up front is especially important.  Marriage equality is an earthquake of changes that will not be settled for some time.  And even when it is “settled” law, not all couples will choose to marry.

After beginning discussions with your partner, often a difficult task even on easy topics, start making concrete decisions.  Put those decisions in writing and make sure that they are legally binding.  Execute a will, a living will, financial and medical powers of attorney, and a disposition of remains.

Several publications and websites are available to help you plan for successful aging and end-of-life issues.  A Google search will get you to these.  To help inform your conversations about dying with dignity, contact Compassion & Choices at 800.247.7421800.247.7421.  Another resource,, provides information about controversial and important topics, and they have a state-by-state guide to physician-assisted suicide.

As part of your planning and decision-making process, seek the support of a geriatrician, geriatric social worker, elder-law attorney, or other professional with experience navigating end-of-life decision-making.  The EI’s Clark believes that “it is crucial that you not only express your wishes but also that you develop strong relationships with supportive others. The supportive network, which includes clinicians and loved ones, must establish and maintain an open and trusting relationship.”

Finally, if you are considering suicide because you are depressed or for a reason other than dealing with a fatal or painful and debilitating illness, please seek help from your health care provider, faith representative, or a trusted friend.  Some hotlines that you can access are: VET2VET, a veteran’s crisis hotline, at 877.838.2838877.838.2838; or National Suicide Prevention Lifeline at 800.273.8255800.273.8255 or 800.784.2433800.784.2433.  For Spanish language, call 888.628.9454888.628.9454.



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