JustCare

Category: Long-term care

  • Nursing homes can be cool places to live: The Eden Alternative

    Nursing homes can be cool places to live: The Eden Alternative

    When we think about nursing homes, many of us conjure up images of large, lifeless, antiseptic-smelling institutions filled with lonely people waiting to die. But, nursing homes can be cool places to live.

    Dr. Bill Thomas, a believer in and creator of innovative nursing homes, sees growing older as an opportunity for enrichment and embeds this view into his nursing homes. When he transformed the nursing home at which he served as medical director, he brought in dogs, cats, parakeets, hundreds of plants and a vegetable garden as well as a day-care center for staff’s kids. He called it the Eden Alternative.

    What happened? Older adults no longer felt helpless, lonely or bored. Residents began caring for the animals and the garden. They became more autonomous. They became less anxious and needed fewer medications. And, they were better able to care for themselves. Moreover, the death rate declined.

    Now we can find these nursing homes in all 50 states and around the world,  And, Dr. Thomas has taken it further with Green Houses. Green Houses are small nursing homes, in which every resident has his or her own bedroom and bathroom.  Click here to read more about Green Houses on Just Care.

    You can read more about Dr. Thomas and his work in Atul Gawande’s important book, Being Mortal.

    If you want to learn more about Medicare coverage of nursing home care, which is very limited, click here. And click here to learn what you should know if your income is low and you have Medicare, including your possible eligibility for Medicaid; Medicaid covers nursing home care and other long-term services and supports.

  • Cutting edge small nursing homes: Green Houses

    Cutting edge small nursing homes: Green Houses

    If you’re looking into nursing homes for yourself or someone you love, consider a Green House.  Green Houses, conceived by Dr. William Thomas, are non-traditional nursing homes that transform long-term care, focusing on person-centered care.  They are small nursing homes that are designed to look and feel like a real home. And they promote caregiver relationships based on mutual respect and empowerment to make the lives of their residents meaningful.

    Green Houses are for older adults with or without disabilities. Studies show that they improve quality of life for residents, with higher resident satisfaction and as good health outcomes.  

    Green Houses are designed for between 10-12 residents.  Each resident has his or her own bedroom and bathroom, and there is a shared living room, dining room and kitchen.  The residents design their own daily routines.  

    Caregivers, nurse assistants, and social workers work together as a team to provide personalized care for residents. They provide four times more personal and social contact with residents than a traditional skilled nursing home. Staff are happier with their work than traditional nursing home staff.  

    Studies show that the costs to Medicare and Medicaid are as much as $2300 less than a traditional nursing home.  And, data show fewer hospitalizations for residents relative to people in traditional nursing homes.  

    Green Houses can be established as part of a traditional nursing home or independently. They began operating in 2003.  Today, there are 175 Green Houses, with about 1700 beds, in 27 states.  More than half the residents have Medicaid.  There are 16,000 nursing homes in the U.S., with about 1.5 million beds.

    Click here to learn why community matters in later life.

  • Need for more home care workers to care for older adults at home

    Need for more home care workers to care for older adults at home

    An increasing number of older adults are choosing to age in their homes rather than in nursing homes or other institutionalized settings. With the population aging, there are too few home care aides and nursing assistants to care for older adults in their communities. But, in August the D.C. Circuit upheld a new Obama Administration Labor Department regulation providing home care workers minimum wage and overtime protections, which should encourage more people to enter these professions.

    Nursing assistants and home care aides help older adults bathe, dress, transfer from their beds to a wheelchair or walker, use the toilet and eat. They also talk to patients about their health care needs and may report concerns to nurses. They sometimes take people’s blood pressure and temperature as well. Some are trained to give patients their medicines. Many of the people they care for are chronically ill, disabled or cognitively impaired.

    According to the Bureau of Labor Statistics, in 2012 the median pay for nursing assistants was $11.73 an hour or $24,400 a year. And, there were 1,534,400 jobs. Home care aides had even lower hourly wages of $10.25 and average yearly earnings of $20,820. There were 875,000 of these jobs. Training for these jobs is limited at best.

    The new Obama Administration Labor Department rule designed to provide 2 million home care workers better pay was set to go into effect in 29 states in January 2015 but then was challenged. Those states did not have a minimum wage law that applied to these workers because they did not consider Medicaid payments to be wages. These workers are now eligible for the $7.25 hourly minimum wage, as they already were in 21 other states, as well as overtime pay.

    In the 10-year period between 2012 and 2022, the Bureau of Labor Statistics projects a 21 percent average growth rate for nursing assistants and a 48 percent growth for home care aides, as compared to 11 percent average growth rate for all jobs.

    An increasing percentage of people will be over 65 in the coming years, and about 70 percent of them will require long-term care services and supports. Eleven million people needed paid long-term care services in 2013.

    Here are three tips for planning for long-term care services and supports, including questions to consider regarding long-term care insurance. Keep in mind that Medicare only covers limited home care and skilled nursing care under certain conditions.

    Until now, home care aides, like babysitters, were not eligible under federal law for overtime pay and not covered under labor rules.

  • Older and living alone, the rise of elder orphans

    Older and living alone, the rise of elder orphans

    Elder orphans, older adults living alone, should be among the chief concerns of health policy gurus and, for that matter, presidential candidates. They are single, divorced or widowed, and without children, or with children living far away. These older isolated individuals need both personal resources and community resources in order to age in place.

    According to a new report out of North Shore-Long Island Jewish Health System, there are now more than 9 million elder orphans or individuals at risk to become elder orphans—roughly 22 percent of the older adult population. In 2012, there were 43.1 million adults over age 65, representing about 13 percent of the population, according to the federal Administration for Community Living.

    Elder orphans do not have a health care proxy. They may be physically or cognitively impaired. They have no one to care for them, to act on their behalf, if they are sick or hospitalized, if choices need to be made about their current situation and the future. They often have little income and few assets. That puts them at great risk of not having their health care or life wishes honored. They often live in nursing homes, with no one to visit them or provide companionship.

    If elder orphans cannot make decisions for themselves, the state appoint may conservators or guardians to be responsible for the elder orphans’ finances and persons. The elder orphans become wards of the state and lose all rights to make decisions for themselves.

    The number of elder orphans is likely to grow substantially as the population ages. In 2012, about one in three Americans between the ages of 45 and 63 were childless and living alone, which is 50 percent more than in 1980. We need a strategy for helping them as they age; we need to plan ahead for the next likely larger generation of elder orphans.

    By 2030, some estimate that more than 5 million people—of the estimated 70 people over 65, including 9 million over 85–will need to live in a nursing home or alternative care facility because they will not have anyone to care for them at home. It’s not even clear whether there will be enough nursing home beds for these elder orphans, if they wanted to enter a nursing home. Today, there are 15,700 nursing homes with 1.7 million beds and 1.4 million residents, according to the CDC.

  • Community Aging in Place—Advancing Better Living for Elders (CAPABLE)

    Community Aging in Place—Advancing Better Living for Elders (CAPABLE)

    As the population ages, many experiments are underway to understand how best to keep people living in their homes as long as possible, sometimes called community aging in place. Not only is nursing home care extremely costly, but most older adults prefer to live at home. And, some experts believe that a few low-cost interventions can keep people in their homes months or even years longer. CAPABLE (Community Aging in Place—Advancing Better Living for Elders) is testing that proposition, helping low-income older adults with chronic conditions increase their mobility and functionality at home.

    CAPABLE relies on occupational therapists, nurses, and handymen who can help make a home safer and easier to move around in, to enable older adults to age in place.  The theory is that neither providing supports for individuals nor making changes to the home alone is adequate to help meet the needs of vulnerable older adults at risk of serious disability. But, a small investment–$4,000—in both could make a large difference in their lives and save significant money as well.

    Initial study results show that CAPABLE could improve health and daily life for many older adults, while reducing health care costs. Older adults in the study group received 10 one-hour to one-hour-and-a half visits over five months.  The handyman might lower shelves and install handrails.  The nurse might help a person organize her medications to ensure medication compliance.

    The study found that 79 percent of the 100 people receiving the CAPABLE intervention improved their self-care in five months and experienced fewer symptoms of depression.  The average participant reduced her disabilities by half and was far better able to take care of herself.

    The project was funded by a grant from the Centers for Medicare and Medicaid Services Innovation Center.

  • Long-term care is unaffordable for middle-income families

    Long-term care is unaffordable for middle-income families

    Where you live matters, for all kinds of reasons, including because it affects the long-term services and supports that may be available to you and the people you love. The big headline, though, is that long-term care is too often unaffordable for middle-income families no matter what state you live in.

    As more and more boomers begin to need long-term services and supports, new policy solutions become critical. Today, Medicaid provides the only real safety net for older adults, people with disabilities and caregivers.  But, the adequacy of Medicaid supports varies considerably among the states.  And, long-term care insurance is not meeting people’s needs.

    If you’re interested to know how your state ranks in providing long-term services and supports, AARP has developed a scorecard.  The scorecard looks at how states fare in five areas (1) cost and access, (2) care providers and settings, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions.

    Based on the scorecard, when it comes to long-term services and supports, Minnesota and Washington are the two best states to live in, and Alabama and Kentucky are the two worst states. South Dakota, New York and Montana rank 24, 25 and 26th respectively.

    For simple tips on how to plan for long-term care, click here.

  • Are you ready to start thinking about long-term care? Perhaps you should be.

    Are you ready to start thinking about long-term care? Perhaps you should be.

    It’s time to start thinking about long-term services options.

    According to a new Health Affairs report, most Americans underestimate their future need for long-term care services and supports and know precious little about their options.  Of note, those with minor children were the least likely to think they would need services and supports as they aged. Six out of ten people surveyed thought that they would not have this need, while the data suggests that seven out of ten in fact do need long-term services and supports.

    The researchers looked at expectations of adults age 40 to 65 in different living arrangements.  Those living alone were most likely to appreciate their future need for these services. Even still, long-term services and supports are unaffordable for many middle-income families. 

    Who provides long-term services and supports? Often family caregivers. Medicaid is also a major provider of these services. Click here to learn more from Just Care on different long-term services and support resources.

    For simple tips from Just Care on how to plan for long-term care, click here.

  • Individual saving and spending for long-term care services and supports

    Individual saving and spending for long-term care services and supports

    Fact: Americans pay a lot of money out of pocket for long-term care services and supports. Costs comprise 15% of overall spending in 2011. 

    Fact: In 2013, a private room in a nursing home cost about $84,000. The cost of care in an assisted living facility was $42,000. Home health aides, homemakers and companion services generally charge about $20 an hour. Home care costs can easily total $22,000 a year. Adult day care centers cost about $65 a day.

    Fact: Only 35% of Americans say that they have set aside any money to meet long-term care needs.  Many people will rely on family members for their care because nursing home and home care are so expensive. In fact, 87% of long-term caregivers are unpaid family members. 

    Click here to learn about who pays for long-term-care services and how they are delivered from the Robert Wood Johnson Foundation.  Click here for a brief look at long-term care for older adults from the Kaiser Family Foundation. 

  • Medicaid, Medicare and long-term care

    Medicaid, Medicare and long-term care

    Long-term care can cost a lot.  Medicare sometimes picks up a small piece of the cost.  Medicaid can cover a lot of the cost.  Paying out-of-pocket for long-term care tends to be extremely expensive. Here are some key facts on Medicaid, Medicare and long-term care:
    • Fact: Medicaid covers about two-thirds of all long-term care spending, about $131 billion in 2011.  87% of Medicaid spending on older adults is for long-term care.  One in three older adults with Medicaid receive long-term care through Medicaid.
    • Fact: 43% of people with Medicaid needing long-term care are under the age of 65.
    • Fact: Medicare does not cover long-term custodial care, nor does standard health insurance.  Medicare contributed 21% to long-term care in 2011, because it covers skilled nursing care and skilled therapy services for a limited time post-hospitalization.

    Here’s more from Just Care on aging in place and long-term care services and supports:


    Click here     to learn more about long-term services and supports from the Robert Wood Johnson Foundation and here to learn more about long-term care from JAMA.

    Photo Credit: RWJF