Under the right conditions, about 33% of all seniors in this country could qualify for up to $1,843 a month in additional income from the Department of Veterans Affairs. This money can be used to pay just about anyone to provide elder care services at home. As an example, these funds can be used to pay children, other relatives, friends, home care companies, or domestic workers. Adequate documentation and evidence must be provided in order to receive money from VA for these services, particularly the services provided by family members or other non-professional providers. The National Care Planning Council furnishes detailed instructions and training to those practitioners who wish to help veteran households receive this valuable source of revenue to pay for home care.
This little-known source of money for paying long term care costs is known as Veterans Pension and is available to veterans who served on active duty during a period of war or to the single surviving spouses of these veterans. Pension is also known popularly as the "aid and attendance benefit." Of approximately 35 million Americans age 65 and older in this country, about 11.5 million are veterans who served during a period of war or their surviving spouses. This represents about 33% of the senior population.
The Pension benefit has an income and an asset test. Veteran households with income or assets above the test levels will not qualify for the benefit. Fortunately, there are special provisions that allow -- under certain circumstances -- individuals who would normally fail the tests to still qualify. VA typically does not tell potential applicants about the special provisions. A practitioner who understands how to obtain the aid and attendance benefit can help potential applicants receive the benefit even when they have been told by VA that they do not qualify.
Pension income is often used to pay costs of long term care such as home care, assisted living or nursing home care. That's because the nature of these expenditures allows potential applicants for the aid and attendance benefit to meet the special provisions of the income test.
Over the past 3 1/2 months the National Care Planning Council has received over 750 requests from veterans families all over the country who are trying to find help with their loved ones’ long term care needs. Many of these veterans households would likely qualify for the aid and attendance benefit mentioned above. As a result of these inquiries, the council is looking to train veterans benefits consultants to help veterans obtain their benefits and to handle these requests.
This consultants package not only provides the training but it also provides a listing service, a unique website, a seminar marketing system and business strategies to help consultants reach out to more veterans who might qualify for this benefit.This is a new program. The first trained consultant has been in place for a little over three weeks. In that short time, his personal listing service and personal website, provided by the National Care Planning Council, have already resulted in 15 requests for his services from veterans families seeking help with the aid and attendance benefit. Other consultants who have come online since this first one are experiencing similar results.
If you are interested in becoming a consultant or you know someone who might be you can call the National Care Planning Council at 800-989-8137 or you can check out our consultants training package at www.consultantspackage.com. To learn more about the National Care Planning Council, go to www.longtermcarelink.net.
Tuesday, November 25, 2008
Holiday Blues and the Elderly
Holiday blues and the elderly
With the holidays rapidly approaching, many people will travel to visit elderly relatives. Even if you see your older loved ones frequently or are limited to infrequent visits by distance or other factors, you may notice differences in your loved one during this time of year.Planning for Elder Care (www.longtermcarelink.net) has recently published an article regarding "holiday blues" and depression in the elderly.According to the National Institutes of Health, about two million of the 35 million Americans who are age 65 and older suffer from serious depression. Another five million suffer from less severe forms of the illness. This represents about 20 percent of the senior population, which is a significant percentage.Since depression in the elderly is difficult to diagnose, it is frequently untreated. The symptoms may be easily confused with medical illness, dementia or the aftereffects of poor nutrition. Caregivers and/or family members may be the catalyst for change, through observation of behavioral changes and assisting in seeking treatment for the elderly person.The actual holiday does not cause depression, but often the associated memories of a happier time. Depression can result from loss of a spouse or close friend, a move to another level of care, worries about money in this economy or even a change in the normal routine. Symptoms of depression can also signal an underlying medical problem, such as dementia, chronic pain, diet that is lacking in proper nutrition and vitamins or Vitamin B12 deficiency.Some symptoms to look for in the elderly include: depressed or irritable mood, feelings of worthlessness and sadness, expressions of helplessness, anxiety, loss of interest in daily activities or in decorating for the holidays, loss of appetite, weight loss, failure to consistently attend to personal care and hygiene, fatigue, difficulty concentrating, irresponsible behavior, obsessive thoughts about death and talk about suicide. The older person often denies any difficulties, or may fear a diagnosis of mental illness, thus refusing to acknowledge the need for treatment.Another issue is that depression and dementia have similar symptoms. Depression generally has a rapid mental decline. Motor skills may be slowed but are generally normal. The person may have trouble concentrating, and may worry about impaired memory. However, memory for time and dates, as well as general awareness of the environment remains intact. On the other hand, persons with dementia experience a slow decline, with confusion and memory loss associated with familiar situations. Writing, speaking and other motor skills are impaired, and memory loss is usually not acknowledged by the person who is experiencing symptoms of dementia.A geriatric medical practitioner is recommended for the diagnosis and treatment of depression or dementia symptoms in older individuals. A treatment plan may include cognitive therapy, antidepressants or as simple as steps to relieve loneliness. Underlying medical problems can be assessed at the same time.The Geriatric Mental Health Foundation offers a "Depression Tool Kit" at www.gmhfonline.org/gmhf/consumer/depression_toolkit.html.
With the holidays rapidly approaching, many people will travel to visit elderly relatives. Even if you see your older loved ones frequently or are limited to infrequent visits by distance or other factors, you may notice differences in your loved one during this time of year.Planning for Elder Care (www.longtermcarelink.net) has recently published an article regarding "holiday blues" and depression in the elderly.According to the National Institutes of Health, about two million of the 35 million Americans who are age 65 and older suffer from serious depression. Another five million suffer from less severe forms of the illness. This represents about 20 percent of the senior population, which is a significant percentage.Since depression in the elderly is difficult to diagnose, it is frequently untreated. The symptoms may be easily confused with medical illness, dementia or the aftereffects of poor nutrition. Caregivers and/or family members may be the catalyst for change, through observation of behavioral changes and assisting in seeking treatment for the elderly person.The actual holiday does not cause depression, but often the associated memories of a happier time. Depression can result from loss of a spouse or close friend, a move to another level of care, worries about money in this economy or even a change in the normal routine. Symptoms of depression can also signal an underlying medical problem, such as dementia, chronic pain, diet that is lacking in proper nutrition and vitamins or Vitamin B12 deficiency.Some symptoms to look for in the elderly include: depressed or irritable mood, feelings of worthlessness and sadness, expressions of helplessness, anxiety, loss of interest in daily activities or in decorating for the holidays, loss of appetite, weight loss, failure to consistently attend to personal care and hygiene, fatigue, difficulty concentrating, irresponsible behavior, obsessive thoughts about death and talk about suicide. The older person often denies any difficulties, or may fear a diagnosis of mental illness, thus refusing to acknowledge the need for treatment.Another issue is that depression and dementia have similar symptoms. Depression generally has a rapid mental decline. Motor skills may be slowed but are generally normal. The person may have trouble concentrating, and may worry about impaired memory. However, memory for time and dates, as well as general awareness of the environment remains intact. On the other hand, persons with dementia experience a slow decline, with confusion and memory loss associated with familiar situations. Writing, speaking and other motor skills are impaired, and memory loss is usually not acknowledged by the person who is experiencing symptoms of dementia.A geriatric medical practitioner is recommended for the diagnosis and treatment of depression or dementia symptoms in older individuals. A treatment plan may include cognitive therapy, antidepressants or as simple as steps to relieve loneliness. Underlying medical problems can be assessed at the same time.The Geriatric Mental Health Foundation offers a "Depression Tool Kit" at www.gmhfonline.org/gmhf/consumer/depression_toolkit.html.
Reinventing nursing homes by putting patients first
FOCUS: NURSING HOMES
Reinventing nursing homes by putting patients first
By Henry L. Davis
NEWS MEDICAL REPORTER
Frank Neureuter, sitting comfortably in a motorized scooter at Beechwood Nursing Home, doesn’t look like anyone ready to join a revolution.
Yet, at 82, the retired Buffalo businessman finds himself embracing a small but growing movement to fundamentally change the way care is provided to the elderly.
Instead of a corridor lined with residents slumped in wheelchairs, he lives in a smaller “household” with a bell and mailbox at the front door.
The nursing station, where staff used to congregate, is gone. So is the call-bell system.
Neureuter can get up in the morning when he wants. He can eat a breakfast cooked to order. He has a say over how he spends his day.
“It’s a world of difference from when I came here four years ago,” he said.
The nursing home industry is one of the most regulated businesses in the nation. Nursing home operations have become so regimented in order to control risks and costs that buildings look alike, and residents have virtually every decision made for them, from when to get up to what to eat.
The regulations, although well-meaning, have combined with an outdated payment system to stifle innovation. There’s little incentive to raise quality above minimum standards.
Today, too many nursing homes offer a passionless, hospital-like service built for efficiency. It may have made sense decades ago, but now the homes turn people off, struggle with high employee turnover and continue to experience quality problems.
Against this backdrop, reformers in recent years have pushed for a radical rethinking of the long-term care system that’s become known as “culture change.”
A few nursing homes around the country have adopted some aspects of the movement. Now, advocates in Western New York want to turn culture change into a regionwide initiative, making this community the first in the United States to attempt a transformation in elder care on a large scale.
“If we continue to provide care and treat staff the way we currently do, we will have a crisis,” said Robert Meiss, chief executive of Beechwood Continuing Care in Getzville.
Beechwood is among more than a dozen nursing homes and other organizations, working with funding from the John R. Oishei Foundation, to pull together what’s being called the Western New York Alliance for Person-Centered Care.
The goal: Let their colleagues know there is a compelling alternative to business as usual and make it a reality.
“All people have ever known in the nursing home industry is the institutional model in which all choice and variation is removed,” Meiss said.
Culture change is a general term describing an assortment of different efforts that have one thing in common: The priority is care for the elderly, not the demands of the institution.
Sounds simple, except that it calls for an industry resistant to change to reorganize completely from the top down.
“This doesn’t require a fancy proton beam scanner or a wonder drug. It’s about cooperating to do the things we know are right. The problem is we have a system that devalues imagination. You will never find in the same sentence the words imagination and long-term care,” said Dr. Bill Thomas, a leading authority on elder care.
Thomas in 1991 founded the Eden Alternative, an organization that pushes existing nursing homes to adopt such policies as treating staff the way they want the staff to treat elders, giving workers and residents more decision-making authority and making facilities less institutional.
More recently, he has pioneered Green Houses — small, homelike residences for 10 to 12 people, with private rooms and baths arranged around a kitchen, dining room and living area.
“We need to rebuild the entire field — everything,” Thomas said during a recent stop in Buffalo. “The system we work in every day betrays whatever noble intentions we have.”
Nursing homes felt little pressure to change the design of facilities until 1987, when Congress required operators to consider resident rights, autonomy, choice, control and dignity.
But even forward-thinking operators face a challenge: How do you reduce the boredom and anxiety in homes, yet keep them safe and able to cost-effectively provide medical help?
Beechwood offers an example of one strategy. It is slowly converting its 40-bed units into smaller households and neighborhoods, with 12 to 18 beds per household. The unused semiprivate bedrooms have been replaced with a kitchen, dining room and living area.
A choice of hot food is served from a steam table instead of residents waiting for a lukewarm meal in a central dining hall. There’s a refrigerator stocked with snacks that is available all the time.
It is about more than aesthetics.
Household workers no longer rotate throughout the building, allowing them to get to know the residents and their preferences. No one does only food service or housekeeping or laundry. Everyone is expected to pitch in, as needed, just like at home.
“The big change for employees is that we’re more autonomous. We’re expected to get to know residents and come up with our own ideas to reduce the routine, to make things more fun,” said Jodie Branch, a household coordinator, a new position aimed at smoothing communication among management, staff and residents.
Beechwood is among a few early adopters of some elements of culture change. Others in the Buffalo area include ElderWood Senior Care, Briody Health Care Facility and the Catholic Health System’s Renaissance Project in the former Our Lady of Victory Hospital.
The new nursing home at OLV has adopted the household model and also moved to private rooms.
Advocates say that if nursing homes are serious about the dignity and autonomy of residents, as well as preventing the spread of infections, they will incorporate private rooms in new facilities.
OLV is carpeted and filled with natural light. There is no longer an overhead paging system. The nurses station is hidden. The residents eat on china and not plastic.
The hallways aren’t filled with laundry carts and the smell of dirty diapers. An effort is made to offer a choice of food and serve it hot.
“We want people to see and smell food being prepared, just like you do in your home,” said Aimee Gomlak, vice president for strategic redevelopment for the Catholic Health System.
Like other nursing homes most engaged in culture change, OLV and Beechwood report that residents are more satisfied and healthy, and workers are happier.
At OLV, the facility is seeing weight gain among residents and a reduction in the use of nutritional supplements, as well as a reduction in the use of anti-anxiety medications, Gomlak said.
One key to success will be signs of lower staff turnover, a chronic problem at nursing homes.
“You can’t implement an expensive program, train your employees and then have them leave,” Gomlak said.
A survey released this year by the Commonwealth Fund found that only 5 percent of nursing homes describe themselves as completely adopting culture change.
Resistance is about more than an unwillingness to change.
Operators question whether regulators will punish them for doing things differently. They remain skeptical about the costs, especially with a reimbursement system biased toward acute care. They worry about lawsuits from families if giving residents more independence leads to injuries.
At Beechwood this summer, officials spent days deciding whether to allow an elderly woman to sit outside by herself and read a book, something they would not have allowed in the past.
“All you think about is whether they’re going to fall or walk away in confusion and get lost,” said Susan Moran, the facility’s neighborhood director.
“For us, it was such a big deal to let her out that we celebrated,” she said.
There is evidence that culture change makes good business sense in addition to being the right thing to do, but advocates must make the case.
“You have to do well to do good, and we have to sell this as good business. The good news is it is,” said Bonnie Kantor, executive director of the nonprofit Pioneer Network, a national advocacy group that formed in 1997 to promote reforms.
If you ask Neureuter at Beechwood, there is no doubt.
“I’ve lived both ways, and I like what’s happening now,” he said. “You get to do things how you want to do them.”
hdavis@buffnews.com
Reinventing nursing homes by putting patients first
By Henry L. Davis
NEWS MEDICAL REPORTER
Frank Neureuter, sitting comfortably in a motorized scooter at Beechwood Nursing Home, doesn’t look like anyone ready to join a revolution.
Yet, at 82, the retired Buffalo businessman finds himself embracing a small but growing movement to fundamentally change the way care is provided to the elderly.
Instead of a corridor lined with residents slumped in wheelchairs, he lives in a smaller “household” with a bell and mailbox at the front door.
The nursing station, where staff used to congregate, is gone. So is the call-bell system.
Neureuter can get up in the morning when he wants. He can eat a breakfast cooked to order. He has a say over how he spends his day.
“It’s a world of difference from when I came here four years ago,” he said.
The nursing home industry is one of the most regulated businesses in the nation. Nursing home operations have become so regimented in order to control risks and costs that buildings look alike, and residents have virtually every decision made for them, from when to get up to what to eat.
The regulations, although well-meaning, have combined with an outdated payment system to stifle innovation. There’s little incentive to raise quality above minimum standards.
Today, too many nursing homes offer a passionless, hospital-like service built for efficiency. It may have made sense decades ago, but now the homes turn people off, struggle with high employee turnover and continue to experience quality problems.
Against this backdrop, reformers in recent years have pushed for a radical rethinking of the long-term care system that’s become known as “culture change.”
A few nursing homes around the country have adopted some aspects of the movement. Now, advocates in Western New York want to turn culture change into a regionwide initiative, making this community the first in the United States to attempt a transformation in elder care on a large scale.
“If we continue to provide care and treat staff the way we currently do, we will have a crisis,” said Robert Meiss, chief executive of Beechwood Continuing Care in Getzville.
Beechwood is among more than a dozen nursing homes and other organizations, working with funding from the John R. Oishei Foundation, to pull together what’s being called the Western New York Alliance for Person-Centered Care.
The goal: Let their colleagues know there is a compelling alternative to business as usual and make it a reality.
“All people have ever known in the nursing home industry is the institutional model in which all choice and variation is removed,” Meiss said.
Culture change is a general term describing an assortment of different efforts that have one thing in common: The priority is care for the elderly, not the demands of the institution.
Sounds simple, except that it calls for an industry resistant to change to reorganize completely from the top down.
“This doesn’t require a fancy proton beam scanner or a wonder drug. It’s about cooperating to do the things we know are right. The problem is we have a system that devalues imagination. You will never find in the same sentence the words imagination and long-term care,” said Dr. Bill Thomas, a leading authority on elder care.
Thomas in 1991 founded the Eden Alternative, an organization that pushes existing nursing homes to adopt such policies as treating staff the way they want the staff to treat elders, giving workers and residents more decision-making authority and making facilities less institutional.
More recently, he has pioneered Green Houses — small, homelike residences for 10 to 12 people, with private rooms and baths arranged around a kitchen, dining room and living area.
“We need to rebuild the entire field — everything,” Thomas said during a recent stop in Buffalo. “The system we work in every day betrays whatever noble intentions we have.”
Nursing homes felt little pressure to change the design of facilities until 1987, when Congress required operators to consider resident rights, autonomy, choice, control and dignity.
But even forward-thinking operators face a challenge: How do you reduce the boredom and anxiety in homes, yet keep them safe and able to cost-effectively provide medical help?
Beechwood offers an example of one strategy. It is slowly converting its 40-bed units into smaller households and neighborhoods, with 12 to 18 beds per household. The unused semiprivate bedrooms have been replaced with a kitchen, dining room and living area.
A choice of hot food is served from a steam table instead of residents waiting for a lukewarm meal in a central dining hall. There’s a refrigerator stocked with snacks that is available all the time.
It is about more than aesthetics.
Household workers no longer rotate throughout the building, allowing them to get to know the residents and their preferences. No one does only food service or housekeeping or laundry. Everyone is expected to pitch in, as needed, just like at home.
“The big change for employees is that we’re more autonomous. We’re expected to get to know residents and come up with our own ideas to reduce the routine, to make things more fun,” said Jodie Branch, a household coordinator, a new position aimed at smoothing communication among management, staff and residents.
Beechwood is among a few early adopters of some elements of culture change. Others in the Buffalo area include ElderWood Senior Care, Briody Health Care Facility and the Catholic Health System’s Renaissance Project in the former Our Lady of Victory Hospital.
The new nursing home at OLV has adopted the household model and also moved to private rooms.
Advocates say that if nursing homes are serious about the dignity and autonomy of residents, as well as preventing the spread of infections, they will incorporate private rooms in new facilities.
OLV is carpeted and filled with natural light. There is no longer an overhead paging system. The nurses station is hidden. The residents eat on china and not plastic.
The hallways aren’t filled with laundry carts and the smell of dirty diapers. An effort is made to offer a choice of food and serve it hot.
“We want people to see and smell food being prepared, just like you do in your home,” said Aimee Gomlak, vice president for strategic redevelopment for the Catholic Health System.
Like other nursing homes most engaged in culture change, OLV and Beechwood report that residents are more satisfied and healthy, and workers are happier.
At OLV, the facility is seeing weight gain among residents and a reduction in the use of nutritional supplements, as well as a reduction in the use of anti-anxiety medications, Gomlak said.
One key to success will be signs of lower staff turnover, a chronic problem at nursing homes.
“You can’t implement an expensive program, train your employees and then have them leave,” Gomlak said.
A survey released this year by the Commonwealth Fund found that only 5 percent of nursing homes describe themselves as completely adopting culture change.
Resistance is about more than an unwillingness to change.
Operators question whether regulators will punish them for doing things differently. They remain skeptical about the costs, especially with a reimbursement system biased toward acute care. They worry about lawsuits from families if giving residents more independence leads to injuries.
At Beechwood this summer, officials spent days deciding whether to allow an elderly woman to sit outside by herself and read a book, something they would not have allowed in the past.
“All you think about is whether they’re going to fall or walk away in confusion and get lost,” said Susan Moran, the facility’s neighborhood director.
“For us, it was such a big deal to let her out that we celebrated,” she said.
There is evidence that culture change makes good business sense in addition to being the right thing to do, but advocates must make the case.
“You have to do well to do good, and we have to sell this as good business. The good news is it is,” said Bonnie Kantor, executive director of the nonprofit Pioneer Network, a national advocacy group that formed in 1997 to promote reforms.
If you ask Neureuter at Beechwood, there is no doubt.
“I’ve lived both ways, and I like what’s happening now,” he said. “You get to do things how you want to do them.”
hdavis@buffnews.com
Subscribe to:
Posts (Atom)
Posts
