Tuesday, June 28, 2011

Concerns About Costs Rise With Hospices’ Use

As she surveyed patients’ charts, Nancy Romeo, a medical review auditor at a hospice company, was surprised by the resilience of those supposedly near death.

One patient admitted to hospice care in 2002 was still healthy enough in 2007 to stroll around his yard at home, she found. Another patient received hospice care for four years before the company for which Ms. Romeo worked, SouthernCare, determined she was not dying. “I looked at charts every day, and almost every chart was inappropriate,” said Ms. Romeo, a nurse.

In 2007, she filed a whistle-blower lawsuit against SouthernCare claiming that the company had fraudulently enrolled patients in hospice. Eventually, the government obtained a $24.7 million settlement in the case. SouthernCare, based in Birmingham, Ala., and one of the nation’s largest commercial hospice companies, admitted no wrongdoing, and officials declined comment for this article.

Over the 28 years that Medicare has reimbursed providers for hospice services, it has been praised for giving critical medical and emotional support to dying patients and their families. When properly used — that is, at the very end of life — hospice care also has saved the government money. Providing dying patients with palliative care in their own homes, or in a hospice facility or nursing home, is far less expensive than continuing to order up futile medical treatments, studies have shown.


Indeed, advocates say more patients should be receiving hospice services earlier in the course of their illness. The median time spent in hospice care now is just 17 days.

But as hospice has moved into the mainstream — it is now serving 1.1 million Medicare patients a year — concerns about excessive costs and misuse have mounted.


Four in 10 Medicare beneficiaries now use the hospice benefit before they die. Patients agree to forgo treatments aimed at prolonging their lives, but can receive pain-relieving medication to ease the symptoms of a terminal illness, as well as attention from nurses, social workers and others.

Medicare’s bill for hospice care rose to more than $12 billion in 2009 from $2.9 billion in 2000. Although the benefit is intended for patients who have no more than six months to live, 19 percent now receive hospice services for longer, according to the Medicare Payment Advisory Commission, or MedPAC, an independent Congressional oversight panel. In 2009, 10 percent of patients remained in hospice beyond seven months. Once a patient is enrolled in hospice, Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, regardless of whether a hospice actually provides services. A primary concern of MedPAC is that this payment method encourages hospices to seek out patients likely to live longer. Commercial hospices in particular tend to have longer-staying patients, studies have shown. “The financial incentives do in fact dictate behavior,” said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. “It’s a lucrative business, at least under the current reimbursement system.”

In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash.

Hospice operators say sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive. Currently, most hospices rely on registered nurses to see patients and then relay information back to the office.

“This face-to-face visit is a way to limit the length of people staying on hospice, and it probably will increase the number of people who get discharged,” said Dr. David Casarett, an associate professor of medicine at the University of Pennsylvania and chief medical officer at the university’s Philadelphia-based hospice. “But will we be discharging the right people? I’m not sure.”

But given the financial and political pressures facing Medicare, government officials are not inclined to ignore the possibility that hospice care is being abused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment — hospice patients in nursing homes — and found that hospices routinely failed to document that those patients belonged in hospice or that they were getting the care to which they were entitled. The inspector general is now investigating unusual patterns of hospice stays.

Evidence produced in a series of lawsuits, too, suggests that hospices may need more careful oversight.

A regional vice president at Trinity Hospice, a now-defunct chain based in Texas, “strongly encouraged” employees to “find a way” to keep patients as long as possible, according to a 2005 internal report uncovered in a whistle-blower lawsuit.

In 2006, the government obtained a $12.9 million settlement from another national chain, Odyssey Healthcare, after a former manager there said she was fired for trying to get the company to discharge patients who did not meet Medicare’s eligibility rules.

Both companies settled the cases out of court and did not admit wrongdoing. Odyssey was subsequently bought by Gentiva Health Services, and a company spokesman had no comment on the settlement.

One of the main reasons for longer hospice stays is the increasing prevalence of patients with diseases, like dementia, that follow sometimes unpredictable paths. For instance, Alzheimer’s patients are three times as likely as cancer patients to stay in hospice beyond six months, MedPAC data show.

In 2009, Duane Chirhart, a retired airline pilot, questioned the cost of his aunt’s hospice care while she was in a nursing home in Minnesota. For more than two years, the nursing home had been taking care of most of her needs. At the same time, a hospice company billed Medicare $4,252 a month for its services, which included short visits by outside nurses. “The employees who visited her were really caring people,” he said, “but there only were four or five hours a month when they were actually there.” Mr. Chirhart canceled the hospice service. His aunt, who has Alzheimer’s, is now 89 and still alive.

When the humorist Art Buchwald went into a hospice in February 2006, he expected to die of kidney failure within weeks. But his kidneys kept working, and Mr. Buchwald made national news when he quit hospice after five months. He died the following year.

To allow for greater flexibility, Congress ended the strict seven-month time limit imposed when the benefit was created. Now hospice care can continue indefinitely so long as the hospice says the patient is still likely to die within six months.

“To some degree, the growth in the number of beneficiaries and the duration of stays is the result of conscious policy changes,” said Jonathan Blum, deputy administrator of the Centers for Medicare and Medicaid Services.

Alexander Horvath, who is 85 and has dementia, is in his eighth month of care provided by the Jewish Social Service Agency Hospice, a nonprofit in Rockville, Md. His wife, Jacqueline, believes that he is receiving excellent, cost-effective care. The hospice has taken steps to prevent bedsores, for instance, by replacing his mattresses with special ones that help keep lesions from developing. “I want him to be as happy and comfortable as long as he possibly can be,” she said.

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

About Senior Helpers:
Senior Helpers Provides in home senior care services throughout Central Texas servicing Austin, Round Rock, Georgetown, Cedar Park and all surrounding areas. We provide a wide range of personal and companion care services to assist seniors living independently with a strong focus on quality of life for the client and peace of mind for their families. Home care services are provided by bonded and insured employees and all employees pass a thorough background check. Senior Helpers strives to be the leading companion and personal care provider that offers dependable, consistent and affordable home care. Learn more about Senior Helpers at www.HomeHealthCareAustin.com or www.SeniorHelpers.com/RoundRock .

Friday, June 24, 2011

Low-Carb, High-Fat Diets May Not Pose Risk to Arteries

Short-term studies found no harm to vascular health

By Kathleen Doheny
HealthDay Reporter

THURSDAY, June 2 (HealthDay News) -- New research suggests that low-carbohydrate diets, with regular exercise as part of the plan, don't appear to harm the arteries, as some experts have feared. 
 

"It's pretty clear low-carb is effective for weight loss," said study author Kerry J. Stewart, director of clinical and research exercise physiology at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. "The concern has been that because you are eating more fat this is going to put stress on your blood vessels."

So, Stewart and his team evaluated the short-term effects of a low-carb, higher-fat diet after a single meal. The researchers also compared a low-carb diet with a low-fat diet in dieters. In each case, they found no ill effects on blood vessel health.

Stewart is due to present his findings Friday at the American College of Sports Medicine meeting in Denver.

However, one nutrition expert said longer-term research is needed before concluding that high fat intake doesn't hurt blood vessel health.

For the first study, Stewart's team looked at the effects of eating an extremely high-fat McDonald's breakfast. The breakfast had more than 900 calories and 50 grams of fat. "That's half of what you should eat in a whole day," Stewart said.

The researchers then evaluated a marker of arterial stiffness and another measure of blood vessel health, known as endothelial function. "Even after eating this one meal, we didn't find any vascular changes from before to after," he said.

The arterial stiffness, in fact, improved, he noted, although he is not sure why.

Neither study had industry funding; both were financed by the U.S. National Heart, Lung, and Blood Institute.

For the diet study, Stewart assigned 55 men and women who were overweight or obese to the low-carb diet or a low-fat diet. They also had abdominal obesity and a large waist circumference (35 inches or more for women, 40 or more for men). Both are risk factors for heart disease.

The low-carb plan included up to 55 percent fat at the beginning, and phased down to about 40 percent. It had about 15 percent carbs initially, and then went to 40 percent. The other dieters followed the American Heart Association's low-fat diet, with no more than 30 percent fat a day.

Both groups had supervised exercise three times a week.

At the meeting, Stewart will report on 46 dieters, 23 from each group, who lost 10 pounds. "In the low-carb group, they reached the 10-pound loss at 45 days," he said. The low-fat group needed 70 days to shed 10 pounds.

Their calorie intake was similar, whichever diet they were on.

Stewart performed the same blood vessel measures as in the breakfast study. "There were no differences in any of the vascular measures," he said.

The researchers will continue the study for six months. While Stewart cautioned that these are initial findings, he added, "We are pretty confident this is a real result. At the 10-pound weight-loss mark, we don't see any harm to the vasculature."

Stewart said he put on weight a few years ago, went on a low-carb plan while also exercising and dropped 40 pounds. He has kept if off for four years.

While the study is intriguing, long-term research is crucial, said Connie Diekman, director of university nutrition at Washington University in St. Louis and past president of the American Dietetic Association.

"When it comes to the impact on blood vessel functioning, as a registered dietitian I would like to see more studies in healthy and unhealthy subjects and longer-duration studies before concluding that this high-fat intake does not impact blood vessel health," she said, although the study does show that exercise is important. The breakfast study, with its one-time test, does not provide much information about what impact these diets will have long-term, she added.

To learn more about losing weight, visit the U.S. Centers for Disease Control and Prevention.

Copyright © 2011 HealthDay. All rights reserved.

Monday, June 20, 2011

50% off Heart Rate Monitors

Keep tabs on your Ticker!


Your purchases via this Blog help a worthy cause at no extra cost to you! All monies received go to help Austin Groups for the Elderly

SENIOR HELPERS’ AFFORDABLE CARE PROGRAM PROVIDES LOW/NO COST IN-HOME SENIOR CARE


SENIOR HELPERS’ AFFORDABLE CARE PROGRAM PROVIDES LOW/NO COST IN-HOME SENIOR CARE
Hospitals, Care Providers and Seniors Benefit from Reduced Costs and Medicare Savings

(Round Rock, Texas) – Living at home can often be seen as a luxury for senior citizens because not everyone can afford to pay for care.  Senior Helpers of Central Texas, a leading in-home provider of senior care in Austin, Round Rock, Georgetown and surrounding locales, is helping to make that a more affordable option for our aging loved ones.  Senior Helpers is now working with area hospitals, rehabilitation, skilled nursing facilities and home health agencies to provide seniors with affordable or no cost access to home care.  These partnerships will ultimately produce more positive outcomes for seniors who are discharged to their homes.

“Many of our patients need more consistent care than we are able to provide due to Medicare guidelines,” says Traci Boyle, R.N. Clinical Team Manager at Home Care Dimensions. “This program allows for those patients who need more assistance in their homes to be able to have a peace of mind knowing there are more sets of eyes and helping hands available to help keep them safe and at home.  One of the largest obstacles facing the vast majority of our senior citizens today is living on a fixed-income.  The Affordable Care Program allows us to target the patients with the highest needs and risk of re-hospitalization.”  

The Affordable Care Program is funded solely by Senior Helpers.  10 percent of the services Senior Helpers receives from a health care provider’s referrals are donated to the Affordable Care Program.  Those funds can then be directed by the local health provider who can determine how to best help their respective patient base. Some patients may receive Pro Bono services and some may receive a highly discounted rate.

“Home Care Dimensions is able to select the patients who do not qualify for government assistance due to making too much money, but yet are clearly in need of care,” says Boyle.  “We refer to these people as the “lost middle”.   We are very grateful to Senior Helpers for creating this innovative program and working with us to serve our community.”

In addition to helping seniors improve their individual outcomes, the Senior Helpers’ Affordable Care Program can save hospitals and rehabilitation facilities tens of thousands of dollars in Medicare reimbursements and penalties. 

“Facilities we work with are sometimes charged by Medicare if their patients return to the hospital or a skilled nursing facility within a certain time frame after discharge,” says Frank Hayes, President of Senior Helpers of Central Texas. “The Senior Helpers program can provide more Aides in the home to ensure the senior is better taken care of and has the best chance for recovery.  We look forward to working with many health care facilities in Central Texas to expand the program to a wider audience.”

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About Senior Helpers:
Senior Helpers Provides in home senior care services throughout Central Texas servicing Austin, Round Rock, Georgetown, Cedar Park and all surrounding areas. We provide a wide range of personal and companion care services to assist seniors living independently with a strong focus on quality of life for the client and peace of mind for their families. Home care services are provided by bonded and insured employees and all employees pass a thorough background check. Senior Helpers strives to be the leading companion and personal care provider that offers dependable, consistent and affordable home care. Learn more about Senior Helpers at www.HomeHealthCareAustin.com or www.SeniorHelpers.com/RoundRock .

Friday, June 17, 2011

Olive Oil May Cut Stroke Risk

Higher olive oil consumption is associated with 41% lower risk of stroke over 6 years.



Senior Helpers of Central Texas

Senior Helpers encourages seniors and their families to be sun smart after new FDA sunscreen guidelines

Skin cancer is the most common form of cancer in the United States. Each year, nearly a million people in this country will learn they have skin cancer…and the risk continues to rise as you get older. Senior Helpers of Central Texas, one of the leading in-home providers of senior care from Austin to Georgetown, is raising awareness about new FDA guidelines regarding sunscreens, which apply to people of all ages, not just young children and adults.

“Unprotected skin can be damaged by the sun’s UV rays in as little as 15 minutes, according to the American Cancer Society,” says Moire Hayes, CEO of Senior Helpers of Central Texas. “Most skin cancers appear after the age of 45 and it’s never too late to protect yourself from the sun. We encourage seniors to get some fresh air and exercise to stay active, but their skin is more sensitive than others. Even if they’re going outside for a short 15 minute walk, our caregivers are there to help them apply their sunscreen as needed.”

What We’ve Learned From the FDA’s New Sunscreen Guidelines:
Sun protection is an important public health issue for people of all ages. The FDA just released their new guidelines when it comes to proper product labeling and UVA protection.

• There is no such thing as “sweat proof” and “waterproof” sunscreens. These words are no longer allowed on sunscreen labels.
• Sunscreens can claim to be “water resistant” but the company has to put a label on their product stating the sunscreen only offers 40 or 80 minutes of protection while swimming or sweating.
• You must reapply sunscreen every two hours for continued sun protection.
• Use sunscreens with UVA and UVB protection, also known as “broad spectrum” protection.
• Only broad spectrum sunscreens with 15 SPF or higher provide any type of sun protection (15 – 30 SPF is recommended).

“The sun doesn’t discriminate against age,” says Frank Hayes of Senior Helpers of Central Texas. “When seniors are exposed to too much sun, they risk being severely dehydrated. Our caregivers can make sure the seniors are eating plenty of fruits and vegetables, drinking water, or taking a cool bath to help prevent and/or recover from dehydration. They can also provide ways for seniors to socialize without having to be out in the sun, such as taking their daily walk inside malls or museums; or making sure they’re in the shade and properly protecting themselves while spending time outside. ”


Give Your Senior the Gift of Sun Protection:
• Special UV radiation-absorbing clothes – the Skin Cancer Foundation recommends clothing with an ultraviolet protection factor (UPF) of 30 or higher.
• Wrap-around sunglasses that offer UV protection.
• A hat with at least a three-inch brim all the way around – sun hats provide protection for not only your head, face and ears, but also your neck, shoulders and upper back.
• Look for products that have earned the Skin Cancer Seal of Recommendation.


This story affects all seniors and their families in Central Texas. Help us spread the word about skin cancer and sun safety for senior citizens.
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Sources: American Cancer Society, the Skin Cancer Foundation, Centers for Disease Control and Prevention.

About Senior Helpers of Central Texas 

Senior Helpers Provides in home senior care services throughout Central Texas servicing Austin, Round Rock, Georgetown, Cedar Park and all surrounding areas. We provide a wide range of personal and companion care services to assist seniors living independently with a strong focus on quality of life for the client and peace of mind for their families. Home care services are provided by bonded and insured employees and all employees pass a thorough background check. Senior Helpers strives to be the leading companion and personal care provider that offers dependable, consistent and affordable home care. Learn more about Senior Helpers at www.HomeHealthCareAustin.com or www.SeniorHelpers.com/RoundRock

Friday, June 10, 2011

New Quiz Helps You Decide If Dear Ol’ Dad Needs Help

Research shows dads won’t ask for help 
Quiz helps adult children have that ‘oh-­‐so tough’ talk

(June 9, 2011) - It’s one of the most difficult conversations adult children can have with aging parents, especially those stubborn dads. Can your parents live independently? Or is time to reach out for help? Just in time for Father’s Day, Senior Helpers, a leading in-­‐home care provider, has created a new quiz for adult children to determine their father’s self-­‐sufficiency. The Stay At Home Score Quiz (www.stayathomescore.com) has eight easy questions that help families make difficult decisions about the independence of their aging loved ones.

“It’s a common scenario for aging parents, especially independent dads, to insist they’re well enough to live in their own homes even if they’re not,” says Dr. John Bowling, senior care and positive aging expert, and creator of the Senior Helpers’ Stay At Home Score Quiz. “After years of research, I developed this quiz to give adult children a guideline to determine their parents’ needs, if they are self-­‐sufficient, if they can live at home with help from an in-­‐home caregiver, or if it’s time to move them to a place where they get round-­‐the-­‐clock care.”

Stay At Home Score Quiz

The quiz was developed after decades of working with the elderly and studying the aging process that may suddenly make it unhealthy and unsafe for a senior citizen to live alone.

Sample Quiz Questions:

• Does your dad have easy access to a caring support system of family and friends whom he can rely on for daily assistance with physical, financial, and emotional needs?

• Does your dad regularly cook for himself, shop for groceries without assistance, and keep the home well-­‐stocked with fresh and healthy foods?

• Does your dad maintain the same level of social activity and friendships that he did five years ago?

After taking the quiz, Dr. Bowling says adult children will have at least a good discussion point about the self sufficiency of dad or any aging loved one.

“This quiz would’ve been a great tool to help my mom focus on our dad’s condition instead of her own emotions about not wanting to bring in outside help,” says Susie Thomas of Madison, Alabama. Susie’s father is 74 years old with a neurodegenerative disease called ALS. “When my siblings and I were all trying to talk my mom into hiring a caregiver for Dad, I think she felt like we were ganging up on her. It would’ve been nice to sit down and show her this quiz and use it as a mediator to provide an unbiased opinion. Now, we have such a peace of mind knowing my dad is in good hands.”

Six Telling Signs (regarding your father) That You Should Take the Stay At Home Score Quiz (Source: the Council on Aging):

• Poor eating habits -­‐ resulting in weight loss, no appetite or missed meals.
• Neglected hygiene -­‐ wearing dirty clothes, body odor, neglected nails and teeth.
• Neglected home -­‐ it’s not as clean or sanitary as you remember growing up.
• Scorched pots and pans -­‐ shows forgetfulness for dinner cooking on the stove.
• Unopened mail, newspaper piles, missed appointments.
• Mishandled finances -­‐ losing money, paying bills twice or hiding money.

The Stay At Home Score Quiz would have been a big help for a Senior Helpers client, Arnie, a 78-­‐year-­‐old veteran with mild dementia. He was suffering from depression and not eating well, until he began receiving care from Senior Helpers. “I wish this quiz had been available years ago,” says licensed, clinical social worker, Anne Grasee, who cares for Arnie. “I could have introduced Arnie to Senior Helpers that much earlier.” She says Arnie’s life has turned around since he realized he needed outside help from a caregiver. He now has a companion who visits him and gets him out of the house on a weekly basis.

Other Study/Survey Findings About Dads:


• Dad will overwhelmingly choose to live at home and may try to prove he’s independent, even when he’s not. In a newly released national survey, 94% of fathers surveyed say they would rather live in their own home as they age instead of moving in with any of their children or to a nursing home or assisted living facility.

• Since men are competitive and success oriented by nature, Senior Helpers suggests to approach Dad by acknowledging the courage it takes to ask for and accept assistance and then pointing out why it is a good idea.

• The contrast between men’s and women’s help-­‐seeking behavior is a “growing concern,” according to a 2008 study from the University of Cincinnati and the Medical University of South Carolina. It found that in the U.S., boys learn at an early age that men should be strong, independent, tough and self-­‐ reliant.

TAKE THE 8 QUESTION QUIZ www.stayathomescore.com

About Senior Helpers of Central Texas 

Senior Helpers Provides Senior In Home Care Services in the Central, Texas area. We provide a full array of Home Care services for seniors and the elderly living in this beautiful area. Our Home Care Services are provided by bonded and insured employees and all employees pass a National Background check.
If you need Home Care services in Austin, Bartlett, Bertram, Briggs, Burnet, Cedar Park, Florence, Georgetown, Granger, Holland, Hutto, Jarrell, Johnson City, Killeen, Leander, Liberty Hill, Manor, Marble Falls, Pflugerville, Round Mountain, Round Rock, Salado, Spicewood, Taylor and the surrounding areas we are an excellent choice with impeccable references. Home Health Care for your elderly loved ones is never an easy choice but we can promise we will do our best to make it as painless as possible. From our family to yours we sincerely thank you for considering Senior Helpers of Austin Home Health Care Company. Learn more about Senior Helpers at www.HomeHealthCareAustin.com or www.SeniorHelpers.com/RoundRock

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Wednesday, June 8, 2011

BEWARE THE LIGHT BULB POLICE!

On January 1, 2012, seven months from this week, Washington will effectively ban the sale of conventional 100 watt incandescent light bulbs that Americans have used nearly since the days of Thomas Edison. Instead we will all be required to buy compact fluorescent lights, or CFLs.

No matter how you feel about the issue, it's Not too late to stock up!

And, remember, every purchase you make through our Amazon affiliate is no cost to you and helps Austin Groups for The Elderly!

More bulk choices here for light bulbs.