Please find below my comments an article from TheHill.com (health blog section) about a request from the U.S. nursing home industry to include a “viable” guest worker program in any immigration reform.
I second this request.
Dedicated, loving, well-trained nurses of any nationality should be able to work in the USA.
North America does not have enough nurses and geriatricians as it is. The work is hard. It takes an open heart and deep concern for the well-being of all, especially the elderly and infirm.
It is my experience with most nurses from Canada, Columbia, Ecuador, El Salvador, Italy, and the Philippines, for example, that they are truly caring and connect well with their patients. (I do not have experience with nurses from countries other than those mentioned).
It goes without saying that the U.S. has a remarkable corps of nurses. The point of the comments, however, is that there are not enough nurses to fulfill the needs, not to mention future needs with the ever-growing senior population.
Caring is an intangible talent that goes beyond borders.
It also goes without saying that all those who would be welcome on the guest worker program would be qualified.
NURSING HOMES WANT GUEST WORKER PROGRAM IN IMMIGRATION BILL
By Sam Baker – 03/13/13 10:34 AM ET
The nursing-home industry said Wednesday that Congress should include a “viable” guest worker program in any immigration overhaul, and should also lift caps on employer-sponsored visas for healthcare workers.
The American Health Care Association (AHCA) said immigration reform should recognize the needs of employers — including nursing homes and long-term care providers, who rely heavily on immigrants for positions such as nurses.
“Members of the long term care community employ immigrants and boost the economy. Any visa program must give employers, not the government, the primary say in which workers they need to staff their businesses,” the AHCA said. “In addition, the labor market should also have the primary say in how many workers enter the country annually in a legal program.”
The group is scheduled to testify at a House hearing Thursday on immigration reform.
AHCA said the supply of skilled nurses in the U.S. will fall more than 30 percent short by 2020 if Congress does not act. The nursing-home group said immigration reform should allow employers to access “previously unused” temporary visas for healthcare workers.
Please find below an article from http://www.ecarediary.com about the importance of learning how to fall safely as one ages… worth reading… Note: There are more and more fall prevention/fall safety programs being offered in communities around North America…
Is it Possible to Fall Safely?
Dr. Rein Tideiksaar – February 18, 2013 10:18 AM
A safety concern expressed by elders and caregivers alike is the threat of falling and injury. In an attempt to prevent falling, many elders at risk (due to balance and other mobility problems), tend to limit their everyday movements and activities. Caregivers may act in similar fashion, believing that limiting an elder’s daily activities is the best way to avoid harmful falls. While this strategy may work in the short-term, as a preventive strategy, it’s a really bad idea. If elders move around too little, they may suffer a host of harmful consequences, which can actually increase one’s risk of falling and injury:
• Muscle weakness
• Loss of balance
• Stiffness of knee/hip joints
• Decreased mobility
• Reduced bone strength (osteoporosis)
While prevention is still the ‘best medicine’ to avoid falling, it’s unrealistic to think that every fall can be prevented, so it’s important to limit their complications.
The good news is that elders and their care givers can take steps to ‘fall safely’ and lessen the chances of injury when a fall does happen. The ability to fall safely can dramatically reduce the likelihood of a fall from becoming a life-altering tragedy.
Make it Safe to Move
Elder’s with good balance will catch themselves if they start to fall, while those individuals with poor balance will fall and, may even, injure themselves in the process. Strong muscles are the key to better balance and flexibility. And the best way to regain muscle strength and flexibility is by exercising.
When falling, your muscles (particularly in the butt, abdomen, hips and legs) tend to tighten.
By working these muscles, there’s a better chance of keeping your balance. Consequently, a program of strength training (using weights, resistance bands or body weight) and balancing exercises (such as standing on one leg at a time or standing on your toes) will help improve balance and avoid serious falls.
Before starting any exercise program, make sure to consult your doctor to see if you are healthy enough to do so. If you have mobility issues, a physical therapist can help you choose safe exercises and even supervise you. Lastly, get your bones tested to see if you have osteoporosis (decreased bone strength and the possibility of breaking a bone). If your bone strength is poor, the doctor can prescribe medications to make your bones stronger. Also, weight-bearing exercises such as walking can slow bone loss from osteoporosis.
Learn How to Fall
When a person starts to fall, it’s important to know what to do in order to avoid injury. What people tend to think is that there’s no time to do anything, but that’s not true. Some falls happen immediately, with little time to react (such as fainting or having a dizzy spell or slipping on ice). With most falls, however, a person has a split second from loss of balance to impact. This is usually enough time to put a fall strategy into practice. So it’s best to know how to fall safely in advance.
Breaking a hip often occurs when a person lands on his or her side. One maneuver to avoid such injury is to utilize the ‘parachutist’s strategy’, which involves crouching, leaning so that the outside of your leg hits first and then rolling onto your backside. Learning to fall like a skydiver can reduce the force of impact on the hip bone and the risk of fracture. Practice falling at home by falling off of a chair or a couch and keep doing it a few times until you perfect the fall.
Helping the Falling Elder
If you suspect someone is about to fall, often the best way to help is to allow them to fall safely in a controlled manner. It’s important to learn proper safety techniques, so that you don’t cause injury to yourself or the person. Following this step-by-step guide will lessen the chances of any injury.
Helping the Fallen Elder
About half of all elders who fall are unable to get up again (often referred to as long lies). Complications from lying on the floor for a long time afterward include the risk of pneumonia, pressure sores, dehydration, hypothermia, and even death. Risk increases with declining mobility (stroke, Parkinsonism, obesity, etc.). To avoid long lies, here are three useful strategies to consider:
How to Get Up
Here’s a step-by-step guide on ‘Getting Up From a Fall’
Inflatable Lifting Chair
This lifting chair is designed to lift the person up from the floor and move them in to a seated position. The chair can be used independently or with the aid of a caregiver.
Personal Emergency Response System
Personal Emergency Response Systems (PERS) are designed to let an elder call for help if they can’t get up following a fall. A PERS has three components: a small radio transmitter, a console connected to your telephone, and an emergency response center that monitors calls.
When you need help, you press the transmitter’s help button, which sends a signal to the console. The console automatically dials one or more emergency telephone numbers. Most PERS are programmed to telephone an emergency response center with a trained operator who will alert emergency personnel or contact a relative.
Gadgets to Prevent Injuries
Hip protectors (undergarments and outer garments with extra padding) are designed to reduce the chances of a hip fracture by absorbing the impact of the fall and protecting the hip bones. In essence, hip protectors are shock absorbers for the hip. An added benefit of an elder wearing a hip protector is that they feel more confident and less fearful of falling.
Elders can lose their balance and fall when you least expect it. The use of a gait belt may assist in guiding and slowing a fall. Gait belts are designed to help caregivers provide elders with balance support during transfers and walking. If an elder loses their balance and starts to fall, a gait belt can help stop a fall in progress. If the elder continues to fall beyond your control, the gait belt can be used to slowly lower the person to the floor. Belts also reduce the risk of muscle strains and back injuries suffered by caregivers.
Click here to read Dr. Rein Tideiksaar’s blog, ‘Can Holiday Visits Prevent Falls’?
Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician’s assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at firstname.lastname@example.org
Am re-posting a helpful article on Tax Answers For Caregivers written by another Wordpress blogger….
Below you’ll find a post from McNight’s editor James Berkland published on-line on February 8, 2013
I have found in my work with elders, that yes indeed, your attitude affects your health, positively or not.
Wellness often depends on how we feel and think about it, no matter our age.
Frail or sturdy? Seniors decide what they want to be
James M. Berklan, McKnight’s Editor
If you’re like me, you’re a big believer in the saying “Attitude determines altitude.” If you’re in the eldercare business, this should become embedded in your mind — for the good of those on your watch.
An awful lot of research crosses my desk on any given day. That’s why when something sticks in the mind for more than a few weeks, it’s safe to say it’s remarkable. That is how I characterize the work of Becca Levy, which I first became aware of shortly before Christmas.
An associate professor of epidemiology at Yale University, Levy has worked for several decades studying how seniors’ attitudes affect their ability to deal with disabilities. Her most recent update appears in the Journal of the American Medical Association.
In brief, she’s found that people who subscribe to negative aging stereotypes (“the older you get, the more helpless or useless you’ll be,” etc.), are more likely they are to suffer memory loss, poor physical function and even early death.
On the other hand, when seniors view themselves as being more likely to have wisdom, self-realization and general satisfaction in old age, they are essentially more liable to “will” themselves healthy.
In fact, a positive bias makes seniors 44% more likely to fully recover from some disabling condition, Levy and colleagues found. She also reported in 2002 that individuals with positive age stereotypes lived 7.5 years longer than those without them.
Researchers and reviewers agree that more study is needed. But they openly express confidence that a cause-and-effect dynamic exists.
Positive aging stereotypes are associated with individuals eating better, exercising more, following up with physicians better and stopping smoking more often. Seniors also feel a better sense of control and self-efficacy when they bring positive biases to the table.
How does this pertain to you, the senior caregiver? It’s simple: Realize how profoundly you can affect your residents’ outlook on aging, and, therefore, their lives in general. Help them build self-esteem and a sense of self-worth.
Be cautious with the tone of voice you use around them, and maintain a positive attitude about aging in general. Give your residents your full attention and work hard to avoid using loaded expressions and phrases that cast aging in a negative light.
And then when you go home, keep up the positive attitude. Psychologists note that impressions of aging and the aging condition are formed very strongly early on.
Today’s child who wrinkles her nose at the thought of, well, getting wrinkles, slowing down or becoming less useful in old age could be creating a path to unnecessary disability, or worse.
An interesting dilemma: hospitals and their readmission rates. Catch 22. Hospitals remove patients as soon as possible (often too early) to follow dictates of insurance, however many patients are readmitted shortly afterwards.
Medicare will begin to penalize hospitals for high readmission rates in October; many hospitals that serve the poor (not all) have high readmission rates attributable to patient lack of funds for doctor visits and medications. What does this mean if you are low income? The indications are the hospital will pay a high premium and may not be able to stay in business and you would have to consider other options. The article does not address this situation. What is the solution?
Senior care colleague Steve Moran from www.SeniorHousingForum.net posted the report from a hospital chain’s point of view (link + text included below). Posting of this is merely to present information. The subject requires much discussion; there are no easy answers… and as with any new policy, it may evolve and be tweaked over time.
Medicare To Penalize 2,211 Hospitals For Excess Readmissions
By Jordan Rau
KHN Staff Writer
AUG 13, 2012
More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.
Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.
With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.
Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate has remained steady at slightly above 19 percent for several years, even as many hospitals have worked harder to lower theirs.
The penalties, authorized by the 2010 health care law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. In a few months, hospitals also will be penalized or rewarded based on how well they adhere to basic standards of care and how patients rated their experiences. Overall, Medicare has decided to penalize around two-thirds of the hospitals whose readmission rates it evaluated, the records show.
The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of the records shows. Hospitals that treat the most low-income patients will be hit particularly hard.
A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School.
“A lot of places have put in a lot of work and not seen improvement,” said Dr. Kenneth Sands, senior vice president for quality at Beth Israel. “It is not completely understood what goes into an institution having a high readmission rate and what goes into improving” it.
Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has unusually low mortality rates for its patients, which he says may reflect that the hospital does a good job at swiftly getting ailing patients back and preventing deaths.
Penalties Will Increase Next Year
The maximum penalty will increase after this year, to 2 percent of regular payments starting in October 2013 and then to 3 percent the following year. This year, the $280 million in penalties comprise about 0.3 percent of the total amount hospitals are paid by Medicare.
According to Medicare records, 1,933 hospitals will receive penalties less than 1 percent; the total number of hospitals receiving penalties is 2,211. Massachusetts General Hospital in Boston, which U.S. News last month ranked as the best hospital in the country, will lose 0.5 percent of its Medicare payments because of its readmission rates, the records show. The smallest penalties are one hundredth of a percent, which 50 hospitals will receive.
Dr. Eric Coleman, a national expert on readmissions at the University of Colorado School of Medicine, said the looming penalties have captured the attention of many hospital executives. “I’m not sure penalties alone are going to move the needle, but they have raised awareness and moved many hospitals to action,” Coleman said.
The penalties have been intensely debated. Studies have found that African-Americans are more likely to be readmitted than other patients, leading some experts to be concerned that hospitals that treat many blacks will end up being unfairly punished.
Hospitals have been complaining that Medicare is applying the rule more stringently than Congress intended by holding them accountable for returning patients no matter the reason they come back.
Hospitals That Serve Poor Are Hit Harder Than Others
Some safety-net hospitals that treat large numbers of low-income patients tend to have higher readmission rates, which the hospitals attribute to the lack of access to doctors and medication these patients often experience after discharge. The analysis of the penalties shows that 76 percent of the hospitals that have a lot of low-income patients will lose Medicare funds in the fiscal year starting in October. Only 55 percent of the hospitals treating few poor patients are going to be penalized, the analysis shows.
“It’s our mission, it’s good, it’s what we want to do, but to be penalized because we care for those folks doesn’t seem right,” said Dr. John Lynch, chief medical officer at Barnes-Jewish Hospital in St. Louis, which is receiving the maximum penalty.
“We have worked on this for over four years,” Lynch said, but those efforts have not substantially reduced the hospital’s readmissions. He said Barnes-Jewish has tried sending nurses to patients’ homes within a week of discharge to check up on them, and also scheduled appointments with a doctor at a clinic, but half the patients never showed. This spring, the hospital established a team of nurses, social workers and a pharmacist to monitor patients for 60 days after discharge.
“Some of the hospitals that are going to pay penalties are not going to be able to afford these types of interventions,” said Lynch, who estimated the penalty would cost Barnes-Jewish $1 million.
Atul Grover, chief public policy officer for the Association of American Medical Colleges, called Medicare’s new penalties “a total disregard for underserved patients and the hospitals that care for them.” Blair Childs, an executive at the Premier healthcare alliance of hospitals, said: “It’s really ironic that you penalize the hospitals that need the funds to manage a particularly difficult population.”
Medicare disagreed, writing that “many safety-net providers and teaching hospitals do as well or better on the measures than hospitals without substantial numbers of patients of low socioeconomic status.” Safety-net hospitals that are not being penalized include the University of Mississippi Medical Center in Jackson and Denver Health Medical Center in Colorado, the records show.
Bill Kramer, an executive with the Pacific Business Group on Health, a California-based coalition of employers, said the penalties provide “an appropriate financial incentive for hospitals to do the right thing in terms of preventing avoidable readmissions.”
The government’s penalties are based on the frequency that Medicare heart failure, heart attack and pneumonia patients were readmitted within 30 days between July 2008 and June 2011. Medicare took into account the sickness of the patients when calculating whether the rates were higher than those of the average hospital, but not their racial or socio-economic background.
The penalty will be deducted from reimbursements each time a hospital submits a claim starting Oct. 1. As an example, if a hospital received the maximum penalty of 1 percent and it submitted a claim for $20,000 for a stay, Medicare would reimburse it $19,800.
The Centers for Medicare & Medicaid Services has been trying to help hospitals and community organizations by giving grants to help them coordinate patients’ care after they’re discharged. Leaders at many hospitals say they are devoting increased attention to readmissions in concert with other changes created by the health law.
Sally Boemer, senior vice president of finance at Mass General, said she expected readmissions will drop as the hospital develops new methods of arranging and paying for care that emphasize prevention. Readmissions “is a big focus of ours right now,” she said.
Gundersen Lutheran Health System in La Crosse, Wis., and Intermountain Medical Center in Murray, Utah, were among 1,156 hospitals where Medicare determined the readmission rates were acceptable. Those hospitals will not lose any money. On average, the readmissions penalties were lightest on hospitals in Utah, South Dakota, Vermont, Wyoming and New Mexico, the analysis shows. Idaho was the only state where Medicare did not penalize any hospital.
Even some hospitals that won’t be penalized are struggling to get a handle on readmissions. Michael Baumann, chief quality officer at the University of Mississippi Medical Center, said in-house doctors had made headway against heart failure readmissions by calling patients at home shortly after discharge. “It’s a fairly simple approach, but it’s very labor intensive,” he said.
The problems afflicting many of the center’s patients—including obesity and poverty that makes it hard to afford medications—make it more challenging. “It’s a tough group to prevent readmissions with,” he said.
Health care is quite a hot topic.
I suppose if you are affluent, it is perhaps a non-issue. You may always have enough to pay for the very best care.
National Public Radio (NPR) blogger Eyden Peralta posted a report from the Congressional Budget Office, based on the Supreme Court ruling, which estimates costs for the implementation of the Affordable Care Act (ACA) also known as Obamacare. Apparently, the healthcare plan will save the U.S. $84 billion over 11 years. If it is repealed, it might cost the country over $1 trillion.
This is a complicated subject. But it is worth listening to the various opinions if the outcome will affect you, your loved ones, your friends, and the country.
May we all stay well enough to never need serious medical attention,
And welcome to Wellness Shepherd, a new blog launched under the new moon on a spectacular August day.
I am writing from West Hollywood, CA, an enclave that offers a number of free educational health events at its main library, the senior center, and other venues around town. Today, the National Council of Jewish Women hosted a discussion about the implementation of the Patient Protection and Affordable Care Act (ACA).
The distinguished panel of experts included Susan Berke Fogel, an attorney and women’s rights advocate at the National Health Law Program; moderator Michael Hiltzik, a Pulitzer Prize-winning journalist and author who writes about public policy for the Los Angeles Times; Jim Lott, EVP of the Hospital Association of Southern California; Mark A. Peterson, PhD, Professor of Public Policy, Political Science and Law at UCLA School of Public Affairs; and Paul Song, MD, Board of Directors, Physicians for a National Health Program California.
“We cannot afford not to have healthcare reform,” and “transformation of the US healthcare system is necessary,” were the mantras of the speakers.
They touched on the importance of preventive health programs that will raise public health standards so spending can be reduced, changes in healthcare access (more access for more people), and the continuing shortage of doctors nationwide. It was pointed out that most young physicians have $200,000 of debt from their medical school studies, and, there is an ever increasing number of seniors as the number of medical school graduates dwindle. Seniors tend to have more health challenges than any other segment of the population.
Four of the panelists are advocates for some form of universal health care, preferably a single payer system. No one mentioned that of the 33 developed democratic nations in the world, the U.S. is the only country that does not offer universal health care to its citizens. There was no mention of what happens to those who are indigent and under 65 years of age who do not have employer insurance, nor the ability to pay for government insurance and health services of any kind.
The audience was encouraged to read up on the new program, to ask questions, and to remember ACA is a beginning, that it is necessary to look at the long-term goals, not short term results, and to understand the program has the capacity to evolve and improve. It was noted that when Medicare was founded in 1965 the initial program had its challenges; it was very different from the program in place now – it was improved, innovations were implemented. Ditto for Social Security.
For more information on the new ACA, please see Anna Wilde Mathews Wall Street Journal 16-page article of December 12, 2011, “The Future of U.S. Health Care” at http://online.wsj.com/article/SB10001424052970204319004577084553869990554.html
Blessings of health,