Consumers’ transition period in state’s new long-term care program comes to an end

A new phase of the state’s Community HealthChoices program kicks in this week, with the end of a safeguard designed to protect the aged or disabled participants against service changes or cuts.

The change comes with some of the 80,000 southwestern Pennsylvania participants in the 6-month-old program still finding shortcomings in the coordination and communication that are supposed to be CHC hallmarks, helping people with health issues get more support to live at home.

“They didn’t fulfill what they promised,” said Theresa Quail, explaining that she has been waiting months for modifications to her home in Richeyville, Washington County, to help her avoid falls. “They said things would be easy and more beneficial for us, but I’ve yet to see any advantages.”

Officials from the state and its contracted managed care organizations have maintained that despite some individual problems with service coordination, transportation and other issues, the program has largely served consumers well since its Jan. 1 debut in 14 southwestern Pennsylvania counties. It required some 80,000 individuals covered by Medicare and Medicaid to pick one of three managed care organizations to coordinate any subsidized long-term care services they might need, such as in-home personal assistance.

Full story at the Pittsburgh Post Gazette

Retirement planning: Older Americans face tough long-term care choices

Growing old in America can be wrought with legal problems arising from health concerns, long-term care, and the need for appropriate housing.

The good news is that there are tools and products and strategies that older Americans can use to live as well as possible in the last decades of their lives.

So, what are some of the more common problems older Americans face, and how might they solve or at least alleviate them?

Cognitive decline

Who will make decisions for you when you are no longer able to make them yourself?  According to Bernard Krooks, a partner with Littman Krooks and chair of that firm’s elder law and special needs department, the best way to address this problem is by searching for and retaining a certified elder law attorney who can draft the appropriate documents that you’ll need, including durable power of attorney, advance health care directives and the like.

Full story at USA Today

For-profit medicine incentivizes overmedicating our elderly rather than caring for them

As the “gray wave” of aging baby boomers crowd into the country’s creaking long-term care system, many of them may unexpectedly end up in nursing home where anti-psychotic medication, rather than comprehensive social and mental health services, have become a standard way for some residential institutions to maintain order.

Yet, according to human rights investigators, anti-psychotic drugs are often administered to residents not with a doctor’s prescription, but the management’s. So-called “chemical restraints” have become a routine “fix” for behavioral problems, such as those who “resist” staff’s orders, or for dementia patients with a habit of wandering off. In reality, deliberately over-medicating elderly patients is not designed to help them as much as to help an overwhelmed workforce of clinicians struggling to care for too many patients with too little time and funding.

But the seemingly efficient solution comes at the expense of seniors’ human rights.

Full story at NBC News

‘Abandoned’ stroke survivors need better longer-term care, expert says

Stroke patients need better long-term support to ensure their health and social care needs are met and prevent them feeling “abandoned,” a University of Leeds expert says.

Speaking on World Stroke Day (October 29), Professor Anne Forster, from the School of Medicine, one of the UK’s leading experts in care for stroke patients, suggests that although survival rates have improved significantly, with stroke mortality rates halving over the last 20 years, more needs to be done to safeguard the long-term welfare of stroke patients and their families.

Professor Forster said: “There are many stroke patients who feel abandoned and lost once they are discharged from hospital. In many cases, they may only receive three months of after-care, even though national clinical guidelines recommend a review of their condition after six months.

Full story of stroke survivors need better long term care at Science Daily

Study compares long-term outcomes for types of aortic valve replacements

Among patients ages 50 to 69 years who underwent aortic valve replacement with bioprosthetic (made primarily with tissue) compared with mechanical prosthetic valves, there was no significant difference in 15-year survival or stroke, although patients in the bioprosthetic valve group had a greater likelihood of reoperation but a lower likelihood of major bleeding, according to a study in the October 1 issue of JAMA.

Approximately 50,000 patients undergo aortic valve replacement annually in the United States. In older patients, bioprosthetic valves pose a low lifetime risk of reoperation for structural degeneration and avoid many of the complications associated with mechanical prostheses; bioprosthetic valves are therefore recommended in patients older than 70 years. The optimal prosthesis type for younger patients is less clear, according to background information in the article.

Yuting P. Chiang, B.A., of The Mount Sinai Hospital, New York, and colleagues used a statewide administrative database to quantify differences in long-term survival, stroke, reoperation, and major bleeding episodes after aortic valve replacement according to prosthesis type. The analysis included 4,253 patients ages 50 to 69 years who underwent primary isolated aortic valve replacement using bioprosthetic vs mechanical valves in New York State from 1997 through 2004. Median follow-up time was 10.8 years; the last follow-up date for mortality was November 30, 2013.

Full story of long term outcomes from aortic valve replacements at Science Daily