My Elder Advocate

This article was written by Carol Bradley Bursack, Minding Our Elders (http://www.mindingourelders.com/). The article is owned by Elderlink.Com http://www.eldercarelink.com/Go/Alzheimers-and-Dementia/elders-can-be-adept-at-covering-memory-problems.htm

This article was written by Carol Bradley Bursack, Minding Our Elders (http://www.mindingourelders.com/). The article is owned by Elderlink.Com http://www.eldercarelink.com/Go/Alzheimers-and-Dementia/elders-can-be-adept-at-covering-memory-problems.htm Jack Halpern

Jack Halpern

Recent studies have documented the perception that older adults receive less medical care than younger people. A report published in a recent issue of the Journal of the American Geriatrics Society found that in a controlled study at five Boston... Jack Halpern

Recent studies have documented the perception that older adults receive less medical care than younger people. A report published in a recent issue of the Journal of the American Geriatrics Society found that in a controlled study at five Boston hospitals, people older than 80 received about $12,000 less in care than did patients younger than 50.

This was true even when correcting for the severity of illness and considering when older patients did not want aggressive care.

There appear to be multiple reasons for this de facto rationing. Ageism— defined as discrimination against elderly people because of their age—may be a factor. Our culture places little value on people viewed as “unproductive,” and most elderly people fall into this category. Health care providers may subconsciously subscribe to the perception that valid reasons do not exist for providing the same level of treatment to older adults as younger people receive.

Another reason for less care being provided to the elderly is the medical profession’s lack of knowledge about aging. Schools of medicine and nursing have only recently added courses on gerontology and the special needs of older adults.

Many of these special needs include supportive services to assist with Activities of Daily Living, and most physicians are not trained to address these issues. Also, the majority of health care providers are between 25 and 60 years old, and they sometimes have little personal interest in caring for the frail elderly. Studies have shown that as many as 75% of people over 65 become confused while hospitalized, and this may result in an intentional or unintentional withholding of care.

Economic factors may also influence the amount of care provided to seniors. With the Medicare trust fund facing insolvency in the not-so-distant future, the need to allocate resources through some type of rationing is a real possibility. The commonly held view that excessive resources are devoted to the old and terminally ill may already influence the level of care provided to older adults. This recent Boston study is only one of several which challenges these perceptions. Further study will be needed to determine whether older people are consuming more than their fair share of financial resources, or whether they actually receive less care than they need.

“Managed care” has created a new impetus for rationing health care services. Medicare recipients have recently been able to enroll in HMO type health care plans in which the HMO receives a fixed amount of money from Medicare for each enrollee, and then must manage this money to provide all required care. The concept of the provider being at risk is not new, but having frail elderly receive care through these risk plans has been underway for only five years.

A recent study showed that seniors and poor people fared worse in these managed care plans than did younger and more affluent individuals. As more seniors—particularly those in ill health—enroll in these plans due to aggressive marketing, lower out-ofpocket costs, fewer employer-sponsored retiree Medicare supplementation plans, and no paperwork, the likelihood of an increase in the deliberate withholding of care to maximize profits can be expected.

The most effective method to ensure that seniors receive an appropriate level of health care services is for them to have a knowledgeable advocate working on their behalf. This advocate can be a son, daughter, friend, relative or professional care advocate. It is essential that the advocate be able to speak the same language as the medical providers, and have access to the latest literature on appropriateness of care regarding the senior’s condition.

The advocate should plan to accompany the senior to his or her medical appointments, obtain copies of diagnostic tests, discuss the diagnoses and treatment plan with the doctor, and assist the senior in complying with the recommended treatment. In addition, the advocate should observe the senior for response to the treatment and any adverse effects, and assist the senior in reporting this information to the doctor. When the response to treatment is less effective than expected, the advocate may arrange for a second—or even third—medical opinion for the senior.

Jack Halpern

Bill Sanders, 57, has been taking care of his 90-year-old mother for the past 14 years, both at her home in Brooklyn, New York and the nursing home where she now resides. "When I took care of my mother at home," he explains, "I found that neighbors looked down on me. They thought I was a bum living off my mom. They didn't believe I was really taking care of her." Sanders thinks that a woman would not have faced this kind of ridicule.

After he moved his mother to the nursing home, Sanders faced another challenge. "At first I noticed that medical personnel seemed reluctant to share information with me," he says. "They seemed more open with my sister. Maybe it would have been different if it had been my father I was caring for."

Today, however, Sanders is not just accepted but appreciated. This former hairdresser donates his time and services to other residents of the nursing home.

The Alzheimer's Association and the National Alliance for Caregiving estimate that men make up nearly 40 percent of family care providers now, up from 19 percent in a 1996 study by the Alzheimer's Association. About 17 million men are caring for an adult.

"It used to be that when men said, 'I'll always take care of my mother,' it meant, 'My wife will always take care of my mother,"' said Carol Levine, director of the families and health care project at the United Hospital Fund. "But now, more and more men are doing it."

Often they are overshadowed by their female counterparts and faced with employers, friends, support organizations and sometimes even parents who view caregiving as an essentially female role. Male caregivers are more likely to say they feel unprepared for the role and become socially isolated, and less likely to ask for help.

Men experience more anxiety in handling the multiple demands of care while also learning new skills, have greater physical health difficulties and depression, do not tend to be familiar with dealing with social service agencies, and are often uncomfortable asking for help.

Women still provide the bulk of family care, especially for intimate tasks like bathing and dressing. At support groups, which are predominantly made up of women, many women complain that their brothers are treated like heroes just for showing up.

But with smaller families and more women working full-time, many men have no choice but to take on roles that would have been alien to their fathers. Just as fatherhood became more hands-on in the baby boom generation, so has the role for many sons as their generation's parents age.

Much more needs to be learned about their experiences and the challenges they face. Betty J. Kramer and Edward H. Thompson Jr., both experienced researchers in the area of men as caregivers, provide an in-depth and comprehensive overview of the topic in this collection of articles from various experts in gerontology, social work, psychology, and sociology. Special consideration is given to gay male caregivers of partners with AIDS, men who care for a family member with dementia, fathers of adult children with mental disabilities, spousal care of women with cancer, and sons caring for parents. This valuable collection of current research addresses a much neglected but vitally important area of caregiving.

Many organizations and social-service agencies are beginning to offer male caregiver support groups. Groups can be found through local Area Agencies on Aging, disease associations or online. Bulletin boards and online chat rooms for caregivers may be perfect for those who have demanding schedules and who want anonymity. Try several different groups until you find the one that works for you.

But there's nothing like personal contact, and men are beginning to join and open up even in co-ed caregiver support groups This is where caregivers can know they're not alone, and the men share their stories like everyone else."

Support groups offer more than social opportunities. "When you find others who are in the same situation," says John Radley, "you also may find solutions." That happened to Sean Feldman. "Well Spouse helped me through the maze of hiring a home health aide," he says, "particularly about how to handle compensation and take care of payroll taxes. You get practical information from those who've gone down the same path."

Bill Sanders, 57, has been taking care of his 90-year-old mother for the past 14 years, both at her home in Brooklyn, New York and the nursing home where she now resides. "When I took care of my mother at... Jack Halpern

http://wcbstv.com/video/?id=142329@wcbs.dayport.com

Do Not believe for a minute that this is an isolated incident!

http://wcbstv.com/video/?id=142329@wcbs.dayport.com Do Not believe for a minute that this is an isolated incident! Jack Halpern

By Jack Halpern Nursing homes are generally prohibited from moving residents. They can transfer or discharge residents from the home only for certain reasons and, even then, only when they follow specified procedures. My Elder Advocate has a 100% success... Jack Halpern

By Jack Halpern

Nursing homes are generally prohibited from moving residents. They can transfer or discharge residents from the home only for certain reasons and, even then, only when they follow specified procedures.

My Elder Advocate has a 100% success rate in preventing these evictions. Call 212-945-7550.

In order to lawfully transfer or discharge a resident, the home must be able to prove that it has complied with all the procedural requirements and that the transfer or discharge is for one of the few allowable reasons. Absent such proof, the transfer or discharge must be disallowed or, if the resident has already been moved, the resident must be allowed to return to the bed, room and facility from which the resident was transferred.

There are several reasons why a nursing home may try to evict a resident. From a nursing home’s perspective, the ideal resident does not require expensive care, places few demands on staff, and pays the home at the "private pay" rate. Because Medicaid and Medicare typically pay much lower rates than homes receive from their private pay clients, facilities may try to limit the size of their Medicaid-covered populations. Residents judged by the home to be "difficult" may become a target for eviction or transfer--often to a less appealing nursing home or to a psychiatric hospital. The home may claim that, regardless of the patient’s medical needs or desire to stay in the facility, Medicare-covered or "respite" admissions are time-limited (cutoff points of 20 or 90 days are often cited).

For a nursing home resident, few events are as traumatic as an involuntary transfer or discharge. At best, such occurrences are stressful and disruptive. At worst, "transfer trauma" will leave a frail elderly person frightened, disoriented, and isolated from friends and families, causing irreparable psychological and physical harm. Medical studies indicate that the rate of death will 5 to 9 times higher for residents who are transferred.

The transfers and discharges discussed here include any time the home moves a resident outside of that facility, including transfers to a hospital. There are separate rules and procedures for transfers from one room to another room within the same nursing home.

When can a nursing home resident be transferred or discharged?

A resident can never be discharged or transferred if moving the resident is "medically contraindicated," i.e., if the transfer would be more harmful than letting the resident stay.

If the transfer or discharge will not be harmful, a nursing home can only require a resident to leave in five situations:

1. Medical care the resident requires can not be provided in a nursing home setting.

2. The resident no longer needs nursing home care because the resident’s condition has improved.

3. The health or safety of other individuals in the home is endangered.

4. In the case of a self-pay patient, the resident has not paid for care at least fifteen days.

5. The home plans to cease operations.

The need for particular types of medical care or for extensive care should seldom be the basis for a transfer. Staffing levels should never be a factor. Nursing home law requires that appropriate, individualized care be provided to every resident of every nursing home. Nursing homes are always required to adjust the staffing levels of nurses, therapists and aides as needed to provide the best care possible for all residents.

A nursing home can not evict residents covered by Medicaid when the home decides to drop out of the Medicaid program. In this situation, the home must continue to provide care and accept payment from Medicaid for all those in residence when the home decided to withdraw from the Medicaid program.

What is the procedure for proposed transfers or discharges?

Usually, a nursing facility must give you, your guardian, conservator or legally liable relative a written notice, at least 30 days, and no more than 60 days, before a transfer or discharge from one facility to another. A shorter notice is allowed in emergency situations or for residents recently admitted. The nursing home must comply with all of the following notice requirements even if the home claims that the resident "consented" to the transfer or discharge. This is necessary to ensure that residents are made aware of their rights and afforded the opportunity to appeal.

If the written notice does not contain any of the following information, the discharge or transfer would be unlawful. The notice must include:

* The reason for transfer or discharge.

* The date of the proposed transfer or discharge.

* The location to which the nursing facility proposes to transfer or discharge you.

* Your right to a hearing to contest the transfer or discharge.

* The procedures you must follow to request a hearing.

* The date by which you must request a hearing in order to prevent the transfer or discharge from occurring before the hearing is held. The date given must be at least ten days from your receipt of the notice from the facility.

* Your right to represent yourself or have legal counsel, a relative, friend or other person represent you at the hearing.

* If you are being transferred to a hospital, information regarding holding your bed and readmission to the facility. The name, mailing address and telephone number of Long-term Care Ombudsman.

Should the facility prepare a discharge plan for me?

A resident may not be discharged unless the nursing home have developed a written discharge plan. The discharge plan must:

Be developed by your doctor or, the nursing facility's medical director together with other medical staff.

Consider the possibility of placement near your relatives, spouse, guardian or conservator.

Include a written evaluation of the effects of the transfer or discharge on you and a statement of how the nursing facility will make the transfer or discharge less disturbing.

Outline the care and kinds of services which you will receive upon transfer or discharge.

Except in an emergency, the nursing facility must give you, your doctor, guardian, conservator or legally liable relative, a copy of the discharge plan at least 30 days prior to the transfer or discharge.

Can a transfer or discharge be appealed?

The resident always has the right to appeal a discharge or transfer.

If you receive notice of a proposed transfer or discharge, it is important to start the appeal within 10 days of your receipt of a transfer or discharge notice. If you file an appeal during this 10 day period, you can not be moved until a hearing is held and a written decision is issued.

An appeal, however, can be filed within 30 days of receipt of the transfer or discharge notice. An appeal can be filed even if you have already been moved.

Legal services organizations and the long-term care ombudsman can provide assistance with transfers and discharges.

Facilities that attempt to transfer residents in violation of the law or without providing them with the required advance written notice can be sued. The courts are authorized to issue injunctions to prevent transfers, to order facilities to reverse transfer, and to make nursing homes pay residents compensatory and punitive damages.