Welcome to the blog sub-site for The Center for Long-Term Care Reform. If you subscribe to the Health & Medicine comment feed, you will be able to post comments to some of the posts that appear in this section.
Two recently released reports from HMPRG's Center for Long-Term Care Reform (The Determination of Need Study and the Home Again Report)
July 8, 2010
20-30 Year Olds - You Can Do Your Part To Ensure SocialSecurity's Robust Survival!
Posted byKristen Pavle, Policy Analyst, Center for Long-TermCare Reform
Social Security Will Be Around When You Retire… If YouWant It To Be!
There seems to be agrowing opinion among 20 and 30 yearolds about the United States Social Security program: thatit will not exist upon our retirement, sowhy should we care? Perhaps I am missingsomething here, but the mere fact that we are paying into the SocialSecurityprogram NOW, for others’ benefits, is reason enough to care! Iwant this program to exist in my retirement,too. But even this is only a minorreason to becomemoreinvolved in the discussion surrounding Social Security as a youngerperson.
As of 2006, theSocial Securityprogram has provided more than $541.6 Billion dollars in benefits toover 49million individuals. Social Securityallows citizens of this country to retire with the earned privilege—anenforceable right—of an income after a lifetime of work. SocialSecurity retirement income, withbenefits also paid to spouses, widows (or widowers), minor children, andpeoplewith disabilities represents a fundamental cornerstone of our society. Becauseof Social Security, older Americansare no longer the poorest demographic in the country. Itis the most visible symbol ofintergenerational connectedness and the last remaining leg of thethree-leggedstool (savings, pensions, and Social Security) that its foundersenvisioned. Today it is the bedrock of economicsecurity, particularly in old age, for thousands of people, especiallyolderwomen. Not only do I urge you to careabout Social Security, but I want to start the discussion on WHY weshould allcare about the concept of “social security” as manifested by the SocialSecurity program.
What Does the DataSay About Social Security in the Long-Term?
Didyourparents ever tell you not to worry about Social Security, because theprogramwould not be around for you would not enjoy its benefits? Well,they were not exactly right. According to the “2009Annual Report of theBoard of Trustees of the Federal Old-Age and Survivors Insurance and theDisability Insurance Trust Funds” (read: Annual Report on the SocialSecurityProgram), intermediate (neither conservative nor liberal)projections forthe solvency of the Social Security program are as follows:
- By2016 the benefits program will be paying out more than it will begainingin revenues, thus beginning to deplete the trust fund.
- By2024 the Social Security pot of money, the trust fund, will no longerbegrowing.
- By2037 the Social Security trust fund will be exhausted, empty, no moneyleft. But income will still be coming into the system from payrolltaxesso benefits will be paid but at a reduced amount.
Maybe yourparents were right…? But, these figures about financingSocialSecurity in the long-term function under a rather large assumption: that there will be no structural changes inhow the Program operates. However, lasttime I checked we live in a democratic nation. Ascitizens, we have a choice to demonstrateour commitment to Social Security so that benefits can be available INFULLwhen we retire.
Advocatesfor Social Security are equipped with many ideasfor how we can change the structure by which the Program operates,giving it fullfinancial sustainability beyond 2037, when WE retire. SocialSecurity’s problems are political, notfinancial. Contrary to popular opinionit is not in crises; it does not contribute a single penny to thedeficit. In fact, it is in surplus.
A Call for YourVoice to be Heard: Focus Group
- Areyou in your 20’s or 30’s?
- Do youhave an opinion on Social Security?
- Do youhave questions about Social Security or an interest to learn more?
In an attempt at brevity, Iwill close this blog articlewith an invitation to continue the discussion. Health & MedicinePolicy ResearchGroup (HMPRG) wants to talk with you. On Wednesday, July 28thfrom 6-8pm, HMPRG will host a focus group for individuals intheir 20s and 30s on SocialSecurity. We look to you to help usbuild a campaign to get all younger people committed to SocialSecurity’srobust survival. Quite honestly, we wantto turn you into an informed advocate for a strong Social Securityprogram, onethat will be there for each succeeding generation. Remember,it is the only source of income thatyou cannot outlive.
Please contact KristenPavlefor details and to RSVP.
May 27, 2010
We'd like to share a letter from Cindy Mann, Directorof Centers for Medicare & Medicaid (CMS), to State Medicaid Directorspromotes the Community Living Initiative, and offers assistance to states tobalance the long-term care system to reflect more home and community basedoptions for older adults and persons withdisabilities.
In Ms. Mann’s letter to StateMedicaid Directors, she outlines “Opportunities and Partnership –Tools forCommunity Living”. CMS offers, among othersupports:
· technical assistance,
· waiver programs,
· information on managed care modelsfor long-term care,
· information on affordable housingoptions,
· support for infrastructure reforms,
· financial support for demonstrationprojects,
· guidance in dischargeplanning.We commend CMS for continuing topromote the Community Living Initiative, and for assisting the states in ourefforts to balance the long-term care system to reflect more home and communitybased options for older adults and persons with disabilities. This letter is agreat opportunity for education and advocacy to ensure that Illinois takes advantageof the support and guidance CMS is offering. Please visit this link to read theletter in full: http://www.nasua.org/pdf/health_reform/CMS%20Olmstead.pdf.
May 26, 2010
Photo from Organize for America- Barack Obama - on flickr
National Commission on Fiscal Responsibilityand Reform, and Social Security
On February 18,2010, President Barack Obama issued an Executive Order to establish the NationalCommission on Fiscal Responsibility and Reform (Commission). TheCommission aims to provide recommendations on balancing the federalgovernment’s budget by 2015. Further, the Commission will recommendaction to improve the fiscal outlook of the country in the long-term. Alot of discussion about the country’s long-term fiscal outlook hascentered on entitlement programs, specifically where money coming in tofund programs has fallen below program expenditures. There has beenquite a bit of conversation about theSocial Security entitlement program as a possible way to help reign inspending and balance the budget.
TheSocial Security entitlement program in the United States has a longhistory; President Franklin D. Roosevelt signed it into law in 1935,passing Congress as part of the New Deal. Social Security is a socialinsurance program for retired persons, disabled individuals, andindividuals who depended on a family worker who has died. SocialSecurity is a safety net for many Americans, and specifically many olderadults. With more than 47 million Americans depending on SocialSecurity income, and over two-thirds of retirees relying on SocialSecurity for the majority of their income, it isimperative we protect and strengthen the Social Security program. As the National Commission on Fiscal Responsibility and Reform continuesto meet, behind closed doors, advocacy to preserve Social Security mustbe a priority.
The TrueCost of Living for Older Adults, Illinois Perspective
WiderOpportunities for Women (WOW), a non-profit based out ofWashington D.C., created the Elder Economic Security Initiative (EESI)several years ago. EESI approaches building economic security throughadvocacy, organizing, and research. A key part of EESI is the ElderEconomic Security Standard™ Index, calculating the cost of living for anolder adult. The Illinois state partner for EESI is Health &Medicine Policy Research Group (HMPRG) and detailedinformation about EESI can be found on the HMPRG website. InIllinois, and across the country, EESI is revealing that frequentlyolder adults cannot make ends meet based on their income and the cost ofliving.
According to the policy brief, “EldersLiving on the Edge: When Meeting Basic Needs Exceeds Available Income inIllinois” inIllinois 1 out of 5 older adults relies solely on Social Security. Unfortunately, the average Social Security payment for a single, retiredIllinoisan does not cover the cost of living. Using EESI as a tool,specifically the data of the Elder Economic Security Standard™ Index,Illinoisans can advocate in many ways to protect the economic securityof its older adult population. One way is to advocate for thestrengthening and preservation of the Social Security program. With somany older adults in Illinois relying on Social Security and currentlyunable to afford the cost of living in the community, any disruption ofSocial Security benefits would be tragic.
Fiscal Budget & Illinois State Budget, HowDoes This Affect YOU?
As Washington D.C.tackles the federal budget, states have the task of managing their ownbudgets. Illinois is in abudget crisis, with a deficit of $13 billion, almost half of the state’sgeneral fund revenue. Attempting to come up with a solution tothis deficit has not been easy—state employee pension plans, socialservice agencies, health care agencies, and the education system haveall been threatened by budget cuts. Illinois'budget deficit threatens important health and social programs, andis already affecting social service agencies throughout the state. Particularly concerning to the aging community is the delay in payingsocial service agencies that provide care for the elderly.
Withoutproviding payment to state-funded social service agencies, many olderadults will not be able to access the services they need to remainhealthy and viable in their communities. As the Federal Commissionresearches ways to balance the federal budget and talk of changingSocial Security continues, the economic well-being of older adults hasnever been a more pertinent issue.
WiderOpportunities for Women (WOW) is hosting its second annual Blog Day,Wednesday May 26th, 2010: “America’s Budget Matters, So Does Yours.” Theposts on HMPRG's about the impact of both the federal and state budgetdeficits and their impact on the aging community are only the beginningto an ongoing discussion of elder economic security, and we want to hearfrom you:
• Do you have anything to contribute to thisconversation about the federal deficit?
• About Illinois’ budgetdeficit?
• About cuts to social service programs in Illinois?
• About preserving Social Security?
• How do potential budget cutsaffect you?Please leave your comments below.
HMPRG is working with WOW to make sure that your voice is heard, thatthe Federal Commission and the Illinois state government knows thattheir decisions affect you. Our country, and our state of Illinois, isin difficult times. Now is not a time to be quiet, but a time toadvocate for your right to remain economically secure in your homes andcommunities as you age.
May 19, 2010Elder Economic Security—Update
The U.S. Census Bureau recently announced the creation of a supplemental measure to the federal poverty level.It’s about time! It’s been 50 years since the original poverty level wasdeveloped and its methodology has yet to be updated. This antiquatedmeasure fails to capture the true number of Illinois elders and familiesstruggling to meet their basic needs.
Elders in Illinois are having atough time making ends meet with one out of five living on SocialSecurity alone. The average Social Security payment for Illinois’selders is $12,996. This payment barely surpasses the original federalpoverty line, and is not enough for these elders to be economicallysecure. According to the Illinois Elder Economic Security Standard™ Index (Elder Index),a geographically-based measure of what elders need to age in placecreated by Wider Opportunities for Women and the Gerontology Instituteat the University of Massachusetts-Boston, a single elder renter needs$19,810 a year.
The proposed supplemental poverty measure is agood first step, because it will improve on how poverty is currentlymeasured by providing new data including the cost components of food,housing, and clothing. But, the supplemental poverty measure alone isnot enough.
Decision makers need tools that accurately reflectthe real cost of aging in place. For instance, the Elder Indexdemonstrates that seniors have high health costs, which may affect theirability to pay for other basic needs. In Illinois an elder in fairhealth pays $357 a month for health care while an elder in poor healthpays $387. And if long-term care services are needed, these costs candouble or even triple what an elder needs to make ends meet.
Additionaldata is necessary to better capture elders’ real costs and to determinethe best way policy makers, administrators and service providers canutilize funds and target strategies to promote economic security.
Thesupplemental measure is sure to spur continuous and much neededdiscussion as we grapple with how best to define economic security inour state and in our country. We’ve already waited too long. Too manyelders and their families live without enough to meet their basic needs.Now is the time to move past simply measuring what it means to bedeprived to what it means to be secure.
Please see, “Elders Living on the Edge: When Meeting Basic NeedsExceeds Available Income in Illinois”
for more information, andcheck out Health & Medicine’s involvement with the ElderEconomic Security Initiative
April 26, 2010
Health&Medicine’s Center for Long-Term Care Reform has supported the supportedthe MoneyFollowsthe Person (MFP) program in Illinois since 2007, when the demonstrationproject began in the state. MFPisa federal demonstration grant to assist individuals living innursinghomes for 6 months or longer to transition back into a home andcommunity basedsetting. Through MFP, Illinois was awarded $55.7 million intheform of enhanced Medicaid reimbursements for a 5 year program,2007-2011.
Although Illinoishad set the highest goal for number of people to transition from nursinghometo home and community, the state has been slow in getting started inhelpingpeople make their transitions. Illinois is not alone,however, and most states are finding it difficult to meet theirtransitiongoals.
As a result of the passage of the HealthCareReform legislation, the MFP grant has been extended through 2016withadditional federal funds allocated to the program. Theeligibility requirements have also beenchanged, including the length of stay in the nursing facility;individuals whohave been in a nursing facility under Medicaid payment for at least 3monthsare now eligible for MFP transitional services.
As Illinoiscontinues to reform its long-term care system and works to promotequality homeand community based service options, MFP is an important demonstrationprojectfor the state. Although Illinois hasbeen transitioning people out of nursing facilities into the communityat aslower pace than originally planned, the Health Care Reform legislationgivesthe state the opportunity to make some adjustments in the project andworktowards increasing transitions.
Check out this Kaiser Family Foundation article formoreinformation on the Money Follows the Person grant: http://www.kaiserhealthnews.org/Stories/2010/April/22/states-struggle-to-move-people-out-of-nursing-homes.aspx
Questions?Contact KristenPavle, Policy Analyst, Center for Long-Term Care Reform
April 12, 2010
Author: Nadia Chivers, Policy Intern, Health & Medicine Policy Research Group
Editor: Kristen Pavle, Policy Analyst, Center for Long-Term Care Reform, Health & Medicine Policy Research Group
The Outlawing of Physical and Chemical Restraints
Since October 1990, nursing homes across the country have had to comply with a federal mandate, The Omnibus Budget Reconciliation Act of 1987, that restricts the use of inappropriate physical and chemical restraints on nursing home residents unless the restraint is necessary to treat their medical symptoms.
Physical restraints restrict a person’s movement and may include leg and arm restraints, hand mitts, vests, ties, and trays/tables/bars that cannot be removed from a chair or bed and limit the person’s mobility.
While the use of physical restraints in nursing homes serves some legitimate purpose, unnecessary use has drastically reduced in the past 20 years. The same cannot be said for the use of chemical restraints. While psychotropic drugs are often an essential form of treatment in nursing homes, they become chemical restraints when they are used to control a resident’s behavior rather than administered for medical purposes.
The misuse and overuse of psychotropic drugs on nursing home residents has been well documented and is now considered by some experts to be the newest form of nursing home abuse. It is estimated that 1 in 4 patients in the U.S. receive anti-psychotic drugs and 15,000 nursing home patients are killed each year due to unnecessary anti-psychotics.
As a response to the inappropriate use of psychotropic drugs in Illinois nursing homes, the Illinois Nursing Home Safety Task Force (The Task Force) has included in its Final Report a recommendation that a policy be developed to assure these drugs are used properly.
Read the full post
March 10, 2010
The Nursing Home Safety Task Force has released its final recommendations and has a working group meeting twice a week to discuss translating these recommendations into legislation. However, AARP and Advocates have also been busy drafting their own legislation addressing nursing home care in Illinois. Per AARP’s press release early March 9, 2010:
“The legislation – Senate Bill 685 – is sponsored by Senators Heather Steans (D-Chicago) and Jacqueline Collins (D-Chicago), and is supported by AARP Illinois, The Community Renewal Society, SEIU Healthcare Illinois, Illinois Citizens for Better Care, the Jane Addams Senior Caucus, AFSCME, Illinois Association of Long Term Care Ombudsman, the Illinois Trial Lawyers Association, Age Options, Next Steps, Supportive Housing Providers Association, Health & Medicine Policy Research Group, and the Shriver Center on Poverty Law, the Illinois Network of Centers for Independent Living and Health and Disability Advocates.”
Click here for a view of video footage from the AARP Press Release,from NBC Central Illinois News
We will continue to keep you up-to-date on the various pieces of legislation concerning Nursing Home Reform and let you know how you can become involved as opportunities arise. For more information, please contact: Kristen Pavle, Policy Analyst, Health & Medicine’s Center for Long-Term Care Reform. 312.372.4292 x 27 or email Kristen.
February 25, 2010
Nursing Home Safety Task Force
On October 3, 2009, Governor Pat Quinn formed the Illinois Nursing Home Safety Task Force. The Task Force was charged with addressing the serious issue of mixing populations of persons with mental illness with the elderly and other physically disabled.
On February 19, 2010, the Task Force released its Final Report to the Governor. The Final Report includes 38 recommendations applying to persons with mental illness that currently occupy nursing home beds.
Three broad categories are used to organize the recommendations:
- Enhance Pre-Admission Screening and Background Check Process,
- Set and Enforce Higher Standards of Care, and
- Expand Home and Community-Based Residential and Service Options.
Task Force on Aggressive Timeline for Reform
Task Force chairperson Michael Gelder has set an aggressive timeline to achieve the proposed recommendations. Nine “Immediate Implementation Workgroups” have been assigned to implement recommendations by April 30th, 2010. These workgroups will focus on areas including:
- Pre-Admission Screen and Resident Review (PASRR) enhancement,
- Criminal Background Checks,
- Psychotropic Drugs, and
- Supportive Housing Expansion.
Center for Long-Term Care Reform Influences Task Force
Illinois leads the nation in caring for persons with mental illness in nursing homes. Health & Medicine’s Center for Long-Term Care Reform recently produced on the subject, looking historically at how Illinois finds itself in this current situation, “Illinois Nursing Homes as Care Providers for Mentally Ill: How Did We Get Here?” The Center for Long-Term Care Reform has also researched the federal Pre-Admission Screening and Resident Review (PASRR) program and submitted a report on PASRR to the Task Force.
Recognition from Federal Government & Moving Forward
The Illinois Nursing Home Safety Task Force has done a great job at convening the major state departments and producing recommendations to reform the current system of nursing home referral, admission, and care. There has been a lot of movement around nursing home reform since the inception of the Task Force:
- In a letter to chairperson Michael Gelder, Assistant Attorney General Thomas Perez of the United States Department of Justice expressed praise for the reform the Task Force promises.
- A Chicago Tribune article publicized Illinois Attorney General Lisa Madigan’s office and local police are performing unannounced visits and safety checks at troubled nursing facilities as a result of the Task Force.
- Multiple parties are drafting legislation for nursing home reform: the Nursing Home Safety Task Force, advocates for the elderly and mentally ill (AARP and others), and the nursing home industry.
February 18, 2010
The Illinois Nursing Home Safety Task Force has taken the initiative to address the serious situation of mixing populations of persons with mental illness with the elderly and others with physical disabilities in nursing homes. In moving forward to address the current challenges, it is helpful to look historically at how we arrived here.
Please read Health & Medicine's Center for Long-Term Care Reform’s research report that looks at the care of persons with mental illness after deinstitutionalization in the United States and in Illinois. It is our hope that this review will help as we plan for the future. If you have questions or comments about the document, please do not hesitate to call or email Kristen Pavle, or call Kristen at (312) 372-4292 ext. 27.
November 24, 2009- Observations from Kristen Pavle, MSW Policy Analyst at Health & Medicine's Center for Long-Term Care Reform:
Recently attending an Elder Economic Security Initiative state partner summit in Washington, D.C., I had the privilege to meet with two Congressional staff policy advisors who worked for the Senate Special Committee on Aging.
The Senate Special Committee on Aging was established as a temporary committee in 1961 and was granted permanent status in 1977. Special committees do not have legislative authority, but are a reliable and essential source of research and information, and often useful in pushing legislation for consideration. It is currently chaired by Senator Herb Kohl (D-Wisconsin)
Some key Senators who have played a role in the Senate Special Committee on Aging include:
• Senator Frank Moss (D-Utah)—worked on paying attention to unacceptable nursing home conditions
• Senator Frank Church (D-Idaho)—focused on protecting older Americans from age discrimination
• Senator John Heinz (R-Pennsylvania)—researching the Medicare’s Prospective Payment System and the “quicker and sicker” discharge idea
The Special Committee on Aging staffers had much valuable information about current health and aging legislation, for example: the Nursing Home Transparency and Improvement Act(Senate Bill 647)
, the Physicians Payments Sunshine Act (Senate Bill 301)
, and the Medicare Payment Improvement Act of 2009 (Senate Bill 1249).
Health & Medicine is partnering with the University of Illinois at Chicago School of Public Health—Great Lakes Centers for Occupational and Environmental Safety and Health, in convening an Older Health Care Workers Workgroup. It was reassuring to hear that a key focus of this Special Committee was older workers! Here is a summary of current legislation on older workers from the Special Committee on Aging.
Please contact me if you have any comments or questions about my experience with the Senate Special Committee on Aging, the Elder Economic Security Initiative, or our Center on Long-Term Care Reform.
CLASS Act - Long Term Care Receives Support at the National Level
Long-term care is receiving attention on a national level! Currently over 10 million people need long-term care services and supports, with an aging population this number is continuously growing. Long-term care services and supports are essential to helping older American age in their homes and communities. While we at Health & Medicine’s Center for Long-Term Care Reform recognize the dire need for a long-term care system in Illinois, it is good to see some recognition of these issues at a federal level as well.
The Community Living Assistance Services and Support (CLASS) Act is a bill “to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes.”
The CLASS Act was introduced in both the House of Representatives (HR 1721) and the Senate (S 697), and is also included in the final health reform bill in the House, “America’s Affordable Health Choices Act (HR 3200).
The CLASS Act makes it more affordable and accessible for older adults and persons with disabilities who have long-term care needs to purchase care services helping them remain in their homes and communities.
• The CLASS Act would establish automatic enrollment of workers by employers in a national insurance program; workers may opt-out
- Enrollment in the program consists of monthly premium deductions from payroll
- Individuals must pay into the program for 5 years before claiming benefits
• The CLASS Act insurance program benefits persons needing non-medical long-term care services and supports, with two or more activities of daily living
- Activities of Daily Living include things like: eating, bathing, dressing, and transferring
• The Congressional Budget Office (CBO) concluded that the CLASS Act will not cost the government during the first 10 years
• The CLASS Act also alleviates the burden of financing long-term care for Medicaid
- A projected $2.5 billion will be saved in the first 10 years
The Kaiser Family Foundation does a great job explaining all the details. Check out their site There “The Sleep in Health Care Reform: Long-Term Care and the CLASS Act” has a wealth of information.
HMPRG Testimony delivered to The Illinois Nursing Home Safety Task Force - October 20, 2009
Some background on the task force: Governor Pat Quinn appointed the Nursing Home Safety Task Force in response to a series of articles in the Chicago Tribune by David Jackson and Gary Marx. The central issue currently being addressed is the mixing of two populations with very different care needs: those with severe mental illnesses and the elderly. Yesterday at the Thompson Center in Chicago, Phyllis Mitzen, co-director of the Center for Long-Term Care Reform, spoke to the Nursing Home Task Force. This Task Force Meeting featured public testimonies and drew a crowded room of about 50 people (see link below to the Tribune article covering this meeting and quoting Ms. Mitzen). We welcome you to read the series of Chicago Tribune articles that sparked the formation of this Task Force (links posted below) and visit the official Illinois Nursing Home Safety Task Force Website (link posted below) to voice your opinion.
Illinois Nursing Home Safety Task Force Website:www.nursinghomesafety.illinois.gov
Chicago Tribune coverage of Public Testimonies at October 20th Task Force Meeting ( Health & Medicine’s co-director of the Center for Long-Term Care Reform Phyllis Mitzen testified at the meeting and is quoted.) http://www.chicagotribune.com/health/chi-nursing-home-hearing-21-oct21,0,256620.story
Nursing Home Expose Series in Tribune: http://www.chicagotribune.com/health/chi-nursinghome1-ledeallsep29,0,357882.story
Older Health Care Workers Conference Follow-Up
Health & Medicine Policy Research Group and the Great Lakes Centers for Occupational and Environmental Safety and Health (University of Illinois at Chicago, School of Public Health) co-hosted the Older Healthcare Workers Conference in the morning of Tuesday September 29th, 2009. The conference, on campus at the University Illinois of Chicago, included roughly 50 participants with a diverse range of backgrounds. The conference was a successful stepping stone to convening major home care agencies, health care organizations and workers, policy and research professionals, and labor unions in addressing the important and growing population of older adult healthcare workers. Participants and organizers alike agreed that this conference is only the beginning of a dialogue that must be continued on the topic.
Speakers and workshops focused on five main areas of Older Healthcare Workers:
1.) recruitment and retention issues
2.) training and promotion
3.) workplace design and accommodating workers with disabilities
4.) wellness and health promotion programs
5.) workplace policies and legislative initiatives. Let's keep the dialogue going about these issues and possible solutions. Send your thoughts, resources, news and other information to Kristen Pavle at Health & Medicine and we'll post items here.
If you subscribe to the Health & Medicine comment feed, you will be able to post comments to some of the posts that appear in this section.
Conference Presentations (You can also view these in the slideshare.net reader in the far right column.)
View conference photos on facebook