Preventable Hospitalizations Down Among American Seniors

According to a new report by the United Health Foundation on the state of seniors’ health, preventable hospitalizations have dropped. The third edition of its annual America’s Health Rankings Senior Report show “encouraging news for senior health nationally,” but also indicates the setbacks seniors have faced compared to previous years.

Among the major gains is a 6.8 percent reduction in preventable hospitalizations, a measure that’s also dropped 11 percent since 2013. Reasons for the reduced hospital admissions and readmissions include the push for better population health management and the shift from fee-for-service model to value-based payments.

The report also found a 9.3 percent increase in the number of home health workers year over year, and a 38 percent increase in seniors who choose hospice care at the end of their lives. These findings are supported by a recent report that indicated nursing homes may replace hospitals as the major providers of senior care – a trend that is fueled by the increased interest in palliative care.

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MedPAC Calls For Cancellation Of Medicare Pay Raise For Nursing Homes

In a proposed rule published in the April 20 Federal Register, CMS said it is seeking a 1.4% net hike in the nursing home Medicare payment rate. The rate increase would reflect a market basket increase of 2.6% and two deductions, including a 0.6% cut for productivity adjustment and a 0.6% cut as a forecast error adjustment. However, in a letter to CMS, MedPAC has said that it believes no update is warranted because “Medicare’s current level of payments appears more than adequate to accommodate cost growth, even before any update.”

MedPAC argues that the aggregate Medicare margin for freestanding nursing homes in 2013 was 13.1%, the 14th consecutive year it exceeded 10%. However, the American Health Care Association is now shooting back at MedPAC’s decision, claiming MedPAC’s own research shows that nursing homes operate at an overall margin of only 1.9%.

MedPAC is now calling for CMS to move toward value-based purchasing and quality reporting programs. Additionally, MedPAC has recommended that Congress eliminate the market basket update, revise the prospective payment system, and rebase payments beginning with a 4% reduction to the base rate. Comments to CMS’ proposed rule are due on June 19.

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CMS Posts Specifics For Five Star Rating System For LTC

Under a new payroll system scheduled to become mandatory in July 2016, CMS has posted technical specifications to show long-term care facilities how to electronically submit staffing information based on payroll data. Long-term care facilities will now be able to voluntarily submit data beginning in October 2015. The new Payroll-Based Journal (PBJ) system will be posted on the CMS Nursing Home Compare website and used in the Nursing Home Five Start Quality Rating System to help consumers understand the level and differences of staffing in long-term care facilities.

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Tiptastic Tuesday: How To Spot Signs Of Elder Abuse

According to The Elder Justice Roadmap, a report by the U.S. Department of Justice and the Department of Health and Human Services, five million Americans are affected by elder abuse every year. Abuse of the elderly can be difficult to pinpoint as its signs could appear to be symptoms of dementia or the natural results of frailty that come with growing older. It is important to know that elder abuse is not always physical and  includes other categories, including sexual, psychological, and financial neglect.

Be on the lookout for the following common signs that abuse may be happening:

  • Frequent arguments between the caregiver and the patient
  • Changes in a senior’s personality or behavior
  • Unexplained injuries like burns, bruises, welts, cuts or scars
  • Broken bones, dislocations and sprains
  • Failure to take medication or overdose of medication
  • A caregiver’s refusal to let you see the patient alone
  • Appearing disheveled, in torn or soiled clothing, or not being appropriately dressed for the weather
  • Appearing hungry, malnourished, disorientated or confused
  • Unexplained charges or a suspicious drain of money
  • Unexplained weight loss

If you notice something strange, it is important to notify authorities or to report it to Adult Protective Services (APS).

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Senior Housing Prices Soared In 2014

In 2014, average per-unit prices in the assisted living market increased by 25 percent. Assisted living average unit prices hit a record $188,700 per unit and average per bed prices for nursing homes jumped 4 percent to $75,500, setting records in the industry for the second straight year. The average price for independent living communities also set a new record of $246,800 per unit, 28 percent higher than in 2013. The new prices came in a year that also saw record levels of mergers and acquisitions. In 2014, close to 300 mergers and acquisitions, representing approximately $26 billion, were announced in the senior housing market. As prices increased, cap rates, or the ratio of net operating income to property asset value, plunged last year, providing more cash flow for investments. Rates for assisted living and nursing homes also decreased.

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Study: Behavioral Therapy More Beneficial To Dementia Patients Than Drugs

For caregivers serving those suffering from Alzheimer’s disease or other dementias, the biggest challenge is often coping with other behaviors common in dementia. Antipsychotic drugs to treat these symptoms has become increasingly common with approximately 1 in 3 dementia patients in nursing homes being prescribed them. Outside of nursing homes, 1 in 7 dementia patients are prescribed these drugs – all despite a warning from the Food and Drug Administration saying that antipsychotics increase the risk of death for people with dementia.

According to a recent study published in the British Medical Journal, antipsychotics are much less effective than non-drug treatments in controlling the symptoms of dementia. Researchers say the treatments that show the best results were ones that trained caregivers on how to communicate calmly and clearly, and those that introduced hobbies and other activities to the patient. Researchers believe caregiver interventions work because they train caregivers to look for the triggers of the symptoms. When a caregiver sees the triggers of the symptoms, they train patients on how to manage them.

Healthcare providers typically use antipsychotics because they have not been trained to use non-drug approaches and when they do know how to use them, they are rarely reimbursed for doing so by Medicare or private insurance.

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CMS: More Additions & Rebasings Of Nursing Home Ratings To Come

Last week, CMS released rebased Five Star ratings that caused approximately one-third of the nation’s skilled nursing facilities to lose a rating star due to administrative changes. Next year, more quality measures, including measures for rehospitalization and discharge rates, will be added. Although providers are unhappy with the changes, CMS officials say there have been big improvements, including an almost 20 percent reduction of antipsychotic use in two years. Changes that went into effect last week include the inclusion of quality measures pertaining to antipsychotics use by short-stay and long-stay residents, increased performance expectation, and adjusted staffing algorithms at verifying nurse staffing levels via payroll records. CMS also announced that it will be releasing results of pilot surveys that check “adequacy” of resident assessments and “accuracy” of provider information self-reported to help calculate quality measures. According to CMS officials, many nursing homes will see a decline in ratings until they make further improvements.

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