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Last Modified 07/22/04

CARE Connection

September 2010

New Assessor Training Coming Soon

Training for new CARE Assessors in northwest Kansas will be held on Tuesday, October 5, 2010, in Hays.  The training will be held at the Kansas Highway Patrol Office, 1821 Frontier Road.  Registration for the training will begin at 8:30 am and the training will conclude at 4:30 pm.

Anyone seeking nursing facility placement must have a CARE assessment, as required by Kansas law.  The Kansas Department on Aging, in cooperation with the Area Agencies on Aging provides CARE assessment services, which must be conducted by a qualified CARE assessor.  A qualified assessor must attend the training session and have a Bachelor's degree in gerontology, social work, counseling, human development, health, or other related area, or be a registered nurse licensed to practice in the state of Kansas.

New hospital and contracted assessors are required to attend the full six-hour training.

Nursing facility assessors are not required to attend the full training because they are not allowed to complete the full CARE assessment.  The morning session from 8:30 - 12:00 will cover this process and information.

NWKAAA and KDOA offer this training twice a year for the CARE program.  There is no cost and six CEUs are available.

For more information or to register by phone please contact Tammy G at 1-800-432-7422.

A Portable Alternative to Nursing Homes

Reprinted from AARP Bulletin July - August 2010

On Sundays, the Rev. Kenneth Dupin of Salem, Va., delivers sermons to his congregation and now he is delivering an alternative to nursing homes.  Recognizing a need for aging adults to be closer to their loved ones, Dupin, 55, invented the MEDCottage, a portable 12-by-24-foot high-tech hut with living quarters and a system to transmit an occupant's vital health information to offisite caregivers.  The cottage may be placed in the backyard of the primary caregiver.  Cities from Santa Cruz, Calif., to Seattle to Faribault, Minn., are allowing or expanding zoning for cottages like Dupin's.  Virginia has passed legislation to supersede local zoning laws for the dwellings on single-home properties with a doctor's order.  Dupin plans to start selling the MEDCottages - which will go for $65,000 to $75,000 depending on outfitting - this fall.  - Tauren Dyson

Alcohol Abuse Among the Elderly

Alcohol abuse and dependence is increasing as the baby boomers become senior citizens.  Older people develop substance abuse problems as a method of dealing with the challenges of growing older - whether it's a response to declining health, death of a loved one, pain, loneliness, retirement, insomnia, disruption of lifestyle, decreased social activity, isolation, coming to terms with an illness, or other uncontrollable life events.

Three types of elderly drinker emerge upon further study:  early onset drinkers (survivors), late onset drinkers (reactors) and binge drinkers.  Early onset drinkers account for 2/3 of elderly problem drinkers.  Late onset drinkers are typically reacting to traumatic life events.

According to the Institute of Alcohol Studies, the number of both men and women 45-65 drinking more than the government-recommended "sensible limits" have been steadily rising.

Seniors metabolize alcohol less effectively than younger people so the effects of alcohol seem to be much stronger, resulting in loss of coordination, falls, broken bones, and other injuries that may reduce mobility and decrease quality of life.  Studies have indicated that alcohol can have health benefits, however, it is yet to be determined whether it was really the alcohol causing the benefit or the social situation that is associated with the alcohol.

Elderly people are less tolerant to alcohol because of many physical changes, including a fall in the ration of body water to fat (resulting in less water to dilute the alcohol), lower hepatic blood flow (resulting in more liver damage), inefficiency of liver enzymes (resulting in less efficient alcohol breakdown), and altered responsiveness of the brain (resulting in a faster effect of alcohol on the brain).

Drug interactions are also a concern.  Alcohol can have many effects on medications, including decreasing their effectiveness or changing how they interact with the body, sometimes producing undesirable results.

There are many reasons seniors fail to receive treatment for their alcohol problems.  Many doctors are able to easily diagnose the secondary problems, but some fail to find the primary cause of the situation - alcohol problems.  Seniors usually do not seek treatment on their own, drink in private, receive relatively few DUI citations, and do not have work obligations.  Family often does not typically like to intervene due to embarrassment or the belief that alcohol is "comforting" to their loved one.  Medical professionals are often the first point of contact for people with alcohol problems, although alcohol is not always diagnosed as the problem when more urgent medical matters are simultaneously occurring.

Treatment can be very effective.  Seniors are more likely to finish treatment and participate in follow-up care.  They also have a higher than average success rate of abstinence.

Seniors can participate in treatment groups that are designed for younger adults and have success; however they may feel more comfortable with programs serving their peers.

There are many excellent resources available to help clients and their families learn more about alcohol abuse and the elderly.  Some of these resources are listed below.

Alcohol Abuse Among the Elderly:  A Growing, Often Hidden Problem - New York Times - November 28, 1993.  http://www.nytimes.com/1993/11/28/nyregion/alcohol-abuse-among-the-elderly-a-growing-often-hidden-problem.html

Institute of Alcohol Studies Fact Sheet - www.ias.org.uk/resources/factsheets/elderly.pdf

Personal Health:  Hidden Plague of Alcohol Abuse by the Elderly - New York Times - April 2, 2002.  http://www.nytimes.com/2002/04/02/health/personal-health-hidden-plague-of-alcohol-abuse-by-the-elderly.html?pagewanted=print

Regional Prevention Center of Northwest Kansas - Colby - 505 N Franklin, Ste E - 785-460-8177 - Serving Cheyenne, Decatur, Gove, Logan, Rawlins, Sheridan, Sherman, Thomas, Wallace counties - www.nwksprevention.org

Regional Prevention Center of Northwest Kansas - Hays - 209 E 7th - 785-625-5521 / 800-757-2180 - Serving Barton, Ellis, Graham, Norton, Osborne, Pawnee, Phillips, Rooks, Rush, Russell, Smith, Trego counties - www.smokyhillfoundation.org

A 70-year-old who drinks 3 drinks is equivalent to a 21-year-old who drinks 12 drinks.

Q & A

Do you have any statistics on how many clients go to a nursing facility and then go home?

These statistics can be found by looking at our diversion rate.  In FY 2009 - the most recent year we have data compiled from - our statewide diversion rate was 20.52%.  That is an increase from FY 2008 when it was 19.4%.  This indicates that in Kansas, 1 in 5 persons who entered a nursing facility was able to return to the community within 30 days.  At this time, we do not have data compiled for people who stay longer than 30 days but still return to their homes.

In Northwest Kansas our diversion rate was 13.54% during FY 2009.  That is lower than our FY 2008 diversion rate of 15.15%.

Who can help me find support and fill out paperwork (Medicaid)?

The Information and Assistance department at NWKAAA can help you with many of the forms you need to fill out.  For Medicaid specifically, contact your local SRS office.

Residents Can Enjoy the Holidays with Family

Residents of skilled nursing facilities can leave their facility to attend a family holiday celebration without losing their Medicare coverage.  The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.  Such a notification is "not appropriate," says the Manual.  In addition, the Medicaid regulation allows up to 18 leave days per year for non-hospital related leave.

If the resident return to the facility by midnight, the facility can bill Medicare for that day's stay.  If the resident is gone overnight (i.e. past midnight) and return to the facility the next day, the day the resident leaves is considered a leave of absence day.  While the facility cannot bill Medicare for leave of absence days, it is today unclear whether the facility can bill the beneficiary for those days.

As the Center for Medicare Advocacy has reported in prior years, Chapter 6 of the Medicare Claims Processing Manual says that the facility cannot bill a beneficiary during a leave of absence.  However, a provision in Chapter 1 of the Medicare Claims Processing Manual, issued May 30, 2008, authorizes skilled nursing facilities to bill a beneficiary for bed-hold during a temporary "SNF Absence" if the SNF informs the resident in advance of the option to make bed-hold payments and the amount of the charge and if the resident "affirmatively elect[s]" to make bed-hold payments prior to being charged.  CMS confirms that "a facility cannot simply deem a resident to have opted to make such payments and then automatically bill for them upon the resident's departure from the facility."  Whether these apparently contradictory provisions in the Medicare Claims Processing Manual can be reconciled remains to be seen.

Source:  Center for Medicare Advocacy Alert:  www.medicareasvocacy.org

America's Medication Health Guide - Personal Medication Record books are available by calling the Area Agency on Aging.

Order Form for Materials Available

We have created an order form for CARE materials and KDOA / NWKAAA publications if you would like to use it.  Please indicate the number of each form / publication you wish to order and return it to NWKAAA.  You may also continue to call the office when you need additional materials.  A copy of this form is also available on the webpage at www.nwkaaa.com.

Dementia and Driving - Learn More!

For most people, driving represents more than maneuvering a car.  Driving represents freedom and control.  As we age, most of us will experience physical changes that affect driving, such as eyesight problems and slower reaction times.  The average person will assess and modify their driving without family intervention and will continue to drive safely throughout their lives.

But it is different for someone with Alzheimer's disease or a related dementia.  While the person with Alzheimer's may modify their driving, because the disease is gradual and unpredictable, serious risks increase and often the caregivers must step in.  The challenge is finding a balance to preserve a person's sense of independence for as long as possible, while protecting the safety of the person and others.  At the Crossroad (MIT AgeLab and the Hartford) tells us:

• Consider the frequency and severity of incidents.  Several minor incidents or an unusual major incident may warrant action.
• Look for patterns of change over time.  Isolated or minor incidents do not warrant immediate or drastic action.
• Avoid an alarming reaction.  Take notes and have conversations at a later, convenient time, rather than during or immediately after an incident.

If the driving safety of a loved one has been on your mind, it's time to begin the conversation  - before driving becomes a problem

--Reprinted from Alzheimer's Association Central and Western Kansas Office Newsletter - July 2010 edition

Crime Crackdown

from AARP Bulletin June 2010

A new state law is expected to better protect residents of long-term care facilities and people receiving in-home care from abuse.  Backed by AARP, the law gives adult care administrators access to more of an employee's or applicant's criminal history.  In written testimony, AARP Kansas noted that worker shortages and lack of staff training at long-term care facilities such as nursing homes could lead to situations that place the health and welfare of residents at risk.  Moreover, advocates said, this law could keep workers who have committed abuse and have criminal backgrounds from being hired to care for vulnerable adults.  The law, signed by Gov. Mark Parkinson, D, in late March, goes into effect July 1.

Ask Sid

Reprinted from AARP Bulletin July-August 2010

To save money, see if replacing the hinges on the doors with "offset hinges" will do the trick.  These Z-shaped devices create about 2 extra inches of clearance by swinging a door entirely clear of its frame.  With a regular hinge, a standard 32-inch doorway is only about 30 inches wide, reduced by the thickness of the door.  Offset hinges are sold at many hardware and health products stores.  They cost about $30 for three (the number that's typically needed for a door) and often screw directly into the holes left by the old hinges.  Still, you may need to hire a carpenter to install them.