December 2014


www.hamptonroadsmessenger.com


Eldercare 'Scorecard' Rates States in Effort to Stress Independence


BY RACHEL DORNHELM


WASHINGTON, D.C.--The way the medical


system talks


about aging often gets it all wrong.


That’s what Bruce Chernof, a physician and head of The SCAN Foundation, based in


Long Beach, Calif., wants you to know.


“People define themselves by the


function they retain, not the function they’ve lost,” he said.


That means there’s a huge disjoint


between the words older Americans use most frequently to describe the kind of care they want in later life (words like “choice,” “independence,” “dignity”) and the most common words doctors rely on (“palliative care,” “geriatrics,” “advanced directive,” “donut hole”).


Aging Beyond the Medical Model Chernof, who is also the former


director of the Los Angeles County Department of Health Services, is on a mission: getting health professionals to think about how to engage people around aging outside of the traditional medical model.


While the medical Including system is


largely focused on cure and safety, Chernof argues that there should be new metrics.


measure things like functioning and ability to accomplish things by oneself.


Chernof argues that there should be new measures. Including markers for ability levels and independence.


“There are basic functions,”


Chernof said, “like dressing, bathing, feeding, and toileting. And then there are instrumental functions like transportation and cooking.”


He says it is very important to go


beyond medical diagnoses and to start collecting data on functioning.


perfection in a 90-year-old who has outlived


Chernof said complicating


“Chasing a blood sugar level to three primary care doctors


and really just wants to wake up and have a donut with their coffee — we need to work with that,” said Chernof.


the


long-term care situation in California is the fact that this is a very diverse state.


looks


“The situation in rural California very


different than in San


Francisco or the East Bay. ‘One size fits all’ solutions will be problematic because this looks different in different communities,” said Chernof.


Quality of Care--and Life


In 2014, Chernof’s SCAN Foundation and the Commonwealth Fund of New York produced a scorecard on long-term care capacity that was compiled by the AARP’s Public


Policy Institute. It was the


second annual scorecard and ranked states on criteria like affordability and access, choice of setting and provider, quality of life and quality of care, and support for family caregivers.


California ranked ninth in the U.S.


According to the report that makes it “a leading state in an imperfect system.”


How can California raise its score further? California gets its highest rank those that Sports


Ray Rice Wins Appeal, Indefinite Suspension by NFL Lifted


BY WASHINGTON INFORMER


on the scorecard (#2 in the U.S.) for offering


people Medicaid choice. Many


older Americans prefer not to enter institutionalized care as they age. Recognizing that, California spends more


funding [called


Medi-Cal in the state] on services allowing people to stay in their homes versus on institutional care. Here, 56 percent of all Medi-Cal


long-term


service dollars go to the community. Still, the state lags behind top-ranked New Mexico where 65 percent of Medicaid long-term care dollars go to the community.


San Francisco, itself, has a


national model in this area: PACE — Program of All-inclusive Care for the Elderly. The program is centered on the idea that it is better for individuals over 55 with chronic conditions to live in their communities rather than in institutions. PACE was pioneered at the city’s On Lok Lifeways center and has now been incorporated as a model [combining the Medicare and Medicaid programs].


On the flip side, California does not rate so well when it comes to quality of life and quality of care, and for the support it offers family caregivers.


One disturbing statistic as far


as quality measures in the state is around bedsores-- wounds that can become life-threatening. The report found the rate of pressure sores among California’s nursing home residents is double that of Hawaii, the best-per- forming state.


There are nearly six million


unpaid caregivers in California, mostly family and friends. Their contributions to care are valued at nearly $47 billion annually. California offers 12 weeks per year of job-protected leave, which is


the minimum established by the federal Family Medical Leave Act.


Meanwhile top-ranked


Washington, D.C. provides 16 weeks family leave and 16 weeks of medical leave every two years.


Getting the Issue Right Finally the report also suggests


that California could safely transition many more individuals


from


institutional settings to the community. Eleven percent of California nursing home residents have low-care needs as compared to 1 percent in Maine, the top-ranked state. The benefits of making this transition happen include higher qualities of life and reduced costs.


The scorecard recognizes that the


state is undergoing a huge transition — moving many seniors who are eligible for both Medi-Cal and Medicare into a new program called Cal MediConnect that is receiving mixed reviews.


With the number of adults in


the state over 65 expected to double between 2000 and 2030, experts say now is the time to get this issue right.


Former Baltimore Ravens running back Ray Rice has won his appeal of his indefinite suspension by the NFL, the


players Friday.


"The suspension has been vacated," said George Atallah, assistant executive external


director Rice had of affairs for the


players' union, CNN reported.


been


suspended indefinitely by the NFL, which had been heavily


for initially issuing just a two-game


criticized ban for


striking his then-fiance Janay Palmer in the elevator of an Atlantic City casino resort in February.


released footage of Rice dragging an apparently


out


TMZ, which in February unconscious Palmer


of the elevator at the Reval Casino, revealed a second video in September showing the moments leading up to that point, in which the two are seen in an altercation in the elevator before Rice strikes Palmer with his left hand, knocking her headfirst into a handrail on the elevator wall. The two have since married.


Rice, 27, was charged with felony


aggravated assault, but avoided jail time by entering a pretrial intervention program in May, which could lead to


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As if Oral Cancer Cause was not enough for Linda Miles to take on as what she calls "the most rewarding work of my entire career", she and


the charge being removed from his record if completed successfully.


The Ravens, which drafted Rice


in 2008 and signed him to a five-year, $40 million contract extension in 2012, terminated his contract in September after the second video surfaced.


NFL Commissioner Roger


Goodell on Monday upped his punishment of Rice from a two-game suspension to an indefinite ban, claiming the league had not previously seen the second tape released by TMZ. He levied the initial two-game ruling in July, prompting a national outcry and spurring Goodell to admit he made a mistake. He has since announced an overhaul of the league's domestic-vio- lence policy.


Robin Morrison with their 80 plus combined years in dentistry and Dr. David Rice of Buffalo, NY have teamed to create EPIC II, a two day two part workshop 3-4 months apart on practice and team development. "After working with dental students and recent grads and knowing how even many long ago graduated dentists are struggling due to not getting practice


management or business


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