Tag Archives for health care

Seniors say they hesitate to mix healthcare and matters of faith

Published in RINewsToday on December 26, 2022

When it comes to matters of one’s personal beliefs, most seniors choose to keep their health care and their spiritual or religious lives separate, a new University of Michigan poll finds. But they do see a role for their health care providers in assisting them to cope with illness by looking for meaning or hope.

The National Poll on Healthy Aging (NPHA) is based at the U-M Institute for Healthcare Policy and Innovation (IHPI) and supported by AARP and Michigan Medicine, U-M’s academic medical center.

For this new NPHA report, the poll team worked with Adam Marks, M.D., M.P.H., a hospice and palliative care physician at Michigan Medicine, and L.J. Brazier, M.Div., a chaplain at Michigan Medicine’s Department of Spiritual Care.

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in July 2022 among 2,163 adults, aged 50 to 80. The sample was subsequently weighted to reflect the U.S. population. 

Religious and Spiritual Beliefs and Health Care Decisions

According to new data from the National Poll on Healthy Aging (NPHA), released on Dec. 12, 84% of people between the ages of 50 and 80 say that they have religious and/or spiritual beliefs that are somewhat, or very important to them, including 71% who cited religious beliefs and 80% who cited spiritual beliefs.  About 40% of these older adults say those beliefs have gotten more important to them as they grow older. 

NPHA’s poll findings indicate that women were more likely than men (63% vs. 46%) to report that religious or spiritual believes were important, as those living in the South and Midwest (61% and 59%) compared to those in the West and Northeast (51% and 43%).

In addition, the researchers found that older adults with lower levels of education were also more likely to report religious and spiritual believes as being very important (61% high school or less, 56% some college, 47% bachelor’s degree or higher), as were those with annual household incomes less than $100,000 compared to those with $100,000 or more (59% vs. 43%).

Among older adults with religious or spiritual beliefs that are important to them, 19% say their beliefs have influenced their health care decisions, and 28% say they want health care providers to ask them about their beliefs, note the researchers.

Meanwhile, 77% of all older adults, regardless of beliefs, say health care providers should keep their own personal beliefs separate from how they deliver care.

“While 45% of older adults say their religious beliefs are very important to them, and 50% say that about their spiritual beliefs, even this group largely wants to keep this aspect of their lives separate from their health care,” says Marks, an associate professor of geriatric and palliative medicine, in a Dec. 12 statement announcing the poll’s findings.

“But a sizable majority of all older adults – whether or not they say belief is important to them – reported that they’d turn to health care workers to help them find deeper meaning in their illness, and 78% believe health care workers will help them find hope when they’re having a health-related challenge,” he adds.

According to Brazier, many health care systems have a way to record the religious affiliation of patients in their electronic medical records, and that medical students and others training for health professions are told to ask their patients about any beliefs that might affect their future care.  Having this information available can help providers ensure that patients with strongly held beliefs or specific religious affiliations receive everything from appropriate hospital food to visits with chaplains of a specific faith tradition when they’re having a health crisis or nearing the end of life. 

But for those who do not follow a faith tradition or have strongly held beliefs, having that information available to health providers can also be helpful, says Brazier.

“Being a religious or spiritual person, or not following a faith tradition or spiritual practices, is a highly personal matter,” notes poll director Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System. “So perhaps it’s not surprising that only about a quarter of all people in this age range say they’ve talked about their beliefs with a health care provider, though this rose to about one-third of those who say their religious or spiritual beliefs are very important to them.”  In all, 70% of those who say their beliefs are somewhat or very important to them reported feeling comfortable discussing their beliefs with their health care providers, he says.

Researchers say that even if patients don’t want to discuss their beliefs with their health providers at a typical appointment, it’s important for providers to know if patients with significant health needs, or those experiencing a health crisis, are connected to a faith community that can help provide support. 

In all, 65% of the older adults whose religious or spiritual beliefs are important to them said they belong to a community of people who share their beliefs. 

My Say…

Kathryne Fassbender, Founder and Executive Director of the Hem of Christ: A Dementia Care Ministry, notes that she has never met anyone in her 15 years of work in the field of aging who has wanted to keep their health care and spiritual/religious life separate as the NPHA study states. “What I have found is hesitancy to bring up faith with health care professionals both in physical and mental health care,” she says.

“As Catholics, our health care is woven into how we live our faith, and we wish to have the care we receive be in line with the teachings of the Church. In all honesty, it is increasingly difficult to find doctors who will respect that wish, which opens up a much broader topic of discussion,” she notes. “This hesitancy is across generations, so even care partners for older adults are not always as forthcoming with information regarding faith and health for fear of losing a current healthcare team,” Fassbender observes.

“While the number of doctors who would dismiss someone as a patient because of one’s wishes to keep with the teachings of the Catholic faith in the care they receive is small, the fear is there and it does happen,” says Fassbender, noting that the current medical and social landscape magnifies this fear. “The hostility toward religion and in particular the Catholic Church has a greater impact than I think we understand sometimes,” she warns.

Fassbender says that while it can be helpful to know the personal beliefs of our care providers, it is more important that the doctor, nurse, and therapist, respect our faith. “I know some great care providers who are deeply atheist, yet when they work with their clients of deep faith, they don’t allow their personal beliefs to influence care in any way. They instead assist their client in living out their faith traditions,” she says, stressing that this is what we all seek.

“While I may question some of the findings of this research, I see the findings as a call for care providers to increase seeking to help people of all ages, and all beliefs to live their purpose until their final breath,” says Fassbender.

Fassbender adds: “We must never dismiss one’s faith, regardless of their physical or neuro-cognitive abilities, and most certainly one’s age. I see this study as an invitation to crack open this conversation and allow the hostility, misunderstandings, and fears regarding faith and health to be overcome by the pursuit of care for the human person, fully who they are, what they seek, and how they wish to live life until the final breath.”  

The Hem of Christ started when the time was taken to pause and hear that still, small voice. After years of witnessing how a person’s faith can be diminished simply because of a dementia diagnosis or because someone put their life on hold to care for a loved one, Kate decided that it was time to formalize the small ministry work she had been doing for almost a decade.  Kate answered the call to formalize and set a path for others to walk down, reaching for the hem of Christ. 

NPHA Poll Puts Spotlight on Health Care and Aging Issues

The National Poll on Healthy Aging (NPHA) is a recurring, nationally representative household survey. By understanding the perspectives of older adults, the NPHA provides information to the public, health care providers, policymakers, and aging advocates on issues related to health, health care and health policy affecting U.S. adults ages 50 to 80 and their families.

Launched in spring 2017, the NPHA grew out of a strong interest in aging-related issues among members of the U-M Institute for Healthcare Policy and Innovation (IHPI) bringing together more than 600 faculty members  who study health, health care and the impacts of health policy. In addition to IHPI, the poll receives support from AARP and Michigan Medicine, AARP and U-M’s academic medical center.

The NPHA results can put a spotlight on future research needs and to create an informed national dialogue on poll issues examined. 

World issues pushed nursing home reform to the side in State of the Union. But it’s there

Published on March 7, 2022 in Rhode Island News Today

More than a week ago, President Joe Biden, with Vice President Kamala Harris and House Speaker Nancy Pelosi, sitting behind him in the House Chamber in the United States Capitol, delivered his first State of the Union Address. Harris and Pelosi made history marking the first time two women have been on the dais during a presidential address before the joint session and the American people

According to C-SPAN, Biden’s speech was the fourth-longest of the seven most recent presidents’ speeches, beating out Presidents George H.W. Bush, George H. Bush and Ronald Reagan. Amid frequent applause breaks, chanting from both sides of the aisle and heckling, Biden’s prepared remarks delivered Tuesday, March 1, 2022, totaled around 7,762 words, lasting over one hour and two minutes.

Biden spoke mostly on-script with his prepared remarks on a wide range of topics before lawmakers, Supreme Court Justices, guests, many waving small blue and yellow Ukraine flags or wearing the country’s colors to show solidarity with the people of Ukraine. While the first half touched on the Russian invasion of Ukraine and the need for a global coalition to respond, the second half addressed inflation, COVID-19 and the “new normal,” increasing domestic manufacturing, health care, prescription drugs, energy and taxes, voting rights legislation, and the nomination of Judge Ketanji Brown Jackson to the Supreme Court. 

Biden concluded his speech by proposing a “Unity agenda” calling for a fight against the opioid epidemic, pushing Congress to pass a mental health package, supporting Veterans returning from the battlegrounds of Iraq and Afghanistan and finding a cure for cancer.

The State of the Union and nursing homes

While Biden’s speech briefly touched on the quality of care in the nation’s nursing homes, his Administration is clearly making this a major domestic issue.  During the address, Biden expressed strong concerns about Wall Street firms that were taking over many nations’ nursing homes. “Quality in those homes has gone down and costs have gone up. That ends on my watch,” he told the packed chamber. “Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect and [they’ll be] looked at closely,” he said.

A day before the State of the Union address, the White house released a detailed document, entitled, “Fact Sheet: Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes,” outlining dozens of proposed changes on how U.S. nursing homes are regulated and operate, including a vow to adopt federal minimum staffing requirements for facilities, step up enforcement of regulations and to eliminate overcrowded patient rooms.

Amid the ongoing COVID-19 pandemic that continues to wreak havoc on the nation’s nursing homes, where 200,000 residents and workers have died from COVID-19, nearly a quarter of all COVID-19 deaths in the United States, the Biden Administration says that staffing shortages are getting worse, reducing the quality of care provided to residents

Poorly performing facilities will be held accountable for improper and unsafe care and must immediately improve their services or will be cut off from tax payor dollars. Biden calls for better information to be provided to the public to assist them in better understanding the conditions they will find in each facility and to assist them in choosing the best care options available.  

Centers for Medicare & Medicaid Services (CMS) will begin to explore ways to reduce resident room crowding in nursing homes by phasing out rooms with three or more residents and promoting private, single occupancy rooms. Multi-occupancy rooms increase the risk of the spread of infectious diseases, including COVID-19.  The agency will also establish a minimum nursing home staffing requirement, the adequacy of staffing is closely linked to quality of care provided.

Meanwhile, CMS also plans to strengthen the Medicare Skilled Nursing Facility Value-Based Purchasing Program and base payment on staffing adequacy (including over weekends) and retention and the resident experience.  Although the nation has seen a dramatic decrease in the use of antipsychotic drugs in nursing homes in recent years, CMS will continue its efforts to identify problematic diagnoses and bring down “inappropriate use” of such drugs.

Enhancing accountability and oversight

The Biden Administration calls for the enhancing and accountability and oversight of the nation’s nursing homes by adequately funding inspection activities, beefing up scrutiny on more of the poorest facility performers, expanding financial penalties and other enforcement sanctions, and increasing the accountability for chain owners whose facilities provide substandard care. CMS will work with nursing homes to improve care by providing technical assistance.

To enhance transparency, CMS will create a new database that will track and identify owners and operators across states to highlight previous problems with promoting resident health and safety.  The agency will also collect and publicly report data on corporate nursing home ownership and will enhance the Nursing Home Care website. Finally, CMS will examine the role that private equity investors play in the nursing home sector.

Biden’s nursing home reforms will ensure that every nursing home has a sufficient number of adequately trained staff to provide care to the 1.4 million residents residing in over 15,500 Medicare and Medicaid facilities across the nation.  Nursing home staff turnover can be reduced by creating pathways to good-paying jobs along with ensuring staff to join a union.  CMS calls for lowering financial barriers to Nurse Assistant Training, adequate compensation and access to a realistic career ladder. The agency launches a National Nursing Career Pathways Campaign with partners including the Department of Labor.

Finally, Biden puts together his strategy to ensure emergency preparedness in nursing homes during the ongoing pandemic.  He calls for continued COVID-19 testing in nursing homes and continued COVID-19 vaccinations and boosters to be provided to residents and staff. CMS will strengthen requirements for on-site infection prevention, and make changes to its emergency preparedness requirements,   Finally, the agency will take what it has learned during the pandemic and integrate new lessons on standards of care into nursing home requirements around fire safety, infection control, and other areas, using an equity lens.

Point/Counter Point

In a released statement after Biden’s State of the Union address, AARP CEO Jo Ann Jenkins stated: “We were also encouraged to hear the President describe new actions to ensure that residents in nursing homes will receive the safe, high-quality care they deserve. For years, AARP and AARP Foundation have sounded the alarm about problems in America’s nursing homes. The COVID-19 pandemic exposed the chronic, ongoing issues with our long-term care system and emphasized the need for reform. It is a national disgrace that more than 200,000 residents and staff in nursing homes and other long-term care facilities died. AARP urges the federal government to act swiftly to ensure minimum staffing standards, increase transparency, and hold nursing homes accountable when they do not provide quality care.”

On the other hand, the nursing home industry had its views as to Biden’s call for nursing home reforms.  “The nursing home profession has always been committed to improving the quality of care our residents receive, and we appreciate the Biden Administration joining us in this ongoing effort. Over the last decade and prior to the pandemic, the sector made dramatic improvements. Fewer people were returning to the hospital, staff were providing more one-on-one care than ever before, and the unnecessary use of antipsychotic medications significantly declined,” said Mark Parkinson president and CEO of AHCA, in a released statement.

“Those who continue to criticize the nursing home sector are the same people who refuse to prioritize our residents and staff for resources that will help save and improve lives,” noted Parkinson, whose Washington, DC-based nonprofit organization represents more than 14,000 nursing homes and long-term care facilities across the nation. “Additional oversight without corresponding assistance will not improve resident care. To make real improvements, we need policymakers to prioritize investing in this chronically underfunded health care sector and support providers’ improvement on the metrics that matter for residents,” he said.

“It’s time to stop blaming nursing homes for a once-in-a-century pandemic that uniquely targeted our residents and vilifying the heroic caregivers who did everything they could to protect the residents they have come to know as family,” said Parkinson. ““Long term care was already dealing with a workforce shortage prior to COVID, and the pandemic exacerbated the crisis. We would love to hire more nurses and nurse aides to support the increasing needs of our residents. However, we cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers,” he said.  

To read the White House Fact Sheet to improving the quality of care in the nation’s nursing homes, go to:

https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/

On Monday, March 7th at 9am, AARP Rhode Island and US Senators Reed and Whitehouse will speak on the need for lower prescription drug prices in a virtual press conference.

AARP Rhode Island State Director Catherine Taylor, Volunteer State President Marcus Mitchell and Volunteer Lead Federal Liaison Dr. Phil Zarlengo will join Rhode Island US Senators Jack Reed and Sheldon Whitehouse for a virtual news conference highlighting the need for Congress to lower prescription drug prices. AARP Rhode Island will present the Senators with a petition signed by more than16,000 Rhode Islanders calling for Congress to act now and stop unfair drug prices.

You can listen in via ZOOM at:  

https://aarp-org.zoom.us/j/98668832992?pwd=bktuTjJBMUZhUDRaVDkvN2dCSXZqUT09

Passcode: 618357

Participants will respond to on-topic media questions posted in chat.

More information about AARP’s Fair Drug Prices campaign can be found at aarp.org/rx.

Retirement Survey Bleak for Ocean State

Published in Pawtucket Times on February 1, 2016

Here we go again. This month, America’s tiniest state gets outed as being the most unfavorable state to live out your retirement years. According to a new WalletHub study, “2016’s Best & Worse States to Retire,” when compared to all 50 U.S. states and the District of Columbia, Rhode Island came in dead last when compared against 24 metrics falling in one of these three categories (Affordability, Quality of Life and Health Care).

WalletHub, an internet site that calls itself “a personal finance Web site, taps Florida as being the top state to live your retirement years, followed by Wyoming, South Dakota, South Carolina and Colorado. The in-depth analysis, geared to identifying the most retirement-friendly states, gives the Ocean States the distinct of being the worst place to live in your later years, followed by the District of Columbia, Hawaii, Connecticut and Vermont.

As to affordability, WalletHub looked at the adjusted cost of living, tax friendliness of a state, it’s taxation on pensions and Social Security income, and annual cost of in-home services. Rhode Island was ranked 51 (the worst) in affordability for retirees. In zeroing in on this specific variable, the state came in 41st in adjusted cost of living; 45th in annual cost of in-home services and 48th in taxpayer rankings.

For a state’s quality of life, WallettHub zeroed in on an array of variables including the number of theatres, museums, music venues, golf courses. The researchers also checked out crime rates, weather, the number people age 65 and older and whether the state’s labor is elderly friendly. A sampling of Rhode Island specific rankings for this variable include a ranking of 35th for Museums per Capita; 42nd for Theaters per Capita; and 48th for the number of golf courses per Capita; and 32nd in having employed residents age 65 and over.

As for health care, the study examined the number of family physicians, dentists, nurses, and health-care facilities per 100,000 residents, the ranking of the state’s public hospitals, the resident’s life expectancy and emotional health, even taking a look at the death rate for people age 65 and older. Rhode Island ranks 49th in number of family physicians per 100,000 Residents.

WallettHub analyst, Jill Gonzalez, says that for Rhode Island to become a mecca for retirees, state lawmakers must reconsider how they tax Social Security and pensions. The state’s current tax policy “is not at “all friendly toward retirees,” she adds.

According to Gonzalez, the state’s cost of living index is also high at 122 while the national index is 100. This means that if the cost of goods and services nationwide is $100, the Rhode Island retirees will pay $122. Annual costs to pay for home care are nearly $54,000 per year in Rhode Island and state policy makers must find a way to reduce this key community-based service.
Statewide Reactions to Web site Survey

These surveys aggregate data that does not encourage retirement here,” observes AARP Rhode Island State Director Kathleen Connell. “They do not fully measure quality of life or how the proximity to Boston and New York City make Rhode Island attractive to many retirees. But you often hear people talk about retiring in states where lower taxes and deflated housings prices suggest that retirement income will go dramatically farther.

“The tax issue is a reality driven by the state’s so-called ‘structural deficits’ that have resulted in cities and towns raising property and excise taxes. Meanwhile, hikes in fees and new surcharges have added to the tax burden. Legislative leaders face a great challenge in reversing this trend.

“Many people in their 40s and 50s who want to retire in Rhode Island can save more wisely for retirement and find a way to make it work. Anyone entering retirement now with little savings and expecting to rely primarily on Social Security is faced with difficult decisions.

“So, clearly the survey means different things to different people. Few would disagree that Rhode Island is a great place to retire – maybe one of the best places in the nation. If you can afford it.”

Edward Mazze, Distinguished University Professor of Business Administration, says, “I cannot disagree with the quantitative findings in the study. Behind the numbers are two critical factors that have an impact on retiring in Rhode Island – first, the Rhode Island economy has barely grown in the last eight years – second, the negative reputation of the state with government leaders going to jail, high property taxes, poor school systems and unfunded public pension and health programs.”

Mazze calls on the Rhode Island General Assembly to raise the state estate tax level to the same level as the federal estate tax level and exempt social security benefits from state taxes no matter what the income level. “The legislature has to reduce sales taxes and fees, be more transparent in its operations so that individuals trust government actions and fund the social services that retirees need,” he says.

But even with these negative findings retirees should Rhode Island as place to live because of its strategic location, transportation facilities and cultural and recreational activities. However, he acknowledges that “with the high cost of living in Rhode Island and fewer part-time job opportunities for retirees it is difficult to promote the state as a place to retire.”

Ernie Almonte, Rhode Island’s former auditor and partner at RSM US, LLP, a company that performs audit, tax and consulting services, says the changes in how the state taxes Social Security made by lawmakers last year was a good first step. But the former candidate for State Treasurer urges Governor Gina Raimondo and House and Senate Leadership to take a look at the state’s estate tax in the upcoming session. “I believe last year’s changes made by lawmakers was a move in the right direction but we cannot forget the legislative change to the estate cliff effect. “This certainly is a deciding factor for retirees looking to a place to settle down in their retirement years,” he adds.

Almonte also encourages state lawmakers to sit down with the Rhode Island Society of CPA’s to discuss tax policy. “Having a robust discussion on the role of tax policy to pay for necessary services and investments balanced by the ability to pay and the need to pay would be quite helpful to the long run,” he says.
House Speaker Nicholas Mattiello sees the business climate and economic outlook improving as he works to make the state’s tax structure more competitive with neighboring states. He says that the WallettHub survey did not take into account the repeal of state income tax for most Social Security recipients. The State offers retirees “a great quality of life with easy access to our beaches and we have excellent cultural attractions, restaurants, hospitals and universities, he says.

As she has said over her first year, Governor Gina Raimondo is “laser focused” on improving the quality of life for all Rhode Islanders, says deputy press secretary Katie O’Hanlon. “We’ve made a lot of progress over the past year, including eliminating state taxes on Social Security benefits for low and middle-income seniors and increasing funding for Meals on Wheels. However, we can always find ways to improve, says O’Hanlon.

It’s time for the Rhode Island General Assembly to get serious with enacting legislative proposals to attract retirees, more important to keep them from leaving for other retirement havens. Why not do a thorough review of tax policies of WalletHub’s best five places to retire and seek out best tax practices of other states? In the upcoming legislative session, Governor Raimondo and House and Senate leadership might consider reaching out to AARP Rhode Island and aging groups, along with the Rhode Island Society of CPAs, to organize a tax summit, seeking creative ways to tweak the state’s tax code to retain and attract retirees.

This WebHub study can be found at  http://www.wallethub.com/edu/best-and-worst-states-to-retire/18592/.