Report on Falls, Injuries Released

PUblished in Woonsocket Call on October 20, 2019

Last Wednesday morning in Dirksen Senate Office Building 562, the U.S. Special Committee on Aging held a hearing to put a spotlight on the economic consequences on falls and to explore ways to prevent and reduce falls and related injuries. At the one hour and 55-minute hearing, titled “Falls Prevention: National, State, and Local Level Solutions to Better Support Seniors,” its annual report, Falls Prevention: Solutions to Better Support Seniors, was released.

According to the Senate Aging Committee, falls are the leading cause of both fatal and nonfatal injuries among older adults that incur $50 billion annually in total medical costs. That number is expected to double to $100 billion by 2030, and the majority of these costs are borne by Medicare and Medicaid.

“Falls are the leading cause of fatal and non-fatal injuries for older Americans, often leading to a downward spiral with serious consequences. In addition to the physical and emotional trauma of falls, the financial toll is staggering,” said Sen. Susan Collins (R-Maine), who chairs the Senate Aging Committee. “Now is the time, and now is our opportunity, to take action to prevent falls. Our bipartisan report includes key recommendations to take steps to reduce the risk of falls,” the Maine Senator noted in an Oct. 16 statement.

Pushing for Positive Change in Releasing Fall Report

“We must dispel our loved ones of the stigma associated with falling so that they can get the help they need to age in place – where they want to be – in their homes and communities,” said Sen. Robert P. Casey, Jr. (D-Pa.). “I am hopeful that our work over the past year will propel the research community to do more, get more dollars invested into supporting home modifications and encourage more older adults to be active,” said the Special Committee’s Ranking Member.

At the hearing, the Committee unveiled a comprehensive report that provides evidence-based recommendations on ways to reduce the risk of falling. The Committee received input from multiple federal agencies, including the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, and the Food and Drug Administration. In addition, approximately 200 respondents representing falls prevention advocates, hospitals, community organizations, home health agencies, and others shared their expertise on this issue.

The 34-page Aging Committee’s report made recommendations as how to raise awareness about falls-related risks, prevention and recovery at the national, state and local levels. It suggested ways of improving screening and referrals for those at risk of falling so that individuals receive the preventive care necessary to avoid a fall or recover after one. It noted ways of targeting modifiable risk factors, including increasing the availability of resources for home safety evaluations and modifications, so that older adults can remain in their homes and communities. Finally, it called for reducing polypharmacy so that health care providers and patients are aware of any potential side effects that could contribute to a fall.

Increasing Medicare Funding for Bone Density Testing

In an opening statement, Collins noted that falls are often times attributed to uneven sidewalks or icy stairs, medications, medical reasons or muscle strength. But one key cause of falling is osteoporosis, which can be especially dangerous for people who are completely unaware that they suffer from low bone density, she says.

According to Collins, although Medicare covers bone density testing, reimbursement rates have been slashed by 70 percent since 2006, resulting in 2.3 million fewer women being tested. “As a result, it is estimated that more than 40,000 additional hip fractures occur each year, which results in nearly 10,000 additional deaths,” she said, noting legislation, Increasing Access to Osteoporosis Testing Beneficiaries Act that she has introduced with Sen. Ben Cardin,” to reverse these harmful reimbursement cuts.

Casey stated, “I am particularly interested in sharing this report with the relevant agencies and learning how the recommendations will be implemented. Not just put in a report. Implemented,” adds Casey.

Peggy Haynes, MPA, Senior Director, of Portland-based Healthy Aging, MaineHealth that offers A Matter of Balance, an evidence-based falls prevention program, came to the Senate hearing to share details about its impact. “The health care community has a critical role to play in fall prevention – beginning with screening for falls, assessing fall risk factors, reviewing medications and referring to both medical and community-based fall prevention interventions. Our health system is focused on preventing falls in every care setting,” says Haynes.

“The need for a range of community-based options led MaineHealth to be a founding member of the Evidence Based Leadership Collaborative, promoting the increased delivery of multiple evidence-based programs that improve the health and well-being of diverse populations,” adds Haynes.

Haynes noted that older participants attend eight two-hour sessions to help them reduce their fear of falling, assisting them to set realistic goals for increasing their activity and changing their home environment to reduce fall risk factors. A Matter of Balance is offered in 46 states reaching nearly 100,000 seniors.

Virginia Demby, an 84-year-old visually-impaired retired nurse who is an advocate for Community and Older Adults, in Chester, Pennsylvania, came to the Senate hearing to support the importance of fall prevention programs. Despite living with low vision, Demby remains physically active by participating in exercises classes for older adults at the Center for the Blind and Visually Impaired in Chester. She is an advocate for older adults and now helps the local senior center wellness manager recruit more seniors to take falls prevention classes and find new places to offer the classes.

Kathleen A. Cameron, MPH, Senior Director, Center for Healthy Aging, of the Arlington, Virginia-based National Council on Aging, discussed the work of the National Falls Prevention Resource Center, which helps to support evidence-based falls prevention programs across the nation and highlighted policy solutions to reduce falls risk.

Finally, Elizabeth Thompson, chief executive officer, Arlington, Virginia-based National Osteoporosis Foundation, testified that bone loss and osteoporosis are fundamental underlying contributors to the worst consequences of falls among older Americans: broken and fractured bones. Osteoporotic fractures are responsible for more hospitalizations than heart attacks, strokes and breast cancer combined, she noted.

For details of the Senate Aging Committee report, go to http://www.aging.senate.gov/imo/media/doc/SCA_Falls_Report_2019.pdf.

Caregivers Flying Blind in Providing Complex Medical and Nursing Care

Published in the Woonsocket Call on April 21, 2019

Half of the nation’s 40 million family caregivers are performing intense and complicated medical and nursing tasks, managing multiple health conditions for their family members and friends, says a newly published AARP report.

AARP’s special report, “Home Alone Revisited: Family Caregivers Providing Complex Care,” released April 17, 2019, takes a close look at specific medical and nursing tasks (including giving injections, preparing special diets, managing tube feedings and even handling medical equipment) that family caregivers are currently doing. It’s a follow-up report to AARP’s 2012 Home Alone Study that took the first in-depth look at how caregivers managed providing complex medical and nursing care that was formerly offered by trained professionals.

Changes in the Health Care System Can Support Family Caregivers

“This report shows the extent of complex tasks that millions of family caregivers are providing every day. They are largely alone in learning how to perform these tasks,” said Susan Reinhard, RN, Ph.D., Senior vice president and Director, AARP Policy Institute, in a statement announcing the release of the a 56-page report. “About half of family caregivers are worried about making a mistake. We need to do a lot more across the health care system—with providers and hospitals—to help support these family caregivers,” says Reinhard.

Adds Rani E. Snyder, program director at The John A. Hartford Foundation, “Family caregivers are the linchpin in our health care system, particularly for older adults,” “This study shines new light on the diversity of family caregivers performing complex tasks—from men to millennials to multicultural populations—and is a rallying cry for an all hands-on-deck approach to creating age-friendly health systems that better support and prepare these often forgotten members of the health care team.”

The new statistics in this report shed more light on the demands of family caregiving,” said AARP Rhode Island State Director Kathleen Connell, a former nurse. “These described caregiving responsibilities sound like a task list for a team of home nurses, aides, dieticians, physical therapists and personal drivers who work without weekends off, much less vacations. Is there any question that people worry about making a mistake that compounds existing issues?,” she says.

“The takeaway is quite clear,” Connell added. “Caregiving is stressful and we need to expand efforts to provide assistance. And it’s a very big ‘we’ that I am speaking of. Families need to help out and share more responsibilities as well as offer respite for primary caregivers. Neighbors and extended family also can lend a hand. And we need government to continue to provide assistance through legislation that supports family caregivers. Caregiving responsibilities can be both daunting and exhausting. It’s the new reality. The good news is that as we raise awareness we can work together to improve the lives of caregivers, “ says Connell.

A Sampling of the AARP Report’s Findings

AARP’s Home Alone Revised Report report found that almost half of the caregiver respondents (48 percent) prepare special diets multiple times per day. Preparing these meals often involved taking precise measurements, following specific dietary guidelines, constant monitoring, and the use of special equipment for preparation and feeding.

Thirty percent of the respondents say preparing special diets are hard to manage, this being more challenging to men. Younger caregivers found it more difficult to manage this task than older caregivers.

The caregivers also reported that 54 percent of the survey’s respondents say they manage incontinence multiple times a day. Most say managing incontinence is more difficult than managing medications, helping with assistive devices and performing wound care. Seventy-six percent say they learned how to manage incontinence on their own. More than one in four would appreciate having assistance from another person to help.

According to AARP’s report, 70 percent of these caregivers are dealing with the emotional stress of managing pain relief in the middle of a national opioid crisis. More than four in 10 expressed concerns about giving the optimal dose. About four in 10 faced difficulties in controlling the pain of the care recipient.

Finally, 51 percent of the survey respondents assisted with canes, walkers, and other mobility devices while over a third (37 percent) dealt with wound care.

The researchers conclude that “uncomplicated world of ‘informal’ caregiving” no longer applies” to the nation’s caregivers. “In the current health care environment, it is presumed that every home is a potential hospital and every service that the person needs can be provided by an unpaid family member, with only occasional visits by a primary care provider, nurse or therapist,” say the researchers,” they say.

AARP’s Home Alone Revised Report is a must read for Congress and state lawmakers who can easily address the challenges caregivers face when providing medically complex care by crafting policies and programs that will provide support and resources to the nation’s growing number of caregivers.

This caregiving issue might be a good one for the U.S. Senate Special Committee Aging to study.

A Final Note…

AARP gathered the study’s data through a nationally representative, population-based, online survey of 2,089 family caregivers. This study employed an oversampling of multicultural groups, taking a closer look at difficult tasks, and putting greater attention on available resources and outcomes. The study’s sampling strategy ensured multicultural representation and investigated generational differences. Additionally, the researchers also explored certain topics in greater depth, including special diets, incontinence, pain, and the impact of social isolation on the caregiver.

The AARP Home Alone Study is a special report from the Founders of the Home Alone Alliance℠ (AARP, United Hospital Fund, Family Caregiver Alliance and UC Davis-Betty Irene Moore School of Nursing). With funding from The John A. Hartford Foundation to the AARP Foundation, the study took an in-depth look at the specific medical/nursing tasks that family caregivers are doing.

To read the full report, go to: https://www.AARP.org/ppi/info-2018/home-alone-family-caregivers-providing-complex-chronic-care.html.

Note: Updated April 22, 2018…

Report Details Ways to Improve Guardianship System in US

Published in the Woonsocket Call on December 2, 2018

Just days ago, the U.S. Senate Special Committee on Aging held an afternoon hearing in the Senate Dirksen Office Building to alert Congress to appalling stories gathered across the nation regarding abusive guardianships that are taking advantage of vulnerable older adults. At this hearing the Senate Aging Committee also released its annual report that takes a look at an examination of guardianship arrangements including research and recommendations on ways to improve the nation’s guardianship system.

Although guardians provide a valuable and essential service for many older Americans, from deciding where an individual will live and when to seek medical care to choosing if family members are allowed to visit and how to spend retirement savings, unscrupulous guardians acting with little oversight have used legal guardianship proceedings to obtain control of vulnerable individuals and have then used that power to liquidate assets and life-time savings for their own personal gains.

Last April, the Committee held the first hearing in a two-part series this year on the abuse of power and exploitation of older Americans by guardians. The Committee also held a hearing on guardianship in 2016. The Nov. 28th hearing is a continuation of the Committee’s longstanding commitment to bring awareness and prevention to the financial exploitation of older Americans.

Putting the Spotlight on Unscrupulous Guardians

U.S. Senators Susan Collins (R-ME) and Bob Casey (D-PA), the Chairman and Ranking Member of the Senate Aging Committee, put the legislative spotlight on this important legal issue and released the Committee’s 34-page report at the Wednesday hearing titled, “Ensuring Trust: Strengthening State Efforts to Overhaul the Guardianship Process and Protect Older Americans.”

The released Senate Aging Committee report is the culmination of a year-long examination of ways in which the legal system can be improved to better protect individuals subject to these and similar arrangements from abuse, neglect, and exploitation. It addresses three key areas – the importance of guardianship oversight, alternatives to guardianship, and the need for improved data and it makes 13 recommendations.

“An estimated 1.3 million adults are under the care of guardians – family members or professionals – who control approximately $50 billion of their assets,” said Collins, in her opening statement. “Guardianship is a legal relationship created by a court that is designed to protect those with diminished or lost capacity. We found, however, that in many cases, the system lacks basic protections leaving the most vulnerable Americans at risk of exploitation.,” she said.

“While most guardians act in the best interest of the individual they care for, far too often, we have heard horror stories of guardians who have abused, neglected or exploited a person subject to guardianship. As our report notes, there are persistent and widespread problems with guardianship arrangements nationwide,” says Casey in his opening statement. “This is why Senator Collins and I introduced the Guardianship Accountability Act to begin reforming the guardianship system to ensure the protection of seniors under guardian care from losing their rights, savings or possessions because a guardian abused their power,” he said.

Fixing the Nation’s Guardianship System

The Senate Aging Committee took testimony from four guardianship experts who gave their thoughts as to how to improve the system.

Cate Boyko, Senior Court Research Associate at the National Center for State Courts (NCSC), explained that the state court data it collected revealed that none of the states was able to fully report all the information on guardianships they requested. They found that the most serious issues involved local court authority, lack of standardized reporting, and limited technology.

Bethany Hamm, Acting Commissioner of the Maine Department of Health and Human Services, provided background information on the state’s Adult Protect Services and public guardianship program. Hamm discussed Maine Uniform Probate Code (UPC) enacted during the state’s last legislative session. The Maine UPC takes effect in July of next year and requires private guardians to report annually on the condition of the adult and account for money and other property in guardians’ possession or subject to guardians’ control.

Karen Buck, Executive Director at the Pennsylvania-based SeniorLAW Center, a nonprofit legal services agency, described the work her organization does to tackle issues such as guardianship through free legal representation, education, and advocacy for older Americans in Pennsylvania. She argued that guardianship remains an “important tool” to provide care for vulnerable seniors and therefore merits attention and reform.

Finally, Barbara Buckley, Executive Director at the Legal Aid Center of Southern Nevada, described the steps that her state has taken since 2014 to better protect individuals under guardianship. One year later, the Nevada Supreme Court created a Guardianship Commission to examine the guardianship system and recommend reforms., she said, detailing three significant areas of reform implemented in Nevada: the right to counsel, the protected person’s Bill of Rights and other statutory reforms, and the establishment of the Guardianship Compliance Office.

As a result of the Senate Aging Committee’s work to examine issues surrounding guardianship, Collins and Casey announced at this hearing that they were introducing the Guardianship Accountability Act. This bipartisan legislation would promote information sharing among courts and local organizations as well as state and federal agencies, encourage the use of background checks and less restrictive alternatives to guardianship, and expand the availability of federal grants to improve the guardianship system.

Congress Must Act

One of the report’s recommended actions to strengthen guardianship arrangements is for courts to conduct criminal background checks on ALL prospective guardians. To aid states in this pursuit, Casey and Collin’s legislation, the “Guardianship Accountability Act,” promotes oversight of guardianship arrangements and encourages information sharing among government agencies and with other relevant organizations. This bill would also allow states to fund data collection on guardianship arrangements and conduct background checks on guardians.

According to the National Center for State Courts, there are approximately 1.3 million adults and an estimated $50 billion of assets under guardianship arrangements. State courts are tasked with monitoring guardianships in order to protect individuals subject to guardianship from abuse, neglect and exploitation. Despite this responsibility, few states are able to provide courts with adequate resources to monitor guardianships effectively and hold guardians accountable.

When the new Congress begins, hopefully this legislation will sail through both chambers of Congress and be quickly signed by President Donald Trump. We will see…

To get the Senate Aging Committee’s guardianship report, go to http://www.aging.senate.
gov/imo/media/doc/Guardianship%20Report.pdf.

For a copy of the Guardianship Accountability Act, go to http://www.aging.senate.gov/imo/media/doc/
Guardianship%20Accountability%20Act%20of%202018.pdf.

To watch the one hour and forty-seven-minute Senate Aging Committee hearing, go to http://www.aging.senate.
gov/hearings/ensuring-trust-strengthening-state-efforts-to-overhaul-the-guardianship-process-and-protect-older-americans.