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4 Common Meds Send Thousands of Seniors to the Hospital

Posted on: December 1st, 2011 by accreditednursing No Comments

An estimated 100,000 older Americans are hospitalized for adverse drug reactions yearly, and most of those emergencies stem from four common medications, a new study finds.

The four types of medication — two for diabetes and two blood-thinning agents — account for two-thirds of those drug-related emergency hospitalizations.

“Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans,” said lead study author Dr. Daniel Budnitz, director of the U.S. Centers for Disease Control and Prevention’s medication safety program.

Medications previously designated “high-risk” were implicated in only 1.2 percent of hospitalizations, the study found.

Working with a nationally representative database, CDC researchers identified more than 5,000 cases of drug-related adverse events that occurred among people aged 65 and older from 2007 to 2009 and used that to make their estimates for the whole population.

Nearly half (48 percent) of the hospitalizations occurred among adults 80 and up, according to the study, published in the Nov. 24 issue of the New England Journal of Medicine. Nearly two-thirds (66 percent) were the result of unintentional overdoses.

The four medications, used alone or together, most often cited:

The blood thinning medication warfarin (Coumadin, Jantoven), which is used to treat blood clots, was involved in 33 percent of emergency hospitalizations.

Insulin, used to control blood sugar in diabetes patients, was involved in 14 percent of cases.

Antiplatelet drugs such as aspirin and clopidogrel (Plavix), which are used to prevent blood clots, were involved in 13 percent of cases.

Oral hypoglycemic agents — diabetes medications taken by mouth — were involved in 11 percent of cases.

With antiplatelet or blood thinning drugs, bleeding was the main problem. For insulin and other diabetes medications, about two-thirds of cases involved changes in mental status such as confusion, loss of consciousness or seizures.

“These are important findings,” said Dr. Michael Steinman, an associate professor of medicine in the division of geriatrics at the University of California, San Francisco, who is familiar with the research. “This study highlights a few key issues that are important for doctors and patients to be aware of. The first is that serious adverse reactions to drugs are common among older people, particularly among people over 80. But even those 65 and older are at substantial risk of having an adverse effect from their drugs.”

One challenge for doctors and patients is that the medications may be necessary, Budnitz said.

“These are often critical medicines for patients’ health,” he said. “Patients who are on these medicines should tell all their doctors what they are taking and work together with their doctors and pharmacist to make sure that they are taking these medicines correctly.”

Among U.S. adults aged 65 and up, 40 percent take five to nine medications and 18 percent take 10 or more, according to the study authors. Prior research has also found that older adults are nearly seven times more likely than younger people to have an adverse drug event that requires hospitalization. “As most people age, there often are changes in how their kidneys, liver, heart, and other organs work that can make them more susceptible to adverse drug events,” Budnitz said.

And though taking lots of pills raises safety issues, in 82 percent of cases the treating physician attributed the overdose to a single drug, Budnitz added.

To reduce risks, Steinman said doctors and patients need to discuss whether the drug is truly necessary. For people with very high blood pressure or blood sugar, “the answer is almost always ‘yes,’ you should treat it,” Steinman said. “But if you have only mildly elevated blood pressure or blood sugar, the benefits of treating it versus the harms start to shift. Do these drugs really provide enough benefit that it’s worth taking them?”

Physicians and patients need to consider a person’s age, overall health, other medications they take (keep a list including dosages) and patient preference, such as how easy they find it to keep track of blood sugar and dosages, he said.

With anticlotting or blood-thinning agents, stopping them is probably not an option, Steinman said. So patients need to be attuned to any side effects they experience, even if they seem minor. Catching side effects early can prevent more serious problems later on, and doctors may be able to change the medication or lower the dosage, he said.

http://yourlife.usatoday.com/health/medical/treatments/story/2011-11-25/Four-common-meds-send-thousands-of-seniors-to-hospital/51397208/1

NAHC Asks Us to Oppose Medicare Co-Pays for Home Health

Posted on: November 4th, 2011 by accreditednursing No Comments

Dear Home Care Advocate:

We are delighted that you have taken the time to visit our NAHC Legislative Action Network (NAHC LAN) to contact your Members of Congress.

As part of deficit reduction negotiations, Congress is considering proposals to impose Medicare home health copays and across-the-board cuts in home health payments. I am writing now to ask you to revisit the NAHC LAN to send a new message to your Senators and Representative urging them to oppose home health copays and cuts.

You may send the new message to your Members of Congress by clicking here: Write Your Legislators. There you will find numerous studies, talking points, and a sample message that you may edit to include your experience and the harmful impact home health copays and cuts would have on home health providers and beneficiaries in your state and district.

Thank you again for visiting the NAHC LAN and taking advantage of this opportunity to communicate instantly with your legislators and their staff who make the key decisions that are of vital importance to the home care community.

Val J. Halamandaris
President
National Association for Home Care & Hospice

California gives Telehealth a Push Forward

Posted on: October 20th, 2011 by accreditednursing No Comments

Model statute a guide for moving California telehealth forward
The Telemedicine Development Act of 1996 is as obsolete as the computers in use back then. Hence the effort by telemedicine professionals and advocates to bring the law up to speed with the technology. On Tuesday, the Sacramento-based Center for Connected Health Policy issued a “telehealth model statute,” a policy report that could influence state policy makers in updating the measure. Some of the report’s recommendations involve definitions, like replacing “telemedicine” with the more broadly encompassing term “telehealth,” and ending the ban on delivering such services by e-mail and phone. Another will require equipment and software vendors to prove their products comply with current telehealth industry interoperability standards. And one recommendation would require private healthcare payers and California’s Medicaid program (Medi-Cal) to cover “encounters between licensed health practitioners and enrollees irrespective of the setting of the enrollee and provider(s).”

“We wanted to create the ideal policy platform because we feel that California is a leader in so many ways in the telehealth field,” Patricia E. Powers, CCHP’s CEO, tells the News Alert.

That leadership, she adds, has eroded as other states have caught up. As noted in CCHP’s Model Statute Report, Medicaid programs in Arizona, Georgia, Wisconsin and Minnesota all cover the use of “store-and-forward” technologies for sending data such as images and video, regardless of the service provided, with Arizona and Georgia also reimbursing providers for store-and-forward in all specialties.

The 1996 act requires Medi-Cal to reimburse telemed procedures as it would traditional health services, however the state also set a 2013 sunset to end Medi-Cal reimbursements for store-and-forward for teledermatology, teleophthalmology, and teleoptometry information. CCHP wants Medi-Cal to continue to cover store-and-forward for all services.

As a non-profit health policy institute, CCHP will not lobby California lawmakers, but is counting on supporters to emerge in the legislature–possibly among lawmakers attending a Thursday CCHP briefing on the model statute.

CCHP has support from two key telehealth groups. One is the California Telemedicine & eHealth Center, one of six federally designated Telehealth Resource Centers nationwide. The other is the California Telehealth Network, which is connecting some 850 healthcare providers in poorer and thus underserved areas to a state and nationwide broadband network dedicated to healthcare.

Eric Brown, CTN’s president and CEO, tells the News Alert that this month, “the first 25 (providers) will be up and running, and it’s very likely that we’ll have another 20 to 25 by the end of the month.”

Another sign of telehealth’s growth these days: Last June, California’s largest private insurer Anthem Blue Cross announced its telemedicine program surpassed 25,000 clinical consultations with Medi-Cal members for members for cardiology, endocrinology, dermatology and neurology medical needs over a dozen years. As of Thursday, that number stands at more than 32,000. The number of participating specialists has risen over the past three years to include 34 specialist doctors, up from 31 last June.

In addition to becoming self-sustaining, supporters of expanded telehealth in California would be wise to continue building relations with two key groups.

One is the state’s medical community, which benefited from the limiting of telemed practices under the 1996 law. For example, patients cannot get coverage for services via telehealth under Medi-Cal without an informed consent waiver and documentation that a barrier existed to an in-person visit. The model statute recommends both rules be eliminated. Today’s doctors are expected to be supportive of any new telehealth measures, CCHP’s Martin and Powers says.

The state’s private health insurers, however, will likely be another story, judging from a statement to the News Alert by Patrick Johnston, CEO of the California Association of Health Plans. CAHP represents 39 member health plans insuring more than 21 million Californians.

“Many health plans use telemedicine as an important tool in expanding access to care, selecting quality providers and lowering costs. It can be particularly effective in rural communities or with specialists for rare conditions. Health plans should have the flexibility to apply this technology in the most appropriate fashion rather than dictating the specific use of this or any other innovation,” says Johnston.

CTeC Executive Director Christine Martin tells the News Alert CCHP is not alone in seeking that more healthcare providers be reimbursed for more telehealth procedures; the nonprofit is in synch with her group and the National Rural Health Association. As a result, she says, the model statute “should open a dialogue with our providers and payers as to how we can best optimize the use of telehealth.”

CCHP sought to encourage such dialogue by including an insurance industry professional (Carolyn Carter, business development manager withWellpoint Inc. Anthem Blue Cross) and several doctors on its Telehealth Model Statute Working Group, a 25-member panel of healthcare and policy professionals.

Whether that consensus gels will depend on how well telemed proponents can convince insurers that the savings promised by telehealth will outweigh the cost of services. A 2007 study by the Center for Information Technology Leadership projected telehealth would yield $511 million in annual savings for California and $4.3 billion nationwide. In today’s dollars, that would be $542.75 million and $4.57 billion, respectively.

The cost? Harder to calculate. The California HealthCare Foundation issued a pair of case studies last November for two specific clinics. One studied a year of operations at Open Door Community Health Centers’ telehealth program, which yielded a $220,734 profit. That reflected revenue from in-person visits with the centers’ own psychiatrist and diabetes educator, as well as grants and reimbursement from third-party payers including Medicaid, Medicare and private insurers.

The other studied the first six months of a teledermatology program at Oakland-based La Clinica de la Raza that lost money–$43,991 under the worst of three calculations. The loss was driven largely by La Clinica’s inability to find a doctor able to bill Medi-Cal or another third party; the clinic paid $40,000 to a dermatologist to whom digital images and clinical notes were forwarded by La Clinica providers.

Medi-Cal’s ability to take on additional costs for La Clinica and others is uncertain. As the state scrambles to plug a $26.6 billion shortfall, Gov. Jerry Brown has proposed reducing Medi-Cal spending, now at $41.6 billion, by $1.7 billion.

Flu Shot Recommendations for 2011

Posted on: October 20th, 2011 by accreditednursing No Comments

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011

Weekly
August 26, 2011 / 60(33);1128-1132

On August 18, 2011, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).

This document provides updated guidance for the use of influenza vaccines in the United States for the 2011–12 influenza season. In 2010, the Advisory Committee on Immunization Practices (ACIP) first recommended annual influenza vaccination for all persons aged ≥6 months in the United States (1,2). Vaccination of all persons aged ≥6 months continues to be recommended. Information is presented in this report regarding vaccine strains for the 2011–12 influenza season, the vaccination schedule for children aged 6 months through 8 years, and considerations regarding vaccination of persons with egg allergy. Availability of a new Food and Drug Administration (FDA)–approved intradermally administered influenza vaccine formulation for adults aged 18 through 64 years is reported. For issues related to influenza vaccination that are not addressed in this update, refer to the 2010 ACIP statement on prevention and control of influenza with vaccines and associated updates (1,2).

Methodology for the formulation of the ACIP annual influenza statement has been described previously (1). The ACIP Influenza Work Group meets every 2–4 weeks throughout the year. Work Group membership includes several voting members of the ACIP, as well as representatives from ACIP Liaison Organizations. Meetings are held by teleconference and include discussion of influenza-related issues, such as vaccine effectiveness and safety, coverage in groups recommended for vaccination, feasibility, cost-effectiveness, and anticipated vaccine supply. Presentations are requested from invited experts, and published and unpublished data are discussed. CDC’s Influenza Division provides influenza surveillance and antiviral resistance data, and the Immunization Safety Office and Immunization Services Division provide information on vaccine safety and distribution and coverage, respectively.

Vaccine Strains for the 2011–12 Influenza Season

The 2011–12 U.S. seasonal influenza vaccine virus strains are identical to those contained in the 2010–11 vaccine. These include A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens. The influenza A (H1N1) vaccine virus strain is derived from a 2009 pandemic influenza A (H1N1) virus (3).

Recommendations for Vaccination

Routine annual influenza vaccination is recommended for all persons aged ≥6 months (1). To permit time for production of protective antibody levels (4,5), vaccination should optimally occur before onset of influenza activity in the community, and providers should offer vaccination as soon as vaccine is available. Vaccination also should continue to be offered throughout the influenza season.

Although influenza vaccine strains for the 2011–12 season are unchanged from those of 2010–11, annual vaccination is recommended even for those who received the vaccine for the previous season. Although in one study of children vaccinated against A/Hong Kong/68 (H3N2) virus, vaccine efficacy remained high against this strain 3 years later, the estimated efficacy of vaccine decreased over the seasons studied (6). Moreover, several studies have demonstrated that postvaccination antibody titers decline over the course of a year (7–10). Thus, annual vaccination is recommended for optimal protection against influenza.

Vaccine Doses for Children Aged 6 Months Through 8 Years

Children aged 6 months through 8 years require 2 doses of influenza vaccine (administered a minimum of 4 weeks apart) during their first season of vaccination to optimize immune response. In a study of children aged 5 through 8 years who received trivalent inactivated vaccine (TIV) for the first time, the proportion of children with protective antibody responses was significantly higher after 2 doses than after 1 dose (11).

The importance of vaccine priming might depend more on the similarity of the antigenic composition between the priming and second dose than the temporal interval between doses. From the 2003–04 to 2004–05 influenza seasons, the A(H1N1) virus antigen remained unchanged; however, the A(H3N2) virus antigen changed to a drifted strain, and the B virus antigen changed more substantially to a different lineage. In a study conducted over those two seasons, influenza-vaccine naïve children aged 6 through 23 months who received 1 dose of TIV in the spring of their first year of vaccination followed by a second dose in the fall were less likely to have protective antibody responses to the A(H3N2) and B virus antigens when compared with children who received 2 doses of identical vaccine in the fall (12). Response to the unchanged A(H1N1) virus antigen was comparable between the groups. In another study conducted over the same two seasons, unprimed children aged 10 through 24 months who received 1 dose of TIV during the fall of each season had similar responses to the unchanged A(H1N1) virus antigen as well as to the drifted A(H3N2) virus antigen when compared with children aged 6 through 24 months who received 2 doses of the same TIV during the latter season; however, the first group had significantly lower response to the B virus antigen (13). During two seasons in which all influenza vaccine virus antigens were identical, unprimed children aged 6 through 23 months had similar responses when they received 1 dose in the spring followed by a second dose in the fall, as compared with 2 doses received 1 month apart in the fall (14). Studies of inactivated monovalent pandemic 2009 (H1N1) vaccine in children aged

Vaccination providers should note that, in previous seasons, children aged 6 months through 8 years who received only 1 dose of influenza vaccine in their first year of vaccination required 2 doses the following season. However, because the 2011–12 vaccine strains are unchanged from the 2010–11 season, children in this age group who received at least 1 dose of the 2010–11 seasonal vaccine will require only 1 dose of the 2011–12 vaccine. Children in this age group who did not receive at least 1 dose of the 2010–11 seasonal influenza vaccine, or for whom it is not certain whether the 2010–11 seasonal vaccine was received, should receive 2 doses of the 2011–12 seasonal influenza vaccine (Figure 1). Recommendations regarding the number of doses for this age group might change for the 2012–13 season if vaccine antigens change.

Available Vaccine Products and Indications

Multiple influenza vaccines are expected to be available during the 2011–12 season (Table). All contain the same antigenic composition. Package inserts should be consulted for information regarding additional components of various vaccine formulations.

TIV preparations, with the exception of Fluzone Intradermal (Sanofi Pasteur), should be administered intramuscularly. For adults and older children, the deltoid is the preferred site. Infants and younger children should be vaccinated in the anterolateral thigh. Specific guidance regarding site and needle length can be found in the ACIP’s General Recommendations on Immunization (18).

A new intradermally administered TIV preparation, Fluzone Intradermal, was licensed in May 2011. This vaccine is indicated for persons aged 18 through 64 years and contains less antigen than intramuscular TIV preparations (9 µg rather than 15 µg of each strain per dose) in a smaller volume (0.1mL rather than 0.5 mL). The vaccine is administered intradermally via a single-dose, prefilled microinjection syringe. The preferred site for administration is over the deltoid muscle (19). The most common adverse reactions include injection-site erythema, induration, swelling, pain, and pruritus. With the exception of pain, these reactions occurred more frequently than with intramuscular vaccine, but generally resolved within 3–7 days. This vaccine is an alternative to other TIV preparations for those in the indicated age range, with no preferential recommendation.

As during the 2010–11 season, a vaccine containing 60 µg of hemagglutinin per vaccine strain (rather than 15 µg per strain as in other intramuscular TIV preparations), Fluzone High-Dose (Sanofi Pasteur), is available as an alternative TIV for persons aged ≥65 years. No preference is indicated for this TIV versus other TIV preparations (1).

The intranasally administered live attenuated influenza vaccine (LAIV), FluMist (MedImmune) is indicated for healthy, nonpregnant persons aged 2 through 49 years. Within the indicated groups specified for each vaccine in the package inserts, no preference is indicated for LAIV versus TIV (1).

Vaccination of Persons Reporting Allergy to Eggs

Allergy to eggs must be distinguished from allergy to influenza vaccine. Severe allergic and anaphylactic reactions can occur in response to a number of influenza vaccine components, but such reactions are rare. A review of reports to the Vaccine Adverse Events Reporting System (VAERS) of adverse events in adults noted four reports of death caused by anaphylaxis following influenza vaccine during 1990–2005; the vaccine components potentially responsible for these reactions were not reported (20). A prior severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine.

All currently available influenza vaccines are prepared by inoculation of virus into chicken eggs. Hypersensitivity to eggs has been listed as a contraindication to receipt of influenza vaccine on most package inserts. However, several recent studies have documented safe receipt of TIV in persons with egg allergy (21–29), and recent revisions of some TIV package inserts note that only a severe allergic reaction (e.g., anaphylaxis) to egg protein is a contraindication. In general, these studies include relatively fewer persons reporting a history of anaphylactic reaction to egg, compared with less severe reactions. Several documents providing guidance on use of influenza vaccine in persons with egg allergy have been published recently (30–32).

The quantity of egg protein in vaccine is expressed as the concentration of ovalbumin per dose or unit volume. Among studies in which the ovalbumin content of the administered vaccine was reported, up to 1.4 µg/mL (0.7 µg/0.5 mL dose) was tolerated without serious reactions (22,23,25–29); however, a safe maximum threshold of ovalbumin, below which no anaphylactic reactions would be expected, is not known.

Although ovalbumin content is not required to be disclosed on package inserts for vaccines used in the United States, manufacturers either report maximum albumin content in the package inserts or will provide this information on request. Ovalbumin concentration can vary from season to season and from lot to lot for a given vaccine. Independent assessments of ovalbumin content of commercially available vaccines have noted lower concentrations than those listed on package inserts (33,34).

In several studies evaluating influenza vaccine in persons with egg allergy, additional safety measures have been taken, such as skin prick testing with vaccine (21–24,26,28,29) and administering the vaccine in 2 doses (e.g., 10% of the dose initially, followed by the remaining 90% if no reaction has occurred during a 30-minute observation period) (22,24–29). Skin prick testing with vaccine was poorly predictive of allergic reactions in these studies (22–24,26). In general, administration of both full doses and split doses have been well-tolerated without serious reactions, although systemic reactions (e.g., wheezing, eczema exacerbation, and hives on face/chest) were observed with the initial 10% dose among six (3.5%) of 171 participants in one study (24).

Recommendations Regarding Persons with Egg Allergy

Each of the following recommendations applies when considering influenza vaccination of persons who have or report a history of egg allergy.

1. Persons who have experienced only hives following exposure to egg should receive influenza vaccine with the following additional measures (Figure 2):

a) Because studies published to date involved use of TIV, TIV rather than LAIV should be used.

b) Vaccine should be administered by a health-care provider who is familiar with the potential manifestations of egg allergy.

c) Vaccine recipients should be observed for at least 30 minutes for signs of a reaction following administration of each vaccine dose.

Other measures, such as dividing and administering the vaccine by a two-step approach and skin testing with vaccine, are not necessary.

2. Persons who report having had reactions to egg involving angioedema, respiratory distress, lightheadedness, or recurrent emesis, or persons who required epinephrine or other emergency medical intervention, particularly those that occurred immediately or within minutes to hours after egg exposure are more likely to have a serious systemic or anaphylactic reaction upon reexposure to egg proteins. Before receipt of vaccine, such persons should be referred to a physician with expertise in the management of allergic conditions for further risk assessment (Figure 2).

3. All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available. ACIP recommends that all vaccination providers be familiar with the office emergency plan (18).

4. Some persons who report allergy to egg might not be egg allergic. Those who are able to eat lightly cooked egg (e.g., scrambled eggs) without reaction are unlikely to be allergic. Conversely, egg-allergic persons might tolerate egg in baked products (e.g., bread or cake); tolerance to egg-containing foods does not exclude the possibility of egg allergy (35). Egg allergy can be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin and/or blood testing for immunoglobulin E antibodies to egg proteins.

5. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine.

Reported by

Lisa Grohskopf, MD, Timothy Uyeki, MD, Joseph Bresee, MD, Nancy Cox, PhD, Influenza Div; Carolyn Bridges, MD, Immunization Services Div, National Center for Immunization and Respiratory Diseases, CDC. Corresponding contributor: Lisa Grohskopf, lgrohskopfatcdcdotgov, 404-639-2552.

Acknowledgments

Members of the Advisory Committee on Immunization Practices (ACIP), July 2010–June 2011.* ACIP Influenza Work Group. John Kelso, MD, Div of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego California. Matthew Greenhawt, MD, Div of Allergy and Clinical Immunology, Univ of Michigan Health System. Neal Halsey, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Clinical Immunization Safety Assessment Network Hypersensitivity Working Group. Matthew Fenton, PhD, Marshall Plaut, MD, National Institute of Allergy and Infectious Diseases, National Institutes of Health.

References
1. CDC. Prevention and control of influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8).
2. CDC. Update: recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding use of CSL seasonal influenza vaccine (Afluria) in the United States during 2010-11. MMWR 2010;59:989–92.
3. Food and Drug Administration. February 25, 2011: Vaccines and Related Biological Products Advisory Committee meeting transcript. Rockville, Maryland: Food and Drug Administration; 2011.
4. Gross PA, Russo C, Dran S, Cataruozolo P, Munk G, Lancey SC. Time to earliest peak serum antibody response to influenza vaccine in the elderly. Clin Diagn Lab Immunol 1997;4:491–2.
5. Brokstad KA, Cox RJ, Olofsson J, Jonsson R, Haaheim LR. Parenteral influenza vaccination induces a rapid systemic and local immune response. J Infect Dis 1995;171:198–203.
6. Foy HM, Cooney MK, McMahan R. A/Hong Kong influenza immunity three years after immunization. JAMA 1973;226:758–61.
7. Ochiai H, Shibata M, Kamimura K, Niwayama S. Evaluation of the efficacy of split-product trivalent A(H1N1), A(H3N2), and B influenza vaccines: reactogenicity, immunogenicity, and persistence of antibodies following two doses of vaccines. Microbiol Immunol 1986;30:1141–9.
8. Künzel W, Glathe H, Engelmann H, Van Hoecke C. Kinetics of humoral antibody response to trivalent inactivated split influenza vaccine in subjects previously vaccinated or vaccinated for the first time. Vaccine 1996;14:1108–10.
9. Song JY, Cheong HJ, Hwang IS, et al. Long-term immunogenicity of influenza vaccine among the elderly: risk factors for poor immune response and persistence. Vaccine 2010;28:3929–35.
10. Ambrose CS, Yi T, Walker RE, Connor EM. Duration of protection provided by live attenuated influenza vaccine in children. Pediatr Infect Dis J 2008;27:744–8.
11. Neuzil KM, Jackson LA, Nelson J, et al. Immunogenicity and reactogenicity of 1 versus 2 doses of trivalent inactivated influenza vaccine in vaccine-naive 5–8-year-old children. J Infect Dis 2006;194:1032–9.
12. Walter EB, Neuzil KM, Zhu Y, et al. Influenza vaccine immunogenicity in 6- to 23-month-old children: are identical antigens necessary for priming? Pediatrics 2006;118:e570–8.
13. Englund JA, Walter EB, Gbadebo A, Monto AS, Zhu Y, Neuzil KM. Immunization with trivalent inactivated influenza vaccine in partially immunized toddlers. Pediatrics 2006;118:e579–85.
14. Englund JA, Walter EB, Fairchok MP Monto AS, Neuzil KM. A comparison of 2 influenza vaccine schedules in 6- to 23-month-old children. Pediatrics. 2005;115:1039–47
15. Plennevaux E, Sheldon E, Blatter M, Reeves-Hoché MK, Denis M. Immune response after a single vaccination against 2009 influenza A H1N1 in USA: a preliminary report of two randomised controlled phase 2 trials. Lancet 2009;375:41–8.
16. Nolan T, McVernon J, Skeljo M, et al. Immunogenicity of a monovalent 2009 influenza A(H1N1) vaccine in infants and children: a randomized trial. JAMA 2010;303:37–46.
17. Arguedas A, Soley C, Lindert K. Responses to 2009 H1N1 vaccine in children 3 to 17 years of age. N Engl J Med 2010;362:370–2.
18. CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-2).
19. Sanofi Pasteur, Inc. Fluzone [package insert]. Swiftwater, Pennsylvania: Sanofi Pasteur, Inc.; 2011. Available at http://www.fda.gov/downloads/biologicsbloodvaccines/…/ucm195479.pdf . Accessed August 15, 2011.
20. Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P. Safety of trivalent inactivated influenza vaccine in adults: background for pandemic influenza vaccine safety monitoring. Vaccine 2009;27:2114–20.
21. Bierman CW, Shapiro GG, Pierson WE, Taylor JW, Foy HM, Fox JP. Safety of influenza vaccination in allergic children. J Infect Dis 1977;136(Suppl):S652–5.
22. James JM, Zeiger RS, Lester MR, et al. Safe administration of influenza vaccine to patients with egg allergy. J Pediatr 1998;133:624–8.
23. Esposito S, Gasparini C, Martelli A, et al. Safe administration of an inactivated virosomal adjuvanted influenza vaccine in asthmatic children with egg allergy. Vaccine 2008;26:4664–8.
24. Chung EY, Huang L, Schneider L. Safety of influenza vaccine administration in egg-allergic patients. Pediatrics 2010;125:e1024–30.
25. Gagnon R, Primeau MN, Des Roches A, et al. Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine. J Allergy Clin Immunol 2010;126:317–23.
26. Greenhawt MJ, Chernin AS, Howe L, Li JT, Sanders G. The safety of the H1N1 influenza A vaccine in egg allergic individuals. Ann Allergy Asthma Immunol 2010;105:387–93.
27. Owens G, MacGinnitie A. Higher-ovalbumin-content influenza vaccines are well tolerated in children with egg allergy. J Allergy Clin Immunol 2011;127:264–5.
28. Webb L, Petersen M, Boden S, et al. Single-dose influenza vaccination of patients with egg allergy in a multicenter study. J Allergy Clin Immunol 2011;128:218–9.
29. Howe LE, Conlon ASC, Greenhawt MJ, Sanders GM. Safe administration of seasonal influenza vaccine to children with egg allergy of all severities. Ann Allergy Asthma Immunol 2011;106:446–7.
30. National Institutes of Health. Guidelines for the diagnosis and management of food allergies in the United States: summary of the NIAID-sponsored expert panel report. December 2010. Available at http://www.niaid.nih.gov/topics/foodallergy/clinical/pages/default.aspx. Accessed August 15, 2011.
31. Greenhawt MJ, Li JT. Administering influenza vaccine to egg allergic recipients: a focused practice parameter update. Ann Allergy Asthma Immunol 201;106:11–6.
32. Bernstein HH. Guidance offered on giving influenza vaccine to egg allergic patients. AAP News 2010;31:12.
33. Li JT, Rank MA, Squillace DL, Kita H. Ovalbumin content of influenza vaccines. J Allergy Clin Immunol 2010;125:1412–3.
34. Waibel KH, Gomez R. Ovalbumin content in 2009 to 2010 seasonal and H1N1 monovalent influenza vaccines. J Allergy Clin Immunol 2010;125:749–51.
35. Erlewyn-Lajeunesse M, Brathwaite N, Lucas JS, Warner JO. Recommendations for the administration of influenza vaccine in children allergic to egg. BMJ 2009;339:912–5.

* Roster available at http://www.cdc.gov/vaccines/recs/acip/members-archive.htm.

FIGURE 1. Influenza vaccine dosing algorithm for children aged 6 months through 8 years — Advisory Committee on Immunization Practices (ACIP), 2011–12 influenza season

Alternate Text: The figure above shows influenza vaccine dosing algorithm for children aged 6 months through 8 years for the 2011-12 influenza season, according to the Advisory Committee on Immunization Practices (ACIP). Children aged 6 months through 8 years who did not receive at least 1 dose of the 2010-11 seasonal influenza vaccine, or for whom it is not certain whether the 2010-11 seasonal vaccine was received, should receive 2 doses of the 2011-12 seasonal influenza vaccine.

TABLE. Influenza vaccine information, by age group — United States, 2011–12 influenza season*

Vaccine

Trade name

Manufacturer

Presentation

Mercury content (µg Hg/0.5 mL dose)

Ovalbumin content (µg /0.5mL dose)

Age group

No. of doses

Route

TIV

Fluzone

Sanofi Pasteur

0.25 mL prefilled syringe

0.0

—†

6–35 mos

1 or 2§

IM¶

0.5 mL prefilled syringe

0.0

—†

≥36 mos

1 or 2§

IM¶

0.5 mL vial

0.0

—†

≥36 mos

1 or 2§

IM¶

5.0 mL multidose vial

25.0

—†

≥6 mos

1 or 2§

IM¶

TIV

Fluvirin

Novartis Vaccines

0.5 mL prefilled syringe

≤1

≤1

≥4 yrs

1 or 2§

IM¶

5.0 mL multidose vial

25.0

≤1

TIV

Fluarix

GlaxoSmithKline

0.5 mL prefilled syringe

0

≤0.05

≥3 yrs

1 or 2§

IM¶

TIV

FluLaval

ID Biomedical Corporation of Quebec (distributed by GlaxoSmithKline)

5.0 mL multidose vial

25.0

≤1

≥18 yrs

1

IM¶

TIV

Afluria

CSL Biotherapies (distributed by Merck)

0.5 mL prefilled syringe

0.0

≤1

≥9 yrs**

1

IM¶

5.0 mL multidose vial

24.5

≤1

TIV High-Dose††

Fluzone High-Dose

Sanofi Pasteur

0.5 mL prefilled syringe

0.0

—†

≥65 yrs

1

IM¶

TIV Intradermal

Fluzone Intradermal

Sanofi Pasteur

0.1 mL prefilled microinjection system

0.0

—†

18–64 yrs

1

ID

LAIV

FluMist§§

MedImmune

0.2 mL prefilled intranasal sprayer

0.0

—¶¶

2–49 yrs***

1 or 2§

IN

Abbreviations: TIV = trivalent inactivated vaccine; LAIV = live attenuated influenza vaccine; IM = intramuscular; ID = intradermal; IN = intranasal.

* Vaccination providers should check Food and Drug Administration–approved prescribing information for 2011–12 influenza vaccines for the most updated information.

† Information not included in package insert but is available upon request from the manufacturer, Sanofi Pasteur, by telephone, 1-800-822-2463, or e-mail, MISdotEmailsatsanofipasteurdotcom.

§ Children aged 6 months through 8 years who did not receive seasonal influenza vaccine during the 2010–11 influenza season should receive 2 doses at least 4 weeks apart for the 2011–12 season. Those children aged 6 months through 8 years who received ≥1 dose of the 2010–11 seasonal vaccine require 1 dose for the 2011–12 season.

¶ For adults and older children, the recommended site of vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh.

** Age indication per package insert is ≥5 years; however, the Advisory Committee on Immunization Practices recommends Afluria not be used in children aged 6 months through 8 years because of increased reports of febrile reactions in this age group. If no other age-appropriate, licensed inactivated seasonal influenza vaccine is available for a child aged 5–8 years who has a medical condition that increases the child’s risk for influenza complications, Afluria can be used; however, providers should discuss with the parents or caregivers the benefits and risks of influenza vaccination with Afluria before administering this vaccine. Afluria may be used in persons aged ≥9 years.

†† TIV high-dose: A 0.5-mL dose contains 60 µg each of A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens.

§§ FluMist is shipped refrigerated and stored in the refrigerator at 35°F–46°F (2°C–8°C) after arrival in the vaccination clinic. The dose is 0.2 mL divided equally between each nostril. Health-care providers should consult the medical record, when available, to identify children aged 2–4 years with asthma or recurrent wheezing that might indicate asthma. In addition, to identify children who might be at greater risk for asthma and possibly at increased risk for wheezing after receiving LAIV, parents or caregivers of children aged 2–4 years should be asked: “In the past 12 months, has a health-care provider ever told you that your child had wheezing or asthma?” Children whose parents or caregivers answer “yes” to this question and children who have asthma or who had a wheezing episode noted in the medical record within the past 12 months should not receive FluMist.

¶¶ Insufficient data available for use of LAIV in egg-allergic persons.

*** FluMist is indicated for healthy, nonpregnant persons aged 2–49 years.

FIGURE 2. Recommendations regarding influenza vaccination for persons who report allergy to eggs — Advisory Committee on Immunization Practices (ACIP), 2011–12 influenza season

* Persons with egg allergy might tolerate egg in baked products (e.g., bread or cake). Tolerance to egg-containing foods does not exclude the possibility of egg allergy.

Alternate Text: The figure above shows recommendations regarding influenza vaccination for persons who report allergy to eggs for the 2011-12 influenza season, according to the Advisory Committee on Immunization Practices (ACIP). Persons who have experienced only hives following exposure to egg should receive influenza vaccine with the following additional measures.

National Academy of Elder Law Attorneys to Recognize Parkinson’s Resource Organization Founder Jo Rosen at National Aging and Law Institute

Posted on: October 5th, 2011 by accreditednursing No Comments

Many years ago, I (Neil Rotter) was on the Board of Directors for the Parkinson’s Resource Organization. Jo Rosen is an amazing woman and advocate for Parkinsonians and their families. What a great honor for Jo!

Washington, D.C. – The National Academy of Elder Law Attorneys (NAELA) www.NAELA.org is proud to present its 2011 Elder Leadership Award to Jo Rosen, Palm Desert, Calif. Ms Rosen has devoted more than two decades to improving the quality of life for people with Parkinson’s disease, their caregivers, and their families. NAELA recognizes her significant contribution, and will present the 2011 Elder Leadership Award on November 11, 2011, at the Boston Seaport Hotel during the National Aging and Law Institute http://www.naela.org/Public/Meetings_and_Events/Live_NAELA_Events/Advanced_Institute/Public/Meetings_and_Events/Advanced_Fall_Institute.aspx in Boston, Mass.

Ms Rosen is founder and current president of the non-profit Parkinson’s Resource Organization www.parkinsonsresource.org, which provides educational and emotional, group and individual, support to those making the journey through Parkinson’s.

“Through her selfless dedication to this community and her leadership getting volunteers to participate at the grassroots level, Ms Rosen has made a difference to the lives of seniors and others who deal with this debilitating disease,” said NAELA President Edwin Boyer, Esq. “We are pleased to have this opportunity to recognize her achievements with the NAELA Elder Leadership Award.”

Speaking of how she started the Organization, Ms Rosen says, “The concept of the Parkinson’s Resource Organization came about on a plane ride back from a Parkinson’s symposium.” Her mother and then fiancé had both been diagnosed with Parkinson’s. “I was the adult child of a person living with Parkinson’s and I was soon to become the spouse of a person with Parkinson’s. Where was I going to go to discuss my issues and concerns?

This became the mission and the niche of the Parkinson’s Resource Organization. Advocacy, education, emotional support and respite for those with Parkinson’s and their caregivers. The WELLNESS VILLAGE http://parkinsonsresource.org/wellness-village/a brand new resource on the Parkinson’s Resource Organization’s website is a user friendly online destination connecting the Parkinson’s community with professionals who understand Parkinson’s and who dedicate a portion of their business/practice to the care of the Parkinson’s community.

The NAELA Elder Leadership Award http://www.naela.org/Public/About_NAELA/Media/Elder_Leadership_Award.aspx recognizes the recipient’s life and work for the benefit of seniors. The award can also be given to a senior (age 65 or over) who is making significant contributions to society. The Elder Leadership Award includes a monetary contribution in the recipient’s name to a charitable organization with which the award recipient has worked closely.

Accredited Home Health Services Achieves Home Care Elite for 2011

Posted on: October 5th, 2011 by accreditednursing 2 Comments

For the fourth time in the last five years, Accredited Home Health Services has achieved ‘Home Care Elite’ status as determined by OCS Home Care (www.ocshomecare.com).  Accredited’s Superb Clinical Outcomes are calculated by Medicare and related to these specific indicators;

1) Improvement in Patient Mobility

2) Improvement in Patient’s Ability to Get in & out of bed

3) Patients got better in bathing

4) Patients’ breathing improved

5) Patients’ treatment of heart failure symptoms

6) Patients’ wounds improved after surgery

7) Patients’ got better at taking their oral medications correctly

8) Patients’ rehospitalization rates decreased

9) Patients’ need for urgent care was lessened

For more information about a Home Health Agency’s Outcomes, visit Home Health Compare on www.medicare.gov

Disability Advocates File Lawsuit Against California

Posted on: September 30th, 2011 by accreditednursing 1 Comment

Advocates for Californians with developmental disabilities, led by UCP San Diego (United Cerebral Palsy) and the Arc California, filed a lawsuit against California Wednesday alleging it is violating federal and state law by failing to adequately fund services needed by individuals with developmental disabilities.

The suit, filed in Sacramento against the California Department of Developmental Services and the Department of Health Care Services, contends that the state’s failure to fund programs has hurt community service providers, whose reimbursement rates have been frozen since 2003. Many community providers have been forced to limit services or close.

In San Diego, a UCP adult day care center in the College Area was forced to close last year for lack of state funding, said Dave Carucci, executive director of UCP San Diego.

“With limited funding, we’re not able to provide the quality of staff and service we need to provide,” he said. “We understand it’s a tough time in California, but we’re saying enough is enough.”

The lawsuit accuses the state of violating the Federal Home and Community Based Service Providers (HCBS) waiver program by reducing rates and reimbursements without federal approval and without considering federally required safeguards.

The suit also contends that the state violated California’s Lanterman Act, which guarantees individuals with intellectual and developmental disabilities the right to obtain the support services necessary to live as independently as possible in their own communities.

The California Department of Developmental Services issued a statement responding to the lawsuit.

“Given the size of the budget shortfall, difficult decisions are needed,” it said. “However, consumer health and safety remains our highest priority. California is the only state in the nation with an entitlement to services for persons with developmental disabilities. Beyond that, we do not comment on pending litigation.”

The suit does not seek monetary damages, but asks for an injunction to stop the state from freezing and reducing funding of programs for the 245,000 Californians with developmental disabilities.

“It’s not right, fair or legal and must be stopped,” Carucci, said. “The state’s neglect has left Californians with developmental disabilities at great risk. Their health and safety is in jeopardy.”

http://www.signonsandiego.com/news/2011/sep/28/disability-advocates-file-lawsuit-against-state/

How Strokes Impact Speech

Posted on: September 28th, 2011 by accreditednursing No Comments

Article from MSN Health – http://health-tools.health.msn.com/speech-recovery-and-development-center/after-a-stroke-regaining-your-speech?did=t2_rss1

With speech and language deficits, the greatest progress usually comes in the first few days of therapy. The two most common speech impairments are aphasia and dysarthria.

Aphasia. This is the term for difficulty using words. Some people with aphasia have trouble talking but can easily understand speech. Others talk easily but can’t understand what people are saying. Aphasia is a common problem, especially when a stroke has damaged the left side of the brain, where language is processed. Some people with aphasia get better quickly, but even with speech therapy, others continue to have trouble speaking, finding words, reading, writing, or doing math (the same area of the brain that controls language also governs math skills).

Rehabilitation for someone with aphasia involves a variety of speech and language exercises to help the patient relearn the ability to understand, speak, read, and write to the extent that he or she is able. These include repeating words a therapist says, practicing following directions, and practicing reading and writing. Group therapy sessions led by a speech-language pathologist help people practice talking with others who are recovering from strokes. These sessions may involve role-playing common social scenarios, such as talking on the phone or ordering food in a restaurant. For someone who has trouble remembering, the therapist will suggest some practical tools, such as the use of a daily organizer or cue cards posted around the house as prompts for such things as planning meals or turning off the stove. A therapist may also recommend a voice-output, or speech-generating, device to aid communication in daily life. These devices are covered by Medicare and many other insurance providers.

Dysarthria. This is a more specific problem: the inability to speak, even though you can understand speech and form proper words in your mind. The condition is caused by an injury to the brain centers that control the movement of the tongue, palate, and lips. Speech may be slow or slurred, and one side of the face may droop because the facial muscles are paralyzed. Drooling may also occur. Persons with dysarthria often can write their thoughts down even though they cannot speak them out loud.

A person with dysarthria can do exercises to help increase strength and endurance in the muscles used for speech. The therapist will also provide instruction on how to improve enunciation, such as by speaking more slowly or taking deeper breaths before speaking. Many people with dysarthria also have trouble swallowing, a problem called dysphagia. If this is the case, the speech-language pathologist will provide exercises to strengthen the mouth and throat muscles, as well as tips on how to prevent choking, such as taking small amounts of food at a time, eating slowly, and sitting up while eating. It may be necessary to eat pureed foods at first and gradually introduce more solid foods as muscle strength returns.

Caregiver Article from the Family Caregiver Alliance

Posted on: September 27th, 2011 by accreditednursing No Comments

Introduction
Caregiving takes many forms. Many of us help older, sick, or disabled family members and friends every day. We know we are helping, but we don’t think of ourselves as caregivers. We are glad to do this and feel rewarded by it, but if the demands are heavy, over time we can also become exhausted and stressed. We think we should be able to handle caregiving roles on top of busy work and family schedules and begin to feel guilty and depressed as our stamina wanes.

About 44 million Americans provide 37 billion hours of unpaid, “informal” care each year for adult family members and friends with chronic illnesses or conditions that prevent them from handling daily activities such as bathing, managing medications or preparing meals on their own. Family caregivers, particularly women, provide over 75% of caregiving support in the United States. In 2007, the estimated economic value of family caregivers’ unpaid contributions was at least $375 billion, which is how much it would cost to replace that care with paid services.1

Caregiving: A Universal Occupation
Who are Caregivers?
The short answer is most of us, at some point in our lives. Caregivers are daughters, wives, husbands, sons, grandchildren, nieces, nephews, partners and friends. While some people receive care from paid caregivers, most rely on unpaid assistance from families, friends and neighbors.

Caregivers manage a wide range of responsibilities. In your family, for example, are you the person who:

Buys groceries, cooks, cleans house or does laundry for someone who needs special help doing these things?
Helps a family member get dressed, take a shower and take medicine?
Helps with transferring someone in and out of bed, helps with physical therapy, injections, feeding tubes or other medical procedures?
Makes medical appointments and drives to the doctor and drugstore?
Talks with the doctors, care managers and others to understand what needs to be done?
Spends time at work handling a crisis or making plans to help a family member who is sick?
Is the designated “on-call” family member for problems?

In small doses, these jobs are manageable. But having to juggle competing caregiving demands with the demands of your own life on an ongoing basis can be quite a challenge.

With the 65+ age group expected to double to 70 million people by 2030,2 family caregivers increasingly provide care for aging parents, siblings, and friends, most of whom have one or more chronic conditions3 and who wish to remain in their own homes and communities as they age.4 Others belong to the “sandwich generation,” caring for children and parents at the same time.

Caregiving roles and demands are impacted by a number of other factors, including:

Type of illness. Caring for someone with Alzheimer’s disease, other dementias, or other brain-impairing disorders can be more stressful than caring for someone with a physical impairment. Caring for someone with a cognitive disorder can be a 24/7 job due to the unpredictability of the care recipient’s behavior.5
Long-distance caregiving. Long-distance caregiving is usually defined as care provided by a caregiver living more than an hour away from the care recipient. Caring from a distance is difficult both emotionally and logistically, and is most common in situations where adult children and their parents do not live in the same area. In these cases, the caregiver’s role is not as much “hands-on” as it is gathering information about available resources, coordinating services and putting together a “team” of family, friends and paid help that can meet the care recipient’s needs.
Urban versus rural settings. Caregivers living in rural settings face unique challenges. These include fewer available formal services, fewer physicians and health education services, transportation difficulties, weather problems in winter, geographic distance and isolation.6
Different cultural approaches to caregiving. The United States’ great diversity means that families bring their own histories, traditions and rituals to caregiving. In many cultures, there are family expectations about the caregiving roles of adult children; this is especially true in cultures where daughters or daughters-in-law are expected to assume the primary caregiver role for aging parents.

For some people, caregiving occurs gradually over time. For others, it can happen overnight. Caregivers may be full- or part-time; live with their loved one or provide care from a distance. Caregivers provide a wide range of services, from simple help such as grocery shopping, to complex medical procedures. For the most part, friends, neighbors, and most of all, families, provide–without pay–the vast majority of healthcare in this country.

First Steps: Help for New Caregivers
It is easy to become overwhelmed as a new caregiver. Five steps that can help are:

Start with a diagnosis. Learning about a family member’s diagnosis helps caregivers understand the disease process and plan ahead realistically.
Talk about finances and healthcare wishes. Having these conversations can be difficult, but completing Durable Powers of Attorney for finances and healthcare can help relieve anxiety and better prepare for the future.
Consider inviting family and close friends to come together and discuss the care needed. If possible, it’s helpful to include the care recipient in this meeting. This meeting gives caregivers a chance to say what they need, plan for care and ask others for assistance.
Take advantage of community resources such as Meals on Wheels and adult day programs. These resources help relieve the workload and offer a break. Look for caregiver educational programs that will increase knowledge and confidence.
Find support. The most important thing is for caregivers to not become isolated as they take on more responsibility and as social life moves into the background. Online and in-person groups can be very helpful in connecting with others in the same circumstances. Caregivers can call Family Caregiver Alliance at (800) 445-8106 to learn about local services, or visit www.caregiver.org, and click on “Family Care Navigator.”

Caregiving in the U.S.
Data from many studies and reports reveal the following information about caregivers:

The “typical” U.S. caregiver is a 46-year-old woman who works outside the home and spends more than 20 hours per week providing unpaid care to her mother.7 Most caregivers are married or living with a partner.8
While caregivers can be found across the age span, the majority of caregivers are middle-aged (35-64 years old).9
Most caregivers are employed. Among caregivers age 50-64 years old, an estimated 60% are working full or part-time.10
Studies show that ethnic minority caregivers provide more care than their white counter-parts11 and report worse physical health than white caregivers.12
Many caregivers of older people are themselves elderly. Of those caring for someone aged 65+, the average age of caregivers is 63 years with one third of these caregivers in fair to poor health.13
Nearly half of caregivers provide fewer than eight hours of care per week, while nearly one in five provide more than 40 hours of care per week.14 A statewide California study of caregivers of adults with cognitive disorders such as Alzheimer’s showed that caregivers provided an average of 84 hours of care per week, the equivalent of more than two full-time jobs.15 Older caregivers often spend the most hours providing care16 and the amount of time spent caring increases substantially as cognitive impairment worsens.17
Caregiving can last from less than a year to more than 40 years. In a 2003 study, caregivers were found to spend an average of 4.3 years providing care. Older caregivers (50+) are more likely to have been caregiving for more than 10 years (17%).18
Most caregivers live near the people they care for. Eighty-three percent of caregivers care for relatives, with 24% living with the care recipient, 61% living up to one hour away, and 15%—or about 7,000,000 caregivers—living a one- to two- hour drive or more away.19

Effects of Caregiving
Impact on Physical and Emotional Health
Recent medical advances, shorter hospital stays, increasing life spans with better management of chronic illnesses, limited discharge planning, a shortage of homecare workers, and the expansion of home care technology have increased the caregiving responsibilities of families. Family caregivers are being asked to shoulder greater burdens for longer periods of time. In addition to more complex care, conflicting demands of jobs and family, increasing economic pressure, and the physical and emotional demands of long-term caregiving can result in major health impacts on caregivers.20

Over all, caregivers who experience the greatest emotional stress tend to be female. They are at risk for high levels of stress, frustration, anxiety, exhaustion and anger, depression, increased use of alcohol or other substances, reduced immune response, poor physical health and more chronic conditions, neglecting their own care and have higher mortality rates compared to noncaregivers.21

In addition, most caregivers are ill-prepared for their role and provide care with little or no support22; yet more than one-third of caregivers continue to provide intense care to others while suffering from poor health themselves.23 An influential factor in a caregiver’s decision to place an impaired relative in a long-term care facility is the family caregiver’s own physical health.24

Financial Issues
Long term caregiving has significant financial consequences for caregivers, particularly for women. Informal caregivers personally lose about $659,139 over a lifetime: $25,494 in Social Security benefits; $67,202 in pension benefits; and $566,443 in forgone wages.

Caregivers face the loss of income of the care recipient, loss of their own income if they reduce their work hours or leave their jobs, loss of employer-based medical benefits, shrinking of savings to pay caregiving costs, and a threat to their retirement income due to fewer contributions to pensions and other retirement vehicles.25

Work and Eldercare
Caregiving also has a substantial impact on business. Lost productivity due to informal caregiving costs businesses $17.1 billion annually.26 Absenteeism, replacing employees who quit in order to provide care and other caregiving-related activities also have serious financial consequences to employers. For instance:

The cost to businesses to replace women caregivers who quit their jobs because of their caregiving responsibilities has been estimated at $3.3 billion.
Absenteeism among women caregivers due to caregiving responsibilities costs businesses almost $270 million.
The cost to businesses because of partial absenteeism (e. g., extended lunch breaks, leaving work early or arriving late) due to women’s caregiving has been estimated at $327 million. Caregiving-related workday interruptions add another $3.8 billion to the burden borne by businesses.27

Working caregivers often suffer many work-related difficulties due to their “second careers” as caregivers. Sixty-seven percent of family caregivers report conflicts between caregiving and employment, resulting in reduced work hours or unpaid leave.28

The importance of eldercare is now recognized by a growing number of employers, with movement toward more flexible work schedules, “cafeteria style” benefits, in-house support groups, and education, information, and referrals provided through employee assistance programs.

Policy changes have also supported family caregivers. Companies with 50 or more employees must comply with the Family and Medical Leave Act (FMLA), which allows for up to 12 weeks of unpaid leave to care for a seriously ill parent, spouse or child, while protecting job security. Smaller firms can use the FMLA guidelines to provide support for individual employees. Paid Family Leave (PFL) provides workers with a maximum of six weeks of partial pay each year while taking time off from work to care for a seriously ill parent, child, spouse or registered domestic partner, and has been instituted in several states, including California. Policy changes that could also benefit family caregivers include paid sick leave that can be used by employees for themselves or to care for family members and expanding FMLA beyond immediate family members to include care for siblings, in-laws and grandparents.29

Legal Issues
It is important to make legal preparations in the event a parent becomes cognitively impaired. Typical concerns include who will manage the confused person’s money, who will make important health care decisions and how to plan for long-term care.

An attorney can help plan for the financial aspects of long-term care needs, assist with surrogate decision-making tools such as the durable power of attorney (DPA) and a durable power of attorney for health care (DPAHC), and provide guidance in obtaining a conservatorship should the care recipient lack the capacity to make decisions. A conservatorship provides the legal authority to manage a person’s finances, estate, personal affairs, assets and medical care.30

The Need for Support
Because of the multi-faceted role that family and informal caregivers play, they need a range of support services to remain healthy, improve their caregiving skills and remain in their caregiving role. Support services include information, assistance, counseling, respite, home modifications or assistive devices, caregiver and family counseling, and support groups. While many services are available through local government agencies, service organizations, or faith-based organizations, employers’ programs also can mitigate the impact that caregiving can have on workers.

Services that improve caregiver depression, anxiety and anger benefit both the caregiver and the care recipient.31 Evidence also shows that caregiver support delays or prevents nursing home placement; people with moderate dementia have been able to defer placement by nearly 1.5 years when their family members receive caregiver services, including counseling, information and ongoing support.32

Policy Implications
Family caregiving is the backbone of the United States’ long term care system as well as the core of what sustains frail elders and adults with disabilities, yet caregivers often make major sacrifices to help loved ones remain in their homes. A federal investment in family caregiver support is needed now more than ever.

A national agenda is needed that:

Supports the National Family Caregiver Support Program (NFCSP) to provide caregivers with information and assistance, counseling, support groups, respite, caregiver training and limited supplemental services.
Funds Lifespan Respite Care so that family caregivers can take a break from the demands of providing constant care
Expands the Family and Medical Leave Act (FMLA) and paid leave policies to increase financial support for workers providing essential care for family members.
Promotes financial incentives, career advancement, geriatric education and training, and long-term care policies to expand the geriatric care workforce.
Enacts legislation providing refundable tax credits for family caregivers to defray long-term care costs and compensate for expenses that family and informal caregivers at all income levels incur.
Strengthen Social Security by recognizing the work of family caregivers who leave the workforce to provide full-time support and care for an ill, disabled or an elderly family member.

Conclusion
With the dramatic aging of the population, we will be relying even more on families to provide care for their aging parents, relatives and friends for months and years at a time. Yet, the enormous pressures and risks of family caregiving—burnout, compromised health, depression and depletion of financial resources—are a reality of daily life for millions of American families and pose great strain on family caregivers, many of whom are struggling to balance work and family responsibilities.

Families need information and their own support services to preserve their critical role as caregivers, but frequently they do not know where to turn for help. When they do seek assistance, many community agencies cannot provide adequate supports due to funding constraints and out-dated policies. The federal government can help by taking steps to ensure that all family caregivers have access to caregiver assistance and to practical, high quality, and affordable home and community-based services. These are tough economic times, but supporting family caregivers is one of the most cost-effective long-term care investments we can make. As long as caregivers are able to provide care, they are often able to delay costly nursing home placements and reduce reliance on programs like Medicaid.

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2313

10 Tips on How to Work Smarter, Not Harder

Posted on: September 26th, 2011 by accreditednursing No Comments

Content from this email provided by Jason Tweed at Leading Home Care

http://www.leadinghomecare.com/pdtoday/20110129.html

10 Tips For Working Smarter Not Harder

In 2010, I made a personal New Year’s resolution to “work smarter, not harder” and it worked well for me. At the beginning of this new year, I started thinking about the things I’ve done that helped me accomplish that goal. I thought I would share some of them with each of you today.
ASK MORE QUESTIONS – Business owners get in the bad habit of answering questions. Unfortunately, this can lead to your employees depending on you for decision-making. Ultimately, the major decisions should be made by the owners and chief executives, however, empower your employees to make decisions about the daily operations. When they come to you, ask them questions to stimulate their own decision-making.
SCHEDULE TIME FOR YOUR INBOX – If you’re like me, you get 100 emails a day and about 50 are junk. Another 30 are interesting, but not valuable. Ten are useful. Eight are important, but not urgent. Two are critical. I never open my email first thing in the morning. It’s full of mostly junk and it distracts me from starting my day. I check it once in the morning and once in the afternoon, taking time to delete, read or respond as necessary. Let people know your process as this will help the two people who sent critical emails to make a decision whether an email or a phone call is more appropriate.
VITAMIN C – I take Vitamin C each day. It’s not a cure-all, but it helps me stay healthy. The point is, the most effective and productive leaders are healthy leaders. Pay attention to your health. Get enough sleep, make better choices at meal times, and squeeze in a little exercise. Your body and your company will thank you.
LAUGH – The world around us can be ridiculous…. LAUGH AT IT!
READ – My eight-year-old son prefers math and science over reading and writing. I had to explain to him that even scientists spend a huge amount of time reading what other scientists write. They learn from others’ mistakes and from others’ examples. Whether you’re 8, 38, 68 or 98, reading is essential for growth.
SET LOFTY GOALS – My future scientist already has lofty career expectations. “I’m going to try to find a cure for that cancer that ladies get, or maybe I’ll figure out how to make disabled people learn to walk, or maybe I can even invent a new snack food!” Design your goals to impress yourself, and then go for it!
PET A PUPPY – I work at home with several cats and a Labrador Retriever. The sense of companionship I get from a sleepy dog at my feet keeps me grounded. It helps me keep in mind that no matter how hectic life can get, it’s still not enough to wake my puppy. (By the way, my puppy weighs 90 pounds now.) Find your own source of serenity, and escape to it once in awhile.
CREATE GOOD HABITS – Everyone has something they could do better. Benjamin Franklin tells us, “Do something everyday for 12 days and it will become a habit”. It’s surprisingly simple to develop a good habit.
ELIMINATE A BAD HABIT – Ben’s advice goes both ways. Give something up for 12 days and you will probably no longer feel the need.
SAY “THANK YOU” – I get lots of help everyday and probably say “Thank you” a hundred times. My mother is proud of my good manners, but that’s not the point. Take some time each day to specifically thank one person who has made your life better. Go out of your way to send them a note, a card or a gift. Call them just to say “Thank you”. Giving thanks actually does more for the giver than the receiver.

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