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The Green House nursing care center for seniors is a relatively new concept in "home-like" care for seniors requiring nursing care. Traditional nursing homes are based on a medical model. The Green House projects are based on a home model -- with a smaller, more homelike building with private space and shared community facilities.

Staffing is also different. Each project is based on 24/7 care, but the duties have shifted from highly specialized care to more family-like care provided by a core team, and supplemented with appropriate medical teams from outside.

Clinical Support Team

The clinical support team is comprised of a Medical Director, Director of Nursing, nurses, therapists, social workers, dietician, and activities coordinator to provide skilled care for the residents as required in the care plan. The Shahbazim are certified nursing assistants with additional Green House training) by developing close relationships with the elders, provide the Clinical Support Team with valuable information to assist in developing the care plan.

Licensed nurses are available to and responsible for clinical care in Green House homes on a 24-hour basis. If the nurse is not in the home and is needed, is available to the Shahbazim and elders via pager and other communication technologies. The Shahbaz

The Shahbaz (plural: Shahbazim) is a universal worker who provides personal care, meal planning and preparation, light housekeeping, and laundry for 7-10 elders. Shahbazim core training as Certified Nursing Assistants receive about 120 additional hours of specialized training to cover The Green House philosophy of care, person-directed care for persons with demenia, household operations, building self-managed work teams, policies and procedures for their project, communication skills, culinary training, safe food handling, and certification in first aid and CPR.

The Guide

The Green House Guide serves as coach and supervisor the the Shahbazim, and is responsible for the overall operations and quality of services in the home. The Guide may be responsible for more than one home, depending on the size of the community.

The Sage

The Green House Sage is a resident elder who acts as a coach or mentor, assists facilitating the development and continued growth of the self-managed work team and to serve as a trusted advisor to the Shahbazim. This is a volunteer position.

Extended Nursing Care Residents

Residents in the Green House are encouraged to participate in shared home activities such as cooking, self care and cleaning, as well as hobby activities and participation in the surrounding community.

Family

Family participation is encouraged and welcomed in The Green House home, from sharing meals to participating in activities and volunteering time and services to help their loved one decorate personal space. Well-behaved family pets are also welcome visitors!

Only projects accepted through the application process and developed in cooperation with The Green House Project team are authorized to provide long-term care services under the licenses service mark: THE GREEN HOUSE®.

A five year pilot project ending in 2010 is reaching its goal of 50 projects across the country. Check the website for locations in your region. These nursing care facilities are often developed by nonprofit groups, churches and even municipalities.

In primary care settings, prevalence estimates of major depressive disorder range from 5% to 13% in all adults, with lower estimates in those older than 55 years (6% to 9%).

In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended screening adults for depression in clinical practices that have systems to ensure accurate diagnosis, effective treatment, and follow-up.

Major depressive disorder (MDD) is common, with an estimated lifetime prevalence of 13.2%.

In primary care settings, prevalence estimates of MDD range from 5% to 13% in all adults, with lower estimates in those older than 55 years (6% to 9%).

Primary care practitioners manage approximately one third to one half of non elderly adults and almost two thirds of older adults  who received treatment for MDD. The severity of depressive symptoms in patients who receive treatment in primary care is equivalent to that of patients treated in psychiatric settings. For example, approximately 43% of such primary care patients report some degree of suicidal ideation within the previous week.

In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended screening adults for depression in clinical practices that have systems to ensure accurate diagnosis, effective treatment, and follow-up.

Subsequent reviewers have concluded that screening does not improve health outcomes, but care management systems for depressed patients improve depression remission rates. Commentators on these divergent reviews have been divided.

The Agency for Healthcare Research and Quality conducted a systematic review to aid the USPSTF in updating its 2002 recommendation for adult depression screening in primary care. We sought to

1) identify evidence published since the previous review on the benefits of screening for depression in primary care and integrate it with the previously identified evidence and

2) review the evidence in several areas in which evidence was insufficient at the time of the previous review or not was examined by the previous review.

This includes the benefits of depression treatment in older adults, the harms of depression screening, and the harms of depression treatment with antidepressant medications.

Conclusion:
Depression screening programs without substantial staff-assisted depression care supports are unlikely to improve depression outcomes. Close monitoring of all adult patients who initiate antidepressant treatment, particularly those younger than 30 years, is important both for safety and to ensure optimal treatment.

Read more at the Agency for Healthcare Research and Quality

These new tips and information can help seniors and Medicare beneficiaries deter, detect and defend against Medical identity theft.

Medical identity theft occurs when someone steals a patient's personal information, such as his or her name and Medicare number, and uses the information to obtain medical care, to buy drugs or supplies, or to fraudulently bill Medicare using that patient's stolen identity.

"When criminals steal from Medicare, they are stealing from all of us," said Secretary Sebelius. "Preventing medical identify theft is an important part of our work to stop Medicare fraud, and these tools will give seniors important information about how to deter, detect and defend against ID theft and fraud."

The Department of Justice (DOJ), in collaboration with the Department of Health and Human Services (HHS), will continue to protect the integrity of the nation's public health programs and vigorously pursue those who seek to take advantage of our most vulnerable citizens.

"Medical identity theft can disrupt your life, damage your credit rating, and threaten your health if inaccurate information ends up in your medical records," added HHS Inspector General Daniel R. Levinson.

OIG's agents frequently uncover fraud schemes that involve the sale and use of stolen Medicare identification numbers. 

• Medicare beneficiaries are reminded to beware of offers of free medical equipment, services, or goods in exchange for their Medicare numbers. 

• Beneficiaries are also encouraged to regularly review their Medicare Summary Notices, Explanations of Benefits statements, and medical bills for suspicious charges and to report suspected problems.

The effort to help prevent medical identity theft is one part of the Obama Administration's work to crack down on Medicare fraud. In May, Attorney General Eric Holder and Secretary Sebelius announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud.  

Teams that have been successfully fighting fraud in South Florida, Los Angeles, Detroit and Houston.  Established in 2007, these teams have a proven record of success using data analysis techniques and community policing to identify, investigate and prosecute on-going fraud.

The Centers for Medicare & Medicaid Services (CMS) has undertaken other steps to fight fraud and protect beneficiaries who buy durable medical equipment or rely on home health services.

• On October 1, all durable medical equipment suppliers across the nation, except for pharmacies, must be certified by Medicare, a requirement that assures beneficiaries that their suppliers are valid businesses and meet Medicare's financial and quality standards.

Senior Medicare Patrol programs

The SMP programs are funded by HHS' Administration on Aging and help Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud. Because this work often requires face-to-face contact to be most effective, SMPs nationwide recruit and train nearly 5,000 volunteers every year to help in this effort. Most SMP volunteers are both retired and Medicare beneficiaries and thus well-positioned to assist their peers.

To learn more about stopping Medicare fraud, visit www.StopMedicareFraud.gov. To report suspected Medicare fraud call the Inspector General's toll-free Hotline at 800-447-8477 (800-HHS-TIPS). The toll-free TTY number is 800-377-4950.

Having just tried to find more cost effective health insurance and long term care insurance, I can tell you how frustrating it is to get good data. 

The Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. 

This interactive US Atlas of Health Care shows you various information by local areas... the best, the growth, by hospital referral region.

As you can see, the Los Angeles region has a bit of a difference in prices and cost increases than counties north and south of it.  Hmmmm....

The cost of providing health care to seniors is rising more than twice as fast in Dallas as in San Diego, and Medicare now spends nearly three times more to care for its enrollees in Miami than it does in Honolulu.

Nationally, Medicare spent an average of $8,304 per enrollee in 2006, and national spending grew at a rate of 3.5 percent annually from 1992 to 2006. Among states, New York was tops in spending per enrollee, at $9,564. Hawaii was lowest, at $5,311.

Where Medicare spending per enrollee grew at an annual rate of 5 percent in Miami, the rate was less than half, at 2.4 percent, in San Francisco. Medicare spent $16,351 per enrollee in Miami in 2006, almost twice the spending of $8,331 in San Francisco.

The researchers project that, at current spending rates, Medicare will be $660 billion in the red by 2023.

But by reducing the annual growth in per capita spending from 3.5 percent, the national average, to 2.4 percent, the rate in San Francisco, Medicare could save $1.42 trillion and turn the deficit into a healthy surplus.

Small Differences Make a Huge Savings

Small differences, because of compounding, can make an enormous difference.

The authors call on physicians to lead an effort to reform how the U.S. delivers and pays for health care to bring spending under control.

Systems of Quality Care

They write: "Payment systems could then shift from purely volume-based payments to systems ... that foster accountability for the overall costs and quality of care, allowing physicians to align their work more closely with the values that brought them to health care. "

Read more at:  SolutionsForYourHealthCare.com 

Depression often coexists with other long-term health problems, presenting additional complexities. About 60 percent of depressed outpatients have at least one other chronic medical condition as well, such as a heart problem, high blood pressure, or diabetes.

The US Department of Health & Human Services, through the Agency for Healthcare Research and Quality  has funded research to track effective care of depression. 

Heart Attacks and Depression

Research results have shown that patients with a history of heart attacks have 1.8 times more depressive spells in a year and more persistent symptoms than depressed patients without a history of heart attacks.

Chronic Conditions and Depression in Older Persons

The challenge of treating depression as one of multiple chronic conditions is especially an issue in older persons. AHRQ research comparing elderly patients with and without depression in a primary care clinic found that the depressed patients had:

• Nearly $200 more in annual diagnostic test costs.
• Almost 1.5 more ambulatory care visits per year.
• Over 12 percent more annual visits to the emergency department.
• Five percent more hospitalizations each year.

To reduce the cost of care and improve outcomes for older persons with depression, coexisting psychiatric and medical illnesses must be targeted for treatment.

Best Care:  Mental Health Specialists or Medical Care Providers?

The organization of care can affect care delivery for depression. One AHRQ-sponsored study showed that shifting patients away from mental health specialists to general medical providers (as is the practice in some managed care arrangements) may lead to fewer improvements in patient functioning but costs two to three times less.

Other AHRQ-funded research on the effects of changes in health care payment and delivery found that after switching to a prepaid plan, the health status of outpatients with depression did not appear to suffer although they were 12 percent less likely to use antidepressants and made 35 to 40 percent fewer visits to their mental health care providers.

Even where there is substantial agreement about how treatment for depression can be improved, changes to everyday practice have been slow. Past efforts by managed care organizations to improve compliance with guidelines for improving diagnosis and treatment of depression have met with only modest success.

Two AHRQ studies investigating academic detailing and continuous quality improvement interventions in managed care organizations concluded that these approaches were only mildly effective in improving clinicians' adherence to the recommended guidelines for care. However, promising early results from a current study evaluating ways to increase use of antidepressants and psychotherapy in managed primary care practice suggest that depressed patients in the intervention groups were more likely to receive these interventions and exhibit better outcomes.

The National Guideline Clearinghouse™ (NGC) sponsored by AHRQ in partnership with the American Medical Association and the American Association of Health Plans, allows physicians and other Internet users to assess and compare guidelines online at http://www.guideline.gov. The NGC is being used by Georgetown University Medical Center's Mood Disorder Program in the development of clinical practice guidelines on depression for primary care physicians in managed care settings.

First, primary care is the logical basis of an effective health care system.
 
Second, primary care is essential to reaching the objectives that constitute value in health care: high quality care (including achieving desired outcomes), good patient satisfaction, and efficient use of resources.

Primary care is valuable to individuals in at least the five ways listed below:

1. It provides a place to which patients can bring a wide range of health problems for appropriate attention--a place in which patients can expect, in most instances, that their problems will be resolved without referral.
2. It guides patients through the health system, including appropriate referrals for services from other health professionals.
3. It facilitates an ongoing relationship between patients and clinicians and fosters participation by patients in decisionmaking about their health and their own care.
4. It provides opportunities for disease prevention and health promotion as well as early detection of problems.
5. It helps build bridges between personal health care services and patients' families and communities that can assist in meeting the health needs of the patient.

Seemingly routine or simple problems may be embedded in a patient's conditions that could have serious consequences for his or her health. Excellent primary care training provides  clinicians with the ability to distinguish among simple, serious, and complex conditions and to provide care for all.

Unlike many other areas in health care, the practice of oncology presents unique challenges that make assessing and improving value especially complex.

First, patients and professionals feel a well-justified sense of urgency to treat for cure, and if cure is not possible, to extend life and reduce the burden of disease.

Second, treatments are often both life sparing and highly toxic.

Third, distinctive payment structures for cancer medicines are intertwined with practice.

Fourth, providers often face tremendous pressure to apply the newest technologies to patients who fail to respond to established treatments, even when the evidence supporting those technologies is incomplete or uncertain, and providers may be reluctant to stop toxic treatments and move to palliation, even at the end of life.

Finally, the newest and most novel treatments in oncology are among the most costly in medicine.

"Assessing and Improving Value in Cancer Care: Workshop Summary" summarizes the results of a workshop that addressed these issues from multiple perspectives, including those of patients and patient advocates, providers, insurers, health care researchers, federal agencies, and industry. Its broad goal was to describe value in oncology in a complete and nuanced way, to better inform decisions regarding developing, evaluating, prescribing, and paying for cancer therapeutics.

Start reading online free!

Front Matter

i-xvi

1 Introduction

1-2

(skim)

2 Opening Remarks: What Is Value in Cancer Care and Why Is It Important?

3-6

(skim)

3 Clinician-Patient Communication and Its Influence on Value

9-22

(skim)

4 Generating Evidence About Effectiveness and Value

23-32

(skim)

5 Value and the Oncology Market

33-54

(skim)

6 Value in Oncology Practice: Oncologist and Health Insurer Perspectives

55-68

(skim)

7 Ethical Issues and Value in Oncology

69-82

(skim)

PART II:Solutions for Value in Cancer Care

83-84

(skim)

8 Improving Value in Oncology Practice: Ways Forward

85-108

(skim)

9 Toward a Shared Understanding of Value

109-116

(skim)

Acronyms

117-118

(skim)

Glossary

119-124

(skim)

National Academies Press makes the  "Cancer Care" book available for reading online, or for purchase.

The vaccines that protect against 2009 H1N1 influenza (flu) are available, and more doses will be shipped in the upcoming weeks. As you are preparing to protect yourself and your family from the 2009 H1N1 flu, you may have questions about the safety of the 2009 H1N1 flu vaccines. Here are the Frequently Asked Questions about the Safety of the 2009 H1N1 Flu Vaccines.

http://www.cdc.gov/Features/H1N1Vaccine/

AHRQ is the Agency for Healthcare Research and Quality--the Nation's lead Federal agency for research on health care quality, costs, outcomes, and patient safety.

The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.

AHRQ is home to research centers that specialize in major areas of health care research:

• Quality improvement and patient safety.
• Outcomes and effectiveness of care.
• Clinical practice and technology assessment.
• Health care organization and delivery systems.
• Primary care (including preventive services).
• Health care costs and sources of payment.

Advice Columns from Dr. Carolyn Clancy
Open Enrollment: What To Consider When Choosing a Health Plan

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

Excerpt:

It's open enrollment season, the time when millions of workers will choose the health insurance plan they'll have next year. With premiums for health coverage offered by employers rising, it may feel more like open season on your wallet. That's all the more reason you should understand your options.

To get the best value from your health plan, you need to understand your different coverage options and how they work. Then you need to make a choice that's based on your personal situation, such as whether you are single or married or have a chronic health condition.

Many of the common health insurance plans today offer several choices for coverage, based on factors including cost, flexibility and how much of a role you want to play in managing and paying for your own health care. These include:

• Preferred provider organizations (PPOs). These plans contract with doctors, hospitals, and other providers but typically do not manage your care. PPOs allow you to see providers outside the network, but you will pay more for your care if you do. These are the most common work-based health plans.
• Health maintenance organizations (HMOs). Many of these plans focus on preventing diseases and staying healthy. If you join an HMO, you typically must receive all your care from network providers, except in medical emergencies. When you join, you pick a primary care doctor to manage your care. HMOs usually have copayments rather than deductibles or co-insurance.
• Point-of-service organizations (POS). These plans are a combination of a PPO and an HMO. POS plans have a primary care doctor who manages your care but allow you to seek care from doctors and hospitals that are not part of the plan. You pay more for seeking care out of network, however.
• Consumer-directed health plans. These newer health plans give  you more control over your own health care, both in choosing the care you receive and paying for it. They often require you to pay a substantial deductible (often $2,000 or more) before coverage starts, and are combined with a personal health savings account or another similar product that allows you to pay for care with pre-tax money.   
  

... read Dr. Clancy's complete column, and more topics covering your health care.

RESOURCE:  Agency for Healthcare Research

The Insight Foot Care Scale  helps people with health problems check the bottoms of their feet for erythema and signs of inflammation.

Especially for older folks with diabetes, the bathroom scale has with built-in mirrors that eliminates the need to twist one's feet to see  the plantar surface.

There are about 82,000 amputations in the US every year among people with diabetes. Doctors agree that over half of these amputations could be prevented if people would just check their feet.

The Insight Foot Care Scale helps you do just that, by reminding you to check your feet every time you weigh yourself and also making it easy to see the bottom of your feet with the illuminated, magnified mirrors.


SOURCE:  Insight