OPINION:

Government entities are protected from unfunded mandates by the NH Constitution. The public is not protected from the costs associated with fragmented, isolated, stop-gap measurers.
In the 2009 session, NH’s Legislature will hear public comment on a proposal to formally create a Long Term Care Commission (LTCC). While ENH has some general concerns about creating too many commissions, we do support HB 380 and encourage our readers to make their voices heard.
A sizable group of LTC stakeholders was organized by, and with the support of AARP, as an advisory committee to the Joint Legislative Committee on Elder Affairs. This workgroup, including providers, advocates, county representatives, DHHS staff, ENH and others has been meeting for several months to consider rebalancing the LTC system and strengthening options for community care. Despite the variety of needs, perspectives and concerns (in fact, probably because of them), the group came together with a finalized report to support a values-based approach to the aging experience. Included in the report is the following recommendation:
“New Hampshire should establish a Long Term Care Commission to respond to issues related to the increased demand for long-term care services and supports. The Commission would be responsible for evaluating the capacity of the current long-term care system and recommending ways to develop the needed infrastructure, services and supports for the near-term and longer-term needs of New Hampshire citizens. The Commission would work with existing bodies addressing related issues and would build upon ongoing work. The Commission would address the following subjects at a minimum:
• Home and community-based care options for New Hampshire citizens in all geographic areas;
• Family caregiver services;
• Shortage of health care, long-term care and direct care workers, including medical professionals trained in gerontology;
• Reimbursement rates for long-term care services;
• Prompt financial and clinical public benefit determinations; and
• Services and supports for New Hampshire citizens which embody respect, dignity, choice and control until the end of life.”
ENH Summit participants indicated that expanded home and community-based care was their number one issue, and we believe this Bill is critical to establish a foundation towards that end. More importantly, it provides the unification so badly needed in this fragmented system, and adopts consistent values for NH, which to date have not been clearly articulated and adopted.
Those opposing the bill appear to have two major concerns: unfunded programs and/or services; and the lack of inclusion of the non-Medicaid population. In our December issue, ENH addressed the approach used by Oregon officials who felt that the 20% Medicaid population could not and should not drive the LTC system. In fact, the belief was that the 80% non-Medicaid population, if served well, would create an efficient and effective system that would in turn benefit Medicaid recipients. HB 380 would begin to establish that focus for all aging citizens of NH by creating a cooperative approach that capitalizes on collective intelligence.
Funding shortfalls is an issue which everyone is facing. Creating a clearinghouse approach to ideas and strategy strengthens the probability
of using resources effectively. It could prevent, or at least minimize, the tendency to spend down to Medicaid eligibility at a faster rate than is necessary or desirable. In fact, it may the one thing we can do.
There are also those individuals who still cling to LTC Insurance as a necessary component to any design. They may be right. However, a dependency on the private sector insurance industry in this economy is hardly prudent, and should not hinder forward movement towards rebalancing LTC. Reshaping the system will include ideas that prevent or avoid potential costs. While such concepts may be more difficult to demonstrate, they are probably as valuable in the long run as targeted numbers that may not be met. ENH therefore supports the Bill and will testify, monitor and report updates on its status for you.
The NH Constitution protects the government entities from unfunded mandates. The public is not protected from the costs associated with fragmented, isolated, stop-gap measurers. To date, our state’s approach to LTC has been just that—a crazy quilt of programs and services primarily focused on the medical aspects of aging.
We need holistic state-level planning that includes, but is not driven by, a single state agency. We need to consider the impact on our property taxes, given the recent court decision that leaves the Counties with the payments, the citizens with the tab and the State with setting the policies. We can do better. HB380 is the next step needed to make NH a better place in which to grow old.
Legislative Updates:
There are several bills that affect seniors that we are following. You may find these summaries of interest:
HB 241 allows taxpayers who are age 65 or older, and whose adjusted gross income is less than $50,000, to pay less interest and dividends tax as a result of an additional $2400 exemption. Approximately one-third of older taxpayers will save around $120 in taxes if passed.
HB 121 provides consumer protection to the citizens of NH against residential contractors and subcontractors who fail to meet the requirements of a contract (written or verbal) with the homeowner, including labor, goods and service. All contractors must register with the state, and a person who wishes to hire an individual contractor can access the registry to ensure that this person meets the qualifications of the Board of Residential Building and Remodeling Contractors.
We are also aware of several proposals that we don’t yet have bill numbers for. In upcoming newsletters we hope to bring you a more complete listing and summaries on certain ones. You can track bills and hearing notifications by going online:
http://www.gencourt.state.nh.us/bill_status/quick_search.html
(Tip: Enter the bill number--HB121--with no space between the letters and numbers. HB stands for House bill; SB is for Senate Bill.)





Care Giver Resources:
Family Caregiver Alliance
www.caregiver.org
1-800-445-8106

Nursing Home Ratings:
NH facilities rank highest in New England for 5 stars rankings: National Average is 12.1%, RI 14.1%, MA 16.6%, VT17.5%, ME. 23.2% and NH 24.4%.
For specific information on NH facilities, go to
www.medicare.gov/nhcompare

Forgetting Can Be Good:
A study done by researchers at Duke University and the University at Alberta, and reported in the January issue of Psychological Science looked into possible ways to improve memory. The study found that as people age, they tend to dismiss negative memories and retain positive ones. This tendency may be as rooted in a more mature perspective on life as it is a result of biological changes! As people age they regulate anger and other negative emotional reactions better. Also associated with dismissing certain memories is improvement in some conditions such as phobias, as our brain acts as a filter. The findings may help with the development of drugs that treat memory loss, while recognizing the benefits resulting from brain changes.



Suicide & Older Adults
By Kenneth Norton LICSW
Suicide is a serious issue among older adults. In NH, the suicide rates are highest for males over the age of 75. Across the US, older adults account for a disproportionately high number of suicides. According to the Substance Abuse and Mental Health Services Administration, although adults age 65 and older account for 13% of the total population, they account for 20% of the suicides. This totals over 6,000 deaths per year. Like other suicide deaths, this number may be under reported.
An important factor to understand about older adult suicide is the low number of attempts vs. deaths. Over age 65, there are an estimated 4 attempts to every death. One reason for this is that older adults tend to have less ambivalence about dying and use much more lethal means. For instance over 75% of males and almost 40% of women age 65 or older who die by suicide, use a firearm. Thus restricting access to lethal means should be an important consideration when working with older adults who may be at risk.
Stigma plays an important role in older adult suicide. While attitudes toward getting help for mental illness or treatment for addictions, alcohol, or substance use are improving for younger generations, older adults often have negative views of counseling and are reluctant to ask for help. This is compounded by views regarding depression and older adults. Given that older adults are more frequently dealing with medical illnesses and the death of spouses, friends and family, there is often an attitude of, “well of course they’re depressed, I would be depressed too…” yet depression is not a normal part of the aging process and our failure as a society to recognize this can have lethal consequences.
Research is demonstrating a high correlation of depression with physical illnesses such as diabetes, seizures, heart disease, and cancer. However, depression often goes undiagnosed and untreated despite the fact that effective treatment is available; likewise for addictions and alcohol/substance use. Pain is a serious risk factor for older adults. It is also a complicated one because medication to treat pain can also be used to suicide.
Other important risk factors for suicide in older adults with (or without) serious medical conditions is the issue of burdensomeness. If people perceive that they are a burden to others this may increase their risk for suicide. Social isolation is also an important risk factor for suicide. Individuals living in rural areas may be much more likely to be socially isolated particularly as they age. Loss of a spouse, particularly for males, can significantly increase risk. Financial stress and/or a potential change in living situation, especially circumstances that increase dependency are also significant risk factors for older adults.
One particularly disturbing statistic is that over half (58%) of adults over the age of 55 who die by suicide have had contact with a primary care provider within one month of their death (Louma et Al 2002). Health care providers are in a unique position to discuss important issues like loss, medical concerns, pain, burdensomeness, advanced medical directives, quality of life and end of life issues and can elicit information about depression and thoughts of suicide. This should not be a one time discussion, but should be a regular ongoing process. Health care providers should also be cautious about the potential lethality of medications prescribed for older adults have access to and consider limiting their quantity.
Education is an important suicide prevention tool for older adults and their caregivers. It is important for older adults, caregivers and family members to learn about the symptoms of depression, the risk factors and warning signs for suicide as well as the resources available to assist an individual who may be depressed and/or at risk. One educational resource specific to older adults is NAMI NH’s guidebook, “A NH Guide to Mental Health and Healthy Aging for Older Adults and Caregivers.” NAMI NH also offers an educational program for caregivers of older adults called Side by Side. For more information contact Bernie Seifert bseifert@naminh.org
There are a multitude of services and resources available to assist older adults. One of the best ways to learn about or access them is through ServiceLink. This free service provides information and referrals for older adults and their caregivers to connect them with resources and needed supports. There are Service Link offices in each county in NH. For more information call 1-866-634-9412 or go to www.servicelink.org
It is everyone’s responsibility to prevent suicide. Warning signs include: talking about death or dying, isolation, anger/rage, hopelessness, increased use of alcohol or other drugs and mood changes. If you are worried about someone you think is at risk of suicide call the National Suicide Prevention Lifeline 1-800-273-TALK (8255).
For more information contact Ken Norton 225-5359 or knorton@naminh.org
Reprinted with permission from NH Chapter NASW News. Winter 2009, and NAMI-NH; edited for length

Are You a Human Doing or a Human Being?
There is a tendency in our society to measure a person’s value in terms of productivity or potential productivity, as if we are human doings rather than human beings. Too little attention is given to valuing people for who they are. With age comes the possibility to redefine your own value as well as noticing the simple acts of others.
We are introducing a new feature called Purposeful Living focusing on those who continue to contribute and live a life with purpose and meaning.


Last year, long-term care community residents worked to raise funds to cover the daily operational expense for N.H. Food Bank.
It all began with a simple premise. In the Spring of 2008, the resident community of Pleasant View Center, a nursing home in Concord, was grateful for having enough to eat every day. They decided that it is unacceptable for people in New Hampshire to go hungry. They also worried that high fuel costs would seriously compromise the ability of many NH citizens to balance the financial demands of feeding their families with those of heating their homes. Figuring that their peers in other long-term care communities across the state might feel the same way, they decided to try something big to address the problem and invited them to join Seniors Feed NH.
Using conference calls and email, and with assistance from their homes (NH Heath Care Association, the NH Association of Counties, and NH Food Bank) the group began planning. The goal was to "eliminate a day of hunger in New Hampshire" by raising $16,000--one day's operational expense to run NH Food Bank. Fundraising efforts were varied: raffles, silent auctions, bake sales, and making and selling crafts.
Quality of life for those who live in long-term care communities is too often associated only with issues related to clinical care. While crucial to quality of life, clinical care is only part of the equation. Furthermore, a person's identity should not be defined by their need for long-term care or the fact that they live in a long-term care community.
The members of Seniors Feed NH defined themselves by their compassion, ability, energy and dedication. They are grateful for what they have and want the same for everyone. Most importantly, they are involved in meaningful activities giving their lives a sense of purpose, contribution and excitement.
Today, Seniors Feed NH is a group of seniors living in 52 long-care and independent living communities all over NH. Last year, their goal was met and exceeded, raising more than $42,000 for the NH Food Bank. This year, they look forward to continuing their work and forging collaborative relationships with key state leaders.




The Board met on February 5, 2009, the first time since November. We seem to have an uncanny ability to schedule meetings on dates that coincide with snowstorms!
The vision when we started down this path a couple of years ago was, by this time, to have grants and funding to hire staff, to create a database and web-site, to take over the newsletter function, expand our circulation to those without email, and have trainers to work with developing community leaders.
But that was a different time and a different economy. Like everyone else, we are reassessing how we can do more with less. And at a time when service providers are struggling to meet the needs of our frailest elders, we hesitate to compete for limited grant funds.
We have completed the State level incorporation process as a not-for-profit. This year, we will complete

the federal 501(c)(3) process, seeking donations for the $750 filing fee. To help us, the Disabilities Right Center, acting as our fiscal agent, has set up an online means to receive funds.
We will concentrate our efforts to enhance our communication network, and increase our non-financial support through volunteerism and partnerships. We will continue our focus to strengthen the voice and presence of older adults in NH’s pubic policy arena.
In short, we will be operating on a shoestring, being frugal and as creative as possible. And maybe that’s a good thing, being in synch with the times. It may stimulate a network that involves people in innovative problem solving, rather than political pressure for funding.
Since the newsletter is our main tool for communicating, linking, and sharing, we hope to expand regular features. We welcome suggestions and comments from our readers on what they find most helpful.
If the issues addressed here and other local, state and/or national issues concern you, think about getting together a small group of like-minded people to discuss them. Think about how you might, individually or together, address them. Consider sharing your ideas with us. You can make a difference!
And, PLEASE--share this newsletter with family, friends, neighbors and others in your community. To add your name to our newsletter mailing list, contact lcamst38@peoplepc.com.