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ADMINISTRATION FOR COMMUNITY LIVING
April 10, 2013
The Obama Administration released its Fy 2014 budget request today.
ADMINISTRATION FOR COMMUNITY LIVING (Obligations by program activity)
Source: OMB Appendix, Budget of the United States Government, Fiscal Year 2014/HHS
(in millions of dollars)
|
2012 est. |
2013* CR |
2014 request |
Home and community-based supportive services |
367 |
369 |
367 |
Preventive health services |
21 |
21 |
21 |
National family caregiver support program |
154 |
155 |
154 |
Native American caregiver support program |
6 |
6 |
6 |
Congregate nutrition services |
439 |
442 |
439 |
Home-delivered nutrition services |
217 |
218 |
217 |
Nutrition services incentive program |
158 |
159 |
160 |
Native American nutrition and supportive services |
28 |
28 |
28 |
Aging network support activities |
8 |
8 |
8 |
Long-term care ombudsmen program |
17 |
17 |
17 |
Prevention of elder abuse and neglect |
5 |
5 |
5 |
Alzheimer's disease demonstration grants |
4 |
4 |
9 |
Program administration |
23 |
23 |
30 |
Lifespan respite care program |
2 |
2 |
2 |
Aging and Disability Resource Centers (ADRC) |
16 |
16 |
10 |
Chronic Disease Self-Management Education Program |
10 |
0 |
10 |
Senior Medicare Patrol program |
9 |
9 |
9 |
Elder Rights Support Activities |
4 |
4 |
4 |
National Clearinghouse Long-Term Care Information |
3 |
0 |
3 |
Alzheimer's Disease Awareness and Education |
4 |
0 |
4 |
Adult Protective Services |
6 |
0 |
8 |
Senior Community Service Employment Program |
0 |
0 |
380 |
State Health Insurance Assistance Program |
0 |
0 |
26 |
Alzheimer's Disease Initiative - Services |
0 |
0 |
11 |
Paralysis Resource Center |
0 |
0 |
7 |
Voting Access for People With Disabilities |
0 |
0 |
5 |
State Councils on Developmental Disabilities |
0 |
0 |
75 |
Protection and Advocacy |
0 |
0 |
41 |
University Centers for Excellence in Developmental Disabilities |
0 |
0 |
39 |
Projects of National Significance |
0 |
0 |
8 |
Total, direct program |
1,501 |
1,486 |
2,103 |
|
|
|
|
Total direct obligations |
1,501 |
1,486 |
2,103 |
Reimbursable program - HCFAC and Other |
11 |
11 |
11 |
ADRC's - MIPPA (TRA) |
|
5 |
|
Area Agencies on Aging - MIPPA (TRA) . |
|
8 |
|
MIPPA - Natl Center Benefits Outreach Enrollment |
|
5 |
|
SHIPs |
|
|
26 |
Total reimbursable obligations |
11 |
29 |
37 |
Total new obligations |
1,512 |
1,515 |
2,140 |
*Note.—A full-year 2013 appropriation for this account was not enacted at the time the budget was prepared; therefore, the budget assumes this account is operating under the Continuing Appropriations Resolution, 2013 (P.L. 112–175). The amounts included for 2013 reflect the annualized level provided by the continuing resolution.
###
NIH-supported study finds U.S. dementia care costs as high as $215 billion in 2010
April 3, 2013
The costs of caring for people with dementia in the United States in 2010 were between $159 billion to $215 billion, and those costs could rise dramatically with the increase in the numbers of older people in coming decades, according to estimates by researchers at RAND Corp. and the University of Michigan, Ann Arbor. The researchers found these costs of care comparable to, if not greater than, those for heart disease and cancer.
The study, supported by the National Institutes of Health and published April 4 in The New England Journal of Medicine, totaled direct medical expenditures and costs attributable to the vast network of informal, unpaid care that supports people with dementia. Depending on how informal care is calculated, national expenditures in 2010 for dementia among people aged 71 and older were found to be $159 billion to $215 billion. Dementia is a loss of brain function that affects memory, thinking, language, judgment, and behavior; the most common form is Alzheimer's.
The researchers first looked at care purchased in the health care market — formal costs for nursing homes, Medicare, and out-of-pocket expenses. The direct costs of dementia care purchased in the market were estimated to be $109 billion in 2010, exceeding direct health costs for heart disease ($102 billion) and cancer ($77 billion) that same year.
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University of Michigan Health System
Study finds dementia care costs among highest of all diseases; comparable to cancer, heart disease
April 4, 2013
The costs of caring for people with dementia in the U.S. are comparable to – if not greater than – those for heart disease and cancer, according to new estimates by researchers at the University of Michigan Health System and nonprofit RAND Corporation.
Annual healthcare costs tied to dementia, including both formal and unpaid care, reach $159-$215 billion – rivaling the most costly major diseases – according to the findings that appear in The New England Journal of Medicine.
"Our findings show why dementia is sometimes described as a 'slow-motion disaster' for patients and families," says co-author Kenneth Langa, M.D., Ph.D., professor of internal medicine at U-M Medical School, research investigator at the Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System; and member of the U-M Institute for Social Research, Institute of Gerontology and Institute for Healthcare Policy and Innovation.
"The majority of the costs associated with dementia — about 80 percent in our study—are due to the long-term daily care and supervision provided by families and nursing homes, often for many years. Ignoring these long-term care costs that build up steadily day-after-day leads to a huge under-counting of the true burden that dementia imposes on our society."
To view the entire press release, go to http://www.eurekalert.org/pub_releases/2013-04/uomh-sfd040413.php
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Commonwealth Fund
New Report: 24 States and District of Columbia Have Selected Their Benchmark Health Insurance Plan for "Essential Health Benefit" Required by Affordable Care Act
March 13, 2013
Twenty-four states and the District of Columbia have selected the health insurance plan in their state that will serve as the "essential health benefit" package sold by all insurers participating in the new health insurance marketplace and the individual and small-group markets beginning January 2014, according to a new Commonwealth Fund study.
Designed to improve the adequacy of health coverage, the essential health benefit covers 10 broad service categories, including ambulatory patient care, hospitalization, maternity and newborn care, and prescription drugs. The federal government allowed each state to choose a benchmark plan to help meet the Affordable Care Act requirement that the essential health benefit reflect a typical employer health insurance plan.
The report, Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan, by Sabrina Corlette and colleagues at Georgetown University, reviews states’ progress in selecting these benchmark plans between January 1, 2012, and October 15, 2012. The authors found that 19 of the states that selected plans chose existing small-group plans—typically employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans. For states that did not select a benchmark plan, the federal government will designate the largest small-group plan in the state as the benchmark, meaning that the majority of states will have the most widely purchased small-group plan in the state as the basis of their essential health benefit. According to the report, selecting existing small-group market plans, which are similar to what many consumers already have, will likely mean a smoother transition into the new marketplaces and an easier adjustment to the new rules.
“Many consumers who purchased health plans on their own do not have insurance that covers all their health needs,” said Commonwealth Fund vice president Sara Collins. “The new essential health benefit is designed to ensure people have comprehensive plans. But the federal government allowed states considerable flexibility in adopting this new standard to fit their local insurance markets.”
To view the entire press release, go to http://www.commonwealthfund.org/News/News-Releases/2013/Mar/Benchmark-Health-Insurance-Plan.aspx
To view the Commonwealth Fund report, go to http://www.commonwealthfund.org/Publications/Issue-Briefs/2013/Mar/Choosing-an-Essential-Health-Benefits-Benchmark-Plan.aspx
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University of California - San Francisco
New clinical tool assesses health risks for older adults
March 5, 2013
A UC San Francisco team has developed a tool that can help determine – and perhaps influence – senior citizens' 10-year survivability rates.
The simple checklist helps doctors assess health risks that influence the longevity of older adults, and according to the authors, could be an opportunity for seniors to really engage with their primary care provider in having informed discussions about their health care maintenance.
The UCSF team created a 12-item "mortality index" based on data of more than 20,000 adults over the age of 50 from 1998 until 2008, from the Health and Retirement Study (HRS), a nationally-representative sample of independently living U.S. adults. The point system was based on their risk factors and survival rate at the end of 10 years.
Points for Risk Factors
The clinical tool operates on a point system, and the total determines a patient's 10-year risk of mortality. For example, age, gender and medical conditions were given specific points. Adults between the ages of 60 and 64 received one point, for example, compared to those over the age of 85 who received seven points. Health risks such as current tobacco use, non-skin cancers, chronic lung disease and heart failure each were assigned two points.
The ability to complete cognitive or motor skills such as managing one's finances or walking several blocks also was factored into the equation. The difficulty in performing each aptitude generated one to two points.
The findings will be published Tuesday, March 5, in the Journal of the American Medical Association (JAMA).
For details, go to: http://www.ucsf.edu/news/2013/03/13614/new-clinical-tool-assesses-health-risks-older-adults
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American Geriatrics Society
American Geriatrics Society Identifies “Five Things” Healthcare Providers and Patients Should Question and Discuss
Feb. 21, 2013
The American Geriatrics Society released its list of “Five Things Physicians and Patients Should Question,” as part of the American Board of Internal Medicine Foundation’s national Choosing Wisely® campaign. Choosing Wisely aims to spark conversations between physicians and patients about utilizing the most appropriate tests and treatments and avoiding care that may provide no benefit or may cause harm, resulting in unnecessary healthcare costs.”
The AGS convened a “Choosing Wisely Workgroup,” which reviewed current medical research and surveyed over 6,000 AGS members and other experts, to determine what potentially unnecessary or harmful treatments are most often recommended to older patients. After deliberations with experts in geriatrics and related specialties, and through a final review process with its committees and leaders, the AGS identified the following five recommendations:
“Due to age-related physical changes, many older adults respond differently to medications and other interventions than younger people. And because older people—particularly those with multiple, chronic conditions—are underrepresented in clinical trials, judging the appropriateness and risks and benefits of treatments can be more difficult for clinicians, older adults and their caregivers,” said Paul Mulhausen, MD, vice-chair of the AGS’ Clinical Practice and Models of Care Committee and chair of AGS’ Choosing Wisely Workgroup.
As part of the Choosing Wisely campaign, the AGS and the AGS Foundation for Health in Aging have published a compendium of professional and public resources about the society’s “Five Things,” which can be found at americangeriatrics.org and healthinaging.org.
To view the press release, go to http://www.americangeriatrics.org/press/news_press_releases/id:3815
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American Geriatrics Society
AGS Presents Graduate Medical Education Reform Recommendations to Institute of Medicine
Jan. 9, 2013
American Geriatrics Society (AGS)President James T. Pacala, MD, highlighted the challenges inherent in providing healthcare for older adults and offered AGS' four major suggestions for improving GME. The suggestions were made before the Institute of Medicine's Committee on the Governance and Financing of Graduate Medical Education (GME) Committee on December 19, 2012.
To view the statement, go to http://www.magnet101.com/link.cfm?r=1079126430&sid=22207097&m=2449289&u=AGS_&j=12576485&s=http://www.americangeriatrics.org/files/documents/Adv_Resources/SS_IOM%20presentation12_19_12.pdf
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University of Michigan Health System via Newswise
Researchers Uncover Gene’s Role in Rheumatoid Arthritis, Findings Pave Way for New Treatments
Jan. 24, 2013
University of Michigan research sheds new light on why certain people are more likely to suffer from rheumatoid arthritis – paving the way to explore new treatments for both arthritis and other autoimmune diseases.
The new UMHS research in mice identifies how a specific group of genes works behind the scenes to activate the bone-destroying cells that cause severe rheumatoid arthritis, a debilitating health issue for millions of Americans.
“We believe this could be a significant breakthrough in our understanding of why certain genes are associated with higher risk of rheumatoid arthritis and other autoimmune diseases – a link that has been a mystery in the field for decades,” says lead author Joseph Holoshitz, M.D., professor of internal medicine and associate chief of research in the division of rheumatology at the U-M School of Medicine.
The UMHS research challenges long-held theories. The study shows, for the first time, how this subset of HLA genes causes arthritis – by activating inflammation-causing cells, as well as bone-destroying cells (known as osteoclasts). This leads to severe arthritis and bone erosion.
“We showed how the shared epitope is directly triggering osteoclasts, the very cells that are responsible for joint destruction in people with the disease,” says Holoshitz.
“Understanding these mechanisms at play could be a significant piece of future drug development. Because we now know the molecular mechanism that activates arthritis-causing cells, we have the potential to block that pathway with simple chemical compounds that could be used to treat rheumatoid arthritis and other diseases.”
The research appeared in The Journal of Immunology and was highlighted by Nature Reviews Rheumatology.
###
JAMA
Hospital Readmission for Older Patients Often For Different Illness
Jan. 22, 2013
Among approximately 3 million Medicare patients hospitalized for heart failure, heart attack, or pneumonia, readmissions were frequent throughout the 30 days following the hospitalization, and resulted from a wide variety of diagnoses that often differed from the cause of the index hospitalization, according to a study appearing in the January 23/30 issue of JAMA.
“Hospital readmissions are common and can be a marker of poor health care quality and efficiency. To lower readmission rates, the Centers for Medicare & Medicaid Services (CMS) began publicly reporting 30-day risk-standardized readmission rates for heart failure (HF), acute myocardial infarction [MI; heart attack], and pneumonia after these measures were endorsed by the National Quality Forum. These measures are part of a federal strategy to provide incentives to improve quality of care by reducing preventable readmissions.
Kumar Dharmarajan, M.D., M.B.A., of Columbia University Medical Center, New York, and colleagues analyzed 2007-2009 Medicare fee-for-service claims data to examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for HF, heart attack, or pneumonia, conditions that are primarily responsible for almost 15 percent of hospitalizations in older persons, and are the focus of current public reporting efforts.
During the time period analyzed, the researchers identified 329,308 30-day readmissions after 1,330,157 hospitalizations for HF (24.8 percent readmitted), 108,992 30-day readmissions after 548,834 hospitalizations for acute MI (19.9 percent readmitted), and 214,239 30-day readmissions after 1,168,624 hospitalizations for pneumonia (18.3 percent readmitted). Following hospitalization for HF and acute MI, readmission was most often due to HF (35.2 percent and 19.3 percent of readmissions, respectively). Following hospitalizations for pneumonia, readmission was most likely for recurrent pneumonia (22.4 percent).
“Of all 30-day readmissions, we found that 61.0 percent of the HF, 67.6 percent of the acute MI, and 62.6 percent of the pneumonia cohorts occurred during days 0 through 15 following discharge. More than 30 percent of 30-day readmissions occurred during days 16 through 30 for all 3 cohorts,” the authors write.
Median (midpoint) times to readmission were 12 days for patients initially hospitalized with HF, 10 days for patients initially hospitalized with acute MI, and 12 days for patients initially hospitalized with pneumonia. Neither readmission diagnoses nor timing substantively varied by age, sex, or race.
“The diagnoses associated with 30-day readmission are diverse and are not associated with patient demographic characteristics or time after discharge for older patients initially hospitalized with HF, acute MI, or pneumonia. Although a high percentage of 30-day readmissions occurred relatively soon after hospitalization, readmissions remained frequent during days 16 through 30 after discharge regardless of patient age, sex, or race. This heightened vulnerability of recently hospitalized patients to a broad spectrum of conditions throughout the postdischarge period favors a generalized approach to preventing readmissions that is broadly applicable across potential readmission diagnoses and effective for at least the full month after hospitalization. Strategies that are specific to particular diseases or periods may only address a fraction of patients at risk for rehospitalization,” the authors write.
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Johns Hopkins Medicine via Newswise
Hearing Loss Accelerates Brain Function Decline in Older Adults
Jan. 17, 2013
Older adults with hearing loss are more likely to develop problems thinking and remembering than older adults whose hearing is normal, according to a new study by hearing experts at Johns Hopkins.
In the study, volunteers with hearing loss, undergoing repeated cognition tests over six years, had cognitive abilities that declined some 30 percent to 40 percent faster than in those whose hearing was normal. Levels of declining brain function were directly related to the amount of hearing loss, the researchers say. On average, older adults with hearing loss developed a significant impairment in their cognitive abilities 3.2 years sooner than those with normal hearing.
The findings, to be reported in the JAMA Internal Medicine online Jan. 21, are among the first to emerge from a larger, ongoing study monitoring the health of older blacks and whites in Memphis, Tenn., and Pittsburgh, Pa. Known as the Health, Aging and Body Composition, or Health ABC study, the latest report on older adults involved a subset of 1,984 men and women between the ages of 75 and 84, and is believed to be the first to gauge the impact of hearing loss on higher brain functions over the long term. According to senior study investigator and Johns Hopkins otologist and epidemiologist Frank Lin, M.D., Ph.D., all study participants had normal brain function when the study began in 2001, and were initially tested for hearing loss, which hearing specialists define as recognizing only those sounds louder than 25 decibels.
“Our results show that hearing loss should not be considered an inconsequential part of aging, because it may come with some serious long-term consequences to healthy brain functioning,” says Lin, an assistant professor at the Johns Hopkins University School of Medicine and the university’s Bloomberg School of Public Health.
“Our findings emphasize just how important it is for physicians to discuss hearing with their patients and to be proactive in addressing any hearing declines over time,” says Lin. He estimates that as many as 27 million Americans over age 50, including two-thirds of men and women aged 70 years and older, suffer from some form of hearing loss. More worrisome, he says, only 15 percent of those who need a hearing aid get one, leaving much of the problem and its consequences untreated.
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