President Announces Bipartisan Health Care Summit Feb. 25
Feb. 7, 2010
President Obama’s has announced that he will hold a bipartisan health care summit on Feb. 25 to bring Republicans and Democrats together to discuss reform options. While the summit was welcomed by spokesmen on both sides of the aisle, whether it leads to passable legislation remains to be seen.
The summit may also interfere with negotiations going on in the House to pass a modified version of the Senate legislation.
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One-Third of Seniors Are Not Up-to-Date on Immunizations
Feb. 4, 2010
More than 30 percent of adults ages 65 and older had not been immunized against pneumonia in 36 states as of 2008, according to a new report from the Trust for America’s Health, the Infectious Diseases Society of America and the Robert Wood Johnson Foundation.
Nationally, 33.1 percent of seniors had not been immunized against pneumonia, and even in the state with the highest immunization rate—Oregon—more than one quarter (26.8 percent) of seniors were not immunized. Washington, D.C. had the lowest number of seniors immunized, with nearly half (45.6 percent) of seniors not immunized.
The U.S. Centers for Disease Control and Prevention (CDC) and other experts recommend that all seniors should be vaccinated against pneumonia, which is a one-time shot for most individuals, since seniors who get the seasonal flu are at risk for developing pneumonia as a complication.
The full report, Adult Immunization: Shots to Save Lives, is available at http://healthyamericans.org/assets/files/TFAH2010AdultImmnzBrief13.pdf.
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Metlife/NAC Study Looks at Workplace Impact of Caregiver Health Problems
Feb. 2, 2010
Employees in the U.S. who are caring for an older relative are more likely to report health problems like depression, diabetes, hypertension or heart disease, costing employers an estimated average additional health care cost of 8% per year, or $13.4 billion annually, according to the MetLife Study of Working Caregivers and Employer Health Care Costs.
The report, produced by the MetLife Mature Market Institute with the National Alliance for Caregiving in conjunction with the University of Pittsburgh Institute of Aging, also found that younger caregivers (ages 18 to 39) cost their employers 11% more for health care than non-caregivers, while male caregivers cost an additional 18%. It also found that eldercare may be closely associated with high-risk behaviors like smoking and alcohol consumption. Exacerbating the potential impact to employers is the possibility that these medical conditions may also lead to disability-related absences.
“While this news may be distressing, our research points out that coordination of eldercare services and wellness initiatives may open new avenues of innovation to benefit both employees and employers.”
Proportional Increase in Medical Care Costs and Caregiver Status |
||||||||||
|
|
|
|
Non-Caregivers |
|
Caregivers |
||||
Condition |
|
Cost |
|
Prevalence |
|
Weighted |
|
Prevalence |
|
Weighted |
Depression |
|
$725 |
|
6.8% |
|
$4,930 |
|
8.8% |
|
$6,380 |
Depression + Cardiovascular |
|
$1,082 |
|
1.8% |
|
$1,948 |
|
3.8% |
|
$4,112 |
Hypertension |
|
$910 |
|
11.2% |
|
$10,192 |
|
15.2% |
|
$13,832 |
Hypertension + |
|
$7,914 |
|
1.9% |
|
$15,037 |
|
3.8% |
|
$30,073 |
Diabetes |
|
$3,187 |
|
3.9% |
|
$12,429 |
|
4.7% |
|
$14,979 |
Other conditions |
|
$1,269 |
|
74.5% |
|
$94,541 |
|
63.7% |
|
$80,835 |
Total |
|
|
|
|
|
$139,076 |
|
|
|
$150,211 |
Proportional Cost Increase |
|
|
|
|
|
|
|
|
|
8% |
The MetLife report was drawn from an analysis of 17,000 employees of a major multinational U.S. corporation who completed health risk assessment questionnaires (HRA). Twelve percent were caregivers for an older person.
“While this news may be distressing, our research points out that coordination of eldercare services and wellness initiatives may open new avenues of innovation to benefit both employees and employers,” said Sandra Timmermann, Ed.D., director of the MetLife Mature Market Institute. “Employers can provide support to their employees and, at the same time, reduce their health care costs by anticipating and responding to the challenges of eldercare.”
According to Gail Hunt, president and CEO of the National Alliance for Caregiving, “Caregivers have more unplanned absences. Their performance on the job is also compromised by a lack of focus on their work due to distractions, like phone calls and care coordination, that occupy their time. They need solutions so they can be healthier and perform better.”
Additional study findings:
To meet the health care needs of caregivers while reducing the associated costs, employers should consider integrating their wellness and eldercare programs. In addition to practices like flexible hours, paid time off and telecommuting, the report contains suggestions to connect their employees who are caregivers with wellness programs that will reduce their stress, positively impact their health and provide needed support.
These include stress-reduction seminars expanded to include on-site yoga and exercise classes, relaxation techniques and massage therapy, decision-support systems providing information about available services, financial incentives to encourage participation in preventive benefits offered by employers (like premium reductions for those who obtain annual physicals, mammograms, Pap tests, smoking cessation classes, and exercise), expanded on-site medical screenings, and free legal and financial advice, especially pertaining to Medicare, Medicaid, and insurance.
###
AoA Seeks $108 Million Budget Hike; NIA Wants $33 Million More
Feb. 1, 2010
Despite the tight fiscal environment, the Obama administration is seeking a $108 million funding increase for the Administration on Aging (AoA) and $33 million more for the National Institute on Aging, as part of its FY 2011 budget request. FY 2011 will begin Oct. 1. See table below.
In other areas, the budget would:
Older Workers. Over at the Department of Labor, the administration is seeking $600 million for the Community Service Employment for Older Americans, down from $825 million this year. The department said the funding would preserve the base amount of the FY 2010 appropriation. In FY 2009, there was a one-time special appropriation of $225 million. The current budget request will enable the Department to fund 61,893 participant slots. Click here to view the department’s budget justification documents.
Health Care Fraud. Provide $561 million for Health Care Fraud and Abuse Control (HCFAC) discretionary funding, an increase of $250 million over FY 2010. This total will be allocated as follows: Medicare: $328.4 million; Medicaid: $47.7 million; Department of Justice: $90.0 million; Office of Inspector General, $94.8 million. Funds would strengthen Medicare and Medicaid program integrity activities, with a particular emphasis on fighting health care fraud in the field, increasing Medicaid audits, and strengthening program oversight while reducing costs “Estimates indicate that these investments will generate $9.9 billion in savings from increased recoveries and prevention efforts,” the administration said.
SSBG. Level fund the Social Services Block Grant at $1.7 billion.
Geriatric Education. Fund geriatric education programs at $34 million, the same as the current year.
Senior Housing. Reduce new construction funding for Section 202 housing for the elderly and persons with disabilities. Funding for elderly housing would drop from $825 million in FY 2009 to $274 million in FY 2010 to $551 million in FY 2011. Past studies have found that construction of Section 202 and Section 811 units is prone to delays, cost overruns, and lengthy development times, the administration said.
AoA Budget Increase
The additional funding for AoA includes $50 million more for the National Family Caregiver Support Program (counseling, training, and respite care) and $50 million more for supportive services. This funding will support 755,000 caregivers with 12 million hours of respite care and more than 186,000 caregivers with counseling, peer support groups, and training.
The following AoA programs also would see increases:
Prevention of elder abuse/ neglect, +$0.5 million
Lifespan respite care, +$2.5 million
Long-term care ombudsmen, +$1 million
Congregate meals, +$5 million
Home-delivered meals, +$3 million
Native Americans nutrition/supportive, +$2 million
Program administration, +$3 million
Other programs would be funded at current-year levels: Alzheimer’s disease demonstration, preventive health services, and nutrition services incentives.
The budget proposes to reduce Title IV program innovations by $6 million.
AoA proposed to separate out from the network support activities budget (previously funded at $44 million) $30 million for “health and long-term care programs,” leaving $14 million for “network support activities.” It explains that its budget includes $30 million for Aging and Disability Resource Centers and Evidence-Based Disease Prevention programs.
Click here to view HHS budget documents.
FY 2011 Budget Request for Aging & Health Programs
(dollars in millions)
|
FY2009 |
FY2010 |
FY2011 |
2010-11 |
ADMINISTRATION ON AGING |
$1,489 |
$1,517 |
$1,625 |
+$108 |
Alzheimer’s disease demonstration |
11 |
11 |
11 |
-- |
Elder abuse/neglect prevention |
5 |
5 |
6 |
+0.5 |
Health & long-term care programs |
28 |
31 |
30 |
-1 |
Lifespan Respite Care |
0 |
3 |
5 |
+2 |
Long-term care ombudsmen program |
16 |
17 |
18 |
+1 |
Meals, congregate |
434 |
441 |
446 |
+5 |
Meals, home delivered |
214 |
218 |
221 |
+3 |
National family caregiver support |
154 |
154 |
202 |
+48 |
Native American caregiver support |
6 |
6 |
8 |
+2 |
Native Americans nutrition/supportive |
27 |
28 |
30 |
+2 |
Network support activities |
14 |
14 |
14 |
-- |
Nutrition services incentive program |
161 |
161 |
161 |
-- |
Preventive health services |
21 |
21 |
21 |
-- |
Program administration |
19 |
20 |
23 |
+3 |
Program Innovations |
18 |
19 |
13 |
-6 |
Supportive services and centers |
361 |
368 |
416 |
+48 |
OTHER HHS |
|
|
|
|
Chronic Disease Prevention and Health Promotion (CDC) |
882 |
931 |
937 |
+6 |
Geriatric Programs (HRSA) |
31 |
34 |
34 |
-- |
Geriatric nursing education (HRSA) |
5 |
5 |
5 |
-- |
Health Care Fraud/Abuse (CMS) |
198 |
311 |
561 |
+250 |
Low-Income Home Energy Assistance |
|
5,100 |
3,300* |
-1,800 |
National Institute on Aging |
1,081 |
1,110 |
1,142 |
+33 |
Social Services Block Grant |
1,700 |
1,700 |
1,700 |
-- |
DEPARTMENT OF LABOR |
|
|
|
|
Community Services Employment for Older Americans |
690 |
825** |
600 |
-225 |
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Research Shows Higher Copayments Lead to Higher Health Costs
Jan. 27, 2010
For years many health experts believed that increasing insurance co-payments for routine doctor visits helped control costs. Patients faced with the higher price tag, they theorized, would simply cut back unnecessary visits, saving themselves and insurers money.
Brown University researchers now believe that the practice of increasing co-payments for outpatient visits — at least for senior citizens — may actually make care far more expensive. They determined that patients faced with higher co-payments did cut back on their doctor visits. But those same elderly patients ultimately required expensive hospital care because their illnesses worsened.
Dr. Amal Trivedi, the study's lead author, looked at Medicare data involving nearly 900,000 beneficiaries across the country. All were over age 65.
The finding, to be detailed in the Jan. 28, 2010, edition of The New England Journal of Medicine, has implications for insurers and politicians seeking ways to control costs but also improve quality of care.
Click here to view release.
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Update from Haiti: HelpAge USA Working in Port-au-Prince Nursing Homes
January 21, 2010
HelpAge USA and its local partners in Haiti have reached several nursing homes in Port-au-Prince and have been distributing medical supplies and assessing the needs of older people.
Free medical supplies are being distributed. Medical staff from HelpAge’s local partner CARPA have been examining patients in the Azile Communal nursing home in Bel Air, Port-au-Prince and CARPA doctors visited the UN hospital to collect free medical supplies which will be given out to them today.
Currently an estimated 329 temporary living camps have been established in the Haitian capital. HelpAge is currently working in ten of them, including one near the Port-au-Prince Municipal Nursing Home.
HelpAge Caribbean’s regional representative Jeff James and Programme Officer Julian McKoy hired a bus filled with approximately $5,000 worth of supplies (rice, sugar, cornmeal, corned beef, sardines, water, juices, snacks, tarpaulin, tents, cup soups, biscuits, cooking oil, adult diapers and other items) and drove it from Santo Domingo to Port-au-Prince.
HelpAge USA is an affiliate of HelpAge International, which builds awareness of global aging issues among US audiences, advocates for the empowerment of vulnerable elders, and raises funds.
For more, go to: http://www.helpageusa.org/haiti.html.
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Research Finds Few Nursing Homes Participate in End-of-Life Care Programs
Jan. 4, 2010
Although 25 percent of all deaths in America occur in nursing homes, fewer than 20 percent of homes participate in end-of-life care (EoL) programs, according to a new research report from the Institute for the Future of Aging Services (IFAS), the research division of the American Association of Homes and Services for the Aging.
The IFAS report looks at data from the 2004 National Nursing Home Survey, representing America’s 16,000 nursing homes.
Researchers found that nursing homes were more likely to participate in end-of-life programs if they specialty programs for hospice, pain management or dementia care. There is also a strong correlation between end-of-life program participation and staff training for services related to end of life care.
"When it comes to end-of-life care, providing appropriate staff training may be the key to expanding program participation,” Helaine Resnick, Ph.D., director of research at IFAS said. "Providers must consider the professional value EoL training and participation offers staff and more important, its personal value to the people they serve.”
The research was published in the online version of the American Journal of Hospice and Palliative Care Medicine. Click here to view the report on the IFAS Web site
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Late-Life Depression, Mild Cognitive Impairment, and Dementia May Be Linked
Jan. 20, 2010
Clinical and epidemiologic research has focused on the identification of risk factors that may be modified in predementia syndromes, at a preclinical and early clinical stage of dementing disorders, with specific attention to the role of depression, according to a paper in the February 2010 issue of the American Journal of Geriatric Psychiatry. Dr. Francesco Panza from the Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Italy., et al. from Department of Geriatrics, University of Foggia, Italy, conducted an overview of studies to describe the prevalence and incidence of depression in individuals with mild cognitive impairment (MCI), the possible impact of depressive symptoms on incident MCI, or its progression to dementia and the possible mechanisms behind the observed associations.
Prevalence and incidence of depressive symptoms or syndromes in MCI vary as a result of different diagnostic criteria and different sampling and assessment procedures. The prevalence of depression in individuals with MCI was higher in hospital-based studies (median: 44.3%, range: 9%–83%) than in population-based studies (median: 15.7%, range: 3%–63%), reflecting different referral patterns and selection criteria. Incidence of depressive symptoms varied from 11.7 to 26.6/100 person-years in hospital-based and population-based studies. For depressed normal subjects and depressed patients with MCI, the findings on increased risk of incident MCI or its progression to dementia were conflicting.
These contrasting findings suggested that the length of the follow-up period, the study design, the sample population, and methodological differences may be central for detecting an association between baseline depression and subsequent development of MCI or its progression to dementia.
Assuming that MCI may be the earliest identifiable clinical stage of dementia, depressive symptoms may be an early manifestation rather than a risk factor for dementia and Alzheimer disease, arguing that the underlying neuropathological condition that causes MCI or dementia also causes depressive symptoms. In this scenario, at least in certain subsets of elderly patients, late-life depression, MCI, and dementia could represent a possible clinical continuum.
The research appears in the February 2010 American Journal of Geriatric Psychiatry (Volume 18 - Issue 2 - pp 98-116). Click here to view the abstract.
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AGS Releases Updated Fall Prevention Guidelines
Jan. 19, 2010
The American Geriatrics Society (AGS) and the British Geriatrics Society (BGS) today released new guidelines aimed at preventing serious and potentially deadly falls among older adults. Roughly a third of Americans 65 and older fall each year, and 10 to 20 percent of those who fall suffer moderate to severe injuries that limit their mobility and threaten their independence. Fall-related injuries are one of the leading causes of death for older Americans, accounting for more than 10,000 deaths annually.
"Numerous studies have found that several types of interventions are effective at reducing the incidence of falls," says the AGS' Mary E. Tinetti, MD, of Yale University Medical School, one of the world's leading experts on falls among the elderly. "There is also evidence that some fall prevention interventions reduce the incidence of related injuries, emergency department visits, hospitalizations, nursing home placement, and functional losses among older adults.
"While we know that prevention can work, we need to do more to ensure that all seniors actually get screened for falls and, if necessary, receive appropriate interventions to prevent falls," continues Dr. Tinetti, who, with the BGS' Rose Anne Kenny, MD, and the AGS' Laurence Rubenstein, MD, co-chaired the multidisciplinary panel that updated the guidelines. "That's our goal with these new guidelines."
"The challenge now is to embed these practical guidelines into healthcare services for the growing older population at risk, in a sustainable and effective way," Dr. Tinetti adds. "We also need to continue research that will enable us to further understand contributors to falls among the aging."
They recommend a multi-factorial fall risk assessment for all older adults who have had a fall, who have been identified as having gait and balance problems, or who report difficulties with gait or balance. The guidelines include a clinical algorithm that outlines, step-by-step, recommended evaluations and interventions, and emphasize the key role of evidence-based strength and balance training in effective multi-factorial interventions. The guidelines reaffirm the central role of evidence-based strength and balance training in effective multi-factorial interventions.
Click here to view the online guidelines.
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Vitamin D supplementation can reduce falls in nursing care facilities
Jan. 19, 2010
Giving people living in nursing facilities vitamin D can reduce the rate of falls, according to a new Cochrane Review. This finding comes from a study of many different interventions used in different situations. In hospitals, multifactorial interventions and supervised exercise programs also showed benefit.
Older people living in nursing facilities or who have been admitted to a hospital are much more likely to suffer a fall than those living in the community. In these settings, falls fairly often result in head injuries and fractures, with rates of hip fracture more than ten times higher in nursing facilities than in the community. It is important to try to prevent falls to avoid unnecessary stress for older people and their families, and to reduce pressure on staff and resources. However, prevention is complicated as falls usually happen for several or many different reasons.
"Many of the preventive measures used to avoid falls in older people are combined in what are called multifactorial interventions, so it can be very difficult to separate out the effects of all the different measures," said lead researcher Ian Cameron, who is based at Sydney Medical School at the University of Sydney in Ryde, Australia.
The current review included 41 trials involving 25,422 older people, who were mostly women. Five trials tested the effects of giving vitamin D to patients in nursing facilities, where it was found to be an effective measure for preventing falls.
The researchers found that multifactorial interventions, which often incorporated exercise, medication, or environmental factors including appropriate equipment, reduced the risk of falls in hospitals. In nursing homes, the effects of multifactorial interventions were not significant overall. However, the researchers concluded that multifactorial interventions provided by multidisciplinary teams in these facilities may reduce the rate and risk of falls.
"In our review, we saw limited evidence that these combined interventions work, but we could more confidently recommend them if they were delivered by a multidisciplinary team," said Cameron. "Currently, there's no one component of any of these programs that stands out as more important than any other and we're also missing data on whether increased supervision or new technologies such as alarm systems are of any benefit."
Based on the best available information about healthcare interventions, Cochrane Reviews explore the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances.
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MetLife Foundation and National Guild Award $80,000 in Grants to 12 Creative Aging Programs
Jan. 19, 2010
MetLife Foundation and the National Guild of Community Schools of the Arts have announced the grant recipients of this year's MetLife Foundation Creative Aging Program. Grants will support the design and implementation of sustainable creative aging programs, which provide participatory, skill-based arts education for adults age 60 and older.
In addition, technical assistance will be provided for the implementation of best practices detailed in the National Guild's Creativity Matters: The Arts and Aging Toolkit and program evaluation. Grants have been awarded to 12 community arts education organizations in 10 states.
Click here to view the list of winners.
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CDC Revamps Stroke Web site
Jan. 18, 2010
The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention has launched its new Stroke Web site.
Go to: www.cdc.gov/stroke/.
###
Older Americans Month 2010 Materials Available
Jan. 15, 2010
The Older Americans Month 2010 theme is "Age Strong! Live Long!" The theme recognizes and celebrates the diversity and vitality of today's older Americans.
To view and download the Older Americans Month 2010 logo, poster and other materials, please visit:
www.aoa.gov/AoARoot/Press_Room/Observances/oam/oam.aspx
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CDC Launches New Heart Disease Web Site
Jan. 15, 2010
Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention recently launched its new Heart Disease Web Site.
Go to http://www.cdc.gov/HeartDisease/index.htm
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2009-2010 Assisted Living Salary & Benefits Report: Assisted Living LPNs Show Hourly Increase
January 15, 2010
The national median hourly rate of Assisted Living LPNs is $19.36, according to the 12th annual Assisted Living Salary & Benefits Report, just published by Hospital & Healthcare Compensation Service (HCS). The percent increase was 1.68% for LPNs in facilities reporting data from both the 2008 and 2009 Reports. The report is published in cooperation with the American Association of Homes and Services for the Aging and supported by the National Center for Assisted Living.
Turnover rates for LPNs showed a marked decrease, dropping 8.32% over the previous year. Vacancy rates also fell 1.20%. The table below illustrates the difference in turnover and vacancy rates:
Average Turnover & Vacancy |
2008 |
2009 |
Turnover |
38.51% |
30.19% |
Vacancy |
18.43% |
17.23% |
January 2010
FDA Warnings Associated With Reduced Antipsychotic Use Among Older Adults With Dementia
Jan. 11, 2010
The use of atypical antipsychotics to treat elderly patients with dementia appears to have decreased following a 2005 Food and Drug Administration (FDA) advisory regarding the risks of these medications in this population, according to a report in the January 11 issue of Archives of Internal Medicine.
Clozapine, the first second-generation or “atypical” antipsychotic medication, was introduced in the United States in 1989, according to background information in the article. Several additional drugs, including risperidone, olanzapine and paliperidone, followed. Although they are less likely to cause neurological adverse effects associated with conventional or “typical” antipsychotics, some reports have linked atypical antipsychotics to strokes, diabetes and other severe adverse events. In April 2005, the FDA issued a public health advisory that asked manufacturers to include a boxed warning regarding the increased risk of death associated with using atypical antipsychotics to treat behavioral symptoms in older patients with dementia (an off-label use of the drugs).
Dr. Ray Dorsey, University of Rochester Medical Center, and colleagues analyzed nationally representative data to assess rates of atypical antipsychotic drug use between January 2003 and December 2008. Physicians participating in the national index recorded diagnoses, therapies and patient characteristics for all clinical encounters over a two-day period. The researchers calculated the number of patient-physician interactions during which an antipsychotic was mentioned as a therapy and compared time periods before and after the FDA warning was issued to quantify its effects.
From January 2003 to March 2005, the rate of atypical drug mentions increased 34 percent per year, including a 16 percent increase among patients with dementia. In the year before the FDA advisory, approximately 13.6 million atypical antipsychotic mentions occurred, 0.8 million of which involved patients with dementia.
An overall decline in the use of atypical medications began within one month of the FDA advisory. Mentions of atypical antipsychotics decreased 2 percent overall and 19 percent among those with dementia in the year following the warning; by 2008, monthly drug uses among elderly patients with dementia decreased more than 50 percent.
The use of these medications for both FDA-approved and off-label indications continued decline for all populations through the end of the study period (December 2008). However, despite the uncertain benefits and the decrease in use among elderly patients with dementia, atypical antipsychotics still comprised 9 percent of prescription drug uses for dementia among older adults by the end of 2008.
“The residual use in the population at risk and the decrease in the use of atypical antipsychotics in the general population, who were not targeted by the warning, raise the question as to whether the effect and specificity of FDA regulatory actions could be enhanced,” the authors conclude. “Targeting specific segments of patients and physicians (e.g., high prescribers) and further customizing and evaluating the impact of regulatory actions may improve their impact at minimizing the risks associated with select prescription medications.”
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Substance Abuse Levels Rise among Older Adults
Jan. 8, 2010
A new study released today done by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that the aging of the baby boom generation is resulting in a dramatic increase in levels of illicit drug use among adults 50 and older.
These increases may require the doubling of substance abuse treatment services needed for this population by 2020, according to the report.
The latest SAMHSA short report, Illicit Drug Use among Older Adults, shows that an estimated 4.3 million adults aged 50 or older (4.7 percent) used an illicit drug in the past year. In fact, 8.5 percent of men aged 50 to 54 had used marijuana in the past year (as opposed to only 3.9 percent of women in this age group). The SAMHSA report also shows that marijuana use was more common than nonmedical use of prescription drugs among males 50 and older, (4.2 vs. 2.3 percent), but among females the rates of marijuana use and nonmedical use of prescription drugs were similar (1.7 and 1.9 percent).
Although marijuana use was more common than nonmedical use of prescription drugs for adults age 50 to 59, among those aged 65 and older, nonmedical use of prescription drugs was more common than marijuana.
Substance abuse at any age is associated with numerous health and social problems, but age-related physiological and social changes make older adults more vulnerable to the harmful effect of illicit drugs use.
“This study highlights the fact that older Americans face a wide spectrum of healthcare concerns that must be addressed in a comprehensive way,” said Assistant Secretary for Aging, Kathy Greenlee. “The Administration on Aging is committed to working with SAMHSA and all other public health partners in meeting these challenges.”
The full report is online at www.oas.samhsa.gov/2k9/168/168OlderAdults.cfm.
###
GAO Finds Accuracy Problems in Nursing Home Survey Process
Jan. 8, 2009
The Government Accountability Office (GAO) has reported that 46 percent of nursing home surveyors and 36 percent of state nursing home agency directors found survey methodology was weak and contributed to underreporting of deficiencies. States conduct nursing home surveys under contract with the Centers for Medicare & Medicaid Services (CMS) to identify quality problems.
Limited experience with a new data-driven survey methodology indicated possible improvements in consistency; however, an independent evaluation led CMS to conclude that other tools, such as survey guidance clarification and surveyor training and supervision, would help improve survey accuracy.
According to questionnaire responses, workforce shortages and greater use of surveyors with less than 2 years' experience sometimes contributed to understatement, GAO said. Nearly three-quarters of directors reported that they always or frequently experienced a workforce shortage, while nearly two-thirds reported that surveyor inexperience always, frequently, or sometimes led to understatement.
Substantial percentages of directors and surveyors indicated that inadequate training may compromise survey accuracy and lead to understatement. According to about 29 percent of surveyors in 9 high understatement states compared to 16 percent of surveyors in 10 low understatement states, initial surveyor training was not sufficient to cite appropriate scope and severity--a skill critical in preventing understatement. Furthermore, over half of directors identified the need for ongoing training for experienced surveyors on both this skill and on documenting deficiencies, a critical skill to substantiate citations.
GAO said that CMS provides little guidance to states on supervisory review processes. “In general, directors reported on our questionnaire that supervisory reviews occurred more often on surveys with higher-level rather than on those with lower-level deficiencies, which were the most frequently understated. Surveyors who reported that survey teams had too many new surveyors also reported frequent changes to or removal of deficiencies, indicating heavier reliance on supervisory reviews by states with inexperienced surveyors. Surveyors and directors in a few states informed us that, in isolated cases, state agency practices or external pressure from stakeholders, such as the nursing home industry, may have led to understatement.”
To view Nursing Homes: Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment, http://www.gao.gov/products/GAO-10-70
###
AoA Launches New Website for the National Legal Resource Center
January 8, 2010
Recognizing the challenges many older Americans are facing in today’s economic climate, Department of Health and Human Services Assistant Secretary for Aging Kathy Greenlee has launched a new Website for the National Legal Resource Center (NLRC).
The NLRC was created in 2008 by the Administration on Aging (AoA) to empower legal and aging services advocates with the resources necessary to provide high quality legal help to seniors who are facing direct threats to their ability to live independently in their homes and communities.
The new Website can be accessed at www.nlrc.aoa.gov.
###
New Alliance to Focus on Long-Term Services and Supports Quality
January 5, 2010
A group of the nation’s leading health, consumer, and aging advocates has formed the Long-Term Quality Alliance (LTAQ) to make sure that the 10 million people needing long-term services and supports in the United States receive the highest quality of care regardless of the setting in which it is delivered. The group seeks to broaden quality of care efforts from nursing homes to community-based settings. The focus will be on fostering “person-centered” quality measures for those who need long-term services and supports.
“The way we currently measure the quality of long-term care in this country focuses too much on clinical services delivered in nursing homes. The perspectives of consumers and their family caregivers have largely been ignored,” says Alliance Chair Mary Naylor, a gerontology professor at the University of Pennsylvania’s School of Nursing.
The LTQA board is comprised of 29 leaders from organizations representing caregivers, consumers, quality improvement, nursing homes, accreditation, aging, foundations, the federal government, academia, and private payers.
###
Hispanic Elderly More Likely To Live In Inferior Nursing Homes
Jan. 5, 2010
Hispanic older adults are living in nursing homes in ever-increasing numbers, but they face a gap in their quality of care compared to white residents, according to new research from Brown University.
A team led by Mary Fennell, professor of sociology and community health, found that Hispanic elderly are more likely than whites to live in nursing homes of poor quality. These residences are often faced with structural problems, staffing issues and financial trouble.
The paper is the first full-scale analysis to attempt to look broadly at Hispanics in nursing homes — what kind of nursing homes they live in and how care at those facilities compares to nursing homes which care mostly for white elderly people. Fennell said the data revealed a sharp disparity in care.
"The most shocking finding is the pervasiveness of disparities in nursing home care that are primarily white, compared to nursing homes that are a mix of whites and Hispanic residences," Fennell said.
Fennell said the findings, in part, reflect a departure from prior patterns of elder care among Hispanic families in the United States. Traditionally, the group has used formal long-term care services less frequently than any other U.S. ethnic group. They had also been less likely than white or black residents to live in nursing homes. In Hispanic households, elder care has traditionally been handled by adult daughters at home, but acculturation and financial issues have forced a growing number of young Hispanic women into work outside the home.
As a result, Fennell said, the loss of home caregivers is occurring even as the growth of the elderly Hispanic population rises dramatically. The authors estimate that more than 5 percent of the current Hispanic population is elderly, a number that is expected to quadruple during the next 10 years. That number should rise to 4.5 million by 2010, according to Fennell and her team.
The article appears in the January 2010 edition of Health Affairs.
###
The Culture-Change Movement In Nursing Homes: Is It Delivering on Person-Centered Care?
Jan. 5, 2010
The nursing home “culture change” movement has shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover, according to Mary Jane Koren, assistant vice president, Frail Elders Program, at The Commonwealth Fund in New York City. She spoke at a Health Affairs event held in Washington, D.C. on Jan. 5.
The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes.
A diverse group of stakeholders, including the Centers for Medicare and Medicaid Services helped create a definition of the characteristics expected to be present in the "ideal" facility. They included the need for a homelike rather than institutional environment where residents are enabled to make decisions affecting their day-to-day lives and given choices, and relationships between residents and staff are close. Management hierarchies would be decentralized, with staff empowered to respond to residents' needs. Studies are showing that these changes are having positive effects on staff turnover and performance.
Comparing findings from Commonwealth Fund surveys of health care opinion leaders, Koren finds that widespread awareness of the movement has come about only in the past few years. In 2005, only 27 percent of respondents were familiar with the culture change movement, compared to 66 percent in 2008.
She notes that states have played an important role in recognizing and promoting the movement, using regulatory approaches, recognition programs, and participation in culture-change coalitions. She also observes that "States' efforts to rebalance the mix of long-term care services and supports offered in institutional and community settings...giv[e] consumers alternatives to nursing homes ...thereby forcing traditional nursing homes to reassess what they must offer to stay competitive." Koren concludes that while the difficulties of implementing and maintaining culture changes are still formidable, the current policy environment is conducive to further innovation and adoption of new models, which have the potential of being enacted well before the baby-boom generation arrives at the nursing home doors.
To view the abstract of her article, which appears in the January 2010 issue of Health Affairs, go to: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.0966.
###
Assisted Living Facilities More Likely In Areas With Higher Income, Education Level
Jan. 5, 2010
Assisted living facilities are disproportionately located in areas where people have higher levels of income and education and where home values are higher, according to the first nationwide county-level analysis of supportive housing, published in the journal Health Affairs. Low-income people, minorities, and people living in rural areas have relatively little access to this housing and long-term care option, the authors report.
“The growth of assisted living has been fueled mostly with private dollars, and the distribution of facilities nationally reflects this fact,” says lead researcher David Stevenson, an assistant professor of health policy at Harvard Medical School. “States have been cautious to date in expanding Medicaid coverage for care in assisted living. If this changes in the future and more public dollars flow into this sector, however, policymakers will have to address important issues related to access to services, financing, and oversight of care,” he adds.
The latest data show that there are almost one million assisted living beds nationwide. There is little government financing or regulation of the assisted living sector, and most of those in assisted living pay their own way. In addition, there is wide variation across states in the nature of these facilities and the services that they can provide.
Using county-level data, Stevenson and Harvard associate professor David Grabowski compared the penetration of these facilities nationally with county data on education, median household income, other economic indicators, and racial/ethnic composition.
They found wide variation in assisted living facilities across states. Minnesota, Oregon, and Virginia had the highest penetration of facilities, with more than 40 facilities per 1,000 people who are age 65 and older. Connecticut, Hawaii, and West Virginia had the lowest, with fewer than 10 facilities per 1,000 elderly people.
Specific findings of the study include the following:
###
Older Americans Act Reauthorization Forums
Dec. 17, 2009
The Administration on Aging plans to convene a series of Older Americans Act Reauthorization Listening Forums early in 2010 to get input from the aging network, stakeholders, policymakers and the public on key issues that will impact the 2011 reauthorization.
The forums will be held:
Feb. 18: Dallas (Regions IV, VI, VII and Title VI representatives)
Feb. 25: Washington, DC Metro Area (Regions I, II, and V)
March 3: San Francisco (Regions VIII, IX, X and Title VI representatives)
In addition, a separate listening forum will be held at the NCOA/ASA Annual Conference in Chicago on March 16th.
###
Congress Approves $1.5 Billion for AoA, Hikes Meals and Supportive Services
Dec. 16, 2009
FY 2010 appropriations for the departments of Labor, Department of Health and Human Services, and Education have been signed into law as part of an omnibus funding bill (H.R. 3288).
The measure funds AoA at $1.51 billion, an increase over the $1.49 billion FY 2009 level.
Congress increased funding for meals, Native American programs, program innovations, program administration, and protection for vulnerable elders. See table below.
|
FY 2009 |
FY2010 |
ADMINISTRATION ON AGING |
$1,493,843,000 |
$1,516,297,000 |
Alzheimer’s disease demonstration |
11,464,000 |
11,464,000 |
Lifespan Respite Care |
2,500,000 |
2,500,000 |
Meals, congregate |
434,269,000 |
440,783,000 |
Meals, home delivered |
214,459,000 |
217,676,000 |
National family caregiver support |
154,220,000 |
154,220,000 |
Native American caregiver support |
6,389,000 |
6,389,000 |
Native Americans nutrition/supportive |
27,208,000 |
27,708,000 |
Network support activities |
41,694,000 |
44,283,000 |
Nutrition services incentive program |
161,015,000 |
161,015,000 |
Preventive health services |
21,026,000 |
21,026,000 |
Program administration |
18,696,000 |
19,979,000 |
Program Innovations |
18,172,000 |
19,023,000 |
Protection for vulnerable elders |
21,383,000 |
21,883,000 |
Supportive services and centers |
361,348,000 |
368,348,000 |
Click here to see table with more details.
###
Employers Worry More About Knowledge Drain than Delayed Retirement
Dec. 16, 2009
MetLife has released a new study showing that -- despite high levels of unemployment and the recent trend of older workers delaying retirement -- employers are deeply anxious and concerned about the impact of the knowledge drain on their organizations. When asked which of two retirement-related issues -- delayed retirement or the knowledge drain -- are of greatest concern today, 74% said they are primarily concerned about experiencing a knowledge drain as older workers retire. Interestingly, this is a “today” and a “tomorrow” issue – 70% of employers anticipate being primarily concerned with the knowledge drain in 3-5 years.
As employers search for strategies to manage the knowledge drain, some are looking at phased retirement programs to help with the transfer of knowledge from older to younger employees.
Among the findings of the Emerging Retirement Model Study are:
o 65% of employers would welcome additional legislation/regulation that would encourage the implementation of phased retirement programs.
o 71% of employers strongly or somewhat agree that regulatory complexities and ambiguities involving federal tax and age discrimination laws impact their organization’s ability to offer a phased retirement program.
o 51% of employers also strongly or somewhat agree that the retirement plan nondiscrimination rules can be an obstacle to an effective phased retirement program for their organization.
The report is online at www.metlife.com/emergingretirement.
###
Social Service Activities Can Improve Brain Functions In Older Adults
Dec. 15, 2009
Declining brain function can be delayed or reversed in older adults by engaging in volunteer service, such as tutoring children, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Using functional magnetic resonance imaging (fMRI), the researchers found that seniors participating in a youth mentoring program made gains in key brain regions that support cognitive abilities important to planning and organizing one's daily life.
The study is the first of its kind to examine the effect of Experience Corps, a national volunteer service program that trains seniors to help children in urban public schools with reading and academic success in other areas. The study followed 17 women aged 65 and older. Half participated in existing Experience Corps programs in Baltimore schools, while the other half were wait-listed to enroll in Experience Corps the following year. Participants were evaluated at enrollment and again six months later, which included fMRI brain scans and cognitive function testing.
"We found that participating in Experience Corps resulted in improvements in cognitive functioning and this was associated with significant changes in brain activation patterns," said lead investigator Michelle C. Carlson, PhD, associate professor in the Bloomberg School's Department of Mental Health and Center on Aging and Health. "Essentially the intervention improved brain and cognitive function in these older adults."
"While the results of this study are preliminary, they hold promise for enhancing and maintaining brain reserve in later life, particularly among sedentary individuals who may benefit most urgently from behavioral interventions like Experience Corps," said Carlson, who is now leading a larger fMRI trial as part of a large-scale randomized trial of the Baltimore Experience Corps Program.
The study appears in the December issue of the Journals of Gerontology: Medical Sciences.
###
NAC Releases 2009 Caregiving in the U.S. Survey
December 8, 2009
Caregiving is still mostly a woman's job and many women are putting their career and financial futures on hold as they juggle part-time caregiving and full-time job requirements. This is the reality reported in Caregiving in the U.S. 2009, the latest report from the National Alliance for Caregiving. The study of the legions of people caring for adults, the elderly and children with special needs reveals that 29% of the U.S. adult population, or 65.7 million people, are caregivers, including 31% of all households. These caregivers provide an average of 20 hours of care per week.
Caregiving in the U.S., which was funded by MetLife Foundation and conducted for the National Alliance for Caregiving in collaboration with AARP by Mathew Greenwald & Associates, is the result of interviews with 1,480 caregivers chosen at random. The study was designed to replicate similar studies conducted in 2004 and 1997 and includes, for the first time, a sampling of those caring for children as well as those caring for adults over the age of 18.
The information will be posted shortly at: http://www.caregiving.org/.
Kaiser Family Foundation Posts Analysis of Health Reform Bills
The Kaiser Family Foundation has posted a summary of key Medicare provisions in the health reform legislation pending before the House and Senate.
Go to: http://www.kff.org/healthreform/upload/7948_HR3962_HR3590_Summary.pdf
###
Psychotropic Medications Associated With Risk of Falls in Older Adults
November 23, 2009
Older adults taking several different types of psychotropic medications—such as antidepressants or sedatives—appear more likely to experience falls, new research shows.
John C. Woolcott, M.A., of University of British Columbia and Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada, and colleagues conducted a meta-analysis of 22 previously published studies conducted between 1996 and 2007. The studies involved 79,081 participants older than 60 years and evaluated nine drug classes: antihypertensive agents; diuretics; beta-blockers; sedatives and hypnotics; neuroleptics and antipsychotics; antidepressants; benzodiazepines; narcotics; and non-steroidal anti-inflammatory drugs.
When the data were pooled and results adjusted for other factors, the use of sedatives and hypnotics, antidepressants and benzodiazepines were significantly associated with the risk of falling in older adults.
“Given the divergent results shown by some observational assessments within specific medication classes, the results of our meta-analysis reiterate the need for caution when prescribing these medications to seniors,” the authors write. “It is hoped that future research in this area can be completed with larger sample sizes in both community and long-term care facility settings and thus improve the quality of information about fall risks that is available to physicians and pharmacists when they are deciding which types of pharmacotherapy to provide.”
The study is in the November 23 issue of Archives of Internal Medicine (Arch Intern Med. 2009; 169[21]:1952-1960)
###
Severe and Chronic Pain in Multiple Areas Associated With Increased Risk of Falls in Older Adults
November 23, 2009
Older adults who reported chronic musculoskeletal pain in two or more locations, higher levels of severe pain, or pain that interfered with daily activities were more likely to experience a fall than adults who did not reports these types of pain, according to a new study.
Suzanne G. Leveille, Ph.D., R.N., of Beth Israel Deaconess Medical Center and the University of Massachusetts-Boston, and colleagues conducted a study to determine whether chronic musculoskeletal pain is associated with an increased occurrence of falls in older adults. The study included 749 adults, age 70 years and older, who were enrolled in the study from September 2005 through January 2008. Pain was assessed via questionnaires. Participants recorded falls on monthly calendar postcards mailed to the study center during an 18-month period.
At the beginning of the study, 40 percent of participants reported chronic pain in more than one joint area and 24 percent reported chronic pain in only one joint area. A total of 1,029 falls were reported by the 749 participants during and up to 18 months of follow-up. Four hundred five participants (55 percent) fell at least once during the follow-up. Analysis indicated that compared with participants who reported no pain or those in the lowest groups of pain scores, participants who reported two or more sites of pain had an increased risk for falls; those reporting the highest levels of pain severity also had an increased rate of falls; and pain interference with activities was also associated with a greater occurrence of falls.
The researchers write that they observed a strong graded relationship in the short term between pain severity ratings each month with risk for falls in the subsequent month. “For example, among persons who reported severe or very severe pain for any given month on their calendar postcard, there was a 77 percent increased likelihood for a fall in the subsequent month compared with those who reported no pain.” Persons reporting even very mild pain also had an elevated odds of falling in any given month.
The authors suggest there may be several possible mechanisms for the pain-falls relationship, including neuromuscular effects of pain, which could lead to leg muscle weakness or slowed neuromuscular responses to an impending fall. “Another factor may be gait alterations or adaptations to chronic pain that lead to instability and subsequent balance impairments. Chronic pain may serve as a distractor or, in some way, interfere with cognitive activity needed to prevent a fall. Successful avoidance or interruptions of a fall typically requires a cognitively mediated physical maneuver.”
“The findings provide evidence suggesting that the common complaint of the aches and pains of old age is related to a greater hazard than previously thought. Daily discomfort may accompany not only difficulties in performing daily activities but equally as important may be a risk for falls and possibly fall-related injuries in the older population. The significance of this work is in the identification of chronic pain as an overlooked and potentially important risk factor for falls in older adults. A randomized controlled trial is needed to determine whether improved pain control could reduce risk for falls among older patients with chronic pain,” the researchers conclude.
The research appears in the Journal of the American Medical Association (JAMA. 2009;302[20]:2214-2221)
###
Senate Clears Health Reform Bill for Floor Debate
Nov. 22, 2009
The Senate voted 60-39 along party lines on Nov. 21 to halt a Republican
filibuster and bring health care reform legislation to the floor after
Thanksgiving. Senate Majority Leader Harry M. Reid (D-Nev.) has an ambitious
plan to pass the bill before the end of the year.
Link to Patient Protection and Affordable Care Act,
http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf
###
CDC,
AARP Promote Preventive Services for Adults 50-64
Nov. 19, 2009
Adults ages 50 to 64 are not accessing enough preventive services, concludes
a new report from Centers for Disease Control and Prevention, AARP and
the American Medical Association. Fewer than 25 percent of people in this
demographic currently receive routinely recommended preventive services
(i.e., influenza vaccination, colorectal cancer screening, and breast
and cervical cancer screening).
The report focuses on opportunities to improve the health of the growing number
of adults in the 50-64 age bracket to broaden the use of potentially lifesaving
preventive services.
It identifies 14 recommended preventive services, as well as preventive
screenings for behaviors that could negatively impact health such as binge
drinking.
The report also addresses:
Strategies to promote, facilitate,
and deliver preventive services in communities.
National summary and state-by-state
data to monitor progress in the delivery of services to Americans aged 50 to
64.
Calls for action on existing gaps,
barriers, and opportunities to deliver multiple preventive services.
“Given the demographic forces, current economic and healthcare challenges, and
important societal contributions of adults aged 50 to 64, the time is ripe for
a well-planned public health response to enhance the delivery of preventive
services throughout the nation,” said Lynda A. Anderson, PhD, director of the
Healthy Aging Program at the CDC’s National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP). “This report highlights the
strategies needed to increase preventive services for this age group.”
“People aged 50-64 need access to preventive services to help stay healthy,” added
CDC Director Thomas R. Frieden, M.D., M.P.H. “CDC and our partners AARP and AMA
are excited about this new resource because it makes it easier to monitor
improvements in health behaviors, screenings and immunizations. Our goal is to
enhance the delivery and use of these recommended preventive services.”
By 2015, an estimated 63 million U.S. adults will be between the ages of 50 and
64, comprising 20 percent of the nation’s population. They are at greater risk
of developing chronic diseases such as heart disease and cancer than younger
adults. Almost one-third of adults in this age group are uninsured or
underinsured, which heightens the challenges of ensuring they receive critical
preventive services.
The report, “Promoting Preventive Services for Adults 50-64: Community and
Clinical Partnerships,” is online at http://www.cdc.gov/aging/pdf/promoting-preventive-services.pdf
###
Senate Approves Veterans
and Caregiver Support Bill
Nov. 19, 2009
The Senate has approved the Caregivers and Veterans Omnibus Health Services Act
(S. 1963) by a voice vote of 98-0. The House veterans committee is not expected
to take up the bill until next month.
The legislation by Senator Daniel Akaka (D-HI) includes provisions to assist
caregivers of wounded veterans. It would authorize a monthly stipend of $2,350
to a family caregiver or friend who has been designated to care for a severely
injured veteran. The measure would also provide training, education and
counseling for these caregivers. The VA would contract with home health
agencies to oversee caregivers.
The bill would also provide for VA medical care for qualified caregivers who do
not have insurance.
Under the legislation, the VA and DOD would contract for a national survey of
family caregivers of seriously disabled veterans and service members and report
to Congress with their findings.
###
Aging
Boomers May Have More Disabilities than Prior Generations
Nov. 12, 2009
For years people have said the baby boomers would be the healthiest generation
ever when they enter old age. But now a new study shows Boomers are entering
their 60s suffering far more disabilities than their counterparts did in
previous generations.
Researchers from the division of geriatrics at the David Geffen School of
Medicine at UCLA found that individuals between the ages of 60 and 69 exhibited
increases in several types of disabilities over time. By contrast, those
between the ages of 70 and 79 and those aged 80 and over saw no significant
increases — and in some cases exhibited fewer disabilities than their previous
cohorts.
The findings hold "significant and sobering implications" for health
care because they suggest that people now entering their 60s could have even
more disabilities, putting an added burden on an already fragile system and
boosting health costs for society as a whole, researchers say.
“If this is true, it's something we need to address," said Teresa Seeman,
UCLA professor of medicine and epidemiology and the study's principal
investigator. "If this trend continues unchecked, it will put increasing
pressure on our society to take care of these disabled individuals. This would
just put more of a burden on the health care system to address the higher
levels of these problems."
The researchers used two sets of data — the National Health and Nutrition
Examination Surveys (NHANES) for 1988 and 1999 — to examine how disabilities
for the three groups of adults aged 60+, 70+, and 80+ and older had changed
over time. They assessed disability trends in four areas: basic activities
associated with daily living, such as walking from room to room and getting
into and out of bed; instrumental activities, such as performing household
chores or preparing meals; mobility, including walking one-quarter mile or
climbing 10 steps without stopping for rest; and functional limitations, which
include stooping, crouching or kneeling.
One reason for this uptick, researchers say, is that disabilities may be linked
with the changing racial and ethnic makeup of the group that recently reached
or will soon be reaching its 60s, with the most rapid growth projected to be
among African Americans and Hispanics — groups with significantly higher rates
of obesity and lower socioeconomic status, both of which are associated with
higher risk for functional limitations and disabilities.
The researchers note that their controls for differences in sociodemographics,
health status (such as chronic conditions and biological risk factors) and
health behavior do not completely explain the increase in disability trends
among the 60- to 69-year olds. Still, the trends within that group "are
disturbing," Seeman said.
The study will be published in the January 2010 issue of the American Journal of Public Health.
###
House
Passes Health Care Reform Legislation
November
8, 2009
The House approved its health care reform legislation -- the Affordable Health
Care for America Act (H.R. 3962) -- on a close 220-215 vote yesterday. Action is slower on the Senate side, where Senate Majority
Leader Harry Reid hopes to bring a bill to the floor by Thanksgiving.
The House version would require every individual to have health insurance, and
would require most employers (businesses with payrolls above $500,000) to
provide coverage to their workers. Insurers could no longer deny coverage for
people with preexisting conditions. The House bill would expand Medicaid and
create federal subsidies for individuals to buy insurance from either private
companies or a government-run insurance plan.
H.R. 3962 would gradually reduce the Medicare prescription drug doughnut hole
by 2019. Other Medicare changes would:
(1) permit physician assistants to order post-hospital extended care services,
and to provide for recognition of attending physician assistants as attending
physicians to serve hospice patients;
(2) provide adjustment to Medicare payment localities for physician services;
(3) modify the Medicare payment systems to address geographic inequities;
(4) limit cost-sharing for individual health services under the Medicare
Advantage program;
(5) eliminate Medicare part D cost-sharing for certain non-institutionalized
full dual eligible individuals;
(6) cover marriage and family therapist services and mental health counselor
services; and
(7) expand access to vaccines.
The House legislation includes the CLASS Act, which would establish a national,
voluntary disability insurance program to purchase community living assistance
services and supports (CLASS program) under which:
(a) all employees are automatically enrolled, but are allowed to waive
enrollment;
(b) payroll deductions pay monthly premiums; and
(c) benefits are provided, based on the level of disability, to purchase
nonmedical services and supports that the beneficiary needs to maintain
independence.
H.R. 3962 would also
(a) establish a Prevention and Wellness Trust for carrying out prevention and
wellness activities;
(b) create the Center for Quality Improvement to focus on quality improvement
activities in the delivery of health care services;
(c) the position of Assistant Secretary for Health Information;
(d) require the HHS Secretary to
establish within the Agency for Healthcare Research and Quality a Center for
Comparative Effective Research;
(e) establish accountability requirements for long-term care facilities and
provides for transparency with respect to them; and
(f) provide enhanced penalties for fraud and abuse.The bill would be financed through gradual cuts in Medicare spending and new
taxes on high-income families.
###
House
Health Care Reform Includes Medicare Improvements
Nov. 2, 2009
The health care reform bill (H.R. 3962) released by House Democratic leaders
includes several improvements to Medicare, according to the Center on Budget
and Policy Priorities (CBPP). In its latest report, CBPP says the House bill
would:
House May Begin Health Care Reform
Debate Next Week
Oct. 28,
2009
House leadership is striving to get a health care reform bill ready this week
for debate on the floor next week, assuming a public option can be
incorporated. They will need 218 votes for passage.
The House bill is expected to include the Community
Living Assistance Services and Supports (CLASS) Act, a voluntary program in
which participants would pay a monthly premium toward future long-term care up
to $50 a day. The $50 a day could be used toward home care, equipment and
supplies, home improvements, or nursing home care.
Senate Majority Leader Harry Reid (D-Nev.) meanwhile is moving to include a
public option in the bill that will come up on the Senate floor. This bill may
allow states to opt-out of the public option. Whether such a bill can garner
the 60 supports needed to break a filibuster remains to be seen.
In the Senate, the CLASS Act is part of the Health, Education, Labor and
Pensions Committee bill, but was not included in the Senate Finance Committee
version. Reid has not said whether he will include the CLASS Act in his Senate
floor bill.
###
Thomson Reuters Report Identifies Healthcare Waste at $700 Billion
October 26, 2009
The U.S. healthcare system wastes between $600 billion and $850 billion
annually, according to a white paper published today by Thomson Reuters.
The report is based on a review of published research and analyses of proprietary
healthcare data.
The Thomson Reuters report identifies the most significant drivers of wasteful
spending -- including administrative inefficiency, unnecessary treatment,
medical errors, and fraud -- and quantifies their cost. The report defined
waste in healthcare as “Healthcare spending that can be eliminated without
reducing the quality of care.” Waste (estimated at $600-$850 billion annually)
includes:
|
Waste |
Example |
Percent |
Dollar Cost |
|
Unwarranted use |
Payments for services with no evidence that they contribute to better health outcomes, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure |
40% of waste |
$250-325 billion |
|
Fraud and abuse |
Ranging from fraudulent Medicare claims to kickbacks for referrals for unnecessary services |
19% of waste |
$125-175 billion |
|
Administrative system inefficiencies |
The large volume of redundant paperwork in the U.S healthcare system |
17% of waste |
$100-150 billion |
|
Medical errors and provider inefficiencies |
Medical mistakes |
12% of waste |
$75-100 billion |
|
Preventable conditions and avoidable care |
Hospitalizations to address conditions such as uncontrolled diabetes, which are much less costly to treat when individuals receive timely access to outpatient care |
6% of waste |
$25-50 billion |
|
Lack of care coordination |
Inefficient communication between providers, including lack of access to medical records when specialists intervene, leads to duplication of tests and inappropriate treatments |
6% of waste |
$25-50 billion |
|
|
|
100% |
$600-850 billion |
Committee markup is
expected to begin Sept. 22.
Financing for the bill would come from Medicare and Medicaid spending
reductions, a tax on insurers offering benefits-heavy insurance plans, and new
fees on some providers such as medical device makers.
The legislation proposes changes to Medicare, including: