Health and Disability

Alzheimer's Society comment: Adults with Alzheimer's disease who are talked to like children are more resistant to care.

This is according to new research presented at the International Conference on Alzheimer's Disease (ICAD).

Good communication skills and regular interaction are vital when caring
for people with dementia. This research shows that speaking to people
with dementia in an adult manner not only enhances their quality of
life but also improves the entire care experience.

Quality care relies on simple principles and even small changes can
vastly improve quality of life for people with dementia. Alzheimer's
Society research is calling for mandatory specialist dementia training
to help empower staff and ensure everyone gets access to a high
standard of care.

Scenario: Do physicians have a responsibility to report suspected self-neglect?

Older patients with chronic conditions can, over time, lose the
ability to care for their own basic needs and safety. But how can
physicians maintain respect for a patient's autonomy while assessing
self-neglect?

Response:

Self-neglect is the inability to care for one's own basic needs,
including health, welfare and safety. In two national studies,
self-neglect was cited most often for referrals to adult protective
services, more common than any category of elder mistreatment,
including neglect by others. Older people who do not care for their own
health and well-being adequately typically have functional impairments
and lack necessary support networks; ultimately, they lack the
cognitive capacity for self-protection.

A landmark 1998 study in the Journal of the American Medical Association
revealed that self-neglect is medically significant and is associated
with an increased risk for death. Those who refuse medical care may
suffer higher morbidity from untreated medical conditions. Usually the
person who is neglecting his or her own care is not aware of the need
for assistance, or agrees to get help but then refuses services. The
factors that contribute to self-neglect are still incompletely
understood. But a geriatric medical team at the Baylor University
College of Medicine, Houston, recently developed and published a model
of self-neglect in the American Journal of Public Health, and
researchers are seeking to understand it as a geriatric syndrome rather
than a distinct medical condition. In geriatric medicine, the concept
of a syndrome assumes multiple etiologies and resultant functional
decline.

he American Association for Homecare (AAH) opposes the decision by the
agency that oversees Medicare to cancel the accreditation deadline for
durable medical equipment providers in the 70 metropolitan areas
throughout the U.S. designated for Round Two of the Medicare
competitive bidding program.

The Centers for Medicare and Medicaid Services (CMS) announced last
week that it was canceling its January 14, 2009 accreditation deadline
for durable medical equipment (DME) or home medical equipment providers
in the 70 metropolitan areas that were to be included in Round Two of
the recently postponed bidding program.

"The home medical industry has advocated accreditation of homecare
providers for three decades because accreditation helps ensure quality
care for Medicare beneficiaries and can serve as a powerful tool in
preventing fraud," said Tyler J. Wilson, president and CEO of
AAHomecare. "We are surprised that CMS would in the first case argue
against the reforms and the delay enacted by Congress in the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA) by stating
that it would delay accreditation - and then cancel the accreditation
deadlines it had already set for providers in 70 metropolitan areas.
Enactment of MIPPA is no reason to push back accreditation deadlines."

From Current Biology:

Sleep changes markedly across the life span and complaints about insomnia are prevalent in older people [1].
Whether age-related alterations in sleep are due to modifications in
social factors, circadian physiology, homeostatic drive, or the ability
to sleep remains unresolved. We assessed habitual sleep duration at
home and then quantified daytime sleep propensity, sleep duration, and
sleep structure in an inpatient protocol that included extended sleep
opportunities covering 2/3 of the circadian cycle (12 hr at night and 4
hr in the afternoon) for 3–7 days in 18 older and 35 younger healthy
men and women. At baseline, older subjects had less daytime sleep
propensity than did younger subjects. Total daily sleep duration, which
was initially longer than habitual sleep duration, declined during the
experiment to asymptotic values that were 1.5 hr shorter in older (7.4
± 0.4 SEM, hour) than in younger subjects (8.9 ± 0.4).
Rapid-eye-movement sleep and non-rapid-eye-movement sleep contributed
about equally to this reduction. Thus, in the absence of social and
circadian constraints, both daytime sleep propensity and the maximal
capacity for sleep are reduced in older people. These data have
important implications for understanding age-related insomnia.

Alexandria, VA - The model for person-centered long term care can be
found in assisted living communities according to testimony submitted
recently to the US Senate Special Committee on Aging.

"Assisted living is a philosophy of care that embraces choice,
independence and the opportunity for seniors to live enriching lives
with dignity, respect and privacy," said Richard Grimes, the President
and CEO of the Assisted Living Federation of America, in testimony on
the need and value of person-centered long term care for American
seniors.

The nation's leading assisted living association told the
Committee that assisted living has become the fastest growing long term
care option in the United States because it puts the individual first.

Bringing a community nursing and physiotherapy team into residential
care homes for older people improves quality of life and reduces
hospital admissions, according to a new evaluation study's reports
published by the Joseph Rowntree Foundation.

The research, undertaken by the University of the West of England,
Bristol (UWE) and the University of Warwick, found that savings made
through reduced hospital admissions and delayed transfer to nursing
homes offset any potential costs of the scheme. The study suggests that
the overall cost ranged from an added £2.70 a week per resident to a
more likely weekly saving of £36.90.

Mild memory impairment may be associated with a sound processing
disorder called central auditory processing dysfunction, say U.S.
researchers.

People with the disorder have difficulty hearing in
complex situations with competing noise, such as making out what one
person is saying while many people in a group are talking at the same
time.

"Central auditory processing dysfunction is a general term that is
applied to persons whose hearing in quiet settings is normal or near
normal yet who have substantial hearing difficulty in the presence of
auditory stressors such as competing noise and other difficult
listening situations," according to background information in the
study. "Central auditory testing is important in evaluating individuals
with hearing difficulty, because poor central auditory ability, per se,
is not helped by amplification and requires alternative rehabilitation
strategies."

Previous research has found that people with
Alzheimer's disease and other types of dementia have central auditory
processing dysfunction.

This new study by Dr. George A. Gates, of
the University of Washington, Seattle, and colleagues included 313
people, average age 80, taking part in a dementia surveillance program
that began in 1994. Of the participants, 17 had been diagnosed with
dementia, 64 had mild memory impairment, and 232 had no memory problems.

Three
tests were used to assess the participants' central auditory
processing. In one test, nonsense sentences were read over the
background of an interesting narrative. In the other two tests,
separate sentences or numbers were read into each ear simultaneously.

"These
central auditory processing test paradigms evaluate how well an
individual manages competing signals, a task that requires adequate
short-term memory and the ability to shift attention rapidly," the
researchers noted.

See Wikipedia article for more info...

Nearly four of five (79%) respondents favor or strongly favor adding
a long-term care benefit to Medicare, financed by a premium, to pay for
care.

More than two-thirds (69%) of respondents to the survey believe it
is very important (41%) or important (28%) that the health reform plans
of the presidential candidates address the quality and financing of
long-term care.

"As our population ages, health care opinion leaders are sounding
the alarm about the significant challenges we will face financing and
improving the quality of long-term care," said Commonwealth Fund
President Karen Davis.

Information Bulletin # 255 (7/08).

Texas has compiled impressive data regarding its commitment to move people

out of nursing facilities, and its Medicaid expenditures reflect its

efforts.

Between 9/1/2001 and 5/31/2008, Texas implemented its own "Money Follows

the Person," and did not wait for or need the federal program. During

these years, Texas moved 15,626 people out of its nursing homes.

Here are some interesting demographics:

43% or 6,719 people were 64 years old or younger;

53% or 8,282 people were 65 or older.

Of the total, 27% or 4,219 people were 85 years old or older.

67 % or 10,469 people moved from the nursing facility to either live

alone or live with family members or other people.

A breakdown of the 67 % shows that 22% or 3,438 people left the

nursing facility to live alone, and 45 % or 7,032 people moved in with

their families, relatives, or others .

28% or 4,375 people live in assisted living and 5% or 781 people live

in a group homes (adult foster).

Now let's look at how Texas allocated its Medicaid expenditures:

In FY 2001, Texas spent 70.6% of its long-term care Medicaid funds on

nursing homes. In FY 2006, it reduced its nursing home expenditures to

54.6%.

Conversely, in FY 2001, it spent only 29.4% of its long-term MA funds

on waivers and other community-based services. In FY 2006, it spent 45.6%

in the community.

Big surprise. There is a relationship between how a state spends its money

and whether or not people moved out of nursing facilities.

To determine if your state is truly committed to ending unnecessary

institutionalization of people with disabilities in nursing facilities,

and therefore ending discrimination against people with disabilities, look

at how your state allocates its Medicaid "long-term care" expenditures.

Look at the numbers of persons who moved out of nursing facilities and

returned to the community. After the 1999 Supreme Court decision in

Olmstead, many disability and elderly advocates waited to see how their

states would implement the "integration mandate." Well, it's been nine

years!

Disability and older American advocates:

Do you know how many people in your state have been moved out of

nursing facilities and where they moved to? Do you state officials know

this information? Can you or they find out? Since Texas can track this

information, other states probably can and do, too.

In Information Bulletin # 251, we calculated by state the changes in

long-term care expenditures from 1999 thru 2006, and we expect to have the

FY 2007 data available soon.

I’m constantly surprised by the numbers of people I talk to about
LTCI who have the assets to comfortably pay for a policy but who
ultimately decide to take their chances with the Medicaid system if
they exhaust their assets and still need care.

This mentality
of reliance on government programs to bail people out of tough
financial situations may have worked in the past, but there are ever
increasing signs that it will be very risky business in the future.

We
are already starting to see many facilities who decline participating
in the Medicaid program altogether due to the fact that funds provided
for Medicaid patients are often less than what is needed for providing
their care. And this is before the baby boomer generation begins to
retire and place an even greater strain on the Medicaid coffers in the
years ahead.