Health and Disability

You can download a copy of  Planning an Accessible Meeting for People with Environmental Sensitivities or Intolerances as a word document, and read it below. It is more detailed than what is in the online Guide.

Consumers can now look up a hospital emergency room's average wait time, fines paid by a nursing home, or how often patients getting dialysis treatment are readmitted to a hospital because of treatment-related infections or other problems.

The review site is partnering with ProPublica, a nonprofit news organization based in New York. ProPublica compiled the information from its own research and the Centers for Medicare and Medicaid Services. The data is for 4,600 hospitals, 15,000 nursing homes, and 6,300 dialysis clinics in the United States, and it will be updated quarterly.

Through the pilot effort, the Kelly Cullen Community, a newly renovated housing development with an onsite federally qualified health center, reserved nearly one-third of its 172 units for SFHP’s highest-need, highest-cost homeless members. To date all of the reserved units have been filled.

Leveraging Medicaid dollars, SFHP uses care managers from its Care Support Program to provide ongoing care management to members once housed. This community-based model meets patients where they are and works closely with local social service providers who have experience in providing services to these members. A variety of funders, including city and state agencies, private banks, and CSH, supported both the construction of the building and the ongoing provision of housing services. Through a randomized controlled study of the pilot, researchers at New York University are measuring impacts on housing stability, mortality, tenant satisfaction, health status, and health care costs. Resultsare likely to be available later in 2015 and preliminary health care cost trends are promising.

For nearly 50 years Medicare has required patients to endure at least a three-day stint in the hospital before they become eligible for coverage of skilled nursing care afterward. A new study, however, finds that the main consequence of waiving the rule, as Medicare Advantage plans commonly do, has been a good one: less time in a bed and a gown for those who go on to skilled nursing care.

Specifically, the Brown University research team found that between 2006 and 2010 the average time in the hospital per year increased by half a day among 140,739 people in 14 plans that never waived the rule, but decreased by 0.2 days among 116,676 people in 14 otherwise similar plans after they waived it. That net difference of 0.7 fewer days on average in the hospital -- a 10 percent relative reduction -- likely saved Medicare Advantage plans money, but also meant less time before patients could move to the next phase in their recovery and less time when they were at risk of experiencing hospital-acquired complications, such as an infection or blood clot.

"This policy dates back to the mid-1960's, when the average length of a hospital stay was two weeks," said Dr. Amal Trivedi, associate professor of health services, policy and practice at Brown University and corresponding author of the study in the August issue of Health Affairs. "Requiring patients to stay in the hospital for three days before they can be transferred to a skilled nursing facility may unnecessarily lengthen hospital stays, leading to more spending, but also subject patients to unnecessary complications arising from hospital care."

Meanwhile, the researchers found no evidence of several potential negative consequences of waiving the rule: Did members of plans that waived the rule have more skilled nursing admissions? No. Were they in skilled care for longer? No.

The researchers also checked to see if patients in rule-waiving plans had more hospital admissions. They did not.

"It wasn't as if discharging them early and letting the patients go to the nursing home just led to the patient going back into the hospital," said lead author Regina Grebla, a Brown alumna and research consultant.

Alzheimer's disease and other dementias are prevalent, affecting one in six people over age 80. The main drug treatments, a class of medications called cholinesterase inhibitors (i.e., donepezil, galantamine, rivastigmine), are marginally beneficial for most patients and may have serious side effects such as gastrointestinal symptoms.

Weight loss also is a significant problem in dementia patients and linked to increased mortality. Data from randomized controlled trials suggests this weight loss may be an under-recognized side effect of cholinesterase inhibitors, but evidence is limited and conflicting.

The analysis of government inspection reports found that, between 2011 and 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin. In some cases, homes gave residents too much of the drug, which caused internal bleeding. In other cases, they gave residents too little, leading to blood clots and strokes.

ProPublica’s findings “highlighted the adverse effects of poor Coumadin management for our beneficiaries and nursing home stakeholders,” Thomas Hamilton, director of CMS’ survey and certification group, said in a written response to questions from ProPublica. “We wanted the public to have confidence that CMS is aware of this as well as other high risk medications.”

In its July 17 memo, CMS – the federal agency that regulates nursing homes – also told state health departments that inspect nursing homes on its behalf about a new tool for identifying and reducing medication errors. The tool, developed with the Agency for Healthcare Research and Quality, is designed to help determine whether nursing homes are taking adequate steps to prevent mistakes and whether they respond appropriately if they occur.

Although Coumadin has clear benefits and is life-saving for those taking the right dose, a number of peer-reviewed studies suggest that it is can be dangerous if not closely monitored. A 2007 study in The American Journal of Medicine estimated that nursing home residents suffer 34,000 fatal, life-threatening or serious events each year related to the drug.

More than $100 million in federal funding was spent last year toward searching for a cure for Alzheimer's disease. However, if given the choice, most people with dementia and those caring for them would like to see the money go elsewhere, according to a recent study led by University at Buffalo researcher Davina Porock.

The study surveyed people with dementia and their care providers on how funding from the National Alzheimer's Project Act (NAPA), a federal plan to overcome the disease, should be spent.

It revealed that the majority of respondents ranked caregiving support and resources for long-term care ahead of research for a cure.

The findings are in contrast to current NAPA spending to support those with Alzheimer's disease, which dedicated only $10 million to care services and education, according to the Department of Health and Human Services.

With more than 5 million people in the U.S. living with dementia, each person receives less than $2 for care support, says Porock.

"Sure, most people in our surveys would love for there to be a cure, but in the meantime they all have this disease and they need help," says Porock, PhD, professor in the UB School of Nursing.

Jenny (not her real name) was a week or so short of her sixtieth birthday when she came into the hospice. She had advanced cancer and she, and her family, knew the end was close. And her family were devoted. Not a day went by without one or more of them at her bedside.

We stabilised Jenny's condition; she was comfortable, more independent and able to have quality time with her family. And, as often happens with good palliative care, the prospect of her imminent death receded. Then came her birthday. It was a muted affair, but understandably so as it was clearly her last.

But then the family visits gradually fell away. "It's a pity your family can't come so often these days," one of the nurses said to Jenny. "Oh," she replied. "They won't be in so much now. You see, my fixed-term life insurance expired on my birthday."

“Our findings suggest that psychotropic medication use is widespread among older adults in outpatient care, at a far higher rate than among younger patients,” he says. “In many cases, especially for milder depression and anxiety, the safer treatment for older adults who are already taking multiple medications for other conditions might be more therapy-oriented, but very few older adults receive this sort of care.” 

The issue of medication use is particularly concerning for older adults, because the risk/benefit balance can shift as they become more likely to experience side effects or other adverse events. 

For instance, anti-anxiety benzodiazepine drugs such as Valium, Xanax, Klonopin and Ativan (and their generic counterparts) may be relatively safe for younger adults, but carry a higher risk of car accidents, falls, fractures and worsening of thinking ability or memory for older patients. 

Antidepressants can interact with blood thinners and painkillers and can raise blood pressure, all of which are more likely to be problems for older adults, who are generally on more medications than their younger counterparts.