Health and Disability

A Statement from Secretary Sebelius on the Administration for Community Living

All Americans – including people with disabilities and seniors – should be able to live at home with the supports they need, participating in communities that value their contributions – rather than in nursing homes or other institutions.

The Obama administration and my department have long been committed to promoting community living and finding new mechanisms to help ensure that the supports people with disabilities and seniors need to live in the community are accessible. 

Today, with the creation of the new Administration for Community Living (ACL), we are reinforcing this commitment by bringing together key HHS organizations and offices dedicated to improving the lives of those with functional needs into one coordinated, focused and stronger entity.

The Administration for Community Living will bring together the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities into a single agency that supports both cross-cutting initiatives and efforts focused on the unique needs of individual groups, such as children with developmental disabilities or seniors with dementia. This new agency will work on increasing access to community supports and achieving full community participation for people with disabilities and seniors. 

The Administration on Community Living will seek to enhance and improve the broad range of supports that individuals may need to live with respect and dignity as full members of their communities. These support needs go well beyond health care and include the availability of appropriate housing, employment, education, meaningful relationships and social participation.

Building on President Obama’s Year of Community Living, the ACL will pursue improved opportunities for older Americans and people with disabilities to enjoy the fullest inclusion in the life of our nation.

For more information, please visit http://hhs.gov/acl

Tornado, hurricane or flood, nursing homes are woefully unprepared to protect frail residents in a natural disaster, government investigators say. Emergency plans required by the government often lack specific steps such as coordinating with local authorities, notifying relatives or even pinning name tags and medication lists to residents in an evacuation, according to the findings.

Nearly seven years after Hurricane Katrina's devastation of New Orleans exposed the vulnerability of nursing homes, serious shortcomings persist.

"We identified many of the same gaps in nursing home preparedness and response," investigators from the inspector general's office of the Department of Health and Human Services wrote in the report being released today.

A new study that tracked what Alzheimer's disease and related disorders (ADRD) costs Medicare during three distinct stages of patient care suggests that the government insurer could realize substantial savings through efforts to reduce the hospitalizations that occur before patients became permanent nursing home residents.

Brown University experts collaborating with researchers from Pfizer Inc. analyzed millions of nursing home and Medicare patient data from 1999-2007 to determine that between the time patients were diagnosed with ADRD and the time that they entered a nursing home, Medicare spent, on average, $29,743 per patient on ADRD-related hospitalizations. That figure dropped below $19,000, over a much longer timeframe, once the patients became permanent nursing home residents.

Is it really possible for a senior to be significantly disabled, dependent on others for help with basic activities of daily living, yet consider their quality of life good? A recent study in the Journal of the American Geriatrics Society suggests that the answer is an emphatic YES.

This fascinating study interviewed 62 elderly persons who were cared for by On Lok, a San Francisco based program that cares for disabled older persons who are eligible for nursing home care, but wish to continue living in the community. In extended interviews, the seniors were asked about positive and negative aspects of their life.

A study published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals, reveals that antipsychotic drugs can increase the risk of heart attack in older patients with dementia. Older patients with dementia are often prescribed antipsychotics in order to control symptoms, such as hallucinations, physical aggression, and agitation. Earlier studies have indicated that the use of antipsychotic agents (APs) was associated to an increased risk of stroke, as well as death from all causes. As a result, safety warnings were issued in several countries.

I was listening to NPR on the radio last weekend and heard, This I Believe. The featured story was: Listening is Powerful Medicine by Dr. Alicia Conill. She offered a statistic that might surprise the general public, but is intuitively known to those of us in the field.

Studies have shown that it takes a physician about 18 seconds to interrupt a patient after they begin speaking. The doctor will take the conversation in the direction they feel it needs to go. When you see how busy most MDs are you can see why this happens; like many other professions they are doing more with less.

However, the research also shows that one of the side-effects of this is low patient-compliance rates with prescribed treatment plans.

Veterans are almost twice as likely as the general public to have chronic illnesses, such as diabetes and heart failure. Therefore, veterans may require more assistance from informal caregivers, especially as outpatient treatment becomes more common. A University of Missouri researcher evaluated strain and satisfaction among informal caregivers of veterans with chronic illnesses. The findings show that more than one third of veterans' caregivers report high levels of strain as a result of taking care of their relatives; yet, on average, caregivers also report being satisfied with their caregiving responsibilities.

Researchers at the Perelman School of Medicine at the University of Pennsylvania have demonstrated that aggressive treatment of severe traumatic brain injury, which includes invasive monitoring of intracranial pressure (ICP) and decompressive craniectomy, produces better patient outcomes than less aggressive measures and is cost-effective in patients no matter their age - even in patients 80 years of age. These important findings can be found in the article "Is aggressive treatment of traumatic brain injury cost-effective? Clinical article," by Robert Whitmore and colleagues, published online in the Journal of Neurosurgery.

In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medical outcomes.

The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. In New York City, a program run by a division of CenterLight Health System, formerly known as the Beth Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

They are talking about PACE programs, the oldes form of managed care outside nursing homes for very elderly people.