Health and Disability

“Not Fade Away,” a documentary from Retirement Living TV about Alzheimer’s Disease, recently received an Emmy for best original documentary from the National Academy of Television Arts and Sciences.  During production, the filmmakers visited Ohio’s Jennings Center for Older Adults to chronicle resident Bill Jennings and his wife Evelyn. Bill and Evelyn shared the way that Bill’s struggle with Alzheimer’s Disease has impacted their lives and their marriage.

The film features several interviews with other people touched by the disease as well as researchers and  clincians. Click here to watch Bill and Evelyn’s story.

Archives of Internal Medicine: Geographic Concentration And Correlates of Nursing Home Closures: 1999-2008 - During that 10-year span "2,902 nursing homes closed, or nearly 16% of all Medicare/Medicaid-certified facilities. The cumulative closure rate was substantially higher in hospital-based facilities than in freestanding ones (50% vs 11%). Urban hospital-based facilities had the highest cumulative closure rate (60%). The closure rate among freestanding facilities was roughly the same in urban (11%) and rural (10%) areas." Additionally, the authors note, "The relative risk of closure was significantly higher in zip code areas with a higher proportion of blacks or Hispanics or a higher poverty rate. Closures tended to be spatially clustered in minority-concentrated zip codes around the urban core, often in pockets of concentrated poverty. ... Since nursing home use among the minority elderly population is growing while it is declining among whites, these findings suggest that disparities in access will increase" (Feng et al., 1/10).

The findings, based on audits of nursing-home billings from 2006 to 2008, “raise concerns about the potentially inappropriate use of higher-paying” billing codes, said the report by the Health and Human Services Department’s Office of Inspector General. It recommends that Medicare, the U.S. health insurance program for the elderly and disabled, consider changing its payment method for nursing home services.

three technologies that seemed to have the most appeal. More than half of the 1,000 people surveyed — all of whom have already used some form of tech to help out with caregiving — said none of the usual barriers, such as cost or privacy worries, would stop them from trying the following:

Personal health record tracking: A full 77% of respondents said they’d find a web- or software-based personal health record very or somewhat helpful to track medications, test results and other data.

Caregiving coordination system: This kind of system, which 70% said they’d find helpful, would log a care recipient’s medical appointments and also coordinate the scheduling of help from family members or other volunteers.

Medication support system: Devices that remind patients to take their meds and give them info on side effects, plus alert a caregiver when the dose isn’t taken, would be useful to 70% of respondents. (The WSJ’s Digits blog recently wrote about one pill-cap-based medication alert/data collection system.

Veterans of all ages with disabilities will gain additional support in 28 states under a new program designed to help them live independently, with more choice and control over the services they receive in their homes. Through a contract with the Veterans Health Administration (VHA), the National Resource Center for Participant-Directed Services (NRCPDS) will provide training and assistance to VA Medical Centers that are implementing participant-directed services for Veterans.

Bout Time.

For several years, the professor and his wife, who has Parkinson’s disease, managed in their house in Cambridge, Mass. But two years ago, finding living on their own too difficult, they moved together into an assisted living facility.

The professor, retired from MIT, was in good health and didn’t need personal care. So I wondered: Why not move just his wife, whose mobility would deteriorate, and visit her regularly from his own home?

He sounded puzzled at the question. Live apart? “That never occurred to me,” he said. “She’s my wife.”

As is often the case, though, assisted living proved only a temporary solution. His wife developed intensifying dementia and needed more care than the facility could provide. In November, at 85, she moved to another facility in a neighboring town. The professor stayed behind in assisted living. Now 87, he is living alone for the first time in 55 years. (He asked that I protect her privacy by not identifying them further.)

Basel Kikhia and colleagues at Luleå University of Technology and Johan E. Bengtsson of InterNIT, Luleå, Sweden, suggest that a more holistic approach to memory aid, known as life-logging, might be more effective and easier to implement. "Life-logging is recording activities that a person experiences for later retrieval, while context-awareness is reacting on changes in contexts," the team explains. "For example, logging a picture when a person changes location. The aim is to create a semi-automated system which helps persons with mild dementia in supporting and maintaining their life story." An entirely portable, lightweight and simple to use device that could be worn at all times would be ideal and the time has devised just such a system. The device will focus on support for reminiscence and having access to information about previous activities to support memory recollection as well as allowing the patient to annotate images, diary entries, and notes, either alone or with their carer.

Assistive Tech Idea

Yesterday, U.S. Department of Health and Human Services Secretary Kathleen Sebelius wrote to House Appropriations Chairman Harold Rogers, (R-KY), that the implementation of the Community Living Assistance Services and Support (CLASS) program will be housed in a new office in the Administration on Aging and overseen by Assistant Secretary for Aging Kathy Greenlee.  This is very good news for this program, which is a game changer for America.

A professor forced into retirement by a severe disability finds his personal care assistants essential. But he may not be able to afford their help much longer—and he faces going on Medicaid and possibly becoming institutionalized.

A Call for the CLASS Act Implementation.

The psychologists Barbara Okun and Joseph Nowinski, authors of the new book “Saying Goodbye: How Families Can Find Renewal Through Loss,” call this experience “the new grief,” a consequence of the way contemporary medicine can keep people with serious illnesses alive for extended periods.