Health and Disability

House Energy and Commerce Committee Chair John Dingell (D-Mich.) on Thursday introduced a bill (HR 5613) that would postpone seven new Medicaid regulations for one year -- "potentially killing them, depending on who is president by then," CQ Today reports (Wayne, CQ Today, 3/14). The regulations, proposed by the Bush administration, would prohibit states from using federal Medicaid funds to help pay for physician training, place new limits on Medicaid payments to hospitals and nursing homes operated by state and local government, and limit coverage of rehabilitation services for people with disabilities, including those with mental illnesses (Kaiser Daily Health Policy Report, 3/4).

Dingell in a statement said, "The restrictions the administration is imposing on Medicaid are harmful and will undoubtedly put the health of thousands of our most vulnerable children at unnecessary, indefensible risk." Dennis Smith, director of the Center for Medicaid and State Operations at CMS, said the Bush administration does not plan to delay the regulations because of congressional concerns.

APH Ltd is using KNX technology as part of a project which is looking to helping dementia sufferers stay in their own homes for as long as possible - a flat within a Sheltered Housing Scheme in Bristol, England, has been converted into a prototype "Smart Home".

APH is a member of the KNX UK Association and was asked to tailor an intelligent design to suit the requirements of the occupant of the flat. KNX smart technology is employed to monitor the occupant's activity and sounds a warning when it thinks there may be a problem. Special sensors have been fitted into the flat that can tell, for example, if the front door is being opened at night. In this particular flat, wireless light switches, motion detectors, speakers and a voice messaging system have been installed. Coercive messages pre-recorded by the occupant's family are then played when appropriate.

In the early stages of Alzheimer’s disease, individuals may still be able to perform the daily tasks necessary to live and function independently. As the disease progresses, these responsibilities increasingly fall to the caregiver.

A new section on MayoClinic.com for Alzheimer’s caregivers provides helpful information on daily routines, communicating with the patient, dealing with family issues, long-term care options and self-care.

The feature offers a number of practical tips that can make providing care easier.

The Community Choice Act levels the playing field and assures choice in the long term “care” system. Right now, institutional “care” is mandated by the federal government. States MUST pay for nursing facility care. The Community Choice Act doesn’t create a new mandate, but it expands the existing mandate so that people who would be eligible for placement in a facility could have the CHOICE to live in the community with supports. The Community Choice Act would require that states have a community-based option for people who would otherwise be placed in an institutional setting. Until we get the Community Choice Act passed, institutional “care” will remain the standard/norm. As other states have run into financial problems, they have cut community based services in order to maintain funding for nursing facilities because the institutions are REQUIRED under federal Medicaid law and community services are not.

Falls are the leading cause of fatal and nonfatal injuries for persons aged >65 years. National estimates for rates of fatal falls and fall-related injuries treated in emergency departments have been published previously; however, this report presents the first national estimates of the number and proportion of persons experiencing fall-related injuries associated with either restricted activity or doctor visits. The results in this study suggest that in 2006, approximately 1.8 million persons aged >65 years (nearly 5% of all persons in that age group) sustained some type of recent fall-related injury.

Some nursing facility administrators and physicians have raisedconcerns about the increased administrative burden of workingacross multiple Part D prescription drug plans (PDPs), citingthe possibility for adverse resident outcomes and financialburden on facilities when PDPs reject drug claims for residents.We examined data on claims in rejected status for one largelong-term care pharmacy as of December 2006. There was considerablevariation across PDPs in both rejection rates and reasons forrejection.

You have perhaps heard that Michigan passed a form of estate recovery in September of 2007, becoming the last state in the union to do so. Estate recovery is a program through which states attempt to recoup the costs of Medicaid long term care benefits paid out. Although Michigan has passed the necessary legislation to begin estate recovery, it will not be until the program is reviewed and approved by CMS that it is officially implemented.

What is subject to estate recovery? Many commentators say that only probate assets are subject to estate recovery, and conclude that one must only avoid probate in order to avoid estate recovery. But I believe this is misleading for a few reasons. First, annuities purchased or modified after February 6th, 2006 must name the state of Michigan as a remainder beneficiary to the extent of Medicaid benefits received. For all practical purposes, this is estate recovery on a non-probate asset. Second, many common techniques for avoiding probate of real estate can interfere with qualification for Medicaid. So to say that one must only avoid probate in order to avoid estate recovery is not accurate.

Researchers from the Department of Preventive Medicine and Public Health from the University of Granada have carried out a study with patients over 60. The main conclusion they have come to is that an efficient response in primary care would reduce hospitalisations in more than 50% of the cases caused by three of the most frequent pathologies in older population: diabetic ketoacidosis, digestive haemorrhage and chronic bronchitis.

The study, carried out by Doctor Isabel Valenzuela López and supervised by Professors Aurora Bueno Cavaillas and José Luis Gastón Morata, has analysed the main reasons for hospitalisations caused by the pathologies that demand an effective response in primary care and how these hospitalisations could be avoided.

The significance of such study is unquestionable, considering that the elderly population represents the highest public health consumption. Furthermore, the percentage of the Spanish population who reaches an elderly age has risen from 26% at the beginning of the 20th century to 86% today.

The hardest part of caring for loved ones with Alzheimer's type disorders is not the everyday practical challenge, but rather the emotional impact of losing the patients' support and companionship as the disease robs them of their faculties, according to new research at the University of Indianapolis.

"You are losing and grieving while you're providing the care, because Charlie isn't Charlie anymore," says Associate Professor Jacquelyn Frank of UIndy's Center for Aging & Community. She says the results point toward new avenues of service that could be provided by community-based support agencies.

Frank gathered responses from more than 400 dementia caregivers around Indiana, most of them spouses and adult children of Alzheimer's patients. She is continuing to analyze data from the survey's 100-plus items, but she was struck immediately by the responses to this open-ended question: "What would you say is the biggest barrier you have faced as a caregiver?"