Health and Disability

Aging populations around the globe have motivated companies small andlarge to focus more on senior care technology. Multinational tech giant Philips (NYSE: PHG) has been among these companies, and its new initiative places even more emphasis on helping aging people maintain their independence at home, whether that’s a private residence or senior living community.

Philips’ Aging Well Services is meant to be a whole portfolio of personalized services, solutions, and content around this mission of independence. It launched last month, with tele-rehabilitation company RespondWell as the first participant. RespondWell uses a gamification approach to help enable and improve home-based rehab.

The Aging Well ecosystem also currently includes BrainHQ, a cognitive health platform offering brain-training exercises, as well as medication management options and senior living/home health referral partnerships, Marcia Conrad Miller, senior director of business transformation at Philips, told Senior Housing News. The team at Philips is actively involved in discussions to expand the Aging Well portfolio, she added.

As for why Aging Well is launching now, it is related to the recent division of Philips into two separate holding companies, one for lighting and one that merged consumer products and health care products into a health tech category. Aging Well is an important part of Philips’ effort to provide support at every point in the health care continuum, at every stage of a person’s life, Conrad Miller said.

Nine million community-dwelling Medicare beneficiaries—about one-fifth of all beneficiaries—have serious physical or cognitive limitations and require long-term services and supports (LTSS) that are not covered by Medicare. Nearly all have chronic conditions that require ongoing medical attention, including three-fourths who have three or more chronic conditions and are high-need, high-risk users of Medicare covered services.

Gaps in Medicare coverage and the lack of integration of medical care and LTSS have serious consequences. Beneficiaries are exposed to potentially high out-of-pocket expenses. Medicaid covers LTSS for very low-income Medicare beneficiaries, but only one-fourth of Medicare beneficiaries with serious physical or cognitive limitations are covered by Medicaid.

This blog presents a Medicare Help at Home policy proposal to add home and community-based services to Medicare to enhance financial protection for beneficiaries, provisions to ensure the quality and efficient use of services, and honor beneficiary preferences for independent living and care at home.

It has three elements:

1. A Medicare home and community-based benefit for those with two or more functional limitations, Alzheimer’s, or severe cognitive impairment, according to an individualized care plan based on beneficiary goals. This would cover up to 20 hours a week of personal service worker care or equivalent dollar amount for a range of home and community-based LTSS.
2. Creation of new Integrated Care Organizations (ICOs) accountable for the delivery and coordination of both medical care and LTSS that meet quality standards, honor beneficiary preferences, and support care partners.
3. Innovative models of health care delivery including a team approach to care in the home building on promising models of service delivery that improve patient outcomes, reduce emergency department use, prevent avoidable hospitalization, and delay or reduce long-term institutional care.

The benefit is financed by income-related cost-sharing, and a 25-75 mix of Medicare beneficiary premiums and an incremental payroll tax on employers and employees.

Scientists have long known that there is a strong association between diabetes and Alzheimer's, but the nature of that relationship - and how to treat it - was unclear. Now Melissa Schilling, an innovation professor at NYU, has discovered the pathway between diabetes and Alzheimer's, and it has big implications for how Alzheimer's can be prevented.

Professor Schilling compared and integrated decades of research on diabetes, Alzheimer's, and molecular chemistry, focusing in particular on results that seemed to yield conflicting results. It turns out that routine practices in research - like excluding all patients with known medical problems such as diabetes from an Alzheimer's study, for example - had obscured the mechanisms that connect the two diseases. Those main mechanisms turn out to be insulin and the enzymes that break it down. The same enzymes that break down insulin also break down amyloid-beta, the protein that forms tangles and plaques in the brains of people with Alzheimer's. When people have hyperinsulinemia (i.e., they secrete too much insulin due to a poor diet, pre-diabetes, early diabetes, obesity, etc.) the enzymes are too busy breaking down insulin to break down amyloid-beta, causing amyloid-beta to accumulate.

The American Diabetes Association estimates that roughly 8.1 million Americans have undiagnosed diabetes and 86 million have pre-diabetes and have no idea. The good news is that hyperinsulinemia is preventable and treatable through changes in diet, exercise, and medication. Schilling notes, "If we can raise awareness and get more people tested and treated for hyperinsulinemia, we could significantly reduce the incidence of Alzheimer's disease, as well as other diabetes-related health problems. Everyone should be tested, early and often, preferably with the A1C test that doesn't require fasting.Dementia patients should especially be tested - some studies have shown that treating the underlying hyperinsulinemia can slow or even reverse Alzheimer's."

In late March, the CMS Office of Minority Health released the Mapping Medicare Disparities (MMD) tool, an interactive map that displays differences in chronic disease prevalence and outcomes among Medicare beneficiaries. The tool uses Medicare claims data to present geographic differences down to the county level, searchable by parameters of sex, age, dual eligibility status, and race and ethnicity. This powerful resource can show measures of disease prevalence, Medicare spending, hospital and emergency department utilization, readmission rates, mortality rates and other health outcome measures for up to 18 chronic conditions. Users can compare outcomes between counties, racial and ethnic groups, and in comparison to national and state averages.

I decided to take the MMD Tool for a spin and checked out some of the data from the Boston area. I looked at how Black and White women in Suffolk County compared in terms of diabetes prevalence and emergency department visits. With a few clicks, I found the disturbing, but all too familiar, statistics: in 2014, 22 percent of White women enrolled in Medicare fee-for-service in the county had diabetes compared to 40 percent of Black women. And, the rates of emergency department visits among Black women were 22 percent higher than for White women.

Medicare covers many services, but routine oral health, vision, and hearing care are not among them. This fact sheet highlights alternative resources that may be able to help low-income seniors and person with disabilities receive free or discounted dental, vision, and hearing services.

A study that will be presented at next week’s American Academy of Neurology (AAN) meeting offers one of the most conclusive pieces of evidence yet of a definitive link between brain injury and playing football.

It shows that “more than 40 percent of retired National Football League players … had signs of traumatic brain injury based on sensitive MRI scans called diffusion tensor imaging,” according to a press release from the AAN.

This isn’t the first study of its kind. Last year Frontline reported that researchers with the Department of Veterans Affairs and Boston University found chronic traumatic encephalopathy (CTE), which the Mayo Clinic defines as “brain degeneration likely caused by repeated head traumas” that is “a diagnosis only made at autopsy,” in 96 percent of the NFL players they examined and in 79 percent of football players at various levels of play.

The researchers studied 165 deceased people who had played the sport in high school, college or professionally, and found evidence of CTE in 131 of them.

But this newest study is “one of the largest studies to date in living retired NFL players” and the “first to demonstrate significant objective evidence for traumatic brain injury in these former players,” study author Dr. Francis X. Conidi of the Florida Center for Headache and Sports Neurology and Florida State University College of Medicine said in the release.

A sweeping new initiative from the Centers for Medicare & Medicaid Services (CMS) may focus on primary care, but it appears to bode well for the future of home health and community-based services.

The Comprehensive Primary Care Plus (CPC+) model is a new Affordable Care Act (ACA) initiative and CMS’ largest-ever multi-payer initiative to improve primary care nationwide, the agency announced Monday. The five-year CPC+ model will be implemented in as many as 20 regions and can accommodate up to 5,000 practices, which would involve more than 20,000 doctors and clinicians and the 25 million individuals they serve.

Under CPC+, CMS will pay practices a monthly fee to manage care for up to 25 million Medicare beneficiaries. To promote high-quality and high-value care, the practices will either get to keep or have to repay the up-front incentive payments based on their performance on utilization and quality metrics. The payments under this model encourage physicians to concentrate on health outcomes, as opposed to the volume of tests or visits, CMS said.

And although the initiative is ultimately meant to improve cost and quality while granting doctors and patients more control over health care delivery, it spotlights and encourages the use of home health, telemedicine and community-based services.

For people with MCS/ES, exposures can  trigger temporary or long term brain and behavior issues that look like mental health problems to people who don’t know how toxic chemicals, molds, food sensitivities, or wireless exposures can affect our brains and bodies. And sometimes we are capable of doing some things, yet completely incapable of doing others, as exposures can affect different parts of our bodies and brains, and for varying amounts of time.

What people also don’t understand, is that when we are able to live free of those exposures, we can be free of the brain or behavior problems the exposures cause.

Finding ways to access goods and services without being subjected to disabling levels of exposures can take 10 to 100 times more effort than people normally have to extend for the same goods and services. Sometimes, despite our best efforts, we cannot safely access the goods and services everyone else takes for granted. These challenges can mean we may need to turn to others for help with survival and coping , yet not only is it difficult to receive practical support,

Cilantro is one of the most effective and gentle detoxifiers of heavy metals and other toxic contaminants. It is excellent for extracting mercury from your body’s organs. Heavy metals have been linked to serious health problems such as cancer, heart disease, brain deterioration, emotional problems, kidney disease, lung disease, and weak bones.

Cilantro is a rich source of minerals, such as potassium, calcium, manganese, iron and magnesium.  It contains high amount of vitamins A and K. It is also a proven antiseptic, antifungal and anti-inflammatory; it can help quickly reduce infection and inflammation as it works to clear your system.