Do Taxpayer Dollars Result in Good Nursing Home Care?
More than $7 billion of Medicaid funds goes into the nursing home industry annually, yet little of this money encourages quality care. To ameliorate this crisis, the Long Term Care Community Coalition, supported by The New York Community Trust, has released a report, Modifying the Case-Mix Medicaid Nursing Home System to Encourage Quality, Access and Efficiency (available at http://www.nursinghome411.org). It is the first major effort to examine, from a consumer perspective, whether the different ways nursing homes receive funding actually result in good care for vulnerable residents and are a smart use of taxpayer dollars. The report recommends major changes in the New York State nursing home Medicaid reimbursement system to both save money and focus on quality.
Gathering information from 34 other states as well, the report presents more than 30 recommendations for improving the system. Some of these include:
- The state should set specific goals, required programs, and positive resident outcomes for any additional funds given to facilities to encourage admittance and proper care of hard-to-place residents or residents with special needs.
- Encourage facilities to spend more on direct care by permitting providers to spend more than the average in this area.
- Put caps on reimbursement in indirect areas such as administrative costs.
- Link reimbursement to facility performance on inspections.
- Reward facilities that develop energy efficient systems or make “green improvements” to their facilities.
Source.“Do We Get What We Pay For With Nursing Home Care?” (2009, March 16). Retrieved April 1, 2009, from http://nursinghome411.org/documents/prreimbursementreport.pdf.
Online Resource Helps with Medication Management
A free downloadable online tool from AARP makes it easy for older adults to manage their medications safely and effectively. An initiative of Create the Good, a network of independent volunteers active in neighborhoods across the country, Rx Snapshot is an easy way to help older Americans record the drugs they are taking and talk with their health care professional about how they might better manage their medications. The free resource is available at http://www.AARP.org/CreateTheGood.
AARP is encouraging people to download the tool and either call older relatives and loved ones or organize a community group to help neighbors fill out the brief document. The Rx Snapshot toolkit gives older Americans a way to keep updated records of their medications, tips to having a conversation with their health care provider about the risks and benefits of their prescriptions, and the opportunity to consider generic drugs as money-saving alternatives.
Source.“New AARP Initiative Encourages Community Members to Help Others Better Manage Their Prescriptions.” (2009, March 12). Retrieved April 1, 2009, from http://www.aarp.org/aarp/presscenter/pressrelease/articles/Rx_Snapshot.html.
Few Friends OK, but Loneliness is Harmful
According to a study published in the Journal of Health and Social Behavior, older people who are able to adjust to being alone do not have the same health problems as those who also feel lonely. For their research, the investigators examined the results of the National Social Life, Health and Aging Project, a nationally representative study of older adults. The study, a comprehensive look at aging and health, included interviews with approximately 3,000 people ages 57 to 85 between 2005 and 2006. Investigators were able to consider in detail older adults’ social networks, their participation in social activities, their feelings of loneliness, and their perceptions of the availability of help or advice from friends and family members. They also asked questions about physical and mental health and feelings of sadness or depression.
Investigators found that older adults who feel most isolated reported 65% more depressive symptoms than those who feel least isolated, regardless of their actual levels of connectedness. In other words, social disconnectedness is not related to mental health unless it brings feelings of loneliness and isolation.
For a closer examination of the relationship between friends and loneliness, specifically among older women who live alone, see the article by Eshbaugh in this issue of JGN (pp. 13–16).
Source.“Few Friends Combined with Loneliness Hurts Health for Elderly.” (2009, March 18). Retrieved April 1, 2009, from http://www.medicalnewstoday.com/articles/142825.php.
New Knees at 80 Can Improve Quality of Life
© iStockphoto.com/ Steven Reed
Knee replacement surgery, once considered too risky for patients in their 80s, may have a new reputation, now that adults are living longer. A study presented at the 2009 annual meeting of the American Academy of Orthopaedic Surgeons found that patients in their 80s can benefit both physically and socially from knee replacement surgery.
The study team reviewed data from 128 patients older than age 80 who underwent knee replacement surgeries at Singapore General Hospital between October 1998 and December 2006. The results were measured using two quality of life scales, the Short Form-36 and the Oxford Knee Score, which assign scores to elements of physical and emotional health, such as physical pain, social functioning, vitality, and physical functioning. When researchers compared the patients’ preoperative scores with their postoperative scores up to 2 years following surgery, they found the patients’ quality of life scores had risen significantly during the postoperative period. According to the researchers, the patients’ improvement in pain and function was remarkable as early as 6 months and continued through the 2-year follow up.
Source.“Octogenarians: Not Too Old for Joint Replacement.” (2009, February 17). Retrieved April 1, 2009, from http://www.medicalnewstoday.com/articles/140476.php.
Reasons Cited for Lag in Alzheimer’s Treatment
A survey of neurologists and primary care physicians (PCPs) has found that 70.7% of newly diagnosed Alzheimer’s disease patients do not receive treatment within a year of being diagnosed for reasons such as patient denial, preference for no drug therapy, concerns about cost, or the side effect and safety risks associated with drug treatment. In addition, the report, Treatment Algorithms in Alzheimer’s Disease, from Decision Resources, found that while neurologists primarily attribute their decision not to prescribe treatment for newly diagnosed Alzheimer’s disease patients to patient prerogatives, PCPs also cite presence of mild disease as a factor to delay drug treatment.
Another facet of the survey focused on the anticipated integration of disease-modifying therapies expected to launch by 2012, such as Elan/Wyeth’s bapineuzumab, into Alzheimer’s disease treatment: 72% of surveyed neurologists and 63% of surveyed PCPs report they are very likely or likely to prescribe disease-modifying therapies first line after their launch. Forty-five percent of surveyed neurologists knew of bapineuzumab, and 65% of this group believe they will prescribe the drug if it is approved. In contrast, only 8% of surveyed PCPs were aware of the drug but were enthusiastic about its potential.
Source.“Seventy Percent of Newly Diagnosed Alzheimer’s Disease Patients Do Not Receive Treatment Within a Year of Diagnosis.” (2009, February 23). Retrieved April 1, 2009, from http://www.medicalnewstoday.com/articles/140045.php.
Online Tool Offers Drug Interaction Info
In response to recent reports citing increases in at-home deaths from medication errors, MMR Information Systems, Inc., which through its subsidiary MyMedicalRecords, Inc. provides consumer-controlled Personal Health Records (PHRs) and electronic safe deposit box storage solutions, has made its comprehensive Prescription Drug Database available for free at the MyMedicalRecords PHR Web site ( http://www.mymedicalrecords.com). Using the Cerner Multum® Drug Content Database, visitors can immediately check for potential adverse interactions (including with food) across multiple prescription and over-the-counter drugs in a single step. The customized database includes detailed information on more than 20,000 drugs, with potential adverse reactions across all of them. MyMedicalRecords PHR account holders are also able to maintain an ongoing database of prescription and over-the-counter medications taken by up to 10 family members (including pets) in a secure online account.
Source.“Drug Interaction Tool Offered Free in Response to Increasing At-Home Deaths From Medication Errors.” (2009, March 3). Retrieved April 1, 2009, from http://www.reuters.com/article/pressRelease/idUS207850+03-Mar-2009+PRN20090303.
Diabetes, Cholesterol Linked to Cognitive Decline
The ability to follow patients before they began to show symptoms of Alzheimer’s disease and for several years following their diagnosis has allowed a group of researchers to study the role of vascular risk factors in the onset and progression of Alzheimer’s disease. The study, published in the Archives of Neurology, shows that a history of diabetes and elevated levels of cholesterol, especially LDL cholesterol, are associated with faster cognitive decline in patients with Alzheimer’s disease.
The research team used longitudinal data for a mean of 3.5 years (up to 10.2 years) for 156 people diagnosed with Alzheimer’s disease who were participants in the Washington Heights/Inwood Columbia Aging Project, a 10-year multiethnic, prospective, epidemiological study of cognitive aging and dementia in northern Manhattan. They found that a history of diabetes and higher cholesterol levels (total cholesterol and LDL) were associated with faster cognitive decline. A history of heart disease and stroke was found to be associated with cognitive decline only in carriers of the apolipoprotein E*4 gene, which has been implicated in late-onset Alzheimer’s disease.
Source.“Diabetes & Elevated Cholesterol Linked to Faster Cognitive Decline in Alzheimer’s.” (2009, March 5). Retrieved April 1, 2009, from http://www.medicalnewstoday.com/articles/141607.php.
Cost of Drugs Causes Some to Skip Treatment
A national telephone survey of 2,004 adults age 18 and older conducted by Consumer Reports has found that the cost of medications is causing consumers to cut corners and fail to adhere to treatment. Sixty-six percent of those polled said they found out the cost of a drug when they picked it up at the pharmacy counter, while just 4% said they had a conversation with their physician about the cost of a drug. In addition, 28% of Americans reported they had taken potentially dangerous actions to save money, such as not filling prescriptions, skipping dosages, and cutting pills in half without the approval of their physician. In a separate poll of Hispanic consumers, Consumer Reports found that half of Hispanic Americans are not following through on their physicians’ prescriptions, and nearly 3 in 10 had decided against filling one for cost reasons.
Consumers’ misgivings about generic drugs were also expressed in the survey: Nearly half of those polled (47%) had reservations or misconceptions about taking generic drugs, and 46% said their physician never or sometimes recommended generics.
The poll was released in conjunction with Consumer Reports Best Drugs For Less, a 60-page magazine that rates more than 200 prescription drugs and over-the-counter medicines for more than 20 conditions including heart disease, asthma, diabetes, and depression. Best Drugs for Less can be purchased by visiting http://www.ConsumerReportsHealth.org, where the ratings can be accessed for free.
Source.“Consumer Reports Poll: 66% of Americans Blindsided by Cost of Drugs; Many Not Taking Needed Medications.” (2009, March 17). Retrieved April 1, 2009, from http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=ind_focus.story&STORY=/www/story/03-17-2009/0004989617&EDATE=.