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AAA Warman Home Care’s E-Update is intended to bring to you timely and useful articles and information at the click of the mouse. It is sent monthly in an effort to keep you apprised of what is happening across the healthcare continuum of care effecting hospital, hospice and rehabilitation social workers and case managers, as well as Assisted Living, Independent Living and Skilled Nursing facility executives. Warman understands that time is limited and has undertaken to share with you important industry information without your having to search for it.
As lawmakers return to Washington to tackle health care reform, AARP is pressing them to improve the country's long-term care system as a part of comprehensive reform. Millions of older Americans rely on Medicaid for the long-term services and supports they need, but the program's bias toward institutional care prevents most from getting more affordable care where they want it: their own homes.
"It's shameful that so many people are forced into nursing homes when we could improve their quality of life and typically spend less money by caring for them at home," said AARP Executive Vice President Nancy LeaMond. "As we overhaul the health care system, we need to build on win-win solutions that expand choices and could save billions of dollars."
Under current law, Medicaid-the largest payer of long-term care-has an institutional bias. While states must provide coverage of nursing facility services, they do not have to cover most home and community based services (HCBS). On average, Medicaid can pay for three older people in HCBS for every one person in a nursing home. Despite this, HCBS is often one of the first programs to lose state funding during an economic downturn, often forcing more people into higher cost nursing facilities even if they would prefer to remain at home.
AARP has endorsed the Empowered at Home Act (S. 434), sponsored by Senators John Kerry (D-MA) and Chuck Grassley (R-IA), which would provide incentives and greater opportunities for states to expand access to home and community based services. It would also provide the spouses of people receiving HCBS with protection against impoverishment.
The Association has also endorsed the "Retooling the Health Care Workforce for an Aging America Act" (S. 245/H.R. 468) sponsored by Senators Herb Kohl (D-WI), Bob Casey (D-PA) and Blanche Lincoln (D-AR), and Representative Jan Schakowsky (D-IL). This legislation would provide support, training and information to family caregivers, and improve the health and long-term care workforce to better meet the needs of the aging population.
LeaMond added: "Real health care reform isn't only about covering every American. It's also about rethinking how we provide care. Allowing people to live in their homes with their loved ones means a drastic improvement in the quality of life and potentially huge cost savings in the long term."
SOURCE: AARP, June 4, 2009
Taking aspirin in your 40s could cut the risk of cancer developing later in life, according to research published in the Lancet Oncology.
We all know that vitamin D and calcium are good for bones, but research teams in Europe and USA have shown that both taken daily reduces the rate of hip fracture in older people by 20%.
Speaking at the European Symposium on Calcified Tissue in Vienna today (27 May), Professor Bo Abrahamsen from the Copenhagen University Hospital Gentofte in Denmark, described the results from a major study analyzing seven trials examining the effects of low doses of vitamin D with calcium in 68,500 patients.
Participants in the study were aged 47 - 107 years old, average age 69. Their age, gender and fracture history were taken into account, together with medication such as hormone replacement therapy and bisphosphonates (used in the treatment of post-menopausal osteoporosis and osteoporosis in males). Patients in all the trials included were randomized to receive either vitamin D (given alone or with calcium, usually in the form of 1000 mg calcium carbonate daily) or no active treatment. "The real strength of this study was that we were looking at groups and individuals, not just summary statistics. We were able to calculate absolute fracture rates and the time to treatment effects," he said.
After about 16 months, the reduction in hip fracture rates by 20% was seen in people who took vitamin D (10ug; 400 IU) and calcium (1000 mg) together, regardless of age, gender and fracture history. Fracture rate in other bones was reduced by 10%. "Vitamin D on its own is not very effective, even if the dose is doubled," said Professor Abrahamsen, a consultant physician at the hospital. "In people over fifty, the combination of vitamin D with calcium, however, seems to work equally well in people with or without a history of bone fractures - this is important new knowledge," he said.
The impact of calcium plus vitamin D on fracture however is somewhat more modest than that seen for other osteoporosis interventions. People with a high risk of fracture will benefit more from being treated with specific osteoporosis drug therapies such as bisphosphonates, together with oral vitamin D and calcium.
Professor Tahir Masud from Nottingham University Hospital and a UK collaborator said, "Previous data have shown that there is a high degree of vitamin insufficiency in the older population in the UK. Many older people at high risk of fracture do not receive vitamin D and calcium supplements."
The study cannot separate the beneficial effects of daily vitamin D from daily calcium, but the results suggest that vitamin D by injection every three months given to many elderly patients does not make a big impact on fracture rates.
"We cannot yet recommend that all adult, healthy people should take oral vitamin D and calcium supplements to prevent bone fracture in later life, but our findings indicate that vitamin D supplements taken daily with calcium is a simple and cheap way of reducing the risk of bone fractures in people in late middle age and onwards, " said Professor Abrahamsen.
SOURCE: The European Calcified Tissue Society, May 29, 2009
Three patients at New York-Presbyterian Hospital/Columbia University Medical Center were among the first in the United States to be implanted with a next-generation artificial heart pump called the DuraHeart™ Left-Ventricular Assist System. The surgeries took place earlier this year. New York-Presbyterian/Columbia is one of only three centers in the U.S. currently enrolling patients in a clinical trial studying the device.
The DuraHeart is designed to sustain patients with severe left-ventricular heart failure while they wait for a heart transplant. Without intervention, they are at risk of death.
The surgeries were led by Dr. Yoshifumi Naka, director of cardiac transplantation at NewYork-Presbyterian Hospital/Columbia University Medical Center and associate professor of surgery at Columbia University College of Physicians and Surgeons. He elected to implant the device without stopping the heart and putting the patient on a heart-lung machine. This "off pump" approach reduces risk for bleeding and stroke associated with putting a patient on bypass.
"In this clinical trial, we hope to show that this device can help patients retain a healthy and meaningful quality of life while awaiting a heart transplant," says Dr. Naka, one of three national co-principal investigators of the DuraHeart trial. "Eventually, the DuraHeart may also prove to be a long-term solution, even for those ineligible for transplantation."
There are fewer than 2,500 hearts transplanted each year in the United States, while 500,000 to 800,000 patients have advanced heart failure; many do not qualify for transplantation due to other health issues. The average wait for a transplant is nine months due to a shortage of donor organs.
In patients with advanced heart failure, their heart isn't strong enough to pump sufficient blood for normal activities, leaving them greatly fatigued and frequently bedridden with difficulty breathing; heart failure is the number one reason for hospitalization. Mechanical heart pumps like the DuraHeart are designed to help the heart pump blood from the left ventricle to the aorta, increasing flow throughout the body. Previous research has shown the approach can help alleviate symptoms and improve survival.
The first left-ventricular assist device, or LVAD, became available in the mid-1980s. Since then, the technology has improved, becoming more compact and with fewer moving parts — including through clinical research at New York-Presbyterian/Columbia leading to the FDA approval of Thoratec's HeartMate® and HeartMate® II. The DuraHeart is considered a third-generation device, with unique features -- including a paddlewheel-like component called an impeller that is suspended by an electromagnet — eliminating any bearings or contact points and allowing it to work at slower speeds, potentially reducing device wear and risk for blood cell breakage.
The DuraHeart Trial will ultimately enroll 140 patients in up to 40 centers nationwide. The trial is designed for end-stage heart failure patients that have been placed on a heart transplant list in the U.S.
The trial is sponsored by Terumo Heart Inc. of Ann Arbor, Mich., maker of the DuraHeart System and a wholly owned subsidiary of Terumo Corporation of Tokyo, Japan.
SOURCE: New York-Presbyterian Hospital/Columbia University Medical Center, June 4, 2009
June 1, kicks off Sun Safety Week, and while the sun is a fundamental, life-fueling force, Health Net Inc. (NYSE:HNT) wants to remind everyone that it's important to remember that this standout star also is responsible for thousands of deaths annually due to skin cancer and heat-related illnesses.
"Skin cancer awareness has increased a lot in recent years, but I don't think that people are as well informed about the serious problems that can result from being in the heat," explains Jonathan Scheff, M.D., chief medical officer for Health Net, Inc.
And that lack of knowledge can be deadly. Scheff cautions, "Heat stroke can result in death, so it's important to regard it as a medical emergency." Heat stroke occurs when the perspiration mechanism fails, and the body becomes unable to control its temperature. In fact, heat stroke can send body temperature soaring to 106 degrees Fahrenheit or higher within 10 to 15 minutes.
As Scheff points out, "It doesn't have to be triple digits outside to experience heat stroke. If there's high humidity, there can be a danger at 75 degrees, particularly if you're exerting yourself physically."
Heat stroke warning signs, which require immediate medical attention, include:
Although less dangerous than heat stroke, heat exhaustion and heat cramps are serious conditions that pose a threat as the weather warms. According to Scheff, "Heat exhaustion most commonly occurs when people perspire heavily because they've overexerted themselves and this leads to dehydration." Common symptoms are: pale, clammy skin; weakness; dizziness; headache; nausea; vomiting; and fainting. Those experiencing heat exhaustion should immediately seek shade, hydrate with non-alcoholic, non-caffeinated beverages, and take a cool shower, bath, or sponge bath.
Heat cramps also are linked to overexertion and most often strike in the arms, legs, and abdomen. Scheff explains that when the body loses salt through profuse perspiration, painful cramps can result. If this happens, Scheff recommends stopping all activity, sitting in a cool place, and drinking clear juice, a sports beverage, or water.
"Prevention, of course, is the best option," says Scheff, "so you should limit your time in the sun and stay well hydrated." As a general rule of thumb, drink 16 fluid ounces of water before going out into the heat. Those working in the heat should drink one-half liter of water every half-hour.
Prevention also is the frontline defense against skin cancer, a disease that strikes 1.2-million Americans annually, according to the Sun Safety Alliance. Even more startling, melanoma — the deadliest form of — such as 30 to 45 — only needs to be applied once for full protection," Scheff notes. Adding, "To be effective, sunscreen should be reapplied every two to three hours, especially if you've been sweating or in the water."
The importance of staving off sunburns can't be overstated. "A history of severe sunburns," says Scheff, "unquestionably increases your risk of developing skin cancer." Additionally, warns the Sun Safety Alliance, one blistering sunburn can double a child's lifetime risk of developing skin cancer.
"Sun safety really needs to be taken seriously," observes Scheff. "Fortunately, the precautions that should be taken aren't difficult to do." For its part, the Sun Safety Alliance recommends:
SOURCE: Health Net, Inc, June 2, 2009
Over the past 20 years, the health care system has made tremendous progress in reducing the use of physical restraints among hospitalized elderly patients, a positive change that has had numerous ripple effects, improving outcomes, maintaining mobility and preserving dignity and independence for these individuals.
But, a new Congressional mandate changing hospital reimbursement made by the U.S. Centers for Medicare and Medicaid Services (CMS) could inadvertently reverse these positive steps, according to Beth Israel Deaconess Medical Center (BIDMC) gerontologist Sharon Inouye, MD, MPH, writing in The New England Journal of Medicine (NEJM). Inouye, a Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center at Hebrew Senior Life, points out in a "Perspective" editorial, that in an attempt to keep patients safe from falls, the CMC's good intentions may have adverse consequences.
"In 2005, in response to disturbing and widely cited findings by the Institute of Medicine about the prevalence of life-threatening conditions acquired by patients in U.S. hospitals, Congress authorized the CMS to implement payment changes designed to encourage the prevention of such conditions," write Inouye and coauthors Cynthia Brown, MD, of the University of Alabama and Mary Tinetti, MD, of Yale University. As such, Medicare will reduce reimbursement rates to hospitals if one of eight hospital-acquired conditions develops during the patient's stay; hospital falls and trauma were included as one of these eight.
"Our greatest concern is that the heightened focus on fall prevention will have unintended consequences," notes Inouye. These are likely to include a decrease in mobility and a resurgence in the use of physical restraints and other restraining devices, such as bed alarms, in what Inouye calls "a misguided effort to prevent fall-related injuries.
"While hospitals are understandably concerned about reductions in reimbursement as well as the public reporting of fall rates that could emanate from this mandate, the use of physical restraints can create other problems," she adds.
Physical restraints have long been used because they are believed to prevent falls. But studies have consistently shown that not only are restraints ineffective in reducing the risk of falls and related injuries, they are actually associated with increased rates of medical complications, including immobility, functional loss, delirium, agitation, pressure sores (which are themselves one of the non-reimbursable hospital-acquired conditions), asphyxiation, and death. Moreover, accumulating evidence suggests that restraints may actually increase the risk of falling or sustaining an injury from a fall.
"At present, there are no proven strategies that are documented to be effective in preventing falls in the hospital setting," explains Inouye. However, she adds, because previous studies have indicated that a change in mental status is the leading risk factor for falls in the hospital, strategies that incorporate multiple components may prove beneficial.
"In writing this 'Perspective,' my coauthors and I wanted to emphasize that there are alternatives to physical restraints that can help keep patients safe," says Inouye. One such program is the Hospital Elder Life Program (HELP), which prevents the onset of delirium through a number of interventions targeted at maintaining mobility, orientation, hydration and sleep. Early evidence lends strong support that this program is also effective in preventing falls.
"A guiding principle of medicine is 'First, do no harm,'" she adds. "Unfortunately, a resurgence in the use of physical restraints and restraining devices would erode over two decades of work to reduce the use of these devices and to enhance the safety of elderly patients during hospitalization."
SOURCE: Beth Israel Deaconess Medical Center, June 4, 2009
AAA Warman Home Care is a family-owned Residential Service Agency which has been providing in-home health care services to thousands of clients for the past twenty years. Warman specializes in providing the highest quality of private duty, non-medical care and companionship for the elderly, those recuperating after hospitalization / rehabilitation, the terminally ill, disabled, alone or at-risk. It is our goal to assist our clients in living the most independent, healthy and comfortable lives in the privacy of their own homes.
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