What works for a spouse with dementia? Alzheimer's disease and other forms of dementia represent an exponentially growing social and health care challenge for American families - not only family members who face the progressive brain disease, but also those who love them. Many spouses of those with dementia do more than watch as their partners deal with the disease's effects on brain functioning, memory, motor skills and emotional health. They often assume round-the-clock caregiving responsibilities as their husband or wife of many years faces progressive decline. Communication can become a particularly difficult issue. "We found that breakdowns in communication may trigger or deepen problem behaviors in family members with dementia, " says Marie Savundranayagam, assistant professor of social work at the University of Wisconsin-Milwaukee (UWM). "These problem behaviors by those with dementia, such as agitation and aggression, have consistently been linked with caregiver stress ." Through a UWM Research Growth Initiative grant and an Alzheimer's Association New Investigator Research Grant, Savundranayagam is working to identify communication strategies used by caregivers to resolve communication breakdowns.
A large study of family child care providers shows that while nutrition standards are often met, most children ages 2 to 5 are not getting enough physical activity and are exposed to the television for most of the day. A study of about 300 home-based child care providers by Oregon State University's Stewart Trost, an internationally-recognized expert on childhood obesity issues, sheds light on both positive and negative aspects of family daycare providers. The findings are published in the December issue of the American Journal of Preventive Medicine. Trost, who directs the obesity prevention research core at the new Hallie Ford Center for Healthy Children at Oregon State, said a big concern was television exposure in such a young age group. The providers surveyed were caring for young children up to age 5, and two-thirds of providers said they had the TV on most of the day. The American Academy of Pediatrics recommends no more than two hours of television per day for children between the ages of 2 and 5, and discourages any television viewing for children younger than 2.
New Study: State-by-state Impact Of Proposed Medicare Cuts To Skilled Nursing Facility Care For Seniors
A new American Health Care Association (AHCA) analysis of the pending House health reform bill, combined with the impact of a recently-enacted Medicare regulation cutting Medicare-funded nursing home care by $12 billion over ten years, finds seniors in fifteen states requiring nursing and rehabilitative care will face total funding cuts in excess of $1 billion over that same time period. Nationally, the study finds, seniors' Medicare cuts will total $44 billion over ten years, prompting AHCA President and CEO Bruce Yarwood to warn that U.S. seniors' care needs are endangered by the House bill, as are the jobs of more than 50, 000 caregivers nationwide. "The bottom line is that U.S. seniors' Medicare-funded nursing care will be substantially undermined by the pending health reform bill in the U.S. House of Representatives, and we urge lawmakers to use the last two weeks of the August district work period to revise its plan to ensure seniors are helped by the reform measure - not hurt by it, " said Bruce Yarwood, President and CEO of AHCA.
A longer life expectancy has led to an increased demand for family members to serve as caregivers for older adults. Caregiving can be a demanding, stressful and seemingly thankless job, but really it is an amazing gift to allow a loved one to "age in place" rather than in a clinical setting. SCAN Health Plan Arizona, a private nonprofit Medicare Advantage Plan, offers these seven secrets to success for caregivers of older adults: 1. Learn about your loved one's illness(es). As a caregiver you become the eyes of the physician and voice of the patient. Be sure that you can knowledgeably speak to the symptoms, challenges and changes of your loved one's physical and mental health. 2. Seek support. Caregivers needn't face their challenges alone. There are many resources and support groups to help you; the key is to find them. Some Medicare Advantage plans, like SCAN Health Plan, provide caregiver relief, in-home support, access to medical equipment, transportation options, and care coordination between the doctors and you.
The risk of infant death following planned home birth attended by a registered midwife does not differ from that of a planned hospital birth, found a study http://www.cmaj.ca/press/cmaj081869.pdf published in CMAJ (Canadian Medical Association Journal). The study looked at 2889 home births attended by regulated midwives in British Columbia, Canada, and 4752 planned hospital births attended by the same cohort of midwives compared with 5331 physician-attended births in hospital. Women who planned a home birth had a significantly lower risk of obstetric interventions and adverse outcomes, including augmentation of labour, electronic fetal monitoring, epidural analgesia, assisted vaginal delivery, cesarean section, hemorrhage, and infection. The safety of home births is under debate. American, Australian and New Zealand Colleges of Obstetricians and Gynecologists oppose home births while the United Kingdom's Royal College of Obstetrics and Gynecology and the Royal College of Midwives are supportive, as are midwife organizations in Canada, Australia and New Zealand.
Many families struggle on a day-to-day basis with insufficient in-home care or problematic out-of-home care for their emotionally or behaviorally troubled children and adolescents. Researchers have recently shown that an integrative family care model, which incorporates the strengths of external agencies and care providers, may be the answer. The latest issue of Family Process features this new model. The I-FAST system was developed specifically to assist families dealing with a diversity of ongoing, severe, emotional and behavioral issues. Its foundational techniques are based on evidence-based practices found within the mental health and psychotherapy communities. I-FAST allows clinicians, therapists, case managers, and agencies working with at-risk children, adolescents, and families to modify and creatively tailor their approach to meet the needs of their clients. These measures can not only improve the child's and family's situation and overall functioning level, but can also reduce frequent out-of-home placements and train parents to directly care for their children's problems at the home with less difficulty.
A one-year evaluation at Group Health Cooperative is the first to demonstrate the measurable benefit to both patients and staff when a primary care practice adopts a "patient-centered medical home" model. This model gives patients more time with doctors, more preventive care, and improved collaboration among caregivers. The September 2009 American Journal of Managed Care will publish the results - which include significantly fewer emergency room visits and hospitalizations. Much national attention is focused on the medical home model as a way to improve health outcomes, control costs, and help solve the U.S. shortage of primary care (from generalists). A medical home provides expanded primary care that is personalized, focuses on prevention, actively involves patients in making decisions about their care, and helps coordinate all their care and get their health needs met. The new study provides some of the nation's first empirical evidence of the benefits of this new type of care.
Colorado Braces For Mental Health Cuts, Florida Nursing Homes Brace For Medicare Cuts, And Other Developments
Today's state coverage includes anxieties about Medicare cuts, tips from Massachusetts health officials and executives and a pro-migrant court ruling in Hawaii. Kaiser Health News : "Three years after Massachusetts implemented a state program to provide near universal health care, officials said that a key to their success was that stakeholders from the state's health care sector and the business community had a commitment to implementing the program." Despite successes, one state official said cost containment remains a challenge (Marcy, 9/1). Boston Globe : A new health program for migrants in Hawaii, scheduled to begin Tuesday, was postponed by a judge, who ruled that the program failed to live up to an obligation promised by the U.S. after nuclear weapons tests in the Pacific Islands. The plan would not have covered dialysis and chemotherapy treatments for the migrants (Niesse, 9/1). The Florida Times-Union : "Plans to cut Medicare spending to pay for a health care overhaul in America will cost Florida nursing homes nearly $3.
In his latest Kaiser Health News column, Howard Gleckman writes: "In the ongoing congressional debate over the CLASS Act - the proposed national long-term care insurance program - critics and supporters have been arguing over whether a benefit of $50- or even $75-a-day is worthwhile. Some in the insurance industry, for instance, assert that given the high cost of care in nursing facilities and even at home, a $75 benefit is hardly worth the premium cost" (12/14). Read entire column. This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org. © Henry J. Kaiser Family Foundation. All rights reserved.
NPR : "Twenty-two years ago, the federal government started keeping a list of nurses, nurse aides, pharmacists and pharmacy aides who've been disciplined by state licensing boards. It's called the Healthcare Integrity and Protection Data Bank. But hospitals and nursing homes aren't allowed to see the database." The database was intended to be "open to hospitals and nursing homes when they hire staff and want to run a background check. But the Department of Health and Human Services never completed the regulation implementing the law. Turns out, slow-moving bureaucracy is the main culprit." A separate data bank of doctors who have been disciplined is open to hospitals. Dr. Sidney Wolfe, head of the consumer advocacy organization Public Citizen's Health Research Group "notes there are more than 102, 000 nurses, nurse aides, pharmacists and pharmacy assistants who've been disciplined and included in the registry." States have their own open databases, but Wolfe "says there's a need for access to a centralized, federal data bank.