The AARP Public Policy Institute, in partnership with the Scan Foundation and Commonwealth Fund, released a report earlier this month that assess each state's system of long-term care services and supports.  The report includes 25 measures to assess affordability and access, choice of setting/provider, quality of life/quality of care; and support for family caregivers.  Support for family caregivers was measured by the percent of family caregivers who report usually or always getting assistance they need; a compilation measure that assesses state public policies that support family caregivers (i.e. paid leave, anti-discrimination policies, and spousal impoverishment); and the number of health maintenance tasks that can be delegated to direct care workers.  The authors also find that the national average price for nursing home care is 241% of older people's average annual household income, which leads many Americans to exhaust their life savings and then turn to Medicaid financed long-term care. For more information, visit: 

 

 
Leaked List Of $500 Billion In Potential Cuts For Medicare Program Over 10 Years

Congressional Quarterly reported earlier this month that the House Ways and Means Democratic staff has prepared a list of possible cuts for the Medicare program in preparation for potential cuts being considered by the supercommittee.  Some of the cuts have been previously recommended by MedPac, and include raising the eligibility age to 67 ($125 billion savings), requiring drug companies to pay rebates for drugs ($120 billion), and charging higher premiums to high-income Medicare patients for Part B and Part D benefits ($14 billion).  The Kaiser Foundation released a brief that explains the process and timeline for the supercommittee, as well as potential consequences to Medicare if the supercommittee can't agree on how to trim $1.3 trillion, or if Congress won't support their proposals.  For more information, visit:

Commonwealth Fund/CQ "Washington Health Policy Week in Review Ways and Means Democrats Outline Possible Medicare Cuts for Debt Panel" 

Kaiser Foundation: The Budget Control Act of 2011: Implications for Medicare 

 
Research Briefs Focus On Medicare, Levels Of Disability, Settings, And Cost

The Scan Foundation released four data briefs focused on Medicare recipients, where they live, and their utilization of services.  Data Brief No. 16 focuses on the rebalancing that states have engaged in with their LTSS systems, resulting in 58% of older Americans who need assistance with two or more ADL's living in the community or residential care settings while 38% reside in nursing homes.  Data Brief No. 17 addresses how Medicare spending varies for seniors with moderate or severe disabilities varies depending on the setting in which seniors live.  Medicare spent $14,594 per capita on nursing home residents, $14,001 on residential care residents, and $18,307 per capita on community residents in 2006.  Data Brief No. 18 compares expenditures on seniors with moderate or severe disabilities to seniors without disabilities and finds that seniors with disabilities use more services across all groups, with community-residing seniors having higher utilization of inpatient care.   Data Brief No. 19 analyzes spending for seniors with moderate or severe disabilities (needing assistance with two or more ADL's) and finds that 21% of seniors who live in community settings had hospital stays as compared to 12% for these seniors who reside in nursing homes.  All four of the briefs connect the policy issues with initiatives within the Affordable Care Act to address the issues contained in the brief.  

Scan Foundation Data Briefs
 

 

Study: 43% Of NC Nursing Home Contracts Contain Arbitration Agreements

A recent study by a law professor used a telephone survey and examination of admission contracts used by nursing homes in North Carolina from 2007 to 2009 and finds that 43% of the homes incorporated pre-dispute binding arbitration provisions in their admission contracts.  The author explains that all of the major nursing home chains used the agreements in at least some parts of their admissions contracts while smaller companies used them more sporadically.   In half of the agreements, the nursing home chooses the arbitration company, and the most popular company (36.59%) was the National Arbitration Forum, a company that agreed to stop doing business in credit card and healthcare arbitration after being sued by the Minnesota Attorney General in 2009.   Almost 70% of agreements allowed for consumer rescission within 30 days, though only 40% explained that the arbitration agreement essentially waived a right to a trial by jury.  In some cases, nursing homes required residents to sign the arbitration as a condition of admission, contradicting language in the agreements stating that signing the agreement was voluntary.  For more information, visit:  

Arbitration Agreements Used by Nursing Homes: An Empirical Study and Critique of AT&T Mobility v. Concepcion 

World Alzheimer's Report 2011: Start Earlier Diagnosis And Intervention  

Alzheimer's Disease International released its third annual report focused on Alzheimer's and the authors suggest that earlier diagnosis and intervention is preferred by people, may allow for more effective interventions, and may make better economic sense.  The authors explain that most people receive a diagnosis later in the stages of the disease (if at all), creating a "treatment gap."  Recommendations to address this gap include every country developing a national dementia strategy to promote early diagnosis and a continuum of care after diagnosis.  In a review of economic analyses, the authors suggest that earlier diagnosis could create savings of up to $10,000 per patient in high-income countries.  The authors also recommend all primary health care workers being trained in early detection of dementia, and where feasible, establishing specialist diagnostic centers for both diagnosis of Alzheimer's and formulation of care plans.  For more information, visit:  

"World Alzheimer Report 2011: The benefits of early diagnosis and intervention" (Executive Summary)   

Alzheimer's Disease Was Sixth Leading Causes Of U.S. Deaths In 2007

The Center for Disease Control recently released data on the leading causes of American deaths, and Alzheimer's was ranked as the sixth leading cause of U.S. deaths in 2007.  The data is divided by age, sex, and race, for example, Alzheimer's was the tenth ranked disease for males (accounting for 1.8% of deaths), but ranked fifth for females (accounting for 4.3% of deaths).  For more information, visit:  

National Vital Statistics Reports, Volume 58, Number 8 Deaths: Leading Causes for 2007  

Prescription Drugs: FTC Criticizes Delays; Study Finds Donut Hole Leads To Less Prescriptions Being Filled

The Federal Trade Commission (FTC) released a report in August that criticizes the pharmaceutical industry for "pay-for-delay" agreements between pharmaceutical companies and generic drug makers that delay the availability of generic drugs.  From Sept. 30, 2009 to Sept. 30, 2010, there were 15 drug patent settlements that included promises from generic drug companies to delay their generic version's entry to market, and the FTC suggests these types of agreements cost consumers $3.5 billion a year.  A recent report from the Kaiser Foundation finds that Medicare Part D beneficiaries who use drugs in one or more of nine drug classes fell into the "donut hole" in 2009 and these enrollees filled an average of 11% fewer prescriptions once they reached the donut hole.  For more information, visit:  

New York Times: "F.T.C. Criticizes Agreements That Delay Generic Drugs" 

FTC: "Authorized Generic Drugs: Short-Term Effects and Long-Term Impact" 

Kaiser Foundation: "Understanding The Effects of The Medicare Part D Coverage Gap in 2008 and 2009" 

Mild Cognitive Impairment Research Update

The New York Times recently addressed research on Mild Cognitive Impairment (MCI), a condition that is not as severe as Alzheimer's or other forms of dementia, though it may foretell these diseases.  A study in the June issue of the New England Journal of Medicine by Dr. Ronald Petersen on MCI cited previous research that suggests between 10 and 20% of people older than 65 have mild cognitive impairment.  Dr. Petersen explains two subtypes of the condition: amnestic and nonamnestic.  Amnestic MCI is more common and is associated with significant memory problems and forgetting important information and generally progresses to full-blown Alzheimer's.  Nonamnestic MCI is associated with difficulty making decisions, finding the right words, visual-spatial tasks, and navigating.  While the FDA has not approved any drugs to treat MCI, Dr. Petesen explains that Aricept and Namedna may be prescribed "off label."   Family Caregiver Alliance recently updated its MCI Fact Sheet with information for family caregivers and their loved ones with tips about MCI, necessary transitions, and community resources.  For more information, visit:

New York Times: "When Lapses Are Not Just Signs of Aging" 

Family Caregiver Alliance Fact Sheet: Mild Cognitive Impairment (MCI) 

Rosalinde Gilbert Innovations In Alzheimer's Disease Caregiving Legacy Awards   

The application deadline for the fourth annual Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards is this Friday, September 16th. The awards are given in three categories, Creative Expression, Diverse & Multicultural Communities, and Policy & Advocacy. Each of the three award recipients receive a $20,000 award, and applications are invited from non-profits, government agencies, and universities. The application deadline is September 16, 2011. For more information or to view the application, visit:

FCA: "Rosalinde Gilbert Awards Application"

 WSJ: Issues To Consider When Planning An Inheritance For Disabled Heirs

The Wall Street Journal recently addressed estate planning for parents whose children have a chronic disability.  Supportive programs like Medicaid often include asset and income tests that parents need to consider to avoid accidently disqualifying their adult children through an inheritance.  The supply of housing for adults with disabilities has not kept up with demand, and according to an ARC report, 2/3 of parents/caregivers don't have a plan for where the person they support will live when they are older.   The article suggests one possibility to address housing for a disabled adult is to use a trust to pay the mortgage and property taxes.  Special needs trusts are another strategy for parents to "spend down" to a level where they (the parents) will qualify for long-term care services without being penalized by Medicaid "look back" provisions.  Another possibility is leaving an inheritance to a sibling who can serve as the caregiver, though if the sibling divorces, that money could ultimately go to an ex-spouse instead of the adult disabled child.  For more information, visit:  

Wall Street Journal: "Taking Care of Disabled Heirs"