What Causes One of Stroke's Most Common Complications?

Medscape | Batya Swift Yasgur, MA, LSW

The mechanisms underlying poststroke depression (PSD), a common and debilitating complication of stroke, are unclear. Is it neurobiological, psychosocial, or both?

Two studies offer new insight into this question. In the first, investigators systematically reviewed studies comparing stroke and non-stroke participants with depression and found the groups were similar in most dimensions of depressive symptoms. But surprisingly, anhedonia was less severe in patients with PSD compared with non-stroke controls, and those with PSD also showed greater emotional dysregulation.

"Our findings support previous recommendations that clinicians should adapt the provision of psychological support to the specific needs and difficulties of stroke survivors," lead author Joshua Blake, DClinPsy, lecturer in clinical psychology, University of East Anglia, Norwich, United Kingdom, told Medscape Medical News.

The study was published online on September 5, 2023, in Neuropsychology Review.

A second study used a machine learning algorithm to analyze blood samples from adults who had suffered a stroke, determining whether plasma protein data could predict mood and identifying potential proteins associated with mood in these patients.

"We can now look at a stroke survivor's blood and predict their mood," senior author Marion Buckwalter, MD, PhD, professor of neurology and neurosurgery at Stanford Medicine, California, said in a news release. "This means there is a genuine association between what's happening in the blood and what's happening with a person's mood. It also means that, down the road, we may be able to develop new treatments for PSD."

The study was published in November 2023 in Brain, Behavior, and Immunity.

'Surprising' Findings

"There has long been uncertainty over whether PSD might differ in its causes, phenomenology, and treatability, due to the presence of brain injury, related biological changes, and the psychosocial context unique to this population," Blake said. "We felt that understanding symptomatologic similarities and differences would constructively contribute to this debate."

The researchers reviewed 12 papers that sampled both stroke and non-stroke participants. "We compared profiles of depression symptoms, correlation strengths of individual depression symptoms with general depression, and latent item severity," Blake reported.

They extracted 38 symptoms from five standardized depression tools and then organized the symptoms into nine dimensions.

They found mostly nonsignificant differences between patients with PSD and non-stroke controls in most dimensions, including negative affect, negative cognitions, somatic features, anxiety/worry, and suicidal ideation. Those with PSD more frequently had cognitive impairment, and "work inhibition" was more common in PSD.

But the most striking finding was greater severity/prevalence of emotional dysregulation in PSD vs non-stroke depression and also less anhedonia…

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Draft OASIS-E1 Instrument Now Available

NAHC Report

The Centers for Medicare & Medicaid Services (CMS) recently posted the draft OASIS-E1 All Items instrument, scheduled for an effective date of January 1, 2025. The accompanying OASIS-E1 Manual will be released at a later date. An Office of Management and Budget (OMB) number and the information collection timeframe estimate are yet to be assigned. 

The OASIS document needs to be updated to accommodate some changes related to policy including the end of the temporary suspension of OASIS for non-Medicare/non-Medicaid home health patients and the removal and addition of OASIS items related to measures for the Home Health Quality Reporting Program (HHQRP), payment calculation, and/or Medicare conditions of participation.

Beginning in 2025, home health agencies will need to collect OASIS data for all patients regardless of payor source. Existing exemptions will continue for those under the age of 18, receiving maternity services, or those receiving only personal care, housekeeping or chore services.  A phase-in period is in place for January 1, 2025 through June 30, 2025 in which failure to submit the data will not result in a penalty.  Mandatory collection and reporting begin with discharges on or after July 1, 2025.

CMS is adding the COVID-19 Vaccine measure to the HH QRP necessitating the addition of data collection through the OASIS and also removing OASIS items that are no longer necessary:

  • M0110 – Episode Timing
  • M2220 – Therapy Needs
  • GG0130 and GG0170 – Discharge Goal

NAHC staff are reviewing the document and will provide more information after an analysis of the to be released OASIS-E1 Manual.
 

CAHPS Hospice Survey Updates

NAHC Report

The CAHPS Hospice Survey Technical Corrections and Clarifications to the CAHPS Hospice Survey Quality Assurance Guidelines V10.0 (QAG V10.0) document has been posted. Specific content items that were corrected, added and/or clarified include:

The CAHPS Hospice Survey mail and telephone materials from the Quality Assurance Guidelines V10.0 (QAG V10.0) in all approved translations have also been posted. To view or download the mail materials, please click here and to view or download the telephone materials please click here. Survey vendors must utilize the revised CAHPS Hospice Survey materials beginning with January 2024 decedents (caregivers surveyed beginning April 1, 2024).

The Centers for Medicare & Medicaid Services (CMS) has also made available a bibliography of publications from the CAHPS Hospice Survey Project Team to make locating research on the survey easier. No new research information has been added.
 

HCBS Staffing Shortages Lead to Severe Cuts to Programs, Services, New Report Finds

McKnight’s Home Care / By Adam Healy
 
With the vast majority of home- and community-based services providers suffering from a lack of direct support workers, patients in need of home care have fewer programming options. 
 
Among 581 HCBS providers across 45 states, as many as 95% have experienced moderate to severe staffing shortages throughout 2022 and 2023, according to the American Network of Community Options and Resources’ (ANCOR) most recent State of America’s Direct Support Workforce Crisis survey. And as a result, 77% have had to turn away patients due to a lack of available workforce, and more than half said they have had to discontinue programs because of their staffing situations.
 
As part of the fallout from the shortage, connecting patients with care has become harder. About 75% of case management providers have experienced challenges connecting patients with services, since many are understaffed and unable to accept new patients. And though many states have laws barring providers from turning away new referrals, wait lists can make it just as difficult to access care.
 
“Even if someone is cleared from their state’s waiting list and approved to seek services, they are likely to continue facing barriers because of a lack of available providers,” the researchers wrote.
 
Lack of staff also makes it more challenging to meet quality standards. More than 70% of survey respondents said this was the case, and the HCBS Settings Rule implemented by the Centers for Medicare & Medicaid Services has made compliance even trickier, according to the report.
 
The biggest problem, according to ANCOR, is the lack of sufficient funding for HCBS programs. Many funding flexibilities put in place during the COVID-19 public health emergency have reached their expiration date.
 
“The roots of our ongoing direct support workforce crisis trace back to one source: underinvestment in Medicaid,” They noted. “Insufficient reimbursement rates in the Medicaid program have long hindered the ability of providers to compete for labor against other hourly wage industries.”
 
Last month, the Biden administration celebrated the American Rescue Plan Act’s investment of $37 billion in states’ HCBS programs.
 

IRS Issues Standard Mileage Rates for 2024

SESCO Management Consultants

  • The Internal Revenue Service (IRS) has released the optional standard mileage rates for 2024.
  • The standard mileage rates for 2024 are: 67 cents per mile for business uses; 21 cents per mile for medical uses; and 14 cents per mile for charitable uses.
  • FAVR allowance for 2024. For purposes of the fixed and variable rate (FAVR) allowance, the maximum standard automobile cost for vehicles places in service after 2023 is $62,000. Employers can use a FAVR allowance to reimburse employees who use their own vehicles for the employer’s business.
 
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