10% of People with Dementia May Actually Have Different Disease, Research Suggests
Becker’s Clinical Leadership | By Ashleigh Hollowell
Certain cases of dementia — potentially up to 10% — could instead be undiagnosed liver disease and related neurological issues, according to a study published Jan. 31 in JAMA.
Additionally, researchers believe that the 10% of undiagnosed liver disease and brain dysfunction could possibly be resolved with treatment.
For the study, researchers analyzed a decade of data — spanning 2009 to 2019 — from 177,422 veterans who had a diagnosis of dementia, and looked for a high Fibrosis-4 score, which is a sign of advanced liver fibrosis that can lead to cirrhosis.
Across the dataset, around 10.3% of patients who did not previously have a cirrhosis diagnosis showed high Fibrosis-4 scores and signs of hepatic encephalopathy (HE), a neurological disorder that is often challenging to distinguish from dementia.
But, a reversal of symptoms is possible through treatment for metabolic encephalopathies like HE, and researchers suggest clinicians pay particular attention to "the determinants of undiagnosed cirrhosis among veterans with dementia" and use that information to help properly "identify those eligible for screening and subsequent HE therapy." |
For Home Care Providers Still Invested In Medicare Advantage Business, Patience Is Wearing Thin
Home Health Care News | By Andrew Donlan
Around 2019, Medicare Advantage (MA) was all the rave among home care providers.
That’s because, in 2018 and 2019, two pathways opened for MA plans to provide more benefits to beneficiaries: the primarily health-related benefit pathway and the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway.
Included in those were plenty of areas of opportunity for personal home care providers to step in and become more involved with the Medicare dollar. In-home support services (IHSS), namely, were a popular benefit that providers theoretically stood to benefit from.
But, since 2019, that optimism around MA has waned for most. The return on the investment has largely not been there.
For one, providers that generally dealt with private-pay clients were met with less favorable rates in MA, plus less reliable scheduling for their caregivers. Then, particularly recently, the growth in plans’ adoption of SSBCI and primarily-health related benefits has slowed.
This year, for instance, 867 plans are offering IHSS as a supplemental benefit, according to the research and advisory firm ATI Advisory. That’s a significant drop off from 2023, when 1,308 plans were offering the benefit.
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New Legislation Would Expand Access to Occupational Therapy
NAHC Report
In a promising bipartisan effort, the Medicare Home Health Accessibility Act, H.R. 7148, has been introduced by a coalition of legislators including Reps. Lloyd Smucker (R-PA-11), Dr. John Joyce (R-PA-13), Paul Tonko (D-NY-20), and Lloyd Doggett (D-TX-37). This crucial bill aims to revolutionize home health care by allowing occupational therapy (OT) to be ordered as a stand-alone service for Medicare beneficiaries.
Currently, OT services are excluded from qualifying beneficiaries for Medicare’s Part A home health benefit. This limitation means that OT services can only be provided in a beneficiary’s home if other therapy services, such as nursing, physical therapy, or speech and language pathology, are simultaneously ordered at the start of care.
Congressman Lloyd Smucker (PA-11) expressed his enthusiasm for the bill, stating, “The Medicare Home Health Accessibility Act will ensure beneficiaries can receive the care they need in a setting that more and more prefer—at home. Our commonsense measure will tailor home health orders to each patient, maximizing their ability to thrive at home and avoid costly rehospitalizations.”
Congressman John Joyce, M.D. (PA-13), emphasized the bipartisan nature of the bill, calling it a “game changer for patients who wish to heal and recover in the comfort of their homes.” He stressed the importance of in-home occupational therapy, especially in rural communities.
The proposed legislation received widespread support from Congressman Lloyd Doggett (D-TX-37), who highlighted the critical role home- and community-based care play in the healthcare system. Removing unnecessary barriers to receiving health care at home, he said, would provide more patient choices and access, particularly benefiting seniors.
Congressman Paul Tonko (D-NY-20) pointed out that passage of the bill would better target home health services to meet specific patient needs, particularly in preventing falls and accidents, ultimately enabling Medicare beneficiaries to remain independently at home.
The National Association for Home Care and Hospice (NAHC) supports this new legislation and applauds the sponsors for their leadership. With the bill’s introduction NAHC President Bill Dombi said, “It is time that Congress rectify a long-standing weakness in the home health benefit by making occupational therapy a qualifying skilled service. OT is an essential service not only for patients, it also is a proven means to saving Medicare expenditures.” |
Increasingly, Americans Believe Government Should Pay for Aging Care, Study Finds
McKnight’s Home Care | By Adam Healy
As families and unpaid caregivers endure high out-of-pocket costs for care, a growing share of adults have called for greater government assistance for aging in place.
In 2012, about 37% of American adults believed the government should pay for elder care services. But by 2022, the share of people who believed the government should help pay these costs had grown to 51%, according to a new study published by the American Sociological Association.
The share of people who think families should foot the bill for aging care is also shrinking. In 2012, 48% of people agreed that older adults and their families should be responsible for the costs of aging in place. By 2022, the share had shrunk to 28%.
The average out-of-pocket costs of providing loved ones with unpaid care is more than $7,000 annually. And for those who are employed, caregiving can have a significant toll on work responsibilities and performance, and many are forced to forego career advancement opportunities or even delay their retirement to support aging loved ones.
A growing proportion of people also believe that the government should be primarily responsible for providing aging care services. About a quarter of respondents indicated that the government itself should help older adults with services such as housekeeping duties, grocery shopping and assistance with other activities of daily living.
However, results differed by age. Of a sample of almost 2,400 people, older adults were more likely to expect aging support from their family members. Younger adults, who are often responsible for providing unpaid care for older family members, were more likely to believe the government should offer financial assistance for aging care than older adults.
“These results could be due to increasing pressure from an aging population or potentially a reaction to a real-world event (i.e., the coronavirus disease 2019 pandemic) that unevenly affected older adults and affected families’ ability to provide care,” the researchers wrote in the study published Jan. 17. “This change in attitudes may reflect changing norms about the social programs the government should provide to older adults and changes in family expectations for care.”
On Jan. 30, congressional representatives introduced the Credit for Caring Act, which would help offset caregivers’ out-of-pocket expenses by providing a tax credit up to $5,000 for personal care, respite care, transportation assistance and other kinds of home care. |
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