Monday, 19 May 2014

Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

Jails, treatment facilities, drug courts and hospitals are struggling to provide the necessary help as more Kentuckians become addicted to heroin, Chris Kenning writes for The Courier-Journal: "In a state that already had a shortage of drug-treatment options, the heroin problem is badly outstripping Kentucky's ability treat it." A Kentucky Health Issues Poll found that 9 percent of Kentuckians and 15 percent aged 18 to 29 reported awareness of a family member of friend struggling with heroin.

"We're just bursting at the seams," said Karyn Hascal, who is head of The Healing Place, a Louisville drug-treatment center. "I've been around 35 years, and I've never seen anything hit this fast and this hard." Though heroin users were few and far between several years ago, now they take up 90 percent of The Healing Place's detox beds.

The Louisville jail deals with 30 to 90 inmates every day. It has hired four around-the-clock detox nurses, started new detox dorm programs and added training officers since 2012, and "increased our inmate health-care budget by hundreds of thousands of dollars," said Metro Corrections director Mark Bolton.

Heroin may be "the most addicting drug there is," said Dr. Christopher Stewart, an addiction psychiatrist and medical director at the Jefferson Alcohol and Drug Abuse Center. Heroin crosses the blood-brain barrier and becomes morphine, "binding to opioid receptors in the brain and sparking an intense rush of pleasure and euphoria�one that's far more sharp and immediate than opiate pills," Kenning writes. People become immune to its effects and need to take more of it, and withdrawal symptoms include pain, vomiting, insomnia, spasms and cravings.

While longer-term treatment for severe addictions often includes patient resident programs including counseling, Kentucky lacks this kind of care. "There are not enough open-entry detox and treatment beds in this community�I'm talking non-insurance beds," Bolton said. Dr. Eric Fulcher, an emergency room doctor said that providing emergency treatment for heroin addicts has become "the new normal" at Sts. Mary and Elizabeth in the South End. "We're so used to it, we're almost numb to it."

Although the former director of the Office of National Drug Control Policy, Gil Kerlikowske, recommended the increased availability of naloxone, used to counteract heroin overdoses, the General Assembly didn't pass a bill "that in part would have made naloxone more widely available, along with other heroin-related measures," Kenning writes.

Jefferson District Judge Stephanie Pearce Burke said that "heroin use is present in more than three-quarters of her cases." Something has to be done. "People still have the idea that it's a drug from the '60s and homeless people in the park," she said. "But the face of heroin has changed. It's suburban teens and middle-class housewives, too." (Read more)
Princess Health and Princess Health andForum hears ideas for improving long-term care in Kentucky.Princessiccia

Princess Health and Princess Health andForum hears ideas for improving long-term care in Kentucky.Princessiccia

People gathered at the Lexington Senior Citizens Center May 16 to discuss problems with long-term care and potential ways to improve it, at an event organized by the Nursing Home Ombudsman Agency of the Bluegrass. Gov. Steve Beshear requested that such forums occur across Kentucky.

Attendees split into groups to discuss various topics regarding care of the aging in Kentucky. DG Gridley, founder of Grace Place, said that when she gets older, she would like to continue living in her own house but go to a facility during the day. Grace Place, staffed by medical professionals, is a health club for seniors. Several attendees said care in a nursing home should be based the preferences of each resident. For example, if the requirements were that each resident get a bath twice per week, and one resident wants a bath every day, he or she should be able to do that.

Some attendees encouraged others to speak up when they think elders are not being properly cared for. If something seems out of line, investigate, but people should also share positive stories, they said. Discussing such topics will help get people involved in such issues, some said.

Do you have complaints or comments about long-term care in Kentucky? Do you have suggestions to improve care for the aging population? Send your comments to nhoa@ombuddy.org. Comments will be sent to Beshear. All submissions must be sent by Aug. 31.

Forum attendees addressed these questions:

1. What does quality care mean to you? What does quality care look like, feel like? What are the key components to quality care? Who is responsible for good quality care in each of the settings?

2. If you have used a facility (assisted living, personal care, adult day and nursing homes) what did you like the most? The least? If you could make one improvement in a facility placement, what would it be?

3. What are the qualifications of a good caregiver regardless of the setting? How does staff impact care? Is staff education and training important? What topics/techniques should staff learn to address or demonstrate proficiently?

4. In a facility, is the number of staff persons on duty important, or is the quality of the staff more important? Why do you feel that way?

5. Where do you believe abuse and neglect are most prevalent? Knowing the definitions of abuse, neglect and exploitation which do you think is the biggest threat to the elderly and why? What might reduce these threats and help the elderly live safer higher quality lives?

6. Community involvement aids facilities, caregivers and providers in ensuring quality care and quality living for Kentucky's vulnerable citizens. How can members of our community be more involved in ensuring quality living and quality care for the elderly and individuals with disabilities?

Friday, 16 May 2014

Princess Health and Princess Health andRepublican governor of Indiana wants to expand Medicaid under Obamacare and existing state program; federal OK needed.Princessiccia

Princess Health and Princess Health andRepublican governor of Indiana wants to expand Medicaid under Obamacare and existing state program; federal OK needed.Princessiccia

Approximately 24 states still have not participated in health reform's Medicaid expansion, which provides coverage for adults who earn up to 138 percent of the federal poverty level. Some Republican-controlled states are "still looking for alternative ways to accept hundreds of millions, and even billions, federal dollars to expand coverage�all the while trying to maintain some rhetorical policy distance" from the controversial law, Jason Millman writes for The Washington Post.

Republican Gov. Mike Pence of Indiana is discussing a new plan to provide coverage for low-income people through an existing state insurance program. remains to be seen whether the federal government will approve Pence's plan or ask him to make changes. It also remains unclear whether the program will be better than traditional Medicaid.

When Pence said last year he would only consider expanding coverage if it was through the Healthy Indiana Plan, the Obama administration said the state couldn't do that because the program had an enrollment cap and potential cost-sharing issues. Now, Pence plans to get rid of the enrollment caps and make the program available to all adults who earn less than 138 percent of the poverty line. "Between 334,000 and 598,000 people will be covered under the plan, according to Pence's office," Millman writes. "Enrollment will open in 2015, with federal approval."

The current program only provided coverage for those under the poverty line and required them to pay for the first $1,100 of their care, the new program will provide two levels of coverage. Participants will be allowed to make monthly payments, but if they do not, they'll be given simpler coverage that doesn't include vision and dental benefits. The lesser coverage calls for co-payments for services but not for preventive care and family planning services. Participants living above the poverty line who do not give a monthly payment within 60 days will be "locked out of the program for six months. They can't opt into the basic coverage level," Millman writes.

"Exposure to and awareness of the cost of care are key components of the consumer-directed model that encourages price and quality transparency from providers," according to a document from Pence's office. "The increased deductible aligns with private market high deductible health plans paired with a health savings account, providing members valuable experience with a private market plan design." (Read more)

Though Pence does not support President Obama's health-care overhaul, the governor said that states "have an obligation to lead the way on health care reform," Maureen Groppe and Barb Berggoetz write for The Indianapolis Star. Pence said, "Reforming traditional Medicaid through this kind of market-based, consumer-driven approach is essential to creating better health outcomes and curbing the dramatic growth in Medicaid spending." (Read more)
Princess Health and Princess Health andFeds investigating possibility that Humana overbilled taxpayers for Medicare Advantage; firm says it reported information.Princessiccia

Princess Health and Princess Health andFeds investigating possibility that Humana overbilled taxpayers for Medicare Advantage; firm says it reported information.Princessiccia

Louisville-based "Humana Inc. faces multiple federal investigations into allegations that it overbilled the government for treating elderly patients enrolled in its Medicare Advantage plans, court records reveal." So reports Fred Schulte of the Washington-based Center for Public Integrity, a non-profit, inevstigative news agency.

"The status of the investigations is not clear, but they apparently involve several branches of the Justice Department," Schulte reports, adding that federal prosecutors said in a document filed in March that they expect at least one of the investigations will be completed �in the next few months.�

Federal prosecutors in West Palm Beach have "opened a criminal case involving overbilling allegations that the government says is similar to the Miami investigation," Schulte writes. "Meanwhile, the criminal division of the Justice Department in Washington has reviewed fraud allegations against the company, according to court records. Humana, which insures more than 2 million people through the Medicare Advantage plans, is also the target of two Florida whistleblower civil lawsuits that allege similar overcharges."

Humana spokesman Tom Noland told Schulte that the company has made �several public disclosures about these matters over a long period of time� and �self-reported� them several years ago, but �Humana to our knowledge is not the subject of any criminal investigation.� (Read more)


Thursday, 15 May 2014

Princess Health and Princess Health andStudy finds that antidepressants might slow the development of Alzheimer's Disease.Princessiccia

Princess Health and Princess Health andStudy finds that antidepressants might slow the development of Alzheimer's Disease.Princessiccia

A antidepressant that is often prescribed might slow production of amyloid beta, which is part of what causes Alzheimer's disease, according to new research from Washington University School of Medicine in St. Louis and the University of Pennsylvania. Science Translational Medicine published the research, which described mouse studies examining a variety of antidepressants.

Brain plaques are related to memory issues involved with Alzheimer's, and scientists showed that the antidepressant citalopram halted plaque growth in a mouse model of the disease. Also, one dose of the antidepressant reduced the production of amyloid beta by 37 percent in health young adults.

The research is promising, but researches warned people should not take antidepressants just to help reduce the risk of Alzheimer's disease. ". . . While antidepressants generally are well tolerated, they have risks and side effects," said senior author John Cirrito, PhD, assistant professor of neurology at Washington University. "Until we can more definitively prove that these drugs help slow or stop Alzheimer's in humans, the risks aren't worth it. There is still much more work to do."

Normal brain activity produces amyloid beta, but when too much is present, it can clump into plaques. Some of Cirrito's previous research revealed that serotonin, one of the brain's chemical messengers, decreases amyloid beta production. Because many antidepressants help serotonin circulate in the brain, Cirroto and first author Yvetter Sheline, MD, speculated about whether antidepressants might help slow the development of Alzheimer's.

"We also plan to study older adults who will be treated for two weeks with antidepressants," said Sheline. "If we see a drop in levels of amyloid beta in their spinal fluid after two weeks, then we will know that this beneficial reduction in amyloid beta is sustainable." (Read more)
Princess Health and Princess Health andPublic forum on nursing homes set Friday at 2 in Lexington.Princessiccia

Princess Health and Princess Health andPublic forum on nursing homes set Friday at 2 in Lexington.Princessiccia

A public forum on nursing-home care will be held Friday at 2 p.m. at the Lexington Senior Citizens Center on Nicholasville Road next to the University of Kentucky campus.

The forum "may reveal what, if anything, is being done in Kentucky to improve care in nursing homes," Kentuckians for Nursing Home Reform says in a news release. It says the event "is a result of direction from Gov. Steve Beshear that public forums be held across the state to give citizens a chance to present not only their complaints about long-term care, but suggest possible improvements. Tomorrow�s forum is the only reaction so far to the governor�s request."

The forum is organized by the Nursing Home Ombudsman Agency of the Bluegrass.

Wednesday, 14 May 2014

Princess Health and Princess Health andStudy finds that obese workers cost employers thousands in extra medical costs every year; Kentucky ranks ninth in obesity.Princessiccia

Princess Health and Princess Health andStudy finds that obese workers cost employers thousands in extra medical costs every year; Kentucky ranks ninth in obesity.Princessiccia

A morbidly obese employee costs his or her employer approximately $4,000 more in health care and related costs every year than an employee of normal weight, according to a study in the American Journal of Health Promotion. Kentucky ranks ninth in obesity among the states.

As might be expected, the study also found that obese workers with high blood pressure, diabetes and high cholesterol brought more costs than obese workers without those conditions. "Someone who is overweight or obese and also has diabetes is more likely to file a short-term disability claim compared to someone who doesn't have diabetes but is overweight or obese," said Karen Van Nuys, Ph.D., lead co-author of the study and economist at Precision Health Economics in Los Angeles.

The study showed that an employee with a body mass index of 35 has almost twice the risk of filing a short-term disability claim or workers' compensation claim than an employee with a BMI of 25. A BMI of 30 or more indicates obesity. While employees who are of average weight incur approximately $3,830 each year in medical claims, sick days, short-term disability and workers compensation, and morbidly obese employees incur about $8,067 every year.

The researchers analyzed three years of data from almost 30,000 workers, including "self-reported employee health information, medical visits and prescription claim and employer-reported data on absenteeism, short term disability and workers compensation claims."

"Overweight/obesity are just one of several modifiable risk factors in the workplace�but ones that are most problematic right now because they're getting worse by the minute," said Ron Goetzel, Ph.D., of the Johns Hopkins Bloomberg School of Public Health and Truven Health Analytics. 

Van Nuys and Goetzel said their report is not meant to encourage employers to discriminate against overweight people, but Goetzel said employers should "invest in robust, comprehensive health promotion programs for their employees that include physical activity, healthy eating, stress and depression management and control of blood pressure and diabetes." He added, "If you do those in combination and you do them right, not only is [this type of intervention] cost-effective, in some cases it is cost-beneficial, so that there is potentially even a return on investment here for employers." (Read more)