University Study Seeks to Unlock Secrets of Alzheimer’s

Published in Pawtucket Times on December 8, 2003

 Planning bingo, finding that right word for the crossword puzzle you are working on, reading The Times or the latest bestselling book and even dancing might just be the right mental stimulation to help slow down the ravaging advances of Alzheimer’s.

Boston University researcher Nancy Emerson Lombardo, Ph.D., is seeking Rhode Island and Southern Massachusetts research participants to determine if the theory “use it or lose it” is fact or fiction.

“The brain never stops growing, especially in an enriched learning environment,” said Lombardo, who said science has shown the brain can actually replace neurons and grow connections between them.

Lombardo’s current research study is looking to prove that the brain’s ability to adapt, through cognitive training therapies can help persons who are already have Alzheimer’s disease slow down and even regain some of the cognitive losses they are experiencing.

Lombardo said that even with a diagnosis of Alzheimer’s disease, over the last decade researchers have found you can still exercise your brain, reap the benefits of improved short-term memory and experience a better quality of live.

These studies suggest keeping the mind active can help explain how some people can delay the onset of memory loss and Alzheimer’s disease symptoms for years.

In one study, research B.P. Sobel found that playing bingo improved short-term memory, Lombardo noted.  In another study, H. Wang reported in the American Journal of Epidemiology that staying active in social and leisure activities is associated with a decreased risk of memory loss, she said.

An Albert Einstein College of Medicine study even reported in a recent issue of the New England Journal of  Medicine that “reading, playing board games, playing musical instruments and dancing were associated with a reduced risk of [memory loss].”

Lombardo, serving as principal investigator at the Boston University Alzheimer’s Disease Center, told All About Seniors about the BEST (Brain Enhancement Strengthening Treatment) study.  This study is currently examining whether fun, combined with a challenging set of cognitive exercises, can be performed in a home setting to sharpen up the cognitive abilities of a person diagnosed with early Alzheimer’s.

The BEST study, based on the work of Lynn Lazarnus Seper, Ed.D. – who serves as the co-principal investigator with Lombardo – is working with early-stage Alzheimer’s participant and their care partners over a six-month period.

Serper used many of these same techniques in her successful self-recovery from a major debilitating stroke. She has also experienced successful results in her clinical practice with persons with Alzheimer’s, as well as those with stroke and other brain injuries.

Lombardo’s study is currently seeking early-stage Alzheimer’s participants in Rhode Island and Southern Massachusetts, ages 58 to 85, who will meet over 26 weeks in their own homes with cognitive educator Ann Lewis.  Lewis has received rigorous training from Serper and other researchers on the BEST team.

Eligible participants, who must have at least a two-year college degree, must have a diagnosis of probably Alzheimer’s disease.  Additionally, they  must be taking one of the three medications – Aricept, Exelon or Reminyl.

Finally, they must reside within a 40-minute drive of Newton, or Billerica, Mass. Or Newport, Rhode Island.

Study participants will work on mental exercises aimed at their prior and current interests/hobbies as well as current local and world news.

The format turns theses everyday activities into brain therapy. The cognitive educators will also assist participants in developing strategies for social and conversational situations.

Greyhound Subsidy Could Go a Long Way in Funding Senior Programs, Services

Published in Pawtucket Times on December 2, 2002

Now that the dust has settled after the Nov. 5 gubernatorial elections. East Greenwich businessman and Governor-elect Don Carcieri has assembled his transition team.

The pencils have been sharpened and the evaluation begins as Carcieri starts his work to whittle down the state budget deficit for the next fiscal year, estimated to be in the hundreds of millions of dollars.

The incoming Republican governor has his work cut out for him as he begins his efforts to determine where hie will funnel state dollars.

At press time, special-interest groups and aging advocates are sitting on the sidelines wondering what programs will be the winners and losers in Carcieri’s efforts to battle a state budget gap.

It is obvious to this columnist how Carcieri can add a slice to the budgetary pie. That is, the $ 13.5 million revenue from the Lincoln Park video slot machines given by the state to greyhound dog owners could go a long way in helping the frail elderly throughout Rhode Island.

Here’s a wish list from senior advocates and long-term care providers of programs and services for Ocean State seniors that could benefit from an infusion of $13.5 million.

The state must find $ 15 million to overhaul the existing Medicaid payment system, which would greatly improve the quality of care and services provided to the 10,000-plus nursing home residents. The federal government would pick up another $ 15 million, for a total increase of $ 30 million. The $ 13.5 million subsidy to greyhound dog owners could pay a large chunk of the state’s share.

Also, this $ 13.5 million could fund 180 assisted-living units already approved by the federal government but not funded in the state budget. That would allow 180 or more frail and low-income seniors to live in an assisted-living residence who couldn’t otherwise afford it.

With drug costs skyrocketing, $ 13.5 million could provide more than twice as much increased pharmaceutical assistance to low-and moderate-income seniors so they can afford the medicines that the need. It could also reimburse health care and nursing home costs for frail, sick, seniors with no health coverage so they can get the care they so desperately need.

State agencies are not staffed up enough to oversee the regulation of nursing homes, assisted living and home care. Re-targeted monies from the greyhound subsidies could be used to adequately fund state and private agencies, such as the Alliance for Better Long-Term Care, to perform that mandated oversight of these long-term care providers.

But that’s not all. By redirecting a portion of the $ 13.5 million to increase funding for Meals on Wheels, a program that provides meals to homebound seniors, 200 people on the waiting list can be served.

Additionally, increased funding could also provide reimbursement to health care workers to at least be on the same levels as neighboring states so the severe shortage of experienced health care workers can be effectively addressed.

With a growing ethnic and minority population, additional state dollars- reallocated from the $ 13.5 million subsidy to greyhound owners – could adequately fund a system of services for elders of different cultural backgrounds.

Services might include meal sites, home-delivered services, programming, information and referral and other needed services that are already provided to the majority of seniors.

We must fund organizations struggling to perform these services for older minority populations.

The Carcieri administration can keep seniors independent by redirecting some of the $ 13.5 million to adequately fund home care and community-based services to provide assistance to keep seniors in their own homes. It could also be used to establish a dental care program for seniors. Most seniors have no dental coverage and many suffer from dental-related problems.

With Carcieri beginning his “Big Audit,” we hope that he will place the needs of the state’s frail elderly above the subsidy to owners of greyhound kennels. To many Rhode Islanders, that is the right thing to do.

Home Care Quality Data Not Always Easy to Interpret

Published in Pawtucket Times on November 10, 2003

A 70-year-old widow was recently discharged from a local hospital after surgery for cancer. Her daughter has agreed to take on caregiving duties, but because of her demanding job, there will be frequent periods of time that the elderly woman will be left home alone.

To keep this elderly woman at home after her hospital stay, her physician has referred her to a home health agency that will provide skilled nursing services for wound care and medication management.

Additionally, physical therapy has been ordered for rehabilitation. By being eligible for skilled nursing care, Medicare will also pay for a certified nursing assistant for five weekly visits to provide personal care services.

Although fictional, this situation is very typical of the care provided by 21 Medicare-certified home care agencies to 12,000 older Rhode Islanders who have a medical need for skilled care.

These agencies offer an array of health care (i.e. skilled nursing care, physical, occupational, respiratory and speech therapies, social services, psychiatric nursing and palliative care) and personal care services to patients in their own homes.

Federal and state officials, home care agency providers and Rhode Island Partnership for Home Care recently gathered at the Quality Partners of Rhode Island offices to unveil the Centers for Medicare & Medicaid Service’s (CMS) new quality improvement initiative.

CMS’s quality data will allow consumers to evaluate Medicare certified home care agencies on 11 quality measures. They include four measures related to improvements in getting around, four measures related  to improvement in meeting basic daily needs, two measures related to medical emergencies and one measure related to mental health improvements.

Quality Partners has been involved in the state’s public reporting program, which is designed to facilitate consumer choice and promote quality improvement in health care. The Providence-based independent quality improvement organization, under contract with CMS, is working with local home health agencies to improve the quality of care and inform consumers about the availability of the federal agency’s recently released quality performance data.

CMS’s new initiative is a “key step toward improving quality in getting consumers the information they need to make informed health care choices,” said CMS Administrator Tom Scully in a written statement. “By generating and publishing quality data, we are helping consumers make decisions that best meet their needs and are creating incentives for home health agencies to further improve quality.

“These quality measures should be used as an additional resource when making decisions about a home health agency or addressing the quality of care that a loved one is receiving,” said Scully. “Use these measures as an opportunity to discuss the care provided by the home health agency and address not only the areas of care covered by the quality measures, but all services as well.”

Lt. Gov. Charles j. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, added, {CMS’] rating system for home health agencies fits in nicely with what we are doing here in Rhode Island. Having this information will help foster quality among the rated agencies. It will create an environment for home health care agencies to continue to improve on their quality of care.”

“Most home care agency providers embrace this quality initiative as an opportunity for agencies to focus more resources on quality for all agencies to achieve the highest standards of care which will result in an informed pubic,” noted Paula Parker, executive di rector of the Rhode Island Partnership for Home Care.

“Consumers can e confident that their home care provider has practices and policies in place to measure quality indicators. This will empower consumers to discuss quality with their providers,” she says.

While recognizing the merits to this initiative, Maria Barros, clinical director of the Pawtucket-based Nursing Placement and Saranna Home Care, is concerned that consumers may have difficulty in interpreting the quality data.

“The Home Health Quality Initiative does not really measure the agencies’ performances (in some situations),” says Barros, especially when agencies take care of patients who have chronic disabling or terminal conditions. “The patients do not improve and the quality measurers reflect this, ultimately giving a false impression that quality care is not being provided,” she says.

“Not all of our patients with diseases get better or are cured,” Barros adds. “We help them to manage their disease processes, keep them at home and enhance their quality of life until they are ready to enter into hospice care.”

Moreover, Barros said some agencies that take care of younger patients with acute medical conditions that only require short-term home health services will have better outcome data when compared to agencies that care for sicker patients’

“The intensity of the medical care is not always reflected in these 11 quality indicators,” she said.

Parker agreed, stressing that it is important for consumer to interpret the numbers released by the CMS in the context in which home care is provided.

For Medicare certified home health agencies, CMS has published advertisements in local newspapers that will include three of the quality indicators. The complete listing of quality data along with  other consumer information on home health care agencies in Rhode Island, is available at Home Health Compare located on Medicare website, www.medicare.gov and throughout Medicare’s 24-hour help line at 1-800-MEDICARE (1-800-633-4227).

For those 5,000 Rhode Islanders who receive home care through programs other than Medicare quality of care is measured by the R.I. Department of Health through their performance measurement and reporting program, mandated by legislation introduced by then-state Senator Charles Fogarty and passed by the General Assembly in 1998. Signed by the governor, this law is designed to provide consumers with published reports of quality measures for every segment of Rhode Island’s health care system.