Tag Archives for mental health

National Report Grapples with Impending Alzheimer’s Epidemic

Published in the Pawtucket Times, July 25, 2013

.This 56 page report must not sit on a bureaucrat’s dusty shelf.

With the graying of the nation’s population and a skyrocketing incident rate of persons afflicted with Alzheimer’s disease, the Chicago-based Alzheimer’s Association and the U.S. Centers for Disease Control (CDC) and Prevention release a report last week to address a major public health issue, an impending Alzheimer’s disease epidemic on the horizon.

Researchers say that in 2013, an estimated 5 million Americans age 65 and older have Alzheimer’s disease. Unless more effective ways are identified and implemented to prevent or treat this devastating cognitive disorder the prevalence may triple, skyrocketing to almost 14 million people.  Simply put, Alzheimer’s disease is now the 6th leading cause of death and 5th among those 65 to 85 years of age.

A Call to Arms

A July 15, 2013, CDC, the federal agency charged with protecting public health and safety through the control and prevention of disease, injury, and disability, and the Alzheimer’s Association, the world’s leading voluntary health organization in Alzheimer’s care, support and research, unveiled The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018 at the 2013 Alzheimer’s Association International Conference in Boston.

The released report calls for public health officials to quickly act to stem the growing Alzheimer’s crisis and is a follow-up to the 2007 The Healthy Brain Initiative: a National Public Health Road Map to Maintaining Cognitive Health.

“The public health community is now paying greater attention to the Alzheimer’s epidemic that millions of families have been facing for decades and that is poised to drastically increase,” said Robert Egged, Vice President of Public Policy at the Alzheimer’s Association. “On the heels of the 2012 release of the country’s first-ever National Alzheimer’s Plan, the Alzheimer’s Association and CDC have partnered again to create a tool for public health officials to improve the quality of life for those families and advance cognitive health as a integral component of public health,” says Egged.

Released five years ago, the original Road Map addressed cognitive health and functioning from a public health perspective and provided a framework for the public health community to engage cognitive health, cognitive impairment, and Alzheimer’s disease and other dementias. More than 280 experts in the field contributed to this new Road Map report that outlines specific actions steps that state and local public health officials can take to promote cognitive functioning, address cognitive impairment for individuals living in the community and help meet the needs of caregivers.

While federal agencies play a critical role in leading and funding efforts to address Alzheimer’s disease, state and local health departments organize and provide public health services at the community level.

“The goal of the Healthy Brain Initiative is to enhance understanding of the public health burden of cognitive impairment, help build evidence-based communications and programs, and translate that foundation into effective public health practices in states and communities. This Road Map provides guidance to states, communities, and national partners to plan for and respond to this major public health issue,” said Lynda Anderson, PhD, Director of the Healthy Aging Program at CDC.

A former Assistant Secretary at the U.S. Administration on Aging, Bill Benson, now a managing partner of Silver Spring, Maryland-based, Health Benefits ABC, notes that the cost of providing care to people with Alzheimer’s disease will have a drastic impact on the nation’s economy due to the cost of lost productivity, and the care costs for those no longer able to care from themselves. “This does not include the profound personal impact and consequences to those who suffer from Alzheimer’s and to their loved ones,” he says.

“The scope, cost and the extraordinary burden both to individuals and to society make it a true health crisis,” says Benson, stressing that public health officials need to know more about the disease and those who have it, better ways to diagnosis it.  There must also be a better understanding of the economic impact and programs and services that are proven to ease the burden of those who suffer from it and their caregivers, he adds.

Action Steps for Local Communities to Follow

The Road Map report includes more than 30 action steps that the public health community can take at the federal, state and local levels over the next five years to address cognitive health and cognitive impairment from a public health perspective. The actions are intended as a guide for what state and local public health officials could do – on their own or with other national, state and local partners. Agencies are encouraged to select those actions that best fit state and local needs and customize them to match priorities, capabilities and resources.

As to specifics, the Road Map report calls for improved monitoring and evaluation of persons with dementia including Alzheimer’s disease and younger onset as they relate to employment and employers, and defining the needs of these individuals and their caregivers.  Also, increased support should be given to state and local needs assessments to identify racial/ethnic; lesbian, gay, bisexual, and transgender; socioeconomic; and geographic disparities related to cognitive health and impairment.

Public health officials must educate and empower the nation in confronting the epidemic of Alzheimer’s disease by promoting advance care planning and financial planning to care partners, families, and individuals with dementia in the early stages before function declines.  They can and promote early diagnosis.

The Road Map report urges that sound public health policies be developed and partnerships created to collaborate in the development, implementation, and maintenance of state Alzheimer’s disease plans. It also recommends that state and local government integrate cognitive health and impairment into state and local government plans (e.g. aging, coordinated chronic disease, preparedness, falls, and transportation plans).

Finally, the Road Map report also recommends that strategies be developed to help ensure that state public health departments have expertise in cognitive health and impairment related to research and best practices.  Support must also be provided to continuing education efforts that improve healthcare providers’ ability to recognize early signs of dementia, including Alzheimer’s disease, and to offer counseling to individuals and their care partners.

A Local View

Maureen Maigret, policy consultant for the Senior Agenda Coalition of RI coordinator of the Rhode Island Older Women’s Policy Group, agrees with the assessment of theRoad Map report, especially with the Ocean State having the “highest percent of persons age 85 and over in the 2010 Census and this is the population that is growing fast and most likely to have dementia.”

Maigret notes the economic impact will have significant impact across our economy for the state budget and for individual families. “It is imperative for our public officials to promote programs to identify those with early cognitive problems and implement policies to strengthen community and caregiver supports that will help persons to safely remain in home and community settings as long as possible, she says.

The Rhode Island General Assembly passed legislation this year that requires caregiver assessments in the state Medicaid long term care system.  “It’s a good first step in helping caregivers. But we must do so much more to inform the public about available resources, to adequately fund assistance programs such as RIde, Meals on Wheels and respite services and to promote cognitive screening as part of annual wellness visits funded by Medicare,” she says.

“Having a clear active mind at any age is important but as we get older it can mean the difference between dependence and independent living,” says Executive Director, Donna McGowan, of the Alzheimer’s Association-Rhode Island Chapter. “We are excited that the CDC has partnered again with the Alzheimer’s Association to create a tool for public health officials to improve the quality of life for those families afflicted by the disease,” she says.

For more information on The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018, visit alz.org/publichealth. For more information on Alzheimer’s disease and the Alzheimer’s Association, call 1-800-272-3900 or visit alz.org®.

 

Mental Health’s Forgotten Constituency

Published in Aging Today in March/April 1996

The principal authors of a new report on mental health nursing homes charge that cutbacks in Medicare and the block granting of Medicaid will have a disproportionately large impact on the funding of mental health treatments. The report, “Achieving Mental Health of Nursing Home Residents: Overcoming Barriers to Mental Health Care,” which this writer helped prepare, calls mentally ill residents long-term care’s “forgotten constituency.”

According to Nancy Emerson Lombardo, one the new report’s authors, mental health experts worry that the situation for mentally impaired elders may worsen if proposals are passed by the 104th Congress to drastically cut Medicare, dismantle the Medicaid program and repeal essential features of the Nursing Home Reform Act.

Big Battle

Lombardo emphasized in an interview that, given present efforts in Washington to reduce Medicare and Medicaid spending. “It will take a big battle to restore mental health funding even to the inadequate levels of a few years ago, let alone bring it up to par with payments for treatment of other medical problems.”

She said that adding to the difficulties facing mental health advocates is evidence that many managed care programs taking over Medicare benefits for elders have greatly reduced mental health services.

Evidence has mounted in recent years, some from federal investigators, that physical illnesses of people especially frail elders, cannot be treated separately from mental illness. The report quotes a 1982 Government Accounting Office report that stated, “Left undiagnosed and untreated, mentally ill residents have limited prospects for improvement, and their overall conditions m ay decline more rapidly and ultimately place greater demands on the health care system.”

Achieving Mental Health…is being published this spring by the nonprofit Hebrew Rehabilitation Center for the Aged’s (RCA) Research and Training Institute in Boston, in conjunction with the Mental Health Policy Resource Center (MHPRC) in Washington, D.C. It is based on a 1993 invitational conference that brought together more than 130 experts in mental health and aging. Besides being released as an HRCA issue brief, the 50-page paper will be simultaneously published in the Journal of Mental Health and Aging (New York: Springer Publishing Company). The findings are being presented at the American Society on Aging’s 42nd Annual Meeting in Anaheim, Calif., in March.

The report enumerates a variety of obstacles to the provision of appropriate mental health services.  These include a shortage of mental health professionals trained in geriatrics; lack of in-service training in nursing homes to teach facility staff to treat behavioral and functional consequences of mental health or dementia; and inadequate Medicare payments and reimbursement rules that do not reflect the relative costs of preferred treatments.

Model Programs Recommendation

The report also notes that, in spite of these hurdles, model mental health programs do exist in some nursing homes; they are funded by an array of federal and state agencies, nonprofit foundations and even by some of the facilities themselves, drawing upon nonfederal funds.  The issue brief recommends that such programs be identified, cost-benefits calculated and the results widely disseminated to nursing homes for replication.

However, mental health experts involved in the issue brief agree that progress is slow and good mental health care in nursing homes is still exception rather than the rule.

Key recommendations in the report include:

  • Additional funding for research, staff training, and consumer education initiatives;
  • Improved Medicare and Medicaid reimbursement to pay for psychiatrists to train nursing home staff members in mental health services;
  • Sthe “unbundling,” or separating, of mental health services from nursing home per diem rates, so that funding intended for such assistance cannot be buried in lump-sum reimbursements for care and forgotten;
  • Full implementation of all federal nursing home reform mandates passed in 1987 and 1989, such as those requiring training for nursing home staff and strictly limiting the use of psychotropic drugs and physical restraints with residents;
  • Increasing the percentage of mental health services paid for by Medicare and other federal and private insurance to match that paid for other medical services.

Further, the report recommends that reimbursement incentives to be redirected to recognize  behavioral methods and deemphasize “medication-only” treatment.

The report’s authors added that Washington has failed to recognize cost-effective but humane alternatives to wholesale budget cuts.

For example, given the current antiregulatory mood in Congress, report cards for consumers can be one solution to assist family members in choosing a nursing home that provides adequate mental health training to its staff, said another of the report’s authors, Gail K. Robinson, deputy director of the MHPRC.

She suggested, “With such ratings, consumers and their families can be more selective in choosing a nursing home that provides better quality mental health care. Moreover, facilities could use the ratings to identify their weaknesses and correct them.”

According to Lombardo, there are less costly ways to improve mental health services than obtaining psychiatric specialists care for most residents. For example, she said, “The facility’s in-service training budget could easily be used to bring in experts to teach staff how to care for residents with mental illness or behavioral problems.” This redirection of funds would allow specialists to serve as trainers and troubleshooters, rather than as  consultants for individual residents.

Lombardo also called on nursing home administrators to support simple changes in their in-service training philosophies: “Administrators must realize the actions of all staff members in their facilities affect the mental health of residents either positively or negatively. Therefore, every person should attend training on mental and behavioral issues.”