Study: Older Dementia Patients Go to ER Twice as Often as Other Seniors

Washington Post | By Erin Blakemore
 
Older people with dementia seek care in the emergency room twice as often as their peers, a new analysis suggests — leading to what researchers call “potentially avoidable and harmful visits” for some patients.
 
The study, published July 24 in JAMA Neurology, examined data from the 2016-2019 National Hospital Ambulatory Medical Care Survey, which collects demographic and other information about a nationally representative sample of ER visits. About 1.4 million of the annual 20.4 million ER visits among adults over 65 involved patients with Alzheimer’s disease and related dementias, researchers found.
 
Patients with dementia presenting at the ER were more likely to be age 85 or older and female. The most common reasons for seeking care were accidents (7.9 percent), behavioral disturbances (7.4 percent) and general weakness (5.3 percent).
 
Once they got to the ER, patients with dementia were likelier to receive diagnostic tests such as CT scans and urinalysis — perhaps because of communication issues or behavioral concerns. They also were twice as likely to receive antipsychotic medication, which is cause for concern, the researchers write, because of the risks of taking such drugs and the potential for them to continue being used long-term. (Antipsychotics are associated with higher mortality risk and life-threatening falls in older adults.) They were less likely to be prescribed opioids than their counterparts.
 
The statistics reflect challenges in the daily lives of people with dementia, who may behave erratically and often cannot communicate about their symptoms. Despite these challenges, the study says the ER is often not the best place to care for adults with dementia due to long wait times, unfamiliar staff and a potentially disorienting environment.
 
The researchers call for better caregiver supports and the development of more geriatric-friendly emergency rooms, although they acknowledge that in some situations emergency care is needed.
 
“While dementia is thought of as a cognitive or memory disorder, it is the behavioral aspects of the disease such as anxiety, agitation and sleep disturbances that can cause the most stress for caregivers and patients alike,” study co-author Lauren B. Gerlach, a geriatric psychiatrist at Michigan Medicine and an assistant professor in psychiatry at the University of Michigan, said in a news release.
 
“Emergency departments are often not the right place to manage these behaviors,” she added. “We really need to do better to support caregivers so there are options other than seeking emergency care.”

Home Health Value-Based Purchasing Model Sixth Annual Report - Key Takeaways:

The original Home Health Value‐Based Purchasing (HHVBP) Model provided financial incentives to home health agencies for quality improvement based on their performance relative to other agencies in their state. The goal of HHVBP is to improve the quality and efficiency of delivery of home health care services to Medicare beneficiaries. Nine states were randomly selected to participate in the original HHVBP Model CY 2016-CY 2021. Home health agencies in these states received performance scores for individual measures of quality of care that were combined into a Total Performance Score (TPS) to determine their payment adjustment relative to other agencies within their state. CMS first adjusted Medicare payments by up to ±3% in 2018, using agencies’ 2016 TPS. Payment adjustments increased each year, peaking at up to ±7% in 2021, the last year of the original HHVBP Model prior to the nationwide expansion of the model in January 2023. This document summarizes the impact observed in 2016 through 2021, the complete six years of the original model, including all four payment adjustment years.

The six years of the original HHVBP Model resulted in cumulative Medicare savings of $1.38 billion, a 1.9% decline relative to the 41 non-HHVBP states, as well as improvements in quality. These impacts were observed during 2021, the fourth and final year for quality-based payment adjustments, as well as in the preceding five years of the original model.

The Two Page Overview:

• Findings At-a-Glance (PDF)

The Report (includes an Executive Summary):

• Sixth Annual Evaluation Report (PDF)
• Go directly to the Executive Summary (PDF)

Additional Supporting Materials:

• Appendix: Data Sources and Quality Measures  (PDF)
• Model Page: Home Health Value-Based Purchasing Model

Changes to Form 1-9 and New Options for Employers to Remotely Examine Employees’ Documents

SESCO Management Consultants

USCIS and DHS Announce a Revised Form I-9 and a New Option for Employers to Remotely Examine Employees’ Documents

The U.S. Citizenship and Immigration Services (“USCIS”) has announced that a revised version of Form I-9, Employment Eligibility Verification will be available starting August 1, 2023. The current version can be used through October 31, 2023; however, as of November 1, 2023, only the revised version may be used.

Additionally, the U.S. Department of Homeland Security (“DHS”) has announced that employers who are enrolled in E-Verify will have the option to remotely examine employees’ identity and employment authorization documents. The revised Form I-9 will have a checkbox designated for E-Verify-enrolled employers to indicate when the employer has remotely examined an employee’s documents. This new flexibility option also goes into effect on August 1, 2023.

To take advantage of the new option for remotely verifying employees’ identity and employment authorization documents, the employer must:

• Be enrolled in E-Verify;
• Examine and retain copies of all documents;
• Conduct a live video interaction with the employee; and
• Create an E-Verify case if the employee is a new hire.

DHS is considering expanding these flexibilities to even more employers, but for now, employers who are not enrolled in E-Verify must comply with DHS’s previous deadline of August 30, 2023, to perform all required physical examination of identity and employment authorization documents for employees hired on or after March 20, 2020, if the employee’s documents were examined only virtually or remotely as was permitted under prior COVID-19 temporary flexibilities.

In its announcement, USCIS also highlights the following new features of the Form I-9:

• Sections 1 and 2 are consolidated into a single page.
• The I-9 is available as a fillable form on tablets and mobile devices.
• The “Preparer/Translator Certification” section is now a standalone supplement of the form, permitting employers to provide employees a copy of that single page as needed.
• Section 3 for reverifications and rehires is now a standalone supplement of the form that employers can print whenever a rehire or reverification is required.
• “Acceptable Documents” include receipt notices for certain filings that automatically extend employment authorization, along with related guidance and links to information.
• The form instructions are reduced from 15 pages to 8 pages.
• A checkbox has been added for employers enrolled in E-Verify to use in performing remote examination of employees’ identity and employment authorization documents (as previously noted above).

If you are not a retainer client, contact us to learn about our services by calling 423-764-4127 or click here.

Parkinson’s Foundation: Community Partners in Parkinson’s Care

What is the Program
A program designed to educate and prepare staff to provide better care for people with Parkinson’s disease (PD) who are living in senior care communities or utilizing home care agencies across the country.

Benefits to Joining the Program
The program provides a full curriculum of Parkinson’s education through virtual and in-person trainings. Utilizing the train-the-trainer model, the membership program educates two or more site champions at each location and provides the necessary tools to educate at least 70% of the staff at their site. The program, formerly known as the Struthers Parkinson’s Care Network, funded by the Edmond J. Safra Foundation, has continued to expand and now includes more than 100 member sites across North America.

Cost to Join Program*

• Membership for home care agencies: $1,500 (annual fee)
• Membership for senior care communities: $2,750 (annual fee)

*Care communities serving underserved communities should reach out to us to discuss possible discounted rates as from time to time, sponsors will cover these costs.

Steps to join the Program as NEW members

1. Complete new member application (www.parkinson.org/communitypartners)
2. Application is reviewed for acceptance
3. Agreement and Invoice are sent for completion and payment (this triggers the membership cohort, Q1, Q2, Q3, or Q4)
4. Once payment is received, site champions are invited to the virtual training with program details and given access to the online modules
5. Two site champions participate in the training
6. After training, site champions return to work and share materials with colleagues, they (the administrator) work with staff to ensure 70% or more of clinical staff have completed the modules
7.  Once 70% threshold is met and confirmed, member is recognized as part of the program and may advertise their membership

Current members who wish to train new or additional site champions

1. Complete current member application (www.parkinson.org/communitypartners)
2. Application is reviewed for acceptance
3. Person(s) is/are invited to next quarterly training

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