(Circulation. 2000;102:e9009.)
© 2000 American Heart Association, Inc.
Cardiovascular News |
Cardiovascular News
US Government Seeks More Stringent Nursing Home Regulation
After 8 years of study, officials from the US Department of Health and Human Services reported that most nursing homes have, on average, so few staff that patients are in danger, according to a July 23, 2000, report in the New York Times. As a result, officials are proposing new rules that would beef up the staffing requirements for the facilities that provide care to the nation’s elderly and infirm.
In a report to Congress, federal officials said that a lack of staff in nursing homes has contributed to an increase in severe bedsores, malnutrition, and abnormal weight loss among residents. The report also claims that patients suffer from life-threatening conditions that require hospitalization. Among these are congestive heart failure, infections, and dehydration.
The federal experts noted that the more severely understaffed a
facility is, the more likely that patients will suffer from poorer
care. To alleviate the problem, federal regulators recommend that each
patient receive 
2 hours of care each day from nurse’s aides and 12
minutes of care per day from a registered nurse. According to the
New York Times, large percentages of nursing homes do not
reach these levels.
Nonprofit nursing homes had significantly higher staffing levels than homes owned by for-profit agencies. According to the Times, nursing homes said it is unrealistic to require specific minimum staffing levels because payments from Medicare and Medicaid are too low.
In testimony before the US House Government Reform and Oversight of Human Resources and Intergovernmental Relations Subcommittee on Human Resources on April 16, 1997, George F. Grob, deputy inspector general for the Department of Health and Human Services, said that the stays of an estimated 3 million Americans in nursing homes are paid for by the federal government through Medicare or Medicaid. Both programs paid an estimated $46 billion for such care in 1995. At that time, he called the problems in the nation’s nursing homes "pervasive."
On July 28, 1998, Michael Hash, deputy administrator for the federal Health Care Financing Administration, told members of the Senate Special Committee on Aging that "intolerable situations have occurred, and our most vulnerable citizens have suffered." Citing a 1998 report to Congress on the problems of nursing homes, he said state-run nursing home inspections are too predictable and that inspectors rarely show up on weekends or during evening hours. States cite nursing homes for poor care only rarely, leading regulators to believe that their inspections are inadequate.
The American Health Care Association, an industry group, revealed on July 18, 2000 that one-fifth of nursing homes in the state of Texas and 12% of those in the United States have been involved in bankruptcy hearings. The industry group attributed the financial troubles to reductions in reimbursement from Medicare, according to the Austin Business Journal.
Companies Anticipate Big Increase in Cost of Drug Benefits and Health Insurance
A survey of the 61 employers of 1.7 million Americans found that the companies expect the cost they pay for prescription drug benefits to rise an average of 22.5% for active employees and 23.4% for Medicare retirees, according to the American Hospital Association. The survey, which was conducted by Watson Wyatt Worldwide and the Washington Business Group on Health, said the groups expect overall medical costs to rise 12.2% for each employee and 13.3% for retirees covered by Medicare.
Nearly one-third of the employers (32%) said they will absorb the increases in costs rather than passing them on to their employees. However, 57% said they will expect employees to pay more if that will keep the workers’ share of healthcare costs the same as it is currently. Another 12% of the firms plan to ask employees to pay a greater share of the healthcare costs.
Syphilis Remains a Problem in the United States
Syphilis, a curable sexually transmitted disease, remains a problem in the United States, with an estimated 7000 newly identified cases each year, according to a report to the Kaiser Daily Health Report by journalism fellow Leslie Laurence. Twenty-eight cities or municipal areas account for half of all the new infections; they are the focus points of a program to the eliminate the disease that was begun by the federal Centers for Disease Control and Prevention (CDC) in 1999. Ms Laurence quotes Jeffrey Koplan, MD, director of the CDC, as saying, "This disease doesn’t (belong) in a modern industrialized country. It should be and could be eliminated."
Elimination is the hope of the CDC’s program and, if it occurs, syphilis will be the first sexually transmitted disease to be totally eradicated. The disease is one of the easiest to treat and diagnose. However, in the past 10 years, more of the CDC’s budget for sexually transmitted disease prevention was funneled into the agency’s AIDS program. As a result, the funding to fight diseases such as syphilis dwindled, according to Ms Laurence. Without active programs to combat it, syphilis established new beachheads in communities across the nation.
Clinton Announces $50 Million New Initiative to Fight Alzheimer’s Disease
President Clinton has promised the National Institutes of Health $50 million over the next 5 years for research into the treatment and prevention of Alzheimer’s disease, a degenerative brain disease that affects 4 million Americans today. Mr Clinton said that a particular focus of such research should be the development of an Alzheimer’s vaccine, such as the one recently discussed at the World Alzheimer Congress 2000.
The vaccine, which is under development by Elan Pharmaceuticals, seems to be well tolerated by patients in preliminary results from phase 1 trials. However, although animals studies have identified a mechanism by which the vaccine can sweep the brain clear of disease-causing amyloid plaques, no one knows if it has a similar effect in the brains of humans. Expanded phase 1 trials were announced at the meeting.
Mr Clinton’s announcement came in the wake of realizations that the number of Americans with the disease is expected to more than triple—to a total of 14 million people—by the year 2050.
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