Essex Happenings.....APRIL 27, 2012

Essex Happenings …April 28. 2012 2012 Heritage Hero Event scheduled for May 9th. It is not too late to purchase tickets for one of the most important events offered by Essex Heritage. To secure your reservations contact www.essexheritage.org or call 978 740 0444. Town of Ipswich Without a permanent Manager I have always used this vehicle to both keep track of the administration of the 34 communities in the ENHA and to report on all of you on those posts. It now appears, at least for some period that, the Town of Ipswich will be operating without a Town Manager. Since the departure of George Howe, the town that has been guided by interim manager, Thomas Younger is now without his assistance as he has left that assignment to assume his post as the new Town Administrator in Swampscott. The Chairman of the Selectmen, Ray Morley on an interim basis, is currently looking after the Town that has yet to name finalists from whom a new Manager will be selected. Briefs Recently Received from the Director of North Shore Elder Services and others. From the Kaiser Weekly Update Briefs Examine Spending, Utilization and Efforts To Integrate Care For People Eligible For Both Medicaid and Medicare Three new and updated briefs from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured examine spending, utilization and policy efforts to align payment systems and service delivery for the 9 million individuals nationally that are dually eligible for both Medicaid and Medicare. The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare examines dual eligibles' utilization and spending in both programs in 2007. As a group, dual eligibles are costly - with per capita Medicare and Medicaid spending over four times Medicare spending for other beneficiaries, but a small share of dual eligibles account for most of the group's spending. Dual eligibles who are high cost to the Medicare program are generally not the same individuals who are high cost to the Medicaid program. These findings have important implications for efforts to integrate benefits and align financing for dual eligibles. An Update on CMS's Capitated Financial Alignment Demonstration Model for Medicare-Medicaid Enrollees describes significant characteristics of CMS's capitated financial alignment model and summarizes key dates in the state demonstration approval and plan selection processes. Massachusetts' Proposed Demonstration To Integrate Care for Dual Eligibles looks at Massachusetts' plan to create an integrated service delivery and payment model for disabled dual eligible in that state. Massachusetts is the first state to submit such a proposal as a part of this nationwide effort guided by CMS. The Foundation also has a broader collection of resources on dual-eligible beneficiaries available online. From our Philanthropy Advisor: Volunteer Appreciation Week!
By Mike Davenport, Davenport & Barr, Inc. April 9th through the 15th is Volunteer Appreciation Week. Although, not asking for any compensation in return is what volunteering is all about, the special work these individuals do is worth recognizing. According to the Independent Sector -- a coalition of charities, foundations, corporations and individuals that publishes research important to the non-profit sector -- Americans have come together through voluntary organizations for over 230 years! Today the estimated dollar value of volunteer time in the U.S. is $21.36 per hour -- certainly worth acknowledging! For ideas on recognizing volunteers, click here. After Hospitalization, Mental Trouble for Elderly Patients By JUDITH GRAHAM New York Times, New Old Age Blog Many older people fear that a hospital stay could leave them even more disabled than they were before. Unfortunately, there’s new reason to believe this fear is justified. Elderly patients who are hospitalized are at much higher risk of cognitive problems afterward, according to a study published on Wednesday in the journal Neurology. The cause is unclear: Both the illness that brought the patient to the hospital and the treatments received there may contribute. But the risk appeared to last for years, said Robert Wilson, lead author of the report and a professor of neurological and behavioral sciences at Rush University Medical Center in Chicago. Dr. Wilson and his colleagues examined data on 1,335 people age 65 and older participating in the Chicago Health and Aging Project, a long-term study of chronic illness in three racially mixed Chicago neighborhoods. All of the patients were hospitalized at some point between January 1993 and December 2007. They were interviewed every three years and given tests of mental status. At least one interview occurred before a hospitalization and two interviews after, allowing changes in mental status to be tracked over time. The researchers found that the rate of cognitive decline in older patients more than doubled after a hospital stay, generally affecting thinking and memory across the board. Before these older people were admitted, mental test scores slipped 0.031 units per year on average; after a hospitalization, the decline was 0.075 units annually on average. “Essentially, it’s as if people became 10 years older, from a cognitive standpoint, than they actually were before a hospitalization,” Dr. Wilson said.
Especially vulnerable to this effect were patients with more serious illnesses who stayed in the hospital for longer periods of time, and patients who started experiencing worsening memory and thinking problems before they were admitted. “We think that a hospital stay can help unmask and accelerate previously unidentified cognitive problems,” Dr. Wilson said. Not every older patient who goes to the hospital will experience these kinds of issues, Dr. Wilson added; many return home after an acute-care stay without any kind of impairment. It’s already known that a hospital stay can interfere with an older person’s physical functioning and ability to perform the so-called activities of daily living — bathing, toileting, dressing and so on — said Dr. Kenneth Covinsky, professor of geriatrics at the University of California, San Francisco. “What this new research does is add another layer and show that there’s also this cognitive loss that’s occurring,” he said. “While we suspected this before, there wasn’t strong enough data to firmly establish it before this study.” What explains the loss? Dr. Malaz Boustani, associate professor of medicine at Indiana University, suspects the culprit is delirium — an abrupt change in mental status occurring in up to 20 percent of hospital patients, who become very confused, disoriented, agitated or unresponsive and withdrawn. Delirium once was thought to be transient. Now, it’s increasingly regarded as a form of brain injury that can “change the trajectory of your cognitive status,” said Dr. Boustani. “Even when you supposedly recover, there’s a residual effect.” Dr. Boustani and colleagues at Indiana University are searching for the underlying mechanism, and think it may involve low oxygen levels or inflammation that kills neurons in the brain. But these are hypotheses only. “Is this cognitive insult caused by the illness that brought the patient to the hospital, or by what we do in the hospital?” Dr. Boustani asked. “It appears to be both.” Of special concern are medications that acutely ill patients receive in settings such as intensive care. “I worry a lot as an I.C.U. physician that there are long-lasting effects of the medications we use,” said Dr. Catherine Hough, an associate professor of medicine at the University of Washington. “Unfortunately, the cognitive effects of these medications have rarely been studied.” Dr. Hough was an author of a study, published in 2010 in The Journal of the American Medical Association, that found that older people hospitalized for non-critical conditions were more likely to receive a new diagnosis of dementia. The paper also documented a link between critically ill patients and cognitive decline. Other factors that might contribute long-term to cognitive problems include tiny, undetectable strokes that afflict older patients, uncontrolled blood sugar, or a lack of stimulating mental activity while people are in the hospital, Dr. Hough and other experts suggested. Since there are ways of preventing delirium and addressing these other concerns, it’s likely that some of the cognitive decline in older hospital patients is preventable, Dr. Wilson said. For families, the new study adds to evidence that hospitalizations can be a seminal event that changes an older person’s functioning going forward. “Know that when your elderly parent is coming out of the hospital, this has the potential to be a very vulnerable period,” Dr. Covinsky said. “Whatever need your parent had prior to the hospitalization, there’s a good chance they may change and that more support will be required.” ALZHEIMER'S PLAN ON THE TABLE The Obama administration recently released a first-of-its-kind roadmap to eradicate Alzheimer’s disease by 2025. It comes just weeks after President Barack Obama pledged more than $156 million in federal funding to the cause, and a year after he made it a national priority. The draft plan builds upon "ongoing research and clinical inquiry" to delay and ultimately minimize the symptoms of the disease, which affects more than 5 million Americans. It clears a path for accelerated public and private research and hinges on a partnership between a number of different agencies. NSES Close to Opening Longevity Center The leadership of North Shore Elder Services is getting closer to opening their subsidiary corporation at their Danvers headquarters. The new facility that will offer a collection of desired services to the elders of this region will be opening later this spring. Much work has been in the most recent past to prepare this facility to meet the needs of this region’s elders. We will keep all of you up to date as we move closer to an opening date. Announcement from Salem State University Join us for the 2012 Salem State Series. Purchase your tickets today! Tuesday, May 1 (NEW DATE) Anderson Cooper Journalist, author, television host Thursday, November 8 Bobby Valentine with Peter Gammons Boston Red Sox Manager and Sports Journalist ORDER TICKETS ONLINE at salemstate.edu/series Download a ticket order form and mail to Salem State Series, 352 Lafayette Street, Salem, MA 01970 Assorted Seating Options Available For more information, call the Series Box Office at 978.542.7555 The Series, presented under the auspices of the Salem State University Foundation, is pleased that longtime supporter Giant Glass returns as a presenting sponsor and Cranney Companies also continues support as the feature sponsor for the 2012 programs. Tickets may be purchased online at salemstate.edu/series.