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The Medicare and Medicaid home health benefits cover over 4 million persons annually, costing an estimated $17 billion or more. However, these benefits are based on a medical model, with limited social work coverage. Historically, social work represents only 1-2% of all national Medicare home health visits and less than 1% of all Medicaid home health visits. There has been some research on the frustrations of home care social workers and unmet patient needs, but no research on factors affecting their care decisions and coping strategies of nurses and social workers. The paper presents the results of an interview-based pilot study of coping strategies, using a convenience sample of 33 home care nurses and 39 home care social workers in the New York City metropolitan area. The focus is on their care decisions for persons with Alzheimer's disease, a disease affecting over 5 million Americans, most aged 65 and older, and expected to impact over 16 million by 2050. The interviews occurred from October 2005-December 2007. Three dominant coping strategy types emerged: conformist, innovator, and rebel. The article discusses interview results and other evidence to assert the need for a more robust social workbased psychosocial care component in home health care. Implications for policy change using the Hospice Medicare Benefit model are discussed. [ABSTRACT FROM AUTHOR]

There is significant literature characterizing the pharmaceutical industry in the United States as a powerful, unified, and monolithic profit-oriented industry manipulating elected officials, and their emissaries, in various policy-making venues, as if they were marionettes, to generate more profits at the expense of public health. The 2003 Medicare Modernization Act (MMA), which created the Medicare Part D outpatient prescription drug benefit, is used by some as evidence of this characterization. This paper explores the roles of the pharmaceutical industry and elected officials from a broader perspective by asking the question: What are the respective roles and influence of the pharmaceutical industry and elected officials in policymaking, examined through the lens of passage of the MMA and 2010 Patient Protection & Affordable Care Act (PPACA)? The paper uses a comparative case study of the 2003 Medicare Modernization Act (MMA) and 2010 Patient Protection & Affordable Care Act (PPACA). The analysis finds that in both the MMA and PPACA politicians moderated the relationship between the pharmaceutical industry and other organized interests and the legislative outcomes, which included a combination of positive outcomes for public health and the pharmaceutical industry. Lessons for public health advocates are discussed. [ABSTRACT FROM AUTHOR]

Alzheimer's disease is a major and increasing cause of illness in the United States, imposing significant social, economic, and psychological burdens. Over 5 million Americans had to Alzheimer's disease in 2007, with most being aged 65 or older, living at home, and cared for by family members (Alzheimer's Association, 2007). Projections are that 16 million Americans will have Alzheimer's disease by 2050 (Federal Interagency Forum on Aging Related Statistics, 2004). Literature indicates that evidence-based psychosocial interventions yield the most significant mental and physical health benefits for the Alzheimer's population. Despite these findings, the $15 billion annual Medicare is based on a medical model, providing limited medical and virtually no psychosocial care to this largely home and community-based population. The IRB-approved study uses a convenience sample of 34 home care social workers in New York City interviewed between August 2006-October 2007. Using Merton's (1957) adaptation model, three coping strategies emerged: conformist, innovator, and rebel. The study asserts results indicate a significant unmet client need, social worker frustration, and cost-ineffective care. The study further asserts the need for a robust inclusion of psychosocial home care for persons with Alzheimer's disease and their caregivers, either as part of the current Medicare home health benefit or as a separate benefit. The study suggests demonstration or pilot studies drawing on the Hospice Medicare Benefit experience and model to address Alzheimer's disease in a more cost-effective and more positive quality of life manner to limit the adverse consequences of the evolving epidemic. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Early indications are that the Medicare home health prospective payment system (PPS) has controlled Medicare home health expenditures. However, studies indicate many unresolved questions about whether PPS improves patient quality of care and is cost-effective. The question persists as to whether PPS has intensified the Medicare home health benefit's historic focus on acute medical care, ignoring the needs of persons with chronic diseases. The paper reviews effective home-based palliative care interventions and presents the views of seven home health care nurses regarding the impact of Medicare requirements on their management of Alzheimer's disease patients. The nurses identify Alzheimer's disease symptom management and psychosocial needs as phantoms, omnipresent below the surface but not attended to by home care clinicians. Nurse coping strategies are discussed. The paper asserts the policy failure to address the cost and quality of life issues of home health Alzheimer's patients is analogous to the end-of-life care situation Medicare confronted in the 1970s prior to the demonstration program which preceded the Hospice Medicare Benefit. The article asserts that a similar demonstration is appropriate to determine how PPS might better facilitate management of home health Alzheimer Disease patient quality of life and costs. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a growing condition having significant financial, psychological, and social burdens on persons with the condition, thei caregivers, business, and government. Over 70% of persons with AD are community-based. The Medicare home health benefit is the government's major program for dealing with homebound elderly. However, the Medicare home health benefit does not cover psychosocial interventions for persons with AD and their carregivers, despite extensive randomized controlled studies (Gitlin; Mittelman) supporting their quality of life and ecomnic benefit. The paper presents results of interviews of over 70 home health care nurses and social workers explaining organizational constraints resulting from such Medicare restrictions and their impact on unmet client needs. Policy alternatives are explored including use of pilot tests of a Medicare home health model based on the Medicare hospice benefit. [ABSTRACT FROM AUTHOR]

There has been extensive study of individual and neighborhood-level predicters of adult depression (Kim, 2008; Mair, Diez-Roux, & Galea, 2008). However, all studies have significant limitations and only eight studies in the last fifty years address predicters of elderly depression. Using potential predicters from an extensive literature review, variables from the Health Indicators Project (HIP) database were used to derive a predictive model for elderly depression. HIP is composed of data from a 2008 survey of 1870 enrolles from 56 New York City senior centers. A stepwise regression analysis was conducted resulting in a predictive model of seven variables. The model and its implications for public policy and further research will be discussed. [ABSTRACT FROM AUTHOR]