Predicted economic damage from a quick, simple Alzheimer's disease cure.

The estimated 5.8 million Alzheimer's disease patients in the U.S. require an enormous share of national healthcare expenditures. Other nations face similar economic burdens. There have been great efforts, thus far unsuccessful, to discover an effective therapeutic, with 1081 Alzheimer's disease drug trials completed as of May 2019. The pessimism thus engendered has forestalled contingency planning for the potential major economic repercussions of a simple, quick cure. Yet, promising new research spotlighting the possible "trigger" role of infectious agents might allow some or all cases of Alzheimer's disease to be halted, reversed, or prevented with an antibiotic or antiviral compound, possibly even one already approved by drug regulators for other uses. The sudden advent of such an unexpected therapy would theoretically have dramatic impacts, both detrimental and beneficial, on the American economy. The damages would include a $414 billion shrinkage of Medicaid, Medicare and other revenues to all six sectors comprising the healthcare provider category. Nursing homes and skilled nursing facilities are projected to suffer the greatest loss of annual revenue: $51 billion and $16 billion, respectively. This would cause the loss of an estimated 654,000 jobs. Facility mortgage and commercial loan repayments could stop. Other adverse consequences would include detrimental effects on reserves for Social Security and pensions, cutbacks in dementia research funding, and reduced donations to Alzheimer's disease advocacy groups. Insurance company reserves for fixed payment annuities already sold could be jeopardized. However, an Alzheimer's disease cure would also create economic beneficiaries. Medicare and Medicaid would save up to a projected $195 billion annually. Life insurance companies and unpaid caregivers would also benefit financially. By identifying the healthcare sectors likely to be detrimentally impacted by a simple, quick Alzheimer's disease cure, contingency plans can be made in the U.S. and other countries to assist the foreseeable painful transitions for staff and facilities.

The Role of Assisted Living Capacity on Nursing Home Financial Performance.

The rapid growth of the assisted living industry has coincided with decreased levels of nursing home occupancy and financial performance. The purpose of this article is to examine the relationships among assisted living capacity, nursing home occupancy, and nursing home financial performance. In addition, we explore whether the relationship between assisted living capacity and nursing home financial performance is mediated by nursing home occupancy. This research utilized publicly available secondary data, for the state of Florida from 2003 through 2015. General descriptive statistics were used to assess the relationships among financial performance, assisted living capacity, and occupancy. To explore the relationships among financial performance, assisted living capacity and occupancy, and test potential mediation of occupancy, we followed Baron and Kenny's approach and estimated 3 models examining the relationships between (1) assisted living capacity and nursing home financial performance, (2) assisted living capacity and nursing home occupancy, and (3) nursing home occupancy and financial performance after assisted living capacity is included in the model. We used generalized estimating equations, to adjust for repeated measures and to model the above relationships. Year fixed effects control for time trend. The independent variable, assisted living beds, was lagged for 1 year to account for the potential influence on financial performance. The final analytic sample consisted of 7688 nursing home-year observations from 657 unique nursing homes. Our findings suggest that assisted living capacity does have a negative impact on nursing homes' financial performance. Even though, assisted living capacity seems not to significantly decrease nursing home occupancy. The relationship between assisted living capacity and financial performance was not mediated through occupancy. These findings suggest that assisted living communities may not be able to significantly reduce nursing home occupancy; however, the presence of assisted living communities may create additional financial/competitive pressures that result in decreased nursing home financial performance.

Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia.

BACKGROUND: This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs. METHODS: A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women's Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention. RESULTS: The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and-AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820. CONCLUSIONS: The costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents.

Costs of potentially inappropriate medication use in residential aged care facilities.

BACKGROUND: The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care. METHODS: Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults. RESULTS: Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted ß = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care. CONCLUSIONS: The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.

Aging in Place: Our House Is a Very, Very, Very Fine House.

As 10,000 American baby boomers turn 65 years of age every day between 2017 and 2030, society needs to help our aging population find ways to handle the restrictions and limitations that come with increasing age: visual impairment, hearing loss, osteoarthritis, dementia, and other conditions common in older adults. Institutional or long-term care for elderly individuals costs an average of $82,000 to $92,000 per person per year and varies by location. Care in an assisted living facility costs $43,500 per person annually. Living in a personal home or residential setting-aging in place-by contrast, costs an average of $23,000 per person per year. Successful aging in place encompasses safety, health, and economic security. Numerous aging-in-place programs exist in contained geographic areas (towns and counties) or in areas that promote community living (e. g., cohousing or homesharing) or focus on special interests like the arts. Two such programs, the naturally occurring retirement community (NORC) model and the Village model, seem to have had the most success. Elderburbs-older, age-unfriendly communities not focused on residents' health care and mobility needs-remain and can present unique problems. Handheld technology or that integrated into housing can improve the standard of living, help elders improve their functioning, and even monitor medication. The aging-in-place movement presents numerous opportunities for consultant pharmacists.

Factors contributing to high-cost hospital care for patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admission, the fifth leading cause of death in North America, and is estimated to cost $49 billion annually in North America by 2020. The majority of COPD care costs are attributed to hospitalizations; yet, there are limited data to understand the drivers of high costs among hospitalized patients with COPD. In this study, we aimed to determine the patient and hospital-level factors associated with high-cost hospital care, in order to identify potential targets for the reorganization and planning of health services. We conducted a retrospective cohort study at a Canadian academic hospital between September 2010 and 2014, including adult patients with a first-time admission for COPD exacerbation. We calculated total costs, ranked patients by cost quintiles, and collected data on patient characteristics and health service utilization. We used multivariable regression to determine factors associated with highest hospital costs. Among 1,894 patients included in the study, the mean age was 73±12.6 years, median length of stay was 5 (interquartile range 3-9) days, mortality rate was 7.8% (n=147), and 9% (n=170) required intensive care. Hospital spending totaled $19.8 million, with 63% ($12.5 million) spent on 20% of patients. Factors associated with highest costs for COPD care included intensive care unit admission (odds ratio [OR] 32.4; 95% confidence interval [CI] 20.3, 51.7), death in hospital (OR 2.6; 95% CI 1.3, 5.2), discharge to long-term care facility (OR 5.7; 95% CI 3.5, 9.2), and use of the alternate level of care designation during hospitalization (OR 23.5; 95% CI 14.1, 39.2). High hospital costs are driven by two distinct groups: patients who require acute medical treatment for severe illness and patients with functional limitation who require assisted living facilities upon discharge. Improving quality of care and reducing cost in this high-needs population require a strong focus on early recognition and management of functional impairment for patients living with chronic disease.

AAL Service Performance Measurement Cube - Key Criteria for AAL New Service Development.

UNLABELLED: The living environments of senior citizens are gaining in complexity with regard to health, mobility, information, support and behaviour. The development of Ambient Assisted Living (AAL) services in order to reduce this complexity is becoming increasingly important. The question is: What relevant criteria support the development, measurement and evaluation of business models of hybrid AAL services which have to be considered in an appropriate Performance Measurement Set? Within the EU funded research project DALIA (Assistant for Daily Life Activities at Home) a Service Performance Measurement Criteria (SPMC) Set has been developed and described. With the help of literature review and expert interviews relevant performance criteria were identified and described in the context of Analytic Hierarchy Process (AHP). In conjunction with an AAL business models scanning, a set of performance measurement criteria could be created. DISCUSSION: The development and application of a specific AAL SPMC Set offers the possibility in a targeted and conceptual way advance the development of marketable AAL services. Here it will be important to integrate with software support the SPMC Set in the service development process of future marketable AAL applications. With the application of an adjusted AAL Service Performance Measurement Cube, the conceptual development of marketable AAL services can be maintained and relevant decisions can be supported.

Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review.

Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.

Banks Cater To Long Term Care.

Providers are looking for money to invest in their businesses both for the short and long term.

Hands-On Experiences in Deploying Cost-Effective Ambient-Assisted Living Systems.

Older adults' preferences to remain independent in their own homes along with the high costs of nursing home care have motivated the development of Ambient Assisted Living (AAL) technologies which aim at improving the safety, health conditions and wellness of the elderly. This paper reports hands-on experiences in designing, implementing and operating UbiCare, an AAL based prototype system for elderly home care monitoring. The monitoring is based on the recording of environmental parameters like temperature and light intensity as well as micro-level incidents which allows one to infer daily activities like moving, sitting, sleeping, usage of electrical appliances and plumbing components. The prototype is built upon inexpensive, off-the-shelf hardware (e.g., various sensors, Arduino microcontrollers, ZigBee-compatible wireless communication modules) and license-free software, thereby ensuring low system deployment costs. The network comprises nodes placed in a house's main rooms or mounted on furniture, one wearable node, one actuator node and a centralized processing element (coordinator). Upon detecting significant deviations from the ordinary activity patterns of individuals and/or sudden falls, the system issues automated alarms which may be forwarded to authorized caregivers via a variety of communication channels. Furthermore, measured environmental parameters and activity incidents may be monitored through standard web interfaces.

Creating a comprehensive care system for frail elders in "age boom" america.

Current options being discussed by policymakers cannot yield the highly reliable, highly efficient service delivery system-inclusive of both health care and community-based supportive services-that the nation's upcoming and transformative "age wave" will require. More far-reaching and rapid innovations in policy and health care delivery are essential. The MediCaring Accountable Care Community initiative is a comprehensive model that can deliver higher quality care for frail elderly Medicare beneficiaries at a lower per capita cost. The savings generated by adhering to established geriatric principles in the delivery of medical care would help fund community-based long-term services and supports (LTSS), using a modified Accountable Care Organization (ACO) known as an Accountable Care Community (ACC). A Community Board would monitor the quality and supply of services for frail elders, the most expensive phase of most lives. The constellation of improvements that form the basis of this model are congruent with the goal of improving access to LTSS, which is one of the 4 areas targeted by the Sixth White House Conference on Aging.

Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care.

Despite a shift from institutional services toward more home and community-based services (HCBS) for older adults who need long-term services and supports (LTSS), the effects of HCBS have yet to be adequately synthesized in the literature. This review of literature from 1995 to 2012 compares the outcome trajectories of older adults served through HCBS (including assisted living [AL]) and in nursing homes (NHs) for physical function, cognition, mental health, mortality, use of acute care, and associated harms (e.g., accidents, abuse, and neglect) and costs. NH and AL residents did not differ in physical function, cognition, mental health, and mortality outcomes. The differences in harms between HCBS recipients and NH residents were mixed. Evidence was insufficient for cost comparisons. More and better research is needed to draw robust conclusions about how the service setting influences the outcomes and costs of LTSS for older adults. Future research should address the numerous methodological challenges present in this field of research and should emphasize studies evaluating the effectiveness of HCBS.

Characteristics of residents living in residential care communities, by community bed size: United States, 2012.

In 2012, there was a higher percentage of older, female residents in communities with more than 25 beds compared with communities with 4­25 beds. Residents in communities with 4­25 beds were more racially diverse than residents in larger communities. The percentage of Medicaid beneficiaries was higher in communities with 4­25 beds than it was in communities with 26­50 and more than 50 beds. A higher percentage of residents living in communities with 4­25 beds had a diagnosis of Alzheimer's disease or other dementias compared with residents in larger communities. Need for assistance with each of the activities of daily living (ADLs) examined (except walking or locomotion) was substantially higher among residents in communities with 4­25 beds, compared with residents in larger communities. Emergency department visits and discharges from an overnight hospital stay in a 90-day period did not vary across residents by community bed size. This report presents national estimates of residents living in residential care, using data from the first wave of NSLTCP. This brief profile of residential care residents provides useful information to policymakers, providers, researchers, and consumer advocates as they plan to meet the needs of an aging population. The findings also highlight the diversity of residents across the different sizes of residential care communities. Corresponding state estimates and their standard errors for the national figures in this data brief can be found on the NSLTCP website, available from: http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm. These national and state estimates establish a baseline for monitoring trends among residents living in residential care.

A multi-collaborative ambient assisted living service description tool.

Collaboration among different stakeholders is a key factor in the design of Ambient Assisted Living (AAL) environments and services. Throughout several AAL projects we have found repeated difficulties in this collaboration and have learned lessons by the experience of solving real situations. This paper highlights identified critical items for collaboration among technicians, users, company and institutional stakeholders and proposes as a communication tool for a project steering committee a service description tool which includes information from the different fields in comprehensible format for the others. It was first generated in the MonAMI project to promote understanding among different workgroups, proven useful there, and further tested later in some other smaller AAL projects. The concept of scalable service description has proven useful for understanding of different disciplines and for participatory decision making throughout the projects to adapt to singularities and partial successes or faults of each action. This paper introduces such tool, relates with existing methodologies in cooperation in AAL and describes it with a example to offer to AAL community. Further work on this tool will significantly improve results in user-centered design of sustainable services in AAL.

Nursing home prices and market structure: the effect of assisted living industry expansion.

Since the 1990s, there has been substantial expansion of facility-based alternatives to nursing home care, such as assisted living facilities. This paper analyzes the relationship between expansion of the assisted living industry, nursing home market structure and nursing home private pay prices using a two-year panel of nursing homes in the State of Ohio. Fixed effect regressions suggest that the expansion of assisted living facilities are associated with increased nursing home concentration, but find no effect on private pay nursing home prices. This would be consistent with assisted livings reducing demand for nursing homes by delaying entry into a nursing home, though assisted livings are not direct competitors of nursing homes.