Ideas for making care for elderly adults safer

The ideas and innovators shaping health care

Oct 06, 2022 View in browser   By Grace Scullion, Ben Leonard, Carmen Paun and Ruth Reader FORWARD THINKING A nursing home in Rockland, Mass. | David Goldman/AP Photo The reimagining of how nursing homes are staffed, funded, structured and regulated to make a safer future for their residents has begun. The brainstorming comes after the Covid-19 pandemic revealed dangerous conditions and staff shortages at the homes. More than 200,000 residents of nursing homes and other long-term care facilities had died of Covid-19 as of February, according to the Kaiser Family Foundation. Four recent nursing home proposals: The National Academies of Sciences, Engineering, and Medicine called for sweeping reforms in a 500-page report this year. It recommended increased investment in the nursing home workforce, a redesign of nursing home financing and more stringent standards and oversight. Experts in health care for older adults backed the National Academies' report at a recent hearing of the House's Select Subcommittee on the Coronavirus Crisis. The co-founder of the House Democratic Caucus Task Force on Aging and Families, Rep. Jan Schakowsky (D-Ill.), wants to upend the current system with a bill that would set aside $30 million for grants to develop "small-home" nursing facilities with 12 or fewer patients living in private rooms. The Government Accountability Office, the watchdog arm of Congress, recommended that the Centers for Medicare and Medicaid Services increase oversight, training and guidelines to prevent disease spread. Two years ago, GAO found that more than four in five nursing homes inspected by CMS had serious flaws in their disease-prevention procedures. The Biden administration has called on Congress to address the issue and raised concerns about private equity-owned nursing homes, where studies found higher average Covid infection rates in 2020, and greater taxpayer spending per resident and antipsychotic drug use last year.  Covid's cost: Beyond the thousands of deaths, lockdowns exacerbated mental and physical health issues among nursing home residents. GAO's analysis of CMS data showed seven in eight mental and physical health indicators worsened in 2020. Depression increased by 3.7 percent and unexplained weight loss by 4.3 percent from 2019 to 2020. Though both metrics fell in 2021, they remained above pre-pandemic levels. What's more, nursing home staffing declined by 10.2 percent since 2020, according to the Bureau of Labor Statistics. More people are opting for home and community-based care instead of nursing homes, according to the Kaiser Family Foundation. The number of nursing home residents decreased 13 percent from July 2019 to July 2022. WELCOME TO FUTURE PULSE This is where we explore the ideas and innovators shaping health care. The World Health Organization is relaunching its AI-powered, virtual "digital health worker," Florence 2.0. Honestly, we find her a little creepy — would you ask her for health advice? Share news, tips and feedback with Ben at bleonard@politico.com, Ruth at rreader@politico.com, Carmen at cpaun@politico.com, or Grace at gscullion@politico.com.  Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today in our Pulse Check podcast, Daniel Payne and Ben Leonard on a Tuesday letter from more than 100 researchers, scientists and public health professionals who want fentanyl-related substances to no longer be Schedule I drugs. Plus, Jason Gibbons explains a new study on using buprenorphine in Medicare patients. Listen to today's Pulse Check podcast. THE LAB Joe Raedle/Getty Images People taking the opioid buprenorphine to wean themselves off stronger opioids were more likely to overdose if they stopped taking the medicine, new research on Medicare patients has found. The findings underscored the importance of carefully monitoring the care of people with opioid use disorder, which killed more than 70,000 people in 2020. What can be done to make sure patients stick to their treatment plans? Telehealth makes it easier to access care and has shown potential to boost adherence, the authors of the study in JAMA Psychiatry noted. Insurance coverage of buprenorphine and improved housing, transportation and child care services are usually prerequisites for treatment success. But research has found many patients aren't that fortunate. "Adherence to buprenorphine is pretty low. A lot of factors do come down to your ability to access treatment, which are determined by basic things like 'Do I have childcare so I can go to my appointment? Do I have access to a bus that can take me close to where my provider is?'" Jason Gibbons, a postdoctoral fellow at Johns Hopkins University who co-wrote the report, told Future Pulse. A 2020 study on Philadelphians placed on buprenorphine regimens found only about one in four were still following it six months later. The toll: Gibbons and his colleagues found that patients who stopped taking buprenorphine before weaning themselves off opioids were at least 1.5 and as much as 4.3 times more likely to overdose, depending on the treatment protocol. WORLD VIEW 570 million Projected cases of diabetes in adults by 2030 BRINGING INSULIN TO THE WORLD — It's an age-old story: Therapies for a disease that could kill people exist, but those in the poorest countries can't get them. That's the case for insulin for people with diabetes in some two dozen countries, according to a new report by the Netherlands-based Access to Medicine Foundation. No insulin is available in 24 countries, including Angola, Belize, Papua New Guinea, South Sudan and Tajikistan. This has deadly consequences, given diabetes rates in some of those nations. Current forecasts predict 70 million more people will have diabetes worldwide by 2030, most of them in low- and middle-income countries. That's on top of the half a billion adults worldwide who have diabetes today, the report said. Some progress: The companies that control the global insulin market — Eli Lilly, Novo Nordisk and Sanofi — have implemented programs over the last few years to expand access to their products to people living in poorer countries, but they need to better monitor the impact, the foundation said. The companies should also provide broader access for poor patients everywhere by considering their ability to pay and adjusting prices accordingly, the report said. And drugmakers should prioritize filing for regulatory approval in the countries where the need is most urgent, such as countries in the western Pacific, which accounted for most diabetes-related deaths among adults in 2021, according to the report.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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