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https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/dementia/dementia-and-music/

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Music  Therapy for agitation in Dementia

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Music  Therapy for agitation in Dementia

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This week we will look at a cost effectiveness synthesis that included music therapy as a non-pharmocological intervention. Livingston et al. (2014) conducted a synthesis paper in order to determine the cost-effectiveness of different sensory and behavioral interventions for agitation in adults with dementia.

Music therapy using a specific protocol was categorized with "evidence of efficacy" for decreasing agitation during the intervention in care home residents. The authors report that trained music therapists led interventions in the included studies (p. 20). They also indicate that these studies included w warm-up, listening to well-known music, and playing music. There was no evidence for long-term decreases in agitation and little evidence outside of care homes.

Music therapy without a specific protocol was categorized under "too little evidence to make definitive recommendations" (p. 17). A quick review of the studies listed in this section includes studies using recorded music - sometimes preferential, sometimes not - played during times of agitation. There were fewer studies in this category and the authors report that the studies were of lower quality.

The cost of effectiveness of services was calculated using literature that examined costs and or cost-effectiveness of interventions. Music Therapy was noted as cost effective at the price of 13-27 pounds ($22-46) for the intervention. These rates are below current US rates for intervention; however, this is an analysis of past studies (and therefore past rates). Since there a few studies that report costs, these data would be generated from a small sample of studies.

The authors also completed a cost-effectiveness analysis, where cost was calculated in consideration of per unit improvements in agitation (Pg. 62 of the report). This included studies where the Cohen-Mansfield Agitation Inventory (CMAI) was used to measure agitation. In this analysis the cost of the intervention was divided by the the change in agitation scores. Therefore, the cost reported is the incremental cost per unit reduction. Music therapy was the lowest of the interventions, at 4 pounds ($6.83) per CMAI unit. I would be interesting to see this value calculated using current music therapy intervention rates.

I am not an expert in this type of research, so I look forward to hearing other's opinions of this study. I appreciate that these authors took the time to separate music therapy interventions with protocols from music therapy interventions without protocols. I did some spot checking of cited articles in the both categories and found that articles in the "with protocols" category were led by trained music therapists or individuals with training in music interventions. Music therapy in the "without protocols" category was led by numerous professionals including nursing staff in my quick check. This distinction is very important, as the training of a music therapists to use protocols ensures that the patient receives services that are appropriate and will best facilitate intended outcomes. With all the excitement about playing recoded music for older adults in the popular media, this study provides some grounds for consideration of the type of services provided - with evidence of improvements for protocol-based services.

Reference:
Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, Omar RZ, Katona C, & Cooper C. (2014). A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technology Assessment, 18(39), 1-226. PMID: 24947468

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This week we will look at a cost effectiveness synthesis that included music therapy as a non-pharmocological intervention. Livingston et al. (2014) conducted a synthesis paper in order to determine the cost-effectiveness of different sensory and behavioral interventions for agitation in adults with dementia.

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My essay on reminiscence therapy - I ain't saying it's a masterpiece :-D ... but might be some useful stuff within

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Dementia and the Role of Occupational Therapy

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Follow @AOTAinc on twitter for the latest updates about AOTA!

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NICE-dementia interventions

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NICE- dementia overview

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NICE guideline- dementia

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A protocol set forth by the cochrane database to study the effectiveness of cannaboids as a treatment for dementia. 

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A protocol set forth by the cochrane database to study the effectiveness of cannaboids as a treatment for dementia. 

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Although this is just a PROTOCOL, it is very interesting to see whats involved in a Cochrane review and, more importantly, to see that active research is ongoing in relation to the medicinal use of cannoboids.

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“Community Mobility and Dementia” Literature Review 

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“Community Mobility and Dementia” Literature Review 

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The focus of concern surrounding transportation for those with dementia has until recently been on driving cessation. However, while it is important to be aware of issues related to driver screening and assessment, equal attention should be devoted to cessation counseling and helping the driver move to the passenger seat. Currently, alternative modes of transportation are not very “elder-friendly,” let alone “dementia-friendly.” This paper reviews the available literature on community mobility and dementia, beginning with driving and concluding with community-mobility options. The document provides a starting point for addressing the policy, program, and research issues implicit in finding ways to meet the community mobility needs of a population for whom driving is no longer safe..

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Community Mobility and Dementia DOT HS 810 684

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Megan Vanderbur was supported in this project through an internship with the Alzheimer's Association Public Policy Division, Washington, DC. Dr. Silverstein supervised Vanderbur in her preparation of this literature review. Dr. Silverstein was supported, in part, through a cooperative agreement with the National Highway Traffic Safety Administration, Department of Transportation, and through the Alzheimer's Association.

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https://www.alzheimersresearchuk.org/about-dementia/facts-stats/10-things-you-need-to-know-about-dementia/

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Interesting piece on safeguarding those with dementia

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Interesting piece on safeguarding those with dementia

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Couldn't paste the URL but if you search for:

Safeguarding people with dementia by SCIE you'll get a very sober, useful assessment on understanding dementia and many of the fears that exist around the condition

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Dementia in adults Diagnosis: Pathways for practitioners Mental Capacity Act (2005) Care Act (2014) NICE: Dementia guidelines Enduring Power of Attorney Act (1985) Deprivation of Liberty Safeguards (2009) Embracing Risk (RCOT) The wider context Stigma Growing awareness Research Innovative interventions Advocating for OTs Associated symptoms OT Process Client-centred care Environment Meaningful occupations Social support networks Community services Holistic process Assessment Telling the public Telling professionals Pressure on leaders Political action

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Legislation protecting dementia patients 

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Legislation protecting dementia patients 

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http://www.careinfoscotland.scot/topics/your-rights/legislation-protecting-people-in-care/adult-support-and-protection-scotland-act-2007/http://www.careinfoscotland.scot/topics/your-rights/legislation-protecting-people-in-care/adult-support-and-protection-scotland-act-2007/

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Interesting fact: Traditionally the role of OT working in local authorities has been shaped by statutory legislation, focusing on the assessment and provision ofequipment and adaptations for disabled and vulnerable people. OTs deal with between 35–45% of local authority referrals yet only make up 2% of the workforce. This in itself demonstratesthe considerable contribution that the profession makes to social care.

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Interesting fact: Traditionally the role of OT working in local authorities has been shaped by statutory legislation, focusing on the assessment and provision ofequipment and adaptations for disabled and vulnerable people. OTs deal with between 35–45% of local authority referrals yet only make up 2% of the workforce. This in itself demonstratesthe considerable contribution that the profession makes to social care.

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Legislation: (Statutory) Enduring Power of Attorney Act (1985)

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Legislation: (Statutory) Enduring Power of Attorney Act (1985)

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Impacts heavily on OTs working with dementia patients who have no capacity (and this includes control over own finances)

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Lots of reading to trawl thro - but this is NICE guidelines on working with / treating those with dementia (including notes on legal framework)

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Lots of reading to trawl thro - but this is NICE guidelines on working with / treating those with dementia (including notes on legal framework)

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Basic outline on stat/non-stat services (UK based)

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Basic outline on stat/non-stat services (UK based)

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Nice article on social care and challenges to it - including back-door privatisation: 

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Nice article on social care and challenges to it - including back-door privatisation: 

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Accountable care systems are being sold as the new way of preventing hospital admissions and saving money. But are they privatisation by the back door?

y life now is 100% better. In my old flat I was socially isolated and didn't get out much. But here I have as much privacy but also as much activity and company as I want. And I feel safe here." Michael James is describing life at Priory View, a sheltered accommodation block in Dunstable, Bedfordshire, that is trying to keep its 83 elderly, often disabled, residents as healthy as possible for as long as possible. Dozens of residents attend its two-hour chair-based exercise class every Thursday, and almost as many turn up for the gadget sessions, where iPad and iPhone skills are taught, to help people stay in touch with friends and loved ones.

"I go out to the supermarket at the front of the complex to collect a newspaper every morning for myself and six others, and have a chat when I deliver them to people who aren't as mobile as me. It keeps me active and takes me about 75 minutes," says James, 70, who has walked with a stick since breaking his back in a car crash in 2014. Bingo sessions, as well as book, knitting and gardening clubs offer opportunities to socialise that few residents would have had in their old homes. The year before he moved into Priory View, James - who takes 49 tablets a day for a range of ailments - got four birthday cards; this year he received 48.

Priory View is an example of how the NHS and local councils in some parts of England are pooling their shared expertise and money to promote health and wellbeing among local people by working together through " accountable care systems " (ACS). This is the latest buzzphrase in the NHS. Few outside the service understand them, sceptics doubt they will work, and some even see them as a Trojan horse for the ultimate privatisation of the NHS. But whatever their merits, these systems are certainly revolutionary - and they are now the NHS England's declared direction of travel. They will involve huge change and oblige people in the NHS and local government to work together to an unprecedented degree while somehow avoiding their new shared mission being scuppered by rows and old-style organisational thinking.

They are the brainchild of Simon Stevens, NHS England's chief executive, they are seen as the best chance of overcoming its huge staffing and financial problems, while simultaneously keeping people healthier and reducing the soaring demand for care that is crippling hospitals and GP surgeries. Announcing the first eight "pathfinder" areas that would become care systems, Stevens described them as the key element of "the biggest national move to integrating care of any western country", which would end the fragmented system through a massive expansion in out-of-hospital care.

Bedfordshire, Luton and Milton Keynes together form one of the eight pathfinder areas that will become fully operational in 2018-19. It is a collaboration, but not a merger, between 16 public sector organisations that between them provide health or social care for 960,000 people. It comprises three NHS clinical commissioning groups, four local councils, three acute NHS trusts and six NHS ambulance, mental health and community services trusts.

All eight pathfinders are due to receive £450m of extra funding from NHS England over the next four years in return for taking on their responsibilities for improving health. For the ACS in Bedfordshire, Luton and Milton Keynes, that means making progress on life expectancy, suicide rates, the number of hospital bed-days being used, cancer survival, incidence of cardiovascular events such as strokes, and other key indicators of its population's health and care outcomes. There are wide inequalities in health between, for example, Luton's poor, multi-ethnic population and the elderly, often prosperous population of central Bedfordshire.

Its three main priorities are ramping up preventative healthcare, moving care closer to home, and keeping hospitals sustainable. All that has to be delivered for a combined budget of less than £1bn.

The ACS's chief of staff is Mark England, until recently a senior executive at the Luton and Dunstable hospital trust, while its senior responsible officer, Richard Carr, is also the chief executive of Central Bedfordshire council. The bosses of the 16 bodies will keep their jobs for the foreseeable future, but Carr - who is also running the NHS sustainability and transformation plan (STP) in the area - and Pauline Philip, the STP's chair and NHS England's national urgent and emergency care director, will hold the reins.

Carr and England are helping the 16 partners adjust to their new role of working together and, crucially, trying to persuade those worried that what England calls painful but necessary change in how things are done will be worth the upheaval involved in the end - even if they lose out. But their powers are limited. "[An ACS] is a voluntary agreement between 16 different organisations that together we can deliver a better system," says England. "There's not a statutory basis for it. There's no legal umbrella under which it sits. "It all depends on trust and confidence between individuals and organisations that together we make decisions that may not benefit a particular organisation's interest - for example, that of a hospital trust - but is in the interests overall of the population and the system."

Cuts to services in many parts of England will pose a stiff test of these new relationships that the 44 STPs, and especially the eight care systems, are meant to embody. The potential reconfiguration of hospital services as a result of the Bedfordshire, Luton and Milton Keynes ACS has already sparked controversy. Dave Hodgson, Bedford's directly-elected mayor, is a notable critic. He and fellow councillors are worried that A&E, maternity and children's services at Bedford hospital will be downgraded and that NHS trusts have been "sidelining" local councils in the creation of the ACS, despite them being full partners. The MPs in the area appreciate the need to prioritise out-of-hospital care but fear that the resulting changes to local hospitals may prove unpopular, especially after changes to a hospital in Canterbury helped Labour gain the seat from the Conservatives at the general election.

But England says that the ACS, with its combined budget, will incentivise all the partners to prioritise prevention and keeping patients out of hospital. "The way the current [NHS] payment system works, hospitals have a financial self-interest in getting patients in and doing things to them. But it's in the system's interest and the population's interest to stop that happening. We want to keep people well so they don't have to go into hospital," explains England. "That will leave a financial hole for one of the partner institutions. Therefore, whichever trust that is has to know that they have the support of the system to make a deficit if there's a counterbalancing surplus elsewhere."

England describes himself as almost the NHS equivalent of a travelling salesman. Every week he travels up and down the M1 and around the ACS area meeting people to explain why the it is painful but necessary medicine the care system has to swallow. "I'm trying to sell transformation when inertia is the biggest force in the NHS," he admits. "Everybody sees healthcare as hospitals, and in trying to change that view you are pushing against immense professional and economic forces, as well as public perception. ACSs are the NHS's way of breaking free from that inertia."

Getting the ACS up and running has not been easy, he admits. But England is certain this is the only way to tackle huge problems caused by the ageing and growing population. "I hope that by 2020-21 the population of Bedfordshire, Luton and Milton Keynes will all be receiving well-designed out-of-hospital care - and only when really necessary visiting sustainable hospitals, - and seeing much greater join-up between public services as a whole, while outcomes such as gaps in life expectancy should be beginning to close."

Priory View is "entirely consistent with the thinking of the ACS", says Carr. "That is, looking at the population's health needs and the public services available to meet them, then coming up with ideas to improve their outcomes".

Its residents appear happy with their surroundings. "I like the spa, the bar and the restaurant. But most of all it's the cameraderie I like. There are lots of people here in the same situation as me, who have medical conditions or disabilities. But we don't feel our pain because we're talking to each other or laughing a lot," explains James.

* This article was amended on 2 August 2017 because Dunstable is in Bedfordshire not Hertfordshire as an earlier version said.

Topics

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How to keep older people out of hospital? Get the NHS and care services together

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Accountable care systems are being sold as the new way of preventing hospital admissions and saving money. But are they privatisation by the back door? y life now is 100% better. In my old flat I was socially isolated and didn't get out much.

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Here's an interesting article on deaths among the elderly due to NHS 'crisis': 

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Here's an interesting article on deaths among the elderly due to NHS 'crisis': 

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Years of austerity has fueled a rise in overall death rates - especially among frail, elderly people, according to new research.

Experts writing in a British Medical Journal (BMJ) paper said a "crisis in the NHS" and problems in social care, as a result of restricted public spending, are at least partly to blame for increasing death rates from 2015 in England and Wales.

A team from the universities of Liverpool, Oxford, Glasgow and York analysed data from August 2010 to March 2016 on delayed discharges, where patients are stuck in hospital even though they are fit to leave, and death rates across England. Between July 2014 and June 2015, England and Wales saw an additional 39,074 deaths compared with the same period the previous year.

"We have consistently raised the issue of delayed discharges over the past three years while the Government failed to acknowledge the scale of the crisis in social care and the record numbers of delayed discharges in our hospitals as a result."
Dr Nick Scriven, President, the Society for Acute Medicine

"While mortality rates fluctuate year on year, this was the largest rise for nearly 50 years and the higher rate of mortality has been maintained throughout 2016 and into 2017," the authors write in the Journal of Epidemiology and Community Health. Most of these additional deaths were in frail, older individuals.

During the same period, there have been funding issues, with the number of NHS trusts amassing budget deficits increasing sharply since 2014-2015, alongside rising waiting periods for elective surgery in 2015.

"Issues within the NHS are being compounded by problems with the provision of adult social care to support individuals leaving NHS care and pressures of increased demand," the team added.

Excess deaths

They believe delayed discharges - often caused by an inability to arrange adequate social care in the community for people leaving hospital - could be preventing other, sick people from being admitted to hospital for the care they need. The authors estimated that up to a fifth of excess deaths were down to delayed discharges.

"Our study provides evidence that a lower quality of performance of the NHS and adult social care as a result of austerity may be having an adverse impact on population health," they conclude.

Previously, health officials have suggested flu was to blame for taking the lives of a significant number of people aged 75 and over in 2015.

Across England and Wales, there was a rise of 28,189 deaths in 2015 (up 5.6 per cent), from 501,424 deaths in 2014 to 529,613 deaths in 2015. The Office for National Statistics found there were 24,201 extra deaths in the 75 and over age group in 2015 - accounting for 86 per cent of the total increase. Many of the deaths were registered in the first three months of 2015.

"Our study provides evidence that a lower quality of performance of the NHS and adult social care as a result of austerity may be having an adverse impact on population health."
Dr Mark Green, University of Liverpool, et al

Dr Mark Green, from the University of Liverpool, who worked on the study, said flu was a factor in 2015 but cannot account for the entire increase in deaths.

He said: "It also does not explain that mortality rates were higher in warmer months compared to previous years - i.e. when flu does not operate."

He added: "Since 2014, the number of patients admitted for acute conditions who were delayed being discharged from hospital has almost increased by 50 per cent. This creates blockages in the NHS where beds are not available for new patients, and since these individuals are being admitted for acute and often pressing issues any delay to accessing services can be deadly.

"It is clear that increased funding to both the NHS and adult social care to minimise issues with discharged patients would benefit the population widely."

NHS England declined to comment on the study.

Record numbers

Dr Nick Scriven, president of the Society for Acute Medicine, said: "We, along with many other health professionals, have consistently raised the issue of delayed discharges over the past three years while the Government failed to acknowledge the scale of the crisis in social care and the record numbers of delayed discharges in our hospitals as a result.

"As more evidence becomes available of the effects, more pressure grows to ensure the right support and infrastructure is in place to discharge medically-fit patients safely and that is essential to patient safety as well as the sustainability of the NHS."

In January, Theresa May told parliament that just 24 trusts were responsible for half of all delayed discharges while others did not have any. The Prime Minister argued that the problem was about best practice in hospitals, rather than funding.

Last month, the Royal College of Surgeons warned the UK could face a 'winter of woe' unless more beds were freed up. More than 181,000 'bed days' were lost to delayed discharges in July 2017, latest figures show.

Caroline Abrahams, charity director at Age UK, said: "We already knew that being stuck in a hospital bed when you're medically fit to leave undermines your chances of a full recovery but this research raises the worrying question of whether in some instances it may shorten your life as well.

"That's why the Government must stand by its commitment to addressing the failings of our social care system, by investing in its future and publishing proposals that set out a long-term solution."

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Rising death rates among elderly 'fueled by years of austerity'

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Years of austerity has fueled a rise in overall death rates - especially among frail, elderly people, according to new research. Experts writing in a British Medical Journal (BMJ) paper said a "crisis in the NHS" and problems in social care, as a result of restricted public spending, are at least partly to blame for increasing death rates from 2015 in England and Wales.

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http://www.dementiapartnerships.org.uk/archive/workforce/learning-pathway/step-2/11-legislation/

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Non statutory- Georgia USA. Tracking devices for wandering dementia patients. 

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Non statutory- Georgia USA. Tracking devices for wandering dementia patients. 

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https://www.alz.org/care/dementia-medic-alert-safe-return.asp

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Statutory- Georgia, USA. Entitlements to care for patients covered by medicaid.

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Statutory- Georgia, USA. Entitlements to care for patients covered by medicaid.

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What is Medicaid?
Prior to a discussion of Medicaid's benefits for persons with Alzheimer's or other forms of dementia, it is helpful to provide an explanation about what the Medicaid program is. Persons who fully understand Medicaid and its sub-programs may want to skip this section of the article. Medicaid is health insurance for low-income Americans (more on Medicaid eligibility follows). Medicaid should not be confused with Medicare. Medicare is health insurance for all Americans, aged 65+ regardless of their income. Medicaid, unlike Medicare, pays for many non-medical services that persons with Alzheimer's or other dementias require.

Critical to understanding Medicaid, is understanding the difference between institutional Medicaid and Home and Community Based Services (HCBS). Institutional Medicaid is provided in nursing homes. Home and Community Based Services, as implied by the name, are Medicaid services provided to individuals living at home or "in the community". The phrase in the community typically refers to assisted living residences or assisted living specifically designed for persons with dementia called "Memory Care".

Institutional / nursing home Medicaid is an entitlement in all 50 US states, meaning should the individual be eligible for Medicaid, the state must pay for their nursing home care. HCBS (Medicaid services at home) in most states are not entitlements, meaning a person can be eligible for the program but may be placed on a wait list for services. Wait lists in some states can be several years long (although, admittedly these are extreme cases).

Note that many states have their own names for their Medicaid program. For example, in California it is called Medi-Cal and in Massachusetts, MassHealth. Also be aware that HCBS are sometimes called Medicaid Waivers.

Medicaid Benefits for Alzheimer's & Dementia by Location
At Home
Rather than thinking of Medicaid's home care benefits, one should think more broadly because Medicaid offers much more assistance in the home, than just health care. First, we'll discuss the range of benefits, and then how the Medicaid beneficiary would get access to these benefits. IMPORTANT - each state offers slightly different benefits, this article is written in generalized terms, not state specifically.

Beyond home health care, most critical for persons with dementia or Alzheimer's, is personal care or assistance with activities of daily living such as bathing, grooming and eating, which fortunately, Medicaid covers. Most states also offer assistance with the Instrumental Activities of Daily Living such as medication management, shopping for essentials and preparing food. Chores services, typically for home maintenance are sometimes a benefit as well. Medical alert services (called PERS in formal Medicaid language) are frequently covered by Medicaid. However, Medicaid will typically pay for the most basic service which may or may not include GPS tracking (to prevent wandering).

Medicaid recipients can access in-home support services either through their state's regular Medicaid program or through a HCBS Medicaid Waiver. Generally, a state's regular Medicaid program will have more restrictive financial eligibility requirements than their HCBS Waivers. However, regular Medicaid benefits are entitlements while Waivers have limited enrollments and sometimes have waiting lists.

In Adult Day Care
Adult day care is a formal supervision during day-time hours, typically only on weekdays, in a structured, dedicated environment. Meals, activities and often medication management are included as well as personal care. However, for persons with dementia, regular adult day care may not provide enough structure. Specialized adult day care centers, sometimes called Alzheimer's Day Treatment Centers may be necessary. Employees of these organizations will have received additional training for dementia-related behavioral challenges and security is increased to preventing wandering. In nearly all states, Medicaid will pay for adult day care. Many states offer adult day care both as a benefit of their regular Medicaid programs and as a HCBS Waiver benefit.

In Assisted Living / Memory Care
For most persons with Alzheimer's or dementia, normal assisted living communities cannot provide adequate support. Instead, these communities have "memory care" wings (often a secured floor) or there are also standalone memory care residences. In almost every state Medicaid will pay from some care in assisted living / memory care residences. However, an important distinction must be made. Medicaid, by law, is prohibited from paying for the cost of room and board or "rent" for its beneficiaries who reside in assisted living residences. Medicaid can pay for their cost of care in those residences. In very ballpark terms, half of the monthly cost of memory care goes toward "rent" and the other half towards the care the residents receive.

In most states, care in assisted living / memory care is covered by a Medicaid waiver. Some states also offer personal care assistance through their regular Medicaid program. In these states, the law does not put restrictions on the location in which personal care can be provided. To clarify, the care recipient would be receiving "personal care" but instead of living at home, they would receive that care in their primary place of residence which happens to be a memory care residence.

In Adult Foster Care
Adult foster care is similar to assisted living in that the person with Alzheimer's / dementia resides in the location full-time. However, instead of their being 10-100 residents as there is in a memory care residence, there may be only 1-4 residents in the home. Homes are often the homes of private individuals who "take in" persons with dementia and receive compensation from Medicaid for doing so. Medicaid's coverage of adult foster care is very difficult to generalized. In a few states, Medicaid outright has programs that pay for adult foster care. However, many states don't have clear laws defining their Medicaid policy for adult foster care or don't have clear laws that distinguish what adult foster care is vs. assisted living.

In Nursing Homes
In all 50 states and Washington D.C., Medicaid will cover nursing home care for persons with Alzheimer's or other dementias and Medicaid coverage is an entitlement. Unlike, memory care communities, states are not prohibited from covering the cost of room and board in nursing homes. Medicaid will pay for the individual's room, meals and their care. However, do all nursing homes accept Medicaid patients? No, not every nursing home will accept persons on Medicaid. There are private pay only nursing homes. Fortunately, the vast majority of nursing homes do accept Medicaid. In California, for example, it is estimated the 90% of nursing homes accept Medicaid. Complicating matters is the fact that nursing homes may only accept a certain number of Medicaid beneficiaries. If one enters a nursing home as a private payer, and then becomes Medicaid eligible, the nursing home, by law, must continue to house and provide care for that individual.

Medicaid Eligibility / Qualifying
Medicaid is a program designed for persons with low income and limited financial assets. The actual income and assets limits are determined by each state separately. Furthermore, the income and asset requirements vary based on for which Medicaid program one is applying, their marital status and the criteria change annually. To say Medicaid eligibility is complicated, is an understatement. A quick, easy, free but non-binding Medicaid eligibility test is available here, should the reader not want to sort through the details which follow.

Single Applicants - in most states, single applicants are permitted up to approximately $2,000 in monthly income. However, those wishing to utilize nursing home Medicaid may be subject to lower income limits. Applicants are also permitted to have up to $2,000 in "countable assets". Countable assets exclude one's home provided they live in their home and their value of their home equity does not exceed $500,000 - $800,000 (depending on their state).

Married Applicants (with one spouse applying) - in most states, married applicants are permitted considerably higher income and assets than single applicants. The rules allow this because the "wellspouse" (non-applicant spouse) needs adequate funds to continue to live on their own. In this mixed status situation, the couple's incomes are evaluated independently. Largely, the same income rules apply as described above for a single applicant. However, their assets are not evaluated separately. Again, this is state dependent, in most states the non-applicant spouse is permitted up to between $60,000 - $120,000 in countable assets not including the value of their home, vehicle or other personal affects.

Married Applicants (with both spouses applying) - in most states, married couples must have joint income less than $4,000 and countable assets valued at less than $3,000. However, there are many exceptions to these rules and Medicaid planning professionals have strategies to help couples gain eligibility who do not immediately qualify but cannot afford their care costs.

Persons or couples who exceed these limits may still become Medicaid eligible by working with a Medicaid Planner. Read more about the pros and cons of doing so here.

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Medicaid Benefits for Dementia & Alzheimer's Care

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What is Medicaid? Prior to a discussion of Medicaid's benefits for persons with Alzheimer's or other forms of dementia, it is helpful to provide an explanation about what the Medicaid program is. Persons who fully understand Medicaid and its sub-programs may want to skip this section of the article.

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Legislation- Georgia, USA. Alzheimer’s Disease and Related Dementia (ADRD) State Registry- to collect data to inform best practice and correlate risk factors.

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Legislation- Georgia, USA. Alzheimer’s Disease and Related Dementia (ADRD) State Registry- to collect data to inform best practice and correlate risk factors.

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In 2014, the Georgia Legislature established the Alzheimer's Disease Registry within the Department of Public Health. The purpose of the registry is: 1) to collect and disseminate usable data to inform programs and services for the aging population, 2) identify epidemiological trends, 3) bring awareness at the state level to issues that affect healthy aging, and 4) inform stakeholders for planning and for future registry needs.

Publications

Perceived Cognitive Impairment among Georgia Residents

This report presents updates on various Georgia Alzheimer's and Related Dementias (GARD) State Plan Workgroups. We also examine various demographic factors associated with the prevalence of perceived cognitive impairment (PCI) among Georgia Adults, using Georgia Behavioral Risk Factor Surveillance System (GA-BRFSS) data.

Alzheimer's Disease and Related Dementias Report

Other Resources

Chronic Disease: Alzheimer's Disease
Information about Alzheimer's Disease efforts and local support services available to Georgia residents and their loved ones can be accessed by contacting various organizations.
Page last updated 5/23/2017

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Alzheimer's Disease and Related Dementia (ADRD) State Registry

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In 2014, the Georgia Legislature established the Alzheimer's Disease Registry within the Department of Public Health. The purpose of the registry is: 1) to collect and disseminate usable data to inform programs and services for the aging population, 2) identify epidemiological trends, 3) bring awareness at the state level to issues that affect healthy aging, and 4) inform stakeholders for planning and for future registry needs.

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http://resources.hwb.wales.gov.uk/VTC/2012-13/22032013/hsc/eng/unit_1/u1-serv/u1-tocs.htm

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Social interaction for people with Dementia

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Social interaction for people with Dementia

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https://www.theguardian.com/society/2018/feb/07/social-interaction-dementia-patients

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Dementia films, The unconscious mind, Citizen mental health campaign

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Dementia films, The unconscious mind, Citizen mental health campaign

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http://www.bbc.co.uk/programmes/b09gh5ht

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Misuse of medication to 'control' dementia patients.

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Misuse of medication to 'control' dementia patients.

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Nursing homes across the US are giving antipsychotic drugs to residents with dementia to control their behaviour, despite rules against the misuse of drugs as "chemical restraints", a new report claims.

Even though the use of antipsychotic drugs on older people with dementia is associated with a nearly doubled risk of death, their routine use continues. In many cases, facilities administer the drugs without obtaining informed consent from either the residents or their families.

Using such medications for the convenience of staff or to discipline residents, violates federal regulations and can amount to a breach of international human rights law, claims the report by Human Rights Watch (HRW). However, it says even when facilities were found to have broken the rules, they were rarely punished.

"People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse," said Hannah Flamm, a New York University School of Law fellow at HRW.

"All too often, staff justify using antipsychotic drugs on people with dementia because they interpret urgent expressions of pain or distress as disruptive behaviour that needs to be suppressed."

The report - They want docile: how nursing homes in the United States overmedicate people with dementia - claims that every week, as many as 179,000 people, mostly older and living with dementia, are given antipsychotic drugs without an appropriate diagnosis.

The report is based on visits by HRW researchers to more than 100 nursing homes located in six US states and interviews with people living in facilities, relatives and staff. It also includes interviews with experts on long-term care and disability, and government officials.

The report says 1.1 million people aged 65 and above lived in around 15,600 nursing facilities in 2017. Medicaid, the main US public health insurance programme for people with low incomes, which is jointly administered by the federal government and the individual states, is the primary payer for this form of long-term care.

Antipsychotic drugs were developed to treat psychiatric conditions, such as schizophrenia. The Food and Drug Administration (FDA) requires manufacturers to label them with the strongest warning, the report claims.

It says federal regulations bar using the drugs without adequate indication for use or appropriate monitoring. While the administration of Barack Obama said it was planning to strengthen regulations around their use, in November 2017, the Centres for Medicare and Medicaid Services (CMS) announced a moratorium on this.

The report quotes a 62-year-old woman who says she was given Seroquel without her knowledge or consent at a nursing facility in Texas.

"It knocks you out. It's a powerful, powerful drug. I sleep all the time. I have to ask people what the day is," she said.

The daughter of a 75-year-old woman recalled that when a nursing facility in Kansas put her mother on an antipsychotic drug she "would just sit there like this". She added: "No personality. Just a zombie."

The American Health Care Association represents more than 13,000 care homes across the US.

Dr David Gifford, the group's vice president, said in a statement: "It's important to note that the CMS measure does not equate with inappropriate use. It captures many people with FDA-approved diagnoses, such as bipolar disease and refractory depression. CMS inspects and reviews the use of these drugs and most are found to be appropriate.

"These types of drugs can also increase the risk of complications in the elderly living with dementia, which is why our members support safely reducing usage through a person-centred approach to care."

Reuse content

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US nursing homes misuse drugs to control residents, says HRW report

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Nursing homes across the US are giving antipsychotic drugs to residents with dementia to control their behaviour, despite rules against the misuse of drugs as "chemical restraints", a new report claims. Even though the use of antipsychotic drugs on older people with dementia is associated with a nearly doubled risk of death, their routine use continues.

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https://www.youtube.com/watch?v=P20bGhbK2hs

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http://www.alzheimer-europe.org/Conferences/Previous-conferences/2017-Berlin/Videos-and-photo-gallery/SS1.-Living-well-with-dementia-We-are-still-here-and-I-am-still

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OT group: disco class for clients with dementia 2

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OT group: disco class for clients with dementia 2

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OT group: disco class for clients with dementia 

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OT group: disco class for clients with dementia 

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https://www.scie.org.uk/dementia/after-diagnosis/support/safeguarding.asp

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Improve lives with Dementia

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All the latest news about Dementia from the BBC

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Does the pt have capacity to make decisions about their treatment?

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Does the pt have capacity to make decisions about their treatment?

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https://www.nhs.uk/conditions/social-care-and-support/mental-capacity/

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Confusion Care Pathway- Improving care for pt's w/ dementia, delerium or cognitive imapairments within the NHS

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Confusion Care Pathway- Improving care for pt's w/ dementia, delerium or cognitive imapairments within the NHS

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https://improvement.nhs.uk/resources/confusion-care-pathway/

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https://www.nhs.uk/conditions/dementia/about/

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