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Doctors and Families Are Handling Dementia All Wrong, Says This Expert

Clinical neuropsychologist John DenBoer believes doctors and relatives of people with dementia need to rethink their strategy to cope with the disease and its effect on their loved ones, according to MarketWatch. DenBoer criticizes the assumption that dementia is just a part of aging, calling it “a deep-seated philosophical myth because people tend to base a lot of their actions around that.

They don’t take action, they don’t treat dementia like they would treat heart disease or diabetes, they don’t do a lot of the prevention or intervention because they don’t believe anything can be done,” he asserts. DenBoer says this mindset reinforces the myth that nothing can be done to stop the disease, as well as the falsehood that simple brain activities will encourage prevention and intervention. He stresses the need to reengineer the conversation about dementia that doctors, caregivers, and recipients should have. “We should really be having the conversation of what we can do to help people when they get into their 60s and 70s,” DenBoer argues. “What can we do to promote optimal brain health so they don’t develop the disease at all.”

This should start with a neuropsychological evaluation and magnetic resonance imaging study of the brain, to be repeated every two years after age 65. Compassion and emphasis on brain health, rather than deterioration, should then be the focus of the caregiver-recipient conversation.

Future Shortage of Health Workers Will Impact All of US

Most of us have been reading about the need for many more health care workers at all levels. A recent report highlights both by type of position and by state what the shortage really looks like in numbers. American Indian tribes can be effected by these shortages as most do not employ onlyTable tribal members in their health and social programs. Additionally, many tribes work with their nearby Area Agencies on Aging, home care providers, etc. to provide care to tribal elders.  Please click on link that follows.

3-19 Workforce needs


Hearing loss and dementia

Senior living residents wondering whether they are experiencing early symptoms of Alzheimer’s disease may want to schedule a hearing examination to make sure the symptoms aren’t related to hearing loss instead, suggests a small study recently published in the Canadian Journal on Aging.
Researchers found that 56% of study participants who were being evaluated for memory and thinking concerns and potential brain disorders had some form of mild to severe hearing loss, but only approximately 20% used hearing aids. Among the participants, one-fourth did not show any signs of memory loss due to a brain disorder.

“We commonly see clients who are worried about Alzheimer’s disease because their partner complains that they don’t seem to pay attention, they don’t seem to listen or they don’t remember what is said to them,” said Susan Vandermorris, PhD., C.Psych., one of the study’s authors and a clinical neuropsychologist at Baycrest Center for Geriatric Care, Toronto. “Sometimes addressing hearing loss may mitigate or fix what looks like a memory issue. An individual isn’t going to remember something said to them if they didn’t hear it properly.”
And in those who have or are at risk of developing memory issues, addressing hearing loss may help, the study authors said.

“Since hearing loss has been identified as a leading, potentially modifiable risk factor for dementia, treating it may be one way people can reduce the risk,” said Marilyn Reed, another author on the study and a practice adviser with Baycrest’s audiology department. “People who can’t hear well have difficulty communicating and tend to withdraw from social activities as a way of coping. This can lead to isolation and loneliness, which can impact cognitive, physical and mental health.”

Summary of key tribal programs in the legislative package follows

Interior-Environment – House Appropriations Committee Democrats have filed legislation to reopen the federal government and fund the Department of the Interior, Environmental Protection Agency, Forest Service, and other agencies. The legislation is nearly identical to the FY 2019 Interior, Environment, and Related Agencies bill that passed the Senate Appropriations Committee on a 31-0 vote and was adopted by the full Senate on a 92-6 vote.

Bureau of Indian Affairs and Bureau of Indian Education – BIA/BIE would receive $3.07 billion, an increase of $13 million above the FY 2018 enacted level and $663 million above the President’s budget request.

IHS – The IHS would receive $5.77 billion, an increase of $234 million above the FY 2018 enacted level and $348 million above the President’s budget request.

Commerce-Justice-Science (CJS) – The CJS portion of the Consolidated Appropriations Act that will be taken up in the House largely tracks the CJS appropriations bill that was adopted by the Senate Appropriations Committee earlier this year. Specifically, the bill includes increases over FY 2018 in several key areas including:

$167.65 million to improve tribal crime victim services through a 5% set-aside from the Crime Victims Fund administered by the Office for Victims of Crime. This compares to $133.1 million for FY 2018;

$50 million for “tribal assistance” through the Office of Justice Programs, which is $15 million more than the $35 million funding level for FY 2018;

$7 million for the Tribal Youth Program through the Office of Juvenile Justice & Delinquency Prevention – an increase of $2 million over FY 2018;

$3 million for the Tribal Access Program. This is the first time the TAP Program would receive a direct appropriation.

Several additional programs would be funded at the same level as FY 18, including:
$4 million for implementation of special domestic violence criminal jurisdiction through the

Office on Violence Against Women;
$1 million for research on violence against Native women; and
$500,000 for a national clearinghouse on sexual assault in Indian Country.

Tribal funding at the Community Oriented Policing Services (COPS) Office, which is aimed at improving tribal law enforcement, including hiring, equipment, training, anti-methamphetamine activities, and anti-opioid activities, would be funded at $27 million-a decrease of $3 million compared to FY 2018 levels.

from NIHB information

Native American Leadership Fellowship Program.

The Henry Luce Foundation, in partnership with the First Nations Development Institute, has announced the launch of a Native American leadership fellowship program.

The Native American Leaders Program will provide support to knowledge makers and knowledge keepers serving indigenous communities in the United States through a competitive fellowship program administered by First Nations. Initial support from the foundation will enable First Nations to develop and launch the program, select an initial cohort, and support those leaders during their fellowship experience.

Leaders, as defined broadly in the context of the program, includes spiritual leaders, media makers, scientists and health professionals, academics, curators, artists and writers, and policy makers, and their work can take many forms, including journalism, visual art, film and video, speeches or sermons, educational curricula, music or theater, formal scholarship or research, public health strategies, legal arguments, and policy analysis.

To be selected by a committee of indigenous leaders convened by FNDI, each fellow will receive $50,000 to advance her or his work and will convene with other fellows three times during their fellowship year. In addition, all fellows will be eligible to seek an additional $25,000 to continue their work in the year after their fellowship ends.

Applications for the first fellowship competition will be invited in the second half of 2019, with further details to be made available by First Nations. Additional information will be provided on the First Nations website, www.firstnations.org.

Include Your Tribe’s Victim Services in the Tribal Resource Mapping Tool



‘The National Congress of American Indians, the Tribal Law and Policy Institute, and the National Center for Victims of Crime are launching a web-based resource tool and app to connect victims of crime with victim services in Indian Country.

Organizations providing resources and/or support to AI/AN crime victims are encouraged to submit their information to be included in the service mapping tool. Information can be added by visiting www.tribalresourcetool.org.

The tool aims to identify services in all geographic regions, including but not limited to reservations, urban areas, and Alaska villages.


Examples of victim services sought to be included in the tool are listed below:
AI/AN victim service providers
Legal services
Tribal leadership
Non-tribal specific service providers
National hotlines
Governmental agencies
General support services (non-victim specific)

NCAI Contact Info: Gwynne Evans-Lomayesva, NCAI Policy Research Center Researcher, gevans-lomayesva@ncai.org or Kelbie Kennedy, NCAI Policy Counsel, kkennedy@ncai.org’

Three Million Older Americans are now raising their grandchildren

(We know that many tribal members are raising their grandchildren. This article is not specific to Native elders but the information is generally helpful in terms of understanding the scope of this topic. Based on our experiences some of the causes are consistent with the tribal setting.)

More than 3 million older Americans are now raising their grandchildren as their own, even as they struggle with health problems and financial stresses, a new survey shows.

Not only that, the children they take in are more likely to be troubled as they struggle to adjust to new lives, the researchers found.

Still, these grandparents seem to be handling the challenges as well as biological parents do.

“Our study found that grandparents raising grandchildren — despite having greater physical and mental health issues, and despite raising somewhat more behaviorally challenging children — appear to be coping with the stresses of parenting just as well as biological/adoptive parent caregivers,” said survey author Dr. Andrew Adesman. He is chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park, N.Y.

That’s not to say it’s easy. Researchers found that grandparents who take on a late-in-life role of parenting tend to be in worse physical and mental health than actual parents. They are also more likely to be single and to struggle financially.

But responses offered in the 2016 National Survey of Children’s Health by roughly 46,000 caregivers in grandparent- and parent-led households suggested that grandparents are no more overwhelmed by the burden of caregiving than parents are.

Why are more grandparents finding themselves having to make this tough choice?

“The reasons for this are many, with fatal overdoses related to the opioid epidemic responsible for a significant proportion of these cases,” Adesman said.

“Child abuse or neglect is another frequent reason for children being placed with their grandparents,” he noted. “Other common reasons include mental health problems of one or both parents, or unexpected deaths due to health problems or motor vehicle accidents.”


Adesman is to present his team’s findings Monday at the American Academy of Pediatrics meeting, in Orlando, Fla. Such research is considered preliminary until published in a peer-reviewed journal.

The survey enlisted nearly 45,000 parent-led households, of which about 5,000 were single parents. Grandparent-led families made up another 1,250 of those surveyed.

They were also more likely to say they had nobody to turn to for emotional support (31 percent of grandparents versus 24 percent of parents).

Children cared for by grandparents were more apt to lose their temper, argue, and/or become anxious or angry when confronted with change, according to the report.

But the researchers found no appreciable difference between grandparents and parents in terms of being bothered or angered by their child, and neither group suggested that caregiving was more difficult.

Amy Goyer, family and caregiving expert at AARP, observed that the roughly 5.7 million American children now being raised by grandparents are following a well-trodden path.

Goyer also pointed out that, on average, first-time grandparents are in their late 40s, “so it’s important not to assume these grandparents are older than they are.”

But Goyer, who is the former head of the AARP’s Grandparenting Program, also said that “the phenomenon of grandparents raising grandchildren has risen in recent decades, due to increased problems with substance abuse and addiction, incarceration, divorce and military deployment among other issues.”

In that context, she suggested that the relatively positive findings are somewhat surprising, “considering the extreme challenges so many grandparent caregivers face.”

Goyer pointed out that “this issue hits families in every socioeconomic level, but we know that grandparents with lower incomes struggle all the more with the extra costs. These children often have chronic health problems, mental illness. They have suffered trauma. They may be born addicted or suffer from attachment disorders. They tend to have more learning disabilities, and they may have more behavioral problems.”

Still, grandparents have a leg up when it comes to experience, she added. “They do this out of love. They do it because they want to keep their family together. They are motivated, and they are survivors,” Goyer said.

The bottom-line is that “children raised by relatives do better than those being raised in foster care,” she said. “There is the continuity of family. A child’s identity is so closely tied to their family and being with grandparents helps continue that. The love from a grandparent is a special thing.

SOURCES: Andrew Adesman, M.D., chief, developmental and behavioral pediatrics, Cohen Children’s Medical Center of New York, Northwell Health, New Hyde Park, N.Y., and co-author, “The Grandfamily Guidebook: Wisdom and Support for Grandparents Raising Grandchildren”; Amy Goyer, family and caregiving expert, AARP, and former head, AARP’s Grandparenting Program, Washington, D.C.; Nov. 5, 2018, presentation, American Academy of Pediatrics meeting, Orlando, Fla.

High-dose vs. standard dose influenza vaccine in 2016-17 was associated with lower rates of hospitalization in dialysis patients

Receiving high-dose vs. standard dose influenza vaccine in 2016-17 was associated with lower rates of hospitalization in dialysis patients, although this association was not seen in 2015-16 (when few dialysis patients received the high-dose vaccine). There were no differences in rates of death between patients receiving the high-dose vs. standard dose influenza vaccine during either time period

Results from a new study suggest that high-dose influenza vaccine is associated with lower risk for hospitalizations in kidney failure patients on dialysis. The findings appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

High-dose influenza vaccine, which contains fourfold more antigen than the standard dose, is linked with fewer cases of influenza and less severe influenza symptoms in the elderly general population. Whether the high-dose influenza vaccine benefits dialysis patients, whose immune response to vaccination is less robust than healthy patients, is uncertain. To investigate, Dana Miskulin, MD (Tufts Medical Center) and her colleagues compared hospitalizations and deaths during the 2015-16 and 2016-17 influenza seasons by vaccine type (standard trivalent, standard quadrivalent, and high-dose trivalent influenza vaccine) administered to more than 9000 patients in season within a national dialysis organization.

Receiving high-dose vs. standard dose influenza vaccine in 2016-17 was associated with lower rates of hospitalization in dialysis patients, although this association was not seen in 2015-16. There were no differences in rates of death between patients receiving the high-dose vs. standard dose influenza vaccine during either influenza season.

“We found that the administration of the high-dose influenza vaccine was associated with 8% fewer first hospitalizations than the standard dose vaccine in 2016-17. In 2015-16 there was no difference by vaccine type although statistical power was limited, with only 8% of patients receiving high dose that year, compared with 61% in 2016-17,” said Dr. Miskulin.

Dr. Miskulin noted that the 2016-17 season results are consistent with lower hospitalizations with high-dose as compared with standard dose seen in the elderly general population. Adverse events were not collected in this study, but large clinical trials in the general population suggest that the high-dose vaccine is not associated with more adverse effects. “While these results should not be considered definitive, because vaccine type was not randomized, they suggest that there may be a reduction in influenza related morbidity in dialysis patients with use of the high-dose vs. standard dose vaccine,” said Dr. Miskulin.

Studies of other strategies to increase influenza vaccine effectiveness in dialysis patients and other immunocompromised populations, including the use of adjuvants and booster doses, could also be beneficial, according to an accompanying editorial by Megan Lindley, MPH and David Kim, MD (Centers for Disease Control and Prevention). “Even in the absence of increased vaccine effectiveness, improvements in influenza vaccination coverage among medically vulnerable populations such as dialysis patients could increase protection against influenza,” they wrote. “In groups where the burden of influenza disease and its complications are disproportionately felt, small improvements in vaccine effectiveness and vaccination coverage may have large impacts.”

Study co-authors include Daniel Weiner, MD, Hocine Tighiouart, MS, Eduardo Lacson Jr., MD, Klemens Meyer, MD, Taimur Dad, MD, and Harold Manley, PharmD.
Disclosures: The authors reported no financial disclosures.
The article, entitled “High Dose Seasonal Influenza Vaccine in Patients Undergoing Dialysis,” will appear online at http://cjasn.asnjournals.org/ on October 23, 2018, doi: 10.2215/CJN.03390318.



Trump can’t stop insulting Native Americans.

Trump can’t stop insulting Native Americans. On Friday, at a speech in Fargo, North Dakota, the president made a strange appeal to Native American voters. “Maybe they don’t know about what’s going on with respect to the world of Washington and politics, but I have to tell you, with African-American folks, I would say what do you have to lose?” he asked.


Trump has often made disrespectful comments about Native Americans. Testifying before congress in 1993, he challenged the casino license  given to some reservations. “If you look, if you look at some of the reservations that you’ve approved, that you, sir, in your great wisdom have approved, I will tell you right now—they don’t look like Indians to me,” Trump said.


“The President has a long record of attacking Native Americans,” Simon Moya-Smith, a citizen of the Oglala Lakota Nation, argued in 2017. “He pushed through the Dakota Access Pipeline, which violates the Native American land and threatens indigenous lives and water. And while that pipeline was already leaking like a garden hose with bullet holes, he resurrected the Keystone XL Pipeline, which again is in direct violation of our sovereign treaty rights.” Moya-Smith also mentioned Trump’s frequent use of the name “Pocahontas” as a slur directed against Elizabeth Warren.

Difficult to find personnel to administer long-term support services (LTSS) within home and community-based settings (HCBS), says a new GAO report

Managed care payers and state Medicaid agencies are finding it difficult to find personnel to administer long-term support services (LTSS) within home and community-based settings (HCBS), says a new GAO report.

Currently, Medicaid spends $167 billion a year to cover LTSS through state Medicaid programs and managed care organizations (MCOs) in either institutional settings or HCBS.

As patients age, they are more likely to need long-term care support, and are increasingly expressing a preference for receiving that support in their own homes, GAO found.

“Medicaid spending on LTSS is significant, representing about 30 percent of total Medicaid program spending in fiscal year 2016, and the percentage of LTSS spending used for HCBS has grown over time,” GAO said.

“According to a 2018 CMS report, 24 states had implemented 41 managed care LTSS (MLTSS) programs as of August 2017, and there were about 1.8 million Medicaid beneficiaries enrolled in MLTSS programs.”

Recruiting and retaining professionals to administer HCBS LTSS has proved extremely challenging for managed care payers. Managed care payers told GAO that low wages contribute to workforce shortages and make it hard to retain workers to assist beneficiaries with daily living activities. Payers noted that many direct care workers can earn more money working at fast food restaurants or accepting other employment opportunities.

State officials and MCO officials from Montana and Mississippi also told GAO that workforce shortages are also extremely common in rural areas. The officials explained that it is difficult to get direct care workers to travel long distances to only work a few hours for a low wage.

Managed care organizations and state governments are trying to address workforce challenges by increasing provider wages, GAO said.

In 2017, the Montana legislature approved a new spending provision that increased reimbursement rates for HCBS providers to create a more competitive wage. The increased wage may be particularly beneficial to rural care provider organizations.

Managed care payers are also addressing workforce shortages by allowing family members to become paid caretakers. Beneficiaries enrolled in HCBS services for LTSS can ask friends, family members, or neighbors to become caretakers, which may reduce provider turnover and ease financial burdens for those devoting time to previously unpaid care.

Many MCOs and state Medicaid programs experienced high participation rates in these programs during 2017.


“Arizona officials said that roughly half of beneficiaries in its HCBS program who were receiving personal care services got their care from family members, including spouses and parents of adult children living in the home,” GAO said.

For beneficiaries with significant mental or behavioral healthcare challenges, providing care can be an even more problematic task. Conditions such as dementia and traumatic brain injury are common among LTSS beneficiaries and create additional stressors for providers, managed care payers told GAO.

Payers have responded to these challenges by developing condition-specific LTSS programs, training providers to manage behavioral health conditions, and increasing care coordination within HCBS.

GAO found that one MCO worked with nurses in a community setting to develop adult foster homes as an alternative to institutional care. State officials in Montana reached out to assisted living facility owners and educated these owners about best practices for providing care to members with traumatic brain injuries.

MCOs can also send behavioral health specialists into assisted living facilities to train staff on how to manage a patient’s mental health issues. Managed care payers emphasized a need for a care coordination model that integrates medical and behavioral healthcare under a single managed care contract.

“Officials from one MCO said this model of care will help better identify and coordinate care, for example, for children with autism and a co-occurring behavioral health condition,” GAO explained.

In addition to these challenges, organizations pointed out that limited funding for HCBS programs can prevent the delivery of quality care.

States including Arizona, Mississippi, Oregon, and Florida said that state legislatures did not budget properly for HCBS, leading to shortages in HCBS beds, services, and staff. In addition, state governments also found that sometimes Medicaid budgets fail to cover the total cost of HCBS.

States responded to budgetary challenges by using federal waivers to secure new funding sources. For example, GAO said some state governments rely on the Money Follows the Person demonstration to receive extra funds for transitioning beneficiaries from institutionalized care to HCBS settings.

MCOs and states are hopeful that wage growth, federal funding, and integrated care can address HBCS staffing concerns. However, MCOs and states may need to rethink their entire HCBS programs if staffing issues still remain, GAO concluded.

“Given the variety of options available for providing HCBS and the wide variation in HCBS spending among states, questions arise about how states are structuring their HCBS programs, as well as challenges they may face in providing access to these services,” GAO said.