Nursing-home referral service, A Place for Mom, is funded by nursing homes and has no information about their violations

Image from home page of A Place for Mom website

Kentucky Health News

The nation's largest nursing-home referral service, A Place for Mom, does not inform users about citations of facilities for neglect or other substandard care, The Washington Post reports.

A Place for Mom charges no fees to people seeking senior housing, but "is paid large fees by assisted-living facilities and does not independently assess their records," the Post reports. "More than a third of its most highly recommended facilities in 28 states were cited for neglect or substandard care in the past two years, many of them repeatedly."

Those 28 states put nursing-home inspection reports online, enabling the Post to easily research them. Kentucky is among the 22 states that do not put inspection reports online. Medicare's Nursing Home Compare website, which ranks facilities on a five-star systen, is based on those reports.

"A Place for Mom does not include these reports in its profiles of facilities, even in cases where poor care has led to death," the Post reports. 

Some places cite for substandard care have received a “Best of Senior Living” award from A Place for Mom for providing “exemplary care and support to aging loved ones.” The company says the awards are based on user reviews, "which are often anonymous," the Post reports.

"Current and former staff of some large chains told The Post that these reviews are often manipulated by the care providers; some claimed they were encouraged to obtain fake reviews from their own friends and relatives. . . . None of the sources suggested that A Place for Mom itself is involved in generating fake or manipulated reviews. But they say the site’s prominence creates incentives for facilities to push for favorable ratings."

UK researcher wins $3.1 million grant to study proteins that go haywire and lead to dementia; one goal is early treatment of it

Maj-Linda Selenica, Ph.D., works in her lab on March 27, 2024. (UK photo by Carter Skaggs)

By Hilary Smith
University of Kentucky

A University of Kentucky professor has received a $3.1 million grant from the National Institute on Aging to continue her research that she thinks could lead to treatments for early dementia.

Maj-Linda Selenica, Ph.D., assistant professor in the UK College of Medicine and associate director of outreach and partnerships at UK’s Sanders-Brown Center on Aging, has been working on research surrounding misfolding of the protein TDP-43, which is common feature of many neurodegenerative diseases, including Alzheimer's disease.

The condition is found in 1 in 5 people over 80. When severe it is associated with episodic memory loss, mimicking Alzheimer's-type dementia, and hastens the cognitive decline in patients with co-existing Alzheimer's pathology, 

Proteins that fold into a different, incorrect shape than their normal functional form are often unable to perform their normal functions and can even become toxic to cells. They can clump, which can lead to neurodegenerative diseases like Alzheimer's.

“We have uncovered completely novel modification of TDP-43 that uniquely and irreversibly changes the cellular mechanisms in the brain,” said Selenica.

Scientists have few strategies to intervene in the disease process, but Selenica and her lab have discovered that peptidyl arginine deiminases (PADs) promote the conversion of amino acid arginine in TDP-43 to the amino acid citrulline. This process, called citrullination, modifies TDP-43 and may be a potential therapeutic target.

Selenica began her research at the University of South Florida, where her team made novel antibodies for the citrullinated TDP-43, which did not exist as research tools. The team was able to use these antibodies to start looking at the potential mechanisms.

“Alzheimer’s disease brains and dementia brains undergo longstanding stress, so we asked the same thing of the cellular models and cross-validated our findings in animal models,” said Selenica. “We obviously cannot mimic what happens in the human brain, but these models permit us to understand mechanisms that underlie the human disease.”

Selenica’s lab collaborated with Sanders-Brown’s Daniel Lee, an associate professor in the UK College of Medicine and co-investigator on the grant. He was first to investigate the effects of PAD-dependent tau citrullination in Alzheimer's. Their efforts now focus on better understanding how citrullination impacts TDP-43 and other proteins.

The terms “Alzheimer’s disease” and “dementia” are no longer interchangeable. Now scientists understand that a variety of diseases and disease processes contribute to dementia, which is why so much of the ongoing work within the labs at Sanders-Brown are connected in some way. Selenica and Lee’s laboratories are joining forces to focus on two prominent pathological hallmarks in dementia-related diseases.

Selenica’s colleague, Dr. Pete Nelson, a professor of pathology and laboratory medicine at UK and leader of neuropathology at Sanders-Brown, led a group of international experts who characterized TDP-43 effects as a new form of dementia. 

Selenica collaborated with Nelson to look at human brain tissues from the UK Alzheimer’s Disease Center Tissue Bank in Sanders-Brown. Nelson is also a co-investigator in this new grant.

Based on her research and the work that planned under the new NIA grant, Selenica is hopeful it can result in several therapeutic avenues to target TDP-43 early in the disease development process.

 “I’m hoping that several years from now we can develop disease-modifying therapeutic strategies and future biomarker assays targeting TDP-43 pathology,” Selenica said. And she doesn’t think the work will stop there. “I think this project will open the field to much more fruitful collaborations. It has us really thinking about, could we develop something to target all the pathologies at once?”

Physician who treats only seniors endorses CDC recommendation that everyone over 65 should get a Covid-19 booster this spring

By Laurie Archbald-Pannone
Associate professor of medicine and geriatrics, University of Virginia

In my mind, the spring season will always be associated with Covid-19.

In spring 2020, the federal government declared a nationwide emergency, and life drastically changed. Schools and businesses closed, and masks and social distancing were mandated across much of the nation.

In spring 2021, after the vaccine rollout, the Centers for Disease Control and Prevention said those who were fully vaccinated against Covid-19 could safely gather with others who were vaccinated without masks or social distancing.

In spring 2022, with the increased rates of vaccination across the U.S., the universal indoor mask mandate came to an end. In spring 2023, the federal declaration of Covid-19 as a public health emergency ended.

Photo from Senior Lifestyle

Now, as spring 2024 fast approaches, the CDC reminds Americans that even though the public-health emergency is over, the risks associated with Covid-19 are not. But those risks are higher in some groups than others. So the agency recommends that adults age 65 and older receive an additional Covid-19 vaccine, which is updated to protect against a recently dominant variant and is effective against the current dominant strain.The shot is covered by Medicare. But do you really need yet another Covid-19 shot?

As a geriatrician who exclusively cares for people over 65 years of age, this is a question I’ve been asked many times over the past few years.

In early 2024, the short answer is yes.

Compared with other age groups, older adults have the worst outcomes with a Covid-19 infection. Increased age is, simply put, a major risk factor.

In January 2024, the average death rate from Covid-19 for all ages was just under 3 in 100,000 people. But for those ages 65 to 74, it was higher – about 5 for every 100,000. And for people 75 and older, the rate jumped to nearly 30 in 100,000.

Even now, four years after the start of the pandemic, people 65 years old and up are about twice as likely to die from Covid-19 than the rest of the population. People 75 years old and up are 10 times more likely to die from Covid.

Vaccination is still essential

These numbers are scary. But the No. 1 action people can take to decrease their risk is to get vaccinated and keep up to date on vaccinations to ensure top immune response. Being appropriately vaccinated is as critical in 2024 as it was in 2021 to help prevent infection, hospitalization and death from Covid-19.

The updated Covid-19 vaccine has been shown to be safe and effective, with the benefits of vaccination continuing to outweigh the potential risks of infection.

The CDC has been observing side effects on the more than 230 million Americans who are considered fully vaccinated with what it calls the “most intense safety monitoring in U.S. history.” Common side effects soon after receiving the vaccine include discomfort at the injection site, transient muscle or joint aches, and fever.

These symptoms can be alleviated with over-the-counter pain medicines or a cold compress to the site after receiving the vaccine. Side effects are less likely if you are well hydrated when you get your vaccine.

Repeat infections carry increased risk, not just from the infection itself, but also for developing long Covid as well as other illnesses. Recent evidence shows that even mild to moderate Covid-19 infection can negatively affect cognition, with changes similar to seven years of brain aging. But being up to date with Covid-19 immunization has a fourfold decrease in risk of developing long Covid symptoms if you do get infected.

Known as immunosenescence, this puts people at higher risk of infection, including severe infection, and decreased ability to maintain immune response to vaccination as they get older. The older one gets – over 75, or over 65 with other medical conditions – the more immunosenescence takes effect.

All this is why, if you’re in this age group, even if you received your last Covid-19 vaccine in fall 2023, the spring 2024 shot is still essential to boost your immune system so it can act quickly if you are exposed to the virus.

The bottom line: If you’re 65 or older, it’s time for another Covid-19 shot.

This article was republished from The Conversation, a platform for journalism by academics.

UK researcher says chemicals in plastics can speed Alzheimer's

Researchers at the University of Kentucky are studying chemical compounds used in the production of water bottles and their link to Alzheimer's disease. (Photo by monticelllo, iStock/Getty Images Plus)

By Lindsay Travis
University of Kentucky

Researchers at the University of Kentucky are studying how elements of our natural surroundings can be potential risk factors for Alzheimer’s disease — including chemicals widely used in plastics.

“Bisphenols can accelerate Alzheimer’s disease and lead to cognitive deficits. Simply: Be smart and stay smart by avoiding plastics,” says Anika Hartz, the UK professor leading the study.

Anika Hartz, Ph.D., is the lead resarcher. (Pete Comparoni, UK) 

“Identifying environmental risk factors for Alzheimer’s is critical to mitigate cognitive decline in humans,” said Hartz, who holds positions in the College of Medicine and the College of Pharmacy. She is also affiliated with UK's Sanders-Brown Center on Aging, one of the nation’s leading centers on aging, Alzheimer’s disease and related neurodegenerative disorders. It is one of 33 National Institute on Aging-funded Alzheimer’s research centers in the U.S.

The study is funded by a grant from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

Alzheimer’s is a progressive and irreversible neurological disorder. It’s estimated that 6.2 million Americans aged 65 and older are living with the disease that affects cognitive function, memory and behavior.

Hartz and her colleagues are examining three types of bisphenols, chemical compounds used in the production of polycarbonate plastics and epoxy resins. Theys are commonly found in food containers, water bottles and the lining of cans.

“Human exposure to bisphenols is inevitable due to their widespread presence in the environment,” said Hartz. “Our data show that bisphenols trigger blood-brain barrier dysfunction and memory problems, both hallmarks of Alzheimer’s, indicating that environmental bisphenols are a critical yet underrecognized risk factor for the disease.”

Hartz’s research team provided some of the first evidence that the chemicals are a clinically relevant environmental risk factor for Alzheimer’s. Bisphenols are a concern because previous research has shown they can affect the endocrine system, which regulates hormones. The brain plays a complex role in that system.

UK researchers want to better understand how the chemicals’ disruption of the endocrine system impacts the blood-brain barrier function, potentially driving cognitive decline and accelerating Alzheimer’s disease.

“The goal of this project is to develop fundamental knowledge of environmental impacts on human health that will help promote healthier lives and reduce the burden of diseases and conditions related to aging,” said Hartz. “New insights are expected from our study that will open the door for future evidence-based health management aimed at preserving cognition in health and disease.”

The work builds on preliminary data funded by a pilot grant from the UK Center for Appalachian Research in Environmental Sciences. Hartz said, “Without the pilot funding, the strong support of the UK-CARES leadership Drs. Ellen Hahn and Erin Haynes, the entire UK-CARES team, my colleagues Drs. Bjoern Bauer, Kevin Pearson, Richard Kryscio, Bernhard Hennig, Peter Nelson, Scott Stanley and the continuous support from Dr. Linda Van Eldik and the team at the Sanders-Brown Center on Aging, this would have not been possible.”

This study brings together a multidisciplinary group of researchers spanning the colleges of Medicine, Pharmacy, Public Health and Martin-Gatton College of Agriculture, Food and Environment.

Uncle Sam wants you ... to help stop health-insurance companies from using misleading tactics to sell Medicare Advantage plans

iStock/Getty Images Plus illustration via KFF Health News

By Susan Jaffe
KFF Health News

After an unprecedented crackdown on misleading advertising claims by insurers selling private Medicare Advantage and drug plans, the Biden administration hopes to unleash a special weapon to make sure companies follow the new rules: you.

Officials at the Centers for Medicare & Medicaid Services are encouraging seniors and other members of the public to become fraud detectives by reporting misleading or deceptive sales tactics to 1-800-MEDICARE, the agency’s 24-hour information hotline. Suspects include postcards designed to look like they’re from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties.

The new rules, which took effect Sept. 30, close some loopholes in existing requirements by describing what insurers can say in ads and other promotional materials as well as during the enrollment process.

Insurance companies’ advertising campaigns are in high gear because Dec. 7 is the end of open-enrolment season, when seniors can buy policies that take effect Jan. 1. People with traditional government Medicare coverage can add or change a prescription drug plan or join a Medicare Advantage plan that combines drug and medical coverage. Although private Advantage plans offer extra benefits not available under the Medicare program, some services require prior authorization and beneficiaries are confined to a network of health care providers that can change anytime. Beneficiaries in traditional Medicare can see any provider.

Catching Medicare Advantage plans that step out of line isn’t the only reason to keep an eye out for marketing scams. Accurate plan information can help avoid enrollment traps in the first place.

Although insurers and advocates for older adults have generally welcomed the new truth-in-advertising rules, compliance is the big challenge. Expecting beneficiaries to monitor insurance company sales pitches is asking a lot, said Semanthie Brooks, a social worker and advocate for older adults in northeast Ohio. She’s been helping people with Medicare sort through their options for nearly two decades. “I don’t think Medicare beneficiaries should be the police,” she said.

Choosing a Medicare Advantage plan can be daunting. In Ohio, for example, there are 224 Advantage and 21 drug plans to choose from that take effect next year. Eligibility and benefits vary by county.

“CMS ought to be looking at how they can educate people, so that when they hear about benefits on television, they understand that this is a promotional advertisement and not necessarily a benefit that they can use,” Brooks said. “If you don’t realize that these ads may be fraudulent, then you won’t know to report them.”

Meena Seshamani, CMS’s Medicare director, told KFF Health News in a written statement that the agency relies on beneficiaries to help improve services: “The voices of the people we serve make our programs stronger,” she said, noting that complaints from policyholders prompted the government’s action. “That’s why, after hearing from our community, we took new critical steps to protect people with Medicare from confusing and potentially misleading marketing.”

Although about 31 million of the 65 million people with Medicare are enrolled in Advantage plans, even that may not be enough people to monitor the tsunami of advertising on TV, radio, the internet, and paper delivered to actual mailboxes. Last year more than 9,500 ads aired daily during the nine-week marketing period that started two weeks before enrollment opened, according to an analysis by KFF. More than 94% of the TV commercials were sponsored by health insurers, brokers, and marketing companies, compared with only 3% from the federal government touting the original Medicare program.

During just one hourlong Cleveland news program in December, researchers found, viewers were treated to nine Advantage ads.

This year, for the first time, CMS asked insurance and marketing companies this year to submit their Medicare Advantage TV ads to make sure they complied with the new rules. Officials reviewed 1,700 commercials from May 1 through Sept. 30 and nixed more than 300 they deemed misleading, according to news reports. An additional 192 ads out of 250 from marketing companies were also rejected. The agency would not disclose the total number of TV ads reviewed and rejected this year or whether ads from other media were scrutinized.

The new restrictions also apply to salespeople, whether their pitch is in an ad, written material, or a one-on-one conversation. Under one important new rule, the salesperson must explain how the new plan is different from a person’s current health insurance before any changes can be made.

That information could have helped an Indiana woman who lost coverage for her prescription drugs, which cost more than $2,000 a month, said Shawn Swindell, the State Health Insurance Assistance Program supervisor of volunteers for 12 counties in east-central Indiana. A plan representative enrolled the woman in a Medicare Advantage plan without telling her it didn’t include drug coverage, because the plan is geared toward veterans who can get drug coverage through the Department of Veterans Affairs instead of Medicare. The woman is not a veteran, Swindell said.

In New York, the Medicare Rights Center received a complaint from a man who had wanted to sign up just for a prepaid debit card to purchase nonprescription pharmacy items, said the group’s director of education, Emily Whicheloe. He didn’t know the salesperson would enroll him in a new Medicare Advantage plan that offered the card. Whicheloe undid the mistake by asking CMS to allow the man to return to his previous Advantage plan.

Debit cards are among a dizzying array of extra nonmedical perks offered by Medicare Advantage plans, along with transportation to medical appointments, home-delivered meals, and money for utilities, groceries, and even pet supplies. Last year, plans offered an average of 23 extra benefits, according to CMS. But some insurers have told the agency only a small percentage of patients use them, although actual usage is not reportable.

This month, CMS proposed additional Advantage rules for 2025 plans, including one that would require insurers to tell their members about available services they haven’t used yet. Reminders will “ensure the large federal investment of taxpayer dollars in these benefits is actually making its way to beneficiaries and are not primarily used as a marketing ploy,” officials said in a fact sheet.

Medicare Advantage members are usually locked into their plans for the year, with rare exceptions, including if they move out of the service area or the plan goes out of business. But two years ago, CMS added an escape hatch: People can leave a plan they joined based on misleading or inaccurate information, or if they discovered promised benefits didn’t exist or they couldn’t see their providers. This exception also applies when unscrupulous plan representatives withhold information and enroll people in an Advantage policy without their consent.

Another new rule that should prevent enrollments from going awry prohibits plans from touting benefits that are not available where the prospective member lives. Empty promises have become an increasing source of complaints from clients of Louisiana’s Senior Health Insurance Information Program, said its state director, Vicki Dufrene. “They were going to get all these bells and whistles, and when it comes down to it, they don’t get all the bells and whistles, but the salesperson went ahead and enrolled them in the plan.”

So, expect to see more disclaimers in advertisements and mailings like this unsolicited letter an Aetna Medicare Advantage plan sent to a New York City woman: “Plan features and availability may vary by service area,” reads one warning packed into a half-page of fine print. “The formulary and/or pharmacy network may change at any time,” it continues, referring to the list of covered drugs. “You will receive notice when necessary.”

The rules still let insurers to boast about their CMS one-to-five-star ratings, even though the ratings do not reflect the performance of specific plans that may be mentioned in an ad or displayed on the government’s Medicare plan finder website. “There is no way for consumers to know how accurately the star rating reflects the specific plan design, specific provider network, or any other specifics of a particular plan in their county,” said Laura Skopec, a senior researcher at the Urban Institute, who recently co-authored a study on the rating system.

And because ratings data can be more than a year old and plans change annually, ratings published this year don’t apply to 2024 plans that haven’t even begun yet — despite claims to the contrary.

How to spot misleading Medicare Advantage and drug plan sales pitches (and what to do about it)

The Centers for Medicare & Medicaid Services has new rules cracking down on misleading or inaccurate advertising and promotion of Medicare Advantage and drug plans. Watch out for pitches that:

• Suggest benefits are available to all who sign up when only some individuals qualify.
• Mention benefits that are not available in the service area where they are advertised (unless unavoidable because the media outlet covers multiple service areas).
• Use superlatives like “most” or “best” unless claims are backed up by data from the current or prior year.
• Claim unrealistic savings, such as $9,600 in drug savings, which apply only in rare circumstances.
• Market coverage without naming the plan.
• Display the official Medicare name, membership card, or logo without CMS approval.
• Contact you if you’re an Advantage or drug plan member and you told that plan not to notify you about other health insurance products.
• Pretend to be from the government-run Medicare program, which does not make unsolicited sales calls to beneficiaries.

If you think a company is violating the new rules, contact CMS at 1-800-MEDICARE, its 24-hour information hotline. If you believe you chose a plan based on inaccurate information and want to change plans, contact CMS or Kentucky's State Health Insurance Assistance Program at 1-877-293-7447 or online at https://chfs.ky.gov/agencies/dail/Pages/ship.aspx. For more information about protecting yourself from marketing violations, go to www.shiphelp.org/about-medicare/blog/protecting-yourself-marketing-violations.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation, an independent source of health policy research, polling and journalism. Reporter Susan Jaffe is at Jaffe.KHN@gmail.com.

Nursing homes say they can't afford more staff, but critics say they manipulate their financial arrangements to make that case

Photo via iStock and KFF Health News

By Jordan Rau

KFF Health News

Nursing homes say they can’t afford higher staffing, as the Biden administration proposes to require. But their finances are often opaque.

Perhaps the biggest mystery, as the Monday deadline for comments on the proposal nears, is how much extra money do the nation’s 15,000 homes actually have to hire and retain more nurses and aides.

The proposal has provoked a fierce lobbying battle between nursing homes and patient advocates, with more than 22,000 comments filed already to the Centers for Medicare and Medicaid Services.

Official nursing home financial records — those submitted to the government — report that more than 4 in 10 homes lost money in 2021. The industry says that it can’t afford higher payrolls. But instead of pumping more dollars into Medicare and Medicaid to ostensibly help homes hire more staff, CMS has proposed a relief valve: exempting homes from higher staffing requirements if they’re more than 20 miles from any other long-term care facility and in an area with a documented shortage of health-care workers. That would include many Kentucky nursing homes.

To the further consternation of patient advocates and many rank-and-file nurses and aides, the agency announced in its draft rule, released in September, that it may also exempt homes that are financially struggling.

Beyond understaffing concerns, excusing broke homes could encourage more financial chicanery in an industry where many operators have mastered the art of appearing poor while their owners siphon money into their own pockets.

The most common trick, honed over decades, involves owners setting up a bunch of separate companies to offload big chunks of the nursing home business — sometimes management, the staff, the equipment or the building itself.

Those companies charge the nursing home whatever their common owner decides, while only the licensed home is required to reveal its finances to the government. The industry insists there is no evidence these related companies charge any more than independent contractors would.

The CMS proposal would require that states do more to track how much money each home spends on direct care billed to Medicaid, the biggest source of revenue for most homes. In theory, that could help discover which homes are shortchanging employees — and patients. The requirement, however, may be no match for the ingenuity of industry accountants, and notably lacks transparency about where money from Medicare, private insurance and out-of-pocket revenue ends up.

Existing federal rules only require homes to have at least one registered nurse working for eight consecutive hours each day, and at least one licensed nurse to be on duty around-the-clock. (Those workers are usually licensed practical nurses, or LPNs, who don’t go through as much professional education as registered nurses do.) CMS has mandated that homes have “sufficient” staffing but has never defined the term.

The new proposal would require each of the nation’s 15,000 nursing homes to have at least ne registered nurse on duty for every 44 residents, and a nurse aide for every 10 residents.

The agency has indicated it might add yet another requirement when it finalizes its rule: An umbrella staff ratio of one nurse or nurse aide of any kind for about every seven residents.

(If you’re reading the rule or planning to comment, be aware that CMS talks about staffing in a less accessible way than we do here, using a measurement of hours per resident day — HPRDs, in nursing-home lingo — instead of a staff-to-resident ratio.)

Patient advocates say the industry has plenty of money to raise staffing levels. They are demanding much more staffing than required in the CMS proposal, enough to provide the highest quality care — not just a minimum level of acceptable coverage.

Advocates want at least one nursing home worker for about every six residents, which a 2001 CMS study concluded would result in the best care. But in a move that enraged proponents of greater staffing, CMS didn’t even bother modeling that scenario when it drafted its proposal.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Kaiser Family Foundation — an independent source of health policy research, polling and journalism.

 

What's new in Medicare plans? 'Check, check and double check'

Photo illustration by iStock/Getty Images via KFF Health News

By Julie Appleby

KFF Health News

Consumers know it’s fall when stores start offering Halloween candy and flu shots — and airwaves and mailboxes are filled with advertisements for Medicare options. (Editor's note: One of the latest ads plays off a "viewer" saying she's tired of the ads.)

It’s annual open enrollment time again for the 65 million Americans covered by Medicare, the federal health program for older people and some people with disabilities.

From Oct. 15 to Dec. 7, enrollees in either the traditional program or Medicare Advantage plans, which are offered by private insurers, can change their coverage. (First-time enrollees generally sign up within a few months of their 65th birthday, whether that’s during open enrollment season or not.)

There are a few new features for 2024, including a lower out-of-pocket cost limit for some patients taking expensive drugs.

No matter what, experts say, it’s a good idea for beneficiaries to examine their current coverage because health and drug plans may have made changes — including to the pharmacies or medical providers in their networks and how much prescriptions cost.

“The advice is to check, check, and double check,” said Bonnie Burns, a consultant with California Health Advocates, a nonprofit Medicare advocacy program.

But as anyone in the program or who helps friends or relatives with coverage decisions knows, it is complicated.
Here are a few things to keep in mind.

Know the basics: Medicare vs. Medicare Advantage

People in traditional Medicare can see any participating doctor or hospital (and most do participate), while those in Medicare Advantage must select from a specified list of providers — a network — unique to that plan. Some Advantage plans offer a broader network than others. Always check to see if your preferred doctors, hospitals, and pharmacies are covered.

Because traditional Medicare doesn’t cover prescriptions, its members should also consider signing up for Part D, the optional drug benefit, which includes a separate premium.

Most Advantage plans include drug coverage, but make sure before enrolling, because some don’t. These private plans are advertised heavily, often touting that they offer “extras” unavailable in traditional Medicare, such as dental or vision coverage. Read the fine print to see what limits, if any, are placed on such benefits.

Those 65 and older joining traditional Medicare for the first time can buy a supplemental, or “Medigap,” policy, which covers many out-of-pocket costs, such as deductibles and copays, which can be substantial. Generally, beneficiaries have a six-month window after they enroll in Medicare Part B to purchase a Medigap policy.

So, switching from Medicare Advantage back to traditional Medicare during open enrollment can raise issues for those who want to buy a supplemental Medigap policy. That’s because, with some exceptions, private insurers offering Medigap plans can reject applicants with health conditions, or raise premiums or limit coverage of preexisting conditions.

Some states offer beneficiaries more guarantees that they can switch Medigap plans without answering health questions, although rules vary.

Making all of this more confusing, there is a second open enrollment period each year, but it’s only for those in Medicare Advantage plans. They can change plans, or switch back to traditional Medicare, from Jan. 1 to March 31.

Drug coverage has changed — for the better

Beneficiaries who signed up for a Part D drug plan or get drug coverage through their Medicare Advantage plan know there are a lot of copays and deductibles. But in 2024, for those who require a lot of high-priced medications, some of these expenses will disappear.

The 2021 Inflation Reduction Act places a new annual limit on Medicare beneficiaries’ out-of-pocket costs for drugs.

“That policy is going to help people who have very expensive medications for conditions like cancer, rheumatoid arthritis, and hepatitis,” said Tricia Neuman, senior vice president and head of the Kaiser Family Foundation's Medicare policy program.

The cap will greatly help beneficiaries who fall into Medicare’s “catastrophic” coverage tier — an estimated 1.5 million Americans in 2019, according to KFF.

Here’s how it works: The cap is triggered after patients and their drug plans spend about $8,000 combined on drugs. KFF estimates that, for many patients, that means about $3,300 in out-of-pocket spending.

Some people could hit the cap in a single month, given the high prices of many drugs for serious conditions. After reaching the cap, beneficiaries don’t have to pay anything out-of-pocket for their medicines that year, potentially saving them thousands of dollars annually.

It’s important to note that this new cap won’t apply to drugs that are infused into patients, generally at doctor’s offices, such as many chemotherapies for cancer. Those medicines are covered by Medicare Part B, which pays for doctor visits and other outpatient services.

Medicare next year is also expanding eligibility for some low-income beneficiaries to qualify for low- or zero-premium drug coverage that comes with no deductibles and lower copayments, according to the Medicare Rights Center.

Insurers offering Part D and Advantage plans might have also made other changes to drug coverage, Burns said.

Beneficiaries should check their plan’s “formulary,” a list of covered drugs, and how much they must pay for the medications. Be sure to note whether prescriptions require a copayment, which is a flat dollar amount, or coinsurance, which is a percentage of the drug cost. Generally, copayments mean lower out-of-pocket costs than coinsurance, Burns said.

Help is available

In many parts of the country, consumers have a choice of more than 40 Medicare Advantage plans. That can be overwhelming.

Medicare’s online plan finder provides details on the Advantage and Part D drug plans available by ZIP code. It allows users to drill down into details about benefits and costs and each plan’s network of health providers.

Insurers are supposed to keep their provider directories up to date. But experts say enrollees should check directly with doctors and hospitals they prefer to confirm they participate in any given Advantage plan. People concerned about drug costs should “check whether their pharmacy is a ‘preferred’ pharmacy and if it’s in network” under their Advantage or Part D plan, Neuman said.

“There can be a significant difference in out-of-pocket spending between one pharmacy and another, even in the same plan,” she said.

To get the fullest picture of estimated drug costs, Medicare beneficiaries should look up their prescriptions, the dosages, and their pharmacies, said Emily Whicheloe, director of education at the Medicare Rights Center.

“For people with specific drug needs, it’s also a good idea to contact the plan and say, ‘Hey, are you still covering this drug next year?’ If not, change to a plan that is,” she said.

Additional help with enrollment can be had for free through the State Health Insurance Assistance Program, which operates in all states.

Beneficiaries can also ask questions via a toll-free hotline run by Medicare: 1-800-633-4227, or 1-800-MEDICARE.

Insurance brokers can also help, but with a caveat. “Working with a broker can be nice for that personalized touch, but know they might not represent all the plans in their state,” said Whicheloe.

Whatever you do, avoid telemarketers, Burns said. In addition to TV and mail advertisements, telephone calls hawking private plans bombard many Medicare beneficiaries.

”Just hang up,” Burns said.

Medicare open enrollment runs through Dec. 7; your advantage isn't always with Advantage; use caution when choosing a plan

AARP graphic

By Melissa Patrick

Kentucky Health News

Open enrollment for Medicare occurs each year from Oct. 15 through Dec. 7, with new coverage starting Jan. 1. During this period you can change your choice of health coverage or add, drop, or change Medicare drug coverage.

People with Medicare can get coverage through either original Medicare or one of the Medicare Advantage plans, which are private insurance offerings under contract with the federal government to provide Medicare-covered benefits.

It is often reported that one of the biggest pitfalls of Advantage plans, which manage the care for most Medicare beneficiaries, is that they often have a limited network of doctors and hospitals and often charge more to see out-of-network providers, if a person is allowed to see them at all. In other words, a person doesn't have the same level of choice as they would with an original Medicare plan. Also, Advantage plans are reported to require a high number of prior authorizations that can lead to denial of coverage.  

Longtime health journalist Trudy Lieberman has often written about the challenges of Medicare Advantage plans, noting that the lure of low premiums and added benefits like dental care and gym memberships seems great when you are well, but it's important to remember that these plans may not offer what you need if you get sick. 

Lieberman reminds you to see what an Advantage plan offers if you get sick or get a get a serious illness, including your out-of-pocket maximums, and what the rules are if you switch back to an original Medicare plan; if you developed a health condition while on Advantage, it could be hard to switch back. 

The rationale for Advantage plans is the flat fee they get for each enrollee and their management of the enrolleees' care to limit claims for care. Writing for Jacobin, which calls itself "a leading voice of the American left," Matthew Cunningham-Cook and Lucy Dean Stockton call the approach an incentive to "ration care, leading to high rates of wrongful claim denials, worse health outcomes, and costly administrative headaches for providers."

The writers note that research by the Medicare Payment Advisory Council, an independent agency that advises Congress on Medicare, shows that the program has not yielded savings in the two decades since it was established, despite proponents' claims that it would do so. A report by Physicians for a National Health Program says Advantage plans overcharge $88 billion to $140 billion a year.

The report "identified four major ways that private insurers systematically exploit the publicly funded national health insurance program while denying care to the nation’s most vulnerable patients," the Jacobin article says. The four ways are favorable selection and deselection, which causes Advantage clients to use fewer services than those on original Medicare; upcoding, which makes patients appear sicker than they are; quality benchmarks and county bonuses that "fail to capture savings for the Medicare program [according to MedPAC]; and induced utilization, an assumption that Advantage plans provide more care than they actually do, so they get paid more. 

Lieberman, noting that the federal government continues to move away from traditional Medicare to some version of privatized managed care, like Medicare Advantage, Lieberman concludes her story for the USC Annenberg Center for Health Journalism by asking, "Will this latest Medicare experiment, which brings in more private equity firms that want a piece of the program, really solve Medicare’s cost problem, or will it simply hand over more of the program to private companies seeking to grow their profits? Is this solution really in the best interest of America’s seniors and their health, or another clever instance of American companies mining the health-care system for fresh profits?"

90% of for-profit nursing homes would need more staff to meet proposed rules; 60% of others would, KFF Health News estimates

KFF Health News graph; individual estimates for staffing by RNs and aides are in the story.

Kentucky Health News

For-profit nursing homes would have to hire more staff to meet proposed federal rules than other nursing homes would, according to an analysis by KFF Health News, a service of the Kaiser Family Foundation.

"90% of for-profit facilities would need to hire additional nursing staff, compared with 60% of non-profit and government facilities," says the analysis by Alice Burns, Priya Chidambaram, Tricia Neuman and Robin Rudowitz.

In Kentucky, about two-thirds of nursing homes are for profit, and only 21% of all homes meet the proposed standard, which is about the same as the national figure of 19%, KFF Health News estimates.

The Centers for Medicare and Medicaid Services has proposed that nursing homes employ registared nurses for at least 0.55 hours per resident per day, and nurses' aides for at least 2.45 hours per resident per day. The rule would also require facilities to have an RN working at all times.

"CMS is seeking comment on several alternatives to the proposed rule, one of which would require facilities to comply with requirements that were adjusted to reflect the health and frailty of nursing facility residents," KFF Health News notes. "Assuming this alternative was implemented using CMS’ existing approach for adjusting staff hours for resident health and frailty, virtually all facilities would need to hire new staff to meet the requirements."

Nursing homes say some of them might have to go out of business because they already have big problems finding enough nurses and nurses' aides. To address that concern, the rules would be phased in, with some differences for rural and urban nursing facilities.

The first phase, starting 60 days after publication of the final rule, would require facilities to "assess the needs of each resident, include input from nursing facility staff and residents’ families or legal representatives, and develop a plan to meet required staffing levels given residents’ needs," KFF notes.

Two years after publication, urban nursing homes would need round-the-clock RNs. For rural nursing homes, that would occur three years after publication. After that, the rules for number of nursing hours per resident day would kick in.

The proposed rule would allow nursing hoems to have less staffing if they are "at least 20 miles from the nearest nursing facility, or in an area with workforce unavailability (defined as having a provider to population ratio that is at least 20% lower than the national average)," KFF notes. "Nursing facilities would also have to demonstrate good faith efforts to hire and retain staff and a financial commitment to staffing by reporting the total amount of money spent on direct care staff." They could not get such exemptions "if they had any staffing-related violations" or had been designated as a Special Focus Facility "with a history of serious quality issues."

KFF explains, "Nearly half of facilities meet the RN requirement (52%) but only 28% meet the nurse aide requirement. . . . When looking at ownership of facilities that meet the RN requirement, a larger share of non-profit facilities would meet the 0.55 standard than for-profit and government facilities (75%, 44%, and 61%, respectively). When looking at nurse aides, about half of non-profit and government facilities meet the minimum staffing levels, compared with only 20% of for-profit facilities."

However, "If the proposed staffing levels were enforced after accounting for resident health and frailty, virtually no nursing facilities would meet the requirements in the proposed rule," KFF estimates.

And what about the workforce shortage? "As of June 2023, employment levels were still more than 11% below pre-pandemic levels for workers in skilled nursing care facilities and 3% below pre-pandemic levels for workers in elderly care facilities," KFF reports. "Although fewer facilities would need to hire new RNs, those that do may find it difficult to compete with hospitals, many of which are also trying to increase the number of RNs they employ. To the extent that many nursing facilities receive hardship exemptions on account of workforce shortages, the effects of the proposed rule on minimum staffing levels will be muted."

CMS estimates that the proposed rules would cost nursing homes $40 billion in the first 10 years after the final rule takes effect. "Such costs are likely to be passed on to public and private payers for nursing facility services, including residents and their family members who paid $45 billion in out-of-pocket costs for care in nursing homes" and other long-term care in 2020. "Medicaid spent nearly $53 billion in that year, about twice the amount ($26 billion) that traditional Medicare spent on skilled nursing facilities in 2020, and although Medicaid financing is shared by the state and federal governments, all states except for Vermont must meet balanced budget requirements."

5 things to know about new Medicare negotiations on drug prices

By Arthur Allen, Rachana Pradhan and David Hilzenrath

KFF Health News

The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ever-rising drug prices for seniors and, eventually, other Americans.

Under the 2022 Inflation Reduction Act, Congress gave the federal government the power to negotiate prices for certain high-cost drugs under Medicare. The list of drugs selected by the Centers for Medicare and Medicaid Services will grow over time.

The first eligible drugs treat diabetes, blood clots, blood cancers, arthritis, and heart disease — and accounted for about $50 billion in spending from June 2022 to May 2023.

The United States is clearly an outlier on drug costs, with drugmakers charging Americans many times more than residents of other countries “simply because they could,” Biden said Aug. 29. “I think it’s outrageous. That’s why these negotiations matter.”

Democratic lawmakers cheered the announcement, and the pharmaceutical industry, which has filed a raft of lawsuits against the law, condemned it.

The companies have until Oct. 2 to present data about their drugs to CMS, which will make initial price offers in February, starting negotiations set to end next August. The prices would take effect in January 2026.

Here are five things to know about the impact:

1. How important is this step? Medicare has long been in control of the prices for its services, setting physician payments and hospital payments for about 65 million Medicare beneficiaries. But it was previously prohibited from involvement in pricing prescription drugs, which it started covering in 2006.

Until now the drug industry has successfully fought off price negotiations with Washington, although in most of the rest of the world governments set prices for medicines. While the first 10 drugs selected for negotiations are used by a minority of patients — 9 million — CMS plans by 2029 to have negotiated prices for 50 drugs on the market.

“There’s a symbolic impact, but also Medicare spent $50 billion on these 10 drugs in a 12-month period. That’s a lot of money,” said Juliette Cubanski, deputy director of the Kaiser Family Foundation’s analysis of Medicare policy.

The long-term consequences of the new policy are unknown, said Alice Chen, vice dean for research at University of Southern California’s Sol Price School of Public Policy. The drug industry says the negotiations are essentially price controls that will stifle drug development, but the Congressional Budget Office estimated only a few drugs would not be developed each year as a result of the policy.

Biden administration officials say reining in drug prices is key to slowing the skyrocketing costs of U.S. health care.

2. How will the negotiations affect Medicare patients? In some cases, patients may save a lot of money, but the main thrust of Medicare price negotiation policy is to provide savings to the Medicare program — and taxpayers — by lowering its overall costs.

The drugs selected by CMS range from specialized, hyper-expensive drugs like the cancer pill Imbruvica (used by about 26,000 patients in 2021 at an annual price of $121,000 per patient) to extremely common medications such as Eliquis (a blood thinner for which Medicare paid about $4,000 each for 3.1 million patients).

While the negotiations could help patients whose Medicare drug plans require them to make large copayments for drugs, the relief for patients will come from another segment of the Inflation Reduction Act that caps drug spending by Medicare recipients at $2,000 per year starting in 2025.

3. What do the Medicare price negotiations mean for those not on Medicare? One theory is that reducing the prices drug companies can charge in Medicare will lead them to increase prices for the privately insured.

But that would be true only if companies aren’t already pricing their drugs as high as the private market will bear, said Tricia Neuman, executive director of KFF’s program on Medicare policy.

Another theory is that Medicare price negotiations will equip private health plans to drive a harder bargain. David Mitchell, president of the advocacy group Patients for Affordable Drugs, predicted that disclosure of negotiated Medicare prices “will embolden and arm private sector negotiators to seek that lower price for those they cover.”

Stacie B. Dusetzina, a professor of health policy at Vanderbilt University, said the effect on pricing outside Medicare isn’t clear: “I’d hedge my bet that it doesn’t change.”

Dusetzina described one way it could: Because the government will be selecting drugs for Medicare negotiations based partly on the listed gross prices for the drugs — distinct from the net cost after rebates are taken into account — the process could give drug companies an incentive to lower the list prices and narrow the gap between gross and net. That could benefit people outside Medicare whose out-of-pocket payments are pegged to the list prices, she said.

4. What are drug companies doing to stop this? Even though negotiated prices won’t take effect until 2026, drug companies haven’t wasted time turning to the courts to try to stop the new program in its tracks.

At least six drug companies have filed lawsuits to halt the Medicare drug negotiation program, as have the U.S. Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America, known as PhRMA.

The lawsuits include a variety of legal arguments. Merck & Co., Johnson & Johnson and Bristol Myers Squibb are among the companies arguing their First Amendment rights are being violated because the program would force them to make statements on negotiated prices they believe are untrue. Lawsuits also say the program unconstitutionally coerces drugmakers into selling their products at inadequate prices.

“It is akin to the government taking your car on terms that you would never voluntarily accept and threatening to also take your house if you do not ‘agree’ that the taking was ‘fair’,” Janssen, part of Johnson & Johnson, wrote in its lawsuit.

Nicholas Bagley, a law professor at the University of Michigan, predicted the lawsuits would fail because Medicare is a voluntary program for drug companies, and those wishing to participate must abide by its rules.

5. What if a drug suddenly gets cheaper by 2026? In theory, it could happen. Under guidelines CMS issued this year, the agency will cancel or adjourn negotiations on any drug on its list if a cheaper copycat version enters the market and finds substantial buyers.

According to company statements this year, two biosimilar versions of Stelara, a Johnson & Johnson drug on the list, are prepared to launch in early 2025. If they succeed, it would presumably scotch CMS’ plan to demand a lower price for Stelara.

Other drugs on the list have managed to maintain exclusive rights for decades. For example, Enbrel, which the FDA first approved in 1998 and cost Medicare $1.5 billion in 2021, will not face competition until 2029 at the earliest.

Feds call for first nursing-home staffing minimums, weaker than industry feared, but homes say it would force some to close

Federal officials' proposed minimum standards for nursing-home staffing are weaker than expected, Bridget Early reports for Inside Health Policy.

The nursing-home industry had anticipated a proposal for about 4.1 hours of employee work time per resident day, meaning that a home with 25 residents would require 18 staffers (times 4.1 hours per resident day = 175 hours per week, divided by 40 hours per week = 17.9 employees).

Instead, the Centers for Medicare and Medicaid Services proposed "minimum nurse staffing standards of 0.55 hours per resident for registered nurses and 2.45 HPRD for nurse aides," as well as a requirement to have a registered nurse at the nursing home around the clock.

"The combined three hours falls short of what a government analysis two decades ago said was the optimal level for quality care: 4.1 hours per day. It also falls short of the 3.76 total hours that a government study said nursing homes currently provide on average," reports Christopher Rowland of The Washington Post.

The proposal is "a long-anticipated response to decades of complaints about neglect and abuse in an industry that critics say is unprepared for the tsunami of seniors heading its way from the Baby Boom," Rowland writes. "Much of the rule would kick in within three years for urban facilities and five years for rural facilities."

The regulation would have major implications for Kentucky, which is farther behind on its nursing-home inspections than any other state but Maryland.

"To address concerns in rural areas where workers are scarce, the Biden administration has provided a series of exemptions in the rule for facilities that can prove they can’t find staff even if they made good faith efforts to recruit and retain workers," Rowland reports. "It plans to pump $75 million into programs intended to bolster the nursing home workforce, such as scholarships and tuition reimbursement."

CMS estimates that the rules would make about three-fourths of nursing homes increase staffing, USA Today reports: "Having enough nurses and aides is the strongest predictor of whether nursing home residents will thrive, researchers have found. But a USA Today investigation last year documented how rarely the federal government enforces decades-old staffing guidelines and rules for nursing homes that participate in Medicare and Medicaid."

The regulation "cleared the White House Office of Management and Budget on Tuesday, Aug. 29, the same day a CMS study underpinning the rule was leaked and created a firestorm among stakeholders," Early reports. "The White House budget office also canceled its two remaining stakeholder meetings on the issue in the wake of the leak. The proposed rule had been pending at OMB since May 30. The two meetings were scheduled for the first and second weeks of September. The meetings were requested by the Organization of Nurse Leaders and the Association of Jewish Aging Services."

Early notes, "The nursing-home industry has lobbied hard against staffing minimums and has called for a White House event to explore alternatives, but patient advocates have backed staffing minimums."

LeadingAge, the largest association for nonprofit nursing homes, told USA Today that the propsoed regulation would be impossible for many nursing homes to meet. “There are simply no people to hire—especially nurses,” said Katie Smith Sloan, the group's president and CEO. “America’s under-funded, long-ignored long-term care sector is in a workforce crisis.” Sloan said nursing homes would have to “reduce admissions or even close” if the rule takes effect.

Kentucky is next to last in currency of nursing-home inspections, and it may not have hit bottom yet, health officials tell legislators

Kentucky is farther behind on nursing-home inspections than only one other state, and the huge backlog might last a long time, Beshear administration officials state officials warned a legislative committee Tuesday. That could leave health and safety problems undiscovered, reports John Cheves of the Lexington Herald-Leader.

“We’re waaay behind,” Health and Family Services Secretary Eric Friedlander told the Health and Human Services Delivery Task Force. “It’s gonna take us, if we’re lucky, a year to dig out of this.”

There are many reasons, he said, including the pandemic, but the main one is a lack of registered nurses, who "form the backbone of the health cabinet’s inspection teams," Cheves reports. Adam Mather, the cabinet's inspector general, said only 30 of the 83 nurse inspector positions are filled.

Adam Mather (KET image
via Lexington Herald-Leader)

“As a nurse myself, I’ve never seen a more challenging environment for the profession,” Mather said. “We’re just unfortunately, nationally, we’re not educating enough nurses to provide the care that’s needed in the country.”

The task force co-chair, Sen. Stephen Meredith, R-Leitchfield, said “We’ve got a very serious issue that kind of caught us by surprise.”

Cheves notes, "The Herald-Leader reported in July that 73 percent of Kentucky’s 277 nursing homes were listed as going more than two years without a so-called 'annual' inspection. According to federal data, only Maryland had a larger backlog, at 75 percent. The national backlog average is 11 percent." The figures come from the federal Centers for Medicare and Medicaid Services, which requires states to inspect nursing homes each year.

"Gov. Andy Beshear’s administration is trying a variety of possible solutions, including pay raises that have bumped the nurse positions from about $50,000 a year in 2020 to a salary range of $72,328 to $95,834," Cheves reports. "It’s also using private contractors to recruit nurses to the health cabinet and even to perform some facility inspections. And it’s creating a new career ladder at the health cabinet to allow licensed practical nurses, with less formal education than registered nurses, to be hired and advance while on the job, the officials said. In the meantime, as it works to reduce the inspection backlog, the cabinet will prioritize nursing homes that have a history of more serious citations or complaints, Mather said."

But Friedlander still isn't sure what they're doing will work. “I’m hoping we are at the nadir,” he said. “I’m hoping we’re at the bottom. But I cannot swear it to you all. It has been a tremendous challenge retaining and hiring nurses, and that’s exactly where we are.”

The 'sandwich generation' still supports its children while caring for its parents, which is playing a toll on its health

Cornell Cooperative Extension graphic

Kentucky Health News

America has Generation X, Generation Z and more, but it also has "the sandwich generation," adults between 40 and 59 who care for their aging parents and help support their own children. Most family caregiving falls to this generation, and most of the caregivers are women.

Historically, when people reached this age group, they became empty nesters. But the Pew Research Center "found 54% of parents in their 40s are caring for seniors while also financially supporting their adult children," says a study report from the Seniorly Resource Center.

"The sandwich generation is bound by a unique set of social and demographic forces that include a record number of aging seniors and financial challenges that have stunted the economic stability of their adult children," the report says. "As the prevalence of Alzheimer’s disease and other conditions linked to old age continue to rise, and the financial stability of young adults remains stunted, America’s ‘sandwich generation’ is seeing substantial declines in their own physical, mental, and financial health."

In Kentucky, 45.8% of caregivers have two chronic health conditions, 15.5% are mentally distressed, Alzheimer’s disease is expected to increase 14.7% by 2025 and 3% of homes are multigenerational, according to a news release about the study.

In a report titled "Valuing the Invaluable: 2023 Update," the American Association of Retired Persons found that there are 610,000 caregivers in Kentucky who provide 570 million care hours, at an estimated economic value of $8.6 million. 

The Alzheimer's Association says in Kentucky, 75,000 people 65 and older are living with the disease and 157,000 family caregivers bear the burden of caring for them, while providing 302 million hours of unpaid care.

The report offers tips to prevent caregiver burnout, such as creating a financial strategy, prioritizing self-care, delegating tasks, utilizing available resources, staying organized and communicating openly with family about challenges. 

The release added three suggestions:  

Respite care provides short-term stays for seniors to give primary caretakers a break. It is also a great way to try out senior living and some organizations provide respite grants to help offset the cost.

Assistive technology: Caregivers should use new technology. Grandpad is a user-friendly tablet with 24-hour live support; Lively is a waterproof watch that replaces emergency pendants like Life Alert; and caregiving apps such as Medisafe are designed to keep track of tasks.

Ask for help and be specific: Most people want to help their friends and family but don’t know how. If you are overwhelmed, it is critical to ask for help. Determine what needs to be done and assign people specific tasks.

The report also offered information on some support groups, including: 

• National Alliance for Caregiving: The NAC is a non-profit organization dedicated to supporting caregivers. You can visit their website at www.caregiving.org.
• Caregiver Action Network: CAN is an organization that provides education, support, and resources for family caregivers. They offer a helpline, support groups, and an online community. You can contact them at 1-855-227-3640 or visit www.caregiveraction.org.
• Eldercare Locator: This is a public service of the U.S. Administration on Aging. They can help connect you with local resources and support services for caregivers. You can contact them at 1-800-677-1116 or visit their website at www.eldercare.acl.gov.

Using data from the Alzheimer’s Association and federal agencies, Seniorly did state-by-state estimates of likelihood of increasing caregiver burnout. Kentucky was at about the national average.