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Court rules home care aides are not entitled to overtime
BY PETE YOST The Associated Press

   WASHINGTON — Home care workers are not entitled to overtime pay under federal law, the Supreme Court ruled Monday, a setback for a growing labor force of more than 1 million people.
   The unanimous decision came in the case of Evelyn Coke, a 73-yearold retiree who spent more than two decades helping the ill and the elderly and is now in failing health herself.
   The Labor Department did not exceed its authority when it excluded home care workers from overtime protection and “courts should defer to the department’s rule,” Justice Stephen Breyer wrote, relieving employers and angering workers’ rights groups.
   The Bush administration opposed Coke’s challenge to the Labor Department’s 1975 regulation. A new administration should rewrite it to give workers the protection they deserve, said the Service Employees International Union, which represents hundreds of thousands of workers in that industry.
   The Clinton administration had drafted a regulation to cover the workers, but the rule was shelved after President Bush took office in 2001.
   Home care aides are the key to the independent life senior citizens want, but lack of adequate pay is fueling turnover rates of 40 to 60 percent annually, the employees’ union says.
   Government lawyers told the Supreme Court in April that the goal is ensuring that the elderly who most need home care service receive it “at a reasonable cost.”
   Nancy Duff Campbell, co-president of the National Women’s Law Center, called the decision “another blow to struggling, low-wage women.”
   Two weeks ago, the court limited workers’ ability to sue for pay discrimination, ruling against a Goodyear employee who earned thousands of dollars less than her male counterparts but waited too long to complain.
   Half of home care workers are minorities, and 90 percent are women, according to 2000 census data. Their wages remain among the lowest in the service industry, says the Bureau of Labor Statistics.
   “I would say, ‘If you feel it’s an easy job, step into my shoes,’ ” said home care worker Lori Reynolds in New York City, who said she is “truly disappointed” by the court’s ruling.
   In Coke’s case, the Supreme Court was “wrong about what Congress intended,” said Harold Craig Becker, Coke’s lead attorney.
   The Labor Department wrote the restrictive regulation after Congress expanded the law’s protections.
   Paying time and a half for hours in excess of 40 a week would cost billions, the home care industry says.
   “When you try to apply traditional labor law to this home-care scenario it’s really pretty impractical,” said Paul Hogan, founder of an Omaha, Neb.-based firm providing home health care services. The fi rm, Home Instead Senior Care, has 540 franchises in the United States with 41,000 full- and part-time caregivers.
   “Many seniors need long hours of companionship, even overnights,” said Hogan. “If the exemption is eliminated the cost of service would go so high it would drive many seniors into the gray market where they would be hiring home care workers directly. There would be no screening, no training, no supervision and no backup.”
   In New York City, the annual cost of the Medicaid-funded Personal Care Services Program would rise by at least a quarter of a billion dollars if the appeals court decision is allowed to stand, the city says.
   Coke’s former employer, Long Island Care at Home Ltd., says it would experience “tremendous and unsustainable losses” if it had to comply with federal overtime requirements.
   Many home care workers were brought under the law’s protection starting with Democratic administrations in the 1960s.
   In 1974, Congress broadened the law to cover workers in a variety of fields. The subsequent Labor Department rule reversed Fair Labor Standards Act coverage for home care workers who previously had the protection.  

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Panel: Childhood obesity should be addressed bluntly
BY LINDSEY TANNER The Associated Press

   CHICAGO — Doctors ought to quit using fuzzy terms to defi ne children’s weight problems and instead refer to truly fat kids as overweight or obese, a committee of medical experts recommended.
   Less-blunt terms used by the government and many doctors diplomatically avoid the term “obese.” Instead, they refer to children many would consider too fat as being “at risk for overweight” and “overweight” for those others would consider obese.
   Those categories don’t adequately define the hefty problem, according to the group, which was convened by the American Medical Association and funded by federal health officials including the Centers for Disease Control and Prevention.
   The nonbinding recommendations are designed as guidelines for pediatricians and other medical professionals who work with children. The CDC will consider whether to adopt the recommendations; the AMA has no plans to endorse them.
   Dr. Reginald Washington, a committee spokesman and member of the American Academy of Pediatrics, said Tuesday that some doctors have avoided the blunt terms for “fear that we’re going to stigmatize children, we’re going to take away their self-esteem, we’re going to label them.”
   The recommended terms cut to the chase, at least medically, but don’t mean that doctors should be insensitive or use the label in front of every patient, he said.
   “We need to describe this in medical terms, which is ‘obesity.’ When we talk to an individual family, we can be a little more cognizant of their feelings and more gentle, but that doesn’t mean we can’t discuss it,” Washington said. “The evidence is clear that we need to bring it up.”
   About 17 percent of U.S. children are obese and one-third are overweight, using the committee’s recommended definitions. Those numbers are rising, putting children at risk for diabetes, high blood pressure, cholesterol problems and other ailments more commonly found in adults.
   The obese category — the CDC’s “overweight” — is kids with a bodymass index in the 95th percentile or higher, or above 30. The overweight category — the CDC’s “at risk” — refers to children with a BMI between the 85th and 94th percentiles. The committee’s definition for overweight doesn’t include a specific BMI, but BMIs between 25 and 29 generally are considered overweight for adults.
   The definitions refer to children heftier than 85 percent to 95 percent of youngsters the same age and gender. With current obesity rates, that sounds mathematically impossible, but the percentiles are based on growth charts from the 1960s and 1970s, when far fewer kids were too fat.
   To some extent, the fuzzier labels let pediatricians “off the hook,” allowing them to avoid counseling patients who clearly need to lose weight, said Dr. Peter Belamarich, a pediatrician with Children’s Hospital at Montefiore in New York City.
   The blunter terms make sense if they motivate doctors to work with more kids who need help, “but you have to be real careful about labeling or saying it in front of a child,” Belamarich said.
   “I’ve had mothers ask me not to use the [obese] label,” he said. “Sometimes you can see it in the child’s face. They’re ashamed.”  

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HEALTH
AMC scientists study effect of omega-3 acid on Alzheimer’s
Researchers seek volunteers for clinical trials
BY KATHY RICKETTS Gazette Reporter

   ALBANY
   Nutritionists have long endorsed fish as part of a heart-healthy diet, and some studies suggest that omega-3 fatty acids found in the oil of certain fish, eggs, organ meats, micro-algae, fortifi ed foods, food supplements and human breast milk may also benefi t those suffering from Alzheimer’s disease.
   Now, researchers at the Alzheimer’s Center at Albany Medical Center are involved in a study of DHA (docasahexaenoic acid), to see if the omega-3 fatty acid can slow the progression of the disease.
   The local study is supported by the National Institute on Aging, part of the National Institutes of Health, and coordinated by the University of California, San Diego.
   The trial, which is taking place at 52 sites across the United States, is seeking 400 participants age 50 and older with mild to moderate Alzheimer’s disease. Albany Med is seeking about 20 volunteers.
POTENTIAL FOR PROGRESS
   “Because of its protective nature, DHA potentially could reduce the level of abnormal plaque, also known as amyloid, found in the brains of Alzheimer’s patients,” explained Dr. Earl Zimmerman, director of the Alzheimer’s Center at Albany Med, who will conduct the study locally. “Study volunteers will be critical to helping us fi nd out if DHA can make an impact on slowing the progression of this destructive disease.”
   Earlier studies at the University of California, Irvine, found that DHA slowed the accumulation of tau in mice. Tau is a protein that leads to the development of neurofibrillary tangles, one of the two signature brain lesions of Alzheimer’s.
   Researchers also found that DHA reduced levels of the protein beta amyloid, which can clump in the brain and form plaques, another kind of lesion associated with Alzheimer’s.
   “There is data to show that this antioxidant, DHA, when given to mice does cause some improvement, which looks promising,” said Zimmerman.
   Researchers will primarily evaluate whether taking DHA over several months will slow the progression of both cognitive and functional decline in people with mild to moderate Alzheimer’s. During the 18-month clinical trial, investigators will measure the progress of the disease by using standard tests for functional and cognitive change.
   For the clinical trial, the Martek Biosciences Corp. of Columbia, Md., will donate a pure form of DHA made from algae devoid of fish-related contaminants.
   Participants will receive either two grams of DHA per day in a capsule or an inactive placebo pill. About 60 percent of participants will receive DHA and 40 percent will receive a placebo. To ensure unbiased results, Zimmerman said the study will be double blind, meaning neither the researchers conducting the trial nor the participants will know who is getting DHA and who is getting the placebo.
DIET SUPPLEMENTS
   When asked if people should take omega-3 fatty acid supplements to lower their risk of developing Alzheimer’s disease, Zimmerman said he didn’t know.
   “There’s a lot of interest in this, but we won’t really know until after the study,” he said.
   For people who do take supplements, Zimmerman suggested looking for those that contain about 600 milligrams of DHA per dose.
   Zimmerman said participants will be tested every three months. There are no fees involved.
   “This study is designed to see if it slows the progression,” said Zimmerman. “So I’m guessing it will take about six months after the study ends to analyze the data.”
   That means the data will be made public in approximately 24 months.
   “It’s a very interesting field right now,” said Zimmerman. “There are trials of probably more than 100 different new drugs and compound approaches being tested. The goal is to stop the disease early.”
   Zimmerman said within three to four years, researchers hope to have a way to diagnose the disease early, manage it and eventually prevent it.
   “That’s what everybody is so excited about,” he said.
   An estimated 4.5 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. The disease gradually destroys a person’s memory and ability to communicate.
RISK FACTOR
   The risk for Alzheimer’s disease goes up as people age — 50 percent of people age 85 have Alzheimer’s disease; 25 percent of people age 75 have it; 18 percent of people age 70 have it. It is more common in women.
   While there is no sure way to prevent the disease, mental stimulation, exercise, eating a healthful diet, staying engaged in social activities and avoiding stress and not smoking lower people’s odds, according to the Alzheimer’s Association of America.

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Researchers hope home sensors can help predict Alzheimer’s
BY LAURAN NEERGAARD The Associated Press

   WASHINGTON — Tiny motion sensors are attached to the walls, doorways and even the refrigerator of Elaine Bloomquist’s home, tracking the seemingly healthy 86-year-old’s daily activity.
   It’s like spying in the name of science — with her permission — to see if round-the-clock tracking of elderly people’s movements can provide early clues of impending Alzheimer’s disease.
   “Now, it takes years to determine if someone’s developing dementia,” laments Dr. Jeffrey Kaye of Oregon Health & Science University, which is placing the monitors in 300 homes of Portland-area octogenarians as part of a $7 million federally funded project.
   The goal: Shave off that time by spotting subtle changes in mobility and behavior that Alzheimer’s specialists are convinced precede the disease’s telltale memory loss.
   Early predictors may be as simple as variations in speed while people walk their hallways, or getting slower at dressing or typing. Also under study are in-home interactive “kiosks” that administer monthly memory and cognition tests, computer keyboards bugged to track typing speed, and pill boxes that record when seniors forget to take their medicines.
   More than 5 million Americans, and 26 million people worldwide, have Alzheimer’s, and cases are projected to skyrocket as the population ages. Today’s medications only temporarily alleviate symptoms. Researchers are desperately hunting new ones that might at least slow the relentless brain decay if taken very early in the disease, before serious memory problems become obvious.
   Dozens of early diagnosis methods also are under study, from tests of blood and spinal fluid to MRI scans of people’s brains. Even if some pan out, they’re expensive tests that would require lots of doctor intervention when getting someone to visit a physician for suspicion of dementia is a huge hurdle. And during routine checkups, even doctors can easily miss the signs.
   Bloomquist, of Milwaukie, Ore., knows the conundrum all too well. She volunteered for Kaye’s research because her husband died of Alzheimer’s, as did his parents and her own mother.
   “It’s hard to know when people begin Alzheimer’s,” she reflects. “Alzheimer people do very well socially for short periods of time. If it’s just a casual conversation, they rise to the occasion.”
   Measuring how people fare at home — on bad days as well as good ones, not just when they’re doing their best for the doctor — may spot changes that signal someone is at high risk long before they’re actually demented, Kaye told the Alzheimer’s Association’s international dementia prevention meeting last week.
   “If you only assess them every once-in-a-blue-moon, you really are at a loss to know what they are like on a typical day,” Kaye explains.
   High-tech monitors under study:
   Researchers at New York’s Mount Sinai School of Medicine are heading a study that ultimately plans to recruit 600 people over age 75 to help test in-home “kiosks” that turn on automatically to administer monthly cognitive exams. A video of a smiling scientist appears onscreen to talk participants through such classic tests as reading a string of words and then, minutes later, repeating how many they recall, or seeing how quickly they complete connect-the-dot patterns.
   An Oregon pilot study of the motion sensors tracked 14 participants in their upper 80s for almost a year. Half had “mild cognitive impairment,” an Alzheimer’s precursor, and half were healthy. Impaired participants showed much greater variation in such day-to-day activities as walking speed, especially in the afternoons.
   Why? The theory is that as Alzheimer’s begins destroying brain cells, signals to nerves may become inconsistent — like static on a radio — well before memories become irretrievable. One day, signals to walk fi re fine. The next, those signals are fuzzy and people hesitate, creating wildly varying activity patterns.
   The pilot study prompted a fi rstof-its-kind grant from the National Institutes of Health to extend the monitoring study to 300 homes; 112 are being monitored already, mostly in retirement communities such as Bloomquist’s. Participants are given weekly health questionnaires to make sure an injury or other illness that affects activity doesn’t skew the results.
   In addition, participants receive computer training so they can play brain-targeted computer games and take online memory and cognition tests. The keyboards are rigged to let researchers track changes in typing speed and Internet use that could indicate confusion.
   Finally, a souped-up pill dispenser called the MedTracker is added to some of the studies, wirelessly recording when drugs are forgotten or taken late.

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HEALTH
Quick quiz can help flag dementia
BY SANDRA G. BOODMAN The Washington Post

   Distinguishing early signs of dementia from other memory problems can be an arduous and expensive process. But a brief questionnaire developed by neurologists at Washington University School of Medicine appears to be able to differentiate between mild dementia and forgetfulness, according to a study of 325 elderly patients.
   Researchers led by neurologist James E. Galvin developed the eight-item inventory called the AD8, which asks questions about recent changes in memory. Although the screening test is not a diagnostic tool, the researchers note, it can signal whether early cognitive changes are under way that would suggest the need for a more complete workup.
   Patients enrolled in a long-term study took the test, which asked if they had noticed a change in their ability to name the correct month or year, had trouble remembering appointments or had perceived problems exercising judgment. The patients’ answers were compared with those of a reliable observer,
usually a spouse or child.
   Galvin and his team found that the self-test, which took less than three minutes to complete, reliably distinguished patients with early dementia from those who were forgetful but did not show signs of cognitive impairment. Of the 325 patients, whose average age was 77, roughly 54 percent showed signs of dementia, according to the selftest. Previous studies had found that the test reliably differentiates between forgetfulness that is not clinically significant and symptoms of dementia.
   Because the questions are neutral in tone and do not attribute functional change to a cause such as Alzheimer’s disease, they may prove less threatening and yield useful results if no observer is available to report recent alterations in cognitive functioning.
   Information about the test and its scoring is available at http:// alzheimer.wustl.edu/About—Us/ PDFs/AD8form2005.pdf. The study appears in the May issue of the Archives of Neurology.  

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Main Entry: de·men·tia  
Pronunciation: \di-ˈmen(t)-shə, -shē-ə\
Function: noun
Etymology: Latin, from dement-, demens mad, from de- + ment-, mens mind — more at mind
Date: 1806
1 : a usually progressive condition (as Alzheimer's disease) marked by deteriorated cognitive functioning often with emotional apathy
2 : madness, insanity
— de·men·tial  \-shəl\ adjective

Maybe the second definition would apply to us here who post.....no matter the age....
Emotional apathy- would that mean depression....'cause most of America is LOVING the zoloft/paxil/wellbutrin world.....now the illegal "feeling" is legal,,,and someone is making $$ on it other than the so called street dealers......

the old rule---if we cant beat 'em control 'em......

What color is your coolaide????

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Staph germ a growing concern
Study: Superbug infects thousands of hospital patients
BY MIKE STOBBE The Associated Press

   ATLANTA — A dangerous, drugresistant staph germ may be infecting as many as 5 percent of hospital and nursing home patients, according to a comprehensive study.
   At least 30,000 U.S. hospital patients may have the superbug at any given time, according to a survey released today by the Association for Professionals in Infection Control and Epidemiology.
   The estimate is about 10 times the rate that some health officials had previously estimated.
   Some federal health officials said they had not seen the study and could not comment on its methodology or its prevalence. But they welcomed added attention to the problem.
   “This is a welcome piece of information that emphasizes that this is a huge problem in health care facilities, and more needs to done to prevent it,” said Dr. John Jernigan, an epidemiologist with the U.S. Centers for Disease Control and Prevention.
   At issue is a superbug known as Methicillin-resistant Staphylococcus aureus, which cannot be tamed by certain common antibiotics. It is associated with sometimes-horrifi c skin infections, but it also causes blood infections, pneumonia and other illnesses.
   The potentially fatal germ, which is spread by touch, typically thrives in health care settings where people have open wounds. But in recent years, “community-associated” outbreaks have occurred among prisoners, children and athletes, with the germ spreading through skin contact or shared items such as towels.
   Past studies have looked at how common the superbug is in specifi c patient groups, such as emergencyroom patients with skin infections in 11 U.S. cities, dialysis patients or those admitted to intensive care units in a sample of a few hundred teaching hospitals.
   It’s difficult to compare prevalence estimates from the different studies, experts said, but the new study suggests the superbug is eight to 11 times more common than some other studies have concluded.
   The new study was different in that it sampled a larger and more diverse set of health care facilities. It also was more recent than other studies, and it counted cases in which the bacterium was merely present in a patient and not necessarily causing disease.
   The infection control professionals’ association sent surveys to its more than 11,000 members and asked them to pick one day from Oct. 1 to Nov. 10, 2006, to count cases of the infection. They were to turn in the number of all the patients in their health care facilities who were identified through test results as infected or colonized with the superbug.
   The final results represented 1,237 hospitals and nursing homes — or roughly 21 percent of U.S. inpatient health care facilities, association officials said.
   The researchers concluded that at least 46 out of every 1,000 patients had the bug.
   There was a breakdown: About 34 per 1,000 were infected with the superbug, meaning they had skin or blood infections or some other clinical symptom. And 12 per 1,000 were “colonized,” meaning they had the bug but no illness.
   Most of the patients were identified within 48 hours of hospital admission, which means, the researchers believe, that they didn’t have time to become infected to the degree that a test would show it. For that reason, the researchers concluded that about 75 percent of patients walked into the hospitals and nursing homes already carrying the bug.
   “They acquired it in a previous stay in health care facility, or out in the community,” said Dr. William Jarvis, a consulting epidemiologist and former CDC officials who led the study.
   The infection can be treated with other antibiotics. Health care workers can prevent the spread of the bug through hand-washing and equipment decontamination, and by wearing gloves and gowns and by separating infected people from other patients.
   The study is being presented this week at the association’s annual meeting in San Jose, Calif., but has not been submitted for publication in a peer-reviewed medical journal.  

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SCHENECTADY COUNTY
More nursing home beds sought
Proposal needs state approval
BY MICHAEL LAMENDOLA Gazette Reporter

   Schenectady County is seeking a compromise with the state Health Department that would allow constructing a 240-bed nursing home rather than reducing Glendale Home to 168 beds.
   The county is under state mandate to decertify 192 beds at the 360-bed nursing home and consolidate services into a single wing there by June 2008.
   County officials say the state proposal is based on erroneous information and will leave the county with fewer nursing home beds to care for a rapidly aging population.
   “We have been discussing options quietly but productively with the Health Department for months,” said county Legislature Chairwoman Susan Savage, D-Niskayuna. “We believe the department recognizes that the recommendations of the Berger Commission are unrealistic.”
   The Berger Commission, also known as the Commission on Health Care Facilities in the 21st Century, issued recommendations last year as part of efforts to modernize the state’s health care system and save up to $800 million a year in Medicaid and other insurance costs. The recommendations became law Jan. 1.
   State Health Department spokeswoman Claudia Hutton said, “We have not made any promises. We understand what it is they are proposing, but we have to see their whole plan and then we will evaluate whether it meets with Berger.”
   The county is required to submit a preliminary plan to the state by Saturday on how it will meet the Berger Commission mandates. The county Legislature will meet Thursday to vote on the plan.
   The county asks to reduce beds at Glendale from 360 to 308 on Sunday and to 240 beds by June 2008. It also asks for state approval to build a 240-bed nursing home, to replace the aging and obsolete Glendale Home.
MORE REVENUE
   The county had hoped to build a new 280-bed nursing home by 2009. A new nursing home would allow the county to increase its state reimbursement rate and thereby generate more revenue for the facility.
   But under Berger, the state will not accept any certificate of need applications for the establishment, construction or renovation of a county nursing home until the completion of another study. The study would examine the county’s role in providing nursing home services, especially to people who are indigent, and to examine alternative services.
   To reduce Glendale’s beds under the state mandate, the county would have to stop admitting people to the nursing home for one year, according to County Manager Kathleen Rooney.
   “The other nursing homes in Schenectady County are currently operating near capacity and cannot absorb 110 to 120 residents Glendale can no longer serve,” Rooney said. “This will result in families needing to fi nd facilities outside of Schenectady County and very likely out of the region.”
   The county’s annual subsidy to maintain Glendale under this scenario would increase by $1.5 million, Rooney said. The county’s subsidy for 2007 is $6.4 million, representing 22 percent of the home’s budget.
   The state wants the county to consolidate beds in the C-Wing, an addition built in 1960. It is one of three structures on Glendale’s Hetcheltown Road campus in Glenville. The other structures were built in 1934 and 1979. Beds are in the 1934 and 1979 buildings while the 1960 building is used for administrative and support services.
   Rooney said C-Wing cannot be operated as a stand-alone facility; it does not contain boilers, dining facilities or other “critical services.” These are contained in the other buildings, which the county would have to keep open, she said.
   Further, officials from St. Clare’s and Ellis hospitals have told the county that the loss of Glendale beds would backlog emergency rooms, would result in a shortage of short-term hospital beds and would affect additional health care services in the region.
   Rooney said the county consistently downsized Glendale, which once had a capacity of more than 500 beds, in response to the growth of services designed to keep the elderly out of nursing homes, which are more expensive than home-based care.
   Additionally, the need for nursing home beds in Schenectady County and in the region is expected to increase, Rooney said. The number of frail, elderly people age 85 and older is projected to increase by 3,000 people in the Capital Region over the next five years, she said.
   “Schenectady County’s elderly population was the fastest growing of any county in the state in 2006,” Rooney said.

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CAPITOL
Following rate hike, panel will study malpractice costs
The Associated Press

   Regulators in New York approved a 14 percent increase in medical malpractice insurance rates on Monday and Gov. Eliot Spitzer formed a task force to find ways to rein in the high cost of the coverage.
   The state Insurance Department said the latest rate hike was lower than insurance companies wanted and “is necessary to avoid further financial deterioration of the companies and perhaps an irreversible crisis in an already severely distressed market.”
   State Insurance Superintendent Eric Dinallo will lead the task force, which will report back to Spitzer by the end of the year. It will include state Health Commissioner Dr. Richard Daines and representatives of physician and hospital groups, the insurance industry, consumer groups, health plans, trial lawyers and state lawmakers.
   “I am concerned that the increasing cost of medical liability insurance will drive some physicians out of the field and will discourage young people from entering the medical profession in the first place,” Daines said.
   Consumer groups questioned the rate increase and said there hasn’t been a recent increase in medical malpractice claims. They’ll urge the new task force to focus on the root problems of malpractice by reducing medical errors and correcting industry mismanagement.
   “We look forward to the New York Insurance Department carefully examining remedies that specifically address the true reasons behind the hike,” Joanne Doroshow, executive director of the Center for Justice and Democracy, said in a prepared statement.
   The Center for Justice and Democracy, Center for Medical Consumers and New York Public Interest Research Group on Monday released an analysis of 30 years of state insurance data by actuary J. Robert Hunter, director of insurance for the Consumer Federation of America and a former federal insurance administrator. Hunter’s research found that since the mid-1980s, there hasn’t been a signifi cant increase in the amounts medical malpractice insurers paid out in claims, including all jury awards and settlements.  

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“I am concerned that the increasing cost of medical liability insurance will drive some physicians out of the field and will discourage young people from entering the medical profession in the first place,” Daines said.