The National PACE Association (NPA) is lauding bipartisan House and Senate legislation directing the Centers for Medicare and Medicaid Services (CMS) to publish the Program of All-Inclusive Care for the Elderly (PACE) Final Rule by Dec. 31, 2018. "We appreciate leaders in Congress supporting our efforts to expand the number of individuals who can benefit from the unique PACE model of care," says NPA CEO Shawn Bloom. "NPA and PACE organizations have been working for years to obtain greater flexibility in the PACE regulations to help PACE grow faster and reach more people." The bills were motivated by CMS's release of the Proposed PACE Rule in August 2016. PACE providers have been urging regulatory changes so they can expand faster, operate with greater efficiency, and improve care for enrollees. PACE programs serve those whose health conditions make them eligible for nursing community care but allow them to remain in the community for as long as possible. Ninety-five percent of PACE enrollees live in the community, with the appropriate services and supports supplied by the program. "It is a testament to the hard work of our membership to see CMS support new opportunities opening up to expand PACE," Bloom says. The Final Rule is expected to permit PACE to tailor the makeup of the interdisciplinary team around the needs of each individual enrollee, deliver more services in community settings outside of the PACE center, and give PACE more flexibility to partner with community providers.

Sen. Marco Rubio (R-Fla.) has introduced a bill to fund paid leave for new parents out of their future Social Security payments, reports the Washington Post . The plan would permit parents of newborns to receive a Social Security benefit paying a portion of their salaries for at least two months, while later they would postpone the date at which they begin receiving Social Security retirement benefits to compensate for the amount withdrawn during their leave. Democrats and some family-leave advocacy groups are taking issue with the legislation. Their complaints include the skimpiness of the proposed benefit, and the idea of limiting beneficiaries' future retirement payments. Furthermore, they say most people who use the federal Family and Medical Leave Act (FMLA) do so to care for sick family members or when they themselves are seriously ill, as opposed to because of childbirth or adoption. The FMLA ensures 12 weeks of unpaid leave for anyone who works for the government or for a company with 50 or more employees. "This proposal forces workers into an impossible position: if they need to cover a medical emergency today, then their Social Security benefits get cut when it's time to retire," warns Sen. Kirsten Gillibrand (D-N.Y.). "If they need to take care of a sick or dying parent, as three out of four people who need paid leave would use it, they get nothing." Democrats are backing a rival plan to create a national paid-leave program with a small payroll tax, which has not advanced.

Philanthropy can help the application of technology solutions to address mobility and health issues faced by rural communities, reports Health Affairs . Its contributions can include bringing people and groups together to outline communities' needs and assets and to coordinate resources better. Philanthropy also can help surmount barriers such as jurisdictional barriers to transportation availability, limits on sharing information protected under the Health Insurance Portability and Accountability Act, and insurance and liability concerns. In addition, philanthropy can incentivize new partnerships and test and distribute good ideas. An investigation by Grantmakers In Aging, CITRIS, and the Banatao Institute at the University of California, Berkeley explored ways healthcare providers and payers should participate in rural mobility. They cited a model that enrolls healthcare providers and communities that pay a fee for mobility management and coordination services and pre-fund rides for beneficiaries, using a unified technology platform that connects transportation providers, volunteer drivers, and members and staff. Other tools under consideration include employing drones to help provide medical supplies to rural communities.

A study published in the British Journal of Nutrition used data from more than 5,000 individuals to determine an association between a measure of belly fat and reduced cognitive function in older Irish adults, reports ScienceDaily . The data was taken from the Trinity Ulster Department of Agriculture aging cohort study. The researchers learned that a higher waist:hip ratio was tied to reduced cognitive function, which could be explained by a greater secretion of inflammatory markers by belly fat. However, body mass index was found to safeguard cognitive function, suggesting the fat-free mass component is likely to be the protective factor. In view of the high prevalence of overweight and obesity in the older population and the economic and social burden of cognitive dysfunction, the study's results imply that reducing obesity and exposure to obeso-genic risk factors could be a cost-effective public health strategy for the prevention of cognitive decline. "While we have known for some time that obesity is associated with negative health consequences our study adds to emerging evidence suggesting that obesity and where we deposit our excess weight could influence our brain health," says Trinity Professor Conal Cunningham. "This has significant public health implications."

A study published in Neuropsychology determined that alternative enactment techniques, such as acting, can improve prospective memory, which is especially positive for people with mild cognitive impairment (MCI), reports ScienceDaily . The team gauged the prospective memory performance of 96 participants, including persons with MCI aged 64 to 87 years, healthy older adults 62 to 84, and younger adults 18 to 22. This performance was studied prior to the introduction of an encoded enactment technique, which was then compared with performance afterwards. The method involves encouraging subjects to act through the activity they must remember to do. Improvement in prospective memory was seen across all age groups, but it was particularly pronounced in older subjects with MCI. The implication is that encouraging people in this demographic to practice enactment as a way of improving prospective memory could result in them living independently longer.

A study published in JAMA Ophthalmology found age-related vision loss leads to decline of cognitive function, reports Healio . The researchers studied 2,520 adults 65 to 85 years old living in the greater Salisbury area in Maryland. At baseline, mean visual acuity was 20/25, and mean cognitive functioning was within the normal range. Poorer baseline visual acuity was significantly associated with worse baseline Mini-Mental State Examination (MMSE) scores. Over time, both vision and scores on the MMSE experienced a decline. The mean loss of vision was one letter, and the number of participants with cognitive impairment rose from 11 percent at baseline to 20.6 percent in eight years. The rate of visual acuity loss was tied to the rate of declining MMSE score. When comparing the impact of visual acuity at baseline on cognitive function at two years versus the reverse, the researchers observed that the standardized regression coefficient of visual acuity to MMSE score was nearly twice that of MMSE score to visual acuity. "This demonstrated visual acuity is likely the dominating factor of the dynamic associations between visual acuity and MMSE score," they note. "To our knowledge, this is the first time this dependency has been shown." The study's results also support the theory that visual impairment might affect cognitive function because it makes older adults less able to participate in brain-stimulating activities.

A study published in Science Advances details how Northwestern University researchers have invented a non-invasive technique to bombard people's brains with magnetic fields to stimulate memory, reports the Daily Mail . Tests with 16 volunteers showed memory retention lasted for at least 24 hours afterwards, improving the subjects' recall of various connections between a number of photos. The researchers suggest the method could dramatically transform treatments for loss of cognitive function due to aging, strokes, head injuries, and dementia. Their technique uses the magnetic field to stimulate the hippocampus, which governs memory. "The fact we can use non-invasive stimulation to increase excitability in this targeted brain network means we're making the network do more of what it naturally does to succeed at memory formation," says Northwestern Professor Joel Voss. Participants underwent magnetic resonance imaging (MRI) scans to measure brain activity while they played a memory game. "Essentially, every day in the experiment that we tested them, subjects would play the memory game, where they would have to remember that a picture went in a particular spot or they'd have to remember that two pictures went together while we used MRI to measure their brain activity," Voss says. "And what stimulation did was improve their performance to be able to play that game and improve the activity of their memory network while playing the game."

A study published in The Gerontologist analyzed factors related to hearing aid use that play into the gap between users and those with hearing loss, reports AAFP News . The researchers studied the records of more than 35,000 participants in the Health and Retirement Study, and interviewed 21 older adults with hearing loss who lived in the surrounding community. Among the factors determined to have an influence on hearing aid use were insurance coverage, cost, personal wealth, veteran status, personal stigma, and relationship with significant others. Among the recommendations the study authors provided to boost the population of hearing aid users was for policymakers such as the Center for Medicare and Medicaid Services to consider covering hearing aids for beneficiaries. They also suggested additional training for primary care health professionals on the importance of addressing hearing loss, as well as augmented education to reduce stigma associated with the condition. Their final recommendation was to implement personalized public service campaigns to improve overall acceptance of hearing aids.

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services has released a study on Medicare's Hospice Program, identifying vulnerabilities and presenting recommendations for protecting beneficiaries and other improvements. OIG found that hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care. In some cases, hospices were not able to effectively manage symptoms or medications, leaving beneficiaries in unnecessary pain for days. OIG also found beneficiaries and their families and caregivers do not receive crucial information to make informed decisions about their care. Further, hospices' inappropriate billing costs Medicare hundreds of millions of dollars. The current payment system also creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs. OIG recommends that CMS strengthen the survey process—its primary tool to promote compliance—to better ensure that hospices provide beneficiaries with needed services and quality care. CMS should also seek statutory authority to establish additional remedies for hospices with poor performance. CMS should educate beneficiaries and their families and caregivers about the hospice benefit, working with its partners to make available consumer-friendly information. To reduce inappropriate billing, CMS should strengthen oversight of hospices. Lastly, CMS should take steps to tie payment to beneficiary care needs and quality of care to ensure that services rendered adequately serve beneficiaries' needs, seeking statutory authority if necessary.

The Central Oregon Health Council is teaming up with the Institute of Aging in San Francisco to open a friendship line for seniors and disabled individuals in Central Oregon, reports The Bulletin . It will allow participants to call for free and speak to trained volunteers 24-7. The line was originally founded in 1973 by Patrick Arbore, director of the institute's Center for Elderly Suicide Prevention, and it currently manages about 13,000 calls a month. "It was really to try to introduce another way of engaging older people and younger disabled individuals," Arbore says. "We've talked to thousands and thousands of people, many of whom are lonely, and that's why they call us, because it's safe for them." In addition to being an accredited suicide prevention hotline, the line features a call-out service, where doctors or other health professionals can, with permission of care recipients, have the volunteers call those recipients. A friendship line client can get as many as seven calls weekly, and each call can last about 10 minutes. "It's very hard for older people to say, 'I need you. I'm lonely,'" Arbore notes. "Referring someone to the friendship line is a way that feels comfortable to them. What we're doing is creating a conversation, not a confrontation."