Mick Mulvaney, the acting director of the Consumer Financial Protection Bureau (CFPB), said Wednesday that he is launching a review of all the federal consumer watchdog agency's policies and priorities. The review is the clearest sign yet that the future direction of the CFPB will be dramatically different than it was under the Obama administration. Mulvaney said in a statement that he is putting out formal requests for information for all "activities" of the bureau. Requests for information are a beginning step by federal agencies such as the CFPB to make changes to any rules they may have already put into place, reports CBS News .

Sources say National Labor Relations Board (NLRB) General Counsel Peter Robb plans to roll out a major reorganization of the board's field office operations, reports Bloomberg Law . In a Jan. 11 conference call with regional directors, Robb said he is considering restructuring the NLRB's regional offices into a smaller number of districts or regions overseen by officials who would report directly to him. The sources note they are concerned that Robb wants to restrict regional directors' authority and demote at least some regional office officials. Regional directors are currently authorized to issue complaints and dismissals of unfair labor practice cases, and they make decisions in union representation cases. A reorganization could entail local office decisions in NLRB cases requiring final approval from agency officials located hundreds of miles away from employers, unions, and employees involved in labor disputes. This could complicate interactions between NLRB stakeholders and labor lawyers and regional directors. The National Labor Relations Act and labor board regulations accord the general counsel broad authority over regional office operations, but board approval may be required for office reorganizations and personnel actions. NLRB memoranda outlining delegations of authority from the agency's board to the general counsel have long required board approval for an appointment, transfer, demotion, or discharge of a regional director to become effective, while federal personnel law and regulations also could impact the board's ability to reduce the rank of regional directors.

Although Medicare covers home care services for qualifying persons, incentives intended to combat fraud and reward high-quality care are causing some home health agencies to refuse to help chronically ill persons, reports Kaiser Health News . "We feel Medicare coverage laws are not being enforced and people are not getting the care that they need in order to stay in their homes," said Kathleen Holt with the Center for Medicare Advocacy. Under federal law, Medicare must pay indefinitely for home care, with no copayments or deductibles, if a doctor ordered it and beneficiaries are unable to leave home. Obtaining Medicare coverage for home health services demands persistence, says John Gillespie, whose mother has ALS. "You have to have a good doctor and people who will help fight for you to get the right company," he notes. "Do not take no for an answer." The National Association for Home Care and Hospice argues Medicare's home health care policies are often misconstrued. "One of the myths in Medicare is that chronically ill individuals are not qualified for coverage," says association president William Dombi. He notes part of the problem is that some agencies are afraid they will not get paid if they take on people who need their services for prolonged periods. This can draw the attention of Medicare auditors who can refuse payments if they think the beneficiary is ineligible or they suspect billing fraud.

The Alzheimer's Association on Jan. 18 issued new dementia care practice recommendations to help nursing communities, assisted living communities, and other long-term care and community care providers provide the best quality, person-centered care for people with Alzheimer's and other dementias. The recommendations will be published as a supplement to the February issue of The Gerontologist . The document specifies 56 recommendations across 10 content areas, based on the fundamentals of person-centered care. They aim to better define quality care across all care environments and throughout the progress of the disease. The recommendations are designed for professional care providers who work with persons living with dementia and their families in long-term and community-based care settings. The recommendations deliver guidance to community-based and residential care providers on detection and diagnosis and continuing medical management, and they are crafted specifically for non-physician care providers and address what they can do to help with these important aspects of holistic, person-centered dementia care. "Detection and diagnosis, and medical management are critical, vital areas of care," says the Alzheimer's Association's Sam Fazio. "While clinicians must continue to take a lead role in these areas, there are important contributions dementia care providers can make to improve outcomes in these areas. Our recommendations outline appropriate actions dementia care providers can make to complement and enhance the work clinicians are doing. Having both groups focus on these critical areas will result in better care for people struggling with this disease."

A study published in PLOS One found older Americans with negative beliefs about aging were significantly more likely to develop dementia than others, reports the Los Angeles Times . The researchers studied 4,765 older Americans who answered five questions about their attitudes toward aging. Their cognitive condition was assessed by a standard test conducted over the phone, and only people who did not have dementia when they entered the study were included in the analysis. Participants took the test again every two years. Participants with positive beliefs about aging were 44 percent less likely to develop dementia over the next four years than those with negative beliefs. Even when accounting for other dementia risk factors, the investigators determined the chances for the disorder were lower among those with a positive attitude toward aging. In addition, the benefits of positivity were higher among a sub-segment of adults who had a genetic disposition toward dementia. The researchers theorized positive beliefs about aging could negate the handicap associated with carrying a risky variant of the APOE gene. In the four years after joining the study, 4.6 percent of participants with negative beliefs about aging developed dementia, as did 2.6 percent of those with positive beliefs. Among those with an e4 variant of the APOE gene, 6.14 percent of subjects with negative beliefs about aging developed dementia, versus 2.7 percent of those with positive beliefs.

A study published in the Journal of the American Geriatrics Society sought to learn whether cognitive training without medication could improve mild cognitive impairment (MCI) in older adults, reports EurekAlert . The team enlisted 145 older adults about 72 years old and diagnosed with MCI from Canadian memory clinics who were assigned to one of three groups. Each group met for eight weekly sessions for two hours, and one group received special training to improve their memory and attention span. A second cohort were encouraged to improve their general well-being by learning to focus on the positive aspects of their lives and find ways to boost positive situations. The third group had no contact with researchers and did not follow a program. Participants in the first group elevated their memory scores by 35 percent to 40 percent and maintained their scores over a six-month period. The researchers note the improvement was most significant for older adults with "delayed recall," or when memory words are measured only 10 minutes after people have studied them. People in this group also said they applied their training in their daily lives so they had different ways to recall things. Participants in the other groups did not experience memory benefits or improvement in their moods.

Leaders' self-awareness of their own strengths and weaknesses can be of far greater benefit than an MBA in running an organization and ensuring workforce loyalty, reports the Harvard Business Review . Harvard Business School Professor Bill George says self-awareness is the skill of being aware of one's thoughts, emotions, and values from moment to moment. Self-awareness allows people to lead themselves with authenticity and integrity, and subsequently better lead others and organizations. A Harvard poll of more than 1,000 leaders from more than 800 companies in more than 100 countries determined leaders at the highest levels tend to have better self-awareness than leaders lower down, possibly because stronger self-awareness expedites promotion, or because they are pushed toward improving their self-awareness as they assume more leadership responsibilities. Among the steps people can follow to enhance their self-awareness are short daily mindfulness practices to be more cognizant of what is occurring within one's mind from moment to moment. Taking regular awareness breaks to relieve pressure is another recommendation, as it gets people out of habitual thinking and behavior. A third tip is committing attention to others' concerns and opinions.

A new AARP study estimates 45 million family caregivers will look after 117 million people by 2020, but functionality and usability of digital health tools designed to help caregivers were found wanting, reports MedCity News . Three studies conducted by HITLAB between May 2016 and January 2017 involved caregivers assessing care coordination tools, personal emergency response devices, and home care aide hiring tools. In terms of care coordination, one study determined poor product design meant the tools failed to sufficiently meet caregivers' coordination needs. The data that already had been recorded in a calendar or email was basically siloed and impeded simple sharing, with the device creating more work for caregivers because they had to repeatedly input the same information due to the lack of an autofill setting. Meanwhile, personal emergency response systems came up short because some caregivers wanted more control over who would be alerted under emergency circumstances, while another barrier was a low activity alert setting that made caregivers worry about false alarms. The evaluation of home health aide hiring services found most caregivers must see 11 to 25 home aides before they choose one, with in-person interviews deemed crucial. Caregivers in this segment noted increasing caregiver control of vetting, interviewing, hiring, and scheduling, supplemented by professional guidance to help them with decision-making, was critical to their peace of mind.

A review published in BMC Medicine looked at 44 studies that included more than 12,000 people aged 60 and older to determine that although frailty, mental impairment, depressive symptoms, and smoking elevated the risk for post-surgical complications, age did not, reports HealthDay News . In addition, the researchers observed no link between the risk for complications and a person's American Society of Anesthesiologists (ASA) status, which assesses a subject's physical health prior to surgery. In general, 25 percent of the individuals in the reviewed studies experienced some type of post-surgical complication. "The fact that age and ASA status were not risk factors for postoperative complications is somewhat surprising because these are the factors a clinician would typically look at when assessing a person's risk of developing complications after surgery," says study author Dr. Jennifer Watt with St. Michael's Hospital in Toronto, Canada. "Older adults are a diverse group of subjects whose risk of postoperative complications is not solely defined by their age, co-morbidities multiple health problems or the type of surgical procedure they receive. This study highlights how common postoperative complications are among older adults undergoing elective surgery, and the importance of geriatric syndromes, including frailty, in identifying older adults who may be at risk." Watt believes spotting and addressing risk factors before surgery, especially smoking and depressive symptoms, could be useful.

Alzheimer's Germ Quest CEO Dr. Leslie Norins has announced a three-year contest starting Jan. 16 offering a $1 million award to the researcher who provides convincing evidence that an infectious agent is the cause of Alzheimer's disease, reports PRWeb . The details are presented at ALZgerm.org and Norins cites a number of studies suggesting the disorder is the end result of a microbial infection. Last year, 33 leading Alzheimer's scientists were signatories to an editorial calling for more research on this. "It's time to more aggressively fund the hunt for a microbe that is the villain in Alzheimer's," Norins contends. His rationale for the contest is detailed in an accompanying white paper, "It's Time to Find the Alzheimer's Germ." Norins notes major funders are still focused on research subjects such as amyloid plaques and protein tangles. "Hopefully, this challenge will help jump-start additional research interest globally in microbes," he says. "To not investigate guarantees we will find nothing." Norins notes there is an intriguing resemblance with the discovery of the long-overlooked Helicobacter pylori and its role in inducing gastric ulcers. Norins' challenge is a project of Alzheimer's Germ Quest, and is open to all researchers globally. The prize money will be contributed by Norins and his wife, with no outside donations sought or accepted, and no medical advice supplied.