Journal of general internal medicine
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Previous reports suggest patient and caregiver lack of awareness of dementia. Little is known about how this varies by ethnicity and how informal (family) caregiver burden is associated with knowing a dementia diagnosis. ⋯ Dementia diagnosis unawareness was very high in this community. MAPs are more likely to be unaware of a diagnosis than NHWPs. Lack of access to primary care and caregiver burden were not associated with dementia diagnosis unawareness.
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On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) announced new staffing mandates for long-term care (LTC) facilities in an effort to improve care quality in nursing homes (NHs). The guidelines require a minimum of 3.48 h of daily care per resident, including 0.55 h provided by registered nurses (RNs), 2.45 h by nurse aides (NAs), and an additional 0.48 h by other care staff. These requirements, including a 24/7 RN presence, aim to address chronic understaffing that has been linked to poor outcomes such as increased emergency visits and lower compliance with quality standards. ⋯ Despite these challenges, workforce shortages may be alleviated by the CMS initiatives, which include a $75 million national campaign to grow the NH workforce. This commentary discusses the implications of the CMS staffing rule, the legal challenges it faces, and the potential to improve RN work conditions and resident care. The paper concludes with recommendations for expanding workforce capacity and enhancing compliance through financial investment and policy reform.
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The growth of telehealth care delivery during the COVID-19 pandemic highlighted its potential to enhance access to care and improve patient outcomes. As the healthcare landscape moves toward a new equilibrium in care delivery, few studies have examined physician usage of specific telehealth modalities. ⋯ This study identifies and assesses the widespread adoption of telehealth among U.S. physicians, particularly for provider-to-patient interactions, and highlights the potential for greater use of provider-to-provider modalities. While variations in usage patterns across provider types and specialties reflect the diverse needs and contexts within healthcare, ensuring that these variations are appropriate is critical to avoiding disparities in access and utilization. Addressing barriers related to reimbursement, interoperability, and training will be key to promoting equitable and appropriate adoption of various telehealth modalities across diverse clinical settings.
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Little is known about the population of Medicare beneficiaries with both chronic kidney disease (CKD) and Alzheimer's disease and related dementias (ADRD). ⋯ The prevalence of Medicare FFS enrollees with both ADRD and CKD is increasing. Although the ADRD prevalence has declined, there is a rising number of individuals with CKD who are diagnosed with ADRD and a rising proportion of those with ADRD who also have CKD. Due to shared clinical and demographic risk factors, interventions to reduce CKD progression could also delay ADRD onset. In patients with both advanced ADRD and advanced CKD, clinicians and policymakers should focus on treatment options that consider both co-morbidities.