Workplace wellness programs that financially incentivize employees may become even more controversial in 2019, as several court rulings have cast uncertainty over what is the appropriate limit for such incentives that employers can offer, reports Kaiser Health News . The dollar amount is a contentious issue as it raises questions about when the incentives become so high that employees feel they have no option but to participate. "You and I can look at the same incentive and you will find it's truly voluntary and I would say, given my financial circumstances, I feel I'm being compelled," says attorney Tom Luetkemeyer. Consequently, workers may find programs offer smaller incentives, while programs might give employees options for qualifying for those incentives. In one court ruling, the judge noted the Equal Employment Opportunity Commission, which in 2016 stipulated that a 30 percent amount is the limit for employer wellness incentives, failed to justify for how it settled on that percentage. A 2017 Kaiser Family Foundation survey found 85 percent of large employers offering health insurance included a wellness program to help people quit smoking, lose weight, or take other healthful actions. Slightly more than 50 percent of those included medical screening. Rewards or incentives to participate vary, with the most common being gift cards, fitness trackers or other merchandise, or discounts on workers' health insurance coverage.

A study published in the Journal of the American Geriatrics Society says a loved one with Alzheimer's disease can cost their family between $144,000 and more than $200,000 over a two-year period, reports HealthDay News . The actual cost of informal care is unclear; when these costs are typically accounted for, researchers multiply the hours of care by the wage that paid home healthcare workers would earn, which tends to fall short of the real costs of care given by family members. University of Pennsylvania Professor Norma Coe says such costs totaled at least $277 billion in 2011. "As baby boomers age and policies shift long-term care towards the community, these costs will likely rise substantially," she predicts. Coe also observes that with the move away from institutional care, "it is important to remember the costs to the family and informal caregivers. Caregiving involves significant costs, in line with the costs of a nursing community." The Alzheimer's Association's Keith Fargo says caregivers for someone with Alzheimer's need training and time off, and support can include adult daycare and workplace policies that can help caregivers continue to work while they are providing care. He notes people should start thinking about the cost of caring for someone with Alzheimer's and how to manage before it happens, gauging long-term care insurance and options for care in their community.

A report from the Health and Human Services Office of Inspector General warns that privately-run Medicare health plans may be improperly denying beneficiaries medical care, according to Bloomberg . Federal auditors claim they have found "widespread and persistent problems related to denials of care and payment in Medicare Advantage." Such plans assess a fixed fee from the government for caring for people 65 or older who qualify for traditional Medicare coverage, and the report suggests the fixed rates the government pays may give plans "an incentive to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits." The auditors determined Medicare Advantage plans in 2016 denied 4 percent of requests to approve treatment before it was provided and 8 percent of requests for payment after treatment. Just 1 percent of beneficiaries disputed the insurers' denials, but in those cases, the decisions were overturned most of the time. Improper denials "may contribute to physical harm for beneficiaries if they're not getting access to services that they need," says Rosemary Rawlins with the Inspector General. She also points out that the Centers for Medicare and Medicaid Services audit different organizations every year, "but consistently find problems related to denials of care and payment."

An eHealth.com poll found nearly 40 percent of Medicare enrollees have either delayed medical care or passed on a prescription due to expense, amid concerns about deductibles, copays, and the cost of dental and vision coverage, reports CNBC . "Deductibles can sometimes be surprising to people with Medicare plans, and they don't fully understand how the deductible works and the concept of having to float a decent amount of money before the coverage really kicks in," says eHealth.com's Andrew Shea. Forty-five percent of respondents who said they skipped the pharmacy due to drug costs noted both the brand name and the generic medication were too expensive. Individuals enrolled in Medicare Part A, which covers hospitalization and skilled nursing, face a deductible of $1,340 per benefit period when they go into the hospital. Enrollees in Medicare Part B, which covers doctor's visits and other outpatient services, are subject to an $183 annual deductible in 2018, and then they must cover 20 percent of the Medicare-approved amount for services. Beneficiaries often mistakenly assume they will be covered for everything once they have enrolled in the program. Overall, 44 percent of survey respondents expressed concerns about the cost of dental and vision services. Certain Medicare Advantage plans may offer hearing and vision benefits, and Shea advises enrollees to check the depth of that coverage if they get it. He also notes enrollees can buy standalone dental, vision, and hearing insurance coverage, which averages between $35 and $45 a month at eHealth.

A study published in Proceedings of the National Academy of Sciences of the United States of America details an "innovative drug discovery approach" to attack the toxic particles that cause dementia, which the authors hope will be trialed in the next several years, reports Newsweek . The researchers say the method cultivates small molecules that can slow down the formation of the particles. The team has thus far tested the molecules in laboratory assays and in roundworms, and is currently running tests on mice. The University of Cambridge's Michele Vendruscolo says the team may see the first results of clinical trials two or three years from now. Stony Brook Medicine Professor Nikhil Palekar says the work is theoretically promising, but it "needs to translate into successful drug development." Palekar also notes, "Alzheimer's disease is a hugely important public health issue, with millions afflicted worldwide. The need for more research towards novel therapeutic targets cannot be overstated."

A Microsoft poll of healthcare workers learned many feel tired, stressed, burnt out, and are struggling to feel engaged with their work, reports Australian Ageing Agenda . Both frontline staff and managers experienced similar workplace pressures, with the most profound being managing health and well-being, fatigue and workload, and coping with deadlines. Moreover, although healthcare workers were dedicated to their job, 26 percent noted they did not feel engaged in the workplace. Microsoft's Modern Workplace Lead Ian Heard says the use of up-to-date technology could help ease many employees' pressures, with the poll revealing a disconnect between frontline workers and management. "Employee engagement goes right to the heart of an organization, particularly in the healthcare sector where care recipients' lives and health are on the line," he emphasizes. "For healthcare providers, employee engagement and satisfaction are closely linked to recipient satisfaction. A passionate, connected, and engaged firstline promotes positive recipient care and propels an organization forward." The survey estimated that 40 percent of frontline workers felt they had limited access to the latest technologies, and 50 percent of healthcare workers said they would use devices to boost workplace engagement and satisfaction.

A study published in the British Journal of General Practice found using certain over-the-counter herbal medicines and dietary supplements in conjunction with prescription drugs could pose serious health risks, especially among older adults, reports Medical Xpress . The dangers include alterations in the concentration or effects of drugs such as blood pressure treatments, statins, and aspirin, and the most serious outcomes are related to higher blood glucose concentration, risk of bleeding, and reducing the effectiveness of a prescription drug. The researchers found 33 percent of 149 participants aged 65 and up used herbal medicines and dietary supplements bought over the counter, by self-prescription. Forty-three percent of participants were female, versus 23 percent male. In addition, some people were taking up to eight different alternative medicines and supplements, making them particularly at risk due to co-morbidities, metabolic changes, and the body's reduced ability to absorb prescription drugs associated with aging. Common remedies with potential drug interaction risks include evening primrose oil, St. John's wort, and ginkgo, while supplements with potential interactions include glucosamine and Omega3 fish oil. "The potential risk of interactions with certain combinations of prescription drugs, herbal medicines, and dietary supplements shows the need for healthcare professionals to routinely ask questions regarding the use of other medications that are not prescribed," says the University of Hertfordshire's Taofikat Agbabiaka. "This would help to initiate conversations about wider herbal and dietary supplement use and their possible interactions to help increase ... safety."

Cleveland teen Jacob Cramer, 18, used his experiences as a nursing community volunteer to inform what eventually became the Love for the Elderly nonprofit, a global program to combat seniors' isolation and loneliness, reports Next Avenue . The organization works with more than 50,000 seniors, sending cards and letters to older adults in similar situations. "What challenges a lot of my volunteers is what to write," Cramer says. "In the first letter I ever wrote, the cover said 'You are amazing' and the inside said 'You are loved' with a little heart. It's cheesy, but for people, it means a lot. Especially when there's decoration." Cramer notes when recipients hang the letters up in their rooms in nursing and assisted living communities, or prop them up on their night stands, it can hopefully have a long-lasting impact. The nonprofit has since expanded to include the Sunshine Box, which encourages people to fill up a box with fun little objects and bring it into a nursing community near them, and a Senior Buddies pen pal program.

A study published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association suggests regular exercise could postpone a rare form of early onset Alzheimer's, reports HealthDay News . The investigators determined 2.5 weekly hours of walking or other physical activity foiled mental decline linked to autosomal dominant Alzheimer's disease (ADAD). They analyzed data on 275 people carrying a genetic mutation for ADAD, average age 38. The researchers sought to learn whether 150 minutes of walking, running, swimming, or other exercise a week could help delay or slow disease progression. Participants who received more physical activity scored higher on brain function assessments, and also exhibited lower levels of key biological markers of Alzheimer's in their cerebrospinal fluid, including the tau protein. "A physically active lifestyle is achievable and may play an important role in delaying the development and progression of ADAD," say the researchers. "Individuals at genetic risk for dementia should therefore be counseled to pursue a physically active lifestyle."

Under congressional mandate, Medicare is loosening its annual readmissions penalties for many hospitals serving large populations of low-income persons, reports National Public Radio . For the last six years, Medicare has penalized hospitals for having too many care recipients wind up back in their care within a month. However, beginning in October, lawmakers decreed that Medicare address a long-standing complaint from safety-net hospitals. They claim their recipients are more likely to suffer complications after discharge through no fault of the institutions, but rather because they cannot afford medications or lack regular doctors to monitor their recoveries. This year, the Centers for Medicare & Medicaid Services stopped rating each hospital's performance against all others, and instead assigned hospitals to five peer groups of institutions with similar proportions of low-income visitors. Medicare then compared each hospital's readmission rates from July 2014 through June 2017 against its peer group's readmission rates to see if a penalty was justified and the amount it should be. Generally, Medicare will apply payments to 2,599 hospitals in fiscal 2019, while fines against safety-net hospitals will fall by a fourth on average from fiscal 2018. Meanwhile, the average penalty for the hospitals with the fewest low-income visitors will rise from last year. Medicare has begin to differentiate hospitals that serve a high proportion of low-income persons by considering how many of their Medicare beneficiaries also were Medicaid-eligible.