Provision of Medicare-covered physical, occupational, and speech therapy services for seniors is a persistent source of confusion, reports Kaiser Health News . Services have been discontinued for some seniors because therapists said their progress was not significant. Others have been told that they reached a yearly limit on services and were ineligible for further care. However, Medicare does not mandate that seniors demonstrate improvement in order to receive ongoing therapy, and it does not restrict the amount of medically necessary therapy. All Medicare-covered therapy must be designated "reasonable and necessary to treat the individual's illness or injury," require the services of skilled professionals, and be subject to medical oversight. With ongoing improvement not a precondition for receiving services, claims from therapists that they can no longer help the individual due to a lack of improvement could give beneficiaries grounds for an appeal. Medicare Part A services entitle people with untoward events requiring hospitalization 100 days of rehabilitation at a skilled nursing community, while seniors who return home after hospitalization may receive therapy from a home health agency. Qualification is determined by a need for intermittent skilled services, and the beneficiary being substantially homebound. Each episode of home healthcare can last as long as 60 days and be renewed with a physician's authorization. Part B services also cover physical, speech, and occupational therapy in private practices, hospital outpatient clinics, skilled nursing communities, and people's homes.

Medicare's plan to deny payment for long-term, high-dose opioid prescriptions has provoked criticism from many people who would be directly affected by it, including those with chronic pain, primary care physicians, and experts in pain management and addiction medicine, reports the New York Times . The new Medicare rule means Medicare would deny coverage for more than a week of prescriptions equivalent to 90 milligrams or more of morphine daily, except for those with cancer or in hospice. The Centers for Medicare and Medicaid Services estimates that about 1.6 million persons currently have prescriptions at or above those levels. A Medicare official says the limit for monthly high doses was intended not only to catch overprescribing physicians, but also to monitor people accumulating opioid prescriptions from several doctors. Critics say the regulation could make people who lost access to opioids go into withdrawal or force them to buy dangerous street drugs. "The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that beneficiary," argues Albert Einstein College of Medicine Professor Dr. Joanna L. Starrels. "That takes a lot of clinical judgment. It's individualized and nuanced. We can't codify it with an arbitrary threshold."

At least 12 states on Tuesday indicated that they would sue to prevent the Trump administration from adding a question about citizenship to the 2020 census, warning it would be unconstitutional and that fewer Americans would be counted, reports the New York Times . New York State Attorney General Eric T. Schneiderman announced he was spearheading a multistate lawsuit and officials in Connecticut, Delaware, Illinois, Massachusetts, New Jersey, New Mexico, Oregon, Pennsylvania, Rhode Island, and Washington said they would join the effort. California filed a separate suit on Monday. "This ... will result in an undercount of the population and threaten federal funding for our state and cities," said Massachusetts Attorney General Maura Healey. The Constitution mandates that every U.S. resident be counted, with the results used to redraw political boundaries and allocate federal grants and subsidies to where they are needed most. Critics have charged the administration of adding the question to lower the population tally in predominantly Democratic areas where more immigrants live, ahead of state and national redistricting in 2021. Schneiderman contended the act "will create an environment of fear and distrust in immigrant communities that would make impossible both an accurate census and the fair distribution of federal tax dollars." The administration said the question is needed to enforce the Voting Rights Act, a claim dismissed by critics.

A study published by the American Action Forum found 919,400 people between the ages of 25 to 54 were out of the U.S. workforce because of opioid addiction in 2015, reports the Washington Post . This cost the U.S. economy $702 billion, or slightly less than $44 billion annually from 1999 to 2015. The loss of work hours caused the economic growth rate to slow by 0.2 percentage points from 1999 to 2015. "Estimates suggest, had these workers been in the labor force and not addicted to opioids, the growth rate would have been 2.2 percent," says the American Action Forum's Ben Gitis. More work hours were lost for women — 6.4 billion — compared to men, who were down 5.7 billion over the 16-year study period. Employers in some parts of the country are struggling to fill vacancies despite the economic recovery and in some regions they say it is hard to find people who can pass a drug test — so much so that some firms are eliminating them. "It's something we hear companies talk about all the time, not being able to have workers pass drug tests and being unable to simply get workers to apply because they know they won't pass the drug test," Gitis says. "It was really important that we get a sense of what the magnitude of this could be."

Healthcare providers in Connecticut are attempting to prepare to meet the psychiatric needs of the state's senior population, reports Hartford Business . "We're all living longer and as we live longer, we change physiologically, medically, and psychiatrically, cognitively," says Hebrew Senior Care's Dr. Ava Pannullo. She also notes dementia is a complicating factor in combination with psychiatric problems such as depression, schizophrenia, anxiety, bipolar, or personality disorders that people might have had throughout their life, in addition to other medical conditions faced by seniors. Several Connecticut hospitals have invested millions of dollars since last year, adding capacity to their geriatric psychiatry inpatient units. The utilization of geriatric psychiatry beds is high in Connecticut, with 87 percent of the 629 staffed beds at acute-care hospitals being filled in 2015, according to a 2016 study by the state Department of Mental Health and Addiction Services (DMHAS). Moreover, in fiscal year 2015, more than 33,000 people were discharged from Connecticut hospitals for inpatient mental disorder treatment. DMHAS also estimates that state hospital beds for people 65 and older have been relatively constant since fiscal 2013, about 4.5 percent of total beds in the system. Dr. Martin Cooper at Farmington's Connecticut Mental Health Specialists says he is concerned about a serious shortage of geriatric psychiatrists in the state's hospital system.

A study published in the Journal of the American Geriatrics Society analyzed the 2006-2015 National Ambulatory Medical Care Survey to learn more about prescribing trends of high-risk anticholinergic medications in the United States, reports Medical Xpress . "Older adults are vulnerable to these medications due in part to physiological changes as they age," says University of Minnesota College of Pharmacy Professor Greg Rhee. "In general, older adults have a higher likelihood of developing adverse drug events from taking multiple medications." The investigators probed whether prescribing patterns of these drugs have changed over time and whether they vary by physician specialty and anticholinergic class among older adults in their office-based care. The results indicated that 6 percent of doctors' visits studied within the survey period listed an anticholinergic medication, suggesting the prescribing pattern varies by specialty. In addition, antidepressants were most prevalent among anticholinergic drugs prescribed to older adults, by medication class. Meanwhile, women were more likely to receive high-risk anticholinergic prescriptions, as were people from the South. Another finding was that people prescribed with six or more medications had a greater probability of being given high-risk anticholinergic prescriptions. Rhee calls for increasing awareness of potential adverse effects and encouraging providers to prescribe less-risky drugs.

Researchers at the University of Antioquia in Colombia will take brain scans of persons with Alzheimer's to track the tau protein and see if monitoring its formation in real time could reveal the role it plays in the disease, reports Nature . The team has already performed a preliminary imaging study in which 24 people from the same Colombian family had their brains scanned with positron-emission tomography to look for tau. The results indicated for the first time that tau starts accumulating in the brains of people with a mutation unique to Antioquia six years before symptoms start manifesting. Each participant in the new study will receive infusions of crenezumab or a placebo every other week for five years, while their cognitive abilities also will be assessed, and their brains scanned for amyloid, blood proteins, and other biomarkers that could be early Alzheimer's indicators. The researchers want to determine how tau spreads through the brains of young people with Alzheimer's, and whether that pattern reflects the distribution of tau seen in seniors with the disorder. They aim to compare their results with data from two clinical trials of anti-amyloid drugs in the United States that have started scanning participants' brains for tau. Should the study have promising results, the researchers might administer crenezumab to people younger than 30 who carry the mutation for early-onset Alzheimer's.

The U.S. Commerce Department has agreed to a Department of Justice request to include a citizenship status question on the 2020 Census, reports Roll Call . Opponents warn the reinstatement of such a question could undercut the proper tally in minority communities, especially those having large populations of undocumented immigrants. "Importantly, Commerce's review found that limited empirical evidence exists about whether adding a citizenship question would decrease response rates materially," said Commerce Secretary Wilbur Ross. "Concerns about decreased response rates generally fell into the following two categories — distrust of government and increased burden." Rep. Grace Meng (D-N.Y.) has expressed frustration for receiving what she called incomplete answers from Ross about the Census questionnaire during a House Appropriations subcomittee hearing. "Adding a question about citizenship status would be reckless and misguided," she emphasized. "It would lower response rates from those in immigrant communities, make the census more expensive, and add further complications to an already underfunded and underprepared Census Bureau." Ross said his ultimate decision was based on the perception that the need for accurate data for the Justice Department's efforts to enforce the Voting Rights Act outweighed potential cost hikes or other reduced response rate issues. "Completing and returning decennial census questionnaires is required by federal law, those responses are protected by law, and inclusion of a citizenship question on the 2020 decennial census will provide more complete information for those who respond," he argued.

A survey conducted by MindEdge found 21 percent of healthcare employees are concerned about job security because of the adoption of robotics and artificial intelligence (AI), reports Clinical Innovation + Technology . The survey, which polled 1,000 Americans with managerial positions or higher, outlined implementation rates of robotics and AI and the future of employees against automation. MindEdge estimated that 28 percent of the healthcare industry have adopted robotics or other forms of advanced automation, and 35 percent of managers in technology are worried about their job security due to this trend. Moreover, 49 percent of managers in technology said workers are missing soft skills, and 41 percent said employees are lacking hard skills, in preparing for the adoption of robotics and automation. Furthermore, half of polled managers believe it is a shared responsibility of both employees and employers in ensuring workers are trained to work in the future of robotics and automation.

The Trump administration has proposed replacing the family-based chain migration immigration practice with one that prefers skilled immigrants, but economists think this could be harmful, reports the New York Times . "In any plausible future scenario, the United States needs far more new low-skilled workers than high-skilled workers, so many that it will be impossible for native labor to fill all those jobs, even if native workers wanted to," says Michael Clemens with the Center for Global Development. Personal care and home health aides are expected to be the most-needed new workers through 2026, according to a Bureau of Labor Statistics analysis. The Pew Research Center also estimates that more than 50 percent of aging baby boomers will require long-term care, and Conference Board economist Brian Schaitkin determined foreign-born immigrants comprised 26 percent of personal care aides and home health aides in 2017, while 62 percent of home aides in New York were foreign born. Advocates for immigration limits say low wages in senior caregiving are a key reason why immigrants have started displacing American workers in these jobs. Senior-care agencies are especially worried about an immigration overhaul because many rely on Medicaid and Medicare and therefore cannot easily increase wages to make caregiver positions more appealing to native-born workers. Should Congress restrict chain migration, "Where are all these workers going to come from?" asks Belmont Village founder Patricia Will.