The Bureau of Labor Statistics (BLS) estimates 28 percent of civilian employees lack access to paid sick leave, which is likely to add to the severity of the current flu season, reports the Washington Post . Multiple studies indicate that employees without access to paid sick days are more likely to go to work sick than those with it. A 2010 policy brief published by the Institute for Women's Policy Research cited data from the Centers for Disease Control and Prevention (CDC) and the BLS to determine that during the 2009 flu season, about 8 million American workers went to work while infected, causing an additional 7 million people to become ill in the process. Rates of showing up to work sick were much lower in the public sector, where paid sick leave is offered more frequently than in the private sector. Meanwhile, a 2016 study from the National Bureau for Economic Research found the launch of sick leave mandates lowered the incidence of flu-like illnesses by about 6 percent across the total population. A 2017 study published in PLOS One found access to paid sick leave made employees significantly more likely to stay home with a flu-like illness. The CDC also determined that "providing paid sick leave to workers who lack it might help decrease the number of workdays lost as a result of flu and similar illnesses by nearly 4 to 11 million per year," leading to overall cost savings of $1 billion to $2 billion.

Kaiser Health News (KHN) on Feb. 13 hosted a discussion about improving care and services for people with dementia and supporting caregivers. It was an opportunity to learn from experts about the challenges and difficulties facing individuals, caregivers, the community, and policymakers. Among the subjects raised were understanding the stages of dementia from a medical, social, psychological, and environmental point of view, ways to find help, managing difficult behaviors, and understanding medications for people with dementia. KHN's "Navigating Aging" columnist Judith Graham led a discussion with panelists that included the University of Pennsylvania's Nancy A. Hodgson, a specialist on dementia care and end-of-life care for people with dementia; University of Michigan geriatric psychiatrist Helen Kales, an expert on dementia care and mental health issues; New York University Professor Yvonne Latty, whose mother has Alzheimer's; Katie Maslow with the Gerontological Society of America, an expert on improving care for people with dementia and supporting caregivers; and Mary L. Radnofsky, a former professor who lives independently since being diagnosed with dementia 12 years ago and who is an advocate for persons with dementia.

Results of a phase II trial published in Lancet Neurology found oral pimavanserin only had short-term effectiveness in treating Alzheimer's psychosis, reports MedPage Today . The drug reached the peak of its effectiveness at six weeks of treatment compared to a placebo, but neither cohorts exhibited significant treatment differences after 12 weeks. The trial's findings "cannot be considered to be positive or clinically meaningful," says the University of Southern California in Los Angeles' Lon S. Schneider. He implies that the "significance of the primary outcome was driven by a worsening of the placebo-treated group at six weeks that was not observed at four weeks of treatment or at nine and 12 weeks of treatment." Pimavanserin received FDA approval in 2016 for the treatment of delusions and hallucinations caused by Parkinson's psychosis. There are currently no approved treatments specifically for psychosis in individuals with Alzheimer's. In the trial were 181 adults about 50 years old from more than 100 U.K. nursing communities. Ninety participants received two tablets of 17-mg pimavanserin daily, and were compared with 91 individuals who got the placebo. "The designation of a primary efficacy outcome at six weeks while continuing double-blind treatment for 12 weeks allowed assessment for a continuing effect over 12 weeks, and is a unique feature of this trial," Schneider says. "If the primary outcome had been specified for 12 weeks, typical of previous trials with antipsychotics, then pimavanserin would have been considered as not effective."

A statement from U.S Department of Health and Human Services (HHS) Secretary Alex Azar said President Trump's fiscal year 2019 budget "makes investments and reforms that are vital to making our health and human services programs work for Americans and to sustaining them for future generations. In particular, it supports our four priorities here at HHS: addressing the opioid crisis, bringing down the high price of prescription drugs, increasing the affordability and accessibility of health insurance, and improving Medicare in ways that push our health system toward paying for value rather than volume." Azar stated Trump's budget supports the diligent work that HHS staff are already doing to achieve these goals. "In particular, the budget's efforts to reduce the high cost of prescription drugs, especially for America's seniors, are a reflection of President Trump's deep commitment to addressing this important issue," Azar said. The HHS Budget in Brief is available here . The budget calls for major cuts for many discretionary programs, as well as hundreds of billions of dollars in savings through amendments to Medicare and Medicaid, reports Politico Pro . The request would expand Medicare's policy on site-neutral payments, in which providers are paid the same amount of money no matter where they deliver care, saving taxpayer up to $80 billion over 10 years. Paying hospital-owned doctor practices the same as independent practices would save an additional $34 billion. The White House also wants to "modify hospital payments for uncompensated care," which it forecasts would save slightly less than $70 billion. Another $37 billion would be saved via changes in how Medicare covers bad debt, saving another $37 billion. Trump also wants to roll back the Affordable Care Act expansion, instead pushing a plan to provide healthcare funding in block grants to states. The budget also proposes charging care recipient higher co-pays for emergency room visits and strengthening requirements that Medicaid recipients show immigration status before enrolling. In addition, the proposal calls for a revamp of medical malpractice laws, which Republicans contend is necessary to reduce frivolous litigation and expensive "defensive" medicine. Click here for an agency-by-agency look at the budget proposal.

Advocates of medical aid-in-dying and residents of the Veterans Home of California-Yountville are opposing a regulation passed in 2017 by the California Department of Veterans Affairs (CalVet) that would evict anyone living in veterans' communities if they plan to use the law, reports Kaiser Health News . CalVet's June Iljana says the agency adopted the rule to avoid breaking a federal law banning the use of government resources for physician-assisted death. To do so would imperil nearly $68 million in federal funds that helps run such communities. Iljana notes none of the 2,400 residents of California's veterans' communities has so far formally requested medical aid-in-dying. "We would respectfully and compassionately assist them in transferring to a hospice, family home, or other location," she says. "We will readmit them immediately if they change their mind." Oregon, Colorado, and Vermont also bar the use of lethal medications in state-run veterans' communities. Only Washington state has a policy that permits veterans to remain in government-run residences if they intend to ingest lethal medications. At least one veteran has died in a state-run community using that law, says Heidi Audette with Washington state's Department of Veterans Affairs. "Nothing exists in the federal statute's language that would prohibit a resident from receiving aid-in-dying services at state homes, so long as they are not provided using federal funds or employees," contends End of Life Liberty Project Executive Director Kathryn Tucker.

Physicians all too often overlook the stresses and challenges caregivers face in the emergency department, writes Brown University Professor Jay Baruch in STAT . "Caregivers are individuals, usually family members, who regularly look after one or more sick, frail, or disabled individuals," he notes. Baruch also cites a broad spectrum of adverse biological responses among caregivers when their responsibilities cause psychological and physical distress. Examples include slower wound healing, high blood pressure, and an impaired immune response. "These can take a toll, leading to an overall increase in caregiver mortality," Baruch warns. He also says caregivers' tendency to drop off loved ones in the emergency department and leave "is typically the result of systems that don't provide enough resources for caregivers who often face daunting tasks. These obligations are equivalent to unpaid full-time jobs. Could anyone blame them for seeking a breather?" Baruch suggests social workers can play an essential treatment role in such situations. "A social worker can explore whether the individual is eligible for services and, if so, help arrange them." Baruch notes about 14.7 million older adults receive assistance with daily activities from spouse and family caregivers, but only 25 percent of caregivers leverage supportive services, "possibly because many of them may not perceive themselves as caregivers, a term with professional connotations. In the emergency department ... their assistance can be a treasure trove of information and insight when the individual has trouble communicating with the medical staff. But when the strain of caregiving reveals itself, clinicians like me have a responsibility to pursue those worrisome cracks."

President Trump has asked Congress to slash Department of Labor (DOL) funding by 9 percent, or $1.1 billion, in fiscal year 2019, targeting job-training programs that receive broad bipartisan support for the second consecutive year, reports Bloomberg BNA . The request includes a $407 million cut in spending on Job Corps centers for disadvantaged youth and $400 million in savings from removing the Senior Community Service Employment Program. A memo from Office of Management and Budget Director Mick Mulvaney implies the White House plans to offset some of those reductions with $1.5 billion in newly available funds for DOL workforce development grants. This year's request pushes for reductions in programs implementing the Workforce Innovation and Opportunity Act (WIOA) grants for adult, youth, and dislocated worker training. WIOA funds 33 job-training programs across the country, and it was signed into law in 2014 with overwhelming Senate and House endorsement.

A study published in the Journal of the American Geriatrics Society found 7.3 percent of older veterans in the United States have a prescription for benzodiazepine, which is flagged by international guidelines as a drug that few people older than 65 should take, reports Medical Xpress . A steady decline in all benzodiazepine prescriptions has been observed since new guidelines were issued, while the number of older adults starting on the drugs for the first time has fallen even faster. However, the continued use of the drugs demonstrates much more needs to be done to notify providers, users, and families to their risks and the need to find alternative treatments. The countries the study focused on participate in Choosing Wisely International, an initiative supported by the Commonwealth Fund to help countries mirror the Choosing Wisely effort launched by the American Board of Internal Medicine that currently offers U.S. doctors and care recipients many evidence-based recommendations. University of Michigan Medical School Professor Donovan Maust says newer antidepressant drugs, and non-drug psychotherapy approaches, can ease many of the symptoms that often spur doctors to prescribe benzodiazepines, without the hazards. Research also has shown that those who take a benzodiazepine to calm the effects of acute stress are likely to develop post-traumatic stress disorder.

A study published in PLOS Medicine found boosting social interaction for nursing community residents with dementia by as little as one hour a week improved their quality of life, agitation, and neuropsychiatric symptoms in conjunction with a person-centered care intervention, reports Healio . "To date, interventions to promote person-centered care have not achieved a significant improvement in quality of life for people with dementia," says Exeter University's Clive Ballard. "The exception is a recently published intensive proof-of-concept study that confirmed the added benefits of combining person-centered care training for care staff, antipsychotic review, and social interaction — the WHELD intervention — and demonstrated significant benefits in quality of life, as well as a significant reduction in antipsychotic use." The randomized controlled cluster trial conducted between Jan. 1, 2013, and Sept. 30, 2015, compared the WHELD intervention with conventional treatment in people with dementia living in 69 U.K. nursing communities. Generally, 553 people completed the trial, and subjects who received the WHELD intervention exhibited statistically significant improvements in quality of life versus typical treatment over nine months. There also were significant benefits in agitation and overall neuropsychiatric symptoms, with participants with moderately severe dementia enjoying the most benefits. Also noted was significant benefit in positive care interactions among people receiving WHELD compared to typical treatment, although no statistically significant differences were observed for the other outcomes.

More than 50 percent of all over-75-year-olds in the United Kingdom live alone, and in January the country appointed a minister for loneliness to help such people, reports Al Jazeera . Sports Minister Tracey Crouch will assume this post. Dr. Kellie Payne from the Campaign to End Loneliness says the healthcare impact of loneliness is quantifiable. "Having chronic loneliness predisposes you to many health conditions," she notes. "There's been a meta-analysis that looked at loneliness and it showed that it was as bad for your health as smoking 15 cigarettes a day. People that are lonely are more likely to get heart disease and stroke. Early onset of dementia comes earlier if you're lonely. It's linked to many mental health issues, like depression and suicide." One way to combat loneliness is to arrange for young persons to move in with seniors who are living alone, while another is Cocktails in Care Homes, an initiative to bring young people into senior care communities for an evening of cocktails and conversation.