CDC Unveils New Adult Vaccination Rates; nfid Surveys Illuminate Barriers to Vaccine Uptake

/PRNewswire/ -- New data from the Centers for Disease Control and Prevention (CDC) show that adults remain largely unvaccinated against preventable infectious illnesses. At a news conference convened today by the National Foundation for Infectious Diseases (NFID), experts in public health, infectious disease, oncology and other medical specialties discussed the data and the health consequences for adults who skip vaccines. They collectively called on all adults and health care providers to improve vaccination rates.

"For more than six decades, vaccines have protected us from infectious illnesses that have a wide range of consequences, from lost work days and inability to meet our daily obligations, to pain, discomfort, hospitalization, long-term disability and death," said Susan J. Rehm, M.D., NFID medical director. According to Dr. Rehm, by foregoing needed vaccines, adults not only leave themselves vulnerable to sickness, but they expose those around them to unnecessary risks, too.

This problem is evident right now, as pertussis (whooping cough) continues to claim the lives of infants in California, while adults, who are frequently responsible for transmitting the disease to infants, fail to get the one-time pertussis booster vaccine. The impact of other vaccine-preventable infections may not be as immediately apparent, but they are no less important. Other vaccines for adults protect against viruses that cause several types of cancer, reactivation of the chickenpox virus that causes shingles later in life, and infection with bacteria that are the leading cause of community-acquired pneumonia.

New survey results from NFID suggest that doctor/patient communication challenges may be at least part of the problem. While physicians perceive they are encouraging their adult patients to be vaccinated, patients say the topic of vaccination rarely comes up during their doctor visits.

Vaccination rates highest among seniors; lowest among minority groups

In unveiling the adult vaccination data from the 2009 National Health Interview Survey (NHIS), Melinda Wharton, M.D., M.P.H., deputy director of the National Center for Immunization and Respiratory Diseases at the CDC, noted that the highest immunization rates are among older Americans, who tend to be vaccinated against influenza and pneumococcal infections. She suggested that one reason for this might be that older persons tend to have more routine visits with health care providers, providing more opportunities to learn about and adopt good preventive care behaviors.

"A good ongoing relationship with your medical provider is positive for so many reasons," said Dr. Wharton, "not least of which is that you will have an ongoing opportunity learn about the best ways to stay healthy, including the best preventive care choices like vaccines."

While adult vaccination rates are showing slow improvement overall, one vaccination trend Dr. Wharton specifically noted is the 7.4 percent decrease in pneumococcal vaccination rate in high-risk adults 19 to 64 years of age. She pointed out that this is not because people are suddenly foregoing this vaccine. Rather, the decrease reflects the recent addition of new risk groups -- namely smokers and people with asthma -- increasing the pool of people who should get the vaccine. Dr. Wharton called on smokers and people with asthma to check with their physicians or other health care providers about this vaccine.

In addition to generally low adult vaccination rates, Dr. Wharton touched on the problem of racial and ethnic vaccination disparities. While strides have been made to close racial and ethnic gaps, some significant vaccination gaps continue to exist among Whites, Blacks and Hispanics.

Vaccine (age and/or risk status)	Non- Hispanic White (%)	Non- Hispanic Black (%)	Hispanic or Latino (%)
Tetanus, diphtheria, pertussis (19-64 years)	51	54	49
Pneumococcal (65 years and older)	65	45	40
Pneumococcal (19-64 years, high risk)	18	18	12
Hepatitis B (19-49 years, high risk)	43	44	37
HPV (19-26 years)	20	13	13
Shingles (60 years and older)	11	4	5
Influenza (65 years and older)	69	51	51
Influenza (50-64 years)	42	37	31

The NHIS survey also reported vaccination rates in health care professionals for influenza (up 7 percent, to 53 percent), hepatitis B (up 2.5 percent, to 65 percent) and Tdap (up 1.6 percent, to 58 percent). "It's gratifying to see health care worker vaccination rates continue to increase," said CDC's Melinda Wharton. "By modeling good preventive care behaviors our health care professionals are truly leading the way as good partners in their relationship with patients." The NHIS vaccination data include anyone employed in a health care occupation or setting. In contrast, physician-only vaccination rates are much higher (>90 percent for influenza) as reported in two separate NFID surveys fielded before and during the current influenza season.

Doctor/patient communication breakdown a factor in low vaccination rates

A dramatic physician-patient communication disconnect was revealed by new data from two NFID surveys. Nearly 90 percent of primary care physicians say they discuss vaccines with their patients, yet in a separate survey of consumers, almost half cannot recall ever discussing vaccines with their physicians. As further evidence of the communication gap between physicians and their patients, 99 percent of physicians say that they or their staff initiates vaccine discussions, but just 44 percent of patients say that is true.

"Busy primary care physicians think they're doing a good job recommending vaccines, but the survey indicates that patients aren't getting the message," suggested Dr. Rehm. "Consumers overwhelmingly said they look to physicians for vaccine recommendations and are likely to act on those recommendations, so it's clear that we physicians need to be more effective in communicating with our patients."

Among the positive findings, consumer familiarity with vaccine-preventable illnesses is rising, although still limited. Familiarity with specific vaccine-preventable diseases rose 4 to 12 percent compared with results from a 2009 survey, with the largest increase for pertussis vaccine. The only vaccine-preventable disease not to register an increase in familiarity is pneumococcal vaccine. Consumers also report that they rarely refuse vaccines if their physicians recommend them.

A realized consequence: disease resurgence

The ongoing pertussis epidemic in California demonstrates the danger still posed by diseases once thought to be gone in the U.S. There are reports of more than 6,400 cases so far in California this year, the most since 1958. While pertussis can affect people of any age and in fact, national rates have been rising in adults, it is the infants who adults pass this on to who bear the burden. Ten infants, all younger than three months, have died from whooping cough in California this year.

Patrick Joseph, M.D., a California infectious disease physician who is NFID's vice president, implored adults to get the one-time booster vaccine, "While the epidemic is in adults, the tragedy is in kids. The situation is grave when babies too young to be immunized are dying."

Dr. Joseph said this crisis means California doesn't have the luxury of bringing people along slowly. The time to increase vaccination rates for pertussis is now. The California Department of Public Health recommends pertussis boosters for all adults, including those over 65, a move supported by the CDC's Advisory Committee on Immunization Practices (ACIP). At its October meeting, ACIP voted to extend pertussis booster vaccination recommendations to include adults 65 and older nationwide.

While California has been hardest hit so far, many other areas have seen increased cases this year, including Ohio, South Carolina, Michigan, Texas, Idaho, upstate New York and the Philadelphia suburbs. Since pertussis knows no boundaries, Dr. Joseph voiced his hope that adults outside his home state would also take notice and seek a Tdap vaccine now to protect themselves and infants around them.

Importance of pneumococcal and influenza vaccines also highlighted

AARP board member Catherine Georges, R.N., Ed.D., reminded adults that the time to get an influenza vaccine is now. "We know it's important for Americans of all ages to go out now and get the flu vaccine, but it's even more critical for people 50-plus," said Dr. Georges, a registered nurse and professor and chair of the department of nursing at Lehman College and the Graduate Center at the City University of New York. "Older Americans are often caring for their children and for older loved ones. Getting vaccinated not only protects you, but also helps protect your family and friends." Dr. Georges echoed the universal recommendation from CDC for influenza vaccination of all Americans six months and older.

Since pneumococcal infection is an all too frequent complication of influenza, Dr. Georges reminded Americans that, "pneumococcal and influenza vaccines can be given at the same medical visit." Pneumococcal vaccine is recommended for everyone 65 and older and for younger adults with certain risk factors or conditions like asthma, smoking, heart disease and diabetes. For most people, pneumococcal is a one-time vaccination.

Alarmingly few Americans immunized against debilitating disease of shingles

The lowest vaccination rate for a routinely recommended vaccine is for the shingles vaccine, which is recommended for everyone starting at age 60. Only ten percent of eligible persons have received the shingles vaccine. Not only does the likelihood of getting shingles increase with age, so does the severity of shingles pain, which can last long after the shingles rash has disappeared (this pain is known as post-herpetic neuralgia, or PHN). This pain diminishes quality of life and functional capacity as much as congestive heart failure, a heart attack, type II diabetes or major depression.

Adults in the NFID survey say they are familiar with shingles, but further questioning reveals knowledge gaps; for instance, 42 percent do not know that anyone who has had chickenpox is at risk for shingles. Still, adults are aware of the pain of the disease; 55 percent say they "know someone who has had it and it was terrible." Unfortunately, only half of adults even know there is a shingles vaccine available and just 16 percent know it is currently recommended for everyone 60 and older.

"Shingles can be a terribly painful and debilitating disease, particularly in the elderly," said Jeffrey Cohen, M.D., chief of the Laboratory of Infectious Disease at the National Institute of Allergy and Infectious Diseases. "Shingles pain can be very difficult to treat. Current therapies are only somewhat effective and often associated with frequent and problematic side effects, especially in older people, which is why it is vitally important that we educate Americans about the vaccine."

Vaccines prevent cancer

"Human papillomavirus (HPV) not only causes cervical cancer, but also a growing portion of head and neck cancers," according to Maura Gillison, M.D., Ph.D, Jeg Coughlin Chair of Cancer Research at the Ohio State University College of Medicine. "Twenty years ago about 40 percent of these cancers were due to HPV; today that number is over 60 percent in the U.S. Even more alarming is that these cancers are happening in younger people without traditional risk factors—smoking and alcohol consumption."

The hepatitis B vaccine also protects against certain cancers. The hepatitis B virus causes 30 percent of all liver cancers in the U.S. and doubles the risk of non-Hodgkin's lymphoma. Both HPV and hepatitis B viruses are common. An estimated 70 percent of Americans will be infected with HPV in their lifetime and up to 1.4 million Americans have chronic hepatitis B infection.

CDC recommends HPV vaccine for all women 19 to 26 years of age if not previously vaccinated and recommends the hepatitis B vaccine for all sexually active adults who are not in a long-term, mutually monogamous relationship and others in more defined risk groups.

"I urge everyone to get the HPV and hepatitis B vaccines as recommended," said Dr. Gillison. "These vaccines are truly life-saving. As a cancer-specialist, I can tell you that prevention is a far better option than treatment. These are not cancers you want to have or want your kids to have."

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Medicare Meltdown Looming As Steep Medicare Cut Begins

/PRNewswire/ -- The U.S. Senate's failure to act before this week's 21 percent Medicare physician payment cut has put seniors' health care at grave risk. A new American Medical Association (AMA) physician survey shows that many physicians are already limiting the number of Medicare patients they treat. The AMA today launched a multi-million dollar national advertising campaign, with ads on TV and radio and in newspapers, including The New York Times, USAToday and The Wall Street Journal.

"The Senate has turned its back on our nation's seniors and the physicians who care for them by leaving for vacation and failing to stop a 21 percent Medicare cut before their self-imposed June 1 deadline," said AMA President J. James Rohack, M.D. "Today, the AMA is unveiling a new multi-million dollar ad campaign encouraging the public to contact their Senators and tell them to get back to work and fix Medicare now."

The 21 percent cut also hurts our nation's military families, as TRICARE rates are tied to Medicare. "It is sad and ironic that Senators raced home to celebrate Memorial Day without first voting to preserve health care for active duty military families," Dr. Rohack said.

Yesterday, the AMA received a call from Joan, a retired nurse, who was looking for a Maryland physician for her 72-year-old sister and could not find one who took Medicare. Both physician offices she called said that as of this June 1 they were no longer accepting new Medicare patients -- a real life example of how decisions made in Washington hurt real people.

Our new online survey of 9,000 physicians who care for Medicare patients confirms that seniors are already being hurt by Congress' mismanagement of the Medicare program. About one in five physicians (17%) say they have already been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians (31%) have already been forced to take that action. The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low.

"Make no mistake: Physicians want to care for seniors and military families, but the chronic instability caused by the threat of future payment cuts has already taken its toll - and a 21 percent cut will make matters much worse," Dr. Rohack said.

"This is the third time this year that Congress has allowed a Medicare deadline to expire without action," Dr. Rohack said. "Each time Congress delays fixing the Medicare physician payment cut makes the problem worse and the price tag higher for the American taxpayer. Enough is enough. The Senate needs to fix the Medicare physician payment system for America's seniors once and for all."

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HHS Secretary Kathleen Sebelius and Other Health Experts to Host Webchat on Health Insurance Reform and Seniors

U.S. Department of Health and Human Services Secretary Kathleen Sebelius and Assistant Secretary for the Administration on Aging Kathy Greenlee will host a webchat today, THURSDAY April 8, to
discuss the benefits of the new health reform law as it relates to America's seniors. Sebelius and Greenlee will highlight some of the immediate benefits of health reform for America's seniors before
answering pre-submitted questions from the public.

The chat is the second in a series of discussions that is designed to help Americans understand the benefits of the newly passed health insurance reform law.

Members of the public are encouraged to submit questions via email to HealthReform@hhs.gov. HHS officials will try to answer as many questions as possible during the web chat and post up questions and answers on the web site as well.

WHAT: Health Reform Weekly Webchat with HHS Secretary Kathleen Sebelius, Assistant Secretary for Aging Kathy Greenlee and Principal Deputy Administrator for the Centers for Medicare & Medicaid Services, Marilyn Tavenner

WHEN: Thursday April 8, 2010 at 1:00 p.m. EDT

WHERE: www.HealthReform.gov

The webchat will be available via satellite feed at the following coordinates:

SATELLITE:
G-19 04K Digital Only Slot B
Orbital Location: 97' West

Ku-Band
D/L: 11786.4Mhz Horizontal
FEC: 3/4
Symbol Rate: 6.111319 @ 204 packet = 8.448 Data Rate
4X3 Aspect Ratio


For more information on the new health reform law please visit www.healthreform.gov

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FDA Approves a High Dose Seasonal Influenza Vaccine Specifically Intended for People Ages 65 and Older

/PRNewswire/ -- The U.S. Food and Drug Administration today approved Fluzone High-Dose, an inactivated influenza virus vaccine for people ages 65 years and older to prevent disease caused by influenza virus subtypes A and B.

People in this age group are at highest risk for seasonal influenza complications, which may result in hospitalization and death. Annual vaccination remains the best protection from influenza, particularly for people 65 and older.

Fluzone High-Dose was approved via the accelerated approval pathway. FDA's accelerated approval pathway helps safe and effective medical products for serious or life-threatening diseases become available sooner. In clinical studies, Fluzone High-Dose demonstrated an enhanced immune response compared with Fluzone in individuals 65 and older.

As part of the accelerated approval process, the manufacturer is required to conduct further studies to verify that the Fluzone High-Dose will decrease seasonal influenza disease after vaccination.

"As people grow older, their immune systems typically become weaker," said Karen Midthun, M.D., acting director of the FDA's Center for Biologics Evaluation and Research. "This is the first influenza vaccine that uses a higher dose to induce a stronger immune response that is intended to better protect the elderly against seasonal influenza."

Fluzone High-Dose, manufactured by Sanofi Pasteur Inc., is formulated so that each 0.5 mL dose contains a total of 180 micrograms (mcg) of influenza virus hemagglutinin (HA) which is made up of 60 mcg of each of the three influenza virus strains.

Other currently licensed seasonal influenza vaccines for adults are formulated to contain a total of 45 mcg of influenza virus hemagglutinin (15 mcg HA from each of the three influenza strains per dose). Sanofi Pasteur, also manufactures Fluzone, a seasonal vaccine for the United States approved for use in individuals ages 6 months and older.

As expected, because of the higher HA content, non-serious adverse events were more frequent after vaccination with Fluzone High-Dose compared with Fluzone. Common adverse events experienced during clinical studies included pain, redness and swelling at the injection site and headache, muscle aches, fever and malaise. The rate of serious adverse events was comparable between Fluzone High-Dose and Fluzone.

People with hypersensitivity to egg proteins or life-threatening reactions after previous administration of any influenza vaccine should not be vaccinated with Fluzone High-Dose.

Fluzone High-Dose is administered as a single injection in the upper arm and is available in single dose pre-filled syringes without preservative.

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Healthcare Bills Will Hamper Medicare Services for Seniors and the Disabled

/PRNewswire/ -- The following is news about the Medicare power mobility benefit from Support Mobility Now Volume 1 Issue 2:

Significant changes are needed in healthcare reform legislation to prevent senior citizens and the disabled from facing a difficult time obtaining homecare products through Medicare. The current legislation would likely prevent or delay many Medicare beneficiaries from receiving critical medical equipment that helps sustain their lives and allows them to live independently in their homes for longer periods of time.

Unfortunately, in piecing this historic legislation together, lawmakers may have overlooked the fact that some of the changes for medical equipment providers would adversely impact their ability to deliver timely and quality service to Medicare beneficiaries.

To be sure, America's healthcare system must be improved. But there should also be a responsibility to ensure that the changes don't place additional burdens upon Medicare beneficiaries, who are already some of the most vulnerable men and women in our society.

Medicare's power mobility benefit would be hit especially hard.

Currently, Medicare allows a beneficiary to purchase power wheelchair in the first month it is prescribed or rent the equipment for 13 months. The legislation eliminates a beneficiary's early purchase option. Seniors and people living with disabilities, who qualify for power wheelchairs, usually suffer from long-term, chronic conditions so they overwhelming chose the early purchase. Without the first month purchases, providers say they won't have the cash flow to pay the wheelchair manufacturers or provide other services required. Many equipment suppliers anticipate that they may go out of business or no longer offer power wheelchairs, a development that would make it more difficult for beneficiaries to find providers in their area.

Some in Congress recognize the potential danger from ending the early purchase.

Pennsylvania Sen. Arlen Specter proposed an amendment to preserve the first-month purchase option while obligating suppliers to pay back Medicare when equipment isn't used full term. The Congress, however, quickly showed how much financial concerns are out weighing practical ones: The Specter amendment essentially died when the Congressional Budget Office (CBO) contended that only $200 million would be saved over 10 years with his proposal, while lawmakers sought $800 million in savings. The industry maintains that the CBO was wrong, and that much more than $200 million would be saved with Specter's amendment.

Aware that the Congress is fixated on finding savings to pay for healthcare reform, providers are willing to accept further, yet agonizing, reductions in the reimbursement rates for power wheelchairs in exchange for keeping the purchase option and sustaining a process that would at least allow companies to stay in business.

The Senate legislation also accelerates the implementation of the competitive bidding program for Durable Medical Equipment (DME), which includes oxygen, power wheelchairs and other homecare products. Competitive bidding for these products was first implemented last year, but the program was flawed to the point that patients' lives were endangered because of confusion and delays in getting life-sustaining equipment to beneficiaries, hospitals and other institutions. Congress stepped in, and temporarily halted the program in July 2008. The Centers for Medicare and Medicaid Services (CMS) has re-launched the bidding program, but providers say that many of the original problems have not been corrected. The healthcare reform legislation makes matters worse by ordering a rapid expansion of the competitive bidding process before stakeholders can gauge whether the program can avoid putting some of the most vulnerable people in our society at risk.

Once again, some lawmakers recognize that the rush to pay for healthcare reform legislation could have a devastating impact on their constituents. Competitive bidding is projected to save millions of dollars. But Florida Rep. Kendrick Meek is more concerned about his constituents: he has sponsored legislation in the House that would end the competitive bidding experiment and obtain savings for the government by cutting the reimbursement rate for homecare products by 0.25% from 2010 to 2012 and an additional 0.5% in 2015. Moreover, the industry wants to work with CMS to establish a system that allows providers to deliver quality service and products to Medicare beneficiaries at a fair price to the government.

Comprehensive healthcare reform is long overdue, but we must ask our Representatives and Senators in Congress whether the cost of enacting this legislation should include placing new burdens on seniors and people with disabilities. One would hope that this population would benefit from reform, and not be its victims. It's clear that the current legislation delivers critical blows to the companies committed to providing medical equipment to Medicare beneficiaries.

What's unclear is whether enough lawmakers in Congress will recognize the consequences for their constituents back home when there are significant delays in providing medical equipment for Medicare beneficiaries, or only a few companies left to supply the products. There are ways to fix healthcare reform legislation so that the seniors, who built and protected our nation, can live with dignity and independence in their homes during their twilight years.

Let's hope Congress understands how much this means to them.

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HHS Announces $27 Million from Recovery Act to Help Older Americans Fight Chronic Disease

HHS Secretary Kathleen Sebelius has announced the availability of $27 million to help older individuals with chronic conditions to improve their health and reduce their use of costly medical care. These funds are made possible through the American Recovery and Reinvestment Act, which has provided up to $650 million to HHS for the Communities Putting Prevention to Work initiative launched earlier this fall to promote evidence-based prevention strategies in communities and states across the country.

"This program is about getting money to communities to help seniors manage chronic conditions that threaten their ability to remain in their own homes. Through HHS' national aging-services network which reaches into nearly every community in America, we are helping people living with chronic conditions and others better manage their own health," Secretary Sebelius said.

Research has shown that prevention programs can improve the quality of life for older individuals, including frail seniors with multiple chronic conditions, and also reduce health care costs. The Recovery Act funds will put the results of HHS' research investments into practice at
more than 1,200 community-based sites across the country -- reaching tens of thousands of older Americans and their families.

"The American Recovery and Reinvestment Act has been about helping families in need during challenging economic times, " said Assistant Secretary for Aging Kathy Greenlee. "This innovative program will give at-risk older people and their caregivers the tools they need to make their own decisions so they can live longer, healthier and more independent lives."

This competitive initiative gives every state Aging and Health Department and U.S. territory the opportunity to implement rigorously tested Chronic Disease Self-Management Programs (CDSMP), one of the most prominent being the Stanford University model. The CDSMP is a six-week peer-led training program that covers topics such as healthy eating, exercise, managing fatigue and depression, and communicating effectively with health care professionals. While further research is underway, rigorous evaluations have suggested that the program improves
participants' overall health and energy levels and result in savings to Medicare through fewer hospital stays. CDSMP are specifically designed to be delivered by non-health professionals in community settings, such as senior centers, congregate meal programs, faith-based organizations and senior housing projects.

"Too many seniors do not receive the recommended preventive and primary care they need," said Assistant Secretary for Health, Dr. Howard K. Koh. "This program will strengthen the health care that our seniors need and deserve by coordinating and integrating care in the community."

Eligible entities include all 50 states and U.S. territories. States will identify the communities and the organizations that will be involved locally in the delivery of this program. The deadline for applications is Feb. 12, 2010.

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As August Congressional Recess Concludes, Polls Show Seniors, General Public Strongly Opposed to Medicare Cuts in Congressional Health Reform Plan

As August Congressional Recess Concludes, Polls Show Seniors, General Public Strongly Opposed to Medicare Cuts in Congressional Health Reform Plan, Says AHCA

/PRNewswire/ -- As Congress prepares to reconvene next week following an August recess replete with wide-ranging local discussion of how to fund health care reform, new polling finds both seniors and the public at large are strongly opposed to slashing Medicare-funded nursing home care to pay for the plan. Meanwhile, at events in Florida and Pennsylvania - states with large concentrations of Medicare beneficiaries - seniors and caregivers are urging their respective state congressional delegations to help preserve, protect and defend quality nursing home care as the legislative debate resumes Tuesday on Capitol Hill.

According to a new national poll (1000 RVs, 8/21-24, +/- 3%) and analysis from the Mellman Group (D), "78% of voters nationwide predict that if Congress cuts $32 billion in Medicare payments to nursing homes, the quality of care delivered to seniors will decline. Seniors are equally concerned, as 78% of those over 65 believe nursing home care will get worse because of such cuts, and a majority believes care will get 'much worse' (58%). Those approaching retirement age (55-64) express even more concern. 83% believe care will worsen." The Mellman Group data also finds a full 66% of voters are less likely to support their local member of Congress for re-election if he or she votes for cuts to Medicare-financed nursing home care. The poll analysis is available in its entirety at www.ahca.org.

Additionally, A new CNN poll (1010 Adults, 8/28-31, +/- 3%) released 9/2) finds that by a 43% to 26% margin, Americans believe senior citizens will be "worse off," not "better off," from the health care reform proposals now being advanced. 30% said "about the same"; 1% expressed no opinion.

The 9/2 Florida Times Union, in a story entitled, "Proposed Medicare Cuts Have Nursing Homes Worried," reports on a Jacksonville-area event in which seniors' advocates and nursing home staff warned Florida's Medicare funded nursing home care benefits will be cut $3.5 billion over ten years to finance health care reform. Lisa Cantrell, President of the National Association of Health Care Assistants, spoke at the Southlake Nursing and Rehabilitation Center in Mandarin, FL. "To Cantrell's side, propped against a wall, was a large, scroll-like petition urging Florida's congressional delegation to rethink the cuts. . . Patricia Johnson, 68, signed the petition with her left hand, as her dominant right hand remains paralyzed from a recent stroke. 'If they have to cut staff here,' her husband, Artie, said, 'it would be down to what I would call the bare minimum.' He added his name, too."

The 9/4 Wilkes-Barre Times-Leader, in a story entitled, "Residents Petition Against Any Medicare Cuts," reports that "Caregivers, residents and family members gathered at the Riverstreet Manor Nursing Home Thursday to sign a petition to members of Pennsylvania's congressional delegation asking that any health care reform bill does not include crippling cuts in Medicare funding." The story notes "Representatives of The Coalition to Protect Senior Care are touring the country's nursing homes asking them to urge their respective members of Congress not to support the currently proposed health care reform measure as long as it includes Medicare funding cuts for seniors in nursing homes by more than $32 billion over 10 years. In Pennsylvania, which would be the seventh hardest hit state, the cuts would total $2.1 billion. In the 11th Congressional District alone, where Riverstreet Manor is, the loss over the next decade would be about $142 million."

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