Consumers revolt

Alzheimer's Disease Gene Typing 9 The results of a new study published in The Lancet (July 13, 1996) show that testing for a certain gene type can help physicians determine which patients have Alzheimer's disease. Scientists at Duke University Medical Center conducted a postmortem examination of the brains of 67 patients who had been diagnosed with Alzheimer's disease. They found that the brains of every patient who had the Alzheimer's susceptibility gene (APOE4) showed the neurofibrillary plaques and tangles indicative of the disease. Of the three different gene types (alleles) for APOE, only e4 was associated with an increased risk for development of Alzheimer's disease. Therefore genotyping is only useful for patients with Alzheimer's disease with an e4 allele. According to Dr. Ann Saunders, lead author of the study, "In a clinical setting, then, APOE genotyping will identify three of four patients who have the disease. It is no help with patients who do not have an e4."

ASHE and JCAHO Reach Consensus on E n v i r o n m e n t o f Care

Issues 9 The American Society for Healthcare Engineering (ASHE) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have reached the

GERIATRIC NURSING Volume 17, Number 6

following initial agreements regarding the interpretation and application of the Environment of Care standards: 9 The JCAHO will continue to evaluate life safety management programs in health care facilities that are classified as business occupancies. However, the requirement that these sites complete a statement of conditions will be discontinued, as will the requirement that they be inspected for compliance with the National Fire Protection Association Life Safety Code. 9 Decisions about the designation of alteration or renovation projects as major or minor construction, with respect to the installation of sprinkling systems, will be deferred to state, local, and other "authorities having jurisdiction." The JCAHO will remain a recognized "authority having jurisdiction." These Environment of Care standards are included in the Joint Commission's Accreditation Manual for Hospitals. Information about other changes may be obtained from the ASHE fax-ondemand service, (800) PMG-FAX4. To obtain the Environment of Care standards update, callers should dial document number 431214.

Consumers Revolt l Health care consumers have revolted against HMO cost cuts, causing HMO stock prices to drop. Several managed care organiza-

tions, including United Health Care Corporation (Minneapolis), Humaria (Louisville), Right-Choice Managed Care (St. Louis), and Mid Atlantic Medical Services (Rockville), will have lower than expected earnings for this fiscal year. Because employers and individuals have demanded improvements in service and quality of care, only the HMOs able to comply with those demands will thrive.

Retirees Benefit from Insurance Reform Law 9 President Clinton signed into law the Health Insurance Reform Act (HIRA) of 1996, which gives senior citizens and patients requiring long-term care some welcome tax breaks. Paul Willging, executive vice president of the American Health Care Association (AHCA) endorsed the reform measure, saying, "The new law fundamentally reshapes how Uncle Sam will view long-term care expenses when tax time rolls around. People will be able to add these expenses to their other health care expenses for tax purposes for the first time." Beginning January 1, 1997, individuals will be able to itemize their out-of-pocket expenses for longterm care and long-term care insurance premiums with other medical expenses on their yearly income tax returns. Additionally, the new law includes consumer protections for those who buy long-term care insurance policies. Presently, more than a million people, or two of three nursing

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