Archive for October, 2009

High tech health care doesn’t always mean better lives for our elderly. But we should be careful with the language we use when discussing other “options”. Futile care is an example I would hesitate to speak right now.

LOS ANGELES — A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal.

One found that putting nursing home residents with failing kidneys on dialysis didn’t improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.

Most LTC nurses and aides I know do not support aggressive treatment. We see the frail, dehydrated, malnourished bodies of the very old and know these treatments will not help.

Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible — more like the palliative care given to terminally ill cancer patients.

“We probably need to be offering a palliative care option to many more patients to make the last days of their lives as comfortable as possible,” said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, who was not involved in the studies.

Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life.

Isn’t this what we do with our nursing home residents? Don’t we go out of our way to keep them comfortable and clean? Calling this all “palliative” and using phrases like- “last days of their lives” really isn’t good right now during the fight for health care reform. All this discussion brings many people to believe there really might be “Death Panels” and that turns folks away, especially older people. Who can blame them?

As with all stories, there are two sides. I’m not sure what to make of this.

LOS ANGELES — Amelia Mendoza’s last words to her husband were that she was afraid she would be fired for reporting that she had been assaulted at her hospital nursing job.

Moments later, she had a massive hemorrhagic stroke that has left her in a vegetative state and in a health care limbo because of a dispute over her coverage.

What happened?

Amelia Mendoza, 52, was struck in the face, head and neck by a violent patient while working as a certified nurse assistant at Huntington Memorial Hospital in Pasadena, attorney Russell Glauber said. She is not expected to recover from her April 20 collapse.

Claims for her care have been denied by her insurer, Blue Cross, and by workers’ compensation, Glauber said. He is appealing Mendoza’s workers compensation denial and calling on the state board to expedite its response.

At issue here is whether the assault caused the stroke.

Glauber said Mendoza was attacked on April 14 and 16 but was told to make an appointment at an in-house workers compensation clinic at Huntington hospital on April 20.

Why did she wait so many days before seeking medical help?

An April 20 note in Mendoza’s medical records says she was “in her usual state of health until about a week ago when she was bitten at work and had increased anxiety about her work injury.”

The records also note that Mendoza had developed high blood pressure since the incidents.

Dr. Arthur E. Lipper, who was hired by Glauber, has examined Mendoza’s medical records and said he believes the stroke was a result of Mendoza’s workplace injury.

“Whatever conspired to cause her to have her stroke, clearly at least in part transpired after and because she was bitten, hit in the head and neck,” Lipper said. “She was agitated because of it, and then she stroked.

Not quite true, but it makes for a good headline. I feel terrible for her, but her family, lawyers and others need to be honest and realistic with this. Strokes happen all the time without any “warnings”- and “stress” is not a factor. Read the facts about stroke, HERE, and keep them in mind when forming an opinion on this article.

The main point to this article is the denial of medical care payment- the worker comp people are saying the assault did not cause the stroke; the health insurance people are probably waiting for the worker comp report and will take over the case once it’s released.

As reported:

WILMINGTON– An 82-year-old patient at Governor Bacon Health Center suffered a cut on her forehead and a skull fracture when she was left unattended and fell out of bed, officials said.
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The incident occurred when a certified nursing assistant left the resident to take a personal phone call Monday morning without taking steps to assure the woman’s safety, according to a news release from the state Department of Health and Social Services. The woman’s bed was elevated about two feet above the floor.

Lesson? Don’t accept phone calls while tending to your resident! I suspect the phone involved was a cell phone, and if it was, perhaps we really need to evaluate there use at work. I have seen dozens of co workers texting and talking while working, and sooner than later we will read more stories like this.

Why I haven’t seen links to this article at other nursing home blogs is beyond me.

HARTFORD, Conn. (AP) – The nation’s nursing homes are perilously close to laying off workers, cutting services – possibly even closing – because of a perfect storm wallop from the recession and deep federal and state government spending cuts, industry experts say.

The spending cuts are only just beginning. Wait until this health care reform really gets going. It’s all in the details, which hopefully we will all have a chance to read and comment on. It appears that some of our elected officials are not even reading the devilish details.

A Medicare rate adjustment that cuts an estimated $16 billion in nursing home funding over the next 10 years was enacted at week’s end by the federal Centers for Medicare and Medicaid Services – on top of state-level cuts or flat-funding that already had the industry reeling.

And Congress is debating slashing billions more in Medicare funding as part of health care reform.

Add it all up, and the nursing home industry is headed for a crisis, industry officials say.

“We can foresee the possibility of nursing homes having to close their doors,” said David Hebert, a senior vice president at the American Health Care Association. “I certainly foresee that we’ll have to let staff go.”

So in order to fix one part of health care, we have to sacrifice another part? Seems so. A saving grace here might be that home care would be the most cost effective “choice”- which is far better for the elderly person than a nursing home admission.