Articles Posted in End of Life

reuters-300x153Although countless doctors and nurses put in untold blood, sweat, and tears to provide quality care to their patients, health care profiteers can undo these good works in an instant with shameful plundering. Here is a roundup from multiple fronts.

The nonprofit, nonpartisan Kaiser Health News Service deserves credit for its painful reporting on the rising problems in the once much-admired area of hospice care.

Reporters JoNel Aleccia and Melissa Bailey have written, in a story carried by Time Magazine, that they “analyzed 20,000 government inspection records, revealing that missed [hospice worker] visits and neglect are common for patients dying at home. Families or caregivers have filed over 3,200 complaints with state officials in the past five years. Those complaints led government inspectors to find problems in 759 hospices, with more than half cited for missing visits or other services they had promised to provide at the end of life.”

nursinghome-300x200With more Americans than previously thought needing care in the nation’s nursing homes, will more of us start to pay greater attention to the unacceptable and under-reported elder abuse occurring there? And with calamities like Hurricane Harvey fresh in mind, will more sons and daughters, nephews and nieces, and other friends and loved ones take a bit of time now to think how safe their elder relatives’ care facilities might be and where they might go in catastrophic circumstance?

Although most previous research has indicated that just 35 percent of Americans will use a nursing home in later life, new study by the independent, nonpartisan RAND Corporation indicates that figure may be far too low. More than half (56 percent) of those now aged 57 to 61 will spend at least a night and likely much more time in nursing home care, RAND researchers found.

If seniors need the care, they stay on average 272 nights in nursing homes, though 10 percent of the population the researchers studied spent more than 1,000 nights in such facilities.

syphillis-150x150The myriad problems tied to the nation’s opioid drug abuse epidemic seem only to worsen and grow more complex by the day. They are, recent news reports say:

Nursing-home-holding-hands-300x200Federal regulators need to ramp up their oversight of nursing homes, big time, with recent news reports and studies finding persistent abuses of elderly patients, including during crackdowns on problem operators, and facilities failing to care for vulnerable charges so they don’t lapse into emergency or hospital care.

Jordan Rau and the independent Kaiser Health News Service deserve kudos for digging into Uncle Sam’s “special focus status,” in which the nation’s “most dangerous” nursing homes get an ultimatum to correct major and continuing harms to patients or they may lose crucial Medicaid and Medicare funds from the federal government.

Rau found that more than half of the 528 homes deemed since 2014 to require the supposedly stringent “special focus” from regulators and that still are operating have since harmed patients or put them in jeopardy in the last three years.

clockYour time is precious, and when you are a patient, you may feel it’s more so, especially if you’re ill or even in the end stage of your life.

So why do health care providers keep us waiting, or worse, why must doctors and hospitals act downright oblivious to how valuable our time might be as opposed to theirs—and what might be done about it?

Take a look at a thoughtful piece on how one health system has tried to keep true to the idea that patients matter above everything else and the delivery of care needs to focus on them:

end-of-life-800-300x198Many hospitals and doctors rightly have campaigned to get more patients to provide information in advance about their end-of-life care choices, but doesn’t that mean that the choices when made should be respected? And if they’re not, what role do the courts have?

Paula Span, a New York Times columnist who writes on aging issues, reports that a growing number of patients and families have sued hospitals, doctors, and nurses for disregarding or overriding advance directives. There are various kinds of these legal documents. But they often become part of patients’ medical records, directing caregivers, for example, that an individual does not want extreme measures taken to resuscitate them or to sustain their lives.

This can go against deep traditions in medicine, especially for caregivers accustomed to crisis responses in difficult, exigent circumstances. They think of themselves as life changers and life savers. At the same time, patients have insisted that their rights and choices demand respect. Many physicians and hospitals have recognized and encouraged this, as has the U.S. health care system more generally, for example, via Medicare.

NL_DifferenceThere’s  more encouraging news about dementia rates, which a new study has found fell 24 percent between 2000 and 2012, decreasing among Americans 65 and older from 11.6 percent to 8.8 percent. The experts aren’t sure why the rates declined. But it means that 1.5 million or so seniors will be spared the severe cognitive declines that would have been expected from earlier rates of the tragic disease.

Researchers, who published their latest findings in the peer reviewed and respected Journal of the American Medical Association, said that greater educational attainment and improved heart health may have led to the decreases in the prevalence of the condition associated with loss of memory or other mental abilities so severe it interferes with daily life. Alzheimer’s disease is most commonly linked to dementia. Vascular dementia is the second most common type of dementia and occurs after a stroke.

The new study, funded by the National Institutes of Health and on Aging (NIH and NIA), produced continuing surprises as experts have projected an explosion in cases among Americans, who are increasingly gray, obese, and diabetic—factors that significantly increase dementia risks.

death-certificate-state-by-state-default-750_50California regulators have reversed themselves and decided to require hospitals to report outbreaks of “superbug” cases, rare infections that also can prove deadly. At the same time, officials in the Golden State haven’t moved to increase the information disclosed on death certificates−data that advocates suggest would give the public clearer outlines of just how severe a problem hospital-acquired infections have become.

Kudos to the Los Angeles Times, which delved in a recent front-page investigation into the dearth of information disclosed on death certificates, especially about hospital-acquired infections. The paper detailed how a Los Angeles area patient had contracted, while hospitalized, a rare carbapenem-resistant enterobacteriaceae or CRE infection. This superbug resists treatment with an array of antibiotics, eventually killing half those it afflicts. Its outbreaks are a huge concern for public health authorities.

But, The Los Angeles Times said, hospitals had cried “poor me” to the state, saying it required extensive resources to monitor and report CRE outbreaks. The death certificate for the patient with the CRE infection, the newspaper said, listed a perforated ulcer as her cause of death. Her family was outraged because they had urged Torrance Memorial Medical Center to report a CRE outbreak to the state.

Layton Reid is a 40-something-year-old husband and dad who lives in Halifax, Nova Scotia. A few years ago he had a growth taken off his back that turned out to be melanoma. It’s now in his brain.

Mr. Reid has a Facebook page that celebrates living life in the moment. He wrote a post on September 11 addressed to “Dear Mel.” An excerpt:

i know we’ve had our differences in the past and i know we’ve not always seen eye to eye, but i’ve learned so many lessons i never would have, had we not been introduced a handful of years ago in the back of a sketchy walk-in clinic in downtown ottawa. back where this whole silly adventure began. back when you taught me all the ultra important rules to remember about this unmistakably messy yet miraculous life of mine.

The events of recent days ─in Texas, Louisiana, and Minnesota─ have been so tragic that it’s easy to despair. Here are four health-related people stories worth reading to remind us of humanity’s enduring better side:

  • In the horrors of Syrian combat, medical Samaritans strive to maintain some kind of care

syriaFirst, let’s stipulate that there’s almost as much barbarous conduct as can be imagined in this recent New Yorker report about the struggle to maintain medical care in combat-ravaged Syria. President Assad’s predation on his own people has become an international abomination, including his forces unleashing snipers to maim emergency medical personnel, and their dropping barrel bombs, laden with lacerating shrapnel, on hospitals or known care-giving sites (February, 2016, photo of a bombed hospital from Doctors Without Borders/Medicins san Frontieres).

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