Articles Posted in End of Life

voxsnip-300x134Americans are confronting a care-giving calamity with the elderly at home, and the alarms are sounding loudly about it. But are experts and politicians grasping the severity of this crushing health care shortfall?

The New York Times, Vox, Washington Post, and Forbes all published detailed and solid news articles about the nation’s quiet nightmare with the workforce needed to deal with the booming population of aging baby boomers.

Just a reminder: This is a huge group that is graying rapidly, with 10,000 boomers each day turning 65 and this startling reality continuing for the next  decade or so. Seniors long have said they prefer to age at home, that they dread and may not be able to afford nursing home care, and they are panicked about who will help them in their daily lives as they become debilitated, especially with dementia or Alzheimer’s — conditions predicted to explode in prevalence and cost as the nation’s elderly population increases.

Lawmakers and regulators must significantly improve the oversight of the burgeoning business of hospice care, a federal watchdog says. Its report came with two notable numbers: from 2012 through 2016, health inspectors cited 87% of the end-of-life care facilities for deficiencies, with 20% of them having lapses serious enough to endanger patients.

In one case cited by the Office of the Inspector General in the Department of Health and Human Services (HHS), a hospice patient had a deep, poorly treated pressure wound on the tailbone, apparent pain that caused grimacing and — in a crisis requiring a trip to the emergency room — a “maggot infestation’’ where a feeding tube entered his abdomen, the Washington Post reported.

ECMO-300x212Medical ethicists and patient advocates are raising concerns about a big, costly, and often unsuccessful procedure that “pumps blood out of the body, oxygenates it, and returns it to the body, keeping a person alive for days, weeks or months, even when their heart or lungs don’t work,” the Kaiser Health News Service reported.

Extracorporeal membrane oxygenation or ECMO (eck-moe) is considered an appropriate treatment for some patients on death’s door.

But hospitals, to maintain their competitive business standing, are battling to get the equipment and staff to provide this therapy, which costs on average half a million dollars per patient.  The number of hospitals that can do ECMO has increased from 108 in 2008 to 264 now, with the number of ECMO procedures tripling since 2008 to almost 7,000 in the last count in 2014.

NaitoRon Naito already had been rebuffed by one specialist about the severity of his illness. He was awaiting in a doctor’s examining room for his lab test results and a consultation with a second expert about his already advanced cancer. What happened next stunned the Portland, Ore., resident. But now he’s doing something to help other patients in this way too common situation.

Naito overheard his doctor and a medical student talking about him and his lab results as they passed by the open room door, saying a tumor in his pancreas was “5 centimeters,” and was “very bad.”

That was the way Naito, who has practiced as an internist for 40 years, learned his condition was terminal. The cruel delivery of that crucial news convinced him that he needed to spend what time he has left working with his medical colleagues about their communication skills, especially in conveying the news to patients that they are dying.

surgery-300x120Recognizing that seniors face different health challenges than younger folks could help doctors and hospitals better safeguard older patients who undergo complex and demanding surgery.

Paying heightened attention to age’s changes also can be beneficial to older adults in protecting themselves from damaging falls and getting retirees to keep moving to stay fitter — without getting hung up on a mistaken exercise measure.

A specialty group within the American College of Surgeons may be on a beneficial course in recommending new geriatric guidelines for older patients, a rising number of whom undergo extensive procedures that once were considered risky for those of an advanced age, the New York Times reported. This is a significant issue in surgical practice, the newspaper reported:

toomey-150x150casey-150x150Federal regulators have given up the unwarranted secrecy enshrouding their watchdog efforts on the nation’s most problematic nursing homes.

With prodding from the U.S. senators from Pennsylvania, Democrat Bob Casey (above left) and Republican Pat Toomey (above right), the Centers for Medicare and Medicaid Services (CMS) disclosed its list of hundreds of nursing homes that perform so poorly they are on the brink of regulators’ most dire supervision.

CMS had declined to disclose its candidates for designation  as a “Special Focus Facility” (SFF), preferring instead just to tell the public about its worst of the worst nursing homes, 88 facilities with the SFF tag that receive a targeted, higher level of inspection because of their poor performance. The most rigorous oversight can be resource intensive, and CMS can only scrutinize at the highest level a few poor performing homes, whose infamy is made public. When one facility “works its way off” an SFF designation by improving its failings, others are on the heretofore secret list to take their place.

asstdcareunaffordable-300x188As the nation rapidly grays and income disparities widen by the day, a sizable number of Americans — a group that built the nation to greatness and has been its economic bedrock — is headed to yet another ugly indignity: More than half of middle-income seniors won’t be able to afford their medical expenses and the cost of assisted housing they will need at age 75 and older.

New research published in the journal “Health Affairs” has projected what already soaring medical and housing costs will mean to those whose incomes fall between $25,001 to $74,298 per year and are ages 75 to 84. These middle-income elders will increase in number from 7.9 million now to 14.4 million by 2029 and soon will be 43% or the biggest share of American seniors.

But the picture for them and their finances, housing, and medical expenses may be glum. Projections show they will lack the money, even if experts calculate in their home equity, to afford assisted living they may need in their late years.

eldersuicide-300x173With 3 out of 4 Americans insisting they would prefer to age in place at home, senior care institutions already face stiff headwinds. But an investigation by two media organizations paints a glum picture of a little discussed aspect of elder life: the “lethal planning” some older residents make in nursing homes, assisted living centers, and adult care facilities — to end their own lives.

The exact suicide toll among the 2.2 million elderly Americans who live in long-term care settings is poorly tracked and difficult to quantify, reported the independent, nonpartisan Kaiser Health News (KHN) service and PBS NewsHour (see the broadcast report by clicking here). But the two news organizations found:

[An] analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care. Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows. Each suicide results from a unique blend of factors, of course. But the fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline and disconnectedness — and events such as losing a spouse or leaving one’s home. More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as ‘rational suicide.’

care-300x180Americans have real reason to fear a health care catastrophe: If loved ones suffer major injury or illness, who will feed, bathe, and care for them 24/7 after they get out of the hospital and recuperate at home? Who will take time off from work to set up and take them to unending and long medical appointments? Who will wait for and get all the pills and devices they need?

The nation has been locked in a decade-long battle over health insurance that helps cover medical costs, but caregiving, a crucial part of the social safety net, gets short shrift, writes Aaron E. Carroll, a professor of pediatrics and health research and policy expert at Indiana University School of Medicine. As Carroll noted in a timely and personal column for the New York Times “Upshot” feature:

Americans spend so much time debating so many aspects of health care, including insurance and access. Almost none of that covers the actual impossibility and hardship faced by the many millions of friends and family members who are caregivers. It’s hugely disrupting and expensive. There’s no system for it. It’s a gaping hole.

With the nation fast graying, a long-term care crisis looms, and too many Americans may not realize that not only will nursing home care be tough to find and afford, it also may be less than ideal. But what happens if seniors themselves — especially the frail old — are asked how care-giving services might best serve them, so they not only can stay in their homes but also enjoy their lives more?

That’s the experimental approach taken by a health care team in Denver, working in the long-titled program, “Community Aging in Place — Advancing Better Living for Elders.” CAPABLE staff intervene with the aged, asking them how, even with disability and debilitation, to improve their lives. The program offers them six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1,300.

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