Articles Posted in End of Life

cdcnhomesmay72021-300x156Residents and their loved ones may have reached a major turning point with nursing homes and other long-term care facilities, agonizing as to whether the institutions really can provide safe, hygienic, and welcoming places for the vulnerable — or whether other, tough options must be considered.

Who can forget that that 132,000 elderly, injured, and seriously ill residents died of the coronavirus during the many months of the pandemic, and almost 1.4 million infections were recorded in 38,000 long-term care facilities? The institutions — even as the pandemic’s terrible toll keeps rising — still account for a third of all U.S. deaths due to the disease.

The facilities’ covid-related deaths have plummeted by 91% since December, especially as public health officials campaigned to get residents and staff vaccinated, the New York Times reported (see chart above, based on federal data). But public confidence in long-term care facilities also has plunged, as reflected in admissions and occupancy:

cdcvax7may2021-300x165The campaign to quell the coronavirus pandemic is a lot like a Herculean tug of war now, with the prospect tantalizingly near of  pulling a big measure of success over the line.

The Biden Administration, to its credit, is not easing a bit in conveying the urgency of its task in dealing with a disease that has infected more than 32 million in this country and killed at least 576,000 — roughly equivalent to the population of Baltimore.

At the same time, more than 148 million Americans older than 18 have received at least one dose of the coronavirus vaccine, roughly 57% of the adult population. Those statistics, as shown in the chart above from federal experts, were reported as of May 7.

apindiafuneralpyres-300x200After months of chafing under tough restrictions to battle the coronavirus pandemic, who among us isn’t ready for more relaxed times, especially as the summer nears? For tens of millions of Americans, vaccination means new safety and freedoms, notably for long awaited closeness with loved ones.

But are those allures and more enough to coax the resistant and reluctant to get the shots, as tens of millions of us already have?

The Biden Administration and health officials across the country may need to give the unvaccinated not only altruistic but practical reasons for joining a campaign that has achieved the notable result of getting shots for 100 million of us.

covidmichmayo-300x203The campaign to conquer the coronavirus pandemic is having its cautious optimism tested by a stubborn and concerning surge of cases in the Midwest and Northeast, as well as frustrating vaccine supply problems — worsened by manufacturing bungles in a Baltimore plant.

Expert forecasters now see options for how the crucial next several months could go in the battle against the disease. These include an effective vaccination program outpacing the rise of variants (including the B117 strain that has become the most common in this country) and quashing the pandemic, to the viral mutations getting out of control and the nation limping into persistent and unchecked infections for a long time.

In Michigan, where one of the worst outbreak rages (see Mayo Clinic hot spot map, above), the governor and state officials have found themselves in a public policy quandary, uncertain whether stern health restrictions may have lost their public support to be effective now after showing results before. But in California, officials are waiting and watching to see if plunging infections, hospitalizations, and deaths will reverse as they have elsewhere.

agedwalk-179x300As the coronavirus pandemic’s most catastrophic effects recede in nursing homes and other long-term care facilities, notably due to vaccinations and other public health measures, residents and their loved ones still face costly, confounding issues in safeguarding the aged, sick, and injured. The Biden Administration wants to spend hundreds of billions of dollars to help.

But will the plans founder due to Republican resistance? And will even a huge jolt of funding be enough to deal with a graying nation’s growing problems with long-term care?

Our own homes provide a cornerstone of Democratic proposals to deal better with nightmares with the cost, safety, and availability of long-term care. Instead of sinking yet more public money — via Medicare and Medicaid — into institutions, can the federal government, instead, improve funding so seniors, the ill, and injured can stay home and get treatment there? As the Washington Post reported:

cmsnursinghomecompare-300x139Federal regulators, by allowing owners and operators to self-report quality and safety data and failing to audit vital information with diligence, have “broken” the national nursing-home rating system — what was supposed to be an invaluable tool for consumers to make life-and-death decisions about where to place vulnerable loved ones needing round-the-clock care.

Instead, the New York Times reported, the popular and convenient star rankings have become little more than an inaccurate means for facilities to advertise and market themselves, even while keeping from the public their serious problems — including abuse, neglect, over medication, sexual assault, and killings of the aged, injured, and ailing.

The system’s glaring shortcomings were exposed even more by the coronavirus pandemic, the newspaper reported. It launched its deep dig into the ratings when it became clear that highly rated homes, when the pandemic struck, did not fare notably better, as might be expected.

churninnhomes-300x300Churn may be a wonderful word when discussing fresh milk, heavy cream, and butter. But it can be a nightmare term for the too-common, rapid, and lethal turnover that occurs in health staff at nursing homes and other long-term care facilities.

Personnel turnover left the aged, injured, and ailing residents at care centers, with an average annual health staff churn-rate of 128% and some facilities hitting as high as 300%, even more vulnerable during the coronavirus pandemic, a new study reported.

David Grabowski, a professor of health care policy at Harvard Medical School and one of the study’s authors, told the New York Times of the information he and his colleagues gathered:

declinenhomedeathsnytfeb21-300x189Just as good news expands about vaccines and declining coronavirus cases and deaths in the nation’s nursing homes and other long-term care facilities, grim information also is developing on how the facilities’ ownership, particularly by wealthy investors, can be lethal to residents.

The positive effects of early efforts to get vulnerable long-term care residents and staff vaccinated can be seen in the accompanying graphic (courtesy of the New York Times). The newspaper reported this:

“Throughout the pandemic, there has been perhaps nowhere more dangerous than a nursing home. The coronavirus has raced through some 31,000 long-term care facilities in the United States, killing more than 163,000 residents and employees and accounting for more than a third of all virus deaths since the late spring. But for the first time since the American outbreak began roughly a year ago — at a nursing care center in Kirkland, Wash. — the threat inside nursing homes may have finally reached a turning point. Since the arrival of vaccines, which were prioritized to long-term care facilities starting in late December, new cases and deaths in nursing homes, a large subset of long-term care facilities, have fallen steeply, outpacing national declines, according to a New York Times analysis of federal data. The turnaround is an encouraging sign for vaccine effectiveness and offers an early glimpse at what may be in store for the rest of the country, as more and more people get vaccinated.

coronavirusvaxallocationfmgao-300x167As coronavirus vaccine supplies  keep far exceeding demand, and as the new administration races to acquire and distribute more doses, as well as to kick start  plodding vaccination campaigns across the country, it may be a challenge not to ask the people who oversaw battling the pandemic before: What the heck were you thinking?

More on that in a second.

As of Jan. 29, the federal Centers for Disease Control and Prevention reported that ~49 million vaccine doses had been shipped and ~28 million were administered, with ~23 million patients now having received at least one of two shots required.

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