Articles Posted in End of Life

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.

advanced-300x158Many Americans took a good step for themselves and their loved ones after getting shocked by learning about treatments, like prolonged machine ventilation, that coronavirus patients may undergo. Not for me, the healthy may have decided. They committed to determining end-of-life wishes, committing these to “advance directives” or POLST (portable orders for life-sustaining treatment) forms.

That may just the start of what people need to do with these formal documents, now easily found online, reported Paula Span, the New York Times’ “New Old Age” columnist. They need to do more. (Hint: Some of this even may be covered under older adults’ health insurance, especially Medicare).

They need to ensure that their doctors and their lawyers, too, support their recording of their end-of-life plans. These must be as clear, specific, and concise as possible, so there can be no mistaking what patients want with vague discussions, such as avoiding “heroic” or “unusual” interventions. They need loved ones to know where they may be stored, especially knowing how to locate them and give them to health workers, including first responders.

chartnytnhomedeaths-300x213Nursing home owners and operators have pleaded “poor us” through a lethal 2020. But profit-seeking players in the industry clearly still see rapacious opportunity in long-term care facilities — with residents suffering the consequences.

NPR and the Washington Post both have dug into the results when investment groups or chains acquire and operate nursing homes, and, as the media organizations reported, resident care declined.

The newspaper focused one of its deep digs on long-term care on New Jersey-based Portopiccolo Group, and how it “buys troubled nursing homes and tries to make them profitable,” paying “hundreds of millions of dollars to acquire facilities in Maryland, Virginia and elsewhere,” with little federal, state, or local oversight of its acquisitions.

covidhealthcasualties-300x130As the nation closes out 2020 and months of a raging coronavirus pandemic, will old acquaintances be forgot and never brought to mind?

Covid-19, unchecked, has killed at least 330,000 Americans and almost 19 million of us have been infected with the disease.

Those numbers likely are underestimated. Based on still tallying “excess deaths” in this country — the higher than expected number of fatalities above the norm and likely due to the coronavirus, the truer toll from Covid-19 as of Dec. 16, likely exceeds 377,000.

countylahospicegrafic-300x139With coronavirus infections and deaths rising anew in worrisome fashion from coast to coast, matters could not get worse with the nation’s long-term care, right? Guess again. Profit-mongering and “audacious, widespread fraud” apparently has run amok in hospice care in the Golden State.

Because California, alas, too often serves as a trend-setting locale, patients, their loved ones, clinicians, regulators, and politicians may wish to take heed of an investigation published by the Los Angeles Times. The newspaper reported that too many older, sick, and injured patients have been gulled into signing up for unneeded and undelivered services meant for folks at the end of their lives:

“[M]any [hospice patients] are unwitting recruits [of] unscrupulous providers who bill Medicare for hospice services and equipment for ‘terminally ill’ patients who aren’t dying. Intense competition for new patients — who generate $154 to $1,432 a day each in Medicare payments — has spawned a cottage industry of illegal practices, including kickbacks to crooked doctors and recruiters who zero in on prospective patients at retirement homes and other venues … The exponential boom in providers has transformed end-of-life care that was once the realm of charities and religious groups into a multibillion-dollar business dominated by profit-driven operators. Nowhere has that growth been more explosive, and its harmful side effects more evident, than in Los Angeles County. The county’s hospices have multiplied sixfold in the last decade and now account for more than half of the state’s roughly 1,200 Medicare-certified providers, according to a Times analysis of federal health care data.”

covidnrsnghomenovdeaths-300x149While untold Americans tried to do right by older and more vulnerable friends and family members by taking extra precautions and even canceling Thanksgiving gatherings, the nation crossed a ghastly threshold for the aged, sick, and injured in late November: The coronavirus has killed at least 100,000 residents and staff in nursing homes and other long-term care facilities.

The number of deaths is likely under-reported in federal and other data sources, as several states lag in providing information about problems in the facilities. The deaths of those institutionalized also is spiking as Covid-19 cases have, too, from coast-to-coast. “Community spread” poses grave risks to those in institutions.

If these figures are not already bleak, the Wall Street Journal reported that its research finds that there also are “more than 670,000 probable and confirmed Covid-19 cases in long-term care, affecting both residents and staff members.”

With the pandemic  tearing through the United States and overwhelming U.S. health care system,  we pause from the grim news to tally  some of the nation’s blessings in this time.

We can be thankful for the courage, fortitude, dedication, and skill of an army of health workers of all kinds. They have put themselves and their loved ones at formidable risk and strain to treat patients under unprecedented duress. They have dealt with fear and uncertainty, giving little quarter, and approaching their own breaking points. Some health workers have themselves fallen ill, with some dying. Their sacrifices cannot be forgotten, and we need to give sustained and extra support to health workers as the pandemic enters its next perilous phase.

srabuse-150x150The coronavirus pandemic’s terrible toll on nursing homes and other long-term care facilities may be much worse than now estimated, as resident advocates, watchdog groups, and experts  tally “excess deaths” in the facilities — perhaps one additional casualty beyond any two formally attributed to Covid-19.

These fatalities are unacceptable, resulting from frantic and low-paid health workers’ inability to care for the aged, injured, and chronically ill infected with the coronavirus while also dealing with the needs of people so frail they require institutionalization. It’s tough reading, but here is what the Associated Press reported:

“As more than 90,000 of the nation’s long-term care residents have died in a pandemic that has pushed staffs to the limit, advocates for the elderly say a tandem wave of death separate from the virus has quietly claimed tens of thousands more, often because overburdened workers haven’t been able to give them the care they need. Nursing home watchdogs are being flooded with reports of residents kept in soiled diapers so long their skin peeled off, left with bedsores that cut to the bone, and allowed to wither away in starvation or thirst.

apnursinghomesurgechart-270x300Coronavirus cases are spiking among residents and staff at nursing homes and other long-term care facilities. They increased four-fold between May’s end and late October — even as deaths among the vulnerable also doubled, disturbing new data show.

Those are the findings of Rebecca Gorges and Tamara Konetzka, University of Chicago researchers who analyzed federal data at the request of the Associated Press. They focused on 20 states hard hit by the latest pandemic surge.

Konetzka said the data raise major questions about the Trump Administration’s efforts to safeguard the aged, ailing, and injured in institutional care by sheltering them from infections in their surround areas and increasing testing for residents and health workers. But Koentzka, an expert on long-term care, told the AP this about such a plan:

elderaide-300x200Nursing homes put their residents at heightened health risks by scrimping on personnel costs and failing to deal with significant staffing shortfalls, especially as the coronavirus inflicted some of its highest death and infection tolls on the elderly, sick, and injured in long-term care, media investigations have found.

The profit-focus by health providers is not unique, and it has put huge burdens on poorly paid, lightly trained, and over worked home health aides. They have toiled to keep the vulnerable out of institutional care, even as the agencies that employ them give them little support.

Here is what the Wall Street Journal reported about long-term care facilities, based on its “analysis of payroll-based daily staffing data released … by the Medicare agency …  [for hundreds of] nursing homes that reported to the federal government virus-related deaths in the first half of 2020″:

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