Articles Posted in End of Life

capnurse-300x169What’s in a name? The Covid-19 pandemic should force a major change in the big misnomer of long-term care institutions: Let’s stop labeling them with the term nursing — as if they provide significant medical services to the elderly, sick, and injured.

Instead, the coronavirus may lead the public to bust the myth put forward by owners and operators of nursing homes, skilled nursing facilities, assisted living centers, and other similar centers about how they treat some of the nation’s most vulnerable people, especially based on growing evidence amassing in news reports.

The care facilities knew they were not hospitals, with extensive equipment and highly trained doctors and nurses. The facilities found they often were sorely lacking gear — especially personal protective equipment. They too many times did not have the staff with the skills or training to treat already fragile residents infected with the novel coronavirus or recuperating from significant bouts with a debilitating illness. They did not have the Covid-19 tests they needed. They struggled to isolate the infected.

covidmdnatguard-300x174Federal and state officials almost seem as if they are competing with each other to race to new lows in their wrong-headed failure to protect elderly, sick, and injured Americans who require institutional care and whose health and lives are being savaged by the novel coronavirus.

An estimated 1.5 million Americans live in long-term institutions, including nursing homes, assisted living centers, skilled nursing facilities, memory care hospitals and the like. Covid-19 has taken a terrible toll on these frail, chronically ill, or seriously injured and debilitated people with more than 27,000 residents and staff dying from the novel coronavirus — roughly a third of all the disease fatalities nationwide. A third of the coronavirus deaths in the District of Columbia have been in skilled nursing facilities, while 40% of the Covid-19 deaths in California, the nation’s largest state, have been in nursing homes.

In the latest baffling response, President Trump and Vice President Mike Pence both suddenly have  “recommended” that states get nursing homes and other similar facilities to step up the testing of residents and staff.  They did not make this common-sense step mandatory, nor did they offer any word on how the federal government could help achieve this. As the Associated Press reported:

hopkinsnursinghome-300x169The news about the institutional care of vulnerable seniors during the Covid-19 pandemic just keeps getting worse in too many unacceptable ways. Just consider:

aged-alexboyd-300x200The Covid-19 pandemic is forcing many Americans to think and act on tough issues they otherwise might wish to avoid, and they’re getting thoughtful reminders on ways they may want to proceed with advanced or end-of-life medical planning and decisions on whether to keep elderly loved ones in nursing homes and other long-term care facilities or to bring them into their residences.

These are hard topics to deal with in the best of times. But failing to do so can leave families with not only a lifetime of regrets but also possibly significant financial consequences. Americans long have insisted that they want to have maximum control over medical decisions that affect their care.

So, thinking ahead about our own advanced medical plans, and revisiting the institutional care of beloved seniors may not only be appropriate, but necessary as the world struggles with the Covid-19 pandemic and medical caregivers are overwhelmed and may be stretched to their limits.

drugpromotrump-300x178President Trump has stormed past accepted professional practices and triggered alarms about ethical decision making by caregivers, as he persists in his noisy advocacy for treating seriously ill patients with Covid-19 infections with an unproven pair of prescription drugs.

Promoting this drug regimen — on social media and in White House news conferences — has pitted the onetime real estate developer and reality show host with an undergraduate economics degree squarely against Dr. Anthony Fauci, one of the nation’s foremost infectious disease experts at the National Institutes of Health.

They have squared off publicly, with the leader of the free world talking about how he “feels good” about giving patients two, long-used antimalarial drugs — chloroquine and hydroxychloroquine (aka plaquenil) — while Fauci has insisted such prescribing has no basis now, and, at best, should be subjected to rigorous clinical trial to determine their effectiveness.

grayillustration-213x300Although Americans may have particular wishes as to how their lives might close out, they aren’t getting these optimal outcomes for themselves and their loved ones.

Instead, the much-desired option of dying at home is proving to be stressful and draining to the extreme for families, and, when it comes to the dreaded loss of control involved with Alzheimer’s disease and dementia, drug therapies seem elusive in a concerning and crushing way.

Older workers’ health is becoming a startling concern, too, for many more employers as seniors stay on the job longer than they have before — leading to more workplace injuries and deaths.

vcuhospital-300x200A  Virginia hospital has found an eyebrow-raising solution to some of  its struggles with elderly, poor, and sick patients who take up beds and medical resources that might generate more revenue and less headache for the institution: Administrators hired a law firm and turned to the courts to strip legal control over the frail seniors from their loved ones.

Over families’ objections, the seniors’ newly appointed guardians then allowed the patients to be moved out of the Virginia Commonwealth University Health System hospital in Richmond and into poorly rated nursing homes. As the Richmond Times-Dispatch reported:

“A yearlong investigation by the Richmond Times-Dispatch, which involved analyzing more than 250 court cases and interviewing more than two dozen people, revealed that VCU Health System has taken hundreds of low-income patients to court over the past decade to remove their rights to make decisions about their medical care. This process, which frees up hospital beds at VCU Health System and saves thousands in uncompensated costs, often results in sick, elderly or disabled patients being placed in poorly rated nursing homes, sometimes against the wishes of their own family members. In these cases, VCU Health asks the court to grant an attorney at the ThompsonMcMullan law firm the power to make critical medical and life decisions for its patients. The court orders the attorney to represent the best interests of those patients, but the law firm continues to look out for the hospital’s interests on dozens of guardianship cases each year.”

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.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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