Articles Posted in Nursing Care

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:

sagepoint-300x176With nursing home operators bleating up a storm of weak defenses and denials, soaring Covid-19 infections and deaths have laid siege to far too many long-term care facilities in Maryland, Virginia, and the District of Columbia. The consequences have been dire.

In Maryland, the Baltimore Sun reported:

“Nearly three-fifths of Marylanders killed by the coronavirus are residents of long-term care facilities, according to [a recent state] update of nursing home data …The Maryland Department of Health reported that 793 of the state’s 1,338 victims, almost 60%, were residents of nursing homes, rehabilitation facilities and similar long-term care facilities. An additional 11 deaths were staff members of those facilities, with more than one of every five of Maryland’s confirmed infections being a resident or staff member of congregate living facilities.”

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.

candidaauris-300x224The battle to reduce the sky-high cost of hospital care may have created its own unforeseen and harmful consequence: By hastening to get patients out of traditional hospitals and into skilled nursing facilities and long-term care centers, doctors and policy-makers may be contributing to a medical nightmare — serious infections acquired in health care institutions.

The New York Times reported that “public health experts say that nursing facilities, and long-term hospitals, are a dangerously weak link in the health care system, often understaffed and ill-equipped to enforce rigorous infection control, yet continuously cycling infected patients, or those who carry the germ, into hospitals and back again.”

Hospital-acquired infections (HAIs) pose significant risks to already ill and injured patients, as well as adding to the fearsome costs of institutional care, the Leapfrog Group, an independent patient safety and advocacy group has found. As Leapfrog has reported:

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.

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.

Nursing homes, by scrimping on their staffing to maximize their profits, put their residents at grave risk for infections that too often have grisly and deadly results. Low-rated facilities run by Uncle Sam to care for elderly veterans also may be concerning. And those oft-pricey assisted living facilities may have their own response to dealing with difficult to care for elders — putting them out on the street.

Kaiser Health News Service, the Chicago Tribune, USA Today, and the Boston Globe all deserve credit for their digging into problems at facilities caring for the old, focusing on issues that should be at the fore for regulators, policy-makers, and politicians as the nation grays.

carehands-300x205Life can be hard, lonely, and difficult for adults who must become caregivers for their parents. If that sounds like the challenging story for tens of millions of millennials and Gen-Xers, yes, it’s true. But Judith Graham, in a column for the Kaiser Health News Service, describes what may be an even tougher role for startling numbers of seniors who find themselves solo caregivers for still older moms and dads.

Graham reported that a new analysis from the Center for Retirement Research at Boston College has found that 1 in 10 Americans between the ages 60 and 69 take care of parents in their 80s, 90s, and even older. For those 70 and older, the numbers increase, so 12 percent of these seniors care for even more elderly relatives. The research is based on data from 80,000 interviews (some people were interviewed multiple times) conducted from 1995 to 2010 for the Health and Retirement Study.

The analysis found that roughly “17 percent of adult children care for their parents at some point in their lives, and the likelihood of doing so rises with age. That’s because parents who’ve reached their 80s, 90s or higher are more likely to have chronic illnesses and related disabilities and to require assistance.”

krumholzIn many parts of the developing world, families play a big part in patients’ hospital care. They not only sit for long hours with loved ones, supporting and encouraging their recovery. They also may help with direct services, bathing and cleaning patients, tending to their beds and quarters, and even assisting with their medications and treatments.

Such attentiveness from loved ones— once common in this country, too —  may be deemed by many now as quaint and unnecessary, what with the rise of big, shiny, expensive American hospitals.

But think again: As Paula Span reported in her New York Times column on “The New Old Age,” care-giving institutions across the country have become such stressful, disruptive places that seniors, especially, not only heal poorly in them but also may be launched into a downward cycle of repeat admissions.

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