Nursing homes

July 19, 2019

U.S. must boost hospice oversight, watchdog warns, citing serious lapses

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.

June 9, 2019

Uncle Sam forced to disclose secret list of 400 poorly performing nursing homes

by Patrick A. Malone

Federal 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.

April 19, 2019

Concern grows over seniors taking their own lives in long-term care facilities

by Patrick A. Malone

With 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.’

April 15, 2019

When hospitals battle superbug outbreaks, shouldn’t patients be informed?

by Patrick A. Malone

When big hospitals are locked in bare-knuckle battles against debilitating and deadly bacterial and fungal infections sweeping their institutions, don’t patients have the right to know about these situations that might affect their lives and care? According to some hospital insiders, no.

The New York Times reported that a “culture of secrecy” prevails in hospitals as they combat “super bugs,” bacteria that have become resistant to antibiotics and now fungi that have evolved immunities to antifungals.

The newspaper found the institutional opposition to making public outbreaks of hospital-borne infection as it followed up its own scary page one story about the global spread of Candida auris, a drug-resistant fungus that preys on patients who already are hospitalized and may have compromised immune systems.

March 22, 2019

Health care has its share of gaming by the deep-pocketed and powerful

by Patrick A. Malone

The rich and powerful may seem to run amok as the nation lurches through its latest gilded age. But sometimes:

They get reined in by public shaming, as seems to be occurring with a developing scandal over insider deals in the University of Maryland Medical System (UMMS).
It takes prosecutors to check abuses, as is occurring with the college admissions mess and notably how it harms students with genuine need for learning accommodations.

February 7, 2019

For frail seniors, program offers choices and supports to keep them home

by Patrick A. Malone

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.

January 1, 2019

‘Bleed Out’ details how daunting the pursuit of justice can be for harmed patients

by Patrick A. Malone

When doctors, hospitals, insurers, and their captive lawmakers howl about how unfair malpractice lawsuits allegedly can be for modern medicine, patients who have suffered harms while seeking medical services should require loved ones, friends, and members of their community to view Bleed Out.

This new HBO documentary details the decade-long quest by comedian Steve Burrows and his family for justice for his mother, Judie. She was an energetic, retired teacher when she fell from her bike and needed emergency hip surgery. Before she had recovered, she fell again and needed a second operation. But this time, something went wrong: She lost more than half her blood, fell into a coma, and suffered irreversible brain damage that meant that she would spend the rest of her life in institutional care in rural Wisconsin.

December 21, 2018

As assisted living facilities increase dementia care, resident safety risks rise

by Patrick A. Malone

They look like nursing homes, but they’re not. And for the health and safety of our elderly loved ones, we must know the difference.

These so-called assisted living facilities, operating with much less regulation and oversight than nursing homes, are raising concerns about the safety and quality of their dealings with a growing number of elderly Americans. That’s because they’re full not only of older residents but also difficult — and costly to care for — seniors with dementia.

Jordan Rau, of the independent, nonpartisan Kaiser Health News Service, deserves credit for diving deep into rising complaints and documented harms to residents of facilities “originally designed for people who were largely independent but required help bathing, eating or other daily tasks.” These places, “unlike nursing homes … generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.”

December 12, 2018

Medicare is fining nursing homes when patients are readmitted too soon to hospitals

by Patrick A. Malone

Federal regulators have warned nursing homes nationwide to improve the quality and safety of their patient care or face consequences that operators may hasten to heed. That’s because new penalties and rewards will hit them in a place that counts — their pocketbooks.

Two-thirds of the nation’s nursing homes will see a year’s worth of their Medicare funding reduced, the nonprofit, nonpartisan Kaiser Health News Service (KHN) reported, “based on how often their residents ended up back in hospitals within 30 days of leaving.”

KHN said that:

September 25, 2018

Doctors too readily provide dubious treatments to vulnerable seniors

by Patrick A. Malone

Doctors subject older patients to risky, costly, invasive, and painful tests and treatments, perhaps with good intention but also because they fail to see that the seniors in their care are individuals with specific situations with real needs that must be considered.

If physicians too readily accept conventional wisdom in their field, for example, they may push patients 65 and older to take low-aspirin, with the popular but mistaken belief that this practice will help prevent heart attacks, strokes, and dementia. This doesn’t work, and, it increases the risk in seniors of “significant bleeding in the digestive tract, brain or other sites that required transfusions or admission to the hospital,” the New York Times reported.

The newspaper cited a trio of studies, published in the New England Journal of Medicine and based on “more than 19,000 people, including whites 70 and older, and blacks and Hispanics 65 and older. They took low-dose aspirin — 100 milligrams — or a placebo every day for a median of 4.7 years.”