Nursing homes

September 20, 2019

Nursing homes and long-term care facilities may be infection ‘cauldrons’

The 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:

September 13, 2019

Home care for the aged has become a quiet calamity for all involved

by Patrick A. Malone

Americans 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.

August 2, 2019

Government watchdog, finding abuse complaints doubled, criticizes nursing home oversight

by Patrick A. Malone

With complaints of nursing home abuses doubling between 2013 and 2017, the federal agency with oversight of these facilities must improve significantly its efforts to protect millions of vulnerable seniors, the U.S. Government Accountability Office (GAO) has found.

That recommendation, from one of Uncle Sam’s top watchdogs, infuriated members of the U.S. Senate Finance Committee, which called on the Centers for Medicare and Medicaid Services (CMS) to act fast on six recommendations to address its failures in regulating nursing homes.

Sen. Thomas Carper, a Delaware Democrat, described these as including “CMS – the agency charged with ensuring that these facilities meet federal quality standards – often cannot access information about abusive incidents after they occur and, therefore, cannot take the necessary steps to remedy the situation.”

July 19, 2019

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

by Patrick A. Malone

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.