Nursing homes

July 18, 2018

In health care, nursing homes not alone in confronting staffing problems

It’s unlikely to surprise anyone who has visited friends or loved ones at a nursing home that such facilities too often are woefully staffed.

But why have federal regulators allowed themselves to be gulled about nursing home personnel levels, and how will not just these care-giving sites but also others, notably hospitals, deal with the growing need for and imbalances in health care staff, including a tilt toward “astonishingly high” numbers of costly administrative staff folks who don’t provide direct patient care?

Jordan Rau, a reporter for Kaiser Health News Service, deserves credit for digging into daily payroll records that Medicare only recently has gathered and published from 14,000 nursing homes nationwide. Rau found that:

June 26, 2018

Why are advance directives so key? Look at tough stats on ventilator survival

by Patrick A. Malone

Grown-ups with the least bit of gray on them may want to step up their thinking on how they want to receive medical care under tough circumstances, especially if they consider a new, clear-eyed and hard-nosed study that dispels any myths about possible life-sustaining “miracles” of artificial breathing machines.

A research team with experts from Boston, San Francisco, and Dallas studied 35,000 cases in which adults older than 65 had undergone intubation and use of mechanical ventilators at 262 hospitals nationwide between 2008 and 2015.

They found that a third of patients intubated died in the hospital.

June 19, 2018

Hospitals and nursing homes need to do more to stop ‘boomerang’ abuses

by Patrick A. Malone

Uncle Sam soon will step up what may be a positive trend: getting hospitals and nursing homes to halt the unacceptable boomeranging of elderly patients between them. But will Trump officials be as quick with health care providers as they have been with poor, sick, and old patients to employ not just carrots but also sticks to get better outcomes?

The nonprofit, nonpartisan Kaiser Health News Service deserves credit for looking ahead to this fall, when the administration aims to accelerate the end of perverse incentives that have hospitals and nursing homes shuttling the sick and elderly between them far too often. As Jordan Rau of the news service reported:

With hospitals pushing patients out the door earlier, nursing homes are deluged with increasingly frail patients. But many homes, with their sometimes-skeletal medical staffing, often fail to handle post-hospital complications — or create new problems by not heeding or receiving accurate hospital and physician instructions. Patients, caught in the middle, may suffer. One in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions such as dehydration, infections and medication errors, federal records show. Such re-hospitalizations occur 27 percent more frequently than for the Medicare population at large.

May 31, 2018

A bit of optimism for the 65+: a dozen years on average of cognitive health

by Patrick A. Malone

As many as five million Americans already have Alzheimer’s and other dementia-related conditions, and their resulting loss of cognitive capacity and personal control rank among the top causes for health dread among those 55 and older, polls show. So it’s worth noting that new studies are showing that seniors 65 and older get on average a dozen years of good cognitive health ── and that span is expanding.

Further, the onset of problems typically may occur in relatively mild fashion, with the most serious cognitive decline occurring in a short but late period of 18 months or so, Judith Graham reported for the independent, nonpartisan Kaiser Health News Service.

In her story for the KHNS feature “Navigating Aging,” Graham looks at an array of the latest and reliable research on seniors and cognitive decline, finding glimmers of optimism in what has been increasingly gloomy, evidence-based studies on how huge a challenge may be posed for our fast-graying nation by dementia, Alzheimer’s and their care.

April 3, 2018

Off-label drug tied to deaths, $1 billion in harms — and $3.6 billion in sales

by Patrick A. Malone

In a display of just how corruptive big money has gotten to be in modern medicine, Big Pharma keeps getting dubious doctors to write so-called off-label prescriptions for powerful anti-psychotic medications — no matter their proven harm to patients nor big settlements drug makers have been forced to pay.

The Washington Post deserves credit for its investigative dissection of AstraZeneca and its “blockbuster” product, Seroquel (generic name quetiapine). It’s a medication developed to treat severe cases of schizophrenia.

Instead, as has occurred with several other drugs of its kind, doctors — in response to major marketing and sales campaigns by AstraZeneca — have decided this wallop-packing drug can be given for uses for which there is less or little evidence. The Washington Post says doctors write abundant Seroquel scripts for patients with an “expansive array of ills, including insomnia, post-traumatic stress disorder and agitation in patients with dementia.”

February 15, 2018

Unacceptable, still: Nursing homes turning 180,000 seniors into drug zombies

by Patrick A. Malone

Imagine if Uncle Sam permitted everyone who lives in Newport News, Va., or maybe Fort Lauderdale, Fla., to be chemically restrained, drugged with powerful medications so they fell, day and night, into a speechless stupor. Now, further envision the furor if these 180,000 souls and their families each were forced to pay as much as $100,000 annually to be reduced to a near vegetative state.

This real situation with over-medicated Americans, in this case seniors in nursing homes, is just one more cruelty happening against the aged. It’s also hard to see federal officials issuing faint praise on how regulations slowly — too painfully so — are reducing abuse of potent anti-psychotics in the nation’s care for the old, especially those with dementia.

The Centers for Medicare and Medicaid Services, aka CMS, has issued new data on its seven-year campaign to slash elder care facilities administering antipsychotics sold under brand names like Abilify, Risperdal, and Zyprexa. Questions also have been raised about a newer drug, the little red pill branded as Nudexta.

January 2, 2018

U.S. eases fines even as nursing homes faulted for infections, evictions

by Patrick A. Malone

Thousands of nursing homes nationwide have failed to control dangerous and often deadly infections, with their basic contagion controls so poor and widespread that federal regulators repeatedly have issued disciplinary citations to almost 3 out 4 facilities.

Thousands of other nursing homes have drawn the ire of families, advocates, and the AARP for summarily evicting or discharging residents in dubious or possibly improper fashion.

So, what action did the Trump Administration officials announce during the hectic holidays about their oversight of nursing homes? They agreed with complaints by facility operators and owners, the New York Times reported, with officials saying they would be “scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury [as] part of a broader relaxation of regulations under the President.”

December 20, 2017

As bad 2017 ends, So. Calif. wildfires put yet more big stress on public health

by Patrick A. Malone

The clock may be counting down to 2017’s end but Mother Nature isn’t giving up on whipping up calamities that wreak havoc on parts of the nation’s health care system and millions of Americans’ well-being. After swaths of the country were inundated by hurricanes and flooding, the West Coast is now battling yet more huge blazes.

Raging wildfires in Southern California not only have added big time to the billions of dollars that such blazes have caused this year in damage and suffering to people, property, and animals, they also have provided the entire coast with a harsh reminder of the importance of air quality to health.

With luck, public cooperation, and outstanding work by fire fighters, police, and other first-responders, the loss of life has been low in a series of blazes on the Westside of Los Angeles, in the city’s northern reaches, in San Diego, and most especially in Ventura and Santa Barbara. The “Thomas Fire,” burning over hundreds of acres in Ventura and Santa Barbara, has become the third largest wildfire in California record books. The Southern California blazes follow hard on the heels of disastrous infernos in Northern California’s wine country.

December 12, 2017

It’s clear to see: Cataract surgery can extend and improve women’s lives (and men’s too)

by Patrick A. Malone

Cataract operations, performed on more than 3 million Americans each year, not only may be the most common surgeries in the nation—they also may be life prolonging, especially for older women.

A 20-year study—published in JAMA Ophthalmology— of more than 74,000 women who were 65 and older and who had the all too common clouding of and discoloration of the eye lens found a 60 percent lower risk of death among the 41,735 women who had their cataracts removed, the New York Times has reported.

Further, older women who had cataract surgeries not only lived longer but better, researchers said. As the New York Times has reported:

December 6, 2017

A Kansas reminder: Nursing homes over-reliant still on antipsychotic drugs

by Patrick A. Malone

When families and friends visit Kansas nursing homes, they may be startled to see how listless and lethargic their elderly loved ones may be, especially if the facility residents suffer from dementia. There’s a sad, simple, and likely reason—the seniors may be drugged up with potent anti-psychotics.

The Kansas City Star deserves credit for providing a powerful reminder that nursing homes, not just in the Heartland but nationwide, persist in over-relying on off-label dosing of their sometimes difficult to handle patients with drugs such as olanzapine (more commonly known by the branded product Zyprexa), aripiprazole (Abilify), risperidone (Risperdal), or quetiapine (Seroquel).

As the newspaper reported: