For sick seniors, hospitals and nursing homes can be nothing but bad news

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.

She looks to formal research by experts who have studied Medicaid and Medicare readmission data and other information, finding that patients, in general, and specifically older and sicker individuals may suffer the equivalent not only of traumatic shock but also be harmed by “post hospital syndrome.”

She quotes Harlan Krumholz, a Yale University cardiologist who has studied and written about patients and their struggles for weeks and months after hospitalizations to regain not only their health but also a sense of normalcy in their lives.

Patients, he says, are woken at all hours of the day for tests, blood draws, and measurements of their basic indicators like their pulse, blood pressure, and temperature. Their rooms rarely are darkened like their home bedrooms. Instead, they’re put on bright, noisy units where, even in single rooms, they lack privacy and quiet, as they’re exposed to medical device alarms, other patients’ pain and complaint, and, yes, the high likelihood that they may acquire hospital infections.

Because they’re kept in beds, they lose their sense of time, and can see their balance and muscle tone slip. They’re forced to eat at times to which they’re unaccustomed, and they’re served meals that they may find unfamiliar if not inedible.

Although enlightened institutions, prodded by patient advocates, have sought to improve patients’ experience — from admission and especially through discharge — the weak and sick, Span reported, still pretty much get booted out of hospitals as soon as possible. This, of course, is attributed to cost-saving and efficiency reasons.

But, she noted, it can leave older patients especially vulnerable. They’re going from 24/7 attention, potentially to little or none, particularly if they’re independent and try to live alone and manage themselves.

The shock can be too great, though, leading to a revolving door of hospital readmissions, with patients growing weaker and more fragile at each trip.

The remedies that Span suggests might come under the heading of “back to the future,” reminiscent in some ways of the family focused care that once was part of American hospitals and persists in less affluent parts of the world:

Families can bring in favorite foods and help their relatives eat. They can ensure that patients have their hearing aids, dentures, eyeglasses, and walkers or canes to help them stay oriented and mobile. With a physician’s OK, they can accompany relatives on short strolls down the corridor to ward off de-conditioning and ask about curtailing wee-hour tests and readings.

Span and Krumholtz argue not only for major change in hospital policies, procedures, and practices, including night quiet and dark times but also greater emphasis on according patients’ privacy and tranquility, including special facilities with less hubbub for geriatrics.

In my practice, I see the harms that patients suffer while seeking medical services — and how much damage can be inflicted on them when their sickest and most vulnerable and in institutional care. Hospital acquired infections sicken almost 750,000 Americans annually and will lead to the deaths of 75,000 hospitalized patients each year, research has shown. They’re also only a slice of preventable medical errors that claim the lives of roughly 685 Americans per day. That’s more people than die of respiratory disease, accidents, stroke and Alzheimer’s. It also would rank medical errors as the third leading cause of death in this country, behind only heart disease and cancer.

Doctors and hospitals need to look hard at themselves to remedy the reality that patients may be safer with many of their illnesses, all but the gravest sickness, by staying out of rather than in hospitals.

As for nursing homes, an alternative that may spring to mind for many for caregiving, especially for the old and sick, the news here isn’t great either: Uncle Sam has just slashed its star ratings for 1 in 11 nursing homes, reported Jordan Rau, of the independent, nonpartisan Kaiser Health News Service.

He says that Medicare officials, following an embarrassing analysis that the news service conducted of nursing home payroll records newly required for submission to federal regulators, found that almost 1,400 of the facilities “were either inadequately staffed with registered nurses or failed to provide payroll data that proved they had the required nursing coverage.”

The federal government has taken account of this questionable and risky short staffing for “Nursing Home Compare,” its online-posted rating system, which seeks to summarize multiple, key measures of nursing homes quality and safety performance with a ranking of one to five stars.

Medicare previously had relied on self-reporting by nursing homes on the key issue of their staffing numbers. But the agency recently switched to a system based on payroll data. Rau and colleagues beat the agency to the punch in analyzing that information to show how poorly homes are staffed, particularly on weekends. Good for Kaiser, not so great for our taxpayer-supported federal watchdogs at Medicare. They did act, rather than shuffling on the critical information.

Now, however, Medicare officials and nursing homes need to find ways to ensure one of the nation’s most vulnerable populations — elderly, sick and disabled home residents — get the care they need and for which their loved ones pay dearly.

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