The Cost of Hospital Budget Cuts

Hospitals are a lot more dangerous than people think, especially for the elderly. Three times as many people die from errors in hospitals than from car accidents every year. Experts in the medical field tend to agree that if someone does not absolutely have to have access to hospital grade care, they are safer recovering at home. It’s not just the exposure to infections and disease, but also a whole host of other problems that largely come from putting the budget above patient-centered care. Reducing our national health care expenditure has led to a reduction in quality of care, and while people are living longer healthier lives now more than ever before, how much better could we be doing with the appropriate attention given to each patient’s needs?

Hospital stays increase risks for ill effects in patients, especially the elderly. Just a few days of bed rest is damaging to an aging body, making it harder to get up and get moving after a stay, independent of the medical recovery needed. Patients are prone to infections, pressure ulcers, and other illnesses that add to recovery time and overall poor health. Testing and treatments can lead to unintended side effects, complicating health issues even further. The stress of the illness and the strange environment increases falls, confusion, and even delirium, which often goes unnoticed and untreated. Incontinence develops in more than 40% of elderly patients within a day of admission. It’s very difficult to get a good night’s sleep in a hospital; there is always noise, uncomfortable devices monitoring health, and often patients are woken for a test or check in – this is not good for recovery. Nobody finds hospital food appealing; add in difficulty managing a food tray while in bed and a lack of assistance to eat, and undernutrition becomes a problem for many. Prescriptions are often added or changed, and this can lead to unintended interactions with medicines the patient is taking at home. The pitfalls are many, and even with all the staff available to treat illnesses, there isn’t enough time to take care of patients.

One story from the Washington Post illustrates this point beautifully. It tells of a 91 year old woman who fell in her garage while home alone. She pressed her medical alert button and had EMTs helping her within five minutes; fifteen minutes after that she was at the hospital. From there her care devolved. She spent eight hours having tests run and waiting for a bed, with next to no attention paid to her personal needs or her pain. A chest X-ray was taken, but no one checked it for 12 hours despite her worsening cough, fever, and low blood oxygen levels. Her son, a geriatrician, asked for the results and only then was the X-ray checked, pneumonia discovered, and her condition treated. Trays of unappealing food mush were delivered to her room and left out of her reach. Equipment alarms went off regularly, but no one ever came to check on her or turn off the obnoxious, sleep-depriving noise. She was not bathed in more than a week, never repositioned, and no one came to ask if she was in pain or needed anything. The discharge planner, however, came by from the first day. The patient’s advanced directive stated that she did not want a feeding tube, but the doctors tried to order one anyway; the geriatrician son insisted that her wishes be honored and reminded them that the feeding tube would not resolve the medical issues at hand.

This woman was lucky in that her sons stayed with her and provided her care. They helped when she needed something, pestered doctors and nurses for test results, and made sure the staff knew when her condition changed. They were advocates for their mother’s care. The sons asked why their mother was not being tended to in the way they expected; more than one nurse responded, “We used to do all those things, but there is no longer any time.”

The patient’s overall health is no longer the focus at hospitals. They have shifted their attention to the bottom line in order to stay in business. Cut backs from Medicare and the skyrocketing cost of healthcare have forced cuts in hospitals that are not good for people. While there are certainly still untold numbers of dedicated doctors and nurses who go the extra mile for their patients, tighter budgets mean everyone has a heavier workload – more patients per caregiver, a wider range of responsibilities, and less time for the kind of personal attention people need. This has contributed to 100,000 deaths every year due solely to medical errors in hospitals. Unless a hospital stay is absolutely necessary, consider other options before heading to the emergency room for treatment.

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Healthcare Super Spending

A hospital superutilizer sounds like some sort of heroic patient whose experience in hospitals has earned them untold knowledge and power over their illnesses. In fact, the word is much more grim and problematic. A superutilizer is a member of the 1% of the US population that consumes nearly a quarter of the country’s health care budget. This is not the “one-percent” we all pine to be a part of. This is a group of sick people who spend an average of $97,000 per person, per year on health care. Beyond the “super” one-percent, around half of our entire health care budget is spent on just 5% of the population. This is largely a senior population; almost half of adults occupying hospital beds are over 65. Medicare spends more than $100 billion per year on hospital care. This group of people presents an enormous opportunity to cut health care costs.

Superutilizers often suffer chronic conditions that are not well managed, and their frequent hospital use tends to compound their health issues. Take Jean, for example. Over a period of 30 months, she was admitted 76 times to a total of fifteen different hospitals. She spent about two-thirds of her days in a hospital. She received many tests and treatments over that time, some of which caused further medical problems – like a dropped lung in one case – and led to longer stays. Sometimes the prescriptions she received upon discharge interacted badly with the meds she was already taking at home, and the result was another hospitalization. With so many different doctors and nurses overseeing her care, no one was watching the big picture. As so often happens in hospitals, the focus was on solving the immediate problems that present themselves, rather than improving the overall health of the patient.

What if her care was better managed? What if someone was monitoring her closely enough that small problems were treated before she ended up in the hospital? And keeping an eye on her prescriptions to prevent dangerous interactions? And checking on her during hospital stays to monitor complications the staff might not be aware of? What if there was someone she could call before going to the ER to offer medical advice based on an in depth knowledge of her case, rather than trying to inform an ER doctor of all the intricacies of her care in an emergency? Some of this sounds like her primary physician’s job, but they aren’t always available when needed, don’t always have hospital privileges, and have so many other patients that it’s difficult to keep track of everyone’s history. What’s really needed is a team of specialists, working together to manage the specialized care of people like Jean whose needs are far more complex than the typical patient. Programs like these are beginning to take off in some areas, and are showing some interesting results.

In Washington State, the top 1% of healthcare spenders were assigned teams of doctors, including their primary care provider, who were notified whenever the patient arrived at an emergency room. The team managed their care and health. Emergency room usage of this group fell 37%, saving Medicaid over $33 million right off the bat. Another home based care program cares for patients well before they even get to the ER. The team of doctors oversees their care, and meets weekly to discuss their case. Most care is given at home, and patients are instructed to call their care team before considering a trip to the emergency room. The system saves Medicare an average of $2000 per month for each patient involved and has reduced their hospital days by a third. While the model is still finding its stride in some areas, the successes are promising and offer hope of providing better care while still reducing the astronomical healthcare bill our country has been running up. No one wants to be part of this particular 1%, but finding a better way to manage healthcare for those with complicated needs is definitely heroic in my book.

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Seniors Are Going Back to Preschool

This idea is brilliant.

Nursing homes are often thought of as depressing places that no one wants to visit, never mind live in. Residents are surrounded by others in very similar situations and opportunities for social connections are limited to a small circle. Typically, joy and liveliness are not terms associated with a nursing home. This is not to say they are completely absent, but hard to come by in the least. And yet, there is an abundance of energy and excitement in your typical preschool. Very young children are so open and carefree that they bring love and laughter with them everywhere they go. So why not bring it to a nursing home?

This relatively uncommon program goes well beyond regular visits to the elderly. The Intergenerational Learning Center is a full time preschool program that is actually located within a senior center in Seattle. Elderly residents do far more than sit around and enjoy the site of children playing. They participate and share the rich experiences they have to offer, while the children light up their lives five days a week.

Social isolation is a serious problem for the elderly. It is estimated that 43% of seniors experience it and it is unhealthy in many ways, both mentally and physically. While it may be difficult to form strong connections amongst peers, especially in a place and time where the social pool is regularly shifting and too often on the brink of death, children offer an open and far less risky opportunity to bond and interact. Their innocence, simplicity, and open nature can reach into lonely hearts and bring joy.

Housing a preschool in a nursing home is a beautiful and elegant pairing that’s mutually beneficial. Seniors get value from helping others, teaching, and simply enjoying the exuberance and sincerity of children. The children benefit from the experience and love that elderly residents offer in abundance, not to mention the value of connecting with others experiencing different life situations. The following documentary showcases the incredible tenderness with which each generation interacts with the other and is a touching but powerful argument for the development of more programs like this one.

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Senior Care Exposed: Bal Waterbury

Inspection reports offer a glimpse into the care a prospective resident can expect to receive in a given community. Sometimes, violations are easily fixed and don’t necessarily indicate a dearth of caregiving. Other times, a particularly disturbing picture is painted by the reports, reinforcing the need for thorough research before moving into a facility. Here are some of the incidents we discovered from one of the yearly inspections at Bal Waterbury in Connecticut.

Incident:

A resident with dementia was identified with incontinence issues. One night she removed all her sheets and mattress pad and soiled her bed and herself. Staff found her nude and messy and proceeded to take pictures of the scene, including the undressed and soiled resident. The photos were posted on the staff computers and were only removed when someone else filed a complaint on the residents’ behalf; permission for photos was never given. This is not the type of dignified caregiving promised to prospective residents. Furthermore, after this incident, it was ordered that the resident be checked on more frequently – every hour instead of every two hours. The responsible staff member did not document the change in orders and no one carried them out. In other words, nothing changed.

Violations:

  • failed to follow up adequately
  • failed to update care plan
  • failed to treat client with dignity during an investigation

Incident:

Another resident was admitted with dementia and COPD. She developed a cough with congestion and the doctor ordered a urinary dip test and nebulizer treatments four times daily to improve her breathing, plus five days of antibiotics. A full week later, only two attempts to get the urine sample were made, both unsuccessful, and no one notified the doctor or family that the doctor’s orders could not be carried out. For the three days following the doctor’s orders, there is no record of the resident being given her antibiotics (boxes on the record sheet were either blank or, worse yet, crossed out). The woman was admitted to the hospital after a fall, according to the facility’s records. It was noted that she fell at 2 am and had a nosebleed, but was only sent to the hospital after the LPN came on duty around 7 am and saw her head wound. The hospital records indicate a urinary tract infection and pneumonia in addition to her injuries, both of which could have been improved with the antibiotics the doctor originally prescribed. Complaints about lack of appropriate care administered after the doctor visit and fall were not investigated, according to records.

Violations:

  • failed to follow up adequately
  • failed to deliver on nursing services
  • failed to conduct post fall assessment
  • failed to update care plan
  • failed to document complaint investigation

 

These are only two of the stories outlined in the report. There is also a resident who fell and was not sent to the hospital until four days later, and family wasn’t contacted until 15 minutes after the ambulance left the facility. Another indicates a resident with seven falls over the course of a month, the final of which landed her in the hospital, but no reassessment was conducted, nor were steps taken to reduce the risk for future falls. Yet another tells of a resident with an open wound for which there was no care plan, no documented observations of the wound, and the care director had no knowledge of it or a plan for treatment.

Facility Response:

The facility responded to this inspection report by finding a new care director and LPN to oversee staff members and retraining staff on care services and appropriate documentation for resident care. Procedures and checks were planned to ensure proper steps are taken in resident care. It would be wise to check the most recent inspection reports for this (or any) community before making a decision to move in or send a loved one to live here.

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Celebs Who Still Have It at 70+

We’ve posted our list of celebrities who are over 80 and have maintained that certain something that made them famous in their youth. Here’s our picks for 70-79 year old celebs who still make us sit up and take notice.

Tom Selleck, 70

 

Gladys Knight, 70

 

Harrison Ford, 72

Raquel Welch, 74

Patrick Stewart, 74

Chuck Norris, 75

Tina Turner, 75

 

Jane Fonda, 77

Robert Redford, 78

Julie Andrews, 79

Diahann Carroll, 79

 

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Your Chair is Killing You

Sitting is deadly.

This is not an exaggeration or a euphemism. Sitting causes actual physical harm to the human body, and Americans sit so much that it is killing us. And don’t suppose that the exercise routine you make yourself do every day is keeping you safe from the harm – it isn’t.

While it is true that exercise impacts your body in many healthy ways, an hour or so a day will not stave off the effects of prolonged sitting. If you go to the gym or get out for a walk after a day seated in front of a computer at the office, you are still very much at risk.

An hour of sitting (be it in front of the TV, working at a computer, or reading a book) knocks 22 minutes off your life. Two hours a day raises the risk of lung cancer by 6%, of colon cancer by 8%, and of endometrial cancer by 10% – independent of other risk factors. Women who sit more than seven hours a day are 47% more likely to have depression than those who sit under four hours; those who also do not exercise have a 99% higher chance of developing depression. One study found that people who spend the most time sitting have a 49% higher mortality risk in general, and increase their risk for fatal cardiovascular events by 90%, cardiovascular problems by 147%, and diabetes by 112%, as compared to those who spend the least time on their posteriors.

How can sitting be so very harmful to our health, especially when it is so very cozy? The human body is built to be on the move. Generations past had to keep moving to survive; the TV and computer chair-based culture we live in now is not what nature designed us for. Here are some of the many ill physical effects going on inside a seated body:

Unused Muscles…

  • Become stiff, and in the long run weak
  • Lead to poor balance, decreased stride length, and increased falls (especially in the elderly)
  • Don’t use fat well, leaving more in the blood to clog the heart
  • Lead to a weak back and abdomen, and added strain on the spine and discs
  • Don’t use insulin well, so the pancreas keeps making more (leading to diabetes)

Poor Blood Flow…

  • Allows more fatty acids to build up in the blood stream
  • Leaves fluids pooling in legs, leading to swelling, varicose veins, and clots
  • Reduces blood and oxygen delivery to the brain, decreasing function and productivity
  • Reduces delivery of mood enhancing hormones, leading to depression

Bones

  • Without enough weight bearing activity, lower body bones don’t get dense or strong enough to hold us up, leading to osteoporosis and likely more fractures and falls as we age
  • Discs between vertebrae get squashed unnaturally, and don’t soak up enough nutrients, leading to degeneration and hardening of collagen – not good for spine health

Perhaps just as scary is the fact that the damage is not reversible; the best we can hope for is to halt the destruction in its tracks. But it may not be as easy as it seems. The average American adult sits for eight hours a day – combined with eight hours of laying down to sleep at night (if you’re lucky!), that’s two-thirds of every day spent not moving. If you have an office job, even the most active lifestyle won’t undo the damage of eight hours a day in a chair. Switching to another field is an option for some, but is not realistic for most people. What choice is there?

Alternative workstations are becoming more popular in many offices. Executives may have room for a treadmill, but not everyone does. However, a desk that allows standing could be an option or a chair that engages more muscles than the typical office seat. There are a wide variety of “active seating” chairs that require some balance and muscle control to stay on. Another option is to take a 2 minute walk every 20 minutes. Walking at just 1 mile per hour burns twice the calories of sitting, and gets the blood moving through your brain. It actually makes you more productive at work, despite the loss of 6 minutes of butt-in-chair time each hour. Stretching hip and back muscles a few times a day helps with flexibility and keeps muscles working properly to support your weight.

And when you get home at night, don’t park yourself on the sofa until bedtime. Move as if your life depended on it…because it does.

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Black Bear Vs. Lacy and Carl

Chihuahua vs. black bear – who would win? 

As it turns out, the Chihuahua’s senior citizen owner, if it’s 73 year old Carl Moore. Ex-marine, boxer, and bouncer, Mr. Moore took on a black bear that was threatening his beloved dog, Lacy, and chased it off his property. The bear was trying to get under a fence onto his porch where Lacy was loose. Mr. Moore ran at the bear yelling and when it gave him a look he didn’t like before turning to leave, Moore chased after it. That’s when the bear got serious. It reared up on its hind legs, typical of a bear trying to intimidate an opponent. But Carl Moore doesn’t intimidate easily. Instead of backing down, Moore ran up to the animal and socked it in the face. The bear took off and hasn’t been back.

While this seems like an unlikely tale, the story is corroborated by two friends who were at the house when it happened. Neither one was terribly surprised at Moore’s actions – apparently he doesn’t back down from anybody. As Mr. Moore himself puts it, “I ain’t running from nothing. I never have in my whole life, and I ain’t gonna start now.”

It goes to show that age doesn’t change who we are at heart – if anything, it makes us even more so.

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Why You Can’t Sue Long Term Care Facilities

John Mitchell was dropped by staff members at an assisted living facility and they cancelled the ambulance when he seemed to stabilize. He died from internal bleeding. Beulah Addison suffered a stroke; she signed whatever papers the nursing home put in front of her. When an employee conned her out of her house, she asserted that the home played a role in the scam. In both cases, arbitration agreements had been unknowingly signed at admission, which prevented any legal action as a result of the facilities’ wrongdoing.

Moving into a long term care facility is an extremely difficult process. There are hundreds of factors to consider and stacks of paperwork to be filled out either by the resident or a representative/family member. People in need of a facility are in a very emotional and anxious frame of mind – not the most reasonable time to be signing legal documents with permanent consequences. It becomes rote: sign here, and here, and here…but pay attention to the papers going by, or you could sign away your rights.

It is all too common for one of those documents to be an arbitration agreement that takes away the right to sue for any wrongdoing on the facility’s part down the line. It’s fine to expect that everything will go well; after all, you picked the safest most caring environment possible. But no one is perfect, and a poor hire or negligent practice could cause harm. And because of a paper hurriedly signed in the bustle of move-in, residents and family members may have limited recourse when something goes wrong.

Arbitration is not all bad, but the agreement is intended to protect the community, not residents. For starters, the cost of holding the arbitration is shared by both sides, so families have to spend money to bring a complaint to arbitration. They likely will also need to pay a lawyer, bringing down their compensation further, assuming they are awarded anything at all. Also, the actual dollar amount granted tends to be smaller in arbitration than the same case in a public hearing. There is no further recourse if the result is unfavorable, and the arbitration is confidential, so there’s no public awareness of the issue, including a warning to others looking to move into the same facility.

Residents and their representatives should be aware that they do not always have to sign these agreements as a condition of moving into a facility. The person asking you to sign will not offer up that information, but press them to find out if it is a requirement of admission. If it is, consider if there is a better option out there, or if this is still the right place for your needs. Better yet, make the question a part of your initial research into potential communities. Much better to know what you are getting into ahead of time than to wait for an accident before discovering you have no legal recourse to recover costs for a facility’s illegal or negligent actions.

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Betty is White Hot!

Betty White has always appeared sweet and naïve while wielding a wicked sense of humor that catches audiences off guard. Now that she is a nonagenarian, her bawdy, quick-witted style has even more of an edge.

Betty has had a rather impressive career – still in progress – with records for oldest SNL host (thanks to a viral Twitter campaign), oldest Emmy winner ever, and longest career for a female entertainer. She’s the only woman to have won Emmys in all categories for her performances (lead, supporting, and guest actress in a comedy series). She was also among the first female producers, with creative control of her show Life with Elizabeth in the 1950s. She was asserting herself and taking on leadership roles in Hollywood at a time when women were not offered governance over much of anything outside the home.

As Sue Nivens on The Mary Tyler Moore Show, she displayed her characteristic timing and humor. Then, on The Golden Girls she took on the opposite role – naïve Rose Nylund – which played on her innocent looks. Both roles are remembered and loved by older audiences today, but the younger generation is in love with Betty, too. Her newer role on Hot in Cleveland is less clever and more bawdy (edging into vulgar, which is not her usual style), but she has earned the right to a cheap laugh here and there. The routine of little-old-lady-who-says-things-no-one-expected is definitely working for her; Betty is White hot right now.

Add in a Snickers commercial where she is ruthlessly tackled in a football game, dancing Gangnam Style with Psy, and riding a wrecking ball á la Miley Cyrus, and it’s clear that Betty White is not too afraid, or too old, to go all out for the laugh. She has a love for entertaining and a keen sense of what people want. At 93 years old, she has captured the hearts of fans at all ages. And aren’t we all hoping to have that much health and vitality by the time we reach 93? A few years ago she said, “I was only 88 last Sunday, so I have lots more stuff to do.” It’s hard to imagine what she will do next; according to Betty herself, the only thing she hasn’t done in Hollywood is Robert Redford. America can’t wait to see what she comes up with. In the meantime, check out Betty’s beat:

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