Good Medical Care for the Elderly and How to Get It

Is online medical record storage safe?

As I have earlier written on Aging in Place, companies like Microsoft and Google are getting into the medical record storage business.  Last week, however, the New England Journal of Medicine raised important questions about whether medical privacy rules should be extended to these private firms. Steve Lohr wrote in the New York Times that the authors of The New England Journal article say there are still more questions than answers about the new “personalized health information economy.'’

Avoiding an inappropriate psychiatric hospitalization

Recently, a caregiver complained that a hospital would not allow her to elect a transfer to a psychiatric unit for her parent suffering from dementia. The hospital’s position was that the health care power of attorney did not allow the patient advocate to make a psychiatric admission. They said that only the patient could make that choice. The patient was described as being “delusional.” What seemed probable was that this patient was delirious, not psychotic. If that were the case, then a psychiatric admission would potentially be very harmful to the patient.

Avoiding an inappropriate psychiatric hospitalization for an elderly person can be life-saving for that patient.

Reducing incidence of bedsores using teamwork

Bedsores can be a serious complication of aging. The clinical name is pressure ulcers. These ulcers occur when skin breaks down because blood circulation is cut off by sustained pressure. Bedsores can be so difficult to heal that prevention is the recommended approach. A recent study shows that a teamwork approach can reduce the incidence of bedsores by 69%.

Patients who are confined to beds and wheelchairs in hospitals and nursing homes are most at risk for bedsores. Other complications, such as dehydration and poor nutrition, can put the elderly at greater risk to develop bedsores. Incontinence also can lead to bedsores.

The checklist | A simple way to reduce medical error

In the December 10, 2008 issue of the New Yorker, author Atul Gawande writes: “If something so simple [as a checklist] can transform intensive care, what else can it do?”

Gawande gives some amazing examples of extraordinary ICU care evolving through the use of checklists. ICU care is complicated. A time and motion study of ICU care in Israel was cited. The study showed that the average ICU patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs. Any kind of mistake, in the procedure or in the sequence of actions, could result in fatal error.

Speak up and prevent health care errors

Caring at Home has published a valuable article about how seniors can help prevent serious medical errors by paying attention and speaking up when they have questions about their care or the medications prescribed for them.

You can read and reprint this article here.

"To Prevent Health Care Errors, Patients are Urged to SPEAK UP"

Palliative Care & End-of-Life Care articles available

Three articles in the current Annals of Internal Medicine provide useful information about palliative and end-of-life care. A helpful table is included with each article to help caregivers manage decision-making. Although written for doctors, many family caregivers will find this information useful.

Rosalyn Carter's message about caregiving

I'd like to share with you today, a wonderful message from Rosalyn Carter about caregiving. Our former First Lady has been actively involved in caregiving for a long, long time. The Rosalyn Carter Institute provides a wide variety of valuable resources for family caregivers and for professional caregivers.

Mrs. Carter writes:

"My interest in caregiving goes back to my childhood. I was deeply influenced by how chronic illness affected and shaped my family and by the heroic and selfless efforts of health care providers, including Jimmy’s mother, Lillian Carter.

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In fact, the backbone of our country’s long-term, home-based, and community-based care systems is the family caregiver. The approximately 15 million caregivers in the United States provide $306 billion worth of unpaid services each year. That amount is almost twice as much as is spent on homecare and nursing home services combined ($158 billion).

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But the strains on our society and on these individuals as a result of providing care are becoming apparent. To read more, click here.

Do not resuscitate orders | A family's dilemma

The Boston Globe today (December 3, 2007) explores the complicated subject to DNR orders -- do not resuscitate orders. When are they appropriate? What if the elderly patient waits too long? What decisions must be made and how can they be made?

The problem is, says the Globe's writer Patricia Wen, many families aren't sure about how to discuss this difficult subject. Often they wait too long, and by the time it's obvious that this decision needs to be made, the elderly loved one is not mentally competent to execute the required documents.

My book Taking Charge: Good Medical Care for the Elderly and How to Get It, discusses end-of-life decisions, the Five Wishes (called by the Miami Herald "the Living Will with a Heart"), and how and when to have this difficult conversation with your elderly loved one.

The Boston Globe article, by Patricia Wen may be read here:

For many, 'Do Not Resuscitate' too painful to discuss
Relatives, doctors often delay in offering patients the option

Dehydration, malnutrition, and falls in nursing homes

From the Hartford Courant on November 19, 2007 comes an indepth expose of nursing homes operated by Haven Heathcare, which owns 25 nursing homes -- 15 in Connecticut and 10 in other New England states. The article cites a litany of deaths caused by neglect of the nursing home staff and/or understaffing leading to resident harm.

What good is oversight when nursing homes are fined only a few hundred dollars where a resident dies of dehydration after the home has been cited for violations numerous times, has been made to come up with a plan for correcting the deficiencies leading to harm, but continues to neglect its residents?

The Courant also notes that these nursing homes are owned by limited liability corporations in a maze of three and four-tiered structure, such as the New York Times exposed earlier this year. [See Choosing a good nursing home for your loved one, September 23, 2007] Families can spend a year or more suing a nursing home to recover damages for the needless death of their loved one only to learn that they sued the wrong corporation.

See No Haven for the Elderly: Nursing Home Troubles Show Lack of State Oversight.

Patients & caregivers as partners in care

Jim Conway, chairman of The Partnership for Healthcare Excellence and senior vice president of the Institute for Healthcare Improvement was a featured Op-Ed writer in the Boston Globe on October 29, 2007.

Conway advocates for partnerships between patients, their advocates and the healthcare system. These key points are part of his important message:

Informed, empowered, and engaged patients are key to preventing medical errors and improving the quality of healthcare

Patients who view themselves as partners in their care

• seek doctors and hospitals who provide quality of care
• are empowered to ask more questions about their conditions and to more accurately describe their symptoms
• are better able to comply with treatment regimens because they understand them

What keeps patients from being actively involved in their treatment decisions? Conway says that evidence indicates it’s a lack of knowledge. He says that his partnership is working to empower patients and caregivers by providing them with information on crucial topics such as medication safety, how to choose a doctor or hospital, how to make the most of doctor or hospital visits, etc.

You may read Conway’s editorial, Partnering for better care here.