Good Medical Care for the Elderly and How to Get It

Baby Boomers ambivalent about longevity in parents

Today, it's not unusual for Americans to live to be 90 or even 100. Problems occur when the elderly outlive their savings. Sometimes elderly parents own their own home and a reverse mortgage can help them stay there.

And now about the Baby Boomers -- one quarter of the US population. These folks are accustomed to the idea that their parents might bail them out from time to time, contribute to a down payment on a home, etc. And last, but not least, leave them an inheritance.

Well, it's not happening. Longevity means eating into capital. Not everyone is a Rockefeller. How do baby boomers feel about their parents spending what they'd counted on as an inheritance.\?

Read Hey Folks, You're Spending My Inheritance in the Fall 2007 issue of Dissent Magazine.

Choosing a good nursing home for your loved one

Charles Duhigg reports in the New York Times Health section on September 23, 2007 that private investors have purchased groups of nursing homes, reduced staff (often below minimum requirements), and cut other expenses. As a result, profits for the owners have increased, but quality of care is down, mobility and health of nursing home residents is compromised, and complaints to regulatory agencies are higher.

Families of patients who have died as a result of alleged negligence in such nursing homes increasingly find that complex corporate structures are like mazes and act to insulate the real owners of the facilities from any negligence that might be proven.

Read More Profit and Less Nursing at Many Homes

For help in choosing a safe nursing home for your loved one, see the resources in Appendix A of Good Medical Care for the Elderly and How to Get It. This and other appendices are online and yours to use without charge.

New report criticizes government oversight of nursing homes

The New York Times revealed on April 21, 2007 that the Government Accountability Office (GAO) will release a report this week about the failure of federal health officials charged with oversight of nursing home regulations to impose penalties upon nursing homes repeatedly cited for “poor quality of care.” The net result is that nursing homes that should have been closed remain open and residents of those nursing homes continue to be abused.

The report notes that federal investigators found that a Michigan nursing home (unidentified) was still open even though it had repeatedly been cited for “poor quality care,” poor nutrition services, medication errors and employing people who had been convicted of abusing patients.

The US has about 16,400 nursing homes in which about 1.5 million people live on any given day. Annually, more than 3 million people receive nursing-home care. Medicaid and Medicare pay for more than two-thirds of this care. The cost is significant. In 2005, the most recent year for which figures are available, $122 billion was spent on nursing home care. 60% of that was paid for by Medicaid and Medicare.

I’ll be watching for this report and will post a link to it when it is released.

Read the NY Times article Oversight of Nursing Homes is Criticized

Technorati tags: caregiving, caregiver, family caregiver, nursing homes, nursing home, GAO, Government Accountability Office,

Should family caregivers be paid?

An article from Reuters published in the April 21, 2007 edition of The Washington Post poses this question: Should families pay the dutiful daughter or son who steps up to be an aging parent's primary caregiver?

Experts in the field of eldercare suggest there are good reasons why families should work out formalized agreements so that the family member shouldering the greatest care-giving burden is paid. To avoid hard feelings or disagreements later, it’s important for families to sit down, figure out what’s best for their aging parent, and perhaps put their agreement in writing.

Sometimes this care-planning is done as part of overall estate-planning. Some families transfer money out of an aging parent's name to help the parent more easily qualify for Medicaid if nursing-home care becomes necessary. Some states, Arkansas, California, Oregon and Washington, for example, have initiated programs that pay families to provide care so that seniors can remain at home. Home care is still less expensive than nursing home care. Some long-term care insurance polices will pay for home care also.

The article provides some helpful advice and can be the first step that helps families plan for the future. You can read “Compensating family caregivers” here.

Technorati tags: caregiving, caregiver, family caregiver, aging parents, aging, baby boomer, baby boomers, sandwich generation

Another reason why family caregivers need to be attentive

My sisters and I relied upon the nursing home staff--doctors, nurses, and physical therapists, among others--when our 84-year-old mother was admitted to a care facility because we thought that they had critical knowledge and skills that we lacked. As an indirect result of our failure to independently monitor Mom's medical care, our mother died of multiple complications only 65 days after being diagnosed with a common urinary tract infection.

Another family suffered a similar, albeit not fatal, complication as a result of nursing home neglect. The Boston Globe on March 9, 2007, reported that a nursing home resident had her leg amputated as a life-saving measure after a nursing home failed to provide adequate care. Although the woman's daughter was present on a daily basis, she never saw the decubitus ulcer that led to a life-threatening infection resulting in the amputation because her mother's ankle was always covered in a sock or by bedding.

Advocacy for the elderly, whether they live in a nursing home, in their own homes, or in the homes of family caregivers is essential, a point made ever so clear in Taking Charge: Good Medical Care for the Elderly and How to Get It.

Feds Seek New Regulations to Require Fire Safety in Nursing Homes

The federal government wants to fill a gap in fire safety at nursing homes by requiring that about 3,500 older homes install sprinkler systems. A rule proposed by the Centers for Medicare and Medicaid Services would end an exemption in existing law that requires sprinklers for new nursing homes but not older facilities. Federal data shows that the exemption has left about one in five facilities nationwide without full sprinkler coverage.

Patient advocacy groups and fire officials have advocated for a universal sprinkler requirement since 2003 -- a year when 31 patients died in two fires at nursing homes without sprinklers in Hartford, Conn., and Nashville. Other deaths have occurred in nursing home fires around the country since then, according to a USA Today analysis of federal statistics.

USA Today conducted a study that showed that about 2,300 fires are reported in nursing homes annually. Lack of sprinkler systems contributed to deaths in every one of the 18 worst nursing home fires since 1970, killing more than 200 patients. "Sprinkler systems are integral to increasing fire safety in nursing homes," said Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services.

Current proposals call for a phase-in program -- allowing 3 to 10 years to comply. Janet Wells, policy director for the National Citizens' Coalition for Nursing Home Reform, welcomed the rule but said, "It should have been done 30 years ago." Wells commended the efforts of the USA Today stories, which she said "really exposed the problem to a wider audience and put a lot of pressure" on regulators."

Bruce Yarwood, president of the American Health Care Association, a nursing home trade group, supported the rule and said the phase-in was critical to making it work. "We're pleased," Yarwood said. "Fire prevention remains a top priority for our members."

WHERE NEED IS GREATEST?

States with the lowest percentage of nursing homes that were fully equipped with sprinklers through 2005:

Michigan 36%

South Dakota 36%

New York 39%

Arkansas 49%

Colorado 51%

Sources: Centers for Medicare and Medicaid Services, American Health Care Association


To read the entire USA Today article, click here.

See a related article in the Washington Post today, October 31, 2006.