The chasm between the perceived need for hospice care and referral from nursing homes has grown due to lack of education and the knowledge that hospice is able to complement nursing home care. In conversations with social workers at various nursing homes, administrators are directing the preference that palliative care and hospice care be kept “in house” for financial reasons versus outsourced to hospice companies who are experts in providing care. While this seems like an apparent conflict of interest the reality is that financial concerns do come into play versus patient best interest. When no family is near or exists, nursing home staff does control the quality and level of care. Again another case for family members to become more involved in the care of family members and to question motives of expertise when care is involved.
Archive for January, 2009
If you talk with your parents, or are an older adult yourself, you’re likely to state that your wish is to remain in your home as long as possible. It’s no secret that this is usually the best situation for all involved. However staying at home becomes increasingly difficult as a person ages because of decreases in physical, cognitive, psychological and social aspects that result in loss of ability to safely complete daily tasks. Many times, cognitive issues, often evidenced by general stubbornness prevent individuals from accepting or receiving care and this includes medical care. In other cases, children have enabled their parents NOT to accept assistance provided by non-family members. After all, who wants to admit they’re not as sharp as they once were. It takes a greater individual to acknowledge and accept the fact that help is needed. If you’re a child needing help in talking with your parents or an older adult ready to learn about care options, email me for assistance, pamela@pameladwilson.com
As time goes on we will continue to see more press in the news about healthcare and the lack of adequate provision of services. A report, Crossing the Quality Chasm: A New Health System for the 21st Century discusses reinventing the health care system. Included are mentions of increasing patient safety, patient centered care, and effective provision of services. The more educated we can all become about the challenges of the health care system the more effective we can be in managing our own personal health care needs. While it’s nice to think that the government will be able to make quick changes, history dictates otherwise.
Depression is the most common emotional disorder among older adults. Many of us, including those with parents, often miss the signs which are more obvious after the loss of a spouse. Increased sleep, weight loss, inactivity, a loss in desire for socialization are other signs. My own father who likely suffered from depression his entire life was not formally diagnosed until after the death of my mother. The National Institute of Mental Health estimates that although 15% of older adults suffer from clinical depression, fewer than 10% receive a diagnosis or apropriate treatment (Department of health and Human Services, 1999). Older adults are especially vulnerable to having their depresion overlooked because they generally receive health care from primary care physicians who, according to a major Institute of Mental Health report,do not provide adequate assessment and treatment of depression for this age group (Institute of Medicine, Shaping the Future for Health 2005). If you suspect depression in yourself or a parent seek an assessment from a mental health professional.
How many of us have considered how increased body weight impacts the environment? Statistically speaking, “a world of persons weighing 198 lbs has 29% more mass than a world of persons weighing 154 lbs; this extra 44 lbs per person results in proportionate increases in demand for resources and increased stress on the environment. In 2000, the extra 10 lbs weight of an airline passenger compared with 1990 required more than 350 million additional gallons of fuel to carry the extra weight with the production of an extra 3.8 million tons of carbon monoxide. Increasing body size requires adjustments in all resources, with an estimated cost of $2.6 trillion per year.” Curious to learn more about how we affect the world’s resources? Read Human Body Size and the Laws of Scaling by Thomas Samaras, at www.amazon.com/Human-Body-Size-Laws-Scaling/dp/1600214088
Let’s continue the conversation from yesterday about the obesity epidemic in the U.S. It’s never too late to modify daily living habits in today’s world of over-eating and inactivity. According to the CDC, overweight and obese individuals are at increased risk for many diseases and health conditions, including the following: 1) Hypertension (high blood pressure), 2) Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint), 3) Dyslipidemia (for example, high total cholesterol or high levels of triglycerides), 4) Type 2 diabetes, 5) Coronary heart disease, 6) Stroke, 7) Gallbladder disease, 
Sleep apnea and respiratory problems and 9) Some cancers (endometrial, breast, and colon). For more information about these and other health problems associated with overweight and obesity, visit Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.
Can exercise reduce risk factors of aging? It is well known that obesity, a national epidemic in the United States, is a risk factor for early death and is associated with an increase in inflammatory diseases. However it is also documented that physical fitness can reverse or reduce these risk factors (Sui, JAMA, 298, 2507-2516). So why isn’t there more education about the risks of obesity resulting in early death from the medical profession? I return to my previous question, after all, what doctor wants to tell a patient they are dying? And who would take a physician seriously if told that their weight “was killing them”? Obviously not many people as the epidemic continues. Read about U.S. Obesity Trends 1995-2007 at http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm It’s real.
Where you live prior to a hospital admission can make a difference in the result of your treatment and your return home. According to the “Hazards of Hospitalization”, research indicates that individuals admitted to the hospital from an assisted living facility were more than 16 times as likely to fall and 5 times more likely to experience functional decline that their community dwelling counterparts. The implications of this decline can be seen immediately as 75% of assisted living residents were discharged directly to nursing homes rather than back to their previous residence. (Source: The Gerontologist, Vol. 48, No. 4, P 537-541, website www.geron.org/journals/gerontologist.html). This research bears two important questions: 1) Do assisted living facilities have a responsibility to ensure residents receive appropriate, regular and ongoing medical care in order to avoid or prevent hospitalizations and 2) What responsibility remains on the part of the individual and the family to ensure that regular and appropriate medical care continues. Many believe once a move is made to a retirement-type community that the community bears the greater responsibility for individual care. Children are now relieved that their parents care is complete — NOT true. Many communities provide meals, housekeeping, laundry, medication reminding and other services. The responsibility remains with the individual and the family to ensure proper, regular and ongoing medical care. Want to make sure that you or your parents don’t end up in a nursing home? Don’t leave the responsibility of your medical care to someone else.
Is the health of nursing home residents compromised due to the fact that they live in a nursing home whether short or long term? Whether you know it or not, the moment you enter a nursing home you are under the care of physicians who provide services to the particular nursing home and who in most cases, know little about your medical history or ongoing care. This means that you lose control over your care – unless you take action to contact or involve your own private physician. Also know that you can make an appointment to see your own private physician at his or her office while in a care facility. If you’re worried about the level of care you’re receiving, take charge, it’s within your right to consult your own physician.
Further discussion regarding the quality of care in nursing homes indicates that staffing ratios, the number of nurses to patients etc. are the primary indicator of the quality of care. While it might be logical that more staffing is better, it is the quality of the staffing that is actually more important. Some care facilities hire “agency or temporary” staffing, these are staff that do not have relationships with residents and can be as much an obstacle because they are unfamiliar with care practices and coordination of information. This then takes a logical step toward the consideration that the stability of permanent staff is extremely important, as these employees are more likely to provide consistent care and have a greater concern for resident well-being. When interviewing nursing homes and care facilities ask about the tenure of staff; this will not only give you a good idea of how the organization treats their employees but how the employees treat their residents.
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