Health and Disability

Olympia, WA – A group of advocates for Washington seniors and disabled citizens soon will ask the State Legislature to increase the amount of training that in-home caregivers receive. They say the current training standards are inadequate, and they also want training to be available to family members.

"Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs, the report says."

Wow.

3.5 billion dollars a year? I bet it's way more than that.

Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. The committee noted that these are likely underestimates.

Amazing. Almost 2 million a year.

I agree that the numbers likely represent gross underestimates. The problem, as I see it, is not preventable, nor fixable in the current fragmented environment of health care delivery. Breaking down the problem reveals so many in congruent variables that the current delivery of health care is wide open to errors.

I lost this link, so you'll have to trust me on this one:

As people age, the part of their brain that tells whether there is enough water intake begins to malfunction. The brain underestimates the amount of water intake required to prevent dehydration. Thus, the person is always close to dehydration.

The only practical answer is to double the intake of water during the day from the amount that seems right.

ALBANY—The New York State Department of Health has awarded $800,000 to 16 nursing homes to support implementation of an evidence-based best practice shown to significantly reduce pressure ulcers.

Known as “On-Time Quality Improvement for Long Term Care,” the approach to preventing pressure ulcers was developed by the federal Agency for Healthcare Research and Quality (AHRQ).

A pressure ulcer (also called a bedsore) is an area of skin that breaks down when a person stays in one position for too long, putting pressure on the same spot without shifting weight. They occur most often in people who are bedridden or in wheelchairs, even for a short time after surgery or an injury.

“The State Health Department is pleased to work with AHRQ and nursing homes across New York on this important effort to improve the health and well-being of nursing home residents in the state,” said State Health Commissioner Richard F. Daines, M.D. “In addition to creating pain and suffering, pressure ulcers can become infected, causing fever, confusion, weakness and even death. They are also very preventable, and costly to treat.”

Nursing home residents at highest risk for pressure ulcers are those in a coma and others who can’t move around or change position on their own. Among this high-risk population the incidence of pressure ulcers is 14 percent in the state (the U.S. average is 12 percent). Among low-risk patients in New York, the incidence is 2 percent (the same as the national average).

The “On-Time” program uses health information technology (HIT) to collect, analyze and promptly report back to staff the information they need to identify which nursing home residents are at risk for pressure ulcers and to track the results of their efforts to reduce risk. It has been implemented, tested and refined in more than 35 nursing homes across the nation and produced an average decrease of 33 percent in prevalence rates in the nursing homes that implemented the model.

Elderly nursing home residents receive relatively few cancer care services, including screening, surgical treatment, or hospice care.

Few studies have examined cancer treatment and care among elderly patients residing in nursing homes. Yet as the U.S. population ages, more people will move into nursing homes, many of whom will later be diagnosed with cancer. Cancer risk increases as people age.

Cathy Bradley, Ph.D., of the Virginia Commonwealth University Massey Cancer Center in Richmond and colleagues assessed the cancer care received by elderly nursing home residents who were insured by Medicaid. Using data from the Michigan Tumor Registry and Medicare records, they identified 1,907 nursing home residents diagnosed with cancer. They analyzed the patient data by cancer stage at diagnosis, type of cancer, survival time, and whether the patient received surgery or hospice care, as well as other variables.

Sixty-two percent of the nursing home residents with cancer had late or unstaged disease when they were diagnosed, and almost half died within three months of diagnosis. Among patients with late stage cancer, only 28 percent received hospice care. Patients aged 71 to 75 were three times more likely to have surgery than patients aged 86 and older.

Dec 24, 2007

Anyone reading this report will draw a sharp intake of breath at some of the appalling examples of restraint, in many cases involving people with dementia.

It is devastating to hear of vulnerable people not being treated with the dignity and respect they deserve.

CSCI's report is right to acknowledge that often there isn't simply one place to lay blame for this abuse, as it is partly a result of an overstretched and under resourced system.

It's all too easy to think that restraint is about belts and shackles. In fact restraint goes far wider: from the thousands of people with dementia being sedated by the inappropriate use of anti psychotic drugs to people being denied access to outdoor space because of a lack of staff in care homes.

Many of the horrendous stories of abuse in the report occurred because of care staff's lack of understanding and training in dementia care. Alzheimer's Society's recent Home from Home report echoed these experiences and we believe mandatory dementia training for staff in all care settings would begin to tackle the huge variation in dementia care.

This report makes tough reading for any involved in or using older people's care services. It should provide a wake up call that we can no longer leave people in the front line of care to cope alone without adequate resources; proper inspection and regulation; and specialist dementia training.

Notes

- The All Party Group in Dementia has announced an inquiry into the overuse of anti psychotic drug treatments in care homes.

- Alzheimer's Society spokespeople are available for comment.

- 700,000 people in the UK have a form of dementia, more than half have Alzheimer's disease. In less than 20 years nearly a million people will be living with dementia. This will soar to 1.7 million people by 2051. 1 in 6 people over 80 have dementia.

- The Alzheimer's Society is the leading care and research charity for people with all forms dementia and their carers. It provides information and education, support for carers, and quality day and home care. It funds medical and scientific research and campaigns for improved health and social services and greater public understanding of dementia.

- The Alzheimer's Society provides a national help line on 0845 3000 336 and website http://www.alzheimers.org.uk

BenefitsCheckUp(R), the nation's most comprehensive online benefits screening service for seniors with limited income and resources, served its two millionth senior as of this month.

Historically, no more than half of older Americans who are eligible for these needed programs ever apply for them. For example, 70 percent of those qualified for food stamps have not enrolled in the program and nearly half of those who qualify for supplemental security income (SSI) have not applied. Similarly, there are still as many as 4.2 million who have not enrolled in the extra help available through Medicare prescription drug coverage.

Developed and maintained by The National Council on Aging (NCOA), BenefitsCheckUp® enables seniors with limited income and resources as well as those who care for or serve them to screen for and in some cases apply for federal, state and local benefits programs.

BenefitsCheckUp® includes more than 1,550 public and private benefits programs from all 50 states and the District of Columbia. These programs include health care, prescription drug assistance, heating and energy assistance, legal services, housing assistance, property tax programs and nutrition programs, as well as volunteer and training opportunities and education programs.

Since its inception in 2001, BenefitsCheckUp® has helped two million seniors determine eligibility for these programs and has identified over $5.8 billion in public benefits...

See http://www.ncoa.org/content.cfm?sectionID=305

The number of nursing homes nationwide that were cited for placing residents in "immediate jeopardy" increased by 22% from 2000 to 2006, according to a USA Today analysis of CMS records. The citations are the most serious reprimand inspectors can issue and often follow cases in which residents have been physically or sexually abused or did not receive their medications, USA Today reports. Nursing homes that are cited for immediate jeopardy may be fined or prohibited from accepting new Medicaid beneficiaries, "a major source of their income," USA Today reports.

The analysis found that inspectors in 2006 identified nearly 2,000 violations that jeopardized residents at about 850 of the 16,000 nursing homes across the U.S. Those violations account for about 6% of total violations found in nursing homes. CMS records for 2007, which are incomplete, show that more than 1,300 immediate jeopardy citations have been issued.

As someone with a parent in a nursing home, I am very glad to learn that Hillary Clinton and Tom Harkin (D-IA) have introduced a bill "that would force a federal agency to make public its list of the nation's worst nursing homes."

The U.S. Centers for Medicare and Medicaid Services has compiled a list of 128 nursing homes that have repeatedly fallen in and out of compliance with government health and safety regulations and caused harm to their residents. Those so-called "special-focus facilities" are now subject to more frequent government inspections.

Two weeks ago, the agency released an abbreviated, public version of the list that identified only 52 of the facilities. The agency refused to release the full list of 128 homes, even though it had already provided the full list to nursing home association lobbyists at the American Health Care Association.