Health and Disability

Normal sundowning responds well to a multi-faceted approach which is easy to put into place and rewards consistency by working well.

First, the caregiver notes the time and format of the sundowning. For example, suppose Mildred gets restless and agitated each afternoon at about 3pm, becoming calm again at about 5pm — just in time for early dinner. Her sundowning involves weeping insistence on seeing her mother. She berates her caregiver, sometimes she paces.

How could a caregiver help Mildred?
1. Ensure that Mildred has an after-lunch snack and drinks juice and water about an hour before sundowning begins;
2. Calm the environment itself by diffusing pure essential oil of lavender throughout the afternoon. This is notably successful in care units, failing only because staff do not consistently use it. It is also effective to have either age-appropriate music or something very soothing playing.
3. Apply the care-plan made for Mildred to help her through sundowning. This could be Kleenex and family photos, being taken for a drive, watching a favorite dvd, redirection to making cookies — whatever works.
4. If Mildred can’t be calmed, redirected or bribed into something else, then sitting with her or walking with her while she vents her feelings is also fine.

I seek not to discuss in this post whether today's management cadre is capable of executing the business strategy of a system, as compared to a single hospital or physician group. While that is a topic worthy of discussion, my purpose today is to focus on broader issues.  In particular, let's explore the possibility that the growth of hospital networks can lead to such a reduction in competition that the result is one or more systems that are "too big to fail" in a given geographic area.  When firms reach this status in society, there can be dangerous ramifications.

It is important to note that the Settlement Agreement standards for Medicare coverage of skilled maintenance services apply now – while CMS works on policy revisions and its education campaign. The Center is hearing from beneficiaries who are still being denied Medicare coverage based on an Improvement Standard, but coverage should be available now for people who need skilled maintenance care and meet any other qualifying Medicare criteria. This is the law of the land – agreed to by the federal government and approved by the federal judge.  We encourage people to appeal should they be denied Medicare for skilled maintenance nursing or therapy because they are not improving.  

For people needing assistance with appeals, the Center for Medicare Advocacy has self-help materials available. This information can help individuals understand proper coverage rules and learn how to contest Medicare denials for outpatient, home health, or skilled nursing facility care.

Guided Care is a model of proactive, comprehensive health care that can help primary care practices transform into patient-centered medical homes. Guided Care focuses on improving care for patients with multiple chronic health conditions. Guided Care teams include a registered nurse, two to five physicians, and other members of the office staff who work together to perform home-based assessments, create an evidence-based care guide and action plan, monitor and coach the patient monthly, coordinate the efforts of all the patient's healthcare providers, smooth transitions between sites of care, promote patient self-management, educate and support family caregivers, and facilitate access to community resources.

The unit creates a homelike setting with uncluttered hallways and rooms and a peaceful quiet zone for patients and visitors. Everything from low-glare flooring and a warm color palette to a common dining area is designed to promote mobility and socialization, two cornerstones of recovery for the elderly patient. Simple activities such as enjoying the fresh air and sunshine on the unit’s patio can mitigate depression as does eating in a communal dining room. Improving mobility is high on the priority list as it makes it easier for a patient to return to their own home rather than a nursing home.

Surprisingly, the most common way to die after age 65 is to fall down, According to the American Association of Neurological Surgeons (AANS).

These metal on metal hip replacements have failed at a frighteningly high rate, requiring revision surgery at least 4 times as often standard hip replacements.  The public health disaster caused by this device has been nicely chronicled in a series of NY Times articles by Barry Meier.

But here is the real shocker and outrage of this episode:  Did you know that the metal and metal hip replacement was never shown to be safe and effective?

Is it really possible that a new hip replacement device could be used in thousands and thousands of patients with little proof that it is safe?  Even when the standard device has a proven track record?  Don't we have the FDA to protect us from stuff like this?  Unfortunately, yes, this was totally possible, and no, the FDA did not protect us.

There are 81 questions that are addressed in depth in the corresponding chapters.  Some of my favorite questions from the book include:

Symptom Management Section:

• How should patient-controlled analgesia be used in patients with serious illness and those experiencing post-op pain?
• Which opioids are safest and most effective in renal failure? 
• How should methadone be started and titrated in opioid-naïve and opioid-toerant patients? 
• When should corticosteroids be used to manage pain? 
• When should radiopharmaceuticals be considered for pain management? 
• What nonopioid treatments should be used to manage dyspnea associated with COPD? 
• What interventions are effective for relieving acute bowel obstruction in cancer and other conditions? 
• What treatments are effective for anxiety in patients with serious illness?

With the opening of a new outpatient clinic at its 270 Hoover Blvd. building, Hospice of Holland is the first area facility to offer non-hospice palliative care to its patients.

Palliative care, according to The Center to Advance Palliative Care, is a medical specialty that addresses pain, stress and other symptoms that come with a serious illness like cancer or organ failure.

Palliative care benefits those who are not yet ready for hospice care, but need relief from their difficult symptoms like pain, discomfort, nausea, shortness of breath or depression.

In response to a Freedom of Information Act request by ProPublica, the government has released unredacted write-ups of problems found during nursing home inspections around the country. We’re making them available today for anyone who wants to download the complete versions.

For several months now, ProPublica has made redacted versions of this same information available in an easily searchable format in our Nursing Home Inspect [1] tool. These versions, which reside on the U.S. Centers for Medicare and Medicaid Services website, Nursing Home Compare [2], sometimes blank out patients’ ages, medical conditions, dates and prescribed medications.