Health and Disability

The Government Accountability Office published a study in July of 2011, reviewing complaints that for-profit nursing homes provided poor quality care. Many of these claims focused on the growing trend of private investment (PI) firms purchasing large nursing home chains with a focus on monetary output instead of quality of care.

The study compared these PI held homes with other for-profit and nonprofit homes. Results supported other research findings that higher rates of serious deficiencies were present in PI held homes. PI homes also reported lower nurse staff ratios.

The Health Services study corroborates these reports, finding top for-profit nursing homes provide "lower staffing and higher deficiencies than government facilities." The level of nursing staff is repeatedly linked to "quality of care, affecting such measures as the number of resident pressure ulcers, resident functional status, mortality rates and number of regulation violations."

Lower labor costs are used to increase profit. These nursing chains are debt financed and pressured by shareholders and investors to turn a profit, fueling the growing endemic of poor-quality care for the elderly. Specifically, the top ten for-profit homes received 36 percent higher deficiency citations and 41 percent higher serious deficiencies. These deficiencies are issued whenever a facility violates regulations that can lead to injury.

Jane Gross recommends these ten organizations as invaluable set of resources for caregivers. Find her full list of recommendations in her book A Bittersweet Season.

A new study from Karolinska Institutet and Umeå University shows that non-pharmacological caregiving at the end of life in specialized palliative care is not as basic as one might believe but is based on complex professional decisions that weave physical, psychosocial and existential dimensions into a functional whole. The researchers have found that particularly important aspects of palliative care are an aesthetically pleasing, safe and comfortable environment, bodily care and contact from another person and dying-related rituals

RM: Why should a remodeler consider doing universal design work?

RD: Customers have an increased appreciation and awareness of the benefits of universal design and the way they can be rendered. When the remodeler starts to mention [universal design], he’ll get a more receptive reaction than he would have before [the concept was more widely recognized]. Also, the economics of the construction industry lately have shown that remodeling has survived the downturn so there is an opportunity now that may not be present in a few years to take advantage of that. People are doing remodeling jobs instead of buying new homes. Finally, on an individual basis, you have the opportunity to take advantage of these trends over other remodelers who aren’t as savvy.

RM: It would seem that the biggest market for this type of project is the baby boomers. Is there a bit of denial from this particular demographic?

RD: There is and that’s why the care in marketing and sales has to be present. We’ve seen lots of folks do good work but market it badly. For all their good intentions, they’re not aware of just how much pushback there is. The stuff that resonates most doesn’t include these reminders [of aging in place]. People still fear growing old, but we all maintain this convenient fiction that it’s the other guys who are aging. You need to acknowledge that but you don’t need to hit people in the face with it. You need to emphasize the non-aging things. Talk about the convenience and ease-of-use. Show them that this stuff can still look sexy, interesting, and fun. With increased use of technology and whole-house systems, those can also be serving universal design goals at the same time. Have the sexy, fun aspects of technology now knowing that later on it can be useful for other purposes.

The HearMeFeelMe project, a collaborative effort by VTT, TopTunniste (Finland) Tecnalia (Spain) and Demokritos (Greece), introduced five different applications for acquiring medical information, all of them based on NFC technology (Near Field Communication). By touching the info code on the packaging with his or her mobile phone, the user downloads product and dosage information which can be heard on a phone or computer. End users participating in the project represented the Finnish Federation of the Visually Impaired (FFVI), the Caritas Foundation, Joutsen Pharmacy 6 in Oulu and SSI, a Spanish provider of geriatric services.

Speech tagging application finds most favour

The testers' favourite was Top Tunniste's Touch 'n' Tag demo, a mobile phone application that enables visually impaired users to identify everyday items, including food, with the help of voice memos. The phone must be equipped with an NFC reader. To record a memo tag, the user touches the NFC label on the packaging and dictates the information into the phone. The recording can then be listened to by touching the label again with the phone. The test run indicated that the application was most commonly used to mark food packaging. According to the majority of users, it was useful in recognising items and recalling product information. Additional benefit was seen in the possibility of recording the desired information in the user's own words.

We are getting there. If only I had NFC on my phone!

We have created a free guide to aging in place design principles.  It is a basic set of practices that we think are important to consider when designing a home for a life time of use.

You can receive this free guide by just clicking here. 

The demographic picture of the homeless has shifted markedly over the last 20 years, with a marked increase in the average age of homeless persons. Currently, nearly 1/3 of the homeless are over the age 0f 50.

A remarkable study paints a concerning portrait of the struggles faced by the aging homeless. It was led by Geriatrician Rebecca Brown who conducted the study while a Geriatrics Fellow at Harvard Medical School. Dr. Brown is currently our colleague in the UCSF Geriatrics Division. The senior author was Harvard Senior Life Geriatrician, Dr. Susan Mitchell. The study was published in the Journal Of General Internal Medicine.

Ken Covinsky previously posted on GeriPal a while back about the dangers of hospitalization in older adults.   Ken notes in that post that hospitalization is a vulnerable period leading to major new disability for many older adults.  More recently, Ken, GeriPal contributor Bree Johnston, and honorary GeriPal member Edgar Pierluissi authored a terrific article about hospital-associated disability in one of those pre-blogging era, old-fashioned periodicals...JAMA.

I'm not going to be able to sum up this meaty piece of scholarship in this post.  Let me say only that if you care for hospitalized older adults, and can only read one article that changes for the better how you care for them, this would be that article.   Let me relay some of the disruptive perspectives offered:

Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.

The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve this care. When put to their best use, quality indicators can improve care.

However, a recent commentary in JAMA from our UCSF colleagues, Geriatricians Sei Lee and Louise Walter raise serious concerns about unintended harms from quality indicators. Lee and Walter make a compelling arguement that quality indicators, when used indiscriminantly, can actually harm the quality of care provided to the older persons. This is particularly true for the most frail and vulnerable elders.

Aging men and women are the most rapidly growing group in US prisons, and prison officials are hard-pressed to provide them appropriate housing and medical care, Human Rights Watch said in a report released today. Because of their higher rates of illness and impairments, older prisoners incur medical costs that are three to nine times as high as those for younger prisoners.

The 104-page report, “Old Behind Bars: The Aging Prison Population in the United States,” includes new data Human Rights Watch developed from a variety of federal and state sources that document dramatic increases in the number of older US prisoners.