The relationship between Medicare funding/reimbursement patterns and nursing home operational expenses has always been a factor in long term care delivery — often taking the brunt of state Medicaid systems’ lapses in payments to facilities for healthcare services. That relationship just became a little more tenuous. Faced with looming cuts courtesy of Medicare adjustments that call for at least a $15B drop in long term care funding over the next 10 years, skilled nursing facilities could see more urgent staff layoffs and outright closure. For example, some facilities in Connecticut were forced to shut doors when proposed state Medicaid payment increases promised by lawmakers there fell by the wayside — presumptively because of recession influenced budgetary issues.
Could long term care delivery to the nation’s rapidly increasing elderly population (last year, nursing homes housed almost 1.9M elderly and disabled residents — an increase of around 4% over the previous year) be getting short shrift in the entire healthcare debate? It would certainly appear so — setting up a perfect storm of deep federal and state cuts and sharp increases in geriatric patient care needs. | LINK
Recently, the murder of a nursing home resident in Minnesota made headlines when a peer, a locally famous wrestler in his younger days, became agitated and assaulted the resident, breaking his hip — an injury which led to the victim’s death. The aggressor, a patient with longstanding Alzheimer dementia, was not charged with a crime because of his diagnosis. While this episode highlights the issues patients with dementia may pose to other nursing home residents with respect to the potentially violent behavior that characterizes the condition, it does not address the other etiology of such behavior in long term care settings.
With increasingly tight budgets and even tighter staffing standards, many group homes and traditional boarding facilities for the functionally mentally ill in this country are forced to cease operations, transferring patients to nontraditional settings such as nursing homes. Adult mentally ill patients in society needing skilled nursing in settings other than nursing homes are being forced into those new environments and facing similarly violent fates; as a consequence, criminal charges usually follow. Staff and elderly patients are increasingly the vulnerable ones. | LINK
Sunday § February 22, 2009
Nursing homes (NH) and — by extension — long term care, have always been the also-rans in discussions related to the delivery of healthcare in this country. Generally, healthcare and the potential profits of third parties render policy considerations on anything but acute hospital care, ambulatory care, and drug and medical device patents as essentially insignificant. However, as we approach the end of the first decade of the 21st century, the rules of the game are about to change, if they haven’t already.
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Saturday § January 17, 2009
Certain Minnesota home care agencies which accept payments from Medicare and Medicaid for services rendered are not taking a recent national survey lightly. Recent CMS quality assurance parameters[] place this state just above three others in overall “quality”.[] Only Texas, Wyoming — and surprisingly Vermont — scored lower in 30 specific areas. An organization which represents these CMS-certified home health agencies has hired an East Coast consultant to jack up the state’s rankings within the next two years. Gotta love that Minnesota defiance and tenacity. | LINK | OASIS Parameters LINK
What should I do as a physician rounding on one of my many patients on my nursing home service with dementia, complicated by the fact that they are also are suffering from some of its effects on mood? While institutionalized skilled care remains the standard for these patients who are not able to care for themselves, the agitation and delusional thinking suffered by many patients with dementia syndromes puts a new wrinkle on the next level of care — other drugs which carry a certain risk of mortality.
Anti-psychotic drugs commonly used to treat Alzheimer’s disease may double a patient’s chance of dying within a few years, suggests a new study that adds to concerns already known about such medications. [...] Ballard and colleagues followed 165 patients aged 67 to 100 years with moderate to severe Alzheimer’s disease from 2001 to 2004 in Britain. Half continued taking their anti-psychotic drugs, which included Risperdal, Thorazine and Stelazine. The other half got placebos. Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia
In this country, the risk associated with both the newer and older agents essentially requires physicians to frankly discuss risks and benefits with the patient’s family, principal decision makers, and other stakeholders in their care prior to using. For some, the use of these medications (which primarily are used in the mentally ill) represent the only option in dementia with extreme mood and behavioral instability. For others, options are myriad and should be sought. | LINK
Monday § December 29, 2008
The reports of sexual abuse in nursing homes which two recent cases catalyzed the issue into the national spotlight is a mixed blessing. For years incidence of these cases was rare, simply because of the stigma involved among all parties. Over the past 10 years, however, it has been brought squarely into the spotlight, undoubtedly the result of massive paradigm shifts in patient advocacy and Boomer generational values — as the latter group represents a potentially affected age demographic. The recent cases of bizarre abuse of nursing home residents in southern Minnesota at the hands of female staff illustrate how atypical this issue is, and how atypical the need to contain such episodes needs to be. | LINK
