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I don't have any other agenda in this diary than making sure that this story does not go unnoticed.

"By ROBERT PEAR
Published: September 29, 2008

WASHINGTON — More than 90 percent of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes, federal investigators say in a report issued on Monday."

Please read this story:

http://www.nytimes.com/...

Perhaps this isn't the real purpose of a diary, but I just don't want this going unnoticed with all the financial turmoil focusing our attention. Excuse me if I've abused the system.

Originally posted to Don the swing voter on Mon Sep 29, 2008 at 02:20 PM PDT.

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Comment Preferences

  •  More proof that profits and health care are (2+ / 0-)
    Recommended by:
    Marie, mint julep

    a toxic combination. Thanks for bringing this to my attention. Now someone will tell you it isn't a diary.

    820 Illinois-427 Senate Sponsored-152 Senate authored. Obama record on Bills. Palin record 0-0-0. Palin Lies-1 big one and counting.

    by marketgeek on Mon Sep 29, 2008 at 02:27:31 PM PDT

  •  Part of the problem (2+ / 0-)
    Recommended by:
    mint julep, EAColeInEmporia

    is that JCAHO's standards are often weird and unrealistic.

    Many of the regulations are written up by bureaucrats who don't understand the underlying issues, or the situation.

    Most facilities waste a lot of time and energy conforming to rules and standards that don't actually promote safety or health, in an effort to conform to JCAHO's rules.

    I'd like to see JCAHO reformed as much as I would the facilities themselves.

    •  No fooling. Kafka comes to health care. (2+ / 0-)
      Recommended by:
      raines, mosesfreeman

      Here's the classic Catch-22 example:

      One of many performance measures for nursing homes is frequency of resident falls/injuries. I mean, how can you not care about poor old folks falling and breaking a hip, right?

      But it's nearly an impossible task. How do you prevent a frail, demented, confused 87 year old patient from falling? Especially when they're on three blood pressure meds with a side effect of orthostatic hypotension (meaning blood pressure drops when you stand up)?

      Well, you could restrain them (i.e. tie them down in bed), but this is cruel and potentially hazardous as patients have strangled on their restraints, so JCAHO guidelines place very stringent limitations on the practice.

      You could sedate them, but this actually increases the risk of falls as patients become tipsy from the meds.

      You could have a nursing aid at the bedside 24/7 to make sure the patient doesn't fall...but that would explode the per diem cost because the nursing home would have to hire scores of extra aids. Nursing homes are already under fierce cost pressures, so this is a non-starter.

      So what do you do? You do your best to settle and calm the confused elderly patients so they don't wander. Many homes use alarms that go off when the patient tries crawling out of bed at 3 am, hoping an overworked staff member can get to the bedside before the patient hits the floor. Some homes place matresses on the floor to limit the damage, though families tend to be horrified when they see this. For a few patients who repeatedly wander and fall, physical restraints become the only way to prevent a hip fracture.

      Of course, the nursing homes with the fewest resources and the sickest, frailest patients—generally public nursing homes with lots of Medicaid and little private pay resources—will have the worst outcomes. Hence they get pummelled by JCAHO and savaged by the press. Sort of like No Child Left Behind, where the poorest schools with the most disadvantaged students are financially punished for their misfortune.

      •  Thanks for your response. (1+ / 0-)
        Recommended by:
        raines

        This is one situation where I find that the market isn't working and government needs to step in. Allowing this in our society is a national disgrace. I don't care how much money it costs.

        Trying to make the libertarian Democrat a reality

        by Don the swing voter on Mon Sep 29, 2008 at 03:23:09 PM PDT

        [ Parent ]

        •  Well so far (0+ / 0-)

          the "help" provided by the government has caused a lot of waste and frustration without solving the underlying problems.

          The biggest problem I have with JCAHO is their "one size fits all" approach, and the attitude that they know best, in all cases. They say they are open to input from the rest of us, but in fact they aren't, as evidenced by the many hare-brained quandaries they put us in.

        •  "I don't care how much money it costs"? (0+ / 0-)

          Oh, but you do. Here's the thing: unlike every other civilized nation, America has done essentially nothing to provide for the care of frail elderly patients in nursing homes.

          Medicare explicitly does not pay one nickel for nursing home care after the first few weeks. Long term care insurance is obscenely expensive, and loaded with "Gotcha's" designed to permit the insurer to weasel out of paying. Meanwhile American society is uniquely 'mobile' and chaotic; most Germans (or Japanese, or French, or British, or...name your favorite European country) live and die in the same locale, surrounded by extended family. Millions of Americans end up living a thousand miles from their kids, and those kids are often working 80 hours a week holding down two jobs because of our non-existent "social safety net". So a very high percentage of Americans end up in nursing homes compared to any other industrialized nation.

          And because we have adamantly refused to plan on paying this care for the massive wave of aging boomers...it's one more massive financial burden about to be dumped on my childrens' generation. It will bankrupt the nation, even at the most parsimonious, mean-spirited level of care.

          It's gonna get really, really ugly. America before Social Security ugly.

      •  The restraints thing drives me berserk (0+ / 0-)

        In critical care, we use restraints only to prevent accidental, imminent death, yet JCAHO refuses to adequately understand the issue.

        The people who regulate us have only rarely worked in a critical care setting.

  •  Not surprised (1+ / 0-)
    Recommended by:
    mint julep

    Once you are involved in the nursing home system you learn a lot.
    It doesn't matter if you think you are paying for "quality care"
    best to be prepared to be involved 24/7.

    Thanks for posting.

  •  Not surprised! (0+ / 0-)

    Most nursing homes are chronically understaffed and/or have untrained staff.

    "In a time of universal deceit -- telling the truth is a revolutionary act."

    by mint julep on Mon Sep 29, 2008 at 02:49:12 PM PDT

  •  my mother-in-law (0+ / 0-)
    worked as a LPN in nursing homes for years.  The horror stories she used to tell me... oy.

    No matter how many times she changed jobs, it was always the same - the lunatics were running the asylum, basically.  In fact at one place in Connecticut - a nursing home that had some psych patients, I was never really sure when she was telling one of her stories whether she was talking about the patients or the staff.  

    Nursing homes are very bad places - across the board.

    'The votes are in, and we won.' - Jim Webb, 11/07/2006

    by lcork on Mon Sep 29, 2008 at 03:17:18 PM PDT

  •  Thank you for the comments. (0+ / 0-)

    I believe that this is a real disgrace in our society, and it is, quite frankly, being accepted. I'm glad that a few of you agree with me. Take care, Don

    Trying to make the libertarian Democrat a reality

    by Don the swing voter on Mon Sep 29, 2008 at 03:20:45 PM PDT

  •  I think we're seeing symptoms (0+ / 0-)

    of the massive imbalance/inequities in the health care system play out in this one corner.

    I also wonder about how much goes unreported, due to manipulations designed to protect the stats, oh so important for attracting patients and dollars.

    For instance, my mother in law clearly died last February at the extended-care facility, near her home. However, they transported her to the hospital where the declaration was made, perhaps to keep down the patients-dying-onsite number.

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