by Tyra Phipps, Ed.D. (tyra.phipps@gmail.com)
Dr. Lucian Leape, a Surgeon and Adjunct Professor of health policy at the Harvard School of Public Health said, “The United States is the only country in the world that has a business based healthcare system, everybody from the drug and insurance companies to the hospitals and medical device makers is in it for the buck. That’s fundamentally antithetical to the public good.” When addressing the rise in medical mistakes, Dr. Leape further clarified what he describes as the 19th century United States medical culture where the doctor is the head of everything and breeds a culture of disrespect. “Getting doctors to take responsibility for their peers is part of the professional code. We just haven’t done it.” This information comes from Error epidemic: What every patient needs to know about medical mistakes, by Mr. Jay MacDonald.
The author of the article began by writing, “Our healthcare system is killing us” (April, 2015).
Mr. David Grubin in the documentary film PBS RX The Quiet Revolution explains that there is a new breed of healthcare providers. People are calling doctors to put down the computers and just listen. He covered an alternative to nursing homes located in San Francisco where people live with dignity when they make it to their 80s or 90s. In contrast to the information in the first paragraph, this filmmaker claims there is a quiet revolution in medicine. There is patient centered care with physicians, physician assistants, and nurses. There is a movement back to the 1950s where the patient has a personal relationship with the physician and that provides hope for the patient. There is in fact, optimism and hope even though the health care debate involves a lot of pessimism. To give more optimism to the healthcare situation, Mr. Grudin cites the recent report that 65,000 people in Alaska are satisfied with healthcare!
How can this disparity exist? Why does it exist? Dr. Jana Brown, Audiologist explained in an interview during April, 2015 that all of our problems in healthcare are insurance company driven. Insurance companies only want money. She talked about how much of her time is spent with paperwork to conduct a hearing test for someone with a minimal or significant hearing loss. Even a screening test requires paperwork documenting every single medicine that the patient is taking whether prescribed or not. Without that paperwork, every insurance claim is rejected. That page is just for starters, because there is much more documentation necessary to complete the medical interview. Dr. Brown works in Western Maryland and is very well respected by physicians and patients alike. She stated emphatically, “I get so upset over this. Insurance companies dictate everything!”
What does this mean for families struggling with the issue of long-term care and the aging population in need of more healthcare? Dr. Travis Shipp is a retired Professor in Adult Education from Indiana University in Bloomington, Indiana. He and his family had the personal experience of placing their father in a nursing home. His observations point to a bigger set of problems beginning with the staffing of nursing homes.
“Nursing home workers--they have no power in negotiating for wages. They are fragmented and the managers are in the catbird seat offering minimal wages because the workers have not gotten organized and established job duties, job standards, or how to negotiate as a member of a powerful organization. The management sets the standards as low as practical in their market. Low standards mean minimal training, minimal training means poor job performance. Poor job performance means low wages and no job security. All of that keeps labor costs down. Long-term care homes are in competition with each other and with organizational homes (run by unions, churches, and other not for profit groups). Many homes try to become not for profit. Success in doing so depends on a lot of things that bring ethics and law into play. It's fairly difficult to get that status. Therefore, long-term care facilities have to protect their profits as best they can and show losses. That's why some homes cut corners on food and employees. It is a lose -- lose situation.”
There is a change for the healthcare worker as reported on Sound Medicine, March 29, 2015.
A Guided Care Nurse Center is dealing with complex chronic conditions for the patient. Overwhelmed doctors and short office visits do not provide an opportunity to talk about one condition or problem in a ten or fifteen minute appointment schedule. Mostly older people acquire chronic conditions, but there is a younger smaller group with AIDS, chronic kidney failure, or multiple sclerosis. There is a necessity to manage these types of patients. About 80% of Medicare money is spent on people with multiple conditions. There is a need to have an understanding of the relationship of Medicare to the office visit and practice. Providing better quality and value gives better outcomes and Medicare pays a higher rate. That is where the Guided Care Nurse plays a valuable role in working with one patient, but multiple physicians. It is not uncommon for people in long-term care to have multiple conditions with multiple physicians prescribing medicine. That crossover leaves a resident or family member in a state of confusion. Furthermore, it takes up valuable nursing aide time reporting reactions to medicine, overmedicated states, and calling family members for help or advice about what to do for the resident.
A personal story from Mr. David Cravey March 23, 2015 gives a reality check. “So many procedural errors yesterday at the hospital during my wife’s stress test makes me wonder about the soundness of future medical care. I have worked in hospice for years and been to the hospital with many patients. I know how the system is supposed to work. Even when there are no major mistakes, just a poor work ethic on the part of techs and doctors scares me. The nurses are always the ones to carry the day. I hope they keep the battle going.”
Another personal story from Mr. Wade Benson points to similar problems in long-term care and healthcare. On March 24, 2015, Mr. Benson talked about the mixed experiences of the last three years with his mother’s long-term care. “She is 95 years old and in her second long-term care facility which is brand-new and half the cost of the first one. That was a facility connected and owned by the major hospital and urgent care facilities in a county of about 150,000. The new one was built in the last two years by a banker who wanted to be sure his parents had a good place to live. My mother has been happy there, but as of last night, she is in the hospital, diagnosed with pneumonia. She's in north Georgia. The new facility is called Tranquility of Dalton, Georgia. Mother and I had a good talk on Wednesday, and she has been remarkably capable of talking over family history, whether old or new, and has enjoyed a good local community support. My father never experienced extended care and died at age 88. Both of my parents were teachers and librarians. This new place really is quite positive and my mother even had the final decision on making the move. She is eating and interacting well and that’s how it should be when you get to be 95!”
Is finding a banker, who can build a long-term care facility and make sure it is financially stable with caring personnel the only answer for enjoying the later years in life when there is a decline in physical, and/or mental states? Location and the right place with an attitude of, “We appreciate the privilege of caring for those most in need of our care at a most difficult time of their lives.” That observation was written by Mr. Frank A. Calamari, President and CEO of Calvary Hospital located in the Bronx, New York. This is a hospital dedicated to hospice and palliative care where the emphasis is not on suffering and death, but a sense of hope, gratitude and joy for life. The Board of Directors, Administration, Nursing Medicine, support staff and volunteers are proud to make our patients and their families as physically, spiritually, and emotionally comfortable as possible. The goal at this facility is to help people find peace in dying. Despite the anguish of the final stages of cancer and a withering body, the staff remain positive and caring day after day. The success of the hospital in large part is attributed to Mr. Calamari.
Whether it was a banker who wanted a nice place for his mother or the CEO of a large nonprofit hospital, there are good places for long-term care. There are not nearly enough long-term care facilities with good people helping those who need assistance. Another harsh reality follows as written by Dr. Travis Shipp, April 10, 2015.
“This is what I was able to glean about long-term care from an employee at the State Health Department, a nursing home chaplain, and an attorney who represents homes in court. I heard some horror stories that caused me to shiver. Homes can hire damn near anybody they want as long as they finish the mandatory training, do not have a violent felony conviction, are not currently incarcerated, and can demonstrate normal social skills. This is a very low bar to pass. Anyone with a room temperature who can get through an interview without drooling can be hired. The turnover is horrible, with some places in a prosperous area at a 100 or more percent turnover per year. This means the home operates short staffed most of the time, personnel directors get jaded and just want to keep a good warm body to resident ratio thereby satisfying state regulations. Unless they find an employee misbehaving, workers can get away with almost anything. I wish I had some good news but the main saving grace is that many employees try very hard to make life a little better for the residents. You cannot go make people to be truly kind, that comes from within. Now that I know all of this stuff, I am really worried. People need good, competent care. Yet, everyone is subject to the random chance of whomever and whatever will take care of them. No one in a compromised state should have to worry about all of these things.”
Reverend William Carpenter, a retired Methodist minister is one of those chaplains who visited long-term care facilities for more than thirty years. He wrote, “Caregivers and the baby boomer population are all moving toward stages in life where we are going to need various levels of care. The broader public and legislatures need to show a sensitivity and gained awareness of what is taking place and how needs can be met by institutions and government for the betterment of all.”
Mr. Scott Simon, a journalist with NPR commented in an interview, “We don’t really grow up until we lose our parents.” The name of his book is Unforgettable. He describes the last days of communication with his mother when she was in intensive care. It has been said by more than one person that the loss of the last parent is the most difficult. The state of grieving is paralyzing, but Mr. Simon wanted to share his story and help other people going through the same process. For many people, the memories and last days with our parents may be horrific. Battling cancer, open-heart surgeries, or sudden death of a parent leaves a silence that is deafening. Finding the right hospital, long-term care facility, or hospice where family members may enjoy the end of their lives and depart the earth in a peaceful way is a very tedious investigation. The abundance of situations that are Lose -- Lose reach the media on a daily basis. Then again, there is the story of a banker who was determined to build a good place for his parents and opened a facility called Tranquility.
Mr. David Berry of College Confidential and a writer says that he will never retire. “So many people are at the mercy of Long-Term Care incompetence. The words we use to make a change are like a sword that slashes at the dragon of indifference and cruelty that prowls the halls of many places where our elderly reside. I hope our baby boomer generation takes up this cause.”
Father Michael Coutts of St. Basil’s Church at the University of St. Michael’s College in Toronto, Canada said on March 28, 2015, “It is easier to do what is practical rather than what is right.” He spoke of how easy it is to just walk away from people who are laying in a nursing home beds and do nothing to help them when they are in total care because it is practical. His voice was passionate when he asked why people do not do what is right and care of others during the times of their lives when they need the most help.
WIN --WIN
Fast forward to Setember, 2023, there is now a mandate from the White House to increase staffing levels and ensure that residents receive a minimum of 3 hours of care. This also includes an RN on staff at all times in every one of the 15,000 nursing homes in America. The president said in a USA Today opinion piece, “We are working to make sure no nursing home can sacrifice the safety of their residents just to add some dollars to their bottom line.”
Also, Biden promised the mandate in his 2022 State of the Union. "As Wall Street firms take over more nursing homes, quality in those homes has gone down and costs have gone up," "That ends on my watch." He then added "Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect."
The Secretary of Health and Human Serves, Xavier Becerra, stated, "It's been the wild, wild west when it comes to quality and accountability at nursing homes throughout the country. What we're simply saying is we don't want [the] wild, wild west where we send our loved ones." "It's a big change in the sense that the industry hasn't had to follow particular standards." CMS would work with private sector partners to invest over $75 million in financial incentives to hold them accountable.
April, 2015
September, 2023