May 16, 2020
The 73rd Year
Day 58
The Covid-19 virus continues to kill seniors living in nursing homes almost three months after the first case and deaths were reported in a Washington State facility.
The Washington outbreak alerted Americans that the virus had swum ashore and was targeting our most vulnerable, percolating among seniors warehoused together in nursing homes. A Covid-19 surge was forecast!
The states scrambled to react, adding hospital beds, expanding ICU units and launching a world-wide, competitive scramble for ventilators and masks, gowns and other personal protective equipment.
The surge came in first New York City, New Orleans and urban New England. Many places are still surging. The scramble for PPE is ongoing. But there are enough hospital beds. And this begs the question:
“Why is anyone still dying in a nursing home? If a patient is sick enough, surely they should be sent to a hospital if there is any chance their life may be preserved. It makes me wonder if something nefarious has been exposed in the middle of this pandemic.
There are some understandable answers to my question. I am a senior and know what an advance directive is. For those who do not, an advance directive instructs medical professionals about how you would like end-of-life care to be administered. It is utilized when a patient is incapacitated. The ADF form specifically asks if a patient wants life to be extended with a ventilator and if so, for how long.
My advanced directive is sitting on a shelf, yet to be filed with the state. For the record, it says “tube me for a week” and if I am unresponsive send me on my way into the next life.
So this is part of the answer why seniors are still dying in nursing homes. Another partial explanation is that some nursing homes are quite capable of administering end of life care.They employ pallative care nurses who specialize in the last six months of life, These professionals, mostly nurse practitioners, are noble warriors fighting to protect and comfort the most vulnerable and precious lives among us. Another explanation is that some seniors were dying already from cancer or other conditions and the coronavirus simply made saving them impossible.
These don’t address all the nursing home deaths. There have been too many and there is no sign that they are abating.
The New York Times this week reported one third of all Covid-19 deaths across the country were in nursing homes. More than 28,000 residents and employees in 7,700 senior facilities have died from the coronavirus.
This by itself is a national tragedy. Surely many of these lives could have been saved. More than 90 percent of all patients who get the coronavirus survive. Most patients older than 80 survive. My wife’s aunt in Cambridge celebrated her 91st birthday yesterday after twice testing positive for Covid-19. Her symptoms were mild and she has recovered.
So senior lives can be saved and they are worth saving. I worry there are financial incentives to not transfer patients to a hospital. I worry that our for profit health care system is costing us lives.
If a nursing home sends a patient to a hospital it loses revenue. Margins are thin, revenue is badly needed. Also the virus has put a wall between seniors in nursing homes and their families. This makes it harder for families to demand accountability and a hospital transfer.
Also our health care system is designed to keep patients out of the hospital. They are the provider of last resort as inpatient care is the most expensive care.
The nursing home industry has convinced lawmakers in more than a dozen states to give them protection from lawsuits related to the coronavirus. They are lobbying for similar or greater protections everywhere.
These immunity protections are misguided. The coronavirus has exposed chronic problems that have long plagued the long term care industry. The threat of a lawsuit may well be the only way to protect patients and assure accountability in facilities that have been delivering shabby care for years
Our health care system and the underlying policy that drives it are not up to the task. We need major long term care reform in this country. The original Affordable Care Act included a section championed by former US Sen.Ted Kennedy-D-Massachusetts that would have overhauled the long term care system. But the program was never funded and that section of the law was not designed or implemented.
The largely for-profit long term care system is broken on both ends. First, many facilities are inadequate; they operate on razor thin margins; staff is poorly paid and regulation is sketchy.
Second most Americans cannot afford to access residential care. It is simply way too expensive. There is one simple path to residential care: declare personal bankruptcy and file for Medicaid.
Bankruptcy as a path to residential care is not public policy, it is a public embarrassment.
The White House, the Congress and the states should make long-term care reform a priority. It has always been the step-child of the larger health care reform debate. The argument has always been: first we’ll reform the overall system and in the future tackle long term care.
The future is upon us; it is time to pick up the long-term care ball and head for the goal line.
Finally, I have changed the header on each blog from “The Long Haul” to “The 73rd Year.” Yesterday was my 72nd birthday so a new title reflecting the journey forward seemed appropriate.
Be safe!
The 73rd Year
Day 58
The Covid-19 virus continues to kill seniors living in nursing homes almost three months after the first case and deaths were reported in a Washington State facility.
The Washington outbreak alerted Americans that the virus had swum ashore and was targeting our most vulnerable, percolating among seniors warehoused together in nursing homes. A Covid-19 surge was forecast!
The states scrambled to react, adding hospital beds, expanding ICU units and launching a world-wide, competitive scramble for ventilators and masks, gowns and other personal protective equipment.
The surge came in first New York City, New Orleans and urban New England. Many places are still surging. The scramble for PPE is ongoing. But there are enough hospital beds. And this begs the question:
“Why is anyone still dying in a nursing home? If a patient is sick enough, surely they should be sent to a hospital if there is any chance their life may be preserved. It makes me wonder if something nefarious has been exposed in the middle of this pandemic.
There are some understandable answers to my question. I am a senior and know what an advance directive is. For those who do not, an advance directive instructs medical professionals about how you would like end-of-life care to be administered. It is utilized when a patient is incapacitated. The ADF form specifically asks if a patient wants life to be extended with a ventilator and if so, for how long.
My advanced directive is sitting on a shelf, yet to be filed with the state. For the record, it says “tube me for a week” and if I am unresponsive send me on my way into the next life.
So this is part of the answer why seniors are still dying in nursing homes. Another partial explanation is that some nursing homes are quite capable of administering end of life care.They employ pallative care nurses who specialize in the last six months of life, These professionals, mostly nurse practitioners, are noble warriors fighting to protect and comfort the most vulnerable and precious lives among us. Another explanation is that some seniors were dying already from cancer or other conditions and the coronavirus simply made saving them impossible.
These don’t address all the nursing home deaths. There have been too many and there is no sign that they are abating.
The New York Times this week reported one third of all Covid-19 deaths across the country were in nursing homes. More than 28,000 residents and employees in 7,700 senior facilities have died from the coronavirus.
This by itself is a national tragedy. Surely many of these lives could have been saved. More than 90 percent of all patients who get the coronavirus survive. Most patients older than 80 survive. My wife’s aunt in Cambridge celebrated her 91st birthday yesterday after twice testing positive for Covid-19. Her symptoms were mild and she has recovered.
So senior lives can be saved and they are worth saving. I worry there are financial incentives to not transfer patients to a hospital. I worry that our for profit health care system is costing us lives.
If a nursing home sends a patient to a hospital it loses revenue. Margins are thin, revenue is badly needed. Also the virus has put a wall between seniors in nursing homes and their families. This makes it harder for families to demand accountability and a hospital transfer.
Also our health care system is designed to keep patients out of the hospital. They are the provider of last resort as inpatient care is the most expensive care.
The nursing home industry has convinced lawmakers in more than a dozen states to give them protection from lawsuits related to the coronavirus. They are lobbying for similar or greater protections everywhere.
These immunity protections are misguided. The coronavirus has exposed chronic problems that have long plagued the long term care industry. The threat of a lawsuit may well be the only way to protect patients and assure accountability in facilities that have been delivering shabby care for years
Our health care system and the underlying policy that drives it are not up to the task. We need major long term care reform in this country. The original Affordable Care Act included a section championed by former US Sen.Ted Kennedy-D-Massachusetts that would have overhauled the long term care system. But the program was never funded and that section of the law was not designed or implemented.
The largely for-profit long term care system is broken on both ends. First, many facilities are inadequate; they operate on razor thin margins; staff is poorly paid and regulation is sketchy.
Second most Americans cannot afford to access residential care. It is simply way too expensive. There is one simple path to residential care: declare personal bankruptcy and file for Medicaid.
Bankruptcy as a path to residential care is not public policy, it is a public embarrassment.
The White House, the Congress and the states should make long-term care reform a priority. It has always been the step-child of the larger health care reform debate. The argument has always been: first we’ll reform the overall system and in the future tackle long term care.
The future is upon us; it is time to pick up the long-term care ball and head for the goal line.
Finally, I have changed the header on each blog from “The Long Haul” to “The 73rd Year.” Yesterday was my 72nd birthday so a new title reflecting the journey forward seemed appropriate.
Be safe!
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