Among people over age 65, just four types of medications are responsible for 2/3 of all emergency hospitalizations. That’s right: 4 drugs = 67% of hospitalizations due to accidental overdoses or because the medication had a more powerful effect than intended. Wow.

According to an article in The New York Times, the drug classes are:

• Warfarin (also known as Coumadin) is a blood thinner. It accounts for a whopping 33% of emergency hospital visits.
• Insulin injections, which accounts for 14% of hospitalizations.
• Drugs that help prevent blood clotting. These drugs, which include aspirin and clopidogrel, account for about 13% of emergency visits.
• Diabetes drugs known as oral hypoglycemic agents, which account for 11% of hospitalizations.

Despite how common these drugs are, they can be difficult to use correctly—it is a very fine line between a good “effective dose” and a dangerous dose. According to Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention:

“We weren’t so surprised at the particular drugs that were involved,” Dr. Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”

The trick of these medications is that the doses have to be managed within a narrow range that leaves little room for error. For example, insulin is necessary for some people with diabetes, but taking just a little too much could cause insulin shock…and could even be fatal. The blood thinner warfarin is needed by some people to prevent the kinds of blood clots that can cause stroke or heart attacks—too little could cause a stroke…too much could result in uncontrolled bleeding.

“These are medicines that are critical,” Dr. Budnitz said, “but because they cause so many of these harms, it’s important that they’re managed appropriately.”

The bottom-line message is that if you or someone you love is taking one of these Risky Four, make your doctor and pharmacist your best friends. Make sure you totally understand how the drugs work, and how to recognize a potentially serious reaction.

For more information about drug injuries, visit our website at www.lawmed.com. If you have questions, HensonFuerst has answers.

Pain is pain, right? Not according to a new study by researchers from the University of North Carolina at Chapel Hill.

The study, published in the Annals of Emergency Medicine and reported in The New York Times, examined pain-related visits to Emergency Departments (ED) in the United States for 7 years. The goal was to compare the age of the patient, the reports of pain severity, and whether pain medication was prescribed.

The results were surprising:  Patients who were over age 75 were much less likely to receive pain-controlling medication compared with younger patients. In fact, compared with people ages 35-54, patients over age 75 were 20% less likely to receive any sort of analgesic (pain-reducer), and about 15% less likely to receive a more powerful opiod pain medication.

According to The New York Times, the researchers suggested that hospital personnel may be concerned about adverse effects of pain medications on the elderly…or may be less concerned with pain relief in the elderly, choosing to focus instead on diagnosis.

“There are side effects of pain medications,” said Dr. Timothy Platts-Mills, the lead author of the study and an assistant professor of medicine at the University of North Carolina, Chapel Hill. “But in almost all cases, you can provide some pain relief for older adults by selecting appropriate medications or reducing doses.”

Of course, that assumes that the medications that are given to the elderly are effective in controlling pain. In other studies, elderly  patients claim that they don’t receive the same care in hospitals as younger patients. We hope that the elderly don’t receive pain medications due to a excess of concern for their benefit, rather than because their reported pain is more easily dismissed.

To read the full article in The New York TImes, click here:  Disparities in the E.R.

To read a summary of the research, click here:  Annals of Emergency Medicine

In The New York Times, reporter Jane Gross wrote a fascinating opinion piece about Medicare. She calls it the “dirty little secret of health care in America”:  That while we assume that Medicare provides universal health care coverage for the elderly, what Medicare actually covers isn’t what recipients want or actually need.

With all the advances in medicine, much of the medical care provided to the elderly today are dangerous, pointless, and expensive. As Jane Gross writes:

Of course, some may actually want everything medical science has to offer. But overwhelmingly, I’ve concluded in a decade of studying America’s elderly, it is fee-for-service doctors and Big Pharma who stand to gain the most, and adult children, with too much emotion and too little information, driving those decisions.

Researchers have discovered that some “standard” treatments are both useless and harmful. For example, feeding tubes cause infections, nausea, vomiting, and agitation…but rarely prolong life. Frail elderly patients who have abdominal surgery, gall bladder surgery, or joint replacements, experience  complications…and often require placement in nursing homes.

Medicare pays for all those hazardous treatments. However, Medicare does not typically pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet. Ms. Gross continues her story:

In the case of my mother, who died at 88 in 2003, room and board in various assisted living communities, at $2,000 to $3,500 a month for seven years, was not paid for by Medicare. Yet neurosurgery, which I later learned was not expected to be effective in her case, was fully reimbursed, along with two weeks of in-patient care. Her stay of two years at a nursing home, at $14,000 a month (yes, $14,000) was also not paid for by Medicare. Nor were the additional home health aides she needed because of staffing issues. Or the electric wheelchair after strokes had paralyzed all but the finger that operated the joy stick. Or the gizmo with voice commands so she could tell the staff what she needed after her speech was gone.

She paid for the room. My brother and I paid for the private aides and bought her the chair and the “talking board.” What would her life have been like without the skilled care she required and the ability to get around her floor and communicate her needs? I shudder to think. But none of this was Medicare’s responsibility.

Yet Medicare would pay for “heroic” care for a woman who was dying of old age, not a disease that could be treated: Diagnostic tests. All manner of surgery. Expensive medications. Trips to the emergency room or the hospital — had she not refused all of them, in the last year of her life. So, in less than a decade, by my low-ball estimate, my mother spent $500,000 of her own money and uncalculated sums from her two children before winding up what she considered, with shame, “a welfare queen.”

Did you catch that last bit? Half a million dollars?

If you think that’s not in your parents’ future (or your own future), consider that 70 percent of the elderly will need extended care before they die. It would be enormously helpful if Medicare would pay for the care that older patients actually need.

That’s the dirty little secret. That while we count on Medicare to help us keep up with medical care in our golden years, what it actually does is pay for mostly pointless procedures. The actual care falls to families, until all resources are drained, relationships are strained, and adult children lose their retirement savings.

This article scared me. This is one secret that’s not good for anyone.

To read the full article in The New York Times, click here:  How Medicare Fails the Elderly

A disturbing article published in The New York Times reports that 92% of nursing homes employ one or more people who have been convicted of at least one crime…it amounts to 5% of all all nursing homes employees have had at least one criminal conviction. About half of nursing homes employ five or more people with at least one conviction.

While there is no federal law or regulation that specifically requires nursing homes to check criminal history records of prospective employees, it seems wrong that criminals are put in a position of intimate care of vulnerable individuals.

Senator Herb Kohl, Democrat of Wisconsin, who has investigated nursing homes as chairman of the Aging Committee, said: “The current system of background checks is haphazard, inconsistent and full of gaping holes in many states. Predators can easily evade detection during the hiring process, securing jobs that allow them to assault, abuse and steal from defenseless elders.”

It was suggested that nursing homes typically have difficulty recruiting and retaining employees, especially at the low-paying nurse’s aide level. Still, that is no reason to scoop from the bottom of the hiring barrel.

“Even some of the better nursing homes have problems with theft, rampant theft of residents’ clothing and personal possessions, including jewelry,” Dr. [Charlene] Harrington [professor at the School of Nursing of the University of California, San Francisco] said. “People convicted of crimes are often left alone with nursing home residents because the supervision of care is, in many homes, very inadequate.”

The new health care law offers $160 million to states to improve criminal background checks on prospective employees at nursing homes and other providers of long-term care.

HensonFuerst would welcome any change that would keep our valuable, yet vulnerable, senior citizens safer.

To read the full article in The New York Times, click here: Study Finds Criminal Pasts of Nursing Home Workers

To read more about nursing home abuse, please visit our website at http://www.lawmed.com/. If you have questions, HensonFuerst has answers.

The Department of Health and Human Services released a report titled “Questionable Billing by Skilled Nursing Facilities.” The title says it all… but we’re still going to comment.

In recent years, government analyses have discovered improprieties in the amount of Medicare dollars billed by–and paid to–to skilled nursing facilities (a general term that includes nursing homes and other long-term care facilities). We’d like to be clear that Medicare dollars are OUR dollars, yours and mine. Medicare dollars are paid from our tax dollars. So as you read the rest of this blog, keep in mind that this story is personal to everyone in the United States, regardless of whether or not you know anyone in a nursing home.

Here’s a summary of this very long, dry government report:

1. Within two years, from 2006 to 2008, skilled nursing facilities (from here on, I’ll simply refer to this as “facilities”) increased billing for the most expensive therapies by 11%…even though the ages and diagnoses of residents didn’t change. (Translation: Similar resident groups, with higher billing = facilities billed for unused  or unneeded expensive therapies.)
2. For-profit facilities were far more likely than not-for-profit facilities to bill for expensive therapies. AND, the facilities most likely to bill for higher-cost therapies were owned by large chains. (Question: Is this how “for-profits” make more profits?)
3. Some facilities were found to have a pattern of routinely billing Medicare for higher-cost therapies, and/or for having residents stay longer. (Translation: Some facilities routinely abuse the billing system…and now the government knows which ones they are.)

The recommendations to remedy the problems are for Medicare to monitor payments more closely…to change the current method for figuring out how much therapy is needed…to keep a closer eye on those facilities (especially the chains) that seem to have a bigger problem with unusual or “questionable” billing.

For more details without having to read the report itself, Paula Span wrote a really nice opinion piece in The New York Times. In it, Ms. Span says:

Families looking into nursing home care for their elders already have reason to be conscious of the distinctions between for-profit and nonprofit homes. For years, studies have found that nonprofits do better on some vital measurements.

“It’s consistent. The for-profits have the worst staffing ratios and poorer quality based on the number of deficiencies — violations of federal requirements — and the most serious deficiencies,” said Charlene Harrington, professor emeritus of social and behavioral sciences at the University of California, San Francisco, who has led a lot of that research.

In a new study, not yet published, Dr. Harrington also has found that of all forms of ownership, homes owned by the 10 largest chains fared worse than other for-profits. “These facilities are reporting the highest acuity levels” — meaning the most serious conditions for patients — “and the worst staffing,” she told me. “Facilities are supposed to increase their staffs when people are sicker.”

In addition, professor of health polity and management at Texas A&M Catherine Hawes notes that while there are some for-profit facilities that provide good care, in general these facilities have to spend more money making stockholders or owners happy (and possibly wealthy).

“If I had to rely on a single piece of information, deciding about a facility for myself or a loved one, I would choose based on ownership status,” [Dr. Hawes] said.

(Translation: The expert would choose the average not-for-profit facility over a for-profit facility.)

If you have any legal questions about long-term care facilities, check out our dedicated nursing home page: HensonFuerst Nursing Home Abuse and Neglect. If you have questions, HensonFuerst has answers.

If you’re old enough to remember Eurhythmics as the British New Wave duo of Annie Lennox and David A. Stewart (signature song: “Sweet Dreams [Are Made of This]“), then this is an article you may find particularly useful. For your parents, anyway.

A new scientific study found that senior citizens could reduce their risk of falls by taking classes in eurhythimics, a program of physical movements set to musical rhythms. The program was developed in the early 20th century by composer Emile Jaques-Dalcroze, and is now widely used in the fields of music, theater, dance, and physical therapy. After just 6 months of a weekly one-hour eurhythmics classes, participants reduced the risk of falls by 54 percent.

That’s an amazing result. Compare it the effects of Tai Chi for the reduction of falls: Tai Chi has been shown to be a great way to reduce falls, but Tai Chi only reduced falls by 37 percent. Amazing. And people seem to really like it–about 80 percent of study participants kept up with the classes. It’s hard to get 80 percent of any group to do anything, let alone go to exercise class regularly.

In addition to reducing the risk of falls, people who took the eurhythmics classes also had a more regular gait, had better overall balance, and could multitask while walking–so, for example, they could walk and hold a conversation at the same time. (Although the scientists don’t actually say this, it means that the participants could finally walk and chew gum at the same time.)

How can you (or your parents) take advantage of this research? Well, chances are we’ll see a bunch of new eurhythmics classes in the future. But for now, we’ll have to make do with general guidelines for exercising to music. According to an article in The New York Times:

The program, developed by the early-20th-century Swiss composer Émile Jaques-Dalcroze, teaches movement in time to music, from Mozart minuets to jazz improvisations. Participants have to walk and turn around, stay in step with changing tempos, learn to shift their weight and balance, handle objects while walking, and make exaggerated upper-body movements while walking.

Simple enough to do: Hook up your iPod, put in the ear buds, step outside, and walk to a random assortment of musical beats. It’s more fun that exercising in a gym, and way more fun than recovering from bruises or broken bones from a fall.

RESOURCES

To read the full article in The New York Times, click here: Unsteady on Your Feet? Try Moving to Music

The scientific article citation: A. Trombetti, M. Hars, et al. “Effect of Music-Based Multitask Training on Gait, Balance, and Fall Risk in Elderly People,” Archives of Internal Medicine. Published online November 22, 2010. (abstract page)

Elizabeth Goodyear, who died last month at age 103, loved chocolate, champagne, and books. She enjoyed all three daily, until she became blind. Then, she regained the joy of books thanks to the generosity of strangers. Those strangers became friends and surrogate family. Ms. Goodyear’s moving story was told earlier this month in The New York Times.

It all began about seven years ago, after Alison West, a yoga instructor who lives in Ms. Goodyear’s building, posted a sign in yoga studios downtown seeking readers and sent an e-mail that was forwarded again and again.

“Liz has no family at all, and all her old friends have died, but she remains eternally positive and cheerful and loves to have people come by to read to her or talk about life, politics, travel — or anything else,” the message read. “She also loves good chocolate!”

Young women in their 20s, many of them Ms. West’s students, started to visit.

During these visits, the women learned about Ms. Goodyear’s remarkable life, they read to her, and shared chocolate and champagne. They sustained her, and she became a friend to them all.

Ms. Goodyear was lucky enough to be able to spend all of her days in her own home, a feat even more remarkable when you consider that she had no children and no immediate family. Her young neighbors and readers became her family, and at the end, she left them a legacy of caring and a life well-lived.

We all should be so fortunate as to have the opportunity to visit with an elderly person desperate for love, and, later, to have caring people in our lives to visit with us.

To read the full article in The New York Times, click here: “As 103-Year-Old Dies, Her Reading Circle Mourns”

Aging isn’t always dignified. That’s especially true for people with dementia. Alzheimer’s disease dismantles a person’s life piece by piece: short-term memory is the first to go, followed by long-term memory, recognition of family members, recognition of self, all cognitive abilities. In addition, a person loses physical capabilities–the ability to walk, to talk, to balance, and even to eat.

Eventually, a person with dementia becomes totally dependent on the care of others. Because the medical needs are intensive, families are generally unable to provide adequate care and a loved one is placed in the hands of a long-term care facility.

We’d like to think that a nursing home that courts families of dementia patients would provide trained and compassionate care. Unfortunately, that’s not always true.

In a letter to the Chicago Tribune, Kim Warchol (of Dementia Care Specialists, Inc.) notes that nursing home residents can’t achieve their best lives unless nursing home staff are properly trained to provide safe, therapeutic care. She states:

“Based on my experience, between 60 to 80 percent of those living in geriatric nursing facilities have dementia, and well over 50 percent of those admitted to assisted living facilities have functional loss due to cognitive impairment. And with a new diagnosis being made every 70 seconds, long-term care facilities must empower their staff for the challenges ahead.” [Kim Warchol, letter to Chicago Tribune]

Her wish is that new laws be enacted to encourage facilities to move from an impairment-based practice to an abilities-based practice, which respects the person behind the disease. What a fantastic idea. Why does it have to even be mentioned as a “revolutionary” concept? It seems basic–dignity for all, but especially for those who lose everything else.

Feeding Dementia Patients with Dignity

A related article in the New York Times this week talks about the “revolutionary” concept of feeding dementia patients with dignity. After a person loses the ability to eat, the family typically is asked whether they would prefer to have a gastric feeding tube inserted so nourishment can be forced, or not…which is the equivalent of withholding nourishment. The decision is always heartbreaking.

But get this…some social workers are suggesting that there is a third option: to feed the patient carefully and slowly by hand, stopping when the person has enough, starts choking, or becomes agitated.

Doctors are calling this new option in palliative care “comfort feeding only.” In a recent paper in The Journal of the American Geriatrics Society, the authors argue that feeding tubes do not necessarily prolong life in patients with advanced dementia, and that surveys indicate that a vast majority of nursing home residents say they would rather die than live with a feeding tube.

“Just imagine someone interacting with the patient, talking to them, cueing them into eating,” Dr. Teno [Joan Teno, professor of community health at Brown University's medical school] said, “as opposed to someone walking to the bedside and pouring a bottle of Ensure down the feeding tube.” [from New York Times article]

Dignity…who knew it could be so revolutionary. At HensonFuerst, every day we fight for the basic dignities of people in nursing homes. We agree that special training should be required of everyone who treats dementia patients, but we would like to take that one step further. Let’s require compassion, caring, and, yes, dignity for our parents and grandparents when they live their days in a nursing home.

HensonFuerst Attorneys provide a voice for people in long-term care, and their families. If you have questions about how your loved one is being treated and suspect neglect or mistreatment, feel free to contact us. If you have questions, HensonFuerst has answers.

As part of their on-going series, the New York Times published an informative article about how to choose a good nursing home. Read the full article here: “Stressful but Vital: Picking a Nursing Home.”

If you have additional questions, please see the Nursing Home Abuse page on our website. At HensonFuerst, if you have questions, we have answers.

Long-term care policies are offered as a way to pay for a nursing home, assisted living, home health care and other costs associated with growing older.  This link will take HensonFuerst blog viewers to an informative New York Times article, which is part of an ongoing Times series, on long-term care options.

Click to read Walecia Konrad’s article in the June 26 New York Times.