Tag: nursing homes

Bioethics Blogs

Whatever Happened to Long-Term Care Reform?

From the Trenches: A Prescription for Change

I have enjoyed looking at the pictures of protestors being arrested in our nation’s capital. I concur with many commentators who credit the civil disobedience of the protestors – many of whom are members of the disability rights activist group ADAPT – with the defeat of the Senate bill to abolish the Affordable Care Act. It’s also been fun because I know so many people in the photos.

The Affordable Care Act was a massive piece of legislation. The complexities and moving parts are best understood by people who have very closely followed or implemented the law. I generally think of the ACA as three things:

1. Reform of the private insurance market with the goal of providing greater access to insurance coverage;

2. Changes to Medicare, such as closing the prescription drug donut hole; and

3. Changes to Medicaid.

Mike Oxford, Executive Director for Policy at the Topeka Independent Living Resource Center and a member of the national chapter of ADAPT, was one of many who protested against the Senate bill to repeal the Affordable Care Act.

Community Services Optional?

The Medicaid issue that has drawn the most attention is the matter of expanding access, appropriately called “Medicaid expansion.” But the law contains other Medicaid provisions as well. It provides incentives for states to continue to “re-balance” their systems of providing long-term care. “Re-balance” is often mentioned in quotation marks because states were never in balance. Nonetheless, through the ACA, states were provided additional federal matching funds if they would transfer more long-term care to community services and away from institutions, such as nursing homes.

Bioethics Blogs

Whatever Happened to Long-Term Care Reform?

From the Trenches: A Prescription for Change

1. Reform of the private insurance market with the goal of providing greater access to insurance coverage;

2. Changes to Medicare, such as closing the prescription drug donut hole; and

3. Changes to Medicaid.

Community Services Optional?

Bioethics Blogs

Advance Care Planning and End of Life (ACPEL) Conference

The program for the 2017 Advance Care Planning and End of Life (ACPEL) Conference in Banff is now available.

Pre-Conference Sessions (Part 1)
Session 1: CRIO
1. How do people with disabilities perceive advance care planning – Robin Gray, University of Calgary

2. Differences in survey methodology of two Advance Care Planning survey polls conducted in Alberta, Canada – Sunita Ghosh, Alberta Health Services-CancerControl

3. Efficacy of Advance Care Planning and Goals of Care Designations Discussions: A Randomized Controlled Trial and Video Intervention – Maureen Douglas, University of Alberta

4. Identification of indicators to monitor successful implementation of Advance Care Planning policies: a modified Delphi study – Patricia Biondo, University of Calgary

5. The economics of advance care planning, Konrad Fassbender, University of Alberta; Covenant Health

Session 2: Health Care Consent, Advance Care Planning, and Goals of Care: The Challenge to Get It Right in Ontario

Health Care Consent, Advance Care Planning, and Goals of Care: The Challenge to Get It Right in Ontario – Tara Walton, Ontario Palliative Care Network Secretariat

Session 3: How to Invite Clinicians to Initiate ACP

1. How to Invite Clinicians to Initiate ACP to Residents, Patients, and Family Carers? – Luc Deliens

2. Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study – Aline De Vleminck, Free University of Brussels & Ghent University

Pre-Conference Sessions (Part 2)

Session 1: Faith Based Workshop

Inviting the voice of Spirituality within the conversation of Advanced Care Planning – Thomas Butler, Bon Secours Health System Inc.

Bioethics Blogs

Ethics, sexuality, and dementia in long-term care

Alisa Grigorovich and Pia Kontos suggest that long-term care residents with dementia can benefit from leisure and social activities that are supportive of sexual expression and the formation of intimate and romantic relationships.

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Recently, media stories on dementia have focused on the sexualities of persons living with dementia in residential long-term care settings, such as nursing homes. This media attention has been predominantly negative, consisting of descriptions of sexual violence, and apocalyptic warnings of the legal, ethical, and moral dangers of allowing persons with dementia to express their sexuality.

Often the primary criterion used to determine whether sexual encounters between residents with dementia are involuntary is the cognitive ability of the female resident. Frequently, she is characterized as globally incapable of agreeing to sexual activity because of cognitive impairment.

Consider, for example, the now infamous case of Henry Rayhons. He was accused (and ultimately acquitted) of sexually assaulting his wife who had dementia. As well, there is the lawsuit filed in a case involving two residents with dementia who had intercourse while living in Windmill Manor. While such stories highlight the importance of protecting vulnerable persons from sexual abuse, they ignore the need to also ensure that persons with dementia have opportunities to pursue intimate and romantic relationships.

Sexual expression is a universal human need that transcends age and disability. It has many positive health and wellness benefits, including the opportunity to experience pleasure, decreased pain sensitivity, and increased relaxation. However, older persons living in nursing homes often experience reduced sexual freedom.

Bioethics News

America’s Other Drug Problem

Every year nursing homes nationwide flush, burn or throw out tons of valuable prescription drugs. Iowa collects them and gives them to needy patients for free. Most other states don’t

Bioethics News

Sick, Dying and Raped in America’s Nursing Homes

February 22, 2017

(CNN) – The unthinkable is happening at facilities throughout the country: Vulnerable seniors are being raped and sexually abused by the very people paid to care for them. It’s impossible to know just how many victims are out there. But through an exclusive analysis of state and federal data and interviews with experts, regulators and the families of victims, CNN has found that this little-discussed issue is more widespread than anyone would imagine. Even more disturbing: In many cases, nursing homes and the government officials who oversee them are doing little — or nothing — to stop it.

Bioethics Blogs

Beyond the Destination LVAD

There are many forms of life sustaining treatment available
to patients thanks to advances in medical technology. When a person’s
physiology weakens or fails, devices may be attached or implanted to take over
for organs that can no longer bear the workload of processing, moving, or
taking in the elements needed to keep a body alive. Conceptually, this is
appealing to a society that is as averse to death as are those of us here in
the US. But we still struggle to accommodate the range of needs that crop up
when function is compromised. As an ethicist, the general trend in my work
suggests that the more advanced the technology, the more questions it raises
when it comes time to talk about halting the mechanical support. Among the more
advanced tools for sustaining physiological function is the Left Ventricular
Assist Device, or LVAD, which maintains the circulatory function for persons
with severe heart failure.

There is little doubt that individuals who are eligible for
the device can experience remarkable quality of life gains whether they move on
to receive a heart transplant or receive the implant as a destination
treatment. Recipients of LVADs can typically return to their daily activities,
and enjoy a level of independence not previously possible for persons with
otherwise lethal heart conditions. However, these patients are not just like
everyone else when complications arise. Decisions about how best to manage long
term care for persons who have LVADs can be unexpectedly complex, most notably
when the patient lives outside a major metropolitan city center.

Bioethics Blogs

Medicare Is Reducing the Cost of Knee Replacements (Here’s How That Could Backfire)

Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the United States doubled, to more than one million. Experts think the figure might rise sixfold more in the next couple decades, because of our aging population. Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. In response to this huge rise in expenditures, Medicare is experimenting with ways to reduce the cost of procedures. But that raises a disturbing possibility. If orthopedic surgeons make less money on each knee replacement they perform, they might start performing unnecessary procedures.

Consider Medicare’s recent experiments with reimbursing knee replacements according to “bundled payments.” Under such reimbursement, Medicare gives healthcare organizations a lump sum to cover the cost of a knee replacement–not just the cost of the operation but also the cost of post-operative x-rays, physical therapy, even time in nursing homes or rehab hospitals. Before bundled payment, providers would receive separate payments for each of these services, meaning inefficient providers might take more x-rays than necessary, or keep patients in rehab hospitals longer than they needed such comprehensive care, and be rewarded for this inefficiency by receiving additional payments. Under bundled payment, Medicare tracks all the knee-replacement costs for a given patient, over a 90-day period. If a patient incurs fewer expenses than expected, Medicare gives the providers part of these savings back as a reward. (Warning–this is a very oversimplified description of bundling.)

Early evidence suggests that bundled payments reduce the cost of knee replacements by an average of almost $1,200 per procedure.

Bioethics News

Angels of mercy

It appears that Canada has experienced a visitation from an “angel of mercy”, a media euphemism for a medical serial killer. Arrested this week, Elizabeth Wettlaufer allegedly killed eight patients in Ontario nursing homes since 2007. The Canadian media is describing her as one of Canada’s worst serial killers.

She faces stiff competition in other countries. In Italy, Daniela Poggiali, a nurse, was sentenced earlier this year over 13 deaths. In the US, Charles Cullen, a nurse. was sentenced in 2006 over the deaths of about 40 patients. In Germany Stephan Letter killed at least 29 patients in 2003 and 2004. And then there is Dr Harold Shipman, the quiet English doctor who killed 250 patients.

These horrors never seem to be mentioned when the legalization of euthanasia is being debated, but they should be. The existence of these mad “angels of mercy” demonstrates that some healthcare professionals feel compelled to kill the defenceless people entrusted to their care.

Legalisation creates a class of people who do the same thing but without the secrecy. In Belgium and the Netherlands, the bulk of the euthanasia business seems to be carried out by a handful of doctors. Some of them have killed scores of patients. What does that do to them? Why do they volunteer? Will there be more “angels of mercy” in jurisdictions where euthanasia is legal? These are all questions that need to be asked and answered.

Bioethics News

Where the Elderly Die Can Vary by Region, Study Shows

October 28, 2016

(The Wall Street Journal) – How much time people spend in hospitals or nursing homes in the final months of life, instead of at home, varies widely depending on where they live, new research shows. Across the Rockies and regions of the Gulf Coast, the dying spend more than two additional weeks hospitalized or in other facilities, on average, compared with those at the end of life in the Midwest and Montana, researchers reported Wednesday in the New England Journal of Medicine.