The Los Angeles Times and The New York Times reported on recent findings that states, by adopting an expansion in Medicaid coverage, could lower their death rate by up to six percent. The study by Harvard researchers found that when Medicaid was expanded to give more people health insurance less people delayed health care and, overall, less people died.  Sounds like common sense. The study was published in the New England Journal of Medicine.

This study reflects efforts by researchers to provide policy makers with the information needed to make informed, “evidence-based decisions” as they choose to accept the hundreds of billions of dollars the Affordable Care Act will provide or decline the federal funding and continue on with limited Medicaid eligibility.

Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation explains, “Actual mortality studies are few and far between. This is a well-done study: timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need.”

The study looked at data from three states; New York, Maine, and Arizona, who have expanded their coverage and compared them to similar neighboring states that have not expanded their coverage. The three states that expanded their coverage to include people that previously were uninsured, mainly low-income adults without children and without disabilities that otherwise would not be covered, saw an average of 2,840 fewer deaths for every 500,000 people that were added. “Policymakers should be aware that major changes in Medicaid, either expansions or reductions in coverage, may have significant effects on the health of vulnerable populations,” the authors of the study wrote in their conclusion.

 

A jury in Roanoke, Virginia has awarded 6.5 million dollars to a nursing home patient who fell from her bed. The man was at risk for falling out of bed and the nursing home failed to implement adequate preventative measures.  A nursing home is required to initiate all appropriate interventions to prevent falls.  According to published reports the plaintiff claimed that the fall was caused by the nursing home’s failure to apply and monitor a fall alarm in her bed. The plaintiff claimed almost $75,000.00 in medical and related expenses because of the injury. Prior to trial the nursing home did not make any offer to settle the case.  Bad bet by that insurance company.

 

Kaiser Health News had an article on the failure of doctors to provide recommended interventions for chronic health issues.  "Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new survey from the John A. Hartford Foundation."  Medicare pays doctors about three times their ordinary office visit rate for asking about older adults’ ability to function, evaluating their mood, recommending preventive services, and connecting them with community resources during wellness visits.

Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year.  More than two-thirds of the time doctors and nurses didn’t ask older patients whether they’d taken a tumble or provide advice about how to avoid tripping on carpets or slipping on the stairs.  62 percent of seniors said doctors and nurses hadn’t inquired about whether they were sad, depressed or anxious.

The results, which cover a period of 12 months, speak to doctors’ and nurses’ lack of training in geriatric medicine. Providers need to recognize that “care of an 80 year old differs from that of a 50 year old,” said Dr. Rosanne Leipzig, professor of geriatrics at the Mount Sinai School of Medicine in New York.

 

 

USA Today reported on one of the biggest successes of the Affordable Care Act–more than 2.65 million Medicare recipients have saved more than $1.5 billion on their prescriptions this year, a $569-per-person average, while premiums have remained stable.  The Department of Health and Human Services announced in August that 2012 Medicare prescription drug plan premiums would average about $30 a month, compared to $30.76 in 2011.

A provision in the health care law put a 50% discount on prescription drugs in the "doughnut hole," the gap between traditional and catastrophic coverage in the drug benefit, also known as Part D.   Seniors who reach the doughnut hole in prescription benefits receive a 50% discount on name brand prescription drugs. Drug companies must provide the discount to participate in the prescription plan. Before the health care law took effect, Medicare patients had to pay full price for their prescriptions once they reached the gap in coverage.

Also, more than 24 million people, or about half of those with traditional Medicare, have gone in for a free annual physical or other screening exam since the rules changed this year because of the health care law.  Preventive care should lower the cost of future care.

 

The Orange County Register had an article about the lawsuit filed on behalf of Oliver J. Shrock who was neglected at Kindred Healthcare Center of Orange.  The nursing home was fined $85,000 for their neglect and maltreatment.

Oliver J. Shrock’s death on July 18, 2009 – four days after he suffered a fall and fatal head injuries  was labeled by the state as an "AA" citation – the worst violation that the state can issue against a skilled nursing facility.  The state concluded that the center disregarded Shrock’s safety by not listening to the family’s warnings, and not implementing safety measures, such as the use of a bed alarm.

Shrock’s daughters, Kathleen S. Sakoguchi and Deborah Anne Whitman, sued the center and its former owner, Kentucky-based Kindred Healthcare Operating Inc.. Shrock’s family told the center that Shrock – who was dependent on staff for most needs – was at high risk for falls, according to the lawsuit.

He fell soon after arriving at the center, but wasn’t injured significantly. The center installed a bed alarm to help prevent future falls and placed mats on the floor to limit possible injuries.  But these measures weren’t always in place when Sakoguchi visited her father, and she repeatedly had to tell staff to attach the bed alarm. The fall that caused his death happened on July 14, when Shrock was preparing to go home.

"A nurse assistant discovered Shrock on the floor bleeding from his head and she did not know how long he had been lying on the floor,” according to the suit.  Shrock was taken to a hospital, and died four days later.

 

Chicoer.com reported the filing of a lawsuit against Windsor Chico Creek Care and Rehabilitation Center for negligence and the wrongful death of a Geraldine Pavcik.  Pavcik was admitted to the facility on June 17 for short term rehab after a minor back injury.

Because Pavcik was at risk of falling, her doctor had ordered bed-rail restraints, a lowered bed, an alarm system, and that she be closely attended to.   All are standard preventative measures available in most nursing homes but they depend on proper supervision and a quick response time to call bells and alarms which, of course, depends on adequate staffing.  Most residents fall because the nursing home chose to be understaffed and that leads to falls.

These measure were not in place on "multiple occasions" while Pavcik was in the nursing home.  On July 3, Pavcik was left unattended and without bed rails and a bed alarm.  At 7 a.m. that day, she fell out of bed, severly fracturing her left hip.  Although her hip was X-rayed at the facility at 2:45 p.m., she wasn’t transferred to an acute-care hospital until after 9 p.m.

Pavcik had surgery for her fractured hip, but the operation affected her mental condition, and she was no longer able to eat or drink effectively.   As a result, she contracted "aspiration pneumonia," a type of pneumonia that can develop in people who inhale liquid or bits of food. The woman died of respiratory failure as a result of pneumonia.

Among the accusations against the nursing home are that its administrators failed to hire enough staff to keep Pavcik safe, that her doctor’s orders were not followed, that she wasn’t transferred to an acute-care hospital when she needed to be, and that her doctor was not notified as her condition declined before she died.

 

We have numerous cases where a resident suffered horrible painful pressure ulcers because of the lack of preventative treatment.  The nursing homes always claim that the pressure ulcers were "unavoidable" due to the age of the resident.  A new comprehensive study disproves that claim.

This article discusses the purpose and success of preventing pressure ulcers from forming when nursing homes provide preventative care.

The Pressure Ulcer Collaborative project had been aiming for a 25 percent reduction in new occurrences of bedsores by encouraging health workers to use proven strategies to prevent skin deterioration.  Instead, the 150 hospitals, nursing homes and home health care agencies participating reduced new bedsores on average by just over 70 percent between September 2005 and May 2007.

Bedsores, technically known as pressure ulcers, are painful, occasionally deadly skin lesions caused by unrelieved pressure  that can cause infection and destroy tissue, muscle and bone if not properly treated.  They also can trigger depression, affect a patient’s self-image and complicate treatment.

At the beginning of the New Jersey project, 18 percent of newly admitted patients developed a bedsore while receiving care. By the end, the rate had been cut to 5 percent of new patients, Holmes said.

Holmes said the preventive steps started with a prompt evaluation of each new patient, with every square inch of their skin examined and their risk of developing bedsores determined based on a standardized scale.

Hospitals then had to follow strategies to prevent development of bedsores. Options included shifting the patient to a new position every two hours, use of heel cushions and other padding for vulnerable pressure points, even use of special air mattresses that alternately inflate and deflate different areas, spreading pressure around.

Patients not eating or drinking enough water _ a common problem with older patients _ got a nutritional consultation because inadequate caloric intake or protein stores, as well as dehydration, can lead to skin tearing and breaking down.  Frequent follow-up examinations of the skin also were required, along with new ones for patients suddenly bedridden, as after surgery.