Health Care Thoughts: Re-admissions, Resident Rights and Pie
by Tom aka Rusty Rustbelt
Health Care Thoughts: Re-admissions, Resident Rights and Pie
A follow up to a post on evidence based medicine….
PPACA is putting extreme pressure on hospitals to reduce Medicare re-admissions.
Hospitals are putting increasing pressure on nursing home to reduce re-admissions, particularly due to diabetes.
Nursing homes are under constant pressure to respect “resident rights” including the right of residents to eat just about whatever they want, including piles of junk food provided by families of diabetics.
Nursing home nurses are under extreme pressure to 1) respect resident rights, 2) maintain blood sugar levels at the same time, and 3) document all of this at an extreme level.
Mrs. Rustbelt and a couple of other nurses may be in trouble for denying pie to a really, really sick diabetic (both legs amputated) who regularly sends his blood sugar readings north of 400.
The fans of increased regulation should think through some of the conflicts and consequences.
(My thoughts in comments…Rdan)
Good news update, Mrs. R is not in trouble, but continues to battle in the junk food versus blood sugar wars.
STR:
Hmmm, I believe the readmission policy is the result of hospital mistakes; in which case, the hospital would have to suck the fees up. This part of the ACA was force the issue on hospital and doctoring mistakes which are relatively high.
Your point on the junk food being prevalent in our lives has merit. How many junk food restaurants do you need in a 1 square mile area?
“Mrs. Rustbelt and a couple of other nurses may be in trouble for denying pie to a really, really sick diabetic (both legs amputated) who regularly sends his blood sugar readings north of 400.”
Perhaps this person does not want to live and wants to rush his inevitable kidney failure or whatever. Also, Mrs. R. should not be held responsible or feel responsible. I personally think if the only way such a person can achieve some semblance of a quality of life is to gouge on sweets, let them and let them die. It is their choice, not Mrs. R’s or Obamacare’s.
STR, this is not meant as a criticism. It is just that I feel that since we do not have easy euthanasia options for such people, we don’t have the right to chose for them what makes their life tolerable.
On the other side, many folks when they feel the end is near cease eating, does this mean criticism for not force feeding these folks from the powers that be? Perhaps the solution is some type of record of the patients decision, so that the patients actions are not held against the physician.
If food provides him pleasure does the medical community have to play scrooge?
Anna and Lyle
I have to agree.
C.S.Lewis wrote a novel (not to everyone’s taste) in which a guillotined man’s head is hooked up to an artificial blood supply and he is kept “alive”… forever?
maybe this will be what our keepers will do for us.
Keeping people alive is probably too expensive to do unless ROI to providers is sufficient as both cultural and choices change. Currently there is a lot of money that seems expensive to the system except to the interests who receive it, who I suspect would move on if it changes.
Nursing homes are a class of service under extreme pressure from private insurance as well in MA. (I am nly familiar with greater Boston).
A bigger problem surfacing is the staffing patterns for aides and nurses at the major hospitals that affect ‘care’, and probably some sort of systemic influence to be “in network’ provider.
I have watched three friend/acquaintances go through serious medical events in differing networks, and level of response was shocking when contrasted with the world class “excellence” reputation.
Staffing for the floors (3 differing events and hospitals) were odd combinations of 12 hr., 8 hr. and 4 hr. shifts, aides were essentially unavailable to help to teach family how to help or perform help even with basics such as bathroom, or ie oral fluid intake every 15 minutes, or say regular nebulizer treatment, doctors were in short supply unless you had your own from outside, scheduling OR time was not timely and in two cases resulted in injury, serious infection (“non emergency” appendectomy which finally burst for one example between the MRI and actual operation 16 hrs later…world class hospital) etc.
Aside from individuals being to blame, my guess from watching patterns this is a growing problem.
Anna Lee:
Problem is, Mrs. R and her facility are subject to a dizzying number of possible civil and criminal sanctions from the feds (CMS) the state health surveyors, the state nursing board, the state pharmacy board, the state AG, and etc. etc.
See other entries below.
Based on an internal audit of medical records, Mrs. R was to have signed her name and put her initials in little boxes about 1200 times in one month, for 17 work days.
Good news, Mrs. R was about 98.5% compliant.
Bad news, the state and feds view that not only as negligent, but could consider billings based on her work as intentional fraud.
Whether she is an excellent nurse or not is irrelevant.
So once a month she goes through thousands of pages of records and makes certain she is as close to 100% as possible.
I just purchased a new set of text and commentary on nursing home enforcement.
Counting sample forms, it added up to 1100 pages.
And this is just the fed CMS regulations.
Rusty
I agree that “regulation” is out of control. On the other hand, I still remember what “no regulation” leads to.
Any thoughts on making it better?
Anon:
My theory is that ten clear regulations well enforced are better than 100 regulations not well enforced.
And I do realize that the government has pressures from lots of directions and that writing regs is difficult.
However, nursing home regs have gone from bizarre to insane, and we are hiring (wasting) nurses to summarize paperwork of other nurses.
Rusty
i agree.
problem is how to fix it.