by Kate Harrison and Todd South
Times Free Press
December 16, 2012
Details of an ongoing federal investigation into Life Care Centers of America reveal claims that elderly patients undergoing end-of-life care at several company facilities were pushed to high levels of unnecessary therapies so the company could bill maximum Medicare amounts for profit.
The examples in the federal complaint show a more personal side to the allegations of corporate-encouraged fraud that prosecutors have leveled against the Cleveland, Tenn.-based company.
One segment details the case of “Patient D,” a 92-year-old resident at a Life Care facility in Orlando, Fla., who was dying of melanoma in 2007. Though the cancer had spread to Patient D’s brain and lungs and radiation treatments had made him “medically fragile,” he still was administered two hours of therapy every day.
Two days before Patient D died, he was spitting out blood. Yet therapists recorded 48 minutes of physical therapy, 47 minutes of occupational therapy and 30 minutes of speech therapy in one day.
“The day Patient D died, Life Care therapists recorded 35 minutes of physical therapy and had him scheduled for occupational therapy later in the day,” court records state. More
by David Wahlberg
Wisconsin State Journal
December 10, 2012
When patients near the end of life, many doctors say there’s nothing more they can do.
But “there is so much we can do for people at the end of life,” said Dr. Jim Cleary, UW Health’s director of palliative care.
Doctors can provide pain relief, comfort care and guidance to families, Cleary said.
“For a physician to say, ‘There is nothing else I can do,’ is really, I think, a neglect of their physician duties.”
Cleary’s comments are from “Consider the Conversation: A Documentary on a Taboo Subject.” The 2011 film by two Wisconsin men has sparked an initiative to expand advance care planning around the state.
In the first phase of the effort, nurses, social workers and clergy at Madison’s health systems will begin offering discussions about end-of-life decisions to select groups of patients in March. Broader outreach is planned in 2014.
Instead of merely asking patients if they have living wills or health care power of attorney documents, hospitals and clinics will offer discussions about a variety of questions — from whether to resuscitate and ventilate to what kind of people, music and lighting patients want to be surrounded by when they approach death. More
by Steve Heilig
November 29, 2012
Nobody gets out of here alive, as somebody said — we all eventually die. But we don’t like to talk about that, even with our doctors. And as the New York Times just editorialized, some politicians like it that way and have done what they can to keep us ignorant of our choices and to keep our doctors ignorant of what we desire toward our ends. Remember those nonexistent “death panels,” a figment of politicized paranoia? The sad and maybe even lethal irony here is that, as with so-called “pro-life’ activism about reproduction, such politicization most likely has the opposite effect of what’s intended — more suffering and less control over our own lives.
There’s a better way, and some people and even states are moving forward, despite some lingering opposition by political opportunists, certain religious “leaders,” and the like. As noted by the Times:
Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.
One of the advances the Times recommends is a relatively new tool called POLST — Physician Orders for Life-Sustaining Treatment. It’s another type of medical/legal “advance directive” that can give you, and your loved ones, more input in how you are treated — or not treated — when gravely ill, even if you can no longer express your wishes. Doctors often recommend it too, once they learn about it, and there is a concerted effort to spread awareness about POLST around the nation. It can allow you and your — or any — doctor to act in according to your preferences for medical care as you are dying. More
by Kristen McConnell
The Brooklyn Rail
November 16, 2012
Last year I graduated from nursing school and began working in a specialized intensive care unit in a large academic hospital. During an orientation class a nurse who has worked on the unit for six years gave a presentation on the various kinds of strokes. Noting the difference between supratentorial and infratentorial strokes—the former being more survivable and the latter having a more severe effect on the body’s basic functions such as breathing—she said that if she were going to have a stroke, she knew which type she would prefer: “I would want to have an infratentorial stroke. Because I don’t even want to make it to the hospital.”
She wasn’t kidding, and after a couple months of work, I understood why. I also understood the nurses who voice their advocacy of natural death—and their fear of ending up like some of our patients—in regular discussions of plans for DNRtattoos. For example: “I am going to tattoo DO NOT RESUSCITATE across my chest. No, across my face, because they won’t take my gown off. I am going to tattoo DO NOT INTUBATE above my lip.”
Another nurse says that instead of DNR, she’s going to be DNA, Do Not Admit. We know that such plainly stated wishes would never be honored. Medical personnel are bound by legal documents and orders, and the DNR tattoo is mostly a very dark joke. But the oldest nurse on my unit has instructed her children never to call 911 for her, and readily discusses her suicide pact with her husband. You will not find a group less in favor of automatically aggressive, invasive medical care than intensive care nurses, because we see the pointless suffering it often causes in patients and families. Intensive care is at best a temporary detour during which a patient’s instability is monitored, analyzed, and corrected, but it is at worst a high tech torture chamber, a taste of hell during a person’s last days on earth. More
by Jean Vaneps
Duluth News Tribune
November 8, 2012
How would you like to star in your own reality show?
In applying the concept of “reality” to healthcare costs, some stark truths need to be realized by all U.S. citizens to avoid an inevitable crash. The challenge to all of us as consumers is to honestly examine our health habits and to take personal responsibility in being part of the solution to our country’s healthcare crisis.
There is one thing all of us can do, and it’s painless, proactive and will not call for any diet plan, smoking-cessation plan or payment plan. It is taking the time to complete an Advance Healthcare Directive (or just Advance Directive). The potential healthcare cost savings are staggering, but
70 percent of Americans do not have an Advance Directive, according to the Centers for Disease Control.
According to federal Medicare statistics, end-of-life care provided in 2010 accounted for more than 25 percent of total annual spending. Reasons for this include aggressive treatment that was not necessary or was not desired by the patient. Advanced medical technology has brought increases in life spans, despite chronic diseases. U.S. studies show that in areas where increased Advance Directives exist, health-care costs are reduced and patient satisfaction is high. More