Hospice Care

Society glorifies people who never give up. Their heroic struggles end in professional, financial or personal success. We’re told that quitters never win and we should go down fighting. Though that attitude is key to getting ahead during our lives, for many of us in Maryland we need to switch gears as we approach the end of our lives. The focus should be on the quality of life, not just on lengthening it, and that’s where hospice comes in. Hospice care provides medical services, emotional and spiritual support for those in the last stages of a serious illness, such as cancer or heart failure, with the goal of keeping a person comfortable and improving the quality of life. A critical, but often overlooked, part of hospice care is the support it also provides to family members who need to manage the practical details and emotional challenges of caring for a dying loved one. These programs offer services in a home, a hospice center, nursing homes, long-term care facilities or hospitals. We all need to make decisions about our medical treatment. For many people facing serious health threats that won’t be resolved with a happy ending, hospice care is a way to pivot from battling a condition or disease to living the best life possible for as long as possible. The goal isn’t a mathematical gain in weeks or months of a person’s life, but how well lived that remaining time can be. Depending on the person and his or her health conditions, hospice care for people who are terminally ill may actually give a better chance at a longer (and better) life compared to active treatment where patients are treated with potentially highly toxic drugs with serious side effects, while the person spends his or

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Sepsis in Nursing Homes

Sepsis is a potentially life-threatening complication of an infection. It can be a dangerous situation for anyone, but it’s especially grave to those who are older, disabled or have other medical conditions. It’s not unusual for Maryland nursing home residents to suffer from sepsis, often because the underlying infection isn’t treated properly, setting the stage for sepsis. Infections are a leading cause of deaths and complications for nursing home residents, according to the author of a 2014 study on infections in nursing homes, Carolyn Herzig, MS, project director of the Prevention of Nosocomial Infections & Cost Effectiveness in Nursing Homes (PNICE-NH) at the Columbia School of Nursing. With the exception of tuberculosis, researchers found a significant increase in infection rates “across the board.” Herzig stated, “Unless we can improve infection prevention and control in nursing homes, this problem is only going to get worse as the baby boomers age and people are able to live longer with increasingly complex, chronic diseases.” Herzig and researchers from Columbia Nursing and RAND Corporation reviewed how common infections were from 2006 to 2010 based on data that nursing homes provided the U.S. Centers for Medicare and Medicaid Services. Sepsis happens if chemicals released into the bloodstream to combat the infection also trigger inflammation throughout the body, according to the Mayo Clinic. This can cause a number of changes that can result in damage to multiple organs, ultimately causing them to fail. Sepsis can progress to septic shock, which can cause blood pressure to drop dramatically and may lead to death. Sepsis is most common and most dangerous in older adults or those with weakened immune systems. Treatment for sepsis in its early stage before it becomes more dangerous, normally with antibiotics and large amounts of intravenous fluids, improves the

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Maryland Sues Nursing Homes for Kicking Out Residents When the Medicare Payments Stop

It’s not often that a government entity sues a nursing home operator for how they treat their residents, which is why private lawsuits like the ones we file for our clients are usually the only way for residents and their families to try to obtain justice.  But one operator’s ongoing treatment of residents was so blatantly wrong that Maryland Attorney General Brian Frosh sued it in December. Neiswanger Management Services (NMS), which operates five nursing homes in the state, is accused of aggressively and illegally removing residents from its facilities to maximize payments it collects from public health plans. After being kicked out of their nursing homes, many residents were dropped off at homeless shelters or unlicensed and unsafe senior living facilities, according to the complaint filed in Montgomery County Circuit Court, reports the Washington Post. The company, based in Hyattsville, is alleged to be basing the treatment of residents on the reimbursement differences between federally funded Medicare and Medicaid, which uses state and federal money to pay for health care for low-income patients, including a large number of nursing home residents. NMS is accused of deciding who is treated and who leaves to maximize the number of residents with Medicare whose more than $500-a-day reimbursement is about twice what Medicaid pays. The complaint states patients were illegally discharged without their consent once their Medicare coverage ran out (normally 100 days after admission) and without the required planning to put them in a “safe and secure environment.” It’s estimated that there are about 700 residents in NMS’s Maryland nursing homes. Under the law, when NMS involuntarily discharges a resident it must give the person a notice, and the resident must have an opportunity to be heard and possibly fight the discharge. In nearly all such

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Future Care Nursing Homes

Future Care is a Pasadena-based, family-owned operator of 14 skilled nursing and rehabilitation facilities in Maryland. Its first one, in Pineview, opened in 1986, and the company now employs about 3,800 people. Future Care provides dialysis, short-stay rehabilitation, ventilator care and skilled nursing facilities. Their locations include: Canton Harbor in Baltimore Charles Village in Baltimore Cherrywood in Reisterstown Chesapeake in Arnold Cold Spring in Baltimore Courtland in Baltimore Good Samaritan in Baltimore Homewood in Baltimore Irvington in Baltimore Lochearn in Baltimore Northpoint in Baltimore Old Court in Baltimore Pineview in Clinton Sandtown in Baltimore. Eleven of the facilities are on Medicare’s Nursing Home Compare website. For most of them, their overall rating is “above average”; one is “much above average”; three are “average”; and one (Chesapeake in Arnold) is ranked as “below average.” The company’s website states its facilities are involved in a “Hospitalizations” campaign. Its reported goal is to “prevent our residents from the trauma and risks associated with hospitalization when an acute condition can safely be managed in the facility.” The benefits listed include the fact that residents avoid the hassle of a trip to the hospital while staff cares for residents on-site. While residents can face problems while being cared for in a hospital, there are conditions and situations which Future Care is not equipped to handle. Failure to transfer a resident because of a serious medical problem that gets worse in a nursing home can be a basis for a negligence lawsuit. One factor motivating Future Care may be the fact that they don’t receive payment for care if a resident is elsewhere, so there’s a financial incentive to keep ill residents in the facility as long as possible. Virtually any nursing home can be the scene of neglect or abuse.

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Nursing Home Residents Can Wander Into Trouble

A major problem for Maryland nursing homes, and for their residents, is when inhabitants wander and the physical and mental injuries that can result. If a resident is able to leave the premises or enter an area of the building that isn’t safe, it’s a sign the nursing home may be negligent; e.g., the resident isn’t being properly supervised or doors to the outside or to areas limited to employees aren’t locked or alarmed. These facilities have an obligation to keep residents safe. Residents who wander may do so because they have some form of dementia or psychiatric condition. They may not know where they are or feel a need to go outside. They might not understand staff instructions that they shouldn’t leave the building. Other residents may be mentally competent but feel bored, stressed, want to get outside or feel rebellious. Wandering can cause significant problems for the resident and anxiety and stress, if not panic, for family members. Falls are common for residents who wander because of fatigue, anxiety, balance or gait problems. Residents, especially those suffering some form of dementia, can get lost; even if a helpful stranger encounters them, they may not be able to tell their name or where they came from. Wandering carries high risks: Falling and suffering severe bruises, broken bones and head injuries. These injuries if not treated promptly could be very serious and potentially life-threatening. Going into an area of the nursing home where there are safety hazards, such as chemicals, fire hazards, tools and equipment that pose safety threats. Entering an area that is physically unsafe, such as stairwells, poorly lit areas, or parts of the building that may be undergoing repair or renovation or are under construction. Exploitation or harm if the wandering resident

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National Doctor’s Day

March 30th is designated as National Doctor’s Day, and it’s meant to bring attention to the role physicians play in our lives. They’re especially important to those living in Maryland’s nursing homes and assisted living facilities who need more attention because of their health conditions and age. There were about 209,000 practicing primary care physicians in the U.S. in 2010, according to research by the Agency for Healthcare Research and Quality. Primary care physicians are considered those working as family physicians and general practitioners, general internists, general pediatricians and geriatricians. Of the 624,434 physicians in the country who spend most of their time in direct patient care, slightly less than one-third are specialists in primary care. Every nursing home is required to have a medical director. Often, a nursing home also assigns a doctor to care for residents. Most work part-time and are contracted to do the work. One type of specialist is a geriatrician who works in a sub-specialty of internal medicine. It’s one of the few medical specialties in the country whose numbers are shrinking while the need for their services increases, ranking at the bottom of the specialties that internal medicine residents choose to pursue, according to the New York Times. A geriatrician is a physician who is certified in internal or family medicine and who has additional training in the care of older adults. They provide clinical care and are able to navigate the many psychological and social problems that often plague our aging population. Today there are about 7,000 geriatricians practicing in the country. The American Geriatrics Society estimates that to meet the demand of our future, older population, we will need at least 6,250 additional geriatricians between now and 2030, or about 450 more a year than the current

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Celebrate National Caregivers Day By Giving Them Some Care

February 17 is National Caregivers Day, a day to remember and honor all those who care for people who are too disabled by age, disease or physical condition to care for themselves. In addition to professionals (who are paid not nearly enough in most cases), there are the friends, family members and relatives across Maryland who make life livable for those truly in need. Caregivers are taken for granted by our society. They are critical to the care of millions of Americans; but often, because of the time and effort they spend on others, they need care themselves. Their finances and health suffer. They must juggle caring for family members and jobs, often neglecting their own needs in the process. Because of the aging of our population, this is a situation that’s going to be increasingly untenable for our country. An opinion piece in the New York Times, citing the AARP and the National Alliance for Caregiving, provides the following information: The average family caregiver is a 49-year-old woman caring for an older relative. Nearly a quarter of caregivers are millennials, and they are about equally split between men and women. About a third of caregivers work full-time, and one-fourth work part-time. One-third provide more than 21 hours of care per week. Family caregivers are usually unpaid, but the economic value of their work is estimated at about $470 billion a year — about what the U.S. spends on Medicaid each year. 60% of those caring for older family members state they have had to cut back the hours they work, take a leave of absence or make other career changes. Half report they’ve started work late or had to leave early because of their caregiving duties. About 20% report significant financial troubles. Family caregivers

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