White House: Changes In Quality Of Care In NHs

Jo C.

https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/?emci=d8173310-de98-ec11-a507-281878b83d8a&emdi=6a962eed-e098-ec11-a507-281878b83d8a&ceid=4164101

Ed1937

That looks great! Let's hope it gets through Congress.

markus8174

I'm not sure I agree with many of the items in this proposal. Where are they going to get the staff to provide for their "minimum safe level"? The NH my wife is in struggles to keep her floor staffed, especially on the weekends. They have a constant turnover of licensed staff who find it more lucrative and less stressful to work as a cashier at a grocery store. I'm already paying an up-charge of $25/day for her to have a private room ($750/month + $300. Medicaid "share of cost" charge). If they have to raise wages and pay current staff more, I'd expect a further increase in my upcharge.  I'm afraid my DW will have to give up the room that has become her home if my costs continue to climb.

Most seriously I'm worried about people with Poli.Sci and Law degrees making decisions about what medicines would be helpful to a patient's sense of wellbeing. There is a lady on my DW's floor that is obviously terrified by any staff interaction. A shower or bath (even a bed bath) requires 2 or 3 staff members, and you can hear her screaming everywhere in the floor. This is good care?  A NH already loses brownie points if it places a person on antidepressants or a hypnotic sedative. Thanks to the massively restrictive regulations that poor lady has to live her final years in a constant of terror, not to mention the upset with other residents who hear the commotion and don't understand what's happening.  Let's not make it any worse for the staff who are trying to provide care. So many of these type regulations are poorly thought out and are sponsored by people who have no background in LTC or any health care. Our distinguished statesmen are regulating medical intervention by a licensed and experienced team of gerontologists, geri-psyc providers, and ID professionals.

Crushed

markus8174 wrote:

Most seriously I'm worried about people with Poli.Sci and Law degrees making decisions about what medicines would be helpful to a patient's sense of wellbeing.

Ive taught this precise area both in medicine and other areas for many years.  The critical issue is one of EVIDENCE 
Judicial decision makers are trained and experienced in weighing  the evidence and making decisions.  
The medical evidence itself has to come from subject matter experts.  

  

 These are not the same functions.  

 

markus8174

Crushed-

We don't often agree on some issues, but I respect the heck out of your background. I guess I fear we are more-and-more taking decisions out of the attending physicians' hands and forcing practitioners to follow arbitrary guidelines instead of their experience and judgment. Why have care provided by doctors at all? Surgeons will still need training, but medical management will just follow a flow-chart algorism that makes all the decisions. A unit clerk and a pharmacy tech can handle any patient. That will solve "tort reform" for malpractice issues. If the winning answer is "we followed the best practice guidelines" then there won't be medical malpractice.  I just see this type of thing growing at an exponential rate. I first became aware of it early in my career when the government decided we had to go to Electronic Medical Records! Never mind there was no software to do that, and no one was trained in this non-existent software. All it did (and still does) was muddy the patients record to where no caregiver had any idea what was changing and how it was being addressed. I see a doctor with whom I have a good rapport. I expect her to evaluate any problem and make decisions not purely based on what some federal guidelines say, but also on her own judgment and previous outcomes. Nursing homes can no longer do that to any real extent. I've been fighting for a week to get Tramadol (one daily) for my DW for her chronic headaches. These have been aggressively worked up, and the best guess is severe spinal stenosis in her c-spine. This would be 5MMEs/day (pain management doesn't even get worried until a patient breaks 50MMEs), but the rules for nursing homes (Medicare & Medicaid) say a patient can't have opioids for chronic pain except through hospice. Are they afraid my wheelchair bound, almost non-verbal, and completely disoriented wife is going to make a break for the nearest CVS and hold the pharmacist at gunpoint to get her "fix"? She was on 3x that dose at home but rarely used more than 5MME. I just don't want "evidence-based practice" to keep trumping skill and experienced based practice. Every time the government comes up with more "best practice" rules, the care of my DW and the other residents on the floor gets worse.