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Nursing Homes. The bodies are just pilling up.

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30 minutes ago, signet said:

You nurses who say that these seniors have lived too long, because they've been propped up by modern medicine. How about those vaccines and pediatrician visits you got as a child. A hundred years ago, you may have died in childhood, did medicine prop YOU up? How about the chances you're getting because of school. You can put all those initials after your name. That's because of all the people who came before you and helped pave the way. Those are the same ones who you say have outlived their usefulness and deserve to die. Adolf would be proud of you. Wait until you get a few years past your prime. Things will look different. 

Thank you for better expressing my own reaction. It is a Faustian Bargain at best to be willing to sacrifice your seniors along with other institutionalized populations prisons to psych wards and effectively anyone 39 and over who has so much as hypertension or asthma.

The worst part is they don't even have anything like evidence to accompany the bellows and petulant insistance that we must do this right now to "save" the economy. How will it "save" the economy and return them to their happy pre-pandemic days by spreading disease to even more people before more places have even peaked whiole overrunning and collapsing the health care industry and disabling or killing doctors and nurses? All as a terrified public looks on and completely loses faith in the government or going out at all. And how does opening tatoo parlors and beauty salons in Georgia create a rebounding economy when the large industries which actually employ a lot of people at high wages who pay a lot of taxes in Atlanta are down?

It's like nobody has even bothered to think about what happens if they're wrong.

Edited by HeartlandRN

toomuchbaloney

Has 43 years experience.

Uh...lots of people have thought about what happens if they are wrong, HeartlandRN. Important people who should be listened to have cautioned that what happens if they are wrong is not in any way helpful.

25 minutes ago, toomuchbaloney said:

Uh...lots of people have thought about what happens if they are wrong, HeartlandRN. Important people who should be listened to have cautioned that what happens if they are wrong is not in any way helpful.

Agreed. I was referring to the defenders of the caravans of mouth breathers who have descended on state halls and city centers across the country to call the Governors who have been working tirelessly to save lives "Nazis" and otherwise do the bidding of the wealthy demagogues and organizers who remain safely at home in their gated communities.

Edited by HeartlandRN

toomuchbaloney

Has 43 years experience.

3 minutes ago, HeartlandRN said:

Agreed. I was referring to the caravans of mouth breathers who have descended on state halls and city centers across the country to call the Governors who have been working tirelessly to save lives "Nazis" and otherwise do the bidding of their wealthy far right culture war leaders - who remain safely secure in the gated communities and vacation homes of course.

Wink*

I knew you knew. It was like a basketball play...or hockey... an assist.

LOL

Edited by toomuchbaloney

Just now, toomuchbaloney said:

Wink*

I knew you knew. It was like a basketball play...or hockey.

LOL

Hey, just so long as you got a smile out of it. We can all use them in these times.

Daisy4RN

Specializes in Travel, Home Health, Med-Surg. Has 20 years experience.

1 hour ago, signet said:

You nurses who say that these seniors have lived too long, because they've been propped up by modern medicine. How about those vaccines and pediatrician visits you got as a child. A hundred years ago, you may have died in childhood, did medicine prop YOU up? How about the chances you're getting because of school. You can put all those initials after your name. That's because of all the people who came before you and helped pave the way. Those are the same ones who you say have outlived their usefulness and deserve to die. Adolf would be proud of you. Wait until you get a few years past your prime. Things will look different.

I dont think anyone said these elderly deserve to die or advocated for their untimely demise. When people are kept alive artificially or not allowed to die a natural peaceful death (near the end/activity dying) it is more likely than not causing that person trauma and physical pain (for instance tube feeding someone when the GI tract is already shutting down). Our society has become one of do everything possible to keep them alive. Many people (understandably) want this not understanding the physiology of the dying process. This is why I thought that the end of life care mandated by Obamacare was a good thing because most MD's will just do whatever the families want at the expense of the patient. This is a general concept not just related to covid. Nursing homes are a difficult place because of the close proximity and poor staffing among other things which in part is why there are so many deaths. Of course our elderly and younger patient who live there deserve better!

12 minutes ago, Daisy4RN said:

I dont think anyone said these elderly deserve to die or advocated for their untimely demise. When people are kept alive artificially or not allowed to die a natural peaceful death (near the end/activity dying) it is more likely than not causing that person trauma and physical pain (for instance tube feeding someone when the GI tract is already shutting down). Our society has become one of do everything possible to keep them alive. Many people (understandably) want this not understanding the physiology of the dying process. This is why I thought that the end of life care mandated by Obamacare was a good thing because most MD's will just do whatever the families want at the expense of the patient. This is a general concept not just related to covid. Nursing homes are a difficult place because of the close proximity and poor staffing among other things which in part is why there are so many deaths. Of course our elderly and younger patient who live there deserve better! 

actually they most certainly have throughout this thread with one person ever referring to them as just being stored until they passed, as if they were an inconvenient societal nuisance. another person implied only the elderly in institutions with family were worth bothering with, etc ad nauseum.

2. Please point to the code in the Affordable Care Act (aka "ObamaCare") with a citation to the actual Affordable Care Act itself, not some rightwing crackpot opinion piece, tto support it mandating end of life as you just claimed.

I've worked on the ACO and plan side analytics of the ACA for over 8 years and I've never seen anything like that and best I know it's still guided by Advanced Directives, living wills and POA.

Edited by HeartlandRN

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

On 4/22/2020 at 6:48 AM, HeartlandRN said:

Either they are ALL senior citizens at a different point in the natural life cycle , as we're taught in nursing curriculum or they are not. That is independent of whether or not they have family.

My take is they are NOT stored. They are NOT furniture and they are NOT expendable because Jimmie Jack wants to go get his hair cut.

Have you been in a nursing home lately? I don't agree with it, and I don't think it is anything but heartbreaking, but reality is many are their and nobody but the facility staff cares for them. Not all, but many. Acknowledging the reality is not agreeing that it is right in any way.

Edited by CrunchRN

Daisy4RN

Specializes in Travel, Home Health, Med-Surg. Has 20 years experience.

10 hours ago, HeartlandRN said:

actually they most certainly have throughout this thread with one person ever referring to them as just being stored until they passed, as if they were an inconvenient societal nuisance. another person implied only the elderly in institutions with family were worth bothering with, etc ad nauseum.

2. Please point to the code in the Affordable Care Act (aka "ObamaCare") with a citation to the actual Affordable Care Act itself, not some rightwing crackpot opinion piece, tto support it mandating end of life as you just claimed.

I've worked on the ACO and plan side analytics of the ACA for over 8 years and I've never seen anything like that and best I know it's still guided by Advanced Directives, living wills and POA.

Someone not using appropriate language is not the same as saying the "deserve to die" which is what the PP stated.

The facility I worked at had an inservice about that part of Obamacare so if you are right then I guess somebody there dropped the ball (not a big surprise for that place). Either way it did get the Docs talking more to patients and families which was a good thing because IMO people deserve dignity at their end of life and this provided that as well as a more peaceful natural painfree (as much as possible) death when there were no good alternatives (meaning going to ICU etc just to prolong the process a little longer which would have been traumatic) and no good outcome expected.

Emergent, RN

Specializes in ER. Has 28 years experience.

I don't think allowing people to die a natural death is at all equivalent to Adolf Hitler's mass murder of millions. That is a ridiculous comparison.

People should be allowed to have a different philosophy on when medical intervention is too much without being called a Nazi.

11 hours ago, Daisy4RN said:

When people are kept alive artificially or not allowed to die a natural peaceful death (near the end/activity dying) it is more likely than not causing that person trauma and physical pain (for instance tube feeding someone when the GI tract is already shutting down). Our society has become one of do everything possible to keep them alive. Many people (understandably) want this not understanding the physiology of the dying process. This is why I thought that the end of life care mandated by Obamacare was a good thing because most MD's will just do whatever the families want at the expense of the patient. This is a general concept not just related to covid. Nursing homes are a difficult place because of the close proximity and poor staffing among other things which in part is why there are so many deaths. Of course our elderly and younger patient who live there deserve better!

I agree with you that coverage for the "hard conversation" about what a patient would really want should things get bad is a good thing.

For example, my grandmother had her Living Will, and it included a DNR portion. She felt she had lived a long good life, and wanted to keep living it as long as she could, but when it was her time to go, she accepted that it would be her time. Passed not in the nursing home but the hospital (they xfered her for increased coughing, she had congestive heart failure) -- massive MI in the middle of the night. (The nurse with her said she had been resting comfortably, then suddenly said "I've never hurt like this before..." and the monitors started going nuts & she lost consciousnes.)

She'd already stated her wishes, so they followed the DNR.

But if the wishes aren't stated, or if families are in pain and want to delay their own grief by extreme measures, doctors are forced to do that -- to try to save a life, even if it's futile.

They will even treat over the objections of a not-quite-there pt -- they have to, if they judge that the person is not truly capable of refusing treatment. When my father collapsed from high calcium and hadn't worn his DNR bracelet, the hospital couldn't confirm his living will/DNR (he was in end-stage AIDS), and they had to treat him until they were able to contact me. I advocated for the treatment he wanted, and we got him into hospice... but he fought the workers trying to save his life so hard, begging then to "just let (him) die", that they ended up sedating him.

I think Advance Directives help a great deal, both for patients to determine while they are still in fairly good health what they would want, and so families know if their relative would want every treatment possible or would just want supportive/comfort care instead of a ventilator.

And knowing a pt would refuse a vent would probably make a doctor feel better psychologically, as well as nursing staff, when they know that a vent going to be is close to futile and they have to deliver that news.

11 hours ago, HeartlandRN said:

2. Please point to the code in the Affordable Care Act (aka "ObamaCare") with a citation to the actual Affordable Care Act itself, not some rightwing crackpot opinion piece, tto support it mandating end of life as you just claimed.

The very good provision proposed in the ACA, to cover a visit for any patient who wanted to discuss their advance directive, was blown out of proportion and then removed thanks to those right-wing crackpots.

Medicare, however, is covering those visits, so doctor and patient can discuss/create an advanced directive that shows what THEY want. Which may be full treatment, a trial of full treatment, supportive treatment, or comfort-based treatment only. Or whatever they add on in a POLST "extra instructions" section.