Nursing Homes. The bodies are just pilling up.

toomuchbaloney · Apr 24, 2020

44 minutes ago, Emergent said:
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.

I don't think that the Lt Gov of Texas suggesting that grandparents would happily sacrifice their lives for the economy of their grandchildren is consistent with "natural death" scenarios.

What is going on with COVID in our detention centers. How are those thousands of people doing in their cramped and crowded containment areas? How many people are sick there? Or is it OK for them to die of natural causes during a pandemic too?

guest1146168 · Apr 24, 2020

7 hours ago, toomuchbaloney said:
I don't think that the Lt Gov of Texas suggesting that grandparents would happily sacrifice their lives for the economy of their grandchildren is consistent with "natural death" scenarios.
What is going on with COVID in our detention centers. How are those thousands of people doing in their cramped and crowded containment areas? How many people are sick there? Or is it OK for them to die of natural causes during a pandemic too?

If I recall correctly, he was among the Outrage Crowd back during the Terry Schiavo debacle insisting that her husband had no right to terminate life control on her after she'd been in a coma and vegetative state for almost 3 years. The hypocrisy just never ends.

maggie0, BSN, RN · Apr 24, 2020

On 4/19/2020 at 6:41 PM, Trampledunderfoot said:
Why not with their families?
When did we decide they weren't worth our time? They are smarter than us, wiser than us, and loved and cared for us. They earned the same. They deserve a better more honored place in society than you do. Where can we store you? BTW: a hit with WHAT ladies?

This OP doesn't talk like a nurse. And... a tiny pic of the VP? Just saying.

guest1146168 · Apr 24, 2020

8 hours ago, moriahcat said:
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.

In other words an optional and sensible provision rather than an "end of life mandate". Thank you for the facts. How very refreshing.

moriahcat · Apr 25, 2020

1 hour ago, HeartlandRN said:
In other words an optional and sensible provision rather than an "end of life mandate". Thank you for the facts. How very refreshing.

Well, it was always going to be optional for the patient, but there was to be mandated coverage of such visits no matter what your insurance was.

Self-insuring organizations that erroneously (and sadly, still) think "Living Wills" are just statements of refusal of treatment (and also against the ACA for other mandated coverage provisions) jumped on the bandwagon, and soon the whole "conversation when not in crisis" turned into "OMG death panels!"

Le sigh.

guest1146168 · Apr 25, 2020

13 hours ago, CrunchRN said:
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.

No doubt. And yes, I've been to lots of them and those dementia/ALS wings are depressing as heck (though I don't think the life expectancy of someone in full blown dementia is all that long, right?) OTOH there are plenty of people in LTC who have merely lost enough of their vision/hearing/mobility/pulmonary function/etc as to be unable to live safely alone and drive. They still have interests, friends and attend the church services and other community activities.

So which is which is it when we are abstractly discussing if approximately 30 million people are expendable? if You decide by all means. I want no part of it.

"Perhaps we can only finally be free when we stop listening for God's voice and instead serve as a vessel for it" (can't remember where I first heard this quote but I never forgot it)

toomuchbaloney · Apr 25, 2020

8 minutes ago, HeartlandRN said:
No doubt. And yes, I've been to lots of them and those dementia/ALS wings are depressing as heck (though I don't think the life expectancy of someone in full blown dementia is all that long, right?) OTOH there are plenty of people in LTC who have merely lost enough of their vision/hearing/mobility/pulmonary function/etc as to be unable to live safely alone and drive. They still have interests, friends and attend the church services and other community activities.
So which is which is it when we are abstractly discussing if approximately 30 million people are expendable? if You decide by all means. I want no part of it.
"Perhaps we can only finally be free when we stop listening for God's voice and instead serve as a vessel for it" (can't remember where I first heard this quote but I never forgot it)

Hospice was my specialty for a spell. Some dementia types deteriorate very slowly. Too slowly for hospice care under today's guidelines. It's sad.

I never interacted in a skilled or unskilled facility that was only one type of patient. If they were skilled facilities they even had relatively short stay patients, there for nursing care and therapies before discharge into the home. Are those people expendable also?

Many people say they do God's work, but God doesn't really know them. That's a paraphrase of something Jesus is reported to have said.

guest1146168 · Apr 25, 2020

12 minutes ago, toomuchbaloney said:
Are those people expendable also?
Many people say they do God's work, but God doesn't really know them. That's a paraphrase of something Jesus is reported to have said.

Better question for the Lt. Governor of Texas and crowd who say 70 and over should fend for themselves ....rather than muck things up by having to ask their big donors to pay for any of the corvid fall out. (there, fixed it for him, see?)

Paraphrase from Matthew 7:23 and Luke 13:27 by chance?

allnurses Guide · Apr 25, 2020

This study is no surprise.

I worked with SNF patients decades ago as a CNA. At a SNF in a wealthy neighborhood I reported them to the state and gave 2 weeks notice. It was much better at the VA. I was 19 and 29 then. I am now 75.

Last year my sister and I were fortunate to find an excellent assisted living home for our step-Mom. The care was great. They had two or more caregivers on duty for six patients 24/7. She had dementia and hated losing her Independence. She didn't want her friends to see her in an "Old Folks Home". Thankfully twenty years before she had made a living will so t the end received comfort care only. She lived there almost a year. One or both of us were there every day.

So I hope we do something about the suffering of residents/patients and their care givers some time soon.

Quote
The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes
... Many studies have specifically identified the benefits of implementing higher federal and state staffing standards. The proportion of residents with pressure ulcers, physical restraints, and urinary catheters decreased, following the implementation of the U.S. Nursing Home Reform Act in 1987, in part, due to adoption of the 24-hour licensed nursing standard.39 Moreover, numerous studies have consistently shown that higher state minimum staffing levels (beyond the federal minimum requirements) have had significant positive effects on staffing levels and quality outcomes.19,31,40–45 In addition, higher state minimum RN and total nurse staffing have been shown to have a stronger effect on nursing home staffing levels than higher Medicaid payment rates...
... Conclusion: Low staffing levels and poor quality of care continue to be problems in a significant number of U.S. nursing homes, despite the overall staffing improvements in many homes. The problems of low nursing home staffing have also been found in other countries such as the Canada and England.22,23
Compelling evidence supports the need for higher U.S. minimum nurse staffing standards, adjusted for resident acuity, to ensure adequate quality of nursing home care as a necessary precondition for making other quality improvements such as in leadership, management, and training.
Economic, regulatory, and political solutions are needed to ensure that all nursing homes provide safe and high quality of care. Researchers should not only take up the challenge of studying barriers to reform but also studying new regulatory, payment, and accountability strategies to improve nursing home staffing and quality...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833431/

guest1146168 · Apr 25, 2020

On 4/24/2020 at 9:19 AM, Daisy4RN said:
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.

My issue was with a provision for a paid visit with providers to prepare Advanced Directives and end of care documents was being represented as an End of Life "mandate" which is false.

moriahcat · Apr 25, 2020

Just now, HeartlandRN said:
My issue was with a provision for a paid visit with providers to prepare Advanced Directives and end of care documents was being represented as an End of Life "mandate" which is false.

Again, and I hate to be the "mediator" (though it's usually my role)....

I believe that what she meant by "mandate" was "mandated coverage for such visits", not that they were going to mandate someone's life end.

And considering the way Daisy4RN has spoken positively about coverage for such visits, and even when calling it a "mandate" was talking about how those conversations are important to have...

I put it down to Internet and the fact many use shorthand/type a post off fast, and then end up triggering someone (who likely, as I did, had to explain during all that craziness the proposed mandate was for coverage of such visits, not making the visits mandatory) for the way they phrased something.

No offense to either of you two. I think you're both wonderful people, and from what I can tell on this forum, wonderful nurses. Things on the Internet get heated, though, especially if a person was tired after a shift and might not have spent a long time proofreading.

guest1146168 · Apr 25, 2020

2 minutes ago, moriahcat said:
Again, and I hate to be the "mediator" (though it's usually my role)....

I believe that what she meant by "mandate" was "mandated coverage for such visits", not that they were going to mandate someone's life end.

And considering the way Daisy4RN has spoken positively about coverage for such visits, and even when calling it a "mandate" was talking about how those conversations are important to have...

I put it down to Internet and the fact many use shorthand/type a post off fast, and then end up triggering someone (who likely, as I did, had to explain during all that craziness the proposed mandate was for coverage of such visits, not making the visits mandatory) for the way they phrased something.

No offense to either of you two. I think you're both wonderful people, and from what I can tell on this forum, wonderful nurses. Things on the Internet get heated, though, especially if a person was tired after a shift and might not have spent a long time proofreading.

Yes, she has and if that was her intent than I apologize to her for misunderstanding what she meant by Obamacare end of life mandate. ( I probably would have said the End of life Planning provision option provided by the Affordable Care Act. But that's me).

Thank you for being reasonable.