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Thread: Cancer Patients in Nursing Homes

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    Cancer Patients in Nursing Homes

    Elderly nursing home residents receive relatively few cancer care services, according to a study published in the Journal of the National Cancer Institute. Few studies have examined cancer treatment and care among elderly patients residing in nursing homes. Yet, as the population ages, more people will move into nursing homes, many of whom will later be diagnosed with cancer. Cancer risk increases as people age.

    Few Cancer Services Provided To Nursing Home Residents, Study Finds

    Nursing home residents (including any cancer patients) are already supposed to be receiving 24/7 care. The hospice service is an additional $130 a day the home receives. Because Medicare does not collect detailed data about the medical treatments a hospice patient receives, there is very little information about what services are actually being provided.

    Neglect is the silent killer in nursing homes. By some estimates, malnutrition, dehydration, bedsores and infection - caused by neglect - account for half of nursing home deaths and injuries.

    A recent indication of negligent care for cancer patients at nursing homes involved a woman in Pennsylvania who was put on the chemotherapy drug Nexavar. Its side effects include decreased blood flow to the heart, heart attack and high blood pressure. The woman was supposed to get emergency care immediately if she started to exhibit any signs of the side effects.

    The woman reported a dull heavy chest pain and a severe band-like pressure around her head. Her blood pressure (200/123) was far higher than normal. There was no evidence that a physician was contacted about the situation. Later, a physician said she would have sent the woman to a hospital emergency room immediately.

    Instead of calling the physician or getting the woman to the emergency room, the nursing home nurse gave the woman her scheduled dose of painkiller. Two hours later, the woman was found face-down in a small puddle of blood.

    The home was cited for violating regulations relating to quality of care, management, patient rights, records and more. The home had previously been cited for similar violations.

    There would be a much higher level of care given to residents if adequate staffing were provided. But, "for-profit" nursing homes, the desire for profit margins translates into less staffing at nursing homes, less training for the staff that they do have, less food (or a lower quality of food) for the residents, and less management and oversight.

    A conflict arises between saving dollars and providing good care. Administrators benefit from the amount of profit generated by the nursing home they manage, usually paid annual bonuses based on bed-count. They must choose between increasing the profit margins of their individual facilities or supplying more support staff for the care of residents.

    Even nursing home abuse may occur because of the desire for profit. Caregivers who work in nursing homes are often stretched beyond their ability. They try to do the best job that they can, but the lack of additional support restricts what they can do to help residents.

    Congress had introduced the "Nursing Home Transparency and Quality of Care Improvement Act of 2008." The bill increases the transparency of nursing home ownership, ensures that residents and their families have information about the quality of care at these facilities, and strengthens enforcement of nursing home compliance with quality of care standards.

    The Nursing Home Act enables nursing home residents and government regulators to better know who actually owns the nursing home and who controls the decision-making that impacts the quality of care provided. In addition, the bill improves the reporting of information on staffing levels and direct patient care expenditures.

    This legislation did not come before the chambers for consideration before the 110th Congress adjourned. Consequently, this bill needs to be reintroduced in the 111th Congress and get this much needed legislation passed, with "mandatory staffing levels" put back into the bill, and implemented.

    Nursing Home Legislation and Mandatory Staffing Levels | Best Syndication

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    Senior Member Grandma-RN's Avatar
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    Re: Cancer Patients in Nursing Homes

    Thanks for the article. Will comment later.
    ER-RN

    It is alright to get tired, but, never give up."




    Proud Grancama!

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    Re: Cancer Patients in Nursing Homes

    A Federal Complaint Survey was conducted at one of the local nursing homes last September. Based on the survey, the facility was not in compliance with 42 CFR Part 483, Subpart B, and Requirements for Long Term Care. The summary report that took me four months to obtain from the FOIA, cited 13 violations.

    The most outrageous violation was Infection Control. Review of the facility's Monthly Infection Control Summary Tool indicated that the infection reate within the facility ranged from a low of 14.42% to a high of 44.44%. During an interview with the Administrator and the Director of Nursing, the Administrator acknowledged that the Monthly Infection Control Summary Tools reflected an "extremely high" infection rate within the facility.

    Even though the Administrator acknowledged to the CMS surveyor of an extremely high infection rate with the facility (almost double to five times the national average), the CMS surveyor saw no Administion violations (492's). If the Administrator and Director of Nursing were more in keeping with appropriate and good nursing home care, instead of worrying about year-end bonuses, these things never would happen to nursing home residents.

    It's a foregone conclusion that mangement is ultimately responsible for the quality of care. The most conscientious, well-trained hands-on caregivers cannot possbily perform to the best of their abilities when short-staffing is either allowed to occur out of indifference or as a deliberate act to protect profits.

    Whether management is simply satisfied with the risks and resulting harm to the residents that come with that under-staffing, or simply focused on the profits and bonuses that come with keeping every bed filled, they are paid and licensed not only to hire adequate staff, but to hire competent workers and abide by state and federal regulations.

    Decades of industry whinning about being unable to find or keep caregivers only requires management to look one place - in the mirror - as they are ultimately responsible for providing a living wage and at least minimum benefits for workers.

    None of the issues, which were ultimately the responsibility of management, were addressed by oversight agencies, and these were not issues with which the administration was unaware or uninformed. But they fired the Medical Director and one of the best nurses the place ever had, for speaking out against failures in care delivery. That signals a conscious choice to ignore the risks and resulting harm, and the buck stops at the front office.

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    Super Moderator cougarnurse's Avatar
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    Re: Cancer Patients in Nursing Homes

    One thing that is overlooked in the study: we cannot force patients to eat or drink. In effect, that is considered a form of abuse.

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    Re: Cancer Patients in Nursing Homes

    Sometimes that is used as an excuse not to take the time to assist patients who cannot feed themselves or who need encouragement to eat and drink.

    The lack of staffing can explain it in simplified terms, right down to the basic facts that residents don't receive even basic humane care: i.e. fed, hydrated, changed, bathed, turned, given their meds on time and/or given correctly.

    Residents lose weight and some starve to death because no one helps them eat or leaves the tray at bedside, out of reach. Same thing with drinking fluids.

    They are subjected to the humuliation of soiling themselves, often just because no one assists them to the bathroom, and such lack of hygiene also creates physical problems as well, from skin breakdown all the way to deadly, septic pressure sores.

    This lack of care also translates into even more taxpayer dollars down the drain because the health problems that result from the lack of staff means costly hospitalizations, surgeries, and/or other medical treatment and/or medications that wouldn't have been necessary.

    Federal law only requires nursing homes to provide minimum standards, and nursing homes operate at just that level - minimum.

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    Super Moderator cougarnurse's Avatar
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    Re: Cancer Patients in Nursing Homes

    Unfortunately, I had the bruises, scratches AND bite marks to prove otherwise. A state surveyor even got kicked by the person who hit and bit me.

    I am not saying things don't happen elsewhere; I am speaking of where I worked for a decade. Trust me, I have seen it all.

    Also...have seen homebound patients treated much worse by their families. Have had 2 such cases in the past 9 months up around my 'neck of the woods'.

    Also, placing the blame on management is not always a good thing. The Union that the LPN's and CNA's belong to FOUGHT getting a CNA terminated. No matter that s/he did the bare essentials, if that much. No matter that the LPN's who belonged to the Union, RN's, other staff, AND visitors provided us with needed 'back up'.

    However, we digress from the original article, which was Cancer Care amonst the elderly.

    It isn't any wonder we, as a whole, are living longer. Back 200 years ago, we died in our 40's or 50's IF we survived diseases that are now cured by vaccinations, ABT, and other treatments. Women died from 'childbed fever', or from having multiple pregnancies close together....

    I am sure that, if we could examine several people who died 'back then', they had the beginnings of cancer, also.

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    Re: Cancer Patients in Nursing Homes

    All I would want to say is that if some feeder was attacked while trying to feed a patient, someone else needed to step in and try. Residents who are in such demented states react differently to different people.

    Also, residents who are in such demented states need continual staff redirection and supervision. The nursing home administrator and/or director of nursing may be allowing an impaired resident to violate nurse's and other resident's rights, even a state surveyor.

    Management may try to make everyone else adapt to the trouble, instead of dealing with the source of the trouble.

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    111th Congress Gets to Work

    Sen. Chuck Grassley and Sen. Herb Kohl will reintroduce the Nursing Home Transparency and Improvement Act on March 19th. The bill, which would require disclosure of nursing home ownership and operations and give consumers better information about nursing home quality, deficiencies, nurse staffing, expenditures, and enforcement, will contain most of the provisions that were in the legislation when it was first introduced in February 2008.

    However, it will not require increases in civil monetary penalties that were in the original bill and the focus on independent audits of facilities that are part of chains has shifted to internal quality assurance and compliance and ethics programs that include procedures to detect criminal, civil, and administrative violations. Congress should increase those penalties to as much as $100,000 if a resident is harmed or dies due to negligent care. If simply composing a typical generic Plan of Correction is the only remedy required for verified violations, where is the motivation for the facility to change their practices?

    The most critical aspect of nursing homes is the lack of staffing which can be explained in simplified terms, right down to the basic facts that, without it, residents don't receive even basic humane care; i.e., fed, hydrated, changed, bathed, turned, given their meds on time and/or given correctly. Lack of staffing, in turn, creates a constant high turnover among even the most highly-trained, dedicated workers. Mandatory staffing levels were taken out of last year's bill, hoping it had a better chance of passing. Mandatory staffing levels should be put back into this legislation.

    House sponsors of the legislation, Rep. Pete Stark and Rep. Jan Schakowsky, are expected to reintroduce their version of the bill in April. Now is the time for caregivers of loved ones in a nursing home, and hopefully anyone else, to call/write their federal legislative representatives to pass this bill, with "mandatory staffing levels."

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    Carlyle Sees Handwriting On Wall

    Treasury Secretary Timothy Geithner said that "new rules of the game" are necessary to restore confidence in the financial system after credit markets seized up and stocks fell the most since the Great Depression. He proposed requiring private-equity firms to register with the U.S. Securities and Exchange Commission and to disclose information about their holdings.

    After opposing increased federal oversight for years, David Rubenstein, co-founder of private-equity firm Carlyle Group, admitted that they are not going to be able to stand in the way of including them in an overhaul of U.S. financial regulation.

    The government would have the power to peer into the inner workings of companies like the Carlyle Group that currently escape most federal supervision. Private-equity funds operate almost entirely outside the regulation of either the Securities and Exchange Commission or the Federal Reserve.

    Regulation of Carlyle's Manor Care nursing homes is good and necessary, particularly since the company accepts taxpayer funds for the majority of the residents of their facilities. The private-equity for-profit operators of these nursing homes need to hire the best caregivers available and pay them a living wage. They need to provide clean, well-kept facilities that meet all state and federal standards, with good food and good access to healthcare services.

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