I am a Hospital (SNF) CEO in favor of Universal Healthcare

I posted this as a response in another forum - then it got out of hand as I started to rant and thought it should be its own post as it becae less and less relevant to the original thread.

Yes we need universal healthcare.

It would cost me significant amounts of money in the short term.
BUT the waste in health care is phenomenal and anytime waste is eliminated it has a large long term positive effect on the bottom line.

this is the argument for universal healthcare from the perspective of senior healthcare - my field.

In the 80's and early nineties waste was encouraged. The medicare and medicaid systems were on a strict reimbursement (cost+) system i.e. the more you could spend the more you could make.

Then they went to PPS and hospitals were paid DRG levels - basically the diagnosis sets a per diem rate and all costs are the hospitals responsibility. Nursing homes ended up becoming hospitals as post op rates were so low that hospitals were shoving people out the door and rehab and recovery no longer was profitable for the acute hospital - so the SNF came along (skilled nursing) and filled the niche along with LTAC's and hospices all wanting to cash in on the medicare rates.

The waste comes in because so many businesses want in. The Govt has your medicare money - the HMO takes your medicare money and gives half of it to the SNF. The SNF uses about half of the HMO money to pay for people whose sole job is to collect money (usually after a fight) from the HMO and report MDS data to medicare to prove they should get paid for caring for people, in addition the SNF pays massive liability and lawsuit insurance because no one believes their 104 year old grandma with Congestive heart failure should die. The other half goes to room and board and paying nurses and comes far short of covering that cost.

This is just the start of the waste. Then the pharmacy bill comes - mine is usually around 35k a month. this is the per diem I pay the pharmacy - the pharmacy claims poverty and gets a matching amount from medicare. Now under Part D the pharmacies have set up their own Fiscal intermediaries and their own part D plans - essentially the pharmacy through a shell company decides how much to charge itself for meds then turns around for reimbursement from the govt and a tax break on the other side for using the part D plan.

Hospice, enteral feeding, med supply, home health, Long term acute, food conglomorates, and bed companies all have similar legal scams running but partD is the most ambitious and breathtakingly bad for seniors (just wait till they get past the threshhold for the year around May and have 10k in "donut hole" bills to pay before part D kicks back in. 30k may sound like a lot of drug coverage but it wouldn't last three months for a dialysis patient or someone on 3rd generation IV antibiotics that can run 5k a day)

The hospitals often get the blame for nursing wages and all sorts of things from a few unions - we are not the bad guys here. The system itself and the ancillary providers and HMO's are fleecing the govt and the hospitals get whats left. Medicaid pays me 136 per patient for the 75% of my patients who are completely covered by medicaid. Including rent my costs are 187 per patient per day on average. This is a loss of $51 per patient per day. HMO's pay an average of 240 per day but typically have higher costs (I pay all IV's and a few other costs medicaid picks up). Medicare pays an average of 440 per day for rehab (although Physical therapists cost about 50 an hour so I often lose money on even the medicare patients as well) The only way I can make a profit is by attracting more rehab patients with higher than medicaid reimbursement rates and by filling the last 20 beds where the marginal cost is less (after fixed costs are met). This means having better care so doctors send us their patients. This means paying higher rates to have the best nurses.

I pay around an average of $3 an hour over the local avg rate for nurses. With benefits that is a cost of about 4.15 per hour more. My nurses voted no on having a union as they did not want to take the lower union contract rates and pay dues - I also like to think they are actually happy working here :). Based on my interactions with the union here they adverserial approach is simply damaging. I would suggest working with providers who are trying to be socailly responsible and not price gouging to go after the real culprits - HMO's, hospices, pharmacies and ultimately a non nationalized health care system.

They take the premiums and hire lawyers who's #1 job is to keep from paying anyone anything. (Got to keep the shareholders happy, you know.)

sorry for the ignorance....

:shrug:

they used to be called nursing homes - 95% of my patients would have been in a acute hospital 15 years ago - the change in reimbursement moved us from hospital and old folks homes to hospital, transitional care unit, Long term acute, sub acute, skilled nursing, convalescent hospitals, assisted living (this is the granpa simpson type of place), board and care, and home health

"massive liability and lawsuit insurance because no one believes their 104 year old grandma with Congestive heart failure should die."

Hyperbole will get you no converts.

But, you knew that, right?

Universal health care is important..... please go back and restate that part accurately.

I pay over 50k a month in liability insurance despite a phenomenal record of care - best in LA county and Orange County.

I was being a little glib but - I recently got served in a suit where a 104 year old woman with congestive heart failure, diabetes, kidney failure, liver failure, Pulmonary disease, severe dementia, and 6 other medical diagnosis, died suddenly in her sleep (massive sudden heart attack that would have killed her immediately)

the family was shocked that she died. They were stunned that she would die while in a hospital. Since she was alive when she came in we must have done something wrong that she had this heart attack.

I am also a little jaded today after dealing with many families in denial about their loved ones prognosis. today was a bad day for telling multiple families that they really need to stop expecting that their terminally ill 100 year old relative is going to bounce back and come home to run in next years local 5k race. (this really is not an exaggeration)

You would be astounded by how silly some lawsuits are - my all time favorite: An 87 yr old man comes in with a stage 4 wound on his scrotum (this is gangrene territory) he stays with us 2 weeks and the wound improves - infection cleared out (this type of wound is a 6 month minimum healing process) his wife serves me with a 10 million dollar lawsuit for loss of consortium. She claimed we should have done the medically impossible and healed this wound (which he got at home with her as caregiver) in 2 weeks. She further claimed that because her 87yr old husband could no longer perform and satisfy her sexually that we should pay her 10 million dollars (I always write out ten million dollars instead of $10mil in remembrance of Katherine Harris) for her pain and suffering at not getting laid.

90% of the lawsuits filed against my facility in the last 3 years have been thrown out right away the other 10% have all come up in our favor regardless the cost of each of those idiotic merit less suits is significant.

on edit: most lawsuits come from guilt - families feel guilty about grandma being sick, guilty that they are not the ones caring for her, guilty about visiting, or guilty about the neglect at home that led to them coming to stay with me in the first place (in some cases). guilt leads to blame and since people don't like to blame themselves they tend to blame the wicked old nursing home and throw a rock into a crowd to hit the nearest medical malpractice lawyer willing to take a silly lawsuit.

on further edit: there are some really really bad SNF's and hospitals out there and they should be sued - but it is getting to the ridiculous place where when I take a patient who we know is not going to survive or who has families in denial we have to constantly worry about what stupid suit we will see.

but I KNOW you know the other side of this.

Until/unless you're willing to be reasonable, there is no sense in trying to communicate.

Im not sure what you're after here - please explain. I did say that there is a good reason for lots of lawsuits.

maybe I'm stupid - please assume that I am - what is the other side of what? I'm really truly clueless as to what you are in a huff about here. And I do want to be reasonable and communicate but if you sit in the corner holding your breath and won't tell me what you want, or even what your position is I don't know what else to say.

Im a nice bloke honest - and I am willing to accept that everything I think I know is wrong on any topic - but I don't know what you think so please speak up.

on edit: I think we are on the same team here, I just don't know that I am communicating well.

"sitting in the corner holding your breath"

Yanno, I didn't snark at you, and I don't appreciate that at all. Really, is that the way you at work, as a CEO???? Is that the way you talk to your board? Have we completely lost any ability to actually hold conversations in this society?

Let me know when you want to actually be "reasonable".

Really i am - I am not used to people telling me I'm wrong without telling me why and about what. My board and my employees are all pretty good about being explicit with complaints and I am used to hearing it and getting right to the point - saying I'm not telling you is not an approach I have experience in dealing with (it tends not to be very effective). That was snarky and i do apologize - the intent was defusing through humor which never works well in typewritten messages.

so please tell me what i am wrong about and why. Tell me what you think and why. help me see your point of view or at least point me in the right direction to look.

I genuinely want to know what you think - or I would be doing something else while I am listening to this bed vendor on the phone at 7pm at night in my office and not typing to you.

on edit: you did say have we lost the ability to have conversations in this society - I am beginning to wonder that as clearly I don't have the ability to even extract what your opinion is that you clearly feel so strongly about!

As I said, there are two sides, and I'm sorry for your troubles with that one side. Yes, it happens, and it's part of the whole sickness of our damned society.

BUT--- I think you also know that the only way people can get the care they need is often to sue. That's just wrong, and also really sick. If a dr makes a mistake (and they do--sometimes accidently, and sometimes it's sheer negligence), the only way in this society to get the followup treatment is to make the dr pay.

I contend, and so does the PNHP, that if we had universal coverage, there would be far fewer suits, just because people could quickly and easily get the care they need to take care of the mistake.

Same with car wrecks, workplace injuries, etc. Most people simply want to be treated and be well. Going through the court routine (especially when ill or injured!) isn't their idea of a good time.

Are you a member of PNHP?

"defusing through humor which never works well in typewritten messages."

What you said (and for those who wish to stick pins, I will repeat you apologized for and I accepted)would offend me if spoken, also. I just don't appreciate the way people now want to power people into doing what they want them to. I will respond to kindness, but I'm sick of snark. Verbal or written. I couldn't deal with that in a work situation.

:shrug:

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:)

I may well be wrong - but until know what im wrong about I can't admit my inevitable defeat.

Sorry, is mistook your apology for geniune.

My mistake.

You're the one who should be apologizing, bobbolink.

I thought he was sincere. Clearly, I was mistaken.

Some of us here are damned tired of snark.

And I'm not going to get into it with you. If you want snark, snark it out with the other snarks.

you are way more patient than I would have been. He who would calleth snark- is often the biggest giver of said snark...

This poster constantly crosses over the line of decent communication and then has the unmitigated gall to take umbrage over perceived slights. I don't put her on ignore because I want to see people stand up to her narcissistic bullying.

Any point you were trying to make you shot down with your rudeness and assumming that anyone knows what the heck you are talking about.

My GP sent me to the local hospital a few weeks ago to get labs done-- mostly just routine blood work for a physical. I got the bill the other day-- even though I have pretty good Blue Cross insurance through the state employees plan (California) my cost after insurance was over $500. So after I went back to my doctor he looked at my lab report and requested some new tests-- then I got the $500+ bill for the last ones. I can't afford to have the new tests done-- AND I HAVE INSURANCE.

This is insane. Somebody is making HUGE amounts of money. The lab work I had done is largely automated or done by people without advanced degrees, and yet the hospital charged nearly $1,700 for them.

insurance or your employer does and you still end up paying for much of your health care anyway. It's a bad scam that has to stop.

you will probably save money in the long run, and the monthly charges are usually less too.

pm me if you want a referral to an agent, I am not one, but my boss is and she's fantastic. If you aren't in her area, she'll refer you out to someone good.

Physicians for a National Health Program

http://www.pnhp.org/

Their health plan would fully fund Hospitals, you know maximum staff, equipment and other medical needs like drugs, with the idea that this would be the way to fill all the beds. There would be no need to check on a patient's insurance because health care would be distributed by need, not ability to pay.

The patients needing care would benefit and the health care provider would benefit. They could look to the business of taking care of patients and not worry about how they were going to meet their expenses.

MOst most just want to "reform" insurance.

This nation can no longer envision life without corporations hands in everything, it seems.

Sad.

I guess people will have to hurt much more before this change takes place.

strangelhold on Washington.

:shrug:

Well, folks... just how important is it to you to have decent healthcare?

:shrug:

question now is - who cares enough to do the job we are paying them to do?

sigh....

well, take a look in a couple of years, and see how that pans out...

So yeah, dems are the answer right now. Unless you know someone else making laws?

And, you may have noticed, the Dems are ALSO hand in hand (or in bed with) corporations. That doesn't make them very likely to promote legislation that favors the people, at the expense of their beloved corporations.

As I said, you can see how it looks in two years.

Now, I answered you politely and would appreciate the favor returned.

Thank you.

My point was that there were many factors in why we want dems in power, this was surely one of many.

That does not mean we are on auto-pilot, we still need to pressure them and hold them accountable.

A concern in all this though is where we draw lines at party loyalty. Are we willing to hammer dems in an election year (presidential next big one up) for failing or give them a pass to keep them in power hoping they do the right thing?

I am all for calling out dinos, and working hard to replace them with real progressives. Yes, there is a lot of work to do - but I also see we have done a lot already getting the right party into power to make changes.

personally, I damned well hate the insurance company (I posted a thread long time back - I have no accidents, no tickets, zip on my record and I am 41 - but my rates are higher then others due to my freakin low credit score - so yeah, we need to make huge changes.)

I am sure folks here, especially folks like you, will track closely their voting record and new legislation that could help people out here.

We need real answers, not rhetoric - and we got the first real answers when we got our party into power. One step at a time. Now we need to figure out real answers - what do you propose we do and how can we get such legislation introduced?

I don't have that answer myself yet, damn sure wish I did :)

But I see insurance as a huge root of evil - from telling me I cannot smoke at home or be fired, to telling me I have to pay a lot more then some drunk driver caught twice because their credit is better than mine.

I'm really afraid that so many will now relax and breath easy (OK, we all need to breath...:) ), thinking that the new majority will right the wrongs.

WRONG!!

I have a Dem rep, who is considered very liberal, yet she is NOT in favor of Universal Health Care! It just ain't gonna happen unless/until we all throw a major shit fit!

"what do you propose we do and how can we get such legislation introduced?"

Conyers HR 676 is perfect, already "introduced", has many co-sponsors.

We ALL need to get behind it, get our churches and organizations to call in speakers, and pressure our Reps to sign on to 676. If your rep is already a co-sponsor, be sure to send a thank you!

The bill is there-- we MUST make it happen.

Yes, we must keep on the pressure and kick some ass. And HR 676 is one such example. Hopefully we can track this and keep people informed, and put pressure where it is needed.

We cannot relax, though some breathing room is good right now. We have people in power we asked for, and I damned well hope we hold them to an even higher standard than we did the other people in power.

I don't play favorites, I am against something bigger and I expect the people I spent my time voting for to be on the same track. Our work on DU has just begun, we got the bums out - now lets make change happen for our fellow citizens.

Thanks for the reply, and a :toast: for ya :)

Have you ever heard, "be careful what you wish for, you may get it?"

What if we go immediately to a national healthcare plan? Well, first of all, every corporation and every person paying health insurance premiums immediately stops paying them. Fine, that just puts the evul corprats out of business, right?

What about the people who work there? I'm not talking about the CEO, I'm talking about the raters, the mailroom clerks, the filing clerks, the executive secretaries. They're on the street, huh? So, now who's gonna pay for that? Should THEY pay? Now they have GREAT healthcare- is that gonna help them starve healthier?

OK, so what about all the MIDDLE CLASS people who own stock in them, or who own mutual funds that are based on them? What about the retirement accounts that they are going to lose? Do THEY get to starve healthier too?

That's why it's a "mess."

We had the opportunity as a nation after WWII to fix this. We squandered that opportunity, because we were all comfy and shit, so we could afford to be conservatives again. And when Bill Clinton tried, the Democratic Congress at the time nixed it. Great move, Democrats. Neato.

I REALLY hope that something was learned after the debacle in 1994. Please excuse me if I wait and see.

Please stop pretending there's a simple solution. If it was easy, it woulda been done a long time ago. Please stop demonizing anyone who opposes you, and anyone who works in a management position in the healthcare industry. You were more than oversensitive, you were combative. I thought it was inappropriate.

How much stock do you have in an HMO, etc?
How many of your middle class friends have this sort of portfolio?

and look up HR676.

I think you'll find that your objections have already been answered.

Or, we can continue to let thousands and thousands of people die every year in the richest country in the world because we're too afraid to change our system.

all those little people working for the ebil inshurants cumpanys gonna be outta jobs.

Good try. Claims will still have to be processed and most likely the companies who do it best will be contracted by the government to do so, like they do with Medicare and Mediaid today.

I doubt very much if anyone is going to lose their job and if they do, there will be a new job opening up with the agency that will process all of this. Guess what, it happened in other countries who went to NHC.

It does sound like you own this nursing home.

their wages would be higher. He pays better than the union. I'd rather not pay dues either if I had a great boss, great benefits, great wages, and great work environment.

It's common to see a wage increase in advance of a union certification.

Besides, great boss, great benefits, great wages, great work environment = how many places?

it is more than money - it is about having a voice. my employees have a voice. I am spending a half million dollars more on a different model of bed (same specs, garuantees, etc) for 60 buildings based solely on ease of use recommendations from 5 CNA's in my building. So it is a real voice that matters in decisions that make a difference to them.

Also I gave some large increases recently without any union involvement or attempt to organize in my building. Don't get me wrong - I've been an organizer (trying to get health insurance for grad student teachers at UGA) I like the unions. I just think that sometimes some unions pick targets that are not the most helpful and some unions use tactics sometimes that are less than helpful - slashing my Director of nursing's tires afer the nurses voted no was not neccessary. There are crap buildings that treat their workers badly they should go for them. The avg turnover in nursing homes is 85% + per year - I have 18% turnover. I have nurses that have worked in my building longer than i have been alive (okay only 2 and they really need to retire soon.) You don't keep good staff without taking care of them - its good business sense.

Funny the right thing to do so often is the profitable thing to do in the long run.

if my boss had more employees, she'd create one of those places too. Everyone i know personally who belongs to a union hates it and was forced to join in order to get the job. I am not a fan of most unions- I am a fan of the IDEA of unions though. I just think that some are greedy operations that don't really care that much about their members per se.

that's just my anecdoctal opinion of a few unions though, by and large I totally would choose unions over no representation at all. In many places, it's the only way for the little guy to have a voice.

--because their employers think that's better than having to deal with a union are indirect union members of a sort, benefitting from the very existence of unions. Which is why we will always need unions.

I pay more for a few reasons -

paying more means i get and keep the best nurses (not the only way to get and keep them - having the best care attracts the best nurses who give the best care etc) which increases my bottom line.

Paying more helps me hold people to a higher standard and brings a level of accountability - in CA nurses paid the going rate often feel ok to do a mediocre job because the nursing shortage means they can get another job anywhere.

Paying more feels good - I mean what is the point of being the boss if you can't do something that is the right thing to do.

Nursing wages are crap. medicaid payments are crap - medicaid recently gave us a raise in rates to pay for more nurses they promptly took that raise away again with a new "quality assurance" tax that was instituted the same day and took the money the raise gave me and more away again. Its like money laundering - take money for healthcare improvements and then take it away as a tax to spend on something else. That being said we do still make a profit and i want to give as much of that as possible to the people who made that profit for us. not just in pay but also in ownership and stock in the company - receptionists, housekeepers, nurses - they are the owners in my building.

Our Healthcare is out of control

and Its time

Other countries have better systems

All they have to do is reintroduce it next session and we put the pressure on Nancy Pelosi. The ridiculous costs of healthcare affect everyone in this country, this might be the single most important issue for every American,even more important that raising the minimum wage, because free healthcare would reduce everyone's monthy expenses.

more from Kucinich
And so what I’ve advocated with John Conyers is HR 676: universal single-payer not-for-profit healthcare, which provides that everyone’s covered for everything. And we’re already paying for a universal standard of care—we’re just not getting it because—if you took that almost $500 billion a year and put it into healthcare in the form of a universal system, we would have enough money for all basic medical care, plus dental care, vision care, mental healthcare, long-term care, prescription drugs and even broader coverage. We’re already paying for this. We’re not getting it. We need to have the end of healthcare for profit in the United States and the beginning of a healthcare system which helps those who don’t work or can’t work, which helps workers, small businesses, manufacturers. This could be—this single move towards healthcare for all can bring about a dramatic shift in the American economy and in the lives of every man, woman and child in the United States.

http://www.truthdig.com/interview/item/20061128_rep_dennis_kucinich_tackles_health_care/

because every other industrialized country in the world has this. And we're paying for it anyway- and not getting what we are paying for. That's because a bunch of rich bastards are getting obscene profit margins from it.

But I have to ask: what will happen to the health insurance companies' employees? Has anyone thought of that?

phenomenal waste - 8 people who basically argue with HMO's for a living. They all have great skills that would be more usefull elsewhere. my most clinically qualified nurses don't work in direct patient care they fight with other qualified nurses who work for HMO's to determine which treatments to pay for and when a patient has reached a point where they have a lower chance for recovery (and so the HMO stops treatment).

and people wonder why there is a nursing shortage - absurd isn't it.

most of these folks are clinicians and considering I have to fly nurses in from the philipines to fill positions - there are plenty of jobs for good nurses.

I'd like to see some acknowledgment of it in any legislation that gets passed. And keep in mind that while this helps with the individuals who are otherwise qualified, it doesn't necessarily help those who have specialized jobs that don't have any more use; and it does nothing for people who are holding equity in a company that no longer has any market.

you know the when the automobile was invented it put all the buggy whip manufacturers out of business and they had no specific skills that transfered - so should we limit automobile research and production?

creative destruction is the nice way economists put it - which still stinks for the schlub who is made obsolete - retraining, and the odd entreprenuerial type who finds a new way to use his skills is the only way forward.

like the baking soda guys - when baking soda was no longer something people used to make their own bread with they still found ways to sell it with alternate uses (toothpaste, fridge deoderant etc) People need to be marketed - retooled, repositioned, or replaced.

I would like to see employers and the govt team up to find ways to train the newly unemployed and newly obsolete workers to put even more back into the system after eliminating the waste that the HMO system creates.

For many years I handled the office work for my father's medical practice. I can very much relate with your post as he was affiliated with the same hospital for nearly 50 years and saw it go through big changes in the final years. The biggest one was how the insurance companies had determined that they would decide what care a patient got and what they didn't get. If a patient didn't have the proper coverage (meaning they weren't paying the big premiums), they ended up with little say in their care and even worse information about that care. Many end up with doctors they aren't familiar with since the Insurance company determines that since you can't afford your own personal physician or that that physician didn't sign up with their HMO or PPO, you got whatever "care" they felt was cost effective. The relationship between patient and doctor...one that develops over years was gone and many of these patients became case numbers, no longer were human beings. Their illness was considered a cost drain and the quicker they could be passed in and out of the system, the more in Insurance company was for it. This meant shorter hospital stays, reduced tests or care if the insurance company thought the doctor's diagnosis wasn't to their liking and lack of follow-up care as many patients max out their benefits and are afraid to have their coverage cancelled.

Managing a care facility such as yours requires the patience of a saint and the strength of Hercules as the combination of state regulators and insurance companies have turned bottom line into the top priority in any patient's care. It's strongly advised for older DU'ers to get some form of catastrophic or "umbrella" coverage...a big expense for many on a fixed income...as their only hedge against being priced around by the insurance companies.

I've looked at this issue many times over the years and it's gotten so messed up and complex that a simple fix can't be applied here, but it must be fixed as our population ages and more people will be requiring health services in the years and decades ahead. A National health insurance program is long overdue...a system that returns diagnosis and treatment to doctors rather than actuaries and lawyers. This includes a revamping of the malpractice situation that adds a large cost on everything medical, allowing medicare to compete for lower prescrption drug prices (take that big Pharma) and giving some breathing room to operators such as yourself who are caught in the middle of many personal tragedies and always get the short end of the stick (look at some of the posts above to see some of that frustration).

Thanks for your post...

So a lawyer, a teacher and an HMO agent all die and get to the gates of heaven.

God says why should I let you in?

the lawyer says " I defended those with no one to speak for them, I only took ethical cases and fought for people's rights"

God says "ok you can come in to heaven"

The Teacher says " I shaped minds, helped people to learn and better themselves. I gave skills to those who needed them and changed the world by helping children"

God says "ok you can come in to heaven"

The HMO agent says " I made sure people had afordable health insurance, and that they could see a doctor when they needed it - I took a bad system and helped people to get the benefit they needed from it"

God says "ok you can come in to heaven - but after 3 days you can go to Hell"

you are wrangling a huge problem in a way that makes a positive difference to your employees(and ultimately the patients). For that I salute you.

:toast:

After her husband (my stepfather) died, she "crashed" - dehydration and related problems. She was hospitalized and, after acute care, she was transferred to what is reputed to be one of the best SNF's in the area. They all but warehoused her, easily continuing a range of medications from therapeutic doses of B-1 to Lovastatin to Toprol-XL to Actonel to Wellbutrin to Duragesic patches to whatever. She wasn't mentally acute. (D'oh.) Her physical therapy was superficial. Her occupational therapist discarded her as not being responsive. They brought in their pet Psychologist who dribbled away a lot of (billable) time. They deemed her incapable of independent living and suffering from dementia.

I visited diligently and constantly. I was puzzled at her inability to focus mentally ... almost buying in to their 'diagnosis' as I was seeing her become more disconnected over a period of a couple of weeks.

Then, as I called her (as I did every day) in the morning around breakfast time (to assist in getting her going) and was talking with her about what she was having fro breakfast and other trivialities, I heard her cough. It wasn't the first time, of course, but I started wondering.

I called back and talked to the floor nurse.

Me: "Has ANYONE checked her for pneumonia? Checked her chest and lungs??"

RN: "I don't know. Probably not"

Me: "Check her!"

Sure enough ... listening to her lungs and taking her temperature (masked by all the drugs), they ordered the mobile X-ray to take pictures.

Diagnosis: pneumonia. It wasn't dementia, it was delerium.

Treatment: Z-pack antibiotics.

After a few days, she was mentally acute. She knew what year it was. She knew what month it was. She knew who the pResident was. She could name the Governor. She could play simple card games and keep track.

She'd had pneumonia for AT LEAST three weeks! And not one of the fucking "professionals" even bothered to put 2 and 2 together. After all, she was 83 years old, right? That makes it easy - she's OLD!

I was the one who had to figure it out AFTER A FRIGGING TELEPHONE CONVERSATION!

They sure as hell collected their fees and payments, though - Medicare and Medicare Supplemental (State retiree's BC/BS).

:puke:


Today - four years after her husband died - she uses a walker (balance) but can walk around the block, walk (endlessly, it seems) doing shopping, beat young adults playing dominoes, nag the shit out of me, bathe herself unassisted, dress and undress and do ALL her own personal hygeine without assistance ... and bitch and moan like the PITA she has always been.

In the SNF's defense I would say that they are bound to follow the doctors orders and the range of meds tried would be because of the doctors orders.

HOWEVER, when someone shows a sudden change in cognition 99% of the time it is one of two things - a stroke (CVA or TIA) or it is an infection. A stroke or TIA will have a couple of obvious signs so when someone who was not confused gets confused the first thing we check is for urinary tract infections then respritory infections. I am really surprised that a reputable SNF would not have checked for infection when there was an obvious decline in mental acuity. Especially since she had been dehydrated - I would almost be surprised NOT to find a UTI or respiratory illness like pneumonia.

I am really glad that she eventually got the right treatment and is up and about. I just had a visit 2 minutes ago from a patient who was here a year ago - 90 year old Scottish guy - went home after 3 weeks to get back to his 102 yr old girlfriend he goes dancing with. He popped in to say hello. It really is the best part of this job to see people get better and annoy their kids for many more years. Of course sometimes the declines are not reversable.

I agree national health insurance is needed. But I don't think it really would be all that expensive. At this point, it's about shifting costs around. Right now costs fall on state and local governments, doctors, and nonprofits (Catholic Church, etc.) that believe in care for all. The system as it is discourages preventative care, and people without insurance wait until it gets really bad to show up in the emergency room. Laws and medical ethics dictate that they be treated, but the hospital rarely, if ever, gets paid for these extremely expensive services.

Doctors in poor areas get rushed into emergency surgeries frequently. Mistakes are more likely to happen in an emergency surgery. A patient who can't work, or a family that can't pay the bill, is often convinced by bad lawyers to file a baseless lawsuit. Everybody's malpractice insurance goes up as a result of those baseless cases. And the charges for services rise--leaving more people out of the system, and exposed to non/inadequate care. Those that use the system (employers) pay the cost in higher insurance premiums. It's a sad cycle that makes it difficult for the ill to get treatment.

But one could enact a national PPO. Tie the PPO to medical Tort reform. Provide tax breaks for employers that provide coverage beyond the national PPO's basic plan. Doctors and hospitals that join the PPO's network could get a tax break. Insurance companies--perhaps excluding United Healthcare--should also get a tax break to make up for lost business. And everyone could buy into the plan, which would have sliding premiums based on income.

I wrote in more detail about this on my blog: I agree national health insurance is needed. But I don't think it really would be all that expensive. At this point, it's about shifting costs around. Right now costs fall on state and local governments, doctors, and nonprofits (Catholic Church, etc.) that believe in care for all. The system as it is discourages preventative care, and people without insurance wait until it gets really bad to show up in the emergency room. Laws and medical ethics dictate that they be treated, but the hospital rarely, if ever, gets paid for these extremely expensive services.

Doctors in poor areas get rushed into emergency surgeries frequently. Mistakes are more likely to happen in an emergency surgery. A patient who can't work, or a family that can't pay the bill, is often convinced by bad lawyers to file a baseless lawsuit. Everybody's malpractice insurance goes up as a result of those baseless cases. And the charges for services rise--leaving more people out of the system, and exposed to non/inadequate care. Those that use the system (employers) pay the cost in higher insurance premiums. It's a sad cycle that makes it difficult for the ill to get treatment.

But one could enact a national PPO. Tie the PPO to medical Tort reform. Provide tax breaks for employers that provide coverage beyond the national PPO's basic plan. Doctors and hospitals that join the PPO's network could get a tax break. Insurance companies--perhaps excluding United Healthcare--should also get a tax break to make up for lost business. And everyone could buy into the plan, which would have sliding premiums based on income.

I wrote in more detail about this before. It had to do with healthcare in my state. But the same idea would work on the national level. It had to do with healthcare in my state. But the same idea would work on the national level.

interesting thoughts... you wrote 3 of your paragraphs twice, though... you can always hit preview before actually posting. Just FYI.

:hi:

And all I know is what I've seen. Ten years ago, my employer covered the cost of healthcare for my family, doctor visit copays were ten bucks, and prescriptions were either five or ten bucks, depending on generic or brand. Deductibles were $250 per person per calendar year.

In that ten years, we've gone from that to this: to cover my family, $525 comes out of my paycheck a month. My employer covers the other $525. Doctor visit copays are $35. Prescriptions--I have a prescription deductible now, of $100 per person per year, so we pay the first $100 of that, then the rx is anywhere from eight bucks to eighty, depending. Deductibles are now $500 per person per calendar year. They were as high as $2000, but we switched providers, thank goodness.

Nothing medically major has happened in my family in that ten years. No long-term hospital stays, nothing unusual, etc. We're really healthy, no smokers, exercise daily, etc. Rarely ever sick.

I take one medication daily and in the past year that I've been taking it, my health insurance provider has moved it from a preferred brand to a tier something or other brand, to a nonpreferred brand. What that translates into is a price hike. Three in twelve months--it's gone from $15 a month to eighty bucks a month in one year. I'm getting nervous about this. The medication is for severe OCD. Without it, I am a miserable, barely functioning person. I lived that hell for years. It was getting markedly worse before I finally agreed to try the medication and it has worked wonderfully. I don't want to go back to that. I'll do anything I can to keep affording it, but I'm scared of higher and higher prices for it.

I am not optimistic that we can get health care for all
this year or next, because Bush has robbed the coffers and
the war has about tapped us out.

But maybe...

Or we can get our act together now, and be ready for 2008.

I don't think many people will be complacent and trust
any politicians for a long while, regardless of party
affiliation.

We have been too burnt for too long.

In today's world, there are no lifelong careers, so
folks get kicked off of insurance all of the time.

Its immoral.

But thank you for starting this thread.