Nurses laugh as a 89-year-old veteran dies in nursing home

An 89-year-old World War II veteran in a nursing home bed called for help, saying he couldn’t breathe.

A hidden camera recorded nurses failing to take life-saving measures for the patient and laughing as he struggled to breathe, and eventually died. The man’s family had secretly recorded a video, which was kept from the public for 3 years until a television station, WXIA-TV, persuaded courts to unseal it.

The family of James Dempsey of Woodstock, Georgia, sued the Northeast Atlanta Health and Rehabilitation Center in 2014. Two nurses lost their licenses after the video was made public in September, with a link sent to the Georgia Board of Nursing. The nurses did not start CPR immediately and did not follow emergency procedures; then they laughed while trying to start his oxygen machine.

The nursing home issued a statement claiming that care has improved since the incident, under different leadership. But records show continued problems at the home, including $813,000 in Medicare fines since 2015.

Watch the video here: https://youtu.be/lU6NlK3OQDc

The video will probably cause families to think seriously about care options for their loved ones, including home care in some cases. A long term care insurance policy can support care either at home or in a facility. Find out more and get insurance quotes at Guide To Long Term Care.

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After Disaster: New Emergency Requirements for Nursing Homes

During Hurricane Irma, 14 people died at The Rehabilitation Center at Hollywood Hills, Florida, due to a power outage that left residents in extreme heat. Lack of air conditioning made the building heat up like an oven. One of the victims died with a body temperature of 109.9 degrees. The nursing home’s owners now face criminal investigation and civil lawsuits.

In response to the tragedy, Florida Governor Rick Scott issued an emergency order requiring nursing homes to have generators that can run air conditioners.

The nursing home industry has brought court cases to challenge the emergency order. But in the meantime, state senators Lauren Book and Rene Garcia have filed bills to make the generator requirement a state law. Also, state senator Gary Farmer is preparing a more comprehensive Florida nursing home reform bill.

On the Federal level, U.S. Representative Debbie Wasserman Schultz is sponsoring a bill that will require nursing homes to have generators that can run air conditioning for at least 96 hours in the event of an emergency power outage. The bill will also put nursing homes on the top priority list, along with hospitals, for restoring power after a hurricane.

The Federal bill provides for loans to help small facilities comply with the new regulation. Homes that have fewer than 50 beds, or a private room monthly rate of $6,000 or less could qualify for a loan to get the generators and other required equipment. This bill also sets up higher fines for facilities that break the rules and adds nursing homes to the critical infrastructure list so power will be restored there first.

Nursing homes are among the most important resources for long term care. For more information about long term care insurance see the Guide To Long Term Care.

 

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Dying at Home

Most people (70%) want to die at home, in a familiar place surrounded by loved ones. However, only about 25% do. Nearly 50% of Americans die in a hospital, and another 20% die in a nursing home or long-term care facility.

The trend is for more people to die at home, with a 29.5 percent increase from 2000 to 2014, according to the Centers for Disease Control and Prevention. During the same time period, the percentage of deaths in hospitals, nursing homes and long-term care facilities has dropped.

Seven out of ten Americans die from chronic disease, and more than 90 million Americans are living with at least one chronic disease. The Centers for Disease Control (2007) listed the ten leading causes of death in America (in order):
1.
heart disease
2.
cancer
3.
stroke
4.
chronic lower respiratory disease
5.
accidents
6.
Alzheimer’s
7. diabetes
8.
influenza
9.
pneumonia
10.
kidney disease and sepsis.

Almost a third of Americans see ten or more physicians in the last six months of their life. And almost 30% of Medicare’s budget each year is spent on patients who are in the last 12 months of their lives.

According to LongTermCare.gov about 70% of Americans over age 65 will require long-term care. If a person has an extended illness requiring long-term care, long-term care insurance will help cover those expenses whether in a hospital or at home. Studies show that those with long-term care insurance stay at home longer because the insurance provides more money for care. This includes extra money for home modifications like a wheel-chair ramp, a medical alert system and a stair lift.

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It is often the lack of money that prevents people from staying at home when they need care. Who pays for long-term care? In some cases they will spend all their savings and now are forced to rely on Medicaid (welfare health care). With a Partnership asset-protection insurance policy you will be exempt from the Medicaid spend-down requirement, the exemption is based on the total benefits your policy has paid out for care.

More than 80% of patients with chronic diseases say they want to avoid being in a hospital or intensive care unit when they are dying. While dying at home is usually preferred by the patient, it can be difficult for the caregiver. Hospice services can help.

Hospice care is for those in the last six months of their lives. More than 88% of hospice patients are Medicare beneficiaries.

Traditionally, for a patient to qualify for Medicare-supported hospice, a doctor must certify that the patient has: a home, a diagnosis of six months or less to live, a full-time caregiver, and a willingness to give up curative care and receive only palliative care.

In 2016 the Medicare Care Choices Model began offering some patients “concurrent care”: the choice of continuing curative care while starting palliative care and hospice care. An evaluation of concurrent hospice in non-elderly patients showed this plan improves quality of life and reduces costs.

The Medicare hospice benefit emphasizes home care, with almost 60% of patients receiving their care at home as of 2014. Medicare coverage is limited, additional care would be paid for out-of-pocket. Do you really want to spend-down your hard-earned savings and investments leaving open the option that Medicaid will require your estate to repay Medicaid for your care costs? There are 30 states with a filial responsibility law that could require your family to reimburse Medicaid.

Home care is much less expensive. Inpatient hospice services are used when the patient’s pain and symptoms must be closely monitored in order to be controlled, when medical intervention is required to control pain or symptoms, or when the family needs a rest from the stress of care giving.

A hospice team arranges for doctors, nursing care, medical equipment like wheelchairs and walkers, medical supplies, prescription drugs, hospice aide and homemaker services, physical and occupational therapy, speech-language pathology services, social workers, dietary counseling, grief and loss counseling for the patient and family, short-term inpatient care, and short-term respite care.

After evaluation by a doctor, a patient can enroll in hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit extensions. A patient can decide to stop hospice care at any time.

A recently proposed bill, The Patient Choice and Quality Care Act of 2017 (H.R. 2797), aims to give patients and families living with advanced and life-limiting illnesses the information and services they need.

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Have You Had The Conversation?

The Conversation Project is dedicated to helping people talk about their wishes for end of life care. They offer a collection of “Conversation Starter Kits” that you can download for free.

Talking with loved ones openly and honestly, before a medical crisis happens, ensures that everyone understands what matters most to each individual at the end of life. You can use a starter kit for yourself, or to help others communicate their wishes.

conversation2There are several different kits: for families and loved ones of people with Alzheimer’s or other dementias; how to choose a health care proxy and how to be a health care proxy; how to talk to your doctor or nurse about your wishes; and one for parents of a seriously ill child.

There are starter kits in English, Spanish, Mandarin, French, Hebrew, Korean, Russian, Vietnamese, and Hindi.

Organizations can purchase printed copies to distribute and add their logos.

The cost of care can be devastating, the national average is over $7,000 per month. To plan means to be insured before needing care, even before the diagnosis and not everyone can health-qualify for insurance (Can You Qualify?).

To find out more about long term care insurance see the Guide To Long Term Care

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How your nose can expose your risk of Alzheimer’s disease

Alzheimer’s researchers found that a person’s sense of smell declines strongly in the early stages of Alzheimer’s disease, suggesting a noninvasive “sniff test” for diagnosis.

The test can help identify the pre-dementia condition called mild cognitive impairment (MCI), which often progresses to Alzheimer’s dementia in a few years.

David Roalf, Assistant Professor at the Perelman School of Medicine, University of Pennsylvania, led a study in which scientists used a simple, commercially available test called the Sniffin’ Sticks Odour Identification Test. Subjects have 16 different odours to identify.

Along with the sniff test, researchers administered a standard cognitive test (the Montreal Cognitive Assessment) to 728 elderly people who had already been diagnosed by doctors as healthy, having mild cognitive impairment, or having Alzheimer’s disease.

The research team found that the sniff test, when combined with the cognitive test, increased diagnostic accuracy. The cognitive test alone identified 75% of people with mild cognitive impairment; after adding the sniff test, 87% of cases were identified.

Using the two tests together also helped the researchers to detect subjects with Alzheimer’s and those who were healthy, and to determine the degree of cognitive impairment.

Doctors believe it is more possible to help people with Alzheimer’s disease if they begin treatment before dementia symptoms appear.
Genworth 2015 Cost of Long-Term Care Survey Chart

Many people get Long Term Care Insurance to protect themselves and their families against the debilitating effects of Alzheimer’s and other dementias.


 

 

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Using technology to keep track of Alzheimer’s patients

The city of Iruma in Japan has a new plan to keep track of people with Alzheimer’s and dementia.

Each patient will have a little square QR code that is attached to a fingernail or toenail. The code carries personal information including a unique identification number, an address, and a telephone number. The information will help families find loved ones who have wandered away. The adhesive chips remain attached to the nail for about two weeks, even if they get wet.

alzWandering is a common problem with Alzheimer’s and dementia patients. Sometimes confusion and memory problems cause them to get lost even in familiar surroundings. Various technologies are available for keeping track of elderly loved ones. Some methods resemble technology used for tracking packages, children, or pets.

A variety of GPS tracking devices can help a user find the location of a lost person. Some enable the user to set up a safe zone, with notification when the patient goes outside a designated area. Some trackers can keep track of several people at the same time.

An SOS button is another common feature, so the person wearing it can call for help. Some devices facilitate audio conversation between the patient and caregiver.

Many of these devices are battery operated, but the batteries are rechargeable and may keep a charge for as long as three years. Some are connected with services that operate by monthly subscription.

GPS trackers can be worn around the ankle or wrist, or as a pendant. They can be locked on. One model looks like a wristwatch. A small personal transmitter emits an individualized tracking signal. GPS Smart Sole wearable technology puts satellite monitoring in a shoe insert to allow real time tracking of the wearer in areas with T-Mobile coverage.

Some GPS tracking watches provide international monitoring. An alarm will sound if the watch and GPS receiver get separated.

MedicAlert ID bracelets carry important medical information, and provide emergency hotline and family notification.

Cellular tracking uses cellular towers to determine the person’s location. The device used is the size of a credit card, and the user can follow its location with a mobile application.

The caregiver will usually carry a small tracking device, smart phone, tablet or web browser to monitor the patient. Some apps provide updates through email and text.

Hospitals can use special technology to monitor entry and exit doors. A door can be programmed to lock down when a tagged patient approaches. In a home setting, door alarms and locks, motion detectors, and intercoms can be helpful in monitoring a patient.
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By 2050, the number of people with Alzheimer’s disease worldwide could triple, from 5.1 million to 13.8 million. About six in ten will wander. Traditional search and rescue operations can cost thousands of dollars an hour, and take days. New technology makes it possible to find a person much faster and with fewer people needed in the search. The tracking technology saves a lot of money and helps rescue people sooner, before they may get hurt.

For information on insuring for Alzheimer’s and dementia care, see the Guide To Long Term Care


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Eli Lilly’s latest Alzheimer’s drug fails clinical trials

Eli Lilly’s drug solanezumab, designed to treat dementia caused by Alzheimer’s disease, failed to show significant benefits in a large multi-national trial. The trial, which began in 2013, involved over 2,100 Alzheimer’s patients with mild dementia.

The pharmaceutical company announced that in the Phase 3 clinical trial of solanezumab, patients taking the drug did not show a significant slowdown in cognitive decline compared to those who took a placebo.

Solanezumab was designed to reduce the buildup of amyloid plaques in the brain. Some researchers have postulated that amyloid plaques may cause or contribute to the memory loss associated with Alzheimer’s disease. The failure of this trial brings that theory into question.

Some scientists say there is still no convincing evidence of a clear relationship between amyloid plaques and dementia. Amyloid deposits begin to form up to twenty years before the onset of Alzheimer’s disease, but may not cause it. Some people who have the plaques do not show cognitive decline.

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While disappointing, the failure of this trial will not end efforts to find a cure. The results of this test will stimulate the scientific community to look in other directions. Even failed trials can provide helpful information and point to new avenues for research.

The next drug to be tested will be aducanumab by Biogen, which also attacks plaques but in a different way.

Alzheimer’s disease is involved in 60 to 80 percent of dementia cases. Almost 47 million people worldwide have Alzheimer’s disease and other dementias, and many require special care whether at home or in an institution.

Alzheimer’s disease is the leading cause of Long Term Care Insurance claims.


 

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