Risks of polypharmacy during and after a hospital stay (Washington Post, 8-15-16)

This Washington Post article is about the risks of polypharmacy — taking multiple medications — among the elderly, especially during and after a hospital stay.  The two angles of this particular article are that lots of medication is administered at the hospital that may not be needed, and patients bring home medication from the hospital (“souvenirs”) that may not need to be continued.

Some key excerpts from the article in today’s paper:

* “Older adults account for about 35 percent of all hospital stays but more than half of the visits that are marred by drug-related complications, according to a 2014 action plan by the Department of Health and Human Services. Such complications add about three days to the average stay, the agency said.”

* “Even if a drug doesn’t cause an adverse reaction, that doesn’t mean the patient needs it. A study of Veterans Affairs hospitals showed that 44 percent of frail elderly patients were given at least one unnecessary drug at discharge.”

* “Some drugs prescribed in the hospital are intended to treat the acute illnesses for which the patients were admitted; others are to prevent problems such as nausea and blood clots. Still others are meant to control side effects of the original medications.”

* “A 2013 study found that nearly a fifth of patients discharged from the hospital had prescription-related medical complications during their first 45 days at home. About 35 percent of those complications were preventable, and 5 percent were life-threatening.”

* A geriatric pharmacist working at a UCLA hospital “tries to answer several questions to determine what’s best for a patient. Is the drug needed? Is the dose right? Is it going to cause a problem?”

* “One of [the pharmacist’s] go-to references is known as the Beers list, a compilation of medications that are potentially harmful for older patients. The list, named for the doctor who created it and produced by the American Geriatrics Society, includes dozens of medications, including some antidepressants and antipsychotics.

Link to the Beers list

Access is free but you do have to register for online access.

Here’s a link to the Washington Post article:

https://www.washingtonpost.com/national/health-science/americas-other-drug-problem-giving-the-elderly-too-many-prescriptions/2016/08/15/e406843a-4d17-11e6-a7d8-13d06b37f256_story.html

Health & Science
‘America’s other drug problem’: Giving the elderly too many prescriptions
Washington Post
By Anna Gorman
August 15, 2016 at 3:51 PM

Robin

Confusion between palliative care and hospice care

This article is about the confusion between palliative care and hospice care.  According to the author, the confusion means that some people don’t get the care they need.

www.nextavenue.org/confusion-palliative-vs-hospice-care/

Palliative Care Is Not Just for Hospice Patients
Confusion between it and hospice means some get less care
NextAvenue
By Jennifer L. Boen
July 20, 2016

This article appeared previously in the Fort Wayne News-Sentinel.  The link above is to the NextAvenue website, which is a publication of Twin Cities Public Television.  Thanks to Debbie, a member of our local support group, for sending this article to me.

Robin

Medicare Hospital Ratings Coming Soon

A recent article from Kaiser Health News, khn.org, notes that the Centers for Medicare & Medicaid Services will be releasing soon ratings of 3662 hospitals in the US, based on 64 measures.

Info on these 64 measures are already public on Medicare’s Hospital Compare website, medicare.gov/hospitalcompare.

The star ratings will “provide people a broader picture,” according to Medicare’s statement.  According to the KHN article, the “government originally planned to release the star ratings in April [2016] but postponed it after a majority of members of Congress echoed the [hospital] industry’s concerns.”

How do the 3662 hospitals rank?  According to the KHN article:  “Medicare said that based on its current data, 102 hospitals would receive the best rating of five stars, 934 would get four stars, 1,770 would receive three stars, 723 would be awarded two-stars and 133 would get the lowest rating of one star.”

KHN analyzed the data and found two things I thought were interesting:

#1 – “CMS rates shows 22 percent of safety-net hospitals were rated above average — four or five stars — compared with 30 percent of hospitals overall. Twenty-nine percent of safety-net hospitals were rated as below average, with just one or two stars, while 22 percent of other hospitals received those lower ratings.”

#2 – “Teaching hospitals also received lower scores on average.  … The teaching hospitals include large academic medical centers that often top the lists of best hospitals put together by groups like Healthgrades and U.S. News & World Report.”

Here are links to the two lists of hospitals mentioned above:

* Healthgrades – Top Hospitals for 2016
www.healthgrades.com/quality/top-hospitals-2016

* US News & World Report – Best Hospitals/Ranking & Advice
health.usnews.com/best-hospitals

So….stay tuned.

I’ve copied the full Kaiser Health News article and a link to it below.

Robin

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khn.org/news/medicare-prepares-to-go-forward-with-new-hospital-quality-ratings/

Medicare Prepares To Go Forward With New Hospital Quality Ratings
Kaiser Health News
By Jordan Rau
July 22, 2016

Despite objections from Congress and the hospital industry, the Obama administration said it will soon publish star ratings summing up the quality of 3,662 hospitals. Nearly half will be rated as average, and hospitals that serve the poor will not score as well overall as will other hospitals, according to government figures released Thursday.

The government says the ratings, which will award between one and five stars to each hospital, will be more useful to consumers than its current mishmash of more than 100 individual metrics, many of which deal with technical matters. The hospital industry, however, fears the ratings will be misleading and oversimplify the many types of care at the institutions.

The Centers for Medicare & Medicaid Services said it would release the ratings “shortly.” In a preemptive effort to rebut criticisms, it noted its analysis showed “hospitals of all types are capable of performing well on star ratings and also have opportunities for improvement.”

The stars are based on 64 individual measures of hospitals that are already public on the government’s Hospital Compare website. Those include mortality rates, the number of readmissions, patient opinions, infection rates and frequency of medical scans like MRIs.

Medicare said that based on its current data, 102 hospitals would receive the best rating of five stars, 934 would get four stars, 1,770 would receive three stars, 723 would be awarded two-stars and 133 would get the lowest rating of one star. Another 937 hospitals would not be rated because the government did not have enough data to properly evaluate them.

“The star ratings provide people a broader picture,” Medicare officials said in a statement. “CMS used a similar approach to simplify complex quality information on other healthcare quality reporting websites, such as Nursing Home Compare, Home Health Compare, Dialysis Facility Compare and Medicare Plan Finder.”

The ratings factor in the mix of patients at a hospital, so those with a high proportion of sicker patients are not supposed to rate lower than those that handle more run-of-the-mill cases. The analysis showed hospitals of different sizes also did about the same, and critical access hospitals — small, mostly rural facilities — performed slightly better overall.

Medicare did not consider the relative wealth of patients. Its analysis showed hospitals serving large swaths of low-income people tended to receive lower star ratings. An analysis by Kaiser Health News of the hospitals that CMS rates shows 22 percent of safety-net hospitals were rated above average — four or five stars — compared with 30 percent of hospitals overall. Twenty-nine percent of safety-net hospitals were rated as below average, with just one or two stars, while 22 percent of other hospitals received those lower ratings.

Teaching hospitals also received lower scores on average. A third were rated with only one or two stars, while only a fifth of other hospitals received fewer than three stars, according to the KHN analysis. The teaching hospitals include large academic medical centers that often top the lists of best hospitals put together by groups like Healthgrades and U.S. News & World Report.

Dr. Janis Orlowski, an executive at the Association of American Medical Colleges, said the fact that so many prestigious hospitals fare poorly in the star ratings is a signal that Medicare’s methods are flawed.

“These are hospitals that everyone in the know tries to get into, so we need to be careful about the consequences, that this star rating can be misleading,” Orlowski said. “Putting the information out at this time is not in the patient’s interest.”

The American Hospital Association also expressed continued concerns.

The government originally planned to release the star ratings in April but postponed it after a majority of members of Congress echoed the industry’s concerns. Debra Ness, the president of the National Partnership for Women & Families, a nonprofit in Washington, urged Medicare to post the ratings before the end of the month.

“We believe great thought and care went into development of the Hospital Star Ratings Program,” she wrote on the group’s website.  “If needed, the program can be adjusted over time. But now is the time to move forward and give consumers a tool that will allow them to assess which hospitals do the best job of providing the care they need.”

A few resources for “healthwear” (clothing for disabled)

There was an article in the WSJ a couple of weeks ago on clothes for the disabled.  Now it’s the turn of the New York Times.  The NYT article notes that 1 in 5 of every American adults is disabled.

In the NYT article, these “healthwear” businesses and products are mentioned:

* MagnaReady, magnaready.com:  shirts with magnetic closures instead of buttons

* Care and Wear, careandwear.com:  shirts and arm bands designed for use for people with medical ports

* Runway of Dreams, usa.tommy.com:  children’s clothing from Tommy Hilfiger incorporating MagnaReady and velcro

Note that the NYT article also discusses clothing for refugees so not all of it is about clothing for the disabled.  Here’s a link to it:

www.nytimes.com/2016/07/21/fashion/solution-based-design-disabled-refugees.html

Fashion’s Newest Frontier: The Disabled and the Displaced
Unbuttoned
New York Times
By Vanessa Friedman
July 19, 2016

Robin

Self-compassion: a test, some guided meditations, and on-the-job self-care for caregivers

Someone in our support group recently told me about Kristin Neff, PhD, who has written extensively about self-compassion and has a nice website at self-compassion.org. Most of us seem to have an easier time showing compassion towards others but not ourselves.

To see where you fit on the self-compassion spectrum, you might take this short test:
self-compassion.org/test-how-self-compassionate-you-are/

Her website also offers several guided meditations:
self-compassion.org/category/exercises/

And, she talks about on-the-job self-care for caregivers. I’ve copied her “exercise” on that below.

Robin

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Exercise 8: Taking care of the caregiver
Kristin Neff, PhD
self-compassion.org/category/exercises/

If you work in a care-giving profession (and that certainly includes being a family member!), you’ll need to recharge your batteries so you have enough energy available to give to others. Give yourself permission to meet your own needs, recognizing that this will not only enhance your quality of life, it will also enhance your ability to be there for those that rely on you. For instance, you might listen to relaxing music, take a yoga class, hang out with a friend for an evening, or get a massage.

Of course, sometime our time is limited and we aren’t able to take care of ourselves as much as we’d like. Also, one limitation of self-care strategies is that they’re “off the job,” and can’t be done while you’re actually caregiving. Thus, it’s important to also engage in “on the job” self care. When you’re feeling stressed or overwhelmed when with the person you’re caring for, you might try giving yourself soothing words of support (for example “I know this is hard right now, and it’s only natural you’re feeling so stressed. I’m here for you.”). Or else you might try using soothing touch or the self-compassion break. This will allow you to keep your heart open, and help you care for and nurture yourself at the same time you’re caring for and nurturing others.