Grand Rounds points to end-of-life posts
AHCJ member Larry Beresford hosts the Palliative Care Grand Rounds this month and has compiled an impressive roundup of end-of-life blogs and related posts.
Highlighted sites include a blog from the American Academy of Hospices and Palliative Medicine, a blog that’s looking for hospice and palliative care professionals to become guest bloggers, one - irreverantly named “Death Club for Cuties” - for nurses who care for patients and families at the end of life, posts about do-not-resuscitate orders and more.
See Beresford’s post for all the links and details.
Palliative care piece launches embedded dispatches
Philadelphia Inquirer staff writer Michael Vitez has been embedded with Abington Memorial Hospital in suburban Montgomery County, Pa. Karl Stark, the Inquirer’s health and science editor, writes that “means he went there for an extended period and reported what he saw with almost no restrictions.”
Here’s how Vitez describes the series, which will be published over the next few months:
My goal is to spend a year at Abington, writing stories that show how one hospital deals with the biggest issues in health care today and also the changes that are coming fast and furious - regardless of what Congress and the President do - to hospitals and health care.
This first story looks at how the palliative care movement is medicine’s response to the dismal way people have died. I try to show, up close, how the team works, the agony that families feel, the immense costs involved.
In future stories, I’m going to look at how a hospital struggles to bring down infection rates, how it handles patients who have nowhere to go, the madness of one Medicare rule, the impact of the uninsured, and more. I hope in the end readers will get a bedside view of how things work, how things are changing, and I hope a great appreciation for our common humanity.
Vitez’s first report is a very readable and nuanced account of palliative care, something he looks at from the perspective of a patient’s family as well as that of the medical professionals.
Old, frail fall through the cracks in Wash. system
In a series of articles, Seattle Times reporter Michael J. Berens looks at Washington’s adult family homes - legally sanctioned facilities in which the state licenses “homeowners to provide spare bedrooms and care for the old or frail who might otherwise have to live in nursing homes.”
These private residences — called adult family homes — were marketed as opportunities for seniors to live in cozy settings and familiar neighborhoods, close to family and friends, with more freedom and superior care.
The owners were given freedom, as well. To encourage this new industry, the state imposed few regulations — no requirements for a minimum level of employees or even, for many years, liability insurance.
Through interviews with more than 250 people, documents obtained through public-records requests and analysis of computer databases and disciplinary actions, Berens found that “thousands of vulnerable adults have been exploited by profiteers or harmed by amateur caregivers” in the state’s 2,843 adult homes.
The Times uncovered accounts of elderly victims who were imprisoned in their rooms, roped into their beds at night, strapped to chairs during the day so they wouldn’t wander off, drugged into submission or left without proper medical treatment for weeks.
In part two of the project, Berens reports on one home that was cited for numerous serious violations but remained in business. Part three will be published on Tuesday.
More information about how the series was reported and a list of other people involved in the project is included in the “About the series” sidebar.
The Times posted a searchable database of the state’s adult family homes.
Slim guide:
Covering the Health of Local Nursing Homes
Check out AHCJ’s latest volume in its ongoing Slim Guide series. This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
Other resources
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
In the cold, elderly more likely to break hip
USA Today’s Kim Painter reminds folks, especially the elderly, to practice “defensive walking” during winter months, citing a “decade-long study of 66,346 hip fractures in New York City found that, at least in that city, fracture rates were highest in winter, especially on the coldest and windiest days.”
At the same time, Painter reports, overall fall rates don’t seem to budge to much in the winter, perhaps because folks are more likely to stay inside rather than risk icy steps and walkways. Painter says the increased fracture rates could be because of icy streets, weaker muscles as a result of winter inactivity and even lower vitamin D levels, which have been linked to weak muscles and brittle bones.
Poynter’s Al Tompkins, who first alerted us to this story, also points to CDC resources on the “silent epidemic” of hip fractures in America.
AHCJ on Aging
AHCJ’s Aging in the 21st Century workshop, held Oct. 16 and 17 in Miami, addressed the changing picture of aging Americans and key research and issues related to this growing population. Tip sheets and presentations from that workshop are available to AHCJ members, as are these related tip sheets:
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
Slim guide: Covering the Health of Local Nursing Homes
Check out AHCJ’s latest volume in its ongoing Slim Guide series. This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
Elderly prison population booming
CNN’s Stephanie Chen considers the issues that surround elderly prisoners, a fast-growing group that has generally flown under the radar. According to Chen, “An analysis of Bureau of Justice Statistics data found that the male prison population over age 55 ballooned by 82 percent in eight years, from 48,800 inmates in 1999 to 89,900 in 2007.” 
These older inmates are typically more expensive and in poorer health than their younger peers. In Georgia, Chen reports, “the state spends about $8,500 on medical costs for inmates over 65, compared with about an average of $950 for those who are younger.”
Every inmate here has a medical condition; dementia, hypertension and diabetes are the most common, the warden says. “With the elderly population, we’re beginning to run something comparable to nursing homes,” says Sharon Lewis, medical director for the Georgia Department of Corrections. “This is one of the unhealthiest populations found anywhere. They really lived life hard.”
The boom in geriatric prisoners has stressed state budgets, especially in states where money was already tight. In response, Chen writes, some states are considering softening their stance on older prisoners.
To ease budget woes in California, one bill up for debate would allow nonviolent elderly prisoners to be released into hospice care or monitored with ankle bracelets. In the past few years, Georgia officials say, the state has released more frail and dying inmates on medical reprieve than ever before. Other states, including New York and Virginia, have also allowed early release of ailing elderly inmates.
For tips about reporting on jails and prisons, be sure to read Naseem Sowti Miller’s tip sheet, Covering health care in jails, and her presentation on the topic from the 2008 Urban Health Journalism Workshop. For tips and tools on reporting on America’s graying population, check out reports from last month’s Aging in the 21st Century workshop.
Shalala, Wiener: Long-term care left out
Drawing on AHCJ’s Aging in the 21st Century workshop, New America Media’s Paul Kleyman writes on health care reform’s failure to adequately address long-term care for the nation’s elderly. In particular, he focuses on keynote speaker and former HHS secretary Donna Shalala’s stark political assessment that, despite some promising signs, “we’re not there, yet.”
Donna Shalala spoke at AHCJ's "Aging in the 21st Century" workshop in October. (Photo: Charles Ding)
On a slight note of hope, Kleyman adds that while she’s pessimistic about comprehensive restructuring of long-term care, Shalala said it may be possible to “cobble together” an acceptable system if reformers can make a few key changes.
Kleyman also drew on long-term care expert Joshua Weiner’s speech at the recent On Lok Annual Conference. Weiner is a senior fellow at the Research Triangle Institute (bio) who emphasizes the costly and dangerous disconnect between acute care and long-term care in the American system.
He urges reformers to find ways to integrate long-term care facilities and hospitals, both financially and medically. At present, Weiner says, some parts of the system are covered and others aren’t, a situation which results in uneven and disconnected care, as well as repeated hospital visits for patients with chronic conditions. “Avoidable hospital readmissions, alone, cost Medicare $18 billion a year,” Kleyman writes.
Related
Covering the Health of Local Nursing Homes: Check out AHCJ’s latest volume in its ongoing Slim Guide series. This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
600-plus Ill. patients drugged without consent
After a review of 40,000+ inspection reports for Illinois nursing homes, the Chicago Tribune’s Sam Roe reports that the paper found 1,200 violations (affecting 2,900 patients) involving psychotropic drugs since 2001. More than 600 patients were drugged without their consent. According to Roe, “The actual numbers are likely far higher because regulators inspect some facilities just once every 15 months, and even then they usually check only a small sample of residents for harm.”
The violations, many of which were caused by a desire to make patients easier to deal with, were “for ‘chemical restraint’ and ‘unnecessary drugs’ as well as cases involving dosages that exceeded safety standards or falls in which psychotropics possibly played a role.”
While some nursing home residents suffer from major mental illnesses, such as schizophrenia, the inspection reports show that many patients harmed by antipsychotic drugs had not been diagnosed with psychosis. They were disabled by Alzheimer’s disease, cancer or Parkinson’s disease. Some were blind or so frail that they could not breathe without the aid of an oxygen tank.
In a follow-up story, Roe reveals that doctors responsible for these dubious prescriptions are not held accountable, even when cited by government entities.
The Chicago Tribune’s full series on nursing home safety can be found here.
Recent workshop
AHCJ’s Aging in the 21st Century workshop, held Oct. 16 and 17 in Miami, addressed many topics raised by the Tribune’s reports, as well as the changing picture of aging Americans and key research and issues related to this growing population. Tip sheets and presentations from that workshop are available to AHCJ members.
Related tip sheets
Aging Nation: Troublesome Health Care Issues
Headlines an advocate for seniors would like to see
The impact of aging upon health care
Covering nursing homes and other issues of aging
How will retiring boomers affect the national health agenda?
You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
Biology of Aging: Sources and Resources
Workshop explored issues of aging America
More than 70 people attended AHCJ’s Aging in the 21st Century workshop last weekend, where former HHS secretary Donna Shalala discussed the health reform proposals and former FDA commissioner David Kessler discussed the nation’s obesity epidemic.
Sam Grogg, dean of the University of Miami School of Communication, left, moderates a session with Thomas Prohaska of the Center for Research on Health and Aging at the University of Illinois at Chicago and Sara Czaja of the Center on Aging at the University of Miami. (Photo by Carla K. Johnson for AHCJ)
AHCJ treasurer Ivan Oransky live-tweeted from the workshop, which featured panels about the health care workforce, aging in ethnic communities, brain research, elder abuse and more.
Shalala said she is confident that health care reform will pass and that consensus is within reach. She says the biggest issue remains how to pay for reform and bring down health care costs.
The Miami Herald’s John Dorschner reports that “speaker after speaker laid out a grim scenario” for aging in the United States, with a smalller health care workforce available to care for a growing elderly population.
Presentations from the workshop will be available for members on the AHCJ Web site later this week. A slideshow from the event is now online.
‘Too old for surgery’ a more complicated decision
Marie McCullough of The Philadelphia Inquirer takes a look at lifesaving surgeries performed on older patients, finding that “Age is no longer the deciding factor, even for invasive treatment such as open-heart surgery.”
McCullough reports that the growing population of elderly Americans and advances in surgical procedures are changes the way doctors approach some older patients. With elderly patients better able to survive major surgery, the question moves from the realm of health to that of economics and morality. McCullough explores both.
Blogger, author and doctor Lucy E. Hornstein extends McCullough’s conclusions, writing that “A cost-effective, medically appropriate way to address this issue is to curb overtreatment in those patients with advanced dementia and multiple co-morbidites, whatever their age.”
Upcoming workshop
AHCJ’s Aging in the 21st Century workshop, to be held Oct. 16 and 17 in Miami, will address some of the topics raised above, as well as the changing picture of aging Americans and key research and issues related to this growing population.
Tip sheets
Aging Nation: Troublesome Health Care Issues
Headlines an advocate for seniors would like to see
The impact of aging upon health care
Covering nursing homes and other issues of aging
How will retiring boomers affect the national health agenda?
You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
Biology of Aging: Sources and Resources
Kleyman launches Generations Beat Online
When we posted back in January that, after 20 years at the American Society on Aging, journalist Paul Kleyman was joining New America Media, he hoped to reconstitute his Age Beat Online newsletter.
Paul Kleyman (Photo: Frank Klein)
Well, he has instead launched “Generations Beat Online, the e-news of the Journalists Network on Generations.”
GBO includes information about news briefings, tips on sources and more. It will carry pieces about emerging views and resources on long-term care and caregiving by AHCJ member Eileen Beal.
Kleyman is associate director of the Ethnic Elders Newsbeat at NAM, so you can find news about ethnic elders and an elder news roundup on the site.
To subscribe, e-mail Kleyman at pkleyman@newamericamedia.org.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
