Map of life expectancy at birth from Global Education Project.

Wednesday, August 19, 2009

Pulling the Plug on Grandma

Physicians for a National Health Program wants me to hip you to this report about for-profit vs. non-profit nursing homes. It's what's called a meta-analysis. That means the authors took data from a whole lot of studies and combined it to develop one big picture. The method evens out the variations that happen due to chance and various features of study design, and gives a pretty convincing overall conclusion about what is going on.

You will be interested to know, by the way, that in Canada, even though it's a totalitarian socialist dungeon, more than half of nursing home beds are owned by for-profit companies. Most of the studies covered in the meta-analysis were done in the U.S., but Canadian and Taiwanese studies were also included.

The miraculous virtues of the invisible hand are plainly visible.

Meta-analyses suggested that not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently reported quality measures: more or higher quality staffing (ratio of effect 1.11, 95% confidence interval 1.07 to 1.14, P<0.001) and lower pressure ulcer prevalence (odds ratio 0.91, 95% confidence interval 0.83 to 0.98, P=0.02). Non-significant results favouring not-for-profit homes were found for the two other most frequently used measures: physical restraint use (odds ratio 0.93, 0.82 to 1.05, P=0.25) and fewer deficiencies in governmental regulatory assessments (ratio of effect 0.90, 0.78 to 1.04, P=0.17).

According to the PNHP press release, quoting the senior author:

"The reason patients' quality of care is inferior in for-profit nursing homes is that administrators must spend 10 percent to 15 percent of revenues satisfying shareholders and paying taxes," said Guyatt. "For-profit providers cut corners to ensure shareholders achieve their expected return on investment."

Well duhh. As long-time readers know, my father spent his last years in a nursing home, one which was originally non-profit but was acquired by a huge for-profit chain. It was in the process of transformation from what had been a mission of caring to a mission of making money, and my family observed that first hand. The very compassionate and skillful long-time nursing director suddenly disappeared, and it was pretty clear why: she raised the issue of Medicare fraud, which was going on quite blatantly. Staffing diminished and as I have told you earlier, they tried zonking my father out with drugs so they wouldn't have to look after him, until my mother caught them at it and insisted that it stop.

Since his problem was dementia and he didn't have major physical problems, they were able to get him out of bed every day until close to the end, so he wasn't at risk for bedsores. But those are no joke. It's not a minor issue at all. They result when people are left unattended in bed and not repositioned for long periods. This is done to the most vulnerable among us in order to make money. Then the people who pocket the money contribute it to politicians to try to stop enforcement of standards of care or reimbursement policies that will cut into their profits.

That's evil.

1 comment:

kathy a. said...

this is very interesting stuff.

i cared for my grandmother for 6.5 years after she broke her hip [she also had dementia, and really was bedridden the last 6 years], and for my mother for 2 months after her stroke and broken hip.

it is very easy for elderly people who are immobile to develop pressure sores. that was a concern with my grandmother, but her rest home was very aggressive about prevention and care; this was not a major problem for her. not the same story with my mother; she developed a small pressure sore in the first few days in the hospital, and over the next month [in a not-good rest home] it grew to a significant size needing a lot of attention.

my grandmother's rest home took her off meds she had been on, and paid a lot of attention to her -- particularly sanitary care, shifting positions, getting her out of bed regularly.

we were ready to fire my mom's rest home at the time she took a turn for the worse, in general health, and landed in a second hospital. there is no question she was a lot of trouble as a patient -- she was in pain from the broken hip, couldn't remember she had a broken hip so wasn't cooperative, was often restrained [she kept wanting to get up and leave], sometimes was left in foul conditions. the second hospital told us about the huge bedsore. i remain furious at her so-called attending physician, who never once visited her in the rest home. we fired him.