The trend of “population mixing” in nursing homes is on the rise as more young people with brain injuries and mental illnesses are being placed in facilities intended to serve an elderly population. Unfortunately, for young patients in need of long-term skilled nursing care who rely on Medicaid and other government funding for health care, placement in a nursing home is often the only available option. This is because there are few remaining facilities specifically designed for patients with mental illnesses or brain injuries.
Although “population mixing” in nursing homes has been occurring for some time, the recent increase is linked to a spike in resident-to-resident altercations (“RRAs”). RRAs are most common in nursing homes with shared rooms and pose a significant risk to elderly patients who are involved in an altercation with younger, more physically able patients. In order to decrease the incidence of RRAs between young, able-bodied patients and physically vulnerable elderly patients, experts opine that it is necessary to increase government funding for mental health facilities so as to provide better treatment options for young patients. Nursing home could then be dedicated to care for the elderly populations they were designed to serve.
Nat Turner, along with his former University of Pennsylvania classmate Zach Weinberg (the pair previously founded the tech firm Invite Media that was eventually purchased by Google for $81 Million), created Flatiron Health. The company began collecting data on cancer treatments with the purpose of creating a database focused on providing doctors and cancer centers with helpful cancer treatment data.
Flatiron, now up and running for two years, charges cancer centers for access to its database and they contribute specifics about actual cancer cases, with patients’ personal information redacted. The information includes course of treatment prescribed, and the outcome.
Medical professionals are now seeing an increase in patients with post-hospital syndrome, described as a state of susceptibility that leads to a new affliction. This is different than a relapse. Patients are entering hospitals for particular ailments, but developing independent and unrelated illnesses after the initial reasons for hospitalization have been resolved.
Dr. Krumholz, a professor of medicine and public health at Yale School of Medicine says that in “many ways the hospital environment can be the opposite of healing.” He believes that because patients are often “deconditioned, in pain, malnourished, stressed with circadian disruptions” they become susceptible to new illnesses.
Dr. Krumholz (with the help of Dr. Desky, a professor of health policy at the University of Toronto) proposes an overhauling in hospital care as a solution to the problem. The doctors recommend more cheerful décor and preserving patients’ dignity by allowing them to remain in their own clothing. The doctors gave harsh criticism to the “draconian unsavory diet” provided to patients and believe that eating well is critical for healing. Furthermore, the aggressive treatment provided by healthcare facilities to cure the problems that bring patients into the hospital, may be the very reason a patient will have to return.
Richard J. Griffin, the Inspector General for Veterans Affairs, reported that 1,700 veterans were not placed on the Phoenix V.A.’s official waiting lists for doctors’ appointments. In fact, many of these patients may not have received medical care at all, and there are allegations that some veterans may have died while waiting for care.
Investigators found that out of a sample of 226 patients, the average wait time for an initial primary care appointment was 115 days. But the Phoenix V.A.’s reported average to the National Veterans Affairs Office was 24 days. (The average wait time is a factor in determining bonuses and salary increases. Moreover, several waiting lists were uncovered during the investigation that were separate from the “official” waiting list suggesting that criminal activity may have been involved in reporting wait times in Phoenix.
It is common to find medical institutions that offer medical services geared specifically for women. However, the industry has been silent concerning the specific medical needs facing men… until recently.
Within the last couple of years, medical institutions devoted to men have been popping up all around the country. The new clinics are aware of the lengths to which men will go in order to avoid the doctor and have tailored their marketing and treatments accordingly. The clinics market themselves as “luxury spas” and use slogans like: “It’s the gentlemen’s club your wife would approve of.” The treatments range from those focused on vanity, such as hair removal, to more serious matters such as prostate exams.
Supporters of male-focused clinics think that by giving men a comfortable place to receive not-so-serious treatments, the clinics will lead to men more often receiving care for serious conditions such as prostate cancer. Those opposed feel that clinics like these may over-treat and result in more damage than benefit to men’s health.
Soon, Congress will hear testimony concerning the Helping Families in Mental Health Crisis Act. Republican representative, Tim Murphy, from Pennsylvania, sponsored the bill, and, though many agree that the mental health care system requires revamping, some provisions in the bill have sparked controversy. Among the more controversial provisions is one that supports the increased use of involuntary outpatient treatment—via court-ordered therapy for “certain mentally ill people with a history of legal or other problems.” Detractors of this provision claim that it will erode trust in doctor-patient relationships, and that it presents a civil rights issue. However, 45 states have compelled treatment programs already, one of which is New York.
New York’s compelled treatment program, Kendra’s Law, was passed in 1999. Since the implementation of Kendra’s Law, studies show that the percentage of patients returning to the hospital or getting arrested has greatly decreased. The statistic is significant, as “about 350,000 Americans with a diagnosis of severe mental illness…are in state jails and prisons” and the availability of psychiatric beds meets only 10 percent of that need.
Health care delivery is undergoing a major change in the United States, and it is happening with little fanfare, due to the fervent debate over the viability of the Affordable Care Act (ACA). Hospital systems, such as Mt. Sinai in New York, are cutting out the middle man when it comes to insurance coverage, in order to retain more profits from services provided. Mt. Sinai, located in New York, is an example of a hospital system that is providing its own insurance options to patients who receive treatment within the system.
Both non-profit and for-profit hospitals can benefit from implementing such programs, as there are certain services that are not economically sustainable, but must be accessible to the public. For example, psychiatric care does not generate a lot of revenue, but is a necessary and important service. Ezekiel Emanuel was one of the creators of the ACA, and is chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. He states that “the wave of the future is integrated delivery systems—integrating insurance with the delivery function.”
Montreal’s Health and Social Service Agency requires doctors to “inform off-island patients about treatments available closer to their homes.” Montreal patients, off-island or otherwise, have the right to be treated wherever they wish. However, the agency claims that, by suggesting that off-island patients be treated closer to their homes, the policy conserves the resources of Montreal’s hospitals. Some claim that the policy may confuse patients, and may even discriminate against patients who travel in order to receive specialized care.
A pharmacist must undergo eight years of education in order to obtain a doctorate in pharmacy. Until recently, pharmacists could only fill prescriptions. However, pharmacists across the nation have been taking on a more direct role in patient care. States such as North Carolina, California and New Mexico have implemented laws that allow a pharmacist to perform additional duties, and not just “fill a bottle with pills.” Some claim that allowing pharmacists more responsibility will alleviate the strain on resources experienced by both primary care physicians and hospitals. Others are concerned that pharmacists are being given too much responsibility.
The bill to streamline the involuntary commitment process for mental health patients in Vermont is not finished yet. However, some are concerned that the bill does not sufficiently protect the rights of patients committed involuntarily under the new, streamlined process. The head of Vermont Legal Aid’s Mental Health Law Project, Jack McCullough, requested that the Vermont Senate Judiciary Committee add language to the bill that would preclude a patient’s name from being added to the federal registry’s list of individuals who should not own firearms, at least until a preliminary finding of mental illness was adjudicated fully. Lawmakers indicated that they would not add the requested language in this bill, and would rather deal with that issue in separate legislation.