‘More Men Take the Lead Role in Caring for Elderly Parents’
November 29, 2008
Yesterday the New York Times published this story with the headline: “More Men Take the Lead Role in Caring for Elderly Parents.” Though nowhere near 50/50, the workload seems to have shifted significantly away from female siblings and onto their brothers. Of course, this only makes sense. Women, especially those with children, continue to suffer under the expectation of being the center of the family unit. Between working, running the household, maintaining the ties between distant and not-so-distant relations and the hundreds of other tasks that somehow elide the male gaze and attention in our society, it really is no wonder that some of the responsibility of taking care of an elderly parent will go to the men in the family.
It reminds me of a blog post I read a few months ago. Jane Gross writes The New Old Age blog. One article, published in September, was titled “Dividing the Caregiving Duties, It’s Daughters vs. Sons.” Ms. Gross actually received some heat from this one because she suggests the daughters should not “throw a feminist hissy fit” and focus on the importance of the work (taking care of elderly parents) instead of the thwarted expectations they might have of their poorly contributing brothers. This post is not the occasion to take up that debate; however, the recent NY Times story and Ms. Gross’ comments do make me think about the importance of family involvement and planning for that involvement in long term care.
Every professional in LTC knows there is a lot of guilt flying around when it comes to familes. The daughter or son taking the primary caretaker role feels extremely guilty for putting mom or dad ‘in a home;’ the more absent daughter or son feels guilty because they have not helped more; mom or dad feels guilty because they require so much care assistance that their daughter or son cannot provide it anymore. The band plays on and on. I’ve seen in my own facility how all this guilt can manifest in some pretty strange behavior – – from the innocuous (family members’ inherently contradictory complaints) to the dangerous (residents misrepresenting their condition to nurses).
One way to manage this guilt is through committed and deep involvement between the facility (or home health agency) and the patient family members. An active family council can be a kind of support group for the caregivers/family members. It can also be an occassion to channel the energy created by all of that guilt into something more productive: honoring the time remaining with an elderly parent by enjoying and helping them to enjoy their lives. Even if the support is not as formal as a council, long term care facilities should take an active role in structuring care networks between family members and residents. If the “dutiful daughter” and the “sainted son” can work together to improve mom or dad’s care, they may respect one another that much more. It goes to the heart of what we do in LTC: care for the eldelry, care for families.
Americans Abroad: Long Term Care and Medical Tourism
November 19, 2008
The Dallas Daily News published a story recently featuring the emergent Long Term Care industry in Mexico. (link here). What is remarkable about this story is that the newspaper was not discussing new developments in Assisted Living and Skilled Nursing Care in Mexico, designed for Mexicans, but rather new facilities built for the purpose of serving Americans who want to spend their senior years south of the border.
The listed the pros (strong dollar agaisnt the peso, inclusive culture of long term care in the country, warm weather, little regulation) as well as the cons (little regulation, untested providers, far from family and friends). The experts from the article seemed to think that servicing the long term care needs of Americans will not just be a niche marketing technique, but rather an entire industry. As far as I’m concerned, the jury is still out, but the business model is intriguing. Generally speaking, it is an application of so-called ‘medical tourism.’
I’ve written about this phenomenon with greater precision elsewhere (link here), but the broad strokes are, simply, using the economic inducements of cheaper medical care and exotic, vacation-like locales, to draw wealthy, western patients to poorer, underdeveloped nations for specific, acute medical care. Most of these ventures have focused on providing surgery to the medical tourist patient, but I see no reason why the long term care industry cannot profit from the same underpinning economic advantages as the mega hospitals in Bangkok that offer hip replacement surgeries for a tenth of the cost as hospitals in the U.S.
Such foreign provided care is not without problems (resident safety, payor sources, etc.), and the issues are much different for American citizens who intend to move to Mexico to remain rather than stay for a week of surgery. However, these Mexican facilities may provide some much need dynamic competition to our home-grown long term care facilities. This is a development I intend to watch very carefully.
Five Star Nursing Home Compare
November 17, 2008
Today I happened to read James Berklan’s Editor’s Note in Mcknight’s concerning the coming-soon Five Star rating system on CMS’ Nursing Home Compare website. (full article here)
He makes some awfully good points: the Five Star comparison makes already deceptive data even more important, the promised “phase two” changes that would improve the inherent flaws have no target date — so may never actually come about, it is unclear if there are any Five Star rated homes in the country under this scheme, etc.
I’ve been tracking this 5 star rating system for some time now. (In fact, until very recently, I was convinced the opposition would be able to continuously delay its implementation). In that time, I think I have heard every argument against this system, including Mr. Berklan’s well-reasoned and well-written remarks. What I have not heard is whether this 5 star system will actually affect the way potential residents and their families use the Nursing Home Compare website tool.
The Nursing Home Compare tool, as it currently operates, is convoluted and not very user friendly. Adminstrator colleagues at other facilities complain to me that the Five Star system will confuse potential residents because it compresses dubious data into a relatively arbitrary star system; but I wonder if the charts and spreadsheets of the current system do not leave users jsut as confused? I know DONs and Administrators who pour over each metric on the current system, looking for ways to improve overall care, as well as ways to improve key numbers over the direct competition. But, I’ve seen no real evidence that residents and familes use the website as diligently. They may look closely at a few key metrics, but there is little or no guidance over which spreadsheets identify “good care.” If the current system creates arbitrary distinctions with an overload of data, is the new system which compresses data in order to create arbitrary distinctions really all that bad?
Maybe a familiar and generally well-understood metric like a five star system will be a better occassion for resident and family education than the mountains of data the current Compare website offers.
Health Care Law/Legal Risk Consultants
November 14, 2008
Richard Susskind, professional futurist and this week’s attorney kill joy number 1, recently told the legal newspaper, AM LAW DAILY, that “the party is over” for lawyers. Gone soon will be the enourmous salaries and juicy partner deals of big time corporate law for huge armies of lawyers. Instead, he predicts the practice of the law will be relegated, primarily, to generalized, legal risk consultants.
From anecdotal evidence, I can attest that the long term care industry’s recent push to hire health care lawyers for Admistrator’s position, is clearly in-line with this trend.
Regluation on long term care facilities is up, corporate legal work is down. The credit crunch is souring the growth of business sectors (like corporate law) which require workers to spend massive educational outlays before joining the work force. I forsee more lawyers managing highly regulated businesses, especially health care service providers like nursing homes, in the not so distant future. Any Administrator who has tangled with state surveyors over the interpretation of FTag guidance can attest, reasoning and argumentation skills are very useful in our business. If Susskind is right, then more lawyers will be joining the Administrator ranks.
Terminal Patients’ Right to Know End-of-Life Options Act
November 13, 2008
The much maligned Terminal Patients’ Right to Know End-of-Life Options Act has finally passed in California. This was a law that was blasted by critics from every side when it was first introduced. The final version, which takes effect on January1st of 2009, creates a legal right in patients at that end of life to have access to information about number of end of life issues. Included in these are Advance Directives, Hospice care, and pain and symptom management.
Major opponents of the original language of the bill (which required doctors to discuss palliative care and refusing artificial hydration and nutrition for any patient with a prognosis of less than one year) worried that end of life patients would be given too much overwhelming information. They feared the patient would not have a meaningful conversation with their doctor, and would only suffer mental distress when the physician ran through a checklist of end of life issues.
The new language gives more discretion for when the conversation must take place and what is involved in it. Essentially, the new law creates a right that can be engaged by the patient (they ask their doctor) instead of existing passively (the doctor gives the information whether solicited or not).
This legislation is really the first of its kind in the US, but the changes in the law will probably not ensure information to a patient who wasn’t already going to get it. What it does do is put end of life issues in the vanguard of legislative concerns – a turn of events which is both welcome and sorely needed.