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What You Don't Know About Your Dialysis Clinic Might Hurt You: ProPublica Investigates Dialysis Clinics

Saturday, January 15, 2011, 05:14 PM - Federal Oversight, Medical Issues,Medicare

Are you or a family member receiving dialysis? ProPublica has done a series of articles in the past month spotlighting the lack of proper oversight of dialysis clinics (Led by California, Inspection Backlogs Weaken Dialysis Oversight) that you should read. They report that in California alone, for example, regulators responsible for ensuring that dialysis facilities meet health and safety standards have not conducted full inspections of at least half of the state's 500 dialysis centers for five years or more.

ProPublica has also posted a database that will let you check the trackrecord of your dialysis clinic and those in your area. ProPublica used the Freedom of Information Act to obtain reports to Medicare by dialysis clinics across the country, going back to 2002. This is data and information that the public should have but which the government has not shared with us. ProPublica analyzed the data and the result is a web database that allows consumers to search for a dialysis clinic by name or location. Using the database, you can see how a dialysis clinic is rated and compares on 15 key quality of service measures, ranging from mortality rate, complications, and hospitalization to transplant rates and infection control. The database will help you make informed choices about where to receive dialysis.

Studies show that when this type of data is made publicly available, in report card type form, the mere fact of getting the data out in the open motivates the health care providers who are reviewed to improve their care, because they don't want to lose out on business that might go to better rated competitors.

I looked at the data for dialysis clinics in Oakland, for example, and there's a big difference in mortality rates among different clinics. Medicare will pay for you to have dialysis at any licensed clinic, so use the data base to make an informed choice about where to go.

The url for the ProPublica database is:http://projects.propublica.org/dialysis ... 2&w=10

To go the the dialysis website, click here.

True Grit: 61-Year Old Patricia Maisch Stops Tucson Killer From Reloading, Saving Lives

Thursday, January 13, 2011, 01:29 PM - Heros & Heroines

To see true grit, you don't have to go to the movies. Just take a look at 61-year-old Patricia Maisch, one of the heroes from Saturday's shooting in Tucson, Arizona. The Tucson gunman had already fired a full clip of 31 bullets from a Glock 9mm handgun into a crowd of people who had gathered in a Tucson shopping mall parking lot to meet Congresswoman Gabby Giffords. Patricia Maisch was one of the individuals there to speak to Giffords. This is how Patricia described her story to CBS News:



"I heard a shot and I just knew that it was gunshot," Maisch said. "There was one shot and then a series of shots.

"So I had to make a split-second decision whether I was going to run, or I was going to drop to the ground," she continued. "And I thought if I ran, I might become a target. So I dropped to the ground.

"He shot the woman that was next to me, and I was just waiting for the next bullet," Maisch said.

Then Maisch saw the gunman was on the ground near her. "Two gentlemen had knocked him to the ground, and somebody yelled 'Get the gun,'" Maisch said. "So I knelt up - he was on his right side - I knelt up and reached over him. I couldn't reach the gun, but as he was doing that he also pulled another magazine out of his left pocket, which he dropped on the pavement, and I was able to get it before he did.

"At the same time, another gentleman had picked up the gun. So he was secured."

She said she could not get a good look at the gunman's face. "He had a stocking cap on, and the way he was pushed on the ground, I could only see a little bit of the left side of his face, 'cause he had the stocking cap almost up to his eyes, both at the side, and above his eyebrows," she said.

"And I was on his legs when - after I got the clip, he was struggling, and kicking his legs, so I knelt on his legs. And then I noticed that the one gentleman, Bill, who had knocked him down had a head wound, so I asked somebody else to come and take my place and ran into Safeway and got some towels, and made a compress for Bill's head."

"I think it's pure adrenaline," Maisch said.

Bravo Patricia! You are amazing! We're glad that you were there that day. More people might have been killed without you. Thank you!

Don't Assume That Narcotic Pain Killers Such As Oxycodone and Vicodin Are Safer Than Other Pain Medications: Study Finds That These Drugs Put Elderly Patients At Risk for Death

Sunday, December 19, 2010, 03:49 PM - Federal Oversight, Medical Issues

If a senior in your family is taking narcotic pain medications such as OxyContin, Roxicodone, Oxycodone, Narco, or Vicodin, chances are your doctor thought it was the safest alternative compared to either TYLENOL (which can causes liver damage), or NSAIDs such as Ibuprofen, Advil or Aleve. Because "NSAIDs" (nonsteroidal anti-inflammatory drugs) have been reported to cause bleeding ulcers, stroke, and other cardiovascular problems, doctors often recommend narcotic pain killers instead of NSAIDs. So it may be a shock to find out that narcotic pain medicines have more deadly effects than NSAIDs, as reported by the New York Times, in "Narcotic Painkillers May Pose Danger to Elderly Patients, Study Says." The Brigham and Womens Hospital study compared elderly patients taking narcotics, NSAIDs, and cox-2 inhibitors during 1999 to 2005. It found that, "patients in the narcotic group were four times more likely to experience a compound bone fracture, apparently as a result of a fall, and they were twice as likely to have a heart attack, [compared to patients taking NSAIDs such as Motrin]. The cardiovascular risks posed by narcotics were the same as for drugs like Celebrex and Vioxx, which have come under scrutiny for that hazard. ...The review also found that the rate of gastrointestinal bleeding among patients taking narcotics was about the same as those taking drugs like Advil and Aleve. A principal reason that medical experts have advocated narcotics in older patients is the belief that they reduce such problems."

Because of the sedative effect that narcotics have, it makes perfect sense that they would increase the risk of falls in the elderly, but it is a shock to read that they make a person 4 times more likely to break a bone due to a fall. The finding that such drugs can double the death rate due to heart attack is also very surprising and disturbing.

But perhaps the most disturbing aspect of this study is that we are not learning about deadly effects of these drugs from the Food and Drug Administration (the governmental agency who is supposed to regulate these drugs and warn us about the dangers) or from the companies that make and sell us these drugs. Why is that these drugs have been on the markets for years but this is the first time these kind of deadly effects on the elderly are being made known? Have the drug companies known about the risks for the elderly and not told us? They certainly make enough money from selling these drugs to be able to do this kind of study. What kind of follow-up is the FDA going to do on this issue? Are they going to require the drug manufacturers to warn doctors and patients about these risks? If not, why not?

The conclusion of the study appears to be that if you're a senior on OxyContin, Roxicodone, Oxycodone, Vicodin, or other narcotics, you should talk to your doctor about getting off of them, and switching to NSAIDs instead. Bring a print out of the New York Times article or the Archives of Internal Medicine abstract to the doctor's appointment.

To contact the FDA, call 1-888-INFO-FDA 1-888-463-6332


Clay Greene Elder Abuse Lawsuit Settled By Sonoma County on Eve of Trial

Saturday, July 31, 2010, 05:43 PM - Lawsuits, Heros & Heroines, If You're Not Outraged . . .

Clay Greene, the gay elder who was forcibly separated
from Harold Scull, his partner of 20 years, has obtained a settlement of his elder abuse lawsuit against defendant County of Sonoma, for six hundred and fifty thousand dollars ($650,000). The case, which was filed in Sonoma County Superior Court more than a year ago, was scheduled to go to jury trial this month. The timing of the settlement, right up against the trial date, indicates that the County only settled due to the pressure of the looming trial date.

The National Center for Lesbian Rights, which brought the lawsuit on Clay's behalf (together with The Law Office of Anne N. Dennis, and Stephen O'Neill and Margaret Flynn of Tarkington, O'Neill, Barrack & Chong) issued a press release that struck a cautionary note:

"What Clay and Harold lost can never be replaced, but this settlement brings a measure of justice to their story," said Amy Todd-Gher, Senior Staff Attorney for the National Center for Lesbian Rights,.... This victory sends an unmistakable message that all elders must be treated with respect and dignity, regardless of their sexual orientation, and that those who mistreat elders must be held accountable. Even as we celebrate this victory, however, we are deeply troubled that the County of Sonoma continues to refuse to take responsibility for their egregious misconduct and violations of the law in this case. We urge every citizen of Sonoma County to demand more oversight of the Public Guardian's office. They need to be watched."

They need to be watched indeed. If you read the County of Sonoma's website, it says that the reason it settled the lawsuit was "to avoid costs associated with a lengthy trial." They added, "The County must manage taxpayer money prudently." Did they forget about justice and doing the right thing? The only errors that the County acknowledges relate to Clay Greene and Harold Stull's property:

"The County acknowledges that some administrative errors occurred in the handling and disposition of the plaintiffs' property, which led to improvements in Public Guardian policies with respect to procedures for property disposition and case management. The County remains confident in its position that there was no discrimination in this case....."

They apologize for violating property rights but can't bring themselves to acknowledge they violated Clay's civil rights, as an elder, to be free from elder abuse, and as a gay man, to be free from discrimination. Sonoma County could have brought this episode to a more satisfactory resolution by admitting its mistake and promising it won't happen again. Instead, this case concludes with Sonoma County, which used to known just for fine wine, taking its place in the history of civil rights violators, alongside places such as Little Rock, Arkansas and Birmingham, Alabama.

By the terms of the settlement, only $25,000 of it relates to "property damage." By paying Clay Greene a very large settlement, that is as close as they come to admitting the magnitude of their mistakes. A large settlement for a huge injustice.


New Brain Scans for Alzheimer's Disease Are Forcing A Change in What It Takes to Be Diagnosed With Alzheimer's

Thursday, July 15, 2010, 05:15 PM - Medical Issues, Memory Loss

Based on new biomarker tests that allow the diagnosis of Alzheimer's disease some ten years before symptoms begin to appear, the National Institute of Health (NIH) is proposing to change the diagnostic criteria of Alzheimer's disease, to permit diagnosis of the disease before a patient has started to exhibit the telltale signs of memory loss that are the hallmark of the disease. Scientists believe that the brain of patients who will go on to develop Alzheimer's disease start to exhibit detectable changes in the brain (such as plaque or amyloid) some 10 years before the patient exhibits symptoms such as memory loss and confusion. Recent scientific advances, such as a PET scan of the brain developed by Dr. Daniel Skovronsky M.D. (recently reported on in The New York Times) allow scientists to detect these changes in the brain that are the precursors of Alzheimer's disease. The NIH is proposing that doctors be able to diagnosis Alzheimer's disease when these biomarker tests show the brain changes associated with Alzheimer, even if the person has not yet exhibited clinical symptoms. Within the next few years, it is expected that these tests will be available to the general public.

That means that you or your family members will be able to be tested before you have become impaired. Right now, the prospect of being tested when there is no cure seems like a scary one. But doctor's ability to diagnose Alzheimer's disease before a patient has started to exhibit memory loss carries with it the promise of being able to treat the disease and prevent it from progressing to the stage where memory loss is present. Scientists are optimistic for the first time that treatment will be available in the coming years to diagnose and treat Alzheimer's disease before impairment sets in.

What the NIH is doing is important, to assure that patients receive early treatment for the disease. Insurance companies are not big on paying for preventive treatment, and by labeling certain persons as having Alzheimer's, before memory loss appears, it will be easier for such persons to qualify for insurance coverage for whatever pre-memory loss treatment that becomes available.

To read the New York Times article (Promise Seen For Detection of Alzheimer's) about Dr. Skovronsky's test for Alzheimer's disease, click here.

To read the Times article ("Rules Seek to Expand Diagnosis of Alzheimer's) about the proposed change in diagnostic criteria for Alzheimer's disease, click here.

Nursing Home Abuse, Caught On Tape, Shows Vulnerability of Elderly To Neglect

Friday, June 18, 2010, 02:14 PM - Nursing Homes

Wonder what it is like to be an elderly resident of a nursing home and totally dependent on your care givers for help? A security videotape taken at a nursing home in Queens, New York, which forms the basis for a criminal elder abuse prosecution, can give you an idea. The nursing home care giver is shown to walk away as an elderly lady falls to the floor out of her wheelchair, after the care giver jerked the chair forward. In the process the lady breaks her hip. The care giver then walks away and leaves the elderly lady struggling on the floor.

Why would a care giver walk away like that? As part of a cover up of her own involvement in the lady's fall. She hopes that someone else at the nursing home will "find her on the floor" and it will get reported as an "unwitnessed fall." The elderly victim herself will often be too impaired to speak for herself and tell what happened.

This scenario is repeated every day in nursing homes across the country, but this time it was caught on tape. Does the tape force this nursing home to take responsibility? You'd think, but instead the clip shows how the nursing home tries to use the "blame the victim" approach so typical in these cases. The nursing home lawyer (the guy in the suit) is quoted as saying that the elderly 85 year old lady -- who had dementia -- "caused her own fall." Is it also her fault that she can't get up from the floor or that she is old and frail?

Ask President Obama Your Questions At June 8 Tele-Town Hall On The New Health Care Law's Effect on Medicare

Saturday, June 5, 2010, 12:23 PM - Healthcare Insurance, Medicare The National Assocaition of Elder Law Attorneys (NAELA.org) has announced

"Next Tuesday, June 8, at 11:15 a.m. EDT, President Obama and Kathleen Sebelius, Secretary of Health and Human Services, will host a "tele-town hall" event with older adults in Wheaton, MD. The purpose of the event is to answer questions from older adults in person and by phone about how the Affordable Care Act will affect Medicare. NAELA is co-sponsoring the event along with other national organizations which represent older adults.

Individuals interested in viewing the town hall may do so through the White House website or at a regional viewing events. The town hall will also likely be broadcast on C-SPAN. Obama Administration officials will be present at some of the regional viewing events in order to answer questions from participants. The list of regional events includes some private events highlighted in yellow. The rest of the events on the list are open to the public and include the location and contact information for the person organizing the event.

Individuals interested in asking a question of President Obama or Secretary Sebelius can call in during Tuesday's town hall at 1-800-837-1935, pass code: 80272058."

Sonoma County Destroys Life of Elderly Gay Couple in Kafkaesque Scenario

Saturday, May 8, 2010, 04:29 PM - Lawsuits, Elder Abuse Laws, Heros & Heroines, If You're Not Outraged . . .

If there was a contest for "Worst Place For (Gay)Elderly to Live," Sonoma County, California would have to be on the short list, based on what they did to two elderly gay gentlemen, Clay Greene and Harold Scull, pictured here in happier times. Clay Greene was living in his home in Sonoma County, with his partner of 20 years, Harold Scull. Harold, then 88 years old, fell and was hospitalized. What happened then is every elder person's - and gay person's - worse nightmare. The County sprung into action, removing Clay from his home, and sending Clay and Harold, against their will, to separate nursing homes.

Although Clay and Harold had wills, powers of attorney, and medical directives, all naming each other as their responsible persons, the County even obtained court orders preventing Clay and Harold from seeing each other. The County sold their belongings at auction, and as reported by Scott James of the New York Times, removed the men's cats from their home, right in front of Clay Green. Clay is still haunted by the scene. "When Clay M. Greene remembered the events of June 2008, he clenched his teeth, his hands tightened into fists and his body shook. They grabbed them by their necks and tossed them in a car,' he said last week, recalling the fate of his beloved cats, Sassy and Tiger. He never saw them again." Harold died in the nursing home, a few months later. With the assistance of a court-appointed attorney, Anne Dennis, of Santa Rosa, Clay was finally released from the nursing home

According to Kay Kendall of the Bilerico Project, all Clay has left from his life together with Harold is a photograph. The rest was destroyed by the County.

Clay Greene has decided to strike back against this despicable and egregious conduct, and is suing Sonoma County for violation of his civil rights - as an elder and as a gay man - in a lawsuit that will go to trial in July. Clay is from a generation that was forced to live their lives behind closed doors, so he does not use the term "gay" to describe himself, or the term "same sex partner" to describe his relationship with Harold. By standing up for himself, though, he will vindicate the rights of senior citizens in general and gay senior citizens in particular who live in fear that the same thing could happen to themselves.

To read the New York Times article about Clay Greene, click here.To read Kay Kendall's article in Bilerico, click here.

You can learn more about the lawsuit, by visiting a Facebook page set up by Clay's supporters:www.facebook.com/JusticeForClay?v=app_2347471856


What Is Aspiration Pneumonia And What Causes It In Elderly Persons?

Friday, April 30, 2010, 12:24 PM - Nursing Homes, Medical Issues

If you have an elderly parent or grandparent you should take time now to familiarize yourself with the causes of aspiration and its signs and symptoms. When a patient aspirates, food, drink or even saliva that should be channeled from the mouth into the stomach instead gets channeled into the lungs, causing a pneumonia in the lungs. Aspiration is usually, but not always, a life threatening situation, compromising the person's ability to breathe on their own.

When my Dad landed in the hospital in 2002, after having a fall at home and breaking his hip, I had heard of aspiration, but that was the furthest thing from my mind. After all, how could a broken bone lead to aspiration? My Dad was aging amazingly well - he was mentally and physically intact, sharp as a tact, with normal blood pressure and no health troubles other than a bad back. My main concern was that the hip surgery go well, which it did. Without a hitch in fact.

The night before he was to be discharged from the hospital, I visited him at night after work. We were looking forward to the next day, when he would be discharged to a rehab center for physical therapy, and after that, to go home. He had already eaten dinner when I arrived at 8 pm. He had told me that earlier that day he had become confused and thought that the furniture was flying around the hospital room, and realized that it must be the pain medication. I noticed that he was wheezing off and on -- something he had never done before. Dad said that the wheezing had started just before I arrived. I asked the nurse what that meant, and she said that he "might just have a little congestion." I asked her to ask the doctor about it and get back to me. Other than the intermittent wheezing, Dad seemed fine, so I left at 11 pm without having heard back from the doctor.

The hospital called me at 2 a.m. and said that my Dad was transferred to the ICU. I rushed to the hospital and was told that he had aspiration pneumonia -- most likely caused by aspirating his dinner the night before. That's what that wheezing meant. When I spoke to Dad's doctor, he said that most likely the pain medication Dad was on for the hip fracture (the Oxycontin and Vicodin) interfered with his swallow mechanism, causing the food Dad ate at dinner to go down his windpipe instead of into his stomach.

My Dad never regained consciousness, and within 48 hours he was dead from complications of the aspiration.

There are many other unlikely causes of aspiration. For example, patients who became malnourished are at risk of aspirating. Safe swallowing depends on working swallowing muscles, and drastic weight loss diminishes the swallowing muscles' ability to function properly. A malnourished elderly patient can be at risk for aspirating simply because their swallow muscle has atrophied due to malnutrition. Because malnutrition is so prevalent in nursing home residents (for many reasons, most of which are preventable), that's one reason why nursing home residents are vulnerable to aspirating in a nursing home.

The New York Times New Old Age Blog has just posted an article on swallowing disorders, When The Meal Won't Go Down. It is an excellent introduction to swallowing issues in the elderly and will refer you to other resources on the web, such as the American Speech-Language-Hearing Association website.

AARP Article Describes Veterans Benefits for Senior Vets
Friday, April 23, 2010, 11:08 AMDo you have a veteran in your family? The Veterans Administration has many programs that might help your family, including the seniors in your family. You should read an article the AARP has posted, called Giving Back to Vets, that describes the veteran benefits available.

Click here to read the article.