hospitals

  1. The great nursing home swindle

    It's the biggest scandal -- and the biggest swindle -- you've never heard of: Dementia patients are being shipped back and forth between nursing homes and hospitals in a calculated attempt to raise their cash value.

    And boy does it ever work.

    State Medicaid programs usually pay an average of $175 a day for the long-term care of dementia patients.

    Usually.

    But when those patients are sent to a hospital and then returned to the nursing home, Medicare steps in and pays triple the fees -- because the agency believes these patients now need skilled care to help with the recovery.

    Ka-ching!

    As you can imagine, nursing homes have caught onto this little game in a big way: A new study finds that a fifth of all advanced dementia patients are sent off for dubious hospitalizations in the final months of their lives.

    The study labels these transfers as "dubious" because the end was clearly near for these late-stage patients and hospitalization wouldn't have made a difference -- and obviously didn't, since the patients died anyway.

    Instead, they're shipped around and put through sheer torture, often suffering bedsores and needing feeding tubes. Many of them can't handle the stress and the movement -- making their conditions worse, not better.

    What's more, many of those hospital stays were for conditions nursing homes can and should handle on their own: pneumonia, urinary and other infections, swallowing problems and dehydration, for example.

    "These are people who are unable to recognize their relatives, they're bed-bound and they're now usually having problems with swallowing. This is a population where the burdens of hospitalization often outweigh the possible benefits," study co-author Joan Teno, a palliative care physician and health policy professor at Brown University, told the Associated Press.

    "These patients actually do better when they stay in a nursing home," she said.

    And that's exactly right, because the research on dementia care shows clearly that patients in all stages of the disease respond better to familiar surroundings, comfort and kindness than they do to the dangerous -- not the mention zombifying -- off-label meds they're so often given.

    The sad truth is that no one's ever gotten rich by selling compassion -- but it looks like there's plenty of money to be made in swapping dementia patients.

  2. Why your doctor needs more sleep

    How sharp would you be after 28 hours without sleep? If your answer is "not very," you're like most people.

    Doctors are like most people, too, once you take away the white coats, stethoscopes, and medical degrees -- but they're routinely scheduled for those infamous 28-hour shifts during their residencies.

    Earlier this month, new rules kicked in that are supposed to limit shifts to 16 hours -- but don't celebrate this as a victory for common sense.

    In reality, it's going to be business as usual at most hospitals.

    Not only are 16-hour shifts ludicrously long on their own, but the new rules only require a five-hour nap at the end of them.

    After that, young docs better stock up on coffee and Red Bull -- because they're back on the clock for yet another double shift.

    Even worse, the rules only apply to first-year residents. In years two and beyond, those 28-hour shifts are still perfectly acceptable.

    So much for change.

    Now, a group of leading doctors and patient safety experts are calling for stricter limits, writing in the journal Nature and Science of Sleep that all residents should be limited to between 12 and 16 hours.

    It's a common-sense approach that acknowledges the reality that some 180,000 patients are killed every year by medical mistakes -- and that many of those errors are committed by sleepy docs.

    At one conference held last year, 26 experts agreed that humans simply can't function with a clear head after 16 straight hours of work. Other studies have found that lack of sleep can have the same effect on skills and judgment as a night of drinking.

    And in other industries where public safety is on the line, there are strict limits in place. Truck drivers, for example, are only allowed to operate for 11 hours after 10 hours of rest.

    Pilots are only allowed to fly for 12 hours in any 24-hour period.

    But docs can keep right on slicing, zapping, diagnosing, and prescribing well beyond the established limits of human endurance.

    And if that's not enough to keep you up at night, consider this: It would cost hospitals about $1.7 billion to hire enough doctors to allow everyone to get the sleep they need.

    With that kind of money on the line, you can see why there's no rush to change the system.

  3. Robots put to work

    Here's what I think of when I picture a hospital pulling the wrapper off a shiny new surgical robot, like the ones commonly used to perform prostate surgeries: A kid getting a pair of skis in July...Same goes for those hospitals -- because a new study confirms that the first response isn't "how can we use this machine best?" It's "how quickly can we put this thing to work -- and how many patients can we use it on?"
  4. Dirty docs spread disease

    It's the last place you'd expect to face infection risk -- but it turns out it's the one place you need to be on your guard the most. It's your doctor's office.
  5. Fighting the superbugs

    Superbugs may be present in the places we live, work, eat and play.
  6. Don't turn spring cleaning into a germ-fest

    If you think you're doing a healthy thing wiping down your counters, doorknobs and appliances with those antibacterial wipes, research shows you need to reconsider.

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