LTC Bullet: Of Superman, Bedsores and Nursing Home Litigation

Wednesday, November 3, 2004

Santa Fe, NM--

LTC Comment: Christopher Reeve inspired millions in the field of long-term care. His passing inspires consideration of our struggling LTC system. More after the ***news.***

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*** LAST CHANCE TO ENROLL in our BOSTON Long-Term Care Graduate Seminar. Steve Moses will present this highly regarded class on Thursday, November 11, 2004 at the University of Phoenix, 100 Grossman Drive, Suite 201, in BRAINTREE, MASS. Pre-registration is required. Contact Executive Director Amy McDougall at 425-377-9500 or amy@centerltc.org to register. Tuition is $225 for the full-day program but we're discounting this session $50 for CLTCs, CSAs, and ARMs. Knock off another $25 if it is not yet certified for CEUs in your state or for your profession. Check out the syllabus, rave reviews, and other details at http://www.centerltc.com/ltc_grad_seminar.htm . We call this class a "LTC graduate seminar" because it is intended for experienced and knowledgeable insurance agents, financial advisors, attorneys, and LTC providers. Instead of sitting through another dose of "Introduction to LTC," you'll be getting an advanced program available nowhere else from a leading national authority on long-term care service delivery and financing. ***

*** GET YOUR "CSA" AND HELP THE CENTER: The Certified Senior Advisor organization makes a contribution to the Center for Long-Term Care Financing for every new enrollee to their program who mentions the Center and cites the "source code" number 8196. Although the Center does not endorse any companies or professional designations, we've heard a lot of good things about CSA and we've met many capable professionals who have attended their training and received that designation. For information on the CSA course and certification, go to http://www.society-csa.com/ . If you enroll in the CSA program, please mention the Center for Long-Term Care Financing in your application and reference source code 8196. Drop us an email to mailto:info@centerltc.org and let us know you've enrolled. Then send us your evaluation of the program when you've completed it. CSA classes are coming up November 10-13 in Las Vegas, NV; December 1-4 in Orlando, FL; January 12-15, 2005 in Charlotte, NC; and January 26-29 in Phoenix, AZ. ***

*** LATEST DONOR-ONLY ZONE CONTENT: Here's the latest Zone content followed by instructions on how to subscribe so you can receive these critical epistles daily by email.

LTC E-Alert #4-054--Details on the Forthcoming White House Conference on Aging (Who should attend to avoid another intellectual exercise with no policy or practical outcomes?)

The LTC Reader #4-042--Sunny Vacation to Prevent Hip Fracture Epidemic? (Explore the connection between sunshine, Vitamin D, osteoporosis, bone disease, and LTC.)

The LTC Reader #4-043--LTC Mistakes? (What does the Wall Street Journal think are the biggest mistakes purchasers of LTC insurance make?)

LTC E-Alert #4-055--What if Nursing Homes Were Air Conditioners? (A government giveaway of AC units after 9/11 parallels waste, fraud and abuse of Medicaid LTC benefits.)

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Individual donors of $150 or more and corporate donors to the Center for Long-Term Care Financing receive our daily email LTC Bullets, LTC E-Alerts, LTC Readers, and LTC Data Updates for a full year. You'll also get access to the donor-only zone where these publications are archived along with other donor-only features. If you already qualify for The Zone, you can click the following link, enter your user name and password, and go directly to the latest donor zone content and archives: http://www.centerltc.com/members/index.htm . If you do not already qualify for The Zone, mail your tax-deductible contribution of $150 or more to the Center for Long-Term Care Financing, 2212 Queen Anne Avenue North, #110, Seattle, WA 98109. Then email mailto:damon@centerltc.org your preferred user name and password (up to 10 characters each). You can also contribute online by credit card or direct withdrawal at http://www.centerltc.com/support/index.htm . ***

LTC BULLET: OF SUPERMAN, PRESSURE SORES AND NURSING HOME LITIGATION

LTC Comment: According to a New York Times article published shortly after his death (excerpts and a link follow below), Christopher Reeve succumbed to cardiac arrest following "a severe systemic infection that was, in turn, caused by a pressure wound, the medical term for a bedsore, a common complication for people who are paralyzed."

The Times article goes on to observe that "Mr. Reeve was, in fact, one of the lucky ones. Though his injuries were among the most severe possible, he also had the resources to get the best treatment." Furthermore, "Mr. Reeve's own problems with pressure sores show how difficult they can be. Patients who cannot move for themselves must be shifted and turned regularly during the day and often must have 24-hour nursing care. "And even when expert full-time care is available, as in Mr. Reeve's case, it is no guarantee." There is a "proclivity to skin breakdowns that comes from sitting or lying in one place day after day, month after month, year after year." . . . "And any infection, in the skin, in the lungs, in the kidneys, can get out of hand, with bacteria pouring into the bloodstream, producing septicemia."

The Times article focuses on medical problems associated with paralysis caused by spinal cord injury. But the facts also point in another troublesome direction. What about elderly, custodial long-term care patients who, because of end-stage Alzheimer's or a severe stroke, are unable to turn themselves in bed? They need 24-hour nursing care and attendance. They must be "shifted and turned regularly during the day" and night. They have a "proclivity to skin breakdowns." They are vulnerable to pressure sores and infection that may lead to septicemia and ultimately death. But how many people in need of custodial long-term care in America actually receive the kind and level of attention Christopher Reeve was able to obtain? Answer: very few.

The bigger question is: Why not? You've read the answer in this space many times. Preponderant public financing of long-term care pays too little to ensure access to quality care but anesthetizes the public to the risk so few people plan, save, invest or insure for long-term care. Government programs like Medicaid and Medicare cannot afford to pay adequately for home and community-based care, so we have an underfinanced nursing-home-based system that struggles to sustain minimally acceptable quality. Heavy state and federal regulation of nursing homes fails to ensure quality: "you can't make a silk purse out of a sow's ear." In other words, regulation is no substitute for adequate financing. Bad outcomes are inevitable. Lawyers entice families whose Medicaid-financed loved ones develop bedsores to sue nursing home companies. Juries award gigantic settlements. Liability premiums for long-term care providers skyrocket. Litigation and insurance costs extract ever larger sums from the already financially starved long-term care system. And the ugly downward spiral continues toward the eventual collapse that will inevitably occur sometime early in the declining years of the baby boom generation.

Here's the point. If Christopher Reeve, who could afford the best possible long-term care, can succumb to complications from a pressure sore, how can we expect nursing homes to eliminate such complications for Medicaid residents when Medicaid pays nursing homes $4.1 billion short of break-even annually (BDO Seidman report: http://www.ahca.org/brief/seidmanstudy0312.pdf) and liability insurance costs are consuming most of the meager reimbursement increases Medicaid occasionally provides (Aon report: http://www.ahca.org/brief/aon_ltcanalysis2004.pdf )?

People need to wake up and realize that already, but far more so in the future, access to quality long-term care--especially home and community-based care--will depend on the ability to pay privately for such care.

Juries need to realize that bad outcomes in nursing homes are not necessarily caused by greedy owners or corporate bureaucrats unwilling to pay for quality care. Bad outcomes usually reflect systemic problems caused by excessive dependency on inadequate government financing.

Policy makers and tax payers need to realize that the same lawyers artificially impoverishing affluent seniors to qualify them for Medicaid nursing home care are often the same practitioners suing nursing homes for providing allegedly poor care to their Medicaid-underfinanced residents.

Until we understand the complicated, deep-seated connections between these superficially unrelated facets of the long-term care problem, we'll have little hope to improve care quality.

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Excerpts from John Schwartz, "With Paralysis, Challenge Goes Beyond Walking," New York Times, October 12, 2004, http://www.nytimes.com/2004/10/12/health/12infe.html?pagewanted=print&position=

"The death of Christopher Reeve illustrated something that those who live with paralysis know all too well: the challenges go far beyond the inability to walk. . . .

"Mr. Reeve died of cardiac arrest on Sunday. He had previously been treated for a severe systemic infection that was, in turn, caused by a pressure wound, the medical term for a bedsore, a common complication for people who are paralyzed.

"Mr. Reeve was, in fact, one of the lucky ones. Though his injuries were among the most severe possible, he also had the resources to get the best treatment.

"'He had extraordinarily good state-of-the-art care, which is not necessarily something available to everyone who suffers a spinal cord injury,' said Susan Howley, the executive vice president and director for research the Christopher Reeve Paralysis Foundation in Springfield, N.J. . . .

"Mr. Reeve's own problems with pressure sores show how difficult they can be. Patients who cannot move for themselves must be shifted and turned regularly during the day and often must have 24-hour nursing care.

"And even when expert full-time care is available, as in Mr. Reeve's case, it is no guarantee. . . .

"And any infection, in the skin, in the lungs, in the kidneys, can get out of hand, with bacteria pouring into the bloodstream, producing septicemia. . . ."