Nursing homes behaving badly

 All of us learned, at the beginning of the coronavirus outbreak, that a nursing home in Kirkland, Washington, was at the center of the outbreak. A couple of months later, we learned about the nursing home in New Jersey where 70 people died and 17 bodies were found sequestered there. In fact, 40 percent of the nation’s fatalities have been residents of nursing homes. They have much to answer for:

• While it looks like nursing aids may be responsible for much of the virus spread, I don’t blame them. The national average pay for aids is $13.38 an hour, mostly without benefits. Thirteen percent live below the poverty line and almost 36 percent rely on some form of public assistance. They are not paid if they contract COVID and go out sick. To make ends meet, many work multiple jobs at multiple facilities, going from one to another in a single day. 
• Nursing homes are a $100 billion business. Around 70 percent of them are for-profit and more than half are affiliated with corporate chains. Just five companies own more than 10 percent of the country’s 1.7 million licensed nursing-home beds. Private equity has bought up four of the ten largest for-profit nursing homes. It’s a growth industry! (Studies have shown that when nursing homes are bought by private-equity groups, frontline nursing staff are cut, and residents are more likely to be hospitalized.)
• Nursing homes complain of being in financial distress because of low Medicaid reimbursements. This is actually not true. Three-quarters of nursing homes have created networks of sub-companies called “related parties” that trade with one another, including real estate, insurance, management, consulting, medical supplies, hospice, therapy, private ambulances, and pharmacy services—even interior design firms. This arrangement allows companies to siphon profits out of their nursing homes through overpriced transactions with their sister companies. By 2015, nursing homes were spending $11 billion a year on contracts with related parties. Nevertheless, Life Care Center of Kirkland has received nearly $919,571 in federal pandemic relief (Life Care is one of the biggest chains).
• To increase billing, nursing homes provide unnecessary therapy. Example: a 92-year-old man who was dying of metastatic cancer was allegedly given 48 minutes of physical therapy, 47 minutes of occupational therapy, and 30 minutes of speech therapy two days before he died.
• The five-star rating system for nursing facilities is a fiction. “Quality measures,” such as the number of residents who get pressure ulcers, are self-reported and rarely audited.
•  American Health Care Association, which represents for-profit nursing homes, devotes around $4 million a year to political lobbying, which consists primarily of asking Washington for less “burdensome” regulations and more empowerment to the free market.

I usually try to keep my posts short but was unable to in this instance. Even so, the above is only told part of the story.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

New wrinkles in the placebo effect

 To gain FDA approval for a new drug, pharmaceutical companies must show that it outperforms placebos in two independent studies. This is not easy. For example, more than 90 percent of pain medications fail in the final stage of drug trials. In other words, most drugs did not perform better than placebos. Every clinical trial is actually a study of the placebo effect.

The placebo effect is powerful. It can evoke a real neurobiological healing response, using the pathways that affect bodily sensations, symptoms and emotions. As one scientist remarks, “It seems that if the mind can be persuaded, the body can sometimes act accordingly.” The healing response is also affected by healing rituals and acts of caring. The brain translates the act of caring into physical healing, turning on the biological processes that relieve pain, reduce inflammation, and promote health.

Scientists have recently discovered that the response to placebos varies among people depending on their genetic makeup. A particular snippet of our genome governs the production of an enzyme, called COMT, that affects people’s response to pain and painkillers. Some people have weak placebo responses and some have strong responses.

For years scientists thought that the placebo effect was the work of the imagination. Now, with the use of imaging machines, they can see the brain lighting up when a test subject is given a sugar pill. Those people who are strong placebo responders show consistent patterns of brain activation.

If drug companies can weed out the strong placebo responders from their trials, they’ll have better luck!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Allergic contact dermatitis

 I wrote this post--using an iPad--on September 2 while evacuated to a cabin at Huntington Lake in the California Sierra Mountains. September 2 was day 17 of our evacuation from our home in Boulder Creek, California, site of the CZU Lightning Complex fire. I'm editing this at home on September 7th. Huntington Lake is now the site of a wildfire. We left the day before it started.

While at the cabin, I read an interesting medical-related story and wrote this: A man was doing yard work when he felt a sting on his shin—an insect bite, he figured. He did see a puncture mark. A couple of days later, the spot had become a little red, so his wife suggested that he put Neosporin on it, which he did.

He also decided to see a doctor about it. After examining him, the doctor decided that the spot--which had become enlarged and darker red--was not infected. Nevertheless, she prescribed an antibiotic for him to take in the event that the red area became larger.

In the days that followed, the area did become larger and the man started the antibiotics—to no effect. In fact, the red area continued to enlarge until it was about the size of a hockey puck and was surrounded by red dots. Not only that, but a red area also appeared on his other leg at about the same location. Again, he sought medical help. This time several doctors examined him and ruled out Lyme disease, brown recluse spider bite, and several other possibilities. Finally, one of the doctors figured it out: he was allergic to Neosporin. 

Neosporin is a triple antibiotic ointment, which his skin mistook for an invader, triggering an inflammatory response: allergic contact dermatitis. It turns out that triple antibiotic ointments are among the top ten causes of allergic contact dermatitis, along with some of the common ingredients in lotions and fragrances. As to the fact that the man’s other leg developed the redness, it was because it had come into contact with the ointment on the affected leg.

Update: we learned, on 9/11, that the cabin burned, a casualty of the Camp fire.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

The AgeLab at MIT

 The Massachusetts Institute of Technology has an AgeLab. Among other things, they created a suit that simulates the effects of aging. The suit includes yellow glasses, neck harness, bands around the elbows, wrists, and knees, boots with foam padding, and special gloves that add resistance to finger movements. Writer Adam Gopnik tried the suit and discovered that every small task becomes effortful. More than that, he reports, “the concentration that each act requires disrupts the flow of life…the ceaseless flow of simple action and responses…mostly without effort.” The suit made him aware not so much of the “physical difficulties of old age, which can be manageable, but of the mental state disconcertingly associated with it—the price of age being perpetual aggravation.”

Well, maybe Gopnik was perpetually aggravated while wearing the suit, but I’d guess that most of us old people are only aggravated part of the time. As for our activities requiring added concentration, he’s right about that. I’m more careful than I used to be about walking down the stairs and around impediments. Until reading his words, I hadn’t been aware of the “willful attention” now required for activities that I’d previously managed without thinking about it. He also equates the "ceaseless flow of simple action" as the "happiness of life." "Happiness is absorption, and absorption is the opposite of willful intention.” That’s a bit over the top, I think.

The purpose of the MIT AgeLab is to encourage and incubate new technologies and products for old people. They quickly learned that old people “are a market that cannot be marketed to,” the reason being that old people will not buy anything the reminds them that they are old. For example, after developing the neck pendant (“I’ve fallen and I can’t get up!”), they discovered that no one wants one. That would be me. Happily, the iPhone and Apple Watch have a red panic button app that alerts your emergency contact people. No one need know.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.