Inside the News

Change is in the wind for nursing home industry

      The nursing home industry is one of the most regulated businesses in the nation. Their operation has become so regimented to control risks and costs that buildings look alike and virtually every decision is made for residents, from when to get up to what to eat.

   The regulations, although well-meaning, have combined with outdated payment system, to stifle innovation. There is little incentive to raise quality above minimum standards.

   Today, too many nursing homes offer a passionless, hospital-like service built for efficiency. It may have made sense decades ago, but now turns off people, struggles with high employee turnover and continues to experience quality problems.

   Against this backdrop, reformers in recent years have pushed for a radical rethinking of the long-term-care system known as "culture change."

   A smattering of nursing homes around the country, including Buffalo, have adopted a few aspects of the movement. Now, advocates in Western New York want to turn culture change into a regionwide initiative, making this community the first in the U.S. to attempt a transformation in elder care on a large scale.

-- Henry L. Davis

Teaching doctors to deliver bad news with care

   One of the hardest jobs in medicine doesn't require high-tech devices or sure hands. It's that painfully awkward moment when a doctor has to deliver bad news.

   Patients generally just want the facts cushioned by compassion and encouragement. Yet, as simple as that sounds, the right words often go unspoken.

  Of course, some doctors do communicate well with patients or work at the skill. But others don't, as reflected in the large number of studies about improving the doctor-patient relationship.

   Relaying bad news is difficult. Few people are comfortable talking about death and dying. And, empathy can take time that busy doctors often believe they don't have.

   Doctors also come with different skills and personalities. Some can communicate naturally while others are uncomfortable talking to their patients.

   Patients are different, as well. Some want their information direct. Others require a go-slow approach. Some will handle a diagnosis of cancer with poise. Others will wilt over a negative test result for a condition that isn't fatal.

   One expert put it this way: "It's a situation no one wants, yet there needs to be some interaction. Physicians are people. They are not all stamped out of the same mold. Patients are different and bring with them emotional, family, religious and cultural issues."

   -- Henry L. Davis

Obesity programs: do they work?

 
   The nation's childhood obesity rate has nearly doubled since 1980, and obese children and teenagers today are developing diseases formerly only seen in adults, such as type 2 diabetes.

   It's a growing epidemic in which American adults are getting fatter from unhealthy diets and lack of exercise, and their young ones are waddling in their footsteps.

   To reverse the trend, increasing attention here and across the U.S. is being paid to schools.

   Schools are where children spend a large part of their waking hours and consume a large portion of their daily calories.

  In the Buffalo-Niagara region, for instance, Independent Health recently announced a school-based obesity program. Later this month, Blue Cross and Blue Shield of Western New York is expected to introduce a school-based fitness program in collaboration with the Buffalo Bills. Those organizations join an existing program operated by Univera Healthcare.

   Still, it's not clear if such programs here and elsewhere across the U.S. work or are cost-effective. One of the problems with many of the programs is that there are few, if any, measurements to gauge success.

-- Henry L. Davis 

A prescription needed for fewer meds?

   A recent national study determined that for the first time, 51 percent of all insured American children and adults are taking one or more prescription drugs regularly for a chronic condition.

   The most widely used drugs are those that lower high blood pressure and cholesterol - problems often linked to heart disease, obesity, and diabetes.

   Medco Health Solutions, which manages prescription benefits for about one in five Americans, gathered the numbers last year. The company sampled 2.5 million customers, from newborns to the elderly and medication use was seen in:

• Almost two-thirds of women 20 and older.

•  One in four children and teenagers.

•  More than half of adult men.

• Three out of four people 65 and older.

   Do you think Americans are over-medicated?

   What steps have you taken to get off prescription medications?

   --- Deidre Williams

A stellar report card for area hospitals

   It may not be the final word yet, but at least the first word on the value of hospital care nationwide puts Buffalo on the map.

   A new study and index by a health care information firm ranks Buffalo Niagara No. 1 in the nation among large cities for the value of hospital care that is provided.

   That's after ranking eight Western New York hospitals as among the top 100 nationwide for hospital value.

   That doesn't mean the Buffalo-area hospitals offer the best possible care money can buy. But for the money you spend, it's the most bang for your buck of any large metropolitan area in the country, it contends.

   The study of more than 1,400 hospitals nationwide scored the institutions using publicly available data on medical quality, prices, the hospitals' costs, patient satisfaction and the hospitals' local reputations.

   All four Catholic Health System hospitals -- Sisters of Charity, Mercy Hospital of Buffalo, Kenmore Mercy Hospital and St. Joseph's Hospital -- made the top 100, as did Kaleida Health's Buffalo General Hospital, Erie County Medical Center, Niagara Falls Memorial Medical Center and Mount St. Mary's Hospital and Health Center in Lewiston.

   Not too shabby.

   -- Jonathan D. Epstein

Glut of medical ads crossing the line

   The advertising of prescription drugs and medical devices to consumers has grown  --  from $11.4 billion in 1996 to $29.9 billion in 2005. So, too, has controversy over the practice.

      Proponents of advertising to consumers say it encourages more informed decisions about health care and treatment options. But critics of this marketing contend it increases the demand for expensive brand-name medications, turns normal human experiences into medical conditions, skims over safety concerns while highlighting benefits, and interferes with the doctor-patient relationship.

      In the New England Journal of Medicine, an article by a Buffalo physician takes issue with a television ad for the Cypher heart stent by the Cordis Corp. He and others contend it crosses a line in direct-to-consumer advertising. The company defends the ad campaign as an effort to educate consumers and physicians about the newest research on the device and its use as a treatment option for coronary artery disease.

      The article comes at an important time. Congress and the Food and Drug Administration are conducting hearings about medical advertising to consumers. However, it is not clear what will happen. Some experts, even critics of current regulations, say there isn't enough information about the advertising in print, TV or online to make informed decisions about what policy changes to make.

     -- Henry L. Davis

Some shocking stats on teens and sex

   The first time I read about the study that says one-quarter of America's teenage girls has a sexually transmitted disease, I didn't believe it.

   It must be some fly-by-night non-scientific study that just surveyed girls going for birth control, I thought.

   But it was a study for the federal Centers For Disease Control, which says: "The authors analyzed data on 838 female adolescents (aged 14-19) who participated in the 2003-2004 National Health and Nutrition Examination Survey, a continuous annual study that examines a nationally representative sample of the U.S. household population to assess a broad range of health issues."

   So then we thought we'd ask local health care providers. Is this study for real, do you see the same things? And they said they weren't surprised. It's a wake-up call for many parents across the region.

   --Barbara O'Brien
   

Retired? Not for long

The dream of retiring with full health benefits is now just that - a dream.

As News reporter Deidre Williams reports in her Page 1 story today, more and more retirees are looking for parttime jobs to help pay the bills - particularly health insurance premiums.

Whether it's a parttime job at a fast-food restaurant, a supermarket, or a teaching position at a local university, retirees are spending as much time on the job as on the golf course.

  Also adding to the growing local labor pool are the baby boomers who are retiring in their 50s and early 60s, and who are faced with increasing health care costs, even before they're eligible for Social Security checks and Medicare benefits.

Is this the new retirement - going from a full-time job to a parttime job, just to pay for health care?

Locally, are there enough jobs available for all the retirees who need to work?

What can be done about the problem of soaring health care premiums for retirees?

 

Caring for an aging population

     For decades, Americans have depended on nursing homes to care for them in old age. But as the population rapidly ages, more care is shifting from institutions to homes and senior residences, and more responsibility is shifting to families.

   It's a change of major proportions, and it's happening quietly with little national debate. Read my story in Sunday's  Buffalo News.

   Today, about 36 million people in the United States are 65 or older. That number is projected to grow to roughly 54 million over the next 12 years, with the oldest and frailest growing faster than any other age group.

   It's not clear where they will live, how they will pay for their care or who will take care of them.

   The United States lacks an overall policy for long-term care. In New York State, meanwhile, it's unknown if a handful of promising initiatives will meet future demands and if the state can adequately fund them.

   People prefer to age in their homes or in senior residences.

   But community-based alternatives remain underdeveloped, especially for those with low incomes. Moreover, there are projected shortages of geriatric specialists, nurses and other health care personnel.

-- Henry Davis

New technology expands horizons for the disabled

   People who are visually impaired, hearing impaired or who have a severe physical disability in the past could have difficulty communicating with others.

   People who are deaf had to rely on the assistance of others to place a phone call. Someone who is blind could find it time consuming to search for information and was limited by the holdings of the nearest Braille library. And someone who is non-verbal and limited in the use of his hands would have difficulty expressing himself to others.

   Today, the latest adaptive technology is helping people with disabilities communicate more readily and do so with a greater sense of independence.

   This assistive technology is opening social, educational and career opportunities for the disabled, experts said.

   Some of this technology is helping people with disabilities take full advantage of the computer and Internet revolutions.

   For example, someone who has limited use of her hands can control a mouse cursor through the movements of her head or, failing that, just her eyes.

   The Internet, and the digitization of information, has opened a vast new library of books that can be downloaded in audio format or onto a refreshable Braille display for the blind.

   And two deaf people who are most comfortable communicating through sign language can have a conversation over a pair of video phones.

   Though obstacles to access remain, advocates for the disabled are excited about the new opportunities that this assistive technology is creating.

   It's giving people who want a chance to go to college, to work, to participate more fully in society, the chance to do just that.

-- Stephen T. Watson

The soap and water solution

Having three children under age 2 in the house (a toddler and infant twins) means you do a lot of laundry.

And after one of the babies develops a MRSA infection and spends three days in the hospital -- with two surgeries to cut the abcess out of her tiny leg and hooked to an IV drip of antibiotics -- you do even more.

Now in our house, tubes of Clorox wipes are in almost every room. Baby bedding (for all three) is washed every day, as are the blankets they like to drag around and are not allowed to share. In fact, everything that can go in the washer does, after every single use.

Because fighting MRSA is like something out of a science fiction movie. The monster laughs off powerful antibiotics; in fact using some of them appears to encourage it to grow even stronger and more resistant.

But it doesn't like soap and water.

The house was clean before; now you could probably do surgery there. That's because we don't know where the infection came from: Did her mom pick it up having her C-section? Did Grandpa get it traveling on crowded airplanes for work? Did big brother bring it home from day care? People can carry it around (often in their noses!) without even knowing it.

The wonderful doctors at Women and Children's Hospital told us they see hundreds of cases of MRSA in children each year. For them, unfortunately, the baby's surgery was routine.

Cold and flu season is starting, and MRSA is out there. There's no better time to make sure kids know how to wash their hands.

-- Melinda Miller

The future of our health care

   New York State's move on Wednesday to name a new board of directors to oversee a combination of Erie County Medical Center and Kaleida Health is a significant step forward in a long and complicated process.

   Constituting a new board for both entities had been viewed as one of the most difficult steps in the state-mandated process, because of long-entrenched interests and both organizations' efforts to preserve as much of themselves as possible. As recently as last week, spokesmen from both hosptial organizations were sniping at each other over how to go about a merger -- and whether state action would be in the community's best interest.

   But now the state has acted, and one of the most difficult obstacles in the process has at least been initially addressed. In addition, it is significant to note that Dr. Richard F. Daines, the state health commissioner, said Wednesday that no one now disagrees with the idea of consolidation.

  There's a long way to go before the state's health facilities consolidation plan becomes fully implemented in Western New York, but Wednesday's action marks an important first step.

-- Robert J. McCarthy

Postpartum depression overwhelms some new mothers

     Most new mothers find that the joy of childbirth is also accompanied by strange feelings of sadness and irritability. The brief mood swings are known as the "baby blues."

     Although all the details in the suffocation death of Shauna Mahoney's 17-month-old son are not known, the case brings attention to an important medical issue … the women who go on to suffer more serious depression disorders.

     Postpartum depression, for instance, can overwhelm a woman with feelings of hopelessness, lack of energy, sleeplessness, loss of interest and discomfort around the baby. It's more common than people think … occurring in 10 percent to 22 percent of new moms.   In rare cases, a woman develops postpartum psychosis, losing contact with reality and becoming a danger to herself and her baby.

--Henry L. Davis