Medical Tourism in the Nursing Home Industry?

As a health care marketing professional, I have done some overseas work in the area of medical tourism, that is helping overseas hospitals market to U.S. and European patients. Until yesterday, I had never seen the concept applied to nursing homes. This is an interesting article in the Chicago Tribune about just that, farming mom and dad to the nursing home in India.

Even for me, a pretty liberal thinking guy, this seems over the top. Or is it? People faced with dire financial situations will resort to what they need to do to get the care they need. Just today another article on how medical tourism in Mexico is picking up, fueled in part by some Texas hospitals building in Mexico and offering cheaper care just across the border.

Oscar the Cat

The business of nursing homes and caregiving is a serious one. But you can't help but pause and maybe find the gallows humor in the following. Oscar, a two-year-old feline was adopted as a kitten and grew up in a third-floor dementia unit at the Steere House Nursing and Rehabilitation Center in Providence, RI. The facility treats people with Alzheimer’s, Parkinson’s disease and other illnesses.

Oscar seems to have an uncanny knack for predicting when nursing home patients are going to die, by curling up next to them during their final hours. His accuracy, observed in 25 cases, has led the staff to call family members once he has chosen someone. It usually means they have less than four hours to live. “He doesn’t make too many mistakes. He seems to understand when patients are about to die,” said Dr. David Dosa in an interview. He describes the phenomenon in a poignant essay in Thursday’s issue of the New England Journal of Medicine.

“Many family members take some solace from it. They appreciate the companionship that the cat provides for their dying loved one,” said Dosa, a geriatrician and assistant professor of medicine at Brown University. After about six months, the staff noticed Oscar would make his own rounds, just like the doctors and nurses. He’d sniff and observe patients, then sit beside people who would wind up dying in a few hours.

No comments necessary.

Nursing Home Watch List

Senator Charles Grassley is proposing a new "watch list" for nursing homes that aren't meeting federal health and safety standards. "That would include nursing homes that yo-yo in and out of compliance by using grace periods to correct deficiencies, but only then on a temporary basis," Grassley says. The public would be better able to judge whether a nursing home is the right place for their loves one if a "watch list" disclosed which homes aren't up to snuff, according to Grassley. Sanctions against nursing homes are often withdrawn before they go into effect because the homes are given time to correct deficiencies, according to Grassley, so the public often never knows of serious health and safety violations.

One of the myths I covered in my book was the perception that nursing homes were rampant with abuse. In actuality, when I looked at the existing watch list, about ten percent of homes were on the list. Of that, half had been on the list since its inception and another forty percent had already been on the list three to four times.

Point is that there are good and bad homes but the majority, if you go by a watch list alone, are in compliance. Do your homework as always. Pay attention to these watch lists and other statistics but don't forget to talk to others who have been through it. As to those on the list repeatedly well perhaps they should be prohibited from operating or be operated by new management.

Long-term Care Insurance

One of the myths I dispel in "Who Moved My Dentures?" is how long-term care is paid for in this country. Forbes had a recent article outlining the issues. I paraphrase it here.

Overall demand for long-term care is expected to expand massively over the next 50 years, as the number of U.S. residents over age 85 is projected to rise from 5.3 million in 2006 to 20.9 million in 2050.

Spending on long-term care, at roughly 10% of national health expenditures, is large and increasing. Estimates by Georgetown University's Health Policy Institute put national spending on long-term care, excluding unpaid care, at $206.6 billion in 2005--$129.8 billion on nursing home care and $76.8 billion on home care.

In 1998, about 60% of all long-term care spending was funded by either Medicare (20%) or Medicaid (40%). "Self-insurance," or private savings used for out-of-pocket expenses, accounts for about a quarter of all long-term care spending. In addition, private long-term care insurance covers 7% of total expenditures.

Given the uncertain and expensive nature of long-term care, simple economic theory suggests that risk-averse individuals should purchase long-term care insurance. Paradoxically, the private long-term care insurance market remains small: In 2002, only about 6 million people had private long-term care insurance.

The demand for this type of insurance is slack for several reasons. Consumers underestimate the risks of foregoing insurance; Kaiser Family Foundation surveys indicate that one-third of respondents underestimate the cost of nursing home care. In addition, many wrongly assume that Medicare or Medicaid automatically covers long-term care expenses.

Nonetheless, despite its small size, the private long-term care insurance industry is growing, and the share of total long-term care expenditures covered by private insurance is increasing. Any decline in elderly disability rates due to advances in medical care will be outweighed by the number of aging baby boomers and accelerating health care costs. Indeed, the Congressional Business Office projects that long-term care expenditures for the elderly will quadruple by 2050. If private long-term care insurance coverage remains limited, the welfare of the elderly will decline, as could the wealth of their adult children, due to onerous out-of-pocket spending on long-term care. Medicaid spending on long-term care will have to rise, putting enormous strain on government budgets, and the existing infrastructure, already suffering from low standards--16% of nursing homes have serious deficiencies in quality, according to a 2005 Government Accountability Office report--may deteriorate further.

Concerns about large and rising long-term care spending in the United States are warranted. Promotion of private long-term care insurance should be high on the agendas of both state and federal lawmakers, as the future long-term care cost burden on Medicare and Medicaid will be unsustainable.

And that brings us full circle to what I have been telling people. The burden of health care is increasingly on our shoulders. Ultimately we are going to have to take responsibility for it. The writing is already on the wall with consumer driven, high deductible health plans. So start looking into this issue for yourself or a loved one.

Beware the Outspoken Board Member

An outspoken member of the Grady hospital board, an Atlanta facility experiencing a severe money crunch, last week took it upon himself to hand a neighboring county a $4 million bill for Grady services, implying that the hospital would not be in a money crunch if it didn't have to care for the indigent of its neighbors.

I have always been wary of public hospitals run by commissioners or politically appointed board members. And this is frankly an issue that really does not get looked at much. If I am going to be a patient somewhere, why in the world would I check, among the ten thousand things on my mind, who makes up the board. I agree. But maybe when you are not a patient and just forming opinions about where you might go for care that knowing who is on the board might be important. I say important in the sense that it gives you a feel for the hospital overall.

A hospital with a bunch of political cronies on the board says it is more interested in the bottom line and back room deals than patient care (so I generalize). A board that is made up of community individuals who are respected and have valid platforms for being on the board makes another statement.

In some respects, the same look see of hospital, nursing home management makes a similar statement. I know for a fact that stable, long-term management in a nursing home usually translates to a facility with less turnover, a culture of caring, satisfied employees and residents.

So does knowing who is in management and on the board of your local health care entity matter? I guess you know my answer.

Hospital and Nursing Home Infections

Pennsylvania's hospitals and nursing homes would be required to promptly report patient infections to state authorities and take measures to reduce such infections under a bill sent to Gov. Ed Rendell on Saturday. The measure is intended to reduce insurance premiums by requiring more stringent measures to monitor for and reduce infections that patients contract while under the care of doctors and nurses. Each hospital, outpatient surgery center and nursing home would have to develop an internal infection control system that meets the standards developed by the state Department of Health. By 2010, the department would have to establish benchmarks for individual facilities to reduce infection rates. Hospitals and nursing homes would have to report infections within 24 hours to state authorities, while hospitals also would have to report to the National Health Safety Network at the U.S. Centers for Disease Control and Prevention.

No doubt a good move but my friend Jim Tobalski, head of marketing and his team at Novant Health System has been way ahead of the game. Novant wanted to institute a systemwide hand hygiene program and make germ prevention and infection reduction part of the system’s culture. Nationally, it's estimated that hospital staffs comply with proper hand hygiene techniques only 20 percent of the time. Novant's goal was to reach 90 percent, and eventually achieve 100 percent compliance. Marketing ran with it--and rarely does marketing gain an opportunity to make a real difference in people's lives. It initiated a unique and edgy campaign to create a buzz inside the organization and permanently change the quality and safety culture. This successful, award-winning campaign caught the attention of local and national media, in addition to other unintended audiences--such as community clergy who used the campaign’s inspirational messages in Sunday sermons. More importantly, the campaign helped shift employee opinion, increase hand hygiene compliance and save lives.

Nursing and assisted living facilities would be wise to follow suit. Of course it is the right thing to do but more than that people will take notice that you are doing it. Make the experience better and people will talk about it. No better marketing exists. Consumers should add infection rates to their list of criteria when evaluating a facility. Ask for their statistics. Or have a nurse accompany you when you are looking at facilities and have he or she ask the tough questions.

Nursing Home Demographics Changing

The Kaiser Family Foundation issued a report this month entitled "Changes in Characteristics, Needs, and Payment for Care of Elderly Nursing Home Residents: 1999 to 2004."

The proportion of elderly adults over age 65 in nursing homes has declined over the past two decades, most noticeably in recent years.

Some of the reports findings include:

• The number of elderly long-stay nursing home residents (90 days or longer) declined from 1.21 million to 1.06 million between 1999 and 2004, while the demographic profile of these residents changed little during the time period;
• Disease prevalence was higher and multiple conditions were more common among elderly nursing home residents in 2004 compared to 1999 indicating an increasingly sicker population; and
• Medicaid is the main payer for elderly long-stay residents, accounting for 68% of these residents in 2004.

Two points -

First, the numbers are declining - for now. Fact is with a World Health Ranking of 37 and chronic conditions abounding, people will need these facilities, just not until their 85 or 90. Life lesson - we need to take responsibility for our health.

Second, no surprise that Medicaid is the primary funder. State budgets are bursting because of the Medicaid burden. How long until they start cutting back or pulling out. Look at health care in general, everything is moving toward our pockets. When pundits say consumerism that means more money out of pocket. And maybe that is OK if we take responsibility for it. My advice is that people seriously look at long term care insurance as yet another thing they need in their portfolio of aging with grace materials.

Elder Abuse

State and federal authorities have imposed "some of the most severe penalties" possible - short of shutdown - on a nursing home plagued by recent problems, including two patient deaths. The Chicago-based company that owns East Peoria Gardens Health Care Center faces a $100,000 fine and the loss of five days worth of Medicaid reimbursements for all its patients.

As a part insider and outsider to this industry, it strikes me that this penalty is termed severe. Any home that has allegedly through poor care or mistreatment caused the death of residents should be considered for closing. I assume that this is not feasible in all cases as it would impose a real dilemma in where to place the residents.

That said, families should be paying attention to these stories well before mom, dad or themselves need care. Start a file of these stories so that when the time comes for you to evaluate these facilities, you will already be educated.

See the article here: http://www.pjstar.com/stories/071207/TRI_BDOOT82S.062.php

The Benefits of Humor

Loma Linda University conducted a study in which they separated a group of people into two subgroups, one group watching comedy videos, the other not. When they measured body chemistry levels afterwards, they found that all of the good chemistry we associate with exercise (endorphins and such) was elevated in those that watched the comedy. They made the connection that humor and laughter have benefits similar to exercise. Now that doesn't mean sit on your recliner and watch television all night instead of walking, yet, the point is taken.

And that makes this bit of news disturbing.

Researchers at Washington University tested about 40 healthy adults over age 65 and 40 undergraduate students with exercises in which they had to complete jokes and stories. Participants also had to choose the correct punch line for verbal jokes and select the funny ending to series of cartoon panels.

The research showed that the younger adults did 6 percent better on the verbal jokes and 14 percent better on the comic portion than did older participants, It was a study about whether they got what was supposed to be funny. Older adults, because they may have deficits in some cognitive areas, may have a harder time understanding what a joke is about they concluded.

My opinion - a positive, happy outlook on life in which we can find the humor in it all will outweigh a grumpy old man personality any day. But life is tough and comedy is hard. So you have to be cognizant of this in your daily life. I think if you develop a sense of humor early in your life and raise your kids likewise you may have a fighting chance as you grow older. Then the joke will be on them!

Elderly Scams

The New York Times yesterday had an excellent article on scams aimed at the elderly. They particularly took to task organizations that offer "credentials" as a certified professional/advisor, credentials that are typically bought more so than earned. I have been approached by these firms as well and have been cautious. Rightly so it turns out.

Bottom line, do your homework when looking at getting your financial house in order. The credentials you want to look for in a professional counseling you or a loved one in this area is "Certified Financial Planner" or "Chartered Financial Analyst." These professionals have truly earned their titles and know what they are talking about.

About the Blog!

Welcome. I have been toying with this idea for some time and finally decided to just do it as they say. I wear many hats. I am a health care marketing professional who consults with organizations world wide. As a lifelong entertainer, I fell into a mission serving older adults when I one day wandered into my then hospital's adult medical day care center and started singing for the seniors. Everything fell into place after that.

My mission:
Working to assure our oldest citizens are respected and dignified.
Educating people about aging issues so they are not met in a time of crisis.
Providing marketing expertise for businesses to reach this demographic.
Using our talents as a conduit for businesses to build good will.

My posts will try to make sense of a crazy health care system, offer views from an insiders perspective and seek to educate people about aging issues. I welcome your comments and participation.