Tuesday, August 23, 2016

Palliative Patients in Hospital made to co-pay

Our South East LHIN (Local Health Integration Network)  is demanding that vulnerable patients in hospitals, as well as the dying patients in palliative care rooms who are being told to take their loved ones home or pay a co-pay. This is criminal. They are forced to sign contracts to co-pay, on top of OHIP payments.

On top of this, many Ontarians have been told to take their palliative family members home, or to long-term care, WHILE THEY ARE IN A DESIGNATED PALLIATIVE CARE ROOM.

 Ontario hospital staff continues to pressure patients (This I wrote in May.)

Do these staff members not understand when patients are dying?
What pressure is administration putting on family members?
What is wrong with doing a Palliative Performance Scale (PPS) assessment, to determine the patient's situation?
What are the qualifications to be in a palliative bed in a hospital?

Staff tell the spouse the patient has to be removed and sent to long-term care. There isn't a place. They tell the spouse the patient is turning the corner, improving, and moves her to a room down the hall. The oxygen tube falls off the patient's face and it's up to the spouse to replace it.
'Here she is dyin' on you, and they move her to another room.'
There should be a PPS test done on a regular basis by staff. This doesn't seem to happen. She's at 30% when I visited her last at home, no better (20%) when I visited two weeks later in hospital.

dying patients deserve to be in hospital
their families have earned this right
There is a difference between Complex Continuing Care (CCC) requirements and palliative patients who need proper nursing, and pain and symptom management. Many have bedsores, catheters and infections. Family members are often unable to change soiled adult incontinence products, empty a catheter bag, or help a palliative patients navigate their way to the bathroom.

ACE Publications

In 2012, the Advocacy Centre for the Elderly (ACE) had over 250 requests for assistance relating to discharge from hospital. In the first six months of 2013, this number skyrocketed to 200 such requests! Patients requiring admission to other care settings or requiring additional care in the home are often told that they must comply with hospital or Community Care Access Centre (CCAC) policies. These policies may “require” the patient or substitute decision-maker (SDM) to select possible LTC homes from a “short list” where a bed is or will soon be available. If they do not comply with the policy, the hospital threatens to charge the uninsured daily rate which ranges anywhere from $500.00 to $1,500.00 or more per day. Hospitals may also require the patient/SDM to sign a “contract” indicating that they “agree” with this policy. In fact, no one is required to sign such a contract. More and more frequently, hospitals are blocking LTC home applications and CCAC workers are refusing to take applications from hospital patients, based on their interpretation of hospital policies or Home First/Wait at Home Program requirements. 

ACE dealt with this in Toronto in 2008:

Many people should be in hospital as they die, since family members are unable to change adult incontinence products, empty catheter bags, or have a CADD pump, which is only available in hospital, and provides morphine pain management on a regular basis. Families have a hard time keeping medications straight, let alone doing the nursing needed.


Friday, August 12, 2016

The Burden of Premature Opioid-Related Mortality

Key findings demonstrate:

  •  The overall rate of opioid-related mortality increased by 242% between 1991 and 2010 
  • The annual YLL due to premature opioid related death increased 3-fold 
  • The proportion of deaths attributable to opioids increased significantly over time among all ages 
  • By 2010, nearly 1 of every 8 deaths among individuals aged 25 to 34 years was opioid-related 
  • The majority of opioid-related deaths occurred in men, involved a single opioid, and were deemed as accidental. 
  • The opioids most commonly involved in opioid-related deaths were morphine and or heroin (or the two combined), followed by oxycodone, methadone and codeine. Oxycodone was the opioid most commonly involved in overdose deaths involving a single opioid 
  • For overdose deaths where multiple opioids were involved, the most commonly involved opioids were codeine, morphine or heroin (or both)

Comfort for family of palliative patients

Once our most intensive interventions end, we are left with this — a choice of tuna fish or chicken salad, or maybe some Oreos, brought up from the hospital basement.

Ontario Drug Policy Research Network - Citizen's Panel

Attached to St. Mike's hospital, we were in the ODPRN building, very interesting work. Hubby took a trip around downtown Toronto while I was in the meetings.
The ODPRN is funded by Ontario SPOR Support Unit (OSSU) and the Ministry of Health and Long-term Care (MHLTC), as well as The Keenan Research Centre of St. Michael's Hospital, and the Institute for Clinical Evaluative Sciences (ICES).

The Ontario Drug Benefit Formulary has 12 large prescription classes.  The Ontario MHLTC pays for some drug classes, for some patients (Ontario Drug Benefit Program). Seniors have subsidies, as do people on ODSP (disability), residents of LTC, receive social assistance, are enrolled in a home care program, or in hospital. Administrative Claims Data is an historical archive of all submitted medical claims for specific services by patients in Ontario.

Research on the data allows the MHLTC to answer questions, ensure the efficacy of drugs prescribed, and track the effect of changes to drug policy.
For example, through good research, the government has saved money by changing the number of diabetes test strips available to patients, making the testing process more effective. They have also changed the high-strength opioid formula making it less susceptible to being abused by those using it for recreation.

Which drugs do the programs pay for?

Tuesday, August 2, 2016

Informal caregiving in Canada

Saturday, July 23, 2016

Thursday, July 21, 2016

Delirium in Advanced Cancer Patients Often Goes Undetected in the Emergency Department

I wrote about this issue in my book, which few have read.
The ER is no place to look after issues such as this one.

Delirium in Advanced Cancer Patients Often Goes Undetected in the Emergency Department
A new study indicates that delirium is relatively frequent and underdiagnosed by physicians in patients with advanced cancer visiting the emergency department. Delirium was similarly common among older and younger patients, which suggests that in the setting of advanced cancer, all patients should be considered at higher risk for delirium. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society.

Full Citation: “Delirium Frequency Among Advanced Cancer Patients Presenting to an Emergency Department: A Prospective Randomized Observational Study.” Ahmed F. Elsayem, Eduardo Bruera, Alan Valentine, Carla L. Warneke, Sai-Ching J. Yeung, Valda D. Page, Geri L. Wood, Julio Silvestre, Holly Holmes, Patricia A. Brock, and Knox H. Todd. CANCER; Published Online: July 25, 2016 (DOI: 10.1002/cncr.30133).

Editorial: “Cancer Patients With Delirium in the Emergency Department: A Frequent and Distressing Problem That Calls for Better Assessment.” Peter G. Lawlor. CANCER; Published Online: July 25, 2016(DOI: 10.1002/cncr.30132).

Saturday, July 16, 2016

Changing the Culture of Prescribing in Ontario Nursing Homes

Researchers at the Women's College Hospital Institute for Health System Solutions and Virtual Care suggest that educating professionals who work in nursing homes and giving them feedback on how their practices compare to others could improve the high anti-psychotic prescribing rates for seniors in Ontario.

Read more

Tuesday, July 12, 2016

PART L: Urologist follow-up

He's continuing on his naturopathic immunity boosters. His PSA has risen a tad in 6 months. It's what we hoped for, a slow trajectory.

Visit #50 for healthcare

10:30 appointment

8:20 left house Construction River Rd. Manotick, took Limebank, backed up into the intersection. Passed a factory building that caught fire at 10:45-ish.
10:00 arrived at waiting room "I", although hubby wanted to try "H" It's funny how I remember the right room, he doesn't!
10:40 Intern came and got us. Dr. C. is in a meeting. He's head of urology.
Dr. C. Is working with a target for 5 - 10 PSA level until anti-androgen treatment.
Intern asked about symptoms.
If stomach or colon issues it'd be consistent, likely diet is causing the issue. Constipation, stool softener helps. Colonoscopy was negative, likely not cancer. Maybe need to increase fluids, urine should be lighter than a post-it note. We have noted, in our non-flushing drought period, this isn't the case! No leakage, bladder frequency sometimes, 5 - 6 times/hour. No blood in urine.
Happy Pills for anxiety helps the frequency. No bone pain, weight the same, which is good. Back in 6 mos. for PSA: January!
Saw Vanessa, appointment made. Back on the road. Much construction in spots. We anticipated coming down Limebank, again, but there was a massive fire. The dashcam pooched out on me, no photos. Lots of buzz on social media regarding the fire, though.
12:00 Arrived at The Swan for lunch. Went to Merrickville for sorbet ice cream cone for hubby.
2:30 home again. Deep breath.