Study links Medicaid fees, use of feeding tubes: “Thirty-four percent of US nursing home patients who suffer from Alzheimer’s disease and other forms of dementia receive their food through a stomach tube, even though the practice is of dubious medical value, according to a study published today in the Journal of the American Medical Association.
The study suggests the economics of Medicaid reimbursements favor the potentially harmful practice and that large, for-profit nursing homes were more likely to use the devices. In addition, the study found that nonwhites were more likely to be given feeding tubes than whites.
Sufferers of Alzheimer’s and other neurological diseases gradually lose the ability to swallow. Yet critics say feeding tubes can agitate patients and takes away much of the dignity associated with dying. The other method, feeding people by hand, often is more time-consuming and requires more staff attention. ”Staff time required for hand feeding is expensive,” according to the study. Nonetheless, Medicaid, the government-run healthcare system for the poor and disabled, tends to pay more for tube feeding than for feeding people by hand. So for-profit homes may have a concrete financial incentive to feed their patients by tube, said Joan Buchanan, a Harvard healthcare policy analyst.” Boston Globe
This is probably the tip of the iceberg of the shameful care received by nursing home patients, probably the segment of the American healthcare industry where it is most evident how pecuniary influences overpower compassionate motives. You FmH readers who think you’re young now and don’t need to attend to this issue, reconsider. The proportion of American adults caring for their aging parents or other seniors is substantial and growing, and the likelihood is significant that you or someone you know will have to consider placing your loved one in a long-term care facility.
If you find this study credible, should you refuse to consent to the placement of a feeding tube for your loved one? How much confidence would you have that anyone would take the time to monitor and encourage their nutritional intake in that case? On my hospital’s geropsychiatric unit, routine admission bloodwork reveals evidence of malnutrition in a shocking proportion of cases I see. Think twice, then twice more, before you consign a family member to a for-profit nursing home. If you have no choice, definitely visit and obtain references from families of other residents before deciding on a place. Maybe you’ll be fortunate enough to find the exception to the rule…
Sorry to sound hackneyed and clichéd but — instead of the billions we are spending to project American imperial might to distant lands, and the billions on giveaways to the rich and the corporations, how about augmenting the reimbursement rates for human services such as nursing home care so that they can hire and train adequate personnel and give them a feasible caseload? (And while we’re at it, prioritize other services for this society’s least fortunate as well, e.g. by augmenting daycare, preschool and schoolteacher salaries?)
