This is one of those things that can be fixed by starting off first by removing the financial incentive for these patients to be sent to the hospital in the first place.

Don`t triple the payments when they return from the hospital.

When someone is diagnosed as having dementia then they, if they are still capable of doing so, or their designated caregiver if they are not capable of doing so, should have to create and execute an end of life plan which covers such things as hospitalizations for infections, inability to swallow, etc. If they refuse to do so (to make those decisions at the beginning of the process) then Medicare (actually medicaid since medicare does not cover non-rehabilitive nursing home care) should refuse to cover the care. Medicaid is taxpayer funded so we the taxpayer should be able to make these rules.

I am nearing that age and I have already made these decisions for myself with a living will, and my family all know what those decisions are. I cover more than just dementia but everyone should have these not just those over 65.

No one mentions that these patients still remain "full code" rather than Do Not Recesutate. It mentions in the article that they tend to be black or latino and don't have advanced directives. Blacks and Latinos tend to have notoriously low rates of filing advanced directives and requesting DNR status for their family members. If there is a problem and the nursing home fails to send the patient to the hospital, the facility is liable and is often sued by the family. Get a clue. Yes, they are terminally ill, but unless the family deals with it, the facility is blamed when the person dies.  

Most people are ignorant when it comes to taking care of themselves, let alone another person with such a complicated disease. the doctors are too.

I have been taking care of my brother for 7 years now and he has AD. He was diagnosed when he was just 49 years old and he's 55 now.

I was able to get him seen at a geriatric clinic for his AD. However, ever discovery and the medical regime I had to inform the Doctors about.

My brother lives with me and i care for him 24/7. Fortunately I have research and nursing in my background or my brother would have been die, just from the negative impact of mixing certain medications he takes for other illness's

Taking Care of anyone with a condition as serous as AD is not for Opinionated sound byte sites.

Not all people know how to administer care appropriately, including the DOCTORS.

Especially when that person is not in the "ACCEPTED AGE CATEGORY" of people who NORMALLY get AD

Slightly off topic. I'm cofounder of an excellent home in the Philippines that caters to Americans suffering from AD and other forms of dementia. It's not for everyone, but definitely for a few.

Filipinos are known world-wide for their loving care, and because the care is given in their country, we are able to offer GREAT SERVICE (all care-giving staff are nurses) at a price that more than reasonable (around $2,000 per month).

Of course, the drawback is distance, but with your loved one (the AD patient), you have to do what is best for them and find a way to give them the best, most loving care that you can manage. LovingCareALF.com

BINGO ! I have had my family member in a nursing home for over 6 years now. I have seen the practice of a MEDICAID patient go to the hospital for a Kidney stone, come back after the "three day" requirement....and then spend 100 days on skilled MEDICARE and receive "speech therapy" for a "swallowing problem....something the patient had before they went in the hospital for the kidney stone...but now the facility could BILL (BILK) the MEDICARE system for 600 or 700 per day rather than the MEDICAID rate of about 160

THIS is disgusting and CRIMINAL behavior if you ask me...just a taxpayer!

Due to a small nest egg, my mother does not qualify for Medicaid. She is in a private home setting with only about a dozen patients. There will be NO feeding tubes, NO resuscitation efforts, NO procedures to prolong her life. The only thing that is important at this stage is her comfort. I only hope her little nest egg lasts as long as she does, otherwise, when it's gone, she'll be transferred to a nursing home and be subject to all this bureaucratic crap, and before Medicaid kicks in, I'll be subject to an audit to make sure her money wasn't squandered away! If they determine that I spent her money incorrectly, Medicaid can turn her down altogether, then the expense of her care falls on my shoulders.

Excellent article! As a Director of Nursing in a Long Term Care Center I totally agree! But, the side you totally failed to mention is the families understanding that there loved one's can't always be "fixed" by a hospital visit! Families need to assume some of the responsibility! More often than not, we encourage hospice, pallative care and DNR status for residents with advanced disease. If I could truly let you see the resistance we recieve from people who want us to do "everything possible to keep her here with us", you would be as heartbroken as I am. Yes, we make more money from medicare residents, but to have see the pain and suffering we put these people through, for the lack of a better work, selfishness of their families, breaks my heart! We, the members of the long term care team, suffer along with the residents that we love as if they were our family! I truly wish the media, people who have never spent a day working in this environment, and families looking to make a quick buck at our expense, would give us credit for choosing to love your family member and do the best we can with the little that the goverment gives us to provide care! EVERYONE should step up and take responsibility for taking care of the people who are history!!!

As a Director of Nursing in a Long Term Care facility, I must say your article is mostly true. We do benefit financially from residents who come back from the hospital. But, you must also remember our reimbursement is at the most, pathetic for the daily cost of providing competent, loving care to the residents we love and view as our family! People have been so misled to believe that this is a glamorous, prospering field. The true is, I battle with families daily to sign Do Not Resusitates (DNR), place your loved one on Hospice Care or Pallative Care, do not place a feeding tube, do not sent them to the hospital for this! Please allow them to live out their last days in peace, here with us the people they see everyday! No, it's not all about our profit, it is about families accepting and understanding that we all grow old and no matter what is done, we all must leave this world sometimes. Please, let our elders go in the with the peace and dignity they deserve and with people who dedicate their lives to giving it to them!

As a nurse in a Long Term Care facility many times I have sent patients to the hospital who, if they were my loved one, WHO I HAD THE SAY SO FOR!, would not have gone. All too often we have patients who are at their end of life but their families are not ready to let them go. If there is any doubt from the family about the patient going to the hospital I send them. Even with a DNR and an advance directive, the family has to be on board too. These issues need to be clear in the patient's chart. Guardians and DPOA's may want different things at times than what the patient has listed in their advance directives. I try to discuss these issues with family members in advance but frequently family members will want everything done. I am not willing to chance my license or the facility's on the family coming back later "Shoulda, coulda, woulda" I am frequently explaining to family members that DNR does not mean do not treat. It does not mean they will not receive antibiotics for infections, hydration, or basic care, but these things all need to be discussed and what is wanted decided on before it is critical. At the last minute in an emergency or critical situation is NOT the time to be trying to decide this when emotions are high.

Sad,Sad article. It shows how we as americans want to write off our seniors.If you sign a DNR you are an idiot. This gives the hospital the right to look the other way and let you die.Hospitals are there to prolong life,regardless of the age or condition of the patient. Forget about the costs,forget about the REAL reason why we write off our seniors,just because its such a burden on the children to take care of their parents after all your parents did for you. Advance directives are nice,but most nurses and doctors misunderstand them. The quality of life issue is a pathetic arguement as each person has a different view of what quality is. Doctors and Nurses tend to believe all cases are the same when each person is different.Lets honor our elders,not write them off because we believe they are a burden to OUR lifestyle.

this is the sad story of my mother- in- law. her husband left her over 20 some yrs ago, she being catholic didn't divorce him, and he lived about 300 mi. away. although, a daughter, ( who is the 5th oldest of the 7 children) claimed to be the care-giver of this 84 yr who lived by herself, decided she no longer wanted to care for her mother. she started a campaign to try and convince her siblings that their mother had dementia which consisted of telling them that she had found her mother sitting naked watching the kids show "barney & friends" and other such lies. i spent lots of time with my m-i-l taking her shopping, hair appts, etc. mentally there was nothing wrong with her and i mean from mental standpoint we had conversations about past, present, and future. she did have a couple mini strokes that effected her speech. thats another thing that daughter/caregiver decided against taking her mother for second round of speech therapy cause it was an inconvenience to her and would not allow anyone else to intervene( i offered). i could go on with examples of how this was abuse but will sum up with: my m-i-l was berated mentally and verbally(to the point of not wanting to be around her daughter at all, when the youngest daughter got wind of this abuse filed a report with adult protective services and when they came out to the daughter/caregiver's house to talk found my m-i-l baracaded in the house at which point APS decided this was abuse and opened case but closed it when they found out that she was still married( don't know what that has to do with anything, abuse is abuse)(if it was a child said child would have been removed immediately) daughter convinced the estranged husband(her father) that my m-i-l needed to be put in nursing home, daughter took my m-i-l's hearing aid away her glasses for reading dropped her off at hospital ER where m-i-l appeared to have dementia to people that didn't know her. in the hospital, where she didn't want to be but in her own home because she knew there was nothing wrong with herself was tied down with 5-point restraints because she would try to get up and was heavily medicated with depokote. an assisted living facility was found to put her in because 1st hospital said nothing was wrong with her after running all kinds of tests on her and most importantly, neurologist said there was no further damage since her last mini stroke. at assisted living facility they were putting depokote in her food, m-i-l knew this from the way it made her feel so she was very careful of what she ate. but she did fall and the facility said she had a seizure and m-i-l was taken to another hospital and then the beginning of her demise. the state of michigan allowed this estranged husband to be in charge of medical decisions. my husband tried to get guardianship of his mother to no-avail. then she was put in HOSPICE where she was determined to be dying and was drugged to death. she didn't deserve to be treated this way but was because the whole system failed her.