Scarcity of specialists creating local crisis

[Miulang]

Re: Scarcity of specialists creating local crisis

Bear in mind that, depending on the disability, a nursing home might not even be an option in Hawaii.

Especially if the patient is vent-dependent. Often the only option is placement in a mainland NH.

I've seen families opt to withdraw care rather than move their loved one to the mainland.

Or you could pay for a private nursing staff...but who can afford that?

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

Going to a doctor is a choice. For that reason they should be immune to lawsuits. In the event of malpractice, they should lose their right to do any more doctoring.

It's a SUE happy society we live in.

Let's hear your tune when your surgeon leaves a pack of sponges inside your thoracic cavity resulting in sepsis, renal failure, and death. Or an anesthesiologist connects a carbon dioxide tank to your tubing instead of an oxygen tank and renders you a drooling shadow of your former self.

Bet you and yours would be calling 1-800-HAVE-YOU-BEEN-HURT-BY-ANYTHING? before you could mumble "choice."

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

Or you could pay for a private nursing staff...but who can afford that?

Some can and do, here, but they are few and far between.

Those "care homes" can be quite scary. They certainly serve a purpose here, for those who need minimal care. The problem, IME, is when a patient decompensates and the need for more skilled care is either not recognized or ignored. Yes, ignored---I think the financial incentive sometimes supercedes the conscience of some of those care home owners, unfortunately.

It is a sad state of affairs, often, for the physically and mentally impaired here.

I truly believe we need a very high level SNF here. The time has come and the need must be addressed.

[Miulang]

Re: Scarcity of specialists creating local crisis

Some can and do, here, but they are few and far between.

Those "care homes" can be quite scary. They certainly serve a purpose here, for those who need minimal care. The problem, IME, is when a patient decompensates and the need for more skilled care is either not recognized or ignored. Yes, ignored---I think the financial incentive sometimes supercedes the conscience of some of those care home owners, unfortunately.

It is a sad state of affairs, often, for the physically and mentally impaired here.

I truly believe we need a very high level SNF here. The time has come and the need must be addressed.

Agreed, on all counts. Private group homes have to be licensed by the State but the few inspectors that exist have too many places to visit, so it's very often not until a client dies under suspicious circumstances that the State steps in and investigates. And that's when elder abuse occurs (but it can also happen at the hands of a frustrated and overwrought family member who is a caretaker, too). This is the other end of the age spectrum from child abuse, but the causes are very often the same.

Miulang

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

Agreed, on all counts. Private group homes have to be licensed by the State but the few inspectors that exist have too many places to visit, so it's very often not until a client dies under suspicious circumstances that the State steps in and investigates. And that's when elder abuse occurs (but it can also happen at the hands of a frustrated and overwrought family member who is a caretaker, too). This is the other end of the age spectrum from child abuse, but the causes are very often the same.

Miulang

We recently had a case where a family caretaker (son) had locked his elderly mom in a room for her own protection. She was a "wanderer" who had often ventured out into the neighborhood in varying degrees of undress.

Appparently she started doing something that alarmed neighbors, who subsequently called HPD. She ended up being taken to the ER. Quite ill, she was admitted and eventually ended up in ICU.

The son has been reported for elder abuse.

He is extremely distraught.

I honestly think he was trying to do his best to protect his mom in a terrible situation.

[Miulang]

Re: Scarcity of specialists creating local crisis

We recently had a case where a family caretaker (son) had locked his elderly mom in a room for her own protection. She was a "wanderer" who had often ventured out into the neighborhood in varying degrees of undress.

Appparently she started doing something that alarmed neighbors, who subsequently called HPD. She ended up being taken to the ER. Quite ill, she was admitted and eventually ended up in ICU.

The son has been reported for elder abuse.

He is extremely distraught.

I honestly think he was trying to do his best to protect his mom in a terrible situation.

I'm wondering if this would have happened if he knew about the eldercare resources available through the Office of Aging (they also can contract for respite care if necessary to help defuse a stressful situation).

Maybe that's a place to start: educate the public about the resources available (including subsidized training for family members who are caretakers for the kupuna...Maui County had a pilot program which I was fortunate enough to participate in which taught attendees about the aging process, gave attendees a chance to share their own challenges with taking care of kupuna and included the same handbook that is used to train CNAs so the caretakers would have a handy reference) and then have the Legislature allocate more money to KupunaCare programs so that more kupuna can live out their final years in safe, healthier environments.

Miulang

[brianca]

Re: Scarcity of specialists creating local crisis

The price differential between an assisted living facility and a nursing home on Maui is about $4,000/month for the assisted living facility and $8,000/mo for the nursing home if the elderly person is a private pay client (this happens when you don't spend down enough to qualify for Medicaid). The average length of stay in a 24x7 SNF is about 2 years, so figure on $8k/mo for 24 mo and you can see how easily a person's life savings (and your possible inheritance) can disappear.

how does that compare with mainland pricing? Is that level just breaking even for the facility?

[cynsaligia]

Re: Scarcity of specialists creating local crisis

Let's hear your tune when your surgeon leaves a pack of sponges inside your thoracic cavity resulting in sepsis, renal failure, and death. Or an anesthesiologist connects a carbon dioxide tank to your tubing instead of an oxygen tank and renders you a drooling shadow of your former self.

Bet you and yours would be calling 1-800-HAVE-YOU-BEEN-HURT-BY-ANYTHING? before you could mumble "choice."

DAMNED STRAIGHT!!

another thing...

i can safely say that sometimes, court cases re physician malpracticecome down to a physician's "judgement call." MDs make judgement calls on how to treat a patient, based on what they know at that moment, and also keeping in mind the technology/resources available.

twould be easy for everyone (even plaintiffs' attys) if "malpractice" were a black and white issue.

[Miulang]

Re: Scarcity of specialists creating local crisis

Most of the nursing homes in my area are pretty reticent to post their rates on their websites. I did find this little bit of information on the general cost of living in a nursing home and the differentiators in the types of services (the price obviously goes up the more services you sign up for). The list is undated, so I can't tell if these are current rates or not, but they are a pretty good rule of thumb, I think.

Nursing home costs currently average around $181/day for private pay and $155/day for Medicaid residents in Seattle and King County. The difference in rates between and within facilities depends on many factors including the level of care required and the services included in the basic rate.

How can costs be met?
Selection of a nursing home depends to a great degree on how services will be financed and the level of care
needed. It is advisable to explore all possibilities of financing. Costs may be met by one or a combination of
the following:
• Medicare (limited coverage)
• Private insurance coverage
• Retirement or pension benefits
• Veteran’s benefits
• Social Security benefits
• Personal assets and savings
• Medicaid

Based on those averages, a private pay client in the Seattle area in a 24x7 nursing home staying for 30 days would pay almost $5,500 (as opposed to nearly $8k/mo on Maui). That's a pretty significant difference for people who are on limited incomes. Besides the social and cultural advantages to being taken care of by a relative at home, I think the cost to be in a nursing home is a major factor, too, in Hawai'i, and why so many families end up taking care of their kupuna themselves. This sometimes poses a problem because many of our kupuna love their independence and given a choice, they want to live away from their families so as not to place a burden on them.

Miulang

[Miulang]

Re: Scarcity of specialists creating local crisis

DAMNED STRAIGHT!!

another thing...

i can safely say that sometimes, court cases re physician malpracticecome down to a physician's "judgement call." MDs make judgement calls on how to treat a patient, based on what they know at that moment, and also keeping in mind the technology/resources available.

twould be easy for everyone (even plaintiffs' attys) if "malpractice" were a black and white issue.

Patients tend to forget that the practice of medicine is more of an art than pure science, too. Doctors are not gods (although sometimes they think they are ). They are just as fallible as you and me, but the stakes are way higher for them (i.e., keeping a patient alive v. killing or maiming him).

Miulang

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

Patients tend to forget that the practice of medicine is more of an art than pure science, too. Doctors are not gods (although sometimes they think they are ). They are just as fallible as you and me, but the stakes are way higher for them (i.e., keeping a patient alive v. killing or maiming him).

Miulang

MD=Major Diety.

IME....NOT.

[cynsaligia]

Re: Scarcity of specialists creating local crisis

MD=Major Diety.

IME....NOT.

buahahahahahaha!

crap. i'm laughing here, but i'm sure, sometime this week when i'm at work, i'll remember what you've said here and curse myself for laughing.

*asks the gods of bachi for mercy*

[timkona]

Re: Scarcity of specialists creating local crisis

:::Sadly disappointed with the attitude of many MD's here:::

You can pretty much insert a variety of words in the underlined part.

"students"
"parents"
"administrators"
"cops"
"politicians"

Seems to me that 'attitude' is THE NUMBER ONE PROBLEM in Hawaii. This is perpetuated by the ingrained defeatist mentality that permeates the islands at every level. This likely stems from the whole overthrow issue, but you would think that after 115 years, people would be sick of the crutches. It's always easier to bitch and complain than it is to DO something positive and constructive.

A good attitude will carry you further in life than just about anything else.

[Miulang]

Re: Scarcity of specialists creating local crisis

:::Sadly disappointed with the attitude of many MD's here:::

You can pretty much insert a variety of words in the underlined part.

"students"
"parents"
"administrators"
"cops"
"politicians"

Seems to me that 'attitude' is THE NUMBER ONE PROBLEM in Hawaii. This is perpetuated by the ingrained defeatist mentality that permeates the islands at every level. This likely stems from the whole overthrow issue, but you would think that after 115 years, people would be sick of the crutches. It's always easier to bitch and complain than it is to DO something positive and constructive.

A good attitude will carry you further in life than just about anything else.

Tim, don't give the people of Hawai'i so much credit. This kind of thing is pervasive EVERYWHERE, not just in Hawai'i.

Miulang

[Bard]

Re: Scarcity of specialists creating local crisis

Pardon me for butting in here and asking a question whose answer is probably known to most people posting here anyway but are you guys saying that people who live on neighbor islands who have working and reasonable insurance are not able to get primary care doctors? And that things like stuff like broken bones you have to get flown to Honolulu? What about things like pre-natal care and other pregnancy related issues?

I know the previous posts talked a bit about this stuff but it is not totally obvious to me from reading them if the people in question were on medicare, didn't have insurance, or whatnot...