Does Money Sometimes Motivate Medical Decisions?

A recent study in the highly respected New England Journal of Medicine (  reports that a significnt number of patients with Alzheimer’s disease or other terminal conditions are moved from their care facilities to the hospital for tests or treatment that do not make medical sense.  It appears that some percentage of these moves are motivated by the fact that Medicare will pay a premium to the nursing home when it takes the patient back after a period of hospitalization. 

In addition to enduring the trauma of the move, these patients are more likely to have a feeding tube inserted or to develop a pressure wound (bedsore) than those patients who remain in their care facility. And many of the conditions for which these individuals are moved could be treated just as well in the nursing home. 

Many of us who are involved in caring for the elderly, either in our families or through our professions, react by thinking “they needed a study to tell us that?”  Unfortunately, for all the focus in The Patient Protection and Affordable care Act on reducing hospital readmissions, there is minimal attention to preventing unnecessary first admissions. 

As with most medical decisions at the end of life, the best prevention is to have your medical directives in place, and to make sure the agent in your health care power of attorney  understands that you do not wish to endure unnecessary hospitalizations at the end of your life.  The ability to honor our loved one’s wishes can be the best gift we can give them at this sacred time of life.

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