Thursday, August 13, 2009
WHAT’S WRONG WITH THIS PICTURE?
• How many programs are there out there operating for the purpose of securing benefits for the Alzheimer’s afflicted and our caregivers.
• Who directs them, decides there policies and performance, decides on their goals. Usually it is the organization itself.
• How much of the time and effort of the organization goes to benefit the organization. How responsive are they to input and the needs of the population supposed to be served.
• All too often service groups, charitable organizations, similar specific purpose undertakings become self sufficient and self serving losing sight of their initial goal and purpose.
• Does all the activity concerning the scourge of Alzheimer’s disease serve to eradicate the scourge or does it take advantage for some other self perpetuating purpose?
• Who is it that benefits from the expenditure of funds financing the search for a cure?
o The organizations formed around the fund raising peopled by salaried employees performing the fund raising?
o The Drug Companies financed in their continuing research seeking cures.
o The Media, PR entities, professional support that goes into the activity, namely the infrastructure seeking the service?
o The lobbyists who advocate favorable terms for treatment of the search.
o The government creating agendas and agencies dealing with the problem?
• What is the outcome of this effort?
1. Salutary to say the least if a cure is found and our disease goes away like the Red Death, Leprosy and others!
2. But is the opportunity for discovery of a cure coupled with chances of doing it likely to happen before the calamity of occurrence of an AD epidemic which wipes out all further funds for anything?
3. We are fast approaching a junction in time between finding a cure and suffering the epidemic catastrophe should the cure not be forthcoming. This is called a point of diminishing return.
2. Currently we have insufficiency in funds to both provide care and do with the quality of care that is needed.
• Between onerous regulation and centralized service, both parent of the other, the cost of creating the infrastructure to provide the service has risen beyond containment.
o The quality of service is sacrificed by prioritizing economy of cost. To provide any service it is first necessary to create the agency and plant to provide the service.
o Once created and in place, often as not, after payment of overhead, management, administration, supporting services, regulatory adherence formulation of centralized services little remains with which to provide the care it was designed to provide.
o If the provider is not sufficiently organized to serve it can’t serve. If because there is insufficiency of funds for everything, it is better that some service as no service be provided. Therefore economy is obtained by cutting back the value of the service thereby impugning the quality of the service.
o Examples of this are:
Large institutionalized nursing home and extended care facilities, overwhelming the functionality of the smaller more specialized service.
Over qualification required for certification for people providing service. The cost of these people rises as does the cost of securing their compliance with the certification process and the administration and policing of the process.
o The quality of service is homogenized for sake of a greater population able to be served with similar service. This sacrifices specialization and expertise directed to the needs of the particular groups served. Although often a tragic loss greater economy by the number served utilizing the same style of service justifies the loss.
o A friend of a friend, a lawyer by education and training, an entrepreneur by choice, who made his money in the creation, operation and leveraged sale of nursing homes, left that because the profit margin was disappearing. He has gone into the development of Alzheimer’s care facilities because of increased profit potential.
The service of his chains of facilities will be limited to those able to pay full fee, no one needing any kind of assistance need apply
To create his chain, to build his plant, to establish his ++++ to provide the service
• He as available to him all of the public incentives supplied startups particularly those in the health service field.
• He is liberally supported by tax deduction, credit, incentives, tax increment financing, forgiveness, all for the purpose of serving those not needing assistance so long as their lucre lasts.
o Recovering from surgery I recently spent time in a transitional care facility. It was considered the best service provider in the area. It was the best but for the following:
The hands on service of the providers was plagued by gaps and omissions caused by cost economy limiting services, such as:
• Baths – Once a week because they can’t afford all of the nursing assistants required to give more baths a week.
• Medical care provided by a physician’s assistant purportedly operating under the management of a doctor who was never seen. This PA was part-time three days a week.
• Lower level support personnel primarily foreign born, recent émigrés with substandard ability in the English language making it impossible to understand them or them to understand us.
• The lower pay of the lower level support produced service style commensurate to the pay. They are treated minimally and they serve in the same way.
• The nursing staff is overworked, spread far too thin, harried and not able to respond were they willing to do so.
• The administration of medications needs constant self monitoring to see, are they right kind; are they the right quantity, are they little more than palliating with too many sedatives? (designed to keep us quiet and on ice wcinc did happen to me, I was unaware of it, lost in LaLa land, my wife caught it and put a stop to it?)
• Beds clothing designed to withstand the vagaries of the frail and impaired. As such the bedclothes are laundered in toxic cleaners. The beds have rubber, latex or plastic mattress covers. These produce a variety of sensitive skin reaction.
• The nursing and support staff are not equipped to provide suitable care or medication for skin and bed rash. (In my case with severely sensitive Irish skin I brought my own prescription for itching that took four days to be replace when quickly used up)
• Medical consultation and care did not really exist
o I had a cough and sore throat. They didn’t have cough drops, they could get me lozenges. They had cough syrup. I requested lozenges, they came in, no one from the nursing staff told me they had arrived
o I was terribly sick, suspected it to be more than symptomatic of recovery from substantially severe surgery. It acted and felt like a case of the flu. Although asked for medical review or recommendation was never received by me.
o The reason. They provided their own medical care by the physician on staff advising the PA on the line seeing the patients part time. The facility had the exclusive right to provide this service which was one of their selling points. Cost economy limited utilization. It didn’t seem the staff doctor saw patients. The part time PA could not get to everyone.
o The facility itself, namely the physical plant was fantastic. A wonderful campus, in a scenic river setting consisting of many beautiful brick buildings, architecturally magnificent, maintained exquisitely on grounds that competed with the best of parks. Not a dime was spared to make this an attractive inviting setting for someone in need of it.
This was the top of the line in quality service providers in our area. I was appalled by the quality it lacked because of cost economies.
What must the quality of other service providers be that are provided at greater economy?
o The size and the homogenization of service in order to survive in the highly regulated competitive marketplace has produced this neutering anomaly.
Under the guise of provision for and protection of the people served, the infrastructure has become so top heavy and cost prohibitive it precludes the availability of funds for the care they exist to provide.
It is in the provision of care that the cost economies are imposed denying the people the care their existence is intended to provide! The cost of their continuing in existence exceeds their ability to provide adequate care.
Now tell me: What IS WRONG WITH THIS PICTURE?