A little learning is a dangerous thing ... covid-19 deaths

“A little learning is a dangerous thing.
Drink deep, or taste not the Pierian Spring;
There shallow draughts intoxicate the brain,
and drinking largely sobers us again.”

Alexander Pope

The graphic below is circulating among Ohio residents on social media. At first glance, the statistics presented make a strong case Covid-19 is not the menace to the general populace it has been portrayed to be. In actuality the graphic depicts partial truth and the rest of the story supports the proposition this strain of coronavirus has been and remains a dangerous threat.

I learned quite a bit about hospitals, nursing homes and health insurance over the last few years. First through my mother’s struggles with Alzheimer’s and cancer. Then through my own struggles one year ago.  I am far smarter about certain aspects of the information presented above yet hardly an expert.

When one is hospitalized the facility walks a fine line between healing and operating as a business. It is important to remember a nursing home also operates as a for profit business. Insurance companies operate as for profit businesses. And Medicare and Medicaid have guidelines to follow and conditions that must be met.

In my mother’s case, she was diagnosed with cancer in the hospital. Quality of life was far more important to us the quantity of life given she was 88 years old.  We decided not to treat the cancer. The hospital wanted to release her to go home that day EXCEPT Medicaid required a three day hospital stay before she could enter a nursing home.

The Hospitalist pressured to have mother released from the hospital in subtle ways. He made it clear mother did not need to be hospitalized. I knew several of the physicians who had attended to mother when she was brought into the hospital. They knew the game and were able to “run tests” on mother over the course of the 43 day stay required to get her admitted to a nursing home.

Once in the mourning home things went smoothly for the first week to 10 days. Mother was Alzheimer’s ravaged, but handled the required physical and occupational therapy well. The cancer was advanced but not yet physically debilitating. The accompanying pain was being mitigated through the administration of narcotics.

Then the nursing home administration began broaching the subject of sending mother home.  This became a daily occurrence. Luckily for me, my wife is both a CPA and an attorney.  Through her work asa guardian ad litem she understood what was going on. A nursing home has only so many beds. Medicaid patients like my mother was are not profitable. They wanted mother’s bed for a patient with private insurance or individually wealthy enough to pay for their own stay. A business decision.

Home Hospice was mentioned often in those days, but home healthcare of any type can be expensive and less than adequately staffed. We had been done the home health care route after mother had fallen and broken her tailbone a few years prior. And what I knew of hospice was it was as much or more for the family as it was for the patient.

We were caught in no-mans-land. A nursing home that preferred not to have her there - would her quality of care suffer - on one side. A hospital that felt she did not need hospitalization. Whatever limited level of home health care would be provided by Medicaid with the remaining burden falling upon my family.  We would gladly have cared for mother. In fact, Mother had lived with us for 17 years. Her deteriorating condition had become overwhelming to us and our 3 sons.

As it worked out, Mother passed in the nursing home after a 2 month stay. Hospice was called in and they were a tremendous help to me and the family who availed themselves to the care offered. I learned a lot about the healthcare process through Mother’s travails. Not nearly as much as I would learn in the last year though.

My own health issues are chronicled elsewhere on this blog. The short version is, I suffered a heart attack while on vacation, had double by-pass surgery and spent 11 days hospitalized. I thought at the time the hospitalist was rushing my discharge. I just didn’t feel right, but he finally wore me down and pretty much shoved me out the door.  I had good insurance, but evidently there are l8muts the insurance company placed on stays in the hospital and the hospitalist served as the enforcer if those policies.

I struggled at home and was finally advised to return to see my cardiologist. I saw a nurse who determined I had fluid on and in my lungs and abdomen. A specialist cane in and drained 2 liters of fluid from me. I was sent home, but only made it a few minutes down the road. I was transported back to the hospital by ambulance while in respiratory arrest. Upon arriving in the emergency room, I went into sudden cardiac arrest. I was given last rights. I died. After 13 minutes I was resuscitated.  That time I spent 13 days in the hospital. The last 4 or 5 days under increasing pressure from the hospitalist to discharge me home, to a short-term care facility or to a nursing home. I did not qualify for the short-term facility. I wanted no part of a nursing home. I finally said “fuck it” and went home.

I called the world renown Cleveland Clinic for a second opinion. I had to wait a week, but was seen, admitted and spent another 11 days in the hospital. The last 2 days were in a secondary step down room and then a normal hospital room.  It was kind of like beginning a stay in a 5 star hotel, being forced to move to a mid-range hotel and finally to a no-amenity cheapie hotel.  I got the message and returned home. I have been steadily progressing ever since. Thank you.

What does all this have todo with the graphic above?  Well, I’ve been vetting myself for you so you understand I speak from experience.

When patients are admitted to the hospital for Covid-19 they often stay a few days before being discharged either home or to a nursing home for extended care. Just reading local health department reports of those dying from this disease it becomes apparent it is a slow death. From diagnosis to death is often 4 - 6 weeks. Where are many of these final days spent? In nursing homes.

Even if the patient had never set foot in a nursing home before contracting Covid-19, once they stay in a nursing home that becomes listed as their place of residence. If they are re-admitted to the hospital, they are listed as being from the nursing home. So, yeah, most deaths from covid-19 are to residents from nursing homes ... only now you know more of the story.