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GJAlexander Asked November 2023

What's being done to exempt the elderly from the Medicare HRRP that's incentivizing hospitals to kill them to prevent revisitation?

Not many are aware of the Medicare Hospital Revisitation Reduction Program that assesses heavy penalties on hospitals and other health- care institutions that re-admit a patient for the same condition within a 30 day period.


 


That program is incentivizing hospitals to kill off the elderly to prevent the possibility of revisitation penalties!


 


That's exactly what they did to my 91 year old uncle who aspirated and developed pneumonia after taking a new muscle relaxer medication, Tizanidine, prescribed by a pain management doctor for his arthritis that depressed his breathing and relaxed his throat muscles landing him in the Emergency Room. He had no history of aspiration pneumonia prior to that one event. They tried to push my uncle into hospice. He was doing OK for the most part other than this one incident and wasn't ready to die so I refused.


 


Once admitted to the hospital they refused to feed him for the first 11 days of his 20 day visit. He wasn't able to eat while reclined in bed so they just didn't feed him at all. I insisted that a feeding tube be placed every single day he wasn't able to eat but was given one excuse after another for why it wasn't possible. Only after I threatened to go to the media to expose the abuse did the surgeon expeditiously place a feeding tube. By that point my uncle was emaciated and very weak. He was also overdosed on antibiotics (Vancomycin, cautioned against use in elderly by the pharmaceutical, Pfizer) to treat a bacterial infection that had been colonized for over a year prior to this hospital visit. Vancomycin destroyed his kidneys just as cautioned by Pfizer. He never had a problem with his kidneys prior to this visit.


 


The hospital discharged my uncle to his home without a plan or equipment for his enteral feeding or home care. He died a day later from stage 5 renal failure and starvation.


 


How many other elderly patients are being killed off through medication overdose or starvation or whatever other means the heartless doctors and nurses use to eliminate the possibility of revisitation? The fact that it's even remotely possible for hospitals to do so should exempt the elderly from this horribly ill conceived Medicare program that claims to be a benefit that "encourages hospitals to improve communication and care coordination..." The fact is, hospitals are killing people to stay profitable. How is this any different from premeditated murder? At which age do we lose our Civil Rights to life?


 


There has to be more awareness of the HRRP. The public needs to know what's happening to their elders when they're being abused by medical facilities and the incentive behind it.


 


There's a list of the six conditions on the CMS.gov website (see link below) targeted for this ill conceived plan to reduce Medicare cost:


 


https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp


 


I urge "AgingCare" to take this issue to task and help to exempt the elderly from the HRRP!

AlvaDeer Nov 2023
A) The program you mention is clearly not understood by you at all. This act is there to prevent unsafe discharges. Hospitals are penalized when they discharge patients who are not ready to go home alone. Too rapid re-admission is indicative of unsafely discharge. This was a measure to PROTECT patients.

B) Of course they didn't feed your elder for that number of days. He was clearly have a swallow deficit. Feeding would have caused aspiration pneumonia and almost instant death. You have chosen to be very vague about refusal to put in tubes; one wonders why that is so.

C) "They tried to push him into hospice". No one can be PUSHED into hospice. However, doctors can, do and SHOULD suggest hospice to elder patients with debilitating illnesses who are suffering and who will in medical assessment likely not make it more than 6 months. It is an OPTION for quality of life. And THANK GOODNESS FOR THAT. My first years as an RN was a time when we HAD no hospice, a time when they didn't administer meds if it was dangerous to breating; I saw UNSPEAKABLE agony that YOU cannot imagine; I will never forget it. You do not mention your 91 year old Uncles history or his underlying condition, nor even of his wishes to go on with his life. His WISHES for a tube to feed him. THOSE are what should/would be taken into consideration.

D) Vanco is the last ditch effort antibiotic to save someone, a very powerful antibiotic. It couldn't save my brother from his sepsis, either. You don't mention how or why your loved elder was septic, nor the infection requiring vanco. That it was given was an effort to SAVE your 91 year old uncle. Not to kill him. Vanco is very tough on the kidneys. SO IS SEPSIS. SO IS being 91.

D) You are grieving. I give you my condolences. Your elder was 91. We all die. You are also in my opinion very misguided and you are giving out false conspiracy theories that I consider to be unfortunate. They are quite simply WRONG.

I am a retired RN. I spent my life trying to save people and I find your theories just this side of offensive. I am also 81 and were I a believer I would pray to God that hospitals stopped attempting to "save" those who are being tortured as they try to go to their rest. I had literally to FIGHT for my brother who wanted to go home on hospice when his treatment for sepsis failed, to be allowed to die in peace at home. As my Dad said to me "Kid, stand between those doctors and me with a gun, OK?". There is no sense to ongoing torment. I wish to heaven we were issued a pill to take when we are ready to exit. I am getting closer every day to happily swallowing it while I still CAN swallow. I have had to make clear in my own advance directive that I speFICIALLY refuse any fluid replacement, any intubation, any administation of nourishment either by IV or PEG or NG, that I refuse any and all dialysis, even temporary, and so on and on and on, because I KNOW FULL WELL what they can and sometimes DO to make us go endless on in torment.

You have my sympathy in your loss. But your thinking is in my opinion very skewed, and I can't give you my respect for it. It is, happily VERY rare.
cindileigh Nov 2023
Excellent response, as always Alva. From an RN who has been there, done that and is very close to retirement :-)
Southernwaver Nov 2023
OP, I’m sorry your very elderly and sickly uncle died. We are not meant to live for ever.

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Fawnby Nov 2023
I'm sorry for your loss. Your uncle was 91, sick and dying. You might as well calm down and realize that people don't live forever. If you'd accepted hospice care, you might have spared him some of the rest of it.

Again, my condolences.

BarbBrooklyn Nov 2023
I'm so sorry for the loss of your uncle.

HRRP incentivizes hospitals to "get it right" the first time and to do careful discharge planning

I was able to use it as leverage several times to delay my mom's discharge and to get underlying conditions treated.

MACinCT Nov 2023
The HRRP has been around for several years to standardize quality of care by best practices. Hospital plans changed some of the ways to reduce mortality but not exactly cure 100% and those plans did some reduction that saved $ all around by a percentage. Those penalties were a small percentage in overall payments but hospitals have been working on very slim margins of profit for a long time.

Your other issue is about your uncle's care. Medical staff work on a rule of rescue and in the end and upon family wishes, can switch to a rule of comfort and being pain free. This was your uncle. Were you his medical authority? The reason that I ask is that it seems that you failed to understand that your uncle was near the end of his life. It appears that he was discharged on hospice that you may have not been in that decision process or spoken to his immediate family.

Pneumonia at an advanced age has a high mortality. Nutrition can only be given under medical conditions. Somehow, your explanation of his care is rather twisted and you found this CMS rule that makes you think that the medical profession killed him. In light of all of your claims, I disagree with you. The change in practice did help based on many many post studies.

LoopyLoo Nov 2023
I am sorry he died. But the hospital didn’t kill him.

Claiming such meds are just a conspiracy to kill old people results in elders having severe mental and physical pain they should not have. Meds are not the enemy.

Tynagh Nov 2023
The readmit rates have 0 to do with elderly patients dying while hospitalized. Hospitals are also measured by death rates and an unfavorable rate will lead to investigation. I am so sorry your loved one passed away, and accept condolences on your loss. However, readmit rate monitoring has zero to do with his death. If you feel there was malpractice, that's a different story. You can gather the information you have and discuss with a lawyer, but while malpractice and negligence occur in hospitals, hospitals do no aim to kill people.

Fawnby Nov 2023
Here we are living in the USA where in most states, Death With Dignity is not allowed for those with serious illnesses who wish to put an end to their lives in a peaceful way.

Both of my parents begged to be able to end it when they were terminally ill. When my time comes, I hope that physician-assisted death is available to me. I am a firm believer in it after the horror of what my parents endured.

But wait - NOW I KNOW THAT ALL I HAVE TO DO IS CHECK INTO A HOSPITAL AND THEY WILL KILL ME IN ORDER TO STAY PROFITABLE!

What a blessing this is for so many. Who knew. I hope I'll get fries with that.
Cocosmom Nov 2023
Sad one finds humor in devaluing life.

Homicide, the opposite of blessing, rather is the ultimate disrespect for our creator for the value of human life, however, 10 states have in one form or another MAID.

10 States and DC Have Medical Aid in Dying (MAID)
9 states (CA, CO, HI, ME, NJ, NM, OR, VT, and WA) and DC legalized Medical Aid in Dying (MAID) via legislation
1 state (MT) has legal Medical Aid in Dying (MAID) via court ruling
40 States Consider Medical Aid in Dying (MAID) Illegal
33 states have laws prohibiting Medical Aid in Dying (MAID)
3 states (AL, MA, and WV) prohibit Medical Aid in Dying (MAID) by common law
4 states (NV, NC, UT, and WY) have no specific laws regarding Medical Aid in Dying (MAID), may not recognize common law, or are otherwise unclear on the legality of Medical Aid in Dying (MAID)
0 Federal Laws on Euthanasia and Medical Aid in Dying (MAID)
The federal government and all 50 states prohibit euthanasia under general homicide laws. The federal government does not have Medical Aid in Dying (MAID) laws. Those laws are generally handled at the state level.
JoAnn29 Nov 2023
Seems to me this is HRRP is a contradiction. Its Medicare and the insurances that determine the length of the hospital stay, correct? So how can Medicare penalize them if a person returns within 30 days if Medicare is the one who had the patient discharged. Same with transferring from the Hospital to Rehab. My daughter was an admitting nurse in a Rehab and has turned away patients because they still needed hospital care. And the hospital was penalized by Medicare for releasing them too soon. Are the hospitals falsifying reports to Medicare to get these people released? And if so, why?
Southernwaver Nov 2023
OP is confused on multiple levels.
Rhetorica Nov 2023
I'm sorry to hear of your loss, as well as the frustration that is accompanying the loss. Although not entirely similar, I actually just had to hospitalize my mother because of a UTI and leg infection that was easily preventable at her SNF. Three days prior to sending her out, I told the nurse to check for a UTI. The SNF didn't do it. I also discovered they increased her anxiety medication on top of giving her Ativan injections. So, we're now in the process of looking for another home for her. I will say that when it comes to medication and elderly individuals, it's often a catch 22. Or, at least, that's been my experience. In the case of my mother, she really should be on an antidepressant, but she can't take them because of low sodium. She can't take a low dose of an antipsychotic because it messes with her heart. Most doctors wouldn't advise an elderly person to regularly take benzodiazepine, but without it, she's a raging hot mess. And it's just about the only thing she can take. Most medications are not without some kind of risk. And, it seems that the risks are more pronounced and severe in elderly individuals, partially, because they're fragile beings at that point. As far as the feeding, I'm having a hard time understanding why they didn't feed your uncle unless it was related to aspiration but, even then, they do have tools at their disposal related to that. It seems strange that a nurse or nursing aide didn't try to feed him. I would say to gather as much documentation as possible if you plan to take some kind of action. I would contact your state or county's social services office. I would also contact administration in the hospital. At this point, this is really about you taking the action to get to the bottom of what has happened.

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