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

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.

Sorry to hear about your uncle and his terrible treatment in the hospital. It really is unacceptable that they would refuse to feed him and do what was necessary to make sure he could eat. Was he on a vent at the hospital? A person doesn't starve to death in 20 days.

"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."

I imagine they gave him a pretty strong dose of the Vancomycin because of this year long bacterial infection he had. Unfortunately antibiotics can be very dangerous and can cause kidney failure and other terrible side effects at high doses. I would think his cause of death was more the renal failure because of the antibiotics rather than starvation.

Tube feedings can also cause aspiration pneumonia which is probably why the hospital didn't want to put a tube in.

With all that being said would your uncle have recovered from the aspiration pneumonia caused by the medication he was given. Maybe. Maybe not. But pneumonia is very hard to shake the older you are.

"He was doing OK for the most part other than this one incident and wasn't ready to die so I refused." What does this mean exactly? He had a year long bacterial infection, so his immune system was pretty weak, and it sounds like he was in a lot of pain from his arthritis too.

Tizanidine is a pretty strong medication to give to someone with just arthritic pain. Did your uncle have MS or some kind of spinal cord injury?

Ironically if an old person has decent insurance then they are given every procedure under the sun. No matter if it is beneficial to the patient or not. I don't know if this program HRRP contributed to your uncles death but it sounds like the medications he was given were the cause of his downward spiral.

The reality is your uncle was 91 years old and in poor health. The medications he was given to try and help him did more damage to his body and caused his death in my opinion. First the Tizanidine and then the Vancomycin (which is a standard treatment for what your uncle had).

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.

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.

OP, I’m sorry your very elderly and sickly uncle died. We are not meant to live for ever.

I'm very sorry for the loss of your uncle. I think you are still very raw from shock and grief. I agree with what was posted by AlvaDeer. I've work around the medtech industry for decades and can attest that hospitals are not interested in nor do they benefit by "killing off the elderly". You may or may not have a case of malpractice due to incompetence, which is different. Take all your hard evidence to an attorney to discuss the feasibility of legal action.

In regards to not feeding your uncle while in the hospital... aside from what AlvaDeer pointed out about his swallow deficit, I don't think the nurses and staff are paid to feed people. My 100-yr old Aunt broke her hip and went to rehab. She was alert and physically active but had pretty advanced dementia so she didn't eat or drink much unless her family helped her (and she cooperated). We had to come to see that rehab was for rehabbing and not "care". I think a lot of these expectations (like who feeds who) are not met due to misunderstanding or lack of communication by facilities. The feeding of hospital patients by staff may be something that is specific to each facility, if they do it at all. I don't know the answer to this.

Hospitals want to have as little staff as possible because employees are usually any business' biggest overhead expense. That's why I would find it hard to believe they'd want their people doing unskilled work by skilled staff who could be used elsewhere.

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.

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.

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.

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?

I'm sorry for your loss and that so many have lectured and attacked instead of listening and being there for you in your time of great sadness and loss. I recently lost my Mom we believe due to older people being treated by some, if not the majority of medical staff with indifference and worse. There were some good medical staff but it was far too late after not being allowed food or water for such a long period of time as well as conflicting consultations. We were told she was NPO'd due to a swallowing problem, however, we believe the majority if not all of any "swallowing problem" was due to being over medicated (which we tried to stop). Before someone mysteriously NPO'd her we were able to feed her without incidence. After Mom's death, ordered her medical records and have so far gone over 850 pages of documentation which says she didn't have an appetite and difficulty swallowing which is NOT what we were told and many other errors & omissions. I feel for you.

Hospice has become like a religion, a culture of death. While there may be some descent hospices there are many that are not. One MD questioned my faith because I didn't want a DNR, pointing at my cross and scolding me. Google 'You're not God': Doctors and patient families say HCA hospitals push hospice care. Profiteers turn hospice into a $22 billion industry

and hospice cocktail. It's pitiful. If I could go back in time and pick my Mom up and carried her out, I would. At the time didn't understand how healthcare is basically rationed. I feel she was discriminated due age and handicap.

Also, why do we need hospice at all? Our family MD's are well able to prescribe pain medications and order home health. How did the world get along without organized Hospice until, what, the 1980's? Again, so sorry for your loss and maltreatment.

So, if "Before Hospice, many people, especially those with cancer, died in screaming agony because doctors were loathe to prescribe enough morphine to control pain--because it might surprise breathing. That's WHY hospice came into being. Doctors were afraid of being accused of killing their patients."
So you're saying that hospice is euthanasia that kills the patient while protecting doctors?

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.

People have adverse reactions and allergies to medications - I Know I do . You Can report what Happened to you to a Journalist at Propublica .

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.

Fawnby: We completely agree in principle. We may have a semantic divergence in that, IMO, MAID and its equivalents are not "suicide". MAID = Medical Assistance in Dying. In Switzerland, it's called "VAD", Voluntary Assistance in Dying. The term "suicide" is strongly discouraged, and I think that can be important in how the process is viewed. (VAD is legal but very pricey for non-residents.)

The OP and I most likely hold very different views on religion. I strongly believe that there is a difference between LIVING and EXISTING. As I see it, if I am simply existing in an old, worn out, failed body and/or a lost mind, I am no longer living.

I do agree that some hospices appear to have lost sight of their mission. They have been purchased by private equity firms and turned into profit centers for their investors. That is never what hospice was intended to be. Personally, I do not think that "health care" and "profit" should be related at all in any way! Ever.