Fungi are not the same as bacteria. The author conflates the two, talking about antibiotic-resistance. Antibiotics do not treat fungal infections. Please get better scientific advice so you can properly inform the public about the dangers of anti-fungal-resistant medicines. Taking several antibiotics at once will not contribute to antifungal-resistance.
108
"conducted extensive training and education on infection control policies and procedures for Palm Gardens and other nursing home providers"
That's all well and good, but who trains the executives who make the decisions that lead to under-staffing and shoddy practices? They don't consider themselves healers. Few of them probably ever even walk in the door. It's all about ROI for them.
56
When the doctor comes to talk to you about your loved one who can no longer eat, walk, speak or breathe on their own, say NO to the feeding tube. This is critical because once it is in, it is much more difficult legally to remove. And if the nutrition keeps going, they will keep going. Then you’re talking nursing home, ventilator floors, bedsores, infections, a life of pure hell we wouldn’t wish on anyone we love. Ask them about hospice. Death is not the worst thing that can happen, this is.
234
My mom caught MRSA in either her nursing home or hospital. Similar set of problems(her myriad other problems necessitated frequent hospitalizations). As a result, she was put in isolation, so she had no contact with other patients she had been friendly with, just a limited number of staff. We saw her wearing gowns and masks. She asked to see the priest to confess nearly daily....partly for the company and partly because she thought it was all punishment for her sins. She was nearly 80. It must be the same for folks with C. auris, C. diff., etc. My deepest sympathies.
29
Respiratory pavilions? Ventilator units? Dear God, this is no way to exist. Give me a bed at home, start my ‘playing her out’ playlist, let me kiss my dear ones goodbye, and release me from this life to whatever adventure may await. And if I have any money left let it go to those who will enjoy it and use it.
147
As I read this piece I thought about the sci-fi book I am currently reading, Cold Storage by David Koepp, about an out-of-control fungus that could wipe out humanity. We worry about super-viruses, as well we should, but fungi is another threat that has leapt off the pages of horror fiction into real life.
23
Could someone with the requisite expertise explain how Ms. Davila is breathing? The article talks about her being on a ventilator or respiratory floor. Was she trached? If so, how does that work long-term? Can she speak? I thought ventilator meant a breathing tube, but that doesn't seem to be the case here.
3
@aggrieved taxpayer---She has a tracheostomy; you can see it in the last picture in the article. Most times the patient can't speak while it's in except by blocking it, which can't be done while the ventilator is working. There are tracheostomy tubes with a valve that allows the patient to speak, but this doesn't look like one of them.
The tube can be left in for a very long time, which is why it's used instead of a tube through the vocal cords, which can produce serious problems after a relatively short period.
16
@aggrieved taxpayer She has a trach, you can see it in the pictures. Trachs are for long term. An endotracheal tube is placed through the mouth and only used for short term purposes.
I'm an RN with over 36 years experience in acute care.
20
80% of Texas’ Medicare/Medicaid nursing homes are owned and/or managed by private, for-profit businesses. At 95 yrs, with severe cognitive and physical restrictions, and bed bound, my mother lives in one of them in a very rural area. Many comments cite gloves, gowns, and washing hands as major issues in nursing homes. How about raw sewage bubbling up the central drain in the kitchen floor, while lunch is being served, certified nursing or CNA people absent from the floor for weeks if not months, water bugs the size of my thumb darting from under closet doors and bathrooms, failure of nutrition standards for months, medical waste pushed into secret closets due to not paying disposal vendors for months, actual harm done to all residents due to untrained staff who were hired with no background checks. Should I go on? Oh. I almost forgot to let you know the facility now is managed by some faceless person in Los Angeles. And the owner is a Religious person with his business headquartered in a far flung province in Indonesia, and who loves to pal around with the Prime Minister of Malaysia. Now tell me about washing hands.
93
@Dan Holton Amen to that!
14
@Dan Holton -- To support this comment. My father was in a county-owned and operated nursing home in Wyoming his last few years. It was clean (even smelled clean), well-staffed, modern and bright with resort-like views, and supportive of family. The care he got was very good. Because of his mental state he was prone to complaining, but rarely did. The anti-government types will tell you I'm making this up.
54
Long term elder care is already stretched to the breaking point as it is. Now as the largest age cohort in US history, baby boomers, start needing care? Things have to change or stories like this will amplify
23
Even when the article is about a deadly fungal infection, and the nursing home not following precautions, even then the family member can't be bothered to properly gown and glove for the photograph. The hands touching make for a good image, but geesh... this touches all the last nerves.
43
@Johnson
Yes! My first thought when I saw the picture was omg what kind of infection control is that?!?!
31
So scary. As a patient with cancer and bad immune system this is so frightening to me. God bless this amazing lady...
14
No surprise. We have people "living" way past their expiration date and so become petri dishes to farm multi drug resistant bugs. They develop the inevitable infections a moribund body will; a microbial terrarium of sorts.
And, have y'all been to one of those long term care places lately? It's so sad so little money that's supposed to pay for patient care, goes to patient care.
We're going to have to have a long talk about our health care system...oh yeah we tried that and got sidetracked by death panels and government takeover of insurance that's bilking you.
55
I do not like to comment on this kind of piece because it is too sensitive to folks who are such in a predicament. But if you go out to a forest where you see a tree creeping up with fungus/mushroom and moss, it means that tree is aged. It is nature's way of getting rid of old protoplasm.
29
Palliative Care, Palliative Care, Palliative Care. Please help us.
85
Opening photo of husband, gown covering only his forearms, no mask, kissing his wife with a “very contagious “ fungal infection. This is not poor quality of infection control, this is complete disregard!
How does such complete negligence occur. Complete!
62
@Warren
Yes!!!!!! I created an account just so I could comment on this! The worst example of infection control ever! And now this guy is bringing the fungus back home and to his community ugh.
47
I'd suppose that this GOP's take on these sad facts is (1) these people are among the 47% "takers"--or, as our World War II enemies put it succinctly, "life unworthy of life," and (2) goody!
We can find a way to free up the funds that proper hygiene and medical care--which these elderly people have already paid for, and put it into the pockets of our donor class and ourselves!
Yes, today's Trump/Putin GOP is THIS amoral.
23
We need to take the profit motive out of health care. (Disclosure: I am a health care provider.) These kinds of facilities employ the fewest, cheapest caregivers they can find in order to keep as much of that $530 per day as they can. The only people served by this system are the owners of the facility and their shareholders, if it’s owned by a corporation.
101
I’m sorry, but why is this woman; at her age and her condition, on a ventilator in the first place? If she wants that; I guess that’s fine. But if she doesn’t, it’s nothing short of cruel. I am 39 years old and have multiple chronic health issues. If I ended up needing a ventilator to survive; even at my age, I would absolutely refuse it. I hope that she is not being kept on all of this treatment against her will. That’s all I can say about that.
As far as these fungal infections, CMS and accreditation agencies need to send a very clear message and remove accreditation and funding if they are not found to be compliant with basic patient care; including infection control and hygiene standards. They need to have random checks monthly by unidentified investigators verifying these measures; with zero tolerance for non-compliance. At some point; if not already, it will be ourselves or a family member being cared for in these places. Demanding and enforcing better should be a no brainer.
55
Frequent monitoring is not going to occur because there are not enough state employees with the requisite knowledge assigned to do it and not enough money in most state budgets to support it. Another problem is that state legislators historically take a hands off attitude toward staffing levels in healthcare.
19
Sheesh! She's only 65! Even Zeke Emanuel MD would want to be treated at that age!!
12
65 years old is not so young. I’m younger than this and I would definitely NOT want to live this way. The main question is, is there a hope she will recover and not need a ventilator?
16
My grandmother who raised me lived independently until the age of 94 when she was placed in a nursing home. Relocation to my home on the West Coast at that time in 1988 was not an option because of her medical needs. Flew back immediately. Within a week catastrophic infection. Done. 1988.
14
Since having a staph infection in my knee 20 years ago I have made myself very unpopular with health care workers by insisting that they wash their hands thoroughly where I can see them. The standard little blob of sanitizer isn't enough.
Even so I also ended up with MRSA after spinal cord surgery. After a cascade of other issues, including a spectacular (Steven Johnson Syndrome) allergic reaction to Vancomycin I was transferred to a long term acute care hospital.
Anyhow, since I had just had the MRSA I was supposed to be under isolation status both for my sake and presumably to prevent spread. (This really is the short version.)
Most of the nurses and other direct care providers just quickly threw on the yellow aprons, without even tying them, and never bothered with gloves.
I still had to insist on hand washing.
46
Wow...I’m sorry to hear you went through that. Good for you for insisting on the hand washing. I have MRSA too from lots of hospital stays; though it is in my urine, not external in a wound or something, and I’m good about handwashing myself. I was told by an infectious disease doctor that most people have MRSA on their skin; which surprised me. What is really dangerous is when it gets into the bloodstream through a wound or something; particularly in an immunocompromised patient. That’s a little scary for me, as I am on immunosuppressant medication for an autoimmune disease and it is possible that the MRSA could at some point migrate into my general circulation. I think it is terrible that these facilities are not following known infection control and hygiene standards. I believe that CMS and accreditation agencies should be pulling accreditation and funding from those found to be non-compliant, with zero tolerance. There should be anonymous random checks for such measures monthly. Someday; if not already, we ourselves or a family member will be a patient at such a facility (or in a regular hospital or ER where infected patients have been previously treated). Therefore, demanding better should be a no-brainer!
15
@Kathryn Ann Harris-Radelt
Yes there are supposed to be unannounced visits to check but there’s always somewhat of a warning. And unfortunately when I worked in hospitals, I saw it all. I was always strictly adhered to infection control precautions though bc I’m a paranoid germophobe lol but none of my patients acquired infections!
11
I had a great grandmother last into her 90's. Suffering from dementia she was off in some other world for 20 years, not knowing where she was or who anyone around her was. It took her years to die from cancer in a nursing home - oblivious to the world. That was not a 'good' death.
My mother entered the hospital after having been on Oxygen for two years. An active life had come to a screeching halt after she contracted the flu. Despite DNR orders she was put on a respirator. She lived a week and a half longer than she should have, miserably aware of her situation. While we fought to have her wishes followed, my brother fought every step, unable to let go.
My father was on dialysis for years - in and out of the hospital. He finally said 'Enough' and died on his own terms. A 'good' death? I don't know but it wasn't so bad.
My godmother was lost in dementia for two years. Her husband took care of her to the end at home. He did not begrudge it but felt sorry for her. She was oblivious. Was it a 'good' death for him? I can't say but it clearly was burdensome.
I've spent weeks in a hospital, on IV antibiotics, fed through tubes, pumped full of painkillers. You want such an experience to be as short lived as possible and if you are NOT going to get better, you want it over as soon as possible. I do NOT want a drawn-out death but am unlikely to drop dead on my feet as my grandfathers did. Though stuck in a worn out body, I never smoked.
37
And yet.....every time anyone tries to pass any kind of regulation about staffing levels and ratios they ALWAYS fail. Way to throw caregivers under the bus....yet again....and not hold corporations and administration accountable AT ALL! When you've got too many patients, care is inevitably going to go down. It's not rocket science. And what do articles like this do? Continue to blame the workers and yell at them to do more. I would love to see an article actually addressing these realities, that actually and REALLY called out our profit-driven healthcare system for how it operates. As we continue, as a society, to do absolutely nothing to remedy any of this, we can just watch as our aging population increases and this problem worsens. Sounds like other issues our country is facing and continues to do nothing about, doesn't it? "Weak link in the healthcare system,".....my god the entire "system" is a weak link!
74
You are absolutely right, though I didn’t see the article as just blaming workers. They were simply reporting what was happening as they saw it there. They did talk about how patients were being pushed into these underresourced facilities due to profit incentives; and that their infection control policies were non-existent or poorly implemented. I definitely saw it as a criticism of the larger system; but like it not that is in part defined by what the workers are or are not doing. They could have specifically pointed out that this may be due to understaffing though. That much I will give you.
7
There is technology available that will destroy many (most) of the various infectious materials. The radiation kills just about everything; bacteria, viruses, fungus. It won't cause drug resistance from its' use.
The process uses ultraviolet light at specific wavelengths. When I initially investigated the process researchers were focused on 207nm but I believe moved to 222nm. The light is harmless to humans. It is stopped by human skin or eyes.
A hand portable device has been used in some Asian hospitals for several years.
A test comparing the current UV light used in operating room air handlers/filters and the 222nm UV significantly reduced airborne contaminants to essentially zero. Lamps in the surgery could keep surgical sites sterile.
Lamps in patient rooms could significantly curb hospital acquired infections and stop people and things from propagating the infection to others.
School rooms and any other space, transportation, aircraft, anywhere. Homes, cars. ad infinitum. Help suppress propagation of things such as measles, flu, and other communicable dangerous infections .
I believe there is work being done to develop LEDs that provide 222nm light. That will probably be the optimal solution. The initial work uses a fairly expensive eximer lamp.
I am not involved in any of this work. Only my research into the approach. I do think that this information should be examined and supported for a fast track from the FDA if at all possible.
36
@CH please tell me where we can purchase this hand held device ? do you know a website, do you have further information to share about it
7
@jeannene
Unfortunately, we do not have access to this technology in the US. And there are no sources (as far as I can tell) willing or capable of selling components.
I tried to buy a development kit, and the people developing this technology refused to sell me equipment. Possibly because of a fear of the FDA or for product security. I am an electrical engineer and could simply deal with the parts.
Trying to buy a working device from China will probably meet a stone wall. It will certainly be in violation of whatever the FDA thinks. The FDA tends to be a barrier to many things. As an outsider, I know nothing of their processes. Although they currently seem to be heading toward regulating a safe herbal material in common use for 15,000 years or more. Depending on how you spell the name of the herb. After, of course, really stupid political actions prohibiting the herbal material years ago.
As far I can tell, the 222nm UV can be a world changer. It can probably not fix anything already in the body (unless a blood circulation attempt). But health care people can be protected. People shown to have the nasty fungus on their skin (and clothes, bedding, anything) can be "cleaned" rather than fearfully put in a cage. Even in remote primitive areas; if they can get a solar array (or other power source), they can help protect medical staff.
This could be at the level of the discovery of Penicillin.
11
I adore all reporting by mrichtel. I think the remarks here should be expanded. nursing homes are breeding grounds for influenza and common cold, let alone candida auris. medicare pays for antibiotics but not for lysol. the cursory swab of floors--once a week in nursing homes, a little more often in hospitals--- is done by same cleaning lady who swabs the grubby ventilator control panel, food tube/IV stand, and the bedrails. medicaid only requires nursing home bedbath twice a week, even if the resident is capable of getting into a full shower, there is not enough staff to give showers and the facility is afraid of fall risk so need two staff to give shower which is non-starter. residents share sink and toilet with roommate. nobody gets hands washed before meals, ever. if residents are moved to different room, they use the same recliner, same window sills, same side table as last person. nurse who touches the sheets also touches the grubby equipment. so, in my view, soap and water and some good disinfectants are badly needed, let alone the "universal precautions" taught to nursing students and CNA's.
27
"Mr. Hernandez doubts his wife will recover. “If I can take her home to die that would be a blessing,” he said."
Maybe the cost of care would be better spent on hospice services that could grant the man his wish. These infections are thriving in people who are ill in ways from which they will not recover. Our medical system has prevented Ms. Davila from dying from her lung and kidney disease, so nature is finding another way. In the meantime, every time she (or another patient like her) gets taken to a hospital, other patients who have a chance at recovery are put at risk. This isn't just a question of whether nursing home reimbursements are adequate to fund the level of care patients need. It's a question of whether the care being provided is really appropriate at all.
62
@Nikki
What you have said may not be popular, but if this is the usual sort of situation where this particular fungus can be deadly, there are many problems which have set the stage , really, for death. This is nor a person who is going to be "cured" of any of her ailments, - it's a matter of which one of her existing infirmities or what opportunistic infection will lead to death. She will probably be uncomfortable -even anguished, during the entire time. It seems horrible to me.
Which is not a reason not to fight the spread of this and other infections. It's just that the end of life issues here are different from the problem of spreading infections.
18
@cheryl
This is one of the reasons why there needs to be uniform national "Right to Die" standards/laws. People infected by this fungus (and anything else) are headed to an agonizing death. And they do not have control in many cases.
If a person decides they need to die (for whatever reasons), that is their choice. No other person, government, or philosophical arguments may override the will of the subject. Expedient action is all that should be handled by anyone other than directives of the subject. Torturous processes for a dignified death need to be prohibited.
A less popular point is the national impact of massive costs expended to clearly keep dying people alive for an additional short time.
Regardless of the ability of a seriously sick person to control their own future. Our health system is seriously warped toward "Treat at all costs" and no rational decisions.
The costs to the nation for this approach is huge. And the costs are all coming out of our medical support system.
22
When my father needed nursing home care to rehab after a stroke, I called each of the facilities that were an option and spoke with the Director of Nursing to ask about the nurse-to-patient ratio. All but one stated cheerily that they had one RN or LPN for every 20 patients. Each licensed nurse had 2 aides for those 20 patients. Now think of how sick and dependent the patients are in those settings as you consider how understaffed the facilities are.
The one place that did not have a 20:1 patient-nurse staffing ratio was 19:1.
21
As a society we are doing a horrible job dealing with end of life.
The ethics of death have not kept up with the technology available to delay it. If you need to be 'kept alive' with a ventilator and feeding tube, SHOULD you be 'kept alive?' How often has that decision been made for someone, without knowing - or even against - a patient's wishes?
I recently overheard two ICU nurses talking about good and bad deaths. The latter were often kept alive at all costs at the wishes of family who could not let go. Too often those decisions were made by family who were seen once - if at all. In other cases a dedicated spouse could not let go. Some were at a spouses side for days until they died. Their spouse was unconscious, on a ventilator, fed through tubes. But is keeping someone alive at all costs, prolonging the process and pain of death, really love?
'Good' deaths were where a conscious and alert person got to say goodbye to family and was allowed to pass quickly, feeling as little pain as possible.
If you are not going to recover, you want to be in ICU for as short a time as possible. Dying is best as a short term process - neither nurse knew of a 'good' death that took a long time postponed by using 'everything' possible.
40
I strongly agree. and that end of life care in many cases results in mounting patient charges. It "kills" me that someone lives a frugal life, then his wealth is diminished at the very end when no one enjoys it.
21
@AH
I am firmly convinced that my mother was kept alive for weeks longer than she should have been BECAUSE she had great insurance. With a career at a Fortune 500 company she was one of the last to get medical insurance with retirement (it was eliminated the year after she retired). The hospital probably got another $250,000 for those two weeks - and that was 20 years ago.
I do not necessarily begrudge spending down one's savings to pay for care BUT I am fed up with an economic system that keeps you from building up any real savings for retirement. Inflation reduces the value of what you earn. 401K's disappear with market declines.
Seems like you have to kill yourself when the cash runs out... wait, I've read a few stories like that....a murder-suicide by an 84 year old who couldn't pay for his wife's medications
25
The article says this is a highly infectious fungus that can be invisibly spread to relatives. The husband of the patient in the photograph appears to be kissing her. Shouldn't relatives and staff be wearing masks when they're with infected patients?
50
@Linda
Unfortunately we have not yet figured out to fix stupid.
13
I so feel for Maria Davila and her husband. This is no way to live and certainly no way to die--lost in the limbo between both worlds.
16
Nursing homes are nothing more than warehouses.
They take every last penny from you and your family.
Instead of a Nursing Home, I would rather be put in a cardboard box and stowed under a bridge.
24
Where did it come from four years ago?
4
An interesting question; though I’m not sure it matters. We live in a very small world now, where you can be on the other side of the globe in a matter of hours. That’s why we can’t afford to just care about what happens within our own borders. We ended the Ebola epidemic in a matter of days when we finally decided to send the military to set up the infrastructure to intervene, and we only did so because we became afraid of it affecting us on a mass scale. Imagine how many lives could have been saved if we decided to care and intervene before that (when it would have been even easier and cheaper to do so). Marianne Williamson is a bit of a flake, but I hope everyone was listening to at least one thing she said:
“Populations of desperate people around the world is our greatest national security threat.”
Nationalism will ultimately destroy us, because we are looking at our problems in exactly the wrong way. Hopefully we will figure that out before it is too late!
6
Which is why our elderly population should be enabled to age and die in their own homes.
A visiting nurse once said to me, "If your aunt had been put into a nursing home, she'd be dead by now." She died in her own home, probably not, I admit, given her dementia, not soon enough.
My 100-year-old friend, sharp as a tack, lives in the one-bedroom apartment she's lived in for sixty years. It could be a bit cleaner, she could be a bit cleaner, but she refuses help. She knows where her things are, takes buses everywhere, keeps track of her bills, and is living her last years on her own terms.
I have tried to get her interested in a cleaning service, but her bathroom and kitchen are clean enough, much cleaner than some of my friends' when they were first out of college.
Were I to rat on her to her relatives, who do not visit her, they'd put her into a nursing home, where she would become unhappy and disoriented and then perish.
48
It would be helpful to inform the public about the difference between fungal and bacterial pathogens. Fungi are eukaryotes and are thus in a completely different kingdom than bacteria. While multidrug-resistant bacterial pathogens are a serious problem, at least there are many classes of antibacterial antibiotics.
Fungal pathogens, on the other hand, are much more closely related to humans, evolutionarily. Consequently, they are (i) intrinsically not sensitive to antibacterial drugs and (ii) drugs that target them are much more likely to also target our own cells and tissues. As a result, it is difficult to identify antifungal antibiotics that are not extremely toxic to patients, and so there are relatively few anti-fungal drugs. Unfortunately, much less research on identifying new antifungal drugs is supported either by the NIH or by pharmaceutical companies.
Fungal pathogens are ordinarily effectively controlled by a mature and robust human immune system. However, in immune-suppressed patients (e.g., undergoing cancer chemotherapy, transplant patients) and those with weakened immune systems due to aging or disease, fungal pathogens can proliferate rapidly, invading many tissues and organ systems, and resulting in catastrophic physiological failure. Development of effective new antifungal drugs should be a priority for both the NIH and the private sector.
34
@voreason Thank you!! Couldn’t agree more...
2
Nursing homes have become dumping grounds--for patients, as well as caregivers, most of whom are paid the lowest legal wage.
Patients such as this poor woman become little profit centers--they are ill beyond any possibility of recovery yet are hooked up to dozens of machines and fed antibiotics and other medications---
Every person needs to execute an end of life directive and appoint a medical power of attorney who is authorized to make rational decisions when the maker of the directive is no longer capable. It is not unduly expensive to do so, and it spares loved ones from having to make the decision unilaterally.
It borders on criminal, in my opinion, to continue to artificially feed and respirate people of advanced age and/or multiple conditions such as this woman suffers.
In short, there is a time to simply let go. Medicine is a field where now, more than ever, we should consider that just because we can, does not mean we should.
(Dr. Atul Gawande has authored several excellent articles and books on end of life issues and encouraged both physicians and families to focus more on quality of life and perhaps less on extending it when there is truly no hope. His writing on this subject is most helpful and informative.)
53
@Mary Melcher She could be catholic in which case the directive is to extend life for as long as possible.
7
@Bandos
The so called teaching does NOT insist on extraordinary measures only normal ones such as hydration--- When it comes to mercy, I would not rely on the Church (and I was raised in it).
Force feeding, dialysis, resuscitation as well as many others are not normal.
23
@Bandos
The so called teaching does NOT insist on extraordinary measures only normal ones such as hydration--- When it comes to mercy, I would not rely on the Church (and I was raised in it).
Force feeding, dialysis, resuscitation as well as many others are not normal.
"as long as possible" could be years---cruel unusual, expensive. Will the Church chip in on the costs?
11
"Advances in medical technology have made it possible to prolong the lives of desperately ill patients, while changes in Medicare reimbursement rates created a financial incentive for the expansion of such facilities,"
This sums it up: prolonging the lives of desperately ill patients is cruel, expensive and indefensible.
Mrs. Davila should be left to die peacefully with a family who loves her. I'm not sure if her husband wants to prolong her life, the article didn't say. But she could go on like this for a long, long time. No, she's not going to get better and she's suffering. He could decide to remove the ventilator and feeding tube.
24
@ls The article does say he wishes he could take her home to die. My guess is he has not been presented with this as a real option by doctors.
13
Let's not forget the profit motive here. Keep the patient alive as long as possible, while spending the bare minimum on staffing and training. At 61, I hope and pray that when the time comes, I will be allowed to opt out of this world on my own terms.
51
@CMC
I’m 73 and want exactly the same thing. My 95 yo mother-in-law just died after years of dementia. At least she could afford the care, but my husband and I pray we go quickly like my parents and grandparents. None of them were in nursing homes and my parents died at home. Such a blessing..I pray Maria goes home and finds a peaceful death.
9
Yes, of course resistant organisms are increasingly difficult to treat and continue to create significant challanges.
But I have to also say that I've become increasingly aware of the NYT health reporters turning up the volume of emotion, and to a certain extent, hysteria regarding multiple health issues within the past several months. Lyme disease, urinary tract infections, Candida auris, all deserve to be covered but the last several articles have been far from dispassionate and even-handed.
With all of the knowledge that has supposedly been amassed by this team, why has the editor chosen to photograph this patient's husband not wearing gloves while citing the breakdown in infection control measures? Didn't the reporters, presumably quite alarmed by the spread of this organism, pull the husband aside and suggest a bit more caution might be in order?
And bringing up Betsy McCaughey seems a bit rich--and probably hysterical itself--when you consider she's the one originally describing "death panels" sure to evolve from Obamacare:
https://www.theatlantic.com/politics/archive/2016/08/betsy-mccaughey-donald-trump/495758/
Might the editors in the health section consider reporting facts without the hysteria? As a physician who specializes in infectious diseases, I can assure you that a well-balanced and less emotional reporting style will go a lot further in educating professionals and the public alike.
36
@Jeff
it’s not up to the reporters to tell a family member about infection control! The facility is responsible.
19
Absolutely right about Betsy McCaughey. She is not anyone I'd listen to.
14
@Jeff
I am sorry I didnt find anything hysterical about the article. People die in hospitals and nursing homes because most hospitals are poorly run. Maybe not hospitals you work at, but for us regular people who visit friends in multiple hospitals they have indifferent professionals and downright ignorant support staff.
People who have dementia are yelled at by support staff and left to sit for hours in their chairs, branded hospital names are far from being the place where a loved one should be. If your in NYC just look at our own institutions of care.
As a medical professional stop complaining about the article and look at these hospitals who have terrible ratings and decide what you can do to assist in resolving the poor quality of so many hospitals that are nothing more than the last stop before death from medical indifference.
When you work at a hospital you are suppose to care about the patients, actually talk to them .That is not the case , hospitals care only about you paying the bill nothing more .
11
Look at the picture. Ms. Davila's husband is not adequately covered. He surely will be a carrier of his wifes C. auris. This has nothing to do with low staffing. But the staff should have made sure that he was properly covered before he went to her bedside.
28
My close friend is a nurse. She has often said that a feeding tube is the kiss of death.
Prolonging a life in a bed with little chance of recovery for a 'normal life' is not something we should hope for, and I already wrote a will stating 'no feeding tube'.
43
@mainesummers
Yes, It's in my advisory,as well, and I refused this on behalf of a relative, saving him months ( or years) of distress. But if I hadn't read about what a terrible problem it becomes before being put on the spot I would have been guilted into agreeing to one.
13
Yes, nursing homes are understaffed and they send patients to the hospital in a constant boomerang back-and-forth. Easy to see how infections get passed from nursing home to hospital and back again. And no, precautions are not followed adequately because it is hard to keep up the hyper-vigilance, so they give it up and treat infected people like everyone else. Yes, this is very bad. Do your best to stay out of these places.
15
I remember walking into my father's room in an expensive, highly regarded nursing home one night and finding him and his roommate trying to stay warm together in the same bed with the widows wide open and the air conditioner blasting in the middle of winter.
The nursing home, I surmised, was doing the best job it could of sending these two good men off to their happy hunting ground.
This was a long time ago, so I wouldn't be surprised to discover that things have deteriorated since then.
17
Thank you for this valuable reminder. An intrinsic feature of nursing homes is that they sequester the late stages of life outside our collective circle of attention. We turn our back on these scenes at our peril. The drug-resistant fungi reaching outward from these zones of decay perhaps offer a fitting metaphor for the sinister effects of this system of dying on our whole society.
Our technology condemns the most vulnerable of us to a horribly protracted final act. This end-of-life ordeal abuses the trapped, impotent patients themselves; their frightened, impotent families; their "care"-givers; and now everyone else. The world of the nursing "home" breeds not only antibiotic resistance in microbes but awareness-resistance in people. The unappeasable wretchedness of the mute or bleating or pleading patients; the futile, farcical cycles of hospitalization and 'bounce-back'; the impracticably time-consuming demands for isolation precautions despite inadequate staffing––this onslaught can foster indifference to both persons and best practices. The indifference extends to a society that mindlessly funds lengthy, if low-quality, end-of-life incarceration by directing resources away from potentially effective programs.
We need to rethink an industry whose products are individual entrapment and collective microbial danger. There's no quick fix, but we could start by reading Atul Gawande's book "Being Mortal"...
55
A future article might question how effective the NY State Health Department life-safety nursing home surveys are.
11
You can surely tell how much the general public cares about these issues - 13 comments is all ? Some of the other ridiculous subjects covered get hundreds & hundreds of comments in a few short hours.
Don't any of you get it ? Everyone, yes everyone reading this "newspaper" is going to end up at this time & place in life. Imagine if we all gave a damn what could be accomplished. And then, by the time you & you ...& you end up here -you may be glad someone cared to fix this terrible problem.
48
@Dheep'
We all know how bad out health care system is and we know that it is not going to change in the near future. Everyone of us is caring for a loved one and we are powerless to do anything to make the system right. We can argue ,yell, protest, send letters but we cant be at the hospital 24hrs a day.
There is no trust with the medical community and yes its sad that people arent commenting, probably because the reality touches all of us so deeply we dont want to put our fears into words that it will never change.
Most of us want to die or be sick at home not at a nursing home or a hospital where no one cares.
4
@Dheep'
I was thinking the same thing Dheep'. Kinda unbelievable!? The main issue is regulation of these facilities which is lacking at best. Usually overseen at federal and state levels. Trump administration cut federal oversight regulations(surprised?) and depending on the state not much has changed in their regulation requirements There is one independent agency that investigates and rates Adult Care and Nursing facilities
and sorry I cannot remember the agencies name. In my state there were only 3-4 facilities that were given the agencies 'acceptable' rating. The C.M.S. does it's best
at ranking nursing homes but the job becomes more difficult with constant cuts to their funding. Stricter enforcement of laws and regulation need to be addressed..the sooner the better when considering people's health and lives.
My mother was an Army nurse during WW11 and was a
teacher and nursing supervisor after the war until retiring. I can remember her 'discussions' with hospital and nursing home administrators on a few occasions when family members were being cared for at the facilities. My father would ask my mother later what was the matter and she would say the rooms were not being
cleaned properly and patients needed proper treatment
to prevent infection. I do remember one time when my uncle was moved to another room after my mother making sure it passed her cleanliness test. If only everyone had a care advocate. Families try there best
but it is usually not enough.
6
@Dheep' Appointing a medical power of attorney and executing a detailed end of life directive can avoid this hellish end.
4
For another in-depth article on this topic: https://monthlyreview.org/2019/06/01/superbugs-in-the-anthropocene/
1
Carelessness with hygiene isn't just a problem at nursing homes. I went to a surgical center for minor surgery and they put me in a prep room that obviously hadn't been cleaned after the last patient. I also had a flu shot a couple years ago at CVS and was shocked that the pharmacy technician didn't put on gloves or even use hand sanitizer. I should have said something but she stabbed me with the hypodermic needle before I could mentally process what was wrong. After she gave me the shot, I watched her fumble to open a bandaid, getting her germy ungloved thumb all over the gauze in the process. I told her to skip the bandaid. It was really gross! I'll never get another flu shot at CVS.
18
@Sarah
Not to belittle your concerns at all (but in an effort to make you feel slightly better about the flu shot), the tech most likely washed her hands outside of your view & gloves are really to protect the healthcare provider from the patient versus the other way around (at least in that setting--of course the gloves used in surgery are sterile and put on using sterile technique--hopefully!)
3
Nursing homes have always been breeding grounds for multi-drug resistant bacteria. Back in the 70's, MRSA was only known in long-term nursing homes such as these. Now at least 30% of Americans are colonized and a disease once known only to long term institutions crops up in the young and healthy (remember the outbreak among the Rams football team?)
When we read that C. auris is spread by contact, and we see images of the infected patient's husband kissing her and holding her hand, we observe him colonizing himself and taking this infection home and into his community. This is an important vector for how such virulent pathogens become as widespread and difficult to treat as MRSA is now. It is not fair to blame the overworked and underpaid employees of LTC facilities. If these staff were paid commensurate with the value of their work, it would be easy to combat these germs, instead they are treated as disposable employees and then blamed for the poor outcomes. As the population continues to age and more people demand life-extending technologies, it is not just our elderly who are put at risk, it is our entire society, for these germs are carried out into the world by both staff and visitors.
99
@RN While I definitely had the same thoughts when I saw pictures of the husband touching his wife, I have to disagree slightly about the pay and responsibility of the workers. I agree they could and should be paid a bit more. But I also believe that when they accepted the job, they knew or had some vague understanding of the safety obligations and agreed to adhere to them when they accepted. Therefore, they should follow the protocol that keeps everyone safe, including themselves. Imagine bringing this virus home to your family all because you felt you weren't paid enough to be safe. I can't understand or agree with that logic. I would encourage anyone entering these areas to use precaution.
12
@TLynn
It is not that the staff are deciding on whether to use precautions. It is a simply a matter of time. It adds minutes to each trip into and out of the room to tend to these people. It can take longer to gear up than what you are actually doing in the room. Minutes add up to hours and one patient like this can absorb a percentage of your shift, yet administrators do not take this into account when staffing the facility. The other patients pay the price with diminished care, longer waits to the call buzzer, and on an on.
45
@TLynn
Paid "a bit more"? Physicians, R.N.'s, occupational therapists, and physical therapists who work in nursing homes are paid professional wages. The lowest wage the law will allow goes to the people who do the unpleasant work of changing adult diapers, cleaning people who have soiled themselves, bathing immobile people, feeding people who can't manage cutlery anymore, and trying to cope for hours on end with impossible demands from desperate patients and their families. Yes, they knew what the were signing up for, but they need the money. And they're overwhelmed.
We have great sympathy for children's illnesses, but we don't want to be confronted with end-of-life realities. Children's hospitals run television ads that show kids who are visibly ill and pathetic, and raise a great deal of money. Can you imagine the reaction if nursing homes did something similar?
33
Why is staff “struggling” with basic concepts of cleanliness and infection control? It’s not hard to learn how to use a gown, gloves and a mask. My guess is that this is more about staffing that has been cut to the bone, so that the owner can reap an even larger profit. I am a retired RN and it never ceases to amaze me how bad nursing home care has gotten. These folks deserve much much better than they are getting, and there is virtually nothing they can do about it, in a lot of cases. These people who run these facilities should be made to reside in them when they get old and sick. Want to guess how many would even consider it? One word: shameful.
36
Honestly we take more safety precautions in a deli.
28
All one has to do is look at the photo in this article. Mr. Hernandez isn't securely gowned up to even be in her room. Enough said. Any person who has ever worked in a SNF/hospital/around the elderly or anyone needing universal precautions would see this and laugh, then cry.
30
Why is Betsy McCaughey the second expert cited in this article? This is an unserious person who seems to lack the basic scientific knowledge to differentiate bacteria from fungi. After her efforts a decade ago to torpedo the ACA by spreading death panel lies, it should be clear flimflammery is her field of expertise. She should never be treated as a reliable source when important public health information is needed.
88
If or when I get to be like Ms Davila don't take me to one of those horrid nursing homes, that's no way to spend your remaining days. let me sit in the sun and fade away with a large comforting dose of opiates.
155
@PPP My choice also! Should be standard protocol. Just because we can extend life doesn't me we should. I agree with another commenter that this subject is not getting the level of discussion/involvement in society that it should. Between the expense and the spreading of infectious disease, expending life needs a lot of thought and discussion in our culture.
37
duh .. we so love our children and elderly that we pay as little as possible to care for them
24
One of my fellow trainees in medicine came up with the idea that we should make a short film about what being in intensive care is really like, and that we should show that film to family members of critically ill patients with little hope of recovery.
Families continue to insist that their failing relative be given "everything possible," even in the face of futility. They generally have low health literacy and unrealistic expectations about what medicine can do.
Sure, we need to maximize infection control. But we should also spend substantial resources on education, grief counseling, home hospice, and social supports to families with chronically ill ventilator dependent patients with no quality of life.
My father, with cognitive decline and metastatic prostate cancer, declined a potentially life saving operation. He went home under hospice, and lived another six months. It was hard, but neither he or I would have allowed technology to prolong his life.
123
I knew a Doctor who had hip replacement surgery and released himself from the hospital 24 hours after surgery. He knew that all he had to do was to show his surgeon that he could get up and walk to the door. So he demonstrated that he could.
When he told me that story I asked why he wanted to go home so fast and risk proper healing?
He responded that he was willing to take the risk rather than risk getting a nosocomial infection while at the hospital. A nosocomial infection is what Doctors call an infection that you get after you go in; a disease that the patient didn’t bring with them.
It is all about hygiene wherever we are.
125
@Truth Is True. Proper healing can take place at home. My hip replacement was a same day surgery. Had it first thing in the morning, light general anesthesia, up walking with crutches and moderate weight bearing after the spinal wore off. No bugs for me, thank you!
8
Nursing homes are understaffed. Period. Don’t be fooled by the pretty pictures and nice furniture. Staffing is the biggest economic driver for the nursing home industry. They use the cheapest and most uneducated labor to make that money.
If you can’t advocate for yourself and don’t have a family or friend there constantly there for protection, it is hit or miss on getting the proper care.
76
@Susan C
You are so right. I have worked in skilled nursing and the staffing model is atrocious. I love working with that population but had to leave because my patient load was 38! How am I, one nurse, supposed to responsibly and properly take care of 38 people? I know of worse patient to nurse ratios as well.
81
@cmd
Yep. I have family members who quit working at SNFs ( skilled nursing facility) precisely because they were leaving 30 plus patients unmedicated /unattended while they dealt with a crisis for hours alone or couldn’t keep up with basic care like dressing, bathing, feeding so many patients.
No RN or MDs in the building except day hours
( mds see patients very little in a SNF) LVNs are the most educated staff most of the time. One year of education. Impossible to care for 30 plus patients alone. CNAs have 90 days of education.
My schizophrenic elderly Aunt died in a nursing home from so much tranquilizing medication she
couldn’t stay awake to eat.
Go home and pay for a caretaker is my best advice.
13
@Susan C
I had the misfortune a couple of years ago of falling and breaking my ankle in 3 places. Since I had to be totally non-weight-bearing I ended up in a nursing facility for rehab.*
Many of the lower level care employees were Somali refugees. The care they provided was excellent and several were studying for practical and registered nursing diplomas.
* Funny thing, my rehab wrapped up exactly at the maximum week that Medicare would pay for.
19
A very interesting article. Just wondering though, why the husband in this story is not wearing gloves and a gown as recommended. Is he not potentially contributing to the spread, and if so doesn't he have some responsibility to mitigate the risk?
27
@Steve
Family members and other laypeople visiting patients in isolation rarely comply fully with isolation procedures. Some of that is lack of education, and some is refusal. "I wasn't at home, so why should I here?" is a common retort.
What people fail to understand is that we do not isolate patients primarily for our sake, but rather to prevent transmitting pathogens such as MRSA, C. difficile, VRE, etc to other vulnerable patients.
When Mr. Davila leaves that room, he will touch handrails, countertops, door handles, elevator buttons, etc. So will we, unknowingly. Failure to comply fully with isolation procedures in the hospital by anyone leads to failure by everyone. Our efforts are made far less effective by the noncompliant.
51
Heavy metal ions in tiny concentrations kill micro-organisms. It's the oligodynamic effect that was described in the 1890s. Witness the use of silver in Japanese toilets to keep stuff pure. It turns out that these same heavy metal ions (also UV light) act exactly like antibiotics in selecting for antibiotic resistance (AR).
Modern economies allow for an ever increasing spread of "stuff" to people; much of this stuff has copper, mg, mn, and other oligodynamically active minerals, and untangling the relative contribution of antibiotics, metals and UV is fraught. The genetic elements that allow for AR in hospitals and in pathogenic bacteria arise not in health care settings but rather in nature where they are exposed to metals in mines, polluted factory sites and the rest and have been there for eons so far as anyone can tell. And most antibiotics are derived from natural sources, like other bacteria and fungi. Not even the Buddah can provide guidance here.
The promiscuous use of antibiotics costs money, encourages toxic and allergic reactions and probably does no good, but blaming this abuse for increasing AR seems to be getting ahead of what is currently established in scientific literature.
Correlation is not causation, to quote Daffy Duck; maybe there is causation, maybe not. And the frisson of poor people around the world being especially victimized probably appeals to the simple, but does not especially tug at my heart strings.
2
@erwin haas There is a fabric that includes silver threads. From what I understand, with MRSA being such a large problem at NHS hospitals, pajamas with these threads ware frequently purchased by patients before entering the hospital (they're allowed to wear their own). I also recall studies that showed physician's ties were an enormous source of cross-infection. Here's to physicians wearing sleek silver suits!
2
I'm 68, I'd rather be dead than in that situation. It's ridiculous.
110
@Jane four words: End of Life Directive, and four more :Medical power of attorney.
14
Unfortunately, the nursing homes want family members there constantly to do their jobs for them! When my parents were in a nursing home in Brooklyn, we had to hire private nursing care for them. This way, we were assured that they were bathed, clean and fed and that their room was clean! The nurses on their floor couldn’t care less about my mom who had severe dementure and would constantly get “on their last nerve”! They were glad that there was someone else taking care of my parents! And this was in a nursing home that supposedly was “one of the best” in the State. They are all the same. Whether it is because they are severely understaffed or the staff just doesn’t care, I don’t know but something has to change.
38
@RJW and not just nursing homes. Hospitals do this on a regular basis.
10
@RJW
Know many ambitious, high energy, recent college graduates who are hankering to work in care homes? I don't either.
16
Long term ventilation as is depicted in this article suggests a medical system that has not offered its patients good choices for dignity and quality of death- that will be at the expense of many who have a shot at life
59
@Nicholas
Long term ventilation in a nursing home would be hell on earth. Death would be a welcome friend.
26
My husband gets hospice care and it makes all the difference. If the husband in this piece wants his wife to die at home in a peaceful, dignified way, hospice is the answer.
120
@Ann Hadley
I'm very sorry about your husband.
Regarding the husband and wife in the article, it's possible her family opted for the extreme measures described to keep her alive rather than "letting nature take it's course." That happens a lot.
10
Thank you, NYTimes, for bringing the deplorable state of outer-borough nursing homes to light.
Understaffed, patients left to rot in urine-soaked hallways, they are one-way ticket death-traps.
Frontline staff is thinly spread out and overburdened. Owners like Shimon Lefkowitz are reaping the benefits, literally.
34
Completely agree that these facilities need a strong revamp and standardization of best practices, policies and staffing. But we also need to take a hard look at what we're supporting by building (and expanding) them. There is incredibly good and growing evidence that most chronically critically ill (permanently ventilated) patients have a terrible prognosis in terms of mortality and quality of life. With some exceptions, they die in a never-ending cycle of hospital-"rehab/snf"-hospital. Until we recognize this and provide more dignity to end of life care, this problem will grow and be perpetuated.
134
C.Auris is one of a group of infections that patients contract from nursing homes and hospitals. My father died from C. diff ( Clostridoides difficile), after breaking a hip. He probably contracted it while in a relatively well run skilled nursing home wing in Philadelphia.
Other than this becoming a lawyer's dream, how can we mitigate this problem while still keeping nursing home care affordable? This is an important issue that should be addressed in future articles.
34
@Ron Boschan
Nursing home care is not affordable.......people who say they want everything done to preserve their loved ones life are not thinking of the patient who is suffering and they do not want the burden of their care , the staff at these fascililties cannot do their job. Employers watch their bottom line so all these places are poorly staffed and when the patient suffers they are transported to hospital until they can be sent back. Hence carrying infections from one place to another. If these comatose patients were able to respond they would reply, death with dignity. Unfortunately the medical professionals would lose some dollars that could be used to aid patients who might have a chance to live life.
18
@Ron Boschan I am sorry to read about your dad. My mom was recently in the hospital in The Villages for emergency angioplasty. She developed cellulitis while she was there, which was undetected by the staff but by her PCP. Back to the hospital, where they treated her with a vast array of antibiotics. Then she developed c-diff and bam, into isolation and another antibiotic. Luckily she survived this latest round of infections picked up at the hospital. During my grandmother's day, no one wanted to go to the hospital, as that is where people went to die. Things have changed much in the 100 years since then.
11
@dogtrnr12
My mother a registered nurse for her entire working life, fell and broke her hip in two places at the age of 85. She was an active senior, with places to go and people to see. Within 48 hours of admission to the hospital she was put into intensive care for 11 days and intubated, for insufficient respiration. That's what happens when you're 85, complain that IV pain medication isn't sufficient and they up the dosage. 11 days.
At some point she contracted sepsis, whether from breathing or cathiter tubes. No one knew a thing (and she was being monitored for all kinds of things hourly) until her kidneys started to fail and it was all downhill real fast.
My mother loved hospitals and being a nurse.
The system failed her.
22
Hospitals and nursing homes spread these pathogens when their personnel wear pants that drag on the floor. I’ve witnessed this several times, even at top notch facilities. Gowns, masks, hand sanitizers are a waste of time if medical staff clothes are literally transporting disease from one room to their next.
21
This makes sense, but is not correct based on outbreak studies. If germs got on your pants leg, first they would be disproportionately “floor germs” not as adapted to living on humans.; second, how would they get from your pant cuff to the next patient?
Turns out that for the spread of actual pathogens, and to make it all the way from patient to patient, hand colonization is the key. That is why hand cleaning is (and should) be the focus, since it is the most dangerous.
Please don’t say that pant cuffs are the major vector, (or ties or whatnot), and that hand cleaning is useless, unless you have evidence that I’m not aware of. (Ps: MD here, with family member who specializes in infection control—the medical specialty devoted to minimizing spread of colonization within facilities).
56
@Jorgietown proper and patient hand-washing is the key. Has to be done. And clean rooms. So many times health care professionals throw or drop things on the floor and it sits there. A tidy room is a clean room as it creates good habits all the way around. Wash hands. Touch yourself, wash again. It's tough and it requires patience but good practicioners know this is the only way.
14
What drives me nuts are the long, fake fingernails many health care workers are allowed to wear on their jobs. Any food service worker would be called out foe that. Starbucks (at least when I worked there) prohibited long nails and nail polish for sanitary reasons.
18
"Advances in medical technology have made it possible to prolong the lives of desperately ill patients..." To what end? Certainly not the promise of "rehabilitation" in the name of the featured institution. One look into the sad eyes of Ms. Davila really makes ponder what she must be suffering and thinking.
Yes, some people become seriously ill and, with the intensive care regimen noted, can, perhaps, recover, at least to a functional degree if not outright cure. But in the elderly, with a litany of systemic failures as well as a disease like this reference fungus, what is the actual hope? Prolonging their lives so they can never leave their bed, breathe or eat on their own? That's not living, to me at least, and a cruel sentence of prolonged torture with no positive outcome until the release of death.
These are serious questions our society (and, in fairness, others places around the world as well) simply has not adequately addressed. Quality of life is not the same as mere endurance in a clinical care setting from which one never escapes. Can't talk, can't eat, etc. is not quality and, honestly, not really life beyond the biological.
227
@George S Not to mention that taxpayers are in many cases such as this one having to foot the not unconsiderable bill--$16,000 a month?!
22
@George S Do you have a Living Will, a Binding Health Care Directive that will enforce your wishes ?
A healthcare proxy is a document (legal instrument) with which a patient (primary individual) appoints an agent to legally make healthcare decisions on behalf of the patient, when he or she is incapable of making and executing the healthcare decisions stipulated in the proxy.
7
@George S
So who gets to "draw the line?"
You. your family, or an unelected bureaucrat?
5