Obviously I am going to respond, I was at a similar conference at Hadassah Har HaZofim 10 days ago with about 1000 participants of the same topic at the Berman Auditorium which was sponsored by all the health funds and the Hospice Care Association, a group that wasnt trying to sell anything or toot their own horn but really educate. This article made it clear they were all about selling their own facility. This is an important topic, however please know that all geriatric facilities are fulfilling at least the minimum standard that the article relates to as is required by the Ministry of Health (MOH) . What bothers me is:
1) It is untrue that others arent building more beds, our facility has just opened up another wing to our nursing home (and was approved by the MOH) . However,the financial structure and constraints that the Health funds put into place make it very hard to fill those beds in a profitable manner (and we are a non-profit organization who charges from the least of those in our category). I am glad that Herzog is adding beds and they do a good job but to say that they are the only ones is stretching it. A few years ago, the MOH LIMITED the number of geriatric beds claiming that there are too many. We were shocked but they claimed they had studies to prove that we dont need so many beds. 3)Regarding dietary services and standards, all Israeli facilities have to maintain at least minimum standards and are verified by frequent inspections of the MOH, the standards mentioned in the article are the same as most facilities. Once in a while we hear of a bad facility that gets closed relatively quickly and the patients are distributed to surrounding facilities. Like with all things in life, you get what you pay for including the quality of care and food that a patient gets in any facility. The idea that we have to maintain a patients weight is controversial at this point. In theory we all know that Alzheimers and cancer patients lose weight over time for obvious reasons but Oy va Voy is to the dietician who has to explain even a 5% weight loss in a half year to the MOH . We give loads of Peratives, Nephrocares, Suplena, Nutrema, Glucerna, Ensure Plus etc (these can cost up to 25 shekels per can) just so we dont have to explain weight losses, when study after study prove that we are not improving quality of life nor prolonging it. It is not clear cut if the cost of all these supplements is justified. We do it now but with more studies from the states that prove that this doesnt prolong or improve health and quality of care, we will see. 4)It is quite a few years now that the MOH has told nursing homes to skip the low sodium, low fat, low sugar diets (Unless the patient wants them). We all focus on quality of life, If a patient wants hot dogs every day, and herring, and ice cream, so be it. Many nurses return from vacations with treats that they distribute to all their patients (from their own pockets), On Fridays a certain patients sister sponsors a tasty erev Shabbat party with all sorts of special foods and of course birthday parties are full of stuff that I cant look at on my diet. We do carefully follow low gluten diets and allergies of all types (can you imagine we diagnose Celiac on 80 and 90 yr olds!!, they come in complaining of years of diarhea and we cut out the gluten and WOW (we also diagnose it from blood tests but rarely send for an EGD as we dont want the patient to suffer) The important thing is they are eating and enjoying. We monitor protein levels (Albumin) and give protein powder and shakes, and multivitamins as needed. When they dont want to or cant eat and we have done our all including sending to swallowing specialists, psychiatrists, snoezline therapy- then we check out the ability to attempt mechanical feeding based on their own wishes (as per living wills) or their loved ones wishes (apotropus or POA) I thought the section on Hypo and HyperNatremia was to complicated for the average joe, Here in Israel it s hammered into the RN, BSN but I wouldnt want people to self diagnose, change their mother's fluid intake or think they are now experts in such a thing and would have mentioned that the general public must seek professional medical attention for the symptoms of Hypo or Hypernatremia just as they get in the geriatric facilities.I would have preferred more attention spent on the depressed or suicidal elderly. and he doesnt mention Chok Steinberg (Right to Die for end of life (Sofani) patients. What bothers most of us professionally is the paternalistic approach of many facilities to do as they see fit rather than respect the patients desires, see: www.ncbi.nlm.nih.gov/pubmed/10509829?dopt=Abstract&holding=f1000,f1000m,isrctn
Good to know, I was burnt by a colleague of hers when our childrens school was undergoing some problems and was called by the paper to give a quote, all I said was that the school was a good place and whatever internal problems it may be having be resolved quickly and quietly, as I didnt think this was an issue for the public. The next thing I know , I was written in the paper for something very controversial that I didnt say. I called the columnist to complain and was told (get this)" Yeah I see what you said, well another parent said the thing that I wrote in the column but since he didnt want to be quoted (he was smart enough to ask to be off the record) so I attributed it to you as you didnt ask to be off the record". I demanded an official apology and retraction, and was told I would get it, For two weeks I waited and 2 weeks later on page a zillion buried somewhere was some blurb that few could understand but just about covered my demand for apology and retraction (I had neglected to ask for an IMMEDIATE and CLEAR retraction!) Bottom line, I stay away from newspapers, even as I am sure that Ms Seigel-Itzkovitch is the exception to the rule.