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WHY HEALTH-CARE WORKERS ARE QUITTING IN DROVES
About one in five health-care workers has left medicine since the pandemic started. This is their story—and the story of those left behind.
The Atlantic / By Ed Yong
The moment that broke Cassie Alexander came nine months into the pandemic. As an intensive-care-unit nurse of 14 years, Alexander had seen plenty of “Hellraiser stuff,” she told me. But when COVID-19 hit her Bay Area hospital, she witnessed “death on a scale I had never seen before.”
Last December, at the height of the winter surge, she cared for a patient who had caught the coronavirus after being pressured into a Thanksgiving dinner. Their lungs were so ruined that only a hand-pumped ventilation bag could supply enough oxygen. Alexander squeezed the bag every two seconds for 40 minutes straight to give the family time to say goodbye. Her hands cramped and blistered as the family screamed and prayed. When one of them said that a miracle might happen, Alexander found herself thinking, I am the miracle. I’m the only person keeping your loved one alive. (Cassie Alexander is a pseudonym that she has used when writing a book about these experiences. I agreed to use that pseudonym here.)
The senselessness of the death, and her guilt over her own resentment, messed her up. Weeks later, when the same family called to ask if the staff had really done everything they could, “it was like being punched in the gut,” she told me. She had given everything—to that patient, and to the stream of others who had died in the same room. She felt like a stranger to herself, a commodity to her hospital, and an outsider to her own relatives, who downplayed the pandemic despite everything she told them. In April, she texted her friends: “Nothing like feeling strongly suicidal at a job where you’re supposed to be keeping people alive.” Shortly after, she was diagnosed with post-traumatic stress disorder, and she left her job.
Since COVID-19 first pummeled the U.S., Americans have been told to flatten the curve lest hospitals be overwhelmed. But hospitals have been overwhelmed. The nation has avoided the most apocalyptic scenarios, such as ventilators running out by the thousands, but it’s still sleepwalked into repeated surges that have overrun the capacity of many hospitals, killed more than 762,000 people, and traumatized countless health-care workers. “It’s like it takes a piece of you every time you walk in,” says Ashley Harlow, a Virginia-based nurse practitioner who left her ICU after watching her grandmother Nellie die there in December. She and others have gotten through the surges on adrenaline and camaraderie, only to realize, once the ICUs are empty, that so too are they.
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Just Released: 2022 AHHQI Home Health Chartbook
Co-Sponsored by NAHC
The Alliance is excited to announce the 2021 AHHQI Home Health Chartbook is now available online!
Released annually, the Chartbook, co-sponsored by the National Association for Home Care & Hospice (NAHC), and compiled and charted by Avalere, summarizes and analyzes statistics on home health from a range of government sources. The Chartbook offers a glimpse of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies. The Chartbook includes updated statistics from the Bureau of Labor Statistics, the U.S. Department of Commerce, Medicare Cost Reports, Home Health Compare, Medicare fee-for-service claims, the Medicare Current Beneficiary Survey, and other data from CMS.
This year's Chartbook features data from 2020 and includes clinical profiles of patients, workforce trends, and more.
We would like to thank 2021 Chartbook sponsor NAHC for their continued support of the Alliance and the Chartbook. Learn more about NAHC at www.nahc.org.
A copy of the 2021 AHHQI Home Health Chartbook is available here.
We are working on scheduling a webinar with the team from Avalere and our sponsors at NAHC, to answer questions and provide an in-depth analysis of the Chartbook. The webinar will be free and will be recorded for later use. Stay tuned for more information!
For more information on the Chartbook, please reach out to the Alliance's Executive Director, Jen Schiller, at [email protected] or (202) 239-3427. |
To Those Who Work In End Of Life
By Barbara KarnesNovember 17, 2021
I was asked to say a few words to a graduating class of end of life doulas. I thought about what to say for quite a while. What could I give them that hadn’t already been given in their course? What would I have wanted someone to say to me when I started out in this end of life arena?
After I wrote what I wanted to share I thought, “I want to share this with all those who work in end of life!” It isn’t just when we begin our journey of working with end of life that words of encouragement and direction can be of guidance. These thoughts apply to us anywhere on the path, the beginning, after years and even as we are about to end our career. These words apply to hospice workers and volunteers, Stephens Ministers, parish nurses, all EOL workers ———
To all those who work or volunteer with end of life:
The greatest gift you have to give is time. It won’t be the words you say, even the guidance you give, although that is all very important. It will be the time you spend or don’t spend, your presence, that will be remembered.
Your presence literally takes away the “ghosts of fear” most of us bring to the bedside of someone who is dying. The “I’m not alone no matter what happens, someone who knows is with me” is what we bring. Our knowledge, our manner, our expressions, our words are important but our time is our most valuable tool.
Those who work with end of life are on a fantastic journey. It can be a scary journey. There will be times you feel insecure in your knowledge and your abilities. Times when there will be no words to say, no comfort to give but you will be there. Be there to guide all present into a sacred experience. You will be the conductor of their life’s song. By your guidance that song will become their sacred memory.
That is no small job!!
Read more at www.bkbooks.com |
New Cures 2.0 bill extends key telehealth flexibilities, hastens CMS approval of medical devices
Fierce Healthcare
Nov 16, 2021 12:51pm
New major legislation would require Medicare to cover breakthrough medical devices faster and make permanent key flexibilities to telehealth reimbursement for providers.
Lawmakers introduced on Tuesday Cures 2.0 bipartisan legislation that builds on the 21st Century Cures Act of 2016. The legislation includes major investments in medical research including the creation of a new agency to research difficult diseases such as Alzheimer’s, but also contains several reforms to Medicare reimbursement and coverage.
The legislation would permanently remove Medicare’s geographic and originating site requirements that require a patient to live in a rural area and be in a doctor’s office to qualify for telehealth services.
The use of telehealth has exploded since the pandemic when patients were afraid of going to the doctor’s office. The Centers for Medicare & Medicaid Services also granted greater flexibility for providers to get reimbursement from Medicare for telehealth services.
But those flexibilities are expected to be removed at the end of the COVID-19 public health emergency, which will now sunset early next year.
The legislation would make some of those flexibilities permanent.
Another key provision is to codify a rule that would let Medicare automatically cover products approved or cleared by the Food and Drug Administration under the breakthrough therapy pathway, which grants advanced approval to devices that treat unmet medical needs.
The bill would allow CMS to temporarily cover breakthrough products approved by FDA for four years. The agency will have to make a permanent coverage determination in those four years. It also calls for the Government Accountability Office to offer recommendations on how to enhance Medicare coverage and reimbursement of innovative health technologies.
But the decision comes a few days after CMS issued a final rule that got rid of a Trump-era regulation that requires CMS to approve breakthrough medical devices under the same type of pathway as in the Cures 2.0 bill.
CMS said that it was concerned the clinical data necessary for the FDA breakthrough therapy approval may not meet Medicare’s guidelines for a coverage determination.
The insurance industry has fought the Trump-era rule, arguing that it could lead to premature coverage of medical devices.
The legislation now heads to the House Energy & Commerce Committee. The lawmakers behind the legislation—Democratic Rep. Dianne Degette of Colorado and Republican Rep. Fred Upton of Michigan—spearheaded the 2016 law.
“The federal government has shown, time and time again, that when it’s given the resources needed to accomplish the impossible, there’s not much it cannot do,” the lawmakers said in a statement. |
Hospice Quality Reporting Program (HQRP) October Forum Materials Available Now
On Tuesday, October 19, the Centers for Medicare & Medicaid Services (CMS) hosted the October 2021 HQRP Forum to provide information on the new Quality Measure (QM) Specifications User’s Manual v1.00 and the two new claims-based measures included in the Manual. Materials from this HQRP Forum, including a recording of the presentation, are now available in the Downloads section of the Provider and Stakeholder Engagement page at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-QRP-Provider-Engagement-Opportunities. |
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